My first meeting with Jackie
Jackie (as she loves to be called) went into care at the age of 13 and has lived in different health care institutions for over 40 years. She came to live at Hansa Lodge in 2018 and there were great concerns about how Jackie would cope in a community placement.
I remember visiting Jackie at the hospital where she resided for the Initial Placement Assessment. I was led into this huge dining area, and I was introduced to Jackie who was sitting alone in a corner of the room, with a low cut hair style, with no jewelleries and make-up, facing the wall and backing the other patients who were eating at the dining table.
Jackie had two male members of staffing observing her, one on either side. When I asked why Jackie had to sit by herself and face the wall, I was told that she is very unpredictable and could throw her plate at any point without warning, so to protect the other patients she sat by herself at meal times facing the wall.
I sat with Jackie for approximately 20 minutes trying to initiate conversations but and Jackie would not say a word to me or respond to any questions.
I left the hospital with a heavy heart, but thinking that there was potential in this woman.
Welcome to Hansa Lodge
One of our top priorities when Jackie moved to Hansa Lodge was that of inclusion and socialisation.
We had a dining table that could sit two people, so Jackie would sit with a staff member at meal times in close proximity to the other residents. Everyone, including staff, would eat at the same time, and the threat of being “observed” at meal times was removed.
The sense of inclusion and equality helped Jackie settle in quickly. As a staff team we quickly learnt that Jackie loves her ethnic food and if she didn’t get it the way she loves it, the plates went flying…
Once we realised this, we created a culturally appropriate menu with Jackie. This wasn’t difficult to achieve because Jackie would ask for rice and chicken almost every day (with lots of chilli and spices).
Over the years, Jackie has devised her own menu and she would request for her special which she calls ‘Lloyds meal’!
Feeling at home
Jackie also loves cooking. We struggled initially with Jackie’s preference of food; sandwiches should have fresh garlic, chilli pepper, curry powder, thyme, all spice, nutmeg, cheese and ham.
Once we were able to get this right, the incidences of plate-throwing at meal times reduced significantly. Occasionally we still experience this, especially when her coffee just doesn’t taste right. Presentation of food is also very important to Jackie.
We also noticed that within weeks, Jackie became very vocal relating to all staff confidently. For one reason which we still can’t explain, she never calls us our real names. She calls me Millie, and other staff members Blondie, Mama Juke, and Penny etc.
Jackie became very confident and would crack jokes and make us laugh all day.
Jackie is now able to talk about her childhood, the difficult experiences she had in long stay hospitals, and gradually we began to understand better how to relate with Jackie.
Jackie now wears her hair in braids (done by staff), she wears make-up and loads of jewelleries. She is able to dress up in cultural attires when she chooses.
5 tips for culture-inspired care
Reflecting on the success story of Jackie’s care, it simply the fact that people need their culture to be recognised, and their cultural needs met to feel happy and comfortable. Only small changes are needed to make a big difference to people.
Below I share some tips that worked for the staff team at Hansa Lodge and Jackie.
Tap into staff skills
Jackie was more comfortable having staff at Hansa Lodge braid her hair, rather than going out to the salon. This worked well for Jackie because she could take a break whenever she wanted and come back to the staff later. We also found that Jackie was calmer in presentation when braiding her hair.
Utilise team diversity
Jackie gets to see her extended family more now that she lives in the community but this has recently being impacted by the pandemic.
Having a culturally diverse team and staff who are from a similar ethnic background to Jackie helped. Our staff team are from diverse backgrounds i.e. British, Ghanian, Carribean, Indian, Ugandan and Nigerian. We all worked together to understand Jackie’s cultural needs, especially in the areas of food, spirituality, music preference, activity and fashion.
Organise culturally appropriate activities
Jackie loves music and dancing and would request for Afro-beats or Bob Marley. All thanks to our Smart TV, we can access any of these on YouTube.
Jackie would also ask for some food that is culture specific i.e. ackee and salt fish, jollof rice and jerk chicken, and we always have staff available to cook these.
Jackie also enjoys celebrating Black History Month and dressing up.
Reducing restrictive practice
Very important as well is reducing restrictive practice. Although Jackie’s level of observation is 1-1 at arm’s length due to unpredictable behaviour towards others, this is assessed from time to time and we ensure that she has the freedom to do what she wants without the feeling of being watched or observed all the time.
Person-centred approach
Finally, I must commend the staff team on their hard work and person-centeredness in supporting Jackie. For the reduction in restrictive practice and promoting her culture, which in turn has minimised some behaviours and reduce the risk of over dependant on anti-psychotic medication.