Community Mental Health Nursing and Dementia Care
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Community Mental Health Nursing and Dementia Care COMMUNITY MENTAL HEALTH NURSING AND DEMENTIA CARE Practice Perspectives A rounded account of Community Mental Health Nurses’ practice in dementia care has been long overdue. This is the first book to focus on the role of Community Mental Health Nurses in their highly valued work with people suffering from dementia and their families. This book: • Explores the complexity and diversity of community mental health nurse work • Captures perspectives from along the trajectory of dementia • Identifies assessment and intervention approaches • Discusses an emerging evidence base for implications in practice Contributions to this collection of essays and articles are drawn from community mental health nurse practitioners and researchers at the forefront of their fields. It is key reading for practitioners, researchers, students, managers and policy makers in the field of community mental health nursing and/or dementia care. Dr John Keady worked for a number of years as a Community Mental Health Nurse in a community dementia team in North West Wales before moving into teaching and research at the University of Wales, Bangor in July 1993. He has maintained an active interest in dementia care and is founding and co-editor of Dementia: The International Journal of Social Research and Practice. Charlotte C. Clarke is Professor of Nursing Practice Development at the cover design: Kate Prentice University of Northumbria at Newcastle. Her interest in dementia care spans 15 years and combines with her more recent work in service and practice development. She co-edited Dementia Care: Developing Partnerships in Practice with Dr Trevor Adams. Dr Trevor Adams has worked within dementia care for over 20 years. Initially, he worked with people with dementia in hospital settings and then as a Community Keady • Clarke Adams Community Mental Health Nurse. He has contributed to research and the development of practice within community mental health nursing and is particularly interested in communication in this field. Mental Health Nursing and Dementia Care Practice Perspectives ISBN 0-335-21143-7 edited by: John Keady, 9 780335 211432 Charlotte C. Clarke and Trevor Adams Community mental health nursing and dementia care Community mental health nursing and dementia care Practice perspectives Edited by John Keady, Charlotte L. Clarke and Trevor Adams Open University Press Maidenhead · Philadelphia Open University Press McGraw-Hill Education McGraw-Hill House Shoppenhangers Road Maidenhead Berkshire England SL6 2QL email: [email protected] world wide web: www.openup.co.uk and 325 Chestnut Street Philadelphia, PA 19106, USA First published 2003 Copyright © Authors and contributors 2003 All rights reserved. Except for the quotation of short passages for the purposes of criticism and review, no part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission of the publisher or a licence from the Copyright Licensing Agency Limited. Details of such licences (for reprographic reproduction) may be obtained from the Copyright Licensing Agency Ltd of 90 Tottenham Court Road, London, W1T 4LP. A catalogue record of this book is available from the British Library ISBN 0 335 21142 9 (pb) 0 335 21143 7 (hb) Library of Congress Cataloging-in-Publication Data CIP data applied for Typeset by RefineCatch Limited, Bungay, Suffolk Printed in Great Britain by Biddles Ltd, www.biddles.co.uk Contents Contributors viii Acknowledgements xiii Editorial note xiv Foreword by Professor Mike Nolan xv Introduction xvii PART ONE Setting the scene 1 The landscape of contemporary community mental health nursing practice in dementia care 1 Voices from the past 3 The historical alignment of dementia care to nursing Peter Nolan 2 Integrating practice and knowledge in a clinical context 17 Charlotte L. Clarke, John Keady and Trevor Adams 3 Multi-disciplinary teamworking 33 Trevor Adams, Mark Holman and Gordon Mitchell 4 ‘We put our heads together’ 45 Negotiating support with the community mental health nurse Anne Mason, Heather Wilkinson, Elinor Moore and Anne McKinley 5 Risk and dementia 63 Models for community mental health nursing practice Jill Manthorpe PART TWO Dementia care nursing in the community 75 Assessment and practice approaches 6 Assessment and therapeutic approaches for community mental health nursing dementia care practice 77 An overview Linda Miller v vi Contents 7 Cognitive-behavioural interventions in dementia 88 Practical and practice issues for community mental health nurses Peter Ashton 8 Turning rhetoric into reality 104 Person-centred approaches for community mental health nursing Tracy Packer 9 From screening to intervention 120 The community mental health nurse in a memory clinic setting Sean Page 10 The community mental health nurse role in sharing a diagnosis of dementia 134 Practice approaches from an early intervention study Chris Clark 11 Group therapy 148 The double bonus effect of intervention for people with dementia and their carers Kath Lowery and Michelle Murray 12 Psychosocial interventions with family carers of people with dementia 160 Helen Pusey 13 Admiral Nurses 171 A model of family assessment and intervention Alison Soliman 14 Normalization as a philosophy of dementia care 186 Experiences and practice illustrations from a dedicated community mental health nursing team Dot Weaks and Gill Boardman 15 Assessing and responding to challenging behaviour in dementia 199 A focus for community mental health nursing practice Marilla Pugh and John Keady PART THREE Leading and developing community mental health nursing in dementia 213 16 Clinical supervision and dementia care Issues for community mental health nursing practice 215 Angela Carradice, John Keady and Sue Hahn Contents vii 17 Multi-agency and inter-agency working Issues in managing a community mental health nursing service in dementia 236 Cathy Mawhinney, Paul McCloskey and Assumpta Ryan 18 Higher-level practice 250 Addressing the learning needs for community mental health nursing practice in dementia care Jan Dewing and Vicki Traynor Index 265 Contributors Trevor Adams is a lecturer in mental health at the European Institute of Health and Medical Sciences, University of Surrey. Prior to teaching, Trevor worked as a com- munity psychiatric nurse in Oldham. Trevor later completed an MSc Nursing Studies (Brunel University) and a PhD in Community Mental Health Nursing to People with Dementia (University of Surrey). Trevor has written widely on community mental health nursing to people with dementia, and with Dr Charlotte L. Clarke edited Dementia Care: Developing Partnerships in Practice (Baillière Tindall 1999). Peter Ashton is a senior lecturer/course director in the School of Nursing, Midwifery and Health Studies at the University of Wales, Bangor. Previously, he practised for several years as a community mental health nurse with older adults. More recently he has qualified and become registered as a cognitive behaviour therapist, and provides an undergraduate level module on cognitive behaviour therapy for nurses. Gill Boardman is a community mental health nurse based with the community mental health nursing team for people with dementia at Murray Royal Hospital, Perth, Scotland. Gill is both a general and mental health nurse and has worked in her current role since 1988. Gill is a long-standing council member of Alzheimer Scotland – Action on Dementia, and has previously served on the executive of this organization. Gill has a particular interest in ethics and dementia care. Angela Carradice graduated from Hull University with a BSc (Hons) in Psychology in 1994. She then worked in a psychiatric institution with people with severe and enduring mental health problems, cognitive impairments and challenging behaviour. In 1996 Angela began a three-year doctorate training in clinical psychology at Sheffield University. The doctorate research project focused on how community mental health nurses think when they assess carers for people with dementia. This influenced her growing interest in clinical supervision and nursing. Angela now works half time in inpatient services and a community mental health team. Chris Clark qualified as a registered mental nurse in 1981 and is currently working as a community mental health nurse with older people for Doncaster and South Humber Trust. Her completed research study Early Interventions in Dementia has led to developing the role of community mental health nursing in promoting early referral and diagnosis of people with dementia in primary care. Charlotte L. Clarke has worked in dementia care practice and research since the mid-1980s. She is currently working at Northumbria University as Professor of Nursing Practice Development Research and as Head of the Nursing, Midwifery and Allied Health Professions Research and Development Unit. viii Contributors ix Jan Dewing works as a consultant nurse with Milton Keynes Primary Care Trust and General NHS Trusts. She is also an associate fellow in practice development with the Royal College of Nursing. Her specialist practice interests are in dementia care and she is exploring the meaning and purpose of ‘wandering’ for a doctoral degree. Sue Hahn is currently a senior lecturer at the University of Hertfordshire and is the Book Review Editor for Dementia: The International Journal of Social Research and Practice. Prior to this she