Nursing Patients with Dementia in Acute Care - Essay Example

Running head: NURSING PATIENTS WITH DEMENTIA IN ACUTE CARE The Nurse's Role in the Management of Patients with Dementia Who Are Nursed With-in AcuteCare Settings You're Name University Abstract Dementia is an extremely debilitating disease and the nurse's role to those who have been diagnosed with it is indeed crucial. This research will show that because dementia is a disease that occurs in a segmented way the nurse has to be attuned to many interpersonal ways of caring for them and paying consideration to their physical as well as mental well being. Dementia is similar to delirium, except for the course of it. It is more that of an acute transitory disorder, according to the research that has been gathered by those who habitually work with patients who have stages of dementia. It is and has for many years been known as the 'quite epidemic' but it attacks a enormous percentage of those in the elderly population, proving that nurses who work with those who have the disease need to be focused on multifaceted areas of care since, as was stated, both the physical and mental well-being of the patient is included. This research will also show the importance of the nurse as an advocate for those who have mental disabilities such as dementia. Of course there will be thorough discussion on what the best interventions are in the acute care setting to try and maintain a decent quality of life for the patient as well. The conclusion shows that dementia is a severely crippling disease, both physically and mentally, and therefore often the best nursing approach is a holistic one with an interpersonal methodology intertwined. Although there is no cure for dementia, appropriate management of care by the nurse can make a great deal of difference in these patients' lives. The Nurse's Role in the Management of Clients with Dementia Who are Nursed With-in Acute Care Settings Introduction Dementia is actually the gradual destruction of several areas of the brain that affect the cognitive processes. This of course causes maladaptive behavior changes and the nurse sometimes has a more difficult time managing the patient care when these symptomatic occurrences begin to take place (Antonangeli 1995, pg. 167). Typically dementia is viewed as a collection of negative symptoms, but positive symptoms are present as well. During the early stages of the illness when the patient is only mildly impaired it is very common for individuals to avoid active participation in life. Patients tend to withdraw from social engagements, lack initiative, and overall behave in an indifferent and apathetic manner. It is the nurse's role to attempt to manage their care in a way that will keep them from adapting to this type of behavior. In the acute care setting a certain quality of life is attempted to be maintained for as long as possible. This might be through medications prescribed, psychological counseling services, or other methods of intervention that are geared towards each individual patients needs because not every dementia patient requires the same form of treatment in the initial stages nor as the disease progresses (Aylward et al 1997, pg. 155). As the illness progresses and the cognitive deficits increase patients may become more anxious and agitated. Patients with preexisting psychological problems are prone to experiencing hallucinations and delusions. In particular these patients exhibit paranoid delusions, for instance accusing the elderly spouse of being unfaithful. Misperceptions, such as the inability to distinguish real people from television images, are also common at this stage (Bauer & Shea 1986, pg. 144). Aggression, in particular verbal hostility tends to increase as accurate perception declines. It is perceived that these agitated and aggressive behaviors may represent issues where the patient is making an adaptive effort to try and communicate their needs. They are also attempting to express why they are behaving the way they are but they simply become frustrated and angry. Again, this is an area where in acute care the nurse works wholeheartedly to help the patient somehow try and continue communicating what their needs are and if this isn't possible then they take on the responsibility on their own through sincere care and support. It is very important that the patient be left to feel like a human being and this is a goal in an acute care setting, even though some patients are in the more advanced stages of dementia. The nurse has to always remember that these are people and they deserve consideration, their self-dignity left intact, and responsible while sincere care is given to them regardless of what their competency is at any given point (Brawley 1997, pg. 250). Principles and Practices of Adult Nursing Care for those with Mental Disorders Within adult care nursing and in the acute care area there is a heavy responsibility by the nurses to ensure that the physiology of the patient is kept adequate while the psychological well being is maintained as appropriately as possible also (Carpenito 2003, pg. 25). This is an important part of any condition or hospital admission, especially if an individual is entering into an adult acute care setting. One of the main concerns that nurses in this area should have is the affect that this type of occurrence has on the dementia patient's psychological state of mind (Carter & Green 2002, pg. 240). This is one of the reasons that Roper's theoretical framework is utilized quite often in the adult care setting. This model indeed gives an excellent foundation for delivering effective nursing care and it focuses on teamwork and positive interpersonal skills in doing so as well (Roper & Tierney 1996, pg. 55). In the adult care setting it is a necessity for the multidisciplinary team to work collaboratively in order to provide all patients with the appropriate care that they require. It is also beneficial in decision making and problem solving as it encourages involvement from various disciplines as well as the patient. Also, the type of care given is often of a holistic approach. Holistic care not only requires the nurse to have a full understanding about the nature of a patients disease but it also focuses in on the social, physiological, and the psychological needs that the patient might have as well which makes it a plus in the adult care setting (Dimond 1999, pg. 32). This makes the care much more individualized and many patients with the onset of dementia need this form of care desperately to help them through the confusion and their placement in the medical facility as well. Even though holistic care teaches that not every patient requires constant monitoring of their physical condition, they do all require effective communication from the nurse and it has become one of the main underpinning principles of nursing in the adult care setting, especially in acute care (Hogston & Simpson 2002, pg. 55). The families of dementia patients definitely need this type of effective communication so that they remain aware of what is going on with their loved one in a logical and understanding way. Knowing that sincere care is being given can make all the difference in the world for the patient, the nurse, and the immediate family as research gathered has definitely shown. Jean Watson's' theory of human caring has come to be known as an art and science to the field of nursing itself. It is another model that is used quite often in the acute care setting as it holds more positivism in the care being given than many of the other models represent themselves (Watson 1988, pg. 87). It has the main aim of attempting to preserve the worth and values of human kind through the act of caring for others with a sense of compassion and a sincere desire to alleviate the pain and suffering of those who are ill or emotional distraught due to the issues associative with their health concerns (Sourial 1996, pg. 988). Caring in itself is seen as the optimal essence of nursing and a moral idea through the model of this theory. With dementia patients in the adult setting this model brings in more hope for them and a sense of the deepest form of care from one human being to another and many times this is what patients with this illness really need far more than any prescribed drug. It has also become a model that is the backbone of the nursing principles in adult care, just as the approach of holistic health care has managed to become. The reasons are definitely obvious, as the literature can undoubtedly project. The pragmatic adequacy of Watson's theory has recently been judged on its usefulness and how effective the theory is in managing patient care in a proficient and compassionate manner. The idea of pragmatism refers to the usefulness, workability, and practicality of ideas, policies, and proposals as a way to bring the necessary merit to a specific theorization such as Watson's (Marckx 1995, pg. 900. Though this theory is lacking in some areas such as how practical it is to incorporate into the nursing paradigm, it has still been found to be highly useful and functions well in many areas of the medical environment in the management of patient care, specifically well with those who suffer with dementia (Watson 1997, pg. 49). In other words, following a pragmatic framework this theory does seem to play an essential role in getting things done in the correct type of manner that shows sincerity from the nursing profession and a devoted concern to maintain the patients care in a considerate and respectful manner (Watson 1997, pg. 49). Therefore, many studies have defined the theory as being beneficial and highly useful to the profession of nursing, with the concept of pragmatism giving it the harsher of evaluations and yet still finding it as an inept theory in the realm of healthcare. It allows for the nurse to really become an advocate for those with mental health illnesses in a setting that they are not familiar with. The Interventions to Manage Mental and Physical Health among the Elderly Nursing interventions that are often used to manage the physical and mental well being of patients begin with assessments, and this is a habitual routine that is carried out (Kumar et al 2001, pg. 328). Many dementia patients almost always suffer with depression in this type of care setting so the nurse has to make sure she assesses and reassesses, looking for signs of weight-loss and other noticeable changes such as isolation and withdrawal from activities with other patients. If it is possible the nurse ask questions that the patient has the ability to answer but of which can give appropriate means to find a logical way to implement a way to change the adverse behavior. By the assessment it helps establish all the problems causing the depression and how the patient feels (Coburn et al 2002, pg. 661). Not all of it is relevant in elderly care but gives an idea of what is asked during the assessment. The nurses should consider the level of independence any dementia patient has and try to encourage them to be as independent as possible. This would help them in many ways but the main would be it would encourage them to gain some sense of motivation on their own (Neese et al 1999, pg. 30). The nursing interventions used to relieve the mental distress of depression due to diagnosis of dementia or another severe health diagnosis is: - establishing and maintaining trust between nurse and patient. The rationale for this is to put the patient at ease, and helping the patient feel comfortable in nurse's presence. By gaining trust it should help many elderly patients to communicate better and encourage them to be able to talk about their feelings openly without worrying about disapproval or skepticism. Furthermore, social contact with other patients is another method that nurses utilize to draw patients out of depression or anxiety related symptoms due to their disease progression, etc. Nurses in the adult care setting have several goals in these interventive methods and some of these are: Promoting the physical and the mental well being of the patient Ensuring they have enough sleep Ensuring they have enough nutrition Educating them in ways that they can still meet their own needs Educating them in ways that will show how they can reduce their anxiety and stress Teaching relaxation techniques Protecting patients from further stressors brought on by their environment or social interactions (Zimmer et al 1984, pg. 1118). Often patients might be prescribed sleeping tablets and anti-depressants as well. Anti-depressants have been found to make a tremendous difference in the mental processing of some patients with dementia so this is a controlled drug that is often found as one of the prescriptions being written by doctors, among others of course. The Nurse's have to be very focused in their care and pay close attention because dementia can mask signs of other psychological medical conditions which can then pose adverse physical outcomes onto them. The signs and symptoms of a depressed geriatric patient as Rovener et al (1986, pg. 1446) states are: Low mood or irritability; agitation or decreased activity; diurnal variation of mood; feelings of guilt and worthlessness; decreased energy and concentration levels; feelings of hopelessness and helplessness; anxiety; loss of pleasure; sleep and appetite disturbances; and subjective memory loss. These symptoms of geriatric depression are not always recognized which could be due to dementia and other aging illnesses which have similar symptoms of depression. This could be why some elderly patients are at risk of being untreated. Nurses in the adult setting can also look for non verbal clues i.e. sad facial expressions, a slumped posture, lack of attention to personal appearance, and many other noticeable physical characteristics that will help them identify a potential problem. The nurses have an obligation to these patients to provide interventive therapy in order to promote a more positive well-being instead of letting them slip into depression and possible health complications on top of their current problems. There are other interventive means that are put in place as well, depending upon the circumstances and the type of care needing to be given to the elderly patient in the adult care setting. The medications that might be part of the intervention are varied from patient to patient but the majority of dementia patients do receive drugs and the dosages as follows: Frusemide 40 mg. daily, to be taken in the A. M. Digoxin 250 mg. daily Paracetamol 500 mg. every four hours Piroxicam 20 mg. at night Zoloft 50 mg. in the A. M. (Gailbraith et al, 2001, pg. 55). Although some of these are for other disorders such as high blood pressure, congestive heart failure, or osteoarthritis, the majority of dementia patients do suffer with these health disorders so of course some of the interventive means are going to be ensuring that they do receive their medication when they are suppose to. The main point is to make sure that the patient gets all of the appropriate medical care, including their medication in order to try and curtail any adversity in their treatment program. Nurses have to pay particular attention to the smallest details in the patient care regimen so they can pinpoint exactly when and what caused an adverse decline in patients physical or mental health from what it had been recorded as being. Conclusion The research has adequately shown that there are many different ways the dementia patient can be cared for within an acute adult care setting, ensuring their regular health medications are continued along with other care measures being taken into consideration as well. Along with these, the idea has been given that the nurse must remember to treat the patient as a whole human being and not just a body in a medical environment. In caring for the Alzheimer's patient, the adult nursing staff must remember to refer to the patient by name and not by calling them "sweetie" or "honey". A patient has a right to maintain dignity. If dementia is diagnosed early enough, it is advisable for the patient to designate a decision-maker which will help designate that patient's assets. Quality of life in patients with dementia is a big ethical topic that becomes very important in the late stages of dementia as well so this is something that nursing staff have to keep in mind as well. During late stage dementia, ability to express pain or discomfort may be altered. In these patients verbal references to pain are absent, not because they're not experiencing any pain but because they may not know how to express the degree of pain that they are experiencing. Because of this, regular administration of pain medications are often prescribed (Newell & Gurney 2000, pg. 15). Furthermore, the assessment process that has been mentioned must include family history, social history, memory (long-term and short-term), behavioral responses such as wandering, suicide risks, appearance, speech, and hallucinations. Oftentimes, a family member is needed to assist with subjective data as the patient may not remember some things. Sometimes, out of frustration, a person with Alzheimer's will fabricate stories or details (Perkins & Repper 1998, pg. 89). This is believed to be a defense mechanism. They are in denial about having loss of memory. As the research has shown, the main interventions that are implemented are making sure that the patient remains comfortable, nourished, and hydrated. Through all of this the nurses have to remember the code of conduct laid out by the Nursing and Midwifery Council (2002). Every patient is to be valued and treated equally. The care they receive should be diligent and efficient in meeting their needs, keeping their confidentiality as required. This is in fact one of the most important and detrimental principals in all phases of nursing as it draws on the nurses own individual responsibility in working with patients. There is a definite difficult balance between the wishes, demands and rights of the individual patients who have dementia to live as they wish, and then the professional codes of conduct which impose upon the health professionals a "duty of care" to ensure the safety of the individual. However, it is believed that the nurse who works with dementia patients in the adult care setting has the necessary skills and knowledge to work through all diverse obstacles and still substantially meet the needs of their patients while keeping with all codes of conduct that they are meant to duly follow in the profession of nursing. References Antonangeli, J. M. (1995). Of Two Minds: A Guide to the Care of People with the Dual Diagnosis of Alzheimer's and Mental Retardation. Massachusetts: Malden Press. Aylward, E. & Burt, D. & Thorpe, L. & Dalton, A. (1997). Diagnosis of Dementia in Individuals with Intellectual Disability: Report of the Task Force for Development of Criteria for Diagnosis of Dementia in Individuals with Mental Retardation. Journal of Intellectual Disability Research 41, 152-164). Bauer, A. M. & Shea, T. M. (1986). Alzheimer's disease and Down Syndrome: A Review and Implications for Adult Services. Education and Training of the Mentally Retarded 21, 144-150. Brawley, E. C. (1997). Designing for Alzheimer's Disease: Strategies for Creating Better Care Environments. New York: Wiley Publishing. Carter, S. & Green, A. (2002). Foundations for Nursing Practice. London: McMillan Publishing. Carpenito, J. (2003). Nursing Diagnosis: Application to Clinical Practice. Philadelphia: Lippincott Publishing. Coburn, A. F. & Keith, R. G. & Bolda, E. J. (2002). The Impact of Rural Residence on Multiple Hospitalizations in Nursing Facility Residents. Gerontologist 42, 661-666. Dimond, B. (1999). Patients Rights, Responsibilities, and the Nurse. United Kingdom: Quay Book Publishing. Gailbraith, A. & Bullock, S. & Manias, E. (2001). Fundamentals of Pharmacology: A Textbook for Nurses and Allied Health Professionals. Australia: Addison-Wesley Publishing House. Hogston, R. & Simpson, P. (2002). Foundations for Nursing Practice. London: Palgrave & McMillian Publishing. Kumar, V. & Acanfora, M. & Hennessey, C. H. & Kalache, A. (2001). A Health Status of the Rural Elderly. Rural Health 17, 328-331. Marckx, B. (1995). Watson's Theory of Caring: A Model for Implementation into Practice. Journal of Nursing Care Quality 9, 43-54. Neese, J. B. & Abraham, I. L. & Buckwater, K. C. (1999). Utilization of Mental Health Services among Rural Elderly. Archives of Psychiatric Nursing 13, 30-40. Newell, R. & Gourney, K. (2000). Mental Health Nursing: An Evidence Based Approach. London: Churchill Livingston Publishing. Nursing and Midwifery Council (2002). Code of Professional Conduct: London. Perkins, R. & Repper, J. (1998). Dilemmas in Community Mental Health. Oxon: Radcliff Medical Press Ltd. Roper, N. & Tierney, A. (1996). The Elements of Nursing: A Model of Nursing Based on a Model of Living. London: Churchill Livingston Publication. Rovener, B. W. & Kafoneck, S. Fillip, L. & Lucas, M. J. & Folstein, M. F. (1986). Prevalence of Mental Illness in a Community Nursing Home. American Journal of Psychiatry 143, 1446-1449. Sourial, S. (1996). An Analysis and Evaluation of Jean Watson's Theory of Human Caring. Journal of Advanced Nursing 24, 988-996. Watson, J. (1988). Nursing: Human Science and Human Caring. New York: New York National League for Nursing. Watson, J. (1997). The Theory of Human Caring: Retrospective and Prospective. Nursing Science Quarterly 10, 49-52. Zimmer, J. G. & Watson, N. & Treat, A. (1984). Behavioral Problems among Patients in a Skilled Nursing Facility. American Journal of Public Health 74, 1118-1121. Read More