“My Mum was admitted to the medical assessment unit. The next day she was moved to a ward…this was after I told the staff she was very distressed by being moved about. She became so distressed she pulled her cannula out…. I spoke to the nurses in ward about not moving her again, but they said it would likely happen because of policy. Luckily she was discharged suddenly and this did not happen.”
“I would like to say how kind, caring and efficient all the staff were to my Dad when he was admitted before Christmas. He has dementia and as a result really struggles to be an inpatient and get very distressed easily. My mother and siblings were able to stay overnight to keep him calm and secure, and all the staff we encountered, from medical to domestic, showed immense understanding and compassion.”
These two stories from the Care Opinion website show the different experiences people with dementia are having in our hospitals, and the clear need for a consistent approach across Scotland, to ensure both they and their carers can be confident that no matter where they are treated, their care is of good quality. The Dementia in Hospital Collaborative, led by Healthcare Improvement Scotland’s Focus on Dementia team and the Alzheimer Scotland Dementia Nurse Consultants, aims to provide that approach.
A national priority
Dementia was made a national priority by the Scottish Government in 2007. We have made huge strides in improving hospital care for people living with dementia and their carers in the past 12 years. Unfortunately, these are not universal. Excellent work has taken place in some areas to ensure patients living with dementia experience minimal moves during hospital stays and where moves are necessary they are planned and at appropriate times. Yet in other areas, patients continue to be moved or “boarded”, creating distress and potentially prolonging hospital stays. I’ve visited patients requiring one to one nursing due to distressed behaviour to find that they have a nurse who sits and observes them, only intervening to stop “unsafe” behaviour. In other areas I have witnessed this being transformed into a therapeutic experience for the patient, with the one to one being used to provide social interaction and meaningful activity.
“We have made huge strides in improving hospital care for people living with dementia and their carers in the past 12 years.”
Improving on leadership
With a focus on preventing, identifying and managing the symptoms of stress and distress, the Dementia in Hospital Collaborative will support improved care for people with dementia in hospital settings. Key to this is ensuring there is clear leadership in each board to drive and monitor improvement. This leadership and improvement role is provided by our group of 16 Alzheimer Scotland Dementia Nurse Consultants, of which I am one. Our roles are four fold: to provide professional leadership, develop expert practice, training and education and develop and support practice improvement. These roles are partially funded by Alzheimer Scotland and provide the opportunity to develop these aims in a nationally coordinated way.
“With a focus on preventing, identifying and managing the symptoms of stress and distress, the Dementia in Hospital Collaborative will support improved care for people with dementia in hospital settings.”
As individuals, not only do we come from diverse geographical locations, we also have quite diverse professional backgrounds. Some of us have worked in mental health and general nursing, some have come directly from clinical practice and others have had roles in practice development or education. Our day to day roles also vary depending on our board, with a combination of direct patient care and community care. Some have input in mental health settings and others only in acute settings. The bringing together of our varied settings, roles and experience allows us to have a view of the wider landscape but also to identify common themes and challenges. Dementia is a complex condition, often accompanied by frailty and chronic disease. We’re just at the start of our journey to improve things, but believe that by combining our expertise with that of the Focus on Dementia team, we can to make a real difference for people living with dementia and their carers when it comes to hospital care.
Matilda McCrimmon is Alzheimer Scotland Lead Nurse for Dementia at Golden Jubilee Hospital.