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‘Care of older people is our biggest issue’

June Andrews of the Dementia Services Development Trust on the unique qualities of older people's nurses

Picture credit: Nathan Clarke

To describe June Andrews as a nurse is accurate but inadequate. Although proud of her nursing roots, she is also an author, an adviser, a consultant, a professor, an international expert on dementia care and an inspiration to many.

She is a woman who makes things happen. For the past decade she has been doing so as director of the world-renowned Dementia Services Development Centre (DSDC) at the University of Stirling.

For more than 25 years, the DSDC has worked to make services better, and communities and care environments more dementia-friendly. It has disseminated evidence-based research showing best practice around the world. It has influenced policy to help make dementia more tolerable for those who live with it and those close to them.

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Picture credit: Nathan Clarke

To describe June Andrews as a nurse is accurate but inadequate. Although proud of her nursing roots, she is also an author, an adviser, a consultant, a professor, an international expert on dementia care and an inspiration to many.

She is a woman who makes things happen. For the past decade she has been doing so as director of the world-renowned Dementia Services Development Centre (DSDC) at the University of Stirling.

For more than 25 years, the DSDC has worked to make services better, and communities and care environments more dementia-friendly. It has disseminated evidence-based research showing best practice around the world. It has influenced policy to help make dementia more tolerable for those who live with it and those close to them.

Professor Andrews has been instrumental in the DSDC’s success but now she is moving on. Is it time to relax? Not exactly. ‘I’m very, very busy,’ she says.

Two new editions of her book Dementia: The One-Stop Guide are out this year, one for the United States, the second elsewhere in the English-speaking world. Much of her summer will be spent in the US and Canada promoting the book. She will continue her consultancy work on dementia and frailty, as well as a programme on dementia and the arts that is designed to challenge people’s thinking.

On top of all that, she has been appointed emeritus professor at Stirling and is taking up post as executive director of the Dementia Services Development Trust, the charity that funds the DSDC.

It is quite a career for a nurse who fell into older people’s care by accident. ‘I discovered I really liked older people,’ says Professor Andrews. ‘They’re just like young people but with lots of interesting and significant experience, and we have so much to learn from them. I love listening to stories, and most older people have lots to say, given the right encouragement.’

If she were just beginning her training now, would the specialty still appeal to her? ‘I’d be even more interested in the care of older people from a career point of view,’ she says.

‘When I was training, we had no real conception that ageing was going to be the biggest single issue for health and social care, in both the public and the independent sectors, for the next century.’

June Andrews trained as a nurse in Nottingham and has held posts as practitioner, manager, policymaker, strategist and academic.

An RCN fellow and former secretary of the RCN Scottish board, she won the Nursing Standard Robert Tiffany International Nursing Award in 2011 and the Chief Nursing Officers’ Lifetime Achievement Award the following year.

She advises nurses interested in following her lead in older people’s care to:

Be an expert in your field by learning as much as you can.

Network with other nurses. Join a professional organisation that can support you.

Get to know the system so that you can influence it.

Get yourself known for the right things.

Look after your feet. ‘I always get a laugh when I advise nursing students to do this, but it’s hard to do the job well if you’re not fit – and that’s something you can work on, starting from your toes.’

Much has changed since she began nursing older people, such as how much families are now required to step in. ‘That’s increased and will continue to increase. Hospital beds for long-stay care are hard to find.

‘Nurses need to teach families how to cope as the burden falls to them – and many families still don’t expect that,’ Professor Andrews says.

She believes changes in older people’s care mean nurses will have to become ever more resourceful. ‘Money is going to be tighter and the role of the independent sector, whether that’s non-profit, charity or private-for-profit, will increase. Nurses need to be able to work in any of these sectors and respect the skills of colleagues in the others.’

Nursing older people requires complicated interpersonal skills

They will also have to be clued up about how different sectors work, or they will be unable to advise patients and families properly, she adds.

In theory, caring for frail older people should be at the summit of nursing accomplishment. Certainly other specialties will make the same claim, but restoring equilibrium in someone who is confused, distressed, forgetful and perhaps physically unwell requires a unique blend of skills, knowledge and understanding. As Professor Andrews puts it: ‘Nurses working with older people do some of the most complicated interpersonal nursing.’

Attracting staff to the sector and retaining them remains challenging, she admits. It is still not seen as ‘cutting edge’, and nurses working with older people are certainly not there for the glamour – ‘but I am proud because most of what we do is fantastic’.

She offers some examples. ‘Helping people get over incontinence and get on with their lives is an art form. Reducing distress in order to reduce agitation and anxiety is a specialist skill. Allowing people to die where they want, peacefully and with dignity – all of these, and more, are core to our art.’

But she also cites some concerns about current dementia care. There is a tendency towards superficiality, with nurses being named as ‘dementia champions’ on the basis of often brief training without time or material resources to fulfil the role. ‘A little knowledge is a dangerous thing, and nurses need to hesitate before accepting these titles because they will be held accountable,’ says Professor Andrews.

Her book is similarly forthright on the dangers of hospital admission for vulnerable older people. An acute hospital is ‘like a meat grinder’ for those with dementia – ‘it chews them up and spits them out’. Hospitals are run ‘as if every patient has perfect cognitive function’.

It is nurses who can make the difference. ‘The best nurses are people who can really communicate,’ says Professor Andrews. ‘They are communicating with patients at a time when those patients’ communications skills are being undermined – by fear, disability, cognitive impairment or illness – so nurses need to be extra special at communication. You can’t help patients and families unless you hear what they want and can explain to them what might help them achieve it.’

She recalls a ward sister who taught her ways of working with older people that she still uses today. ‘Passing on skills and values is vital for nursing,’ she says. ‘If we don’t learn from more experienced nurses, we will have to develop all that knowledge again’.

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