“There’ll always be something that I can do”: A Qualitative Exploration of Nurse Practitioner-Led Community Dementia Care Enabling a Life of Dignity

Research Design

This study used a qualitative descriptive design to explore how people with dementia experienced participation in a nurse practitioner-led, community-based multicomponent memory clinic. Qualitative description is suited to studies seeking to stay close to participants’ accounts and generate findings meaningful to practice, policy and service development (Tisdell et al., 2025). Nussbaum’s (2011) Central Human Capabilities provided an orienting framework. Reporting followed Tong et al.’s (2007) Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist, with reflexivity and theoretical positioning informed by Braun and Clarke’s (2025) Big Q Qualitative Reporting Guidelines to promote transparency and trustworthiness of the study (Guba & Lincoln, 1989).

Setting

The study was undertaken in a nurse practitioner-led, community-based multicomponent memory clinic in a major regional centre in New South Wales, Australia. The clinic opened in September 2022 to address a local gap in post-diagnostic dementia care. The clinic was developed through consultation with people living with dementia, geriatricians, aged care clinical nurse consultations, exercise physiologists, and academics.

The clinic was nurse practitioner-led, with the nurse practitioner providing initial assessment, clinical oversight, care coordination, review, and referral. At entry, people with dementia and their care partners attended an initial nurse practitioner consultation to discuss medical and life history, functional abilities, interests, goals, and current support needs. Participants then chose a weekly individualised program from the available components in consultation with the multidisciplinary team members. These components included cognitive stimulation, art and creative activities, low-intensity yoga, and exercise sessions (Figure 1). Cognitive stimulation included activities such as puzzles, games, and Lego® model building, and art sessions included painting, clay, craft, and drawing; both were facilitated by registered nurses. Exercise sessions were facilitated by an exercise physiologist, and low-intensity yoga was facilitated by a trained instructor and offered to people with dementia and their care partners. Programs were reviewed every eight to 12 weeks and adjusted in response to changing capabilities, feedback, goals, and availability. Additional nurse practitioner appointments were available to discuss health and wellbeing concerns, coordinate care, or facilitate referrals as required. A monthly support group was also offered to care partners by a mental health registered nurse.OPEN IN VIEWER

Participants

Participants were eligible if they had a diagnosis of early to moderate dementia, spoke and understood English, and had attended the clinic for at least six months. Care partners were also invited to offer complementary perspectives. Study information sheets were distributed to eligible participants, followed by email invitations. Invitations stated participation was voluntary, and would not impact ongoing involvement in the clinic.

Data Collection

Data were collected through emotional touchpoint interviews. This structured interviewing approach enables people with communication or cognitive difficulties to share perspectives by identifying and describing emotions about an experience (Alzheimer’s Society, n.d; Dewar et al., 2010). The Interview guide was developed by the first and last authors, informed by the study aims and emotional touchpoint method (Dewar et al., 2010). Questions focused on key moments in the clinic experience, including arrival, participation in activities, leaving the clinic, and perceived changes over time. Questions were piloted and minor wording refinements were made before interviews commenced.

People with dementia were asked questions such as “How do you feel when you arrive at your clinic session?”, “How do you feel about participating in the activities in the clinic?”, and “How do you feel after your clinic session?”. Care partners were asked questions such as “How do you feel about the person you care for attending the clinic?” and “Have you noticed any changes in the person you care for since attending the clinic?”. Participants chose one or more printed emotion cards, with blank cards available for emotions not represented (Figure 2), and invited to explain why they chose each emotion. Emotions were understood to be evaluative rather than inherently positive or negative (Nussbaum, 2011).OPEN IN VIEWER

Eight people with dementia and six care partners were interviewed (n = 14). Participants had attended the clinic for an average of 16.5 months (range: seven to 32 months). Some people with dementia chose to have their care partner present during interview, and vice versa. Interviews were conducted in the clinic between January and May 2025 by the first and last authors, both experienced qualitative interviewers. Interviews lasted 11 to 63 min (mean 27 min), were audio-recorded and professionally transcribed. Participants were given the opportunity to review transcripts, make changes, or withdraw before analysis. All transcripts were de-identified with participant-chosen pseudonyms.

Data Analysis

Data were analysed using Braun and Clarke’s (2022) six-phase approach to thematic analysis using a deductive-inductive process. First, transcripts were read repeatedly for familiarisation, then coded deductively to Nussbaum’s (2011) Central Human Capabilities. To support consistency, the research team developed contextualised descriptions of the ten capabilities prior to coding (Table 1), clarifying how each capability was understood in relation to dementia care. Theme development was then inductive and iterative by identifying patterns across the capability codes. For example, accounts coded to bodily integrity, affiliation, and emotions included repeated descriptions of feeling safe, comfortable, recognised, reassured, and able to express frustration or grief; which informed the theme ‘emotional safety in a predictable, respectful group.’

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Table 1.

Nussbaum’s (2011) Ten Central Human Capabilities and Descriptions Used for This Study

Central human capabilities as defined by Nussbaum (2011)		How the capability was interpreted and understood in this study
1	Life. Being able to live to the end of a human life of normal length; not dying prematurely, or before one’s life is so educed as to be not worth living (Nussbaum, 2011, p. 33)	A person’s life has inherent value, regardless of age, diagnosis, or cognitive change. For people with dementia, this includes ongoing recognition of the potential for meaning, connection, and contribution to life
2	Bodily health. Being able to have good health, including reproductive health; to be adequately nourished; to have adequate shelter (Nussbaum, 2011, p. 33)	Addresses health in a holistic way by ensuring people with dementia have access to care that is medically appropriate, but is also emotionally supportive, respectful of preferences, and responsive to changing needs
3	Bodily integrity. Being able to move freely from place to place; to be secure against violent assault; including sexual assault and domestic violence; having opportunities for sexual satisfaction and for choice in matters of reproduction (Nussbaum, 2011, p. 33)	Upholds the autonomy and safety of people with dementia by supporting freedom of movement, protecting personal space, and ensuring ongoing consent for participation in the memory support clinic and research
4	Sense, imagination, and thought. Being able to use the senses, to imagine, think and reason—and to do these things in a “truly human” way, a way informed and cultivated by an adequate education, including, but by no means limited to, literacy and basic mathematical and scientific training. Being able to use imagination and thought in connection with experiencing and producing works and events of one’s own choice, religious, literary, musical, and so forth. Being able to use one’s mind in ways protected by guarantees of freedom of expression with respect to both political and artistic speech, and freedom of religious exercise. Being able to have pleasant experiences and avoid non-beneficial pain (Nussbaum, 2011, p. 33)	Supports the ability for people with dementia to engage in meaningful sensory, creative, and reflective experiences that align with their values, beliefs and hopes for the future. This engagement includes cultural, artistic, and intellectual activities that promote dignity through expression, stimulation, and social connection
5	Emotions. Being able to have attachments to things and people outside ourselves; to love those who love and care for us, to grieve at their absence; in general to love, to grieve, to experience longing, gratitude, and just anger. Not having one’s emotional development blighted by fear and anxiety (Nussbaum, 2011, pp. 33–34)	Enables people with dementia to experience, express, and be supported in emotions such as love, grief, gratitude, and anger. Emotions are understood as central to personhood, connection, and dignity, particularly as people navigate changes associated with dementia
6	Practical reason. Being able to form a conception of the good and to engage in critical reflection about the planning of one’s life (Nussbaum, 2011, p. 34)	Affirms the ability of people with dementia to make choices aligned with values, beliefs, and hopes for the future. Even as cognitive changes occur, this capability supports people with dementia and their care partners to express preferences and participate in decisions that shape daily life and future planning
7	Affiliation. a) Being able to live with and towards others to recognize and show concern for other human beings, to engage in various forms of social interaction; to be able to imagine the situation of another. b) Having the social bases of self-respect and nonhumiliation; being able to be treated as a dignified being whose worth is equal to that of others. This entails provision on the nondiscrimination on the basis of race, sex, sexual orientation, ethnicity, caste, religion, national origin (Nussbaum, 2011, p. 34)	Recognises the right of people with dementia to be treated as a person of equal worth and dignity, free from stigma and exclusion, through social connection, mutual respect, and participation in community life
8	Other species. Being able to live with concern for and in relation to animals, plants, and the world of nature (Nussbaum, 2011, p. 34).	Acknowledges the importance of sharing a connection with nature, animals, and the environment as part of a flourishing life. This capability supports a sense of belonging for people with dementia beyond human relationships
9	Play. Being able to laugh, to play, to enjoy recreational activities (Nussbaum, 2011, p. 34)	Values the role of laughter, creativity, and recreational engagement in affirming personhood for people with dementia. Opportunities to play support emotional expression, social connection, and joy that contribute to dignity and quality of life
10	Control over one’s environment. a) Political. Being able to participate effectively in political choices that govern one’s life; having the right of political participation, protections of free speech and association. b) Material. Being able to hold property (both land and movable goods), and having property rights on an equal basis with others; having the right to seek employment on an equal basis with others; having the freedom from unwarranted search and seizure. In work, being able to work as a human being, exercising practical reason and entering into meaningful relationships of mutual recognition with other workers (Nussbaum, 2011, p. 34)	Enabling and supporting people with dementia to participate in decisions that affect daily life, including having choice and influence within the clinic and participating in group decisions

Transcripts from people with dementia and care partners were analysed separately. The first and second authors focused on interviews with people with dementia, while the third and last authors focused on care partner interviews. This approach enabled the voices of the people with dementia to be privileged, while recognising care partners’ perspectives as a meaningful, yet different. Coding was undertaken in a shared Microsoft Excel spreadsheet, with regular team discussions to refine interpretations and ensure themes reflected participants’ accounts, emotional experiences, clinic context, and the research questions. Regular team discussions supported credibility and dependability through the analysis process (Guba & Lincoln, 1989).

Ethical Considerations

Ethical approval was obtained from the University of Wollongong Human Research Ethics Committee (2022/082) before commencing recruitment and information collection. Informed written consent was obtained before participation. Research involving people with dementia raises specific ethical considerations regarding capacity and consent. This study utilised Dewing’s (2007, 2008) process consent, viewing decision capacity as contextual and changeable over time, rather than a fixed state. Consent was an ongoing ethical practice, with interviewers monitoring assent, dissent, or signs of discomfort in participants. This approach aligns with person-centred research principles and a relational view of autonomy, where decision making is supported through trusted relationships (Dewing, 2008; Jacobs et al., 2017). To protect confidentiality and personhood, participants chose pseudonyms to avoid dehumanising means of identification, such as with a number (Braun & Clarke, 2025).

Rigour and Reflexivity

The first and last authors were nurse leaders of the memory clinic and had established relationships with participants through the clinic. This familiarity supported trust and contextual understanding during interviews, consistent with relational, person-centred qualitative research (Dewing, 2007; Jacobs et al., 2017); but also created potential power dynamics. In particular, participants may have felt reluctant to express any negative feedback about the service or practitioners involved in their care.

Several strategies supported the credibility of data generation (Guba & Lincoln, 1989). Study invitations detailed that participation was voluntary and would not affect ongoing involvement in the clinic. Participants were offered an alternative interviewer, although all preferred to speak with someone familiar. Emotional touchpoint cards included positive, negative, and ambivalent emotions, with blank cards available, encouraging participants to identify a range of experiences. Interviewers invited elaboration on all emotions chosen, and prompted participants to consider whether any feelings or experiences had been missed. Reflexivity was embedded in the analysis process, where the research team discussed how existing relationships may have shaped both what was shared and how accounts were interpreted. Authors with different relationships to the clinic contributed to analysis, and regular team discussions were used to question interpretations and consider if positive participant accounts were overly influencing theme development. These reflexive and collaborative strategies supported the credibility, dependability, and confirmability of the analysis, contributing to the overall trustworthiness and rigour of the study (Guba & Lincoln, 1989).

Emotional Safety in a Predictable, Respectful Group

(Linked with capabilities: bodily integrity; affiliation; emotions)

Participants consistently described the clinic as a place where they felt safe and comfortable. These feelings were linked to predictable routines, familiar people, and respectful interactions. Ken stated, “Yes, I feel comfortable… reassured,” and Al, Dave, and Jeff also described feeling comfortable. Birdie said, “I feel safe,” and elaborated “because I’ve connected by the time I leave, well I feel safer.” Recognition on arrival contributed to this sense of safety. Smokey described, “There’s the lovely lady at the front. Always greets us. Friendly, warm smile,” and Jeff said, “When I walk in there, ‘I know that person.’ And you feel comfortable.” These accounts illustrate how ordinary acts of recognition and familiarity supported emotional safety.

The clinic also provided a space where people with dementia could express emotion without judgement. Dave described an “easy” feeling in expressing emotions and Rosie described group conversations were an outlet for her emotions. For some, activities and interactions also surfaced frustration, grief, and awareness of change. Jim explained difficulty finding words during sessions, “Yes, yes. And that’s what’s [messed] up, you know?” He later added, “everybody knows everybody,” suggesting the familiarity within the group helped to make frustration be expressed without judgement. Birdie described grief during activities; “I feel frustrated that once upon a time I could have done that. And I think that’s what the—the feeling around that was grief.” Her account shows that meaningful activity could bring attention to both enjoyment and changing abilities, and that the clinic was a space where these emotions could be expressed and supported in a familiar and respectful environment.

The safe and respectful culture of the clinic supported ongoing attendance. When asked if he ever did not want to attend, Jim said, “No, I don’t do that, no” and Rosie said, “No. No. No” when asked if she felt anxious about attending. Smokey described “lots of positive encouragement, reinforcement. No-one sort of belittled at all,” and Dave noticed the group members as “easy to talk to.” These accounts suggest that emotional safety was created through repeated, respectful interactions that made participation feel possible and worthwhile.

Care partners also recognised the emotional safety of the clinic. Alexandra felt comfort knowing “he’s in somebody’s good care … He seems to be comfortable.” Robyn stated, “He really enjoys it… he goes, ‘The girls are so nice.’” Erica compared the clinic with other programs that created worry: “he wants to take a pen with him. But when he comes here, he doesn’t … Other places, he’ll often say, ‘I’ve forgotten to bring this … I haven’t got that in my pocket.’ And he gets worried.” The experiences highlight how predictability and relational familiarity reduced anticipatory anxiety and supported bodily integrity as more than physical safety. Participants could arrive, move, interact, and express emotion in a setting experienced as respectful and safe.

Relational Autonomy and Everyday Choice

(Linked with capabilities: practical reason; control over one’s environment)

People with dementia described autonomy as something exercised through everyday preferences, adaptations, and choice about participation. Birdie offered a clear example when deciding whether to buy a puzzle: “I nearly bought it but then I thought, ‘No, I’m not going to do a thousand pieces.’ And I knew it would be difficult because of the colours … I’ve had to adjust my expectations, having dementia.” Her account shows practical reason in action; recognising changing capability while maintaining enjoyment and choice. Similarly, Rosie wanted to keep painting: “I’d like to do more … paint,” and used alternative painting methods, such as sponges, which accommodated her physical limitations; which she explained, “it helps.” These examples show how autonomy was supported by adapting activities so participation remained possible and meaningful.

Participants also described choosing how and when to engage socially. Smokey said, “I’m very comfortable doing my own thing. I do enjoy, depending on the activity, being able to mix with others,” identifying that group participation was about flexibility. Dave spoke about choice and engagement, “Look I’ve been doing this, and doing that, and doing something else and thinking, ‘I’ll do it. I’m going to do it.’” Jeff also offered he “never thought it was a waste of time.” These experiences highlight that ongoing attendance was not passive, and reflected participants’ own assessment and choice based on value, comfort, and interest.

Care partners reinforced these accounts by describing changes in confidence and initiative. Alexandra described how the person she supports initially resisted help but now chooses to attend, “He was just so unaccepting of any help that I was trying to organise… and he’s been going there, what, a year now, and he likes going and he comes back happy.” Alexandra’s reflections illustrate how preferences as to what is good and meaningful can evolve for a person with dementia following new experiences. Robyn described active choices to prepare to attend, “He goes ‘Well, I’ll need to have a shower then, won’t I?’” Erica shared the clinic’s support for both the person with dementia and care partners as creating “a synergy that you can’t really get from other places.” These accounts demonstrate relational autonomy as shared and supported, with choices made through trusted relationships, meaningful activities and changing confidence over time.

Autonomy was visible in small, everyday ways; choosing activities, adjusting expectations, preparing to attend, choosing when to join others, and continuing participation because it felt worthwhile. For some, control over one’s environment extended to the continuity in access to the clinic. Smokey noted, “Probably the only thing that I find a little bit frustrating is the eight-week blocks” suggesting that once the clinic had become meaningful, ongoing access to it was also experienced as a part of autonomy and dignity. The clinic supported people with dementia to reason, decide, and act in ways they felt they had control over, and participants recognised that autonomy was strengthened through relational and practical support.

Feeling Truly Known, Respected, and Connected

(Linked with capabilities: life; affiliation; emotions)

Participants described feeling known and valued within the clinic, which affirmed identity, purpose, and belonging. The clinic recognised the contributions and connections people with dementia can continue to make, despite changes in cognition and ability. Birdie described a renewed sense of self, stating “I do feel respected again for my contribution” and said the clinic “has enabled me to believe that there’ll always be something that I can do.” Similarly, Dave shared how being known is meaningful, “…it’s nice to have someone that wants to know me” and “I feel part of it.” For Jim, continuing to actively participate in life was important: “Well, you’ve got to go somewhere!” while Birdie described participation as connecting her “to the human experience.” These reflections demonstrate how being recognised and included supported personhood as ongoing, and not diminished by diagnosis.

Social connection was created through mutual respect, acceptance, and genuine interest in others. Rosie stated, “When I’m here, I love it. Every time … I love all of you.” For Al, the opportunity for social connection was important; “I like mixing with people… your clinic was particularly good at getting people to mix,” and described being “overwhelmed” by the respect shown to him. Jim and Jeff both talked about having made friends at the clinic, and Jeff described the group as “super” and added, “Everyone would help you if you asked for it.” For Jeff, connection was about genuine interest: “Talk to them properly and be friendly and talk to them about their family and things like that.” Ken found it reassuring to be part of a group who, “all seem to have the same sort of targets, aims.” Belonging, therefore, was active and reciprocal for participants and not just about being in the same room together. For some participants, the clinic contrasted with the loneliness felt outside it. Birdie said “I feel included. I feel part of something that’s good.” She further described, “it’s the place, it’s the people, it’s what happens here is quite special and unique … it’s like [the clinic] has been an antidote to the loneliness.” Her reflection highlights how connection was experienced through social contact, but more so through a renewed sense of place and value.

Care partners also described the clinic as supporting connection to life. Erica said the clinic created moments of familiarity, “… a bit like almost a glimpse of the person without the disease,” and explained connection with others enabled the person she supports to feel “still part of what’s going on in the world.” Mabel said, “I think she feels valued, too, coming here… she feels ‘heard’.” For Sue, she felt relieved “he’s got somewhere to go to and do something.” Robbo and Mabel identified the social aspect as one of the most important elements, and Robyn described the clinic as “a positive, and a social thing for him as well.”

Feeling truly known, respected, and connected came through ordinary and repeated acts of being listened to, recognised, included, and valued. These actions affirmed identity and contributed to a sense of continued place in the world for people with dementia. The clinic’s social group model fostered personhood through connection and belonging.

Meaningful Engagement Through Accessible Challenge and Play

(Linked with capabilities: sense, imagination and thought; play; bodily health)

Participants described the clinic activities as enjoyable and stimulating. Puzzles, games, craft, art, exercise, and humour created opportunities for play and engagement that were not experienced as tokenistic. Rosie shared, “Yes, we get some laughs and everything, yes,” and Smokey stated, “I’m really enjoying [the clinic] and mixing the exercise in with it … thoroughly enjoying myself.” Birdie described puzzles as calming: “There’s lots of feelings. Like great ones, really positive ones … I think doing the puzzles makes me feel calm… I enjoy those.” Dave said humour was a source of enjoyment and connection for him; “Joking to those things and that, that sort of thing. I just laugh at them.” Ken valued the exercise and cognitive stimulation components: “I look forward to doing the physical exercises and also the mental – yes … it’s very enjoyable.” These accounts suggest play and stimulation are important to wellbeing and dignity.

Activities also supported creativity, imagination, intellectual curiosity, and cognitive engagement when they were accessible and matched to participants’ interests. Rosie described feeling “good” about painting, and said the clinic was something she looked forward to: “I love it … it’s beautiful.” When engaging in Lego® model building, Al chose emotional touchpoint cards Encouraged, Comfortable, and Respected, indicating that creative activity affirmed self-worth. Jeff liked the intellectual engagement, stating, “There’s always something to learn, right?” Participants also recognised when activities were not accessible or scaffolded appropriately. Dave explained, “I don’t like it when people just give people a whole load of things … that they need to do this and work it out.” His account highlights that challenge was meaningful when it was accessible and not overwhelming.

Meaningful engagement also supported physical, emotional, and psychological wellbeing. Birdie described feeling “energised… physically and mentally,” and stated, “there’s enjoyment and it’s safe … I feel like I’ve been challenged.” Jeff said, “I’m proud that I can come here and I’m hopeful that something comes out of it,” and Smokey chose the emotional touchpoint cards Proud and Confident, elaborating, “it feels good that – achieving something.” These emotions suggest that challenge and achievement were important because they led participants to experience themselves as capable. The exercise component was also valued; Ken said, “It’s good for the brain,” while Rosie stated, “I’d like to do it more,” and laughed. Additionally, Birdie described, “I’m definitely more connected to my body from the exercise,” and “I feel motivated to do more exercise.”

Care partners observed similar effects. Robyn shared “He loves his table tennis and he’s happy to take his reading glasses, whereas normally he wouldn’t.” Mabel stated, “She really just wants to get in there.” Alexandra described how relational connectedness enabled participation: “I’ve tried doing crafty things with him and he’s not interested, but he does do them with you.” Mabel described the person she supports rediscovering painting; “I think [painting] makes her feel a little bit of power.” Erica thought the clinic enabled people with dementia to: “generate activity and feeling and emotions in other people,” and Robbo observed improvements in posture, grip strength, and fewer falls, while also stating: “She’s much happier.”

Meaningful engagement was created through activities that were enjoyable and appropriately challenging. Activities were neither infantilising, nor overwhelming, and were adapted to participants’ interest, capabilities, and goals. This approach in the clinic supported people with dementia to experience creativity, bodily confidence, achievement, pleasure, and contribution.

Dignity Was Supported Through Emotional Safety, Recognition, and Meaningful Participation

A key finding was that people with dementia valued feeling safe, known, and connected within the clinic. Participants described comfort and reassurance through familiar routines, recognition on arrival, respectful interactions, and relationships with group members and staff. These experiences are important because post-diagnostic care is often framed through information, diagnosis, and treatment, and the emotional and relational dimensions of living with dementia are not addressed (Pavković et al., 2024, 2025). In this study, feelings of safety and comfort were central to how participants experienced the clinic as a place where participation was possible. The findings extend understandings of safety in dementia care. Through Nussbaum’s (2011) capabilities, bodily integrity can be understood to include the conditions that enable people to participate and express themselves without fear or humiliation. Participants’ accounts of feeling safe, comfortable, reassured, and able to express frustration or grief suggest that emotional safety supported capability. This support was particularly evident in activities where changing abilities were noticed by participants, and support was provided so emotions such as frustration and grief could be expressed, without being treated as failure.

Participants described autonomy as relational and practical. Choice and practical reason were evident in everyday acts such as preparing to attend, choosing activities, adjusting expectations, deciding when to participate with the group, and continuing participation because the clinic felt worthwhile. These findings align with relational understandings of autonomy, where agency is enabled through trusted relationships and practical support and not always in isolated and independent ways (Dewing, 2008; Jacobs et al., 2017). For people living with dementia, autonomy may be expressed through perceived small, situated choices that can be easily overlooked. The clinic supported practical reason and control over one’s environment by adapting activities to changing capabilities, interests, and goals.

Feeling known and connected also affirmed identity and personhood. Participants valued being recognised as persons with continuing interests, contributions, relationships, humour, and preferences. These findings challenge deficit-based dementia discourse by showing how people continued to learn, create, and contribute within a relational, non-pharmacological model of care. Similar recent evaluations of multicomponent post-diagnostic dementia care programs report that group-based participation can enhance confidence, social connection, and program engagement for people with dementia living in the community (D’Cunha et al., 2025). Participant accounts in this study add to this evidence by highlighting how emotional safety, recognition, and belonging can enable dignity in post-diagnostic care.

Meaningful engagement was also central to participants’ experiences. Cognitive stimulation, creative activities, physical exercise, humour, and play were valued when they were accessible and not infantilising. Participants’ emotions of enjoyment, pride, confidence, calm, and motivation suggest that activities created opportunities to experience their own capability. These findings support evidence for social and non-pharmacological approaches, including cognitive stimulation and multicomponent programs, in promoting wellbeing, mood, and quality of life for people with dementia (D’Cunha et al., 2025; Desai et al., 2024; Woods et al., 2023). In this study, accessible challenge was important to nurture strengths and enable achievement so that dignity is upheld.

Participants wanted what all people need: to know and be known by others. Yet people with dementia continue to experience stigma, discrimination, and exclusion in society (Department of Health and Aged Care, 2024; WHO, 2025). Recent work by Pavković et al. (2025) highlights that after diagnosis, people and care partners often receive empathetic communication but overwhelming or generic information, uncertain pathways, and prefer a single trusted contact to guide them through post-diagnostic support. The clinic responded to this need by centring relational and emotional connection, not only cognitive or functional support.

Nurse Practitioner-Led Care Enabled Continuity and Relational Knowledge

The nurse practitioner-led model in this study offered more than a program of activities. The clinic combined initial assessment, care coordination, review, referral, individualised activity programs, and care partner support. These elements enabled the clinic team to know participants over time and respond to changing capabilities, goals, preferences, and emotional responses. This approach is important in dementia care, where needs are evolving and post-diagnosis support pathways can be fragmented or uncertain (Naismith et al., 2022; Pavković et al., 2024, 2025).

Participants’ experiences in this study suggest that continuity and relational knowledge were important in post-diagnostic dementia care. While many other memory support or cognitive stimulation therapy programs operate within predetermined program durations (D’Cunha et al., 2025; Jeon et al., 2025; Woods et al., 2023), the clinic in this study was able to offer ongoing programs for participants. The ability to return to a familiar place, be recognised by familiar people, and participate in activities adapted to individual needs supported feelings of safety and belonging for people with dementia. Continuity is known to support quality of life and wellbeing in dementia care (Department of Health and Aged Care, 2024; Pavković et al., 2025). Although the clinic was offered on an ongoing basis, some participants’ frustration with enrolment occurring in successive eight-week blocks suggests that uncertainty about continued access to meaningful post-diagnostic care can influence their sense of autonomy, control over one’s environment, and dignity.

Nurse-led multidisciplinary care models have demonstrated value in improving access, continuity, and person-centred care across health contexts, as well as being sound economic investments (Australian College of Nursing, 2024; Luck & Doucet, 2021; Stewart et al., 2024; Terry et al., 2024). However, evidence specific to nurse practitioner-led dementia care remains limited (Luck & Doucet, 2021). This study contributes qualitative evidence from people with dementia and care partners about how a nurse practitioner-led multidisciplinary dementia care model may support dignity in practice. The findings suggest the value of nurse practitioner-led dementia care is in the clinical expertise, and also in the relational continuity, emotional safety, individualised and capability matched activities, and care partner support.

Strengths and Limitations

A strength of this study is the privileging of accounts from people living with dementia, supported by an interview method that enables emotional expression and accommodates communication and cognitive changes. The inclusion of care partners provided complementary perspectives. The use of Nussbaum’s (2011) Central Human Capabilities offered a coherent theoretical framework for interpreting dignity, capability, and flourishing in post-diagnostic dementia care. Additionally, the methodological congruence, transparent reporting, and reflexive team analysis promotes the credibility and overall trustworthiness of the study (Guba & Lincoln, 1989).

This study was conducted in a single nurse practitioner-led clinic in regional Australia, and findings may not be transferable to all dementia care settings. Participants had attended the clinic for at least six months, and therefore the study reflects experiences of people who had remained engaged with the service over time. Participant accounts were largely positive, which may reflect the value participants placed on the clinic, but may also relate to existing relationships with the interviewers. Some interviews included both the person with dementia and their care partner, which may have shaped what was shared. However, participant choice about who was present in the interview was prioritised in the person-centred approach to the study. Finally, participant characteristics were not reported which may limit contextual detail.

Implications for Policy and Practice

This study provides evidence for nurse practitioner-led, community-based dementia care that complements biomedical models through relational, non-pharmacological, strengths-based approaches. In practice, the findings suggest that post-diagnostic care should attend to emotional safety, routine recognition, supported choice, accessible challenge, and opportunities for contribution and play. Emotional expressions should be understood as meaningful information about how people experience care, including whether activities feel safe, overwhelming, grief-inducing, enjoyable, or affirming.

The findings also have implications for service design and funding. The clinic aligned with national and international priorities for flexible, multidisciplinary, community-based dementia care that supports autonomy, wellbeing, inclusion, and care partners (Department of Health and Aged Care, 2024; Low et al., 2021; World Health Organization, 2025). However, supporting a model of care such as the one described in this study requires funding structures that recognise nurse practitioner-led coordination, cognitive stimulation, exercise, creative engagement, and care partner support, as important components of post-diagnostic dementia care. Investment in nurse-led models of multidisciplinary dementia care may help address current service gaps by enhancing continuity, accessibility, and person-centred practice for people living with dementia in the community.

Recommendations for Further Research

Nussbaum’s (2011) Central Human Capabilities show promise for evaluating dementia care. Future research could explore how the framework might inform co-design, or be adapted into a practical evaluative tool or set of indicators. Additionally, while most capabilities were strongly reflected in this study, the capability of other species was not; future research could explore if connection with animals and nature enables flourishing for people with dementia.

Future research is needed into the cost and economic value of nurse-led, multidisciplinary dementia care. Evidence of the cost-effectiveness and efficiency of nurse-led models is needed as calls for dementia care reform increase. This research could include how nurse-led models impact hospital admissions, transitions to residential aged care, and care partner wellbeing. Research is also needed into the emotional and relational dimensions of dementia care identified in this study, including how relational autonomy is created, navigated, and practiced by healthcare workers and people living with dementia. Additional studies of longer-term non-pharmacological dementia care programs are needed.