Standards and themes Dementia standard Quality Themes I have the right to a diagnosis Care and support I have the right to be regarded as a unique individual and to be treated with dignity and respect I have the right to access a range of treatment, care and supports. I have the right to be as independent as possible and be included in my community. Environment I have the right to have carers who are well supported and educated about dementia. Staffing, leadership and management I have the right to end of life care that respects my wishes.

Overall Grading I have the right to be regarded as a unique individual and to be treated with dignity and respect I have the right to access a range of treatment, care and supports I have the right to be as independent as possible and to be included in my community I have the right to carers who are well supported and educated about dementia I have the right to end of life care that respects my wishes Adequate or lower Good or higher 26.2% 73.8% 28.3% 71.7% 40% 60% 38.6% 61.4% 42.1% 57.9%

The full report from these inspections is available from www The full report from these inspections is available from www.careinspectorate.com Heather Edwards heather.edwards@careinspectorate.com http://hub.careinspectorate.com/improvement/spotlight-on-dementia/ @HeatherAHP

Nursing care and dementia Jacqueline Thompson, Nurse Consultant, Older People Andy Shewan, Nurse Consultant, Dementia

Can you find ‘care’ in this wordle?

Defining nursing care ‘Everyone involved has special skills to offer but at the margins of the field of competence and expertise of each professional group, there are areas where there is some overlap of function. Despite these small areas of overlap, the major responsibilities are quite clear – with the exception of nursing, where there is considerable variation in perception’ (Scottish Office, 1991)

RCN definition (2014) ‘The use of clinical judgement in the provision of care to enable people to improve maintain or recover health and to cope with health problems and to achieve the best possible quality of life whatever their disease or disability until death.’

We know when it is absent.... Restricted hospital visiting Delirium unrecognised Nutrition and hydration

And when it’s present...

Pioneer in Palliative Care – Dame Cicely Saunders (1918 -2005)

Is death a medical event? ‘Approaches to death and dying reveal much of the attitude of society as a whole to the individuals who compose it.’ (Cicley Saunders 1984)

Models 8 Pillars RCN (2011) SPACE Staff who are skilled and have time to care Partnership working with carers Assessment and early identification Care that is individualised Environments that are dementia friendly

Advanced Dementia Specialist team, Scotland Established across all HSCP by 2020 Where is the Nurse Consultant and Dementia Nurse Specialist in this model?

GMS Contract (2018) Care from ‘Cradle to Grave’ Increasing numbers of palliative care and deaths within the community Where is the role of specialist and advanced level nursing practice in primary care described?

Shifting the paradigm to nurse-led, Dr supported care CQC ‘Outstanding’ ‘This nurse-led general practice has proven not only to be safe and effective in care delivered, but also exceeded parameters set out within their APMS contract’

‘Models’ of Care Dementia Care Mapping Buurtzorg Nederlands Advanced Dementia Practice Model

Dementia Care Mapping Dementia care mapping (DCM) is an observational method based on Tom Kitwood’s person-centred care approach It involves as much as 6 hours’ observation, recording every 5 minutes the main activity in which the person has been engaged and a subjective rating of the person’s well-being during that period. DCM has many uses and continues to be developed. It can be used to: Help staff understand the experience of people of dementia in their care Rate the quality of a care environment Provide feedback to staff and to assist in drawing up an action plan for change at both the level of the individual resident and the care setting as a whole A further DCM evaluation can then be used to indicate where change has occurred and generate further ideas for action in a repeated audit cycle.

Buurtzorg Buurtzorg is a unique district nursing system which has garnered international acclaim for being entirely nurse-led and cost effective.

Advanced Dementia Practice Model Caring for an individual with dementia is complex and intense Development of advanced dementia specialist teams Bring the care to the person as opposed to the person to the care

Advanced Dementia Specialist Team Consultant Geriatrician Although physicians others may be required Allied Healthcare Professional Specialists OT, Physio, SALT, Dietician District nurses with dementia expertise Skin integrity, bowel & bladder, physical health Mental Health Psychiatrist, Psychologist, CMHN, Palliative Care Specialist Management of pain, distressing symptoms at end of life

References Scottish Office Home and Health Department (1991) The role and function of the professional nurse. Edinburgh:HMSO RCN definition of nursing (2014) https://www.rcn.org.uk/professional-development/publications/pub-004768 accessed 19/3/2018 RCN SPACE principles (2011) https://www.worcester.ac.uk/documents/FULL_RCN_report_Transforming_dementia_care_in_hospital.pdf accessed 19/3/18 Cicely Saunders (2006) Selected writings 1958 – 2004, Oxford University Press (2006)

Questions