Despite the growing view of the importance of a relationship-centred approach to caring for people with dementia, there has been little exploration on how a family approach can be integrated into Admiral Nurse practice. Admiral nursing is a service offered to people with dementia and their carers.

Using the appreciative inquiry 4 ‘D’ cycle - discovery, dream, design and destiny - the study began with a preliminary questionnaire to contextualise current Admiral Nurse practice. The study was then developed in two strands over a nine month period: strand one included the voluntary participation of nine carers. They presented stories of value and well-being of caring for a person with dementia using telephone interviews, photographs and narratives and a focus group. The second strand invited voluntary participation from 54 Admiral Nurses, two carers and people with dementia from peer support groups and stakeholders of the Admiral Nurse Service. Each participant was invited to participate in a sequence of three focus groups over a nine month period. A reference group of nine carers and two Admiral Nurses provided consultation and guidance to the study throughout the data collection period.     

The co-construction of the first study strand revealed the unique way that each carer managed their relationships within a complex and at times very stressful caring situation. Although each carer developed their caring role within sometimes difficult environmental, practical and emotional constraints they developed strategies and coping mechanisms that enabled them to continue to care for the person with dementia. When they were able to implement those strategies they stabilised their relationships in ways that were ‘caring relationships,’ themed as recognising (1), transforming (2), stabilising (3) and moving on (4). In this sense they developed feelings of wellbeing and value of their caring role re-shaping their feelings of self. This is an alternative to the manifestation of isolation, stress and burden as an outcome of a caring role. Secondly the co-construction of four principles with underlying values of Admiral Nurse practice has developed an understanding of a family-centred approach to Admiral Nursing that is relationship-focused.

In summary, carers wish to be recognised as individuals with ‘caring relationships’, this is not only possible but achievable. There is a complex interaction between the carer and the person with dementia and the people that support them which has a powerful influence on how the caring role is supported and maintained. This is represented by the conceptual model that has been developed in this study to present how Admiral Nurse core principles and underlying values support that caring role.