Professional Practice

A diagnosis of dementia almost inevitably moves a person into the medical and health care domain at some point and the person will certainly deal with many professionals on their journey.  It is surprising that the body of work considering areas of professional practice is small although professionals from a variety of disciplines working with people affected by dementia feature in this section. Two of the papers investigate the practice of occupational therapists.  Only one paper relates to GPs despite the fact that they are the first point of contact for many people with dementia, another examines the education needs regarding dementia care of nurses in acute care environments and one examines the experiences of health care workers in care homes, exploring the very specific topic of psychological responses to aggression.  Two papers cover geriatric education in community hospitals where dementia is referred to as the most difficult area of practice, and the final paper takes a very different perspective; this article examines the implications of an ageing professional workforce who may potentially be affected by cognitive decline.

Ageing, cognitive disorders and professional practice

Age and Ageing

Fitzgerald et al. (2013) point to the increasing number of people over 65 years remaining in the workplace and the potential impact of cognitive decline, particularly among those in the liberal professions.

 They distributed a questionnaire to 22 regulatory and professional bodies to assess whether their policies and practices were ‘age attuned’.  None of the respondents had supports in place for older workers with chronic conditions such as dementia to continue to work safely and effectively, with over half stating that professionals were responsible for their own health and safety.  The authors suggest that a joint initiative between occupational health, geriatric medicine and old age could assist professional and regulatory bodies, and protect the public, pointing to a current independent model of support in the UK; The National Clinical Assessment Service.

Education in geriatric medicine for community hospital staff

British Journal of Community Nursing

O’Hanlon and Liston (2010) used a questionnaire to assess the provision of education in geriatric medicine among community hospital staff.

 While not specific to dementia, the results indicated that staff found dementia and challenging behaviour to be one of the most difficult areas of their practice.  The authors conclude that geriatricians have little input to education in community hospitals and that staff would value regular, structured input.

Psychological trauma and fear for personal safety as a result of behaviours that challenge in dementia: The experiences of healthcare workers

Dementia: The International Journal of Dementia Research and Practice

Scott et al. (2011) use a questionnaire to explore the psychological effects of exposure to aggression among healthcare workers in care homes in NI.  The evidence suggests that staff often fear for their safety and that experience did not impact on risk of assault.

 Workers were injured in just over half of the incidents and most assaults took place during care interventions.  Almost a quarter of the respondents met the criteria for ‘avoidance’, a characteristic of depersonalisation and the authors suggest care home staff may avoid ‘aggressive’ residents, thus risking compromised care.  They recommend education that focuses on the skills of communication, empathy, compassion and understanding, and the introduction of infrastructures and guidelines to support staff.

A multicentre survey of acute hospital nursing staff training in dementia care

Clinical Nursing Studies

This paper by Coffey et al.

(2014) reports the findings of a survey of 150 nurses in six acute hospitals in the southern region of ROI, and was conducted as part of a multicentre study of prevalence of dementia, course of dementia and long-term outcomes for people with dementia in acute hospitals. The survey found that 83% of nursing staff in the acute hospitals perceived that they had insufficient training in dementia care. This was despite the availability of a national dementia education programme across all care services and reflects poor uptake of dementia education offered in acute hospitals. However, the survey clearly indicated that nurses at ward level are aware of their poor dementia knowledge and are open to dementia training and the authors recommend strengthened awareness and management support for enhanced and specialist skills in dementia care for nurses practicing in acute care settings

Behavioural and psychological symptoms of dementia in primary care: a survey of general practitioners in Ireland

Mental Health in Family Medicine

Using an anonymous questionnaire issued to GPs in North Dublin, Buhagiar et al. (2011) explored how GPs self-evaluate their confidence and knowledge on the detection and management of behavioural and psychological symptoms of dementia (BPSD).

GP confidence in diagnosing and managing BPSD was found to be low; all GPs reported having diagnosed and managed patients presenting with new-onset BPSD during the previous year but they were somewhat critical of their perceived skills in these areas, despite showing a high level of knowledge about management of BPSD. The authors conclude that GP confidence is likely to be compromised by a lack of guidance and support, limited resources and a health service framework that does not necessarily promote support from specialist services. The study argues that GPs need to be better supported by educational programmes on dementia care, and by a structured shared care approach between primary and specialist services, which would potentially lead to better patient and caregiver outcomes.  

Occupational therapy and dementia care: A survey of practice in the Republic of Ireland

Australian Occupational Therapy Journal

McGrath and O’Callaghan (2014) used an online survey to consider practice among Occupational Therapists (OTs) in ROI working with people who have dementia, or carers of someone with dementia.

 They examine the reported practices in the context of a growing body of research in this area.  The authors report a gap between practice in Ireland and the research, for example, most therapists assess performance components rather than occupational participation; non standardised functional assessments were used; interventions to address behavioural and psychological symptoms were generally not used.  They recommend a global occupational therapy strategy for knowledge translation in dementia care and that future research should focus on developing and evaluating interventions to support translation of research to practice for people with dementia. 

Occupational therapists' experiences and interventions when working with people with early stage dementia

The Irish Journal of Occupational Therapy

Cummins and Warren (2010) report on a qualitative study of six occupational therapists working in Ireland with people with early stage dementia.  They investigated their experiences and the type of interventions they used with this client group.

 Five themes emerged: reaffirming peoples’ right to be independent; looking beyond the diagnosis; facilitating occupational performance; enabling occupational identity; inaccessible and inadequate resources.  The authors suggest that the scope of work for occupational therapists in this area is vast and is taking place in a service landscape that is fragmented, inadequate and slow to respond.