Job responsibilities
Grade:
Band 7 equivalent
Clinically
Accountable To:
Medical Director
Responsible To:
PCN Manager
Location:
Community Action Derby,
30-31 Charnwood Street, Derby, DE12GU
Hours:
37.5 hours - 2 year fixed term
Key Relationships
Service
Managers
Clinical
staff
GPs
within Team Up
Other
Admiral Nurse services
Older
peoples mental health services
Families/carers
affected by dementia1
Social
care
Primary
care multidisciplinary teams
Dementia
UK
Dementia
Palliative care team
Local
voluntary organisations
Social
Prescribers
Local
Area coordinator Derby City Council
Derbyshire
community services
Home
visiting service
Summary of Responsibilities:
The Admiral Nurse will lead, deliver and coordinate relationship-centred
dementia care within operational areas of Derby City South contract, in order to improve the experience of
carers/families affected by dementia[1] with
complex needs.
In line with the Admiral
Nurse Competency framework at an enhanced specialist level, the post holder
will provide:
Specialist bio-psychosocial assessment and
support for people with dementia and families with complex needs
Facilitation of education and training for staff
in the delivery of evidence-based dementia care
Clinical leadership with policy development and
quality improvements in relation to dementia care
Consultancy to other health and social care
professionals regarding dementia
Main Duties and Responsibilities:
Clinical
Work within the GP Led
Complex needs team and Home Visiting Service to provide a holistic approach to
anticipatory care utilising the multi-disciplinary/ multi-agency team where
appropriate
Deliver regular clinical 1:1 sessions for families affected by dementia who meetthe referralcriteriawithin
designated areas/ practices
Provide clinical leadership on the care of people with
dementia and their carers/families with complex care needs from peri-diagnosis
to post bereavement support, to support reduced reliance on GP appointments
Provide
specialist nursing assessment, using the Admiral Nurse Assessment Framework or
appropriate tools for carers/families affected by dementia, including positive
risk taking, managing distressed behaviours and risk minimisation strategies
Provide
a range of bio-psychosocial interventions to promote health and wellbeing for
people with dementia and their carers/families
Work
collaboratively with other professionals to improve the identification and
management of co morbidities and frailty for people with dementia and their
carers/families
Develop
and support care plans for people with dementia and families including positive
risk management
Support
people with dementia, carers/families and staff to understand and respond to
changes in behaviour and relationships as a result of dementia
Provide
care coordination for a clinical caseload of families with complex needs as
identified within triage assessment
Ensure
the safeguarding of vulnerable adults and that all legal requirements relating
to Mental Capacity Act 2005, Mental Health Act 1983 (amended 2007), and Deprivation of Liberty Safeguards (2009)[2] are considered and adhered to in
relation to patient care
Act
as an advocate for people with dementia and their carers/families to promote
their rights and best interests
Participate
and lead on case conferences, continuing health care processes and best
interest meetings where required
Work
collaboratively with health, social and voluntary sector services to achieve
coordinated care
Work
in partnership with colleagues to promote the use of advance care planning for
people with dementia and to support and inform families, around advance care
planning, best interest decisions and end of life care
Manage
and advise on complex care transitions for people with dementia and their
carers/families to reduce the frequency of crisis situations
Regularly
attend multi-disciplinary team meetings for long-term conditions to inform and
receive information regarding patients who have a diagnosis of dementia
Refer
to secondary care if there is deterioration in condition/a review of medication
including antipsychotics is required or any other concerns regarding a persons
health that cannot be managed in primary care, in line with their dementia
expertise
Support
and advise on carer assessments and reviews
Ensure
that care is delivered in accordance with relevant local and national
guidelines and all relevant Derby City South policies and procedures
Recognise
the limits of own competency and professional boundaries and make appropriate
and timely referrals to other services where required
Ensure
that clinical records are up to date and maintained and stored appropriately in
line with local and national GDPR regulations
Education and
Leadership
Facilitate and support the development and delivery of
innovative dementia training and education to staff, to improve competence and confidence, in
line with best practice and guidance
Participate
in and/or lead formal training events promoting best practice in dementia care
and disseminating Admiral Nursing work
Provide
professional and clinical
leadership and mentorship, acting as a clinical role model on the delivery of
evidence-based practice in dementia care within Derby City south PCN
Advise
and support on the development and delivery of work streams as part of Derby City
south, dementia strategy,
where appropriate
Work
proactively with key local and national stakeholders to develop more integrated
care pathways and holistic models of care, through dissemination of specialist
skills and knowledge
Contribute
to the delivery of local policy, procedures and protocol for Derby City
south PCN to improve
identification, assessment, ongoing support for people with dementia and their
family carers
Work
together with Derbyshire Community Services and Derby City Council to develop
and improve upon current Delirium and Dementia Pathways
Evaluation and Audit
Support
the audit and evaluation of quality improvements and initiatives aimed at
improving the delivery of dementia care within Derby City South,
where appropriate to role
Collect
and review quantitative and qualitative data, as agreed, to evaluate and audit
the Admiral Nurse Service and make necessary improvements
Undertake
analysis and evaluation and make any recommendations to the Derby City
South Dementia Strategy
Group or similar
Ensure
service information and data recorded is relevant, accurate, complete and
captured in a contemporaneous manner
Support
evaluation of workforce development in dementia to improve staff knowledge and
skills across Derby City South
Liaise with Dementia UK Insights and Evaluation team where appropriate,
to ensure that the impact and effectiveness of Admiral Nurse interventions are
well evaluated
Be
fully aware of and comply with the Data Protection Act (2018) and the GDPR in
relation to protecting the confidentiality of patient and service-user
information and enabling appropriate information-sharing
Professional
Ensure all nursing practice is carried out in
accordance with the agreed policies and procedures of Derby City
South and the NMC Code
Improve understanding of the management of Long-Term
Conditions in the community supported by GP Led team
Attend
and actively participate in practice development, clinical supervision, and
continuing professional development supported by Dementia UK and underpinned by
the Admiral Nurse Competency Framework.
Develop
own competence through use of the Admiral Nurse Competency Framework and
portfolio development using resources provided by Dementia UK
To
maintain professional registration in line with NMC guidance, including
re-validation
Contribute to and lead the development
of policies, procedures and protocols relevant to dementia and Admiral Nursing
within Derby City South, including the Standard Operational Policy
Ensure
compliance with Derby City South clinical
governance requirements, including all mandatory training
Participate
in clinical supervision/mentoring within Derby City South where appropriate
Maintain
up-to-date knowledge of research and evidence-based recommendations on
supporting people with dementia and their carers/families within the primary
care setting
Agree a rotational working week to
support families and GPs in the identified geographical areas
Managerial
Ensure
the recording and investigation of all accidents, complaints, untoward
incidents and losses in accordance with Derby City South policy
Identify
and record risks to the Admiral Nurse service, escalating appropriately
Participate
in recruitment of other healthcare professionals where appropriate
Lead
on Admiral Nurse steering groups with Dementia UK and Derby City
South
Lead,
manage and develop the Admiral Nurse service, continuously seeking improvement
opportunities in collaboration with the Admiral Nurse Steering Group
Please note
that this job description serves to provide an illustrative example of the
duties and responsibilities the post holder will undertake during the course of
their normal duties. It is not therefore an exhaustive list and the post holder
may be required to undertake other responsibilities and duties that correspond
with the band.
