Optimising the identification and management of dementia in primary care—the role of the general practice nurse in the provision of care for people living with dementia and their carer(s)

<p dir="ltr">Globally dementia is underdiagnosed and less than optimally managed in the primary care setting. Nurses are an existing primary care workforce, accepted by both general practitioners and patients in the care of people with chronic conditions. However, they have been overlooked in the development of strategies to improve the accessibility and delivery of quality care for people living with dementia and their carer(s). The research reported in this thesis contributes new knowledge in dementia-related primary care by investigating whether general practice nurses (GPNs) perceive that they have a role in dementia care, what the role might involve, and what barriers and enablers influence the operationalisation of this role. It also explores interventions that could support GPN clinical practice change. </p><p dir="ltr">My systematic review of the Australian and international literature revealed that limited evidence exists on the GPN role in dementia care provision. This finding led me to the decision to undertake qualitative focus group interviews with 36 Australian GPNs to establish whether they believed that they have a role in caring for people living with dementia. GPNs not only believed they have a role in caring for people living with dementia and their carer(s), but also identified the barriers and facilitators associated with their provision of dementia care. Consequently, I invited a group of experts in primary care nursing to participate in a Delphi process to identify those principles published in the Australian guidelines that they thought were most relevant to GPN clinical practice. In my subsequent study, qualitative interviews with 13 Australian GPNs, person-centred care was described as underpinning these recommended principles, but multiple complex barriers to operationalising these into their clinical practice were identified. Qualitative interviews were conducted with five people living with dementia and six carers to ensure that the perspectives of people living with dementia and their carers in relation to the recommended principles were also considered. They agreed that the GPN had a role in the provision of person-centred dementia care. Three potential models of nurse-delivered dementia care were described from the perspectives of GPNs, people living with dementia and their carer(s). Two approaches to translating the doctorate findings to support GPNs to deliver best practice dementia care are presented. The first is the development of an educational animation tool that had a positive impact on GPN intention to change clinical practice. Following the UK Medical Research Council's guidelines for the development of a complex intervention, the second approach involved the development of a theoretically informed behavioural change intervention targeted at addressing the identified barriers and enablers associated with GPN dementia care provision.</p>