Post on 28-Jun-2020
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Welcome“It’s all about You”
Provincial Long Term & Continuing Care Conference
May 14, 2019
Charleen Phelps, R.N. Teepa Snow, Positive
Approach, LLC
Be a Detective
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The world is full of obvious things which nobody by any chance ever
observes. Arthur Conan Doyle
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The Basics for Success
Be a Detective NOT a Judge
Look, Listen, Offer, Think…
Use Your Approach as a Screening Tool
Sequence for CUES – Visual Verbal Touch
Match your help to remaining abilities
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How we Take in Information
1. What you see
2. What you hear
3. What you feel/ touch
4. What you smell
5. What you taste
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How We Give Information
Visual – How we look
Verbal – What we say
Touch - What we do
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The person’s brain is dying
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Four Truths About Dementia
1. At least 2 parts of the brain are dying
2. It is chronic and can’t be fixed3. It is progressive and will get worse4. It is terminal
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only with permission
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Tab 1
Page 6
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Normal Brain Brain with Alzheimers
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When my brain makes mistakes;
I make mistakes!
• Learning, memory, way finding
• Visual regard
• Language (lost/retained)
• Sensory motor
• Executive Control
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GEMS®: A Positive FrameworkSapphires: True Blue - Healthy Brain - Slower but
Fine
Diamonds: Clear/Sharp – Routines and Routines Rule – Change is Hard – Cutting
Emeralds: On the Go with Purpose – Naturally Flawed – Time Travel
Ambers: Caught In a Moment of Time – Caution Required – All About Sensations
Rubies: Deep and Strong – Others Stop Seeing What is Possible – Stop and Go – Big Motions or Still
Pearls: Hidden in a Shell – Immobile - Beautiful Moments to Behold
Tab 1
Page 13
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Dynamic Assessment
Visual regard
Ability to speak and understand
Skill in movement
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Top Five Human Needs and Emotional Indicators of Distress
• Five Human Needs
IntakeHydration, nourishment,
meds
Energy Flowtired or revved up
directed inward or outward
OutputUrine, feces, sweat, saliva,
tears
Comfort4 Fs and 4 Ss
Pain-Free!!!Physical, emotional, spiritual
• Five Expressions of Emotional Distress
Angryirritated – angry – furious
Saddissatisfied – sad – hopeless
Lonelysolitary – lonely –
abandoned/trapped
Scaredanxious – scared – terrified
Lacking Purposedisengaged – bored – useless
Tab 1
Page 24
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Environmental Preferences:
Four F’s for you to keep in mind:
•What features of an environment provide you a sense of:• Friendliness: I am liked here, I am wanted here
• Familiarity: I am comfortable and at ease in this place
• Functionality: I know what I am to do here
• Forgiveness: I can make mistakes and errors and it will be OK
Four S’s for you to keep in mind:
•What features matter for you, what do you like and dislike:• Spaces (intimate, personal, public)
• Sensations (sights, sounds, feels, smells, tastes)
• Surfaces (sit, stand, work on, rest on, walk on)
• Social (groups, activities, roles, expectations)
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Circadian Rhythms:Natural 24-Hour Cycle
•What is your natural rhythm?• Early bird, night owl (predator/prey), deer
• What happens if you are off schedule?
• How do you recharge - rest and restore? • What options do you use and prefer?
• What is the best frequency, intensity, duration for them?
• How do you know when you are great/good/low/out of gas?
• How and when do you like to be productive?
• How and when do you like to play – have fun?
• How and when do you like to take care of yourself?
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Amygdalae:
Dangerous Need
Risky Want
Dislike Alert/Aware Like
Tab 1
Page 10
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Dangerous
Risky
Annoying
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Amygdala – Emotional StatesAlert
Low – Amygdala ActiveAlert
Medium – Amygdala Stressedat Risk
High – Amygdala in ControlEndangered
IrritatedBothered
AngryFrustrated
FuriousEnraged
Dissatisfied Blue
SadUnhappy
DevastatedHopeless
Missing some______Missing freedom/control
Lonely – DisconnectedConfined/restricted
Abandoned – IsolatedImprisoned
NervousAnxious
ScaredWorried
TerrifiedPanicked
DisengagedAntsy
Bored Roaming
Useless –PurposelessFrantic
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Amygdala Emotional States -Pleasure
Low – Amygdala ActiveLiking It
Medium – Amygdala StressedWanting to Do More
High – Amygdala in ControlNeed Something
Excited Hyped Up Hysterical
Happy Boisterous Slap Happy or Delirious
Connected or In Control Can’t seem to get “it” Controlling or Clingy
Energized Rev’ed Racing Around
Full of Purpose Committed Demanding Others Get Purpose
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Six Pieces of the Puzzle
Brain
ChangesThe Environment
The
Person
The
Stakeholders
Wellness, Health, and Fitness Time
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Six Pieces of the Puzzle
Brain ChangesDementia, Delirium, or Depression?
Dementia
• Type(s) Alz, FTD, VaD, LBD, usually more than one
• PLwD’s awareness of their brain change
• Fully aware, somewhat aware, unaware, aware but covering
Note GEMS® level(s)
• Changed abilities and retained abilities
• Variability – time of day, situation
• Onset and duration
The EnvironmentFour Fs and Four Ss
Four Fs – is the area…
• Friendly – are there people she knows?
• Familiar – does she know the area?
• Functional – is she able to do what is needed?
• Forgiving – is she allowed to make mistakes?
Four Sx – how will he/she interpret…
• Space – Intimate, personal, public
• Sensations – See, hear, feel, smell, taste
• Surfaces – Sit, stand, lie down, work
• Social – People, activity, role, expecations
The PersonPast and Present
Life Story
• Where did he live when younger?
• What did, or does, he do for a living?
• What hobbies or activities does he enjoy?
Personality Traits
• Personal preferences – likes and dislikes
• Key values in life
Roles
• Does he prefer to watch, talk, or do?
StakeholdersCare Partners and Others
• Personal history with the person – Background
• Awareness – What do they know about the person’s health?
• Knowledge – What do they know about dementia?
• Skills – Do they have the skills to work with a PLwD?
• Competency – Can they put the PLwD first in everything they do?
• Relationship – Personal, professional, family, other
• Agenda – Why is the person here?
Wellness, Health, and FitnessHealth Conditions and Physical Fitness
• Fuel and Fluids
• Medications and Supplements
• Emotional and Psychological Condition
• Sensory Systems Function
• Health Beliefs of Note
• Recent Changes – i.e. Acute Illness
TimeCare Partners and Others
• Where in life is the person?
• What time of day is it?
• How long has passed for the person?
Four Categories of Time
• Productive – gives value
• Leisure – fun, playful
• Wellness and Self-Care – brain and body
• Restorative – calm, recharge
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Can you complete the puzzle?
1. What is the challenging behavior?
2. What do you know?
3. What don’t you know?
4. What is the unmet need or trigger?
5. What do you want to try?
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CONSIDER
• Pace• Visual Cues• Verbal Cues• Physical Cues
Tab 1
Page 16
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A Dynamic AssessmentTool for a Shared Relationship
Use the
Positive Physical Approach™
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Positive Physical Approach™* (PPA™)*
• Stop moving at 6 feet out
• Greet: hold your open hand still next to your face, say their
name
• Offer hand in a handshake position
• With their acceptance, slowly come in from the front within
visual range
• Move into supportive stance, turn shoulders
• From the handshake, move into Hand-under-Hand®
• Get low: sit, kneel, or stand at or below their level
• Make a connection: PPC, then wait for their response
• Deliver a message: use V-V-T Cues and a PAS
* = if in public space and you start the interaction
Tab 1
Page 18
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Hand-under-Hand®:
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TEN WAYS TO DE-ESCALATE
1. Create Space
2. Remove the Threat
3. Be on his or her side
4. Get at or below eye level
5. Use hand under hand
6. Breathe in Sync
7. Calm voice
8. Relax Body
9. Attend to needs
10. Be willing to go where he/she is
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THANK YOU!
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