Dementia nurse consultant – one year on

Yvonne Manson, celebrating my year anniversary

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It has been a year now since I took up post as the Dementia Nurse Consultant for Balhousie Care group, covering 21 of their 24 care homes. When I first read the job description it was as if someone had seen my ideal job and created a specific role just for me. It very much matched the role of the AHP dementia consultants that Alzheimer Scotland launched in 2015 but importantly for me it was focussed solely in care homes where my career drive has always been.  Posts like this are fairly unique, I had never seen one within a care home setting before and was delighted to see Balhousie Care Group starting to lead the way in supporting good dementia care. I was overjoyed when I was offered the job and took up the new position in February 2016.

Influences in my career

I have worked in the care home sector for 21 years and have always had a passion for dementia care, which took me from care assistant, through to RMN, management and finally to completing a Msc in dementia studies. Education is important but for me through the years it’s the many people I have met that helped shape my views and they have been instrumental in my career decisions.

The first person to have an impact on me was a resident I supported when I was 19 and working in a residential care home, he took me aside one day and said to me 'Yvonne you're not like the rest, you really care, don't ever be like the rest' this made me both proud that he felt that from me and sad that he felt some people in the job didn't care and I often think on his words and it makes me determined that I want to make a difference. I have met so many people who share a similar story to mine where people they are supporting have had a big impact on their career or life choices and that is the value of really getting to know people and building relationships.

When I started university I was introduced to two books that had a big impact on my learning and understanding of the brain. The first was Oliver Sacks – ‘The man who mistook his wife for a hat’. From reading this, I developed a real fascination with the brain, its power and the impact brain injury could have on life.  I now own all of Oliver Sacks books.

One of my favourite quotes of his is: 'It is the fate of every human being, to be a unique individual, to find his own path, to live his own life, to die his own death.' this strikes a chord with me, it should be a basic human right for all to be able to do that, unfortunately as we know this does not always happen. I am proud that Balhousie signed up to Scottish Cares Human Rights pledge, and are focussed on following a human rights personalised approach, the launch of the recent participation charter (the first for a care home group) really emphasises this move towards a new approach. 

This person-centred thinking brings me onto the next book that I dip in and out of regularly and that is 'Dementia Reconsidered’ by Tom Kitwood. Kitwood. The focus of this is personhood and supports the reader to see the importance of relationships and the impact we can all have on other people; both positively and negatively by our actions. It is a very powerful book and as relevant today as it was when he wrote it 1997.   There have been many new books written that follow a lot of Kitwoods work and some of my favourites are by Helen Sanderson where she has provided tools to support good person-centred care, many of which Balhousie has since adopted in this last year.

The final person I have to give a mention to is James McKillop, I met James when I was a student nurse he had set up the Scottish Dementia Working Group (SDWG). Whilst on placement at Alzheimer Scotland, I was sent along to the Dundee meeting of the SDWG to see what it was all about, this almost immediately changed my view of dementia. Seeing what James and others who have a diagnosis of dementia were achieving was inspiring; I wanted more people to be able to be given a voice.

The Dementia strategy

When Balhousie first asked me to create a dementia strategy I knew that any strategy needed to be inclusive of everyone, including: the people who live in Balhousie homes; the people who work in Balhousie homes; the people who visit Balhousie homes, everyone needed to have a voice.

With that in mind I started a consultation process in all the homes and gathering views and opinions from all stakeholders; from here the first draft of the strategy was created. That strategy went out for consultation and was finalised and published in July of 2016. This strategy shapes my role as it is what residents, staff and other key stakeholders want for dementia care. The strategy has six key themes:

  1. Dementia Ambassador Program
  2. Education for the workforce
  3. Engagement with all
  4. Personalised care within a personalised environment
  5. Evaluation of our dementia services
  6. Best practice and sharing of knowledge on projects to further research in dementia

The collaboration in creating the strategy has resulted in buy in from all parties across Balhousie and since launch the Balhousie family (Residents, staff, stakeholders) have achieved so much more than I thought possible.

 There have been significant gains in all six themes, for example:

  • We now have 70 Dementia Ambassadors across our homes
  • Increase in promoting excellence statistics across the home
  • Pitlochry achieved a 90% staff at skilled level
  • Enhanced level training taking place once every two months

Of course nothing is perfect and by the end of 2017 the strategy will be due for review reviewed to ensure it continues to meet the changing needs of everyone in our care, by which the new national strategy will also have been published. 

Education and research are two of the roles within the dementia nurse consultant role and there are many success stories from this year that you will have read on our website, in our ambassador newsletters, or on social media but below are a couple just in case you missed them.

Memory Boxes

Balhousie Care Group’s Dementia Ambassadors and residents were tasked with creating unique ‘rummage boxes’ as part of the company's Together We’re Great initiative. Staff, residents and their families worked to create the personalised boxes so that they would evoke special memories. Rummage box themes varied depending on the residents. One box took on a school theme, containing items which evoked memories of the resident’s time at school, such as a pair of plimsolls and some chalk. Another box had a farming theme, with pictures of tractors and toy farm animals, and even some straw bales.

The difference this made for the residents was evident to see when I was in the homes. This is exactly why we created the Dementia Strategy at Balhousie Care Group and it shows how our new Together We’re Great initiative is working, with residents and staff coming together to create something special.  Creating these memory rummage boxes gives residents the physical objects that are likely to trigger memories from their past. It’s been so heart-warming to see pictures and hear from ambassadors how residents reacted to the box that held memories special to them. This competition ran last year but the positive outcomes from it mean that it is now an ongoing activity and for those residents who want it something that staff support them to create. Memory boxes are not for everyone but that is the best thing about the strategy people can use what they need and personalise it to their needs.

Exercise and Dementia

At the November ambassador meeting, the importance of daily exercise and how it can improve wellbeing and reduce falls for residents was discussed. Recent research has also shown that daily exercise can help reduce cognitive decline. Taking this on board, the ambassador group looked at improved ways of incorporating relevant and personalised activity into the homes. Thereafter, our ‘Balhousie Daily Exercise’ competition was launched, encouraging staff to work together and be creative with their activities. Edith Mackintosh from the Care Inspectorate came along on the 31st January to deliver a session on Wellness and exercise, as dementia consultant I try to make sure that we have a mixture of speakers to support learning and think this benefits understanding than it being just one individual.  

The competition ran from December ‘16 to February ’17 with Clement Park announced as winners and Lisden as runners up in the competition. The level of response and standard of entry has been impressive across all the homes. Like always, our staff and residents fully embraced the initiative and I was delighted with the outcomes.

Clement Park created an inclusive project for all residents, engaging and consulting to create their daily exercise programme based on individual preferences including: chair exercises, bubble games, darts, balloon tennis, yoga and dancing. Residents all wrote the name of their favourite exercise on a wooden stick and placed it in a jar, which was decorated, and created a scrapbook to document their daily exercises. Each morning they would pick a new stick and that was the activity for the day. Although this is a simple concept, it demonstrates an excellent example of person-centred personalised care. This is now being continued with new residents to the home adding to the jar and so will continuously evolve. 

Events

There are too many too mention them all but I wanted to mention a few of the events of this past year; firstly I attended a dementia care mapping (CM) course, I have to say I wasn’t totally sold on DCM and worried it wasn’t a good evaluation tool as it was going to be my perspective but that view changed after the first trial map where all mappers on the course mapped an event and we all came to the very same score. Since completing I now map at least once per week and it has proven to be an excellent tool for evaluating practice and supporting positive change; secondly I was honoured to be invited to talk on care homes and promoting wellbeing at the launch in London of Dr Shibley Rahman’s latest book on dementia keeping up to date and sharing knowledge in research are key aspects of my role as a dementia consultant; finally the Balhousie conference where three of the dementia ambassadors got up and spoke was one of my favourite events this year. Pat at Monkbarns had been so inspired by Tommy Whitelaw and his talk on love stories that she had been discussing it with families and the family created their mothers love story which she read at the conference, from one talk came a lot of action and for me it is the actions that are important, making that difference. Cat and Chelsea spoke about the change in their workplace and how the program had inspired them to make changes and how these changes had, had a positive impact not just for residents but also for the full staff group.

What next?

The residents and staff already have a lot more ideas and you can keep up to date with what we are doing with our newsletter published every two months, or by speaking to the ambassadors within the home or on our website and social media accounts. Part of my role also means that I can come along to resident/family meetings and can do Q&A sessions or arrange a dementia friend’s session with our partners at Alzheimer Scotland so please say to the manager of the home if this is something you want for your next resident/family meeting or as an extra meeting. If you would be interested in coming along to one of the ambassador meetings which are held every two months and speaking please drop me an email. If you are part of the Balhousie family be that resident, staff member or family member and want to join the ambassador program drop me an email or say to your ambassador within the home. I want to finish by saying a huge thank you to every resident, staff member, family member and visiting professional without you this year would not have been half of what it has been and I know it’s the company slogan but I truly do believe ‘together we’re great’.