Course content – PFLEGE-16

13. Module 12 · Self-care & documentation

Conclusion

Care staff and the bigger picture

Dementia care is fulfilling, but also demanding and stressful – emotionally (witnessing decline and suffering, challenging behaviour, one’s own helplessness in the face of an incurable illness), physically and in terms of time. This is why dementia care also includes the self-care of care staff (covered in depth in Course 26): taking one’s own strain seriously, ensuring balance and recovery, having realistic expectations (you cannot cure dementia, but you can improve quality of life – and that is valuable enough!), exchanging views and supporting one another in the team, using supervision/case discussions, and acknowledging successes (even small ones). An exhausted, overwhelmed carer cannot provide good support; self-care is therefore a prerequisite for good, patient, empathetic dementia care.

Documentation in dementia care includes: the life history (Module 5 – the treasure trove for person-centred care), the individual needs, preferences, habits, wishes, the approach to challenging behaviour (what triggers it, what helps – for continuity!), the resources (what the person can still do), observations (behaviour, wellbeing, changes – delirium!), and the effectiveness of measures. This documentation ensures the continuity and individuality of care across shifts and people.

What this module is about. How to stay well while caring for people with dementia, how to write down what you know so that the next carer can use it, and how all eleven earlier modules fit together.

What you will be able to do afterwards. You can spot early signs of strain in yourself, choose one step for yourself and one for your team, and write a short, factual note about a behaviour and what helped.

Think about it first. Ms Weber (fictitious), 41, has worked on a dementia unit for six years. Lately she dreads Mondays, snaps at colleagues and has stopped writing in the care records because “nobody reads them anyway”. Yesterday a resident she liked very much died. What signs of strain can you see? Write down two signs and one thing that could help her. You will compare your answer with Figure 12.1 and the worked example on page 3.

Learning objectives of this module

You recognise the strain and the importance of self-care.
You make use of the team, exchange and supervision.
You document life history, needs and the approach to behaviour.
You bring together the principles of dementia care.
You can plan one step for yourself and one for your team that reduce strain (apply).
You can write a short care note that separates what you saw from what you think, and that tells the next carer what helped (apply, analyse).

Bringing it all together

Let us summarise dementia care: it is based on an attitude (appreciation, empathy, patience, understanding the inner world, preserving dignity – attitude matters more than any technique), on understanding (dementia as an illness, the inner world, the preservation of feelings and personhood), on communication (calm, simple, validating, non-verbal, responding to feelings – not correcting), on understanding behaviour (as communication/need – look for the cause instead of sedating, think of pain and delirium), on person-centred care (Kitwood – seeing and strengthening the individual as a person with dignity, needs and a life history), on designing daily life and the milieu (structure, meaningful activity, a dementia-friendly environment), on dealing with specific situations, on dementia-sensitive basic care (relationship beats technique, no coercion), on supporting relatives, on protecting freedom and dignity (avoiding FEM, respecting self-determination), and on the self-care of care staff.

The overarching message: people with dementia are and remain valuable, feeling persons with dignity – to the very end. The task of care is not to cure dementia (that is possible only to a limited extent), but to enable the person, despite dementia, to have dignity, wellbeing, safety, relationship and quality of life. This is achieved by understanding their world, through empathetic communication and relationship, by interpreting their behaviour, through person-centred care in line with their life history, and by preserving their dignity and freedom. This task is challenging and demanding, but also deeply fulfilling and meaningful: there are few places where care can give dignity, security and wellbeing as directly as in caring for people with dementia. Those who internalise the attitude and knowledge of this course can stand by these people – and their relatives – on their difficult path and make their lives worth living despite dementia. That is one of the most valuable tasks in care.

When strain builds up

Strain in care work rarely arrives suddenly. It grows from many small loads: short staffing, hurry, hard behaviour, loss of residents you have known for years, and the feeling that you can never do enough. Resources work in the other direction: a team that listens, time to recover, success you can see and a sense of meaning. When the loads are heavier than the resources for a long time, warning signs appear. Figure 12.1 shows the idea as a balance and lists typical signs in four areas.

Figure 12.1: Loads, resources and early warning signs (thinking aid from general professional knowledge). Source: own illustration.

Read Figure 12.1 from top to bottom. The balance shows that strain is not a personal weakness: it depends on both sides. You can reduce loads, for example by asking for help with a hard task, and you can increase resources, for example by using a team debrief. The four boxes tell you where to look. A change in your records, such as careless or missing notes, is often an early sign that colleagues notice before you do.

The World Health Organization (2019) describes burn-out in the eleventh revision of the International Classification of Diseases (ICD-11) as a syndrome from chronic workplace stress that has not been managed successfully, with three features: exhaustion, growing mental distance or cynicism about the job, and reduced professional efficacy. The WHO states that it is an occupational phenomenon and not a medical condition. If your signs are strong or last, speak to your manager, the occupational health service or your own doctor.