Health and Care Research Wales, Swansea University

1. Good Work
A dementia learning and
development framework for Wales
Nick Andrews,
Research & Practice
Development Officer,
School for Social Care
Research, Swansea
University

2. Background – the Developing Evidence-
Enriched Practice (DEEP) project
• An appreciative action
research project;
• in health and social care
services for older people;
• across six sites – five in
Wales and one in Scotland;
• exploring research and
other contextual evidence
and using it in service and
workforce development;
• To promote well-being and
address the Seven
Challenges of the JRF
programme A Better Life.

3. The five elements of the Developing
Evidence-Enriched Practice (DEEP)
approach
Value and
empower
people
Value and use
a range of
evidence
Present
evidence well
Sort things
that get in
the way
Talk and think
together well

4. The importance of narrative in getting
people to engage with research

5. The importance of talking together about
research and other evidence
• Does not come as
naturally as we
would hope
• Use the elephant
metaphor of
reality
• Use dialogue
techniques, e.g.
Exploratory Talk
and Community
of Enquiry

6. Vision for the Dementia L&D Framework
People with dementia, carers and staff who support
them will all experience fulfilled lives within supportive
communities

7. Who is this framework for?
People with
dementia
Carers
The social
care &
health
workforce

8. ‘What do we mean by ‘good work’?
The three Es of ‘good work’:
• Ethics – values based and getting to the heart
of ‘what matters’ (compassionate practice)
• Excellence – technically competent and ‘fit for
purpose’ (competent practice)
• Engagement - personally engaging and
contextualised (wise practice)

9. 1. Ethics – to support compassionate
practice
• Everyone matters
• Everyone has something to contribute
• Everyone is different
• Everything matters – including the little things
• We need to use positive and strengths based
words

10. Everyone matters and have a right to
experience well-being
Within enriched environments of learning and practice (Nolan et al
2006), everyone experiences a sense of:
• Security – to feel safe and secure, not just physically but also
psychologically
• Continuity – to feel that what we are doing in the present has links
with our past
• Belonging – to feel ‘part of things’, maintaining existing
relationships and forming new ones
• Purpose – to have valued goals to aim for and a feeling of ‘I have a
contribution to make’
• Achievement - being able to achieve goals and to feel satisfied with
your efforts
• Significance – to feel that you ‘matter’, that your life has
importance, and that other people recognise and value who you
are.

11. Sense of: Declaration of Rights for Older People in Wales
Security I have a right to safety, security and justice
Continuity I have a right to be who I am
Belonging I have the right to decide where I live, how I live
and with whom I live
Purpose I have free will and the right to make decisions
about my life
Achievement I have the right to work, develop, participate and
contribute
Significance I have the right to be valued

12. This recognises an interdependent
approach to well-being
Well-being of
service users
Well-being of
carers
Well-
being of
staff
… which requires negotiation and compromise

13. Everyone has something to contribute
People in the
local
neighbourhood
Carers
People with
dementia
Frontline staff
Specialised
staff
Service
managers
Commissioners
and regulators
Researchers

14. Everyone is different
• This requires an
individualised approach
that recognises
difference, not
standardised responses
• The example of short
breaks – one carer’s
difficulty is another’s
satisfaction

15. Everything matters and the ‘normal’
and the ‘ordinary’ are important
• ‘Often it is the simple
things that bring the
most pleasure (and the
lack of them can bring a
sense of sadness and
loss) and services do not
always seem to be very
good at delivering “the
ordinary”’. (Blood, I.
2013 p13)

16. We must use positive and strengths
based terminology
Negative and deficit based terminology Positive and strengths based
terminology
The frail elderly Older people with high support needs
Elderly Mentally Infirm (EMI) People with dementia
People suffering with dementia People living with dementia
People afflicted by dementia
Wandering Walking
Dements People with dementia
Feeders People who need help with eating
36 (i.e. naming a care home resident by
their room number)
Never a number!
Senile Old
Not there Still here
An empty shell A person

17. 2. Excellence – to support competent
practice
• Taking an outcomes focused approach
• Thinking carefully about categorising people –
non hierarchical
• Broadly identifying three types of people –
informed, skilled and influencer
• Key learning and development topics for each
group and suggested learning outcomes

18. Informed person
Learning and development topics – linked to
Dementia Friends work in Wales:
• Dementia is not a natural part of ageing
• Dementia is caused by brain diseases
• Dementia is not just about losing your memory
• It is possible to live well with dementia
• There is more to the person than dementia
• Effective communication is important to people
with dementia

19. Skilled person
More complex – 48 learning and development topics
mapped to the National Outcomes Framework covering:
• Rights and entitlements
• Physical and mental health
• Safeguarding
• Meaningful living
• Meaningful relationships
• Community inclusion and contribution
• Social and economic well-being
• Physical environment

20. For example…
Each outcome category has 6 L&D topics.
For example - Meaningful living:
• Life story work
• Identifying the strengths of people with dementia
and their ability to do
• Creative and meaningful activities
• Sensory stimulation
• Experiencing positive transitions
• Meaningful short breaks

21. Influencer
Learning and development topics linked to organisational
leadership and development:
• Drivers, policy and research
• Ensuring effective service mapping
• Collaborative and integrated working
• Promoting congruent values, ethics and culture
• Involving people in creating and owning a clear and
shared vision
• Delivering the vision
• Quality assurance and improvement
• Safeguarding

22. 3. Engagement – to support wise
practice
Engaged people are
compassionate and
technically competent, but
also feel good about what
they do and work within
systems that are
empowering, enabling
them to make wise
decisions about how they
support people with
dementia, carers and staff
within the context of their
daily lives
‘Don't get me wrong. We need rules! Jazz
musicians need some notes… but too many
rules prevent accomplished jazz musicians
from improvising, and as as a result, they
lose their gifts, or worse, they stop playing
altogether’. Barry Schwartz

23. A whole system approach

24. Good leadership within organisations
• ‘Our role as
leaders is to set
the stage, not
perform on it’
Linda Hill.

25. Robust and meaningful quality
assurance
• Owned by everyone –
not done to them
• Experience not tick-box
focused
• Supported by helpful
not burdensome
paperwork
• Identifying and building
on strengths, e.g.
‘Magic Moments’ work

26. Effective approaches to individualised
and collective learning
For example – the DEEP approach that has been
developed in Wales which draws on:
• Appreciative Inquiry
• Communities of Practice
• Community of Enquiry
• Exploratory Talk
• Caring Conversations
• Experience-Based Co-Design
• Collaborative Action Learning

27. Learning and Development topics for
Influencers
• Drivers, polices and research
• Effective service mapping and co-ordinated
delivery
• Collaborative and integrated working
• Shared values
• Creating and owning a clear and shared vision
• Delivering excellence
• Creative approaches
• Quality assurance and improvement
• Complaints and whistle-blowing
• Safeguarding

28. Resources
• Good reading – suggested books
• Helpful Welsh and national organisations
• Free web-based resources

29. Further information
n.d.andrews@swansea.ac.uk