Sexually speaking: person-centred conversations with people living with a dementia.

While sexuality is integral to being human and supporting sexual expression is fundamental to delivering person-centred care, many nurses find this area challenging. This is particularly true when working with people living with a dementia, irrespective of their age. However, it can be especially challenging in older adults. This article aims to support nurses in their work with individuals and couples living with a dementia. After briefly defining the term 'sexuality' and acknowledging the effects of the most common types of dementia, the article discusses the importance of person-centred conversations. It details a new person-centred paradigm that can assist nurses to learn about people's sexuality and sexual wishes. Through enhanced understanding and increased objectivity, nurses can be better equipped to support people to continue living fulfilled sexual lives according to their choices and priorities. The article concludes by summarising the legal and professional context and nursing responsibilities involved in addressing sexuality with people living with a dementia, specifically when mental capacity becomes an issue.

Sexuality and sexual intimacy in later life.

Sexuality is as important in older age as it is throughout life, and its expression can be positive, empowering, joyful and life-affirming. The concept of sexuality has many dimensions including identity, need and desire, relationships and behaviour, all of which develop through ageing and life experiences. The evidence on all aspects of sexuality in later life tends to focus on biological dysfunction rather than fulfilment, well-being and quality of life, and does not acknowledge the enormous diversity of older people in terms of age, sexualities, ethnicity and culture. However, the evidence base is growing and, in broad terms, what older people want is becoming more clearly articulated. This article acknowledges the current evidence and, building on this, suggests ways in which nurses working in health and social care services can address some of the challenges, enhance their own understanding and skills, and work creatively with older individuals to offer services that help them to live, and end, their lives according to their individual identities, choices and deepest, most personal, priorities.

Recommendations From the International Consortium on Professional Nursing Practice in Long-Term Care Homes.

In response to the International Association of Gerontology and Geriatrics' global agenda for clinical research and quality of care in long-term care homes (LTCHs), the International Consortium on Professional Nursing Practice in Long Term Care Homes (the Consortium) was formed to develop nursing leadership capacity and address the concerns regarding the current state of professional nursing practice in LTCHs. At its invitational, 2-day inaugural meeting, the Consortium brought together international nurse experts to explore the potential of registered nurses (RNs) who work as supervisors or charge nurses within the LTCHs and the value of their contribution in nursing homes, consider what RN competencies might be needed, discuss effective educational (curriculum and practice) experiences, health care policy, and human resources planning requirements, and to identify what sustainable nurse leadership strategies and models might enhance the effectiveness of RNs in improving resident, family, and staff outcomes. The Consortium made recommendations about the following priority issues for action: (1) define the competencies of RNs required to care for older adults in LTCHs; (2) create an LTCH environment in which the RN role is differentiated from other team members and RNs can practice to their full scope; and (3) prepare RN leaders to operate effectively in person-centered care LTCH environments. In addition to clear recommendations for practice, the Consortium identified several areas in which further research is needed. The Consortium advocated for a research agenda that emphasizes an international coordination of research efforts to explore similar issues, the pursuit of examining the impact of nursing and organizational models, and the showcasing of excellence in nursing practice in care homes, so that others might learn from what works. Several studies already under way are also described.

Moving the agenda forward: a person-centred framework in long-term care.

BACKGROUND: Internationally, the role of the registered nurse (RN) in long-term care (LTC) settings has evolved in response to the demands of governmental and organisational priorities. In stark contrast to the regulatory mandates, a person-centred care approach in LTC settings would require different outcomes, processes and competencies of the RN. AIMS: This article explores the implications of defining the RN's role in delivering person-centred care in LTC homes. METHODS: Based on a review of the literature, we present a framework that can be used to gather evidence on the outcomes, processes of care and competencies required of RNs to lead their teams to person-centred LTC homes. RESULTS: The development of the framework highlighted several issues: (i) current measures of quality in LTC settings focus on health outcomes and avoiding adverse events rather than on resident quality of life and well-being, which influences the RN's practice; (ii) person-centred care has emerged as a focus of care, yet measures currently developed are limited, and thus, new outcomes are proposed; (iii) to practice in a person-centred way, RNs must work through others on their team to ensure that staff truly relate to their residents, tailor approaches based on the remaining abilities of the residents and manipulate environments to match the competence of the individual, while focusing on residents' personhood and (iv) competencies of RNs to deliver person-centred care include leadership, facilitation, clinical excellence and critical thinking skills. CONCLUSIONS: RNs need to be supported, allowed and encouraged in redesigning their role, to work to their full capacity if they are truly to support person-centred care in LTC settings.

How to optimise the registered nurse contribution in care homes.

This article aims to offer ideas that may be useful to care homes when considering priorities for registered nurse (RN) work. Drawing on the findings of research into the work of RNs and care assistants in UK care homes (Heath 2006), it discusses the distinct contribution of RNs, the delegation of nursing interventions and the need for a 24-hour RN presence. International debates on the distinct contribution of RNs in residential settings for older people are also acknowledged.

Challenges and expectations of the Mental Capacity Act 2005: an interview-based study of community-based specialist nurses working in dementia care.

AIMS: This study aimed to explore experiences of specialist community nurses providing information about the Mental Capacity Act and supporting people with dementia and carers. BACKGROUND: The role of specialist community nurses and case managers, such as Admiral Nurses, suggests that providing information about the recent Mental Capacity Act (2005) in England and Wales would be appreciated by people with dementia and carers and would assist in assessment and support. DESIGN: In-depth qualitative methodology was adopted to explore experiences and opinions of Admiral Nurses using the Mental Capacity Act. METHOD: A volunteer sample of 15 Admiral Nurses were interviewed in 2008 about their experiences of explaining the legal framework to carers and people with dementia and expectations of the Act. Thematic analysis identified textual consistencies in the interviews. RESULTS: Most participants reported positively about the Mental Capacity Act and considered it beneficial when working with people with dementia and carers. Specific themes included knowledge acquisition and training, alongside limited confidence with implementation; practice experiences in the community and the empowering nature of the Mental Capacity Act; practice expectations and challenges with implementation. CONCLUSION: The Mental Capacity Act has potential for supporting the safeguarding and empowerment role of community nurses. However, not all participants felt confident using it and speculated this would improve with greater familiarity and use, which should be facilitated by refresher training and supervision. RELEVANCE TO CLINICAL PRACTICE: The article concludes that nurses providing support to carers and of people with dementia may need greater familiarity about legal provisions. This may assist them in providing general information, making timely referrals to sources of specialist legal advice, and in using the Act to reduce anxiety, conflict and disputes.

Safeguarding adults at risk understand neglect and how to promote care and compassion.

Officially, neglect is a form of abuse. Government guidance states that abuse can be 'neglect and acts of omission, including ignoring medical or physical care needs, failure to provide access to appropriate health, social care or educational services, the withholding of the necessities of life, such as medication, adequate nutrition and heating' ( Department of Health (DH) and Home Office 2000 ).

I want to help nurses articulate their contribution.

By writing the articles in this supplement, we wanted to support nurses in recognising neglect, in understanding the processes that can foster neglect and to offer ideas on how to prevent it.

Frailty and its significance in older people's nursing.

The term frail is commonly used to describe older people, but reports on the care of older adults in hospital highlight that the clinical implications of frailty are not understood fully by all nurses. Frailty can be an indicator of older people's health status and healthcare needs. An understanding of frailty and its mechanisms will help nurses to determine care priorities, particularly the urgency for anticipatory, proactive, preventive and compensatory care to prevent unnecessary mortality and morbidity. This article discusses the significance of frailty in older people's nursing. It highlights the responsibility of registered nurses to recognise deterioration in health as a result of frailty and to implement appropriate interventions.

Older people in care homes: sexuality and intimate relationships.

The Royal College of Nursing has developed guidance to help nurses and care staff work effectively with issues of sexuality, intimate relationships and sex, particularly for older people living in care homes. This article looks at the barriers to ensuring the sexual rights and freedoms of care home residents are protected and suggest how the new guidance might help.

Forum focus.

WELCOME TO the first of a regular RCN older people's forum column.