Some 4N - ACE unit team members
We've heard it before: the senior's population in Canada is on the rise, and the community of Richmond is leading the way—with 70 percent of patients seen in the 70-year-or-older age bracket. With an increasing population of seniors in our community, caring for clients with dementia or other cognitive challenges is a reality that we, as health care professionals, have to prepare for. From specialized units to education on working with patients with cognitive challenges, there are many ways we can improve patient care to make it safe both for patients, and for our staff.
Enter, the Gentle Persuasion Approach (GPA). This evidence-based practical course, teaches participants to fully understand responsive and protective behaviours in order to be able to respond effectively and appropriately in the care setting. With the creation of Richmond's Acute Care for the Elderly Unit (ACE), clinical nurse educator, Audra Leopold, wanted to find a way to educate staff on her unit about how to work with their new patient population.
“We have many patients with dementia, delirium, other cognitive challenges that require a different approach, so I thought this would be beneficial," she says. “Patients often aren't able to verbalize what they need and sometimes due to frustration or anger, this can come out as physical or verbal actions which may be interpreted as violent or aggressive actions. The course helps to identify some of the warning signs ahead of time, how to work with the patient to identify the unmet need, and how to help families understand the behaviours better."
GPA uses person-centered, respectful, compassionate, and gentle persuasive approach to respond to the responsive or protective behaviours which can be seen with some patient experiencing cognitive challenges. It teaches health care providers to recognize warning signs and triggers in their patients—such as verbal language and gestures—to gain a better understanding of the patient's mood in the moment.
“When you're actually listening to a patient and looking for those cues, it can make all the difference to the care of the patient and the safety of the staff," says Audra. “Once you've recognized the warning signs, you can stop, take a few minutes to observe the situation, discuss with the patient and make a plan together."
Thanks to funding from the Kronier Fund, Audra is now a certified GPA coach—and has already hosted three successful training sessions with staff on her unit since September. The goal? To train all 48 ACE unit staff on the GPA technique by December, 2019.
“I'm proud of the team and the care which they have provided to our patient population thus far, and this a good tool for them to have in their toolbox," she says. “Through this training, I hope staff will feel comfortable to recognize and take action before behaviours escalate. It will help our patients to feel they're being heard, and families will feel more secure in leaving their loved one in their care team's hands. It's a win-win for all."
Here's what some of the staff have had to say so far about the training:
“It's allowed me to widen my understanding of patients and clients point of view, their behaviour, and emotions" - Ione Skye Ravina, LPN
“I learned that each patient is different, and that each one needs a different approach to care" – Josie, RN
“Since taking the course, I won't get as stressed as before because I know what actions to take and what care to give" – Michiyo Shishido, RN
“The training has helped me understand dementia patients better and how to avoid injuries" – Grace, RN
“I learned how to care for people with dementia in a gentle way with a calm approach"
Created with funding from Richmond’s Kronier Family through the Richmond Hospital Foundation, the Kronier Family Education Fund supports staff learning and education to strengthen clinical practice and improve patient, client or resident care and safety. Funding is available to all staff, leaders and physicians who provide care, or some aspect of care, in Richmond. Awards are granted throughout the year.
To learn more or to apply for funding, visit vch.ca.