RORY’s VALUES
Dementia-friendly clinical areas
© 2014 MA Healthcare Ltd
O
ver the last year, a number of areas in the NHS across all of the four countries have been criticised for poor environments for people with dementia. So how have you, as a nurse, assessed your clinical area and deemed it appropriate for your patients with Alzheimer’s/dementia? There is no doubt that the accident and emergency (A&E) department is very often the first point of contact for patients with Alzheimer’s/dementia accessing secondary care. Owing to the fast pace and loud noises of emergency care, these areas are the most challenging faced by people with dementia and their carers. My experience has shown me that if this experience is poor for the patient and their carer/ family, it increases their stress levels and makes it more challenging to communicate effectively. However some A&Es—for example, St Mary’s Hospital in Paddington, London—have a designated cubicle identified in a quiet but visible part of the emergency department for patients with Alzheimer’s/ dementia. It was decorated using tranquil colours, low-level pictures and a large clock face with a sun and moon pertaining to night or day. Clinical equipment in the room was reduced and relaxing music was provided. The toilet signage was improved to be dementia-friendly, that is, a picture of the toilet beside the word ‘toilet’.These changes were replicated in the admissions unit to reduce transfer trauma. A tool has been developed to help nursing teams audit their clinical areas in acute hospitals. The Dementia Design Audit Tool Part 2: Workbook, produced by the Dementia Services Development Centre at the University of Stirling (2011), can be used to benchmark new build or current facilities against the environmental standards for dementia. The workbook covers the following areas of a clinical facility: ■■ Ward entrance and way-finding ■■ Lounge/day room ■■ Meaningful occupation and activity in the ward or department ■■ Single rooms, bed bays or Nightingale wards ■■ Toilet areas including ensuite ■■ Toilet area that is wheelchair accessible ■■ Bathroom/shower room areas including ensuite ■■ Treatment rooms/areas ■■ Lighting. Each unit is made up of a number of standards and each standard falls into one of two categories: essential or recommended. There are 45 essential and 71 recommended standards in this audit. A key area within the tool is good visibility from the corridor into the bedrooms or bays. Some NHS trusts have achieved this by incorporating large observation panels giving nursing staff a direct line of sight into the bedroom or bay to ensure safety and allowing patients to be able to see staff. This will
British Journal of Nursing, 2014, Vol 23, No 12
assist in reducing anxiety for patients with dementia and provide reassurance that there are staff members nearby to assist them. Privacy issues can be addressed by the incorporation of interstitial blinds into the observation panel. A ‘sense-sensitive’ palette of appropriate colours must be chosen. Walls should be painted with matte emulsion paint containing anti-bacterial properties. Floors should be a consistent matte colour without stripes, speckles or sparkles. Trusts may take an approach where each area has a separate colour scheme to assist with way-finding. It is crucial that handrails should be fixed to all walls in corridor areas to assist users, and the colour of the handrails should contrast with the walls. High-quality ceiling lighting and user-controllable lighting above the bed should be available in all bedrooms to allow people with dementia to see their environment, help make sense of it and make the most of their remaining abilities. At night, some patients with dementia like complete darkness; therefore the ceiling lighting must be designed so that it can be left on but will not disturb others. Movement-sensitive lighting can be fitted in toilets or ensuites. Toilets or ensuites should be designed into wet rooms if possible, giving level access to the shower area. Shower seats and toilet seats should contrast strongly in colour with the surrounding background. An open shelf must be available to display toothpaste, brushes and shampoo. A handle toilet flush control should be fitted for ease of use. In order to ensure that people with dementia wash their hands after going to the toilet, the design of the taps must have a single easy-use lever for the on/off mechanism and thermostatically set temperature control. It is crucial that clinical areas use their dayrooms as socialisation for patients with dementia; for example, for small group activities, spending time with their family, carer or other relatives, or as a small dining area for people with dementia who may eat better if they are with other people. Hospital care settings can have a significant effect on the ability of people with dementia to be independent or to be appropriately supported. Almost all recommendations for current dementia environmental considerations ask that spaces are homely and that the purpose of the space is obvious, with use of everyday items, e.g. photographs brought in from home. So, how will you as a nurse influence the redesign of your clinical area to be BJN Alzheimer’s/dementia friendly?
Rory Farrelly Director of Nursing & Patient Experience, Abertawe Bro Morgannwg University Health Board, Swansea
Dementia Services Development Centre, University of Stirling (2011) Dementia Design Audit Tool: Design to develop a better quality of life for people with dementia, 2nd edn. University of Stirling
The views expressed in this column are those of the author
695
British Journal of Nursing. Downloaded from magonlinelibrary.com by 137.189.170.231 on November 12, 2015. For personal use only. No other uses without permission. . All rights reserved.
Dementia-friendly clinical areas
© 2014 MA Healthcare Ltd
O
ver the last year, a number of areas in the NHS across all of the four countries have been criticised for poor environments for people with dementia. So how have you, as a nurse, assessed your clinical area and deemed it appropriate for your patients with Alzheimer’s/dementia? There is no doubt that the accident and emergency (A&E) department is very often the first point of contact for patients with Alzheimer’s/dementia accessing secondary care. Owing to the fast pace and loud noises of emergency care, these areas are the most challenging faced by people with dementia and their carers. My experience has shown me that if this experience is poor for the patient and their carer/ family, it increases their stress levels and makes it more challenging to communicate effectively. However some A&Es—for example, St Mary’s Hospital in Paddington, London—have a designated cubicle identified in a quiet but visible part of the emergency department for patients with Alzheimer’s/ dementia. It was decorated using tranquil colours, low-level pictures and a large clock face with a sun and moon pertaining to night or day. Clinical equipment in the room was reduced and relaxing music was provided. The toilet signage was improved to be dementia-friendly, that is, a picture of the toilet beside the word ‘toilet’.These changes were replicated in the admissions unit to reduce transfer trauma. A tool has been developed to help nursing teams audit their clinical areas in acute hospitals. The Dementia Design Audit Tool Part 2: Workbook, produced by the Dementia Services Development Centre at the University of Stirling (2011), can be used to benchmark new build or current facilities against the environmental standards for dementia. The workbook covers the following areas of a clinical facility: ■■ Ward entrance and way-finding ■■ Lounge/day room ■■ Meaningful occupation and activity in the ward or department ■■ Single rooms, bed bays or Nightingale wards ■■ Toilet areas including ensuite ■■ Toilet area that is wheelchair accessible ■■ Bathroom/shower room areas including ensuite ■■ Treatment rooms/areas ■■ Lighting. Each unit is made up of a number of standards and each standard falls into one of two categories: essential or recommended. There are 45 essential and 71 recommended standards in this audit. A key area within the tool is good visibility from the corridor into the bedrooms or bays. Some NHS trusts have achieved this by incorporating large observation panels giving nursing staff a direct line of sight into the bedroom or bay to ensure safety and allowing patients to be able to see staff. This will
British Journal of Nursing, 2014, Vol 23, No 12
assist in reducing anxiety for patients with dementia and provide reassurance that there are staff members nearby to assist them. Privacy issues can be addressed by the incorporation of interstitial blinds into the observation panel. A ‘sense-sensitive’ palette of appropriate colours must be chosen. Walls should be painted with matte emulsion paint containing anti-bacterial properties. Floors should be a consistent matte colour without stripes, speckles or sparkles. Trusts may take an approach where each area has a separate colour scheme to assist with way-finding. It is crucial that handrails should be fixed to all walls in corridor areas to assist users, and the colour of the handrails should contrast with the walls. High-quality ceiling lighting and user-controllable lighting above the bed should be available in all bedrooms to allow people with dementia to see their environment, help make sense of it and make the most of their remaining abilities. At night, some patients with dementia like complete darkness; therefore the ceiling lighting must be designed so that it can be left on but will not disturb others. Movement-sensitive lighting can be fitted in toilets or ensuites. Toilets or ensuites should be designed into wet rooms if possible, giving level access to the shower area. Shower seats and toilet seats should contrast strongly in colour with the surrounding background. An open shelf must be available to display toothpaste, brushes and shampoo. A handle toilet flush control should be fitted for ease of use. In order to ensure that people with dementia wash their hands after going to the toilet, the design of the taps must have a single easy-use lever for the on/off mechanism and thermostatically set temperature control. It is crucial that clinical areas use their dayrooms as socialisation for patients with dementia; for example, for small group activities, spending time with their family, carer or other relatives, or as a small dining area for people with dementia who may eat better if they are with other people. Hospital care settings can have a significant effect on the ability of people with dementia to be independent or to be appropriately supported. Almost all recommendations for current dementia environmental considerations ask that spaces are homely and that the purpose of the space is obvious, with use of everyday items, e.g. photographs brought in from home. So, how will you as a nurse influence the redesign of your clinical area to be BJN Alzheimer’s/dementia friendly?
Rory Farrelly Director of Nursing & Patient Experience, Abertawe Bro Morgannwg University Health Board, Swansea
Dementia Services Development Centre, University of Stirling (2011) Dementia Design Audit Tool: Design to develop a better quality of life for people with dementia, 2nd edn. University of Stirling
The views expressed in this column are those of the author
695
British Journal of Nursing. Downloaded from magonlinelibrary.com by 137.189.170.231 on November 12, 2015. For personal use only. No other uses without permission. . All rights reserved.
