1. Leading From Where You Stand in Providing Supportive Care Annual Alzheimer Conference 2008 Winnipeg Manitoba Joanne Collins collinjb@gov.ns.ca

2. Objectives Revisit Leadership in providing care Highlight strategies and approaches to care Introduce a shared solution finding approach to care and its connection to leading from where you stand.

3. What is leadership? True leadership is measured by one’s ability to motivate and influence others You do not need to be a world leader or have a fancy title to be a Great Leader!

4. What can you do….. Connect with team members!

5. The needs of people living with ADRD Many and often complex Requires interdisciplinary care planning Requires partnerships between the person, family members, and formal health care providers Critical thinking is imperative

6. Critical Thinking Strategies Recognize patterns Setting priorities Searching for information Generating hypotheses Making predictions Forming relationships Providing explanations Starting a proposition Applying best practice Making choices Judging the value Drawing conclusions Rubenfield and Scheffer 2006

7. Critical Thinking Strategies Relate to: Holistic Patient-Centered Care Relationship Approach to Care Evidence Based Practice Quality Improvement

8. Collaborative Approach to Care relates to…. Holistic patient-centered care Critical thinking Relationship approach to care Shared team solution finding

9. Relationship Approach to Care Person with ADRD Family & Informal Caregivers Formal Health Care Providers Recognizes the diverse knowledge base and contributions of all partners in care

10. Shared Solution Finding Collaborative Interdisciplinary Care Flagging – Observations focused on all aspects of the person; what has changed Interaction – Strategies for interacting with the person, family/caregiver, others Reflection & Reporting – Sharing what is observed and understood about the person Support – Care strategies that maximize the persons strengths Team – Shared solution finding that values the contributions of all team members Understanding – All behaviour has meaning, many possible causes

11. Understanding My knowledge that all behaviour has meaning Ask – What is the person trying to tell me? Because of the disease process the persons way of understanding the world around them is different. How does this behaviour affect the person, family/caregivers, me? Remember – there are many possible causes for behaviour!

12. When seeking causes for behaviour think P.I.E.C.E.S! Physical – Pain and physical conditions Intellectual – Memory, thinking, language, self- awareness, problem solving Emotional – Adjusting to change Capabilities – Knowing & building on strengths Environment – Physical and social environment Social – Social and cultural history and needs

13. Flagging My observations of the person’s behaviour Ask – What am I seeing and what has changed? Look for unmet needs or stressors Consider changes in the P.I.E.C.E.S  Infection  Constipation  Unable to understand  Noisy environment  Reacting defensively to care

14. Interaction How I relate to the person, family/caregivers and other health care providers Ask – How do others interpret what I say and do? Be mindful of body language, tone of voice and my reactions Remain non-judgmental and respectful Understand how dementia affects the family and the person Remember the person we see as caregivers and the person the family sees may not always be the same person.

15. Reflection and Reporting My time to think about what I’ve learned about the person, the meaning of behaviour and how what I share improves care. Ask – What do others need to know form me to improve the care plan? Think about the persons response to care. Think about next steps what do I start, stop, continue doing. Think about what to share with team.

16. Support My supportive and creative care strategies Ask – What am I doing to bring out this persons strengths? Focus on strengths Compensate only for losses

17. Team How the care team that I am part of works in the best interests of the person. Ask – What can we do together? Think about the team support you need Contribute by sharing your observations with others Understand that all behaviour has meaning

18. What we have learned… ADRD’s - complex presentation Requires collaborative inter-disciplinary care planning Requires partnerships between the person, family members, and formal health care providers Consider all possible causes - P.I.E.C.E.S Connect with the Team via U-FIRST!

19. Resources Canadian Coalition for Seniors Mental Health, National Guidelines www.ccsmh.ca www.ccsmh.ca P.I.E.C.E.S Canada www.piecescanada.com www.piecescanada.com U-First www.u-first.cawww.u-first.ca

20. The one hand trying to wash itself is a pitiful spectacle, but when one hand washes the other, power is increased, and it becomes a force to be reckoned with. Maya Angelou

21. Thank You Questions?