Discuss about the Nursing in Dementia.
Dementia is a chronic or persistent disorder of the mental processes that mainly takes place in the old age. This mainly occurs due to brain disorders or any sort of brain injury. These are mainly marked by loss of memory and cognitive skills, impaired reasoning and others. Hence the quality of life is compromised and the patient has to live with dependency on others for his regular activities of life (Jutkowitz et al., 2016). Ability to focus and paying attention to particular matter cannot be handled by the patients. Person centered care is therefore found to be extremely helpful in treating dementia patients as the interventions are designed accordingly to the needs of the patients (Kales, Gitlin & Lyketsos, 2014). The following essay will depict how a nurse with her critical analyzing skill can find out the real causes of distress in such patients and accordingly plan interventions that will help in the providing a quality life to the patients and making her comfortable in the acute care settings.
Mrs. Patricia Smith has been suffering from dementia for the last eight months. Dementia is often considered to be a general term that had led to the decline of mental ability of a person to such an extent that it interferes with the daily activities of the patient. a wide range of symptoms are experienced by a patient of dementia. This mainly includes loss of memory and developing language difficulties. Moreover, the patients also face issues with understanding, disorientation, hallucinations, delusions as well as wandering behaviors (Acharya et al., 2015). They often face changes in their moods, behaviors as well as personalities. In the case study, it is seen that the patient used to be extremely independent in her life performing all her activities by her. Her chronic aliment of dementia had impacted heavily on her as it had made her lose her physical ability and mental stability (Husebo et al., 2014). Due to the loss of independency, her self esteem has lowered and herself image had been hurt. Therefore, her belief that she is dependent on the nurses who assists her with her regular activities is giving her a tough time to accept the fact that she is dependent. Therefore it had led to the development of frustration in her which is often seen to be expressed by her by her shouts on the nurses. Moreover, it has been seen that she was admitted to the healthcare ward after about forty years and therefore it is natural for her to find it difficult to adapt to the new environment. There are many important stressors that result in dysfunctional behavior in the patients. These are fatigue, changes in routine, alteration of the environment, change of caregiver, demands that cross functional capacity, different competing stimuli, anger, pain and many others. All these make the patient anxious and stressed those results in triggering of the dysfunctional behaviors. Hence, such behaviour was exhibited by the patient. The altogether new environment to which he had been not accustomed was an initiator of aggression in her (Powell et al., 2014). A patient remaining aloof from hospital environment for such a period of time would face difficulty to accept it. Her family who is accustomed to seeing her independent may develop depression in seeing her dependent on nurses failing to perform the activities that she used to perform jovially at a particular time. Researchers state that family members often feel guilt when such patients are taken to hospitals feeling that they have not cared for them successfully. Development of grief and sense of loss also affects the families seeing their closed one suffering. Her husband would develop similar feelings at the loss of the person whom he used to know and seeing her suffer so much at the tender age (Stinton et al., 2015).
Developing a person centered care mainly involves tailoring the care for the person according to the interest of the patients, their history as well as with their personality. These make the patient feel included in the treatment and help them in participating in different activities which they can enjoy. Researchers have often suggested that such a care is very much effective in the prevention as well as in the management of different behavioral as well as psychological symptoms of dementia. The patient is very nervous due to her admission to the hospitals which is entirely a new environment. Moreover she has not visited such environment for 40 years. Therefore this condition of her, need to be critically analyze. Moreover, being dependent after being independent throughout life is very difficult for her to accept which had depressed her and also made her frustrated (Gotovac et al., 2016). Hence, the main key points that the nurse should incorporate in her practice are treating the person with dignity and respect and develop a strong bond with her based on trust and transparency. The second point that the nurse should incorporate is the proper development of the history, culture, lifestyle as well as preferences. These would include likes, dislikes, hobbies as well as interests. Thirdly, the nurse should develop the ability to look at the situations from the point of view of the Patricia so that she can understand what Patricia is feeling and ten initiatives which can make her calm and relieved. Besides, enveloping different interventions for Patricia according to her needs, she should also provide the patient with enough opportunities to develop conversations and maintain relationships with every people (Duxbury et al., 2013). As Patricia likes to be independent, the nurse should provide her with scopes that will make her participate in activities and enjoy her independency. She should be allowed to try new things and take part in different activities which used to be her hobby. While developing person centered care, family members and carers of her should be included. Researchers suggest that the knowledge as well as the understanding of family members about their patient often provided valuable information which provides huge benefits in developing person centered care for the patient (Madhusudonan & Ting, 2014).
Patricia is feeling restless in the acute care setting and she is constantly calling and shouting on the nurses. Her cause of aggression has to be understood by the nurse in order to develop her nursing care plan and develop ways to manage her behavioral and psychological symptoms. It has been already explained that her loss of independency and also admission to a new environment are the main reason that has resulted in her aggression. This aggression has mainly risen from the frustration and lack of self independent feeling leading to depressed state. She is not being able to adjust with the new surrounding and hence her behaviour has become rude (Power, 2016). The nurse should first take initiatives to develop and create a calm environment mainly by the removal of any stressors. The nurse may take her to a safer as well as quieter place and offer her a security object. Giving her scope for rest and privacy will help soothing her mind. With the help if the family members, the surrounding environment of the room would b altered according to her homely atmosphere which make her feel at home. Any kind of environmental triggers like noise, glare and any background distraction should be avoided. The nurse should monitor personal comfort which would include constant checking for her pain, thirst, hunger, fatigue, full bladder as well as skin infection and skin irritations. Moreover, she should also assure that the rooms are comfortable and monitor whether she is suffering from fear, misperceived threat and being sensitive to her frustrations and wants. Simplifying the tasks and routines as well as providing opportunities for exercise would help in relieving her frustration (Garay et al., 2016). Although she is not complaining of her dependency, but this attribute is clear from her rude behavior that she is depressed as well as frustrated about it. Hence the nurse should be careful and listen to her frustrations and analyze the reason of the agitation. After that, she should provide her with reassurance about being on her side always in every of her difficulty. The nurse should also try to involve her in exciting activities so that her behavior can be altered. The nurse should also find outlet for her energy by accompanying her in the activity she wants to do. The nurse should be very careful in not losing patients, and raising her voice as it will be disadvantageous for her relationship with the patient (Rayfield, Thomas & Borovicka, 2014).
The patient is suffering from dementia and therefore besides, the above mentioned interventions for developing her behavioral and psychological symptoms, other interventions are also conducted. Avoiding stressful situations, assessing fall risk managements, not forcing the patient to do anything, maintain her mealtimes are some of them. Moreover, keeping items in definite spaces without any alterations, properly anticipating what the client is wanting to say, helping her with words if she is unable to remember it, being tolerant to her are some other steps to be included. Allowance of performance or skills as long as they are safe will also keep her engaged (Soto et al., 2015). Maintaining the familiar, social, mental as well as physical and work activities is the duty of the nurse. Needful safe objects should be kept in close vicinity and harmful objects should not be introduced to her. Recent researchers are of the opinion that music therapy, art therapy, light therapy, aromatherapy are extremely helpful and should be provided as long as the patient is staying in the acute care to develop her condition.
Two important assessments can be conducted to develop an understanding of the level of impairment for the Patricia. The first one is called the memory impairment screening or the MIS. It consists of six important steps that the nurse needs to conduct. The patient would be first given four words on a piece of paper. Then four categories would be given and the patients would be told that each word belongs to each category. After identification of the four words, the patient would be asked to memorize them. Then the patient would be distracted by allowing her to engage in different tasks. The fifth step called the free call would be to ask the patient to tell the four words up to five tries. The sixth step is called the cued call where the nurse would provide cues such as mention the categories to make the patent remember the actual word. If the score is given to be 5 to 8 it will result in no cognitive impairment and if the mark is less than 4 then there is cognitive impairment. This will help the nurse to develop an idea about the patients’ cognitive power and accordingly develop interventions (Corbett et al., 2014
The second assessment tool is called the Mini-Cog. It would be also conducted to assess the cognitive ability of the patients. It is a three minute instrument that helps in the detection of cognitive impairment of Patricia. It mainly consists of a three item recall test for testing the memory of the patients along with a simple clock drawing part. The step one consists of the three word registration along with the step two drawing procedures. The step three consists of three word recall. A total scoring of word recall and clock recall is given and this score helps the nurse to develop idea about the level of cognitive impairment and what interventions should be taken.
The patient named Patricia had been admitted to the emergency department due to respiratory distress and was suffering from dementia for last eight months. The patient had been suffering from immense frustration due to lots of her independence. Moreover, being admitted to the new environment of a hospital was difficult for her and she had to issues to adjust. Her depression and frustration mainly resulted in the form of aggression on the nurses. Therefore the nurse has to identify the real causes of the frustration and thereby develop her person centered care. This type of care will help to address the main symptoms of the nurses and will provide her care according to dignity and autonomy of the patient with respect to her choices and wishes. Important interventions need to be taken in order to develop her behavioral and psychological symptoms and accordingly develop the plans of treating. Such a person centered approach is believed to provide not only relief to the patient from her severe condition but would also help her to lead a quality life
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