Living with dementia magazine September 2010

A drive for best practice and a person-centred approach have resulted in excellent care for people with dementia at a hospital ward in north west England by Caroline Graty

Improving quality of care for people with dementia is at the heart of the Society's Putting Care Right campaign. Our Counting the cost report, published last year, revealed unacceptable variations in the quality of care people with dementia receive in hospital.

For Joan O'Hanlon and her dedicated team at Peasley Cross Hospital in St Helens, there is no excuse for poor dementia care. Joan is the manager of the Stewart Assessment Ward, part of the 5 Boroughs Partnership NHS Foundation Trust. Joan and her team are the driving force behind a range of initiatives at a ward for people with dementia.

By putting the well-being of patients at the heart of their work, they have created a culture of person-centred care, improved the ward environment and introduced a range of dementia-friendly activities.

Taking the lead

Joan was part of the commissioning team when the ward was built about 20 years ago. She took the lead in recognising the challenges in dementia care, and, with her team, has been introducing good practice initiatives ever since.

Each year, the ward is assessed using the government's Essence of Care standards, which identify how to achieve best practice. The assessment team includes carers and service users, as well as professionals who don't work on the ward, to ensure an unbiased and objective assessment. As part of the process, action plans are drawn up to overcome obstacles to best practice.

One result of these plans was the creation of a dementia-friendly garden. Joan says,

'We couldn't meet best practice criteria because we didn't have any safe outside space. Patients felt trapped and found the environment challenging.'

The team put a proposal forward and received funding for a specially designed garden.

Another assessment exercise looked at staffing. Joan says,

'We saw that we needed a nurse specifically for activities. Nurses were feeling guilty about doing activities as it meant leaving more routine tasks to their colleagues.'

The recruitment of an activity nurse is one of the many developments that contribute to an engaging, dementia-friendly environment. The ward also has a Reminiscence room and a multi-sensory Snoezelen room. The activity nurse and staff run daily sessions of Sonas (Gaelic for well-being, joy and contentment) - a therapy that stimulates the senses and encourages communication.

Essential training

The ward has also developed its own training facility. Staff across the trust who care for patients with dementia are trained in person centred care using Alzheimer's Society's introductory dementia training resource.

Joan says,

'Attitudes, approaches and getting to know the patient are the key to providing person-centred dementia care. That's why it's essential that the whole team receives training.'

Understanding the person

In order for staff to understand the needs of patients on the ward, nurses complete a questionnaire with each new patient, involving relatives where possible. Joan says,

'If a person is having problems sleeping at night, it could be because they worked night shifts all their life. Once you understand that, you can work around it.'

Some extra background knowledge made all the difference for an Indian patient on the ward who wouldn't eat any of the Indian meals nurses were ordering for her. They discovered from a family member that the patient had never liked Indian food and preferred English cooking. Joan says,

'You've got to get to know as much as possible about the person, and avoid making assumptions about them on the basis of their culture or background.'

This tailored approach leads to improved well-being for people with dementia on the ward. Joan says,

'Patients who are admitted are often agitated. We are able to discharge them, having identified ways of understanding and managing their behaviour.'

Safe hands

Former carer Carol Wilcock was impressed with the care her late husband Terry received on the ward. She says,

'If Terry was distressed or shouting, a member of staff would spend time with him one-to-one. It was awful to leave him when he was distressed, but it was comforting to know that he was in safe hands.'

Carol and another volunteer now hold weekly carers' surgeries - the latest ward initiative - to support and advise other carers with loved ones are on the ward.