In response to the Health Secretary Jeremy Hunt's plans for a safer 7 day dementia service

Jeremy Hunt's recent announcement for a safer 7 day dementia service outlines some basic principles to improve dementia care, none of which are new, but are these principles realistic in the current climate of the NHS and does it address the real issues of providing safer care for people with dementia? I suggest not. Patients with dementia often have admissions to acute hospitals that are unavoidable, which highlights the lack of care in the community, possibly due to cuts in the social care budget. Patients with dementia have longer lengths of stay and are more likely to die in hospital than patients without dementia, this is because they are also older, frailer and have complex comorbidities. The focus on reducing hospital stay by a consultant review once a day every day of the week, does not address the issues of care provided by the multidisciplinary team or the difficulty in accessing community intermediate care, again due to cuts in the social care budget. The National Dementia Strategy in 2009 raised all of these issues and the need to develop of an adequately staffed and trained workforce across both health and social care sectors to provide safer dementia services

Exploration of illness representation dimensions and coping strategies in the acute phase of stroke

Introduction Rapid comprehensive assessment and treatment of stroke, including the commencement of rehabilitation in the hyper acute phase has positively impacted on patient outcomes (Brooke et al. 2010; Cohen et al. 2010). The Common Sense Model of Self-Regulation identifies Illness Representation Dimensions (IRD), which impact on coping strategies and health outcomes (Leventhal, Meyer and Nerenz 1980). However, IRD have not been explored in the hyper acute phase of stroke since the development of stroke as a medical emergency. Aim The exploration of IRD and coping strategies within the first 10 days following an acute stroke. Methods Data were collected from a purposive sample (n=6) from a London Acute Stroke Unit. Semi-structured interviews, based on an interview schedule developed from published literature, a clinical nurse specialist and a stroke patient, were completed during October – December 2012. Thematic analysis was then completed. Results All participants spoke about their experience of stroke using the IRD of identity, consequences and control/cure, two participants referred to a timeline of the impact of their stroke, one participant actively searched for the cause of their stroke. Four participant applied problem-focused strategies, which included active involvement in rehabilitation, and two participants applied emotion-focused coping and discussed the futility of the rehabilitation process. Discussion Illness representation dimensions, problem-focused and emotion-focused coping strategies were identified in the hyper acute phase of stroke. Healthcare professionals need to understand these constructs in order to support patients in cognitively processing their stroke and identifying patients who are developing emotion-focused strategies that may negatively impact on their rehabilitation progress

Community- and hospital-based nurses' implementation of evidence-based practice: are there any differences?

The aim of this paper is to discuss the impact of nurses’ beliefs, knowledge and skills on the implementation of evidence-based practice (EBP) in hospital and community settings. EBP refers to the implementation of the most up-to-date robust research into clinical practice. Barriers have been well-documented and traditionally include negative beliefs of nurses as well as a lack of time, knowledge and skills. However, with degree entry nursing and a focus on community health care provision, what has changed? A comprehensive search of contemporary literature (2010-2015) was completed. The findings of this review show that the traditionally acknowledged barriers of a lack of time, knowledge and skills remained, however, nurses’ beliefs towards EBP however were more positive, but positive beliefs did not affect the intentions to implement EBP or knowledge and skills of EBP. Nurses in hospital and community settings reported similar barriers and facilitators

Development and training of healthcare assistants to join the Care Crew: supporting patients with challenging behaviour in a hospital setting.

Background Healthcare assistants (HCAs) provide care for people with dementia in acute hospital settings; current training focuses on QCF qualifications and dementia awareness. Specialist roles for HCAs are beginning to emerge. The ‘Care Crew’ at Royal Berkshire Hospital is a team of HCAs lead by a band 4 assistant practitioner. The structure of the Care Crew involves the development of HCAs to become recognised and valued members of a team, working independently to provide support and care for people with challenging behaviours, including those with dementia. Methods Care Crew members receive a programme of training and support from the Practice Educator in Dementia. Patients are referred to the Care Crew by nurses from 8 wards including elderly care, renal and bone fragility unit. The Care Crew provide one-to-one support and group activities. One-to-one support can be provided for any patient who is distressed, confused, unsettled, presents with challenging or aggressive behaviours, risk of causing harm to themselves or others, or are at risk of leaving the ward without being discharged. The Care Crew also supplements ward teams at key times of the day to support patients’ activities of living. Results Regular contact provides consistent and continuity of care for people with dementia, formal evaluation of the care crew is ongoing, but anecdotal evidence suggests a reduction in falls due to closer supervision of patients, reduction in use of anti-psychotics and improved uptake of food and drink by providing one-to-one support at mealtimes. Discussion On completion of a formal evaluation of the Care Crew, expansion of the model across Royal Berkshire Hospital will be discussed. Further expansion of the role and training of the Care Crew is currently occurring for example expanding opportunities to take patients off the wards, such as having a designated gardening area within the hospital grounds

The needs of lesbian, gay, bisexual and transsexual (LGBT) who are affected by dementia: a comprehensive scoping review

Purpose: Our aim was to undertake a comprehensive scoping review of the literature to explore the needs of people who identify as lesbian, gay, bisexual or transgender (LGBT) and are affected by dementia. Background: In the UK it is estimated that 850,000 people are currently living with dementia and this is expected to rise to over 1 million by the year 2025 with reports suggesting 5-7% of the population identify as LGBT. Evidence suggests that the LGBT population both delay in accessing healthcare and experience heteronormative services creating inequalities in experiencing good appropriate dementia care and support. There is a need to determine existing knowledge about the needs of the LGBT population who are affected by dementia in order to inform future practice, research and policy. Methods: Four databases were systematically searched along with article bibliographies. Only studies exploring LGBT populations and dementia were included, no further predetermined criteria was applied. Results: Of the 3737 papers identified 16 papers were included. The focus of studies ranged from an emphasis on LGBT partners and/or carers of people with dementia, staff and residents attitudes to LGBT people, and service provision and education around LGBT issues. Conclusion: Early findings indicate a need for a more open discussion about individual needs regarding sexuality and dementia, across all health and care settings regarding dementia care. There is some awareness of the LGBT population in long term care provision and their specific needs are beginning to be addressed, however education of policy providers, managers, staff and other residents is still required

Mentors' attitudes, beliefs and implementation of evidence based practice when mentoring student nurses in the community: a qualitative study

Background: Nursing practice based on evidence improves patient care. Mentors supporting student nurses are in clinical placements are in a unique position to demonstrate evidence based practice (EBP). The NMC (2008) suggest mentors must be able to identify and apply research and EBP, increase or review the evidence-base used to support practice and support student nurses in applying an evidence base to their own practice. However, there is limited literature on nurse mentor’s attitudes, beliefs and implementation of EBP when mentoring student nurses in the community. Methods Data were collected via 7 focus groups in 2015 with 33 community nurse mentors from one NHS Foundation Trust. Community settings of the mentors included: community hospital inpatients and outpatients, minor injury units, and district nurse teams including specialist teams such as long term conditions, tissue viability, respiratory and cardiac rehabilitation. The interview schedule was based on information from a pilot group and previous literature. Data was analysed using Interpretative Phenomenological Analysis (IPA). Results Emergent super-ordinate themes from community nurse mentors included: 1) implementation of EBP 2) community nursing versus acute hospital nursing 3) implications of degree entry nursing 4) bidirectional learning 5) being part of the students’ journey a role model 6) EBP versus practice based evidence 7) barriers: IT, time, student attitudes, agency staff, mentorship course, paperwork 8) facilitators: IT, time, student attitudes, resources. Discussion All nurse mentors believed their clinical practice to be informed from evidence, specifically the structure provided from guidelines and policies both nationally and locally. Reviewing guidelines occurred in job descriptions of more senior roles. Mentors invested time and energy in supporting students to implement EBP as recognised the importance of educating the next generation of nurses. Issues regarding the mentorship course arose including; accessibility, length of the course and content

The challenge of nutritional support in hospital wards

Eating and drinking problems among patients with dementia are too often overlooked in hospitals, as dementia care specialist Joanne Brooke discovered from personal experience

Impact of a dementia friendly ward environment on the care nurses provide for patients: a qualitative study

Background The Dementia Action Alliance (DAA) has launched the ‘Dementia Friendly Hospital Charter’ (2014). The creation of a dementia friendly ward should help to reduce the ‘care burden’ of dementia for staff (Andrews 2013). Nurses have reported striving to achieve good care, but felt this was not always possible (Cowdell 2010). However, there is a lack of evidence on the impact of ward environment changes on the care nurses provide for patients with dementia. Aim To explore the impact of dementia friendly environment ward changes for nurses caring for patients with dementia. Method: Data were collected from healthcare assistants (HCAs) and registered nurses (RN) working on elderly care wards within an acute NHS Foundation Trust in the UK. Nurses’ perspectives were explored via focus groups. The interview schedule was based on information from a pilot group and previous literature. Data were analysed using Interpretative Phenomenological Analysis (IPA). Results: Between September and October 2015 focus groups (n=10) were completed with HCAs (n=3), RN (n=2) and mixed (n=5), with a total of 38 staff. Focus groups lasted between 25 to 32 minutes. Emergent themes included: 1) person-centred care, 2) understanding environment changes, 3) need for a change in staff culture, and 4) positive and negative elements of environment changes. Discussion Person-centred care emerged as a priority over environment changes. Staff discussed the importance of a culture shift and the need to embrace a different approach to caring. Positive impacts of the dementia friendly ward supported this process, such as a cinema room, implementation of the care crew and a regular reminiscence activity. Some elements were disputed as supporting patients, but did provide the impression of a non-hospital environment. Minor changes to the environment were recommended

Paramedics and dementia

Paramedic students are learning more about dementia care, but how many intend to work in the field? Joanne Brooke and Marlon Stiell’s study produced some worrying findings. Dementia requires a person-centred, holistic approach to care which considers the unique challenges faced by each individual. It is essential that health care professionals are competent in a range of skills to support and care for people with dementia as this will form a major part of their role in many cases (Clissett et al 2014). Care of people with dementia has been included in many undergraduate programmes for health care professionals such as nursing and medicine (Alushi et al 2015), but has only recently been acknowledged in paramedic science programmes (Ross 2012)

Older People and COVID-19 isolation, risk and ageism

Internationally, health authorities and governments are warning older people that they are at a higher risk of more serious and possible fatal illness associated with COVID‐19. Mortality data from Oxford COVID‐19 Evidence Service (25/3/20) indicate a risk of mortality of 3.6% for people in their 60s, which increases to 8.0% and 14.8% for people in their 70s and over 80s. Therefore, the global recommendation for older populations includes social isolation, which involves staying at home and avoiding contact with other people, possibly for an extended period of time, currently estimated to be between three and four months