Using Life Story work to deliver person- centred care8th March 2013Rachel Thompson

The policy agenda

• NICE/SCIE Guidelines on dementia (2006)• ‘By learning about each person with dementia as an individual,

with his or her own history and background, care and support can be designed to be more appropriate to individual

needs .....' (p71)

• National Dementia Strategy (DH 2009 p58)

• NICE Quality Dementia Standards (2010) • DH Dementia Commissioning pack (2011)

Community based services

What is life story work?

• Individual biographical approach• Based on story telling & reminiscence • Critical review of life events • Identifies present and future wishes• Used to assess needs, develop and

maintain relationships, promote conversation and pleasurable activity

• Can take a number of formats

The evidence base

• Basis for individualised, person- centred care• Maintains sense of identity, enhances

communication & relationships (Carr, Jarvis & Moniz-Cook 2009)

• Assists in transitions between care environments (Murphy et al 2000)

• Positive effect on attitudes of staff towards their patients. (McKeown et al 2010, Clarke 2000)

• Improves relationships with family carers & promotes participatory care (Clarke et al 2003, Kellett et al 2010)

The evidence base

• Improving Care for People with Dementia: Development and Initial Feasibility Study for Evaluation of Life Story Work in Dementia Care (2012-2015) SPRU, University of York

• People with dementia sometimes need help to communicate their histories and identities.

• This study will investigate how 'Life Story work' can help people living with dementia to do this, and whether this work can enable services to more effectively meet their needs. It will do this by speaking to people with dementia, their carers, and health care professionals about their experiences of Life Story work, andidentifying areas of good practice

Portrait of a Life

Developing a life story tool

• Introduction to my life• Childhood• Working/adult life• Significant places, events, people,

activities• Later life• My life now• Future wishes

Format Benefits Examples

Life story book

Developed collaborativelyMore detailEncourages life review

Dementia UKCaring memoriesPortrait of a Life

Collage CreativeVisual Easy access

Carr et al (2009)Jarvis (2001)

Memory box Support reminiscenceVisual promptsTactile cues

Age UKAlzheimer's ScotlandDementia web

Leaflets Simple and conciseEasy access

‘This is Me’‘All about Me’

DVD’s Visual stimulationMusic /oral prompts

Memories Unlimited

Technology Adaptable(as above)

i padsDigital reminiscenceConnect for care

• ‘Getting to know me’

• ‘Forget me Not’

• ‘Patient passports’

Making it a reality

• Training isn’t enough to change practice (Lintern and Woods 2007)

• ‘Its not what you know it’s the way that you do it!’ (Fossey 2006)

• Fossey and James (2008) Evidence based approaches for improving care in care homes.

Admiral Nurse Practice Development project

• 7 clinical areas / 7 Admiral Nurses – 3 x older adult mental health assessment – 4 x NHS continuing care

• Life Story training with key participants from each area

• Support in practice areas

• Thompson, R. (2010). Realising the potential: Developing life story work in practice.

• In Sanders, K. and Shaw, T. (Eds), Foundation of Nursing Studies Dissemination Series. Vol.5. No. 5.

Outcomes

• Improved understanding of person with dementia which had informed care delivery

• Improved relationship & communication between staff and patients

• Improved relationship between staff and family carers

• Family carers feeling more involved in care and improved relationship with person who had dementia

• Support of Admiral Nurse instrumental

• Carer feedback:• ‘’Doing life story work

with my husband has made a difference to our relationship. I thought we had nothing in common but doing the life story made me realise that we had a lifetime of experience and joy.’’

• As we go through life we build up a personal history , with its unique mix of joys and pleasure, sorrows and pains. Our sense of who we are is linked to that history and if we lose that we also lose something else of ourselves.’

• (Kitwood 1996)

Benefits for staff

• ‘It enabled us to build up a rapport with family carers as we had something to approach them about’.

• ‘It gave me an opportunity to see the patient – I feel I understand them so much better and it really helps us all.’

• Better outcomes in areas with the following characteristics: Strong/consistent leadership Higher ratio of qualified to unqualified staff Context/culture which supports change

and communication Other factors

Relationship of facilitator with staff Higher level of participation by patients

Lessons learnt

• Life story work can be implemented within in-patient settings with proper consideration to leadership, context and facilitation

• Careful consideration should be given to appropriateness of format i.e. different formats for different contexts/individuals

• Life stories must be personalised • Life stories are not an end in themselves and

are never finished!

The secret to successful practice development!

3 key elements:• The evidence :

research evidence, clinical evidence and patient experience

• The context :

culture , leadership, and evaluation

• The facilitation :

purpose, role, skills and attributes

(PARIHS) framework Promoting Action on Research Implementation in Health Services. Rycroft Malone (2004)

Tips for doing life story work

• Assess which tool might be most appropriate

• Discuss with the individual and family and clarify its use

• Provide information and examples

• Agree how the information will be gathered

• Assess capacity of person• Consider the time, place

and approach

• Ensure privacy and protected time

• Decide on most appropriate approach e.g. structured review, reminiscence

• Gather information in ‘short bursts’

• Agree on how the information will be presented

• Decide where the information will be kept so that is easily accessible

Supporting others

• Purpose: making the purpose clear to all participants • Level: ensuring research can be applied to practice at the

level of direct care • Learning: supporting learning throughout the process e.g.

offering training and support to participants and providing resources

• Evidence use: using latest evidence to inform developments • Creativity: supporting and encouraging creativity by

participants in delivery • Methods: using methods which encourage participation of

stakeholders in planning, implementation and evaluation of work

(Manley et al 2010)

Further information

• Dementia UK:http://www.dementiauk.org/information-support/life-story-

work/ – Template– Guidance

• Life Story network http://www.lifestorynetwork.org.uk/• Thompson R (2011) Using life story work to enhance

care. Nursing Older People. 23;8;16-21• Caring Memories: http://www.caringmemories.net/• Portrait of a Life:

http://www.southwestyorkshire.nhs.uk/quality-innovation/initiatives-projects/portrait-of-a-life/