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Kia āta kōwhiri Choosing Wisely

The Choosing Wisely campaign seeks to reduce harm from unnecessary and low-value tests and treatment.

The aged residential care programme is profiling some of the great work done in the sector. In this latest instalment, we hear how a staff training programme is transforming dementia care around New Zealand.

Ten years ago, a local initiative to support rest home staff was introduced to help improve wellbeing and enhance care for residents with dementia. Today, it’s transforming dementia care in residential care facilities and home-based support services throughout the country.

Walking in Another’s Shoes, a training programme based on a person-centred approach, aims to inspire and enable aged care staff to adopt different ways of supporting people with dementia. The idea at the heart of the programme is asking the question – what is it like to walk in the shoes of a person living with dementia?

The programme was originally developed in Canterbury DHB in 2007, and the first cohort of training began the following year. It was soon introduced in other South Island DHBs and picked up by a number of DHBs in the North Island. The training runs over eight months, with one workshop each month that involves group work, discussion and role playing. This is supported by a one-on-one session between facilitator and student.

Carole Kerr, dementia educator for Nelson Marlborough DHB and the South Island Alliance, says the participants bond as a group and realise that although they work in different places, they are all facing similar issues.

'And,’ she says, ‘over time, staff turnover in facilities where carers have completed the training has significantly reduced.’

Olive Redfern, a dementia educator based in Whanganui, educates caregivers, managers and registered health professionals in the programme. Maintaining person-centred care can be challenging in residential care, she says, and Walking in Another’s Shoes is very effective in creating attitudinal change.

‘It effectively opens up all communication channels to look at every aspect of care – bringing in family, general practice and medical to provide one team – so the person becomes the centre of it all. The programme creates an amazing framework to be able to do that.’

She says feedback on the programme has been consistent from caregivers, managers and students in general.

‘It’s an awesome, well-structured programme, which makes a huge difference to carers’ day-to-day practice. Educating people in Walking in Another’s Shoes is the best job I’ve ever had – I love working with aged residential care staff and seeing the passion they have for the job and the changes they make.’

Belinda Brown, manager of Southanjer Rest Home – a 24-bed dementia unit on the outskirts of Oamaru – says four of her staff completed the course over the past year and another four have recently enrolled.

Belinda says she has since noticed improved communication between staff members, and improved interactions with staff and residents who may occasionally have behaviours that can be more challenging to manage.

‘Staff are able to think on their feet and think outside the box more easily, and I’ve seen improved confidence in how to manage different or difficult situations. I’ve also noticed greater contribution and a more positive team culture, as well as a changing focus from task-orientated care to resident well-being-focused care. It’s a great initiative and we hope to have all of our staff attend over the next couple of years.’

Dr Matthew Croucher, clinical director, South Island Dementia Initiative, says most services aspire to best-practice, patient-centred care, but there is a gap when it comes to the ideals of person-centred care.

‘It’s the difference between finding the very best medicine at the lowest dose for sundowning – also known as late-day confusion – versus working out how to best meet the human need that someone is trying to communicate when they try to leave their place of care to ‘go home’ at 4pm every day.

‘Walking in Another’s Shoes is the gold standard programme that DHBs have invested in to kick-start an essential improvement in our models of care for people living with dementia.’

Last updated: 13th November, 2021