Admiral Nursing: case management for families affected by dementia

The numbers of people with dementia are set to increase, however, people with dementia do not live in isolation and any intervention is required to support their family carers also Newbronner et al. 2013.  Dementia UK offers specialist one-to-one support and expert advice in the form of Admiral Nursing AN, first piloted in 1991 and are the only group of qualified nurses in the UK who focus on working with families affected by dementia.  Once a diagnosis of dementia has been made, interventions structured around a family-centred approach provide a framework to help unite families, whilst still recognising individual values. This type of collective approach can help reduce conflict and improve relationships within the family.  AN has evolved from delivering an intervention specifically aimed at supporting family carers to one that supports the whole family through a case management approach Harrison Dening et al. 2017.

Case management has a long and successful history in supporting people with long term conditions and people with a diagnosis of severe mental illness Challis et al. 2010. Case management is a relatively new concept in dementia with early UK research being inconclusive Iliffe et al. 2014, however, it is proving to be a successful model in Holland Van Mierlo et al. 2014: MacNeil Vroomen et al. 2016.

The evidence base for AN, as with the majority of specialist nursing roles, is scant. So it became a priority of Dementia UK to develop the evidence base for AN whilst also supporting the nurses to develop the skills, tools, time and impetus to collect data about their service activity and outcomes which could build the evidence base for the model. Commissioners and employers need data that is relevant to their expected outcomes and, as the AN community grows, it is increasingly important to collect data consistently in order to identify and promote effective AN models. Whilst current evaluation methodology may focus on undergraduate and postgraduate nursing course curriculum; a wider appreciation of the importance of evaluation in practice is required Moule et al, 2016.

This paper will present results of a service evaluation project; Getting Evidence into Admiral Nursing Services GEANS, a mixed methods approach to demonstrate the evidence for the AN case management approach in supporting families affected by dementia. GEANS is a national programme, funded by Dementia UK aimed to support a cohort of AN teams to evaluate their services and to demonstrate the outcomes and impact on families affected by dementia. GEANS is a co-produced evaluation framework and defines outcomes for Admiral Nursing with families and in supporting best practice in other professionals. Outcomes reflect the domains of the NHS Outcomes Framework for England and the Adult Social Care Outcomes Framework.

Three themes focus data collection;

1. Improved quality of life for carers and people with dementia.

2. Positive experience for families of AN Services

3. Cost efficiencies in health and social care costs.

The paper will be supported through presentation of a local service case study from the Midlands, United Kingdom.