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Title: What is the meaning of family-centred admiral nursing for carers?
Author: Hibberd, Penelope
ISNI:       0000 0004 2720 5129
Awarding Body: Northumbria University
Current Institution: Northumbria University
Date of Award: 2011
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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.
Supervisor: Pearson, Pauline Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: B700 Nursing