The changing role and critical importance of the DN in the future of community-based health care for those with dementia and for the frail elderly LOIS SEDDON Senior lecturer University Campus Suffolk With contributions from District Nurse Students: Zoe Thompson and Tracy Schofield

What We know…. Access to a flexible and skilled community nursing workforce is increasingly important as the focus of care shifts from hospital to the community. Nurses in the community need advanced knowledge and practice skills and skills in advanced specialist practice in complex case management and coordinating care across professional boundaries Many nurses already have these skills but this needs to increase along with confidence to practice with greater independence. (Willis 2015)

What we know… ‘Dementia is every nurse’s business – with a change in mindset, practice, commissioning and education, nurses can make a real difference to people living with dementia and their carers and families’. ( Pauline Watts. 2013, Nursing Professional Officer, Clinical Advisor Public Health Nursing and DH Nurse Lead for Dementia Care).

District Nurses and Dementia Care For a range of reasons District Nurses are in a pivotal position to ensure dementia care is effective. This is their ‘bread and butter’ work: Holistic assessment Managing multiple and complex needs Care planning in partnership with patients and carers Delivering and leading sensitive and compassionate expert clinical care Case management to integrate care Coordinating collaborative approaches to care Evaluation of interventions / care Research

Training Recognition of the impact that District Nursing can have in taking dementia care forward Specific skills training for District Nurses in dementia care – assessment / pre diagnosis / post diagnosis / palliative care / end of life care Training for District Nurses in using technology

Commissioning Commissioning more District Nurse training Workload analysis and commissioning to incorporate dementia care in the role of the District Nurse Workload analysis and commissioning to incorporate carers’ assessment and support by District Nurses More real integration of health and social care

Professional development to enhance dementia care in the community Facilitate clinical supervision for District Nurses and their teams specifically related to complex care delivery Facilitating communities of practice to enhance the District Nurse’s role in joining / leading the development of dementia friendly communities / memory clinics. Incorporating a dementia care pathway and its evaluation into the organisations’ governance structure Enabling and supporting community based research projects led by District Nurses

In summary: District nurses are highly trained in advanced clinical practice and their specialism is in providing, leading and coordinating care for patients in a domestic setting. This places District Nurses in the optimal position to coordinate care for the frail elderly, those with dementia and their families and carers. The structure of delivery of community care can impede the potential impact of the District Nurse in this area of care, which means their skills may not be acknowledged. Commissioners of care services and workforce training and education need to consider developing a more integrated approach, and investing in the existing expertise of the District Nursing services. Professional development for the District Nursing workforce should focus on instilling confidence in assessment and management understanding and responding to dementia

References and resources Compassion in Practice: Department of Health Self assessment – The Dementia Challenge: Department of Health 2013 – Making a Difference in Dementia Care: Department of Health 2013 Care in local communities: A new vision and model for district nursing. London: Crown: nursing pdf Health Foundation 2011 Spotlight on Dementia care: NICE Dementia Guideline: Lord Willis 2015 – Shape of Caring Review: National Voices:

Pauline Watts 2013: vision-and-strategy-launched Queens Nursing Institute (2012) Working with healthcare professionals to increase carer awareness, identification and referral. London: Queens Nursing Institute: RCN Dementia resources: