Our Culture Change Journey - ltcam.mb.ca · Purposeful Interactions ... This means that residents direct their own care. ... fulfilling experience, it can also have its

Purposeful Interactions Our Culture Change Journey

“Relationships are not only the heart of long-term care;

they are the heart of life. And life should continue,

wherever we live.”

- Carter Catlett Williams

Seniors’ Health and Continuing Care - Saskatoon

Purposeful Interactions

• What are Purposeful Interactions?

• How are Purposeful Interactions different?

• Importance of the “Observation” experience

• Culture change journey

• Living by the “Platinum Rule”

• Overcoming challenges/evaluating outcomes

Objectives

Purposeful Interactions Music Video

Video

“She calls me Raymond”

By Brett Eldredge

Purposeful Interactions Why we are here…

“Long-term care is full of wonderful, loving staff. It is the system that is broken.”

- Dr. Bill Thomas

Founder of the Eden Alternative


“I did what I knew at the time, when I knew better, I did better.”

-Maya Angelou


• Making connections with each resident

• Focus on connections and relationships versus “tasks”

“[Care team members] go about doing their job – [focused] to get the work done, and don’t realize

that interaction is part of their job.” - Ken Udell, Resident

Purposeful Interactions What are Purposeful Interactions?

• Regularly checking on resident’s needs

• Providing better than expected care

“The more knowledge that the staff has about me, as a person with a life history and experiences, can

only translate into better care for us as residents.”

-Don Barrett, Resident

Purposeful Interactions What are Purposeful Interactions?


• Care team members may already interact regularly with residents while meeting their care needs

• The intention of Purposeful Interactions is to anticipate and individualize the response to the resident’s needs

How is this different?


• Places maximum possible decision making into the hands of the residents. This means that residents direct their own care. Relationships and choice are of greatest value.

• Occurs when care team members encourage independence and support residents to participate in decisions affecting their environment; their home.

• Is based on:

- Communication - Privacy

- Respect - Autonomy

- Choice - Flexibility

- Independence - Security

Resident-Directed Care

• Not all residents are capable of communicating their needs. We need to become “good detectives” to try to determine what unmet needs the person is trying to communicate.

• Care teams must commit to know each resident and their unique needs.

• Respect their individuality and honour their choices.

Purposeful Interactions Honouring Choices


• Acknowledge Resident Rights & Responsibilities

• Commit to resident-directed care and demonstrate that commitment in day to day work.

Care Team Commitment

“We should all know the three plagues of long-term care…I believe [care team members] are very effective

in combating these plagues. The problem is it is different everywhere” – Matt Proctor, Resident

Loneliness Helplessness Boredom


“Words make worlds”

“The words that we use influence how we think and how we think influences

how we act”

- Denise Hyde

What do Purposeful Interactions look like?


I would like to say that living in long term care can be an enriching and fulfilling experience, it can also have its low periods and everything in between for many. I want you all to know that you are important and fundamental to the health and happiness of your residents…You can make the changes and choose to be a blessing in other people’s lives. I am not saying it is easy, for some it may be very difficult, but it is possible. You can make a difference.”

- Matt Proctor, Resident

Photographs

Courtesy of

Rona

Andreas


• “It was good to sit back and watch, and observe how much we do good in our home, and what we need to improve, opened my eyes, will help me be a better care aide.”

• “I thought the “observation” time to be long until we discussed it later and realized that time was needed to do proper observation. The whole experience was an “eye-opener” for me.”

• “… I was amazed at how different the view of observer was compared to being a worker.”

• “I liked the observations; it was surprising to learn how some residents had no contact for over an hour.”

Participants, Purposeful Interactions,

Lakeview Pioneer Lodge, Wakaw, Saskatchewan

Observation Experiences & Reflections


“When someone in a position of power has

control of your day-to-day life”

“… we need to abandon the institutional model which focuses on staff schedules, tasks, and

scarcity … we need to instead create a human habitat in place of the institution where the

focus is always on the relationship with each resident, schedules are based on each

resident’s individual schedule/needs/choices, and focus is on abundance, not scarcity. Through the development of meaningful

relationships residents feel safe and secure.”

What is Institutionalization?

-Robin Kitchen, Sherbrooke Community Centre Manager for Learning and Growth


• What are we doing well?

• What are our missed opportunities for making connections with residents?

• What is stopping us from doing this?

• What improves the experience of work life for care team members?

• How do we know residents are experiencing interactions in a positive way?

What is our Current Culture?

Who are we doing things for and what is best for…?


Four P’s: • Positioning • Personal Needs • Pain • Proximity of Personal Items

How to Implement Purposeful Interactions

Purposeful Interactions What do Purposeful Interactions look like?

Smile

Observe

Interact

Closing Interaction


• “Treat others how they would like to be treated”

• The Platinum Rule means we need to ask, listen, and deliver care that is guided by each individual resident’s needs and preferences

Living by the Platinum Rule


• Right Now Homes immediately began modelling and mentoring quality interactions, seizing every opportunity. Immediate positive feedback to staff recognizing and appreciating caring connections and individualized care in the moment.

• Soon Examining bathing, individualized time to awaken/retire, explore options for meal wait times, and practice customer service principles.

• After Research and Planning Improvements to the welcoming process for new residents, implementation of relaxed breakfast and flexibility around shift expectations.

Identified Actions


• Resistance to change

• Rigid schedules and routines

• Informal culture • Peer pressure • Focus on task vs relationship

• Engrained within the institutional model of care

• Availability of resources

Barriers & Challenges


• Engaged Leadership

• Educated care team members • Initial and continued involvement of

Residents/Families • Self awareness of the home’s current culture

and actions for improvements • Concrete actions to address barriers/challenges

Keys to Success

Purposeful Interactions Evaluation- Antipsychotic Use

0%5%

10%15%20%25%30%35%40%45%

FY 15-16 Q1

FY 15-16 Q2

FY 15-16 Q3

FY 15-16 Q4

FY 16-17 Q1

FY 16-17 Q2

FY 16-17 Q3

FY 16-17 Q4

FY 17-18 Q1

FY 17-18 Q2

FY 17-18 Q3

Manitou Lodge Antipsychotics

Provincial Average Manitou Lodge Target

LAUNCH FEB 2017

Purposeful Interactions Evaluation- Antipsychotic Use

0%5%

10%15%20%25%30%35%40%45%

FY 15-16 Q1

FY 15-16 Q2

FY 15-16 Q3

FY 15-16 Q4

FY 16-17 Q1

FY 16-17 Q2

FY 16-17 Q3

FY 16-17 Q4

FY 17-18 Q1

FY 17-18 Q2

FY 17-18 Q3

Mennonite Nursing Home Antipsychotics

Provincial Average Mennonite Nursing Home Target

LAUNCH MAY 2016

Purposeful Interactions Evaluation- Bladder Continence

0%5%

10%15%20%25%30%35%

FY 15-16 Q1

FY 15-16 Q2

FY 15-16 Q3

FY 15-16 Q4

FY 16-17 Q1

FY 16-17 Q2

FY 16-17 Q3

FY 16-17 Q4

FY 17-18 Q1

FY 17-18 Q2

FY 17-18 Q3

Quill Plains Centennial Lodge Bladder Continence Worsened

Provincial Average Quill Plains Centennial Lodge Target

LAUNCH OCTOBER

2016

Purposeful Interactions Evaluation- Bladder Continence

0%

5%

10%

15%

20%

25%

30%

35%

FY 15-16 Q1

FY 15-16 Q2

FY 15-16 Q3

FY 15-16 Q4

FY 16-17 Q1

FY 16-17 Q2

FY 16-17 Q3

FY 16-17 Q4

FY 17-18 Q1

FY 17-18 Q2

FY 17-18 Q3

Samaritan Place Bladder Continence Worsened

Provincial Average Samaritan Place Target

LAUNCH MAY 2016


“There has been a significant change in the culture. I do notice a big change in that I see staff speaking with residents, and it makes me feel good to know they are engaging my mom even though she may not be completely aware. As family, it takes some of the sadness away for us. Human touch and voice are so integral as people go deeper and deeper into dementia.”

- Roxane Grambo, LTCAC Family Advisor

Positive Experiences


How are we sustaining Purposeful Interactions?


• Lynda Blevins, RN, BN

Supportive Care Projects Coordinator

Seniors’ Health & Continuing Care – Saskatoon

Saskatchewan Health Authority I 306-655-2497

[email protected]

• Jan Berger, RN, BSN

Supportive Care Projects Coordinator

Seniors Health and Continuing Care – Humboldt Saskatchewan Health Authority | 306-682-1236

[email protected]

Contact Information & Resources

mailto:[email protected]

mailto:[email protected]

“A resident noticed more of the care team members taking time during meals to assist our residents and they really are engaging with them. It feels more like a normal meal, like with family, than care teams performing a task.”

-Parkridge Centre

Thank You

Documents

Our Culture Change Journey - ltcam.mb.ca · Purposeful Interactions ... This means that residents direct their own care. ... fulfilling experience, it can also have its