Dr Nutmeg Hallett
Lecturer in mental health nursing.
Postdoctoral researcher within the Risk, Abuse and Violence research programme, focusing on violence prevention in mental health settings.
Location University of Birmingham
Activity
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Thank you Carole. You are right, we are all just human. Even medical experts get it wrong sometimes when working with people with dementia because so much of it is trial and error.
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Dr Nutmeg Hallett replied to Jan Cantle
Thank you Jan, I'm glad it has been helpful.
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Thank you Terri, I am glad that there has been information that will be helpful for you.
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Thank you for your feedback Linda. It is something that we have tried to address in the comments, but we will look at including the carer's perspective more formally next time.
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Thank you Ruth.
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Dr Nutmeg Hallett replied to Dawn Lowe
Thank you, it is really heartwarming to hear that this course has been helpful.
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I'm glad you liked the case study. We find that it is a useful way to get discussions started.
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Dr Nutmeg Hallett replied to [Learner left FutureLearn]
You are right Jennifer, that sometimes we trigger situations unintentionally, but you seem to have a good response to this. It is also worth apologising if you do something to upset someone, even if it is unintentional.
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Dr Nutmeg Hallett replied to Kay Chrysostomou
Thank you Kay for picking up the few positives there were. It is correct that he initially used the correct name, and sitting down was a good thing to do. It did all go downhill from there.
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Dr Nutmeg Hallett replied to Judy Brase
Thank you for sharing your experience Judy. Walking away can be a very effective form of de-escalation in the right situations. It is a very useful idea to think about how important the task is. As you say, leaving dentures in ocassionally probably won't do any harm and if it avoids an argument is good for everyone. It can become more of an issue if someone...
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I am glad that the case study so closely resembles someone that you work with, and that you can put into action some of what you have learnt. I hope it is successful.
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Dr Nutmeg Hallett replied to Lena G
I am sorry that this has not provided the information you need Helen. As Lynn says we have been clear that we have not included how to manage physical aggression. We are aware that this is something that people would like more information about, but we did not feel that we could do it justice within the scope of this course. Physical aggression may sometime...
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There is evidence to show that providing person-centred care for people with dementia can reduce agitation, which would save staff time. So I agree that there are lots of financial constraints, but actually improving attitudes and the culture of staff would probably be a cost effective exercise.
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You are right Maureen. And as I have said in previous comments, taking a person-centred approach to care can often speed things up, it can reduce or eliminate the 'challenging behaviours' that take up staff time.
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Dr Nutmeg Hallett replied to Jan Cantle
Thank you Jan, that is an interesting and insightful analogy.
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Your experience Patricia is a very good example of how we often need to adjust our own expectations. If you expect something to take 10 minutes and it ends up taking 30, that is very frustrating, but if you start out thinking that it will take 30 minutes you feel less frustrated and it can even sometimes everything up!
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Thank you for sharing your experience Antonia. It can be incredibly frustrating when someone gets stuck in a loop. Have you found ways of dealing with it at the time?
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Absolutely Alexandru, it is vital to explain what is happening, even if the person doesn't respond.
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I agree Steve, some people have an innate ability to be patient, but it is something that anyone can develop and improve. As a nurse there is a focus on constantly developing oneself not just in terms of knowledge, but also interpersonal skills. This is something that spills over into my personal life and makes all interactions easier.
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Dr Nutmeg Hallett replied to D martin
It is true that a lot of what people discuss here is not just useful for people with dementia.
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It sounds like you have found techniques that work very well for you. Is this something that took a lot of trial and error?
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Yes, non-verbal communication both in terms of how we come across, and observing other people's non-verbal cues.
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That is a very good point Jan, thank you for raising it. I myself have no idea what a cwtch is!
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That sounds like an incredibly useful coping strategy. Anything that can help you empathise is good.
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Dr Nutmeg Hallett replied to J W
Yes, this can be particularly frustrating for carers. If you feel yourself getting frustrated it can be helpful to briefly step away from the person. It is good that you can remind yourself that it is unintentional.
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Dr Nutmeg Hallett replied to Melissa F
Thank you for sharing this link Melissa. Using simulation of experiences is something that we use with our students and find particularly effective. It is much easier to empathise with someone if you have an idea of how the world is for them.
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You are right Linda. A lot of 'challenging behaviour' is actually just people reacting to frustration or anger. If you can avoid the frustration, often the 'challenging behaviour' vanishes. Of course there will be times when frustration is unavoidable, then it is important to be calm and patient.
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Dr Nutmeg Hallett replied to Melissa F
Thank you Melissa, your experience demonstrates the importance of honesty.
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Dr Nutmeg Hallett replied to Lena G
@LenaG I have worked in a few care homes / residential settings that have not had showers at all. I do agree that it is very important to look at all the risks, including psychological, but there are also sometimes constraints on what can be provided. As I have said in other comments, providing person centred care doesn't mean doing everything the way an...
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@SteveB You raise an important issue, that an intervention or idea may work in one situation or setting, but could cause distress if something is different. There is a lot of trial and error when caring for people with dementia; sometimes you will try things that don't work and may cause upset but it is all part of the learning process.
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@NicolaJames Thank you for sharing the link, this is a very interesting blog. And thank you all for sharing your ideas.
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It is particularly noticeable when reading people's comments that there are some commonalities between experiences, but there are also lots of idiosyncrasies. And you are absolutely right Leonie, that there is a lot of overlap between working with people with dementia and working with people with many other conditions and diagnoses. Also Leonie, it is a common...
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Dr Nutmeg Hallett replied to Leonie Seeds
Thank you Leonie, it is very important to remember that this is Peter's home, and he has every right to feel secure and comfortable there.
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Dr Nutmeg Hallett replied to Lena G
I agree that it is important to work with individuals. However, what if Peter is at risk of falling and so a bath is a safer option? It is easy to blame the care home, particularly with Peter's case study, but sometimes they may be working in the person's best interest. Every story has more than one perspective and it can be really helpful to consider these...
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Often homes have routines that seem to be set in stone, but a good home will allow for flexibility in timetables so that they can provide person-centred care.
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'All about me' sheets can be a really useful way of not only providing information that can inform person-centred care, but also to 'humanise' people. Meaning that it is easy to dehumanise the people living in residential settings, they can become tasks rather than people. Some written information about a person's likes, dislikes and history can act as an...
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Thank you Monica, that is a very nice way of framing the issue, that the facility has a listening problem rather than Peter having communication problems.
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Thank you for sharing Lynn. This is an excellent example of good practice. I wonder if you ever struggle balancing the time it takes to do this with the needs of the residential setting that you work in, or do you find that the approach you use actually saves time in the long run?
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Dr Nutmeg Hallett replied to Kim G
Also making sure that you give people time to answer, it can take much longer for people with dementia to process questions.
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That is a lovely example of the importance of attempting to interpret what someone is trying to communicate Samantha. It can be very frustrating for both parties when attempts to interpret fail, but it is always important to try.
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Thank you for sharing Kirsten. Distraction can be a very useful technique; it is rarely beneficial arguing with someone who has false beliefs.
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Sometimes simply being present can be helpful for a person. So much interaction, particularly in residential settings, is goal-oriented, so just sitting with someone can be a refreshing change.
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Thank you Jan, you make a very good point. Sometimes either/or questions can be too difficult to respond to. You seem to have found a way to manage these situations with your husband.
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Thank you Melissa, that is a very good point, that you can't change other people but you can change your response. But it is also important to not feel guilty if you do occasionally respond emotionally.
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Yes, it can be incredibly draining for families and carers. There is some really good advice on the Alzheimer's Society website: https://www.alzheimers.org.uk/about-dementia/symptoms-and-diagnosis/symptoms/aggression-looking-after-yourself#content-start
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Thank you for sharing Barb and Angela. I think 'losing her filter' is a very good way to describe what is happening.
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Sometimes the behaviour that people exhibit is based on how they were before the dementia, but there are some behaviour changes that can occur as a result of the dementia, including verbal aggression. It may be caused by difficulties communicating physical, social or psychological needs. It can be very difficult to experience but it is important to try to find...
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Yes, body language is very important, as is ensuring there is congruity between the verbal and non-verbal messages that are being given. For example if you have aggressive body language, even if you are saying something nice, the nice message may be lost.
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Some people have an innate ability to pick up visual cues, but others need to work on it. It is something that can be improved with practice.
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Hi Margaret, yes providing person-centred care in a residential settings can be difficult but the fact that some homes manage it shows that it is possible. There are a multitude of reasons why some settings fall behind others. It can be because of low staff morale, the staff culture, lack of training or the mix of patients to name a few.
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It is about balancing the needs of the individual with the needs of the family, but actually, as we will discuss more in week 2, developing routines can be really helpful. However those routines should be developed using a person-centred approach, and there should be an element of flexibility with them.
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Dr Nutmeg Hallett replied to Mai K
Yes, it is better to use open questions, i.e. questions that don't need a simple yes or no answer, when possible. We will look more at communication in week 3.
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Dr Nutmeg Hallett replied to Tracey Pemberton
Thank you for sharing Tracey. 'All about me' or 'this is me' books can be a really useful way of telling staff about an individual's likes and dislikes, but is also a good way to remind staff that people had lives before they were in care. That can really help when providing empathetic care. Here is a link for more information:...
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Gary I agree with you. Although Cathy is responsible for caring for her husband, she also needs to look after herself.
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Hi Rachel, I am sorry to hear that. I hope that this course will provide what you are looking for.
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It is true that we don't have the full picture for Peter, but it shouldn't be inevitable that moving into a residential setting will cause distress. You are right Denise that preparation can help to reduce the negative impact of moving. And said in a previous post, using a person-centred approach can actually save time as it can reduce challenging behaviours...
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Dr Nutmeg Hallett replied to steven clegg
Hi Steven, people have been commenting in these sections so some people can definitely access them. If you are still having problems it might be worth getting in touch with FutureLearn directly.
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Dr Nutmeg Hallett replied to Jason Fuller
I don't think anyone has come up with this as a solution before Jason. It is exactly this kind of creative thinking that is needed. It may not work but it is worth a try.
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Dr Nutmeg Hallett replied to Louise Blyth
Sometimes it can be very helpful to imagine yourself in someone's situation, it can help with feelings of empathy, and if you feel empathetic it is easier to work in a person-centred way. I agree Louise, I would find it very difficult being in a busy dining room every morning for breakfast.
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Dr Nutmeg Hallett replied to Irma Piña
You are absolutely right Irma, it is difficult to balance a person-centred approach with meeting the needs of everyone in a home. The trick is to understand where there can be flexibility in the rules and routines.
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Dr Nutmeg Hallett replied to Denise Elliott
Thank you for highlighting this issue Denise. I will look at removing this link from the page and adding another.
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Dr Nutmeg Hallett replied to Love Life
Thank you Sue, that looks like a very useful resource.
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Dr Nutmeg Hallett replied to Andrew Beardsmore
Early diagnosis is extremely important because as you say Cam, the person can be involved in making plans for the future.
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Dr Nutmeg Hallett replied to Love Life
Absolutely Sue, it is possible to provide person-centred care even when there are time and staff constraints within a care home setting. And it is true that it can in fact save time by avoiding the problems caused by 'difficult behaviour'.
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Thank you Denise. It's true, carers do need practical support but they also need advice on how to manage their situation. There should be a lot more support than there currently is, and you are right that people usually have to seek information themselves. That is fine for the people who have the time and ability to find resources, but it is worrying for...
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Dr Nutmeg Hallett replied to Chris Wilkin
Thank you for sharing Sue. It is extremely difficult caring for a relative with dementia and becoming angry sometimes is natural. It is very helpful if you can remember that; it might help with your feelings of guilt.
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The risks do increase with age, but it can begin much earlier. Early onset dementia tends to start around 50.
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It Is really important to try to make time for yourself, although it can be difficult to get someone to accept a new person in the house. Do you have a friend or relative, someone he already knows, who could come and spend time with him? Or who could take him out for an hour or two?
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Thank you Satish, there are lots of situations where residential care is unavailable or inaccessible and it can be incredibly difficult for family members who have no choice but to care for their relatives. Hopefully this course will provide some strategies that might help people in those situations.
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Thank you Lynn, it is interesting to hear some of the differences in care, and people's expectations of it. Most of the discussion is around maintaining independence but it is interesting to consider what can be done when people choose to relinquish their independence.
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Absolutely Russell, it is about looking at where there can be some flexibility.
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Dr Nutmeg Hallett replied to Chris Wilkin
Thank you for these comments Chris. I agree that it is not possible to constantly give. Carers and people who work with people with dementia also need support and reassurance. And you are right, that we can't always do exactly as a person wants, particularly if they are putting themselves at risk. This is something that we explore in greater depth in...
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Absolutely Jan, it is very easy to incorrectly identify the causes of behaviour, and the 'fear of water' you describe illustrates that perfectly. So much of working with people with dementia is trial and error, but you are right that reflecting on our own behaviour is a very good place to start.
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Hi Terence, thank you for sharing. The focus of this course is about how to work / live with / care for people with dementia who may exhibit behaviours that are seen as challenging, rather than about how to slow down progression, but I hope you continue and find some useful information.
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Thank you Renay. We find that much of the learning on this course comes from other learners and their experiences so it should be really helpful for you.
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Dr Nutmeg Hallett replied to Nicola James
We appreciate all the suggestions provided by learners, and use them when we update the course each year. We will look at adding Elizabeth is Missing to the list.
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You are right Anne, some people's stories are very sad, but from reading all the comments there are lots of very positive experiences.
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Dr Nutmeg Hallett replied to Lynn McWilliam
You're absolutely right Lynn. The sad thing is that there is always a reason behind the behaviour, but once someone is labelled as difficult, everything they do is seen through that lens.
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Dr Nutmeg Hallett replied to [Learner left FutureLearn]
Absolutely Jennifer, in a residential setting it can be very difficult to balance a person-centred approach with the routines that are necessary to run a home successfully. It's about looking at where there could be some flexibility in the routines, rather than rigidly sticking to them. For example, would it be possible to let Peter have his breakfast in his...
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Dr Nutmeg Hallett replied to John Roscoe
Hi John, if you look at the comment from Pam Lomas above, she gives a wonderful example of how residential homes can practice person-centred care.
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Dr Nutmeg Hallett replied to Pam Lomas
It must be very reassuring for you to know that your mother is somewhere where the staff take an interest in her as a person.
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Thank you for sharing what is a very positive account of your experiences with dementia. I hope you will share more Sandra, as I'm sure your experiences will be invaluable to other learners.
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We will look at wandering in week 2 so hopefully you will learn things that will help you and your family, from the course content and other learners.
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I'm sorry to hear that Annie, this must be a very difficult time for you. I hope that you find support from the other learners on this course, although it sounds like your mother is in a care home that works in a person-centred way which must help.
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Dr Nutmeg Hallett replied to [Learner left FutureLearn]
Thank you Jennifer, I'm sure your experiences in both these roles will be useful for other learners. And I hope you find some information that will help you as a carer. It is often much harder caring for someone who you have an emotional attachment to, so I can imagine it has been a difficult transition.
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Thank you John, you have clearly demonstrated the need for person-centred care. Although there are often similarities in the way people present with symptoms of dementia, actually most people have their own idiosyncrasies that often need creative ways of managing.
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Hi Rhona, this course is very much about how to work with people with dementia, and much of the learning comes from other learners. I hope you gain some useful insights.
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Thank you for those suggestions Sandra. Emma, the thing to remember is that different things work for different people, so there is a lot of trial and error involved. Sometimes what people like changes over time and even day to day. You can reassure your mother in law that it is very difficult to get it right and that she mustn't blame herself if things go wrong.
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Thank you for sharing Stephanie. In week 3 we will look more at using de-escalation and communication skills to work with challenging behaviour, so hopefully that will be useful for you. A lot of what we talk about in this course is applicable to other settings, so may be useful for some of the other people you work with as well.
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Dr Nutmeg Hallett replied to Steve B
Thank you Steve. Here is the link to Pippa's blog: http://pippakelly.co.uk/
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Dr Nutmeg Hallett replied to Valerie Woodmansey
Thank you Valerie, this is another fantastic resource.
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Hi Stephanie, I hope this course will be useful for you. The focus of this course is much more about how to work/live with people with dementia so it should compliment the Many Faces of Dementia course.
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Hi Melissa, thank you for sharing. I'm sure this course will provide you with information that you can use on your upcoming placement.
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Thank you Jennie, I'm sure you will be a great help to other learners, and I hope this course will provide you with useful information for your new role.
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Thank you for sharing Mette-Sofie. Hopefully this course will be useful as we look at lots of behaviours that may be difficult to manage, not just aggression.
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If this year is anything like previous years, learners will be very supportive of each other. I hope you get the opportunity to contribute your experiences and learn from others without criticism.
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Hi Louise. If you are having problems with the videos please let FutureLearn know. The videos are a really important element of the course.
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Dr Nutmeg Hallett replied to Barbara Lewis
You are absolutely right Barbara, the focus is usually physical safety, with little consideration of emotional safety. Hopefully over the next three weeks we will explore how we can combine the two, with Peter and with learners' experiences.
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Dr Nutmeg Hallett replied to A Bee
I agree that there is a lot of jargon in healthcare, and that much of 'person-centred care' is about common sense. It's a shame that it even needs verbalising, but it is very easy to get caught up in policies and procedures, or just doing things the way they have always be done, whether in healthcare or community settings. Sometimes people need to be reminded...
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Thank you for adding that link. If you are having any problems with the videos, please let FutureLearn know.
