Example of supervision minutes with a comment

AGENDA
-minutes
-journal
-piece about conflict
-ongoing work
-direct observation
-interim evaluation

Minutes
-agreed that they were fine this week and that the student is developing this skill
-agreed that it was good that they are now on the log as they are safe and easily accesible

Journal
-there was confusion about whether this weeks journal had been done and read but upon discussion it was found that it had and that it was ok

Piece
-discussed the content of this- best practice and ethics
-to be written as a blog entry
-needs to be linked to ethical principles eg duty of care
- could include things from a managerial point of view

Ongoing work
-discussed the carer's assessment and case review to be done once student returns after easter
-discussed possible conflict of previously decided direct observation and reminiscnece groups which studenti and centre manager are going to start- the reminiscence group is decided as the new direct observation
- Thursday the 12th will now go as follows:
10.30-11.30 Supervision
1-2 Reminiscence group
2- Debrief
- Student's parts of the observation forms need to be completed before this date
-discussed the importance of talking about roles in the group with centre manager and agreeing on interjections etc during group time
- PT and student to discuss dealing with anxiety at a supervision previous to this
-discussed possible direct observation of review with client in future

Wednesday afternoons
-discussed the external group and how it is going so far
-discussed the grounds of referral for the men- how voluntary is it?
-what are the consequences if they don't attend?
-to whom is the faciliator and the group accountable? (management and quality
assurance?)
- Student to discuss the possibility of bringing in a reminsicence box with the facilitator

Interim evaluation
-deadline for uni 20th april
-finalise on the 18th april
- Student to hand in finished copy to PT on 12th

A role in serving food

As one of the centre's main services to its clients is a daily lunch club I soon became involved in helping to serve lunch. Each day the clients are invited up to the dining hall just before lunch starts to settle at their tables and choose which option from the menu they wish to have. Some clients need helping reading the menu board and even explaining what certain dishes are.A task such as this which seems so simple taught me about communication and being patient. I am learning the importance of allowing people to choose for themselves, especially as some of the clients who struggle more with verbal communication find it difficult to tell you what they wish to eat and some of those with dementia or other mental illness struggle to choose which dish they want at all. The temptation is to just choose one for them and get on with handing out the food but I began to understand the importance of allowing decisions such as this and not taking away control from the clients just to make a service run that little bit smoother. In the world of an older person in our society choice is not always something allowed to them in many aspects of their life as more and more the have to rely on the provision of services to go about their daily lives. And often in the process of becoming more dependent and in need of help, the element of choice is taken from them bit by bit. So, through watching the workers interact with the clients in this way and by becoming involved in it myself I was caused to consider this.
Also,the workers have some basic rules of serving food which aim to make the clients feel valued and which promote dignity. For example, waiting until all the people at one table have finished eating before taking the plates away so as not to rush anyone or interrupt their eating and conversation. Such small decisions as this really improve the quality of such a service. Also,being involved in this gave me a slightly more defined role for the clients rather than just being a student who hung around them at lunchtime.

On Thursday morning I had the opportunity to be do the referral of a lady, Mrs White. Her husband had referred her to the centre as she has dementia and he is the sole carer. The plan was for her to attend one day a week and I was to do the referral forms and the carer's assessment.

When they came in we went into a room with comfy chairs which was a fairly relaxed and informal setting and I introduced myself to them and we discussed the purpose of all the forms and this visit. We went through details such as address and date of birth etc and I noticed that Mr White had to answer often in Mrs White's place but that he didn't do this too quickly, but allowed her at least a small chance to try and give the correct answer. She often looked to him and told him to answer. At these times they made comments about her memory and cognitive capacity saying things like 'she's still quite bright but just forgets things.' They were very honest and open about her strugles with memory and her confusion.

We came to the part of the referral designed for people with dementia asking a few questions about their uprbringing and family so as to see how well they remember things and to find out where they are coming from. I told them they didn't have to answer these questions if they didn't want but they said they would and I was later glad as I felt that this part of the referral gave me most information about Mrs White herself, her interests and her past experiences and background. I felt this allowed me to understand more where she was coming from and later in the day I was able to chat with her about some of these things and to understand what she was talking about if one of them was mentioned. I noticed again the great support that Mr White was in that he prompted her memory with things such as street names when she was trying to remember siblings and childrens' names and seemed to empower her in this way by being patient and allowing her to answer. This also emphasised to me the great dependence she seemed to have on him.

She told me family is the most important thing to her and they both told me stories about their children and grandchildren. Though Mr White is the sole carer, their children often come round and provide support in meals and things and this highlighted to me the importance of social networks and informal providers of care. It also made me consider the importance of policies and legislation regarding carer's rights and the huge amounts of carers who go unpaid and unsupported at the moment, often due to a lack of awareness.

Because of this I wanted to make sure that Mr White was receiving the support he needed and so, when doing the carer's assessment with him afterwards I made sure we talked about the part of it that offers him more information about support he can receive. However, he said he has received so many leaflets and his daughter-in-law helps him with that side of things, again showing the importance of informal support. Though he did not wish to do the carer's checklist that day he did tell me how difficult emotionally and physically it really is caring for Mrs W and how her coming to this centre and going to the other support agency etc helps him have a time to relax a little. We also discused feelings of guilt at leaving her and, interestingly, how one thing they both struggled with is the fact that often in 'these places' there are people much worse off than her and this makes them a little uncomfortable. This reminded me about a discussion with a local social worker about the future of older people's daycare and how there should be more provisions which recognise that not everyone wants to go to a daycare centre all day with people who are so much older and frailer than themselves. How can services be provided which recognise that even amongst older people there are still individual differences and big gaps in age and need?

Throughout the rest of the day I wanted to be around to help Mrs White settle and to introduce her to the other clients. At one point we had to go sit in the quiet room and just chat together as she was finding it a bit overwhelming and, later on, after 2 games of dominoes she expressed a similar feeling and had to come aside again. Her worries most of the day were about her husband not returning and at one point when I asked her what was troubling her she told me it was the fact that 'they' (which I assumed meant family) can go and do what they want all day while she has to stay here. She seemed very aware of the fact that 'this is my life now' and that she was losing some sort of freedom and possibly even her role in the family as she was now being cared for rather than a carer.

Throughout the whole process the themes of loss and grief were at the forefront of my mind because of situations like this and because of her husband's obvious grief at the kind of loss of his wife as she was and how he had expected her to be until she died. They expressed how they'd assumed she would be the same as her mum and live to an old age without any problems and it seemed that their unmet expectations were a major part of this loss and grief.

HAVE I INCLUDED TOO MUCH PERSONAL INFORMATION ABOUT THEM IN HERE? I FELL LIKE I'M BETRAYING THEIR CONFIDENCE SOMEHOW BUT I'M NOT SURE IF I AM?

Importance of community

On Thursday after returning from a student group meeting I entered the dining hall and saw Mrs Black who I had previously done a referral with the week before. She immediately recognised me and smiled and I went to speak to her. Though she still fidgeted with things around her and seemed a little nervous she also seemed a lot more rested and settled. After she had finished her lunch we walked around the centre for a while as she expressed a preference for walking and viewing the different rooms than sitting and chatting.We talked about how she was finding her time at the centre and she seemed to have taken great pleasure at the fact that she had met someone there who she knew from years ago.This reinforced to me the importance of community and remaining in the community and how this should be an important element of social service provision. She still also repeatedly worried about whether her husband would come back to get her but did not seem as positive that he wouldn't as she had done the previous week. When in fact he did come back she connected the fact that he'd come back and the fact that I had repeatedly assured her that he would and seemed to have a new sort of trust in me.
During the afternoon we went into one of the rooms and looked t some old coins and 'famous faces' from the past and she seemed to enjoy greatly telling me who each of them were and why she liked them or disliked them. I saw her visibly relax as she did this and she only became a little bit confused occasionally in the moving from one card to another. Again I saw the benefits of reminiscence work and this time with the use of props to stimulate. I feel it contributed to her general sense of well-being in the centre and to deepen my understanding of the level of memory she still has and also her general interests.
In future something I will do differently or be aware of is to make sure that she does not become too dependent on me alone. At one point she said something along the lines of 'You're my guardian angel' which though said in jest made me conscious of the possibilty of this kind of dependent attachment forming and I hope to encourage her more in her further integration into the community at this centre.

Using music as a communication tool

On Thursday afternoon we put on an easter afternoon with some visitors from another centre. The afternoon consisted of an easter card competition, a raffle, food and drink and a man playing the accordion or 'squeezebox' as it referred to in this area. I went in to join the clients and visitors in this and to talk to a few different people but also because Mrs Black expressed a desire for me to be there for at least a little bit. Still wanting to make sure she wasn't too dependent on me I left her sitting with a lady from the other centre and a lady from our centre and, though a few times she looked round confused and once she stood up and got confused about where she wanted to go, generally she seemed quite content and also engaged in conversation a little with these ladies.

I stood aside and watched the different reactions to this new experience. Some poeple seemed to revel in it and chatted appily with all around them and introduced themselves to new faces. Others looked a little wary and one lady with dementia began to cry when the music started. The music made a big difference to the situation. The tunes, though not all recognised by me, were all old familiar ones and many people joined in singing and swaying to the music. One lady who is in a wheelchair and stuggles generally to communicate verbally with people was absolutely overjoyed and clapped and smiled along to the music until the last moment before she went home. This reaction to the music highlighted the potential for using music in reminiscence work and also just the potential to use it in centres and homes to help people relax in the comfort of something familiar but also, bearing in mind the reaction of crying and feeling unsettled as well I realised the importance of not generalising this potential to everybody's situation. There is a need to look at each individual's situation and reaction to things such as this and to be prepared to respond accordingly, for example by probing the lady to discuss why the msuic makes her cry or by being aware that music such as this may be bringing up painful meories and feelings linked with them. The memories may not have even been painful, it could have just been the new surroundings and situations which upset this lady or it could even have been happy memories which highlighted the difference in her life then and now. This is all speculation as I personally did not get to speak with her but I certainly found it interesting to consider and to see how after talkig with one of the workers she relaxed a little though still maintained an expression of sadness throughout the afternoon.

Mrs Black, on the other hand, enjoyed the afternoon and I was glad to see her beginning to talk to other people and settle in.

Afternoon tea and reminiscence

During one of the afternoon tea breaks I was interested to watch 'reminiscence' naturally take place. It started with a simple comment by one of the staff members about 'do you remember...' and quickly continued into a general discussion about things from people's childhoods or even earlier adulthood. I watched as they all laughed together and talked about sweets, food, wages, the safety on the streets and many other everyday topics. They made comparisons between their own upbringings and children today and seemed to settle on the idea that their childhood was better. It was fascinating to see all these different people, who sometimes seem to struggle to get conversation going with each other, just open up and share memories. One lady even sang a song her husband used to sing to her and a song in French as everyone else listened and looked thoughtful. It seemed like a happy kind of reminiscing, even though they were remembering poverty.

I could see the confidence building in people as they spoke of subjects they knew well and I began to see more of their individual characters and understand that little bit more where they had come from. These are things that I had read about but it was useful to see this physically happening in front of me to help me actually see the benefits which so clearly arise from this. It was spontaneous and unplanned yet it had managed to create a warm, friendly environment in which everyone's experiences were valued and listened to. The 'Age Exchange' website uses the slogan 'Valuing the past, building for the future.' This was clearly them valuing the past and, I too as I was listening and being invited to share in reliving their memories, was learning to value their pasts. In terms of building for the future, the increase in self-confidence and general well being can contribute to a more positive view of the future. For younger members of society who listen as I did it also builds into our own futures a respect and deeper understanding of the lives our elders have lived.

Whilst this group reminiscing was taking place a lady next to me began to share her own personal memories with me aside from the group. Her memories, however, were mostly ones which seemed to cause her pain and she recalled difficult times such as separation from her parents and poor treatment at the convent she grew up in. It was as if something the rest of the group were talking about had triggered off her memories of the past but they did not fit in with all the relatively happy ones most people were talking about. These memories were of loss in the past yet were still affecting her in the present. For example, the loss of her sisters to whom she was very close because of this upbringing, was causing her pain and loneliness. I felt the need to stop listening to the group discussion so that I could listen with genuine attention to this lady and allow her to express these feelings. We then talked about the people she has in her life at the moment to help her so as not to leave her dwelling on painful memories, whilst still giving her time to reminisce and express these things which were still affecting her life in the present.

All in all this short time in the tea break was an eye-opener for me and helped concrete some of the reading i had done around reminiscence and its benefits for older people in particular. I hope that by looking into this in more detail and staring a more regular, structured time for it, the people involved at the centre will, through it, recapture part of that 'meaningful role'they used to have in scoiety, if it has been lost in the ageing process because of societies views on the elderly as Guttman suggests. (Guttman 1987)