competition: Caring for John Jenkins:
This competition closed on Sunday 31st October 2021
What did the competition involve?
Entrants were asked to read the scenario presented below and consider the relevant issues in relation to upholding the principles underpinning human rights. This could include (but not limited to) principles of dignity, respect, autonomy, choice, fairness and equality.
Entrants could either:
- a) Write a 300-400 (maximum) opinion on the scenario or
- b) Submit a 1-2-minute (maximum) audio or video recording of yourself, verbally expressing your opinion on the scenario.
We were not looking for an ‘academic’ response. The idea was to respond from a human perspective.
The scenario:
John Jenkins is a 75-year-old gentleman who was diagnosed with Alzheimer’s disease 5 years ago. He lived with his wife Helen during this time and has kept quite well. Helen and John were childhood sweethearts and have been married for 55 years. They had no children, but it has been a good marriage and loving relationship.
John’s dementia has progressively worsened, however he and Helen were happy living together and coping well with the support of carers who came to the house to assist John with his hygiene needs. John felt confident with the regular carers and was content to accept help, as long as Helen was close by.
Unfortunately, Helen recently had a stroke and passed away very suddenly. John came to the care home for emergency respite, where he has been for the past 5 days. However, John has become more confused in the unfamiliar environment and has started having episodes of incontinence for the first time.
John does not know where he is. He believes he is staying in a hotel and is concerned that his wife has not returned to their room. John is preoccupied with the lift in the care home. He waits by the lift throughout the day, expecting Helen to emerge from the lift each time it opens, only to become disappointed and worried when she does not appear.
John had been aware of Helen’s passing. However, he has since forgotten about this. It is likely he will become a permanent resident of the home. He has no close family or friends for support.
You work at the care home but have been on annual leave so are only just meeting John for the first time. You have been asked to care for John and to assist him with a shower. You have been told that he can be ‘resistive to care’ and may become agitated.
After the morning handover you find John sitting in his pyjamas waiting by the lift. You notice that he has been incontinent of urine.
John smiles at you nervously and says “I’m just waiting for my wife to get back. Then we can pay the bill and go home”.
What might your approach be in this situation?
So who won?
Awet Belay Wooldegeorges: First Prize: £75 Amazon voucher
Anonymous (entrant wishes to remain anonymous & has not consented to entry being published but a lovely poem was written) Second Prize £50 Amazon voucher
Cerys Perrin and Cody Burgess: Joint Third Prize £25 Amazon voucher
Who funded this?
HEFCW (Higher Education Funding Council for Wales) is funding this as part of the civic mission project to raise awareness of dementia.
Who judged the entries?
The panel included:
Dr Andy Woodhead (Former Director of a Multinational Business and Academic, living with dementia)
Denise Shanahan (Consultant Nurse for Older Vulnerable Adults, Cardiff and Vale UHB)
Sarah Beechey (Student Nurse- Cardiff University, winner of previous competition “The Dignity Debate”
Lesley Butcher (Lecturer in Nursing, Cardiff University)
The winning entries (those who consented to publication):
1st: Awet Belay Woldegeorges
John had a wonderful life with his wife Helen for more than 55 years. Sadly, Helen passed away, and John is missing her who supported him during his bad and good days.
John probably feels frightened and unsafe in his new and unfamiliar environment. It is normal for John to think that he lives in a hotel, because often nursing homes’ layout are similar to a hotel as in our houses, few people have a lift, reception or wide corridors.
As John’s HCSW today, I am going to commence introducing myself, and asking for consent whether it is ok to refer me to him by John and if I could accompany him? Gaining consent is an ethical duty that us all must abide by and a human right, which John could refuse or may choose to accept. Respecting John’s values, choices and treating him with a non-judgmental approach, ensures that he is valued and treated as unique.
John welcomed me with a smile and vice versa as it builds trust (Sarah, 2015). I then asked John if he would like anything to drink? Which would help to get started a conversation and get to know each other. It is important that I speak clearly, and slowly making good eye contact and keeping my sentences short. Allowing John time to respond as he might feel pressured to answer quickly if he is anxious and fearful. By not overwhelming John or focusing on his incontinent of urine only, I am preventing any distress that may arise as well as continue building a therapeutic relationship with John.
I asked John if he would like to walk into his room, which he accepted and asked John how often he has a shower. I then told him that I would be happy to help him. John smiled at me and accepted my suggestion. I guided John into his wardrobe, and we chose his clothes together. Following the shower, I asked John whether he would like to have his breakfast in his room or come in the dining room, John chose to stay in his room and watch the news.
People with dementia are at risk of pressure sores, therefore it is critical that John’s incontinence needs are addressed promptly, but it is also embarrassing and undignifying for John to be incontinent, thus causing him frustration, anger and being labelled by staff as “aggressive”.
Asking for consent, gaining trust, and finding the right time would reduce the embarrassment, anxiety, or fear of being changed by someone who is not a familiar face. We cannot forget that people living with dementia may suffer hallucinations or delusions. Therefore, resident-centred care, kindness, empathy, compassion is key, and it should be noted that there is no day that is the same for people living with dementia.
Joint 3rd: Cerys Perrin
The initial handover of an upcoming shift rarely illustrates the true nature of the day’s work. It is just a passing of information from one shift to the next without the human context. Simply saying that John is “resistive to care” already paints him as stubborn and difficult. Leaving out the part where he has abruptly been moved from the comfort of his own home, the security of his wife and routine.
Of course, we can justify his behaviour from the fact that he has Alzheimer’s disease. But does that mean we should provide any lesser care from that we would give to the resident next door?
I would approach John with an open mind as I have not met him before. Clearly, he does not intend to move from his position therefore I will provide a short-term solution for John by introducing myself and role to build a therapeutic relationship. “Hello John, my name is Cerys It’s nice to meet you I am one of the carers looking after you today…”, In this process I would try to understand why he is staying by the lift. I will also ensure I meet his eye contact by kneeling to his level and suggest a shower before we do anything this morning. Redirecting in a gentle way which is honest and simple for example, “So John after this shower we will go have some breakfast…”. We must ensure care is provided in his best interest. Always providing alternative choices to best tend to his needs no matter what.
Routine plays an important role in our day to day lives. Especially for John who has been waking up next to his wife likely every day for over 55 years. For John, this is engraved into his normality of life. Without awaking next to Helen every morning will likely induce feelings of confusion and anxiety for John. As it would for anyone else. These emotions for John translate to fixation of Helen getting on that lift to take him home. Therefore, the responsibility of the care home is to deliver care to a resident’s activities of daily living which facilitates to person centred care and overall holism of the person as an individual.
It is now John’s home, therefore must be treated like one.
Joint 3rd: Cody Burgess
I feel this scenario can be broken down into 3 major issues – the death of his wife Helen, his discomfort being in the home and his incontinence.
It has long been debated whether it is kinder to lie to patients with Alzheimer disease about the passing of their loved one to protect them from the truth or to tell them out of a duty of candour. Personally, in this situation, I fall into the camp somewhere in between of those who feel it is kinder to avoid or distract from the topic. I understand this may be a controversial stance however I feel as though if he has been told several times about his wife’s passing and is unable to retain the memory, coupled with the late stage of Alzheimer’s it is cruel to force him into a continual cycle of grief – suffering immeasurable sadness and heartbreak that the love of his life has died and the guilt that he cannot remember it. To me, nothing is gained by constantly reminding him of Helen’s death. I do however, believe it is important for him to remember her – engaging in conversations about her and their life together and displaying pictures of them together to honour her memory.
It was mentioned that he had become confused in the unfamiliar environment of the care home – I would firstly look at the possibility of him continuing to live at home with the aid of healthcare staff to allow his care to continue in a familiar environment. If this is not a possibility then I would decorate his room with items from his house and gradually introduce him to the ward.
Well done to all entrants. Thank you for taking the time to enter this competition and consider the needs of the gentleman in this thought-provoking scenario.