Palliative Approach in Dementia Care - Fraser Health Authority

PalliativeApproach inDementia CareDelta Hospital Pilot StudyDella Roberts, Clinical Nurse Specialist, End of Life ProgramGina Gaspard, Clinical Nurse Specialist, Residential Care and Assisted LivingProgramEducation Funded by: Delta Hospital Foundation

Dementia is aprogressive terminalillness for which thereis no cure.Studies found that dementia is not viewed as aterminal illness(Sampson,2006; Mitchell, 2004; Morrison & Siu, , 2002).

Ambiguous Dying

Frameworks

Assumptions‣ Palliative care ought to be a corecompetency when caring for people withdementia.‣ Quality of care for people living and dyingwith dementia will improve whencaregivers’ knowledge, confidence andskill increase.

Will a 4 hour interdisciplinaryworkshop:‣ Raise awareness of dementia as aprogressive illness?‣ Increase staff confidence, skill andknowledge to meet the needs of peopleliving and dying with dementia and theirfamilies?‣ Encourage strategies to be incorporatedinto daily care?

Participants n=60‣ Interprofessional (RN, RPN, OT, PT,RCA, SW)‣ Varied roles (direct care providers,managers, educators)‣ Acute and residential complex care

Pilot Development‣ Literature review‣ Curriculum from Caring Journey: Bettercare, Better life for people with dementia &Hospice Palliative Care Basic andEnhanced days‣ Fraser Health best practice guidelines‣ Focus groups (family & leaders)‣ Refined workshop based on feedback

Workshop Content‣ Person with dementia‣ Family of person withdementia

EVALUATION‣ Identify challenges at start of session‣ Satisfaction survey• Quantitative (excellent/very good/good/fair/poor)‣ Knowledge pre test/ post test• Multiple choice/ True & False‣ Self evaluation• Qualitative (I learned that…)‣ Family feedback‣ Leadership feedback

FindingsStaff satisfiedRated very good-excellentKnowledge increased 10%Confidence increasedAttitudes challengedAwareness raised1-1010 scale 7.2 - 8.3“… they are needy families, notdifficult”“Inform family dementia is aprogressive disease”Compassion triggered“Put yourself in their reality”

Theme one: I can connect with andcomfort the person with dementia.“Don’t t under value the 30seconds you spend withsomeone - residents live inthe moment.”“Enter into the patient’s s realityand emotion.”“Changes in resident could bepain!! Behaviours havemeaning.”

Theme two: I can talk about deathand dying.“Palliative care starts when clients enterresidential care with dementia.”“Initiate conversations re frailty/dying with afamily member.”“It is okay to talk about dying with familymembers.”

Theme three: Families need my care too.“Be more patient, think more aboutwhere they [family] are comingfrom.”“Family knows the person best - weknow dementia the best. Familieswant to teach us how to care fortheir loved one.”“Be honest.”

Theme four: A palliative approachtakes a team“Work to have family’s s voiceheard - don’t t want to repeatstories over and over.”“Encourage nurses and care staffto have advanced careplanning in place.”“As a team approach we need tocommunicate much better-bemore comforting.”

Moving Knowledge to PracticePractice ChangeAwarenessConfidenceKnowledge

Implications‣ Build dementia and palliativecare as core competenciesfor nursing staff working inresidential care and medicalunits.• Develop a strategy to spreadthis workshop and sustainchange in behaviour.• Offer as interdisciplinary,intersectoral education

Further research:‣ What competencies in dementia care dohealth professional possess and whatareas require improvement to deliver apalliative approach?crackskullbob.squarespace.com/journal/lab-coa...

Further Reading‣ Birch, D., & Draper, J.(2008). A critical literaturereview exploring the challenges of deliveringeffective palliative care to older people withdementia. Journal of Clinical Nursing, 17, , 1144-1163.‣ Small, N., Froggatt, K., & Downs, M., (2007).Living and Dying with Dementia: Dialogues aboutPalliative Care .‣ Lusk, C. (2007). The need for palliative/end of lifecare programs in LTC. Canadian Nursing Home,18 (4).‣ Gaspard, G. & Roberts, D. (2009). Palliativedementia care requires a blended model.Canadian Nursing Home, 20 (1), 21-24.24.‣ Manning, Doug. Share my Lonesome Valley.

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