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The Forgotten Revolution: The Priory Method: A Restorative Care Model For Older Persons

by Jessie Mantle and Jeanette Funke-Furber

89 pages; quality trade paperback (softcover); catalogue #03-0112; ISBN 1-55395-749-0; US$14.50, C$16.95, EUR12.00, £8.50

Many are disquieted by how we care for older persons today. This book documents an example of care practices and management infrastructure that restore dignity and wholeness to the elderly.

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about the book      about the authors      sample excerpts      catalogue info

About the Book This book rediscovers this Priory Restorative Care model and places it in the public domain where others might be inspired to follow the originator's path. The Forgotten Revolution documents the care practices and the management infrastructure that restored dignity and wholeness to the older people who made the Priory Hospital their home. It is needed as much in the new millennium as it was 30 years ago. Journey back to the late 1960's and enter the mind and spirit of a visionary woman, Vera McIver. A nurse in her early 50's, new to management and new to caring for the elderly, she dared to think outside the box of traditional care and revolutionize institutional life for frail and ill older persons forever. In 1967 she rebelled against the prevailing system called custodial care - a system that triggered a cascade of effects that led to a loss of pride and dignity and the death of the human spirit. She created an approach called Restorative Care, which she defined as a programme to restore dignity of life to older institutionalized persons within the limits of their capabilities. The Priory Method contained most elements now recognized in 2003 as essential to a progressive residential environment for older persons. What has happened to this model of care in to-day's practices? Unfortunately the model still remains unknown to many working in long term care. In other instances, the model has appropriately changed and evolved over time as the ideas have permeated the culture of long-term care but few people know the origin or the extent of the ideas. By putting this information into the public domain we hope that readers will be informed and reminded about the salient features of the model. We also hope they will examine their own situations with older persons and use McIver's ideas to humanize them where needed. As we go to press the health care system is once again in crisis and advances made in the past are at risk of being lost. The shift to a preoccupation with health care costs is challenging some of the innovative ideas found expressed in this book and which have been successful. Yet again there is a need for creative and informed leadership if the rights of residents for humane and quality care are to be preserved. This book illustrates how one person might seize opportunities for change provided one has the courage and vision to do so.

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About the Authors The authors of this monograph were privileged to inherit the legacy of working with the Priory Method long after its development. During the 1980's and 1990's they were both in positions of leadership at the Juan de Fuca Hospitals, hospitals which included the original St Mary's Priory. Jessie Mantle is Professor Emeritus, University of Victoria, Victoria, BC, Canada. During her career she has been a staff nurse, an instructor in a diploma School of Nursing, a university nursing professor and a clinical nurse specialist in gerontological nursing. Between the years of 1981 and 1995 she held a joint appointment as Professor at the University of Victoria and Clinical Nurse Specialist at the Juan de Fuca Hospitals where she was introduced to the Priory Method. In this latter role she developed evidence-based clinical programs becoming a leader in delineating the salient features of nursing care for the elderly in Canada. She has been a role model and mentor to nurses in this specialty and was a founding member of the Canadian Gerontological Nursing Association becoming the first President of the Association, from 1985 to 1987. Through her teaching, invited speeches, articles and conference presentations she has influenced health care professionals to critically examine how they care for older adults. Jeanette Funke-Furber, is a retired nurse living in Victoria, BC, Canada. Currently she is President of the Greater Victoria Eldercare Foundation. During her career she has been a staff nurse in hospital and home care and a teacher of nursing in hospital diploma, college and university programs. Between the years 1985-2000, she was the senior nurse administrator at the Juan de Fuca Hospitals in Victoria, BC and Adjunct professor, University of Victoria. During this time, she established a shared governance model and introduced Quality Improvement Programs. These programs enhanced the participation of all staff, residents, families and community in developing and implementing patient centered care programs. She taught Nursing Management and Current Issues to BScN nursing students, and supported the expansion of student clinical placements throughout the Juan de Fuca Hospitals. She was a strong advocate for career development of nursing and multidisciplinary staff in the specialty of Gerontology. Sample Excerpts CHAPTER 3: RESTORATIVE CARE PRACTICE In this chapter we will discuss the guiding ideas underlying Restorative Care and follow this with a description of the clinical approaches used in Restorative Care practice. We identify the areas of focus that served to orient the staff in their new practice. We highlight the approaches developed for the special situations of dementia and dying in the elderly and we conclude with a discussion of the particular strategies used to implement the programmes. It is these components that made Restorative Care at the Priory significantly different from the usual care practices offered in other like facilities of that time. Guiding Ideas in Restorative Care In Restorative Care five critical overall strategies were linked together to direct the care programmes. The whole person rather than just their disability became the focus of attention. The total environment, including staff behaviors, was re-designed to convey positive expectations of wellness and the maximum use of remaining abilities. The Priory became a community within itself and a participating member of the larger community outside. The institution was de-institutionalized through humanizing the hospital environment. The activities of daily living were normalized, particularly through environmental changes and strengthening the body. An interdependency model of care was adopted where the residents were supported by staff to carry out their own activities of daily living thus strengthening their ego. In this model, particular clinical and management acts, either alone or in combination, were seen to achieve multiple goals. The reverse was also true and to achieve any particular goal you needed multiple interventions. Later in this chapter we have used summary charts to demonstrate some of the strategies used by the staff. The reader will note the overlap of actions in the charts revealing how a particular action can meet several goals. The blending of strategies to meet a goal is exemplified by the way in which the eating routine was normalized. McIver had observed that many of the residents were not able to feed themselves and had regressed to eating pureed food. She recalls A resident 's apathy toward feeding himself is frequently seen and follows a pattern. This indifference is more pronounced where the resident eats in his own bed, off a tray without social interaction. The resident begins to toy with the food, eating less and less, when this persists, the nurse gives help in order to get sufficient caloric intake. This of course does not improve the situation; the resident hasn't the appetite, is too weak, and forgets how to feed herself. It becomes a downward spiral because the feeding is so time consuming, [and] the nurse resorts to pureed food as it goes down more easily. The road back to self-feeding was slow, but setting up an enabling environment that was more normal was the goal. For the residents, this included getting up out of bed, being appropriately dressed and joining in mealtime conversations with others around a familiar dining room setting. The creation of a family style dining room (communal) where residents no longer had to eat from a tray while in bed or at the bedside was a critical environmental change. Some brief pre-mealtime entertainment was started. The tables were attractively set and mealtime was treated as a special time for residents. The food was not served on institutional-like trays. It was plated from heated bulk food containers directly in front of the residents with the kitchen staff dressed as Chefs and having direct contact and conversation with the residents as to likes and dislikes. Eventually those residents who were capable were given food in bowls and platters for self-serving. These residents served themselves and helped other residents who needed assistance to fill their plates. The physical environmental changes helped to maintain good eating habits that strengthened the body as well as providing opportunity for normal socialization. The reaching for and passing of food provided exercise as well as opportunities for personal decision-making about what to eat and identifying who needed help. By helping others, residents were able to meet their own psychosocial needs for belonging and doing meaningful work. There was also the provision of a kitchenette for residents and family's use. This provided the residents and /or families with a way of participating in meaningful familiar social activities, in a homelike setting. It provided an outlet for the need to perform domestic duties, as well as care giving through preparation of tea and baked goodies when residents and /or family members were capable to do so. Those that were able would also wash their own dishes and tidy up. CHAPTER 5: MOVING FORWARD The Priory Method was a dynamic idea that changed over time as a result of both internal and external factors. Evaluations from a variety of sources reinforced some ideas and modified others. The organization expanded and new staff came on board, many of whom were unfamiliar with the Priory Method. McIver retired in 1979 but the ideas were never completely lost. As we entered the new millennium a new facility, Heritage Woods, emerged on the Priory site embodying many of the ideas that McIver had espoused. In this chapter we show the evolution of the model and its subsequent growth over time. First we discuss the success of the Priory Method. We move on to document how the organization expanded towards the end of McIver's tenure and the subsequent evolution of the Priory Method. We conclude with a brief description of Heritage Woods, a facility we see as the next significant development in facility care for the elderly and which we refer to as "the second generation Priory." Measuring Success When the Priory programme was initiated, there were 71 women in various stages of mental and physical regression. The early results of the programme were evident in the statistics compiled by McIver after 11 months and are found in Table 4.

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Catalogue Information

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