Occupational Therapy News OTnews July 2019 | Page 45

OLDER PEOPLE FEATURE
This involved a process of observing four elderly care wards
and interviewing patients, staff, and families about their hospital
experiences and what would have made a difference to their stay.
A number of themes were identified, including boredom, social
isolation, loss of independence, limited choice, lack of stimulus, loss
of confidence and poor environment.
Many of these factors became the key drivers for change. The
focus for the Small Acts of Friendship programme naturally evolved
into three areas – group activities, self-care activities and the ward
environment.
Group activities
A weekly activity timetable was introduced on the dementia ward.
Each group was run for one hour by a therapist and a facilitator
and included activities such as art therapy, poetry, a sing along and
reminiscence work.
Working within the Small Acts of Friendship project we were
able to understand more about the person behind the patient. This
enabled us to organise activities with a graded approach, adjusting
the tasks and environment for visual, hearing, cognitive impairments
and non-verbal communication.
Where possible, we adapted tasks to patient’s unique needs and
interests, using resources such as jigsaws, books, games, music,
and sensory objects.
Ultimately, having a diagnosis of dementia does not stop a patient
engaging in meaningful activities, enjoying a social connection, and
learning new or old skills. In one case we had a female patient who in
the past had an interest in poetry; with limited verbal communication
she engaged in the poetry group by listening and occasionally
adding comments.
By the third week, however, the patient was able to read out one
short verse of a poem, which really surprised her daughter.
Although many of our patients on the dementia ward may not
recall the groups, or activities that they have engaged in, they will
however experience being in the present moment, their own joy
of doing an activity, of sharing stories with others, and a sense of
belonging such as holding hands or supporting each other.
We aim to provide a safe environment and opportunity for their
sense of self to shine through.
In one case we had a female patient who in the past was a social
worker, so when she came to our groups she would often care for
others, reassuring them and mothering them.
Nyman and Szymczynska (2016) discuss that activities go
beyond mere pleasure, meeting fundamental psychological needs.
This correlates with findings from the Health Innovation Network
South London in 2017, which described seven outcomes that matter
most to people with dementia, as part of the National Dementia
Declaration.
It included factors such as having an enabling and supportive
environment, feeling valued and understood, and a sense of
belonging.
In one case we had a male patient who participated in our
groups. He would often tell his own life story of being in the Navy
during the war and on one occasion he showed others in the group
how to do Morse code by tapping on the table.
Patients and the Small Acts of Friendship team all enjoyed
listening to him, giving him a sense of being supported and valued.
Some of the themes from the patients and family feedback were
that they enjoyed reminiscing, being listened to, appreciated the
kindness and friendliness of the team, grateful to have participated
in an activity, and to have a forum for humour and social
connection.
In some cases patients wanted an end product, for example
a card that they could enjoy by their bedside or give to their
grandchildren, or a painting to show ward staff or hang on the wall.
Self-care activities
The introductions of self-care activities by the Small Acts of
Friendship team on the elderly care wards – including hairdressing,
hand massage and facials – were also found to improve patients’
mental and emotional states.
The provision of comfort, connection and therapeutic touch
allowed patients to feel more relaxed, reassured and cared for.
This is especially important in hospitals where patients are often
only touched when there is a medical intervention, personal care
or moving and handling. One male patient reported after a hand
massage: ‘You miss these mothering things’.
Edvardsson et al (2010) reported that person centered care was
about ‘promoting a continuation of self and normality’. This can be
difficult to maintain in a hospital environment where patients’ choices
and routines are severely restricted.
It is important to see things from the patient’s view and
perspective, and with the establishment of self-care activities on
wards it enabled better person centred care by giving patients more
opportunities to do likeable things with more choices.
Loneliness can also be a huge factor in hospitals, where patients
may already feel vulnerable and isolated.
Self-care treatments presented patients with opportunities
for one-to-one communication and a forum for therapists to
acknowledge patients’ needs and validate their feelings.
If patients found it difficult to speak, treatments aim to show
communication without words, but with therapeutic touch instead.
Therapeutic touch can communicate so much, but particularly,
warmth, care and connection. This was relevant for some end of life
care patients and their families.
Self-care treatments can positively influence mood and behaviour,
and improve sleep.
Suzuki (2010) evaluated the effects of hand massage and found
that both aggressive behaviours and stress levels fell significantly in
those patients that received it.
Massage can also help improve circulation and reduce physical
aches and pains. Patient’s with arthritic hands or joint deformities
often reported improved function and less pain after a hand
massage.
Mok (2004) found that massage significantly reduced the patient’s
levels of pain perception and anxiety levels.
OTnews July 2019 45