The provision of dementia care in general practice: practice nurse perceptions of their role

Abstract

Background Primary care nurses can assist General Practitioner’s to identify cognition concerns and support patient health self-management for those experiencing cognitive impairment or dementia. This support may lead to more appropriate care and better health outcomes for this group. Consequently, there is a need to identify the role of the primary care nurse in dementia care provision, nurse perceptions of this role and to also understand the barriers and enablers that may influence any current or potential primary care nurse role in dementia care provision. Methods Eight focus groups were conducted with a total of 36 primary care nurses. Data was transcribed verbatim and thematically analysed. Results There was a high level of agreement between primary care nurses that they had a role in provision of dementia care. This role was largely attributed to the strong therapeutic relationship between nurses and patients. However, dementia care provision was not without its challenges, including a perceived lack of knowledge, limited resources and the hierarchical nature of general practice. Three main themes were identified: personal attributes of the primary care nurse; professional attributes of the primary care nurse role and the context of practice. Six sub-themes were identified: knowing the person; overcoming stigma; providing holistic care; knowing what to do; team culture and working in the system. Conclusions The findings of this study suggest primary care nurses have a role in dementia care provision and, there is a need to provide support for the nurse to deliver person-centred health care in the context of cognitive impairment. As the demand for good quality primary care for people living with dementia increases, the role of the primary care nurse should be considered in primary care policy discussions. The knowledge gained from this study could be useful in informing dementia training content, to provide better prompts in the health assessment and care planning templates used by primary care nurses to better identify the care needs of people with a cognitive impairment and to develop dementia care guidelines for primary care nurses.

Nurses’ Experience of Nursing Workload-Related Issues during Caring Patients with Dementia: A Qualitative Meta-Synthesis

“…Dementia patients demand more time and commitment from nurses due to their neuropsychiatric symptoms [ 10 , 15 ]. Particularly, types of nursing care for patients with dementia vary from the basic bedside nursing care such as personal hygiene, emotional supports (being a companion to talk with), drug therapy, and safety care, to specific dementia care including cognitive therapy, rehabilitation, and other diverse therapies [ 16 , 17 ].…”

“…As nurses maintain a close relationship with the patient and provide holistic care, they can recognize the cognitive change process of the patient and corporate care with other chronic diseases [ 16 ]. The care delivered by nurses has been reported to affect the overall quality of treatment [ 17 ].…”

A review of the growth and development of Australian practice nursing: Insights for the dietetic workforce

“…112 A further 12 papers related government funding as a contributor to, but not the main driver of, practice nurse role development. These contributors included, funding initiatives to support the overall nursing and midwifery education and workforce, 12,43,90,106,107 GP-item numbers completed by a practice nurse, 25,42,44,79,101,102 and national health programs, such as the National Bowel Cancer Screening Program. 109 Practice Nurse Practice Standards: Practice standards aim to provide practice nurses and their colleagues an outline of key roles and their scope of practice to enhance care.…”

“…62,63 Another four papers described the patient perspective as a contributor, where individuals preferred being cared for by their GP, and that practice nurses were seen as assisting 11,78 or filling gaps in GP care. 40,70 Individual, community and local needs: Seventeen papers described individual, community and local health needs as a key driver to the practice nurse role development and scope of practice, where the practice nurse role should reflect the healthcare needs of the local population, 41,105 including chronic disease management and prevention, 31,33,39,40,44,55,60,65,71,81,86,87,109 women's health, 84 and geographical location. 70,107 Another 13 described these needs as a contributor, such as patient disease status 15,49,58 and age, 27,28 other health risk factors 34,56,63,68,69,99 and the COVID-19 pandemic.…”

Safety and effectiveness of dementia care management in primary care

“…As a result, the needs of those with dementia may not be able to be satisfied by the general practitioner alone. 4 PWD have a lot of benefits from primary care physicians as the stress that patients and caregivers experience is greatly reduced when they receive the proper care, treatment, and support, which enhances their capacity to lead fulfilling lives. The practitioner should optimize the patient's chronic illness care in addition to the aforementioned medications to lower the risk of a cardiovascular event.…”