Hello, my name is Jane Jordan, and I'm the project lead for ReViving Rural Dementia Care. The aims of the project was to address emergent or unmet clinical needs. I'm a Specialist Nurse for dementia and delirium and the Nurse Unit Manager for the older persons ward, and I felt very passionate that we get the care right for people who live with a dementia and/or a delirium. Hospitals are confusing environments for anyone, let alone for someone who lives with a dementia, and poorly designed hospitals contribute to greater confusion and stress for the patient, as well as increasing the risks of falls and adverse events resulting in longer length of stay. And also, lack of inadequate education can lead to poor care for people who live with a dementia, resulting in patients experiencing low self-esteem, depression, and possible delirium. Where I work in Cairns, we have a main hospital and then we have eight rural sites, eight rural hospitals that are about an hour and a half away. So, about 90 kilometres away. Often people who live with dementia are admitted into these rural sites, but the environment is not adequate enough for them to actually care for them and to give them the effective care that they need. So, often they are transported that hour and a half or that 90 kilometre drive all the way into Cairns Hospital. And then they come to my ward, which is the Acute Ward. I'm on the third floor in a tall rise building. I don't have any outdoor areas and I don't have windows that open up and it's an acute facility. So, you can imagine that the confusion that these people have, not only with the journey all the way down to the Cairns Hospital, but then when they get to the acute facility as well, how confusing and disorientating it is. Then they get the anxiety, they get the anxiety and then they can't communicate their needs correctly. So, then they get anxious even more so, and then they can get agitated. So, then their symptoms are exacerbated, and then we have to try and get on top of those before we can actually get to the root of the problem as to what we're trying to deal with. So to me, it made perfect sense that we actually keep patients closer to home. So, we actually care for them in their own home environments, where they can have access to their carers, their families and their friends. But in order to do this, we need to have the right environment right from the very beginning, right in those rural facilities. So, when I applied for this innovation and funding, that was my aim. My aim was to actually improve the environments within the rural facilities so that we don't have to transport them down and we can actually care for them in their own home environment. So, the amount of funding I received was 280,000, and that was to spread across eight rural facilities. So, what I did was I looked at the environment first to how can we change this environment to make it a little bit more home-like and so that it can soothe the patients so that we can actually treat them? So, I looked at very, very simple strategies, like colours of walls, colours of toilet seats, and I know that sounds really bizarre. For a patient living with dementia, all their sights, sounds, hearing, everything is distorted, especially their eyesight. So, when you walk into an all white environment in a, like an acute facility, you've got the pan base and you've got the walls, you've got the toilets that are all white, okay? And often, they can't actually see that. Just changing a toilet seat to make it blue makes it so much simpler. They can actually see the toilet seat and they can actually see their way to the toilet. Changing the colours of the doors. So, if they were in a long ward and if we had different coloured doors and they went for a wander and then they got lost, we can say to them, "It's okay. You can go back to the blue door. That's where your room is." Very, very simple strategies. Little long strips along the walls, different colours, so that if they do go for a wander, they can follow that strip and they can come all the way back. Distraction therapies. So, I introduced distraction therapy boxes to each ward and I even roll that out into the Cairns Hospital as well. So, these boxes contain lots of diversional therapy tactics like colouring books. Very simple things. Dogs. They weren't real dogs can I just say, but like we had pet dogs that could actually breathe. Dollies. So, the ladies, often they like to hold a baby. We had playing cards, we had fiddle blankets. These are blankets that you put on somebody's lap and they can actually fiddle. IV covers. IV covers that have got like things hanging off them so that they don't try and pull out their IV. They can actually fiddle with it. So, they can actually pull on that instead of the actual IV. Lots and lots of things in these boxes, which we can replace quite cheaply, but they're very, very effective. Then I looked to education because that's one of the key points we need to get across that this isn't rocket science. It's very basic, but we need that ongoing education to actually educate people on what's actually going on in their heads with this dementia disease process and how we can actually approach people, how we can actually tackle it, understand what's happening with their delirium, how we actually pinpoint with the five P's. Is it because they've got a urinary tract infection? Why aren't they communicating effectively? Is it because they're in so much pain? All the very, very simple delirium and dementia strategies that we can use. And then I took it one step further because we can do that all the time and we are doing that all the time. I think it's out there that we know that we have to address this, but how sometimes I found I wasn't actually gettin' across to this group. So, I looked at a simulation suit. So, this is a geriatric simulation suit, which where I can actually put somebody into a full suit and actually put them into an ageing frail body. I can also then give them goggles so it distorts that eye sight. I can actually give them tinnitus so I can give them something that's in their ears. And if you put all that on at once and then ask them to do very simple strategies, like can you get dressed, please? And while, "Your cup of tea's there love, but we also need you to get dressed and then I'm going to give you your medication." It's really effective if you've got that suit on and you're getting three commands at once, and you've got lots of stuff going around you, you can finally put yourself into the shoes and live the reality of somebody who's living with dementia and/or delirium. That was one of my breakthroughs I think, is actually getting somebody to step in their shoes. And so, the suit that I actually brought was one of the most expensive items, but I think one of the most effective. So, the other thing that I did as well was enrolled champions because we need to keep this going. You can introduce all these kind of things, but if you don't keep the momentum going, then it all drops off. So, what I did was in all eight facilities was engage a champion and not just one champion, a few champions. So, I identified people who were as passionate as myself about people who live with dementia. We all got together, we did a lot of workshopping and we looked at all the different areas. We created networks, which is still going very strongly today. So, we have a constant group chat. We have a network going, where we all work together, we swap ideas, we troubleshoot with each other, and they are now keeping the momentum going by keeping the resource boxes up to date and the environment quite steady and rolling out the education. So, that's the main way that I actually spent my funding was on the environment, education and the rollout of the champions and keeping that momentum going. Yes, there was. Unfortunately like the rest of the world COVID came along and I was right in the middle of it. So, of course travel was restricted. I couldn't go into the rural facilities. I also was taken offline to do some other roles, but I didn't let go of it. How I could make it work was to teleconference in, keep the group chats going with the champions and then handover things to the champions so the champions could actually continue the work because I still have the funding there. So, the rollout of the environment, like I say, this wasn't big rocket science that I was talking about. This is like, can we get these doors painted? Can we get the toilet seats in? Can we get this rolling? Can we get the education programme up? So, I relied heavily on my champions who stepped up to the mark and continue to carry that out. So, I think the main obstacle was COVID, yeah. Yes, I think the unexpected opportunities was because I'm particularly passionate about this area anyway, but also my champions that came on board with me were just as passionate as I was. And so, we were spreading the love because along the way with this journey, with this funding, we did Delirium Day. So we had a fantastic national delirium day where we were doing lots of advertising and I was promoting what I was actually trying to do with this. So, that registered some interest and I had people from the Lions Club come in, and they wanted me to go and speak to all their group, which was great. So, I went along and did a lovely chat to all their group through the Lions Club, and they actually then came forward and gave me more money to say, because they were very interested in this. And they said, obviously, because that group were like, in that age group and if they weren't in that age group, they had friends or family members that were in that age group. And can I just say at this point, we're all getting older. That's the one thing we can't avoid and if we're very, very lucky, one day, we're all going to get into that over 65s, over 85s. One in 10 over 65 live with dementia, three in 10 over the age of 85 live with a dementia. So, at some point we could be there. So, this was an investment for them. So they were giving me funding to continue the project. And then the Hospital Foundation came on board as well, and I scored 38,000 from them to actually continue this as well. So, that was unexpected and so amazing. So, and it continues. So, we're still plugging it now. Yes, keeping care closer to home. Separating elderly people, anybody really, but I mean, particularly people that are elderly and living with a dementia disease process. It's really, really stressful for them to be moved away from their own hometown. I remember a story once of a lovely gentleman who was born and brought up in one of our rural facilities. He was born in the hospital that was in the rural facilities. And unfortunately, this poor, beautiful man developed dementia and they shipped him into Cairns. That was so stressful for him. So, the lesson here was as soon as I got him back to his own rural hospital, he improved. We were pinpointed as the centre of excellence in the big city, but in actual fact, it's not. We could care for him closer to home. It was a lot more effective. So, the lessons learned were simple, effective strategies can be implemented to keep these beautiful people closer to home. Yeah, I would say that the most significant interest was around the simulation suit. So, actually putting people into the body of a frail, ageing person who's living with dementia and/or delirium triggered a lot of interest. And so, we now have the, I was also funded for another suit, which was awesome through the hospital foundation. And so, putting these suits into the simulation centre in the Cairns Hospital, but they're also portable. So, we can actually take them around to the rural facilities as well so that we can actually roll out this education and really sort of plug how important this education is and across all disciplines. So, it's not just nurses. It's nurses, it's doctors, it's operational workers. And we even got the security people on board as well. They really generated a lot of interest and have now incorporated dementia strategies into their occupational violence education sessions, which is awesome. I hope you found this presentation from the Nursing & Midwifery Showcase Series informative. Please take the time to check out other projects that highlight nursing and midwifery excellence in Queensland Health.