Reframing risk management in dementia care through collaborative learning

Abstract

Risk management is a complex aspect of practice which can lead to an emphasis on maintaining physical safety, which impacts on the well-being of people with dementia. Education for practitioners in risk management is particularly challenging because of its conceptual nature and diverse perceptions of risk between and within professional groups. The practice development research reported here formed one part of a multisite study and contributed to developing a risk assessment and management framework for use by practitioners in partnership with people with dementia and their families. Practice development research uses learning theories in the process of the research, and in so doing its intent is to not only create new knowledge but to view the research process as also a process of learning for those involved. Twenty practitioners from varying professions participated in five Collaborative Learning Groups, each of at least 2 hours duration, which were held over a 7-month period. Data analysis highlighted contradictions in the care system and in the professional's intention to practice in a person-centred way. These were expressed through the themes of: Seeking Certainty; Making Judgements; Team Working; Managing Complexity; Gathering and Using Information.

Evidence of what works to support and sustain care at home for people with dementia: a literature review with a systematic approach

“…A number of papers covered contextualising considerations for the provision of community-based support: drawing attention to the risk-averse culture behind much service provision and its implications for the person with dementia [46]; questioning the criteria used to evaluate provision and their failure to attribute greater importance to supporting identity [47] and maintaining personhood [48] of the person with dementia; and arguing for the application of a recovery model as a framework for the provision of care and support [49,50] (M),(M) .…”

Risk Assessment in Mental Health: Introducing a Traffic Light System in a Community Mental Health Team

“…Any system adopted had to simplify complex risk phenomena [1,17] and provide an increased level of precision on SUs' risk levels that would ensure practitioners were comfortable working with it [16]. One of the reasons for the positive reception given to this TLS was the clarity that it brought to complex and multi-faceted situations requiring decisions concerning how to allocate a colour to a community SU who had been admitted to hospital.…”

“…That is to say, teams operating in continually higher risk scenarios may have become more comfortable with those risks. [16] work, this AR study indicates a desire for greater certainty amongst these mental health practitioners; this TLS allowed them to review each SU's contemporary care with the care coordinator and offer advice to moderate or enhance the risk allocation if necessary. This support for the care coordinator may reduce restrictions to care by introducing -when safe -elements of positive risk taking, which can be empowering to SUs [17].…”

“…Thomas and Staiger [12] note that some Australian practitioners found asking personal questions difficult, resulting in risks being missed on initial assessment, and propose that a screening tool would help with questioning and build a better picture of the risks involved; and this may be useful internationally where risks include socio-economic deprivation, and poor rural access to metal health services [13], mental health and substance abuse co-morbidity [14], and unemployment causing the risk of maladaptive coping strategies such as the use of alcohol, tobacco and general self-neglect [15]. A certain degree of risk may be beneficial to SUs, who may otherwise become deskilled at managing facets of their own daily living [16,17].…”

“…A recurring theme in international literature is the varied nature of sources of risk and the direction of its application [2,[14][15][16][17]. Risk is unpredictable and contextually driven for individual SUs and services, and arguably requires a broadranging assessment tool such as that employed in many care contexts based on 'traffic light systems' (TLS).…”