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Practice comment

Skilled dementia care must not become the preserve of specialists

  • 1 Comment

The predicted rise in cases of dementia means all nurses working with adult patients in acute care must develop skills in caring for people with the condition, argues Liz Lees

The nursing workforce is ageing and so are nurses’ relatives. A colleague recently revealed her exasperation at trying to care for a relative with dementia while also trying to work full-time.

Sadly, this situation is not unique – almost everyone seems to know someone with the condition. That is hardly surprising since around 700,000 people in the UK have dementia, and this number is predicted to double to 1.4 million over the next 30 years (Department of Health, 2009).

It is fantastic that the national strategy for dementia was published and I believe we are already capable of achieving some of its huge list of objectives. These are: radically improving the quality of care; increasing awareness of dementia; and ensuring an informed and effective workforce.

A common problem for acute medical units is managing patients with dementia and delirium, who often present in a distressed state and are frequently aggressive and challenging to deal with. Managing such patients comprehensively represents the ‘bread and butter’ of all acute assessment skills.

Patients with dementia are frequent users of all kinds of hospital services, so the issue of providing radically improved quality of care is therefore not confined to nurses working in elderly care settings.

Across all acute care (especially in acute medical areas) nurse staffing levels must be increased to manage the complexity of caring for patients with dementia.

Delirium is a common problem and often goes unrecognised in patients with dementia, with potentially catastrophic consequences. The challenges of dealing with acute delirium often demand one-to-one care ratios until the episode is over. We readily accept such nursing levels on intensive care units, yet would we readily support this ratio for our most vulnerable adults with dementia?

All nurses caring for adult patients in acute care must have the opportunity to develop new skills in dementia care

Perhaps the key to increasing awareness is to concentrate on developing the most important areas of expertise and not to forget HCAs’ role in the care process. Nursing patients with dementia requires a wealth of expertise at all levels of the workforce. HCAs and nurses must be trained to recognise delirium and to apply management strategies in acute situations.

Outside of such training, nutrition, hydration, safety and communication are pivotal to providing good-quality nursing care for patients with delirium and dementia. I apologise that this is basic nursing care revisited, but that is what is needed – albeit delivered consistently for each individual.

Finally, I am totally supportive of dementia training to achieve an informed and effective workforce (DH, 2009). But while there is discussion about new roles, comprehensive assessors and clinics, I fear there is a hidden danger looming. All nurses caring for adult patients in acute care must have the opportunity to develop new skills in dementia care.

Caring for patients in acute settings with the condition must not become a specialist role where a referral has to be made for specialist knowledge, which is not always shared widely in practice. Practice guidelines, which have transferable principles for all acute areas, must be developed by nurses to address the core issues of managing patients with dementia.

There are some challenging times ahead for nurses working in acute care if they are to truly embrace the changes in practice that this strategy outlines.

LIZ LEES is consultant nurse, Heart of England NHS Foundation Trust, Birmingham



  • 1 Comment

Readers' comments (1)

  • Couldn't agree more with the sentiments of Liz Lees, however l do not entirely agree with her view that increasing staffing levels within the acute setting is the only answer.

    I believe that elderly people suffering with dementia often become agitated and aggressive when they are admitted to acute hospitals, because they are disorientated in place, as a result of being moved from an environment in which they felt safe.

    It is my view that local providers of health services need to increase services which are designed specifically to try and avoid admission to acute hospitals of people suffering with dementia.

    It starts with increasing support for the families who are caring for a loved one in their own home and making sure that the community services are adequate to meet their needs when things start to go wrong. District nursing services and GP do provide support, but community RMN support is often overstretched. It is not enough for the NHS to rely on the charitable efforts of Admiral Nurses to support the carers. Specialist RMN's must have the time to pass on valuable advice to help keep the person with dementia at home where they feel safe and are not exposed to the noise and activity of a busy hospital environment.

    Yes there are going to be times when admission is going to be required, but l suspect that often an admission could be avoided if these services were adequate and in place.

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