Authentic Partnerships and Appreciative Inquiry in Addressing Elder Abuse in Residential Aged Care

1. World Elder Abuse Awareness Day Conference 2016Authentic partnerships and appreciative inquiry: The possibilities for addressing abuse and neglect in residential aged care.Dr Maree Bernoth

2. Let me tell you a yarn… • Yarn - a long story with a lot of • exciting details (Macmillan Dictionary, 2016) • Yarns can be believed or not; they can be ignored or be the impetus for change. • Individuals can choose to ignore stories, wanting them to be fiction • Other individuals purposefully hide the stories • Some become punitive when stories are told

3. Let me tell you a yarn… Previous research • Abuse and neglect in aged care facilities • Stories of REAL people in REAL situations • Impact on the story tellers and the audience being told the stories of abuse and neglect • The outcome did not change when the stories were told and retold nor when similar stories emerged and keep emerging • Roland et al (2016), in their recent article ask … When Is There Enough Evidence for Policy Change?

4. Writing the current yarn… Current research • Understanding that telling the same story did not have any impact • How do I make changes in a way that will impact policy? • How do I impact on the quality of life of those living and working residential aged care? • A different approach for research projects

5. Appreciative inquiry • Appreciative inquiry is based on identifying strengths, on collaborations and nurturing enthusiasm (Ludema, Cooperrider, & Barrett 2006). • What already exists and how can we work together to utilise the positives and reach a mutually determined outcome?

6. Authentic partnerships • All parties involved … should experience relationships that promote a sense of – • security • belonging • continuity • purpose • achievement and • significance (Dupuis et al, 2011, p. 431)

7. Creating and sustaining authentic partnerships • Based on the willingness of partners to be open to- • The developmental nature of the processes • Dynamic (and creative) • Systematic (Barnes, 2009) • Mutual trust • Shared knowledge • Investment of time

8. What happened? • Funding from NSW West Interdisciplinary Clinical Training Network (ICTN) • Involving the community - formation of an advisory group • Provision of preceptor education • Undergraduate tutorials within the residential aged care environment • Inclusion of residents, staff, students and academics • Focus groups

9. Response of staff and managers • What the students saw was the actual person and this is what happened to her and this is what she looked like before … they (the students) had done the theory in class but we did a case study – this is who they (the residents) are. • They (the students) were like “wow I didn’t realise that!”

10. and more from the students… • We can sit here and learn about it out of the text books but at end of the day to get that first hand experience is when you start to see, like we did today • I hadn’t actually really thought … I would want to work in aged care but … I wouldn’t be totally against it, to be honest. • watching the staff there and how dedicated they are to their job and the people they work with and invested in those people’s lives (student’s immediate feedback)

11. Outcomes to date • Valuing the resident and their experiences – appreciating them as individuals and as teachers • Validation of staff of the residential aged care facility • Excitement of students in seeing possibilities • Creation of post graduate positions • Encouragement of post graduate education for existing RNs in aged care • Discussion about closer links between the university and aged care sector • Closer links between agencies in the community

12. A work in progress • Extension to community services • Creation of geographical hubs of RNs • Continuing the project and overcoming challenges

13. How to respond to complaints - industry lawyer’s advice … • Use unfriendly third party • Lawyer letter • Conference with unfriendly – give them ‘bad cop’ someone else to hate, bad news messenger • Be clear as to rules and obligations of invitees onto premises • •Exercise rights as owner of premises – refuse entry to people who create a nuisance or disrupt your business • Visitors to premises including guardians, family members, attorneys, though empowered to act for residents, must abide by your rules(Koumoukelis, 2016)

14. Contrasting Stories

15. As the yarn unravels… • Minister Skinner’s response to NSW inquiry • Peak bodies response to Skinner • Federal Budget • Absence of aged care in political discourse

16. The never ending story… • Satisfied with the small gains • Yet the bigger picture still haunts • As yet, there is no happy ending to the yarn about preventing abuse and neglect in residential aged care in Australia, just possibilities…

17. References: • Barnes, J, V., Altimare, E., Farrell, P, A., Brown, E, R., Burnett, C, R., Gamble, L., & Davis, J. (2001). Creating and Sustaining Authentic Partnerships with community in a Systemic Model. Journal of Higher Education Outreach and Engagement, 13(4), 15-29. • Bernoth, M., Burmeister, O.K., Morrison, M., Islam, Z., Onslow, F., & Cleary, M. (2016). The Impact of a Participatory Care Model on Work Satisfaction of Care Workers and the Functionality, Connectedness, and Mental Health of Community-Dwelling Older People, Issues. Issues in Mental Health Nursing, DOI: 10.3109/01612840.2016.1149260 http://dx.doi.org/10.3109/01612840.2016.1149260. • Burmeister, O.K., Bernoth, M., Dietsch, E., & Cleary, M. (2016). Enhancing Connectedness Through Peer Training for Community-Dwelling Older People: A Person Centred Approach. Issues in Mental Health Nursing. http://dx.doi.org/10.3109/01612840.2016.1142623 • Dupuis, S., L., Gillies, J., Carson, J., Whyte., Genoe, R., Loiselle, L., & Sadler, L. (2011). Moving beyond patient and client approaches: Mobilizing ‘authentic partnerships’ in dementia care, support and services. Dementia, 1 1(4), 427-452. DOI: 10.1177/1471301211421063 • Eldh, A. C., Zijpp, T., McMullan, C., McCormack, B., Seers, K., & Rycroft‐Malone, J. (2015). ‘I have the world's best job’–staff experience of the advantages of caring for older people. Scandinavian Journal of Caring Sciences. • Komakedis, A. (2016). Dealing with difficult families –rights, obligations, strategies. AAG & ACS Conference. Retrieved from https://www.eiseverywhere.com/ehome/index.php?eventid=140135&tabid=398260 • Ludema, J., Cooperrider, D., & Barrett, F. (2006). Appreciative Inquiry: the power of the unconditional positive question. In P. Reason, & H, Bradbury. Handbook of Action Research. London: Sage. • Macmillan Dictionary. (2016). Yarn. Retrieved from http://www.macmillandictionary.com/dictionary/british/yarn • Ronald, L. A., McGregor, M. J., Harrington, C., Pollock, A., Lexchin, J.(2016). Observational Evidence of For-Profit Delivery and Inferior Nursing Home Care: When Is There Enough Evidence for Policy Change? PLOS Medicine | DOI:10.1371/journal.pmed.1001995