The power of care worker presence
The significance of aged care workers being truly present in care and forming genuine connections with residents with dementia cannot be overstated, writes Professor John Swinton.
Being present in care goes beyond task completion; it involves acknowledging and valuing the individual for who they are. In the context of dementia care, where verbal communication may be difficult, being present becomes crucial.
Despite daily challenges of providing care, it requires a dedicated effort to connect, understand, and recognise meaningful communication, even in the absence of shared language.
Presence is a broad concept with meaningful engagement and person-centred care at its core but also encompassing additional attributes like attentiveness, living in the moment, and meeting the person where they are.
It’s a transformative approach that prioritises genuine connections and understanding of the residents’ holistic needs in the care process.
In a world increasingly dominated by technology, the intrusion of mobile phones and social media into our lives is contributing to a culture of absence. Noticing that you are being absent and taking time to bring yourself into the present is a very valuable habit.
If we are more aware of ourselves, we become more aware of the people around us.
Of course, the opportunity for technology to aid connection and create engagement – such as during COVID-19 or separation due to distance – is obvious. But we need to make a conscious effort – to be intentional – about being present, especially in the aged care setting.
The language of presence
Language plays a pivotal role in shaping our perception of people living with dementia. Care workers should be mindful of the words they use, emphasising that the way we talk creates the world we see. And what we see influences the way we respond or behave.
If we avoid using language that implies the person with dementia is already absent, and use language that affirms the person, carers can foster an environment where people with dementia feel, and are, recognised and valued.
As dementia progresses, traditional modes of communication become more challenging. However, care workers can still manifest presence through non-verbal cues, such as body language and touch. Recognising the importance of tactile connections, especially in the lives of older individuals, becomes crucial.
Study examines care worker presence in aged care
While nursing presence programs in the literature demonstrate positive clinical and social outcomes for patients, recent studies highlight a gap in understanding care worker presence, especially in aged care.
Amid challenges identified by the Australian Royal Commission into Aged Care Quality and Safety, we wanted to explore aged care workers’ experiences, challenges, and support mechanisms in providing meaningful engagement and person-centred care for residents living with dementia.
Our study – published in The Gerontologist – provides insights into the experiences of care workers striving to be present.
Challenges to care worker presence were identified, emphasising that overcoming these challenges is key to avoiding poor care practices and unfavourable resident outcomes.
Participants sincerely expressed their eagerness to be present in care. One care worker interviewee recalled her experience as follows:
“When you get to spend quality time with residents, and have a chat, … hear about their day or whatever, … or play a game, that’s the best part. Or go for a walk or something, where you are making them smile or, making their day a bit better.”
Two key findings emerged from the research:
- the importance of trust in establishing meaningful engagement, and
- the need for organisational support, funding or resources, and adequate staffing for facilitating effective care worker presence.
These findings are illustrated by the following comments from participants:
“Everybody is different, everybody has different needs, wants”.
“To build that trust with a resident, and knowing the resident is a major part of them having a good day basically.”
The study highlights the critical role of care worker presence in addressing the challenges of caring for residents with dementia, emphasising the obstacles and the opportunities for meaningful engagement. This is illustrated by the following responses:
“Whenever staff are short, we don’t get the chance to give the resident the care they need.”
The findings underscore the complexity of the care environment, where practical and structural barriers, such as competing work demands and staff shortages, limit opportunities for practising presence.
A catalyst for positive change for dementia care
Meaningful engagement, intrinsic to human connection, is crucial for the wellbeing of residents, especially for those living with dementia. The study suggests that staffing arrangements – influenced by both aged care models and funding considerations – need to align with the evolving needs of residents.
External factors, such as staff shortages and the Covid-19 pandemic, impacted on care worker presence and residents’ opportunities for social engagement. Taken together, study findings suggest that care worker presence could influence physical and emotional health and wellbeing of residents and wellbeing of the staff who care for them.
The importance of recognising care workers’ limited time for engagement cannot be overlooked and the study proposes a combination of factors – including adequate staffing, education, training and reminders – to enhance care worker presence in busy residential aged care settings.
Future research should explore these areas – considering the perspectives of care workers in different settings to inform comprehensive strategies for improving care worker presence and, consequently, the wellbeing of residents living with dementia. The study acknowledges its limitations, urging larger-scale research to confirm the transferability of findings to diverse residential aged care homes.
The human connection, fostered through meaningful engagement and person-centred care, stands as an untapped opportunity in the often-complex landscape of dementia care.
To move forward, recognising the challenges and collectively fostering an environment conducive to being present will undoubtedly enhance the wellbeing of people living with dementia. The transformative power of presence should not just be viewed as a concept but a catalyst for positive change for dementia care.
Professor John Swinton is Professor in Practical Theology and Pastoral Care at the University of Aberdeen
We hope you enjoyed this article – please add your comments below
Visit our features portal for more in-depth stories
