With an immense love and passion towards providing caring for acutely compromised patients with neurological conditions, NP Judy Deimel strives to be a leader of change in relation to the provision of high-quality patient care in a timely, personalised, efficient and effective service.
Tell us about your nursing journey.
My clinical background in nursing gravitated towards neurology care early in my career. In my graduate year, I developed a passion caring for acutely compromised neurological patients. Prior to endorsement as a NP, I worked for 17 years as a Registered Nurse (RN) advancing my nursing practice over these years at The Queen Elizabeth Hospital (TQEH) Neurology Department in Adelaide.
Whilst on the wards, I was charged with caring for post-operative neurosurgical patients, epilepsy patients undergoing video monitoring and patients who had suffered a cerebrovascular accident. It is a highly specialised role where nurses are constantly challenged to maintain a high level of clinical knowledge and capability. Moving to the Neurology Clinical Trials Unit, I identified a clinical practice gap for individuals with a diagnosis of dementia, and their families. Bridging this gap in service, a need for extended nursing scope of practice was deemed necessary and a case for the integration of a dementia nurse specialist role was developed.
From these early deliberations, the advanced practice nursing role of the NP in the Memory Service clinical area evolved. A Premier’s Australasian Scholarship assisted in the development of the NP role, facilitating the advanced practice model with outcome measures to ensure a continuous quality improvement cycle in patient care.
Can you tell us about your current role as a NP?
In my nurse-led clinic I diagnose dementia subtypes based on the person’s natural history and progression of the cognitive changes they are experiencing. This is performed collaboratively within the multidisciplinary team. Features of the NP service include ruling out reversible causes for change, managing unintended consequences of other pharmacologic treatments, prescribing and monitoring medication for dementia symptoms and education about the increased risk of delirium. Working with families in the non-pharmacological approach to care is a meaningful attribute the nursing model contributes. This includes education on the disabling effects the environment and relationships may have for the person with dementia, often first identified by changed behaviours. Dementia creates complex challenges in providing appropriate care and management strategies over the course of this chronic condition. To be an effective change agent in this setting requires a respect for a multidisciplinary team approach, but importantly a shared decision-making relationship with the patient and family to deliver person centred care.
Aside from being a most rewarding clinical role, with direct patient care, it is also satisfying to have the opportunity to lead change.
The NP role in a memory service was an unfamiliar concept in South Australia when I commenced the NP pathway. It required active promotion of the role, a sound business case and a commitment to demonstrate the potential value for investment in a NP model of care. The business case highlighted the merit of timely, equitable, safe, personalised, efficient and effective service delivery by the NP, to improve patient and organisational outcomes.
What influenced your decision to become a NP? Why did you choose your scope of practice?
The year 2005 was seismic in terms of becoming a NP, I engaged the organisation’s nursing leadership group and joined TQEH Hospital NP Working Party. The nurse/physician collaborative relationship was advanced and together these initiatives provided the foundation of the NP dementia scope. The Premier’s Scholarship, a master’s degree, peer support and family belief reinforced the road towards NP endorsement.
Albeit that, proved a rocky road at times and not without obstacles before securing the Memory Service NP position in 2017. This included a 5-year sabbatical employed in the community. The sea-change to community proved valuable expansion of the dementia scope of practice.
What are you hoping to achieve in your current role as a NP?
My goal is to continue to support the development of the nursing profession. As a nurse clinician and a nurse educator, I am in a position to provide this support in a number of ways. I have previously been affiliated with the higher education sector, predominantly as Course Coordinator/Lecturer in the Master of Nursing (Nurse Practitioner) program. I continue this relationship on a sessional basis for educational workshops in Central Adelaide Local Health Network (CALHN) and in the community.
I also strive to achieve NP succession planning. This goal was set some time ago to entrench the role of the NP into the long-term future workforce planning for the care and management of early dementia diagnosis, acute care and OPD.
What advice do you have for anyone wanting to become a NP?
Think the big picture, is the best advice I can offer. Identify the health care gap for your patients in your specialty area and engage key stakeholders early.
Self-auditing of practice has revealed approximately one third of my NP time is non-clinical and supports clinical governance issues. Non-clinical duties operationalise the pillars of education, research and leadership domains articulated in the Nursing & Midwifery Board of Australia NP Standards for Practice and are therefore important activities in strengthening your role within your organisation. Be prepared for repeated knock backs and keep knocking on doors.