Case study – Using reflective practice to improve care at McKillop Gardens Care Home: October 2026

Empowering staff, strengthening rights‑based practice, and using meaningful personal information to reduce stress and distress

McKillop Gardens Care Home reduced incidents of stress and distress by 83% by improving their approach to dementia care. They did this through reflective practice discussions for staff, and working to better know each resident as an individual by collating meaningful personal information. This has led to positive outcomes for residents, and for staff who are more confident in providing high-quality care.

Situation

An internal piece of work at McKillop Gardens highlighted signs of stress and distress were not always recognised early or understood as expressions of unmet need. Staff were committed to providing high-quality care, but a knowledge gap existed, where some behaviours were interpreted as just who the person is, rather than signs of discomfort or confusion. The team were also unaware, or unclear, on how their actions and behaviours may affect residents’ stress and distress.

The team participated in the Reducing Stress and Distress Improvement Programme and completed the Self-Evaluation Tool to better understand their improvement opportunities. Priorities included:

Staff had dementia training, but needed deeper understanding of trauma-informed practice, unmet needs, and the variety of approaches to support stress and distress.
Unpaid carers and families wanted to be more involved.
Information being recorded by staff was inconsistent, which meant that it was not always clear from the documentation what had led up to or triggered a person’s stress and distress.

To provide further understanding of current practice the team analysed information captured in Antecedent, Behaviour, Consequence (ABC) charts. ABC charts are used to report incidents of stress and distress, recording what happened before, during, and after. This analysis revealed patterns that challenged assumptions and showed that staff approach can have an impact on resident experience.

The team aimed to develop staff confidence and understanding of processes. They looked to do this by embedding early recognition, personalised interventions, and rights-based practice into everyday care through reflective practice discussions. They also sought to develop the role of unpaid carers and families to help understand each resident more roundly.

Approach

Staff training and communication to understand the new approach was the first step.

Internal training focusing on approach and documentation, sharing the benefits of clear and consistent documentation and how it supports others to do their job well.
Communication training used interactive exercises to show how clearer language and tone, both among staff and with residents and families, can improve outcomes.
Immersive dementia training with Public Services Delivery Scotland colleagues provided staff with deeper understanding of the experiences of people living with dementia.

Reflective practice discussions were introduced to embed training and give staff a safe space to discuss challenges, share experiences, and receive feedback as they adopted new ways of working. ABC charts continued to be analysed, and these were discussed at reflective practice discussions, helping staff identify triggers, or consider how things might have gone differently. These discussions were a safe collaborative space that encouraged honest reflection, supported positive culture change, and gave staff greater ownership over any change or improvement.

The team used Getting to Know Me (GTKM) with residents and families to improve their involvement and to better understand each person’s life story, recognising that greater knowledge could often help prevent distress.

Results

The project has delivered a sustained culture shift resulting in improved practice, increased staff confidence and more personalised care. Residents experience fewer incidences of stress and distress, alongside reduced use of when necessary (PRN) psychoactive medication use, and more person-centred and non-pharmacological interventions. A chart was produced which shows a reduction in monthly incidences of stress and distress from 13.8 in March 2025 to 2.3 in March 2026 (measured per 1,000 occupied bed days). This is an 83% reduction.

Additional impact includes:

Staff report improvements in residents’ comfort, orientation, and wellbeing.
Staff developed greater confidence in recognising and supporting stress and distress, enabled by a shared language, consistent documentation, and individualised care plans for all residents.
Families and unpaid carer have seen improved involvement and communication. Through informal feedback they have shared that their loved ones are understood as individuals.
The home has seen fewer inappropriate moves to nursing care because of better tailored support.

A key example of impact involved a resident whose distress was initially poorly understood. By analysing behaviour patterns using ABC charts, exploring their life history with family members, and reflecting as a team, staff recognised that their previous role in a business management position influenced how they interpreted activity within the care home. Minor changes to the environment dramatically reduced their distress. These changes included keeping the office door closed or seating her somewhere without view into the office. What had been seen as challenging behaviour was actually a response that made sense within the context of her experiences. This became a turning point for the team, demonstrating how personal history can transform understanding and support.

Key learning

The most important learning from this project was that understanding the person behind the behaviour is often the key to reducing stress and distress. Reflective practice helped keep this understanding at the forefront of care.

Following training, reflective practice discussions were effective for putting their learning into practice and embedding changes. Family input was invaluable for expanding the use of GTKM. Incorporating GTKM into these discussions helped staff build a fuller picture of each resident. Alongside this, ABC charts helped build a fuller picture by using data. Improved recording practices enabled more informed discussions and continuous improvement.

The project also reinforced that person-centred care is about enabling people to continue living meaningful lives. One resident, who was unable to leave the home, was supported to walk his daughter down the aisle at a wedding held onsite and play guitar for her first dance. Staff worked creatively to make this possible, ensuring he could participate fully in a significant family milestone. Capturing and sharing stories like this has helped motivate and empower staff by demonstrating the impact of their work.

Next steps

McKillop Gardens will continue supporting stress and distress by completing and analysing ABC charts and care planning tools. The team is integrating trauma-informed practice into their staff resources and induction programme, ensuring new staff understand these values from day one. Reflective practice discussions have become normal practice and will continue to support staff to approach challenge with curiosity and openness. Resident involvement has increased through the resident-led focus group, which has become both a valuable feedback mechanism and a meaningful social opportunity.

One of the team plans to qualify as a facilitator for the Fundamentals of Skilled Practice in Dementia and to lead trauma-informed practice at an enhanced level. Learning will be shared with sister homes in Lanarkshire, including one that has joined the next cohort of the Reducing Stress and Distress Improvement Programme.

The team recognises that stress and distress will continue to evolve as residents’ needs change. Their commitment is to remain curious, reflective, and rights‑focused, ensuring each resident experiences comfort, dignity, and meaningful connection.