Ruth Cann
Cardiff and Vale University Health Board
Recognising and Strengthening Nursing for Older People living with Frailty and Multiple Health and Social Care Needs
Background
- Wales faces a major demographic shift: the population aged 75+ will rise from 9.9% (2021) to 13.8% (2041), with two-thirds of adults over 65 living with multiple conditions by 2035.
- Nursing roles for older people with frailty or complex needs are undervalued and fragmented, with no national framework guiding education or career progression.
- This creates inconsistent care standards, workforce instability, and limits integrated, person-centred care.
Aims and Objectives
To develop a national framework that:
- Recognises and strengthens nursing roles in older people’s care.
- Improves recruitment, retention, and professional development.
- Promotes older person care as a rewarding career.
- Co-produces an education and development framework for nurses.
- Validates and celebrate nurses’ skills.
- Embeds “What Matters” principles in care delivery.
Approach
Quantitative: Staff survey (60% response) revealed gaps in dementia care, frailty education, future care planning, and advanced skills (e.g., CGA, prescribing).
Qualitative:
- Community of Enquiry explored person-centred care using DEEP methodology.
- Interviews highlighted emotional labour, system navigation, and advocacy roles.
- Unpaid carers reported mixed experiences, often feeling invisible.
- ‘What Matters’ conversations revealed priorities like independence, home life, and personal routines.
Outcomes
- Elevated voices of nurses, carers, and older people.
- Identified gaps in education and career progression.
- Proposed a values-based framework centred on:
Values: Person- and relationship-centred care, collaboration, empowerment.
Themes (Strategic Pillars): Education, relational skills, clinical expertise, MDT collaboration.
Initiated an All-Wales Steering Group to lead co-production of the framework.
Impact
- Positioned older person care as a strategic priority.
- Provided insights for workforce planning and policy alignment.
- Created momentum for national adoption.
Conclusions
Nursing older people living with frailty and complex needs requires advanced skills, emotional resilience, and system navigation. This project has made the “Invisible Visible,” highlighting gaps in education and career progression while proposing a values-based national framework to strengthen professional identity, improve outcomes, and embed person- and relationship-centred care across Wales.”
