Careers
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With the level of dementia cases set to soar and contribute to every nurse’s workload, June Andrews points to a model to overcome the shortfall in care staff education
The number of people with dementia is forecast to double from 800,000 over the next 20 years. Currently, up to half of all patients in acute medical wards are said to be affected by dementia or an associated condition. The latest figures on prevalence in care homes indicate that about 90 per cent of residents have dementia. What should be the nursing response to this rise in dementia among older people, and the corresponding increase in workload? There is evidence that good dementia care costs less than bad care and that correct nursing management of dementia and associated conditions reduces length of acute hospital stay and adverse incidents in care homes, thereby avoiding hospital admission (see box). According to the Cavendish review, more than 1.3 million staff in the unregistered care workforce are giving care in hospitals, nursing homes, care homes and in patients’ homes.
ALAMY
WHY WE NEED DEMENTIA TRAINING
Good nursing management of dementia helps avoid hospital admission
What do nurses need to provide? Advice and support to families and carers on how to keep the person with dementia in the community. A simple dementia screening as part of triage in emergency departments. Resources such as the Butterfly scheme allow the patient to be given particular attention during admission. Understanding how to communicate with a person with dementia and how to manage the hospital environment to minimise the damage that a hospital admission can cause to a person with dementia. Care planning that involves nutrition and hydration, pain control and exercise. Education for carers during hospital admission.
NURSING STANDARD
Nurses are responsible for most of this workforce but research shows there is little dementia education in their pre-registration training. Yet this patient group makes up a large portion of every nurse’s work, as well as a substantial part of what nurses delegate to care assistants who may know even less. This situation constitutes a major risk for nurses as well as patients, particularly because relatives of people with dementia are now more inclined to seek redress for failings in care. The Dementia Services Development Centre (DSDC) at the University of Stirling devises learning programmes that can be delivered by a supervising
nurse or senior care assistant to groups of up to eight staff at their workplace at a time. Over six months, the programme promotes culture change with regular short meetings of the learning group who then cascade their learning back at work. The programme is a low cost, effective response to the problems raised in the Department of Health’s Dignity in Care report and the Francis inquiry. More than a thousand staff in hospitals across the UK and more than 3,000 in care homes have now completed this programme. Some facilitators are training their third or fourth cohort in their own workplace, increasing their experience and using learning materials accredited by the RCN, City & Guilds and others. A crucial element of the package is the continuous support of the DSDC nursing and information staff. Evaluation shows that the programme is a cost-effective way of improving the care of people with dementia in a wide range of settings NS Professor June Andrews is director of the Dementia Services Development Centre at the University of Stirling RESOURCES Dementia Services Development Centre www.dementia.stir.ac.uk Butterfly dementia in hospital scheme tinyurl.com/Butterflydementia Be a dementia friend www.dementiafriends.org.uk march 26 :: vol 28 no 30 :: 2014 63
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If you would like to write for our careers section email the editor at [email protected]
With the level of dementia cases set to soar and contribute to every nurse’s workload, June Andrews points to a model to overcome the shortfall in care staff education
The number of people with dementia is forecast to double from 800,000 over the next 20 years. Currently, up to half of all patients in acute medical wards are said to be affected by dementia or an associated condition. The latest figures on prevalence in care homes indicate that about 90 per cent of residents have dementia. What should be the nursing response to this rise in dementia among older people, and the corresponding increase in workload? There is evidence that good dementia care costs less than bad care and that correct nursing management of dementia and associated conditions reduces length of acute hospital stay and adverse incidents in care homes, thereby avoiding hospital admission (see box). According to the Cavendish review, more than 1.3 million staff in the unregistered care workforce are giving care in hospitals, nursing homes, care homes and in patients’ homes.
ALAMY
WHY WE NEED DEMENTIA TRAINING
Good nursing management of dementia helps avoid hospital admission
What do nurses need to provide? Advice and support to families and carers on how to keep the person with dementia in the community. A simple dementia screening as part of triage in emergency departments. Resources such as the Butterfly scheme allow the patient to be given particular attention during admission. Understanding how to communicate with a person with dementia and how to manage the hospital environment to minimise the damage that a hospital admission can cause to a person with dementia. Care planning that involves nutrition and hydration, pain control and exercise. Education for carers during hospital admission.
NURSING STANDARD
Nurses are responsible for most of this workforce but research shows there is little dementia education in their pre-registration training. Yet this patient group makes up a large portion of every nurse’s work, as well as a substantial part of what nurses delegate to care assistants who may know even less. This situation constitutes a major risk for nurses as well as patients, particularly because relatives of people with dementia are now more inclined to seek redress for failings in care. The Dementia Services Development Centre (DSDC) at the University of Stirling devises learning programmes that can be delivered by a supervising
nurse or senior care assistant to groups of up to eight staff at their workplace at a time. Over six months, the programme promotes culture change with regular short meetings of the learning group who then cascade their learning back at work. The programme is a low cost, effective response to the problems raised in the Department of Health’s Dignity in Care report and the Francis inquiry. More than a thousand staff in hospitals across the UK and more than 3,000 in care homes have now completed this programme. Some facilitators are training their third or fourth cohort in their own workplace, increasing their experience and using learning materials accredited by the RCN, City & Guilds and others. A crucial element of the package is the continuous support of the DSDC nursing and information staff. Evaluation shows that the programme is a cost-effective way of improving the care of people with dementia in a wide range of settings NS Professor June Andrews is director of the Dementia Services Development Centre at the University of Stirling RESOURCES Dementia Services Development Centre www.dementia.stir.ac.uk Butterfly dementia in hospital scheme tinyurl.com/Butterflydementia Be a dementia friend www.dementiafriends.org.uk march 26 :: vol 28 no 30 :: 2014 63
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