Consultant Dementia Nurses

Welcome to our blog!

We are Tracey Williamson and Amy Kerti the Health Board’s new Consultant Nurses for Dementia. We will regularly share our thoughts and experiences here in our blog and we hope that you will be interested if you or someone you know, or care for personally or professionally is living with dementia. If there is something you would like us to cover please do get in touch with us, we would also welcome anyone to get involved as one of our guest bloggers.

Contact us by email BCU.DementiaNurseConsultants@wales.nhs.uk or get involved by tweeting us @dementia_nurses

18/07/2022

This month’s blog introduces Diane Sweeney, Dementia Activities Support Worker from Mold Community Hospital who has recorded a video about her role and recent success gaining a community award.

Diane’s role is to support colleagues and patients with meaningful activities that occupy patients but also have a degree of therapeutic benefit such as keeping patients’ minds active and stimulated and helping them keep socially connected. The Pandemic added challenges to the role but Diane ably responded by devising Memory Books as a tool to engage families and undertaking one-to-one activities instead of with small groups. Diane also engaged with local school Bryn Gwalia and its new head teacher to find ways of enabling interaction with patients to help them through the pandemic. One intergenerational activity was to use the video-conferencing platform ‘Zoom’ to enjoy singing Christmas carols. Another involved the children walking with lanterns to the hospital to sing outside and wave their lights for patients. A few months later Diane and the team won a local community award from Mold Town Council for this inspiring work.

Diane also brought in young performers from Theatr Clwyd's who visited the community hospital to do a play for patients. Due to the Pandemic, content viewed was through the windows but activities included sharing baked items and playing games on the window panes.

We think you’ll agree this is an example of stunning work by one of many talented activity coordinators we have here at Betsi Cadwaladr University Health Board. The benefits to patients and families will have been significant. Hats off to Diane and her colleagues/partners for showing such compassion and creativity – just what we aspire to here at the Health Board!

23/06/2022

Currently, dementia training in BCUHB at Level 1 (Informed) is provided on ESR and is mandatory for all staff. We are hoping that on July 1st, subject to final approvals, we will have Level 2-3 dementia training (Skilled & Influencer) available through the Education Team pages and the Dementia pages on BetsiNet. The details will be cascaded as part of the training launch nearer the time.

Level 2 and 3 training has been largely absent due to the pandemic and so it is very exciting that we will have the Finding the Light in Dementia online training platform by Duetcare Ltd, available to up to 4000 staff, 24/7 and 365 days per year over the next two years.

The course is made up of 6 modules that need be studied in order and there is a pass mark of 80% for each module. The interface is much friendlier than ESR and enjoyable to use. It uses videos, podcasts, soundscapes and presentations and is not ‘heavy going’.

Modules include:

1. Understanding Dementia

2. Communicating & Connecting

3. Using Memories to Keep in Touch

4. Creating a Calm Safe Place

5. Understanding Moods, Emotions & Responses

6. I am Still Me!

Content is mapped to Skills for Care, The Good Work Framework, NHS Training Standards and National Occupational Standards. Staff can register to do the training in their own time but we are hoping it will mostly be part of formal learning agreed through staff development processes.

If we are to get all dementia care in the Health Board to be the best it can be, we will need to invest in this and other high quality dementia training for our workforce. We will also try to make sure that dementia training is integrated in other training and does not take place in a ‘bubble’. For example in Person Centred Care training we will embed examples dementia patient’s experience of care that sees them as ‘the person’ and not ‘the diagnosis’. In Falls Management & Prevention training, we will seek the importance of dementia-friendly environments to be included such as avoidance of shiny floors or a sudden change in floor colouring which can appear to be a step or a hole and therefore a trip hazard.

But don’t just take my word for it – here are a few words from the course provider, Dr Jane Mullins

Why Finding the Light in Dementia?

I expect you have noticed that many people you care for, have some degree of cognitive impairment or dementia. So what does this mean to you?

Well, cognition is all about how we understand the world around us through our thoughts, experiences and senses. When this is affected through illness and disease, it can lead to difficulties with how we sense the world around us, remember things, people and places, communicate our needs, make judgements and decisions. How frightening if we couldn’t do this!

Imagine being in an unfamiliar place, with strange sights and sounds, and strangers making decisions on your behalf? How scary is that? This is often a person’s experience of being in hospital when they have some degree of cognitive impairment or dementia. But we can work together and change this, in an enjoyable and creative way.

There are many myths around what dementia is and how it affects people - By listening to peoples stories in films and podcasts you are about to bust those myths and get to learn a heap of really important stuff about what dementia is, how a person may experience their world and what we can do to help. In return, you will gain much more confidence, enjoyment and satisfaction in your day to day working roles.

Full of entertaining animations, films and podcast, along with presentations, Finding the Light in Dementia does just that! Helps you to navigate through and help care for the person and for yourself. Also as a huge bonus, you will have access to a ‘wellbeing hub’ full of lovely films, soundscapes and podcasts to help you care for yourself too.

So come along and dive in, and enjoy the experience!

30/05/2022

On April 6th 2022, a new Dementia Friendly Hospital Charter for Wales was launched. The Charter is the latest in a set of publications aimed at driving up standards of dementia care across health and social care settings in Wales. The Charter contains 105 principles that hospitals should follow if they are to be dementia friendly.

Charter development was facilitated by Improvement Cymru which has a dedicated team and programme of work to enhance dementia care nationally. The Charter is mainly intended to complement existing All Wales Dementia Care pathway of Standards for Wales but it is also relevant to the Wales Action Plan for Dementia, NICE Dementia guidance and many of BCUHB’s own action plans/learning from complaints processes etc.

The full Charter is available here.

The Charter work is one of five dementia work streams required by Improvement Cymru. Other work streams are Engagement; Memory Assessment/Learning Disability/Mild Cognitive Impairment; Dementia Connectors; and Workforce Development/Measurement/Learning & Development.

The Charter is focused specifically on hospital care which makes it relevant to all disciplines of staff who contribute to a dementia patient’s journey and the experience that the patient and their family have when using our services. Of course that care is also delivered in partnership with a range of agencies. Our dementia patients’ hospital experience is affected by the wider context of what happens prior to hospital attendance/admission and during/after transition out of hospital. Therefore the Charter has implications for a range of partners and its implementation needs to be a collective and multi-agency approach. To be truly inclusive, implementation will involve people with lived experience of dementia, families and friends and reflect diversity in its widest sense.

Improvement Cymru have developed a ‘padlet’ (online repository) where resources from the Charter launch, the Charter documents and other resources are available. It includes a self-assessment tool for organisations to use to appraise their current position and a VIPS quality improvement platform for staff to use. VIPS stands for Values, Individual’s needs, Perspectives. The padlet can be accessed here.

During the national Charter launch last month, Gill Harris (Deputy CEO/Executive Director of Integrated Clinical Services) took part in the Q&A panel and Sophia Keene (Quality & Practice Development Nurse in MHLD), show-cased the excellent ‘Walking with Purpose’ dementia guidance work that she led.

Remember: Walking with purpose could be an expression of unmet needs

The Charter was developed with input from a range of BCUHB staff with dementia knowledge and expertise and will be a very useful tool. Whilst a large number of principles are included, these are very brief so careful interpretation will be needed to establish progress to-date, undertake gap analysis, and plan goals to be achieved which are in turn suitably resourced. Sustainability is key -there is no point having changes that don’t last. The Charter must not (will not) not become a tick list and this will require Board support and adequate investment alongside effective change management strategies. Whilst the Charter is comprehensive, it it does not cover everything that is important and some sections need extra attention such as family carer experience and diversity. The implementation of the Charter will be led by Professor Tracey Williamson, Consultant Nurse for Dementia who alongside Amy Kerti (also Consultant Nurse for Dementia) is part of a growing dementia team pan-BCUHB.

We hope to appoint a regionally-funded Charter Manager to coordinate its implementation across BCUHB.

The governance of dementia work in the Health Board is currently under review in terms of where the actions sit and where progress is reported to etc. This means that dementia will become firmly embedded in the new ‘operating model’ (way the Health Board is organised). The Charter implementation will require new groups/mechanisms to be set up to develop the shared vision for hospital dementia care and to effect its delivery. This work will be starting in a few weeks’ time but first we need do a baseline assessment of where we are with our dementia services, to then see what is needed. We also need look at what actions were completed before from past requirements and action plans to see if they have been continued. If not, we will pick up these issues too. Meanwhile you are encouraged to read a copy of the Charter and start conversations with colleagues and others about what it means for you and your areas. This year is regarded by Improvement Cymru as the ‘preparation phase’ for Charter implementation, so there is time to get these foundations right.

One requirement of the Charter is that the Health Board has an Executive Board member designated with responsibility for dementia care, which we think will be greatly beneficial. Their help will be invaluable when we present an ambitious Business Case for enhancing dementia care, including Charter delivery, to the Health Board later in the year. Dementia is everyone’s concern and patients who have dementia use all of our services across BCUHB. What we need is a transformation so fingers crossed that is exactly what will follow and the Charter will be an aid to achieving this.

For further information contact BCUHB Lead for The Dementia Friendly Hospital Charter for Wales 2022 – Tracey Williamson, Consultant Nurse for Dementia Tracey.Williamson@wales.nhs.uk

21/04/2022

Compassionate Dementia Care – Tracey Williamson

Recently I have invested in the Professor Michael West book on Compassionate Leadership. I believe I practised this approach pretty well over the years without realising, but the book has been a hugely useful read to help me understand how I can help strengthen compassionate leadership even further in myself and others. In March I also attended a conference run by HEIW that Prof West spoke at and this inspired me to do a blog focused on compassionate leadership in dementia care.

One of the things Prof West talked about was the importance of feeling safe and relationships/connections with people. Safety is so important to our patients thrown into our environments at all times of day and night, sometimes with little time or attention to managing the experience as our attention focuses on their condition/reason for admission or attendance etc. The word ‘attend’ is key to compassion too. See below compass:

We ‘attend‘ our patients and empathise and ’feel their pain’ by ‘standing in their shoes’ to better understand how they are feeling, and then we can respond with compassion. All too often in the business of caring, we don’t always value stopping and taking time to reflect. We are often judged by what we do that is visible and standing still and thinking/reflecting can be seen as dawdling. When did we last stop and think how a situation must be for a family member of a patient with dementia that they cannot visit? Did we really try and see the situation from their point of view? Their relationship with the patient, their own life (work/caring for others/health etc) and did we respond to the best of our ability to engage with them and identify and then meet their needs? Attending our dementia patients is so much more than popping them on a behaviour chart. Whilst these charts can be useful tools, they are only as good as the consideration we then give to such things, as what led to their distress and what things calmed them (supported with well-completed This is Me documents, and all-important conversations with family to better understand the person). In this way we can empathise and take steps to support them and reduce their distress.

Take a moment to consider this extract from Prof West’s book and relate it to patients, families and staff situations.

At times, dementia care especially can seem subject to action plans, measurement, reporting and scrutiny. Prof West says that regardless of what is on the Health Board’s website about values, leaders’ behaviour reveals what they truly value. Walking-the-walk is essential in dementia care. It is a field that requires considerable skill and understanding. Over the many years I have been in nursing I have often heard of nurses/bank nurses not wanting to work in an area which has patients with moderate to severe dementia. I firmly believe much of this is about not understanding what is going on with them on the occasions they do not ‘comply’ (to such things as attempts to give personal care) or become distressed. I have the same feeling about computers! I don’t understand them well so I avoid them, but I wouldn’t if I was helped to understand. So in dementia care it is important we ‘attend’ to staff needs and behaviours too so we can empathise and support them better. Patients with dementia may be distressed due to changes of environments, noise, hunger etc and similarly staff can feel distress from over-work, not being spoken to with kindness or simply by not feeling cared about. To drive up quality Prof West talks of team-based working and team appraisals. How good would it be to not simply have individual appraisals (PADR) but team appraisals where the dementia care we deliver as a team is considered?

There are some aspects of dementia care that we need to do even better but Prof West advises we take time to stop, reflect, review and learn together and empathise with what is going on before taking steps to address what we find. If we connect with ourselves and each other we will be more present and interact with others with compassion and courage, and better connect with those we care for and interact with. It starts with the courage for self-compassion. Are you with us?

Michael. A West 2021, Compassionate Leadership – Sustaining wisdom, humanity and presence in health and social care, The Swirling Leaf Press, UK.

10/02/2022

30/12/2021

29/10/2021

This is our fourth month as Consultant Nurses for Dementia, and in this month’s blog we are going to tell you about our activities on International Day of Older Persons which took place on October 1st 2021.

Firstly we held a webinar to share some insights from our work so far that has been informed by speaking to lots of staff and some students and observing patient and family care across our Health Board.

We shared how we had seen some excellent practice across the Board and how the Dementia Support Worker role was found to be hugely successful in ramping up dementia care standards and providing meaningful occupation to our patients. Some staff told us of their own plans to celebrate the International Day of Older Persons with trolleys decked with bunting, doilies and cake for afternoon tea, like this team here!

Lots of examples of person centred care were highlighted as well as the need to look at developing our nursing documentation to make it encourage person centred care. A specific nursing model is not currently followed and staff rely heavily on the very well completed ‘This is Me’ tools.

The Pandemic was found to get in the way of some staff education and the move to online training did not work for everyone. We outlined plans to refresh dementia training and then encourage its uptake once we have completed a ‘training needs analysis’ to accurately identify who has what needs. We will then look at external providers and in-house teams to deliver the training that is needed.

We spoke about building in evaluation to dementia initiatives so we can evidence what works for who and in what context. Importantly we’ll be looking at what works for the patient which sometimes can get lost in the busyness of delivering care. We’ll be encouraging staff to be reflective practitioners and stand in the shoes of patients and families and ask themselves “is this what they need right now”, “how can I be sure” and “could they prefer a different way”?

Finally we shared our programme of work which came under several general headings. As we both carve up our role responsibilities, we will let you know in a later blog what each of us is focusing on. Thanks to those who took part, especially the Dementia Support Worker who joined on their annual leave – you know who you are!

Also on International Day of Older Persons we braved holding a ‘Twitter chat’ that evening using our standard hashtag #BCUHBdementia which anyone can type into the search box on Twitter. Upon doing this all, of the tweets (when the sender remembers to include the hashtag) appear as a grouped conversation. We asked a series of questions to prompt discussion about participant’s priorities for dementia at BCUHB and their views on our plans. However, we hold our hands up to say we had a minimal engagement with the Twitter chat hour which was a bit of an experiment and so we have taken the learning from that!

We wanted to see if it was an approach people liked or would use but we found most comments came in after the Twitter chat had finished later that night or over the next day. So at least we got the feedback - just not as an hour-long conversation! We wouldn’t have known if we hadn’t tried so if there is a next time, we will promote the chat more widely and rope in some champions, trusted colleagues and maybe use some bribes to round participants up! As far as webinars are concerned, we hope to be supporting one about dementia helplines in a few weeks’ time so keep an eye on the BCUHB events bulletins etc.

So after reading this month’s blog, if you have anything about dementia to share widely, or quietly, with Amy and Tracey - however small or large - let us know. We love sharing the excellent person-centred care we are frequently seeing across BCUHB, do get in touch through twitter @dementia_nurses or email BCU.DementiaNurseConsultants@wales.nhs.uk

Thank you, Tracey & Amy

13/09/2021

In our third month as Consultant Nurses for Dementia, we thought we’d talk about our approach to staff engagement.

We’ve been busy visiting wards at the Wrexham Maelor Hospital and many of the Community Hospitals and we’ve been hugely impressed with some of the practices we’ve seen or been told about.

Much of what we want to do in this role is identify good practice that you do daily and we know exists, but all too often isn’t shared or shouted about. Some good ideas and initiatives get a lot of attention and it is good for us all when an individual or a team wins an award locally, regionally or nationally. Publicity is good for us as a Board. Somewhere along the innovation process, other colleagues supported that innovation to take place, whether it was covering the clinical area whilst the innovators led their project, or by sharing their thoughts about it, even if they weren’t directly involved and credited.

What we want to stress is that the small stuff matters and is equally as important. Lately we have heard about the use of photographs of actual meals to help patients make menu choices at Llandudno Community Hospital by a Dementia Support Worker. This Dementia Support Worker also used the ‘This is Me’ document to inform person-centred activities for example, a person’s love for exotic animals was supported by the television being moved to their bay so they could regularly view the National Geographic Channel. A member of staff told us that when a person with dementia in their care expresses frustration during personal care, their favourite songs are played so that the potential for stress is avoided and the event becomes fun.

Staff at Holywell Community Hospital removed the plastic beakers and replaced them with mugs made from a material that mimics ceramic with a dignified and concealed spout for those who struggle to drink from a cup. Also, the Activities Coordinator expertly adapted the activities room to facilitate a cosy, homely and fun feel.

We plan on helping you to find more ways to share good ideas through social media including our newly launched dedicated dementia twitter account (@dementia_nurses). We are continually identifying staff and others who would be willing to create a blog of their own with help (or give us the material to write it for them or be informally interviewed or video recorded). We are keen to be sent photos (with appropriate consent where needed) to use, and we are taking some as we go around the various sites of such things as ‘falls information boards’ like this one at Holywell Community Hospital.

Whilst sometimes we are required to formally review practice in our roles, this is always going to be in an appreciative way, that is looking for good practice first, not problems. Even when difficulties are found that need addressing, we truly believe staff are better helped to learn from mistakes or difficulties by being supported, valued and cared about. Happy supported staff are better able to give excellent patient care. Similarly, staff who are well informed and have regular contact with accessible leaders are more likely to recognise the value of good communication and support for patients and families. We are particularly keen to hear how this is done. Also if anyone makes use of technology in their care of patients with dementia or who have cognitive impairment, or their families, do get in touch. How often do we hear about good ideas and think to ourselves, ‘huh, we’ve been doing that here for years’?!

We are very enthusiastic about ’Compassionate Leadership’, even before it became a ‘thing’! We are loving the book on the subject by Michael A. West at the moment and we are pleased to see the principles of Compassionate Leadership in the Board’s Stronger Together work. We believe that drawing on these principles with staff we work with, as well as ‘walking the walk’ ourselves, will help embed them within the Board. Furthermore we want to look at other approaches such as ‘Shared Governance’ and ‘Person Centred Care’, (more on these in a later blog), which could be ideal vehicles to help staff develop and deliver the care they want to give, to the best of their ability.

In next month’s blog, we will be talking about International Day of Older Persons 2021 being held on October 1st. We will be holding a webinar that day at 4pm and a ‘Twitter chat’ at 7pm, so get in touch if you want joining details.

Thank you, Tracey & Amy

19/08/2021

Hello everyone!

Welcome to our new blog page where we will be sharing information and news about dementia at Betsi Cadwaladr University Health Board. We are Tracey Williamson and Amy Kerti, Consultant Nurses for Dementia and we came into post in July 2021. Our blogs will include us shouting about great practices we discover and that you tell us about, service improvements and innovations that further enhance the experience of our dementia patients and their families.

Here in our launch video and press release about our appointment.

Here is a photo of us both with Kirstie Dolphin, Communications Officer doing our filming!

If you are reading this you have already found our blog page but here is the link again to share with others!

We will also be having guest blogs so get in touch if you fancy writing one (support available) or have an idea for one you would like us to create. Or maybe you know someone who could write one for us on an interesting topic? Similarly with videos we plan on a series of monthly videos about interesting topics including guest presenters. There’s more! We also intend to hold some live events such as webinars, ‘twitter chats’ and good old face-to-face events eventually, when safe to do so!

Everyone is welcome to engage with us – all staff, community partners, families and patients, and members of the public who may be future users of our services.

So if you have anything about dementia to share widely, or quietly, with Amy and Tracey - however small or large, do get in touch through twitter @dementia_nurses or email.

Thank you, Tracey & Amy