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Developing a nursing intervention, using the concept of Amalgamation of Marginal Gains, to improve fundamental nursing care for people living with dementia

Background

Dementia is a syndrome affecting an increasing number of people in the UK. It impacts greatly on the lives of those who live with it and serves many challenges to their relatives and carers, healthcare professionals and the NHS (NICE, 2006; Alzheimer’s Society, 2016). The James Lind Alliance has worked alongside the Alzheimer’s Society to set out ten priorities for research into dementia using input from those living with it, relatives, carers and health care professionals (James Lind Alliance, 2013). Future research proposals should be designed to address these priorities which include maintaining independence, putting research into practice, maintaining nutritional intake and providing best care in acute settings.

There have been reports of failings in the standards of fundamental nursing care (Francis, 2013) and this has also been highlighted in the care of people living with dementia (Care Quality Commission, 2014). The Alzheimer’s Society’s campaign, Fix Dementia Care, described in their report on hospital care, stories where basic needs were not met (Alzheimer’s Society, 2016). Such fundamentals of nursing care include assistance with nutrition and hydration, mobility, elimination, hygiene and communication (Kitson et al., 2010; Nursing and Midwifery Council, 2015).

There has been suggestion that the ‘Amalgamation of Marginal Gains’ could be a valuable tool to use in driving change in healthcare settings, including in nursing care (Richards, 2015). Amalgamation of Marginal Gains was a term originally used in cycling by the previous head of the British team, Sir David Brailsford. He described it as a method the British cycling team used to improve performance and outcomes, whereby a number of small changes are made that, when aggregated together, bring about an overall improvement (BBC, 2015). This PhD project will explore using the concept of Amalgamation of Marginal Gains as a way in which to improve fundamental nursing care for people living with dementia.  

Project aims and objectives

The aims of this project are to:

  • Undertake two systematic reviews that look at:

- The effectiveness of Amalgamation of Marginal Gains as a method in driving change in healthcare settings
- Fundamental nursing care for people living with dementia.

  • Design and test the feasibility of a nursing intervention that uses the concept of ‘Amalgamation of Marginal Gains’ as a method for driving change in care of people living with dementia.  
  • Design the intervention in line with the research priorities set out by the James Lind Alliance (James Lind Alliance, 2013).

For more information, please read the project proposal. If you’d like to learn more, please contact Chloe Wood via Email

References:

Alzheimer’s Society (2016) Fix Dementia Care: Hospitals. Alzheimer’s Society, London.

BBC (2015) Viewpoint: should we all be looking for marginal gains? http://www.bbc.co.uk/news/magazine-34247629. Accessed 10/08/16.

Care Quality Commission (2014) Cracks in the Pathway: People’s experiences of dementia care as they move between care homes and hospitals. Care Quality Commission, Gallowgate.

Francis, R (2013) Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry. The Stationary Office, Norwich. 

James Lind Alliance (2013) Top 10s: Dementia. http://www.jla.nihr.ac.uk/top-tens/dementia-top-ten. Accessed 10/08/16.

Kitson, A., Conroy, T., Wengstrom, Y., Profetto-McGrath, J., Robertson-Malt, S. (2010) Defining the fundamentals of care. International Journal of Nursing Practice. 16:423-434.

NICE (2006) Dementia: supporting people with dementia and their carers in health and social care. NICE guidelines [CG42]. National Institute for Health and Care Excellence, London.

Nursing and Midwifery Council (2015) The Code. Professional standards of practice and behaviour for nurses and midwives. Nursing and Midwifery Council, London.

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