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Profile: the travelling dementia nurse

Travelling round Boston and New York through her Florence Nightingale scholarship was just the start for Natalie Yates-Bolton. Four years later, the senior lecturer in nursing at the University of Salford was recognised at the Florence Nightingale Commemoration Service on International Nurses day for her achievements in the field of dementia. “Every aspect of the day was extraordinary,” says the well-travelled lecturer. 

The Florence Nightingale Foundation has a range of scholarships available for nurses including leadership, travel and research and uptake is increasing with 74 scholarships and five small grants being awarded last year. Yates-Bolton chose to use her Florence Nightingale travel scholarship to go around the States to learn more about dementia.

Following her return she helped to develop the Dementia Design Group, a network that started in 2011 and has now evolved into the Salford Institute for Dementia, which was launched in 2013.

It also aims to connect people with dementia to those close to them for example, their carers and also, charities, organisations, academics and professions, to improve the quality of life for people living with dementia.

The Institute hosts a range of seminars and workshops to explore best practice in dementia.

It was her work making a difference in the area of dementia and as co-lead for the Dementia Design Group that led to her receiving Florence Nightingale's lamp at the alter at the recent commemoration service held at Westminster Abbey on the 6 May 2015.

The ceremony is held to reflect Florence Nightingale's legacy and commemorate the impact she had and continues to have on nursing. Florence Nightingale is held in such high regard due to her work as a nurse in the Crimean war, where she provided personal care to wounded soldiers, which gave her the alternative name of the 'lady with a lamp', and is known as the founder of modern day nursing. 

Speaking about the day Yates-Bolton says: “The abbey was packed with 2,200 people, which is apparently more than the Royal Wedding. There were aspects of the ceremony that reflected on the past, there was a talk on Florence Nightingale's life and her approach to her work, there was a part of the ceremony where representatives of the armed forces carried down the nurses roll of honour, which is to commemorate the nurses that died in the second world war; it was a very powerful emotional experience.”

Yates-Bolton began her career when she was 19 with a degree in nursing at the University of Surrey. She says: “It gave me a really great grounding for a nursing career and I didn't feel there was even an hour of my four year degree that was wasted… I really hope the students I teach receive the same level of education that I received, because Surrey really set the standard for me of what nurse education can be like so I have always aspired to meet that same standard.”

After qualifying she began work at the National Hospital of Neurology and Neurosurgery in Queen Square, London. Following this she flew to Australia to nurse for a year, which she says “was really fascinating and a life enriching opportunity”. Next she returned to the UK and worked in the north of England mainly at Royal Oldham Hospital in Manchester until she began to teach at Salford University where she has now been for 12 years.

The interest in dementia sprang from work on her PhD at the university. “I had become interested in dementia through my PhD, which is on meaning and purpose in nursing home life, but it didn't really focus on dementia. Part way through my PhD I was beginning to wish I had actually looked at people living with dementia and how meaning and purpose could be enhanced in their lives.

“I didn't re-start my PhD as I was already half way through it, that's why I applied for the scholarship because when I was in nursing homes in the UK I felt very drawn to people with dementia and really felt a strong connection with them.

“I wanted to explore the connection you can have with someone who has dementia and how, as a nurse, you can make a difference to their lives but also how patients can make a difference to your life,” she says.

The senior lecturer feels the support she has received from Salford university allowed her to effectively use the scholarship. She says: “My boss really saw the opportunity as something that the university wanted to invest in… he was really supportive.”

“I just think it shows the power of the scholarship and the concept of Florence Nightingale's work carrying on, but also that there are leaders in education and nursing who really invest in the staff and give staff the opportunities and the chance to learn and then come back and make a difference.”

Her motivation to better understand dementia came after receiving amazing care while she overcame Lymphoma and breast cancer a total of four times, being diagnosed for the first time when she was a student nurse.

She says: “As I was becoming more interested in dementia I was having treatment for cancer. Because I was receiving really excellent care it just made me think how I wanted to spend my nursing career and made me re-evaluate. Having cancer makes you think, and that's what sharpened my route to dementia.

“I had benefitted so much from the nursing support that I received, I would hope that maybe I could make the same difference to patients.

Nurses are in such an ideal role to help someone live well with conditions and help them have a positive life experience, despite having a challenging health condition.”

The senior lecturer, who enjoys running in her spare time and even taking part in marathons when she can, explains that she applied for the scholarship at a time where she felt she could make the most of the opportunity.

In January 2011 she received her letter from the Florence Nightingale Foundation explaining her application had been successful. It didn't take long for her to arrange her trip to the United States (US) in July 2011, although she says it was extremely hard to leave her two daughters Lucie and India, then aged 17 and 21, behind for a month.

Yates-Bolton, who currently lives in Oldham ten miles from Salford says: “I went to work for an organisation called Hearthstone Care, the chief executive there was a visiting professor [John Zeisel], I had heard about his work and wanted to know more.”

While in the US she visited all six of Hearthstone's care homes, three in Boston and three in New York, while additionally spending time at their research dementia centre in Cleveland.

“I'd spend two to three days in each of his care homes. Rather than follow the nurses and see their perspective I decided that I would just sit with patients who had dementia every day and learn the approach as closely as I could from their perspective, so whatever they were doing, I would do. It was just a really powerful way to learn about this approach.”

“It's about people being kind. To let someone spend two to three weeks in your organisation could be seen as a burden but [Zeisel] just showed incredible kindness and all his staff did,” she says.

Emotional intelligence was another key thing Yates-Bolton learnt and brought back to the UK with her.

She says: “The staff at Hearthstone had something different about them, and I thought the way they were working was by using emotional intelligence.

“They were very much aware of their emotions because there is some research that shows that the brain of the person with dementia changes, making them more sensitive to the person they are with.

“So the staff were aware of their own emotions and kept them under control, they moved and spoke a bit slower, which had a really calming influence on everyone. It meant that those with dementia could become really emotionally intelligent as well. This meaning there were some really tender moments where the residents showed great compassion for me and I was only there for three days.”

She also felt the residents she met with dementia taught her a lot. She says: “I can become a better nurse and a better person by just being aware of the lessons that someone with dementia can teach me,” for example, when leaving one of the care homes she became emotional, and tried to conceal this but a resident comforted her, which Yates-Bolton feels taught her emotional intelligence.

“The most powerful lesson for me was about emotional intelligence and how as a nurse I need to be aware of my emotions, motivations, meaning and purpose. And to have a sense of hope in my work because people with dementia are likely to reflect these emotions and experience them themselves.”

Professor Zeisel now works closely with Yates-Bolton as an advisor for the Salford Institute of Dementia, created as a result of the scholarship, and attends board meetings.

“We have a human rights and dementia conference in September and he 'Skypes' in for all of our planning meetings and will also be a speaker at the event,” she says.

Once returning back to the UK, Yates-Bolton developed her work in dementia by establishing the Dementia Design Group that has now evolved and emerged as part of the Salford Institute for Dementia.

The work with dementia grew with students of various disciplines getting involved from architects and designers, nurses, occupational health and physiologists along with computer scientists, experts in robotics and digital science professionals. More broadly the wider community participated including: the Salford Art Gallery and Museum, Salford Royal Foundation Trust, Greater Manchester West Mental Health Trust, the city council, flooring companies, the fire service and the police. To share the approach to dementia, the Institute is also linking with a company in Australia called Hammond Care.

“It has just really grown and coming back with my experience from the States I then connected and collaborated across Salford, Greater Manchester and then the UK. We also have a project with five of European universities to develop dementia education across Europe. It has been incredible that over four years it has gone global,” she says. 

Yates-Bolton says her work has only been possible due to the support she has had from the University of Salford allowing her to take time off to use the travel scholarship but also by supporting her to adapt her work to improve dementia care once she arrived back in the UK.

She says: “I have only been able to do this due to my manager at work. Because it takes time and the university has seconded 50% of my time to work on dementia. I couldn't have done that if I had to carry on my normal work full time but I'm released for two and a half days, so it's carried on since the scholarship.”

She now aims to finish her PhD this summer and apply for Florence Nightingale's leadership scholarship to deepen her work in dementia. She says: “The connection between a nurse and someone with dementia is so strong… I think there is great potential in that bond.”