Using P.I.E.C.E.S. to decipher behavior management in long term care

As we continue to witness the rise of dementia cases and the implications for long term care facilities, it is worth noting current behavior management philosophies. As noted by the Canadian Nursing Home the causes of the various dementias are different and complex, but the results are the same: leading to a progressive and degenerative disease of the brain that lead to memory, communication and thinking impairments. In addition, this further leads to behavior changes related to reasoning and judgement; behavioral changes creating stress for the resident and the caregiver.

The Alzheimer Society of Canada (2009) introduced the P.I.E.C.E.S. education approach to care within the long term care system in 2008. This included improvements to the quality of care initiatives in both the long term care and home care environments. This entailed the state for placing high priority on education for professional care staff (R.N.’s,L.P.N., Nurse Practitioners, Physicians, Home Health Aides, support workers, and the public.(Province of Manitoba, 2002 and 2007)

The acronym P.I.E.C.E.S. refers to the individuality of the client including well-being, self-determination and quality of life for the elder. To break it down further:

~”P-I-E” refers to physical, intellectual and emotional health of the individual.

~The “C” refers to the center-piece or focus of care.

~The “E-s represents the environment and the social self.

The P.I.E.C.E.S. program is not just the “train-the-trainer” education program. It is a government sponsored learning initiative to assist long term care facilities, community agencies, home care, improving the performance through the development of:

1. A common set of  philosophies, i.e. person-centered care, social model of care.

2. Developing a common language for communicating these philosphies across the healthcare system.

3. A common set of approaches to behavior management and care.

The approach better known as “Putting the P.I.E.C.E.S. Together” represents the physical, intellectual, emotional and social components which assist the clinician in assessing the triggers to behavior management.

Since the inception of P.I.E.C.E.S. education initiative over 3000 regulated health professionals have been involved in Ontario and more than doubled in other provinces,(Canadian Long Term Care, Dec. 2010). The response has been overwhelming with the advancement of skills and knowledge, standardized assessment scales and the ability to monitor the use and risk of psychotropic medications. For information regarding the P.I.E.C.E.S the following web-sites are recommended:

www.piecescanada.com/,www.piecescanada/pdf/PIECES_Laminate_Nov_09.pdf

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