Utilising volunteers to deliver
person-centred care for dementia
in acute care settings National Dementia Congress 20th February
Kaye Ervin
Background
• Action research project
• A volunteer in the aged care facility
identified a need for volunteers in the
acute care setting
• Acute care staff agreed that patients
with dementia presented difficulties
• A previous project demonstrated good
outcomes and feasibility
Utilising volunteers to deliver person-centred
care for dementia in acute care settings
Utilising volunteers to deliver person-centred
care for dementia in acute care settings
Literature review major findings • Currently estimated that 50% of all people admitted
to acute care have some degree of cognitive
impairment [1]
• There is potential for adverse outcomes for these
patients in an acute environment [2]
• Carers and families report widespread dissatisfaction
with care for confused, older people is acute settings
[3]
• Nurses report challenges caring for patients with
dementia in acute care, against a backdrop of time
constraints and competing demands [4]
Utilising volunteers to deliver person-centred
care for dementia in acute care settings
• Translating research into practice
project funding from the Vic/Tas
Dementia Collaborative Research
Centre provided the necessary
resources.
Utilising volunteers to deliver person-centred
care for dementia in acute care settings
The aim of the project was to improve the
emotional and psychological experience and
care outcomes of patients with dementia
admitted to the acute care setting, through; 1. Recruiting and training volunteers in a person-centred
approach to supporting people with cognitive impairment
2. Development of enduring guidelines and policies to facilitate
the recruitment, training and implementation of the
volunteers for a sustainable program
3. Evaluation of the program
Utilising volunteers to deliver person-centred
care for dementia in acute care settings
Project methodology
• Convene an advisory group of key stakeholders
• Recruit volunteers through local media
• Train volunteers
• Develop policies and
guidelines
• Educate staff
• Implement volunteers
• Evaluate the program
Utilising volunteers to deliver person-centred
care for dementia in acute care settings
The advisory group (10 members)
• Research Academic, Director of Clinical
Services, Volunteer, Community
member, Risk & Quality Support, Nurse
Unit manager, Registered Nurses x 4.
• Met fortnightly to oversee recruitment,
selection, training content and develop
and adapt policies from a former project
Utilising volunteers to deliver person-centred
care for dementia in acute care settings
Recruit Volunteers
• Articles in local newspaper and
snowball effect, resulted in 12
community volunteers offering their
services
Utilising volunteers to deliver person-centred
care for dementia in acute care settings
Train Volunteers
• The VAG suggested appropriate content
such as safe walking, meal assistance,
confidentiality
• Practical components included in training
days such as use of wheelchairs and feeding
elderly people
• Principles of PCC
• Training was conducted by an educator over
a two day period, on site.
Utilising volunteers to deliver person-centred
care for dementia in acute care settings
Develop policies and guidelines
• A previous project undertaken by Catherine Batemen
at Bega Health Service provided existing policies and
guidelines
• Many were adapted to suit our service (referral
forms, volunteer documentation, volunteer duty
statement and responsibilities)
• Others were developed to be service specific
(consent, recruitment, patient profiles)
• Very time consuming process!! But essential for
sustainability
Utilising volunteers to deliver person-centred
care for dementia in acute care settings
Educate Staff
• Documents developed or adapted by the
VAG were explained to staff of the acute
ward, and they were instructed in their use
(referral forms, consent)
• Posters and flow charts also instructed staff
and gave contact numbers
• Staff were very enthusiastic
Utilising volunteers to deliver person-centred
care for dementia in acute care settings
Implement Volunteers
• Volunteers nominated attendance times
8-12.30 am and 4-7pm Monday to
Friday
• For the initial 2 weeks of implementation
the research academic was on site for
support and to ensure consistent
practices
• Then available by phone
Utilising volunteers to deliver person-centred
care for dementia in acute care settings
Volunteer role
• Check for referrals
• Complete a patient profile
• Utilise the resource box to engage patients in
activities
• Assist with walking, meals, physio
• Chat
• Document their activities, what worked, what
didn’t
• Liaise with staff
Utilising volunteers to deliver person-centred
care for dementia in acute care settings
Project evaluation
• Limited to qualitative evaluation due to
the small sample size
• Anecdotal reports of improved patient
outcomes (reduced falls)
Utilising volunteers to deliver person-centred
care for dementia in acute care settings
Evaluation
• All staff invited to undertake an interview by
posting an invitation in pigeon holes
accompanied by the interview schedule
• Staff interviews (16 eligible staff during the
two week time period of interviews)
• 93% response rate
• Audio-taped interviews conducted in the
workplace at an agreed time by the research
academic
Utilising volunteers to deliver person-centred
care for dementia in acute care settings
Data Analysis
• Audio-tape transcribed and analysed
collaboratively by the research
academic and an independent
researcher experienced in qualitative
research
• Identified key words and recurrent
concepts
Utilising volunteers to deliver person-centred
care for dementia in acute care settings
Findings -
• Improved time management for other tasks
• Increased patient stimulation
• Increased patient safety
• Extension of the program
Utilising volunteers to deliver person-centred
care for dementia in acute care settings
Improved time management for other
tasks • ….I find it’s a real relief for my staff because they can go and do
the jobs that they need to do without having to spend so much
time with one person. What’s been good is that it’s freed up out
time to continue with our other work and we’re happy to know
that the patients are being looked after.
• …those patients are quite disruptive often and they take up a lot
of our time just redirecting and the things that volunteers do is
engage them, and keep them occupied so that we’re not
spending excessive time with them. That gives us time to go on
with our other work.
Utilising volunteers to deliver person-centred
care for dementia in acute care settings
Increased patient stimulation • We don’t have time to do what they do. They spend one on one
time with people who really need their company. The volunteers
help them pass the time.
• Reading the newspaper to them, it keeps them more focused on
everyday situations, where the nurses don’t sit there and do that
with them. They don’t have time to do that and I think all those
things are worthwhile.
• We can’t read newspapers to them or anything like that. It’s just
good that volunteers can come in and help and spend quality
time with patients, explain things that they might get confused
about and reinforce things that they might forget…..it’s good
continuity because they have the same volunteer for a long
period….having the same person to talk to, I’m sure it helps.
Utilising volunteers to deliver person-centred
care for dementia in acute care settings
Increased patient safety
• We are a small, busy hospital, we can be very busy
and it just really helps with the higher risk patients,
and its also a great support and comfort for them as
well.
• We can get on with our work knowing those people
are safe, where before it was a constant concern, you
know, like “will they fall out of bed while I’m in the
next room?’. Now we have peace of mind that that
won’t happen.
Utilising volunteers to deliver person-centred
care for dementia in acute care settings
Extension of the program
• We are a seven day a week, twenty four hour service
after all. Their confusion doesn’t stop at five pm
Friday. We’d like it too but it doesn’t. After having
volunteers here all week, we really feel it on
weekends now.
• Weekends would be good and visiting people who
don’t have dementia, just those who are lonely or
have no one visiting.
Utilising volunteers to deliver person-centred
care for dementia in acute care settings
Conclusion
• Volunteers are a valuable resource to
benefit patients with dementia by
providing cognitive stimulation and
improved patient safety through the
constant presence at busy times.
Utilising volunteers to deliver person-centred
care for dementia in acute care settings
Sustainability • Driven by the volunteers with
minimal staff input
•Volunteers phone in daily to
ascertain if they are required
•Staff complain loudly if no
volunteers are available
•Monthly volunteer meetings to
discuss issues of concern
•Extended to other patients
Utilising volunteers to deliver person-centred
care for dementia in acute care settings
Implications
• Volunteers are a rich, but under utilised
resource in health service settings
• Process can be easily replicated for any
service size
• Staff, volunteers, patients and families
benefit
Utilising volunteers to deliver person-centred
care for dementia in acute care settings
References • [1]Yates, M., Theobold, M., An all of hospital program to improve the
awareness of and communication with people with cognitive impairment,
linked to a bedside cognitive impairment identifier. . Neurobiology of
Aging, 2010. 25.
• [2]Borbasi, S., Jones, J., Lockwood, C E. , Health professionals’
perspectives of providing care to people with dementia in the acute
setting: toward better practice. GeriatricNursing, 2006. 27: p. 300-307.
• [3]Jurgens, F., Clissett, P., Gladman, J., and Harwood, R. , Why are
family carers of people with dementia dissatisfied with general hospital
care? a qualitative study. BMC Geriatrics, 2012. 12(57).
• [4]Jones, J., Borbasi, S., Nankivel L, & Jockwood, C. , Dementia related
aggression in the acute sector: is Code Black really the answer? .
Contemporary Nurse: A Journal for the Australian Nursing Profession,
2006. 21: p. 103-115.
Utilising volunteers to deliver person-centred
care for dementia in acute care settings
Ervin, K., & Moore, S. (2014).Rural nurses perceptions
of a volunteer program in an acute setting:
Volunteers delivering person-centred care for
patients with dementia and delirium. Open Journal of
Nursing. 4. (http://wwwscirp.org/journal/ojn/)
Further discussion or questions?
© Copyright The University of Melbourne 2008