Exploring specialist dementia nursing models and their impact on people living with dementia and their family: A systematic review
Pat C Brown, Alexandra Burton, Jordan Ayden, Karen Harrison‐Dening, Juanita Hoe, Claudia Cooper- Psychiatry and Mental health
- Cellular and Molecular Neuroscience
- Geriatrics and Gerontology
- Neurology (clinical)
- Developmental Neuroscience
- Health Policy
- Epidemiology
Abstract
Background
Evidence that brings together the attributes, specialist knowledge, skills, and competencies required by specialist dementia nurses to fulfil their role is currently lacking, making it difficult to assess the effectiveness of specialist nurse‐led interventions. We systematically reviewed the evidence for specialist dementia nursing to determine how it is defined in terms of key skills, models of delivery, and the impact on families and people living with dementia
Method
We searched for papers using three databases (MEDLINE, CINAHL, PsycINFO), grey literature (EThOS), and the National Institute for Health and Care Excellence (NICE) evidence search. Search terms related to ‘specialist nursing’ and ‘dementia’ were used. We screened titles and abstracts of identified articles and conducted forward searches for additional relevant studies. Two authors independently rated study quality. Findings were synthesised narratively.
Result
31 studies were included in the review; 26 were conducted in the UK or USA using a range of methodologies. Role titles varied to include “Admiral Nurses”, “Nurse Practitioners” and “Clinical Nurse Specialists”. We found limited evidence comparing the knowledge, skills, and competencies required by specialist nurses except Admiral Nursing where these were described in three studies. In RCTs (n = 2), specialist nursing did not improve donepezil adherence; and personalised emails to family carers from a nurse specialist did not increase carer self‐efficacy when compared to less intensive interventions. In non‐randomised studies, a USA Nurse Dementia Care Manager service was associated with fewer emergency room and hospital admissions; there were no differences in clinical or cost outcomes in an Admiral Nursing service; and training inpatient specialist nurses in a behavioural intervention increased use of pain‐ relief medication and reduced patient length of stay. Of the 31 studies, 4 reported high carer satisfaction with specialist nursing.
Conclusion
We identified only one framework defining specialist dementia nursing competencies, and limited evidence for effectiveness of specialist nursing dementia services on families affected by dementia, despite care received being highly valued. No RCT has measured the impact of specialist nursing on family carer and client outcomes relative to less specialist care.