1. THE ROLE OF A CLINICAL NURSE CONSULTANT DEMENTIA SPECIALIST: A QUALITATIVE EVALUATION DIANNE P GOEMAN1 2, CHRISTINE BEANLAND1, FLEUR DUANE1, SUSAN KOCH1 1 RDNS Institute, Royal District Nursing Service, Alma Rd, St Kilda, VIC 3182, and 2 Central Clinical School, Monash University, Melbourne, VIC 3004.
Background
Over 12 million people worldwide have dementia and by 2040, it is expected that this will increase to 25 million1.
Evidence exists of delay in the diagnosis of dementia along with difficulties in accessing suitable health care services2.
Delay in diagnosis potentiates the risk for misdiagnosis, inappropriate management, poor psychological adjustment and reduced coping capacity and decreased ability to forward plan3.
Exploration of potential roles to support people in the community to achieve timely diagnosis, access to services and support before crisis.
Aim
To refine and evaluate the role of a Clinical Nurse Consultant with a speciality in dementia working with older people with cognitive decline and their carers in the community.
Participants
Nine clients of the Royal District Nursing Service (RDNS) or an Aged Care Assessment Services (ACAS) aged over 65 years, with a six month history of cognitive and functional decline were enrolled in the study.
Methods
Participatory action research was used to refine the role of the CNC in accordance with the needs of older people with cognitive impairment or their carers. Qualitative methods were used to evaluate the CNC role. These included CNC field notes, interviews with participants and carers and focus groups with staff form RDNS and ACAS.
Results
Focus group data and person and carer interviews were thematically analysed4, major themes relating to the CNC role are reported in Figure 1.
What is a Clinical Nurse Consultant (CNC) Dementia?
A role for a grade 4 registered nurse with specialist knowledge, experience, post-graduate qualifications and the ability to provide clinical expertise, clinical planning and management, education and leadership in dementia
“It’s a very, very, very big help. It’s eased my worries. It’s too much thinking about what’s going to happen in the future and the dementia” (Carer)
Fig 1
The CNC Dementia
Worked directly with participants and their carers to:
Build a trusting relationship
Understand the person’s needs and goals
Facilitate the provision of strategies, services, support and information to meet the person’s needs
Coordinate care between agencies to reduce duplication of assessments
“....gave me a lot of confidence” (Person)
Confidence
Reassurance
Resources
Person
Options
Carer
Navigation/Access
Trust
Strategies
Resources
Education
Streamlined services
RDNS Nurse
CNC Dementia
ACAS Staff
(The CNC) “...advocated for services from the local council and this made a huge difference and so the wife is much happier now and feels she can continue to care for him“ (ACAS)
Responsive
Depth of service
Strategies
Improved
communication
Improved communication
“My knowledge base has increased threefold (due to the CNC)” (RDNS Nurse)
Conclusions
The CNC Dementia led positive dementia practice is novel and this study suggests that it can enhance independence and quality of life for people living with cognitive decline and their carers’. Face to face contact between the CNC and participants was integral to a trusting partnership that addressed client and carer needs and facilitated personalised care.
Future considerations
Replication of this study with a larger sample size, longer time frame and inclusive of non-English speaking persons.
Exploration of how the CNC Dementia role may support link workers, volunteers and other community workers caring for people living with cognitive decline in the community.
References
1.Burns, A., & Illiffe, S. (2009) Dementia, BMJ, 338,
2. Stokes, l., Combes, H., & Stokes, G. (2012) Understanding the dementia diagnosis: the impact on the caregiver experience. Dementia DOI:
3. Pond, C., Brodaty, H., Stocks, N., Gunn, J.,.....Mate, K. (2012) Aging in general practice trial (AGP): A cluster randomised trial to examine the effectiveness of peer education on GP diagnostic assessment and management of dementia. BMC Family Practice, 13 DOI: /
4. Lincoln, Y., & Guba, E. (1985) Naturalistic Enquiry. Newbury Park , CA, Sage.
References 2 1. 4 3 8 6
The study was approved by the RDNS Human Research Ethics Committee and funded by a research grant from the Ian Potter Foundation
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