NIHR - Dementia Researcher Careers Festival
Specialist practitioner Clive Thomas is developing a primary care resource for earlier dementia assessment using an iPad-based app. The initiative aims to address low diagnostic coverage in Wales, optimize support, and overcome challenges in care pathways. The project leverages the Cantab mobile app and has been recognized by the Bevan Commission's Health Technology Exemplar Programme.
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NIHR - Dementia Researcher Careers Festival Using an I-Pad Based Electronic App to Help Triage for Memory Problems in Primary Care Clive Thomas, BA (Hons.), BN (Hons), MSc Registered Nurse (Mental Health), Specialist Practitioner (Mental Health), Professional Doctorate (DProf) Student, Dept of Human and Health Science, Swansea University Swansea Bay University Health Board, Cymru/Wales
A bit of background: Specialist Practitioner Mental Health Nurse o Adult Mental Health - Acute o Dementia Assessment and Long term care o Community Mental Health Nurse Integrated Health and Social Care Team o Memory Assessment Nurse Community Mental Health Team o Primary Care Dementia Support GP Clusters, Primary Care and Community Studying for Doctorate in Professional Practice (DProf) o 6 years, part-time, in final year of candidature o Previous use of reflective practice/auto-ethnography for MSc o Professional doctorates are generic and dynamic and approach may change many times (Fulton et al. 2019); narrative mixed methods action research o No previous experience of doing AR
Current role: 2016-21 Developing a primary care based resource to support the earlier assessment of dementia: oDiagnostic coverage in Wales is low @ 50% and needs to be around 75% in order to maximise support and help with resilience. oProblem is one of over-specialism by Secondary Health Care Services such as Community Mental Health Teams and has created a log-jam oAccessing care pathways notoriously difficult oMounting unmet needs especially amongst those with multiple morbidities, advanced age and physical frailty, made worse during time of Covid-19 oNeeds a person-centred approach and a team around the individual oFundamental human right to a diagnosis is being denied.
Cantab Mobile App oIntroduction to Cambridge Cognition in Summer 2016 oUse of an iPad based app to help triage for clinically significant memory impairment CANTAB looks like a good choice for such a project. iPads are a use-friendly way for giving cognitive tests to older and younger adults and we are already using them in a simple reaction time test . Prof. Andrea Tales, Personal Chair in Neuropsychology & Dementia Research and College Dementia Research Lead, Swansea University
The Bevan Commission* Health Technology Exemplar Programme 2016/17 oApplication to become an exemplar; scrutiny before a Dragon s Den oReimbursement for cost of the licences and access to a full year as a change innovator with the Bevan Commission/Swansea University oTeam of Dementia Support Workers able to deliver this from within an open access referral system located in Social Services oEnabled faster onward referral for further in-depth assessment in the Memory Clinic; project aligns with the Principles of Prudent Healthcare * An independent body that provides advice and guidance directly to the Minister for Health and Social Services on matters relating to health and healthcare in Wales.
Why choose an action research approach? Because:- o First suggested to me by PEER Group (Patient Experience and Evaluation in Research) o Its grounded in practice: an attractive approach for DProf students whose aim is to improve practice (Fulton et al. 2013) o The action researcher acts as an insider and not like an outside consultant many strands to this project not just about an app. o Results in changes to social practice so why not health too? This project is context rich and specific. o Use of reflection is integral to action research and therefore suits the nursing tradition and The Nursing Process (assessment, planning, implementation and evaluation). o DProf candidates are more likely to engage in practical problems; more likely to work across professional boundaries and unlike traditional PhD candidates, go outside of their own discipline (Fulton et al. 2013). o Iterative and suits a doctoral programme in delivering a project over at least 3 phases.
The Continuums of Action Research: Focus on evaluation o Does innovation work? Researcher-led o Yes/No Fixed (pre-designed) o Yes/No Affirmative o Exploring what .. Practical o Making action happen Focus on emancipation o Social Justice (is it equitable?) Participatory o Yes/No Flexible (emergent) o Yes/No Critical o Questioning what .. Philosophical o Generating knowledge Reference: Hardacre, C. (2020), Reframing and Rethinking Theory' in Action Research, AR Study Day, Cumbria Univeristy
The Action Research Cycles Cycle One: 2016/17 o Bevan Commission Health Technology Exemplar Programme o Formation of Community Dementia Support Teams 3 DSWs, 1 MH Nurses o Showcase Conference 2017, Swansea University Cycle Two: 2017/18 o Application to Local Partnership Board successful o First scale up to fit GP Clusters named support worker in each 6 DSWs, 2 MH Nurses o Showcase, Bevan Intl. Conf. June 2018, Celtic Manor Resort, Newport Cycle Three: 2018/20 o Presentation at ICIC19, San Sebastian, The Basque Country o Ulster University Connected Health Summer School; Artimino, Italy 2019 o Selected for first Adopt and Spread Programme to other sites across Wales under the Bevan Commission (Show casing in June 2021)
The Challenges and Rewards of AR Challenges o Finding the right supervisors o PhD vs DProf (Mode 1 vs Mode 2 knowledge) shoehorning, creep towards conventional research pathway. o Wicked vs Tame problems o AR threatened the status quo; they came after me! o Disorientating experience: danger of becoming stuck when disaster strikes o Learning to become unstuck o Learnt resilience and tenacity Rewards o Community of practice; sense of belonging and a safe space to explore o CARN Collaborative Action Research Network, Presented at first virtual conference in 2020 o Combines work with study o Personal and professional growth o Powerful means to force the system o Offers an opportunity to generate new knowledge contributes to theory and practice. o Mechanism to understanding change/resistance to change
Some final thoughts This project was ideal for action research o Multiple strands o Context specific o Potential for scale up and spread to other sites o Triage was meant to help memory assessment services o ..ended up flipping the current model of dementia assessment. o There is novelty value in doing AR where no one else is o Covid has shown that care systems need to be flexible and adaptable: the need for collaborative, relevant and problem focussed research has never been greater (French & Hawkins, 2020) o Future work: Vision is to bring the model back but mainstream it (currently writing a dementia action plan for the health board) o Post doctoral study: fellowship to explore the Advanced Practice Role in dementia. o Action Research is not for the impatient! (Adelman, 1993*) .. but has been really worthwhile. * Kurt Lewin and the Origins of Action Research
Diolch am wrando/thanks for listening Contact details: oClive Thomas, Specialist Practice Mental Health Nurse, oSwansea Bay University Health Board oClive.Thomas@wales.nhs.uk o130971@Swansea.ac.uk
