Nursing Clients with Alzheimers Disease - Essay Example

Nursing with Alzheimer's Disease Alzheimer's Disease starts with a slowly worsening condition of memory. Many aged people begin to fear whilestarting to feel such symptoms, in simple cases, for instance, when person doesn't remember where he put definite things. But the specialists state that this cannot be a reason to worry, as insignificant problems with memory happen due to age-specific processes in human's organism, slowing mental activity etc. All these problems do not affect person's capacity to hear and recognize new information, understand the meaning of the words addresses to this person, analyze the information, and carry out daily chores, as it happens with those who are from Alzheimer 's disease. (The Three Stages of Alzheimer Disease) There are the signs that should be regarded as probable symptoms of the disease, and their presence should make the person visit the specialists. These symptoms are as follows: 1. Problems with recognizing relatives and friends, together with forgetting their names and appearance. 2. Problems with recollecting recent activities and events. 3. Problems with calculations. 4. Problems with picking up words for familiar objects. 5. Problems with carrying out actions that were carried out before. (Alzheimer Disease) Everything above-mentioned can be regarded as the primary signs of the disease, which then become more profound and add the following problems: 1. The person is no more able to fulfil everyday chores, which he carried out before. The person needs help while dressing, bathing, eating etc. 2. The person is no longer able to solve either simple or complex problems and cannot think reasonably. 3. The person has problems with recognizing and analyzing new information. 4. The person has difficulties with all communication activities, such as reading, speaking and writing. 5. The person gets lost in well-known surrounding. 6. Poor discernment and disarray lead to growing risk of accidents. (Alzheimer Disease) As soon as the condition gets worse, the symptoms become more severe and the most common problems are as follows: 1. Impairment of memory, resulting in loss of long-term and short-term memory, the patient may recognize nobody. 2. The person becomes fully dependent upon other people and needs help in fulfilling all daily activities. 3. The person is fully disoriented. The person may go out of doors and disappear. 4. Emotional condition of the person becomes contradictory. It quickly changes from anxious to aggressive. 5. The person is no loner able to move from one place to another without support. 6. The abilities to produce the simplest physical activities, like swallowing also need more physical efforts and can result in aspiration or choking. As the specialists state, "Whichever staging system is used, or if none is used, it's important to remember that the disease affects each person differently. The order in which the symptoms appear and the length of each stage will vary from person to person. There is no clear line when one stage ends and another begins. In many cases, stages will overlap. Some people experience many of the symptoms in each stage, while others experience only a few. There may be fluctuations from day to day with a person appearing more confused one day, for example, and less so another." (Alzheimer Disease) There is no treatment in traditional medicine that is considered to be perfect to cure the disease. But there are some approaches that help in supporting such people and prevent from worsening the health condition of the patient. These approaches pay attention to different aspect and prescribe different therapies. The first includes medical treatment that corrects behavioural schemes associated with the disease, such as depression, psychosis and agitation. There are drugs that are prescribed to prevent from the development of the disease: "tacrine (Cognex), donepezil (Aricept), rivastigmine (Exelon) or galantamine (Reminyl), enhance the effectiveness of acetylcholine (the chemical messenger found in the neurotransmitter system which coordinates memory and learning) by slowing its breakdown". (Oraiswamy) Unfortunately, these drugs do not delete the symptoms, they just temporarily improve person's condition. The next approach improves language, memory, orientation and attention abilities, reducing cognitive dysfunctions. The specialists prescribe cholinergic receptor agents, cholinesterase inhibitors and precursors. (Leibovici) The third approach is based upon the idea of the importance of patient's surrounding. This approach demands changing the life quality and the surroundings to slow the disease development. The last approach lies in increasing the periods between attacks. The medicines and treatment therapies are at work now. "Researchers are looking at methods to enhance cerebral metabolism, stabilize membranes, promote neuronal sprouting, decrease inflammation, neurotoxins and excitatory amino acids, as well as alter metabolism of key proteins." (What Are The Phases Of Alzheimer's Disease And Their Management) Those who study and advance the methods that could improve communication with people that have Alzheimer's disease, give the following notion of communication: "Communication means getting across what you really mean and having another person really understand it". (Reisberg et al. p. 68) It is evident that this cannot be easily implemented under any circumstances even if we speak about ordinary people. The process will be harder with a person who has dementing disease. This illness affects the person's ability to realize the meaning of the words and phrases that are addressed to him, to pick up the words to reply, to shape the ideas and articulate them. This communication disability usually disturbs those who have Alzheimer's disease. The person feels separated from the society, combined with the feeling that he loses control over his actions and the situation. This badly influences person's condition and annihilates his feeling of security. (Galasko et al) These problems also make the caregiving problematic. The persons, nursing the people that have the Alzheimer's disease, are troubled with providing for successful cooperation, supporting the patient's feeling of security and helping them in day chores. These purposes are the most successfully achieved provided that the process of communication is successful. The staff should recognize and take into account the changes in person's abilities. The nurses must be extremely attentive and sensitive, and to pay attention to the fact if the patient fully understands the words addressed to him. It is necessary to be flexible enough to invent and use new methods that could provide for more successful communication. Here is the sample of instructions that are giving to the nursing staff: "You will have to be mindful of safety. A person who cannot understand or remember safety warnings runs an increased risk of self-injury and even of injuring others. You must be alert to any problems such as vision or hearing loss which might further impede communication. Finally, as the person becomes less able to use good judgment, you will need to make all decisions for him or her." (Steps to Enhancing Communication: Interacting with Persons with Alzheimer's Disease.) It is necessary to take into account that communication is something more than just talking and listening. Successful communication includes three elements. The first one is active listening. To achieve the result of the speech transaction one should watch and listen attentively. The purpose that is to be reached lies in recognizing the meaning of what has been said, rather then just hearing the word. The second important thing is attention to the timing and the setting of communication. These elements often influence the result of the speech transactions. It is necessary to pay attention to the settings and take away distractive factors, if there are any. The third one is effective self-expression. It is necessary that the nursing staff pays attention to personal communicating manner. It is significant to say what the person means and express it with clear and simple words. The speech should be supported by the tone, expression of the face and gestures that correspond to the meaning of what is said. (Care settings and the care environment) There are the strategies that enable the staff perfect the abilities that are necessary to achieve the purpose of successful communication with the people that have Alzheimer's disease. The first is designed as to improve one's skill of listening. Here are the main points to be taken into consideration. At first, it is necessary to stop talking when the patient speaks. Talking will prevent mutual understanding. Besides, it will make the patient forget what he intended to speak about. It is also important to remain calm and patient. If the idea that the patient is going to articulate is complex or hard, it may take some time for him to shape it and express. If the nurse asks the question, some minutes may be needed for answering it. Sometimes the nurse needs to repeat the sentence or questions several times to help the patient understand the meaning. The ideas are better articulated with the help of short simple sentences and words, and complicated sentences should be avoided. It is inadmissible when the nurse interrupts the patient. This may extend the period of time the person needs to express his thoughts. It will be useful if the nurse demonstrates the interest to what is said. Eye contact is also important, as well as the expressed care of what is said. The nurse should be gentle, and tolerant towards bad behaviour of the patient. The patient may burst in anger but it is never done deliberately. The nurse should be calm, even in case the patient abuses him or cries out loud. It is necessary to reply negative speech with the comments that make evident that the nurse understands the patient. The patient may say abusive and unpleasant things, or have abusive manners, but the nurse should always remember that aggression is not addresses to him personally. It is necessary to check out several times if the patient understands everything that is said to him. He may state that he understands, but not understand. The best strategy is to watch the subsequent actions of the patient, rather then believe him. He may forget the thing he just has heard, of course, it is frustrating, but it is impossible to do anything with it. To provide for effective communication the nurse should better repeat everything several times. (Hepburn) The methods that are helpful in perfecting timing and settings are as follows: At first the nurse should assure that the patient sees the nurse well. It would be better if the nurse stand or sit in front of the patient. Extremely dark or bright settings should be avoided. All distractions should be taken away. The problems may occur if the patient is involved into other kind of activity, which demands being concentrated. Noisy background also may prevent successful understanding. The other people may often become distracting, especially in crowded places. A special area for communication should be organized in the house where the person lives, if he stays at home. This should be a quiet place, designed in accordance with all above-mentioned. The nurse should take the patient to this place if he wants to achieve the purposes of communication. The daily life of the impaired person should be planned and carefully organized. Sometimes it would be better to communicate according to the plan. Planning will be helpful in most effective usage of daily time to achieve successful communication and effective activity. (Hepburn) Perfecting self-expression is no less significant than the factors that were described above. The nurse should think carefully over the content of what he is going to say and over the words that would be used. The information should be parted into separate parts, each of which should comprise one single idea. Simplifying everything that cold be simplified would be useful, for instance, "give just one direction or piece of information at a time. Ask just one question at a time. Try to think of brief, easy-to-understand words and sentences to explain what you mean". (Hepburn) The nurse should always remember that he speaks to an adult and avoid "baby talk". Foreseeing possible problems will make easier solving them, or even may help avoid the problems. The nurse should be prepared to say the same thing once and once again and feel patient. Eye contact is of a great importance during the process of communication. The nurse should sit or stand on the same level as the patient. It would be useful for the nurse to make sure that the patient listens to him before starting to speak. The nurse should estimate his manner of speaking - voice tone, its loudness. Such emotions as disappointment or anger should not be heard in the voice. Even in case the patient has problems with hearing, the voice should sound pleasant. Speaking slowly is also helpful. The nurse should be attentive to his gestures and mimics. It is always better to smile than to frown. The face expression and gestures should coincide with the words; otherwise the patient may be come confused. The people that have Alzheimer's disease are often sensitive to non-verbal communication. (Morris) The principles of the person centred care in dementia treatment derive from the writings of Tom Kitwood, the Professor and the head of the group that focused upon studying dementia and treatment of this disease in the United Kingdom in the period from 1992 to 1998 year. Kitwood is considered to be one of the leaders in the researches that work out successful strategies that are used in dementia treatment. The history of medicine puts dementia in the sphere of both psychiatry and medicine, which resulted in focusing on medical treatment of these persons, including "focusing on the physical changes that are happening in the brain and how best to "manage" the symptoms related to these cognitive changes". (Person Centred Care) The proponents of the new approach, worked out by the professor Kitwood state that the main omitting of this approach lies in ignorance of the person's previous experience and memories, and understanding emotional conditions of the people that suffer from the disease. They also insist that traditional dementia care methods miss paying attention to the lifestyles of the persons and his surrounding. The new approach, which focuses on personality, tries to regard the person, suffering from dementia as integral organism, and observe how the person is affected by the other factors than physical dysfunction of the human's brain. There are some principles that can be regarded as the basic grounds for the approach. Each person is regarded as the unique case of the disease, despite similar symptoms. It should be taken into consideration while diagnosing and prescribing treatment for the person. Each person is a complex set of elements, which influence our attitudes, values and behaviour. Here is the scheme, reflecting the influences that affect the person, provided by the professor Kitwood: D = P + B + H + NI + SP Where: D = the person with dementia's presentation P = Personality B = Biography (or a persons life history) H = Physical Health status NI = Neuorlogical Impairment SP = Social psychology (or the social and physical world around us) (Kitwood, 1997) It is necessary not to observe the disabilities of the person that suffers form dementia, but also use the capabilities and features of these people to use all the opportunities to integrate them into communication and social interrelations. It is important to realize the sense of one's existing and the importance of person's position in his life and in the society. Such recognition is an important part of the personal centred approach and it points out the positive effects of communication. This approach studies the notion of good and bad conditions of the personality. The next principle is closely connected to the previous. It insists on the importance of understanding the value of other people. The strategies that are worked out according to this principle, assume forging out the policies and methods, that encourage dementia sufferers support each other. (Person Centred Care) The further studies and investigations in this field resulted in bringing a "new culture", that reveals in the way the specialists treat the people with dementia. Kitwood and Marshall in 2001 criticized the major scheme of treating the disease. They called for rejecting depersonalizing trends in the contexts of dementia care. Kitwood in 1997 pointed out the basic principles of the treatment that is focus on the person. This approach comprised allowing the persons suffering from dementia make their choice, try their abilities, reveal their emotions and develop relations with other people. Kitwood and Bredin in 1992 described the essence of treatment as the work over the self, that could compensate identity disintegration, and this approach is becoming central in the practice of treating dementia. Those approaches that focus upon identity are based on traditional psychiatric and psychotherapy strategies. As the experts describe it, "The psychosocial origins of person-centred dementia care are linked to the central premise that attaining a state of wellbeing (which is equated with the maintenance of personhood), regardless of cognitive status, is dependent upon fulfilling various psychological needs - a sense of identity, attachment, psychological comfort, occupation, and inclusion in groups" (Kitwood, 1997, pp. 81-84). The disabilities inherent to the condition of dementia often make harder to recognize these needs, and the purpose of Kitwood's theory of the person-focused treatment is regarded as an attempt to offset the deficit. Traditional therapies, such as validation or reminiscence do not pay attention to the importance of integrity of the person's identity. The method of reminiscence includes remembering biographical facts with the help of supporting factors, such as photos, music, and scrap-books. The result of using such therapy is building up future actions and plans basing upon the facts of person's biography. For instance, the memories of the individual with dementia is utilized 'as a means of helping care practitioners recognize the person rather than the disease process' (Marshall, 2001, p. 149), which leads to perfecting communicational skills and supporting the relations with other people. The method of validation is another frequently used method, which is considered to be effective. It is described as an attempt to put dementia into "personal and biographical context" (Kitwood, 1992. p. 154), aiming at finding the answer to the emotional striving of the person suffering from dementia and confirming personal experience. It derives from the counselling method, focusing on the individuality. It is based upon psychodynamic assumption that the unresolved emotions hurt the person, and as soon as they are expressed, recognized and considered, with the help of the specialist, the hurt disappears. Like the method described, above, this therapy is the mechanism that focuses upon the centrality of the essence of treatment. One of the purposes is to make experts deal with the inner world of the person with dementia to support and encourage the development of relations basing upon the feelings of sympathy and empathy. Those who implement these approaches include the needs of these persons and the medicines that are prescribed to them into a psychological scheme, as they regard the purpose of person's identity is to take part in social relationships. But the statement that the social activity is the essence of the identity misses the fact that the person is a being incarnated into body. In other words, identities participate in social relations, due to their nature, bringing there their intentions and creativity, which is frequently omitted by the approaches that are traditionally used in practice. The opponents of these approaches, however, assume that there are exceptions that enrich the life of dementia sufferers. They are music, theatre, dancing, massage and aromatherapy. These ways of spending time provide for the possibilities of breaking the troubles that occur in the process of communication. Here is one of the samples of such therapies: "Snoezelen' a combination of two Dutch words meaning 'doze' and 'sniff', which are meant to describe relaxation and sensory stimulation involved in this approach, typically consists of multi-sensory input from light, sound effects, materials for touching, smelling and tasting. Multi-sensory environmental stimulation utilizes the senses and provides the dementia sufferer a conduit for expression." (qtd in Konto, 2005). Such therapies that use sensory experiences derive from the notion that all behavioural schemes have context meaning. Even as far as the basic replies to the stimulation of senses, such as "with eye and small lip movements, chin thrusts, shoulder shrugs, hand and finger movements, as well as leg and foot shifts" (Konto, 2005, p. ) are regarded as the signs telling about the conditions of the identity of the person that suffers from dementia. Despite the fact that therapies that influence senses, enlarge the set of opportunities for communication on various levels, including verbal level and non-verbal level, the opponents of these approaches criticize them, as they are based upon the same assumptions that serve the basis for other approaches that focus upon person's identity. In the case of the therapy that is described above, mimics and gestures are regarded as a substitute for expressing the thoughts and fulfilling the actions. To put it differently, identity, which could be also accessed via expression of the thoughts and actions, corresponding to the words, is reached through the human's body. The opponents of these approaches state that taking body just as the intermediate for reaching the identity rejects the meaning and importance of the physical side of the human, the body is given the status of the mechanism. They insist on the importance of the body in all the processes, including mental activity, communication and setting relationships with the people around. They also state that the processes that take place in the person's inner world cannot be judged separately from the body's functioning: "this agency provides a foundational structure for selfhood and thus the body itself must be understood as a fundamental source of selfhood that does not derive its agency from cognition". (Konto, 2005, p.) After examining the symptoms of mental disorders and therapies that are used to treat them, the following conclusion can be made: despite much critics and negative opinions that are addressed to person-centred approach, this therapy remains one of the most effective and successful in modern medicine. Necessary changes could be made, basing upon the critics, but the basic concepts of the theory are evidently helpful in nursing experience. 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