South of Tyne & Wear Workforce Collaborative & Tyne & Wear Care Alliance

Certificate in Dementia Care Level 3 Continuous Professional Development Portfolio Incorporating

Written Questions Projects Reflective Diaries Name Establishment Date of Training

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Contents

Page Acknowledgements 2 Foreword

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Overview of Training Programme for Dementia Liaison and Co-ordination Champions

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Session aims and outcomes for 2-Day Dementia Programme

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Projects

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Questions

DEM 301 Understand the neurology of dementia

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Dem 304 Enable rights and choices of individuals with dementia whilst minimising risks.

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DEM 312 Understand and enable interaction and communication with individuals who have dementia. Level 3, credits 4

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DEM 313 Equality, diversity and inclusion in dementia care practice.

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Dem 302 Understand and meet the nutritional requirement of individuals with dementia.

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DEM 305 Understand the administration of medication to individuals with dementia using a person centred approach Level 3, credits 2

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Using a Model of Reflection

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Johns’ Model of Reflection Using the Post Training Impact Measurement Tool

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Appendix 1 - Post Training Impact Measurement Tool

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Appendix 2 - Certificates

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Acknowledgements

Moira Pinkney Manager Tyne and Wear Care Alliance On behalf of the Tyne and Wear Care Alliance and its members I’d like to thank all those whose contribution made this training package possible. By working in partnership, training has been developed and piloted with the aim of ensuring that frontline Health and Social Care staff have the necessary knowledge, skills and attitudes relating to working with people who have dementia to promote quality care and support. This training package has been developed with the help and encouragement of a number of partners and individuals. Thank you to: North East Regional Development of Skills Group Richard Scott: Senior Business and Contracts Manager Business Delivery Team Dr Wendy Kaiser: Strategic lead - Mental Health Model of Care, NHS South of Tyne & Wear. Sharon Champion: Clinical Lead Community Challenging Behaviour Function Older Persons CMHT South of Tyne and her team. Daniel Collerton: Consultant Clinical Psychologist, University of Newcastle upon Tyne Aspects of the training on working with behaviours which challenge are based upon ‘Challenging Behaviour and Dementia in Gateshead’ a guide to understanding, coping and responding, developed collaboratively by Gateshead Health NHS Foundation Trust; Northumberland, Tyne and Wear NHS Foundation Trust; Gateshead Council; Mental Health Concern; and the Gateshead branch of the Alzheimer's Society, amongst others Finally to the team at the Alliance, who continue to strive to support the independent care sector to develop their staff.

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Foreword

Dr Wendy Kaiser Strategic lead – Mental Health Model of Care South of Tyne NHS The National Dementia Strategy was launched in 2009 by the Department of Health in England. The strategy was based on extensive consultation with service users and carers about what was important to them when they were living with dementia. The strategy therefore sets out what we need to do to support people with dementia to live well throughout their journey. Many people living in residential and nursing care have some form of mental health need, such as dementia or depression, which affects their quality of life and their general health and wellbeing. The care provided by the staff working in care settings is key to living well with dementia. Staff are also very well placed to provide information and support to families of people living with dementia in care. By undertaking the Certificate in Dementia care, each Dementia Champion will be able to improve the quality of life of the people they are caring for, and their families. They will also be able to lead and support their colleagues in further improving the quality of care in their care setting. We hope you enjoy this programme and that it enhances your confidence when delivering dementia care. Your participation and feedback is essential. If you have any difficulties, compliments or comments please contact your Network Development Officer.

Copies of “Living well with dementia: A National Dementia Strategy” can be downloaded from http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_094058

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Overview of Training Programme for Dementia Liaison and Co-ordination Champions

The learning programme will ensure that the 6 Specific Behaviours required to support the delivery of the National Dementia Strategy are covered :- These behaviours are;

1. Communication 2. Early Diagnosis, Assessment and Care Planning 3. Maintaining Quality of Life through Co-ordination 4. Advanced Care Planning 5. Meeting Carers’ needs 6. Overarching values and knowledge

The programme incorporates the following elements

1. What is Dementia? 2. Common types of Dementia. 3. Signs and symptoms of Dementia. 4. How Dementia is diagnosed 5. What are the legal frameworks which apply to people with

dementia particularly around capacity and consent? 6. What is challenging behaviour? 7. What is a person centred approach to caring for someone

with dementia? 8. How Life History work can impact upon person centred care. 9. Medicines and challenging behaviour. 10. Nutritional need of a person with dementia. 11. The needs of the carers and families of the person with

dementia

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Session aims and outcomes for 2 Day Training Programme for Dementia Champions.

Day 1

Session aims; To provide the learner with an understanding of dementia, which enables them to empathise with the person and their family that they are caring for. To be aware of the legal frameworks which apply to people with dementia. To increase knowledge/understanding of challenging behaviour and the impacts of physical/mental and neurological conditions. To define dementia and to increase awareness of signs/symptoms To be aware that other factors maybe cause dementia-like symptoms, such as infections, medicines or pain. To promote person centred care, psycho-social and non-pharmacological interventions. To understand the importance of good nutrition for people with dementia care. To understand the effect of pain upon behaviour for people with dementia. Session outcomes - at the end of the session participants will be able To explain the impact of key legislation that relates to fulfilment of rights and choices and the minimising of harm for an individual with dementia. To identify behaviours which challenge us Understand the factors that can affect interactions and communication of individuals with dementia To understand the difference between delirium and dementia To appreciate that not all dementia-like behaviour is caused by dementia. To investigate reversible factors first. To understand person centred approaches to care To understand the importance of Life History work To discuss dignified care and the impact of the care environment on behaviour To describe ‘a good diet’ To understand the consequences of malnutrition To know how to assess for malnutrition (using MUST) To gain insight into the effects of pain on a person with dementia

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Day 2

Session aims

To develop an understanding of medicines and challenging behaviour To develop knowledge around antipsychotic medicines To understand the term dementia To be aware of common types of dementia To be able to describe a range of causes of dementia To gain an awareness of the key functions of different areas of the brain To develop skilful communication techniques for communicating with the person with dementia, their family and informal carers To develop an understanding of effective person centred care (e.g. Newcastle model) Session outcomes - at the end of the session participants will be able To identify anti-psychotic medications To describe side effects to these medicines To identify and discuss own limitations regarding the prescription and use of these therapies To define and describe dementia To identify some common types of dementia To explore own responsibilities in behaviour/symptom assessment To identify and discuss challenging behaviours/symptoms To describe the components of ‘person centred care’ To identify symptom management strategies within ‘person centred care’

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Introduction Project 1: “I am” Life History work

Gain consent to work with 2 people, who have dementia. Engage with them, at a pace that is comfortable to them over a 6 week period, gathering information and compiling a life history. Explain to these people and their families that you are taking a sincere interest in them and valuing their experiences to help enhance the care provided and to gain insight into how best to support them. Start your work with the sentence “I am (insert the person’s name)” Guidance notes Each person’s experience of dementia is unique, depending on a number of variable factors, which impact on how they cope with their condition. These factors include their Life History or Biography, Health, Personality, Neurological Impairment and Social Psychology. Start a Case study on 2 different people with dementia, begin by looking at the above points and thinking about how these impact on the person’s experience of dementia. Using the Newcastle model begin to document in-depth life histories for these people, talk to them and their families. Start to think about their family life, education and work experiences, achievements, disappointments, significant events, likes, dislikes, interests, hobbies, values and beliefs. Gather photos, meaningful items and use these to create a tool to tell the person’s life story (talk to them about how they can access this, some establishments have created wall displays, scrap book or memory boxes) Observe the emotions and memories evoked Week 6 Complete a reflective report on this project, compare and contrast (what is similar, what is different) the way the 2 people are affected by their conditions. Has this work changed their care package? How has this affected your views of the people you are caring for? Has this impacted upon the families of these people?

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Introduction Project 2: “Developing a Family and Carer Support

Resource Package”

Guidance notes: Dementia affects the whole family, and as the person’s memory fails, it’s the relatives and friends who are able to add substantial richness and depth to assessment and evaluation of the care your establishment delivers. Often families need help to continue relationships with the person. Supporting a loved one with dementia can be a frightening emotional time. Families will experience a range of feelings. The care team can play a crucial role in supporting loved ones, accepting and understanding the changes in their relative with dementia. For this project think about the information and support a family will need, discuss in your project how your establishment involves families in the care of the person with dementia. Over a 6 week period, think about improving the way your establishment interacts with families. Research support networks in your area, contact these and ask for information. Compile a resource package for families. Carers are educators. Think of some questions you have been asked by relatives, gather some fact sheets for the resource file. Write a reflection detailing what you have changed, the reaction from other staff, and the affect upon relatives.

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Introduction Project 3: “Challenging Behaviour”

There are a number of different models for regarding challenging behaviour, in this section you are asked to research and evaluate 2 methods. Please read “Challenging Behaviour” and ‘Dementia in Gateshead’, a guide to understanding, coping and responding. (Downloadable from the TWCA website) This document states some key principles. Describe these principles This is an 8 stage approach which examines Stage 1. The person with dementia Stage 2 The environment Stage 3 Identifying risk Stage 4 The event, describing what is happening Stage 5 Identifying triggers for the behaviour Stage 6 Deciding what can be done. Getting a plan Stage 7 Evaluating the intervention Stage 8 Involving other professionals With permission use this model in your workplace, describe each stage and evaluate the impact. Write a reflective account of this activity. In this account compare this method to how you usually manage challenging behaviour.

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Project 4 Medication

Across South of Tyne, the Medicines Management team are taking forward a project to fund additional Pharmacist input into care homes. The aim of the project is to support care homes by providing advice, training and to review medications as a support to GP’s. Part of this review will be looking at the number of people with dementia and their medicines as part of this course, Dementia Champions are expected to work with the pharmacists. Write an account of this review, talk about how many of your people were taking anti-psychotics and why, discuss observed effects of these medications. Review how the multi disciplinary team interact to support the person, and the outcome of the review.

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DEM 301 Understand the process and experience of Dementia. Level 3, 3 Credits

Learning Outcome 1. Understand the neurology of dementia Complete Worksheet 1. The Brain Explain the term dementia. Describe some of the most common types of dementia

• Alzheimer’s Disease

• Vascular dementia

• Pick’s Disease

• Dementia with Lewy bodies

• Creutzfeld Jakob Disease (CJD)

Huntington’s Disease Why are the numbers of people with dementia increasing?

1.1 Describe a range of causes of dementia syndrome

1.2 Describe the types of memory/cognitive impairment commonly experienced by individuals with dementia (what are the symptoms?)

• Decline in memory

• Decline in reasoning and communication

• Changes in behaviour

• Loss of skills to carry out normal daily activities 1.3 Explain the way that individuals process information with reference to abilities and

limitations of individuals with dementia. Consider how memory is stored ( both short term and long term memory) How new things are learnt.

1.4 Explain how other factors can cause changes in an individual's condition that may

not be attributable to dementia. Consider Depression, infections, side effects of medication, emotional trauma or anxiety.

1.5 Explain why the abilities and needs of an individual with dementia may fluctuate

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Learning Outcome 2. Understand the impact of recognition and diagnosis of

dementia

2.1 Describe the impact of early diagnosis and follow up diagnosis 2.2 Explain the importance of recording possible signs or symptoms of dementia in an individual in line with agreed ways of working

2.3 Explain the process of reporting possible signs of dementia within agreed ways of working

2.4 Describe the possible impact of receiving a diagnosis of dementia on the individual, their family/friends

Learning Outcome 3. Understand how dementia care must be underpinned by a

person centred approach Complete work sheet 2 Explain the term person-centred care 3.1 Compare a person centred and a non person centred approach to dementia care 3.2 Describe a range of different techniques that can be used to meet the fluctuating abilities and needs of the individual with dementia 3.3 Describe how myths and stereotypes related to dementia may affect the individual and their carers 3.4 Describe ways in which individuals and carers can be supported to overcome their fears

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Dem 304 Enable rights and choices of individuals with dementia whilst minimising risks. Level 3, 4 credits

Learning Outcome 1. Understand the key legislation and agreed ways of working

that support the fulfilment of rights and choices of individuals with dementia while minimising risk of harm

Arrange to attend mental capacity and DOLS training 1.1 Explain the impact of key legislation that relates to fulfilment of rights and choices and the minimising of harm for an individual with dementia 1.2 Evaluate agreed ways of working that relate to rights and choices of an individual with dementia

1.3 Explain the way that individuals process information with reference to abilities and limitation of individuals with dementia

Learning Outcome 2. Be able to maximise the rights and choices of individuals with dementia

2.3 Explain why it is important not to assume that an individual with dementia cannot make their own decisions 2.4 Describe how the ability of an individual with dementia to make decisions may fluctuate

Learning Outcome 3. be able to involve carers and others in supporting individuals with dementia

3.2 Describe how a conflict of interest can be addressed between the carer and an individual with dementia whilst balancing rights, choices and risk 3.3 Describe how to ensure an individual with dementia, carers and others feel able to complain without fear of retribution

Learning Outcome 4. Be able to maintain the privacy, dignity and respect of individuals with dementia whilst promoting rights and choices

4.1 Describe how to maintain privacy when providing personal support for intimate care to an individual with dementia

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DEM 312 Understand and enable interaction and communication with individuals who have dementia. Level 3, credit 4

Learning Outcome 1. Understand the factors that can affect interactions and

communication of individuals with dementia

1.1 Explain how different forms of dementia may affect the way an individual communicates

1.2 Explain how physical and mental health factors may need to be considered when communicating with an individual who has dementia

1.3 Describe how to support different communication abilities and needs of an individual with dementia who also has sensory impairment 1.4 Describe the impact the behaviour of carers and others may have on an individual with dementia

Learning Outcome 2. Be able to communicate with an individual with dementia using a range of verbal and non-verbal techniques

2.3 Analyse ways of responding to the behaviour of an individual with dementia, taking account of the abilities and needs of the individual, carers and others

Learning Outcome 3. Be able to communicate positively with an individual who has dementia by valuing their individuality

Learning Outcome 4. Be able to use positive interaction approaches with

individuals with dementia 4.1 Explain the difference between a reality orientation approach to interaction and a validation approach

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DEM 313 Equality, diversity and inclusion in dementia care practice. Level 3, credits 4

Learning Outcome 1. Understand that each individual's experience of dementia is unique

1.1 Explain why it is important to recognise and respect an individual's heritage 1.2 Compare the experience of dementia for an individual who has acquired it as an older person to the experience of an individual who has acquired it as a younger person

1.3 Describe how the experience of dementia may be different for individuals, who have a learning disability, who are from different ethnic backgrounds, who are at the end of life 1.4 Describe how the experience of an individual's dementia may impact on carers

Learning Outcome 2. Understand the importance of diversity, equality and inclusion in dementia care and support

2.1 Describe how current legislation, government policy and agreed ways of working support inclusive practice for dementia care and support 2.2 Describe the ways in which an individual with dementia may be subjected to discrimination and oppression 2.3 Explain the potential impact of discrimination on an individual with dementia 2.4 Analyse how diversity, equality and inclusion are addressed in dementia care and support

Learning Outcome 3. Be able to work in a person centred manner to ensure inclusivity of the individual with dementia

Learning Outcome 4. Be able to work with others to encourage support for diversity and equality

4.1 Work with others to promote diversity and equality for individuals with dementia

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Dem 302 Understand and meet the nutritional requirements of individuals with

dementia. Level 3, credits 3

Learning Outcome 1. Understand the nutritional needs that are unique to individuals with dementia

1.1 Describe how cognitive, functional and emotional changes associated with dementia can affect eating, drinking and nutrition 1.2 Explain how poor nutrition can contribute to an individual's experience of dementia 1.3 Outline how other health and emotional conditions may affect the nutritional needs of an individual with dementia 1.4 Explain the importance of recognising and meeting an individual's personal and cultural preferences for food and drink 1.5 Explain why it is important to include a variety of food and drink in the diet of an individual with dementia Learning Outcome 2. Understand the effect that mealtime environment can have

on an individual with dementia 2.1 Describe how mealtime cultures and environments can be a barrier to meeting the nutritional needs of an individual with dementia 2.2 Describe how mealtime environments and food presentation can be designed to help an individual to eat and drink 2.3 Describe how a person centred approach can support an individual with dementia, at different levels of ability, to eat and drink

Learning Outcome 3. Be able to support an individual with dementia to enjoy good nutrition

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DEM 305 Understand the administration of medication to individuals with dementia using a person centred approach Level 3, credits 2

Learning Outcome 1. Understand the common medication available to, and

appropriate for, individuals with dementia

1.1 Outline the most common medications used to treat symptoms of dementia 1.2 Describe how commonly used medications affect individuals with dementia

1.3 Explain the risks and benefits of anti-psychotic medication for individuals with dementia 1.4 Explain the importance of recording and reporting side effects/adverse reaction to medication 1.5 Describe how "as required" (PRN) medication can be used to support individuals with dementia who may be in pain

Learning Outcome 2. Understand how to provide person centred care to individuals with dementia through the appropriate and effective use of

medication 2.1 Describe person-centred ways of administering medicines whilst adhering to administration instructions 2.2 Explain the importance of advocacy for an individual with dementia who may be prescribed medication

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Introduction to Reflective Diary

Reflection can be a powerful and purposeful experience helping the practitioner to gain

insight into the true effects of their practice.

Everyone’s experience of dementia is unique and practitioners often do not have

answers. Reflecting on experiences of uncertainty helps identify areas where a standard

approach to work is not fully specified and helps the practitioner develop strategies to

cope in often difficult situations.

Reflection is a very personal active process of looking at our own experience often to

explore it in greater detail. This can provide a view on what is working and not working

and may serve as a tool for analyzing the challenges facing staff delivering Dementia

Care.

Using a Model of Reflection

When writing your diary of practice you will be expected to include a piece of reflection

about supporting 2 people with dementia:

These reflections must relate to situations in your work where you feel you have learnt

something that is of value to your practice and future career. It may be a positive

experience where something went well or a negative one where you need to think about

what has happened. From each piece of reflection, you must identify what you have

learned from the experience and how this relates to the theory that you have been

taught or researched.

There are several models that might be useful to help guide your reflection. For this

diary, we have suggested Johns’ model of reflection. However please use whichever

model best suits your own personal learning style.

When working through your diary, consider the content of your training course and

evaluate how this has impacted upon your practice. You may decide to focus upon one

or two elements of the training if these have had a dramatic effect upon you and your

practice, or you may decide to look at the whole package of End of Life Care delivered

by your service.

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The following cues are offered to help practitioners to access, make sense of, and learn

through experience;

Johns’ model

Johns' model of reflection (1994)

Description of Experience

Write a

description of the

experience

What are the key

issues within this

description that I

need to pay

attention to?

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Reflection

What was I trying

to achieve?

Why did I act as I

did?

What are the

consequences of

my actions?

• For the service

user and family

• For myself

• For people I

work with

How did I feel

about this

experience when

it was

happening?

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Influencing factors

What internal

factors

influenced my

decision making

and actions?

What external

factors

influenced my

decision-making

and actions?

What sources of

knowledge did or

should have

influenced my

decision making

and actions?

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Alternative strategies

Could I have

dealt better with

the situation?

What other

choices did I

have?

What would be

the

consequences of

these other

choices?

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Learning

How can I make

sense of this

experience in

light of past

experience and

future practice?

How do I NOW

feel about this

experience?

Have I taken

effective action to

support myself

and others as a

result of this

experience?

How has this

experience

changed my way

of knowing in

practice?

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The Post Course Impact Measurement Tool

This training supports the ongoing development of Dementia Care. It is a pilot programme, which will evolve to be responsive to workforce needs. We need your feedback to help evaluate the effectiveness of this course and to shape future training. We need to measure the impact this programme has upon the following key areas:

1. You as the practitioner who has undertaken training After training and learning, has knowledge and experience been consolidated into practice? Can the practitioner undertake tasks relating to Dementia Care with more confidence and competence and can they transfer and generalise from the learning experience, to be more able to evaluate their own work?

2. Impact on the person with dementia

3. Impact on the organisation

We ask that once you have completed your 2 reflections, you consider the impact and

effect this training has had in these 3 key areas and complete the enclosed Post Course

Impact Measurement Tool.

It would be helpful to us at this stage, too, if you could identify any further training needs

to develop and consolidate the degree of competence of people delivering Dementia

Care.

Please complete your post course impact measurement tool and return these to: The

Tyne and Wear Care Alliance

Unit 1North East Business and Innovation Centre

Wearfield

Sunderland Enterprise Park East Sunderland SR5 2TA

As part of the ongoing support and commitment of this programme to improve Dementia across South of the Tyne, Sharon Campion, Clinical Lead , Community Challenging Behaviour Function ,Older Persons CMHT South of Tyne will offer support and advice with issues raised, via forums Tel: 0191 5699050(Sunderland) 01915699149(South Tyneside) E;mail: sharon.campion@ntw.nhs.uk Please do not hesitate to contact your Network Development Officer if you require any further information about the End of Life Training Programme. Gateshead Sally Riding Tel 07990 793209 South Tyneside Pauline Gibbs Tel 07990 793201 Sunderland Angela Richardson Tel 07990 793203

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