Dementia Care

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62 Australian Journal of Dementia Care October/November 2016 Vol 5 No 5
repeatedly until breakfast was
served at 8am, disrupting all
around her).
Often, staff members were
not encouraged to see and/or
value their approach or simple
strategies as legitimate
interventions where these
avoided or reduced BPSD.
A lack of confidence to
suggest changes was linked to
“feeling inferior” and “newer
staff feeling intimidated”. This
prevented them from raising
suggestions based on their
observations and individual
successes for discussion with
other staff and/or management.
Previous unsuccessful
attempts at implementing
strategies for a particular
resident/client with BPSD
leaving staff feeling defeated,
and inconsistent
implementation of strategies by
different staff members and
across shifts were reported as
problematic. Participants also
described the lack of a forum to
discuss practice change and
reach a team consensus as well
as encourage teamwork and
collaboration in the
implementation process.
Interpersonal and
professional issues related to
group processes reportedly
hindered teamwork that could
affect practice change. These
include lack of co-worker
support, interpersonal conflict,
differing personalities and
viewpoints and resistance to
taking direction based on
others’ suggestions.
Resource constraints
Consistent with the literature
(Phillipson et al 2016; Retsas
2000; Draper et al 2009; Low et al
2015), time constraints were
repeatedly raised as a barrier to
implementing new approaches
to managing BPSD. Participants
reported a “lack of time to try
new things” and that they
found it “difficult to get people
to listen because they are busy”.
Implementing evidence-based
practice was often viewed as a
separate activity to everyday
care, to be trialled if and when
time and resources permit.
Budget constraints were seen
as barriers as “staff may require
training but [it] may not be in
the budget”. Limited access to
training and education reduced
opportunities to identify
relevant evidence-based
information, leading some to
the perception that they did not
have the necessary knowledge
or skills to do their job.
At times, a lack of education
meant BPSDwas viewed as a
‘normal’ part of dementia and
not something that could be
successfully managed.
Attending education was also
hindered by lack of time due to
“work commitments” and
workload, a lack of awareness
regarding opportunities and the
practicalities of “getting all staff
to attend at [the] same time”.
Participants reported that
where some staff members were
sent/invited to attend external
training, opportunities to follow
up or support to consider new
information did not occur
afterwards. New strategies and
information may then be lost to
others in the organisation with
little or no attempt at
implementation.
In some cases where the
physical structure of a care
environment was inappropriate
for those with dementia, this
was seen as a restriction to
implementing changes. Lack of
access to technology such as
computers and hand-held
devices in the workplace was
seen as a barrier to accessing
evidence-based information on
the job.
External factors
Participants indicated that the
person with dementia’s family
and/or doctor may resist
changes to care strategies.
Those participants providing
care in the community reported
finding it difficult when family
or clients resisted suggestions
to trial doing things differently
in their home: “Many
behaviours are difficult to
manage and families do not
always understand [the] care
process”.
Frontline staff indicated that
they did not have the
confidence to make suggestions
to GPs and felt they may not be
taken seriously if they did:
“Some GPS are resistant to
suggestions, even when certain
strategies are successful”.
Where suggesting or
implementing change
was possible
Supportive management and
evidence-based strategies
Participants who indicated less
difficulty suggesting or trialling
DCRC SPEC I AL I SSUE : THE B I G P I CTURE I N DEMENT I A RESEARCH
Promoting the BPSD Guide principles
The BPSD Guide (Burns et al 2012) was developed by Dementia
Collaborative Research Centre: Assessment and Better Care (DCRC:
ABC) with funding from the Australian Government.
The Guide incorporates a comprehensive evidence- and practice-
based overview of BPSD management principles with practical
strategies, interventions and example scenarios. It was developed to
provide guidance for clinicians, particularly those working in the
Dementia Behaviour Management Advisory Services (DBMAS), in their
role of assisting residential aged care facility staff, community care staff
and family members caring for people with dementia with BPSD.
Demand for the BPSD Guide led to the development of a suite of hard
copy and electronic resources to support clinicians, family carers and
frontline care staff.
But just distributing guidelines or providing evidence-based
information does not lead to changes in practice (Vollmar et al 2010;
Phillipson et al 2016; Freeman & Sweeney 2001). The successful implementation of evidence-based
information requires a range of KT activities (Vollmar et al 2010; Fruhauf et al 2004) including providing
ready access to tailored information based on systematic reviews (Conroy & Shannon 1995;
Grimshaw et al 2012).
The DCRC: ABC team undertook the following KT strategies (CIHR 2010) to support uptake of the
evidence-based principles of the BPSD Guide into everyday practice:
• Hard copy and PDF versions of the resources, and links to electronic resources, disseminated to
target audiences throughout Australia, directly and via expert clinicians.
• PDF versions and links to electronic resources available via the DCRC website.
• Oral and poster presentations at relevant dementia forums.
• Tailored in-service training and evaluation packages developed for skilled clinicians to deliver
evidence-based training in their workplace.
• Plain English versions of the hard copy and electronic resources developed for family carers and
frontline care staff.
• In collaboration with the Dementia Training Study Centres (DTSC), BPSD workshops were delivered
to health professionals and frontline staff in urban, regional and remote centres throughout Australia.
The BPSD Guide and associated resources are freely available on the DCRCs’ new
DementiaKT Hub website at