It has been well documented that there is a lack of dementia knowledge of both medics and nurses on the general wards. This perceived lack of knowledge together with demanding work loads, and pressure on beds often means that people least able to express their needs or emotions are labeled 'difficult' and we are requested to medicate them or transfer them to a psychiatric hospital (Moyle et al, 2008). Staff identified the need for a robust training and education programme on dementia in a training needs analysis undertaken in 2009.

Therefore a nurse-led initiative was implemented to improve approaches towards dementia within a general older people’s community hospital. A validated tool entitled ”Approaches to Dementia Questionnaire” (ADQ) was circulated to all staff groups within the community hospital to establish a baseline to develop education and training on dementia, which resulted in the design of a tiered approach training programme. This case study will describe the development of the first tier of this initiative to change practice.

Biggart Hospital is a small general community hospital within South Ayrshire. Predominately for patients aged 65 and over it consists of a day hospital and 164 in patient beds across six wards. There are two continuing care wards, and four rehabilitation and assessment wards. In common with all members of the community, people with dementia can become physically unwell and require general hospital care. Demographic changes and an ageing population mean we will see a disproportionate increase in the common conditions of old age, such as cancer, stroke, and dementia (The Royal College of Psychiatrists, 2005). In addition, dementia is a major risk factor in developing delirium.
In the Dementia Manifesto (Alzheimer Scotland, 2007) it is considered best practice for people with dementia, as with all older people, to be treated with dignity throughout their healthcare journey. To make this a reality in the clinical setting it is necessary to ensure all levels and grades of staff receive some training in dementia care (Cheston and Bender, 1999).

Therefore for the purpose of this initiative it was decided to take a tiered approach in delivering dementia awareness to all staff groups who may come into contact with a person with dementia, from porters and domestics to advanced nurse practitioners. Initially this initiative would be piloted at the Biggart Hospital with a view if successful and sustainable it could potentially be delivered across the organization.

The Biggart Initiative Dementia Sub-group decided to develop an education and training programme. However, in the first instance the Alzheimer Scotland leaflet “What is Dementia” was distributed to all staff within the Biggart l via their wage slips. To complement Tier 1 and to raise the awareness to all staff within the Biggart a booklet was developed entitled “What Everyone in Our Hospital Needs to Know about Dementia” to be given to all staff who attended the Dementia Awareness session.

A key message f

Although dementia care is considered a priority by the Scottish Government and a new dementia strategy is planned in 2010 there are many obstacles to overcome when trying to implement a new initiative to change practice. For example competing demands on staff time, releasing staff from patient care / duties, lack of resources, coordinating various staff groups and support from some of their managers.
Furthermore an added challenge was for the authors to coordinate their workload to free time to design, implement, deliver and evaluate the training programme.
To address these challenges the authors required to be flexible in the delivery of the sessions in order to target the various staff groups. Support from some managers was instrumental in ensuring attendance. We found that anecdotal dialogue between staff resulted in others being keen to attend the training sessions.
Fortunately purpose built accommodation is freely available within our hospital, however we were unable to accept the offer of participation from our University colleagues due to cost implications.

This hospital has recognized that addressing the needs of the person with dementia is imperative within a general hospital setting. As a result of this initiative the awareness of dementia is now high amongst all staff groups; from identification of the condition to positive strategies on how best to improve the experience of the person with dementia in the acute clinical setting.

Subsequently to address Tier 2 of this initiative Dementia Champions have been identified and will undertake a more comprehensive development programme. The dementia awareness sessions will be delivered in other community general hospitals within Ayrshire and Arran.