clinical focus these problems. If we can find the cause of the behaviour, rather than just addressing the behaviour, we can treat the cause. So we had a clinical protocol that helped staff determine the causes of behaviours, so they could put strategies in place to manage them.
How is the program rolled out? What do staff work through? The first session of the program focuses on the diagnosis and treatment of depression. Carers examine the prevalence of depression and train staff in using a simple checklist to mark the symptoms. Then, if there are a number of points ticked off on that checklist, they can use the Cornell depression scale or a geriatric depression scale – whatever the facility employs – to determine whether or not the resident has got depression and start the referral process.
The second session of the training program focuses on BPSD – what these challenging behaviours are and their possible causes. It takes staff through a clinical protocol we have developed that helps them determine the causes of the behaviours and possible treatments. If pain is the cause, what can you do about it? If depression is the cause, what can you do about it? If problems with communication are an issue, what can you do about it?
Then there are another four sessions in the program, and those are primarily focused on organisational change, how staff can work better together to implement these protocols around depression and BPSD. You might think gosh, that’ s a lot of sessions to do the organisational change. But the reason we have so many is because it does require the investment of both senior and junior staff. It requires them to, firstly, see that there is a problem with the way the organisation works, then to put in place strategies to address that problem.
They need to own this. If it’ s going to work after we leave the training process, new strategies must be put in place to implement these protocols. Unless there is investment, unless there is ownership, unless the staff work this through themselves and develop a process that works for their specific residential care facility, things are going back to business as usual when we leave. They’ re not going to embed it in practice. We’ ve found that it takes that number of sessions to work things through for the particular residential aged care facility, and find a process for embedding changes in practice.
With consumer-directed care, it’ s the same kind of thing. We’ re not just talking about tinkering at the edges here. We are not just talking about a protocol. If this is going to work, it needs to have the buy-in and the investment from staff right across the agency. There must be a paper trail. There must be responsibilities. There must be communication. It takes a while for staff to recognise they need that and then to put it all into place.
The program led to improvements in the detection and management of depression, and staff involved reported lower carer strain. What were some of the other changes the program brought about? The program did lead to quite significant reduction in challenging behaviours and improvement in referral for depression. Training staff to better handle these conditions led to improvements in the way they managed the behaviour. The program also addressed the way in which the organisation worked. As a result, staff members demonstrated greater trust among their peers, greater communication between the senior staff and the more junior staff, a greater sense of work satisfaction, lower levels of turnover, lower levels of staff absenteeism, and a greater sense of self-efficacy and self-worth within the workplace. Not only did it improve the wellbeing of the residents, but also it led to an improvement in the wellbeing of staff.
What are the key elements of the program that providers should keep in mind if they decide to adopt it or a similar scheme? First, we need to train up staff so they better understand that these are problems and that they’ re able to manage them. Then we need to give them the strategies they need for managing these behaviours. Staff won’ t go investigating problems unless they know the strategies they can use to address them; problems go ignored because workers don’ t know what to do about them. Education is important, training is important, but we need more than that. We need to give staff permission to [ make change ]. We need to give staff time to do this. We need to empower junior staff to talk with more senior staff about their concerns regarding residents, about changes in the behaviour of residents. We need to improve the communication within residential care. The factors that I was talking about before – such as trust and communication – that improved for staff members need to be addressed in
“ a training program. We need to look at the organisational structures within residential care that prevent trust, communication, and the whole sense of self-efficacy and wellbeing for staff members. We need to give them permission to work with residents and one another to change these types of behaviours. At the moment, many organisations are hierarchical; everybody has got their job to do and you don’ t go outside of that work role. There’ s a sense of‘ It’ s not really my job to do that.’ We get things falling between the cracks; whereas, if we were more focused on the resident and the concerns of the resident, and a staff member noted a changed in the resident’ s behaviour, and there was concern within the facility about the resident’ s behaviour, and there was the opportunity to have a discussion about residents and their behaviour or their mood or their needs, then there would be a greater chance of recognition and treatment of those problems.
We need education, but we also need the organisation to change so it can function in a way that encourages this type of detection and management of the problems of residents, so they are happier and the staff members feel more empowered and have more control over their own working life.
It’ s a win-win if we can implement such changes. Sometimes it’ s painful to do it because nobody wants to change the way they do things – it is always difficult. But if staff go through a process of engaging in these kinds of organisational changes, then it leads to better outcomes, and we then have processes embedded that lead to better work fulfilment and care of residents. ■
Training staff to better manage these conditions led to improvements in the way they managed the behaviours agedcareinsite. com. au 25