Nursingtimes.net is partnering with Netbuddy to help nurses care for people with learning disabilities. Here, we look at tips on establishing routines.
Put yourself in their shoes
Remember that routines are important in everyone’s life and missing a step can make you feel “not quite right”. Think about how you feel if you sleep in and don’t get to eat breakfast or have a shower. This can be useful when trying to understand why an individual is struggling when they can’t complete a routine.
Jacob’s worry box
My son Jacob is seven years old and has aspergers syndrome and high functioning autism. He has very high anxiety levels and worries about lots of things. Every night, after story, we do worry time. We talk about about all my son’s worries that he has put in his worry box (in his head) throughout the day. We also have a deep worry box which we open up too. It’s a fab way of helping him deal with his anxieties/worries with lots of reasurrance and cuddles from his mum.
Just like key words, we have some key routines of daily activities as they build up a structure to each day and this helps to anticipate what is going to happen, like stepping stones through the day.
We try to vary routines very slightly by introducing small changes to prevent obsessiveness, for example not always watching TV at the same time every day.
The destination not the journey
Vary the route to and from school or other places you visit regularly. We have found this helps with rigid behaviour about travelling somewhere. This is very helpful when there are roadworks or accidents on road and you are diverted. We have used visual support for this by showing where we are going so John realises there are different ways to get to the same place.
Don’t get stuck
If you are firmly fixed in a routine at home and nothing will change it, try going somewhere else and doing things differently. After a while routines at home could change too.
a) John would not try feeding himself (finger feeds) until we started having picnics out and about in the summer.
b) Going on holiday forced a change of cereal, which he refused at home prior to this.
When we need to break a routine I have found that giving Sonya as much advance notice as possible, explaining why, works for us. We also try to offer something pleasurable in exchange for her cooperation and flexibility with the broken routine. She copes with the change better when she is able to process it in advance.
These help coping with transition between activities, and provide a sense of security. There are some great free resources available on the internet for visual timetables, including sparklebox.co.uk and www.do2learn.com
Try using a rhyme or song e.g. a hello song for snack time, group time, toilet time, lunch time etc…. to communicate a transition within the day’s routine.
Nag free chores
To avoid lots of nagging and clock-watching in the morning use multiple alarms, maybe ones on mobile phones, to indicate the time things should be done by. (We used to say first ring was dressing bell, next ring was teeth cleaning bell, next ring was shoes on bell etc.)
Nick is an early riser, so we use a character speaking alarm clock i.e. Bart Simpson, and set it to the time we want him to get up. He has to go back to bed unless the clock has spoken. At weekends we set it an hour later which allows all of us to have a lie in!
I use a timer for some activities like watching TV or playing on the computer, this gives Chloe some idea that there is a timescale for the activity. You can also use this for turn taking.
Tidy up time
We have a count down before tidy up time. You can use a five minute egg timer. Using words such as, “In five minutes/when the egg timer is finished, it is time to tidy up.”
Participate and focus
During tidying up time we give Joel a basket to put everything in. This allows him to participate and encourages him to focus on the task.
Think out the box
When trying to build up the concept of time, talk about sleeps instead of days - eg “10 more sleeps to go until Christmas”.
Wipe off checklist
We have drawn a colourful tick-box checklist for getting ready in the morning. Molly likes ticking the tasks off after she has done them.
We use photographs for visits to the dentist, barbers, doctors. They remind Mahmoud of the faces he will meet and the environment. This was especially useful when his language was more limited and a smile when he saw the photo was enough for me to know he remembered the activity.
Photos of me…
People with communication needs find it very useful to have pictures of themselves, for example, cleaning the bathroom, washing dishes, hanging out the washing, cooking, etc. These photos can then be put on a rota on their kitchen pin board (or wherever they choose), to use as prompts for daily living skills and tasks that need to be identified.
Symbols and pictures for charts
We really like www.do2learn.com. They provide print-off series for lots of different activities, eg washing hands, using the toilet, etc.
We stuck a photograph of David showing his keys on the inside of the front door saying: “Don’t forget your keys.” Works a treat!
Step by step in colour
My daughter loves numbers and is obsessed with the colour blue. To get her to go to bed I made up a list for her. I call it the countdown to bedtime. I numbered it from one to six, and typed it up in blue font. It tells her exactly what time to go to her bedroom and when to put her pyjamas on, etc. The fact that it uses a numerical order and is in her favourite colour keeps her motivated and on board. Hope this helps!
Start and finish
Before starting any task, make clear what it is about and make sure it has a beginning and an end. We copied the traffic light system they used to use at Becky’s school. Green for start and Red for finish.
Nursingtimes.net is partnering with Netbuddy to update nurses with the latest helpful tips on caring for people with learning disabilities. Over the coming months, we’ll be publishing tips on nursingtimes.net and encouraging you to share your own ideas on www.Netbuddy.org.uk.
For more on learning disability nursing, see www.nursingtimes.net/nursing-practice/clinical-specialisms/learning-disability