Promoting Resilience in Dementia Care: Small Acts, Big Impacts
Dr Julie Christie
When I decided to focus on resilience as the subject of my PhD little did I know how relevant the topic would be. We have all had to be resilient in ways we never imagined. Resilience is associated with bouncing back from adversity, thriving despite obstacles, and is often used in our work and professional lives to help us deal with challenges in nursing and caring roles. Things like not having enough time to undertake personal care tasks, or feeling overwhelmed, or that you lack the necessary skills to carry out your work. When we work closely with people who are experiencing pain, stress or distress we can become distressed too or experience compassion fatigue as a means of coping. Resilience can help us make sense of these things and help us to self-care and respond. It is the process of using personal resources to find solutions to challenges. Doing this helps us to find a way through, whilst holding onto our values and the things that make us feel like us (our self-image or sense of self). We feel a sense of achievement when we overcome an obstacle (we call this coping). This in turn makes us feel like we can manage if we come up against other challenges in the future. And it’s this process – the sense of confidence in ourselves over time- that is ‘resilience’.
It was this perspective on resilience, as an everyday practical tool that anyone can use, that led to the question ‘could resilience be helpful in the experience of living with dementia?’. Often people living with dementia can have their actions and intentions mislabelled as distressed behaviours or misidentified as symptoms of dementia. However, if we think about dementia as a challenging life event, as any health problem is, is it possible that the person is finding a way to cope, but that we can’t always understand what they are doing? Resilience can help us to problem solve and see everyday life from the perspective of the person with dementia and this is the subject of my book Promoting Resilience in Dementia Care. In it I focus on small acts that can have a big impact using three building blocks of resilience – meaning making (making sense); connectedness (to self and others), and (having) a sense of mastery and control (over events, people, the environment). Using these to think about our practice can build the resilience of the person with dementia and make us aware of how the things we do can also lessen resilience.
Care is a series of micro activities, those small acts that can make a big difference to the people that we provide care to. They include how we approach the person, taking the time to acknowledge their presence and undertaking practical care tasks with skill and consideration. We provide support and continuity through difficult periods, deterioration in health, bereavements, separation from family and friends. In addition, we provide professional care, help with medication and other health conditions, and attend to the clinical needs of people with dementia when they arise. These small acts combine to create the experience of care and have a big impact. Using the three building blocks can help provide an anchor for activities to ensure we build resilience. Let’s take approaching someone as they wake in the morning as an example. Meaning making might include taking the time to introduce yourself, to tell the person where they are and what time it is. You might open the curtains to let in the daylight to help orientate. You could give the person time to come to and to ask any questions they might have. You could then share what is happening next, for example, “it’s time for breakfast and I’m here to help you get washed and dressed”. A sense of mastery and control could include, asking the person what they would like to wear, what they would like for breakfast, or how you can help them.
It is possible to offer a limited choice if open ended questions prove difficult, to use pictures of items that people can refer to, or to physically show the choices on offer. Moving at the person’s pace also helps to create a sense of being in control. Connectedness can be facilitated by having familiar items around, using these items in conversation, talking to the person about the friends they have in the care setting who they will be sharing breakfast with. All these small acts convey the value of the person and promote a sense of self-esteem and self-efficacy.
In busy care environments preparing for these ‘small acts’ in advance can be useful. In contrast consider the impact of rushing the person into the bathroom in the morning with no time to understand why (no meaning making opportunities), dressing the person in the clothes you have chosen and rushing from task to task (sense of mastery and control is lost) and assuming the person recognises the care home setting without taking time to re-orientate them (loss of connection). As a response, the person might then become stressed, disorientated and/or resistant to care. These behaviours can then be viewed as symptoms of dementia and documented in the person’s care record as ‘aggression’ or ‘refusal of personal care’ as examples. The three building blocks of resilience therefore provide us with a simple way to think about resilience, our role, and how to avoid the things that detract from it.
Importantly, we can learn about ourselves by thinking about the resilience of others. We can use the building blocks to:
- build relationships and value the time we have with the person with dementia
- think about behaviour and what the person might be communicating
- think about the impact of the environment and how it helps and hinders
- think about the person’s family and the importance of community connections
- reflect on our own learning and development needs
- convey what we need from our employers to provide great care
You can learn more about resilience and the building blocks in Promoting Resilience in Dementia Care. Why not try using them to build your own small acts of care and together we can create shared stories of big impacts.
Promoting Resilience in Dementia Care is written by Dr Julie Christie. Published by Jessica Kingsley Publishers 21st Feb 2020. Buy your copy here.