Workforce planning and development


While the NDCA is heavily engaged in dementia workforce development in the widest possible sense, it is crucial that the specialist staff it uses in education and training are constantly engaged in professional development themselves. To embed this into professional practice we formulated the following concepts.



Dynamic dementia care


This professional model combines the concepts of ‘person-centred care’, ‘personalised care’ and ‘learner-centred education’ with the high-quality clinical care the specialist services aim to provide for people with dementia: while ‘person-centred care’ focuses on the patient and the care received and ‘learner-centred education’ focuses on education and the learner, Dynamic Dementia Care combines the two and adds in practice reflection as an integral component. This creates an ‘educational workforce’, which continuously and consciously deploys a theory-to-practice-to-theory model, with a heavy emphasis on experiential learning methods. In short: clinical care is informed by delivering education and receiving it (from ourselves to ourselves and from learners to ourselves), and our learning is informed by our clinical practice, as is our teaching (see Figure 16.2).



Figure 16.2 Dynamic Dementia Practice

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The term ‘dynamic’ expresses the idea that through this continuous loop all components are constantly subject to reflective scrutiny, influence each other and therefore benefit from informed and reciprocal improvement, with learning and teaching being embedded in the whole practice model.


The NDCA has two core components: a dedicated Dementia Training Team (DTT) and a Practice Development Team (PDT).



The dementia training team


The DTT provides a range of educational opportunities developing skills and confidence in care workers and deploys a range of learning styles to ensure an effective learning experience, but it places an emphasis on experiential and reflective learning. Learning opportunities are designed to be accessible and relevant to new and novice members of care services and teams, right through to more experienced and advanced practitioners. To illustrate the DTT’s usage of various methodologies, it offers among other educational opportunities a ‘Searching for Connections’ workshop in which participants aim to understand the need for meaningful occupation, exploring a range of approaches, such as memory boxes, short interventions, the use of objects to engage with, supporting mealtimes and specific cognitive stimulation therapy. Participants put the learning material into practice with a person with dementia they already are involved with and are taught to match activities to the abilities of the person with dementia. They are then required to reflect and record their application of the learned strategies in the clinical interaction and share this with fellow participants.


The team furthermore offers opportunities for learners to have experiences alongside more expert practitioners, such as shadowing colleagues, engaging in supported care giving, co-facilitating a Cognitive Stimulation Therapy group or participate in dementia care mapping (a few team members are accredited Dementia Care Mappers3).


It can be seen that the Academy’s educational philosophy is heavily influenced by the need to judge progression in competency through measuring improved outcomes for the person with dementia and their carer, not just through easy-to-measure training inputs, and there exist a number of tools to measure outcomes, with one of the easier to use being the Quality of Interactions Schedule (QUIS). This observational tool codes the quality and number of social interactions between individuals and care staff [14]. An example of measuring training inputs is the so-called sheep dip approach to learning: many organisations assume that sending their staff on short courses will result in increase in competencies and better performance. As educators we strongly doubt the efficacy of that approach, and for a more detailed critique we refer to a thoughtful analysis from the world of ‘human resources’ [15].


The NDCA emphasises the importance of experiential learning as a process of making meaning from direct experience and reflecting-while-doing. Such a depth of learning offers confidence that learners will rationalise and apply their learning, again having a positive effect on the outcome of improved care provision [16]. The NDCA adopts the three learning strategies, which Stern et al. described as being essential to effective practice and skills development [17]:



1. Opportunities to gain perspective in the lives of patients through the use of, for instance, Dementia Care Mapping and other tools, ensuring people with dementia are included in the learning events. Such learning experiences seem to have the greatest impact on care workers [18].

2. Structured reflection on these experiences by self-reflection, guided reflection within workshops, facilitated group reflection and formalised practice reflection within other learning opportunities.

3. Focused mentoring: each learner is given the opportunity to access support from an allocated ‘practice supervisor’. This helps in replicating structures of support in their working environment, such as supervision and mentoring, and these are important to sustain and develop learning.

In developing these unique opportunities for learners to engage with experiential learning situations we heavily lean on expert practitioners to engage as educators: by supporting our own practitioners continually to engage with their learning and reflect upon both learning and practice, their expertise is readily incorporated into their care work and can be meaningfully transferred to others. But it is of course not always easy to extract staff from the busy world of clinical care, so the Academy has initiated the PDT through which it aims to build capacity.



The practice development team


The PDT consists of practitioners from various parts of the specialist dementia service, who are ‘seconded’ part-time to the Academy: it meets regularly with facilitation from a clinical psychologist. The agenda is set by the participants themselves and sessions are confidential. Any topic can be brought to the table by any member of the team, but the essence of the exercise is to discuss and debate matters of clinical interest. It can be seen that the activity of this team is closely intertwined with the educational ethos of the Academy, and it aims to inform in a two-way interaction its overall activity.


One important and recurring theme is the distress many people with dementia and their carers experience. It is recognised that carers who need to respond to this are themselves often ‘irradiated by distress’ [19], a phenomenon which some experts explain through the use of the psychoanalytic defense mechanism of ‘projection’: the person in distress, who may well have problems in communicating their feelings and because of their illness are less able to think their emotions through or deal with them by talking about them as they might have done otherwise, projects the unwanted unpleasant feeling out into others. In care settings this will usually mean care staff, while at home the person’s family members and friends may find themselves feeling distressed and helpless. Often staff (or family members and other informal carers) do not quite understand the reasons why and in professional care settings this contributes to staff not functioning well and suffering burnout. Understanding of all of this can help prevent stress and sickness, and it is through practice development exercises that these phenomena can be brought into focus, discussed and understood. It is clear that here lies a wider task for the PDT: to construct a method in which it can assist and support informal and formal carers alike. With respect to the former, attempts are being made to establish peer support networks, hosted by the NDCA: groups of carers who have been previously involved in Cognitive Stimulation Therapy (which is routinely provided by NDCA throughout its catchment area) are invited to continue to meet up, and it is hoped this will grow into a larger network of ‘alumni’ and ‘peer supporters’.


Staff and informal carers are called upon to ‘contain’ the distress and agitation people with dementia experience, and Bion’s concept of ‘containment’ can be helpful in dementia care: people with dementia who are agitated and distressed need containment of those emotions by the care staff, who in turn need containing by their colleagues, their management and their employing organisations. These concepts, and others, can greatly enrich care of patients with dementia, and they therefore feature in the regular proceedings of the PDT.




Compassion


Exploration of the more intense emotions occurring in dementia care leads us to the topic which in many reports on the quality of care provided in certain dementia services features all too prominently as an issue: compassion or the lack thereof. It has close links to the discussion on the culture in organisations (see above) but is difficult to use in a competency framework, a personal learning plan or a workforce development strategy: it is intangible, but everyone knows when it is absent and it has recently been identified as a major area of concern in the Care and Compassion Report by the UK’s Health Services Ombudsman [20]. It can be recognised in many competencies in the NSDA Competency Framework (see Appendix) but is not defined as a competency in its own right: it is a value and a human trait which weaves itself through everything else. Compassion has been viewed by some people as a passive feeling, but Archbishop Desmond Tutu stated [21]:



‘Compassion is not just feeling with someone, but seeking to change the situation. Frequently people think compassion and love are merely sentimental. No! They are very demanding. If you are going to be compassionate, be prepared for action!’


There are views that compassion has somehow been washed out of health care. One Maori website in New Zealand expressed the following opinion:



‘The Maori name “Waiatawhai” can roughly be translated as “healing waters of compassion”. It’s our belief that all health practitioners enter their profession with a genuine desire to provide caring and compassionate service to patients and families. Unfortunately, the evolution of our health professions and institutions has seriously limited the expression of that humanity and compassion. Clinical detachment and objectivity are emphasised over and above compassionate caring. Our hospitals are overcrowded and under stress. Resources are limited. There doesn’t seem to be time to care’.

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Sep 8, 2016 | Posted by in GERIATRICS | Comments Off on Workforce planning and development

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