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Rewarding dementia nurses

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VOL: 97, ISSUE: 28, PAGE NO: 40

Karen Daniel is press and public relations officer, the Queen's Nursing Institute

Not long ago dementia was shrouded in mystery, misunderstanding and prejudice and those with the condition were isolated, ignored or marginalised. Nurses working in this field were often demoralised and undermined by the general consensus that this branch offered little in the way of career development.

Not long ago dementia was shrouded in mystery, misunderstanding and prejudice and those with the condition were isolated, ignored or marginalised. Nurses working in this field were often demoralised and undermined by the general consensus that this branch offered little in the way of career development.

To recognise and reward the skills, expertise and dedication of nurses working in the field of dementia care the Alzheimer's Society and the Queen's Nursing Institute have launched the Award for Excellence and Innovation in Dementia Care Nursing (see box). The award, which the society believes is the first of its kind in the UK, will initially be presented from 2002 to 2004.

Alison Solomon of the Dementia Relief Trust is a committed advocate of a wider training infrastructure for nurses wishing to enter this field and believes more courses are needed.

'Dementia nursing is where cancer nursing was 30 years ago,' she says. 'Compare dementia training with its cancer equivalents - the ENB has just one dementia-specific course compared with 20 in the field of cancer and palliative care.

'Ageism also comes into it,' she adds. 'Doctors often avoided making a diagnosis of dementia because there was little or no support for those who have it. The Alzheimer's Society has raised public awareness but this has to be matched in other areas. Compare it with the care for a 35-year-old with AIDS and you get the picture.'

The outstanding work done by dementia care nurses in acute, residential and community settings is a blueprint for what can be achieved elsewhere, says Ms Solomon.

The following two candidates, whose names have been put forward for the award, describe their career pathways and practice development work with patients who have dementia.

Admiral support
Admiral nurses are specialist mental health nurses working in the community to support the carers of people with dementia and Debbie Hawkins, Admiral nurse leader at Brent, Kensington and Chelsea and Westminster Mental Health NHS Trust, London, has set up a support group for people who have recently been diagnosed with dementia.

There are many carer support groups but this, she believes, is the first for people with dementia. It allows them to talk freely and frankly about how the diagnosis has affected them and to express their anger, depression and frustration to people who understand best - other people with dementia.

'My first ward was an elderly care ward. From the word go it was the only environment in which I wanted to work. In those days people often complained about giving personal care - washing, toileting and so on - but I enjoyed it. I have always had a great love and respect for older people: they have so much to give us and deserve a lot in return.'

'I became manager of a day hospital for older people, and five years ago became an Admiral nurse team leader. The brilliant thing about this job is that I have a free rein to develop services. The support group is a valuable outlet for newly diagnosed patients - people with dementia have considerable insight into their condition.

'We have learnt not to underestimate what the person with dementia feels and understands. Patients' honesty and openness about their feelings has been very humbling and nurses often shed tears during feedback after the group session.

'Today there is so much career progression available through dementia care nursing,' Ms Hawkins says. 'It is an incredibly exciting time, with practice and research breaking new ground every day. It is not a Cinderella service any more. People in this field have commitment and vision, and I know it is a field in which I will remain for the rest of my working life. It is not about bum washing - the dementia care nurse's world is his or her oyster.'

A first for dementia care
Tracy Packer, who is based at Bristol's Frenchay Hospital, is the country's first dementia care nurse consultant. Her appointment and the work she does is encouraging other NHS trusts in the south-west to develop similar roles.

Ms Packer's role focuses on the perspective of the person with the diagnosis. She is called in where her expertise is needed, such as when a patient exhibits violent or aggressive behaviour.

She says: 'As a student, I was interested in medicine and thought I would work in an intensive care setting. But for three years I worked on a short-staffed elderly admissions unit and loved it.

'In those days, once we completed the medical treatment of a patient with dementia, we believed the problem was solved, allowing us to abdicate further responsibility. I took the ENB course on dementia care and was the only general nurse on it.

'I then became a sister, but ward management took me away from direct patient contact so I applied for a specialist nursing post in Bristol, where a dementia care unit has been established in an acute setting. As many as 10% of acute wards are likely to have people with dementia.

'Two years ago I became a nurse consultant working primarily with dementia patients, their key worker, doctor and carer. Often the most distressing aspect of dementia is when patients exhibit violent or aggressive behaviour. This is a means of communication - the person is trying to express a feeling without words. These non-verbal indicators can tell us a lot and this is one of the most exciting aspects of dementia care nursing,' says Ms Packer.

'This disease is not going to go away and we cannot bury our heads in the sand. People with dementia and their carers deserve better.'

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