Taking a different approach to problems to reduce distress

When distress happens, we often zoom in on a single fix: write another care-plan strategy, schedule refresher training, maybe prescribe a new medicine.

To transform dementia care, we must abandon the fiction that complex problems have simple solutions. The most meaningful innovation isn’t a new technology; it’s seeing the problem differently.

Check out part one of this blog on the Alzheimers NZ website which covers systems factors like language and documentation, culture and risk, environmental design, staff wellbeing and emotional contagion and decision-making frameworks.

The systems factors

• Technology and data

The technologies we use can either provide opportunity for learning or shut it down. How they capture and share data, rigid data parameters where certain aspects are reported for regulatory compliance, differs from what’s needed for organisational learning. When our datasets count only physical injuries and medication use, we miss quieter forms of harm such as humiliation, isolation, loss of autonomy, that residents carry in their bodies and staff carry in moral distress. Better metrics might include the ratio of meaningful engagement minutes to task minutes, or staff reflective-practice sessions logged. These systems should be designed to work for staff needs, not just the business.

• Multidisciplinary input and bio-psycho-social approach

What’s often missing is ensuring multidisciplinary input having the right people involved at the right time to take a truly bio-psycho-social approach. Physical health changes, psychological responses, and social environment factors all interact in complex ways. This requires coordinated input from nursing, medicine, allied health, social work, and whānau members as integral partners in multidisciplinary teams and co-design efforts. Research demonstrates that successful interventions depends on well-being, multidisciplinary work, and skilful teams working together. When we fragment care across disciplines without coordination, we miss the connections between physical discomfort, emotional distress, and environmental triggers.

• Early detection and physical health monitoring

The tools we use to identify timely changes in physical problems are crucial for prevention. Early detection systems that recognise shifts in physical health, pain levels, or comfort can prevent distress before it escalates. It’s critical to understand both slow triggers of distress gradual build-ups such as untreated pain or hunger, and fast triggers as loud noises or insults to personhood. When physical issues go unnoticed or untreated, they often manifest as behavioural changes that get labelled as “challenging” rather than recognised as communication about unmet needs.

• Debrief and post-incident learning

The tools we use to explore and make sense of what’s happened matter profoundly. How we structure debrief and post-incident learning determines whether we learn from distress or simply document it. These processes can either elevate the person’s own voice in understanding their experience or silence it entirely.

• Elevating the person’s voice

Significantly, how a person’s own voice is elevated in these matters transforms everything. This becomes challenging when the person has profound communication difficulties, but this is precisely where the observation tools and supported decision-making frameworks we put in place become critical. When we create multiple ways for residents to share their perspective through careful observation of non-verbal cues, understanding individual communication patterns, and using supported decision-making approaches we move from assumptions to understanding. This shift from talking about people to talking with them

• Primary prevention and systems leadership

This approach, known as primary prevention, addresses root causes before there is any sign of distress. It recognises that much of what we label as “challenging behaviour” actually represents reasonable responses to environments that fail to support individual needs and preferences. Primary prevention means creating systems that prevent distress from occurring in the first place.

When early cues are noticed, secondary prevention involves rapid de-escalation like a traffic-light system where amber signals prompt immediate supportive responses before red-light crises emerge.

Post-incident processes like debrief and learning, while valuable, come after distress has already occurred. Primary prevention happens upstream in the design choices, staffing patterns, early detection systems, and cultural practices that shape daily experience before problems emerge.

These pillars cannot stand on their own. They must be actively assembled and supported by effective leadership. A leader’s most critical role in a whole-system approach is to change how their organisation learns and solves problems.

• Learning revolution

Understanding how things are connected is the essence of this work. For leaders, this means moving beyond linear, reactive problem-solving (“a resident fell, so update the falls plan”). It requires fostering a culture of curiosity that constantly asks why. Why was Jenny covering a double shift? Why is the falls audit measured by paperwork and not by resident well-being? Why does the corridor echo in a way that frightens someone with sensory changes?

This is a profound shift in how we learn. It moves away from annual “refresher training” and toward a continuous process of collective sense-making. Effective leaders create the psychological safety for staff to admit they don’t know, to question old habits, and to see the links between their daily pressures and the wider system. They champion a mindset that views distress not as a failure to be documented, but as invaluable information that reveals where the system itself is breaking down.

• The path forward

Let’s not sugar-coat this this is about violence, and I am not just talking about physical harm. Violence, in this broader sense, is not limited to fists or restraints; it includes any practice or structure that diminishes a person’s dignity or voice. Locked doors, rushed routines, empty corridors with nothing to do: these, too, wound. Leaders who recognise this widen the lens.

You will have noticed that I haven’t mentioned the term “person-centred practice” this is because it’s a systems construct that is evident in all parts of what I have been saying. It’s a term that gets bandied around but not operationalised. True person-centred care isn’t achieved through policies or mission statements, but through the interconnected systems we’ve explored: how we design environments, structure teams, collect data, support staff wellbeing, coordinate disciplines, detect early changes, and create cultures where people feel safe to speak up.

This begins with leadership that understands its primary role is to help everyone see the connections. By fostering a culture of deep learning and addressing the true, systemic roots of distress from building design to staff rosters to the language in a report we can create environments where both the resident in the strange room and the exhausted carer can find a measure of peace.

Interested in learning more?

Join us at our upcoming summit to explore these systems approaches in depth with fellow leaders and practitioners. Register online to be part of the conversation that’s transforming dementia care.