Clinical placements

Dementia at the end of life: why every nursing student needs to learn about it

An Admiral Nurse explains how she uses hospice placements to deepen students’ understanding

An Admiral Nurse explains how she uses hospice placements to deepen students’ understanding


Holistic care for people with dementia is the central aim of Admiral Nurses Picture: Alamy

Dementia is one of the biggest health issues of our time, with an increasing number of people receiving a diagnosis.

Latest data from the Office for National Statistics show dementia is now the leading cause of death in England and Wales; in 2018, it accounted for 12.8% of all deaths.

According to the Alzheimer’s Society, 850,000 people are living with dementia in the UK, with numbers expected to rise to more than one million by 2025, and to two million by 2051. 

Dementia is an essential learning area for nursing students

Many nursing students will care for someone with dementia during their training – and after qualifying – so enhancing their knowledge and understanding of the condition is essential.

Admiral Nurses are an invaluable resource for nursing students. As specialist dementia nurses, we provide expert advice and support to those living with dementia and their families.

The Admiral Nurse Service was developed in partnership with charity Dementia UK. There are currently 277 Admiral Nurses working all over the UK in a variety of healthcare settings, including care homes, hospices and hospitals.

‘An important part of my role is to ensure the person’s wishes, current or past, are heard when difficult decisions are being made’

I have been an Admiral Nurse for a year and work at the Douglas Macmillan Hospice in Stoke-on-Trent, Staffordshire. I joined the hospice three years ago as a palliative care nurse on the inpatient unit, caring for individuals and their families as people near the end of life.

I am one of two Admiral Nurses at the hospice. I offer specialist practical, emotional and psychological support to individuals with a diagnosis of dementia who are in the latter stages of life, most commonly the final year of life, meeting the individual and their family regularly.

Understanding the individual’s wishes, and planning around them

Dementia is a terminal condition. As it progresses, some difficult conversations must be had and decisions made, so an important part of my role is to ensure the person’s wishes, current or past, are heard.

This can be done using documents such as the ‘ceilings of care’ plan, which aims to avoid inappropriate and unnecessary hospital admissions, particularly in the palliative stages.

‘We want students to have a positive experience of caring for people with dementia’

I liaise with other specialist services, such as occupational, psychological or physiotherapy services, sharing best practice and advocating on behalf of the person to ensure they receive the best possible care.


Ensuring the person’s wishes are heard and respected is an essential part of the
Admiral Nurse role Picture: iStock

I also provide tier two dementia training to healthcare staff who care for people with dementia, and run awareness sessions at universities and in primary care services.

Students who work alongside Admiral Nurses will learn about all aspects of caring for a person with dementia, including advance care planning, risk assessment, and how to use assessment tools to measure quality of life for the individual and their carers.

Learning opportunities for students on hospice placement 

We offer students an introduction to Namaste – a holistic care programme that integrates compassionate nursing care with individualised, meaningful activities for people with advanced dementia at the end of their lives. The aim is to engage people through sensory input, especially touch, to enrich their quality of life.

Students also learn how to recognise end of life, the medications used at the end of life (including syringe driver training) and the use of DNAR (do not attempt resuscitation) forms. Caring for people with dementia also helps improve students’ communications skills because they learn how to interpret verbal and non-verbal communication.

What I learned: don’t make assumptions, and carers need to feel empowered

Katie O'Reilly, a second-year adult nursing student at Keele University writes: 

I recently had a three-week placement with the Admiral Nurses at Douglas Macmillan Hospice in Stoke-on-Trent. Before this, I only had a basic knowledge of dementia so I wasn’t sure what to expect or what I would be doing.


Katie O'Reilly

I was worried I would be out of my depth, but the Admiral Nurses were great teachers and I gained so much knowledge. I learned about the different types of dementia, and how each one affects people differently; my communication skills improved as I was taught how to communicate and engage with people living with the condition.

I now realise the causes of confusion are multifactorial

One of the most interesting things I learned was not to assume anything: when people with dementia become increasingly confused, for example, it is often assumed this is due to a deterioration in their condition when it could caused by other factors, such as an infection or medication changes.

The most valuable thing I learned is how important it is to support those caring for people with dementia, and that carers need to feel empowered if they are to care for their loved one to the best of their ability.

As an adult nurse, I will always come into contact with people with dementia and this placement was invaluable in improving my knowledge, skills and confidence in this area.

 

What I learned: how to practise techniques that soothe agitation

First-year trainee nursing associate Angela Lowe writes: 


Angela Lowe

Although I have experience of working with people with dementia, I had no knowledge of the Admiral Nurse role before my two weeks spent with the Admiral Nurses in Staffordshire.

The nurses adopt a person-centred approach to caring for people with dementia, their families and carers, and they have an impressive range of skills.

Admiral Nurses take a holistic view

They focus on patients’ overall health and well-being, listening to any concerns and addressing issues to do with medication and symptom control. They can introduce patients to a ‘buddy’, who can help alleviate loneliness or social exclusion, and work with the multidisciplinary team, including social workers, physiotherapists, and occupational and speech and language therapists.  

I now have a greater understanding of their role, I feel more able to ask for their support if a need arises with the patients in my care. Becky has demonstrated transferable skills that I can use in my clinical practice and disseminate, such as distraction techniques or doll therapy, which can reduce stress and agitation in people with dementia.

 

RCNi Learning modules: caring for people with dementia

To maximise students’ learning opportunities, I organise a comprehensive timetable of learning and arrange for them to spend time with colleagues in the inpatient and day therapy units, and with the community palliative care specialists.

Understanding a student’s experience and knowledge of dementia before the placement enables me to tailor learning opportunities accordingly. Students are given time to reflect after each patient intervention, enabling them think about what they have learned and gain insight into their own emotional awareness.

Ultimately, we want students to have a positive experience of caring for people with dementia and an understanding of how rewarding it is to be an Admiral Nurse.


Becky Kean is a palliative care Admiral Nurse at the Douglas Macmillan Hospice in Stoke-on-Trent, Staffordshire

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