Dementia UK offers free online course for nurses on supporting families and carers

Dementia UK | September 2020 | Dementia UK offers free online course for nurses on supporting families and carers

Working with Families and Dementia: An Introduction is an open-access, six-part module produced for registered nurses by Dementia UK.

This is an online introductory course designed for registered nurses who wish to find out more about the role of an Admiral Nurse and are considering a career in Admiral Nursing. This course will also be useful to Health and Social Care professionals who wish to find out more about the complexities when supporting families living with dementia.

It has been created by Dementia UK which is the charity that supports families facing dementia through the work of Admiral Nursing.

Admiral Nurses work with families and the systems around them by taking a family and relationship focused approach (Source: Dementia UK)

Full details available from Dementia UK

What hinders and facilitates the implementation of nurse-led interventions in dementia care?

Karrer, M., Hirt, J., Zeller, A. et al. | What hinders and facilitates the implementation of nurse-led interventions in dementia care? A scoping review. | BMC Geriatrics | 20, 127 (2020)

Abstract

Background

The implementation of evidence-based interventions for people with dementia is complex and challenging. However, successful implementation might be a key element to ensure evidence-based practice and high quality of care. There is a need to improve implementation processes in dementia care by better understanding the arising challenges. Thus, the aim of this study was to identify recent knowledge concerning barriers and facilitators to implementing nurse-led interventions in dementia care.

Methods

We performed a scoping review using the methodological framework of Arksey and O’Malley. Studies explicitly reporting on the implementation process and factors influencing the implementation of a nurse-led intervention in dementia care in all settings were included. We searched eight databases from January 2015 until January 2019. Two authors independently selected the studies. For data analysis, we used an inductive approach to build domains and categories.

Results

We included 26 studies in the review and identified barriers as well as facilitators in five domains: policy (e.g. financing issues, health insurance), organisation (e.g. organisational culture and vision, resources, management support), intervention/implementation (e.g. complexity of the intervention, perceived value of the intervention), staff (e.g. knowledge, experience and skills, attitude towards the intervention), and person with dementia/family (e.g. nature and stage of dementia, response of persons with dementia and their families).

Conclusions

Besides general influencing factors for implementing nursing interventions, we identified dementia-specific factors reaching beyond already known barriers and facilitators. A pre-existing person-centred culture of care as well as consistent team cultures and attitudes have a facilitating effect on implementation processes. Furthermore, there is a need for interventions that are highly flexible and sensitive to patients’ condition, needs and behaviour.

Full article: What hinders and facilitates the implementation of nurse-led interventions in dementia care? A scoping review.

Specialist nursing support for unpaid carers of people with dementia

Having contact with a nurse who understands dementia and has the time to get to know their situation could improve carers’ confidence and help them to feel supported | National Institute for Health Research | University of York

Admiral Nursing is the only nursing service that specifically focuses on supporting carers of people with dementia in the UK. Research carried out by the University of York found that Admiral Nurses are successfully targeting carers with the most complex needs

The research team, from York’s Social Policy Research Unit and Centre for Health Economics, looked at information routinely collected by Dementia UK which showed that, on average, the needs of carers with an Admiral Nurse reduced over time. However, the data were not detailed enough to show what caused this improvement. In interviews and focus groups, carers themselves said that the sorts of support provided by Admiral Nurses could positively influence their health, quality of life and confidence in caring.

The research team followed this up with a survey, completed by 346 current carers of people with dementia, which demonstrated the heavy burden that dementia carers carry, the low levels of support that they get from health and social care services and the financial impact on carers and their families when they have to pay for help.

Full report: Gridley K, et al. |Specialist nursing support for unpaid carers of people with dementia: a mixed-methods feasibility study | Health Service Delivery Research 2019;7(12).

Using technology enabled care to support cognition in early onset dementia

NHS England | January 2019 | Using technology enabled care to support cognition in early onset dementia

A recent case study on NHS England’s Atlas of Shared Learning spotlights how the Nurse Manager in the Mental Health and Vascular Wellbeing Team at North Staffordshire Combined Healthcare NHS Trust (NSCHT) led a programme of work to introduce a digital application (app) into the care and treatment plans for service users at high risk of developing mild cognitive impairment (MCI).

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The app was designed to digitally link the nursing and medical staff with the service user, enabling care closer to home, empowering service users, families and carers to have greater control and input into planning their treatment and care and improving service user experience and outcomes.

Full story at NHS England

Introducing a Dementia Support Service

NHS England| July 2018 | The Atlas of Shared Learning

NHS England have released a case study highlighting the work of mental health nurses in Somerset, who have established a new community-based Intensive Dementia Support Service (IDSS). It has had a significant positive impact on patients, carers and colleagues – providing interventions at point of crisis in the person’s usual place of residency, with the aim of reducing admissions to an older person’s mental health ward.

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The full case study details are at NHS England

Person-centred care improves quality of life for care home residents with dementia

A person-centred care intervention for people with dementia living in care homes improved their quality of life, reduced agitation and improved interactions with staff. It may also save costs compared with usual care | National Institute for Health Research 

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Image source: discover.dc.nihr.ac.uk

The WHELD intervention involves training staff in person-centred care, with a focus on improving social interactions and appropriate use of antipsychotic medications. An early study suggested it could halve antipsychotic use.

This larger-scale NIHR trial conducted across 69 UK nursing homes focused on exploring the effects on quality of life and other symptoms. WHELD gave small-scale, but important improvements. It didn’t reduce antipsychotic use, as this was low to start with, which is in line with policy to limit use.

It supports the feasibility of the intervention, but there is a need to understand which components are most effective and could be implemented on a wide scale with sustainable effects.

Further detail at National Institute for Health Research

Full reference: Ballard C, Corbett A, Orrell M, et al. | Impact of person-centred care training and person-centred activities on quality of life, agitation, and antipsychotic use in people with dementia living in nursing homes: A cluster-randomised controlled trial. | PLoS Med. 2018;15 (2)

Dementia UK: ‘Together again’

Dementia UK have created a short animated film to show the differences Admiral nurses make in bringing families affected by dementia together again, even for the briefest of moments.

This animation explores those feelings of being lost in dementia – and how the support and guidance of an Admiral Nurse can help bring people back together again.

 

More about Dementia UK and the Admiral Nurse Service available here

Dementia Education: Does It Change Nursing Practice?

Although gerontological nurses are well positioned to care for older adults with dementia, barriers to implementing quality client care remain, including: limited knowledge, poor morale among care staff, lack of professional development opportunities, and unsuitability of acute care hospitals for this client group | Journal of Gerontological Nursing

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The solution most commonly offered is education. Many academic institutions, health care facilities, and even professional associations offer educational activities. The literature is rich with descriptions of activity formats, from workshops of less than 1 hour in duration to courses provided over 12 months or longer, offered in face-to-face format, print, or via online learning. Exceptional educational activities might be described as having a high degree of transference, meaning that the information learned in these activities can be easily applied to gerontological nursing practice.

Yet, I question whether these activities actually change nursing practice. Based on my review of the literature, most educational activities are evaluated in terms of attitude shifts, knowledge gained, and/or satisfaction with course content—few speak to changes in the quality of care provided to older adults with dementia. One reason may be that a large proportion of the published literature on the topic of dementia workforce education describes research studies, which are often by definition initiated by individuals external to a facility, time-limited, and not always sustainable. If we are to face the challenge of demographic aging and the projected increase it will bring in the number of older adults living with dementia, academic and health and human service organizations will need to ensure that their nursing workforce has the knowledge and, more importantly, the skills required to perform their work. However, the value of educational activities in determining clinical interventions and subsequently evaluating the direct effects of these interventions on outcomes for older adults with dementia has been limited.

Full reference: Hirst, S.P. (2017) Dementia Education: Does It Change Nursing Practice? Journal of Gerontological Nursing. Vol 43 (Issue 7) pp. 2-3

Practical problems preventing people with dementia from living at home

Although the majority of people with dementia wish to age in place, they are particularly susceptible to nursing home admission | Geriatric Nursing

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Nurses can play an important role in detecting practical problems people with dementia and their informal caregivers are facing and in advising them on various ways to manage these problems at home.

Six focus group interviews (n = 43) with formal and informal caregivers and experts in the field of assistive technology were conducted to gain insight into the most important practical problems preventing people with dementia from living at home. Problems within three domains were consistently described as most important: informal caregiver/social network-related problems (e.g. high load of care responsibility), safety-related problems (e.g. fall risk, wandering), and decreased self-reliance (e.g. problems regarding self-care, lack of day structure).

To facilitate aging in place and/or to delay institutionalization, nurses in community-based dementia care should focus on assessing problems within those three domains and offer potential solutions.

Full reference: Thoma-Lürken, T. et al. (2017) Facilitating aging in place: A qualitative study of practical problems preventing people with dementia from living at home. Geriatric Nursing. Published online: 14 June 2017

Nurses’ experiences of pain management for people with advanced dementia approaching the end of life

Pain management in end-stage dementia is a fundamental aspect of end-of-life care; however, it is unclear what challenges and facilitators nurses experience in practice, whether these differ across care settings, and whether training needs to be tailored to the context of care | Journal of Clinical Nursing

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Aims and objectives: To explore hospice, acute care and nursing home nurses’ experiences of pain management for people with advanced dementia in the final month of life. To identify the challenges, facilitators and practice areas requiring further support.

 

Conclusions: Achieving pain management in practice was highly challenging. A number of barriers were identified; however, the manner and extent to which these impacted on nurses differed across hospice, nursing home and acute care settings. Needs-based training to support and promote practice development in pain management in end-stage dementia is required.

Relevance to clinical practice: Nurses considered pain management fundamental to end-of-life care provision; however, nurses working in acute care and nursing home settings may be undersupported and under-resourced to adequately manage pain in people dying with advanced dementia. Nurse-to-nurse mentoring and ongoing needs-assessed interactive case-based learning could help promote practice development in this area. Nurses require continuing professional development in pharmacology.

Full reference: De Witt Jansen, B. et al. Nurses’ experiences of pain management for people with advanced dementia approaching the end of life: a qualitative study. Journal of Clinical Nursing. 26,(9-10) pp. 1234–1244