A dementia nurse specialist who ran an educational support group for carers reflects on it
Our clinical nursing articles aim to inform and educate nurse practitioners and students. This is achieved through the publication of peer-reviewed, evidence-based, relevant and topical articles.
Why you should read this article: • To learn how a hospital in Scotland supplemented its support workforce during the COVID-19 pandemic • To understand how staff from non-clinical backgrounds can be rapidly trained to care for older people in hospital • To acknowledge what can be achieved when appealing to local resources in a crisis In March 2020, the World Health Organization declared the COVID-19 outbreak a pandemic, which generated concerns that the NHS could be overwhelmed. The predicted increase in the number of patients requiring hospitalisation prompted the need to increase the number of clinical staff working on hospital wards, particularly healthcare support workers (HCSWs), who play a crucial role in addressing the care needs of older people. This article describes how one health board in Scotland trained and redeployed volunteers among its staff to work as temporary HCSWs in its main hospital during the pandemic. A fast-track, one-day training course was delivered in March and April 2020 to 104 staff from various backgrounds – some non-clinical – by a team of volunteer trainers. Staffing during an emergency, such as the COVID-19 pandemic, presents significant challenges, but the experience at NHS Borders shows that it is possible to develop a training course rapidly and provide additional band 2 staff to supplement the support workforce in a time of crisis.
Why you should read this article: • To recognise that people living with advanced dementia should be offered early palliative and end of life care that aligns with best practice • To acknowledge the importance of early conversations with the person and family during diagnosis, and as dementia progresses, to support understanding and action planning for the advanced condition and end of life • To identify the need for accurate assessment of and response to pain in palliative and end of life care for people with dementia Despite growing understanding in recent years of the biological, psychological, social, environmental and spiritual aspects of dementia, people with advanced dementia continue to experience inequalities in accessing healthcare capable of improving their lives. The complexities of advanced dementia challenge professional competence and demand the highest level of skilled, compassionate care. This article, the last in a series on living with advanced dementia, considers the status and direction of palliative care as it applies to people with dementia and explores contemporary issues regarding advanced dementia and end of life, with a focus on guidance for practitioners and support for best practice. It identifies that open communication, clear information and a person-centred approach adopted as early as possible in the syndrome can make this period less distressing. Crucially, people at the end of life should be offered care in line with best practice in palliative and end of life approaches.
Using iPads can help patients connect with family and take part in person-centred activities
Support for nurses to ensure that older people who lack capacity can participate in research
Changes made to service delivery by a team caring for older people living with frailty
Evidence about leadership skills and competencies needed in advanced dementia care is scant
Why you should read this article: • To gain insight into the complexity of NHS continuing healthcare (CHC) assessments • To reflect on what skills and knowledge are required for the optimal assessment of an older person’s eligibility for CHC • To understand the training and development needs of nurses involved in CHC-associated work Background Nurses in England play a prominent role in NHS continuing healthcare (CHC) assessments, but there are no overview data on their knowledge and educational needs. Aim An online survey was conducted to identify the educational status and development needs of nurses involved in CHC assessments. Method The survey was informed by a literature review and focus group discussions, and distributed via email to the members of the Royal College of Nursing older people’s forum. Descriptive data analysis was undertaken. Results Overall, respondents were confident about their ability to undertake CHC-associated work and manage each aspect of the CHC process. However, respondents were less confident about how to determine whether a primary health need exists based on the four main criteria – nature, complexity, intensity and unpredictability – of a person’s health and social care needs. This was one of the respondents’ priorities for training and development. Conclusion The survey demonstrates the importance of face-to-face and multidisciplinary CHC training delivered locally. It also confirms the need for a standardised approach and more consistency in the CHC assessment process. A CHC competency framework would contribute to standardise the process and benefit all involved.
Why you should read this article: • To understand how the way nurses speak to older people can negatively affect older people’s well-being • To learn about older people’s preferences for forms of address during healthcare encounters • To identify assumptions nurses might make when choosing how to address older people Background The initial interaction between an older person and a nurse, and how the older person interprets this interaction, is important and sometimes overlooked. Evidence suggests that the way healthcare workers speak to older people can negatively affect older people’s well-being. Aim To interview community-dwelling older people aged ≥65 years who had recently held a conversation with a healthcare worker and to understand the meanings older people attributed to these conversations. Method Ten community-dwelling older people were recruited and interviewed. Interviews were recorded and transcribed verbatim. Qualitative analysis was informed by narrative methods. Findings Participants freely and readily interpreted their conversations with healthcare workers in terms of the values and attitudes conveyed. Their preferences for forms of address ranged from formal to informal. They were sensitive to a range of contextual factors shaping the use of language. While they were generally tolerant of forms of address that did not match their personal preferences, some inferred disrespect from the unthinking use of first names and some resented assumptions being made based on age. Conclusion Nurses are encouraged to be skilful and sensitive when speaking to older people. It is advisable to follow older people’s preferences regarding forms of address, as these are important markers of dignity and respect.
Why you should read this article: • To acknowledge that the research base for meaningful activity in advanced dementia is limited but increasing • To recognise that people living with advanced dementia should have the opportunity to participate in personalised meaningful activities that may enhance their quality of life and well-being • To be aware that carers and practitioners will require support and training to implement personalised meaningful activities with people living with advanced dementia This article is part of a series in Nursing Older People exploring the nursing care of people living with advanced dementia. When someone with advanced dementia can no longer communicate verbally and has limited movement, activities they once enjoyed may no longer be possible. This limits opportunities for self-realisation and can lead to a preoccupation in advanced dementia care about the routines associated with the maintenance of comfort and nourishment, at the expense of contentment and moments of fulfilment. Such a narrow focus can lead to changes in behaviour, indicating boredom, frustration and distress. Yet there are opportunities for a more creative approach to activity that can be adapted to the person’s changing needs and the human desire to feel connected and engaged. Examples of these evidence-informed, creative interventions for people living with advanced dementia care include music, doll-focused activity, animal-assisted interventions, multisensory experiences such as Namaste Care and complementary therapies. These activities can engage the person with advanced dementia in a close connection with another human being through individualised and sensory-based care.
Why you should read this article: • To understand the acute hospital experiences of older people with cognitive impairment • To learn about a toolkit that could improve the hospital experiences of older people with cognitive impairment • To support staff to reflect on their care of older people with cognitive impairment A recent review of the progress that has been made in meeting the government’s Challenge on Dementia 2020 detailed the variability, and in some cases suboptimal quality, of hospital care for people with dementia. The review also identified the need for improvements in assessing the individual needs of people with dementia while in hospital, including their emotional and social needs. This article focuses on the development and implementation of an evidence-based toolkit to improve the hospital care of older patients with cognitive impairment, including dementia and/or delirium. The toolkit’s focus is on optimising the patient experience of people with cognitive impairment who have been admitted to hospital. The toolkit also promotes the importance of person-centred care and communication skills.
Designing bespoke services for individuals with frailty in the community and hospital