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Vol 5 No 5 October/November 2016
Australian Journal of Dementia Care
63
changes in their workplace
typically reflected a supportive
management. Where
suggestions were viewed as
being in line with current
policies, managers were more
likely to take them on board and
try to implement change.
Management were reportedly
more accepting of strategies if
suggestions were evidence-
based.
Where management was
perceived as open to
suggestions and actively
encouraged new strategies,
participants felt more confident
to approach themwith their
ideas.
Effective communication between
staff and with family
Unsurprisingly, participants
reported that it was relatively
easy to suggest and implement
new strategies where
communication between staff
was effective via clear
documentation of successful
strategies, considering others’
suggestions, education sessions
and shift handovers. Gaining
family members’ support to
trial and implement
interventions by
communicating with them
beforehand was also reported as
helpful.
Suggested strategies to
overcome barriers to
implementing change
Organisational approach to
implementing changes
Modifying organisational
approaches to implementing
change was proposed as a way
to help overcome KT barriers.
Suggestions included:
• Increased management
support and time to trial
strategies.
• Greater consistency of staff
across shifts as well as referral
to services, such as Specialist
Mental Health Services for
Older People (SMHSOP) and
DBMAS for additional
support and new evidence-
based ideas to assist with
BPSDmanagement.
• Building staff members’
confidence and capacity to
suggest and implement
change, and allowing them to
take leadership of new
strategies. For example, a
catalyst or champion to
provide positive mentoring
and motivate others to work
through the difficulties
around implementing
changes.
• Some participants indicated
that a shift in organisational
and management support, as
well as the broader workplace
culture and hierarchy was
needed to encourage staff to
suggest and implement
changes.
• At an organisational level,
suggestions included changes
to policies and procedures as
well as modifying current
communication and feedback
channels to reduce barriers
caused by hierarchal
structures.
• At a management level,
suggestions included
increased guidance and
mentoring as well as
recognition and
acknowledgment that the
contributions of direct care
staff are valuable.
Communication
Participants suggested that
improved methods of
communication via staff alerts,
meetings, behaviour charts,
memos and documentation
would support implementing
changes. Multidisciplinary case
management meetings were
also suggested as a method of
encouraging staff to develop
and decide strategies and to
trial them as a team. Increased
opportunities for feedback
between staff and management
using formal feedback channels
and anonymous surveys were
also suggested.
Resources
Suggestions related to resources
included more realistic time
frames to trial and evaluate new
interventions, the use of quality
improvement tools and
interagency forums to support
practice. Participants noted that
increased opportunities for
education and training to
upskill staff, such as in-services
and more workshop-based
learning, were needed to
“present fresh ideas and
evidence-based practice, inspire
culture change, and challenge
old [ideas]”.
Training for staff to develop
new or reinforce previously
learned but unused skills to
cope with the challenges of
BPSDmanagement and carer
burnout were suggested.
Participants also requested
access to evidence-based
information that validated their
existing practices. Some
participants felt that in instances
where they were intervening
successfully to avoid or manage
BPSD, having access to research
that showed the intervention/s
were validated by evidence
would reinforce to others that
their approach was worthwhile
adopting.
Engage others in the process
Case/family conferences and
medication reviews to involve
family members and GPs in the
process of implementing new
interventions with their support
and understanding were
proposed.
Feedback on the workshops
Participants also identified
aspects of the workshops that
they found most useful. Many
reported their increased
awareness of the resources
available in hard copy and
electronic formats to assist with
BPSDmanagement.
Others indicated the benefits
of an increased awareness of
services available to support
those caring for a person
presenting with BPSD, such as a
national after-hours helpline,
Dementia Behaviour
Management Advisory Services
(DBMAS), DCRC and DTSC as
well as the benefits of
networking with other services
and health professionals. The
workshops also provided
opportunities to hear and share
others’ experiences of BPSD
management and the challenges
of implementing change in the
workplace, for example “no
matter what area you work in
the majority of the staff felt the
same way and [were] asking the
same questions”.
Some participants reported
that the workshops reinforced
their current knowledge
enabling them to “feel more
confident that in a work
situation I can be more pro-
active in supporting people
with dementia” and another to
“trust my own knowledge base
and position in remote/rural
setting with resistance to
change”.
Participants also indicated
that they gained additional
information on approaches to
BPSDmanagement including
“identifying pain”,
“understanding physical
conditions of dementia”,
“addressing little things (UTI,
environment etc)” and that
“medication is not always an
effective treatment”.
Additionally, teamwork, “the
importance of multidisciplinary
teammeetings”, improved
communication and
information sharing were
identified as key strategies that
would help participants
implement evidence-based
interventions to manage BPSD
more effectively in their
workplace.
Conclusions
The KT experiences of the
frontline dementia care staff
reported in this article are
consistent with the four
categories of barriers to
successful KT identified in the
literature (see ‘barriers and
enablers’ p61). Of these,
‘accessibility of research
findings’, ‘organisational
support to use research’ and
‘support from others to use
research’ were mentioned the
most by participants.
Aged care staff differed from
the health care professionals
reported in the literature in that
the ‘anticipated outcomes of
using research’ category was
underrepresented.
This may reflect a lack of
awareness around the
relevance of evidence-based
information to direct care staff.
This suggests the need to raise
awareness of the potential
benefits of evidence-based care
practices for frontline staff in
aged care.
It is not our intention to
criticise those working in aged
care management and we
acknowledge the challenges of
the system. The organisations
DCRC SPEC I AL I SSUE : THE B I G P I CTURE I N DEMENT I A RESEARCH