Supporting people who live with stress and distress in dementia: exploring the role of the community-based advanced clinical nurse specialist

Background
Aggression, agitation, psychosis, hallucinations, and abnormal motor symptoms have significant impact on people living with dementia. Older-adults’ psychiatrists play a key part in addressing this. However, a shortage of consultant psychiatrists exists, while the number of people with dementia is increasing. Also, some remote and rural areas have no older-adult’s psychiatrist. Thus, support for people affected by these experiences may be increasingly compromised. This study examined an innovative service in the Shetland Islands. Advanced practice dementia nurses provide specialist support to people living with dementia, and other professionals, with the remote input of a psychiatrist based on the Scottish mainland.

Objectives
This study aimed to gain insights into how effective this service approach is in supporting people living with dementia to maintain wellbeing, and to gauge how well it supports carers and other professionals.

Methods/methodology
Realist Evaluation methodology was used to collect, analyse and interpret data from interviews of health/social care managers, professionals, and family carers of people living with dementia.

Key learnings
Service model success here is underpinned by two main factors;
•The use of nurses possessing unusually advanced specialist skills and expertise.
•The emergence of a new service delivery approach shaped around the activities of these nurses, such as the availability of a remote liaison consultant psychiatrist to be called on when required (as opposed to making the new nursing role fit a ‘traditional’ service structure).

Conclusion
It was found that this service model had resulted in notably improved outcomes for participants in the study. It illustrates that, while ‘transforming roles’ of practitioners has been intrinsic to that, it is equally vital to modify service delivery structures to optimally utilise the redistribution of expertise thus precipitated.

Impact and reach
It is suggested that this approach could be utilised more widely as a valid means of addressing contemporary workforce and demographic challenges in this area of dementia support.