Mindfulness in dementia care

Talk to any care worker and they will describe a work day of rushing from one task to the next. This juggling is often punctuated by the need to support residents and family members who are distressed.

The daily experiences of care staff feed into the circle of workplace stress, task oriented care, fatigue and staff turnover.

We need to consider ways to positively influence organisational cultures in what is a busy environment.

So what could be done in the ‘here and now’ for both staff and resident wellbeing?

There are two possible clues within the question.

The first is recognising that the people who live in care homes and the people who work in care homes have a shared wellbeing. Attempts to improve the wellbeing of residents with dementia will likely fail without a parallel effort to improve staff wellbeing. Getting it right would mean the creation of a virtuous circle.

The second clue is about the here and now itself.

The present moment is the only domain in which we can fully experience life as it is. Being aware or mindful is to be available in the here and now, no matter how perfect or imperfect it is.

In a nutshell, mindfulness is being present, aware of where we are, and fully attending to what we are doing. This availability in the moment helps us to avoid being overly reactive or overwhelmed by what is happening. Awareness creates the space for choice in our actions.

With roots in the Buddhist tradition (Hanh, 1975), mindfulness has become a mainstay of therapeutic intervention inclusive of Mindfulness Based Stress Reduction (Kabat-Zinn, 1982), Mindfulness Based Cognitive Therapy (Segal, Williams, & Teasdale, 2002), Acceptance and Commitment Therapy (Hayes, Strosahl, & Wilson, 1999) and countless apps, courses, podcasts and books. Although evidence continues to emerge, mindfulness is recognised as a valid form of mental training.

Why might this be useful in care settings for people with dementia?

Let’s look at just one example:

A family member has requested a meeting with you and from the moment they step into your office you can see they are not happy with the care being provided to their mother. This is not the first time this has happened. As the conversation progresses you notice a rising sense of defensiveness about the care your team provide, and you notice that your heart rate increases just a little.

We need to be aware of our thoughts, feelings and bodily sensations in this moment. In other words, we interpret our own emotions as being very real – and ‘the truth’. We might start to interpret the complaint as an attack on our professional integrity. Any doubling down to defend ourselves or our team will likely escalate the situation.

However, an awareness of our thoughts, feelings, and bodily sensations means we can create space from them in the moment. We can notice their presence, note that we may need to come back to them, then focus our attention on really listening to and understanding the daughter’s point of view. Putting our own feelings aside momentarily doesn’t negate them, but it avoids us becoming stuck in them when we need to focus elsewhere. With our attention devoted to listening, we can reflect back our understanding of the situation at hand. Our mind is also free to offer what the person needs to hear, which is a genuine ‘I’m sorry’, and suggest a plan to reach a solution. If we get it right, we might still have an unhappy family member in front of us but at least they know they have been heard. This is far preferable to an unhappy family member who walks out feeling disempowered with a secondary complaint of, “they don’t care enough to even listen to me.”

Leaders who adopt such approaches themselves are positioned to lead and coach their teams to:

  • Sensitively monitor the environment and reduce noise and unhelpful stimuli (instead of simply learning to tune it out)
  • Notice early cues that something is wrong
  • Foster an environment in which genuine listening is the norm not the exception
  • Notice attempts to interact when skills (of the person with dementia) are changing
  • Stop, stay calm and make good choices in the face of the unexpected
  • Recognise the impact of the staff’s emotions
  • Respond and engage with emotions of residents who are struggling to articulate needs
  • Contribute to a strong team support network

The Dementia Centre has developed workshops to introduce and embed the key concepts of mindfulness, how the concept might be applied in dementia care settings, and provide some practical exercises of the intra- and inter-personal skills to support self, staff and resident wellbeing

To find out more call the Dementia Centre on 02 8437 7355.