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Changing practice

Developing champions to enhance the care of people with dementia in general hospitals

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Nurses in hospitals often lack the necessary skills to meet the specialised needs of people with dementia. One programme aimed to champion this client group

Authors

Julie Crabtree, BSc, Dip HE (Mental Health Nursing), RMN, is Alzheimer Scotland dementia liaison nurse, NHS Ayrshire and Arran; James Mack MSc, PG Cert TLHE, Dip HE (Nursing), RN, is practice education facilitator, NHS Ayrshire and Arran.

Abstract

Crabtree J, Mack J (2010) Developing champions to enhance the care of people with dementia in general hospitals. Nursing Times; 106: 48, early online publication.

Within NHS Ayrshire and Arran, almost 5,500 people have a dementia diagnosis. However, projections over the next 20 years indicate this could increase by as much as 60% (Alzheimer Scotland, 2010). National dementia strategies in the UK have identified a need for improved education and training that supports staff in general hospital settings. While all clinical settings will admit people with dementia their specialist care needs are not always being met. Better awareness will help ensure these are addressed both on admission and throughout their care journey.

This is the second in a two part series describing a nurse led initiative to improve approaches towards dementia within a general community hospital (Crabtree and Mack, 2010).The first article focused on raising awareness of dementia, while this describes the development and implementation of a dementia champions programme.

Keywords Dementia, Champions, Patient experience

  • This article has been double-blind peer reviewed

 

Practice points

  • Dementia awareness sessions with dementia champion involvement should be rolled out to all older adult services sites in the first instance. These sessions could then be targeted at specific areas within the two larger district hospitals to maximise impact.
  • To enhance the role of the dementia champion, like minded individuals throughout the organisation need to identified and undertake a similar programme.
  • Existing champions should be used through continuous development and participation in a variety of dementia services.
  • To ensure service improvement the champions should meet bi-monthly with a structured programme led by the dementia liaison nurse.

 

Background

  • The NHS Confederation (2010) has highlighted the importance of having dementia leads to raise awareness about dementia within the acute setting.
  • An important service delivery area from the UK’s National Dementia Strategy (Department of Health, 2010) is to improve the response to dementia in general hospital settings.
  • A government priority is to enhance the quality of care for people with dementia through local delivery of quality outcomes and local accountability for achieving them (Cameron, 2010)
  • Standards for quality of care are embedded in the Charter of Rights of People with Dementia (Cross Party Group on Dementia, 2009).

 

 

Introduction

Dementia is a syndrome associated with an ongoing decline of the brain and cognitive abilities such as thinking, language, memory, understanding and judgement – and consequently self care abilities.

According to the NHS Confederation (2010) dementia affects about 3% of people aged 65 in the UK, and over 20% of those aged over 80 (Fig 1). As the population ages these numbers will rise, while national strategies aimed at improving diagnosis of dementia means a greater proportion will be identified. As these people will have healthcare needs unrelated to their dementia they will come into contact with healthcare professionals in all clinical settings.

Admission to a general hospital can have a negative impact on people with dementia as nurses frequently lack the necessary skills and knowledge to meet their specialist needs (Scottish Government, 2010; Department of Health, 2009).

To enable best practice in the care of people with dementia within NHS Ayreshire and Arran, we decided to develop a dementia champions programme to raise awareness of dementia and the needs of people with the condition. We began by conducting a scoping exercise of other dementia champion programmes. Copies of Caring for People with Dementia in Acute Care Settings were made available to nursing staff (DSDC, 2010); this resource promotes a person centred approach and contains practical information on caring for people with dementia. It includes a range of topics such as pain management, nutrition, communication strategies and psychological and behavioural symptoms associated with the condition. Given the current uncertain economic climate, the DSDC resource was considered the most cost effective method of supporting the champions in their learning.

We believed a dementia champion programme was the best model to promote hospital ownership of good practice in caring for people with dementia who are admitted to general hospital settings. Consequently, enthusiastic and motivated individuals with a genuine interest in dementia care were identified by ward managers within two rehabilitation community hospitals to become dementia champions. The main elements of the role are listed in Box 1. A staff nurse and healthcare assistant from five wards and two generic workers from another hospital within NHS Ayrshire and Arran were recruited as champions.

 

Box 1. The role of the dementia champion

  • To be a guide, supporter, mentor, and change agent;
  • To challenge poor practice in an appropriate manner;
  • To promote the wellbeing of people with;
  • To promote a person centred approach and be a model for good practice;
  • To support relatives and carers thus enhancing their wellbeing and enabling them to continue in their caring role;
  • To raise awareness, share information and knowledge;
  • To provide ongoing support in the workplace.

 

Dementia champion programme

The 12 week programme was designed to incorporate the themes set out in the DSDC resource. The champions completed three clinical placements within mental health settings for older adults to reinforce their learning from the modules in the resource pack. The modules were also complemented by four supported sessions that allowed the champions to explore each other’s experiences, share ideas for practice and problem solve. The sessions were supplemented by carer stories from a guest speaker and a representative from Alzheimer Scotland.

We involved colleagues from mental health services to ensure a robust programme that delivered on quality, transferability and values, which focused on a person centred approach to dementia care. “Buddy wards” and mentors from mental health settings for older adults were identified before the start of the programme. This gave champions the chance to establish relationships with colleagues within mental health.

Evaluation

To ensure a robust evaluation of the programme we designed three questionnaires for distribution to:

  • The champions;
  • The mentors;
  • Charge nurses within the participating hospitals.

Dementia champion feedback

A total of 11 questionnaires were distrubuted to the champions and 64% (n=7) were returned (Fig 2). Respondents were asked if they had found the programme interesting, pertinent to areas of their work and a good learning experience,. The choice of options of responses ranged from “poor” to “very good”; all respondents rated it as good or very good.

An overarching theme from the practice placements was that champions were able to access ideas from mental health settings that were transferable, for example, using multisensory equipment and communication aids. They were able to make links with mental health colleagues and felt they could continue to use them as a resource on dementia.

The champions found the supported sessions valuable, not only for the information provided but also because they could share ideas for practice and bond with each other. One said: “With the information we have gained from the four components we can make changes and improvements to how we carry out care when patients are affected by dementia and pass this on to other staff”.

Overall, 85% of the champions said their level of confidence in dementia care had improved as a result of completing the programme and that they wanted to continue their development through further coursework and regular dementia champion meetings.

Mentor feedback

A total of 11 questionnaires were distributed to the mentors and 55% (n=6) were returned. Mentors said they had received enough information about the programme before it started, that the learning environment was appropriate, and that both the DSDC resource and supported sessions were invaluable to the programme. One mentor commented: “I think there is a contrast between the two clinical areas enabling staff from the Biggart [Hospital in Prestwick] to see what would be workable in their clinical area. We were able to bounce ideas off each other to see if tactics used within our ward would be feasible in their ward”. However, in hindsight we feel that devoting more time to what was expected from the staff during clinical placement would have ensured mentors were better prepared.

Charge nurse feedback

Seven questionnaires were distributed to the charge nurses and 57% (n=4) were returned. Respondents indicated that the champions had made some or a marked impact within their respective clinical areas. One charge nurse said: “I’ve noticed my participant is now reflecting on how she and other staff work, and is starting to try and educate staff at the bedside, to change attitudes and see things from the patient’s perspective”.

Conclusion

Adopting an integrated approach to delivering awareness and training to staff while working in clinical practice will improve and enhance the knowledge and skills of those caring for patients with dementia. This pilot programme has shown that collaborative working in devising and implementing a dementia champion programme can establish working relationships across services and provide a chance to debate the care and management of dementia patients within a general ward setting.  

A major challenge in national dementia strategies is to enable carers to continue looking after their loved ones safely and effectively with the necessary support. In response to this and through the involvement of family carers and a guest speaker from Alzheimer Scotland in the programme, the champions are in the process of developing resources and support networks for carers within a general hospital setting.

 

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