Alzheimer's Disease Patient and Social Theory - Dissertation Example

Alzheimer's Disease Patient and Social Theory Introduction Alzheimer's disease is a very severe and debilitating form of dementia. The disease robs them of their ability to think or speak coherently, their ability to separate the past from the present and fiction from reality, and even the ability to recall memories of their children's faces (Gross & Kinnison, 2007). I selected a patient that has been diagnosed with possible Alzheimer's disease with whom I worked as my subject, in order to further study the unique challenges and rewards of providing good nursing care to such a complex patient. The key points of this analysis are the medical background and history of the patient, the psychological and sociological factors affecting her and her health, and finally how the patient and those psychological and sociological factors fit into a larger theoretical and policy framework. About the Patient In the interests of maintaining confidentiality and respecting patient privacy, I will be referring to this patient as Mrs. X. Due to her rapidly deteriorating mental and physical condition, Mrs. X's residential care home was no longer capable of providing the nursing services she required, and she was subsequently transferred into the mental health ward. Mrs. X has vascular dementia or Alzheimer's disease and has been declared legally incompetent to make her own medical decisions. In addition, she is prone to mild absence seizures, causing disorientation and occasional falls, though they do not induce unconsciousness. She is receiving phenytoin to treat the seizures. Mrs. X's behavioural issues have progressively worsened to the point that she requires full care and constant monitoring. She will wander the halls of the ward at night screaming. Her husband believes that many of her mental issues are related to her lack of sleep, which does make her agitated and irritable during the day. She has difficulty communicating her needs, as she is completely non-verbal. This factor alone is greatly complicating her nursing care. Other complicating factors in Mrs. X's care are her dislike for the staff to attempt personal hygiene or care needs, and her refusal to comply with treatment regimens. For example, she was found to be refusing her medication by hiding pills in her mouth, and had to be switched to liquid suspensions. Psychological and Sociological Factors It is difficult to assess Mrs. X's psychological condition exactly, due to her dementia and non-verbal state; however, it is safe to say that she is clearly unhappy with the current situation. This is a concern, as a patient's psychological state is often directly related to their ability to heal when hurt or to keep themselves healthy in the first place (Gross, 2007). Even on the first layer of the Whitehead-Dahlgren model of psychological influences, her physical state of being, most effects on Mrs. X are strongly negative (Marks & Evans, 2005). She often seems unaware of her surroundings, becoming lost within the building, which is a traumatising event for her. This most often occurs at night when she wanders. Her sleeplessness is due to severe insomnia, a condition that further damages her poor psychological state. She is helpless to do anything for herself, unable even to eat, drink, or use the toilet without help. Even in her mentally compromised state, this level of dependence on others causes her a significant amount of distress. This is evidenced by her dislike mentioned earlier for staff members trying to attend to her personal care. She is in pain due to arthritis and frequent constipation, which also negatively impacts her psychological well-being. On the second layer and third layers, her lifestyle factors and social networks, the situation is equally as poor (Marks & Evans, 2005). She upsets the other patients by screaming and yelling, with the result that she has very little positive social contact with them. She previously resided with her husband, from whom she has now been separated in order to be admitted to the mental health. Her husband insisting that her problems may only be related to lack of sleep could indicate a denial on his part to acknowledge the severity of the senility she is displaying. This false hope could be upsetting him, and by extension, Mrs. X, when he visits and sees no improvement, and causing him to distance himself from her, furthering her social isolation (Gross & Kinnison, 2007). The fourth and fifth layers, involving environmental factors and living conditions, are largely controlled by the actions of Mrs. X's nursing staff and the state of her living facilities. Mrs. X resides in a mental health ward, having moved there from a more pleasant residential situation. While she may not appreciate it, the total care provided in the ward is fulfilling her daily needs for food, shelter, and water. Quality of care in the ward is of a reasonably high standard, which provides for most of her environmental and socioeconomic needs (Marks & Evans, 2005). Going further up the chain into society, this quality of care is only possible because of the relative affluence of England and its people. England's fairly robust economy helps to support the building and maintenance of high-quality medical facilities (Morall, 2001). However, quality of life is what the residents of a community make of it, and without a positive attitude to her surroundings, the best medical care in the country will not be able to make Mrs. X any happier than she is now (Gross, 2009). Psychological and Sociological Theory Mrs. X's life allows very little freedom, though the nursing and care staff do their best to keep her comfortable and happy. She is constantly under observation, and she is not able to make even the simplest decisions, right down to picking the food she wants to eat or when to use the toilet. She is entirely helpless and, without help, has extremely limited mobility. She is of course assisted with all of these things in the course of her care with as much dignity as possible, but she will always fight against it (Nursing and Midwifery Counsel, 2007). Because of all these factors, Mrs. X fits nicely into psychological and sociological theories about control, authority, and power (Porter, 1998). From the viewpoint of her psychological state, Mrs. X's case fits well under the Ajzen theory of planned behaviour. The theory of planned behaviour proposed by Ajzen states that actions on the part of an individual will depend largely on the amount of control that individual feels they have over that particular action (Marks & Evans, 2005). Also under this theory is the supposition that the intent a person may have for acting out a certain behaviour is largely dependent on their attitude toward that same behaviour (Gross & Kinnison, 2007). As already discussed, Mrs. X has almost no control at all of even the most basic of her daily activities. While it is difficult to determine the root cause of many of her actions, under this theory Ajzen would propose that this loss of control may be aggravating her already abnormal state of mind and acting to accentuate some of her problem behaviours. Perhaps because Mrs. X feels that no one expects her to be able to control her behaviour she does not try to do so. Ajzen's theory does suggest that a person's attitude may be able to predict their future actions (Gross & Kinnison, 2007). The effect of attitude and feelings of control on behaviour may be amplified by Mrs. X's environment. According to Ajzen's same theory of planned behaviour, another factor in predicting behaviour involves the societal and social norms involving that behaviour (Marks & Evans, 2005). However, since Mrs. X currently lives in a mental health ward, there are very few expected standards of behaviour and generally no sense of a social norm among the patients. The combination of all of these variables could lead to the worsening of her behavioural issues. Ajzen also feared that attempts to rectify behaviour through the use of cognitive behavioural therapy in situations where the person is not seeking to change their course of action, as is the case with Mrs. X, would encounter heavy resistance (Marks & Evans, 2005). Unfortunately, it is not possible to communicate to her a need for change in her behaviour or her attitude, so her actions cannot be treated through the use of behavioural therapy. Nor can Mrs. X's perceived lack of control toward her actions be mitigated by increasing the amount of control Mrs. X has over her daily life, as she is not in a competent mental state to take over any of the responsibilities for her own care. Due to the fact that Mrs. X's belligerence is almost exclusively directed towards the staff members, her erratic and disruptive behaviours can be described under Weber's conflict theory of society. Conflict theory focuses on authority and the distribution of power, and the clashes that occur when the empowered groups interact with the rest of their community. Those without power will resent those that have it, and those with power are not willing to relinquish it. (Haralambos & Holborn, 2010). For an example of a conflict with authority, take the fact that Mrs. X has previously used deception to avoid swallowing her pills, and was switched to a liquid formulation. Under England's legal system, since Mrs. X has been declared mentally incompetent, her desire to avoid the medication does not affect her treatment. Instead, the power lies with the medical community to choose the treatment method that is in the patient's best interest, and present those options to a next of kin to make the final decision, if such a person is available (Nursing and Midwifery Counsel, 2007). This fact indicates that England's culture believes that the medical community should have the power to decide treatments for patients who cannot make their own decisions; however, not everyone feels that way. Under Weber's conflict theory, this disagreement may be the cause of a conflict between patients and medical practitioners (Haralambos & Holborn, 2010). The medical staff has an obligation to protect their patients and so holds the power of being knowledgeable on the issue, while the patients desire more power to make treatment decision and attempt to take control back. Patients often are too intimidated by medical practitioners or are afraid of making poor decisions to simply ask for the chance to make their own decisions and end up resenting the medical practitioner for having this control (Gross, 2009). To help reduce these issues, medical practitioners should make sure that their patients and patients' families are as well-informed as the situation will permit, and explain the reasoning behind their treatment decisions (Haralambos & Holborn, 2010; Nursing and Midwifery Counsel, 2007). In the case of Mrs. X, this is more difficult than usual, but attempts have been made to explain the purpose of her medication and treatments. The staff at the mental health ward does try to keep Mrs. X's husband as well informed about the situation as possible to cut down on power struggles based on his feelings towards Mrs. X's prescribed course of treatment. Health and Public Policy Although it focuses mainly on working-age adults between the ages of 18 and 65, the National Service Framework for Mental Health can still be applied to Mrs. X's case, as she does require twenty-four hour psychiatric monitoring and medical care. The National Service Framework for Mental Health lays out a number of new or expanded standards for the provision of safe care, sound care, and supportive services for mentally ill adults. It lays down guidelines for making providers of mental health services accessible to patients, as well as making them accountable for the quality of the care they provide at mental health facilities. Specifically related to Mrs. X, this policy also provides for the publication of educational materials for family and friends of patients with various mental illnesses, including Alzheimer's disease (Department of Health, 1999). Mrs. X's transfer to the mental health ward followed the standard from this policy as it applies to providing access to services. When Mrs. X needed a higher level of mental health care than her previous living situation could provide, she was given a referral and moved to a more suitable environment for her care. The standards for location of the referral for care were also met in Mrs. X's case as this facility is still somewhat close to her husband's home and is within a reasonable travelling distance from the rest of her family members. This short physical distance is important so that Mrs. X does not become more isolated and socially excluded from family interactions due to her mental state. The staff at the mental health ward has also tried to meet the standard regarding socialisation of mentally ill patients by having her interact with other residents of the ward in a positive manner, but her non-verbal state and disruptive behaviour make this hard for her and can upset some of the other patients (Department of Health, 1999). Her carers also have a written care plan for her, in order to ensure smooth transfer of care from one carer to the next, and undergo at least a yearly assessment of their capabilities to re-certify as carers. This care plan details the level of security provisions that Mrs. X requires; these are high due to her inability to recognise her surroundings or communicate with people. If she were to leave the facility she would quickly become lost and disoriented, and would be unable to communicate her needs or find her way back. Ensuring that she continues to follow her medical treatment plan in a way that best protects her health and that she remains within the facility is therefore required by this framework. Involving Mrs. X in the compliance process, however, is unfortunately not possible, and so the care staff simply must not allow her to leave the ward unsupervised in order to make sure she remains safe while under their care (Department of Health, 1999). Conclusion and Future Effects It is obvious that when working with patients with severe dementia that there are many areas to care for other than their physical well-being. Their medical treatment is of utmost importance, of course, but so are their psychological state and social interactions (Nursing and Midwifery Counsel, 2007). Putting these factors into the larger whole of psychological and sociological theory helped me to realise the greater effects Mrs. X's behaviours were having on her and the people around her. It also helped me to see the rebound effect those societal effects could have on her health. Applying the National Framework for Mental Health to Mrs. X reminded me of the great importance of providing adequate, easily accessed care for mental health patients, and of keeping an up-to-date log of treatments for both the other staff members providing care and the family to read (Department of Health, 1999). Keeping the family in the loop is also very important when providing care in this type of situation, and I had many positive interactions with Mrs. X's family as a result of making sure they were always informed as to the nature of her treatment and her current condition. Going forward, I believe that the experience of both working with and analysing Mrs. X, an elderly patient with a severe case of Alzheimer's disease, will help me be more compassionate toward the difficult elderly or mentally ill patients that I may treat in my nursing career. This experience has opened my eyes to some specific needs that patients with forms of dementia have when compared to even other patients of their own age or with similar physical health problems, and also some solutions to those problems. While caring for Mrs. X was extremely difficult and exhausting, it was still a very rewarding experience for me. This experience was able to teach me many lessons about working with mentally ill adults that I could not have learned any other way. References Department of Health (1999) National Service Framework for Mental Health: Modern Standards and Service Models. Available: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4009598 (Accessed: March 15, 2011). Haralambos & Holborn (2010) Sociology: Themes and Perspectives Collins. Marks, D. & Evans, B. (2000) Health Psychology: Theory, Research, and Practice Sage. Gross, R. & Kinnison, N. (2007) Psychology for Nurses and Allied Health Professionals Hodder Education. Morrall, P. (2009) Sociology and Health: An Introduction New York, Routledge. Porter, S. (1998) Social Theory and Nursing Practice Macmillian. Gross, R. (2009) Themes, Issues, and Debates in Psychology London, Hachette UK. Nursing and Midwifery Counsel (2010) The Code in Full. Available: http://www.nmc-uk.org/Nurses-and-midwives/The-code/The-code-in-full/ (Accessed: March 15, 2011). Read More