Supporting diagnosis of patients with dementia in general practice: a training needs analysis to support nurses

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Client: Alzheimer’s Australia Victoria (AAV) is the peak body in Victoria for people living with dementia. It provides support for people with dementia, their families and carers, health care staff, students and the community through education, information, advocacy and raising awareness of dementia.

Project: More than 340,000 Australians are living with dementia and more than 1.2 million people are involved in their care[1]. Families notice symptoms of dementia on average 1.9 years prior to the first health professional consultation, yet it is an average of 3.1 years before a firm diagnosis is made[2]. GPs and nursing staff are often the first point of contact for people who notice symptoms, making it essential that staff have the training, knowledge and skills to make a timely diagnosis. Training staff in general practice will assist people with dementia and their families to receive early support and appropriate medical and social interventions and will reduce the chances of inappropriate medical management and unnecessary hospitalisations.

Alzheimer’s Australia (AA) lead a national project ‘Supporting GPs and Practice Nurses in the Timely Diagnosis of Dementia’ which was funded by the Department of Social Services. Alzheimer’s Australia Victoria were subcontracted to undertake part of this project which involved conducting a Training Needs Analysis (TNA) with nurses in general practice to inform future national nurse training, education and best practice guidelines. AAV engaged Larter for support in developing and conducting the TNA and synthesising the findings into recommendations for the nurse education and best practice guidelines. Informed by the TNA (and a literature review conducted internally by AAV), AAV will develop the education which will be delivered by the Australian Primary Health Care Nurses Association (APNA) to nurses nationally.

Approach: Larter, AAV and APNA met to discuss the best approach to the TNA to learn more about nurses’ understanding of dementia and how the nurse might support timely diagnosis. It became clear that along with understanding nurses’ current skills and knowledge of dementia, further issues would need to be explored.

Larter and AAV worked collaboratively to develop the TNA questions for an online survey, focus groups and a short written activity. The focus groups included one held with consumers (mostly family members) in order to capture the lived experience of diagnosis in primary health care settings. The other focus groups were held with nurses from metropolitan and regional primary health or general practice settings.

All TNA questions aimed to elicit a sound understanding of current skills and knowledge and identify perceptions and ideas for improved practice in the diagnosis and support of people with dementia. The three areas of focus included:

  1. nurses’ knowledge and skills in identification of cognitive impairment, memory problems and dementia
  2. nurses’ roles in assessment and screening, and
  3. how nurses support patients and families with dementia.

The TNA also aimed to capture any current best practice examples of dementia diagnosis and management in general practice experienced by nurses and consumers, for inclusion in the final TNA report.

Outcome: Larter’s recommendation to include a high number of qualitative questions (ten out of the twenty-four questions) in the online survey elicited some rich and insightful information about the training needs of nurses that would not have been disclosed through quantitative data alone. Qualitative survey responses received nationally also strengthened or added new understandings of nurses’ focus group discussions which facilitated more in-depth analysis of emerging themes. Although qualitative responses take more time to review and analyse, Larter did so within the project timeframe and budget and was able to compile a more comprehensive final TNA report.

The final Nurses in General Practice Training Needs Analysis Report provided AAV with a detailed understanding of their dementia knowledge, skills, attitudes and perceptions, and offered recommendations based on the experiences of nurses and families for improved diagnosis and management. Overall the TNA demonstrated the willingness of nurses to play a greater role in identifying, assessing and managing patients with dementia and cognitive impairment in general practice, but also identified their need for additional support. Nurses expressed a need for improved knowledge of memory and cognitive problems as well and more understanding and access to cognitive screening tools. They voiced the need for more time to assess patients and identified the critical need for evidence based clinical pathways to follow, including referral pathways.

The findings of this TNA offer AAV opportunities to respond to the identified learning needs of nurses through relevant and practical education and guidelines that empower nurses and encourage nurse leadership to improve dementia diagnosis and management. In the context of the primary health care reform and the Practice Nurse Incentive Program (PNIP), nurse leadership and empowerment will support the unprecedented opportunities for nurses in general practice to redefine their roles. Dementia is an Australian national health priority and a chronic condition and given nurses are often the driving force behind chronic disease management and the establishment of nurse clinics, the TNA and subsequent education and best practice guidelines present opportunities for greater nurse leadership in general practice.

Larter has been previously engaged by APNA to develop nurse education online learning modules in leadership, nurse clinics, population health, healthy ageing and health literacy. These modules, together with the education AAV has the opportunity to develop, can empower nurses to lead dementia care in general practice to improve health outcomes and quality of life for people with dementia and their families.

Contact us to discuss your next training needs analysis or find out more about our education and education services for primary health care professionals.


[1] Constable, S. (2012) Leadership in Action: A Learning Module for Nurses in General Practice, Australian Medicare Local Alliance

[1] CEO, Carol Bennett, Alzheimer’s Australia

[2] Alzheimer’s Australia website Accessed 2nd April, 2015