Reminiscence and Individualised Care Therapies in Heatherwood and Wexham Park Hospital

Introduction

The aim of this project was to deliver a dementia friendly hospital environment through the provision of a suite of Reminiscence Pods which support flexible reminiscence therapy.

Hospitals are rarely designed to promote effective environments for care of patients with dementia and with increasing demand on use of space a flexible approach is required.   In hospital it is common for people with dementia to become agitated and they are then far more at risk of harms such as falls and malnutrition.  The absence of opportunities to engage with their past and unlock memories can be traumatising for the patients and their families and can also lead to greater demands on staff and services.

Heatherwood and Wexham Park Hospitals Trust are committed to becoming a dementia friendly hospital and in working closely with the community it serves to achieve this.

The project planned to adopt the use of Reminiscence Pods. A reminiscence pod is, in essence, a pop-up scene with activities for reminiscence for example on of the Rempods is a 1950s living room, complete with authentic furniture, wallpaper, a stock of period newspapers and fully-working 50s record player, television and radio, (all with embedded modern technology). Other examples are a traditional pub scene and dance hall.

Pods can provide a focus for reminiscing, encouraging conversations, a more relaxed frame of mind and an acknowledgement of feelings during moments of anxiety. Because they provide a ‘complete environment’ with things to see ,touch and interact with, the elements of the pod often provide a prompt or a starting-point for conversation.

These have been used effectively at the Bristol Royal Infirmary and the UniversityHospital in Lewisham as part of their Dementia care strategy and evidence suggests that the Rempods are supporting better nutritional care, reducing anxiety, distress and other challenging behaviours, changing nursing approaches and level of understanding of dementia. The hospitals also report that verbal feedback from carers/ families has been extremely positive

We also plan to adopt the use of portable IT based Life Story systems which offer the opportunity for the provision of reminiscence, life story work and activities where and when they are needed. This technology has been used widely in care homes across the country and is beginning to be used in acute hospitals.  Most notably within NHS Tayside a hospital introduced this technology to help maintain patient independence as well as provide activities and opportunities for social engagement. The easy to use touch screen technology was introduced to the wards to help Occupational therapists and nurses to interact , engage and communicate with patients.  What they found was that patients were able to engage with their families having used reminiscence therapy as a stepping stone to prompt conversations.

 Objectives

  • Optimize individualized care and outcomes by providing reminiscence, Life story & relevant activity opportunities to patients of Heatherwood and Wexham Park Hospitals Foundation Trust
  • Reduce the risk of harm occurring to patients with a diagnosis of dementia through a reduction of inappropriate prescribing as a result of improved provision in first line psychosocial interventions
  • Promote collaborative working and improved relationships and support for carers by involving them in the sessions and increasing their knowledge in the value of reminiscence/life story activities
  • Provide training opportunities for Healthcare staff and volunteers working with the Trust in relation to providing reminiscence therapies/distraction techniques and individualized care
  • Provide training opportunities to community teams in both public and private sector by inviting them to participate in the reminiscence/life story sessions and gain the confidence and knowledge to cascade the therapies following the active learning sessions. This will      support a WAMCCG training project.
  • Provide Training opportunities for Volunteers by inviting them to participate in the reminiscence/life story sessions and gain the confidence and knowledge to cascade the therapies following the active learning sessions.
  • To support hospital staff and community staff by providing them with skills and coping strategies required in caring for patients with dementia

 Anticipated outcomes

  • Improved  mood, cognitive ability and  well-being of those with mild to moderate dementia
  • Improved relationships, whether family or professional, between the person with dementia and their carer(s)
  • Provision of individualised care in relation to the principles of person centred care as highlighted by NICE Guideline (42)
  • Reduced use of inappropriate pharmacological treatment (About 145,000 people with dementia are wrongly being prescribed powerful anti-psychotic medication which causes around 1,800 deaths a year,”) NHS Choices 2008
  • Reduced number of falls
  • Promotion of independent living/earlier return home to a familiar environment

Progress update

The rempod itself proved too large and cumbersome to install in the ward environment. Patients with dementia often have difficulty with their concentration and the busy ward environment was an obstacle to engaging with this patient group. We took the rationale behind the rempod (creating a therapeutic and calm environment) and created a 1950’s style living room (the Sunflower Lounge) in a meeting room away from the busy ward environment but within walking distance of the wards where the majority of our patients with dementia are.  Objects from the original rempod i.e. the television and the radio furnished the room.

Working with the ethos of the Sunflower lounge we are piloting a ‘dementia friendly bay’. The bay will be a 4 bedded area for patients with dementia. We have liaised with designers who have advised colours and colour schemes, décor and furniture. The bay will provide a calm, therapeutic environment for patients with dementia with emphasis on aiding recovery through social inclusion and individualised care.

The portable IT based life story system (mylife software) in conjunction with The Sunflower Lounge has achieved the projected outcomes when we looked at the changes in patient’s mood although it is too soon to judge regarding the reduction in the use of antipsychotic medication and reduction in the number of falls.

 

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