My future wishes: Advance Care Planning for people with dementia

Beverley Marriott is an Advanced Nurse Practitioner working in the Birmingham community healthcare foundation trust. She is also a King’s College Older Person Fellow. She tweets @bevbighair

The “My future wishes: Advance Care Planning (ACP) for people with dementia in all care settings” document was recently published by NHS England, Dementia Team and End of Life Care Team.

Advance care planning (ACP) is a vital part of personalised care planning. This recently published document acts as a resource to support clinicians and practitioners who provide health and social care for people with dementia. It aims to ensure people living with dementia can develop an ACP through initiating conversations with their supporting clinicians and/or loved ones. It aims to offer a consistent standard of support for patients diagnosed with dementia using ACPs that are developed in partnership with patients and families.

ECFs and ANPs – The Future of Frailty?

Rachel Viggars is an Advanced Nurse Practitioner at Ashley Surgery (North Staffordshire CCG). Brigitte Knowles is a Elderly Care Facilitator at Madeley Surgery (North Staffordshire CCG). Both are undertaking the MSc Frailty and Integrated Care at Keele University.

We’ve always loved working with older people. Our roles in general practice certainly facilitate this!  When we were offered the opportunity to study at Masters Level in Medical Science: Frailty and Integrated Care, we jumped at the chance.  Finally, there was a focus on older people and an opportunity to improve standards and care.  But aside from this, it was a fantastic opportunity for us to complete a MSc in an area that we are passionate about, and the multi-professional learning that took place, really valued us as individual Health Care Professionals.  We were able to share and learn from the other professionals on the course and we really started to believe that we could do this and make a difference to our patient groups. 

Book review: Visiting the Memory Café and other Dementia Care Activities

Matthew Berrisford is a Charge Nurse at The Meadows Community Hospital, Pennine Care NHS Foundation Trust. In this blog post he reviews the recently published book: Visiting the Memory Cafe and Other Dementia Care Activities. He tweets @berrisfjord

Caroline Baker follows her previous publication, Developing Excellent Care for People Living with Dementia in Care Homes, with another informative and practical guide to asset-based and person-centred care.

Visiting the Memory Cafe and Other Dementia Care Activities has been developed by Baker and her colleagues at Barchester Healthcare as a framework for planning and implementing programmes of activity that optimise the wellbeing of people living with dementia.

The framework encompasses seven domains of wellbeing – identity, connectedness, security, autonomy, meaning, growth and joy – and aligns these with evidence-based activities that can be tailored to individual ability, history, and preference.

Swallowing Awareness Day #swallowaware2018

Esther Clift is a Consultant Practitioner in Frailty and Chair of Wessex BGS, as well as the Vice Chair of the BGS Nurses and AHP Council. She tweets as @EstherClift

The Royal College of Speech and Language (RCSLT) held a Symposium on dysphagia to work collaboratively at a system wide level in order to improve patient care, safety and outcomes for adults with dysphagia. The current prevalence data was presented in conjunction with NHS Improvement and the Academy of Medical Royal Colleges. Kamini Gadhok, MBE, the CEO for the RCSLT opened the symposium.

Dysphagia is a significant issue for patient safety. The reality of choking and asphyxia is firmly on the agenda since some high stake cases in February 2015, over ‘a risk of death from asphyxiation by accidental ingestion of fluid/food thickening powder.’

Fostering attachment in dementia care

Matthew Berrisford is a Charge Nurse at The Meadows Community Hospital, Pennine Care NHS Foundation Trust. He tweets @berrisfjord

One of the most useful pieces of advice I can share with a colleague working in dementia care is this: whenever confronted with what you perceive to be attention­-seeking behaviour, reframe it to yourself as attachment-seeking behaviour.

Attachment is a hard-wired evolutionary mechanism in all mammals. Simply put, in order to survive, infants must imprint upon a main carer (typically one or both parents) to ensure that their essential needs are met.

These needs are not purely physical (food, drink, protection); the relationship itself is essential. This fact is aptly demonstrated by animal experiments (Harlow’s monkeys and Skinner’s rats, for example) which consistently show that infant mammals raised in isolation – with no access to a main carer to imprint upon – age quickly and die younger.

Making the most of our assets

Beverley Marriott is an Advanced Nurse Practitioner working in the Birmingham community healthcare foundation trust. She is also a King’s College Older Person Fellow. She tweets @bevbighair

The Reimagining community services report (Kings Fund 2018) highlights the need for strengthening community services with the aim of supporting our  older population, bringing to reality the vision set out in the NHS Five Year Forward View.

Unfortunately, the concept of reimaging services brings about concerns with growing financial and workforce pressures, these pressures could have a huge effect on the delivery of the recommendations. This could have a major impact on the ability of service providers to deliver services to meet the needs of the service user.

The Reimagining Community services report suggests that radical transformation of community services is required.  This would mean an additional share of the NHS budget. The NHS budget would be given to these services in order to make effective use of all the assets with our community. 

Is this your first time?

Dawne Garrett is Professional Lead for Older People and Dementia at the Royal College of Nursing (RCN) Eleanor Sherwen is Professional Lead for Palliative and End of Life Care, and also works at the RCN. They will be delivering a workshop at Living and Dying Well with Frailty Meeting on 6 March in London. Please note this meeting has now sold out and there will be no on site registration. To join the waiting list please email registrations@bgs.org.uk

Approaching end of life care discussions with the patient for the first time…

Dawne and I have been asked to deliver a 60 minute workshop on this key and sometimes challenging area of practice. The importance of choice and the delivery of holistic person centred care is repeatedly highlighted in the literature, both from researchers and policy makers.  Yet how can we even begin to deliver person centred care when there is at times a reluctance to open up and initiate these essential conversations? Let alone when communicating with someone who has limited sight, poor hearing and cognitive impairment. The evidence says that professionals can feel more comfortable approaching conversations in relation to sex, rather than having conversions with patients and those that are important to them focused on death and dying. 

Blue Ribbon Patient: Do Not Transfer

Rick Strang RN is Emergency Care Improvement Lead at Isle of Wight NHS Trust in England. When not involved in all types of emergency care Rick is usually finding innovative ways to avoid household chores.

Most of us across acute care have been involved in late night bed pressures that call for that dreaded decision to need to move some patients around between wards. Typically we see the only beds available to be surgical ones whilst the demand is for acute medical beds. Moving acute medical patients directly to these outlying beds from the emergency department (ED) may present too much of a risk. Lower acuity patients from acute wards are therefore often sought out to be transferred into these surgical beds thus making way for the more acute ED demand. End of Life (EoL) patients seem particularly at risk of being moved, which can be very distressing for families, friends, the patient and the care teams.

LOST: Sense of humour

Bridget Leach has been a nurse for over 30 years. She currently work in falls prevention but was also a ward nurse and ward sister for many years.

LOST: Sense of humour OWNER: NHS Reward for return: happier, healthy & retainable workforce.

The above may seem flippant but a simple google of the term ‘Do hospital managers have a sense of humour?’ returned a myriad of articles including academic research.

Some of the articles were what I would consider odd; for example; a member of hospital staff doing tricks with disappearing scarves while …”the surgeons began cutting away dead flesh …” to a ‘humour cart’ containing, amongst other things, ‘funny props’; I know plenty of hospital staff who, in certain circumstances, would consider a bedpan on the head and a proctoscope a funny prop so who knows?

Book Review: Please tell me…

Liz Charalambous is a nurse and PhD student. She tweets @lizcharalambou and is a regular guest blogger for the BGS. Here she reviews ‘Please tell me…’ by Julia Jones and Claudia Myatt.

Without a doubt, one of the most important documents in older person care is the Alzheimer’s Society This is me support tool. It enables carers to access information with which to provide holistic care and is underpinned by a social model of care rather than a medical model, so important in today’s world of fast paced, pressurised, and increasingly politicised healthcare services. It places the person in the centre of care, ensuring their likes, dislikes, and preferences are recorded for the whole team to access.

Indeed, a favourite teaching strategy when introducing new students to dementia care is to provide them with two copies of ‘this is me’ and ask them to take them home for their partners or significant others to complete in the manner of ‘Mr and Mrs’ style 1970s TV programme. I have heard many stories of students returning the next day reporting back to the group that their other half had failed hopelessly in filling in the form, prompting them to realise the precariousness of ensuring person centred care in such instances.