Kindness in Dementia Nursing and Care- Please

Quoting the Daily Express 26th November 2018- “Betrayal of our Elderly as 4 in 10 care homes fail to make the grade”!

 Despite having gathered extensive knowledge over many years, care in the UK has stagnated and is not addressing the unsafe and poor and inconsistent standards, and still all our frail and vulnerable people, and their families, are not perceived as valued and wanted in all NHS and Care operations. Echoing the findings from *Restraint of people living with Dementia - Ethnography of the Everyday care in Acute Hospitals: it states: Care systems appear to believe the fault lies with the person, rather than the culture. *https://www.storiesofdementia.com/2018/04/research-report.html

Looking back at my fifty years of personal and professional engagement on the front line of care, my own Mum’s abuse and neglect, and her early death in 2009, why are staff skills and performance still falling short of improving outcomes for those people who have varying degrees of dementia symptoms, sensory deprivation, and why are we not providing them with adequate comfort to allay their individual anxieties worries and fears of coping in an kinder environment when, by now, nursing and care processes should be switched on, connected and functional for their needs?

 Clearly what makes care an unbearable place to live for people with dementia, sensory deprivation and complex health condition is where people are not welcome!

When you find in care:

• · Their environment, corridors, walkways and rooms are unsafe, cluttered, badly lit, noisy and smelly, and are difficult to manoeuver, confusing, unfamiliar and disorienting
• · Their bed, chairs and clothes are often wet soiled and uncomfortable and the window is left open for the cold air to drift in as they lay shivering curled up in a foetal position, because in their bed, they are only cover by a flimsy sheet.
• · Management and staff attitudes are restrictive, insensitive and do not wish to answer their constant cries for help, or have time to know and understand people’s likes and dislikes, or their individual needs for comfort, pain management, independence and choices as staff are conditioned to “they have Dementia they will call out, particularly when you are going to moved them”!
• · Little attention is given to the big concerns that relate to people’s poor health and quick progression into demise, - infections, pain, insufficient fluids, poor nutritional food consumption, stimulation and companionship
• · Importantly time and opportunities for involvement relaxation and happiness are not given to people when they might be scared, sad, and showing all the signs that trigger their depression and uncontrollable behaviour frustrations and anger.

There are some broad ranges and practices of care which, when delivered will improve their quality of life and a better understanding of seeing people living in care with dementia, but are these hampered by:

• · A consistent robust clinical judgement of people, when a” label” of dementia is wrongly diagnosed because underlying complex health conditions, (such as severe infections which will resulted in similar cognitive conditions), has not been explored and completely ruled out?
• · Management/ staff relationship behaviours which give little credence in care processes for staff being able to have time and skills to create a safe, sensory, familiar, relaxing, comfortable and accessible environment which is focused on people’s own individual needs of a quality of life and to want to continue to live, and of the huge part that staff attitudes, approaches and actions have on their own staff wellbeing and retention?
• · Management and staff finding difficulty in dismantling the “us” and “them” relationships barriers which make it harder to get to know people personally and those who will withdraw quickly within themselves if they personally feel threatened, scared and fearful?
• · The lack of basic awareness of the need for improved and functional skills in critical and timely observations and reporting of any changes in the symptoms and conditions of people with dementia?
• · Lack of education, knowledge and understand of cognitive stimulation, exercise, and therapeutic activity tools that are necessary to break through the individual barrier which people with dementia surround themselves shapes high standards of greater team opportunities for working together around each individual person’s day and structure in care?

There is an urgency to harnesses staff knowledge of people’s character, limitations, choices, and hobbies, to empathy, understanding, responsive and creative skills attitudes and approach to ensure people have a better life in all aspects of their dementia care.

To bring into care outside support services, therapies and partnerships to aid people’s continued contact with their families, friends, lifestyles, hobbies and their local communities, for everyone to join in, management, staff, residents and family, to share the responsibility to create together a great place for living.

I believe that good care is where:

• ·Management and Staff listen to and understand what people with dementia are trying to say to them
• Staff teams exhibit an inclusive of activities for all people in care, not just some, and there is a clear determination to ensure care creatively nurtures a healing environment for everyone, even for those in hospital wards or confined in care to their beds in care
• There is education and knowledge of an advanced enhanced and healthier culture for people to relax, feel safe and comfortable, which minimise people’s fears, anxieties and frustration.

But primarily it is kindness which is the key to good dementia nursing and care. Kindness brings with it thoughtfulness and consideration, whether it is between patient and staff or management and staff. Instead of conducting routine procedures with a view to ticking all the boxes, the individual needs and preferences of staff and cared for and are recognised and accommodated as essential to preventing unsafe care.

Kindness in care is where Staff recognises the perspectives of people living and coping with their acute illness, their wishes and needs when cared for, and how an improving understanding of humanity has a significant impact on the wellbeing of staff, as well as their families and carers

Kindness in Care is where People regardless of the stages of their illness and complex health conditions, are known as a individuals and cherished by experienced skilled and trained nursing care, who are focused on people’s needs for consistent support, recognition and familiarity, continuity and reassurance and a quality life in care surroundings!

KBEEF Nov 24th 2018