Enhancing communication between dementia care staff and their residents: an arts-inspired intervention

Figures & data

Table 1. Core principles underpinning intervention content and delivery.

Principle:	Example:
Delivery of the creative sessions
The venue(s) is unconventional and confounds expectations	Use of local community venues away from the care home, permitted staff to disengage from their mode of work and relax into a comfortable and neutral environment without risk of distraction
The facilitator's approach is informal	The facilitators blend into the group discussions, offering guidance and sharing perspective when appropriate. Staff are encouraged to take ownership of the discussions, empowering their voices.
The materials booklet is well-designed and attractive, raising expectations	A booklet supports each workshop, containing a collection of poetry, visual arts, song lyrics, pictures, and suggested activities. Music videos are presented via PowerPoint.
All material is available through the facilitator’s website, although access is optional.	Access to an online resource enables staff to review content at any time to refresh their ideas or look back over previous workshop material.
Additional, optional activities are offered outside of the workshops, but no compulsion is exerted.	It is not compulsory for staff to complete extra activities outside the workshops. Instead, the workshops gently encourage curiosity and motivate staff to try activities at appropriate and regular points in their working day.
Content of the creative sessions
No ‘facts’ are given. No instruction is offered. No testing occurs.	The facilitator acknowledges staff as the being the ‘experts in their field ‘and provides them the platform to discuss their work.
All subject matter is of a positive nature. All negative aspects are excluded.	A positive exploration of dementia, where the voices of those living with dementia are prioritised, evolve staffs’ perspective of what it means to live with dementia.
Subject matter is presented for discussion, and no value judgements of responses are made.	Diversity in opinion, perspectives and responses to workshop materials from both the residents and care staff, are celebrated and act as points for discussion and refection.
Activities involve a high degree of sharing.	The first hour of each workshop is dedicated to the sharing of experiences and feedback from trying any new learning from previous workshops.
Creativity is the keynote of all activities both the workshops and optional activities.	The booklet presents materials that facilitate subjective interpretation and the application of imagination. All activities encouraged creativity and innovation in approach/implementation.
Personhood is asserted throughout, both that of the care staff and residents. The message is reinforced at every point without being stated.	During workshop discussions, the unique characteristics, qualities and life experiences of residents’ and care staff are underscored and are used to highlight the wealth of knowledge that can be shared

Table 2. Care staff topic guides.

Baseline
What are the words you use to refer to the people you are caring for? EXPLORE – to start the conversation how do they describe them, are they clients, service users, residents, how are individuals addressed – names, nicknames, and words like ‘dear’ / ‘love’? When are these words used / in which circumstances.
What do you talk about with your residents? EXPLORE – When are conversations based mainly on instructions and when are there opportunities to talk about other things? What sorts of subjects do people want to discuss?
What sorts of communication (either verbal or non-verbal) do you most enjoy having with residents? EXPLORE why? What have you learnt about the people you care for? Have these interactions made you think about things differently? Please use examples.
When you are communicating with people who are losing or have lost language, how do you understand what they might need or want? EXPLORE any evidence of non-verbal strategies to communication, what do the carers recognise from slight nods of the head, small movements of the face and body, repetitiveness of words, etc.
We know that your working day is extremely busy and mostly taken up with caring tasks, how much time do you have to spend with residents talking or doing other activities? EXPLORE whether staff would like more time to engage with residents or whether they feel they have enough.
During which care task do you feel you have the most time to communicate / interact with the residents? EXPLORE what these might be and how they enable closer interaction.
How do your residents express themselves? EXPLORE Language and Behaviour; if they indicate the residents lack communication, explore any evidence of non-verbal strategies to communication, what do the carers recognise from slight nods of the head, small movements of the face and body)
Can you tell me something about some of the friendships between residents in your home? How do you support these? Prompt: by ensuring that people sit with each other at mealtimes / in the lounge? Do similar activities?
Follow up
How have you found learning about dementia through film, poetry, and music? EXPLORE – how did it compare to your first impressions / expectations?
How have you found the way your facilitator led the sessions? EXPLORE – how was it different to other training you have attended? (e.g. John states that he isn’t ‘teaching’ and that there is no right or wrong)
Have you had a chance to try any of the activities in practice? EXPLORE – Was there anything that you found worked very well/ was useful in practice? Tell me your experiences of trying it? In what way did it work very well / was useful?
Have the sessions helped you to understand more about how the people you work with feel? EXPLORE – can you explain in what way? Could you give an example?
Has the Creative Conversations made you think more about the way you communicate with the people you work with, especially those who are losing or have lost language? EXPLORE – can you explain in what way? Could you give an example?
Do you think Creative Conversations has made a difference to how you engage with residents? (For example, have you found that you are using more creative arts? How does this compare to how you engaged with residents before you attended the Creative Conversations sessions?
Have you learnt anything new during Creative Conversations?
Do you feel Creative Conversations has made an impact to your day-to-day practice?
Has coming to the Creative Conversations sessions made a difference to the people that you work with? EXPLORE – in what way? Could you give an example? Has it improved the quality of interaction between yourself and your residents?
Do you think Creative Conversations has made a difference to how you engage with residents? (For example, have you found that you are using more creative arts?
How does this compare to how you engaged with residents before you attended the Creative Conversations sessions? EXPLORE – in what way? Could you give an example?

Table 3. Demographic information for care staff providing qualitative data (n = 28).

Age, mean (SD)	42.29	12.33
Female gender, n (%)	28	100
Marital status, n (%) Married/cohabiting Single Divorced/separated Missing	8 13 6 1	28.6 46.4 21.4 3.6
Ethnicity, n (%) White British Missing	27 1	96.4 3.6
Age leaving FT education, mean (SD) Missing, (n)	16.71 14	1.73
Education level, n (%) Low (No qualifications, 1-4 O levels, NVQ level 1) Medium (5 + O levels, 2+ A levels, NVQ level 2 or 3) High (Higher degree, degree, NVQ level 4 -5) Missing	10 13 4 1	35.7 46.4 14.3 3.6
Full time employment, n (%)	15	53.6
Hours worked per week, n (%) ≤ 20 21 – 30 31 – 39 ≥ 40	2 15 9 2	7.1 53.6 32.1 7.1
Length of employment in current care home, n (%) ≤ 4 years 5- 10 years ≥ 11 years	14 6 8	50.0 21.4 28.6
Total years employment in care homes, mean (SD)	11.84	9.20

Figure 1. The influence of Creative Conversations staff development sessions.