Hope and dementia.

Dementia is a terminal and progressive condition which often brings with it a loss of hope, and feelings of hopelessness in those living with the condition and their family carers. Community nurses are in a unique position of being able to interact with people with dementia and their family carers in their own homes, or the care settings in which they reside, and in some case, will be the only professionals with regular contact with the family. Therefore, they have the opportunity to increase feelings of hope in those they work with. This article will discuss the concept of hope as it relates to dementia. It goes on to give an overview of Snyder's model of hope, which presents hope as a cognitive state, and therefore presents the opportunity for professionals to increase feelings of hope. An overview of the research evidence around hope-based interventions is then given, with the ideas applied to community nursing practice using a case study. This article aims to add some hope-based interventions to the toolkit of community nurses as they work with people and families affected by dementia.

Dementia and communication.

People with dementia of all stages and subtypes can experience challenges with communicating. Therefore, it is vital that community nurses working with people with dementia have an understanding of the ways in which communication might be challenged, and that they have skills in communicating effectively. This article presents an overview of the ways in which dementia might impact on communication and offers the model of person-centred dementia care as a way of communicating effectively. The use of person-centred communication in practice is illustrated through a case study approach, highlighting the practical approaches that can be used by community nurses in their practice.

What are the information needs of people with dementia and their family caregivers when they are admitted to a mental health ward and do current ward patient information leaflets meet their needs?

INTRODUCTION: An admission to a mental health ward is an uncertain and unexpected part of a person's journey with dementia and consequently, families require information about what to expect and how to prepare. This study aimed to establish the information needs of people with dementia and their families at the point of admission to a mental health ward and to collate existing ward information leaflets to explore if they meet these information needs. METHODS: This research was conducted in two parts: (1) a qualitative study using focus groups, one with people with dementia and family carers with lived experience of such an admission (n = 6), and another with Admiral Nurses (n = 6) to explore information needs at the point of admission. (2) Each National Health Service (NHS) mental health trust (n = 67) was asked to provide a copy of their ward information shared at admission. A total of 30 leaflets were received from 15 NHS trusts; after removing duplicates, 22 were included. A content analysis was conducted to evaluate to what extent leaflets met the information needs identified by focus groups. RESULTS: Two main categories 'honest, accurate and up-to-date information' and 'who is the information for' and four subcategories were derived from focus group data. Participants felt that people with dementia and their families were likely to have different information needs. Material for people with dementia needed to be in an accessible format. Information should cover the aim of the admission, a timeline of what to expect and details about how families will be involved in care. Practical information about what to pack and ward facilities was valued. Participants spoke about the need to consider the tone of the information, given that people are likely to be distressed. The information leaflets reviewed did not meet the information needs identified by focus group participants. CONCLUSIONS: People with dementia and family carers have different information needs at the point of admission to a mental health ward. Information provided to people with dementia needs to be in an accessible format with content relevant to these needs. Wards should aim to co-create information to ensure that they meet people's information needs. PATIENT OR PUBLIC CONTRIBUTION: This research was supported by a patient and public involvement (PPI) group of people with dementia and carers who have experience in mental health wards. The idea for the study came from the group and was motivated by their experiences. The PPI group helped with the design of the study and took part in the focus groups. The information generated has been written up in this paper, and the knowledge generated has also been used to co-create a guide for wards on writing their information leaflets and to support the co-creation of a public information leaflet by Dementia UK about mental health admissions for people with dementia.

Person-centred communication with people with dementia.

Communication is a two-way process of exchanging or sharing information and is an essential element of the nursing process. Challenges with communication are a feature of all types of dementia, so understanding how dementia affects communication and how to support people is important for all nurses. This article provides an overview of communication in dementia care. The authors draw on the literature on communication and dementia to present evidence-based, practical approaches for supporting person-centred communication with people with dementia.

'It's just incredible the difference it has made': family carers' experiences of a specialist Lewy body dementia Admiral Nurse service.

BACKGROUND: Lewy body dementia (LBD) is characterised by a complex array of symptoms. Being a family carer of someone with LBD can be challenging, and is associated with high levels of stress, depression and anxiety. Admiral Nursing services support family carers of people with dementia in the UK by providing tailored information, advice and therapeutic support. Recently, the Admiral Nurse model has been adapted to the needs of more specific populations, including the introduction of a new, specialist LBD Admiral Nurse. OBJECTIVE: to explore family carers' experiences of the LBD Admiral Nurse service. METHODS: fourteen family carers of people with LBD were interviewed about their experiences of the LBD Admiral Nurse service. Interview transcripts were analysed using thematic analysis. RESULTS: four themes were identified: theme 1 described how participants valued the LBD Admiral Nurse's specialist expertise, which contrasted with the lack of knowledge they encountered in other services. In theme 2, participants described how the practical, tailored support provided by the LBD Admiral Nurse enabled them to better manage a variety of caring-related challenges. Theme 3 captured the emotional benefits that participants gained from being able to talk to someone who understood their situation. In theme 4, participants explained how the reliability of the LBD Admiral Nurse's support helped them feel supported in their role. CONCLUSIONS: the specialist knowledge and expertise of the LBD Admiral Nurse enabled family carers to better support the people they cared for, and to relieve some of the emotional stress associated with caring.

Effect of sequentially fed high protein, hydrolyzed protein, and high fiber diets on the fecal microbiota of healthy dogs: a cross-over study.

BACKGROUND: Dietary content and environmental factors can shape the gut microbiota, and consequently, the way the gut microbiota metabolizes fats, carbohydrates, and proteins, affecting overall health of the host. We evaluated the impact of 3 diets (all meat [raw], high-insoluble fiber dry extruded diet and hydrolyzed protein dry extruded diet) on the gut microbiota of healthy dogs in a cross-over sequential study. RESULTS: We showed that diet can have an effect on the gut microbiome in dogs, which was influenced by the order of feeding. High-protein (all meat) diets were characterized by an increase in bacteria belonging to the Fusobacteria and Bacteroidetes phyla, whereas a high-insoluble fiber commercial diet correlated with increases in Firmicutes and Actinobacteria phyla. However, the individual dog's baseline microbiota had the most impact on the magnitude and nature of the changes in response to dietary intervention. CONCLUSION: Our results suggest that the dog fecal microbiota is driven by protein and fiber composition to different degrees in individual animals, and targeted modification of these patterns could be useful in the modulation of the gut microbiota in different diseases.

Toxoplasmosis as a cause of life-threatening respiratory distress in a dog receiving immunosuppressive therapy.

Disseminated toxoplasmosis is a potentially fatal complication in dogs receiving immunosuppressive therapy, particularly if multiple immunosuppressive drugs are used. Toxoplasmosis should be considered if signs of acute respiratory or hepatic disease develop, and diagnosis would rely on demonstration of organisms via cytology or PCR rather than a single time-point serological assay.

Implementation of e-portfolios for the professional development of Admiral Nurses.

Nurses are required to maintain their fitness to practise through continuing professional development activities, and must demonstrate this by maintaining a portfolio of evidence that should be available for inspection every three years. The Nursing and Midwifery Council introduced revalidation in 2016 to demonstrate that nurses are practising safely and effectively. Nurses, however, are busy healthcare professionals and, as well as clinical practice, they have other demands on their time, such as providing evidence for annual appraisals. Admiral Nurses, specialist dementia nurses who support families living with dementia, also have a three-tier competency framework designed to demonstrate their acquired expertise and knowledge in dementia care. To support Admiral Nurses in managing these activities, the charity Dementia UK gave them access to the PebblePad e-portfolio system. This article details the implementation and outcomes of this project.

Admiral Nursing: case management for families affected by dementia.

The number of people with dementia is expected to increase globally. People with dementia are not affected in isolation and any intervention should also support their families and carers. Intervention is best delivered using a relationship-centred approach and a case management model. Case management has an established and successful history in supporting people with long-term conditions and those with a diagnosis of severe mental illness. This article, the last in this dementia series, discusses the Admiral Nursing case management approach to supporting patients and families affected by dementia, and provides recommendations for establishing a gold standard model of case management.