British Journal of Nursing Promoting better care for patients with dementia
Admission to hospital or a visit to a local clinic can be a frightening experience for a patient with dementia who faces interactions with strangers in unfamiliar surroundings. A nursing team on an acute medical ward for individuals with respiratory conditions, or in a busy general practice, simply has little time to assess what the patient wants to communicate and provide reassurance. The SPECAL (Specialized Early Care for Alzheimer’s) method of caring for individuals with dementia can assist nurses and other frontline health professionals in building communication bridges with such individuals, optimizing treatment programmes and outcomes, and saving time. At The Good Care Group, we find the SPECAL method an invaluable component of care. Currently, 75% of our clients are living with dementia and we have delivered clear benefits to the overall health and wellbeing of these people through the SPECAL methodology. Our views mirror an evaluation by the Royal College of Nursing Institute (Pritchard and Dewing, 1999) which underlined the value of the SPECAL method, showing how it enabled elderly people with dementia to be cared for at home longer with greater quality of life. The SPECAL method acknowledges that the person with dementia naturally uses intact memories, often from many decades ago, to assist in making sense of their current situation. The SPECAL Photograph Album (Garner, 2008) is an analogy and a way of helping people to understand how normal memory works, what happens as we age, and a single highly significant change which occurs with the onset of dementia. We learn about a person’s likes, dislikes and motivations by detailed observational tracking using SPECAL Observational Tracking (SPOT). This helps us protect the person’s emotional state.
Bridging a gap
We develop a SPECAL Profile for each of the individuals with dementia for whom we care. This sets out the themes which help to bridge the gap between the person’s memories of the past and today’s activities. By using these memories to provide an acceptable context and state of wellbeing, the person with dementia has a stable, contented position, free from anxious questioning and agitation. The SPECAL Profile also contains the questions that the person is most likely to ask and the answers which have been shown to promote wellbeing. It also includes a tried and tested ‘altruistic trigger’- a bottom line bargaining strategy which is useful when the person with dementia is having difficulty with cooperation. We advocate the following rules.
Do not contradict
Informing and correcting an individual with dementia is counter- productive. It is better to go along with what is being said and join the ‘journey’ that the individual is on as a ‘travelling companion’ rather than constantly reminding the person that he/she has got something wrong.
Avoid direct questions
Remember that questions are requests for information and it is information that people with dementia lack. If the working memory is dysfunctional, new information is often not stored. All questions may cause difficulty, e.g. asking a person with dementia if he or she would like a cup of tea could lead to the patient feeling stressed. He or she might start wondering whether or not it was the right time to have a cup of tea or whether anyone else was having tea. Here, a statement is safer than a question, e.g. I think it might be time for a cup of tea. ‘This offers the person an opportunity to express their wishes.
Actively watch for cues from the ‘expert’
Learn from the person with dementia. Watch for behavioural clues to identify what prompts positive and negative reactions and which particular phrases are best at building and maintaining useful dialogue.
Regard repetition positively
Make use of repeated information and stories associated with wellbeing. Once positive intact memories and activities that bring the individual a sense of contentment or ease are recognized, they can be beneficially revisited at any appropriate time.
If a difficulty arises, opt for saying ‘silly me’ rather than ‘silly you’. If blamed, the individual is likely to lose self-esteem and may retreat inward, becoming less communicative and cooperative.
Use of the SPECAL approach can improve the care given by nurses and other health professionals to patients living with dementia, as well as optimizing treatment programmes and outcomes, valuable time is saved.
Garner P (2008) T11c SPECAL Photograph Album. 3rd edn.
Windrush Hill Books, Hawling
Pritchard EJ, Dewing J (1999) A Multi-Method Evaluation of a Service for People with Dementia. RCNI Report No 19. Royal College of Nursing Institute, Oxford
Zoë Elkins, Head of Care Strategy, The Good Care Group
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