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THE PROBLEM

THE PROBLEM. After initial input by the Occupational Therapist (OT) at the early diagnostic stage of a cognitive impairment, there is generally no further contact by the OT for at least 6 -12 months. The opportunity to assist people in dealing with early memory problems is lost.

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THE PROBLEM

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  1. THE PROBLEM • After initial input by the Occupational Therapist (OT) at the early diagnostic stage of a cognitive impairment, there is generally no further contact by the OT for at least 6 -12 months. • The opportunity to assist people in dealing with early memory problems is lost. • Support at this time of diagnosis is not optimised, for persons with dementia and their carers. • Early intervention in helping with the complex range of cognitive, social, physical and emotional impacts of dementia will allow affected individuals and their care givers time to prepare for future challenges.(Grand et al, 2011)

  2. THE CHANGE I WISH TO MAKE • To augment existing OT service for this client group and their carers with the introduction of a six week memory rehabilitation programme. • Research by an OT in Belfast showed that new learning took place and was maintained over time following introduction of an individualised home-based memory programme. (McGrath, Passmore, 2009) • Financial and time constraints out-ruled an individualised programme but the concept of a group approach was feasible. • Cognitive rehabilitation delivered in a timely manner in early dementia can enhance everyday function and satisfaction with daily performance. (Clare et al, 2010) • Occupational Therapy is a client-centred health profession concerned with prompting health and well being through occupation, in a meaningful and purposeful way. (WFOT, 2012). This philosophy also guided my planning of this project.

  3. THE PLAN • HSE Transformation Programme states “everybody will have easy access to high quality care and services that they have confidence in and are proud to provide”. (2007-2010). Research essential to meet this goal. • Time to research this change was a challenge but great support was given by my line manager and Hospital Manager. • Reconfiguration to a level 2 hospital has taken place in last fortnight. Rehabilitation and extended out-patient services to be core functions of the new reconfiguration.

  4. THE PLAN Continued • Using Lewin’s model of change : unfreezing the status quo, moving to a new state and refreezing the new state, I introduced my new initiative to the relevant stakeholders. • Heathfield states “people who are afforded clarity, dignity, understanding, and compassion have a greater openness to change” (2006). • Identification of suitable clients to attend the groups was very time consuming, standardised testing and interviewing of both patient and carer took place. • Many hours spent researching and planning content of the six sessions.

  5. Outcome Measures • Before the groups: • Standardised cognitive tests carried out. • Memory Aids questionnaires and Memory Knowledge questionnaires completed by all participants. • Written comment sheets to be completed by relevant colleagues with an interest in the groups • After the groups: • Repeat of standardised cognitive tests. • Repeat of Memory Aids and Knowledge questionnaires. • Request all participants to complete comment sheets on efficacy of the memory groups. • Test results and questionnaires to be audited to gauge effectiveness of the memory groups. • Plan future groups based on this audit. • Possible involvement of OT students working on memory groups as their final year thesis. • Follow-up home visit in Feb/Mar 2014.

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