Yes 

Exercise 3:  Identifying your purpose

3a) Our patients will see the intensive care offered to them and appreciate the whole process of dementia care. The oval aim of the change care is to improve patient-oriented care to wandering patients. 

3b) Our staffs will see the whole process and feel satisfied since they will be engaged in a teamwork rather than as an individual thereby give a reasonable feedback from our staffs.

3c) Our service will be satisfactory and highly improved due to changes in the dementia care that enhance care for wandering patients. 

Exercise 4:

The puzzle highly relate to the heart of practice and work since offering dementia care to patients is one of the key aspects of our work or practice. Since the puzzle focus on changing the process of dementia care hence concentrate on the area of practice or work.

Exercise 5:

5a. Wandering in dementia is a serious issue that involves many different people. Wandering in dementia is a challenge with limited studies conducted to find solution that can improve the care level for wandering patients. This also follows be the development of a plan of care for wandering patients are offered (Brodaty & Donkin, 2017). 

5b. Several studies conducted on the dementia care process indicates that there is need to improve the care for patients wandering and to change the care strategy for the purpose of improvement. For instance, Jurgens, Clissett, Gladman and Harwood (2012) indicate that changes in the care involved in the wandering dementia patients need to allow more engagement of caregivers as compared to the current process. Edvardsson, Fetherstonhaugh and Nay (2010), also suggest the prevention wandering among the dementia patients that needs prevention owing to many risks associated with wandering patients. This is complex issue requiring steps to go through in order to establish the strategy and necessary care required for the patient.

Exercise 6:

The changes and improvement that need to be effected by the dementia caregivers involve many different staffs. These parties take a various role in the process that ensures every step of dementia care process is followed. Some of these staffs are listed below.

6a)

Pharmacists

Physicians

Laboratory technologists

Nurses

Psychologists

Patient’s family

Health care management

Community health service

Officials from the department of health

Clinical officers

6b)

• Parties shown on the above list consist of various people that will take part in dementia care services. Some of the parties that will directly involve in the process include

Pharmacists

Physicians

Laboratory technologists

Nurses

Psychologists

Patient’s family

Clinical officers

• Some other parties that need to be involved in continuous consultation with our team to effect the changes in the caring for wandering patients include Community health service providers, patient’s family members, and the hospital management will be in continuous consultation during the making of the changes to the care process.
• Those in the department of health and other health care policies makers need to be informed and we will keep them in continuous communication to ensure that all the changes proposed are considered.

6c) Various staffs or parties are showing different experience or impression to the changes that are being proposed. These are positive or negative and below are the various experiences that are most likely to come from parties involved.

• Positively

The previous engagement of staffs in the caring for wandering patients has been a physician and laboratory technologists. In the current care, some staffs are likely to positively involve in the care especially physician and laboratory technologist.

• Negatively

Some of the staffs that have been negatively involved in the caring for wandering patients include pharmacists and clinical officers. 

6d) I think the response of the parties involved in the care for wandering patients will show a positive response to the changes. The changes have been a hot topic among the staff members since the changes will involve most staffs.

6e) It is my impression that parties will be approaching the idea with the intention to succeed in reaching completion. I think the precondition of engagement will the agreement of all parties to participate in the changes. Suppose the changes require more workload parties will also need to consider resources addition (Michie et al 2005). 

6f)No, I just have some suggested solution to the problem that has been experiencing in the caring for wandering patients in most institutions in the country. This suggestion is open for more solution from major stakeholders in the system.

Our key partners are likely to be 

Our key supporters are likely to be

We have a good relationship with

Exercise 7: Understanding the readiness of the environment

Understanding the readiness of the environment require identification of various resources that play a role in the adoption and implementation of the changes that we are proposing.

7a)There is need to devote a substantive effort to the proposal to ensure that the overall result becomes consistency with the required standards of practice. According to the environment currently, services are still offered though there are delay and limited coordination among caregivers when patient is wandering. This can take at least take some months to accomplish the result (Palecek et al, 2010). 

7b)The health practitioners have the capacity and cultural capability to adapt the required changes at this time since the environment allows some changes to the process. This may also involve the management so as to allocate the necessary resources to bring about the required changes. The changes therefore, takes both multidisciplinary approach and design approach. At this time, the parties working in this dementia care environment shows potential ability to change and take up the changes for wandering. This changes include introduction of multidisciplinary approach and designing of structure with minimal risk level among wandering patients (Cerejeira, Lagarto & Mukaetova-Ladinska, 2012). 

Exercise 8: Identifying structural enablers and disablers 

8a)There are existing strategies and policies that can allow incorporation of the puzzle. For instance, strategies that are in place to allow these changes include teamwork policies that allow coming together in case there is a need for. This situation may call for the attention of various staffs into one single unit. The multidisciplinary teamwork will facilitate increase in care and assist caregivers attends to wandering patients. In addition, staffs will help ensure that more care is given to these wandering patients as they need much attention (Mason, 2008). 

8b)Yes, there are also policies that can frustrate the adoption of the puzzle since the current health care system especially when attending to dementia patients. Procedure indicates that the patient or those at risk of the condition need to be taken through series of process to assess and develop care plan to be sued on the patient. This process will be changed by the puzzle since its rigidity does not properly coordinate effective care (Grol, Wensing & Eccles, 2004).

Facilitating Engagement

Facilitating engagement is the level where various identified parties that play an important role in the caring wandering patient’s management are involved in the changes. At this point also various factors that may support or get on the way for the proposal are also identified with measures to overcome them.

Exercise 8: Summary of information

8a)  I think for successful engagement of all the parties in the care, one thing that is most likely to get on the way is proper coordination of the whole care following the new changes that will be introduced into the system. In addition, the management procedures need to be developed in time to pick the whole process quickly (Leatt, Pink & Guerriere, 2000). 

8b) for a successful process, I think have understands the whole system and parties that may likely involve in the implementation of the changes, changing the procedure and policies in the areas that are most likely to get on the way. Changing procedures and policies remain the threat to changes since it takes a lot of time to changes those policies and procedures and this also require a stringent process (Beattie, Song & LaGore, 2005).

8c)  for a successful outcome, procedures and policies are most likely to get on the way. This is due to the strict process that entails changing the entire policies and procedures.

8d) for successful engagement, I think good will and acceptance will support the proposal and its implementation. I think there is a need for strong goodwill for the changes in the care for the better. Goodwill for all the parties that are involved in caring for wandering dementia patient and their acceptance of the changes is most likely to result in success (Larson et al., 2013). 

8e) for a successful process, I think there is a need for acceptance and willingness of all colleagues in the adoption and implementation considering all the parties acceptance of the changes will result in a successful wandering patient care. 

8f) for a successful outcome, I think procedures, strategies, and policies that are part of the dementia care process need to be fully put in place that takes into consideration the proposed changes for the care in wandering. 

Exercise 9:  Establishing your pre-engagement action plan 

9a)  I think I have the right skills to take the proposal though there are some areas that I will have to do a consultation with various stakeholders. For instance, consultation is required on the ways to make changes to the policies that are connected to the dementia care for wandering patient. This is due to the need to factor in the changes and this has to happen on the policies also to allow proposal come to success. The healthcare management is the main parties that will be consulted on the policies procedures (Leatt, Pink & Guerriere, 2000).

9b) the main aspect of the engagement and those parties that will be used in the proposal include coordination of teamwork. I need to sensitize all parties and create awareness before letting the proposal out as this will prepare them psychologically. There are people that need to be identified and some of them are physicians, pharmacists, clinicians and patient’s families that make it beneficial to build a relationship before letting the proposal out. The action that can be taken to achieve this is sensitization and bringing together all these people for teamwork (Atri, 2008). 

9c) actions such as preparation of the environment and allocation of human and machinery resources need to be addressed in preparing the environment for the process. Key stakeholders in the process need to be informed on the proposal to prepare them for the proposal. The environment where the proposal will be launched need to be prepared and machinery or other resources need to put in place. We will inform all the stakeholders on the bout the intention to incorporate them in the changes. This also involves consulting management to allow them to be part of the changes that are being proposed (Edvardsson, Fetherstonhaugh & Nay, 2010).

Exercise 10: Taking your proposal out to your key partners 

10a) We would like to discuss with you how we may work together around a proposal to make some changes to the care process of wander. The reason for undertaking this proposal is to improve the care and meet the current service delivery solution with many clients. We hope that working together will help generate a solution that is beneficial to us and our esteem clients (Bero et al. 2008).

10b) Caring for wandering patient has many different stages of participation, especially when building multidisciplinary approach to this process (APPENDIX 2). Various parties will be involved at a different level ranging from assessment to provision of care. As part of parties that will be involved in the process changes it is prudent for parties to indicate areas and level they need to participate in the process. Therefore, we request each health practitioner to indicate the area where they feel comfortable working on. For instance, the pharmacist needs to indicate their level of involvement in the dementia care that is convenient for them while healthcare management also needs to indicate when they can be consulted (Prince & Jackson, 2009). 

10c) After engaging various parties and staffs that form part of the process that needs changes, there is a need for creation of awareness. Sensitisation of the parties as part of passing the information serves to ensure the proposal reach the parties at the right time and they are ready to contribute towards getting the solution for the problems in the care. This also gives the parties opportunity to suggest their take on the changes that will be introduced in the proposal (Horner & Salazar et al., 2004).

Learning resources

Wandering is a important issue when caring for dementia patient that need some changes. Working together as a team is the overall aim of caring for wandering dementia patients. Proposing this change in the process of offering care to wandering patients require engaging colleagues in the healthcare workplace. In order to develop such process change, there is a need for engaging others to find such solution without posing the solution as this will bring about resistance. The statement need to start with “we need....” instead of “I think..” as this point to inclusive approach rather than personal.

First, there is needs to come off an inclusive question or puzzle that will attract the attention of other colleagues without resistance. For instance, How can we involve multidisciplinary teamwork to change the process and procedures involved in giving care to patients in dementia care? The puzzle needs to have a well-defined purpose that adds more meaning to the proposal for the changes that need to be introduced. Ask yourself is the question positive? Is the question unconditional, or is the question a generative question?

Secondly, identification of those parties that will be engaged in finding the solution for the problem is another step needed. These parties can be various practitioners that are involved in the process either directly or indirectly. When identifying parties their roles need to be known as this will help the creation of awareness before letting out the proposal. “List various parties that are most likely to participate in the process”.  

Lastly, there is need to get the consent of those parties and areas they will be involved in as this will prevent any resistance at all will feel part of the changes. Those parties that are most likely to support or get on the way are also identified with aim of working out a relationship with them. Changes will be made on the proposed areas of participation among colleagues. Ask them question such as “what do you think of the process?”

Implications of learning resource

The learning resources will serve to assist the caregivers who are facing the challenge of caring for patient in wandering state. The approach that identified will enable the institution reduce risk that are associated with wandering patient and assist also in training of caregivers on ways to take care of dementia patients. The leaning resource will also give direction on scoring for the risk associated with wandering and the level of risk as shown in the APPEDIX 2-4.

Conclusion

In conclusion, the report gives the various steps on a collaborative approach to wandering in dementia care and strategies involved. The report seeks to involve colleagues within the workplace to develop a solution for the puzzle identified in the care. In order to avoid resistance, there is need to engage all the stakeholders in taking care of the wandering patients.

References

Atri, A., Shaughnessy, LW., Locascio JJ., and Growdon, JH., 2008. Long-term Course and Effectiveness of Combination Therapy in Alzheimer's Disease. Alzheimer Disease and Associated Disorders, vol.22, no.3, pp 209–21.

Bero, L., et al. 2008. Cochrane Effective Practice and Organisation of Care Group. About The Cochrane Collaboration (Cochrane Review Groups (CRGs)). Cochrane Effective Practice and Organisation of Care Group 2008, issue 2.

Beattie, ER., Song, J., and LaGore S., 2005. A comparison of wandering behavior in nursing homes and assisted living facilities". Res Theory Nurs Pract, vol.19, no.2, pp 181–96.

Brodaty, H., and Donkin, M., 2017. Family caregivers of people with dementia. Dialogues Clin Neurosci, vol.11, no. 2, pp 217–228.

Cerejeira, J., Lagarto L., and Mukaetova-Ladinska EB, 2012. Behavioral and psychological symptoms of dementia. Front Neurol. 3: 73.

Edvardsson, D, Fetherstonhaugh, D, and Nay R, 2010. Promoting a continuation of self and normality: person-centered care as described by people with dementia, their family members, and aged care staff. J Clin Nurs.vol.19, no.17-18, pp 2611-2618.

Hermans, DG, Htay, UH, and McShane, R, 2007. Htay, U Hla, ed. Non-pharmacological interventions for wandering of people with dementia in the domestic setting. Cochrane Database Syst Rev (1): CD005994.

Jurgens, F., Clissett, P., Gladman, J., and Harwood R., 2012. Why are family carers of people with dementia dissatisfied with general hospital care? A qualitative study. BMC Geriatr. Vol.12, no.1, pp 57.

Larson, EB; Yaffe, K. and Langa, KM., 2013. New insights into the dementia epidemic. The New England Journal of Medicine, vol.369, no.24, pp 2275–7.

Levine, C., ed. 2004. Always On Call: When Illness Turns Families into Caregivers (2nd ed.). Vanderbilt University Press for the United Hospital Fund.

Mason, A., 2008. New medicines in primary care: a review of influences on general practitioner prescribing. Journal of Clinical Pharmacy and Therapeutics, vol.33, pp1-10

Michie, S., Johnston, M., Abraham, C., et al. 2005. Making psychological theory useful for implementing evidence-based practice: a consensus approach on behalf of the ‘‘Psychological Theory'' Group. Quality and Safety in Health Care, vol.14, pp 26–33

Miskelly F, May 2004. A novel system of electronic tagging in patients with dementia and wandering. Age Ageing, vol.33, no.3, pp 304–6.

Prince, M, & Jackson, J, 2009. World Alzheimer Report 2009. Alzheimer's Disease International: 38. Archived from the original on 11 March 2012.

Palecek, Eric J.; Teno, Joan M.; Casarett, David J.; Hanson, Laura C.; Rhodes, Ramona L.; Mitchell, Susan L., 2010. Comfort Feeding Only: A Proposal to Bring Clarity to Decision-Making Regarding Difficulty with Eating for Persons with Advanced Dementia". Journal of the American Geriatrics Society, vol.58, no.3, pp 580–584

Robinson L., et al, August 2006. A systematic literature review of the effectiveness of non-pharmacological interventions to prevent wandering in dementia and evaluation of the ethical implications and acceptability of their use. Health Technol Assess, vol.10, no.26, iii, ix–108.

Snyder, L., 2010. Living your best with early-stage Alzheimer’s: An essential guide (pp. 87-88). North Branch, MN: Sunrise River Press.

World Health Organization, 2006. Quality of care - a process for making strategic choices in health systems. Geneva: WHO press. 

Woodward, F., 2007. How to achieve effective clinical engagement and leadership when working across organizational boundaries: practical recommendations. Modernization Initiative. Available from: www.modernisation-initiative.net

Warner, M., 2006. In search of the Alzheimer’s Wanderer: A workbook to protect your loved one. Indiana: Purdue University Press.