Dr Elizabeth Milwain Freelance Dementia Care Trainer elizabeth.pdf · The brain accounts for only...

Dr Elizabeth MilwainFreelance Dementia Care Trainer

Elizabeth Milwain - [email protected]

Everyone understands need for person-centred care

Most workers want to deliver this kind of care But it still does not happen in many places Have we really appreciated what we are

asking of care staff?


OLD CULTURE

Person with DEMENTIA

Objects of careNo feelingsNo needs No agency

NEW CULTURE

PERSON with dementia

Subjects of careFeelings, needs and agency of

the person are central


Doesn’t take any extra time Tendency to think it also does not take any

extra effort But is this true?


Damage to these regions of the brain does not affect IQ but has disastrous effect on personality and emotional behaviour that wrecks a person’s life

Changed from successful, considerate and responsible people into rash and impulsive individuals

“ME-NOW” becomes only motivating force


Integrates emotional information into decision making process

Accesses memory system to assess the likely consequences of behaviours

Feelings steer us away from ‘feel good now’ choices that bad in long term

Regulates instinctive reactions and emotions


Central to our emotional functions Especially fear and anger Coping with threatening situations


The amygdala becomes activated automatically by stressful or threatening situations

If a threat-response is ‘against the rules’, the orbitofrontal cortex has to act to dampen down the activity in the amygdala


The brain accounts for only 3% of body-weight But it demands 20% of the body’s blood supply The frontal lobe is the most ‘energy hungry’ part of

the brain When people are tired or ill, activation levels in the

frontal lobe fall to conserve energy Fatigue associated with reductions in levels of

serotonin which in turn associated with high risk of depression, anger and aggression


Arlie Hochschild (1983) The Managed Heart: Commercialization of Human Feeling

1. Face-to-face contact with the public2. Required to produce an emotional state in another3. Allow the employer, through training and

supervision, to exercise a degree of control over the emotional activities of the employees


Pam Smith (1992) The Emotional Labour of Nursing

“The first-year student … was quite clear that she would only be ‘nice’ to patients if as part of the equal exchange of ‘niceness’ they were also ‘nice’ to her”. (Smith, 1992, p.48)


In Hochschild’s study of air-hostesses, women were less able to maintain high levels of emotional labour when:

staffing levels were low

flights turned around quickly


Empathy Creative thinking Positive response to difficult emotions May be ‘rewarded’ with anger, abuse, anxiety

and so forth Still a huge number of physical tasks that

need completing

CAPACITY FOR EMOTIONAL LABOUR FALLS


“...feelings of love, concern and empathy are in danger of being replaced by ‘social distance’” (Smith, 1992, p.6, summarising

Graham 1983)

“..emotions such as grief, anger, loss, despair and frustration were painful to watch and awkward to respond to …sometimes…nurses would choose to concentrate on the physical aspects of the patient’s care in order to avoid difficult relationships. When this happened the ‘love’ part of the work was lost” (Smith, 1992, p.6, summarising James 1986)


Be aware of impact of staffing ratios and workloads

Management that values and supports emotional work

“If sister cares then I don’t need to take the whole caring attitude of the whole ward on my shoulders” (Smith, 1992, p.8)


Innes et al (2006) Promoting Person-Centred Care at the Frontline. Joseph Rowntree Foundation

V. Tellis-Nayak (2007) A Person-Centred Workplace: The Foundation for Person-Centred Caregiving in Long-Term Care. Journal of the American Directors Association. Volume 8, pp. 46-54


Dr Elizabeth Milwain Freelance Dementia Care Trainer elizabeth.pdf · The brain accounts for only...

Documents

Transcript of Dr Elizabeth Milwain Freelance Dementia Care Trainer elizabeth.pdf · The brain accounts for only...