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

2. Can you find ‘care’ in this wordle?

4. 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)

5. 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.’

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

7. And when it’s present...

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

10. 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)

11. 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

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

15. 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?

16. 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’

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

19. 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.

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

21. 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

23. 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

24. References
Scottish Office Home and Health Department (1991) The role and function of the professional nurse. Edinburgh:HMSO
RCN definition of nursing (2014) accessed 19/3/2018
RCN SPACE principles (2011) accessed 19/3/18
Cicely Saunders (2006) Selected writings 1958 – 2004, Oxford University Press (2006)