Intro to the series:
In this monthly series we explore ways to make the most of the outside spaces around your care setting and help your residents benefit from stepping outside and enjoying meaningful activities there, as and when they choose. Step Change Design focuses on encouraging care settings to take a fresh look at their care culture and care practices in order to engage actively and meaningfully with their outside spaces with their residents.
When we step outside it is a fully immersive sensory experience.
As mentioned in our previous blog, it often creates multiple sensory impressions that are linked to memories of outdoor activities and these can activate all our five senses.
This means that by simply stepping outside there can be very strong triggers to recall activities we enjoyed doing and happy times we spent outdoors.
In effect, your outside space can be a powerful tool in helping to build a wider picture of the way your residents lived their lives and may bring to light information that has not arisen in other life story and information gathering work.
With this in mind, it is important to ensure that the outside space is not overlooked as a key resource in finding out more about residents from their earliest days with you and beyond by seeking out opportunities to step outside even during pre-admittance visits, and to keep your eyes and ears open each time you go out for what you observe and learn about them.
It is also important to ensure that in your conversations with family members, that you mention the outdoors and what it means to their relative.
Even better, why not hold your meetings and conversations with them outdoors when you can?
Overlooking the golden nuggets
In our research project we asked care settings to keep diary records of the interactions that took place with their residents living with dementia and the outside space. As we read these journals we began to build a picture of the way many different residents lived their lives and how they engaged with the garden, both during the visit captured in the diary and in their lives before entering care. From one home in London, with a tiny, shady garden overlooked by the tower blocks that many residents had lived in before entering the care setting, we received two diary entries a week apart. They were written during a very hot part of the summer by different carers, but clearly about the same resident.
In both diary entries, they noted that while spending time in the garden with this resident, she had commented ‘we should have a swimming pool’. While the same comment was captured twice, no follow up action was taken until we inquired to find out more. We had wondered if she had travelled and enjoyed holidays with a pool so we flagged these entries to the Activity Coordinator, who was our project lead. He then spent some time with the resident (who had only recently joined the care setting) and did some further investigations which went on to reveal that the resident had regularly gone swimming at a pool just around the corner from the home. With this new information that we had flagged to him, and his additional research, he was able to arrange for the resident to continue an activity that she enjoyed prior to arriving at the care setting
This information was partially revealed by the resident when prompted during their garden visits, and was even captured in our study, but the carers had dismissed this hidden nugget of potential new information as simply a throw-away comment yet it went on to reveal an important part of who this resident was and still wanted to be.
Remaining ever curious
During our study we captured and observed many instances of new information that came to light when residents stepped outside, that the care setting had not known previously, even for residents that had lived in the home for some time and where other life story work had been undertaken.
Stories of a grandfather having been gored to death by a Friesian cow, prompted by seeing a garden sculpture of a pig or learning that a resident used to open her garden to the public after she began to give us a guided tour of the homes garden or during an activity of hanging washing with a small group of two ladies and a gentleman that brought to light a moment of amusement and clearly real joy as he sat down after hanging one item stating ‘I love watching women work!’. This went on to reveal he used to enjoy sitting and watching his wife carry out this same task.
How many of us in our wider lives find ourselves sharing information about a friend or family member, maybe even using phrases like, ‘I never knew so and so loved to … [horse ride/garden/grow dahlias]..’ or, ‘Did you know they used to be a [pilot/postman/farmer]…’ ?
We can still be surprised about new information that suddenly comes to light about our friends and relatives even when we thought we knew all there was to know about them. Even our nearest and dearest can surprise us with a shared memory after a chance comment or a visit somewhere and new information is revealed. It’s a natural impulse to want to make sure that we remember this and act on it so that we can make future experiences meaningful for them.
It is this key distinction that is alive and well in homes practising person-centred care, and beyond, too. These care settings remain ever curious about their residents, constantly listening and watching out for those nuggets that reveal more about their residents lives, as well as informing them about new interests and preferences. Importantly, it’s what they then do with what they have learnt that sets them apart from other care settings. They share and act on this information so that they, and their colleagues, can tailor the support and activities to remain relevant and meaningful to their residents in the light of what they have learnt, and continue to learn, about them.
Don’t forget the outside from the start
When residents first arrive don’t forget to include enquiring about how they spent time outdoors and what they like to do there. Even better, step outside to ask these questions, and demonstrate that it is just as natural to be there as it is indoors. For those residents living with dementia, actually being outside may bring to light important information about them that may never be prompted from a conversation or reminiscence session that you have with them indoors.
Most of us step outside every day of our lives, even if it is simply to get in the car. We often have our own unique memories, habits, likes and dislikes associated with being outdoors that may contrast with how we behave or interact indoors. In fact, we may act or do things very differently outdoors than indoors. Some of us feel more confident, happy and at peace outdoors, when we are ‘in our element’, and yet we can be quieter and hesitant indoors. If we don’t know someone fully, a chatty and active disposition outdoors could seem out of character based only on what we know about them inside the setting. Becoming aware of these contrasts in behaviour and attitudes adds a layer of understanding about a resident’s life and character that could ignore a large part of who they are if the outdoors is not considered, or even throw up some unexpected behaviours when you do step outside.
Remaining curious and alert to what your residents do and what they talk about, and sharing what you find out, can help to create an up-to-date awareness of what gives pleasure, meaning and occupation to your residents, as individuals, both indoors and outdoors. Family members and friends can also help you to capture, confirm and contextualise new information to help your understanding of your residents and their individual needs and wishes, all of which can provide valuable information to aid the way that you care for and support your residents to live the lives they would choose.
Connect with Step Change Design on Twitter Debbie Carroll @stepchgdesign
About Care Culture Map and Handbook
