mirror reflective learning at work

© MIRROR Project - Co-Funded by EU IST FP7 – www.mirror-project.eu

MIRRORReflective Learning at Work

Exploiting Apps to Support Dementia and Residential Care


Event Agenda

1. Introduction of Mirror, reflective learning and app sphere2. The Digital life history app and manager3. The Yammer App extended with reflective learning4. The 3D Virtual care home App for carer training5. The CaReflect App with proximity sensors to provide

evidence about care activities to reflect on 6. The Carer App for challenging behaviour7. Adoption, exploitation and funding options8. Collaborative buffet lunch for further discussions


MIRROR How technology can help care home staff reflect and learn

Ian TurnerChairman RNHA


Registered Nursing Home Association

▪ 1000 small and medium Care Homes in membership▪ Based in Birmingham with 10 staff▪ 20,000 staff checks on DBS per annum▪ Roadshow of current issues annually▪ Represents members with government, regulator

and other professional bodies


The Mirror Project

▪ Theme “Reflective Learning”▪ Four year EC funded project▪ Middle of the final year▪ Collaboration of various european universities▪ Testbeds also include european partners, eg italian

emergency services and german neurological clinic


Why Dementia Care and Reflective Learning?▪ Healthcare can offer limited support for dementia

being task / intervention based▪ Social Care “enabling” is the dominant model▪ That enabling requires staff to understand the

behaviour of the individual▪ Requires staff to be a detective to reflect on

information known about the person


Caring for those Living with Dementia▪ In the late stages of the disease all the medical

model can offer is sedation▪ Task based care will usually lead to confrontation

between resident and carer▪ Supervision and enabling care is the aim▪ Care Planning is not just task / issue based


Care for those Living with Dementia▪ Carers need to know as much about the person in

order to understand the behaviour and preferences of the individual▪ Gentleman wakes at 4am every day▪ Devon lady becomes agitated in early evening

Currently record life history on paper but life histories only started on admission


Care for those Living with Dementia▪ Memory from this morning will be minimal, if at all,

which means the person will not remember the last meal or drink

▪ They will not remember their visitors or probably where they are living

▪ Long term memory will be much clearer▪ Boredom and inactivity can result▪ Need to start data capture on diagnosis


▪ A range of “meaningful activity” is required▪ Activity cannot be restricted to 2-5pm on weekday

afternoons▪ All care staff must be responsible for such activity in

partnership with activity staff▪ A part time secretary▪ Childcare remembered▪ Swimming for a resident

Care for those Living with Dementia


▪ We need a range of therapies:▪ Music▪ Doll▪ Complimentary therapies, eg reflexology▪ Garden based▪ Hobby based ▪ DIY – the man’s shed▪ etc



▪ Staff cannot be “robotic” in delivering care to those living with dementia

▪ Staff must think about how to approach residents▪ Staff must see the whole person they are caring for▪ Staff must think about why residents are reacting to

them in a particular way



▪ NICE have set an English standard for dementia which concentrates on diagnosis and early stages of the disease with some elements applicable to the later stages.

▪ My three major factors for later stages are▪ Life Histories▪ Meaningful activities, and ▪ Reflective practice



The Carer Role

▪ Demanding role▪ People skills are vital▪ Values are central▪ Person centred▪ Technical skills can be taught▪ Staff training is significant effort


Standards in Social Care in England▪ Regulatory standards – 360 of them in Essential

Standards of Quality and Safety▪ Just about to start another set where the inspectors

judgement will be about is the service safe, is it effective, is it caring, is it responsive to people’s needs, and is it well led?

▪ This will be the fourth major upheaval in ten years


▪ Whilst these standards are not prescriptive (and will not be in the future) this means that everyone has got a different angle / statement / value

▪ Take medication, is it zero tolerance to recorded administration, zero tolerance to medication not being available or some other measure. Compare with general compliance.

Standards in Social Care in England


▪ Consequence is▪ Staff nervousness of not doing the right thing▪ Lack of confidence in many homes▪ Different views and performance levels being demanded

by regulators, commissioners, environmental health or safeguarding staff

▪ Hence providers need to be very clear to staff about the standard of performance expected of them, which is a challenge

Standards in Social Care in England


Information Technology in Care Homes▪ Generally restricted to the manager and

administrator▪ Typically payroll and accounts▪ If care plans are stored electronically they will not

be available to care staff outside office hours▪ 98% of Care Home had internet access 3yrs ago, but

access very limited


Social Care and Information Technology▪ We are at the data capture stage in the sector

overall▪ Systems are percieved as for the administrator and

manager▪ Outside MIRROR - medication is a good example –

the first systems are just coming into use▪ Infrastructure, eg WiFi, in most homes, not

available


Issues Arising from Research

▪ There is little formal reflection in most homes (“too busy”), but widely accepted as needed.

▪ Significant change in acceptance of care staff to technology. Now, often ahead of management!

▪ Many care homes lacking IT infrastructure, with poor provision for carers, and hardly any for residents, but the demand is coming.

▪ A need for care staff training, including how to help and mediate the technology for residents.


Current Position

▪ All MIRROR apps were received positively by homes and staff.

▪ Now second round of testing in residential care homes. Again, positive responses, particularly among new and inexperienced staff.

▪ New & novel apps for staff are seen as a refreshing change. They won’t replace traditional training, but can have a part to play.

▪ MIRROR believes that, at last, the time for technology in residential care homes has come.


NHS Number

▪ Department of Health wishes to encourage the collection and use of NHS Number to facilitate data exchange between all parties.

▪ Currently only asking for collection and storage of NHS number

▪ Validation rules at http://systems.hscic.gov.uk/nhsnumber/stafffaqs.pdf


The Digital Life History App


The Digital Life History App

Tablet-based app providing resident life information▪ Paper-based storybooks difficult to update and share▪ Existing digital solutions insufficiently flexible

Key app features▪ Life history information updates by carers and relatives▪ One-stop for information, videos and external links ▪ Supports reminiscence through stories with residents▪ Guiding personal care on myhomelife care values


ServerServer

The Digital Life History App: Architecture and Evaluation

Resident life history

information database

Resident life history

information database

Carers

Relatives

Resident life history manager

Resident life history app

Carer

Resident

Early use in one residential home▪ Digital Life History Manager used to document full

resident life histories from physical books


The Extended Yammer App


Extended Yammer App

Replace paper notebook with mobile app

▪ Adapt enterprise micro-blogging as prototype

▪ Direct in-situ care note entry on mobile device

▪ Direct access to all care notes about resident

▪ Real-time supervision of care progress

▪ Integration with electronic care record systems


ServerServer

Extended Yammer App Architecture

Resident care record

database

Resident care record

database

DeviceDevice

Exported care notes

Care note reflections

Carers


Extended Yammer App Evaluation

Used effectively in residential homes▪ Carers able and willing to use app during and after shifts▪ Increased number and detail of captured care notes▪ Some increases in number of reflections about care

Important contextual factors▪ Fitted with flexible care work practices▪ Used before shift to prepare for care activities▪ Perceptions of relatives sometimes negative

Future app evolutions▪ More explicit support for reflection about residents▪ Contextualise care notes in digital life history


Virtual Care Home App

• 3D game for the health and care sector to train carers deal with difficult dialogues and stressful situations at work

• To facilitate the reflection process during the training and to giving users a virtual tutoring support during the gameplay.


Virtual Care Home Components

Serious Games

3D Virtual Care HomeMini GamesBranching StoriesVirtual Tutor

User Tools for reflection

Wizard tool for contentSelf-evaluation;Global feedback;Graphic comparison;Learning diary.


The CaReflect App and Proximity Sensors


CaReflect

33


Architecture

▪ CaReflect Configures Sensores Visualizes Data for Carers Overview for management Runs on a PC

Sensors Small and light weight Robust casing, no buttons 7 days on one battery No further infrastructure

required

34

2-3m (7-10ft)


Summary

35

▪ Measure and Quantify Care Wearable sensors Visualize contact times

▪ Current state – after test in two care homes Very positive feedback, e.g. initiated group discussion No privacy concerns but various benefits are envisioned

Neglect monitoring Evidence to relatives

Preparing for next study

«CaReflect does not try to provide the answers but helps to ask the questions»


The Carer App


Carer App

Personal support to resolve challenging behaviour with creative thinking that personalises care

1. Other, less-constrained worlds to resolve case2. Analogical cases to transfer ideas to resolve case3. Previous dementia cases to reuse ideas to resolve

case

Case base of good practices▪ Natural language descriptions of successful care

work

Simple audio-recording of ideas▪ Structure, playback and export care plans to share


ServerServer

Carer App Architecture

Carers

Good care practice xml repository

Good care practice xml repository

Case-based reasoning discovery service

Case-based reasoning discovery service

Analogical reasoning discovery service

Analogical reasoning discovery service

Creativity prompt generation serviceCreativity prompt generation service


Carer App Evaluations

Used effectively in residential care homes▪ Carers used retrieved dementia cases over others▪ Generated, played back, improved and shared audio ideas▪ Led to care improvements attributed to recorded ideas

Important contextual factors▪ More app use outside of shifts – time and space▪ Align app use with care home values, practices

Future app evolutions▪ Integrate idea generation with digital life histories▪ Enhanced web support for collecting good care practices


Third-Source Funding Options


Third-Source Funding Options

1. Knowledge Transfer Partnerships▪ Fund 50-67% of project for 1-2 years▪ Product development, service rollout▪ Incremental proposal process

2. Collaboration with Charities▪ For example Leverhulme Trust,

Joseph Roundtree Foundation, Dementia Action Alliance

3. Bilateral Development Projects▪ Seek University resources to support

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