Nick andrews, good work a dementia learning and development framework for wales
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Transcript of Nick andrews, good work a dementia learning and development framework for wales
Good WorkA dementia learning and
development framework for Wales
Nick Andrews, Research & Practice Development Officer, School for Social Care Research, Swansea University
Background – the Developing Evidence-Enriched Practice (DEEP) project
• An appreciative action research project;
• in health and social care services for older people;
• across six sites – five in Wales and one in Scotland;
• exploring research and other contextual evidence and using it in service and workforce development;
• To promote well-being and address the Seven Challenges of the JRF programme A Better Life.
The five elements of the Developing Evidence-Enriched Practice (DEEP)
approachValue and empower
peopleValue and use
a range of evidence
Present evidence well
Sort things that get in
the way
Talk and think together well
The importance of narrative in getting people to engage with research
The importance of talking together about research and other evidence
• Does not come as naturally as we would hope
• Use the elephant metaphor of reality
• Use dialogue techniques, e.g. Exploratory Talk and Community of Enquiry
Vision for the Dementia L&D Framework
People with dementia, carers and staff who support them will all experience fulfilled lives within supportive
communities
Who is this framework for?
People with dementia
Carers
The social care & health
workforce
‘What do we mean by ‘good work’?
The three Es of ‘good work’:
• Ethics – values based and getting to the heart of ‘what matters’ (compassionate practice)
• Excellence – technically competent and ‘fit for purpose’ (competent practice)
• Engagement - personally engaging and contextualised (wise practice)
1. Ethics – to support compassionate practice
• Everyone matters
• Everyone has something to contribute
• Everyone is different
• Everything matters – including the little things
• We need to use positive and strengths based words
Everyone matters and have a right to experience well-being
Within enriched environments of learning and practice (Nolan et al 2006), everyone experiences a sense of:• Security – to feel safe and secure, not just physically but also
psychologically• Continuity – to feel that what we are doing in the present has links
with our past• Belonging – to feel ‘part of things’, maintaining existing
relationships and forming new ones• Purpose – to have valued goals to aim for and a feeling of ‘I have a
contribution to make’• Achievement - being able to achieve goals and to feel satisfied with
your efforts• Significance – to feel that you ‘matter’, that your life has
importance, and that other people recognise and value who you are.
Sense of: Declaration of Rights for Older People in Wales
Security I have a right to safety, security and justice
Continuity I have a right to be who I am
Belonging I have the right to decide where I live, how I live
and with whom I live
Purpose I have free will and the right to make decisions
about my life
Achievement I have the right to work, develop, participate and
contribute
Significance I have the right to be valued
This recognises an interdependentapproach to well-being
Well-being of service users
Well-being of carers
Well-being of
staff
… which requires negotiation and compromise
Everyone has something to contribute
People in the local
neighbourhood
Carers
People with dementia
Frontline staff
Specialised staff
Service managers
Commissioners and regulators
Researchers
Everyone is different
• This requires an individualised approach that recognises difference, not standardised responses
• The example of short breaks – one carer’s difficulty is another’s satisfaction
Everything matters and the ‘normal’ and the ‘ordinary’ are important
• ‘Often it is the simple things that bring the most pleasure (and the lack of them can bring a sense of sadness and loss) and services do not always seem to be very good at delivering “the ordinary”’. (Blood, I. 2013 p13)
We must use positive and strengths based terminology
Negative and deficit based terminology Positive and strengths based
terminology
The frail elderly Older people with high support needs
Elderly Mentally Infirm (EMI) People with dementia
People suffering with dementia People living with dementia
People afflicted by dementia
Wandering Walking
Dements People with dementia
Feeders People who need help with eating
36 (i.e. naming a care home resident by
their room number)
Never a number!
Senile Old
Not there Still here
An empty shell A person
2. Excellence – to support competent practice
• Taking an outcomes focused approach
• Thinking carefully about categorising people –non hierarchical
• Broadly identifying three types of people –informed, skilled and influencer
• Key learning and development topics for each group and suggested learning outcomes
Informed person
Learning and development topics – linked to Dementia Friends work in Wales:
• Dementia is not a natural part of ageing
• Dementia is caused by brain diseases
• Dementia is not just about losing your memory
• It is possible to live well with dementia
• There is more to the person than dementia
• Effective communication is important to people with dementia
Skilled person
More complex – 48 learning and development topics mapped to the National Outcomes Framework covering:
• Rights and entitlements
• Physical and mental health
• Safeguarding
• Meaningful living
• Meaningful relationships
• Community inclusion and contribution
• Social and economic well-being
• Physical environment
For example…
Each outcome category has 6 L&D topics.
For example - Meaningful living:
• Life story work
• Identifying the strengths of people with dementia and their ability to do
• Creative and meaningful activities
• Sensory stimulation
• Experiencing positive transitions
• Meaningful short breaks
Influencer
Learning and development topics linked to organisational leadership and development:• Drivers, policy and research• Ensuring effective service mapping• Collaborative and integrated working• Promoting congruent values, ethics and culture• Involving people in creating and owning a clear and
shared vision• Delivering the vision• Quality assurance and improvement• Safeguarding
3. Engagement – to support wise practice
Engaged people are compassionate and technically competent, but also feel good about what they do and work within systems that are empowering, enabling them to make wise decisions about how they support people with dementia, carers and staff within the context of their daily lives
‘Don't get me wrong. We need rules! Jazz musicians need some notes… but too many rules prevent accomplished jazz musicians from improvising, and as as a result, they lose their gifts, or worse, they stop playing altogether’. Barry Schwartz
A whole system approach
Good leadership within organisations
• ‘Our role as leaders is to set the stage, not perform on it’ Linda Hill.
Robust and meaningful quality assurance
• Owned by everyone –not done to them
• Experience not tick-box focused
• Supported by helpful not burdensome paperwork
• Identifying and building on strengths, e.g. ‘Magic Moments’ work
Effective approaches to individualisedand collective learning
For example – the DEEP approach that has been developed in Wales which draws on:
• Appreciative Inquiry
• Communities of Practice
• Community of Enquiry
• Exploratory Talk
• Caring Conversations
• Experience-Based Co-Design
• Collaborative Action Learning
Learning and Development topics for Influencers
• Drivers, polices and research• Effective service mapping and co-ordinated
delivery• Collaborative and integrated working• Shared values• Creating and owning a clear and shared vision• Delivering excellence• Creative approaches• Quality assurance and improvement• Complaints and whistle-blowing• Safeguarding
Resources
• Good reading – suggested books
• Helpful Welsh and national organisations
• Free web-based resources