Namaste Care reflects a patient-centred philosophy that has begun to prove its worth on hospital wards for people with advanced dementia. Julie Young found that it helped to reduce distress and agitation, reassured families, and strengthened bonds between staff and patients
As a concept “Namaste” means to “honour the spirit within” and it has been adopted into clinical work with the Namaste Care Programme (Simard 2013). This is a structured programme that incorporates compassionate nursing care and individualised activities for people with advanced dementia in a group setting.
The aim is to meet their needs for comfort and pleasure through sensory stimulation, especially touch. While it was originally developed for care home settings, it has been adapted to people’s own homes and to hospices, and it has been trialled successfully in acute hospitals on a one-to-one basis (Kendall 2019).
Namaste reflects the philosophy of good person-centred dementia care considering the needs of the individual, their likes and dislikes, and personalises the care to their needs (NICE 2018, Kitwood 1997). We decided to trial the Namaste Care Programme on Woodhorn ward, an inpatient dementia care service at St George’s Park hospital in Northumberland.
Our intention was to reduce patient distress and agitation on this inpatient organic assessment ward, which is a 10-bedded assessment unit for older people with dementia. We saw it as underpinning the philosophy of the Newcastle model currently used for assessment on the ward (James 2007).
Kendall (2019) sums up the core principles of Namaste Care as follows:
• a person-centred approach
• explaining the approach to the family engaging their support
• completing life story
• addressing issues around comfort and pain management
• creating calm, peaceful environment
• use of a spritz or an aroma diffuser to scent the room
• music playing which is meaningful to the person
• use of loving touch
• celebrating the seasons bringing outdoors inside
• reminiscence activities
• offering drinks and snacks
• encouraging the person’s range of movement
• having fun
• feedback to the family and their involvement in sessions.
As originally conceived, the Namaste Care Programme is delivered in a group setting seven days a week for two hours in the morning and two hours in the afternoon (Simard 2013). In our case we felt it appropriate to trial the Namaste approach on a more individual basis due to the very different needs and abilities of the patients, particularly those with less advanced dementia.
In summary, we wanted to improve and promote wellbeing and to evaluate Namaste as an intervention to de-escalate people’s distress and potentially behaviours that challenge. It was to be offered to people both in the earlier and later stages of dementia, and a statement on the aims of the intervention was developed by the ward team (see box below).
Introduction on ward
Four staff attended a course at St Christopher’s hospice (London) to be able to implement the Namaste approach on the ward. They also liaised locally with St Cuthbert’s Hospice which has an established team offering the approach.
Consideration was given to the environment in which the intervention would be carried out. A room was identified that could be used for Namaste Care and was made a comforting and pleasant space to be in. Sensory lights (these were also portable so could be taken to the person if needed) were installed and it was decorated with calming posters and portable screens.
Personalised music could be played in the room and we put in a couple of armchairs, a footstool and a rocking chair. Patients were encouraged to go out into the garden.
Each patient had an individualised Namaste bag created for them containing hand creams, scents (such as perfume or after shave), a comb or brush, fleece blanket, sensory profile, CDs of music they might like, preferred snacks and drinks, towel and flannel and any specific reminiscence items such as poetry and photographs. This meant it could be taken to the person if it was not thought beneficial for them to come to the Namaste room.
The person with dementia was involved, if possible, in information gathering to develop a sensory profile. But if the person was unable to communicate the necessary information and was assessed as lacking capacity specific to the decision of accepting Namaste Care, their family or carers would be approached.
If the person did not want to participate this would be acknowledged, as would any increase in distress from the intervention. The sensory profile considered a person’s preferences for music, food, drinks, scents, colour and therapeutic touch.
Discussions were held with medical staff on the ward about any possible risks for interventions such as hand massages (eg, considering any skin conditions, and potential breathing difficulties that could be triggered by room scents). Aromatherapy oils were not used because of the risk of contra-indications, but hand creams were employed as were neutral oils such as grape oil or a baby oil.
During the Covid-19 pandemic, fresh challenges were presented by the need for risk management, but appropriate PPE was worn, and Namaste Care evolved to be a key feature in the palliative approach to supporting patients who got Covid.
Some Namaste sessions were planned at times when it was known that the person needed more support and other times the sessions were more opportunistic and responsive to a need or a situation. It formed part of the care plan as an intervention when there were signs of escalating distress.
Sessions were documented in patients’ notes, and intervention preferences were also noted, to help to ascertain which were most effective in improving a particular patient’s wellbeing. These helped support care plan evaluations.
Anecdotal reports showed that patient wellbeing had improved. Recording in the patient’s notes also showed the positive effect of walks and exploring the garden. Dementia Care Mapping (DCM) was also carried out (Brooker 2004) and the scores showed a boost to wellbeing.
From the evaluation of this trial, the following benefits were identified:
• provides positive time for carers to spend with the person with dementia
• when given prior to mealtimes, patients ate better, their diet improved, and they gained weight
• patient mood was lifted as they would actively seek the Namaste lead out to have their hand massage even though they had previously been very withdrawn
• meets sensory and emotional needs, via a needs-led care plan
• improves quality of life wellbeing as illustrated by DCM
• families have purposeful and structured visits
• gives structure and purpose to “empty time” (ie, time when no personal care tasks are undertaken).
• allows further assessment of mood through one-to-one sessions
• during Covid, the Namaste approach has been used at end of life, providing meaningful touch and support
• more job satisfaction for staff delivering this care.
In addition to benefits, several challenges were noted in implementing Namaste Care interventions:
• consistency of implementation
• training of staff who are happy to carry out Namaste interventions
• educating families to use Namaste
• training staff at a care home to which a patient may be discharged to implement it as part of a care plan.
Person-centred interventions using a Namaste approach have helped patients on Woodhorn ward to reduce their distress and agitation. It has offered staff a sense of achievement and strengthened their connection with the person with dementia. During the pandemic it has fitted alongside palliative nursing care and reassured families who could not visit due to restrictions but were aware that Namaste was being given.
We hope to embed this approach further. A mission statement will be developed and a flyer to provide more information to patients and their families. We are also excited at taking the approach further using Teddy, our assisted animal therapy dog.
A more robust evaluation process is needed which would include DCM as a measure of wellbeing but would also review behaviours and medication regimens. If Namaste de-escalated distressed behaviours without the need for medication, that would be another significant benefit.
Brooker D (2004) Dementia Care Mapping: A Review of the Research Literature. The Gerontologist 45 (issue supplement 1) 11–18.
James IA, Stephenson M (2007) Behaviours that challenge us: The Newcastle Support Model. Journal of Dementia Care 21(3) 32-34.
Kendall N (2019) Namaste Care for People Living with Advanced Dementia. London: Jessica Kingsley Publishers.
Kitwood T (1997) Dementia Reconsidered: The Person Comes First. Milton Keynes: Open University Press.
NICE (2018) Dementia: Assessment, Management and Support for People Living with Dementia and their Carers (NG7) London: NICE.
Simard J (2013) The End-of-Life Namaste Care Program for People with Dementia (2nd edn). Townson, MD: Health Professions Press.