Quality of Everyday Life

for vulnerable elderly

ReykjavikJune 1. 2010

Karin Naldahl, Lecturer, RN,MHH(Master in Humanities in Health)

krn@ucn.dk

Center of Gerontology,

Denmark

Vega

* Vega: Subinstitution to Center of Gerontology in DK.

- produce and share practical knowledge about everyday life

- create networks between practical and educational institutions

* Vega Colleagues at the congress:

Inger-Lise Dyrholm, Center of Gerontology, Cogenhagen, Denmark

Anne-Dorthe Rhode , Department of Health, Copenhagen

Dorte Grenaa, Department of Health, Copenhagen

*

Vega Everyday Life focus:

VEGA interest:

• The good life, life quality

• Meals and cooking

• Outdoor life

• Conversations

• Evening and night life

’Traditional' Health Care interest:

• The healthy body

• Nutrition

• Motion

• Social relations

• Sleep

Investigation question:

Is it possible to map and to improve life

quality for old people who are depentent on

care?

Study objective

• To map, document and communicate methods whith focus on values in old peoples everyday life

(within the four subjects: Meals and cooking, outdorlife, conversations, evening and nightlife)

• To adjust and modify knowledge of ’best practice’ into a local setting via - continously test of interventions for exchange

- exchange of experience and networking

Study method: The ’Breakthrough Series’ Collaborative Method. Institute for Healthcare Improvement (IHI), Cambridge, Massachusetts

(Sarah Frazer, Thomas W Nolan and others) http://www.ihi.org/ihi/about……………………………………………………………………………………………………………………………………………………………

• The Breakthrough method : Evidensbased method for development in health care system

• The Breakthrough method passes Practical Kvowledge from one practise into another practise.

• Knowledge from ’practise nr 1’ ’practise nr 2’ knowledge translation

• Translation of knowledge new meaning, new types of thinking knowledge development care development

The Breakthrough Method: A simple tool for rapid, significant improvements in care

Phase 12007 / 2008(12 month)

Phase 22008 / 2009(18 month)

Phase 32009 / 2010

(12 month) - -------- Project finished April 2010

Search literature

Collect ideas from practice

Establish network

Test ideas

Assess effect:PDSA circle

Communicate to others

Assess effect

Production of cataloques with ideas

Experience documentation -pictures -narratives

Experience gathering - reports - seminars - video etc., etc.

Phase 1: Cataloque of ideas for More Life in Evening and night life

4 Main Subjects:IntimacyRitualsBodily wellbeingPhysical sourroundings

Subjects and spesific ideas for evening and night life

*Intimacy, fx:• a moment of intimacy• information about

tomorrow• say ’goodnight’

*Bodily wellbeing, fx:• heat pad• footbath

• foot massage• midnight snack

Phase 1:Cataloque of ideas for More life in Outdoor-life

2 Main Subjects:

- Garden life- Walking

Spesific ideas for Garden Life , fx:• Country garden• Vegetable garden• Green care

Phase 12007 / 2008(12 month)

Phase 22008 / 2009(18 month)

Phase 32009 / 2010

(12 month) - -------- Project finished April 2010

Search literature

Collect ideas from pratcice

Establish network

Test ideas

Assess effect: PDSA circle

Communicate to others

Assess effect

Production of cataloque with ideas

Experience documentation -picture -narrativ

Experience gathering - reports - seminars - video etc., etc.

The Model for Improvement

The Plan-Do-Study-Act (PDSA) cycle

Our Vega Plan-Do-Study-Act (PDSA) cycleTest period……….………………fx: week 1-2 GOAL:

Which goal do we have for the resident?

4. ACT What did we learn ?

Which changes shall be in focus inthe next plan?

1. PLANWho does: What?When?How ?

3. STUDY Did we reach our expectations?

Why / Why not?

2. DOWhat did we actually do?

Which results did we see?

How did we see the results?

1. Plan:Who does what – when - how?

GOAL: Anna will be more calm, more happy and sleep better at night ………………………………

• Shortly after supper Irene or Gitte gives Anna footbath • A precise description for Annas footbath is made (look in the green

book)

• Evening and night staff wrights in the handwritten journal how Annas evening and night has gone.

• Each Wednesday Jonna collects Annas journal papers and asseses the results

2. Do: What did we actually do and which results did we see?

• Nov. 3.: Footbath according to plan. Anna is happy and smiles during the whole session. Vi talk about ’beeing ticklish’ . Feet and ankles becom lotion. Later on we bring Anna tea and biscuits and she is really happy and smiles.

• Nov. 5., 7., 8., 11.: We follow our plan. Anna is happy and talkative. Allso happy when she goes to bed.

• Nov. 4., 6. og 10.: Anna is a little ’touchy’ at supper and rather quiet when her footbath starts.

During the bath she looses up: Her body is more relaxed, she says ’Mmm………’

* During the period Anna rises from bed x1 each evening She allso rises at night 3 nights x 1, 4 nights x 2. Anna is calm and willingly to

go to bed again.

3. Study: Did we reach our expectations?Why – why not?

Fx:

• At the beginning Anna seemed surprised : ”Do you really want to wash my feet’? Now she fully enjoys her footbath – even if she is a little ’touchy’ at the beginning

• When she is ’touchy’ it is allways around supper

• Why? Do we ’forget ’her at this time? Does she feel ’outside’ social life at this time - or is she just tired?

4. Act: What did we learn ?Which changes shall be our focus in the next plan?

• We continue footbath with same procedure next week. It is too early to make changes. • We try to be more aware of Anna in the afternoon and around supper. Go to

her room, talk with her - or just wave to her if we are busy

Two types of projects:

Developement of institutional conditions for everyday life. Groups of residents - meals and cooking - outdoor life

Two types of projects Developement of everyday life for Individuel residents - conversations - evening and night life

Effect and Analysis • In 18 (of 24) institutions caregivers succeeded in translating ideas of

caregivning into their own practice

• The 18 institutions developed valuable quality in everyday life for the residents.

• Cross case Analysis of the improvements using concepts of everyday life showed quality to be:

• More participation: Activ participation, work-related participation

• More room to manoeuvre: Owner of your own life again, re-unfolding life

• Better contact: Spontanously conversation, personal relationship, recognition, intimacy

• More positiv repetition in daily life: Repetition in days, in weeks

Conclusions

• The breakthrough method is usefull to map and develope quality in everyday life for old vulnerable people if caregivers are able to hold on to the systematics in the method

• The breakthrough model costs very limited economical resources

• Side effect: Developing more life quality for residents gives more work quality for caregivers.

References

*Institute for Healthcare Improvement (IHI), Cambridge, Massachusetts http://www.ihi.org/ihi/about

* 10 Powerful Ideas for Improving Patient Care: Book 4Bisognano M, Conway J, with Schummers DChicago, Illinois: Health Administration Press with the Institute for Healthcare Improvement; 2008

*Breakthrough method : an evidensbased method for change of practice inhealth care (2007 Oct 24;298(16):1937-9.The science of large-scale change in global health.McCannon CJ, Berwick DM, Massoud MR.Institute for Healthcare Improvement, Cambridge, MA 02138, USA. - jmccannon@ihi.org

*http://knudramian.pbworks.com/MereLiv

*Gode hverdage. Et bidrag til diskussionen om kvalitet i ældreplejen (2010 May, ,2(26):17-19.Ramian et al.Gerontologi. Dansk Gerontologisk Institut, Københavnild@geroninst.dk

Thankyou for listening