Get Help In Nursing Essays-Рrороsаl Саrе fоr Dеmеntiа Раtiеnt in Асutе Hоsрitаl Sеtting


Context

Mrs Patricia Smith who has been admitted to your ward in an acute care hospital with respiratory distress, following several hours overnight in the ED. She has difficulty with breathing and her husband said she has had a ‘bit of a cold’ over the last few weeks. On the previous day he thought she had difficulty breathing and her Doctor told them to go to the ED. Due to her respiratory distress, Patricia has not been able to eat.

Eight months ago Patricia was diagnosed with dementia – no specific type. She has always been a very independent lady, with a focus on helping others and not asking for anything for herself.

After admission you notice that Patricia becomes very agitated and restless while in bed. She constantly calls out and lashes out at you (nursing student) and other staff when they come to check on her observations.

Patricia is 75 years old and lives with her husband Frank. They have 4 adult children, 2 males and 2 females, who all live close to the parents and 4 grandchildren. She has not been a patient in hospital since her last child was born over 40 years ago.

Task

Use Patricia’s scenario to prepare a written proposal for a practice /care improvement for her during her time in hospital, using the headings listed below.

Detailed instructions:

Your proposal should include an introduction and conclusion (200 words). The body of your proposal should include the following 4 sub-headings:

Part 1: ‘Patricia and her family’s experiences of admission to hospital’ (400 words)
From what you have learnt from Module 2 on Experiences of Dementia, write how you imagine Patricia and her family are experiencing her admission into hospital, including what you think might be the most difficult aspect of this experience for them.

References that can be use:
Bloomer, M., Digby, R., Tan, H., Crawford, K., & Williams, A. (2016). The experience of family carers of people with dementia who are hospitalised. Dementia, 15(5), 1234-1245.


Madsen, R., & Birkelund, R. (2013). The path through the unknown: The experience of being a relative of a dementia-suffering spouse or parent. Journal of Clinical Nursing, 22(21-22), 3024-3031.

Helgesen, A., Larsson, M., & Athlin, E. (2013). How do relatives of persons with dementia experience their role in the patient participation process in special care units? Journal of Clinical Nursing, 22(11-12), 1672-1681.

Digby, Robin, & Bloomer, Melissa J. (2014). People with dementia and the hospital environment: The view of patients and family carers. International Journal of Older People Nursing, 9(1), 34-43.

Porock, D., Clissett, P., Harwood, R., & Gladman, J. (2015). Disruption, control and coping: Responses of and to the person with dementia in hospital. Ageing & Society,35(1), 37-63.


Part 2: ‘Person Centred Care (PCC)’ (400 words)
From what you have learnt from Module 3 on Person Centred Care write how a PCC approach would be used in providing care to Patricia in the acute care setting.


References that can be use:
Clissett, Porock, Harwood, & Gladman. (2013). The challenges of achieving person-centred care in acute hospitals: A qualitative study of people with dementia and their families. International Journal of Nursing Studies, 50(11), 1495-1503.

Champion, E. (2014). Person-centred dementia care in acute settings. Nursing Times, 110(37), 23-5.

Person-centred care helps dementia symptoms. (2014). Kai Tiaki: Nursing New Zealand, 20(10), 9.

Ervin, K., & Moore, S. (2014). Rural nurses’ perceptions of a volunteer program in an acute setting: Volunteers delivering person-centred care for patients with dementia and delirium. Open Journal of Nursing, 04(01), 27-33.


Part 3: ‘Caring for Patricia’s BPSDs’ (400 words)
From what you have learnt from Module 4 on Communicating with People with Dementia and Module 5 on Managing Behavioural and Psychological Symptoms of Dementia, write on how you might prevent or minimise her BPSDs.


References that can be use:

Kilgore, C. (2015). Improving communication when caring for acutely ill patients with dementia. Nursing Older People (2014+), 27(4), 35. doi:http://dx.doi.org.ez.library.latrobe.edu.au/10.7748/nop.27.4.35.e672

Nazarko, L. (2015). Top-quality communication skills remove obstacles to communicating with people with dementia. British Journal of Healthcare Assistants,9(2), 60-65.

De Vries, Kay. (2013). Communicating with older people with dementia.(Continuing Professional Development). Nursing Older People, 25(4), 30-38.


Song, Jun-Ah, Park, Myonghwa, Park, Jaewon, Cheon, Hong Jin, & Lee, Mihyun. (2016). Patient and Caregiver Interplay in Behavioral and Psychological Symptoms of Dementia: Family Caregivers Experience. Clinical Nursing Research, Clinical nursing research, 17 November 2016.

Desai, A., & Galliano Desai, K. (2014). Management of Behavioral and Psychological Symptoms of Dementia. Current Geriatrics Reports, 3(4), 259-272.

Cankurtaran, E. (2014). Management of Behavioral and Psychological Symptoms of Dementia. Noro Psikiyatri Arsivi, 51(4), 303-312.


Part 4: ‘Nursing care of Patricia in an acute hospital’ (400 words)
From what you have learnt from Module 6 on Managing other acute care issues for people with dementia write on how you might improve other relevant aspects of Patricia’s care while she is in hospital. Include at least 2 assessment tools that should be used and describe why.


References that can be use:

Banks, P., Waugh, A., Henderson, J., Sharp, B., Brown, M., Oliver, J., & Marland, G. (2014). Enriching the care of patients with dementia in acute settings? The Dementia Champions Programme in Scotland. Dementia, 13(6), 717-736.

Baillie, L., Merritt, J., & Cox, J. (2012). Caring for older people with dementia in hospital Part two: Strategies. Nursing Older People (through 2013), 24(9), 22-6.

Griffiths, P., Bridges, J., Sheldon, H., & Thompson, R. (2015). The role of the dementia specialist nurse in acute care: A scoping review. Journal of Clinical Nursing, 24(9-10), 1394-405.

Houghton, Murphy, Brooker, & Casey. (2016). Healthcare staffs’ experiences and perceptions of caring for people with dementia in the acute setting: Qualitative evidence synthesis. International Journal of Nursing Studies, 61, 104-116.

FOR ASSESSMENT TOOLS should be use and why read this link
https://www.fightdementia.org.au/national/about-dementia-and-memory-loss/for-health-professionals/clinical-resources/cognitive-screening-and-assessment

Francis, Nora J. (2012). Assessment tools for geriatric patients with delirium, mild cognitive impairment, dementia, and depression.(Delirium, Depression and Dementia). Topics in Geriatric Rehabilitation, 28(3), 137-147.


Sheehan, B. (2012). Assessment scales in dementia. Therapeutic Advances in Neurological Disorders, 5(6), 349–358. http://doi.org/10.1177/1756285612455733


Perfecto, K., & Ahern, N. (2013). Early Assessment for Alzheimers Disease and Dementia: Comparison of Two Metamemory Diagnostic Tests. Journal of Psychosocial Nursing & Mental Health Services, 51(9), 17-21.


Other information

• Your proposal should include reference to at least 20 recent (past 5 years) and credible peer-reviewed references.
– I PROVIDED SOME REFERENCES Please use them

• Use APA 6 formatting & citation style

Below is a Sample Paper. You Can Order a Custom Essay Written From Scratch From Our Website. Click Here to Order.

Students Name

Institutional Affiliation

Introduction

                Dementia is a psychological condition that is characterized by cognitive impairment, a decline in functionality, and neuropsychiatric behavioral symptoms. There are different types of dementia and professional help is required to determine the symptoms of each. The symptoms of each patient are essential to establish the patient’s distress, the quality of life for the patient and care-giver as well as the end-result of dementia. The severity and prevalence of the disease is highly dependent on the environmental and cultural background of the patient.  A caregiver for a person with the condition is faced with a lot of challenging situations (Mendez, Cummings & Cummings, 2003). It is preferable that multiple family members take on the responsibility to help the patient with the basic daily routine. Caregivers should structure the activities and patient’s time in a way that encourages functional autonomy and occupational and physical therapy.

Patricia and her family’s experiences of admission to hospital

Patricia is described as a very independent woman who is capable of taking care of herself and the fact that he family lives near her means that they actively participate in her care. Patient participation by Patricia and her family take part in her treatment.  As a result of the admission, Patricia may start feeling like she is losing her independence.  Thus, she might refuse to take her medication leading to a deterioration of her illness as well as dementia.  According to Bloomer et al (2016), any negative relations between the family members and the hospital staff may have a negative impact on the stress level of the caregivers. Thus, they might also get the perception that the quality of care provided is low. Being in a hospital setting can be upsetting therefore, every person including Patricia must find a way to cope with the uncontrollable situation so as to avoid more suffering and irritation.

According to a study by Helgesen, Larsson and  Athlin (2013)family caregivers admitted that looking after a person with dementia is challenging and demanding because of the behavioral manifestation of the disease. Inevitable hospital admission disrupts the carefully planned routine of the carers despite the improved care provided by health professionals.  Hospital admission only adds to the stress because of the disrupted habits for both the patient and the care givers. The competence of healthcare facilities is judged by their ability to manage the patient’s agitation and pain (Madsen & Birkelund, 2013). Therefore, Patricia and her family might be concern that the hospital staff is only concerned with providing medical treatment and task-orientated care rather than the overall active physical and emotional care during her admission.

In my opinion, the most difficult aspect of the hospitalization experience for them is the disruption from normal routine. For a person diagnosed with dementia, the interruption may trigger Patricia’s sense of disengagement and distress.  The unfamiliar environment can disconcert her and make her experiences unpleasant. Additionally, sharing a hospital room with an unfamiliar person could cause her to feel afraid and vulnerable because she is not used to having someone else occupy her space.  The family members may also experience a sense of discomfort because of the proximity of the hospital. The travelling can only lead to exhaustion (Porock et al. 2015). Therefore, the experiences of Patricia and her family upon her admission are riddled with anxiety and vulnerabilities because of the constant interruption by the medical providers and a sense of no control.

‘Person Centred Care (PCC)’

A person centered care approach means that the healthcare professional recognize that all patients have unique characteristics and personal histories. Therefore, every patient should be given an opportunity to participate fully in their medical decisions as well as social and physical environment.  the PCC is a holistic and interactive approach that includes the patient, healthcare professionals, and family members in the provision of care so as to enhance the quality of life for the patient.  The dementia patient actively participates in every step of the care process throughout the various stages of the disease and the family members look out for the emotional and physical wellbeing of their relative. The approach would help Patricia and her family in this setting because it will help create a partnership among them all together with hospital staff in a way that improves the outcomes. The PCC is focused on the patient as an individual rather than the disease and as well as their abilities and strengths (Alzheimer Society of Canada, 2011). The process ensures that the services and delivery is mutually respectful and collaborative for everyone involved so as to preserve the dignity of the Patricia.

The safety of the patient is also improved in the person centered care approach. The family carers are better placed to supervise the patients even in the hospital setting when the nurses are attending to other patients (Champion, 2014). The symptoms experienced by dementia patients put them at risk because they can harm themselves or others. An acute care setting is planned in a way that the emotional and cognitive support of the patient is not fully provided for. Other tasks such as administration of drugs and checking vital signs take priority for the nurses. Therefore, the PCC approach is essential because the family members of the patient are readily available to fill in and provide the emotional support to the relative (Ervin & Moore, 2014).  Therefore, this method will ensure that Patricia is cognitively stimulated at all times and she her well-being is promoted by those close to her when the nurses are busy elsewhere.

The PCC approach would be used by allowing the patient and the family to participate in the care process. The healthcare providers will seek the input of the patient and family before administering any type of intervention measure. The opinion of the patient is significant because Patricia is not mentally incapacitated and she can communicate her feelings towards treatment which will work to better her well-being (Clissett et al. 2013). The approach is meant to help the patient because she will be allowed to concentrate on herself which will lead to self-actualization, acceptance and a better understanding of her disease and how she can take care of herself while mainting healthy relationships with those around her.

Caring for Patricia’s BPSDs.

The ability to communicating with Patricia will enrich her life and reduce her stress level significantly. However, communicating with patients with dementia requires great levels of competence and so as to assess the specific individual needs of the patient. There are various methods that can be used to effectively assess and develop the skills of people suffering from dementia. Some of the means that a caregiver can use include memory books and reminiscence interventions (Nazarko, 2015). According To Vries de (2013), studies have shown that there is substantial evidence showing that communication skills for the people with dementia can be enhanced through training skills and education.

The behavioral and psychological symptoms of dementia manifest in different ways such as aggression, agitation, sleep problems and so on (Kales, Gitlin & Lyketsos, 2015). Patricia is already showing some of the symptoms of agitation and restlessness while in bed and she constantly calls out and lashes at the staff. Understanding how to take care of her requires active listening by giving her full attention, paraphrasing what she says back o her, and minimizing distractions (Desai & Galliano Desai, 2014). The carers can use different techniques to encourage her to communicate. Therefore, they can speak clearly using short and precise sentences while maintain eye contact. She should also be given a chance to respond and talk out her feelings without ridicule. Being encouraged to join in the conversation is as sure way of acknowledging her and her presence. The recognition will encourage her to express herself more.

Efficient care means that the caregivers can differentiate between old-age deliriums from a dementia episode (Kilgore, 2015). Additionally, they must learn how to communicate through physical contact and body language. Non-verbal communication to a patient with dementia should be done by remaining calm and patient with them, holding their hand or patting to reassure them and help them feel close to someone (De Vries, 2013). Additionally, keeping a positive and friendly tone to communicate is important to relax them.

To effectively improve communication between Patricia and the healthcare providers, the staff must be trained so as to equips them on how to respond to the psychological and behavioral indications of the patient her (Song, 2016). An unfamiliar environment like an acute care setting should be modified in a way that makes the patient comfortable such as the use of colors and lighting (Alzheimer’s Australia Inc., 2014). The stress of hospitalization could be pushing Patricia beyond her coping levels. Therefore, the healthcare providers should work closely with her family to profile her will help predict and avoid distress on her part.

Managing other acute care issues for people with dementia write on how you might improve other relevant aspects of Patricia’s care while she is in hospital 
Nursing care of Patricia in an acute hospital

The nursing staff endeavors to provide quality care for dementia patients despite the challenges. Nurses can lose interesting taking care of the elderly people due to lack of competencies and training on gerontology (Banks et al. 2014). There are various ways in which a facility can improve the care for people with dementia. The nurses should be trained in developing a relationship with the patient because personal care leads to familiarity thus opening up communication. Additionally, involving the families is a great way of understanding the patient because they actively observe their habits when at home. Therefore, they can advise the carers at the acute setting and encourage their relatives (Baillie, Merritt & Cox, 2012).

When working in a high-stress environment such as an acute care setting, nurses are faced with various ethical decisions and challenging behavior that affect their performance. Some concerns from the nurses include communication, managing difficult behavior and stringent schedules (Hynninen, Saarnio & Elo, 2016). Additionally, some nurses in the acute care setting have indicated that they are anxious around people with dementia .The solution is to develop creative and flexible care routines that positively influence the behavior of the patient (Banks et al. 2014).

There are various assessments that can be used in an acute care setting for cognitive screening and assessment for dementia.  An example of a test is the clock drawing whereby a patient is given a blank paper and asked to draw a clock with a specific time set but on different time frames. The test was designed as a fast screening procedure for dementia. The purpose is to evaluate planning and organization (Perfecto & Ahern, 2013). Additionally, the test is specific to determine and assess a very fine part of cognitive functionality that is affected by dementia.

The second test is the General Practitioner assessment of Cognition which is mainly used in a primary care setting to determine whether the patient requires acute care. Its performance is specific and more sensitive in detecting dementia in patients. The test is reliable and efficient. However, in some cases a follow-up short interview is administered to avoid misdiagnosis (Francis, 2012).  

The third test is the Mini-Mental State Examination commonly known worldwide as MMSE. The scale is easy to oversee and precise in assessing cognitive functions of different areas such as attention, memory, language and so on. The test is recommended for acute care settings where it should be supplemented by the clock drawing test. It is a screening test that is widely used because of its reliability (Sheehan, 2012). Different tests are administered on the patient to evaluate different symptoms such as delirium, depressions, among others. Most of the tests are used in the primary care setting to determine the next course of action before sending the patient to acute care.

Conclusion

                Family support is essential to the caregiver and the patient to avoid feelings of loneliness and loss of control and thus, conflicts and agitating situations must be avoided at all times. Additionally, there should be constant communication between the caregivers and health-care professionals to aid in improving the quality of life for the patient. The impact of dementia is always more significant on the family who are most often the caregivers. The patient centered care approach has proven to be a success in providing care for dementia patients. Constant communication and supervision is the key to avoid harm on the patient and close family members. Therefore, nurses and other caregivers should be trained to use the PCC approach so as to enhance the quality of care and life of the patient.

References

Alzheimer Society of Canada.(2011). Guidelines for Care: Person-centered care of people with dementia living in care homes. Alzheimer Society of Canada. 1-68

Alzheimer’s Australia Inc. (2014). Dementia Care in the Acute Hospital Setting: Issues and Strategies. Alzheimer’s Australia.

Baillie, L., Merritt, J., & Cox, J. (2012). Caring for older people with dementia in hospital Part two: Strategies. Nursing Older People (through 2013), 24(9), 22-6.

Banks, P., Waugh, A., Henderson, J., Sharp, B., Brown, M., Oliver, J., & Marland, G. (2014). Enriching the care of patients with dementia in acute settings? The Dementia Champions Programme in Scotland. Dementia, 13(6), 717-736.

Bloomer, M., Digby, R., Tan, H., Crawford, K., & Williams, A. (2016). The experience of family carers of people with dementia who are hospitalised. Dementia, 15(5), 1234-1245

Champion, E. (2014). Person-centred dementia care in acute settings. Nursing Times, 110(37), 23-5.

Clissett, P., Porock, D., Harwood, R. H., & Gladman, J. R. (2013). The challenges of achieving person-centred care in acute hospitals: a qualitative study of people with dementia and their families. International Journal of Nursing Studies50(11), 1495-1503.

De Vries, Kay. (2013). Communicating with older people with dementia.(Continuing Professional Development). Nursing Older People, 25(4), 30-38.

Desai, A., & Galliano Desai, K. (2014). Management of Behavioral and Psychological Symptoms of Dementia. Current Geriatrics Reports, 3(4), 259-272.

Ervin, K., & Moore, S. (2014). Rural nurses’ perceptions of a volunteer program in an acute setting: Volunteers delivering person-centred care for patients with dementia and delirium. Open Journal of Nursing, 04(01), 27-33.

Francis, Nora J. (2012). Assessment tools for geriatric patients with delirium, mild cognitive impairment, dementia, and depression.(Delirium, Depression and Dementia). Topics in Geriatric Rehabilitation, 28(3), 137-147.

Helgesen, A., Larsson, M., & Athlin, E. (2013). How do relatives of persons with dementia experience their role in the patient participation process in special care units? Journal of Clinical Nursing, 22(11-12), 1672-1681.

Hynninen, N., Saarnio, R., & Elo, S. (2016). Care practices of older people with dementia in the surgical ward: A questionnaire survey. SAGE Open Medicine4, 2050312116676033.

Kales, H. C., Gitlin, L. N., & Lyketsos, C. G. (2015). State of the art review: assessment and management of behavioral and psychological symptoms of dementia. The BMJ350.

Kilgore, C. (2015). Improving communication when caring for acutely ill patients with dementia. Nursing Older People (2014+), 27(4), 35

Madsen, R., & Birkelund, R. (2013). ‘The path through the unknown’: The experience of being a relative of a dementia-suffering spouse or parent. Journal of Clinical Nursing, 22(21-22), 3024-3031.

Mendez, M. F., Cummings, J. L., & Cummings, J. L. (2003). Dementia: A clinical approach. Amsterdam: Butterworth-Heinemann.

Nazarko, L. (2015). Top-quality communication skills remove obstacles to communicating with people with dementia. British Journal of Healthcare Assistants,9(2), 60-65.

Perfecto, K., & Ahern, N. (2013). Early Assessment for Alzheimer’s Disease and Dementia: Comparison of Two Metamemory Diagnostic Tests. Journal of Psychosocial Nursing & Mental Health Services, 51(9), 17-21.

Porock, D., Clissett, P., Harwood, R., & Gladman, J. (2015). Disruption, control and coping: Responses of and to the person with dementia in hospital. Ageing & Society,35(1), 37-63.

Sheehan, B. (2012). Assessment scales in dementia. Therapeutic Advances in Neurological Disorders, 5(6), 349–358. http://doi.org/10.1177/1756285612455733

Song, J. A., Park, M., Park, J., Cheon, H. J., & Lee, M. (2016). Patient and Caregiver Interplay in Behavioral and Psychological Symptoms of Dementia Family Caregiver’s Experience. Clinical Nursing Research, 1054773816678979.

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