Shirley Law, seconded as Project Manager with the Iris Murdoch Dementia Centre at The University of Stirling since November 2007, has been passionate about dementia care for years and while delighted to have piloted a training programme in the subject, admits to being stunned at the lack of knowledge amongst some of the people working in the area.
“Some carers had been in post for 25 years and had absolutely no training,” she says. “Most nurses have had to learn about dementia care on the job, unlike other areas in nursing where they are given specialist training.
“I was working in a dementia ward with NHS Tayside, and along with my colleagues developed a training programme on dementia, which is now accredited by the Royal College of Nursing and is what led to my secondment here.
“It was a really good move for me and I feel that the programme is very valuable because it’s written by people in practice so they know the realities as well as the theory.”
One of the biggest challenges is that dementia care is traditionally low-paid and untrained, which is reflected by the people who go into it, especially in care homes. “Many of them have left school without qualifications, most of them don’t have computer skills and there is often a confidence issue engendered by those in charge,” explains Law
“We need a trained workforce in dementia care, but we also need a change in attitude at the top, where the value of the workforce is recognised and developed, which gives them so much more confidence in their abilities. Sometimes our training has put people on a career path as they realise ‘ If I can do this or learn that then I could become a nurse’ and it’s true -- they’ve been given an awareness of their capabilities which changes their outlook.”
Everyone benefits in that situation, which is why Law is so enthusiastic about training facilitators who then go back into practice and pass that training on, in a system similar to pyramid selling.
“It starts with a two-day training course which is followed by two hours a week for six months, interspersed with self study. At the end of the six months they submit a reflective exercise on what they’ve learned, looking at a challenging situation such as a dementia patient refusing to get changed or becoming very aggressive -- how would they have dealt with that previously and what’s changed after their training?
“Is it communication, not realising that someone needed more time, or to be spoken to in a different way?”
As she points out, care homes and hospitals can be very task and timetable orientated, which can impact negatively on care. “ Tea at 10am, lunch at 12 and no room for manoeuvre,” she explains. “ That can make a challenging situation worse. Often the training is highlighting common sense and how to apply it. The greatest challenge facing nursing now is dementia. It was never glamorous but I think for some of us more than others it was a part of life, even of our culture.
“I was brought up in the East End of Glasgow, my mum was a psychiatric nurse, and I was very involved with my church and the Girl Guides so I was brought up to respect older people.
“ There have been changes in our culture which meant that respect has not always been there but there is also real ignorance of dementia now -- it’s a strange combination of being better educated about it but also more scared of the prospect of it, so we don’t want to think about it or discuss it.”
As well as being in the midst of training, she’s in an ideal position to be kept completely up to date with research. “There’s lots of research going on and a lot of information coming through which I think the public should listen to,” she says. “Lifestyle plays a big part -- keeping healthy, fit and busy, using your brain and staying interested in everything around you. Dementia has always been there but now we can offer people the right support to improve their lives.
“We can put systems in place to help, such as medication, psychiatry, regular prompting and memory exercises, and I would love to see student nurses given more in-depth training on the subject. This programme is unique and it’s changing cultures and attitudes in the workplace which have been ingrained for decades.”
She does recognise that this will take time, but believes that it is all about facing up to the impact dementia is having on the population and recognising that it shouldn’t be regarded as inevitable, but can be prevented, which is why research is so important.
“Changing a mindset does take time but for so long dementia care has been put way down the list in terms of importance,” she says. “You have a workforce whose contribution and hard work hasn’t really been recognised and it is hard work -- dealing with dementia patients takes a lot of patience, especially when they are repetitive, aggressive or totally disinterested. But on the other hand, many of the women in particular who come into this line of work have tremendous empathy.
“The workforce is often very passionate about the standard of care they are offering, a situation replicated by trained nurses working in dementia. I’ve been working in that area for many years now and so many of my colleagues see this as their chosen career path with the enthusiasm and interest to match. “
Since she was seconded Law has been responsible for training nearly 2,500 staff, and there is no sign of her enthusiasm diminishing, despite a very heavy schedule. “Oh no, not at all,” she says. “ This does just feel like the start of a big change and I’m extremely excited to be part of it.
“When my colleagues and I wrote the training programme it was with the hope of having it implemented to some extent and this is a result I don’t think we could have imagined at the time. The Iris Murdoch Dementia Centre is at the heart of research into dementia and putting theory into practice as treatment develops means it’s being addressed at all levels. We are finding out more and more about the condition, what causes it and how it can be treated, and we are also improving care for people who currently suffer from it, giving them a better quality of life and ensuring the highest quality of dementia care.
“I want everyone to be able to see the individual, not the condition, and I think we’re starting to achieve that.”
