Report of an evaluation of a Nurse-led Dementia Outreach Service for people with the behavioural and psychological symptoms of dementia living in residential aged care facilities

Abstract

This paper describes the implementation and evaluation of a Dementia Outreach Service (DEMOS). The service is led by the first Nurse Practitioner in Dementia Care in the State of Queensland in Australia and is highly innovative in terms of its mode of delivery. The evaluation took place due to a perception that new models such as the DEMOS often fail to gain momentum due to a lack of data on their effectiveness and efficiency. The parameters of the project were to evaluate the extent to which the DEMOS met its key deliverables, focusing specifically on outcomes for residential aged care facilities (RACF) residents and staff. The study involved both quantitative and qualitative data collection. Qualitative data was collected through interviews, focus groups and reflective journals. A survey which was administered at three stages of the 12 months of the study was the main source of quantitative data. Additional statistical data was collected from relevant healthcare providers. Twenty RACFs within a specific health service district participated in the study. This included an intervention group of 7 facilities (which received the service) and a control group of 13. A total of 320 RACF staff participated in Stage 1 of the study, although due to staff attrition this had reduced to 153 (54.6%) at Stage 3. Attrition rates were much lower in the 7 intervention facilities, with 67.9% of the original sample remaining at Stage 3. To augment the quantitative data collected as above, drawing on a range of qualitative techniques the researchers canvassed the perceptions, thoughts and opinions of differing stakeholders. The qualitative data proved extremely valuable in confirming the success of DEMOS. KEY SUCCESS AREAS: Increased self-confidence among staff in dealing with residents with dementia; reduced stress among staff; reductions in the instances of difficult behaviours; reduced referrals to acute sector services; high levels of satisfaction among RACF management regarding DEMOS; and a process of continuous improvement of DEMOS based on stakeholder feedback. Recommendations for the future directions of the service include: The continued support and expansion of DEMOS; An increase in the DEMOS service portfolio to actively assist facilities to change the culture of care amongst RACF carers; and Showcasing of DEMOS as an example of 'best practice' in dementia care to argue the need for provision of additional Nurse Practitioners specializing in dementia care.