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Title: Improving the quality of care for people with dementia
Author: Brooker, Dawn J. R.
Awarding Body: University of Birmingham
Current Institution: University of Birmingham
Date of Award: 1997
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The decade 1987 to 1997 was one of enormous change for the NHS and for the profession of clinical psychology and older people. This tiJesis is a product of this decade and demonstrates various ways in which the quality of services for older people with dementia can be addressed. Evidence-based assessment, especially when working with clients who present with a bewildering array of complex behaviours, is the cornerstone of providing quality interventions. The development of the BASOLL and its psychometric properties are described. It can differentiate between clients with different levels of dependency and is a useful aid to care-planning. The literature on measuring quality of care in formal care settings is reviewed. Dementia Care Mapping (DCM) was highlighted as a way forward. Its role as an audit of the outcome of the care process in formal dementia care settings was evaluated. The results were generally very positive with improvements in the quality of care practice being demonstrated. Although anxious about the observational nature of DCM, staff viewed it as a positive means of improving quality of care. Measuring levels of patient Engagement over a five-year period is also described. An overview of the general findings is provided. The advantages and disadvantages of DCM and Engagement as tools for improving quality of care are compared. Whilst DCM is seen as more costly in terms of initial investment, the resultant quality of data is superior when the quality of individual care is the main consideration. Engagement levels may suffice if all that is required is an overall indicator of service quality. Structured interviews were conducted with eighty-five staff and seventy-five service users to obtain qualitative feedback and suggestions for improvement in services over a five-year period. An analysis of the percentage of positive and negative comments enabled the general satisfaction of the respective groups to be compared. Generally service users were more positive about the physical environment and standards of professional care than staff, but less positive about issues of privacy, social interaction and empowerment. Both series of interviews led to a number of positive changes in the quality of care. The importance ofthe single case study approach with this client group is discussed. The effects of aromatherapy and massage on disturbed behaviour in four individuals with severe dementia were evaluated using a singl!) case research design. The opinion of the staff providing treatment was that all participants benefited. On close scrutin~ only one of the participants benefited according to the criteria chosen. In two of the cases aromatherapy and massage led to an increase in agitated behaviour. A new computer-assisted tool (CARJE) for the management of continence in people with severe dementia is described. The records it produces can be used in the development of care plans incorporating prompted voiding. Two single case design research studies are described. The length of time that both participants spent wet dramatically decreased when staff had access to the CARJE records and signals. Using the records assisted staff in managing continence through improved careplanning. The results ofthese papers taken together help to provide a way forward in the complex area of quality management for older people with dementia. Their place within the "New Culture of Dementia Care" is discussed.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available