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 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
How care home staff can improve nutritional care for people living with dementia
Evidence for the assessment of personal care for people with advanced dementia
A reflective account of advanced clinical practice in an older person’s unit
A literature review into the attitudes of nurses who care for patients with dementia
Role of ACP in identifying preferred place of care or death for people with dementia
The advanced ophthalmic nurse practitioner is well-placed to provide high-quality care
Understand the challenges posed by urinary tract infections in older people