Admiral Nurse Research Articles

Implementing palliative and end of life care for people with dementia.

Dementia is characterised by memory loss, behavioural changes and decline of cognitive, social and physical functions and is a life-limiting condition. At the point of diagnosis it is classed as a palliative condition, yet there is limited public and healthcare professional awareness that, once diagnosed, a person will either die of dementia or die with dementia. This article discusses how the recognition and timing of the need for palliative dementia care is pivotal in providing person-centred care. The authors explore factors such as optimal prognostication, advance care planning, staff education and accessing support from palliative and end of life care teams and Admiral Nurses. The authors also use a fictional case study to demonstrate best practice in palliative dementia care.

Coaching members of the healthcare team to improve care provision.

Since the challenges of the coronavirus disease 2019 (COVID 19) pandemic, during which many nurses had to work in extreme circumstances and with limited resources, healthcare leaders have explored how they could better support nurses in the future. Admiral Nurses - who are supported by the charity Dementia UK to provide expert care and advice for people with dementia - have been offered coaching alongside their regular clinical supervision. In the workplace, coaching can be defined as a process that supports another person's understanding, learning, behaviour and progress. Through coaching, nurses can develop their skills and address any negative attitudes and behaviours that may be affecting their work. This article focuses on how coaching techniques and skills might assist nurse leaders to support team members to improve care provision.

Stakeholder Consultation to Establish Research Priorities for Specialist Dementia Nursing in the United Kingdom.

In the United Kingdom, there are a growing number of specialist dementia nurses called Admiral Nurses. Admiral Nurses, supported in their professional development and clinical supervision by the charity Dementia UK, work with families affected by dementia using a relationship-centred approach. Given the growing need for this type of support, Dementia UK is committed to research that will expand the evidence base for Admiral Nursing. This article describes a stakeholder consultation to identify research priorities for Admiral Nursing for the next 3 years (2023-2026). We adopted a participatory approach using an adapted Nominal Group Technique and priority-setting workshop. All elements of the process were designed in consultation with a steering group comprising a range of stakeholders, including people with dementia, carers, Admiral Nurses, Dementia UK staff and researchers. Stakeholders were identified as those who were likely to be affected by or interested in the emerging research priorities. Nominal groups were held both face-to-face and online. A total of 144 people shared their research priorities. Data generated through each nominal group were thematically analysed and then ranked in order of priority. Four themes reflecting research priority areas were taken to a priority-setting workshop for consideration. This resulted in three research priorities for Admiral Nursing: (1) people with dementia who live alone and carers who provide support from a distance; (2) people living with young onset and rarer dementia and their families; and (3) people living with multiple health conditions alongside dementia, including mental health problems. Risk, diversity and the effectiveness of Admiral Nursing were strands that ran throughout these themes. We identified shared research priorities for Admiral Nursing using a rigorous, consensus-driven approach involving key stakeholders. These priorities reflect a desire to ensure that Admiral Nursing services reach the most vulnerable people living with dementia and their families and respond to the widening health and social care inequalities faced by this group. People with dementia and carers were involved in the design of this process as members of our steering group and through consultation on our initial plans with Dementia UK's Lived Experience Advisory Panel (LEAP). People living with dementia and carers also participated in consultation groups to share their views on research priorities. All stakeholders were invited to share feedback on the themes as part of the analysis and interpretation of the priorities, and a meeting was held with LEAP to discuss the emerging priorities.

A time for adaptation and reflection: the experience of Admiral Nurses during COVID-19

COVID-19 has meant that, globally, people, organisations and governments have had to make huge changes in life and work. The aim of this study is to explore the impact of working during the first wave of COVID-19 on Admiral Nurse practice (specialists in dementia care who support families affected by dementia). Semi-structured interviews were used to gather data from 19 Admiral Nurses. Themes drawn from the data show that Admiral Nurses experienced an immediate sense of impotence and helplessness, and, from there, moved through a process of adaptation to reach a new level of competence. This research provides insight into the experiences of Admiral Nurses and their adaptability in extraordinary circumstances.

Factors Affecting Research Participation Among Specialist Dementia Nurses.

Research involvement and engagement is a vital aspect of nursing practice. However, research in dementia care remains limited compared to research focused on finding a cure, presenting a significant gap that specialist dementia nurses (Admiral Nurses) can help bridge by participating in research themselves and facilitating recruitment to research. This study aimed to assess the research involvement and support needs of Admiral Nurses and identify factors affecting their participation in research. This research is particularly timely as Dementia UK has launched its first research strategy, which necessitates strengthening research capacity within Admiral Nursing. We used a mixed methods convergent parallel synthesis design, simultaneously collecting quantitative and qualitative data. An online survey was conducted in January 2023, targeting current Admiral Nurses across the United Kingdom. The survey included questions addressing demographics, research experience, goals, barriers, facilitators, and support needs. Data analysis involved descriptive statistics, frequencies, univariate analyses, and thematic analysis. A positive relationship was found between the highest level of academic achievement and current or previous research involvement, as well as interest in becoming involved in research in the future. Although most nurses recognized the importance of research, only half reported current or past research involvement, indicating a need for increased support. A lack of access and opportunities for peer discussion hindered engagement with research findings. Time constraints, lack of support, and low confidence were major barriers to research involvement. Support needs varied but included mentorship, coaching, and the potential for a community of practice for research. This survey of Admiral Nurses sheds light on their research involvement, support needs, and barriers to participation. Recognizing the significance of research while identifying challenges and support requirements is crucial for enhancing research capacity among these specialized nurses. This study contributes valuable insights into the world of specialist dementia nursing and lays the foundation for future strategies to increase research engagement in this field.

An exploration of how specialist dementia nurses perceive and maintain the skills and competencies that frame their specialism: A qualitative survey

BackgroundUK policy for complex and long-term health conditions including dementia has recommended that specialist nursing intervention is offered across the trajectory of the condition, but there is a lack of agreement regarding the skills and competencies that specialist nurses are expected to possess. Admiral Nurses are the largest UK group of specialist dementia nurses. ObjectiveTo explore how Admiral Nurses met and were supported to meet competencies as defined in the Admiral Nurse Competency Framework, and to develop and maintain skills as dementia specialists. DesignCross-sectional, semi-structured survey. SettingOnline national survey. ParticipantsAdmiral (specialist dementia) Nurses. MethodsWe co-designed our survey with Admiral Nurses; then invited Admiral Nurses to complete it in 2022-23 Data were analysed thematically. Results68 (20% of all Admiral Nurses) completed the survey; most were female (85.2%), from a white ethnic group (88.2%); they reported on average 24 years of nursing experience. We identified three themes in responses: 1.Having time and skills for meaningful support, explored how participants were resourced with time and skills to understand and address family carer client needs by active listening, tailoring person-centred support, and “walking alongside” families. 2.Partnering family carers, concerned how they co-designed interventions with family carers, learning from these collaborative partnerships where expertise was shared. 3.Practice and peer-based learning, explored how participants took responsibility for using available training, peer learning and self-reflection to develop their practice. ConclusionsAdmiral Nurse roles enabled respondents to develop as autonomous practitioners and to access resources that supported them to build and sustain their dementia specialist practice. Learning was practice based, through partnerships with family carer clients, peer support and self-directed learning. Specialist nursing models may help address the global health workforce emergency, through enabling creative practice development and valued roles that support retention of experienced nurses.

Supporting a family living with young-onset dementia: a case study

In the UK, it is estimated that people living with young-onset dementia (YOD) accounts for a small, but significant, number of the total population living with dementia. The diagnosis happens at an unexpected time in one's life, and as a life-limiting condition, there are implications for the whole family, including managing employment, finances and debt, supporting dependent children and accessing age-appropriate support services. YOD causes a disproportionate burden on family members and appropriate care services can be challenging to find. The case study discussed follows a family's journey from pre-diagnosis, to subsequently engaging with the Admiral Nurse Helpline and then an Admiral Nurse in the family's locality, and considers the issues and challenges faced by them.

Exploring specialist dementia nursing models and their impact on people living with dementia and their family: A systematic review

AbstractBackgroundEvidence that brings together the attributes, specialist knowledge, skills, and competencies required by specialist dementia nurses to fulfil their role is currently lacking, making it difficult to assess the effectiveness of specialist nurse‐led interventions. We systematically reviewed the evidence for specialist dementia nursing to determine how it is defined in terms of key skills, models of delivery, and the impact on families and people living with dementiaMethodWe searched for papers using three databases (MEDLINE, CINAHL, PsycINFO), grey literature (EThOS), and the National Institute for Health and Care Excellence (NICE) evidence search. Search terms related to ‘specialist nursing’ and ‘dementia’ were used. We screened titles and abstracts of identified articles and conducted forward searches for additional relevant studies. Two authors independently rated study quality. Findings were synthesised narratively.Result31 studies were included in the review; 26 were conducted in the UK or USA using a range of methodologies. Role titles varied to include “Admiral Nurses”, “Nurse Practitioners” and “Clinical Nurse Specialists”. We found limited evidence comparing the knowledge, skills, and competencies required by specialist nurses except Admiral Nursing where these were described in three studies. In RCTs (n = 2), specialist nursing did not improve donepezil adherence; and personalised emails to family carers from a nurse specialist did not increase carer self‐efficacy when compared to less intensive interventions. In non‐randomised studies, a USA Nurse Dementia Care Manager service was associated with fewer emergency room and hospital admissions; there were no differences in clinical or cost outcomes in an Admiral Nursing service; and training inpatient specialist nurses in a behavioural intervention increased use of pain‐ relief medication and reduced patient length of stay. Of the 31 studies, 4 reported high carer satisfaction with specialist nursing.ConclusionWe identified only one framework defining specialist dementia nursing competencies, and limited evidence for effectiveness of specialist nursing dementia services on families affected by dementia, despite care received being highly valued. No RCT has measured the impact of specialist nursing on family carer and client outcomes relative to less specialist care.

Could you be a consultant Admiral Nurse for frailty?

Could you be a consultant Admiral Nurse for frailty?

Hope: a tool for working with families affected by dementia during the COVID-19 pandemic

SUMMARYThe COVID-19 pandemic significantly increased the challenges faced by families affected by dementia, leading to an immediate increase in both the number of calls received by Dementia UK's Admiral Nurse Dementia Helpline and the levels of distress and complexity of the calls. Consequently, Admiral nurses experienced feelings of helplessness, echoed in the experiences of other health professionals. One of the approaches that enabled Admiral nurses to cope during this time was ‘hope’, and this article explores the use of hope-based approaches as tools for working therapeutically with families during the pandemic. Although written from the perspective of Admiral nurses, the approaches described are transferable to others working across health and social care. The article provides an overview of one of the main models of hope in the healthcare literature, Snyder's hope model, and explores the literature on hope more widely. Fictitious case vignettes, drawn from clinical practice during the pandemic, are used to illustrate how hope-based approaches can be applied to practice.

Reducing and managing dementia risk in primary care

It is expected that the prevalence of dementia will continue to rise over the coming years, with subsequent effects on the well-being of families and increasing the pressure on an already over-burdened health and social care system. This article discusses the modifiable and non-modifiable risk factors for dementia and suggests potential interventions to support the reduction and management of dementia-related risks in primary care. It uses a case study to demonstrate the benefits of a dementia specialist Admiral Nurse role in primary care. The potential for dementia-related risks to escalate can have a wider effect on a person’s family if these are not appropriately identified and managed through specialist support.

What are the information needs of people with dementia and their family caregivers when they are admitted to a mental health ward and do current ward patient information leaflets meet their needs?

An admission to a mental health ward is an uncertain and unexpected part of a person's journey with dementia and consequently, families require information about what to expect and how to prepare. This study aimed to establish the information needs of people with dementia and their families at the point of admission to a mental health ward and to collate existing ward information leaflets to explore if they meet these information needs. This research was conducted in two parts: (1) a qualitative study using focus groups, one with people with dementia and family carers with lived experience of such an admission (n = 6), and another with Admiral Nurses (n = 6) to explore information needs at the point of admission. (2) Each National Health Service(NHS) mental health trust (n = 67) was asked to provide a copy of their ward information shared at admission. A total of 30 leaflets were received from 15 NHS trusts; after removing duplicates, 22 were included. A content analysis was conducted to evaluate to what extent leaflets met the information needs identified by focus groups. Two main categories 'honest, accurate and up-to-date information' and 'who is the information for' and four subcategories were derived from focus group data. Participants felt that people with dementia and their families were likely to have different information needs. Material for people with dementia needed to be in an accessible format. Information should cover the aim of the admission, a timeline of what to expect and details about how families will be involved in care. Practical information about what to pack and ward facilities was valued. Participants spoke about the need to consider the tone of the information, given that people are likely to be distressed. The information leaflets reviewed did not meet the information needs identified by focus group participants. People with dementia and family carers have different information needs at the point of admission to a mental health ward. Information provided to people with dementia needs to be in an accessible format with content relevant to these needs. Wards should aim to co-create information to ensure that they meet people's information needs. This research was supported by a patient and public involvement (PPI) group of people with dementia and carers who have experience in mental health wards. The idea for the study came from the group and was motivated by their experiences. The PPI group helped with the design of the study and took part in the focus groups. The information generated has been written up in this paper, and the knowledge generated has also been used to co-create a guide for wards on writing their information leaflets and to support the co-creation of a public information leaflet by Dementia UK about mental health admissions for people with dementia.

Admiral Nursing: supporting generalist nurses to work with families affected by dementia.

The number of people with dementia in the UK is expected to significantly increase over the next two decades, which has implications for service demand and delivery, as well as for the development of the workforce across all health and social care services. The health and social care workforce requires a range of knowledge and skills to enable staff to meet the complex needs of people with dementia and their families. In the UK, a framework outlining dementia training standards was developed to address this; however, the quality and efficacy of this training is unclear and there are growing doubts that such a 'one-size-fits-all' approach can meet the diverse needs of the workforce. This article discusses the education needs of the health and social care workforce in relation to dementia and outlines how the specialist role of the Admiral Nurse can support these needs. The article also details two case studies that demonstrate the role of the Admiral Nurse in identifying and supporting the education needs of generalist nurses working in acute hospital and primary care settings.

Role of Admiral Nurses in supporting people with learning disabilities and dementia

Role of Admiral Nurses in supporting people with learning disabilities and dementia

'It's just incredible the difference it has made': family carers' experiences of a specialist Lewy body dementia Admiral Nurse service.

BackgroundLewy body dementia (LBD) is characterised by a complex array of symptoms. Being a family carer of someone with LBD can be challenging, and is associated with high levels of stress, depression and anxiety. Admiral Nursing services support family carers of people with dementia in the UK by providing tailored information, advice and therapeutic support. Recently, the Admiral Nurse model has been adapted to the needs of more specific populations, including the introduction of a new, specialist LBD Admiral Nurse.Objectiveto explore family carers’ experiences of the LBD Admiral Nurse service.Methodsfourteen family carers of people with LBD were interviewed about their experiences of the LBD Admiral Nurse service. Interview transcripts were analysed using thematic analysis.Resultsfour themes were identified: theme 1 described how participants valued the LBD Admiral Nurse’s specialist expertise, which contrasted with the lack of knowledge they encountered in other services. In theme 2, participants described how the practical, tailored support provided by the LBD Admiral Nurse enabled them to better manage a variety of caring-related challenges. Theme 3 captured the emotional benefits that participants gained from being able to talk to someone who understood their situation. In theme 4, participants explained how the reliability of the LBD Admiral Nurse’s support helped them feel supported in their role.Conclusionsthe specialist knowledge and expertise of the LBD Admiral Nurse enabled family carers to better support the people they cared for, and to relieve some of the emotional stress associated with caring.

From Traveller community to dementia nurse specialist

How an Admiral Nurse from a Traveller background addresses engagement and discrimination

What it means to be an Admiral Nurse

What it means to be an Admiral Nurse

Be aware of dementia

Dementia UK’s Admiral Nurses are creating a user-friendly resource for everything you want to know about the condition

Admiral Nurses: what these varied roles involve

The education and experience you need, and the salary level, CPD and clinical leadership opportunities you can expect

Using video consultations to support family carers of people living with dementia

Established in 2019, the Lincolnshire Admiral Nurse Service supports family carers of people living with dementia through psychosocial interventions. Before the coronavirus disease 2019 (COVID-19) pandemic, the team provided home visits as standard, but the fact that Lincolnshire is a large rural county affected the team's ability to provide timely support to all the carers who needed it. In 2019-20, a practice development project underpinned by participatory action research was undertaken to trial the use of video consultations with carers. However, carers' uptake of video consultations was low and the project was affected by the COVID-19 pandemic. This article describes the project and discusses the findings of its evaluation. The Admiral Nurse team had mixed experiences and felt that, overall, its support was more effective when delivered face to face. The project provides insights into the challenges and benefits of video consultations for delivering psychosocial interventions to carers of people living with dementia.