Sue Clarke Senior Nurse: Learning Beyond Registration Portsmouth Hospitals NHS Trust

1. Developing Dementia Simulation – But What Shall we do about Alice? Health Education Wessex / Health Education Thames Valley Clinical Simulation Francis Fellowship Programme (Dementia) Sue Clarke Senior Nurse: Learning Beyond Registration Portsmouth Hospitals NHS Trust

2. Alice Alice is a 50 year old university professor, wife, and mother of three. Her 25 year career includes pioneering many of the leading benchmarks in psycholinguistics. Even then, more than a year earlier, there were neurones in her head, not far from her ears, that were being strangled to death, too quietly for her to hear them. One day, Alice sets out for a run on the same route she has taken for years. Suddenly she did not know where she was or how she got there; she was utterly lost. Still Alice (2012)

3. Dementia Simulation Project Overview • This dementia simulation has been developed as part of a Health Education Wessex / Thames Valley Clinical Simulation Training Fellowship • The main purpose of the fellowship was to use simulation training to help build a culture of improved outcomes for both the patient and the clinician • Aim – To develop, test and implement a simulation based educational package on dementia

4. Is there a problem that needs solving? • Data from a thematic analysis of local incidents (related to dementia) and three national reports (Alzheimer’s Society 2009, Skills for Health 2010a, 2010b) was triangulated to inform content of a local staff Training Needs Analysis (TNA) • Pareto analysis was used to inform the most efficient use of limited fellowship time

5. We appear to have a problem

8. Once you involve people how clear is the problem? • Francis (2013) discussed culture within the context of not knowing; essentially asking whether judgements that led to poor standards were due to not knowing or not giving appropriate significance to facts which were known • Staff TNA shows a plateau pareto chart which could suggest staff do not know what they need to know

10. Alice Alice delivers a key note speech at a Cognitive Psychology Conference talking about the ‘mental processes that underlie the acquisition, organisation, and use of language. About 40 minutes into the presentation she suddenly becomes stuck, she simply could not find the word. She replaced it with “thing”. She was on the plane descending into LAX when the word finally came to her. Lexicon. Still Alice (2012)

11. Scenario 1 – Dementia Diagnostic Assessment • Learning Outcomes: • Recognise need for dementia assessment and referral • Knowledge of the policy drivers for the dementia agenda • Undertake a dementia assessment and referral • Recognise and discuss signs of dementia • Explain how an early diagnosis of dementia may affect the person and their family

12. Alice An urgent pressure in her bladder reminded her she had to pee. She opened the door to the bathroom, only to her utter disbelief it wasn’t the bathroom. She looked down the hall, there were five doors. “Please God, please God, please God. How can I be lost in my own home?” John burst through the front door just in time to witness the urine streaming down her legs. “Don’t look at me!” Still Alice (2012)

13. Alice Alice put her hand on the hole, only she found her fingers running over her black hallway rug. She smacked it with her open hand. “Mum, what are you doing” Her hand stung, she was too tired to endure the humiliating answer to Anna’s question. “Leave me alone! Get out of my house! I hate you! I don’t want you here!” Her words hit Anna’s face harder than if she’d slapped her. Still Alice (2012)

14. Learning Outcomes • Demonstrate an understanding of ‘behaviours that challenge’ • Identify common types of, causes and triggers for behaviours that challenge • Identify causes of behaviours that challenge • Understand how an ABC analysis to track and analyse behaviours that challenge can devise methods to approach and respond to them • Understand that when a person is expressing behaviours that challenge they may be communicating unmet needs • Awareness of NICE CG 42 and CG 103 guidelines • Recognise the importance of understanding the different interventions for behaviours that challenge • Explain difference between dementia and delirium Scenario 2 – Behaviours that Challenge

15. Alice Alice needed a plan that committed the future her to a suicide she arranged for now. She needed to create a simple test, one that she could self administer every day. Still Alice (2012)

16. Scenario 3 – Person Centred Care • Learning Outcomes: • Increase understanding of person centred care in dementia • Discuss the value of using life stories in person centred care • Discuss the value of involving carers and family in planning care • Understand the issues of capacity and consent in working with people with dementia and their families • Discuss the value of advanced care planning

18. So - - how is it going? Evaluation Data This project used Kirkpatrick’s evaluation theory (Kirkpatrick 1994) to analyse the impact of the educational intervention. Although current numbers do not lend themselves to meaningful statistical calculations positive trends are seen. Level 1 Data Level 2 Data

19. Level one data

20. Level one data

21. Level two data There was a statistically significant difference between the pre and post knowledge test means when subjected to a t-test (p<0.001).

22. References Alzheimer’s Society. (2009). Counting the cost .Caring for people with dementia on hospital wards. London. Alzheimer’s Society. Audit Commission. (2000). Forget me not: Mental Health Services for Older People. London: Audit Commission. Benner, P. (1984). From novice to expert: Excellence and power in clinical nursing practice. Menlo Park: Addison-Wesley, pp. 13-34. Care Services Improvement Partnership. (2005). Everybody’s business: Integrated mental health services for older adults: a service development guide. Leeds: Care Services Improvement Partnership. DH. (2001). The National Service Framework for Older People. London: Department of Health. Francis, R. (2013).Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry. London: The Stationary Office. Genova, L. (2012). Still Alice. London: Simon & Schuster Ltd. Kirkpatrick, D. L. (1994). Evaluating training programs: The four levels. San Francisco: Berrett-Koehler. Knapp, M. et al. (2007). The Dementia UK Report. London: Alzheimer's Society. McMullan, M. (2003). Portfolios and assessment of competence: a review of the literature. Journal of Advanced Nursing, 41(3), 283-294. National Audit Office (2007). Improving services and support for people with dementia. London: National Audit Office. NICE. (2006). Dementia: Supporting people with dementia and their carers in health and social care a joint clinical guideline on the management of dementia. London: National Institute for Health and Clinical Excellence. Public Accounts Committee (2008). Improving services and support for people with dementia. London: TSO. Skills for Health. (2010a). Working to support the implementation of the National Dementia Strategy Project Scoping Study Report. Bristol. Skills for Health. Skills for Health. (2010b). Working to support the implementation of the National Dementia Strategy Project Mapping Existing Accredited Education/Training and Gap Analysis Report. Bristol. Skills for Health.

24. Alice “What if I see you, and I don’t know that you’re my daughter, and I don’t know that you love me?” “Then I’ll tell you that I do, and you’ll believe me” Still Alice (2012)