Exercise

Managing Transitions - Getting Started

This exercise is designed to help you to start discussion with colleagues on ‘managing transitions’.

We have to deal with change of many sorts in our lives. Things may be relatively stable, and then something happens to disrupt that and it takes things a while to settle down again. These periods of transition can be hard to manage.

Part 1

Consider a period in your life when you experienced a significant transition. What happened? How did you feel? What support did you need? What support did you get? How did your feelings change? Bring your reflections to a group discussion.

Part 2

Now consider a transition that a patient or resident experienced that in your opinion represents how transitions should not be managed within a care system. What contributed to the negative experience? How did it impact on the patient/resident, on staff, on the family? What do you think should have happened to make this a more positive experience?

Now consider a transition that a patient or resident experienced that in your opinion represents how transitions should be managed within a care system. What made this ‘good practice’? How did it impact on the patient/resident, on staff, on the family?

Again, please bring your reflections to your group discussion.

The story below was generated by this exercise. What issues are raised by it do you think?

An elderly man with ‘mild memory problems’ was admitted to a care home temporarily while his wife was in hospital. Over the next 9 months he was moved 5 times and is awaiting a sixth move. In the care home he ‘escaped’ and was identified as someone at risk of escaping. He asked a member of staff for a kiss. She took offence and he found himself accused of sexual harassment. These two labels were then put in his records.

The care home decided that they could not cope with him so he was moved to an EMI care home. There he continued to ‘escape’ aided by the staff who were not careful about security (e.g. leaving a window open).

The family became increasingly unhappy because they thought he was being accused of behaviour that arose from his illness. They found it difficult to get a meeting to discuss his situation with staff.

Although there was no increase in his psychiatric profile, he was considered ‘unmanageable’. However, during this period there was no discernable difference in his presentations. He was moved to a psychiatric unit for assessment. The family felt that the placement was appropriate because here he has continuity of staff, staff are knowledgeable, they’re given information, there isn’t a feeling that it’s all his fault and they feel part of the process.

However, the beds were needed and he was moved to a long term ward which is where he is now. He’s awaiting a community placement in a care home. With ‘escaping’ and ‘sexual harassment’ on his record it may be difficult for him to find a care home that will take him.

Over this period he’s moved from a position where he’s needed temporary institutional care to a position where he’s not going to be going home (his wife is now very worried that she wouldn’t be able to cope with him). He has become system dependent.