Dementia: an Issue in Mental Health Nursing - Essay Example

? DEMENTIA: AN ISSUE IN MENTAL HEALTH NURSING By 10 January Dementia: An Issue in Mental Health Nursing Introduction That dementia is one of the most complex health issues in older people cannot be denied. Aging is associated with the development and progression of numerous cognitive impairments. Older people are extremely vulnerable to the risks of dementia. However, dementia is not the only a problem of older people: mental health nurses face numerous challenges, when caring for patients with dementia. Caring for older people with dementia is a challenging task. It requires a perfect understanding of the health problem, its effects and implications for other life and health functions in older people. Therefore, it is imperative for mental health nurses to develop professional awareness of the dementia problem and its risks in older people, in order to understand the ways of addressing this problem, as well as the personal and medical needs of older people. This paper aims at investigating the issue of dementia in older people from the standpoint of a mental health nurse. The paper will discuss and critically evaluate the significance of the problem for older people. Prevalence of dementia in older people and its effects on the critical life functions will be discussed. The paper will analyze the challenges, which mental health nurses face, while trying to deliver high quality nursing care. Other aspects of mental health care will be discussed, including nursing paradigms and therapeutic approaches, the role and the boundaries of a mental health nurse in dementia care, and the role of effective planning and nurse-patient interactions in caring for older patients suffering from dementia. Legal and ethical factors of dementia care will be evaluated. This paper will expose the key problems related to mental health nursing and its role in dementia care. Practical recommendations for mental health nurses will be provided. Discussion: Is dementia an issue with older people? Dementia is one of the most serious and complicated mental health problems with older people. More often than not, dementia exemplifies a serious challenge to mental health nursing. Dementia is challenging, because (a) the number of older people, including those with dementia, constantly grows, and (b) dementia requires that nurses develop complex approaches to care, in order to reduce its negative influence on other life functions. The World Health Organization believes that the growing proportion of older people to the total population is a global phenomenon, and increasing age turns chronic health conditions into the issue of the main health importance (Anonymous 2009a). Among the most common health problems in older people, mental health disorders and cognitive impairments feature prominently (Anonymous 2009). Dementia and depression as the two most widely spread forms of chronic mental conditions later in life (Anonymous 2009a). Needless to say, the higher the proportion of older people to the general population, the more acute the problem of dementia grows. In its 2009 report, WHO estimated that almost 36 million of older people worldwide would be diagnosed of dementia and Alzheimer’s disease in 2010 (Sorrell 2010). This number is likely to double every 20 years (Sorrell 2010). These statistical results have far-reaching implications for health care systems’ operation and functioning. These implications are equally relevant to mental health nurses. Nurses need skills and knowledge to anticipate the development of cognitive changes in the older people and guarantee high quality care, which reduces social stigmatization of patients with dementia and improves their life and wellbeing. The problem is dangerous and complicated in the sense that dementia produces multiple negative effects on life and health functioning in older people. According to The World Health Organization, quality of life is “an individual’s perceptions of their position in life in the context of the culture and value system in which they live, and in relation to their goals, expectations, and standards” (Weiner & Lipton 2009, p.24). People with dementia are often forced to leave their homes and move to nursing and mental health institutions, where they lose an ability to influence their life circumstances and grow dependent on their care surroundings (Weiner & Lipton 2009). A broad range of neuropsychiatric symptoms of dementia add complexity to the dementia situation (Weiner & Lipton 2009). Older people with dementia are increasingly susceptible to depression and anxiety (Friedman 2010; Lach, Chang & Edwards 2010). They may suffer delusions and hallucinations (Weiner & Lipton 2009). Social impairments and dementia go hand in hand – people lose mobility and ability to interact with other people (Weiner & Lipton 2009). The problems of immobility and the lack of social interactions may be particularly challenging for older people with obesity, as long as obesity and dementia are directly related (Seshadri 2010). All these complications turn dementia into a health and social burden. Unfortunately, the coming years will hardly witness any decline in the incidence and prevalence of the disease under consideration in older people. Thus, it is important that nurses have corresponding skills to reduce the social burden of dementia and improve the quality of life in their patients. Aging is associated with the profound changes in brain functioning and cognition. From the physiological viewpoint, dementia is the result of accumulating extracellular amyloid in the human brain (Neal 2010). Age-related changes in midbrain volume in older adults may also be responsible for the development and progression of dementia (Sung et al 2009). Depression syndromes substantially elevate the chances for developing dementia later in life (Arnett 2010). Physiological transformations in the human brain lead to the development of cognitive impairments and problems in older people, which vary from failure to analyze new information to reduced learning and reading comprehension skills (Reichman, Fiocco & Rose 2010). In this situation, the task of a nurse is particularly difficult to define, but it is essential that older people with dementia have access to the highest quality of mental health care. Analysis The past years were marked with a rapid increase in professional attention toward dementia. Dementia and its implications for care became one of the most frequent topics of scholarly discussion. Dementia is equally complex and challenging to mental health nurses. The multitude of effects, which dementia produces on older adults and their wellbeing, makes it particularly difficult for nurses to define their professional roles. The choice of the best nursing paradigm is another challenging task, which not all nurses can successfully accomplish. However, it is clear that the issues of dementia and its implications for the quality of life must be reconsidered from a nursing angle. The current state of approaches to dementia care leaves sufficient room for improvement. Statistically, between 5 and 10% of older patients suffering from dementia live in mental health facilities or nursing homes (Sorrell 2010). Low nurse-to-patient ratios have already become a distinctive feature of life in nursing homes and mental care facilities (Sorrell 2010). Mental health nurses are being torn between numerous obligations, from medication administration to paperwork, leaving too little time for high quality mental health nursing care to adults (Sorrell 2010). In this sense, dementia is a double challenge for older people. On the one hand, dementia inhibits numerous life functions. On the other hand, dementia is associated with the lack of professional, high quality nursing care. Aging population and the rapid increase in dementia in older adults call for a profound paradigm shift in mental health nursing. During the past two decades, stress and adaptation factors governed the concept and process of dementia care in family environments and medical facilities (Farran 1997). Put simply, medical and family caregivers emphasized the negative outcomes and stressors of the dementia care experience (Farran 1997). These “negative” implications of mental health nursing for adults with dementia reflect the long-established beliefs in disease categories and the underlying socio-cultural meanings. Mental health nurses in their care decisions are governed by a variety of external and personal factors. The paradoxical, tyrannical nature of contemporary mental health paradigms hinders the evolution of positive mental health care nursing (Whitehouse et al 2005). Instead of high quality care, older people with dementia face stigmatization and social exclusion, which affect their treatment-seeking behaviors and relationships with the rest of the community (Whitehouse et al 2005). In this situation, a profound shift in mental health nursing paradigm is required, to ensure positive, meaningful, and emotion-focused care for older people with dementia (Farran 1997). Psychosocial approaches to dementia care must emphasize the significance of community interactions and family members’ presence (O’Connor et al 2010). Caregiver education and non-pharmacological interventions must shape the ground for the development of new, patient-centered approaches to mental health nursing (Buettner 2006). All these elements will help to create a new mental health nursing paradigm, which is equally relevant and useful for maintaining high quality of life in patients. In the context of dementia care, conventional pharmacological treatments are giving place to other, non-pharmacological therapeutic approaches to this mental health problem. Certainly, drug approaches to dementia are as relevant as ever. Acetylcholinesterase inhibitor drugs, glutamate-modulating drugs, and nootropic agents are being actively used by nurses, to reduce the symptoms and alleviate physical and emotional sufferings in older people with dementia (Howland 2010). In the meantime, contemporary nursing science displays the growing commitment to non-pharmacological therapeutic solutions. Therefore, mental health nurses require a better understanding of these forms of dementia treatment for older adults. The emergence of new, non-pharmacological treatment strategies reflects a profound shift in dementia care paradigms, which places the patient to the center of the care continuum. For years, medical models of dementia care exemplified a vice-like grip on the cognitive impairment, which saw the illness instead of a person (Gibson 2010). Today, the complex set of therapeutic care approaches to dementia includes recreation activities, education and awareness building, relaxation and sensory enrichment (O’Connor et al 2010), tailored activity programs for patients suffering from dementia and their family members (Gitlin et al 2010), and even music and singing (Skingley & Vella-Burrows 2010). In this atmosphere of rapid paradigm changes and given the growing incidence of dementia in older people, “the need to define the role of mental health nurses in dementia care is vital” (Newell & Gournay 2000). The role of a mental health nurse in dementia care is complex and multifaceted. Nurses are an inseparable element of an interdisciplinary team for assessing and diagnosing dementia (Melillo 2005). The importance of nurses in dementia assessment process is justified by the fact that (a) the number of older people with dementia constantly increases; (b) hospitals and multidisciplinary teams experience the lack of professional geriatricians and neurologists; and (c) nurses’ diagnoses and assessments can be extremely accurate and related to the needs of older people diagnosed of dementia (Melillo 2005). Following assessment and diagnosis, a mental health nurse is further involved in a broad range of care activities, from taking a home tour to assess safety conditions of the dementia patients to educating caregivers and family members about the disease and its progression (Anonymous 2009b). More often than not, a mental health nurse must serve a vital link between family caregivers and other medical services (Ho 2000). In medical facilities, mental health nurses are expected to promptly assess and treat dementia and its complications, to ensure that the disease does not cause significant personal, social, and financial consequences to older adults (Fick & Foreman 2000). Certainly, planning and interactions are of particular importance to mental health nurses and patients in dementia care. Actually, re-focusing dementia care on interpersonal dimensions is one of the most serious challenges in mental health nursing (Adams & Clarke 1999). Collaborative planning is particularly important in the context of dementia patients’ nutrition and safety (Anonymous 2006; Levine et al 2006). Finally, nurses must be aware of the legal and ethical issues in dementia care, which range from informal coercion (Tannsjo 1999) to the legal duty of care, respect for autonomy, nonmaleficence, beneficence, and justice (Keady, Clarke & Page 2007). In light of this information, caring for an older person with dementia is equally challenging, complex, and vital for better wellbeing of older adults. The complexity of the mental health nurses’ roles is difficult to underestimate. Simultaneously, it is imperative that nurses initiate the development of patient-centered approaches to dementia care in home and health care nursing environments. Reflection This paper has become a unique source of information about dementia in older adults, emphasizing the importance of the issue for older populations and its complexity for mental health nurses. That dementia is a serious issue in older adults is undeniable: the process of aging is invariably associated with the development of mild and severe cognitive impairments which, consequentially, elevate the chances for developing dementia later in life. Depression and other emotional disturbances further complicate the situation. Older people face numerous social, economic, and care challenges. They lack adequate nursing care and have to fight with the social and personal implications of dementia without anyone’s help. The current state of research emphasizes the inevitability of cognitive impairments in older adults. Aging is associated with rapid changes in the human brain, which result in the development of cognitive impairments later in life. However, the problem is not in how many people acquire dementia later in life, but how to develop and implement efficient approaches to dementia care in mental health settings. Undoubtedly, a mental health nurse is the provider of high quality dementia care. Everything starts with the development of a general care paradigm, which must be patient-centered, positively-oriented, and aimed at maintaining high quality of life and wellbeing in patients. Put simply, mental health nurses must shift the emphasis from the disease to the person. It is imperative that nurses avoid stigmatization and treat dementia as part of normal aging. Finally, the concept of personhood must become the defining element of high quality dementia care: high quality dementia care implies the absence of social connotations in dementia and conceptualizes the disease solely in terms of a neurodegenerative paradigm (Kelly 2010). High quality dementia care is the only way to ensure that older people with dementia do not lose their social status and do not have their personhoods undermined (Kelly 2010). These person-centered approaches to care must replace the dominant care practices “that involve bestialization, the attribution of moral deficit, warehousing and the unnecessary use of a medical model” (Kelly 2010, p. 105). This paper supports the multiplicity of competitive models of care and their therapeutic implications for mental health nursing. Tyranny, stigmatization and labeling are gradually giving place to positive, patient-centered approaches to dementia care. The current research emphasizes the relevance of the person-centered care paradigm, but how nurses develop their interactions with patients and what factors affect their attitudes toward patients often remains beyond the scope of scientific analysis. In the context of dementia care, the attitudes of nurses toward older people with dementia largely depend on their experiences of other patients, as well as their experiences of themselves as carers (Norbergh et al 2006). If nurses perceive dementia patients as worthless objects and bestialize their personality, their care approaches are of no value to patients (Norbergh et al 2006). Fortunately, bestialization and stigmatization of dementia patients by nurses are becoming an exception rather than a rule. Contemporary nurses display positive to neutral attitudes toward their patients, leaving some hope that prerequisites for the expansion of “person-centered care models will improve” (Norbergh et al 2006). Positive attitudes shape the ground for developing and implementing care strategies that are equally legal and ethical. Ethical issues exemplify one of the most complex challenges to quality dementia care. However, constant nurse-patient interactions can help mental health nurses tackle with these issues effectively. The analysis of the principal care issues reveals and further reinforces the critical significance of collaboration and collaborative planning in dementia care. The current state of patient-nurse interactions in hospital and home facilities leaves much room for improvement. The situation is particularly complex in inpatient mental health facilities and settings, where the ward staff does not have time and resources to engage in meaningful interactions with patients (Kelly 2010). The interactions between patients and the ward staff are brief and task-oriented – they do not raise the wellbeing of dementia patients and can even be damaging and abusive (Kelly 2010). Interpersonal factors are vitally important for high quality dementia care. From the interactionist standpoint, cognitive abilities in older people in dementia are disintegrating, but the development of interrelationships with others individuals and community have a potential to compensate for the lack of cognitive capacity (Adams & Clarke 1999). Dementia patients cannot maintain high quality of wellbeing, unless they have “the sense of personal worth, social agency, social confidence, and hope preserved” (Adams & Clarke 1999). The interactions between nurses and patients and them and family caregivers are equally important (Adams & Clarke 1999). Family systems and paradigms and the role of family presence in dementia care are to be emphasized (Adams & Clarke 1999). Unfortunately, many of the factors that reduce the quality of the nurse-patient interactions in dementia care are beyond mental health nurses’ influence. Staffing problems and overloading are frequent topics of discussion in nursing literature (Anonymous 2010). In these conditions, mental health nurses do not have sufficient opportunities to practice their therapeutic skills and meet the principal criteria of quality dementia care. It is essential that the task of a nurse in dementia care be precisely defined, which is hardly possible without creating and maintaining appropriate conditions for the provision of quality dementia care. Conclusion That dementia is one of the most challenging and complex health conditions in older adults cannot be denied. On the one hand, dementia is associated with serious changes in brain functioning and cognitive impairments, which cause multiple negative consequences to older adults. On the other hand, older adults face the lack of adequate nursing care. This paper tried to evaluate the current state of dementia care from a mental health nurse’s standpoint. One of the main purposes of the current assignment was to discuss conventional nursing paradigms in dementia care and the factors that impede the development and implementation of efficient care frameworks. The information provided in this paper leads to several essential conclusions. First, the past decades were marked with a slow shift in the dementia care paradigm. Bestialization, stigmatization, and social inclusion of dementia patients are gradually giving place to patient-centered nursing approaches, which emphasize the relevance of nurse-patient interactions and avoid excessive reliance on conventional pharmacological treatment. The emphasis on collaborative planning and interactions in dementia care holds a promise to improve the quality of life and wellbeing in older patients with dementia. Second, it is vital that nurses in dementia care have their roles precisely defined. Nurses in dementia care environments are bound to cope with multiple roles, changes, and challenges. From their participation in multidisciplinary assessment teams to the provision of high-quality emotional and spiritual support, nurses exemplify a vital link between patients and other social/ medical services. It is essential that nurses recognize dementia as a normal factor of aging and do not undermine older patients’ personhood. Ultimately, the quality of dementia care often depends on the factors that are beyond mental health nurses’ control, including staffing and workload issues. Thus, high-quality dementia care is a complex challenge that involves multiple players and cannot be achieved, unless nurses are engaged in collaborative decision-making processes. All these processes must be governed by the need to support dementia patients, as they are trying to preserve and maintain their social status and develop effective reciprocal ties with the rest of the world. References Adams, T & Clarke, CL 1999, Dementia care: Developing partnerships in practice, Elsevier Health Sciences. 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