Person Centre Care

For a long time I have felt guilty when I talk to people that the disease is not the most important thing to deal with, it is how we are going to help the person with the condition; whatever it is. The disease is secondary.

I am pleased to say now that others think along these lines too.

Yesterday I went to a talk given by Graham Stokes a renowned pyschologist from the UK on the care of people with dementia. Here he said that "Person Centred care is not about the dementia but about the person with dDementia".

If you are struggling with writing care plans that are relevant, just think of this. If you had dementia and were unable to take care of your every need, what would be the most important things for you to be able to live your life?

It is times like this an RN has to put their clinical knowledge behind them. Yes it is important as the reason care is required but it is of much less importance for the person who is requiring care and their familiy.

Focus on the care the person requires that keeps them healthy and maintains their dignity. That is delivered to their values and what is important to them. Understand the behaviour displayed always has a reason. ALWAYS! Without exception.

Understanding these simple principles will help you provide person centres care.

Why do audits create so much anxiety?

I went to a very inspiring workshop on Saturday. It was about why we get unwell from a mystics point of view. Now I know you may think I am a bit off the wall here, but just bear with me on this.

Anxiety comes from fear. Fear of what may happen to us. However, this all has little foundation for the reality is WHAT WOULD REALLY HAPPEN IF YOU DIDNT GET A PERFECT AUDIT? An if we let this fear control us, we become unwell. Simple really but very difficult to put into practice. Fear of being wrong or doing things wrong are embedded in our history. This is what cripples us. When you look at the whole scenario what is the likely result?

Reality - Not very much. You would be given an opportunity to relook at areas that could be improved. You won't lose your job, the facility is unlikely to be closed down (unless it is really bad) and you have an opportunity to do better next time. Not that bad eh?

Yet so many people become extremely anxious when an audit is coming up. Some people don't sleep. Some people work extremely long hours in the hope they will get everything perfect and then are devastate when they don't. Some even crash after the audit.

Reality - unlikely you will not be perfect as each auditor will view the facility differently and have a different interpretation and expectations of you an your facility. Many don't even have a residential care back ground and only see it as an acute setting environment and not a person's home. Two different philosophies.

So how do you overcome anxiety prior to an audit?

1. Understand what is going to be required by the auditor
2. Be prepared to provide the auditor with sound argument as to why you provide care in a particular way and explain your reasoning
3. Learn ways to manage your stress so it doesn't control you (You may like to come to the Stress Management Workshop on 3rd November http://www.careadvisoryservices.co.nz/clinicalupdates/resilience-performance.htm)
4. EMPOWER yourself with knowledge through workshops, discussion from others and learn what to do to reduce your stress.

This Wednesday, 1st September, there is a workshop on this that will help EMPOWER you. You will get this from both the trainer, Jessica Buddendijk, and the other attendees.

The more you know, the more empowered you are, the more confident you are to see the audit as just another day in your life as a manager.

Dont miss out on this opportunity. go to http://www.careadvisoryservices.co.nz/clinicalupdates/audit-anxiety%20.htm

You won't regret it.

Inspiration of the day

If you woke up this morning with more health than illness, you are more blessed than the million who will not survive this week.

If you have never experienced the danger of battle, the loneliness of imprisonment, the agony of torture, the pangs of starvation, you are ahead of 500 MILLION people in the world!

If you have food in the fridge, clothes on your back, a roof overhead and a place to sleep, you are richer than 75% of this world!

If you have money in the bank, in your wallet and spare change in a dish some place, you are in fact among the top 8% of the worlds wealthy!

If you can read this message, you just received double the blessing in that someone is thinking of YOU, and furthermore you are more blessed than over two BILLION people in the world who cannot read at all!

Person Centred Care

There are many overseas model working in New Zealand. We have Spark of Life (Australia), Person Centred Care (USA) and Liverpoole Pathway (UK) yet we have our own model that was developed in 1840. Yes that is right, the Treaty of Waitangi.

What it stated, briefly, is that Maori health would have dominion over their own health in the form of Partnership, Participation & Protection.

Is this not what we all should be doing in health care? Is it not indeep what you want for yourself in health?

We are suppose to be in partnership with a person. That to me means discuss, inform, advise, recommend, listen, source help in fact anything that is needed to keep a person well through this partnership. It should not be power and control, "I" prescribe the care, you follow the instructions. It is to discuss what will work for them. It means to look at the person and take every aspect of the person into account. Their lifestyle, support network, finance, comprehension and cultural background into account.

For all of this to occur, a partnership has to be developed with the person or their family. Without a willing partner in health, a positve outcome will never occur. The most important ingredient in this partnership is trust. If a person does not trust the health professional and believe what is being discussed is best option for them then the partnership fails and illness prevails.

A health professional is an advocate for people in requiring care. We are there to protect them from harm or ill effects; to speak up for them if they are unable to speak for themselves; to fight their battles if they cannot do it themselves. None of this can be achieved unless there is a sound partnership and willing participants.

So why do we have to import all these systems and models when the simplicity of the Treaty of Waitangi principles of 1840 apply?

If you are not applying these principles and adhereing to them when dealing with a person then you are letting your clients down.

Registered Nurse Role

Increasingly I am having discussions with facilities who are experiencing difficulties with Registered Nurses understanding their role.

The problems they are finding are an inability to supervise, delegate and in interpersonal relationships. It appears RN's do not understand how important it is for them to supervise caregivers and not just leave them to do their work. There is little or no follow-up.

RN's have to realise that Caregivers do not have the body of knowledge registered nurses have. They require supervison. If an RN is delegating a task they have to make sure the caregiver is actually competent to do it. Delegation by Abdication never works. You will just get more unsatisfactory care and increase RN and Managment frustration.

On top of this there a variety of cultures working in the industy. They come from a variety of value systems that are vastly different to ours and our clients. This needs to be understood and taken into consideration. So to address this, I have put a workshop together to help RN's with these tasks.

What RN's don't realise that there Practicing Certificate is at risk here. All caregiver work under RN's supervision. Are you and your Practicing Certificate safe?

For more information on this contact leigh@clinicalupdate.co.nz

How did the name Pakeha come about

The meaning of Pakeha appears to have changed over time. Prior to 1815 it meant "white person" who came from England to settle in New Zealand. Then was applied to any fair skinned person born in New Zealand. Later it was applied to all fair skinned people in New Zealand.

However Dr Michael King in 1985 defined Pakeha as any "non-Maori" person.

More recently Ross Himona says linguistically Pakeha means a New Zealander of non-Maori or non-Polynesian decent.

This to me make sense. I am happy to be called a Pakeha. It defines who I am. A non-Maori ihabitant of New Zealand.

So what have I learned? As we are all boat people i.e. we inhabitated New Zealand from another land, the Maori were the first to settle and the Pakeha the second to arrive, mainly from Great Brittan. We are a country that has relative harmony between the cultures, that live together to create what we have today. Everyone has contributed to New Zealands very existance.

I give thanks to Jodi Ranford who explored this topic and has written a wonderful artical titled Pakeha, Its origin and meaning. It can be read at http://maorinews.com/writings/papers/other/pakeha.htm
It is well worth a read.

Did you know before European settlers Maori did not have a name for themselves

In the process of research for a new e-book I am compiling to help people understand people, and I am starting with Pakeha', the Maori did not have a name for themselves only a number of tribal names.

According to Dr Michael King, noted New Zealand Historian "Maori relates closely to 'tangata whenua': people of the land: but with connotations of 'those who were here first' and 'host people'.

However the Maori people themselves do not refer to themselves as Maori. They refer to their tribal membership say Maori kaumatua Ross Himona. They are Maori only in relation to Pakeha. Maori means "normal" i.e. in relation to Pakeha. quotes from Pakeha, Its origin and meaning by Jodi Ranford.

Interesting isnt it?

Health Benefits of Vitamin C

The use of supplements in a diet has been hotly debated for years. It is pleasing to note that now their is evidence to support the health benefits of Vitamin C.

According to a Dunedin based research people with tumours have "low levels of Vitamin C present and high levels of a protein which allows the tumour to thrive in conditions of stress". to read more go to http://tvnz.co.nz/health-news/vitamin-c-may-have-benefits-in-cancer-treatment-3654381

So is there a connection between stress and cancer? Maybe.

Where I sit on this is for years I have beleived that our body speaks our mind. Whatever our body is displaying there is a reason. If you find that reason, then you can fix the problem. Sounds simple. Well not really.

More and more scientists are linking disease to stress i.e. Heart Disease is well known for one. Could it just play a bigger part in our lives than we realise? Could managing stress levels be the key to good health?

Living a balanced life is certainly helpful. But do people know what a balanced life is? This creates more questions than answers doesnt it.

I personally believe we are responsible for our own health. If taking supplements is part of your daily health regime, then that is great. However it does not elimnate the need for a good diet, exercise, rest and relaxation. It also means managing your thoughts and emotions. The chatter box that is continually running inside our heads can be as big a cause of disease as anything else.

Stress is much more complex that we realise. It is a part of our everyday life. If it controls you rather than you controlling it, then disease will result in some form. If this is you, you may like to look at the Maintaining Resilience Workshop in November.

I believe the key to a long and healthy life is knowing and understanding yourself, living by your values and taking full responsibility for everything in your life. It is never too late to start.

How well is your team functioning

Yesterday I did a training session for an organisation where a senior staff member was struggling to get all the systems in place and get the team on board.

As is often the case when a new person comes into a position, they pick up all the anomalies. This can be very threatening to the rest of the team as it feels like more being added to their already heavy workload.

Another issues is it depends on what country the RN has done the training in or era the person trained in. These all add to an interesting mix in the team.

On top of this there are also caregivers from many cultures working in the facility. Oten they see time being an issue and do not fully understand what their role entails. it is not just to care for the resident it is to observe what is happening to the resident and report it to the RN but they need to know what to report and why. If they dont know what to look for, why would they report it. A resident is giving a whole heap of clues before they become unwell. It is the caregivers that see this. They now need to know the importance of these observations for a RN to make a clinical decision.

So the whole issue comes down to communication and training.

I know it is yet another issue to deal with in an already very heavy work schedule however if you want to reduce your work load and create more time in your day communication and education are essential.

If you are struggling with similar issues why not run a facilitated session with me. I have no history with your organisation that hinders my ability to see and seek clarity. We create a safe place for everyone to discuss the issues and create solutions. It may just be the way for you to create more time in your day. I could just be a great investment.

Rest Homes Caregivers under fire again

It beats me how the sick in mind manage to find their way to look after the frail and infirm. What is happening to our society? How is it that people go into a line of work with the expressed aim to abuse those in their care for their own gratification. They pray on those who can't fight back but the thing is they do fight back. They display behaviours that is saying something is wrong.

I know the number of people abused is small but it should never happen at all. Every person has a right to life and the right to be cared for with dignity and respect. When cases hit the news media, I become really angry. Many people are out promoting the good work that aged care facilities do and along comes some bad apples the spoil the whole crop!!

How can we prevent this from happening?

Fact is it is almost impossible. A Police check is done on each person (or should be done) but these take forever to come back. Meanwhile a person with a history of abuse has been employed. What else can an employer do? Often these people present very well. They are smart predators and know just what to say.

For me, I just feel really sad that people have so little regard for others that they can even think to cause harm to others.

Did you know?

That laughter produces 167 chemicals! These are antioxidants that keep us healthy.

Laughter increases the number of antibody-producing cells and enhances the effectiveness of T cells i.e. creates a healthy immune system.

Promotes physical and emotional release

A good belly laughs gives is a great body workout

Acts as a distraction from stress - removes the focus away from the problem.

Is a great for socialisation. It connects us with others and elevates our mood.

How long do you spend laughing in your day.

All of this promotes healthy outlook on life, and is known to reduce heart disease and other stress related conditions.

Children do it effortlessly. They laugh at what appears to us to be nothing. Adults appear to have to have a reason.

OR DO WE?

Or is it something we have developed in our process of "growing up.

Or is this what is helping us to grow old?

How often have you laughed today?

Training to care for a Pakeha

Yesterday I did a full days training for an Agency. Of those that attended there wasn't one Pakeha person there. This is not unusual nor is it a criticism. It is just a fact of life.

However, I asked them how much they new about Pakeha's and they looked at me blankley?

We can't blame them for not knowing about Pakeha's. We haven't told them who we are. It is impossible for them to know unless we tell them. Pakeha's, on the whole are not that good at saying what they want to a person's face. It is likely they will ask for very little then complain when they don't get what they want.

Pakeha's need to stand up for themselves. Tell people who you are. Then they will get the care you want.

Psychoneuroimmunology - have your heard of this?

Psychoneuroimmunology is the science relating to the effects the brain has over the immune system.

Now I have long known this. It is not based on empiracle research. It is based on observations of people.

In 1986 I noticed the relationship between stress and colds/flu. It occured to me that people who looked after someone with dementia usually ended up sick in bed when they were given a rest i.e. the person with dementia was admitted for respite care. The first week was forced rest, the second week was recovery and then the person went home again and the cycle continued.

However I did notice that the carer was never able to continuing careing much after this. Their body could not reach the same level of functioning.

You see, for any disease or illness to occur there has to be a host. This host has to create the right environment for it to thrive.

Now scientists are validating this. Interesting mmmmmmmmm

How do we get the care we need?

It is a very different environment in New Zealand today. No longer a we a monoculure or a bi-cultural society for that matter. We are a multi-cultural society.

But let us not forget our own roots. Lets not forget that in this society there is such a thing as a Pakeha culture. We do have the right to be care for as a Pakeha. No matter how we look at it, Pakeha still make a the majority of New Zelanders and are being cared for by a multi-cultural workforce. Pakeha need to tell the carers what they want not let them give them what they think you want.

Now I am not intending to start a riot here. I think we are very blessed to have such rich diversity in NZ. What I am saying, let us not forget that Pakeha has a unique culture of its own and needs to be recognised to. While Pakeha now are good at recognising and embracing other cultures. Do the other cultures recognise and embrace us in the same way.

We must stop medicalising residents in residential care

It seems as though becoming frail and old is now no longer a natural process. We used to be able to have the comfort knowing that if we ever needed this care, we would be could go into a home like environment where we could live out our life in peace and tranquility.

This is no longer the case.

We have to have a medical condition and be medicalised rather than the fact we just need help with our daily living.

There is a huge push to keep people in their own homes where they are cared for in their own surroundings – their home. For some people this is not an option. They have to go into care for a variety of reasons i.e. increased falls, increased memory loss, inability to safely take care of themselves, absence of family members to fulfill the roll or some other very valid reason. Not all of these have a medical condition attached to them. It is as simple as that. The only thing that has changed is their living environment.

Why do we do this to our elderly or disabled people? Surely residential care is precisely that – a place to live where we get help with our daily needs.

We were not meant to live alone, we are after all social animals, and surely we have the right to a home not a “medicalised model of health”.

Think about it. If you get to a point where you are no longer able to take care of yourself, do you really want to live in a hospital? That is what we are in danger of creating if we don’t stand up and say what we want.

People in residential care rarely become sick in fact they are more likely to require less medical intervention once the stress and loneliness of isolation is removed. They are just not able to care for themselves.

A plea to auditors – please don’t make these facilities into hospitals. Think of them as a home where people live 24/7 and look at what is working well for the residents in a home not what you would expect to find in a hospital.

Migrant workforce

Apparently 50% of the doctors looking after us in New Zealand are migrants. I would say it is as high if not higher across the whole health care industry.

My concern is not that they are migrants but how much training do they receive to understand the Kiwi Culture. I am sure they do Treaty Workshops but does that really equip them to look after the emotional needs of New Zealanders?

I have absolutely no doubt as to their technical/clinical skills. I do have concern about communication skills. People who are unwell often feel powerless. They do not have the knowledge or the energy to request information. Combine that with values & beliefs differentation you get people's needs not being met. This is where the focus now needs to be.

Care Creed

Have you asked me today?
Have you acknowlededge me today?
Have you understood me today?
Have you loved me today?
Or am I just another TASK in your day?

How big a part in our everyday work does trust play?

I would say it is our job to creat a high trust environment. We may have all the clinical knowledge in the world if we don't have trust from the people we serve it means nothing.

If you look at the so called "difficult people" in your work and/or life how much is it a trust issue.

Trust is an integral part of our pyschi. Violate that and it becomes very difficult to restore the relationship.

Children do not have a conscious mind till the age of 6 according to Bruce Liptor a biologist. So if a childs trust is violated prior to this age is it fair to say they will go through life with this issue? I think it is a pretty good chance.

However remember trust can be violated at any stage in our lives.

While we cannot do anything to fix people and their trust issues we can at the very least do what we can to work in such a way that they feel safe.

Are you giving safe care?

Speed of Trust

Yesterday i talked about how important trust was in intimacey. Fact is Trust is necessary for any relationship. Check ou Steven Coveys new book "Speed of Trust" Yu can read a review at http://www.bcwinstitute.com/Learningcenter/Press/speedoftrust.pdf

Companionship and Intimacy in Residential Care

Being able to share your life with someone is really important. Being intimate with someone is also important but intimacy does not have to include sex.

I think this is where people get confused with intimacy.

A caregiver, be it RN or caregiver, is being intimate with people every day. Residents or clients allow you to get up close and really personal with their personal care. Whether a person is comfortable with you doing this care or not is directly proportionate to the level of trust a person has in you, the caregiver. You cannot be intimate with anyone without trust.

Don't get confused around intimacy and sex. While they are integral in some relationships, intimacy and companionship is quite different. This is what you see in residential care.

Think about the people in your life that you share you inner most feelings with? Does it always involve sex? No it doesn't.

The people you gravitate towards are those you feel comfortable with and you have a high degree of trust with. If the trust in this relationship is violated, then the relationship breaks down and being intimate is no longer possible i.e. you will no longer share your thoughts, feelings and ideas with. This is what being intimate is all about.

Think about the people in your care. How do they share their lives with others in the facility? It doesnt involve sex but it does entail a sense of joy, wholeness and welbeing. This is intimacy and companionship.

Sunset Love

I dont like the title article in the NZ Herald on Sunday Supplement is actually quite good. On page 3 of the supplement I am quote as saying

We are meant to be iving with other people. We are not meant to be alone". I believe this to be true.

While many people do choose to live in their own home and want to till they die there are some people who know they cannot manage on their own any longer and would love some company.

If a person is frail and mobility a problem then living with other people can help. Living with only your own thoughts can make your unwell. What you focus on is what you get.

I have seen so many people who come in to a residential facility with multiple health and disability problems that often is a very short time don't meet the profile received. While the health problems still remain the happiness scale improves teir health outcomes and they become less of an issue.

If you want to find out how you rate on the happiness and health scale go to http://www.attitudefactor.com/ and do the simple test. I scored in the top 43% of people who will still be alive in 21 years. What is your score. Give it a go.