Home' Australian Ageing Agenda : AAA May-Jun 2011 Contents NWU that having the carer or
a close family member present
reduces behavioural problems.
Carers and family members
generally know what can
trigger behavioural problems
and their presence in the
unit often means the staff
workload is reduced. And the
carers and family also have a
better experience in ED.
Behavioural problems are
often triggered by boredom
and inactivity so the NWU
has invested in a number of
activities and technologies to
keep patients occupied. A large
television with a DVD player
can screen appropriate movies
and patients can also listen
to their choice of music on
headphones. Robotic animals,
especially cats, can have a very
soothing affect on a distressed
or confused patient.
Memory books with familiar
pictures and stories are also
available. We've found that older
males are particularly interested
in our tool box which contains
numerous familiar items
including magnets, chains and
small clockwork mechanisms.
Sharp or heavy items are
excluded from the tool box.
Time passes slowly in ED but
patients are easier to orient
to time of day. The NWU has
several large face clocks, easily
seen from anywhere within
the unit; lights are dimmed at
night, indicating sleep time,
and turned up during the day.
Patients are not discouraged
from 'napping' during the
day but are encouraged to
maintain their natural
We have also placed large
signs saying 'Royal Hobart
Hospital' and recorded the
names of the nursing staff
caring for them.
We recognise that, like
mental health patients and
children, aged patients are
a special group who require
a particular type of care
while in ED. Although work
and development is not yet
complete, we feel we have
made an important and
effective start to better caring
for this group. The next step is
to try and expand our unit.
The University of
Tasmania is currently
researching both the patient
and carer experience of
the Nell Williams Unit. The
concept is also being rolled
out to the general wards
in the hospital, like the
orthopaedic unit, which now
has two dedicated aged care
single rooms that use the
principles from the NWU. n
ED's best asset
The challenges of
acute care for elderly
people with complex
cognitive decline is
being tackled in a
number of ways in
initiative in New South Wales was first established in 2002 and
has since been implemented in a variety of ways in around 50
hospitals across the state.
The ASET principle is to provide specialist multidisciplinary
assessment and care for older people admitted to the
emergency department (ED) and act as a liaison point for family,
carers, the GP, aged care services and other service providers.
The four member ASET team at Wollongong Hospital was
established in 2003, consisting of two clinical nurse specialists
(CNS), an occupational therapist (OT) and a social worker, all
with aged care training. When an elderly person is admitted to
the ED, the ASET team is alerted and swings into action.
"Our ED team is well trained and they alert us immediately,"
says Debbie Clark, one of the CNSs in the Wollongong team.
"The doctors are clued up and we make sure we let new interns
know our role.
"We're working with electronic medical records now and the
admission process has a special icon to click on for an ASET
review," Clark says.
Ironically, the starting point for the ASET team is the end point
of the process.
Social worker on the team, Sarah Foulstone, says they start
with a screening tool to take a history and begin making a
discharge plan for the older person.
"They might have fallen off a ladder and twisted their ankle.
It might be an isolated event or there may be a history of falls.
We might look at possible contributing factors like confusion or
cognitive problems, nutrition or continence issues. They might
need an OT, dietician and physio," says Foulstone.
"Communication is important. If someone has come in from
an aged care facility and they are wandering and unsettled, we'll
call the facility and ask them about the person's history and what
they have done with that resident to settle them in the past. Or we
can call a family member," says Foulstone.
Debbie Clark says a crisis issue is carers. "A fellow might
come in who's had a stroke and can't talk and he's stressed
because he's the main carer for his wife at home. We are
finally getting through to people that they need to identify if
someone is a carer. It is one of the questions on presentation
now and we can organise emergency respite care or
emergency in-home support."
Clark and Foulstone say their job is all about patient care and
advocacy and there is no pressure for bed turnover.
There is an increasing education role for other staff as well
as students. Associate Professor Victoria Trainer, Associate
Director of the NSW & ACT Dementia Training and Study Centre
at the University of Wollongong, has students attached to the
team to learn.
"Most of our education is one on one," says Clark. "We do
a lot of role-modelling and it's so rewarding to see a student or
new nurse, who might have been exasperated the first day, doing
exactly what I was doing and enjoying it.
"We've done two surveys in the last six years and staff have
identified an enormous change and much better patient care. It's
the end point that's important and we do whatever it takes to get
there," she said.
By Keryn Curtis
Sarah Foulstone and Debbie
Clark from Wollongong
Hospital's ASET team
Ian Nethery accepts the
excellence award [photo by
Tony Marsh Photography]
AWARDS AND ACCOLADES
Ian Nethery was Clinical Nurse Consultant with Royal Hobart
Hospital's aged care dedicated allied health team in ED.
He says the ideas for the unit were drawn mainly from the
Dementia Services Development Centre (DSDC) at the University
of Sterling in Scotland; specifically their recommendations about
caring for people with dementia in the acute sector.
In recognition of the Nell Williams Unit's achievements,
it beat over 200 other entries to win the Dementia Design
Innovation of the Year Award at the DSDC's International
Dementia Excellence Awards - part of the 'Coming of Age:
Dementia in the 21st Century' conference held in London in
October 2010. Ian Nethery accepted the award, sponsored by
the Dementia Services Development Trust.
Colm Cunningham, left, was Deputy Director of the DSDC at
Stirling University at that time. Professor June Andrews, centre, is
the DSDC's Director.
AAA | MAY--JUNE2011 | 47
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