MAKING MOMENTS MATTER: DRIVING THE DREAM

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MAKING MOMENTS MATTER DRIVING THE DREAM

• Canadian Gerontological Nurses Association
• 15th Biennial Scientific Educational Conference
• Banff, Alberta
• May 30, 2009

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THE PLAN

• Revisit some elements of what Making Moments
  Matter mean from my perspective
• Quickly look at what we know about 3 m?
• Whats the dream?
• Driving the dream what will it take where do
  we go from here?

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STEVEN SABATS DAD

• He lived in his own home but he needed
  assistance with food shopping, paying bills,
  doing the laundry, house cleaning, medicine
  management, visits to the physician, bathing and
  in his last years, he needed the support of a
  walker. . . . According to my father, he was
  happy to be living in his home, even alone a
  great deal of the time because as he said, I can
  do what I want. . . . . . .He had good days
  still, but the universe of good-ness was clearly
  constricted. (Sabat, 2008)

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• Disengagement Theory
• vs
• Continuity Theory
• Can they both be right?

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Nursing Staffs Responsibility

• We have to lend them our imagination about what
  they might enjoy. Cognitively impaired older
  people live in the present. . . and the people
  who are the most frequent presence in their
  present are nursing staff.

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3M Principle

• Pleasure must be woven into the fabric of the day
  and members of the nursing staff are the weavers
  of that fabric.

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Zingmark, K., Norberg, A., Sandman (1999).
Experiences of at-home-ness in patients with
Alzheimers Disease (2002) Promoting a good
life among people with Alzheimers Disease

• Play and joy are important elements in the daily
  lives of cognitively impaired women living in a
  small special-care unit fun should be included
  as part of the daily activities.

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Buettner, L.L.(1999) Simple Pleasures A
multilevel sensorimotor intervention for nursing
home residents with dementia.

• 30 handmade recreational items
• fishing box, look-in purse, flower arranging,
  picture dominoes, squeezies etc.
• 23 items worked
• Family visits improved staff used them during
  care

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Palo-Bengtsson, L. Ekman, S.L. (2002).
Emotional responses to social dancing and walks
in persons with dementia

• Social dancing walks with staff
• produced
• Engagement
• Mutual tenderness communion

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Schneider, N.M. Camp, C.LJ. (2002). Use of
Montessori-based activities by visitors of
nursing home residents with dementia

• Montessori-based activities
• Used by family members while visiting produced
• Significant increases in residents engagement
• Decrease in passive engagement

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Witucki, J. M. Twibell, R.S. The effect of
sensory stimulation activities on the
psychological well-being of patients with
advanced Alzheimers disease.

• Music known to be liked by resident
• Hand holding hand massage
• Aromas coffee, cinnamon, orange, flowers
• Lowered overall discomfort decreased fidgeting.
• Are these indicators of pleasure?

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Persaud, M. (2008) Pleasure in the daily lives of
people living with advanced dementia in a
long-term care facility A multiple case study
approach

• Some sources of pleasure lost, some maintained
  new ones developed post-illness
• Sources of pleasure is highly individualized
• Both family members and health care aides were
  knowledgeable about sources indicators of
  pleasure
• Persons with very advanced dementia responded to
  touch, music sweets but response not
  interpretable as pleasurable.

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• People in even the very advanced stages of
  dementia maintain their individuality . It is our
  responsibility to learn what that individuality
  is and respect it.

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WHATS THE DREAM?
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Dream has 2 Parts

• Making Moments Matter becomes an integral part of
  nursing practice that attends to the quality of
  daily life gives it equal status with the
  quality of care
• Making Moments Matter is both a philosophy of
  care and a practice

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• The Philosophy is It matters that residents
  have a good day as many days as is possible
• The Practice is Deliberately learning what
  creates enjoyment or contentment in a resident
  and looking for and taking advantage of moments
  throughout the day when something known to create
  pleasure can be introduced..

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Indicators of a 3M Agenda

• Nursing Staff knowledgeable about what residents
  enjoy
• A pleasure page in the chart or ehealth record
• Quality of life adventures embedded into the day
• Nursing staff take pleasure in finding new
  sources of pleasure in their residents days
• Residents who can still determine what they want
  to do, drive their days to the maximum extent
  possible

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Indicators

• A strong 3m research agenda among nurse
  researchers across the country
• The research findings are reported at CGNA, CAG
  provincial meetings and embedded in best practice
  guidelines and
• All members of nursing staff can do attend
  CGNA, CAG other relevant conferences

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• DRIVING THE DREAM

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Why nurses disengagement ?

• burnout from too many patients too much of the
  time,
• inability to deliver the kind of care that one
  perceives is needed
• lack of or insufficient recognition of the work
  that is done
• a sense that it doesnt matter if you do form
  relationships with patients
• repetitive work over many years without
  opportunity or encouragement to add to ones
  knowledge or skills
• many difficult patients or families over the
  years without assistance in dealing with them so
  you go on automatic pilot and
• you never understood that engagement was part of
  your job, and the most important part.

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• Engagement matters because disengagement and
  making moments matter are INCOMPATIBLE

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The Happiness TrilogyRoger Martin (2005)

• A valued member
• of a community
• And is valued That is valued
• by others . . .
  by you . . .
• Value derives from, and therefore necessitates, a
  relationship between the organization and the
  individual

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Four Drivers

• Teams
• Leadership
• Relationships
• Knowledge

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Teams

• Nursing is a team sport

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Leadership

• THE LITMUS TEST OF ALL LEADERSHIP IS WHETHER IT
  MOBILIZES PEOPLES COMMITMENT TO PUTTING THEIR
  ENERGY INTO ACTIONS DESIGNED TO IMPROVE THINGS.
  IT IS INDIVIDUAL COMMITMENT, BUT IT IS ABOVE ALL
  COLLECTIVE COMMITMENT (Fullan, 2001)

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• A LEADER WHO AIMS TO NURTURE EMPLOYEE HAPPINESS
  MUST DEVELOP OPERATING SYSTEMS AND A CULTURE THAT
  REINFORCE THE ROLE OF THE INDIVIDUAL WITHIN THE
  COMMUNITY. . . . LEADERS SHOULD VIEW THEIR FIRM
  AS A NESTED SET OF COMMUNITIES, WITH INDIVIDUALS
  AS THE KEY COMPONENTS OF EACH. HENCE THE
  NURTURING OF COMMUNITIES IS A KEY TASK OF
  BUSINESS LEADERS. (Roger Martin, 2005)

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Invert the Triangle
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• Leaders must be consummate relationship
  builders because you cant get anywhere
  without them and you get everywhere with them.
  (Michael Fullan, 2001)

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Relationships

• THERE NEED TO BE STRONG SUSTAINING RELATIONSHIPS
  BETWEEN NURSE MANAGERS AND STAFF MEMBERS AND
  NURSE EXECUTIVES AND THE NURSE MANAGERS.
• EACH NURSE MANAGER HAS TO CARE ABOUT HOW THE
  PERSON SHE IS DIRECTLY RESPONSIBLE FOR IS DOING
  IN HER RELATIONSHIPS WITH THOSE WHO ARE DEPENDENT
  ON HER.

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Knowledge

• Making Moments Happen on the frontier of
  evidence-based care

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Where do we go from here?

• Humanistic efforts movements
• The Priory Method
• Eden alternative
• Gentlecare
• Others

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• Use the influence, knowledge passion of CGNA
  members and conference attendees to change
  organizations teach students
• Name what you do
• Engage your Nurse Managers CNOs
• Rebrand your organization
• Start flipping the

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• Drive a research agenda