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Vol 5 No 5 October/November 2016 Australian Journal of Dementia Care 51
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Associate Professor Belinda Goodenough
(left) is Senior Visiting Fellow to UNSW Australia
(DCRC: ABC) and KT Program Manger for
Dementia Training Australia. At the time of
writing she was KT Program Manager for the
DCRCs and the NSW/ACT DTSC; Ruby Tsang
is a Doctoral Candidate with the DCRCs; Dr
Michael Young is Senior Lecturer (honorary),
School of Psychology, UNSW Australia. To
follow up on this article contact Belinda at:
.
DCRC SPEC I AL I SSUE : THE B I G P I CTURE I N DEMENT I A RESEARCH
The ‘Cycle of 4Ds’ approach of Appreciative Inquiry
compared with a ‘problem solving’ method
Problem solving method
WHAT’S WRONG?
Define problem(s) and practice gaps:
Example: some residents are not
consuming enough drinks after lunch;
morning and afternoon staff blame the
other shift as having responsibility.
WHO/WHAT IS TO BLAME?
Analyse cause(s) of a problem:
Example: no extra drinks break scheduled
in care plan for afternoon; staff resistant to
taking on what they perceive to be an
extra task at the same time as shift
handover.
HOW TO FIX?
Scope possible solutions to problem:
Example: purchase and install a
thermometer in main lounge area; draft
new policy to cover hot days (>25°C);
designate staff member at shift handover
to deliver extra drink at a fixed time (eg
3pm), with delivery to be recorded in file
notes.
IMPLEMENT/MONITOR A FIX
Action planning (treatment):
Example: managers to educate staff via
in-service training on new policy, how to
read the thermometer, and action
pathway to alert designated ‘drinks staff’
to serve water.
POSSIBLE OUTCOMES
Staff view hydration solution as task-
oriented; potential persistent irritation
about ‘extra jobs’; initiation of solutions
become thermometer-driven and not
‘tuned in’ to resident needs.
Appreciative Inquiry
DISCOVER ‘best of what is’
Identify, appreciate, value practices that
are working well:
Example: most residents are comfortably
hydrated; some enjoy a drink when staff
sit with them; one resident likes watching
her drink poured from a jug into a clear
glass (which was a birthday present).
DREAM ‘what might be’
Envision future practices that might work
well:
Example: could staff and residents take
an afternoon drink break together; could
personalised clear drink containers be
used; serve drinks that have colour?
DESIGN ‘what should be’
Engage in dialogue and plan practices
that should work well:
Example: discussion led by lifestyle
officers on activity/socialising ideas;
attention to other factors, eg music;
personalised glasses; coloured ice-cubes
as a scheduled staff-resident activity.
DESTINY/DEPLOY ‘what will be’
Innovate and implement the proposed
practices:
Example: community (staff and residents)
drinks activity with a ‘butler’ service (staff
volunteer on roster), offering: straws,
personalised clear glasses, coloured ice-
cubes.
POSSIBLE OUTCOMES
Community well-being response to
hydration and comfort for both staff and
residents; sustainable activity not just
‘care’, connect several lifestyle elements;
staff enjoy owning program.
Scenario: In a high-care secure dementia unit, resident hydration is inadequate on hot
days during summer. Drinks are typically served pre-poured into opaque plastic
tumblers. Morning and afternoon staff disagree on which shift has responsibility.