Kaye Ervin, Cobram District Health: Utilising volunteers to deliver person-centred care for dementia in acute care

Utilising volunteers to deliver

person-centred care for dementia

in acute care settings National Dementia Congress 20th February

Kaye Ervin

Background

• Action research project

• A volunteer in the aged care facility

identified a need for volunteers in the

acute care setting

• Acute care staff agreed that patients

with dementia presented difficulties

• A previous project demonstrated good

outcomes and feasibility

Utilising volunteers to deliver person-centred

care for dementia in acute care settings



Literature review major findings • Currently estimated that 50% of all people admitted

to acute care have some degree of cognitive

impairment [1]

• There is potential for adverse outcomes for these

patients in an acute environment [2]

• Carers and families report widespread dissatisfaction

with care for confused, older people is acute settings

[3]

• Nurses report challenges caring for patients with

dementia in acute care, against a backdrop of time

constraints and competing demands [4]



• Translating research into practice

project funding from the Vic/Tas

Dementia Collaborative Research

Centre provided the necessary

resources.



The aim of the project was to improve the

emotional and psychological experience and

care outcomes of patients with dementia

admitted to the acute care setting, through; 1. Recruiting and training volunteers in a person-centred

approach to supporting people with cognitive impairment

2. Development of enduring guidelines and policies to facilitate

the recruitment, training and implementation of the

volunteers for a sustainable program

3. Evaluation of the program



Project methodology

• Convene an advisory group of key stakeholders

• Recruit volunteers through local media

• Train volunteers

• Develop policies and

guidelines

• Educate staff

• Implement volunteers

• Evaluate the program



The advisory group (10 members)

• Research Academic, Director of Clinical

Services, Volunteer, Community

member, Risk & Quality Support, Nurse

Unit manager, Registered Nurses x 4.

• Met fortnightly to oversee recruitment,

selection, training content and develop

and adapt policies from a former project



Recruit Volunteers

• Articles in local newspaper and

snowball effect, resulted in 12

community volunteers offering their

services



Train Volunteers

• The VAG suggested appropriate content

such as safe walking, meal assistance,

confidentiality

• Practical components included in training

days such as use of wheelchairs and feeding

elderly people

• Principles of PCC

• Training was conducted by an educator over

a two day period, on site.



Develop policies and guidelines

• A previous project undertaken by Catherine Batemen

at Bega Health Service provided existing policies and

guidelines

• Many were adapted to suit our service (referral

forms, volunteer documentation, volunteer duty

statement and responsibilities)

• Others were developed to be service specific

(consent, recruitment, patient profiles)

• Very time consuming process!! But essential for

sustainability



Educate Staff

• Documents developed or adapted by the

VAG were explained to staff of the acute

ward, and they were instructed in their use

(referral forms, consent)

• Posters and flow charts also instructed staff

and gave contact numbers

• Staff were very enthusiastic



Implement Volunteers

• Volunteers nominated attendance times

8-12.30 am and 4-7pm Monday to

Friday

• For the initial 2 weeks of implementation

the research academic was on site for

support and to ensure consistent

practices

• Then available by phone



Volunteer role

• Check for referrals

• Complete a patient profile

• Utilise the resource box to engage patients in

activities

• Assist with walking, meals, physio

• Chat

• Document their activities, what worked, what

didn’t

• Liaise with staff



Project evaluation

• Limited to qualitative evaluation due to

the small sample size

• Anecdotal reports of improved patient

outcomes (reduced falls)



Evaluation

• All staff invited to undertake an interview by

posting an invitation in pigeon holes

accompanied by the interview schedule

• Staff interviews (16 eligible staff during the

two week time period of interviews)

• 93% response rate

• Audio-taped interviews conducted in the

workplace at an agreed time by the research

academic



Data Analysis

• Audio-tape transcribed and analysed

collaboratively by the research

academic and an independent

researcher experienced in qualitative

research

• Identified key words and recurrent

concepts



Findings -

• Improved time management for other tasks

• Increased patient stimulation

• Increased patient safety

• Extension of the program



Improved time management for other

tasks • ….I find it’s a real relief for my staff because they can go and do

the jobs that they need to do without having to spend so much

time with one person. What’s been good is that it’s freed up out

time to continue with our other work and we’re happy to know

that the patients are being looked after.

• …those patients are quite disruptive often and they take up a lot

of our time just redirecting and the things that volunteers do is

engage them, and keep them occupied so that we’re not

spending excessive time with them. That gives us time to go on

with our other work.



Increased patient stimulation • We don’t have time to do what they do. They spend one on one

time with people who really need their company. The volunteers

help them pass the time.

• Reading the newspaper to them, it keeps them more focused on

everyday situations, where the nurses don’t sit there and do that

with them. They don’t have time to do that and I think all those

things are worthwhile.

• We can’t read newspapers to them or anything like that. It’s just

good that volunteers can come in and help and spend quality

time with patients, explain things that they might get confused

about and reinforce things that they might forget…..it’s good

continuity because they have the same volunteer for a long

period….having the same person to talk to, I’m sure it helps.



Increased patient safety

• We are a small, busy hospital, we can be very busy

and it just really helps with the higher risk patients,

and its also a great support and comfort for them as

well.

• We can get on with our work knowing those people

are safe, where before it was a constant concern, you

know, like “will they fall out of bed while I’m in the

next room?’. Now we have peace of mind that that

won’t happen.



Extension of the program

• We are a seven day a week, twenty four hour service

after all. Their confusion doesn’t stop at five pm

Friday. We’d like it too but it doesn’t. After having

volunteers here all week, we really feel it on

weekends now.

• Weekends would be good and visiting people who

don’t have dementia, just those who are lonely or

have no one visiting.



Conclusion

• Volunteers are a valuable resource to

benefit patients with dementia by

providing cognitive stimulation and

improved patient safety through the

constant presence at busy times.



Sustainability • Driven by the volunteers with

minimal staff input

•Volunteers phone in daily to

ascertain if they are required

•Staff complain loudly if no

volunteers are available

•Monthly volunteer meetings to

discuss issues of concern

•Extended to other patients



Implications

• Volunteers are a rich, but under utilised

resource in health service settings

• Process can be easily replicated for any

service size

• Staff, volunteers, patients and families

benefit



References • [1]Yates, M., Theobold, M., An all of hospital program to improve the

awareness of and communication with people with cognitive impairment,

linked to a bedside cognitive impairment identifier. . Neurobiology of

Aging, 2010. 25.

• [2]Borbasi, S., Jones, J., Lockwood, C E. , Health professionals’

perspectives of providing care to people with dementia in the acute

setting: toward better practice. GeriatricNursing, 2006. 27: p. 300-307.

• [3]Jurgens, F., Clissett, P., Gladman, J., and Harwood, R. , Why are

family carers of people with dementia dissatisfied with general hospital

care? a qualitative study. BMC Geriatrics, 2012. 12(57).

• [4]Jones, J., Borbasi, S., Nankivel L, & Jockwood, C. , Dementia related

aggression in the acute sector: is Code Black really the answer? .

Contemporary Nurse: A Journal for the Australian Nursing Profession,

2006. 21: p. 103-115.



Ervin, K., & Moore, S. (2014).Rural nurses perceptions

of a volunteer program in an acute setting:

Volunteers delivering person-centred care for

patients with dementia and delirium. Open Journal of

Nursing. 4. (http://wwwscirp.org/journal/ojn/)

Further discussion or questions?

http://wwwscirp.org/journal/ojn/

© Copyright The University of Melbourne 2008

Health & Medicine

Kaye Ervin, Cobram District Health: Utilising volunteers to deliver person-centred care for dementia in acute care