Care of Patients with Dementia - Research Paper Example

?Care of Patients with Dementia Dementia is a haunting problem amongst elderly and they need long term care (Dewing, 2001) They can also get frequently get admitted to acute care settings for other health problems like fever, gastroenteritis and heart disease and thus, nurses and other health professionals who deal with elderly population, both in long term and acute care settings must possess an awareness of management of patients with dementia (Nolan and Tolson, 2000). Research has shown that most hospital nurses do not have the expertise to handle behavioural disturbances like dementia which are mostly managed in mental health wards. It is yet unclear whether, despite abundant literature on the management of dementia in acute care settings, the training and practice of staff meets the demands of the ageing population. Currently, most of the practice is based on biomedical model (McCloskey, 2004). Due to rise in the elderly population and simultaneous increase in the number of patients suffering from dementia, research and practice of dementia patients is a necessity in order to meet the needs of the patients and their families affected by dementia. The purpose of this essay is to identify current practices in the nursing care of patients with dementia discuss best practice guidelines pertaining to care of this population, analyse factors influencing the care of dementia patients in clinical settings and evaluate various options pertaining to alternative modes of management. Gerdner, Buckwalter, and Reed (2002, p363) proposed that there are basically six types of stressors which have detrimental effects on patients with dementia and contribute to development of aggressive behaviours even in those with initial stages of dementia. These factors are environmental factors, excessive fatigue, caregiver factors, demands above and beyond functional capacity, variety of stimuli, physical stressors and perception of losses. Environmental factors play a major role in the development of aggressive behaviour in a patient with dementia and contribute to distress and dissatisfaction. Nurses handling elderly patients must be aware of the fact that the environment of the hospital is new to the patient, the surrounding is filled with noise and the individual can feel uncomfortable in the surrounding (McCloskey, 2004). The first and foremost step in appropriate management of patients with dementia in health care setting is identification of the disease process and careful assessment of the various factors in environment of the patient that contribute to stress. Identification of factors helps in the modification of future care whereas lack of understanding of these aspects leads to frustration, inappropriate care and stress not only for the patient but also for the nursing staff. It is due to such a lack of understanding that many physical restraints are employed in handling dementia patients and these contribute to patient mortality and increased burden of work for the nurses (McCloskey, 2004). One of strategies to prevent distress due to physical restraints is adoption of alternatives to physical restraints (McCloskey, 2004). Some such alternatives include adoption of door knob covers instead of doors, employment of various electronic devices like wandering system, bed alarms, door alarms and electronic monitors to monitor the movements of the patient, change in the regimens of medication in such a way that they offer comfort to the patient and cause minimal disturbance and distress, placing the patient in strategic regions which are compatible to the patient and are familiar to the patient, place safety mattress on the floor to enable safe locomotion, remove tubes and drains in a prompt manner, assist and pursue routine toileting, decrease scope for environmental hazards, prevent falls, employ various aids for seating and positioning and usage of lower beds and employment of split side rails (McCloskey, 2004, table-1). Other alternatives include involvement of volunteers, family members, sitters and hospice workers in the care of the patient, hight time sleep enhancement programs, making interdisciplinary team responsible for the safety of the patient, education of the staff pertaining to dangers of physical restraint, use of belts when on wheel chair and use of wedge cushion (McCloskey, 2004, table-1). Thus employment of suitable alternatives to physical restraints not only makes the patient feel comfortable but also helps the nurse provide care without stress. According to the PLST model, several strategies enhance the comfort level of the patient (McCloskey, 2004, table-2). One such strategy is maximising safety of the patient by modifying certain aspects of environment which compensate for the cognitive losses. Other strategies include controlling of factors which increase stress, planning and maintaining a consistent and familiar routine, implementation of periodic and regular rest periods which compensate for loss of reserve energy and decrease fatigue, provision of unconditional regard which is positive in nature and employing a non-judgemental strategy about the appropriateness of the behaviour of the patient except those who challenge the safety of the patient and others (McCloskey, 2004, table-2). Nurses must be trained to recognise signs and expressions of fatigue, increasing stress and anxiety in the patients and administer interventions which suitably decrease the stressors and increase comfort levels of the patient (McCloskey, 2004, table-2). Only those therapeutic interventions which are appropriate for safe functioning of the patient must be employed. Some reassuring forms of therapy like reminiscence and music may be useful to bring comfort and soothe the patient (McCloskey, 2004, table-2). Strategies to increase comfort levels of the patient must be individualised and based on the need of the hour, person and place. The goal of treatment in dementia is to maintain the quality of life as long as possible. The patient's functional abilities should be maximized and the quality of life should be improved by enhancing mood, cognition and behaviour. Drugs which are prescribed should be encouraged to be taken (Nettina, 2006, p191). Adequate rest must be provided. The family members must also be assisted to find resources for solace like community groups, church groups, social service programmes or hospital based support (Nettina, 2006, p192). Patients with dementia must receive care of all aspects of health. Nurses must have an understanding of the fact that patients with dementia have behavioral disturbances. Stimuli and factors which worsen distress of the patient must be minimised and a calm, safe and composed environment must be created to help the patient feel comfortable and recover as much as possible. At the same time high standards of care must be maintained by using creativity and common sense. Nurses dealing with dementia patients must be sensitive to the needs and demands of the elderly population and behave with patient, compassion and professionalism. References Dewing, J. (2001) Care for older people with a dementia in acute hospital settings. Nurs Older People, 13, 18-20. Gerdner L, Buckwalter K, Reed D. (2002) Impact of a psychoeducational intervention on caregiver response to behavioral problems. Nurs Res., 51, 363-374 McCloskey, R.M. (2004). Caring for Patients With Dementia in the Acute Care Environment. Medscape Pediatrics from WebMD. [online]. Retrieved from www.medscape.com/viewarticle/481616 Nettina, S.M. (2006) Manual of Nursing Practice. (8th ed.). New York: Lippincott Williams & Wilkins. Nolan, M., and Tolson, D. (2000) Gerontological nursing 1: challenges nursing older people in acute care. British Journal of Nursing, 9(1), 39-42. Read More