Engagement in healthcare settings should always be a key factor in ensuring the overall wellbeing of patients and residents, but for people living with dementia, both simplicity and creativity play a role.
Activity programme’s in many care facilities until relatively recently would have been a structured weekly plan of group games such as bingo. Now, don’t get me wrong, many people of all ages love a good game of bingo – it is socially engaging, exciting, fun and includes a little exercise of the hand and arm too. However, there are so many other ways to engage with people. Patients in acute hospital settings don’t always engage with the most basic of activities and often there is a lack creativity. The wards are viewed simply as clinical areas and a holistic approach to care is overlooked. There is no blame implied here but a change in culture and approach could certainly reap plenty of rewards. Some Trusts have seen amazing outcomes from engaging in activities with patients and the results have included better standards of care, reduced agitation and early discharge.
When caring for the elderly, it is important to take both a clinical and a holistic approach to care, as the mental wellbeing of patients has an impact on the speed of recovery. Many Trusts are now employing Admiral Nurses or have Activity Coordinators to support patients living with dementia. In a care setting, an holistic approach to well being has numerous positive outcomes from improved social interaction and engagement, maintaining independence and achieving a sense of contentment.
Trusts that support PJ Paralysis and encourage everyone to get up and dressed during the day report that patients find it easier to maintain a normal way of life as well as benefitting from better sleep patterns. This makes it easier to introduce activities for patients as a simple part of daily routine.
Hospitals that are fortunate to have large day rooms and a dementia-friendly gardens find it easier to take a more holistic approach to care as they are less restricted to space. In summer, gardens are used to hold concerts and tea parties. By building positive relations with the catering team, volunteers and families, one Trust has succeeded in creating events that lift the spirits of patients and create wonderful social experiences. Children and students are welcomed onto the wards and interact well with patients in the large day rooms engaging with singing and arts sessions that the patients love. Regular exercise and dance classes that involve patients regardless of mobility issues, are great examples of engaging with people for fun.
Hospitals are fundamentally clinical areas and staff are trained to care for the physical needs of patients. When something different is suggested, it isn’t surprising that a number of objections are raised (patients don’t want to leave their bed, we are too busy to undertake anything other than the necessary levels of care, risk assessments to name but a few) and it is only by trying a different approach that staff will be convinced not only of the benefits to the patients but the benefits to staff too. At Blackpool’s Clifton Hospital an holistic approach was introduced and some members of staff did initially raised objections over the impact on staffing levels and didn’t feel they would be able to manage the events as well as toileting, answering buzzers and providing general care needs. On the first few occasions, the Dementia Lead ran the events in her own time to prove they would work. The results were amazing as no buzzers rang, no one required the toilet and all clinical needs were met while the events were taking place simply because everyone was so engaged and happy. The events are so entertaining and successful that staff across the Trust now volunteer to assist and the Catering Department are more than happy to provide refreshments.
Other activities undertaken by various Trusts include the use of interesting memory boxes and of course traditional games. YouTube and interactive games such as the magic table are used, which create a fun environment and offer small amounts of exercise. The BBC website Music for Memories https://www.playlistforlife.org.uk/bbc-music-memories/ is a great place to find music through the decades and find something for everyone.
The use of a reminiscence/activities trolley works well for several trust, which include various arts and crafts, reading material and unusual items such as boxes of buttons. Some patients spend time at the Nurses Station, given small jobs to give the person a sense of carrying out a meaningful task. Some care staff keep a number of quizzes and will just go into a bay and say “Quiz time” and the patients love it.
When a truly person-centred approach is taken, the appropriate use teddy, doll and pet therapy are used as another effect intervention.
At Blackpool’s Victoria Hospital, there is a Memory Lane corridor that links several elderly care wards. Featuring all the key landmarks in Blackpool from the Tower, to the funfair, the promenade and the gardens, there are tactile items and the use of smells such as candy floss to help with reminiscence. Staff take patients for walks down the corridor and take the time to interact with them regarding the environment. At first they were worried that some may try to escape, but the patients became so engaged with the environment, that the walk calmed them and they were happy to return to the ward and relax. The staff on these wards have a lot of fun and love dancing. It is not unusual to see people engaged in dancing the conga around the ward, which includes patients in wheelchairs so very inclusive.
When asked what impact an holistic approach to care had produced, a clear outcome was definitely the reduced length of stay.
The power of engagement and social interaction in any setting should never be under-estimated. Of course, the clinical assessment and treatment of a patient is essential to treating a medical condition, however to treat a person holistically is just as important and contributes significantly to their overall wellbeing, quality of life, confidence, independence and dignity. We should never forget the Me in DeMEntia.
I appreciate the potential change to daily care of patients may raise a lot of objections and I am not sure if this is just a Yorkshire saying but “don’t knock it ‘til you’ve tried it”, you never know – when you see the positive changes you may even really like it.