RCN dementia project

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During 2011 the RCN facilitated a national project supported by the Department of Health, to influence and guide the provision of dementia care in acute care settings.

Dementia is one of the most important issues we face as the population ages. There are currently approximately 820,000 people with dementia living in the UK, including 16,000 people under the age of 65. This figure is set to rise to approximately two million by 2033.

Improving the quality of care in general hospitals has been identified as a priority within national dementia strategies. The first round of the national audit of dementia care in general hospitals has found wide variation between participating hospitals on key standards. The report, published in December 2011, presents the findings and makes a series of recommendations which includes recommendations for Government departments, regulatory and professional bodies, commissioners, trust boards, directors of nursing and ward managers. For the full report and an executive summary see Royal College of Psychiatrists: National Audit of Dementia.  

Up to 70 per cent of acute hospital beds are occupied by older people, approximately 40 per cent of whom have dementia. However, patients who have dementia experience many more complications and stay longer in hospital than those without dementia. It is also estimated that 30 per cent of people will die with dementia and many of these die in general hospital settings.

This poses a key challenge as acute general hospital settings are often not conducive to the needs of people with dementia. With approximately 97 per cent of nurses in acute care settings reporting that they are already caring for someone with dementia, the RCN believes that it is essential that this issue is addressed.

Survey of practitioners

As part of this RCN project, a survey of health care professionals was carried out in January and February 2011 to identify examples of best practice that help to promote dignity, improve understanding and enhance the delivery of care.

Findings from over 700 respondents indicated that a number of approaches are required to support improvements in care. However, most important was felt to be the involvement of family carers, and the training and development of staff.

A number of other significant approaches included: improving identification and assessment of people who have dementia; supporting nutrition; improving end-of-life care; making changes to the physical environment to make it ‘dementia friendly’; using life-story information to support care; making visiting times more flexible; providing stimulation and activity; and involving volunteers.

Respondents emphasised the importance of having support from the trust board, backing from senior nurses, mental health liaison and dedicated dementia care posts to provide leadership. Barriers to delivering good quality care included pressure of existing workload and insufficient staffing, movement of patients between wards, inappropriate environment in terms of lighting and space, and a lack of funds to support and drive improvements. To find out more about the survey results, read Dignity in Dementia: Transforming General Hospital Care. Outcomes from Survey of Practitioners (PDF 191.19KB) and Report of the Findings and Analysis from Employment Research Ltd (PDF 217KB).

Survey of carers and people with dementia

A survey of people with dementia and carers was also carried out about the most important ways of improving experience of care in hospital. This survey was carried out in May and June 2011 and followed on from the previous survey of professionals.

A total of 1,484 responses were received which is a far larger response than was anticipated and lends significant weight to the findings.

A range of approaches was identified as being important in delivering better care for people with dementia and their families/carers while in hospital.

Of note more than 90 per cent of respondents considered the following as very important:

Other factors identified included improved communication, gathering information about the person's background and adopting flexible approaches to care.

Staff understanding and time were the two most frequently mentioned barriers to the delivery of care, followed by other factors such as poor communication, lack of understanding of needs and frequent moves between wards.

To find out more about the survey results, read Dignity in Dementia: Transforming General Hospital Care. Summary of Findings from Carer and Patient Survey (PDF 577KB) and Report of the Findings and Analysis from Employment Research Ltd (Word 157KB).

Findings from both surveys of professionals were presented to a range of stakeholders including people with dementia and carers, to develop key messages. These have been used to develop a commitment to improve care for people with dementia in general hospital settings.

The RCN’s dementia project lead, Rachel Thompson, describes the development of tools to help improve the care of people in general hospital settings in this podcast (mp3 3.73MB).

The aim is for this commitment to be used as a guide to support the delivery of dignified care for people living with dementia and their families, within general hospital settings. It sets out five principles for promoting a positive experience for people with dementia and their families and can be used by staff to help support improvements and make positive changes. You can read about the commitment and access the supporting resources.

Make SPACE for good dementia care is an easy way of remembering the commitment.

We are inviting people to sign up to the commitment within their organisations and for dementia leads to use it as a benchmark for their services so that local actions can be developed in support of delivering the commitment.