Featured Project – June 2014 – Mary Moylan

Mary Moylan

On completion of the Dementia Champion’s module in 2012; I felt empowered by the knowledge and experience I gained from participating in this course.

Person centred care for people living with dementia is the cornerstone when supporting people living with the condition. People with severe/profound intellectual disability (ID) are a cohort group at a far higher risk of developing dementia at an earlier age to that of the general population. Working  as an Registered Nurse in Intellectual Disabilities (RNID)  means that I am empowered to assist them with many aspects of living with dementia.

A person with an ID may have many other complex conditions including cognitive issues, communication difficulties and medical conditions such as epilepsy, gastro osephegial reflux disease, respiratory, visual and audio deficits and sensory issues. If the person develops dementia superimposed on an already pre-existing condition, the complexities of care and support delivery is greatly increased.

For me, being a Dementia Champion has enabled me to support a person with ID living with dementia. With skills learned I have being able to adapt individual care plans to support the person with the help from staff and families who know the individual well. We, as a team have reduced the incidence of responsive behaviour by tailoring activity programmes to each individuals need. We also have assisted some individuals with regulating their sleep patterns by introducing individualised programmes tailored to their needs.

For me to see an individual’s quality of life improve validates the efforts and initiatives used by the team to support the person not only to live with dementia but to live well with the condition.

I am very proud to be a dementia champion and it has being the catalyst for me to further my studies in dementia care.

 Mary Moylan RNID/Dementia Champion.

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Person centred approaches to fluid intake for service users with an intellectual disability & dementia

Interview

Transcript

What was the problem you were trying to address with your project?

Issue was that some of the service users were on high quantities of bowel care medication in order to maintain regular bowel movements. Some of the service users were on up to three different types of bowel stimulators  daily with additional stool softners. Some service users have co-morbiding conditions of epilepsy and psychiatric issues which require poly pharmacy of medication on a daily basis which also had an impact. The fluid intake could be less that 1500 mls daily and we also had dysphagia issues requiring the use of fluid thickeners and that in itself has a dehydrating effect. The reliance of service users on staff for assistance for all aspects of daily living skills also made me want to implement this change because they totally rely on a nurse to assist them with everything.

What was your vision for how things should be?

I wanted to introduce this change management practice in a person centred manner, and I hoped that if service users were offered fluids more frequently, particularly between meal times and after activities they would increase their daily fluid intake. By doing this work with service users, staff and GPs this could reduce the amount of laxatives used by service users to maintain their bowel movements.

What did you do?

We highlighted three service users who required the most intervention and monitored their daily fluid intake using recording charts, and offered drinks outside mealtimes introducing a wider variety of hot and cold drinks. Staff were also encouraged to offer service users drinks when they were getting one for themselves. We also asked the night staff to offer additional drinks before service users retired to bed, and if they woke up during the night and when they got up in the morning if they were up early to just offer a drink.

What was the outcome?

The three service users that we were closely monitoring, they all increased their fluid intake by 800 mls plus. The bowel care medication was also decreased significantly with one service user completely off all bowel medication management. Their sleep patterns also improved with one service user in particular who didn’t really sleep at all. Individuals moods seemed to improve and there was a significant decrease in their need to engage in responsive behaviours which was a positive outcome for them and enhanced their quality of life.