The Triadic Approach to Person Centred Care

On 27^th November 2007, a report was launched by the National Alzheimer’s Society. This report, Home from Home, Quality of care for people with dementia living in care homes, was a result of research carried out by the society.

One of the main points highlighted was that only approximately 2 minutes out of every 6 hours was spent on human contact time between the people living in the care facility and those supporting them. In addition to this, the lack of specialist training was also identified as a malignant factor.

Whilst Dr Nightingale supports these findings, (he worked with the society on this report), he believes wholeheartedly that true person centred care is the only way in which people with dementia can avoid such malignant approaches. Dr Nightingale would like to describe his proactive approach to achieving true person centred care.

For over 3 years, Dr Nightingale has been developing and implementing a Dementia Care Strategy that has 3 major components. These are:

• Training, research and development

• Environment

• Holistic, individualised care based on existing knowledge, skills and competence rather than simply need

We are fully aware of how social withdrawal, further confusion and disorientation, combined with the provision of a malignant institution results in total malignant psychology (please see diagram below entitled The vicious circle of a malignant lifestyle in a care home).

Training, research and development:

Dr Nightingale works closely with the National Alzheimer’s Society to roll out the person centred training package developed by the Training & Development Department of the society. This training course is called Yesterday Today Tomorrow (YTT) and is the minimum standard of training expected of any member of the care team supporting people with dementia. This includes kitchen, domestic and maintenance staff as well as managers, nurses, care assistants and activities organisers. Additionally, his philosophy of care involves the whole family; therefore, family members are invited to participate in the YTT training if they so wish.

This course equips enablers with the knowledge, skills and competencies to make the shift from task orientated care to true person centred approaches.

A Multi Disciplinary Dementia Group will carry out continued development of the care strategy, which is chaired by the author with representation from all external agencies

Dr Nightingale places great emphasis on the people using his services to take a lead in all research initiatives. Therefore, about 2 years ago, he established an Ethics Committee, which has representation from a number of people living in care homes as well as professionals, academics and lay members. The Alzheimer’s Society also sits with this committee. This committee supports research that is carried out by academic institutions and clinicians alike. However, our main aim is to encourage and support research and best practice at home level.

Environment:

Dr Nightingale believes that an individual’s environment is central to who they are as a person. Long gone has the traditional clinical environment that was usually white with no stimulation and chairs in a centrifugal position.

He has taken in to consideration the research conducted by the Dementia Development Centre at Stirling University. He has combined this with the philosophy of a community within a community, incorporated an ecological inventory approach and developed some extremely successful living and leisure environments in a great number of care homes through out the country.

The environments are stimulating and interactive with colour schemes and a kind of homeliness that serves to enhance the well being of those living in them. These environments have resulted in a reduction of behaviours that are a challenge to the service and a reduction in the use of neuroleptics.

Holistic, individualised care based on existing knowledge, skills and competence rather than simply need:

This approach may involve various therapies and psychotherapy in conjunction with the person centred approach taught to the care team. It does not look towards medicines as a first resort when things are challenging to the service. Instead, his teachings and philosophies ask us to look at ourselves, our service provision and the restrictions we are asked to put on people’s lives by personal biases and values of commissioners. By doing this, we are often able to help a person and their relatives resolve a challenge in the most practical way possible.

Dr Nightingale believes wholeheartedly in the provision of care that takes into consideration the unique personality, character and abilities of people living in our facilities. He believes that his triadic approach takes us a head of the game. Inspectors and commissioners are sometimes not ready for the non-clinical home life they see in some of the homes that have adopted the approach.

This is a strategy that Dr Nightingale will continue to develop and provide, though he fully supports the outcomes of this latest report that training for people supporting those with dementia becomes mandatory.

He also supports the Government’s National Dementia Strategy and will continue to work tirelessly on behalf of those people that look to us for care and support during the most vulnerable times in their life.

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