Retraining of social and health care assistants

The training was organized for social- and health care assistants working in the elder care sector with persons suffering from dementia. The training course was planned as an “action learning” course. It was a 5 days’ course spread over 2 X 2 days and a summing up day at the end. Between the two days, the participants met twice with their trainer and had sparring about the tasks they have solved in the interim periods.

The participants were obliged to prepare for the course: It was assumed that they had completed “ABC – Dementia” (An online course on dementia of about 6 hours) before attending the training course.

The current course level:  the European Qualification Framework (EQF)  4

The functionel sequenses

The course participants worked with learning loop periods at the workplace between the training days at the SOSU college, for the purpose of transfer. They were divided into staff groups from 4 care homes and they met in learning loop groups at work with the participation of trainers from SOSUØstjylland as facilitators. Each participant had to “identify/select” a person with dementia at their work place,  a particular person that they found challenging. On day two of the course, they formulated a problem (dilemmas and action) and based on the dilemmas and action, a task/assignment was developed.

The case was taken home in own work practice. Here the  participants applied the theory they have learned to deal with the problem, focusing on the quality of life and well-being of the person with dementia. Actions had to be implemented in collaboration with the leader and learning partners/groups – involving the person with dementia, relatives and colleagues. For the first learning loop meeting, the participant brought a video recording of a situation, where new actions were being tested. (This way of working with new actions in practice, required the consent of the participants.) For the second learning loop meeting, the main topic was  how the employee can continue to develop and maintain a person-centered care culture. What are the barriers and how can the organization maintain its implementation; what are your leaders’ tasks and what are your tasks?

Course contents:

 Day 1 and 2:

Analysis of function, behavior and everyday life (Application of ICF, the brain with focus on sensing and perception)

• ICF’s thinking applied to people with dementia
• What conditions do people with dementia have?
• Perception disturbances
• Neuro Education
• Appropriate respons to the reactions of the person with dementia
• Thinking and theory of everyday life. Social Educational Approach (Tom Kitwood)
• The person first of all
• The malignant social psychology
• Strengthening personal identity
• Evidence in the field

Introduction of reflection diary and presentation of the task for 1st learning loop / learning in practice.

Day 3 and 4:

• National action plan for the dementia area and the municipality
• Neglect of care and use of power
• Dilemmas
• Life history and activity choices to promote quality of life / Gary Kielhofner)
• Meaningful activities

Work with relatives and volunteers, expecting the parties to agree.

The needs of the relatives:

• to receive information on the course and prognosis of the disease
• to be able to be involved in care and daily activities
• observation of the relative’s mental state. Awareness of depression and burnout
• relief
• support and acceptance for the relatives to have their own freedom
• preparation for changed / new identity

Collaboration with the volunteers

• Who are they?
• How do we collaborate?

The good working life and taking care of yourself / Creating a learning culture

• Common reflection among colleagues
• Scheduled dialogues with colleagues or immediate superiors

Preparation for learning loop / learning in practice. Introduction of reflection diary and presentation of task for 1st learning loop / learning in practice. Last day: Collection of tasks, sparring for solutions and suggestions for future implementation and facilitation of questions.

The evaluations from both course participants and employers were fantastic and many organizations changed their practice to give the person with dementia more quality of life.

Some reactions:

“We need to become better at seeing the needs of the individual person and working with one to one activities”

“There should be more focus on the person’s life history as the basis for the care and not the demands of the relatives”

“We need to focus more, slow things down and have more nonverbal communication.”

“More presence with the person in need of care, individual care, see the person behind the disease (Life history), one to one contact”

“In the future, we will work on a different approach for each person suffering from dementia”

“We will no longer say the phrase” It cannot be done”

“We will have a more positive mindset”

“We will stop and think before we act.”

“We have gained new knowledge: music can replace painkillers”

“We want to try things out and we are eager to find the right method/approach for each resident”

A concrete example from the training:

It is a case of an 81-year-old woman with Alzheimer’s dementia. She is living in a nursing home with her spouse, however not in the same apartment. He knows she is his wife and he is trying to help her, but she does not know she is his wife. They have a daughter with whom she has good contact and the daughter comes daily. The women has worked as a daycare provider. She is a happy and kind person, easy to smile. She suffers from arthritis and she is a catheter user and incontinent for stools. She was raped earlier in her life and it has left her marked. During the personal care, she is scared out of her mind and screams throughout the process of the personal hygiene. The way the caregivers handled this was by one removing the duvet and one holding her hands away from the diaper. They constantly talked about what they were doing.

The caregivers then decided to change the method of care. Both have now lowered the pace of their action. One of them constantly keeps eye contact with the woman and the caregivers do not talk together during the process. The other caregiver rolls up the quilt from below so the citizen can constantly hug it, even when she has to turn. It also means she cannot see the caregiver who washes her. Furthermore, the staff is aware of only touching her one at a time so that she does not experience it as an assault. The result of these changes is that staff can now complete the personal care without the woman screaming at all.