When did you first introduce the innovation?
More than 24 months ago
Please describe the innovation you have developed
It is known that the experience of general hospital services has fallen well below the expectations of people with dementia and their families and friends (Elvish et al., 2014, Jurgens et al., 2012, Royal College of Psychiatrists, 2011, Alzheimer Society 2009). Admission to hospital can result in increased mortality, increased length of stay in hospital and increased discharge from home to long term care settings. This is also understood to be a common experience of people with dementia in wider areas of health and social care provision. Risk to or a direct contravention of Human Rights is currently used to describe many of the experiences of people with dementia across many services (Kelly and Innes, 2013).
A partnership between the School of Health, Nursing and Midwifery, at the University of the West of Scotland and Alzheimer Scotland produced the Scottish Dementia Champions Programme for the Scottish Government.
This programme prepares professionals to be leaders of change when working with people with dementia being cared for primarily in acute hospitals. As an inter-professional programme, Champions come from diverse professional groups nursing, allied and paramedical groups, social work, chaplains, pharmacists, radiographers and dentists.
All of these practitioners are brought together in a learning group, with the single focus of driving change in the journey for the person with dementia, family and carers through the acute hospital setting and to services which reduce inappropriate admission and support discharge.
We are currently training the sixth cohort of 100 Champions and by February 2016 there will be 600 Champions in Scotland.
What prompted you to develop this innovation?
A Dementia Champions Scheme in Dumfries and Galloway in 2007 led the way to a successful national tender for the NHS Education commissioned National Dementia Champions Programme. This followed a decision by the Scottish Government that the Dementia Champion programme would become a Scotland wide initiative and an integral part of Scotland’s National Dementia Strategy (Scottish Government 2010; 2013).
In your view, what is it about this innovation that makes it different/important?
We work with professionals who had not anticipated they would routinely work with people with dementia. It is recognised that the professional education of health care and social care professionals has not systematically incorporated working with people with dementia and their families. In their survey of 22 HEIs Pulsford et al (2007) discovered that in Mental Health Nursing hours ranged from 3-54, in Adult Nursing it was 0-6 and for Allied Health Professionals and Social Work 0-6 hours were reported. In addition to the lack of pre-registration training, the Royal College of Psychiatrists (2011) found there was no mandatory training in dementia for staff in 95% of hospitals in England. With the anticipated demographic challenges, the Scottish Government has made the decision that all health and social care professionals are the ‘dementia workforce’. It is essential that the dementia workforce possess appropriate knowledge, skills, attitudes and values. Scotland’s National Dementia Champions Programme sets out to do this.
The blended learning programme utilises:
- Case study
- Group discussions
- Simulated practice
- Enquiry based learning
- Use of the DOMUS
- Values based practice activities
- Hearing the experiences of people with dementia and their families and friends
Understanding the experience of the person with dementia and their family and carers is essential and the aim is for the Champions to understand the perspective of people with dementia, thereby supporting the application of the key ethical principles in care. This is achieved by collaborating with people who have dementia, family and carers who co-facilitate learning sessions on the programme. Champions also engage with practical experiential activities in class, with equipment and environmental changes which mimic physical, sensory and cognitive impairment. These are designed to sensitise them to the sensory and neurological challenges the person with dementia might face in acute hospital settings.
To what extent does your innovation make use of existing approaches, resources or technologies?
The learning and teaching resources have all been developed for this bespoke programme. Champions become temporary UWS students for the taught period of the programme, facilitating access to UWS learning resources, including the dementia skills labs on campus (Domus), and the online learning site for communication with tutors and each other. Personal tutor support has proved important to maintaining the motivation and confidence of participants, especially those who have not undertaken recent study.
The Champions will have 2 opportunities to experience the Domus environment. Domus, meaning home, provides the opportunity to see, feel and touch how both clinical and homely environments can be adapted to meet the needs of people with dementia and their families. The simulated domestic environment at UWS allows a variety of learning and teaching opportunities for interpersonal and fundamental physical care. This provides the opportunity to acquire some of the skills required for the ‘dementia enhanced practice level’ delineated in the Promoting Excellence (NES SSSC 2011).
To what degree has this innovation led to changes in education or clinical practice?
The Champions complete a Supporting Change self assessment benchmarking activity then action plan for changes over the course of the programme. Champions report a range of changes in practice as a result of the programme.
These include the introduction of dementia friendly signage to acute hospitals, introduction of meaningful activity for the person with dementia and education of staff and families. Examples include:
- Increasing awareness of dementia amongst colleagues.
- Ensuring all staff access training to support their work with people who have dementia.
- Ensuring new built environments follow evidence based dementia friendly principles and that people with dementia have access to outdoor spaces, quiet spaces and activity as appropriate to individual needs.
- Enhancing existing environments with dementia friendly features, clear signage and noise reduction.
- Making visiting times more flexible to suit the needs of the person with dementia.
- Supporting greater partnership with families and carers.
- Enhancing mealtime experiences for people with dementia by reviewing environments, educating staff on best practice when supporting people to eat and raising awareness of staff regarding the impact of dementia on food and fluid intake.
- Providing training on Adults with Incapacity (Scotland ) Act 2000 to ensure people with dementia are treated according to legal and ethical frameworks.
- Promoting use of ‘Getting to Know Me’ document to ensure staff have the right information from which they can provide care which enables the person and fulfils their needs.
- Providing placement students with support/training on working with people with dementia.
- Creating information points with details of family/carer access to Alzheimer Scotland Helpline and other resources.
- Improving experience for people with dementia in specific departments, e.g. Accident and Emergency, Computerised Tomography and Magnetic Resonance Imaging scanning.
What evidence do you have of the impact of the innovation?
Each cohort of dementia champions have been participants in a research programme to investigate the impact upon their individual learning, focusing upon attitudes, values, competence and confidence. Each cohort has demonstrated significant positive changes in the hopefulness and person centredness when working with people with dementia.
These measures are important as they have been found to have a direct impact upon positive behaviour and amount of engagement of staff with people with dementia increasing. In addition all have reported an increase in confidence. Measures used were the Approaches to Dementia Questionnaire and a scale based on Bandura’s measurement of self efficacy (Lintern et al., 2000, Bandura, 1999, Macdonald and Woods, 2005). Behind the work of the educational team, UWS researchers are investigating the current impact of the programme on the participants. Exploration of contemporary measures of attitudes and knowledge concerning the experience of dementia against current measure is the focus of this study. This is viewed as important as measuring impact, including sustainability is an ongoing challenge for academics in the health and social care field, (Teodorczuk et al., 2009).
The outcome of the early studies can be found in Banks et al., (2013).
In addition to the UWS internal evaluation, an independent external evaluation of the impact of the Dementia Champions and the Alzheimer Scotland Dementia Nurses initiatives reported:
‘…despite the enormity of the task and the relative small scale and immaturity of the initiatives, a significant amount of change and improvement work has been initiated by the two roles, and would likely not have happened without them’. (Blake Stevenson 2014).
To what degree has the innovation been disseminated in your organisation or elsewhere?
The Champions have presented a range of their work as change agents at events across Scotland and on the local work they have done in the form of posters and presentations.
Academic publications and national and international presentations are listed below:
Banks, P., Waugh, A., Henderson, J., Sharp, B., Brown, M., Oliver, J and Marland. G (2013) Enriching the care of patients with dementia in acute settings? The Dementia Champions Programme in Scotland. Dementia.
Waugh, A., Marland, G., Brown, M., Henderson, J., Sharp, B., Banks, P., and Oliver, J (2013) Supporting Change for people with dementia in general hospitals: Dementia Champions as change agents. Journal of Dementia Care.
Please provide details of any plans you have to disseminate the innovation in the future.
All learning experienced with the Champions is fed back into pre-registration and post registration nursing programmes delivered at the University of the West of Scotland. Academic articles are planned addressed further work on stigma in health and social care, one of the UWS programme team members is undertaking a Professional Doctorate, studying the experience of being a Dementia champion which will lead to further publications. The team continue to share best practice and research outcomes with the wider educational and practice development community through the Higher Education Dementia Network UK.