Understanding and Implementing Person Centered Dementia Care and Practice - Essay Example

? Dementia Management; An Action Plan Outline 0 Overview……………………………………………………………………………………...3 2.0 Introduction…………………………………………………………………………………...4 3.0 Forms of Dementia…………………………………………………………………………....4 4.0 Management of Dementia…………………………………………………………………….6 4.1 Pharmacologic Measures……………………………………………………………...7 4.2 Non Pharmacologic Agents…………………………………………………………...8 5.0 Action Plan………………………………………………………………………………...…11 5.1 The Multidisciplinary Team………………………………………………………....11 5.2 Care Programme Approach………………………………………………………….13 5.3 Problem Oriented Approach…………………………………………………………13 5.4 Conclusion………………………………………………………………………...…14 6.0 References…………………………………………………………………………………....15 Overview The practice of nursing requires that its professionals need to have the necessary work ethics and work requirements that will ensure that service delivery is noteworthy. It is the responsibility of every stakeholder in the nursing profession to ensure that quality services are provided to patients. The nurse tends to patients and in the process reassures them of their safety. In order to ensure that there is noteworthy service delivery in the health care setting, it is necessary that every institution should come up with an action plan. An action plan contains the nursing stipulation in a particular condition, and when everyone sticks to these stipulations, the result is that the desired results will be achieved. This paper analyses an action plan for dementia cases. Dementia is a condition that causes progressive loss of brain and cognitive functions, leading to death. It is a condition that affects the old in most cases, and while they are old, they need to be given the best care so as to reduce morbidity and mortality and reduce disease progression. Management of this condition requires the input of many and is intensive as it is a very serious condition. In addressing this question, the paper analyses mental health and social care of people with dementia. The paper will then analyze the different management strategies of people with dementia and the factors that govern each of these strategies. I will then analyze my perspective of dementia management by discussing the person centred approach or the group approach, and the ethical considerations in both of these situations. From this, I will describe an action plan that needs to be implemented in my own setting. Managing dementia is not a simple recipe; it requires a complex approach. This paper will describe this complex approach. Introduction Aging is accompanied with loss in memory and cognition. This is a normal physiological process and no one is able to avoid it. However, in dementia, the loss in intellectual traits in an aging person is abnormal, i.e. more than the usual. In dementia, one loses memory and there is deterioration in social behavior and the ability to conduct the day to day activities. Moreover, patients suffering from dementia have difficulties with language, thinking and judgment (Law 2008, p35). The dawn of the 20th century has witnessed a remarkable increase in the aged in the industrialized nations. For example, in the UK, people over 65 years have grown to 18%, up from the 5% in past centuries. This implies that the ageing burden has increased in developed nations of the world, and this transforms to more cases of dementia in these nations. The only encouraging thing for these worrying statistics is that, even with the high cases of dementia, resources have increased, people’s attitude towards mental conditions is much better. The 20th century is heralding the dawn of much support from the family setting and community as a whole. There are many management measures of dementia, and success in managing the condition is only achieved when timely and noteworthy measures are done (Bezzant 2008, p142). Forms of dementia Many conditions manifest with dementia, hence understanding each of these conditions is important as it determines the management used. It is for this reason also that the management of dementia is complicated since it can be caused by many conditions and pathologies. The major diseases that manifest with dementia are Parkinsonism and Alzheimer’s disease. There are other rare conditions that also present with dementia; urea cycle diseases, canavan disease, and kufs’ disease. Alzheimer’s disease is the most cause of dementia. It manifests as progressive loss in memory and deterioration in ability to do daily activities. It also manifests with social withdrawal and apathy. After diagnosis, the patient survival rate is averagely 10 years. Vascular disease may also cause dementia, although this has not been well understood. Such patients present with vascular problems like hypertension and ischaemic heart disease. In vascular dementia, patients experience urinary incontinence and postural problems, as opposed to Alzheimer’s disease dementia patients. Dementia with Lewy Bodies (DLB) and Parkinsonism Dementia Parkinsonism is a neurological disorder characterized by repetitive movements called tics, rigidity, sluggish movements and tremors. In DLB, patients experience fluctuation in their awareness, and they also have signs of Parkinsonism including rigidity, sluggish movements and tremors. These patients also have hallucinations and delusions in a frequent manner. Fronto-temporal dementia This form is rare, and attacks people below 65 years old. It manifests as behavioral changes, and has less of memory problems. There are also mood disturbances and speech impairments. Creutzfeldt-Jacob Disease CJD, as commonly called is a very rare illness caused when abnormal proteins accumulate within the brain susbstance leading to widespread loss of nerve cells. It manifests as impaired mobility and balance, together with mood disturbances. Management of Dementia Management of dementia involves the use of pharmacological agents and non pharmacological agents which include social support and community help. These two need to be used together in order to achieve widespread efficacy. Dementia cannot be treated, but it can only be managed so that memory loss is controlled and cognitive functions are improved. There is a widespread increase in research that focuses on the roles of ethics, caregivers, medication, community support and person focused management on dementia. These researches are all aimed at ensuring that the management of dementia is improved in nursing practice. Dementia is a non specific illness, which makes it difficult to manage it well (Person et al 2009, 1930). Managing the condition starts from taking a complete medical and surgical history. After this, a thorough physical exam and mental state examination need to be conducted in order to identify any signs and symptoms indicative of dementia. The necessary laboratory exams will then be done to rule out different diagnoses, and after the health care provider has ascertained that there is dementia or dementia related conditions, management measures are then commenced at once. In managing the condition, it is important to get complete information from the informant e.g. the care and also from social services and past doctors of the patient. This is important as it enables you to understand the patient better, hence, better management. When assessing the patient, the aim is to exclude other conditions that mimic dementia with the same symptoms. This includes depression or even delirium. A thorough assessment also enables the health care provider to arrive at the exact type of dementia. This is important as you can exclude treatable forms of dementia from the non treatable ones (Person et al 2009, p1931). In managing dementia, the following approach is used; 1) Treat the cause of dementia if possible 2) Treat any concurrent illness 3) Tackle each of the other major problems 4) Support the carers of dementia patients Pharmacological measures Community care and the role of nurses are seen as the most important aspects during dementia management, but the role of pharmacological agents cannot be ignored since dementia occurs as a result of pathologies in the nervous system. Two classes of drugs are used for management. There are drugs used by health care providers to improve the patient’s cognitive functions, and the other class of drugs is used to reduce problematic behavior. The problem with all pharmacologic drugs is that they pose side effects which complicate the management of the condition. For example, most of the drugs used in dementia cause delirium, and this will complicate the condition. As a result of this, health care providers need to give the correct dosage, and they need to monitor the patients closely. The carers, and close family members also have a role to play in that they should ensure that the patients are compliant to medication. Non compliance is one of the greatest causes of recurrence; hence, the need for a care in dementia patients cannot be overemphasized. Conditions that accompany dementia and occur in the course of the disease include depression, delusions, hallucinations and various troublesome behaviors. These troublesome behaviours include incontinence, phobia, sleep disturbance, dietary change, wandering, restlessness especially during the night, sexual disinhibition and uncooperativeness. The various pharmacologic agents target these conditions. Antipsychotic agents, anxiolytics and antidepressant drugs manage all these conditions. Antipsychotics manage all behavior problems that are associated with dementia. This makes the work of health care providers easier and efficient. Conventional antipsychotics have shown widespread efficacy in treating behavioral disorders like delusions and hallucinations. Conventional anti-psychotics include haloperidol and chlorpromazine. However, they have serious side effects including movement disorders, sedation and enhanced confusion. These drugs also have extra-pyramidal side effects, but atypical anti-psychotics like risperidone solve this problem, but themselves, they have a risk of causing stroke. Antidepressants are recommended for dementia patients who have depressive states. Various classes are used here including tricyclic anti-depressants e.g. imipramine and Selective Serotonin Reuptake Inhibitors (SSRIs). It is therefore, evident that pharmacological agents have a major role to play in stalling disease progression and increasing the chances for survival. Health care providers need to give the correct dosages, and the patients/carers have the responsibility of ensuring that compliance to medication is achieved. Non Pharmacologic Agents Non pharmacologic agents include the measures that are put in place to ensure that the patient with dementia has the right environment to recover. Most of these patients have abnormal behavior and in other cases, bizarre behavior. Some behaviors cannot be treated by pharmacological agents alone , however, he input of non pharmacologic agents is important in these situations. 1) Psychological Interventions This approach involves the use of therapies used to manage dementia and therapies used for particular problems. These psychological therapies include reminiscence, memory therapy, resolution therapy and reality orientation. These therapies follow a structured approach, whose role is to tackle behavioural problems among people with dementia (Black & Hyer 2010, p34). This involves three stages. The first stage involves observing the events that activate the behaviour. The second stage analyses the behavior in question, and the third analyses the consequences of the behaviour in question. The strength based approach can also be used whereby, during the therapy, there is emphasis on what the patient is able to do or enjoy. This is important for their recovery as they spend time doing what they enjoy best. It gives them a sense of hope and rejuvenation, which is of benefit to them as it aids their recovery. 2) Social interventions Social interventions are another form of approach in managing dementia. Social treatments focus more on the environment of those who have dementia and those who help them by caring for them. For one, the environment needs to be restructured in a manner that makes it safer or in a manner that is stimulating and pleasant. What this does is that it enables the patient to cope better. This hastens recovery. People who suffer from dementia are unsafe due a variety of ways. For one, these people can fall down slippery floors or downstairs. They may also start fire easily, may choke or wander off to unsafe areas. They may also ingest chemicals or overdose themselves. Another social intervention in managing dementia is ensuring that dementia patients cope better (Law 2008, p38). The environment needs to be reviewed so that patients are able to cope better. For example, rooms need to be labeled well, and furniture needs to be arranged consistently. Focus should also be made on lighting; lightning needs to be adequate so as to minimize accidents. The environment needs to be designed in a way that is pleasant and stimulating. 3) Carer focus One way of managing dementia patients is ensuring that their carers are given the necessary emotional and practical support. a) Practical support The carers need to be given the necessary financial support. They should also be assisted so that their burden of taking care of the patient is lessened. They also need to be educated about the condition. Most carers are ignorant about the condition; hence, it becomes important to tell them more about the condition, its management and prognosis. b) Emotional support Without emotional support, even the strongest people are unable to cope. Support groups for carers and counselors have a major role to play in providing emotional support to carers. Carers have many problems that they face in their quest to take care of these people with dementia. These forums are going to be beneficial as they will get the necessary emotional and technical advice concerning the condition (Cowdell 2010, p47). Health care providers including nurses, social workers, home staff and doctors also need this support and care. A hospital unit, therefore, needs to put systems in place that ensure that the carer and the health care professionals are given the necessary support and guidance, as they are managing the condition. Action Plan From the above, it is evident that the management of dementia requires the input of pharmacologic agents and non pharmacologic agents. Pharmacologic agents deal with the pathologies of the condition while non pharmacologic agents deal with the environment of those suffering from dementia and their carers. a) The Multi-disciplinary Team In formulating an action plan in my setting, it is important that the multidisciplinary team approach is used. Management of dementia cannot be successful by using one measure; many measures have to be used, and each member of the system has their role to play in the management exercise. Managing people suffering from dementia requires that various tasks should be done. Effective teamwork requires that many people contribute to the success of a venture and not the exploits of one person or a group of people. Besides, in order to ensure that management is effective, there needs to be noteworthy communication between all team members. Lack of communication is detrimental in any venture since some members of the team fail to get vital information concerning a particular operation. In order to create a noteworthy action plan, each member involved in the management process needs to be delegated with his/her duty and this ensures that all events are timely and thoroughly done. a) Doctors: The role of the doctor is to evaluate all the concurrent illnesses and prescribe medication for the patients. Doctors must ensure that patients are compliant to medication and that hospital/community services are facilitated for the benefit of the patients b) Nurses: One of the most important in managing dementia. Nurses are involved in general care. The system needs to ensure that nurses care for all the in-patients or residents of nursing homes. The system also needs to avail enough nurses so that they are able to conduct behaviour modification measures. Nurses also oversee counseling and education activities, and they also coordinate community services. It is, therefore, evident that nurses have one of the most important roles in dementia management. The system, therefore, needs to ensure that there is a sufficient number of nurses who will be able to delegate all these activities. c) Clinical psychologists The system will also need to have clinical psychologists whose role is to initiate behaviour modification programs in the clinical setting. They are also tasked with offering emotional advice and support to patients and carers. Without the input of this group, the other members of staff may not be able to delegate their duties amicably. d) Social workers The system also needs to have a sufficient number of social workers. Despite occupying a low position in the dementia management program, social workers are another important group whose role is to provide respite care, residential care, counseling carers and home care. e) Occupational therapists The system will also need the input of occupational therapists, whose role will be to design the environment and educate the carers. Another role that they would play is to identify the strengths and abilities of dementia patients. As we saw above, discovering their strengths is encouraging for their recovery. Care Programme Approach This approach will be beneficial as it will ensure that patients assigned to a particular health facility are well taken care of until their condition is well managed. This would require that each patient is allocated a particular keyworker whose role will be to draft a care plan that is going to be used by the patient’s care giver. This approach would also ensure that patients are reviewed regularly in case they are not being well managed. Problem Oriented Approach The problem oriented approach is going to key in managing dementia. This plan requires careful planning, and it should involve the patients and their carers, together with the primary healthcare team. This approach should have steps that need to be followed when managing dementia and using this is going to safe time, resources and ensures timely recovery. a) The team needs to identify all the problems that need to be addressed urgently in the patients b) Priorities need to be identified when managing the condition. For example, it may be necessary to treat some concurrent illnesses before managing the dementia itself. c) The team should then set realistic and clear objectives for dementia management d) Every team member needs to be involved in the management. Every member should do his/her particular duty which will ensure that the condition is well managed e) The patients and their carers will need to be involved of the management measures to be taken f) Frequent reviews will then be conducted so that the effectiveness of the management plan is assessed. From this, any problems will be identified, and countermeasures to these problems will be drafted. Conclusion There is no cure for dementia, but through noteworthy management measures, the patient is able to lead a quality life and a prolonged life. Management of dementia needs the interplay of pharmacologic and non pharmacologic agents. Regardless of the approach used, it is necessary for any health care facility managing dementia patients to draft a potent management plan that involves all members of the management team. This plan will stipulate the roles of each team player and will require that management is a stepwise process. Otherwise, managing the condition becomes tedious and unsuccessful. . References Bezzant, K. (2008). Practice development: providing benefits for both managers and older patients with delirium and dementia. Journal of Nursing Management. 16 (2) p. 141-146. Black, K. & Hyer, K. (2010). Person-centred considerations in practice for persons with dementia and their caregivers across the continuum of care. Best Practice in Menta l Health: An International Journal. 6 (1) p. 33-46. Chodosh, J., Berry, E., Lee, M., Connor, K., DeMonte, R., Ganiats, T., Heikoff, L., Rubenstein, L., Mittman, B. & Vickrey, B. (2006) Effect of a dementia care management intervention on primary care provider knowledge, attitudes, and perceptions of quality of care. Journal of the American Geriatrics Society. 54 (2) p. 311-317. Cowdell, F. (2010) Care of older people with dementia in an acute hospital setting. Nursing Standard. 24 (23) p. 42-48. Gormley N, Lyons D, Howard R. 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(2009) Daily observation of cognitive functioning in hospitalised patients on acute geriatric wards. Journal of Clinical Nursing. 18 (13) p. 1930-1936. Read More