Why commission or host an Admiral Nurse service?

For over twenty-five years, Dementia UK has been dedicated to providing specialist dementia support for families through Admiral Nurses. In keeping with the vision of the family of Joseph Levy to help families cope with the complexities of caring for a loved one with dementia, the charity has built the infrastructure to support specialist nursing in dementia care – which is person centered – and takes a bio-psychosocial approach to case management so that families have someone truly expert by their side when things get challenging or difficult.

A specialism in dementia care

In partnership with ‘host organisations’, Dementia UK selects nurses with advanced skills and experience in dementia care across different care settings and then provides a robust programme of on-going practice and professional development so that Admiral Nurses are at the forefront of excellent evidence-based dementia care. Every Admiral Nurse attends monthly clinical supervision and undertakes an afternoon of professional development, alongside master classes, a yearly Admiral Nurse Forum, a bespoke masters competency module and access to a dedicated Practice and Professional Development Facilitator. No other charity provides this level of training and development to allow nurses to truly specialise in family-centered dementia care.

Managing complexity

Admiral Nurses are skilled in managing complexity – assessing and tackling health and social care needs relating to multimorbidity, polypharmacy, social support and carer strain, psychological distress, frailty, risk management, self-management challenges and difficulties with healthcare system navigation. The unique Admiral Nurse Assessment Framework, and well-honed skills in assessing complex family dynamics and the complex interplay of physical, neurological, psychological and social factors, enables nurses to work holistically, helping to prevent ‘complexity’ from tipping over to ‘crises’.

Management of co-morbidities

The number of people with dementia with two or more co-morbidities will more than double by 2025 (MODEM Project 2018) calling for expertise in facilitating and coordinating care across pathways and a holistic knowledge of physical and mental health needs, symptom management and psycho-pharmacological assessment, and subsequent coping strategies for carers. Carers are more than twice as likely to suffer from poor health as those without caring responsibilities and importantly, the role of the Admiral Nurse is also to address carers’ own health needs.

High intensity case management

Admiral Nurses perform a case management function which is focused on improving healthcare outcomes by coordinating care, reducing the fragmentation of service delivery and supporting individuals to receive the right level of care at the right time. Admiral Nurses also ‘hold’ and oversee transitions of care across care settings when there is a heightened risk of breakdown in communication, lack of follow-up care, potential for inaccuracies in information exchange and a period of greater uncertainty for the person with dementia and their family. Admiral Nurses work to a defined caseload management model allowing the time for a truly person centered approach.

Delivering evidence-based interventions

Admiral Nurses have an ability to provide high levels of emotional and psychological support based on evidence-based interventions (including CBT, family/systemic therapy, etc) which are reinforced by regular practice and professional development, the Admiral Nurse Competency Framework and adhering to the Nursing and Midwifery Council’s Code of Conduct.

Addressing wider health promotion

Working alongside people living with dementia and their carers/families, Admiral Nurses play a part in the wider health promotion agenda. They assist carers with developing their own coping skills and self management capabilities and, through specific interventions, help to change people’s health-related behaviour, leading to improvements in general well-being.

Supporting best practice

Alongside direct work with families, Admiral Nurses support the best practice of other health and social care professionals, delivering education and training, coaching and role modelling in order to influence the practice and improve the knowledge of others non-specialist dementia care practitioners.

A suite of bespoke Admiral Nurse tools, frameworks and models

Over the past twenty-five years, Dementia UK has developed and honed a variety of tools specific to Admiral Nursing. This includes a case management model and triage process, an 18-point Assessment Framework, the Admiral Nurse Competency Framework (developed with the University of Worcester Association of Dementia Studies and mapped to the NMC Code of Conduct) and a unique clinical database called COMPASS (capable of capturing outcome-related data as well as producing Admiral Nurse care plans).

Tailored, flexible support in defining a service model

Dementia UK co-creates each Admiral Nursing service in partnership with a local host organisation, wider health and social care partners and carers. This bespoke support extends to scoping local demographics and need, agreeing a service model and specification, defining outcomes and capturing baseline data. Whilst keeping to the core principles of Admiral Nursing, models can be adapted to dovetail with local need. Admiral Nursing services are not developed in isolation, they are part of a stepped model of care, in order to make the most effective use of the Admiral Nurse’s skills in managing complexity, supported by other delivery partners as part of a clear pathway and referral process, to ensure that families receive the right care, first time.