Using narratives to better understand older people's decision-making processes.

Despite the availability of health and social care services designed to support people in their own homes, older people often underuse or refuse these services. It is now acknowledged that this phenomenon contributes to older people being admitted to hospital and long-term care in circumstances that could be avoided. To understand how the uptake of supportive and preventative services can be improved, the first author, supervised by the second and third authors, developed a constructivist inquiry to explore what factors enhance or bar service use. This article describes how narratives were used not only to help identify decision- and choice-making influences, but also as a way of enhancing the hermeneutic processes associated with constructivism

Literature review: understanding nursing competence in dementia care

Aims and objectives. The aim of this study was to review dementia nursing competencies. The objectives were to explain the relevancy of dementia competencies across care settings and levels of practice. Background. Dementia is strongly associated with increasing age and as the world population ages there is an imperative to ensure the healthcare workforce is fully equipped to meet the needs of people with dementia and their carers. Design. A literature review study addressed the research aim and objectives. Method. Literature sources were (i) academic databases, (ii) the internet and (iii) snowballing. Search terms were \u27dementia\u27, \u27care standards\u27, \u27training and education\u27 and \u27competency\u27. Results. The sample consisted of 59 reviewed publications. A synthesis of the findings generated 10 dementia competencies: (i) Understanding Dementia; (ii) Recognising Dementia; (iii) Effective Communication; (iv) Assisting with Daily Living Activities; (v) Promoting a Positive Environment; (vi) Ethical and Person-Centred Care; (vii) Therapeutic Work (Interventions); (viii) Responding the needs of Family Carers; (ix) Preventative Work and Health Promotion and (x) Special Needs Groups. There were also five levels of practice: (i) Novice; (ii) Beginner; (iii) Competent; (iv) Proficient and (v) Expert and no care setting specific competencies were generated. Conclusion. Government initiatives demonstrate commitments to dementia, such as Australia\u27s adoption of dementia as a National Health Priority and the UK National Dementia Strategy. Registration boards for the nursing workforce in Japan and the UK included dementia competencies in generalist frameworks to emphasise the importance of dementia as a healthcare issue. This study demonstrated that there is no dementia competency framework relevant across care settings or levels of practice. Relevance to clinical practice. An empirical study will develop a multi-disciplinary dementia competency framework relevant across care settings and levels of practice to ensure the healthcare workforce can effectively deliver services to people with dementia and their carers