© The Association for Dementia Studies
Nicola Jacobson-Wright & Faith Frost---------------------------------------------------
Association for Dementia Studies
University of Worcester
Namaste Care Intervention UK
Implementing Namaste Care in UK care homes
1
© The Association for Dementia Studies
Joint Working: AcknowledgementsCo Investigators; Caroline Baker (BarchesterHealthcare), Professor Darrin Baines, (University of Bournemouth), Roy and Ros Dibble (University of Worcester LINK group).
Collaborators; Joyce Simard (University of Western Sydney), Ladislav Volicer (University of South Florida), Min Stacpoole (St Christopher’s Hospice) John Killick (Dementia Positive).
Alzheimer’s Society Research Monitors; Rosemary Clarke, Peter Riley,
Elaine Beardsley-Turton.
With special thanks to participating Care Homes, Residents, Staff & Families.
Association for Dementia Studies, University of Worcester Research Team: Professor Dawn Brooker (Principal Investigator), Isabelle Latham (Research Programme Manager), Faith Frost, Nicola Wright-Jacobson, Dr Claire Garabedian, Teresa Atkinson & Jennifer Bray.
© The Association for Dementia Studies
What is Namaste Care?
“Namaste” is a Hindu greeting which can be interpreted as meaning ‘to honour the spirit within’. Namaste Care is a multi-component daily intervention, developed in
the USA to reduce distress behaviours, depressive symptoms, pain, use of antipsychotics, hypnotics and
inappropriate hospitalisation in people living with advanced dementia. Namaste Care combines best
practice through a range of different care interventions, including physical, sensory and emotional approaches.
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Namaste Care: Background
Joyce Simard, founder of Namaste Care in the USA - in response to lack of appropriate stimulation and activity for people with advanced dementia
Translating to a UK context, following up the work of Min Stacpoole at St Christopher’s, London. Collaborative project looking to learn more about implementing Namaste Care in practice.
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Namaste Care: Overview and Key Elements
• Daily sessions of approximately 2 hours once or twice daily
• A dedicated ‘Namaste’ space for use during sessions –creation of a special sensory space
• A dedicated Namaste worker for that session – based on usual staff/resident ratio
• Provision of physical and psychological comfort, skin care, nutrition and hydration
• Focus on the 5 senses, with an emphasis on the use of therapeutic touch
• Opportunities to support improved end of life care
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Once or twice a day - every day
“Namaste Care should be like lunch. When it’s busy or we’re short staffed we don’t say: ‘Oh sorry, we didn’t have time to give
people lunch’.”
Min Stacpoole
• A dedicated, undisturbed space
• A group of residents (4-10)
• No extra staff, but reorganisation of the team
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Session structure
• Individuals are welcomed into the Namaste Room
• The Namaste room has low lighting, aroma in the air, images of nature and calming music
• Everyone is made comfortable – assessment of pain
• Repeated food and drink opportunities
• Hand massage and other sensory interactions
• Elements of nature and cues for the season
• Livelier interactions towards the end of sessions
• Session ends with thank yous and goodbyes
© The Association for Dementia Studies
Researching Namaste Care
Establishing the theory &
evidence behind
Namaste Care
Learning from current practice of Namaste
Care in the UK
Implement the ‘Namaste
Care Intervention UK’ in 6 case
studies
Establishing the health economic
costs & benefits of
Namaste Care
Involving people living
with dementia
Developing an ongoing
community of practice for
Namaste Care practitioners
3 year implementation grant from Alzheimer’s Society to:
1) Explore the implementation of Namaste Care within UK care homes
2) Explore the impact and experiences of Namaste Care from perspectives of residents, staff and families.
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Initial Findings: What’s going on already?
• There are pockets of Namaste Care Practice in the UK taking place in care homes, hospices and people’s own homes.
• The structure and content of this existing Namaste Care practice is highly varied and there is a need for more definition.
• An evidence base exists for some aspects of Namaste Care and this should be used to build a defined Namaste Care intervention
• Care homes are keen to start implementing quickly, but planning and patience are essential for success
• Finding ways to link and motivate practitioners over the long term is challenging
• There is concern and reluctance regarding the ‘twice a day, every day’ requirement
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Initial findings: the Namaste Care Intervention UK
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Namaste Care UK Training & Support: 6 Case Study Care Homes
Lead
ers
hip
Tra
inin
g 1 day training
For those who manage staff and resources
Focus on leading change and supporting team to implement Namaste Care in practice.
Info
rmat
ion
Ses
sio
n
Nam
aste
Wo
rker
Tra
inin
g 1 day training including an experiential element.
For staff who are interested in directly delivery Namaste Care.
Follow up sessions to support practice.
1 hour information session for whole care team, family and visiting professionals.Overview of Namaste Care UK and opportunity for questions.
© The Association for Dementia Studies
Initial findings: how to implement successfully
• Genuine leadership from management is required from the outset and in practical ways
• Planning is more effective than rushing ahead • Enthusiastic ‘drivers’ in the care team are needed • It does not take extra staff, but it does take reorganisation and
support of staff – using a rota• A small enough group of residents to ensure sufficient care and
attention can be provided to everyone • Not every member of staff feels comfortable running the
sessions – that’s ok! Not to expect this role will suit all staff• Once people see the effects it will help motivation• It needs to be seen as a care intervention not an activity • It’s not as complicated as it seems
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Initial Findings: getting started
“Once we’d started Namaste Care it made me a little sad that we hadn’t started sooner. (Residents who had
recently passed away) would have really benefited from it. It feel like we let them down by not starting
sooner,”
Having the project helped – it gave us a structure at the start. I’d identified my “research” staff and gave them
responsibilities, then we identified (a volunteer) for the session role. In the (other) home I will try to replicate that
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Initial findings: positive outcomes for residents
Weight gain
Decreased agitation and restlessness
Increased alertness and awareness
Increased communication – “words when there were no words before”
More accepting of personal care – residents who struggle to have nails cut, hair cut etc. are able to tolerate it within Namaste care
Reduction of repetitive phrases or actions
“And the effects carry on outside Namaste too. Like L,
its like he’s a different person. Alert, looking
around. Before he would call out all the time and we just didn’t know what to do with
him,”
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Initial findings: positive outcomes for residents
D is sitting in the high backed chair in her room as before, nightdress on and
dressing gown over the knees.. She crosses her feet, her hand fusses with the collar of her nightdress, then up to her hair. Her body language now seems agitated/activated compared
to before. Her eyes are open and she is repeating ‘please help me lord,
please help me lord’ over and over again, non-stop for the next 15
minutes.
A resident’s usual care experience
The same resident’s Namaste Care experience
D is brought into room in wheelchair by staff and transferred into a large arm
chair. She is repeatedly saying ‘Please help me lord, please help me lord.” No pauses, just over and over again. Namaste worker
comes over once she is in the chair and kneels down near her and puts her arms
around her, hugging her firmly and closely. She is soothing her, stroking her arm and whispering ‘shhhh, shhhhh’ quietly into
her ear. Towards the end of the minute D quietens down and stops saying ‘please help me lord’. She closes her eyes. She remained like this, occasionally looking
around, for over an hour.
© The Association for Dementia Studies
Namaste PoemIt seemed to be about sitting quietly.
I think it was rather good.
It’s a change from the noisy things
we need to get away from.
It’s nice and cosy, isn’t it?
That we can sit here in peace and quiet
and hopefully be safe.
I like the speciality.
We had some fun today,
especially the bubbles.
We do get lots of laughter,
and I join in.
The people who run it
have obviously created
an interesting situation.
It does seem to work.
Residents’ words, captured by John KillickSeptember 2018
© The Association for Dementia Studies
Thank you for listening!
Nicola Jacobson-Wright & Faith WrayUniversity of Worcester Association for Dementia [email protected]
http://www.worc.ac.uk/discover/association-for-dementia-studies.html
Photographs of people living with dementia taking part in ExtraCare Charitable Trust Enriched Opportunities Programme
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