NHS Trust develops Enhanced Nursing Assistant role impacting Dementia Care to help raise the standards of care and improve patient experiences

Each year, the University Hospital of North Staffordshire NHS Trust (now part of the University Hospitals of North Midlands NHS Trust) cares for over 700,000 people. Since 25% of these have dementia care needs, it is vital for the Trust to identify enhanced needs at the earliest opportunity. A unique project that has upskilled a group of Nursing Assistants with dementia awareness and care skills is helping to raise standards of care, leading to greater patient satisfaction, reduced length of stay, and contributing to CQUIN (Commissioning for Quality and Innovation) objectives.

The Trust agreed to run a project with input from our experts in role development, skills, and national competences to support upskilling Nursing Assistants (NA) to meet the requirements of patients with dementia care needs. The project, which ran for just under 12 months, was part of the Trust’s response to the National Dementia Strategy, focusing on three key areas: improved awareness, earlier diagnosis, and a higher quality of care. The pilot aimed to:

• develop 18 NAs, upskill them in awareness of and care for patients with dementia needs.
• support a more proactive approach to delivering dementia care, including carers and family.
• enhance care for patients through the care pathway at UHNS, from admission to discharge.
• improve hospital experience, reduce the length of stay, and support patients’ return to home.

Outcomes

• NAs helped to assess gaps in dementia awareness, using staff questionnaires to establish baseline knowledge
• use of tools and resources that track the patient from first entry through to discharge – This is Me booklet, butterfly stickers, bed magnets to alert staff at a glance that a patient has enhanced needs
• greater dementia awareness which has cascaded from NAs through to colleagues on their own wards and staff in areas across the hospital
• creation of information points on the wards, as well as interventions such as memory boxes and reminiscence rooms to create a more supportive environment for vulnerable patients
• combined resources, both in house and from The Alzheimer’s Society, which support seamless care through UHNS and enhance dignity for patients
• a competency book was developed to support the programme and the NAs development

“The Nursing Assistants are really enthused, and they have not only changed their own practice, but that of others too. The number of patients with early diagnosis is increasing and our goal is that by 2015, every ward at UHNS will have its own enhanced NA with specialist skills in dementia care.”

Kate Hackett, Senior Nurse Education & Workforce Development, University Hospital of North Staffordshire NHS Trust

Our team worked with UHNS to develop a Transferable Role Template for the enhanced NA role. After recruiting 18 existing NAs, each was tasked with developing a mini-project. The NAs were selected for their personal attributes and work locations since the aim of the project was to help cascade learning and skills across teams, and also to ensure a broad representation of clinical areas across the Trust. NAs were recruited from 13 wards including Emergency Admissions, Acute Stroke Unit, Elderly Care Ward, Medical Outpatients, and the Accident & Emergency Department.

The cohort was released for one day a month training plus attendance at Dementia conferences and learners were supported in their own skills development with a competence-based workbook.

Impact

• anecdotally the project has potentially contributed to reduced length of stay
• NAs empowered leading to effective team working
• NAs help in training junior doctors
• changes in the way staff address patients with dementia, due to NA led training
• greater confidence among the NAs, and desire to share their learning: becoming true Dementia Champions

One of the strengths of the project was that dementia care now began the moment a patient arrived in Accident & Emergency and continued right through to the time when they leave and beyond. For example, Medical Outpatients now has its own dedicated Dementia resources table where people have access to information packs showing where to access services out in the community as well as in the hospital.

The NAs were empowered to help change practice, and it was recognised that even the smallest changes had a big impact. Creative solutions included the development of quick communication guides with pictures that patients can point to if they want, for example, a drink or to visit the toilet. A pocket-size guide has also been developed for staff.

“Please don’t stop; if you have any other ideas, we can keep building on this. We need you to be ambassadors. Dementia is well on the agenda in this hospital, we are ahead of the game here.”

Helen Inwood, Deputy Chief Nurse, University Hospital of North Staffordshire NHS Trust

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