30th October 2019 Maria Donnellan, the multi-disciplinary team, and her mother accepting an award at the Community Healthcare West Staff Recognition Awards ceremony from Tony Canavan, Chief Officer, Community Healthcare West.
Dementia can take away so much from a person but a new initiative at a community care home in Galway has given their residents back their own ‘life story’.
Life Story books were created for each person with dementia living in the Creagh Suite in St Brigid’s Hospital, Ballinasloe, to discover more about them, their lives, likes and dislikes, relationships and interests. It has promoted greater empathy and understanding between them and the staff that care for them.
The Creagh Suite is home to older adults with a dementia diagnosis as well as a history of mental health difficulties.
“For some of the residents, St Brigid’s has been home for many years and memories of their earlier lives are forgotten or rarely accessed. The aim of the Life Story book initiative was to discover more about these residents. For each resident, a physical Life Story book was developed, containing photographs, stories from their youth, details of their childhood and major events and relationships in their lives,” said Maria Donnellan, CNM 3, Psychiatry, at the hospital, who leads the project.
The process of obtaining this information from family and friends resulted in increased visits and parcels to the ward, as well as deepening our knowledge and understanding of the residents that we work with every day. We use the Life Story books to engage residents by looking through photos or talking about aspects of their earlier lives. The books also help us understand the needs and preferences of residents, especially when verbal skills may be limited. As such, we can adapt their environment or activities to better suit their individual interests and needs.
“Life Story books have helped us see beyond the dementia and mental illness to the person, and this naturally promotes greater empathy and understanding between staff and resident.”
Dr Diane O’Mahoney, clinical psychologist, explained how information for the books was gathered.
“You put in lots of information about the person’s early history, where they were born, where they lived, where they went to school, how many siblings they had, what their parents did and so on. For instance, if we knew somebody was a school teacher, we could ask what were the rhymes you used when you were teaching kids, were any of the kids good, were they bold, what kind of outings did you have. If somebody was a nurse, we would talk about the training they had. If they are non-verbal, you can find out about what the training would have been like back then and talk to them about it or show them photographs from settings they may have been in,” she said.
Back in 2016, Maria Donnellan returned to college to further her professional development. Part of the course was to explore new ways to develop person-centred care. She put forward the idea of the Life Story books to the dementia multi-disciplinary team (MDT) at the hospital, who gave the project the green light.
A proof of concept was presented to the MDT so that all relevant professional could give their input. They all volunteered their individual skill-sets so as to aid in the development of a working, content-based system to construct the Life Story books.
“The Life Story book has allowed us to identify many of the likes and dislikes of the residents as well as interests and hobbies they may have had. This valuable information now allows us to tailor the care we provide and helps preserves the personhood of the resident,” said Maria.
“This accumulated insight into the life of the resident has also led to more harmonious work environment. Now staff report feeling more connected on a personal level and are more mindful of the things that make these residents people they can identify with. Residents presenting with challenging behaviour are now beginning to be viewed in a different light, where once viewed as troublesome, are today seen as someone with something troubling them.”
All this has been done without the need for extra funding. In the long-term, according to Maria, this initiative could be cost-saving as incidents relating to challenging behaviour reduce, and residents’ quality of life is enhanced by understanding their individual needs and wants.
The work Maria has done in implementing these Life Story books into residents care plans has helped identify issues and highlight information that could never have been obtained through traditional methods. In many cases, residents have being reunited with friends and relatives they have not seen or spoken to in years.
“We have received photos and items relating to residents when they were only small children and some of these items have come from as far afield as America. I have documented interviews with these long lost friends and relatives as they recalled their childhood memories from when they were close,” said Maria.
The Mental Health Commission has commended this initiative on the last two visits while expressing how they felt moved by the archive of the patients’ lives. The Commission also remarked on how well the Life Story book was being implemented into the care plan. Due to Maria’s work, the Life Story book is now reflected in the therapeutic and recreational time table.
While on a visit to the unit Helen Rockford Brennan, chair of the working group for dementia in Europe, recognised the work Maria was doing and invited her to speak because she was working as a change agent and a champion in the organisation.
The recent Mental Health Commission report found that there was ‘excellent overall compliance’ with regulations at 97%, an improvement from 73% in 2018. Fourteen compliances with regulations were rated excellent.
Commenting on the reports, Dr Susan Finnerty, Inspector of Mental Health Services, said, “It is heartening to see Creagh Suite reaching such a high level of compliance. This provides an example to other approved centres and holds out the hope for patients and families that high levels of compliance are possible and can be achieved.”
Maria paid tribute to the nursing staff on the Creagh suite who work ‘above and beyond the call of duty to deliver such a high standard of care.
“Anyone can have an idea for change but without the frontline staff, nothing can be achieved. All staff have a life story to tell. We are all individuals as our patients are.”