Meaningful connections to reduce aggression in aged care

A new pilot program using a new technique has shown positive outcomes for residents and staff at a Crows Nest aged care service.

The Resident Experience Ambassador (REA) Pilot, funded by WorkCover Queensland, aimed to reduce the risk of injury to staff from resident aggression in aged care memory support units.

The pilot introduced a specific ambassador care role in which three personal care workers and an enrolled nurse were specifically trained to make meaningful connections with residents and de-escalate situations. The pilot included up to 24 hours of ambassador shifts per week during the three-month trial.

Tatjana Jokic, Principal Consultant and Psychologist from JK Corporate Resourcing who delivered the training, said that the ambassadors learnt how to use a person’s life story to discern unmet needs. They were then equipped with strategies to meet those needs.

“Our face-to-face training involving workshop-style feedback and role-plays, alongside our ongoing mentoring, were key to seeing head-knowledge put into practice. It allowed care workers to be proactive instead of simply reactive,” Jokic said.

“Internationally, no one has used care staff to do behaviour management like this. This is the first time that behaviour management doesn’t use restrictive practice.”

The pilot recorded an overall reduction of incidents of aggression from residents — with no incidents occurring when the ambassadors were present. Care workers also observed an enduring improvement of residents’ behaviour after the pilot ended.

Janine Elliot, Crows Nest Aged Care Service Manager, said, “Ambassadors were really good at making meaningful connections with residents and this met a deep-seated need that exists in all people — the need to be known and to have meaningful relationships.”

According to Jokic, a key part of the program was that the ambassadors were not in uniform, removing an obstacle to normalcy and relationship-building between the residents and the ambassadors.

“A uniform represents the organisation, a position of power, and that is not normal. It says to residents they’ve been institutionalised and they’re not at home. It also represents the end of their own independence,” she said. The ambassadors’ plain clothing made residents feel like they were engaging with an ordinary person in a normal environment.

“Normalising everyday life is very important in treating people living with dementia,” Elliot added.

A male resident who’d had no visitors in his five years at the service was part of the pilot. “The ambassadors went to see him, and because they were in plain clothes, he believed they were his visitors who had come to see him. His whole demeanour changed — he was just beaming,” said Penny Behan, Churches of Christ Health, Safety and Wellbeing Manager. 

Behan, who attended the training, coordinated the project and visited the staff during the pilot, is excited about the potential impact this training can have both for staff and residents in aged care settings.

“With just a small increase in well-trained staff, aged care services can experience powerful positive transformation, benefiting both residents and staff,” Behan said.

“The improvement in resident behaviour opened up extra time for staff to complete their tasks, leading to better quality care, better quality relationships and better working conditions,” she added.

One of the ambassadors, Linda Hanson, is an enrolled nurse with 32 years’ nursing experience.

“There has never been any training as effective as the ambassador training in turning knowledge of a resident’s life story into practical, applicable strategies and interventions. It has had such an immediate and positive impact on the living and working environment for residents and staff,” she said.

Jokic said that they didn’t want organisations to feel dependent on the JK Corporate Training. She hoped to see the successful results from this pilot overflow to benefit all staff and be implemented in other centres.

“Once an ambassador is trained, they can go on and train the other staff. The strategies are not difficult to learn or pass on,” she said.

With the resounding success of the ambassador in reducing incidents of aggression and upskilling other care workers, the Unit has continued to roster on a care worker for afternoon shifts. Elliot said that it’s important for that person to think like an ambassador and that the pilot sends a clear message to the industry that there is an answer to occupational violence. “In the end it all comes down to adequate and well-trained staff,” she said.

“All our staff can now make those connections that an ambassador makes and it has made the world of difference having that extra person on,” she said.

The program is a finalist for the Worksafe Queensland 2022 Safe Work and Return to Work Awards in the category of ‘Best demonstrated healthy and safe work design’, which recognises that designing healthy and safe work is fundamental to improving health, safety and wellbeing in the workplace. The award winners will be announced on 21 October.

Image credit: iStock.com/FredFroese