Transcript Providing resident-centered care

Providing Resident Centred
Care
Kathy Peri
School of Nursing
Faculty of Medical and Health Science
University of Auckland
Patient centred Resident centred is
there a difference?
• The principals are the same
• Being resident centred defined as older
people living in long term care facilities
Literature Review
• Quality of life in long term care institutions can be
affected by a number of factors including the physical
social and health care environments (Kane 2001).
• Work force issues in residential care impact on quality of
life for residents (Foner 1995).
• A number of studies suggest quality care equals
improved quality of life and life satisfaction (Tobin 1999).
• ADL impairment has a strong influence on the
relationship between social engagement and mortality –
including mental health (Kempam 1999).
Key Principles
• Having a non judgmental acceptance of the
uniqueness of each person
• Respecting the past experiences and learning of
each person
• Seeing the whole person with emotional physical
and spiritual needs
• Focus of a person’s positives – abilities
• Staying in communication means being flexible,
thinking laterally and listening to the other point
of view.
Key Principles
• Nourishing attachments – ensuring people feels
welcome and included
• Creating a sense of community gives us the sense
of belonging and knowing where we fit in and what
is expected of us
• Maximising freedom for people to contribute to their
work or care and minimising unnecessary controls
• Allowing ourselves to receive from others and
valuing what they have to give
• Building / maintaining an environment of trust
The International Picture
• The Eden Alternative Foundation
(Thomas;
New York)
• Providence Mount St Vincent (Boyd; Seattle)
• Wellspring Innovation Solutions (Eastern
Wisconsin)
• The Pioneer Network (Williams,1997 & Lustbader
2000))
The National Picture
• Promoting Independent Living Study (PILS)
and the Promoting Independence in
residential care study using a goal setting
approach to improve quality of life and function
(UOA research project)
• Adoption of the Eden Model (several individual
facilities)
• Living Independently and having Fun in Elder
Care:LIFE (For profit Chain)
Practical application
Is this possible?
Methods
Randomly selected: rest-homes in Christchurch and Auckland
Organisational Culture survey,
Falls surveillance begun, Baseline Data (Fnc QOL) collected
Randomisation (no statification)
Activity Group
Social Group
•Everyday worlds
interview x2
•falls surveillance
•PIRC, goal set, functional
assessment, PIP to caregiver
• falls surveillance
Outcome evaluation
•Function, QOL 6m
•Organisational culture survey
•continued falls surveillance 1yr
•(12m all measures)
Intervention
• Goal setting with resident
• Goal activitiy individualised program devised by research
team
• Care plan developed and owned by residents
• Implementated by caregivers
• Goals modified and renewed as required
Goal Domains
• Independence day to day functioning (walk to toilet,
shower, walk to dining room, walk to craft room)
• Social activity (visit relatives, attend opera, play piano,
gardening, outings in van, dine out attend church
services)
• Leisure activity (play snooker, shopping, attend
computer classes, dancing)
Outcomes
• Improved quality of life; SF36 physical
component (PILS)
• Improvement of function; functional
measure of the late life disability
instrument. (PIRC)
• Improvement in quality of life;
EQUOL(PIRC)
• What are the ingredients in order to
change care practices in residential care
settings?
Resident centre ness
Returning locus of control to residents
• Assist residents in determining their own
daily schedules
• Restore choices about eating
• Support continence as long as possible
• Promote all remaining capacities for self
care and mobility
Establishing home like environment
• Implement cross training for all staff levels
• Include family members in decision
making
• Promote a sense of community
• Create a human habitat
• Redesign traditional structures.
Enhancing staff capacity
• Flattening a facilities administrative
structure
• Commit to consistent assignment
• Involve nursing assistants in care planing
and care conferences
• Enable nursing assistants to set their own
schedules
• Support team development
Strategies for changing the culture
in long term care facilities
• Encourage frank dialogue
• Supporting staff in developing new models
of supervision
• Communicating a clearly defined
alternative to the status quo
Conclusions
• Providing those who live in residential care
individualized care based on their choice and
personal control will provide unlimited
opportunities for growth in body, mind and spirit
• Acknowledgment to all older people who
unconditionally provided me with knowledge and
information that supports my presentation today.