CHANGE PROJECT - DCU

Catherine Keogh

Occupational Therapy Manager

Bloomfield Care Centre

THE PROBLEM AND PROPOSED CHANGE

The problem Occupational Deprivation in people with dementia

in residential care setting. The problem is that physical risk is prioritised over

psychological risk and the issue of boredom may not be addressed once someone is ‘safe’.

The change: Improve the awareness by staff of the concept of

‘mental bedsores’ and how they can do much to improve the risk of this occurring. This will occur within a larger aim/organisational aim of improving the culture, environment and staff knowledge to support best practice dementia care.

THE PLAN! Choose one mental health approved

centre wards to work with. Meet with the CNM on the ward to

explain and gain support for the change project.

Choose 2 residents who have dementia and who are at risk/or are experiencing occupational deprivation.

Establish a baseline of what a typical day is currently like for those residents

Collate information with staff that will help to engage the person in occupation

THE PLAN – CONTINUED! Meet with CNM’s to discuss ‘findings’ i.e.

the occupations and changes in the environment that will assist the person with dementia to engage.

Create a ‘Resident Appreciation Day’ for both of the residents.

Discuss with the team afterwards any observations, what worked about the day and celebrate the teams’ achievement in putting the spotlight on abilities.

FOUR STAGES OF ‘MENTAL BEDSORES’Stage One

Pressure Ulcer “Mental Bedsores”

Skin is not broken but is red or discoloured.

Spirit not broken but sense of self is beginning to be challenged

Early warning signs to prevent development of ulcer

Warning signs include change of environment, being disempowered to perform normal activities of daily living, reduction of activities that enhance occupational identity.

FOUR STAGES OF ‘MENTAL BEDSORES’Stage Two

Pressure Ulcer ‘Mental Bedsore’

The epidermis or topmost layer of the skin is broken, creating a shallow open sore.

Sense of self is broken. Person is doing less and less for themselves. As the wound is not deep yet, they may still try to initiate activity or try to do for themselves.

If these attempts to do activities that re-inforce occupational identity are unattended to or prevented – the person is at risk of stage three .

FOUR STAGES OF ‘MENTAL BEDSORES’Stage Three

Pressure Ulcer ‘Mental Bedsore’

The break in the skin extends through the dermis (second skin layer) into the subcutaneous and fat tissue. The wound is deeper than in Stage Two.

The break in the person’s spirit extends further. Attempts at communication may now be interpreted as aggression. Or the person may indeed give up all attempts to communicate.

Stage three is complicated further by the response to the aggression – restraints, medication etc which accelerate the progression to Stage 4.

FOUR STAGES OF ‘MENTAL BEDSORES’Stage Four

Pressure Ulcers ‘Mental Bedsores’

The breakdown extends into the muscle and can extend as far down as the bone. Usually lots of dead tissue and drainage are present.

The breakdown of spirit and sense of self extends right down to the core of the person. There sense of who they are has been eroded and there may be no sign of life behind their eyes.

Person withdraws into themselves and can become uncommunicative.

PROGRESS Buy-in secured at Senior Management

level Questionnaire Developed PAL completed on two residents –

strengths focussed and included in care plan

Life history review commenced by family members on both residents

‘mental bedsores’ document developed