A student at the University of Greenwich has developed an app for iPhone and Android phones, in addition to a web application on the internet, to help assess the level of pain being experienced by someone unable to communicate.

The app which uses the Abbey pain scale, takes the user through a series of questions, for which the user selects the most appropriate answer from a set of answers displayed on the device screen. The flow of the questions varies according to the answer to questions provided at each stage. As the application completes each question, a pain profile is being built in the background. If the user is unsure how to answer a question then additional guidance is provided at each stage. At the end of the assessment the application provides feedback to the user on the steps they should take next.

This is a link to the online version of the app: http://cms1.gre.ac.uk/gwizards/pain-app/

“Of all of our inventions for mass communication, pictures still speak the most universally understood language.” said Walt Disney.

Well, he would say that wouldn’t he. But the point he’s making is a serious one, and that was what I was rather clumsily trying to explain to a care home manager recently, when she asked why we bothered with the symbols on our charts. Of course, anyone can stick a white board on the wall and write up the information a carer needs. But are they really going to scan through everything to find the bit that would help them at that moment?

I used to work in print and marketing in a previous career and I was taught many years ago that we have lazy eyes. We need continual stimulation to make the effort to keep reading. That’s why even the most exciting page-turner needs paragraphs. And how many times have you taken a quick look at what promises to be an interesting magazine article only to decide you just don’t have time to plough through it? A different typeface or layout might have given you the encouragement you needed… perhaps a picture to break up the text.

In using symbols on our care charts, not only are we making it quicker for carers to find a specific piece of information they need about an individual, but we’re encouraging them to read on. Perhaps they’ll find some information that provides an opportunity for a conversation with the resident, maybe it will prompt them to update an entry so as to inform other carers. And underpinning it all is the reminder that each individual has a unique set of needs that a carer needs to know about if they are to offer dignified and person-centred care.

The principles are the same for our Because-I-Care Daily Prompt Posters. Would the words have the same effect by themselves? After all, the images we’ve chosen aren’t exactly informative. But they are eye-catching, fun and memorable. They drive home the message that the words impart.

If you think there are other symbols we should include on the charts please let us know, either by leaving a comment below or by emailing feedback@carechartsuk.co.uk

 

I was troubled by a comment a manager made recently during a telephone conversation we were having to decide on which charts would work best in her environment. She was rightly proud of the extensive refurbishment the home had undergone, but I don’t think she was any more comfortable than I was by the instruction from the owners that nothing was to be put up on the newly painted walls. It’s not really an issue for our charts because we have sizes suitable for the wardrobe door or similar, but I thought how sad it was that residents, or families on their behalf, were not allowed free rein (within reason of course) to reflect their personality, their lifestyle, their individuality in the one place they can call home. They are, after all, paying for that space one way or another. I wonder whether this might be a policy that backfires anyway. The owners want their home to look beautiful, but might prospective clients not see the inability to personalise the rooms as a negative point?

What do you think? Are there valid reasons for keeping a tight control on what can go on the walls of a resident’s bedroom?

This is a great resource for anyone needing guidance or to assess how well they are doing in involving people living with dementia.

These resource cards have been written by people living with dementia, carers, volunteers, staff and Local Involvement Networks (LINks) HealthWatch. Their aim is to strengthen and directly involve people with dementia as well as their families and carers.

The focus of these cards is to provide tools and techniques for staff to facilitate and support people to express their preferences, get involved in activities whilst recognising their current abilities.

Link to Making Involvement Count via the Dementia Partnerships website.

My experience of computers stretches back to the days when we expected desktop computers to radically reduce the amount of paper we use, yet here we are, printing on to more of the stuff than ever before – we’re using literally tons more paper than we did in the early 80s.

So technology hasn’t done away with paper yet, but there’s a suggestion that the new generation of handheld computers might finally do it. And it might for some tasks, but we should get used to the idea that there are some jobs for which paper is still the best option and stop considering it the ‘old fashioned’ alternative. They’re both tools, and each has its place.

I couldn’t stand the idea of going back to a paper-based address book, for example, but if I want to share information with people, some of whom may not have access to a computer, I’m very happy to pin a notice on the board, stick a scribbled note on someone’s desk or print a list to hand out. And because I don’t want to give everyone unlimited access to my computer I’ll print out the information I want to share, and keep the rest private.

And perhaps that’s the point… at the risk of simplifying things a bit too much, computers create barriers whereas paper breaks them down. If we try to narrow everything down so that all the information we need is available on a handheld for example, we immediately create a distinction between those who have access to information and those who do not. And here I’m thinking of our Care Charts of course. The needs and preferences of an individual should be instantly available to any visitor where that knowledge will make a difference to the care provided: doctors, cleaners, kitchen staff, agency staff, bank carers etc. Even in the unlikely event that you could place a handheld into the hand of each of these people, you have still left behind the family members and friends who might like to use the chart to leave a message or update some information, and how about the resident themselves? We know of many care homes who involve residents in the completion and updating of their charts. It’s another opportunity for interaction and communication with the individual – and that would be lost if everything a carer needs to know is uploaded to a handheld.

The latest technology can make light of many tasks, including the updating and storing of care plans and medical records. Indeed, we have ideas in development that make use of computer technology ourselves. But in attempting to apply technology to every task we risk losing the benefits of the paper alternative: the opportunity to share information, encourage discussion and create opportunities for communication.

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If anything remotely similar to our charts had existed three years ago, I’d have found it. I scoured the internet and the high street to find something that could provide me with the reassurance that my husband’s carers would be reliably informed and kept up to date about his needs and preferences. It seemed such a no-brainer to me that he deserved this effort to get the details right; there was very little opportunity to give him any quality of life at all, and the least I could do was empower the carers to make his life as comfortable as possible. Guilt played its part of course, it always does with us family carers who finally have to admit that we can’t cope by ourselves.

The care home had generated a care plan for him of course. But all I could see was a sheaf of papers in a file that was supposed to be read and digested by a large group of busy people, some of whom did not have English as their first language.

I was offered whiteboards, note books and computer programmes, but none of them was as effective as the scribbled notes I started sticking to his bedroom wall out of desperation. I started using symbols to catch the carers’ eye and allow them to find the information they needed quickly and easily, and then introduced a wipe-clean surface because when things changed I wanted it to be easy to update the information, sometimes on a daily basis.

When the care home approached me to produce more wall charts for their other residents, I introduced one further element: prompts to help carers and family members provide relevant information. I knew how difficult I had found it when presented with the request for information about Geoff. It had taken me a number of weeks to bring to mind things I hadn’t initially thought about which could make a difference to the quality of his care.

I was a daily visitor to that care home for 13 months. During that time I saw how giving carers information about the individuals they were caring for worked at a level so much more profound than just ensuring they put the correct amount of sugar in their tea. It reminded them that these were people who had families, interests, careers, had travelled, loved, lost, had happy and sad memories, just like those of us lucky enough not to have to live in a care home. I am painfully aware that ‘person-centred care’ has become a cliche too casually bandied about, but if used well, these charts can facilitate person-centred care in the manner Tom Kitwood envisaged so many years ago, exhorting carers to: “treat others in a way you yourself would like to be treated”.

One afternoon, whilst I was visiting my husband in the care home in which he spent the final 13 months of his life, a girl I hadn’t seen before pushed the tea trolley into his room, and asked me how Geoff took his tea. He’d been there a while so I was fairly sure she was new. “The chart on the wall says how he likes his tea,” I point out to her. “Oh yes!”, she says, “I didn’t see that!” She had been working her way down the corridor, so I knew she must have been into at least 6 rooms prior to Geoff’s, and each one of them had a Care Chart clearly visible once you were in the room. She’d have seen them eventually, but had they been mentioned in her training, the home would have had an employee better able to do her job from day one.

The story has a happy ending. A few days later I saw her again, and she was bubbling with enthusiasm. “I’ve been able to have all sorts of conversations when I go round with the tea trolley,” she explained, “because I can ask the residents about the members of their family that are on the chart, and talk about their hobbies, or even just comment on their favourite food or TV programme. Without the chart, it would be difficult to think of something to say.”

I couldn’t have put it better myself!

It’s always a pleasure to receive confirmation that our Remember-I’m-Me Care Charts truly make a difference, and particularly so when it helps a care home implement changes requested by their CQC inspector.

A manager in Kent recently purchased the charts (Standard: RIMWC01) in response to a CQC request that they improve the choices available to residents: preferred bedtime, what did they like to be called, favourite foods… exactly what our charts are designed to record. The carers like them because the knowledge they gain about a resident empowers them to provide more personalised care, the families like them because the chart allows them to stay involved and offer help. It all results in a better quality of life for the resident… and if they have a good quality of life, then so does everyone else around them.

Whilst I was at my mother’s hospital bedside a few weeks ago, being given rather more detail than I wanted about the operation to fit her new hip, I was given a wonderful demonstration of why our latest product can play such a valuable role, and not just to help with dementia sufferers either.

My Mum is a feisty lady and sharp as a pin, but she was tired and woozy and for the first few hours it was a struggle for her even to string a sentence together. Because of possible complications she was kept in intensive care for a couple of days and the staff were wonderful, friendly and extremely attentive. But other than a list of medical needs there was nothing for them to refer to about those other issues that might help them interact with their patient and understand her needs.

Her name for starters. Officially Elizabeth but she’s always hated that so has been called Liz for well over 70 years, yet there was nowhere to make that clear. I could sense her exasperation when, in quick succession, she was called Elizabeth, Lizzie and Jean (no idea where that came from). When I was there I could correct them, but if she’d had a Pocket Chart stood up on her bedside table it would have been there for all to see. They’d also have known that she was anxious to get her teeth back in place, they could have provided her with her preferred hot drink and my contact details would have been available, all without them having to ask.

Just one more thing. I had a chat with one of the intensive care nurses about what sort of information they might like to see. I assumed they wouldn’t want to be bothered with details like past pets and favourite hobbies. On the contrary. They want to know about the person they are looking after, in exactly the same manner as carers do. It helps them to remember the people they are caring for are human beings with needs and preferences like the rest of us, not just a list of symptoms.

Click here to order a pack of Pocket Care Charts now.

The habits of the chimpanzee may not be the usual topic for a talk on activities for older people, but you can always rely on Sylvie Silver to check we’re awake and concentrating. The Director of NAPA, the National Association for Providers of Activities for Older People, gave a fascinating talk at the Showcase for Social Care event in Brighton on 13th March, which clearly forced a large part of the audience to re-think some of their ideas.

Sylvie’s comment about the chimpanzees was in relation to research undertaken on various species of animal as to the size of group in which they function best. And yes, that includes humans, and the answer for us is… 4. So why, Sylvie asked, do we insist that care home residents will be happiest when herded into the lounge and forced to take part in some group activity in which they have never shown a previous interest? Of course she was not saying it would never be an appropriate thing to do, but it certainly made me re-adjust my sense that residents being left in their own room is a failure on the part of the care home. Not at all. Would we not all choose to remain within our own space, our own possessions around us, for most of the time?

Which leads on to another of Sylvie’s points, the importance of treating a resident’s room as their home (which happens to be one of the topics in our set of daily prompt posters). She mentioned a home which had fitted door knockers on each resident’s bedroom door, to reinforce the idea that one was going in to a person’s home. I love that idea, though I can see it wouldn’t work in every environment or for every individual.

And of course it’s the fact that every person has different needs that was at the heart of Sylvie’s talk. Where one person can get delight just watching clowds drift by, she reminded us, another would find sky gazing tedious and nonsensical. The activities board on the wall has its place, but a person’s ‘activities’ is everything they do from morning ’til night.

Thanks, Sylvie, for an excellent talk.