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Quality of Everyday Life
for vulnerable elderly
ReykjavikJune 1. 2010
Karin Naldahl, Lecturer, RN,MHH(Master in Humanities in Health)
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. - [email protected]
*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, Kø[email protected]
Thankyou for listening