Building staff capacity to provide responsive care

Elizabeth Beattie introduces Dementia Training Australia’s new Responsive Behaviours Consultancy – a staff training program to help residential aged care organisations address and reduce dementia related responsive behaviours.

One of the most pressing issues in the care of people living with dementia is that of behavioural changes associated with multiple and complex factors. These factors include, for example, those related to the progression of dementia, such as changes in the ability of the person to adequately express their own thoughts and feelings.

Of equal importance are the legibility and comfort of the person’s physical environment, the effects of psychotropic medications they have been prescribed, the extent to which their expressed preferences and needs are well understood and met, and the way that staff and family involved with the person relate to them.

Building-staff-capacity-to-provide-responsive-care-dementia

Paradigm shift

The philosophy of person-centred care has contributed to a major paradigm shift in the way we think about the care of people living with dementia. An understanding by staff of how their own behaviour can be a powerful influence – both positive and negative – in determining the way in which people living with dementia respond to and experience care is central to improving care.

Yet, as noted in the recent Australian Government Aged Care Workforce report (Kostas et al 2017), considerable ongoing attention to staff training is required in the aged care sector for us to match care aspirations with care realities.

Intensive support

The Responsive Behaviours Consultancy (RBC) is a staff training program offered to residential aged care organisations or other providers by Dementia Training Australia (DTA) as part of a DTA Tailored Training Package. (DTA is funded by the Australian Government to deliver a range of dementia training opportunities to the aged and health care sectors.)

The RBC is offered after a DTA training needs analysis and discussion with a representative from the interested organisation has identified a need for intensive support to improve the way staff address the responsive behaviours of people living with dementia.

Lead And Learn

Once a RBC plan is agreed, DTA will deliver the Lead And Learn Education Program, a core element of the consultancy.

The program is delivered to care champions nominated by their organisation. It’s designed to help create a sustainable capacity-building education framework for addressing and reducing dementia-related responsive behaviours and to build a small group of care champions in a facility.

Throughout the program the champions are closely mentored by DTA staff and supported to develop as leaders in responsive behaviour care. The program content is delivered by a DTA consultant who remains the ongoing contact throughout the program.

Components of the Lead And Learn Education Program include:

  • An introduction to the concept of responsive behaviours within DTA’s salutogenic framework. The salutogenic approach looks beyond problems and symptoms and focuses on factors that support health and well-being, rather than pathogenic factors that cause disease.
  • An exploration of several models to assist with understanding the factors underlying responsive behaviours, for example the Need-Driven Dementia Compromised Behaviour Model (Kolanowski 1999) and the Progressively Lowered Stress Threshold Model (Hall & Buckwalter 1987).
  • An exploration of individual behaviours, including assessment processes, strategies and evaluation that can be used to reduce the impact of behaviour changes on the person living with dementia. Case study scenarios are used to show how this is applied in practice.

The education involves input from experts in the assessment of the older person and dementia-related behavioural changes, stimulating video clips and realistic case study discussion sessions. Specific sessions on workplace leadership and mentoring and managing staff who are providing daily care to people living with dementia are included.

More information

Organisations interested in more information and accessing the Responsive Behaviours Consultancy through the Tailored Training Package program can inquire via the DTA website at https://www.dta.com.au/services/reducing-responsive-behaviours/

DTA-free-dementia-responsive-behaviours-dementia-App

Dementia Training Australia’s (DTA’s) new Responsive Behaviours app provides a quick guide to responsive behaviours for health professionals and care staff in all settings.

The app features prompts on what to consider and tips on how to respond to 10 common responsive behaviours: agitation, apathy, anxiety, aggression, depression, disinhibition, psychotic symptoms, sleep disturbance, vocally disruptive behaviour and wandering. There is also a section on delirium.

Links to recommended tools for assessing each behaviour are embedded, and frameworks for addressing responsive behaviours (eg Need-Driven Dementia Behaviour Model (NDB) and the PIECES mnemonic) are included.

The app is based on DTA’s Behavioural and Psychological Symptoms of Dementia (BPSD) Quick Reference Cards. The app incorporates the ‘lanyard card’ checklists: how well am I communicating?; getting to know the person living with dementia; and understanding the behaviour.

The Responsive Behaviours app is free to download for phone or tablet from the App Store or Google Play Store.

Elizabeth Beattie is Professor of Aged and Dementia Care School of Nursing, Queensland University of Technology (QUT), Director, Dementia Training Australia, QUT, and Director, Dementia Centre for Research Collaboration: Carers and Consumers, QUT.

References

Hall G, Buckwalter K (1987) Progressively Lowered Stress Threshold: A Conceptual Model Of Care Of Adults With Alzheimer’s Disease. Archives of Psychiatric Nursing 1(6) 399-406.

Kolanowski A (1999) An Overview of the Need-Driven Dementia Compromised Behaviour Model. Journal of Gerontological Nursing 25(9) 7-9.

Kostas M, Knight G, Isherwood L et al (2017) 2016 National Aged Care Workforce Census and Survey – The Aged Care Workforce, 2016. Canberra: Australian Government, Department of Health.

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