Utility of PIECE-dem as a practice tool: a tool focusing on the perspective of people with advanced dementia in residential aged care

Author: Alison Campbell

Campbell, Alison, 2018 Utility of PIECE-dem as a practice tool: a tool focusing on the perspective of people with advanced dementia in residential aged care, Flinders University, College of Nursing and Health Sciences

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It has been suggested that ‘dementia challenges our assumptions about what it means to be a person’ (Woods, 1999:35). If there is little or no regard for a person’s self-expression, by whatever means, then effectively many people with dementia become excluded from any form of participation in, or influence over the support and care they receive, other than as a passive, objectified recipient.

The aim of this research was to trial the tool, PIECE-dem, in the Australian context and evaluate its application by practitioners to better support people living with advanced dementia. PIECE-dem, which is underpinned by person-centred principles, was designed by researchers for use by researchers in a UK study. This current research explored the potential for use of the framework by practitioners.

The research took place within one residential aged care (RAC) home, with five staff participating in the training and subsequent observations using PIECE-dem. It was a mixed method research design with the Individualised Care Inventory (ICI) (Chappell et al., 2007) staff-based measure used in the survey as the quantitative component, and observations, interviews and field notes made up the qualitative component.

The tool provides a framework for structuring observations to capture resident efforts at social interactions, supporting observers to look for small and subtle nuances of movement and gestures. The focus of the observations is on the resident and how they are experiencing the care environment. At the conclusion of each observation session there was guided reflection (Johns, 2013) on how the person with dementia was experiencing the care environment and to identify possible trends or patterns in responses and expressions of agency.

The findings provide a positive indication that PIECE-dem would be valuable as a practice tool for staff in RAC homes as a framework to support critical interpretation of observations. Spending time observing and then reflecting on observations gave staff an awareness of patterns of gestures they had not seen. Also, by observing and reflecting on what actions might mean for the person with dementia provided staff with insights into demonstrations of capacity and agency not recognised before. The staff participating found they gained awareness of expressions of wellbeing and illbeing as well as a greater understanding of embodied communication. These findings suggest that PIECE-dem has the potential to advancing an understanding of person-centred practice. PIECE-dem offers a strong foundation for building an awareness of autonomy and expressions of agency as it enables an exploration of how the person with dementia is experiencing and influencing their immediate environment, and provides a framework for reflecting on what is observed.

Keywords: Person centred care, dementia, guided reflection, agency, observations, embodied communication, aged care home

Subject: Ageing Studies thesis, Health Sciences thesis

Thesis type: Masters
Completed: 2018
School: College of Nursing and Health Sciences
Supervisor: Dr Sandra (Sam) Davis