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OPINION

Cliff Kilgore: 'Focus the bulk of nurse training on older people’s care'

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Improving nurses’ knowledge of dementia care is crucial, says Cliff Kilgore

I can appreciate that for many nurses another change to nurse registration education, and one particularly championed by the government, may not be seen as a positive thing. However, politics aside, it is worth taking a good look at this proposal. I believe there may be much to gain from its contents.

In summary, a mandate has been issued by the government to Health Education England setting out its ambitions for healthcare education with some excellent gains for those who work with older people. The obvious key benefits for nursing is the requirement that all staff must have the right skills to work with older people and, in particular, a focus on dementia awareness in pre-registration training, as well as an opportunity to progress to a specialist post-graduate programme and the chance to continue on a clinical academic pathway to progress in this chosen field of expertise.

“Greater emphasis is to be placed on dementia diagnosis rates”

Greater emphasis is to be placed on dementia diagnosis rates, with a target of two-thirds of people estimated to have dementia receiving a diagnosis by 2015 and, equally as important, the improved care of people living with dementia,
which must go hand in hand with the initial diagnosis.

It is hard to escape the reality that we are not only living longer but, statistically, we are seeing an increase in the number of people living with dementia. Inevitably these people will require our nursing expertise. It therefore would seem logical that improving our knowledge in these two fields of practice is crucial.

I admit that my current work as a nurse in a large community trust means I am particularly interested in the mandate’s focus on improving out-of-hospital care for the most frail and vulnerable of older people and the recognition that this takes a particular skill and competence. During my career working both in the acute and community sector it has become obvious how vital out-of-hospital care is not only for early and safe discharge but also for the recognition and response to early deterioration in older people and the subsequent prevention of avoidable admission.

If the workforce implications can genuinely be managed by commissioners and provider organisations then there is a chance real progress could be made.

Being completely honest, I still have concerns regarding the aim of insisting all student nurses undertake a year as a healthcare assistant before they start university. There may be benefits - particularly in understanding people’s essential care needs and it may even reduce the dropout rates of nurses, because nurses may be more aware of the high-pressured career they have chosen - but, inevitably, this does then make nurse training four years and there is a lack of evidence that this makes better nurses. Additionally, we could also ask why other health professionals are not also being asked to do the same if this is so important to patient care?

I have the fortunate and somewhat privileged position of providing education and a clinical presence in the trust I work. Maybe because of this I worry that we may not be going far enough with these changes to education. Anecdotally, my experience still tells me that most of the people we see in healthcare are older, and yet we still do not focus the bulk of nurse, therapy or medical training on older people’s care until we reach a specialist qualification.

There is no doubt that this mandate could be a start but is it only scratching the surface? Only time will tell.

Cliff Kilgore is the vice-chair for the British Geriatrics Society specialist nurse and senior practitioner group and advanced practitioner for intermediate care at Dorset Healthcare University Foundation Trust

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