Evidence-based practice for clients that have dementia

Evidence-Based Practices

for People with

Dementia

By: Heidi Seeger

Agency: Rosewood on Broadway

Overview of Practice

Agency

Client System

My Role

My Duties

Engagement #1

• Definition: “Engagement is concerned with the

process of establishing the client-worker relationship

upon which subsequent steps depend”

• The empowerment process begins in this stage, along

with identifying client needs

(Kirst-Ashman & Hull, 2012)

Research

“Effective Communication with

People Who Have Dementia”

• Communication barriers can

hinder identifying resident

needs and lead to deprived

human contact

• Use person-centered care and

focus on communication

abilities vs. deficits

• Tips: face the resident, use

simple sentences, allow time,

avoid contradicting or

correcting, and use touch

(Jootun & McGhee, 2011)

“Dementia Care: Using

Empathic Curiosity”

• Empathic curiosity = using

empathic listening to

understand perceptual

experiences

• Ask short, open ended

questions

• Pick up on emotional cues

• Give time to think

(Mcevoy & Plant, 2014)

Skills

Methods Used Skills Used

• Name badge

• Read life history

• Read progress notes daily

• Knock on their door

• Adjusted my voice to

resident’s hearing level

• Empathy (ex. Complaints

of pain)

• Meet the resident where

they are-physically &

cognitively

• Smile, acknowledge, and

introduce self

Reflection On Use of Self

• Personality

• Woo: Meeting new people, learning their names, and

finding common interests to start conversations

• Humor

• Self Disclosure

• Anxiety

• The presence of family members during admissions

(Dewane, 2005)

Outcome

• Successful

• Most residents enjoy and appreciate when you engage

with them

• Self-disclosure of where I was from proved to be

successful for making connections

• Improvements

• Become more comfortable around family members

Assessment #2

• Definition: “Assessment considers the process of

gathering and organizing data and information in

order to arrive at an accurate picture of the person-

in-environment situation”

• Involves defining the problem and contributing factors,

and recognizing what can be done to reduce or

eliminate the problem


Research

“Differentiating Levels of Cognitive Functioning”

• Rosewood is mandated to use the Brief Interview for Mental Status (BIMS) assessment tool

• Compared Brief Interview for Mental Status (BIMS) and the Brief Cognitive Assessment Tool (BCAT)

• BIMS strengths: quick, strong reliability, suitable for non-licensed professionals to use, predicts cognitive diagnosis in general

• BIMS weaknesses: cannot differentiate the stages of dementia, cannot differentiate between mild cognitive impairment and dementia, and has a lower sensitivity

(Mansbach, Mace, & Clark, 2014)

Skills

Methods Used

• Sit face-to-face, annunciate

words, and maintain

comfortable eye contact

• Empathy (ex. If the resident

says they are forgetful)

• Patience

Skills Used

• Check upcoming

assessments and due date

• Printed off BIMS

assessment

• Locate the resident at the

right time in a quiet place

• Introduce myself and the

purpose


• Relational Dynamics

• Used empathy during BIMS assessment

• Created supportive worker-client relationship by

highlighting the client’s strengths, not weaknesses

• Reaction Patterns

• Reacting to incorrect answers was difficult

(Dewane, 2005)

Outcome

• Successful

• I became proficient in administering the BIMS

assessment

• I was able to highlight client strengths

• Concerns

• The resident’s level of energy or state of health could

affect the scores and cause inconsistent fluctuations

compared to previous scores

Planning #3

• Definition: “Planning involves establishing goals,

specifying how goals will be achieved, and selecting

the most appropriate courses of action”

• Planning guides how you help the client from

assessment of problems, needs, and strengths


Skills

Methods Used

• Contact family members, if possible, to set up time for initial Care Conference

• Inform others of Care Conference date and time

• Review the client’s records (ex. Reason for admission, progress notes)

• Bring notepad and pen to write down client needs

Skills Used

• Multi-disciplinary

communication

• Empowerment- asking the

client what he or she needs

• Social justice advocacy-

tailoring to the client’s

wants

• Documentation


• Belief System

• Family members should be involved in the resident’s

care and make efforts to attend Care Conference

meetings

• Families should allow clients the time to voice their

needs

• Professional Values

• Empowerment: residents should be asked directly

what their goals are instead of case managers inferring

(Dewane, 2005)

Outcome

• Improvements to be made

• Initial Care Plan: Ask the resident “What would you like

your daily Care Plan to be?”

• Keep resident involved in the outside community

Implementation #4

• Definition: “Implementation in generalist practice

deals with carrying out the intervention plan after

initial engagement, assessment, and planning. It is

the actual doing of social work”

• Intervention encompasses “treatment” and other

activities social workers use to solve or prevent

problems or achieve goals


Research

“Use of Doll Therapy for

People With Dementia”

• “Doll therapy is the careful

use of dolls to improve the

wellbeing of people with

dementia”

• Educate family before

implementing

• Not right for everyone

• Allow for natural

engagement

• Be aware of mislaid dolls

(Mitchell, 2014)

“Using Environmental Modification

and Doll Therapy in Dementia”

• Benefits include calming

effects, improved

communication, social

connectedness, and

reduced aggression and

distress

• Ethics: dignity, age

appropriateness, and

residents’ view of the doll

(Hahn, 2014)

Skills

Methods Used

• Recognize social cues

• Compliment the resident

• Coordination with staff

members and teamwork

(ex. Removing the doll)

Skills Used

• Speak with case manager

about residents and doll

therapy

• Observation

• Do not label the doll as a

“doll” or “baby”-let the

resident decide


• Style of Communication During Conflict

• Negative comments about the dolls

• Belief System

• I favor natural interventions or treatments instead of

treatments that rely on medications and narcotics (ex.

Anxiety or depression)

(Dewane, 2005)

Outcome

• Successful

• Residents’ faces “lit up” when given a doll

• Provides comfort

• Improvements

• Educate staff to treat the doll like an actual baby, if that

is what the resident believes

• Educate staff on how to respond to residents who

belittle those who have a doll

Research

“Dementia and Reminiscence: Not Just a Focus on the Past”

• Purpose: psychosocial intervention that stimulates memories and cognitive processes by using the five senses

• Person-centered approach

• Improves loneliness, depression, recall, personal identity and overall happiness

• Tips: use one theme, do not interrupt, and close by reorienting to current time

(Swann, 2013)

Skills

Methods Used

• Compile short stories or

trivia questions to prompt

memories

• Consult with case manager

about residents who would

benefit from interaction

• Gather residents together if

possible or 1:1 interactions

Skills Used

• Genuineness

• Warmth

• Speaking loudly

• Active listening

• Age awareness

Reflection on Use of Self

• Personality

• Includer: I enjoy having everyone involved during

reminiscence groups so they can feel connected and

valued

• Personal Values

• Religious practices, family structure, sexuality, and

working hard to provide for personal and family needs

(Dewane, 2005)

Outcome

• Successful

• Easy and enjoyable activity for staff to implement

• Easy way to assess the cognitive level of residents

• Repeated stories were told in new ways every time

• Improvements

• Encourage staff to implement more reminiscence

groups to get more residents involved and help them

make connections with their peers

Evaluation #5

• Definition: “Evaluation is a process of determining

whether a given change effort was worthwhile”

• Measures achievement of intervention goals, program

purposes, and client satisfaction


Research

“Clinical Utility of Patient Health Questionnaire-9 (PHQ-9)”

• PHQ-9 measures depression severity and is used to

evaluate the resident’s adjustment to living situation,

medication changes, etc.

• Study results: proved acceptable to patients and

caregivers, quick and easy to use, valid measure of

depression severity, valid measurement of need for

antidepressant therapy, but cannot discriminate between

patients with and without dementia

(Hancock & Larner, 2008)

Skills

Methods Used

• Sit face-to-face and maintain comfortable eye contact

• Empathy (ex. If the resident has complaints about feeling down)

• Probing

• Clarifying

• Broker skills (ex. Thoughts of dying)

Skills Used

• Check upcoming

evaluations and due date

• Printed off PHQ-9

evaluation

• Locate the resident at the

right time in a private place

• Introduce myself and the

purpose


• Personality

• Touch: Used to support residents when they are

experiencing or expressing negative feelings or

emotions

• Belief System

• Consulting residents with religious advice regarding

thoughts of death

(Dewane, 2005)

Outcome

• Successful

• For those who had the ability to comprehend longer

sentences

• The use of touch was successful

• Improvements

• Some questions are not appropriate for the elderly or

those with terminal illnesses (ex. Thoughts of death)

Termination #6

• Definition: “Termination is the end of the professional

social worker-client relationship”

• Occurs when services are no longer needed or no longer

benefit the client’s interest


Skills

Methods Used

• Proactive planning

• Organization and

coordination

• Broker- connecting

individuals with resources

• Effective written

communication (ex.

Forwarding information on)

Skills Used

• Assess resident’s length of

stay

• Communicate with resident

and family regarding

community services and

schedule follow-up

appointments

• Contact Hospice or palliative

care


• Coping Skills

• Termination due to death

• Professional Values

• Residents choosing the services they desire cannot always happen due to financial purposes

• Personality

• Positivity: Helping the client recognize positive aspects of termination

(Dewane, 2005)

Outcome

• Successful

• Staff make their best efforts to provide appropriate

after- care services

• All residents leave with a plan

• Steps are taken to honor, support, and provide dignity

to residents who pass away

• Improvements

• Macro improvements need to be made within financial

assistance programs so residents can afford the care

they need

Follow-Up #7

• Definition: “Follow-up is the act of acquiring

information about a client following termination”

• Focuses on how the client is functioning in the areas

that brought them in for initial services


Skills

Methods Used

• Professional voice and

introduction

• Warmth and genuineness

• Probing and clarifying

• Relaying communication

onto staff members

Skills Used

• Send greeting card

• Obtain satisfaction surveys

and contact information

from coordinator


• Belief System

• The importance of people’s opinions

• Humor

• Responding to family member’s jokes

(Dewane, 2005)

Outcome

• Successful

• Family members and residents that were contacted via

phone surveys were very willing to provide input

• Improvements

• Not all case managers call residents or their families

after discharging

Cultural Biases

• My BiasesMy Values

• Residents receiving disability benefits

• Residents who worked at homeMake all possible

efforts to work

• Religious blindness

• Residents who express thoughts of deathChristianity

• Some elderly residents do not have positive views of diversity

Acceptance and respect for all races

• FavoritismVerbal

Communication

Personal Values Related to Professional Values

Honesty

Teamwork

Individualism-fairness in everything is not

good

Helping Others

Close and open relationships

Everyone's life is valuable

Core SW Values:

Service

Social Justice

Dignity & Worth of the

Person

Importance of Human

Relationships

Integrity

Competence

(NASW, 2016)

Ethical Decision Making

1.10 Physical Contact

“Social workers should not engage in physical contact with clients

when there is a possibility of psychological harm to the client as a

result of the contact (such as cradling or caressing clients).”

Ethical decision of using touch in use of self

1.01 Commitment to Clients

“Social workers’ primary responsibility is to promote the well-being of

clients.”

Ethical concerns regarding Doll Therapy

1.16 Termination of Services

(e) “Social workers who anticipate the termination of services to

clients should notify clients promptly and seek the transfer, referral, or

continuation of services in relation to the clients’ needs and

preferences.

Ethical concern of discharging residents who are not ready

(NASW, 2016)

Professional Boundaries

Appropriate conversations, touch,

self-disclosure, accepting gifts, and professional

relationships with colleagues

1.04 Competence

1.06 Conflicts of Interest

1.09 Sexual Relationships 1.10 Physical

Contact

2.07 Sexual Relationships

(NASW, 2016)

Professional Roles

• Facilitator- activity groups such as balloon toss

• Educator- during admission process and tours

• Researcher- evaluating evidence-based practice

• Enabler- recognizing strengths and feelings of

residents who have situational stress

• Broker- connecting residents with religious

resources

Resources (APA)

Dewane, C. J. (2005). Use of self: A primer revisited. Clinical Social Work Journal, 34(4), 543-558.

Hahn, S. (2014). Using environment modification and doll therapy in dementia. British Journal of Neuroscience Nursing, 11(1), 16-19.

Hancock, P., & Larner, A. J. (2008). Clinical utility of patient health questionnaire-9 (PHQ-9) in memory clinics. International Journal of

Psychiatry in Clinical Practice, 13(3), 188-191.

Jootun, D., & McGhee, G. (2011). Effective communication with people who have dementia. Nursing Standard, 25(25), 40-47.

Kirst-Ashman, K. K., & Hull, G. H. (2012) Understanding generalist practice. Belmont, CA: Brooks/Cole

Mansbach, W. E., Mace, R. A., & Clark, K. M. (2014). Differentiating levels of cognitive functioning: A comparison of the brief interview for

mental status (BIMS) and the brief cognitive assessment tool (BCAT) in a nursing home sample. Aging and Mental Health,

18(7), 921-928.

Mcevoy, P., & Plant, R. (2014) Dementia care: Using empathic curiosity to establish the common ground that is necessary for meaningful

communication. Journal of Psychiatric and Mental Health Nursing, 21(6), 477-482.

Mitchell, G. (2014). Use of doll therapy for people with dementia: An overview. Nursing Older People, 26(4), 24-26.

National Association of Social Workers (NASW) (2016). Code of ethics. NASW. Retrieved from https://www.socialworkers.org/pubs/code/

code.asp

Swann, J. I. (2013) Dementia and reminiscence: Not just a focus on the past. Nursing and Residential Care, 15(12), 790-795.

Presentations & Public Speaking

Evidence-based practice for clients that have dementia