Title:
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What is the meaning of family-centred admiral nursing for carers?
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Admiral Nurses are mental health nurses specialising in supporting family carers of people
with dementia in community and other settings. Working collaboratively with other
professionals, Admiral Nurses seek to improve the quality of life for people with dementia by
focusing on supportive interventions for family carers. However, to date, there has been
limited attention paid to elicit the meaning of such supportive interventions as constructed by
family carers of people with dementia on the receiving end of such services. This thesis aims
to address this imbalance by operationalising an appreciative inquiry 4 „D‟ cycle [discovery,
dream, design and destiny] informed by a preliminary stage questionnaire distributed to the
whole population of Admiral Nurses in the United Kingdom (n=54) to contextualise current
practice. Appreciative inquiry is a research method which explores experiences of services by
eliciting accounts of good practice as a foundation for analysis and development.
The data from the questionnaire identified constructs of respect, empowerment, negotiation
and partnership working with carers that was compared with the literature from the family
centred literature. The empirical indicators of carer ability and competence were articulated as,
decision making, information receiving and sharing. The interview questions for the
„discovery‟ stage of the 4 „D‟ cycle were crafted from these emerging themes.
Using an appreciative inquiry 4 „D‟ cycle data were then collected over a nine month period.
The „discovery‟ phase also included the voluntary participation of nine carers. Telephone
interviews were used to elicit stories of value and well-being of caring for a person with
dementia. Alongside this data collection method, participation was invited from fifty four
Admiral Nurses, two carer‟s and people with dementia peer support groups and stakeholders of the Admiral Nurse Service i.e. service managers, administration staff and support staff from
for dementia. The resultant focus group used mind mapping to capture caring relationships and
steer subsequent data collection. These data were further analysed using a constant
comparison technique before moving in to the „dream‟ stage of the 4 „D‟ cycle. The „dream‟
stage gave an opportunity for creative study methods. The carer group participated in data
collection using photography and narrative whilst the Admiral Nurse, carer, person with
dementia and stakeholder group attended a further focus group using an adapted nominal
technique. During the „design‟ stage of the 4 „D‟ cycle a focus group was held for both groups.
Themes were further analysed using a constant comparison technique moving the inquiry into
the „destiny‟ stage. The carer data revealed the unique way that each carer managed their
relationships within a complex and at times very stressful caring situation. Although each
carer developed their caring role within sometimes difficult environmental, practical and
emotional constraints they developed strategies and coping mechanisms that enabled them to
continue to care for the person with dementia. A reference group of nine carers and two
Admiral Nurses provided consultation, rigour and guidance to the study throughout the data
collection period.
The findings were expressed through four typologies of caring relationships, themed as
recognising (1), transforming (2), stabilising (3) and moving on (4). In this context, carers
developed feelings of wellbeing and value of their caring role, re-shaping their feelings of self.
This is an alternative to the manifestation of isolation, stress and burden as an outcome of a
caring role. Secondly, the co-construction of four principles themed as attributes (1), meeting
the needs of the carer (2), knowledge and skills (3) working with organisations (4) deploying
underlying values (e.g. trust, flexibility, honesty, accessibility, knowledge and continuity) of Admiral Nurse practice have developed an understanding of a family-centred approach to
Admiral Nursing that is relationship focused.
Implications for practice were that carer‟s expressed wish is to be recognised as individuals.
There is a complex interaction between the carer and the person with dementia and the people
that support them which has a powerful influence on how the caring role is supported and
maintained. This is represented by the conceptual model that has been developed in this study
to present how Admiral Nursing principles and values support that caring role.
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