Dementia: Assessing and Meeting Care Needs - Essay Example

Dementia: Assessing and Meeting Care Needs Dementia: Assessing and Meeting Care Needs Dementia is becoming a universal problem that equally prevails in both developed and developing countries. This menace often strikes when people least expect it. Dementia causes psychological problems to the victims and their immediate family alike. Due to increasing cases of dementia, it has become necessary to develop a suitable treatment plan regarding general and specific needs of dementia victims. Currently, there are about 24 million people with dementia, and it is estimated that this number will double in 20 years, with 42 million patients in 2020 (Cox, 2003).In order to achieve effective residential and hospital care for patients with dementia, biological, psychological and social approach to dementia should be taken into account. This helps in understanding the specific needs of people with dementia and aids in improving quality of care with a view to improving May’s health outcomes (Regnard, 2006). The purpose of this essay is to develop a care plan for a person suffering from dementia in a residential care setting. For this purpose, a clear rationale for the assessments, identification of problems faced by May and her caregivers will be done. In addition, the paper will seek to establish how different intervention techniques will help in fighting the challenges posed by this disease condition. Basically, it is critical to assess May’s specific medical needs. This can be done through appropriate assessment and evaluation techniques. On the basis of this assessment, appropriate interventions can be suggested (May et al., 2009). Assessment and Evaluation Although May is likely to exhibit unique signs and symptoms, there are some general symptoms that should be looked for. For instance, there should be a general decline in his memory, his ability to reason as well as the coherence of his communication. This arises from the memory loss that is the underlying pathology of dementia. In addition, he should show signs of loss of skills or his ability to perform daily activities. This is because the brain loses its ability to coordinate several of its functions. Besides, dementia patients have been shown to exhibit some level of confusion regardless of the pathological extent. The assessment and evaluation of patients with dementia requires appropriate diagnosis through symptoms and history of the illness. The duration and extent of cognitive complaints should be documented and any changes in May’s well-being clearly identified. Safety concerns along with past and current occupations should also be taken into account. Assessment is done to determine any history of mood disorders, stroke, trauma and other related psychological and neurological illnesses as these contribute to the decline in the health of that patient (Scott et. al, 2007). In addition, some specific questions regarding May’s early life could be extremely helpful in identifying the patient’s special needs. Along with that, standard tests are available that provide a clear view about May’s condition. One such test is National Adult Reading test that determines pre-morbid condition of the patients (May et. al, 2009. This principally determines the extent of the disease condition with regard to the May’s memory. Brain imaging is one of the modern techniques that have been used to study the progression of the disease condition. These include magnetic resonance imaging (MRI) and routine computed tomography. In some cases, the single photon emission tomography is also used based on the advice from the physician (Brain and spine.org.uk, 2013).The imaging generally outlines the parts of the brain that are already affected. In this manner, the physicians can predict the disease progression and thus psychologically prepare their patients for further memory loss. Based on the imaging, decision about further treatment options available for May can then be made. For instance, he could be referred to a neuropsychologist, a dementia specialist, a geriatric specialist or social worker depending upon their needs (Alzheimers.org.uk, 2013). While assessing May’s medical needs, it is critical to develop communication with the family members as well as the patient. It significantly contributes to the effective treatment of dementia. According to Santamaria (2005), the patients’ ability to feel and perceive emotions remain intact. This moral support can only be achieved through constant communication. The treatment plan should follow the provisions of Dementia and National Dementia Strategy. It helps in determining the extent of pathology and the requisite method of management. The pharmacological and non-pharmacological treatments are designed based on the Dementia and National Dementia Strategy. In addition, National Institute for Health and Care Excellence (NICE) provides clinical guidelines that take into account the patients’ desired medical outcomes as well as their economic situation. The NICE guidelines also stipulate the nature and quality of social care that every patient is accorded. In respect of dementia, National Institute for Health and Care Excellence (NICE) provides that involving the patients’ family is a critical component of their holistic care. This way, the desired medical outcomes can be achieved with minimum expenditure (Schlander, 2007). The NICE guidelines for dementia provide for the use of cognitive stimulation programs in mitigating the symptoms that affect May’s memory. In addition, it provides for the use of galantamine and donepezil in the treatment of moderate dementia of Alzheimer’s type. Besides, it helps clinicians to find correct diagnosis of the various stages of Alzheimer’s disease. Symptoms that adversely affect May’s mood and behavior are treated using pharmacological and non-pharmacological treatments. In this regard, the NICE guidelines recommend an integrated approach between social care providers and healthcare providers to optimize therapeutic outcomes. This provides holistic treatment for the patients (Caroline, 2001). The Interventions Biological approach, when used appropriately, treats disease process of dementia, brain damage and changes in behaviour of dementia patients. However, there is also a need to take into account the psychological aspects of dementia care. It is very important to support May and help him overcome psychological stress (Allan, 2001). Both primary and secondary caregivers of dementia patients need to understand that having dementia does not rob them of their autonomy. They should feel that they still have the right to make choices and decisions for themselves. However, sometimes there is a need to make a rationale choice between patient’s preferences and care needs. This idea arises from the fact that patient’s preferences are not always necessarily helpful to them (Keene et al., 2001). Improving quality of life and social attitudes should be the main objective in developing a person-centred health care plan. This should be extended to the patient’s homes in order to maintain their dignity, respect and promote their health. The standard of care is maintained to the satisfaction level of the person with dementia and his primary caregivers (McCarthy, 2007). However, people providing residential care services need to fully understand their duties and responsibilities. In addition, they should have knowledge and skills needed to provide high quality care (Brooker, 2007). Principles of ‘Duty of Care’ and Accountability Duty of care is a legal obligation that requires that a person involved in the care of another individual must take responsibilities that are given to him by the virtue of his profession. These principles are required to be followed when a person is in a direct relationship with an individual in need of care. In case of person suffering from dementia, these principles should be strictly followed because of the healthcare needs of that patient (Brooker, 2007). Nurses, doctors and pharmacists are specifically responsible for the provision of quality care. It is their duty to carry out their responsibilities in a manner that is acceptable to patient and his family members. At the same time, they must seek to meet the requirement of the rules and regulations of the organization they are working in (Scrivener, 2011). According to Sokol (2006), the principles of duty of care are not absolute. Instead, they are dependent upon the needs of a person with dementia requiring care. The nature of their treatment should be understood and duties should be recognized to acknowledge these needs. Basic principles of duty of care make doctors, nurses, caregivers and other healthcare professionals to adhere to May’s treatment plan and create an environment that can enhance the health outcomes of patients with dementia. Caroline (2001) argues that it is the duty of the entire care management and care planning team is to create an environment that can ascertain the provision of seamless services to patients. However, better results cannot be achieved without creating a fruitful and effective partnership with the primary and secondary caregivers. The entire concept of the duty of care revolves around some principles including. These include ascertaining that all practices are being taken with a person- centred approach. Besides, effort should be done to reduce dependency and negativity as well as focus maintained on positive actions and outcomes (Caroline, 2001). It is the duty of the caregivers to engage progressively in the development of a plan that can enhance the health outcomes of a patient with dementia. For instance, if May wants to go for walk, he needs to be assisted. First of all, it is important to take into account the May’s capabilities. At the same time, expressions showing discontent toward the patient should be avoided. Although caregiver does not always have time to fulfil all demands of the patient, there are some duties that must be fulfilled without objection. Basically, people who are involved in the duty of care need to encourage and support the patient who needs assistance to live a life to his full potential (Dementia care, 2013). Actions that are undertaken in order to perform a particular duty cannot be interpreted as restriction of justification. Instead, there is a need to consider possible consequences of the action to prevent the unwanted situation. There is also a need to identify negative reactions such as anger, non-adherence and aggression as the part of the patient’s personality. Anyone suffering from dementia shows these symptoms and it is the duty of the caregiver to focus on the possible solution of these problems. The basic principles of duty of care are that patients should be kept safe and their needs and requirements are fulfilled properly (Dementia care, 2013). Theories of Practice of Dementia Care Interventions provided to people suffering from dementia have some theoretical basis as well. It tells how knowledge about the patient suffering from dementia is acquired and what treatment and support plan are adopted. In case of dementia, cognitive behavioural theory and support plan is of critical importance because it directly helps in reduction of stress and building of coping strategies. Interpersonal connections can be generated in people having mild to moderate dementia and this is possible with reminiscence and life review. Abilities of a person to pass a near normal life can be optimized by memory training involving cognitive and behavioural impairment therapies (Alzheimers.org.uk, 2013). Enriched Care Planning The concept of enriched care planning for people with dementia revolves around the fact that new ideologies can help promoting a better way of treatment. Medical practitioners should focus their attention to the highly individualized needs if they want to go a step ahead in the process of care delivery. May et al., (2009) also maintains that front line caregivers involved in the care of a person with the dementia should recognize the ultimate purpose of their duty. They must focus on the changing needs of the person under consideration. For this purpose, a review of person’s history and his information about his cognitive abilities, previous health problems and underlying diseases should be collected (May et al., 2009). According to May, enriched care planning provides a framework for helping the person who has dementia and their caregiver(s) to consider each of these components as a basis for identifying and meeting current needs. Socio-Psychological Theory Social psychological theory of care provides a useful track for the establishment of a care plan for a patient suffering from dementia. It is critical to understand how needs and demands of different patients vary to a plan to provide individualized care can be generated. It is also important to understand how thought process of a person changes and create incorrect assumptions for people around him. After developing understanding of basic socio-psychological needs of the patient basic understanding of the need of the patient can be developed and finally a good inter-professional relationship can be created. According to a research conducted by Bredin et al., (1992), the foundations laid by social psychological theory of dementia prove to be very helpful in creating an environment that becomes supportive for patients .Even in case of May, these care plans can work miraculously. The identification of factors that affect the capability of a person to cope up with his disease can aid in bringing useful care plan to life. This helps in understanding the needs and demands of person, his life style and reasons for stress. Finally, evidence based interventions can be applied to enhance the health, quality of life and well-being of a person (James, 2011). Psychodynamic Approach At early stage of dementia, the person with weakened memory tries to protect himself from losses by responses including defence, withdrawal and splitting. However, when this stage progresses the person tries to maintain a state of self and becomes highly dependent on others. Finally, when the stage further progresses, he fails to cope up with his situation and becomes assertive, aggressive and agitated. His reactions are frequently accompanied with emotions of loneliness, catastrophe, distraction, despair and isolation (Solomon et al., 1992). The above concept suggests that a person suffering from dementia relies highly on others to maintain a sense of self. He tries to become overly dependent in order to provide the ego function that maintains his sense of self. His increased reliance on others brings some changes in his attitude that primarily includes the feeling fear, separation and insecurity and for such a person an image or glimpse of past can help in development of self-recognition. In such circumstances it becomes critical to develop a safe relationship that can help the patient think that he is being understood and supported. Long term care facilities and adult day care centres are very helpful. Reduction of emotional distress and creation of environment that can help in coping up with the diseases process are some key responsibilities of the caregivers (Downs, 2008). Swanson’s Middle Range Theory of Care According to Swanson’s Middle Range Theory of Care, caring is an integral part of individuals involved in May’s treatment. In order to provide better care to the patient suffering from dementia, it is critical to take into account a humanistic approach. Through care behaviour, core competencies to enhance the health outcomes of patient with dementia positive results can be achieved. For this purpose, it is critical to understand better methods of care and identify tools that can help in creation of a suitable environment with the help of standard procedures and requirements of technology (Chou, 2010). Ryden (1998) argues that modification of basic principles of theory and practice is required because it can help in development of a rich conception of care. It also gives meaning and direction to the caregiver through which he finalizes his tasks according to the needs of person suffering from dementia. Rationale of the Care In order to reduce May’s sufferings, the most important thing is the early detection of the disease and formation of a care plan according to the specific needs of that patient. The General practitioner (GP), community mental health nurse (CMHN), social worker and other healthcare professionals focused kind of communication with May’s family members and the relative and feasible environment should be provided to him. A multi-disciplinary kind of approach should be laid down to maintain environment that can help these people with dementia live in a normal life. People suffer from memory loss and can also forget about their whereabouts in this disease and it is the main purpose of the caregiver to create a support system to reduce the sense of illness and improve self-identification in these patients (Goodall, 2006). Dementia brings a great deal of stress and anxiety both for the patient and also for his primary caregivers. Persons with dementia need support of people who are close to them. The care plan should be tailored according to specific symptoms of patients and his care needs. For example, if a person has the ability to walk he should be made independent with encouragement and support. He must be made able to carry on his day today tasks including washing, cleaning and eating, however, individuals who are unable to move their body organs should not be forced to do so. A dementia friendly environment in a residential setting can greatly help in this regard. Common core principles of treatment can be applied in residential and hospital settings but specific needs of the patient must be identified to improve the quality of life of the patient (Chrzescijanski et al., 2007). Improved health outcomes can be achieved by creating a comfortable environment with help of people which are trained in treating people with dementia. Common core principles and knowledge should be adapted in relation to the needs and demands of a person. Through this, basis for development of environment suitable for treatment is achieved. The ultimate rationale of the care delivery to patients of dementia should be to create a supportive environment that can deliver a good quality of life to the patient at every stage of his disease (Goudie, 2004). Challenging Behaviours Persons suffering from dementia exhibit some challenging behaviours that cannot be tackled by ordinary interventions applied in a healthcare organization on day to day basis. People with this disease can become aggressive. They use abusive language and also hit the person who is involved in their care. Another challenge is the stress caused by excessive demands of the person having dementia. The patient is always in need of help for even a small task. He needs support in minor tasks such as walking, talking, eating and cleaning. Furthermore, misinterpretation of message at the part of caregiver and another underlying illness of the patient can make the situation even more challenging. Treatment of dementia is not an easy task as these people not only become aggressive in a minute but at the same time they also start blaming the person who is directly involved in their care. However, with appropriate risk management techniques, the entire medical situation can be tackled appropriately. For instance, they should be provided emotional support to ensure they remain emotionally stable. This will save them a lot of emotional baggage that often marks their lives (Goodall, 2006). Risk Management After getting knowledge of the disease the family member’s attitude to accept patient plays a very important role in curing the disease. The biggest challenge is to convince patients and his family members about the course of treatment and difficulties that can arise during it. If they accept the patient whole heartedly then the disease can be overcome but if they don’t it can worsen the things. Not only should their initial attitude be positive it should go all the way down the road so that patient shouldn’t feel alone and can overcome the disease. Another challenge that creates difficulties in care is the lack of knowledge to develop skills and lack of proper training to the caregivers and other staff. There is a huge need of making staff capable enough to cater these patients so that if they are being neglected by the family, nursing staff can cover the whole situation (Chrzescijanski et al., 2007). Communication Gap People suffering from dementia find it difficult to express themselves. In fact the disease renders them unable to communicate their ideas and thoughts properly. In most cases, people like May completely lose track of their discussions as they appear to forget very fast. This sudden memory loss while talking also forces people to express themselves in a wrong way. This often causes them to be misunderstood by people around them. In this regard, it is possible that other people could hate them for things they are not responsible for. Even worse, they could be criminalized because of actions they are not responsible for when the authorities are not aware of their medical conditions. This implies that there is need for protections of their rights, especially with regard to law enforces. These are known to be the internal factors that cause people to react in a violent manner. There are some external factors as well that stress out the patients and then he starts feeling reluctant to express his thought clearly. This internal emotional pressure may explode at some point given the fact that they have a problem expressing themselves. In such circumstances, communication gap becomes the biggest problem that creates a negative stereotypic environment. It is critical to bridge this communication gap and create environment that supports quick recovery. For instance, the community should be sensitized to develop understanding for people like May. This is because some of the traits they exhibit are not out of who they are, but from what they are. Their medical conditions are absolutely responsible for their medical conditions (Cox, 2003). Conclusion The ultimate purpose of the care provision to the person with dementia is to reduce his symptoms by creating a supporting and strain free environment. Hospital environment, nursing staff, home environment and family member’s attitude are few factors that can push the patient on the back-foot. A systematic kind of combined effort is needed to bring patient out of dementia. Comprehensive services and compassionate dementia care requires knowledge, skills, and attitudes that are abhorrent to the patients of dementia. These interventions play a vital role in making patients able to adjust to their condition. 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Psychotherapy of patients with dementia, memory function and aging related disorders. London: Springer publishing company. Read More