AHP Abroad Part 2

PeScreen Shot 2015-07-02 at 21.34.39rmission kindly given by Jane Reid to re-post this blog which she recently posted on AHPAbroad.

At the end of this week I will be travelling home to Scotland for the first time since I moved out to Qatar almost 8 months ago. In one way it seems a long time ago since I was AHP National Lead for Children and Young People, involved in so many different projects with so many different teams and great people. On the other hand I still feel “new” here in Qatar getting to understand the culture and finding out more about healthcare in the Middle East. It is however a great opportunity and I feel very privileged to be involved in the discussions about national standards for healthcare practitioners and their continued professional development, and establishing Sidra as a facility that can accredit continued professional development activities for all healthcare practitioners. I am also very fortunate to work with a great team both in education and simulation who are extremely enthusiastic and innovative.

From a paediatric AHP perspective the use of simulation is still in its infancy. This offers us great opportunities to explore and potentially begin to develop evidence around the use of simulation for this group of professionals. Traditionally simulation has been used within high risk/low volume scenarios and although AHPs may be involved they are generally not the primary professional. Our initial focus is to develop inter-professional scenarios that are pertinent to AHPs which will be used in the clinical orientation period. I am not aware of many publications detailing the use of simulation by AHPs in a paediatric setting but if you happen to be reading this blog and know of anyone who is using simulation for AHPs in paediatric settings, please get in touch.

Screen Shot 2015-07-02 at 21.38.23I was also privileged last month to attend the Institute of Healthcare Improvement’s (www.ihi.org) Middle East Forum which was held here in Qatar. It was fantastic to see and hear so many international speakers sharing their experiences and knowledge. It was incredibly exciting to also hear the likes of Don Berwick & Maureen Bisognano mentioning Scotland and the Early Years Collaborative (http://www.earlyyearscollaborative.co.uk/about-the-collaborative).

I thinks one of the things I am enjoying most about my adventure here in Qatar is the opportunity to try things out and be involved at the beginning of so many things. Later this year I hope to be able to participate in the first inter-professional conference in Qatar which is being hosted by Qatar University and share some of  the AHP inter-professional experiences.

Screen Shot 2015-07-02 at 21.32.25Although 8 months is not that long I do think I have had a great start to my journey both personally and professionally. It will be great to go home and catch up with friends and family but I will also be looking forward to the next steps in my AHP Abroad adventures.

We Need You!

A request from Paths for All

Calling all health profsCan you help us?

Paths for All is a Scottish charity. Our aim is to significantly increase the number of people who choose to walk in Scotland – whether that’s leisure walking or active-choice walking to work, school or shops. We want to create a happier, healthier Scotland, where increased physical activity improves quality of life and wellbeing for all.

How can you help?

We need you to tell us how we can best support you, and others in your profession, to encourage your patients to become more active by walking. By completing our short survey you will help to inform our planning and ensure we are responding to your needs. In return you will be entered into a prize draw to win an iPad Mini.

To complete our short survey, and be in with a chance to win that iPad Mini, please click here before the 30th July.

For more information on Paths for All please visit our website www.pathsforall.org.uk or email info@pathsforall.org.uk

Are your care home staff drinking enough fluid?

Introduction

Screen Shot 2015-06-25 at 15.59.39

A small study into the drinking habits of staff in a Highland care home has indicated that Care Home Staff are not consuming enough fluids each day. [Have a look at our poll at the bottom of this blog to see if you are drinking enough fluid]

Urray House in Muir of Ord supported Karen Gentleman, a student dietitian from Robert Gordon Univeristy, to carry out a short study with staff to clarify whether dehydration might be an area of staff health which needed more focus. Staff volunteered to record their total daily intake of fluids over a 3 day period. These were compared with their calculated daily fluid requirements (weight x 35mls) and the results showed that care staff members were only consuming an average of 56% of what was recommended. This is shown on the slide below.

Screen Shot 2015-06-25 at 16.10.40

Participants noted that they experienced the following symptoms of dehydration; thirst, passing light brown/yellow urine, lack of urine, tiredness, inability to concentrate, headache and light headedness.

Reasons given for such poor intake included:

“We know we need to drink, but it’s difficult to find the time”,

“When walking about it’s difficult to carry a drink with you”,

“Sometimes you make a hot drink, but are distracted by visitors, the phone, then the drink gets cold so you don’t drink it”

Denise Scott (Urray House Manager) said: “the staff members taking part in the survey were surprised at how poor their fluid intake was and this has really highlighted to them that they need to prioritise time to take drinks throughout the day. We will be sharing this work with other staff here and more widely to support our other colleagues in The Parklands Care Group, it is also an area that could be implemented as part of staff health promotion in the induction process”

Evelyn Newman (Nutrition and dietetics advisor for care homes in NHS Highland) said “this has been an excellent way of showing staff how dehydrated they are and how they can benefit from drinking more fluid at work. We can all benefit from this approach, as it is too easy to forget to drink, while doing other work and focussing on residents rather than ourselves. I hope that we can continue to build on this work and by sharing it with a wider audience”

Conclusion

Care home staff members are generally not meeting their daily fluid requirements. This is not because there is poor access to a range of fluid in the home; rather it is because it is not part of a staff routine to take drinks at every opportunity.

The member of staff with the highest intake took more regular opportunities to drink in smaller quantities. Even so, this was still not meeting their requirements.

Dehydration can have a negative effect on staff health and well-being and may promote symptoms such as tiredness, fatigue, low mood and contribute to increased staff absence. Working in a caring environment for vulnerable adults is a demanding role, making adequate hydration essential to perform duties effectively. Dehydration can also cause feelings of irritability and a lack of concentration which could cause trips and mistakes with medication etc.; this could be detrimental to residents. It is therefore in everyone’s interest to ensure that care home staff members remain adequately hydrated.

Screen Shot 2015-06-25 at 16.00.00

Recommendations

Care home managers and staff are encouraged to assess their own fluid intake and to take steps within their own care environment to ensure that drinks are encouraged at every opportunity; for example taking tea with residents; having water at staff meetings/handovers; drinking fluids during teaching sessions.

Good fluid intake is also essential for residents and service users too, so support them to have a variety of drinks and flavours; offer ice lollies or chilled jellies; soups and milky puddings and use prescribed thickening agents for anyone with dysphagia and in need of texture modification.

Evelyn Newman RD and Denise Scott, Manager, Urray House Care home.

June 2015

Resources

Click on each image for a dehydration poster

Screen Shot 2015-06-25 at 16.14.47

Screen Shot 2015-06-25 at 16.15.37


Poll. Do you drink enough fluid at work?

Notes and thanks

With thanks to RGU student Karen Gentleman, from Robert Gordon Univeristy who is currently finishing her B placement.

The attached flyers and posters have been rolled out to all care homes and care at home providers with full support of the Director of Adult Social Care, Joanna MacDonald.

Q&A with Tracy MacInnes; Dietitian and Associate Chief Health Professions Officer

Tracy MacInnes with Marjory MacLeod
Tracy with Marjory MacLeod, BDA Scotland Board Chairperson

Can you start by telling the readers a little bit about yourself and your professional career to date?

Yes, I qualified as a Dietitian from what was, Queen Margaret College, in 1986 and started my first job at Stoke Royal Infirmary. It was a rotational basic grade post so covered renal, paediatrics and community; which provided me with a really solid platform to build on. I then went to Stafford District General and worked as the Senior 1 dietitian where I again managed a complex and varied workload within primary and secondary care. I then made the decision to move back to Scotland in 1992 and was successful in getting the renal dietetic post at the Royal Infirmary in Glasgow. This was my first experience of working outside of a dietetic department and within a wider multi-professional team. This was when I really began to extend my scope of practice. My final dietetic post was as the Chief Dietitian within the Southern General Hospital in Glasgow, after which I moved to work as the Senior Professional Advisor at the Care Inspectorate. In this position I had responsibility for the regulation of independent hospital and hospices in Scotland. This was where my interest in integration started as I lead teams of officers who had professional backgrounds from education, social care, policy and health.

I was awarded the IBEX Award for Professional Achievement in 2003 by the BDA, and in 2005 I completed my Masters in Healthcare Management at Strathclyde University and my Postgraduate Certificate in Social Services Leadership, from Robert Gordon’s University – phew!!

In 2009 I had the opportunity to join the Scottish Government and I’m presently the Associate Chief Health Professions Officer.

How would you describe the work of a dietitian to someone who has never witnessed what we do?

Dietitians use the most up to date health and scientific information on food and health and interpret it in to practical advice so they can support people of all ages to make informed lifestyle and food choices.

With regards to profile, who should dietitian’s/the profession be engaging with and what should their key messages be?

Population health and reducing inequalities is a huge priority for us in Scotland. I believe that the dietetic workforce has a vital role to play by having healthy conversations at every opportunity and interacting with people who use our services, their families or carers, promoting healthy lifestyle choices and signposting to relevant health, voluntary and/or social care services.

In your opinion what makes a good leader?

Someone who can influence outside of their sphere of influence

How can dietitian’s/the BDA encourage leadership within the profession?

We need to build up an evidence base which illustrates the impact of dietary interventions, shows the added value of dietetic input and tells the story of what is the unique skills of a dietitian. I believe that building a dietitian’s knowledge of improvement methodologies and how to apply them is key.

What do you think are the key challenges for the profession over the next few years? And how do you think we can work collectively to address these?

We are living in a challenging economic time with real financial constraints whilst moving forward to working in a more integrated way. People are living longer now and demands on our services will become greater, so we need to deliver services differently and we need to spread and sustain good practice throughout Scotland

The incoming BDA chairman’s theme is ‘Workplace Health’ – why is this an important agenda item and how can dietitian’s lead the way/make an impact on this?

Building up and maintaining our own self resilience is important in maintaining good health; especially considering the pressure we all face. Again dietitains are well placed to sign post work colleagues & friends to resources which can help the person make a more informed decision about their lifestyle; they also have a great deal of practical knowledge and expertise which can be utilised to encourage behaviour change and enable people to adopt healthy lifestyles.

If you could give one piece of advice to a newly qualified dietitian, what would it be?

Remember you can do anything you want to do, as the skills that you have built up are transferable across the public sector.

Some of the Dietitians who attended the Scottish Parliament
Some of the Dietitians who attended the Scottish Parliament

You were able to attend the BDA Scotland Boards event at the Scottish Parliament on Wednesday, why was this important and what were your reflections from the evening?

I have to say I thoroughly enjoyed the Scottish Parliamentary reception hosted by the BDA Scotland Board, it was one of many activities being held throughout the country as part of the BDA’s International Dietitians Week 2015

It was a great opportunity to share with MSPs the vital role that dietitians play in dementia care, and to highlight the many examples of good practice from across Scotland. My congratulations to Marjory and the rest of the team for pulling the reception together

The BDA Scotland Board would like to say a huge thank you to Tracy and all of this week’s bloggers. We would also like to thank AHP Scot Blog for providing the platform and to all of our readers who stopped by and got involved in #DietitiansWeek 2015.

A Case Study In Dementia Care

As Marjory MacLeod told us at the beginning of the week, the BDA Scotland Board were hosting a Scottish Parliamentary Reception on Wednesday June 10th to showcase the role of Dietitians and their work in the area of dementia. Last night that event took place, and it was a great success wth key partners displaying resources and examples of good practice to dietetic colleagues and MSPs from across Scotland.

One of those illustrating her work was Sheila Riddoch Lead Dietitian, Acute Services, NHS Sheila RiddochGrampian, and now she has taken the time to share her work further through our blog.

As Marjory said in her blog on Monday approximately 90,000 people are currently living with dementia in Scotland and Dietitians play a vital part in their care.

Eating and having a good meal is part of our everyday life and important to everybody, not least to people living with dementia. However dementia can greatly affect a person’s relationship with food and eating. Whilst the difficulties experienced vary from one individual to another the result is often weight loss and deteriorating health. Undernutrition is common among older people generally; and the consequences include increased frailty, skin fragility, falls, hospitalisation and increased mortality. In people with dementia, undernutrition is particularly common. It also tends to be progressive, with weight loss often preceding the onset of dementia and then increasing in pace across the disease course. However, whilst weight loss is a common problem for people with dementia, undernutrition can and should be avoided.

Sheila demonstrating the pictorial menus and illustrating colour contrast crockery and trays.
Sheila demonstrating the pictorial menus and illustrating colour contrast crockery and trays at the Scottish Parliament.

The cause of undernutrition in people with dementia is often multi-factorial involving the behavioural, emotional and physical changes which take place as dementia progresses. However one of the common problems which people with dementia encounter is a change in vision and a reduced understanding of what they are seeing. This led to research by a team at Boston University who showed that if we change what we do, and thereby allow people to see their food; they are much more likely to eat it. In context, what the team did was serve food to people with advanced Alzheimer ’s disease on standard white plates and then served the same food to the same client group on red plates. What they found was that people eating from the red plates consumed 25 percent more food than people eating from white plates. The simple reason for this improvement was that the contrast in colours between the food and the crockery allowed people to see their food more easily and subsequently they were more inclined to eat it.

With this research in mind NHS Grampian trialled the use of colour contrast crockery and coloured reusable drinking glasses in a local assessment unit for older people. When compared to the use of the traditional crockery and disposable white tumblers, positive feedback was received.

Since the provision of a good quality eating experience is an integral part of the therapeutic care provided in hospital and the results of the trial were so positive, a decision was taken to introduce the new crockery & tumblers to all hospital wards in NHS Grampian. This is seen to be a very positive move given the fact there is a high number of patients who could potentially benefit from high contrast crockery. This move also serves to ensure that there is a consistent approach across the Board and it supports equitable access whilst eliminating the ‘labelling’ of patients with individual needs.

Key Facts & Case StudiesFor more case study examples which illustrateNDRUK Resource how dietitians are working to improve nutritional care in dementia across Scotland click here.

For more practical information and advice aimed at carers of those with demenia click here.

Finally for more information on Dietitians and Dementia click here.

If you would like to share your case study examples, or your thoughts on the blog, please leave a comment below.

Weight Loss Surgery: The Four Pronged Approach

By
Rona Osborne
Specialist Bariatric Surgery Dietitian, Glasgow & Clyde Weight Management Service
Amanda Hallson
Advanced Dietitian Weight Management, Glasgow & Clyde Weight Management Service

Background

Weigh loss surgery, also known as Bariatric surgery, has been offered as a treatment option for overweight and obese individuals since the early 1980’s. Since then the practice has moved on leaps and bounds with Dietitians and other AHPs’ delivering first rate interventions as part of multidisciplinary services. The three most widely used types of weight loss surgery are:Gastric Band

  1. gastric band – where a band is used to reduce the stomach’s size, so a smaller amount of food is required to make you feel full
  2. gastric bypass – where your digestive system is re-routed past most of your stomach, so you digest less food and it takes much less to make you feel full
  3. sleeve gastrectomy – where some of the stomach is removed to reduce the amount of food that’s required to make you feel full

Bariatric surgery cGastric Bypassan effectively reduce body weight and treat obesity associated metabolic diseases such as diabetes mellitus. There are also significant benefits to individuals’ functional status and psychological health. “Overall mortality is 29-40% lower in the seven to ten years post surgery in patients receiving Bariatric Surgery compared with BMI-matched subjects not receiving surgery”1.

This proven surgical approach has fuelled the number of bariatric surgeries performed in the last 20 years, however it is paramount that weight loss surgery is not seen as a single stand alone intervention but included as part of a supported programme involving a multi-disciplinary team including dietitians, clinical psychologists, physiotherapists, nurses and surgeons.

The four pronged approach

The use of the four pronged approach model illustrates the importance of surgery being 4 Pronged Approachonly one element of a successful weight reduction outcome. At the Glasgow and Clyde Weight Management Service this model is used at all stages of the patient’s surgery pathway, including the initial surgery information session, the preparation for surgery education programme and the post-operative group review sessions. The 4-pronged approach enables patients to obtain clearer insight into what aspects of their lifestyle surgery will help with, and allows the team to explore and ensure realistic expectations.

Weight loss surgery results in an overall reduction in total quantity of food as well as impacting on food choices. Patients learn through the four pronged approach that weight loss surgery does not necessarily impact on other areas of their lifestyle i.e. a patient that struggles with emotional eating will not automatically change this behaviour following a surgical intervention. And likewise a patient that is suffering arthritic pain will not necessarily have relief of pain following a weight loss procedure enabling them to be more active.

Using this 4 pronged approach model helps to demonstrate the importance of the individuals’ involvement in the entire process. This can help in two ways, the patient becomes more empowered knowing that much of the success of the procedure is dependent on them; and secondly it highlights to the patient if they may benefit from additional support from members of the MDT such as psychology or physiotherapy

Those individuals that believe surgery is the easy answer to weight loss often find out early on that this is a gross misconception. In practice it appears that those patients who are well informed about the surgical procedure itself, as well as the necessary dietary and lifestyle changes that are required to go alongside the procedure tend to have better weight loss outcomes. This coincides with the current guidance that highlights that patients who receive, preparation, education and pre and post-surgery support are more likely to be successful.

At the Glasgow and Clyde Weight Managemenet Service the bariatric Dietitian is integral to the surgical service and to clinical decision making.

Where does the Dietitian fit in your local bariatric surgical service?

References

1. SIGN 115 (Feb 2010). Management of Obesity. A national clinical guideline.

“A blog a day blether” for #DAW2015 Allied Health Professionals Q&A Day 5 “Ask a Speech & Language Therapist”

“A blog a day blether” for #DAW2015

Allied Health Professionals Q&A

Day 5 “Ask a Speech & Language Therapist”

Screen Shot 2015-06-03 at 16.39.37

Previously published this week on ‘Let’s Talk About Dementia Blog’

Communication and eating, drinking and swallowing are fundamental to our well-being, and it is the speech and language therapist’s role to help with these skills for people with dementia at all stages of the illness. The following questions highlight many common areas of difficulty and I hope that the answers provide people with ideas on how to work around the challenges.

Screen Shot 2015-06-03 at 16.30.57

Question 1 – Do speech and language therapists work with people to learn to sign some words when speech is going?

Answer – This would be very unusual, unless the person had signed previously. It is recognised that it is generally difficult to learn new skills. However, increased use of body language and natural gesture is fully recommended. Most of us have highly developed skills at reading body language that we developed as babies and toddlers before we even started speaking. It is likely that the person with dementia is reading body language (which includes facial expression, tone of voice, posture etc.) long after language comprehension has deteriorated. It is therefore important to be aware of what you are communicating non verbally and to enhance natural gesture to facilitate comprehension. The person with dementia can also be encouraged to increase their use of gesture to aid their expression when words are difficult to find. Playing miming games such as charades may be a way of encouraging this skill.

Screen Shot 2015-06-03 at 16.39.48

Question 2 –My wife has difficulty with her speech. She gets very confused and often uses words that make no sense. She then gets angry with me when I don’t understand what she wants and sometimes throws things at me. I am weary and at times quite frightened. I have no idea how to help her tell me what she wants.

Answer – this is a difficult one. It is obviously important to reduce frustration because more effective communication is always achieved in calmer settings .Firstly, always ensure that distractors such as television, radios, barking dogs, crying grandchildren etc., etc. are reduced to an absolute minimum. One to one communication is always more likely to be effective.

Then I would recommend acknowledging when you do not understand and posing questions such as ‘are you talking about….. (the doctor?  tea? yesterday?)

Alternatively pick up objects, pictures and say ‘is it this?’ Visual materials help to focus the person and helps them to remember what it is they are trying to talk about.

As in the previous answer, encourage the use of gesture to get messages across.

However, if all this increases frustration and inevitably sometimes this might happen, it is vital to acknowledge that frustration and suggest she comes back to it later. Then try to distract her with another activity or topic.

Screen Shot 2015-06-03 at 16.39.54

Question 3 – My wife gets very frustrated when she can’t find words. Should I finish her sentences for her?

Answer – Finishing sentences for people depends very much on individual relationships and there isn’t one stock answer. I recommend that you ask the person whether they would like support on completing sentences and how soon you should ‘jump in’. Be aware that you need to be listening very carefully to be sure that the word you offer is actually what the person is trying to say, because selecting the wrong word can increase frustration.

Screen Shot 2015-06-03 at 16.40.01

Question 4 – I am finding my friends have stopped visiting because it is so hard to have a conversation. Is there anything you can suggest which might help?

Answer- It can often be daunting for friends to continue visiting if they feel conversation is becoming more difficult; however there are several ways that good interactions can still be achieved. Generally speaking, it is better to focus conversation on a tangible object such as a newspaper, photograph, keepsake or newly acquired item from the shops, for example. This is because 1) the focus is taken off the person and put on to the item and 2) the person is more able to keep in mind what the topic of conversation is.

Old photographs are particularly good as very often older memories remain for longer. Remember though that it is not necessary to correct erroneously remembered memories because the focus should be on the quality of the shared interaction and not the truth as you remember it.

Sometimes people find conversation flows more easily if you are both involved in an activity together e.g. arranging flowers, tidying out a drawer etc.  Simply commenting on things such as ‘that is a beautiful flower’ or ‘I had a pen like this once’ may well result in an exchange of comments.

It is important to avoid the use of questions, particularly open-ended ones such as ‘What did you do in the war?’  Even questions that just require a Yes/No response often don’t lead to further conversation easily and should be used as little as possible.

It is also important not to talk too much. Often we fear silence and try to compensate for the reduced conversation from the person with dementia by talking incessantly. Occasional comments and companiable silence, particularly when engaging in some activity is absolutely fine.

Screen Shot 2015-06-03 at 16.40.06

Question 5 – My husband has been put on a soft diet and really misses his favourites. Is it ok to bend the rules a bit?

Answer- There are many different reasons why people are put on a soft (puree diet). It would be very important to discuss with the Speech and Language therapist (SLT) why he was put on this dietary texture in the first place before bending the rules. Modified diets are used to reduce risk of choking and/ or aspiration of food and drink that might lead to chest infections, and it is vital that the level of risk for your husband is fully understood.

SLT’s are always mindful of balancing the risks against quality of life. It is often found that people manage their favourite foods better due to increased stimulation and therefore an informed discussion with your therapist could result in a controlled trial of these foods.

We welcome ideas and comments from our readers about this blog.

Joy Harris, SLT, Clinical Lead for Dementia, Lothian
@joysltdem