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Supporting Dementia and Delirium Care with Volunteers

Southern NSW Local Health District
Project Added:
11 March 2015
Last updated:
25 March 2015

Supporting Dementia and Delirium Care with Volunteers

Summary

In partnership with Alzheimer’s NSW, volunteers were recruited and trained for a structured person-centred dementia-delirium hospital volunteer program. 

The volunteer intervention provided one to one emotional support and practical assistance aimed at reducing delirium risk to patients with cognitive impairment. 

There was a trend towards reduced falls at the volunteer intervention facility. The program was highly accepted with 96% of staff and 100% of volunteers perceiving the program as having a beneficial effect on patient outcomes and should continue. 

Aim

To enhance the emotional care and security of hospital patients with dementia and delirium (or those at risk of delirium) and reduce their risk of adverse outcomes.

Benefits 

  • Person centred emotional support and practical support for patients with cognitive impairment in hospital.
  • High acceptance of the program from staff and volunteers with perceptions of improved safety and quality of patient care.
  • Improved support and assistance for staff in the care of these patients.
  • Volunteers felt valued by patients, carers and staff and perceived their role to be worthwhile and rewarding.
  • Trained volunteers can positively support and assist in the person centred care of hospitalised patients with dementia and delirium.

Project Status

Project dates: 2009 - 2015.

Project status: Sustained - The project has been implemented, is sustained in standard business.

Background 

Older patients with cognitive impairment are known to experience fear, anxiety and increased confusion when admitted to hospital1,3.  They are more susceptible to falls, functional decline, delirium, prolonged length of stay, premature nursing home placement and death4,8.   

Staff stress can be greatly increased in the care of confused older patients with lack of time to support the necessary emotional care and safety needs highlighted1,2

The use of volunteers in health care settings is wide spread and supportive to many organisations12.  Direct correlations have been found in the relationship of formal volunteering and the benefits to the physical and mental health of those who volunteer10.  

The use of volunteers in hospitals has been shown to be cost effective and result in increased levels of patient satisfaction5. Increasingly the use of volunteers has been promoted as a supportive adjunct to care for patients with dementia or delirium but with limited empirical support6,11

The outcomes of 64 patients receiving the volunteer intervention at Bega Hospital over six months were compared to a control group of 53 patients at Moruya Hospital.

Implementation 

In partnership with Alzheimer’s NSW an intervention using trained volunteers to provide emotional support and practical assistance to patients with cognitive impairment was established and implemented at Bega Hospital. Outcomes were measured for patients, staff and volunteers.

Planning and implementation 

Communication about the program implementation occurred through an existing hospital dementia care working group, represented by key aged and dementia staff and the Nurse Unit Managers (NUMs).  Weekly discussions were held with the NUMs and monthly feedback meetings with the volunteers were conducted throughout the implementation phase. Rolling staff information sessions and promotion through posters and ward meetings were held in the month prior to the program starting.

Key milestones

  • Development of volunteer duty statement and volunteer information and application pack.
  • Media program promotion and volunteer recruitment.
  • Training program over four days. The training consisted of eight sessions plus an additional day for mandatory hospital education. Sessions on dementia, delirium, gentle exercises and safe walking, assisting with menu completion and food choices and positioning and feeding patients were included.
  • Writing of a Staff and Volunteer Procedure and Resource Manual.
  • Volunteers started on 5 May 2009.
  • Data collection occurred from May - December 2009.
  • Data analysis and report write up January to June 2010.

The volunteers provide supportive care over two shifts, five day per week. The morning shift is from 8am-12.30pm and the afternoon shift is from 3pm-7pm. The volunteers assist the patients in two ways.

Firstly, they support the patients emotional needs through such things as one on one emotional care, supporting interactions with others, gentle hand and foot massage, and engagement in therapeutical activities.

Secondly they provide practical assistance and implement delirium risk reduction activities such as assisting with and promoting hydration and nutrition, promoting gentle exercise, assisting with vision and hearing aids and supporting orientation. A personal profile, completed on each patient provides information to support a person-centred care approach.

The dementia delirium hospital volunteer intervention was successfully introduced and maintained for the six month period of the study at the intervention facility.

  • The program was highly accepted with 96% of staff and 100% of volunteers perceiving the program as having a beneficial effect on patient outcomes and should continue.
  • Staff and volunteers perceived positive patient outcomes especially related to improve hydration and nutrition, patient safety and emotional care. 
  • There were less falls (in number and occurrence) at the intervention facility but no statistical significance was found in length of stay, falls, use of antipsychotic medication or death rates. 

There were limitations to these findings on patient outcomes as the intervention and control were not matched on all demographic variables. 

The Tathra Ladies Hospital Auxiliary sponsored the program providing resources for the purchase of the volunteer uniform which is a gold polo T-Shirt, program activity resources and additional resources to support a more dementia friendly hospital environment.

The hospital was committed to supporting the program continuation.

The volunteer program continues six years post implementation with ongoing high acceptance by staff and volunteers. Replication has occurred in other rural hospitals. In 2013 the Agency for Clinical Innovation funded the development of an implementation and training resource to support further replication in NSW hospitals. 

Further roll out of the program in Southern NSW LHD with research into carer and patient outcomes and a cost analysis is to occur from 2015 - 2017.

Partnerships

  • Alzheimer’s NSW
  • Agency for CIinical Innovation (ACI), Aged Health Network.

Implementation sites

Bega Hospital.

The program has since been replicated in Pambula Hospital, Cobram Hospital (Victoria), Maitland Hospital and Nepean Hospital. 

Lessons Learnt

  • The importance of engaging wards staff such as Registered and Enrolled Nurses in the planning phase and staff education about the volunteer role. 
  • The necessity for project leadership resources for 3-6 months for establishment and implementation. 
  • A governance structure and ongoing volunteer coordination resources are essential to maintaining volunteer programs. 
  • The benefits and importance of volunteer and staff feedback for ongoing program improvements.

References

  1. Borbasi S, Jones J, Lockwood C, Emden C (2006) Health professionals’ perspectives of providing care to people with dementia in the acute setting: toward better practice. Geriatric Nursing, 27 (5) 300-307.
  2. Byers D C & France N E M (2008) The lived experience of registered nurses providing care to patients with dementia in the acute care setting: a phenomenological study. International Journal for Human Caring 12 (4) 44-49.
  3. Cunningham C & Archibald C (2006) Supporting people with dementia in acute hospital settings... first in a series of five. Nursing Standard 20 (43) 51-55. 
  4. Hill, K. D., Vu, M., & Walsh, W. (2007). Falls in the acute hospital setting - impact on resource utilisation. Australian Health Review, 31(3), 471-477.
  5. Hotchkiss R B, Fottler M D, Unruh L (2009) Valuing volunteers: the impact of volunteerism on hospital performance. Health Care Manage Review 34 (2) 119-128. 
  6. Jones J, Borbasi S, Nankivell A, Jockwood C (2006) Dementia related aggression in the acute sector: is Code Black really the answer? Contemporary Nurse 21(1) 103-115.
  7. Kitwood T (1997) Dementia Reconsidered: the person comes first. Buckingham: Open University Press.
  8. King, B., Jones, C., & Brand, C. (2006). Relationship between dementia and length of stay of general medical patients admitted to acute care. Australasian Journal on Ageing, 25(1), 20-23.
  9. Nolan L (2007) Caring for people with dementia in the acute setting: a study of nurses' views. British Journal of Nursing 16 (7) 419-422.
  10. Onyx J & Warburton J (2003) Volunteering and health among older people: a review. Australasian Journal on Ageing 22 (2) 65-69. 
  11. Schofield I (2008) Delirium: challenges for clinical governance. Journal of Nursing Management 16(2) 127-133.
  12. Warburton J & Cordingley S (2004) The contemporary challenges of volunteering in an ageing Australia. Australian Journal on Volunteering 9(2), 67-74.

Other resources 

  • Bateman, C (2012) Research into Practice: Volunteers improving person centred dementia care in a rural hospital. An Intervention Study. University of Canberra Digital Thesis. Available at: http://www.canberra.edu.au/researchrepository/items/6d6d1b04-832c-ab2f-ddd1-4626cff49c5f/1/

Contact

Cath Bateman
Substantive position:
Dementia Delirium Clinical Nurse Consultant 
Southern NSW LHD 

Current secondment 30 June 2015:
Confused Hospitalised Older Persons Project Officer
NSW Agency for Clinical Innovation
Phone: 0418 612 580
Catherine.bateman@health.nsw.gov.au

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