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Hospital Admiral Nurse service transforms dementia care

Nurse Pam Kehoe explains how a carer’s complaint about the lack of dementia support prompted her trust to launch one of the first Admiral Nursing services in an acute setting. 

Nurse Pam Kehoe explains how a carers complaint about the lack of dementia support prompted her trust to launch one of the first Admiral Nursing services in an acute setting

The Tameside Hospital Admiral Nursing Service was introduced as a direct result of a complaint raised by the carer of a patient living with dementia.

The patients admissions to hospital were increasing, often via the emergency department, and her daughter felt that while her mothers physical needs were being met, she was not getting the specialist dementia support she needed for her well-being. She felt that with the right support, her mother could be at home.

The daughter also felt unsupported, which was causing increasing stress and distress. She told the trust that people living with dementia and their families were not receiving individualised care and support when admitted to hospital.

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Nurse Pam Kehoe explains how a carer’s complaint about the lack of dementia support prompted her trust to launch one of the first Admiral Nursing services in an acute setting

The Tameside Hospital Admiral Nursing Service was introduced as a direct result of a complaint raised by the carer of a patient living with dementia.

The patient’s admissions to hospital were increasing, often via the emergency department, and her daughter felt that while her mother’s physical needs were being met, she was not getting the specialist dementia support she needed for her well-being. She felt that with the right support, her mother could be at home. 

The daughter also felt unsupported, which was causing increasing stress and distress. She told the trust that people living with dementia and their families were not receiving individualised care and support when admitted to hospital. 


As an Admiral Nurse, Pam Kehoe provides support to dementia patients and family carers. 

The daughter was aware of community-based Admiral Nursing services and suggested that providing the service in hospital would close the gap in specialist provision – something the trust acknowledged.

The trust’s chief executive recognised that Admiral Nurses provide a gold standard of care and connect the different parts of the health and social care system, enabling carers and people with dementia to be supported in a coordinated way. The project was also championed by the assistant chief nurse.

A little research revealed only one other acute trust with an Admiral Nurse service, in the south of England. Admiral Nursing did not seem to be recognised as an approach for hospitals, but we knew it was what we needed to embed best practice dementia care with a clear focus on families and loved ones.

The hospital collaborated with Dementia UK, enabling the trust to convert my existing post of lead nurse for frail/elderly dementia to Admiral Nurse. I had been an Admiral Nurse in a previous role, which eased the process. It also meant that there were no extra cost implications for the trust.

Dedicated support 

When we set out to establish the service, we knew it was important to consider the needs of carers as well as people with dementia. Family members who are also carers often fail to recognise themselves as such, and so may not access the support they need. They can feel overlooked, with staff focusing entirely on the needs of the person with dementia.

As the backbone of care for their loved ones, carers deserve specialist, dedicated support, education and advice at important transitional points in their loved one’s journey. Admission to hospital may be one of those points.

We aimed to implement a range of specialist interventions and group work to help people live well with dementia, developing skills to improve communication and maintaining their relationships.

Launching the service 

We also wanted to provide psychological support to carers and become a contact and source of support at difficult points in the dementia journey, including diagnosis, condition progression and when tough decisions need to be made, such as moving a family member into residential care. The support would also help families cope with feelings of loss and bereavement as the condition progressed.

There were also expected to be benefits for the hospital's staff: the Admiral Nursing service could ‘parachute in’ to other teams to support and increase their skills. This would give the service a wide reach, enabling it to develop lasting changes to working practice and support a change in culture, skills and knowledge.

The proposal approved by the trust board included the job description, a service collaboration agreement and an operational policy developed to meet the requirements of the trust and Dementia UK.

An action and implementation plan was then developed to launch the service in the hospital and the community, in line with the trust’s strategy to deliver an integrated care service model. Our strategy group, including partner organisations and carers, engaged with community organisations and developed training. Promotional events raised awareness of the service.

Positive feedback 

Since its launch in August 2015, the service has introduced a wide range of changes, including one-to-one support for family carers and story box sessions that help ward staff see the person behind the patient (see box ).

I am stopped daily by our staff for advice about their own loved ones, and we have recognised that staff may also be carers for people living with dementia. We recently introduced a dedicated Admiral Nurse clinic for our staff, to offer them one-to-one appointments with an Admiral Nurse for support, education and advice.

While this is a new service, early feedback indicates that it has enabled staff to receive expert support, education and advice, and helped them to build resilience in their role as a carer and as a healthcare worker too.

There have been few major challenges. The initiative was championed by the chief executive and the trust’s nurse leaders, which helped a smooth transition, and financing the role was achieved through our partnership with Dementia UK. An initial lack of understanding by staff of the role has been overcome by training and raising awareness through promotional events, along with ensuring I am visible in clinical areas.

Feedback from patients, carers and staff has been overwhelmingly positive.

More than a diagnosis

Our patients living with dementia have welcomed being seen as more than a diagnosis of dementia, or worse, a bed number. They are individuals, and feel more supported in hospital by the experts who know them best – their loved ones.

Our patients have benefitted from an increased focus on psycho-social interventions, rather than experiencing a task-directed medical model approach with the focus on medication.

Carers feel more supported, informed and heard. They are happy they can continue in their caring role – where they choose to – while their loved ones are in hospital, and feel actively involved from the point of admission to discharge and beyond. They tell us that they feel able to help influence the development of meaningful care for their loved ones.

We have provided bespoke dementia awareness training to all our staff, including the estates department, catering, security, portering and domestic teams. Staff feel more knowledgeable, skilled and confident in supporting people living with dementia in a meaningful way. But when things get tough, they can easily contact an Admiral Nurse to support everyone involved.

Building bridges 

I am proud of the way the service has been taken into the hearts of the community, who have been getting involved in supporting our patients to have the best experience in hospital, attending our dementia cafe and becoming volunteers on our dementia-friendly wards. Feedback indicates they have a real sense that they are contributing to making the hospital more dementia and carer-friendly.

We will continue to focus on supporting a connected, skilled and committed community within the hospital.

As one of the first Integrated Care Organisations, we have a vision for the future – our Admiral Nursing service is an integral part of that vision. We plan to expand the service to incorporate and collaborate with community-based Admiral Nurses, helping carers navigate the dementia journey in the best possible way.

Dementia UK has established an acute hospital community of practice group, which brings together the other Admiral Nurses who are working in the acute hospital environment. This group meets regularly to consider and establish best practice Admiral Nursing in the acute hospital. When complete, this work will be shared nationally.

The work that Admiral Nurses do is important in assisting and connecting people, and maintaining those connections beyond their environments. We act as links and build bridges between patients and their families. Being able to support people with dementia and their loved ones in a meaningful and proactive way is rewarding.

Positive changes spearheaded by the Admiral Nurse service include:
  • One-to-one support for carers.
  • A Forget Me Not programme respectfully identifies people living with dementia, and the person’s wishes in the care-giving process.
  • Our Forever Friendship Cafe provides a vital hub of support and is attended by more than 20 carers at each cafe.
  • Story box sessions are a facilitated therapeutic interactive session, engaging small groups of patients and their carers with activities such as singing and simple exercise. It promotes well-being and helps ward staff see the person behind the diagnosis.
  • Twiddle muffs and Twiddle boards: knitted hand muffs and drawing boards that can occupy patients and help to alleviate their anxiety. Both of these have been provided by our local community group The Tameside Twiddlers.
  • Dementia Champions have been established in all clinical areas and three quarters of non-clinical areas.
  • A strong dining companions network supports patients requiring assistance at mealtimes. We currently have 53 dining companions with a further 46 in the process of being trained. Feedback shows more than 96% of patients are able to have a better experience at meal times.
  • We have signed up to John’s Campaign, supporting carers to continue in the care-giving process where they wish, and through open visiting access.
  • Activity boxes are available on all wards.

Pam Kehoe is Admiral Nurse/lead nurse for dementia at Tameside Hospital NHS Foundation Trust

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