Dementia Specialist Improvement Lead

Case Study

Lorraine Haining, Specialist Nurse Practitioner, Mental Health Directorate, NHS Dumfries and Galloway

Lorraine is a senior and highly experienced mental health nurse and specialist in dementia care. As well as graduating from the Dementia Specialist Improvement Leads Programme on 16 March she is delivering a concurrent session entitled “Quality and Excellence in Specialist Dementia Care”.

Q.Can you tell me a bit about yourself and your current role?

I have worked in the field of dementia for the past 15 years in positions from Community Mental Health Nurse to Nurse Manager but I’ve been in my current role for nearly four years. I am the specialist nurse in our localStress and Distress team for people with dementia. This is a multiprofessional team model which is unique in its approach. Prior to this I also spent some time working in the third sector and this experience has helped me understand some of the challenges it faces such as the regulatory environment.

Q.How would you describe your experience of the Dementia Specialist Improvement Leads Programme?

I had some knowledge of what to expect as I had been a member of the Steering Group. I joined the programme a little late as I replaced a colleague who had to withdraw due to a change in job. As a large part of my role involves education I knew I would be in a good position to implement the training resulting from the programme.

The Dementia Specialist Improvement Leads programme is an 18 month programme designed to grow capacity and capability in specialist mental health services to support implementation of Promoting Excellence and the Standards of Care for Dementia in Scotland in these settings. The programme was targeted at participants who had an identified practice development, quality improvement and education role in their Board. It included a number of ‘training for trainers’ programmes including:

  • Stress and distress in dementia
  • Meeting the needs of people with dementia with complex physical health care needs
  • Palliative and end of life care in dementia
  • Pharmacological care in dementia
  • Cognitive stimulation therapy

It also included leadership development opportunities via a series of Master classesand action learning. There were one, two and three day courses which helped to refresh and update my skills in order to deliver training and support to staff working in specialist Dementia wards. However, many staff across the hospital have attended the training, and in terms of dementia, we now have a much more knowledgeable workforce across our mental health hospital.

Personally, I’ve found the programme very, very helpful and I hope it continues so that more colleagues can take part. I have certainly enhanced my skills and knowledge and am more able to support change in this field and have also made many contacts through the networking opportunities.

Q.What are your plans for taking forward learning from the programme?

To continue the work already started and make best use of the platform and tools to support improvement. The programme has helped us to identify the things we need to work on and there is a lot still to do.

In Dumfries and Galloway we have been undertaking a hospital reconfiguration in our Mental Health Hospital. This has been driven by the changing demographics and ward capacity and has allowed us to look at how we can deliver care using a different approach for people with dementia. Additionally, we have commissioned a small piece of work by an independent charity looking into the user and carer experience of being an inpatient on our dementia wards and we have also conducted a hospital staff training needs analysis and gathered several other baseline measures in order to demonstrate improved outcomes for patients carers and staff. From the learning I gained on the programme it offers further scope and opportunities for improvements in the future.

The Self Assessment Tool which came with the programme has been used to good effect. Most of the things that came out of it were no surprise - but it helped us to focus, on what was not working, on the gaps and areas we needed to address. A good example of this would be activities on the ward and the physical environment.As a result we have made some structural changes in terms of layout of the ward e.g. by removing the nursing station which was a hazard, and we now have more Occupation Therapy input into the ward and they are working with staff on developing meaningful occupation and interventions for stress and distress.

We have introduced three different levels of training: foundation, intermediate and advanced. So far we have trained almost one hundred staff (including hospital and community) at foundation level. Intermediate level training starts this monthand will include community. Different staff groups learning together is something we encourage, that way staff are not working in silos and it ensures we deliver a consistent message around dementia care.

The dementia wards are now seen as a positive place to work, staff are learning new skills and doing rewarding, satisfying work. Training helps staff to be more confident and staff are much more equipped to connect with people with dementia if they have the underlying knowledge and skills.

Q.What have been the most positive aspects of the programme?

Bringing the learning back and sharing it with different staff and communities and seeing the positive results. It has helped immensely in breaking down barriers between staff and made me more aware of the need to be more proactive.

Q.What do you see as your key successes so far?

The one day simulation learning events we organised for all staff with support from the University of West of Scotland (UWS) have had the biggest impact in terms of staff experience of dementia. This event includes a thirty minute simulation experience of what it is like to have a sensory impairment and stillcarry out basics tasks. To date 48 staff have taken part and another event is coming up in May.

These events have helped to shape more positive attitudes towards dementia. Staff were asked to write a reflective account of their experience and we will be using some of this material when we produce our report on the final outcomes. We already have some good baseline data and measurements in place to help us compare against future outcomes, once the work has been completed.

Q.I know you have worked very closely with people with dementia and families and carers in developing your approach in NHS Dumfries and Galloway – can you tell me a bit more about this?

As previously mentioned User and Carer Involvement, a local charity, carried out 1:1 and group consultations with families and service users and theyhave told us they value the importance of a Person Centred approach, a focus on recovery, being able to engage in activities based on personal choice and preference and the telling of (and listening to) ‘Life Stories’ and maintaining connections to their local communities.

People with dementia were very aware of the importance of their legal rights and the value of carer and family Involvement. The priorities they expressed were: getting home as soon as possible, although some appreciated the longer term sanctuary provided and felt safe, well cared for and respected by the staff.

Carers have expressed a need for consistent, clear and accessible information and distance from home was a highlighted as a concern.

The project has enabled the voices of patients and carers to make a significant contribution to the way Dementia Care develops in clinical settings, particularly in regard to personhood, identity and human rights. The views of Users and Carers have now been incorporated into the development of NHS Dumfries and Galloway’s action plan and, by implication, other local and national initiatives.

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