Care Setting
Community care, Education and Training
Care Group
Later Life, Adults
Evidence Base for Practice
Nurses are at the forefront of developing innovative ways of delivering therapeutic interventions for people with an early diagnosis of dementia. Weaks, McLeod and Wilkinson (1) believe that nurse training is not sufficient to prepare nurses to deal with the complex emotional and psychological needs of people with early dementia in the immediate post-diagnostic period. Evidence from Kitwood (2) and Sabat (3) suggests that people with early dementia would benefit from counselling interventions informed by sensitivity to the linguistic and cognitive deficits associated with dementia (2). CMHNs are a key resource in this area and are well placed to deliver counselling interventions.
References
1. Weaks D, McLeod, J. and Wilkinson, H. . Dementia. Therapy Today. 2006; 17:12-5.
2. Kitwood T. Dementia reconsidered: the person comes first. Buckingham: The Open University Press; 1997.
3. Sabat SR. The Experience of Alzheimer’s Disease: Life Through a Tangled Veil, Oxford: Blackwell; 2001.
4. NHS Education for Scotland. Working With Older People in Scotland – A Framework for Mental Health Nurses. Edinburgh: The Stationary Office.
5. Wengraf T and Chamberlayne, P. Interviewing for life-histories, lived situations and personal experience: the biographic-narrative interpretive method (BNIM) – shortest short guide to BNIM interviewing and interpretation. London and Milton-Keynes: London East Research Institute and The Open University; 2006.
Quality assurance/impact of practice
The Project Advisory Group (PAG) has, as part of its remit a key role in the quality assurance process (see ‘Practice Detail’) above. In relation to the evaluation of the projects, a mixed method approach is being adopted. This will allow both a comprehensive analysis of the participants’ experiences relevant to the project’s aims, and comparison with other studies of a similar nature. Quantitative data is collected for each participant using the “Counselling Skills Questionnaire” (a two part, 35 item, validated, self-report instrument), and the “Use of Counselling Skills Instrument” (which invites participants to provide examples of how they have used counselling skills in their professional role). The questionnaire items allow each participant’s progress to be measured (Likert scale) on constructs related to counsellor self-efficacy e.g. ‘Listening’ (capture and understand the messages that clients communicate). Changes in participants’ ratings on each construct can be measured over time, at the beginning, throughout and at the end of the project. Qualitative data is collected by the research assistant primarily through two focus groups (at the beginning of the follow up period and at the end of the data collection period, next year). In addition, three, one to one interviews are conducted with each participant using a Short Question to Initiate Narrative (SQUIN) format to minimise the interviewer micro managing the interaction (5). Data management and analysis is being facilitated by use of SPSS (Statistical Package for the Social Sciences) and NVivo8 software.
Early Findings
The following findings were presented at the BACP Research Conference in Cardiff earlier this year (9th May 2008):
• Participants in the project are highly committed and involved – it meets their needs - a cohesive group has been nurtured;
• “Clients have reported on how my practice has changed over the last months / Edited - for full text please contact contributor - recommended
Practice Summary
The research team and the participants are currently working on a project funded by the Burdett Trust for Nursing. It is a collaborative initiative involving NHS Tayside and the Universities of Abertay Dundee and Edinburgh. The University of Abertay Dundee has funded places on their Graduate Certificate in Counselling Skills course (COSCA accredited) for the 7 Community Mental Health Nurses (CMHNs). NHS Tayside has met the costs of seconding the staff and provided additional teaching resources to the University of Abertay Dundee as part of a reciprocity agreement.
The aim is to train the 7 CMHNs to deal with the more complex emotional and psychosocial issues surrounding the time of adjustment to a diagnosis of dementia.
Practice Detail
The CMHNs attended lectures/classes at the University of Abertay on a weekly basis over a full academic year. The University of Abertay Dundee Graduate Certificate in Counselling Skills is validated by COSCA (lead body for counselling in Scotland) and is a standard training package widely available across the country. Additionally, participants are involved in a monthly learning set, facilitated by the Nurse Consultant in Dementia, in which they learn, explore, discuss and develop the 9 therapeutic tasks (1) included in a recent publication from NHS Education for Scotland (4). This commenced midway through the academic year and will continue for 6 months after the end of the programme. The project is in its third and final cycle (focusing on applying the model in practice) which follows on from the completion of the Graduate programme in May 2008. The participants are tracked for a period of 6 months as they use the counselling skills they have developed with people on their caseloads.
The aim of the project is to train the 7 CMHNs to deal with the more complex psychosocial issues surrounding the diagnosis of dementia. In addition the project aims to:
1. Evaluate the perceived impact that counselling skills training has on nursing practice;
2. Identify the challenges experienced by nurses involved in introducing innovative nursing practice in this domain of dementia care, and their strategies for addressing these issues;
3. Define skills and competencies relevant to this developing role;
4. Examine the perceived relevance of different types of learning, training and supervision structures in relation to the development of competence in this area of nursing.
The project is enhancing the knowledge, skills and role of CMHN nurses, building their confidence in offering post-diagnostic early intervention and support to people with dementia at an earlier stage in the disease trajectory. Edited - for full text please contact the contributor - recommended
Challenges
The second aim of the project is to identify the challenges experienced by nurses involved in introducing innovative nursing practice into their clinical areas and the strategies they use to address these issues. It would be fair to say that at this stage of the project the CMHNs are experiencing ‘varying degrees of warmth and acceptance from within their organisations’ as they try to integrate their new experience and learning into day-to-day practice’.
Additional Comments
The project contributes to fulfilling the objectives and expectations of the following:
• Department of Health (2006) Delivering Care, Enabling Health, Edinburgh: The Stationery Office (Key messages: 4, 5, 11, 19 and 20.).
• Department of Health (2006) Delivering for Mental Health, Edinburgh: The Stationery Office.
• Department of Health (2006) Rights, Relationships and Recovery - The Report of the National Review of Mental Health Nursing in Scotland, Edinburgh: The Stationery Office.
• HEAT Targets (2008) Treatment No. 9 (Each NHS Board will achieve agreed improvements in the early diagnosis and management of patients with a dementia by March 2011), (source: http://www.scotland.gov.uk/Topics/Health/NHS-Scotland/17273/targets/Treatmet).
• NHS Education for Scotland (2008) Working with older people in Scotland; a framework for mental health nurses. Edinburgh.
• Edited - For full listing please contact the contributor - recommended