Admiral Nursing in Primary Care: Peri and Post-Diagnostic Support for Families Affected by Dementia within the UK Primary Care Network Model

Aldridge, Zena; Dening, Karen Harrison

doi:10.21926/obm.geriatr.1904081

Cited by 11 publications

(12 citation statements)

References 5 publications

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“…Care homes in the UK are categorised as either nursing or residential care homes. Nursing homes offer on-site 24-hour nursing care and support for activities of daily living (ADLs), whereas residential care homes offer 24-hour care to support ADLs, with any nursing needs met by external National Health Service (NHS) community nurses [19][20][21]. All care homes in the UK are monitored by regulatory bodies within each of the devolved nations to ensure they meet the prescribed standards of care [22].…”

Section: Care Homesmentioning

confidence: 99%

“…A case management approach ensures expertise from all areas is harnessed and care delivered in a consistent, efficient and cost-effective way [38,39]. The Admiral Nurse ABC model of case management applied to MDT or PCN locality working seeks to integrate health and social care services as well as those provided by the private and charity sectors to support families affected by dementia, wherever the person with dementia may reside (see figure 2) [40].…”

Section: Admiral Nurse Case Managementmentioning

confidence: 99%

“…Whilst GPs have clinical authority, they may have limited knowledge of care home residents and therefore rely on the input of family members and/or care staff to ascertain the normal presentation of the person with dementia and to alert them to deterioration [89]. In using a biopsychosocial model of case management Admiral Nurses consider the complex needs of the residents in totality by incorporating relational, person-centred and biomedical models of care a when communicating and coordinating care [40,85]. Such an approach improves consistency across services to promote clearly defined goals of care so that the person with dementia receives the right care at the right time, whilst taking their wishes and preferences into account and ensuring they are not exposed to futile treatments.…”

Section: Communication and Resource Utilitymentioning

confidence: 99%

“…Therefore, delivering the EHCH framework will require careful consideration of the skill mix required to ensure the needs of care home residents are adequately served within this new model of care [40]. Reconfiguration of the current workforce will not address the gaps in skills and knowledge and there is an urgent need to consider dementia specialist roles, such as Admiral Nursing, within PCN's and integrated multi-disciplinary teams to address this current gap [40].…”

Section: Confidence and Competence To Carementioning

confidence: 99%

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Admiral Nurse Case Management within Enhanced Health in Care Homes

Aldridge¹,

Dening²

2021

obm geriatr

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The United Kingdom’s (UK) older population is higher than the global average. Over the next 20 years, England will see an increase in the number of older people who have higher levels of dependency, dementia, and comorbidity many of whom may require 24-hour care. Currently it is estimated that 70% of residents in nursing and residential care homes either have dementia on admission or develop it whilst residing in the care home. The provision of high-quality care for this population is a challenge with a lack of consistency in the provision of primary care and specialist services and a known gap in knowledge and skills. The NHS Long Term Plan aims to move care closer to home and improve out of hospital care which includes people who live in care homes by introducing Enhanced Health in Care Homes (EHCH). However, such services need to be equipped with the correct skill mix to meet the needs of the care home population. Admiral Nurses are specialists in dementia care and are well placed to support the delivery of EHCH and improve access to specialist support to care home residents, their families, care home staff and the wider health and social care system. This paper discusses current gaps in service provision and how both the EHCH framework, and the inclusion of Admiral Nurses, might redress these and improve outcomes.

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Section: Care Homesmentioning

confidence: 99%

Section: Admiral Nurse Case Managementmentioning

confidence: 99%

Section: Communication and Resource Utilitymentioning

confidence: 99%

Section: Confidence and Competence To Carementioning

confidence: 99%

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Admiral Nurse Case Management within Enhanced Health in Care Homes

Aldridge¹,

Dening²

2021

obm geriatr

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“…Admiral Nurses provide specialist support to people with dementia and their families from peri diagnosis through to post-bereavement, using a biopsychosocial approach to care ( Aldridge & Harrison Dening, 2019 ) across the NHS Dementia Well Pathway ( NHS 2016 ; Figure 2 ). The aim of Admiral Nursing services within acute care settings is to optimise the outcomes for families affected by dementia by delivering relationship-centred dementia care and improving the practice of staff across the hospital ( Figure 3 ).…”

Section: Admiral Nursing In Acute Hospitalsmentioning

confidence: 99%

Admiral Nursing—A Model of Specialist Dementia Care in Acute Hospitals

et al. 2020

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Introduction The rising prevalence of dementia has led to increased numbers of people with dementia being admitted to acute hospitals. This demand is set to continue due to an increasingly older population who are likely to have higher levels of dependency, dementia, and comorbidity. If admitted to the hospital, people with dementia are at higher risk of poor outcomes during and following a hospital admission. Yet, there remains a significant lack of specialist support within acute hospitals to support people with dementia, their families and hospital staff. Methods Admiral Nurses are specialists that work with families affected by dementia and provide consultancy and support to health and social care colleagues to improve the delivery of evidenced based dementia care. Historically, Admiral Nurses have predominantly been based in community settings. In response to the increasing fragmentation of services across the dementia trajectory, the Admiral Nurse model is evolving and adapting to meet the complex needs of families impacted upon by dementia inclusive of acute hospital care. Results The Admiral Nurse acute hospital model provides specialist interventions which improve staff confidence and competence and enables positive change by improving skills and knowledge in the provision of person-centred dementia care. The role has the capacity to address some of the barriers to delivering person centred dementia care in the acute hospital and contribute to improvements across the hospital both as a result of direct interventions or influencing the practice of others. Conclusion Improving services for people with dementia and their families requires a whole system approach to enable care coordination and service integration, this must include acute hospital care. The increasing numbers of people with dementia in hospitals, and the detrimental effects of admission, make providing equitable, consistent, safe, quality care and support to people with dementia and their families a national priority requiring immediate investment. The inclusion of Admiral Nursing within acute hospital services supports service and quality improvement which positively impacts upon the experience and outcomes for families affected by dementia.

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Further development needed: models of post-diagnostic support for people with dementia

Low

Gresham

Phillipson

2022

Current Opinion in Psychiatry

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Purpose of reviewThere is increasing recognition of a service gap immediately after diagnosis for people with dementia and carers. This narrative review of models of post-diagnostic support focuses on recent developments and offers suggestions for future development. We present the current evidence for these models and consider the service components they provide against the recommendations of clinical guidelines and principles underpinning ideal post-diagnostic support. Recent findingsModels of post-diagnostic support include a short-term support worker, ongoing support worker, centre-based support, primary care management, and specialist dementia clinics. Of these, specialist dementia clinics that include ongoing support workers provide most components of an ideal and timely post-diagnostic support framework, but may be more costly to implement universally. The greatest research evidence is for the benefits of long-term support models, specifically case management, though this does not necessarily include medical care or nonpharmacological interventions. There is sparce evidence for the benefits of short-term support worker models such as dementia advisers for people with dementia and carers. SummaryFurther development is needed to create whole-system models of dementia support which meet the needs of people with dementia and their carers, are timely, accessible and equitable, and can be implemented universally.

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Admiral Nursing in Primary Care: Peri and Post-Diagnostic Support for Families Affected by Dementia within the UK Primary Care Network Model

Cited by 11 publications

References 5 publications

Admiral Nurse Case Management within Enhanced Health in Care Homes

Admiral Nurse Case Management within Enhanced Health in Care Homes

Admiral Nursing—A Model of Specialist Dementia Care in Acute Hospitals

Further development needed: models of post-diagnostic support for people with dementia

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