Adapting to Health Changes in the Older Adult with Dementia and Other Health Problem - Case Study Example

Running Head: ADAPTING TO HEALTH CHANGES IN THE OLDER ADULT WITH DEMENTIA AND OTHER HEALTH PROBLEM Adapting To Health Changes in the Older Adult with Dementia and Other Health Problem [Writer’s name] [Institution’s name] Adapting To Health Changes in the Older Adult with Dementia and Other Health Problem Introduction and Case Study The client referred to, a sixty five year old woman who the author will call Peggy for the purpose of this assignment. She had only been at the nursing home for a few weeks, due to her husband not being able to look after her any more, her consultant had diagnosed early onset of dementia. Usually Intellectual performance tends to be maintained until at least 80 years old (Snyder 1995 etal ). However, tasks may take longer to perform because of some slowing in central processing and we can become annoyed or embarrassed with our self as new tasks at home and work may take a longer time to learn (Beers, Berkow & Joynt 2003) It is highly likely that almost two-thirds of us will have some age-related memory changes as we age, and these changes are regarded as normal (Hudson 2003). We also have to take the current model of ageing, disease and illness into account, since they all have an effect on the brain, and they are closely related. When it comes to older people, use the term "healthy ageing" is used when there is a relative lack of disease and the decrease in mental capability and activity is normal (Winker 2002). In this case he Roper, Logan and Tierney model of nursing will be used by the registered nurse. This approach is based on nursing care activities of daily living. It is usually used by registered nurses in medical and surgical settings of elderly patients. However, for this assignment, the author is the registered nurse and will use the assessment skills including bodily language, communication and attitude ,used by a trained member of staff to assess the problem with a client. Analysis of the case with reference to communication, behaviour and attitude of nurse for confused patients It was lunchtime and the clients where eating their lunch when the since I am registered nurse I noticed by looking around the room observing the clients behaviour, that Peggy who was sitting at the dinning table with several other clients was not eating hers. Usually even Older people who are going through a healthy ageing process tend to decrease the amount of food they eat due to lost or reduced appetite and because they use less energy. To compensate for this, low-fat nutrient-rich foods are recommended, because this diet can reduce the chance of nutrient deficiencies, which can impair mental function through physical illness (Ortega et al, 1998) I approached Peggy from behind and put her hand on Peggy’s which made her jump and said, “What’s the matter Peggy are you not hungry” the nurse had eye contact with Peggy and asked Peggy again if she was hungry? Peggy shook her head and said that she felt sick! The nurse then said in an encouraging voice “just try and eat a little, I will be back in a minute”. The nurse thought Peggy looked pale and was very quiet and a bit clammy. According to Hilgard, Atkinson & Smith (1987) the social sciences have taught us that first impressions really do count in human interactions. This has two main implications when assessing a patient, the first is that we should be careful how we approach a client an offhand manor or disorganized approach (e.g. calling a client the wrong name), may upset the client (Stickley &Freshwater 2006). The second is we should be aware of our own first impressions of the client; witch could lead them to be frightened or upset by their illness or surroundings, leading to abnormal behaviour because of this stress (Williams , Kemper & Hummert.2004) I knew that since I was a registered nurse it was my responsibility to help the patient manage herself in this kind of situation, so I went back over to Peggy several minutes later. I pulled a chair over and sat facing her sitting quite close and took hold of her hand, I thought the my use of body language was appropriate at this stage, Body language is particularly important in personal communication according to Tarnow (1997). However, lots of people like those who have certain disabilities may be able to utilize and understand body language in a different way. Buck. (1984) also states that body language includes, facial expressions, hand and arm gestures, posture, and touch, it can also be “open or closed”. For example if a patient is asked are they feeling all right and answer yes, but they are sitting with arms folded tightly across their body, that can be interpreted, as they are not (Thompson 2003). I kept a strong eye contact with Peggy. I knew that eye contact is way of nonverbally expressing my empty for the patient. Argyle (1990). I continued to talk to Peggy in a calm clear reassuring voice; she asked Peggy if she could to stand. Peggy nodded; the nurse put her arm around her shoulder held her other hand and helped Peggy to walk slowly to her room. Rosa etal (1998) advocates that touch can refocus patients, who are distressed or self-absorbed, and it can reduce anxiety in stressful situations. Once in she was in her room, I helped her to sit on her bed, as she sat down Peggy vomited, and started to cry! Peggy said that she did not like it when she was sick and she was very sorry for the mess she had made. I took hold of Peggy’s hand and reassured her that she would be “alright” in a calm soft voice. Moreover, not to worry about the mess, as it could be easily cleaned up. Losing connections between the neurons is also a common feature among elderly people. This can be a result of neuron shrinkage, as well as the loosing of connection and the fact that new connections are harder to establish with increasing age. The level of acetylcholine, dopamine and serotonin (neurotransmitters), which make the neurons able to communicate, are also reduced. This leads to a greater probability of losing connections between the neurones, and since these neurones are involved in the motor process, many older people find that their ability to move around decreases. (Beers, Berkow, Joynt 2003 & Golde 2001) As the ageing process increases, the blood flow to the brain decreases, but the decrease is greater in some areas than others. The areas that have the greatest decrease of blood flow are the hippocampus, frontal lobes and other frontal areas. (Beers, Berkow, & Joynt 2003). Peggy was getting quite distressed at this point. She had vomit on her clothes and looked a sorry sight sitting on the bed crying. I proceeded to get Peggy a clean nightdress, towel and bowl of water; she then helped Peggy to remove her clothes. All the time talking to her in a calm soft voice reassuring her that she would be all right she rubbed Peggy’s cheek and smiled at her, she then washed Peggy and put on her clean nightdress. I sat on the bed next to Peggy maintaining eye contact with her and asked her if she would like to “have a lie down”, Peggy nodded and the nurse helped Peggy to lift her feet on to the bed. Along with aging the psychical changes which take place also include noticeable cognitive changes. However there is not enough research to prove why this happens. (Golde 2001). I asked the ward boy to go to the sluice and get her a kidney bowl, do. When he returned to Peggy’s room the nurse was sponging Peggy’s face with a wet cloth, reassuring her that she would be ok. I took the kidney bowl and knelt on the floor next to Peggy I maintained eye contact with Peggy. In a calm soft voice, I told Peggy that it was all right if she needed to vomit again as she could do it in the bowl. I then asked somebody to stay with Peggy whilst she went to get a thermometer. A few minutes later she returned, she once again knelt next to Peggy’s bed and explained to her that she was going to put it in her ear to see if she was “hot”, she asked Peggy if that would be ok and Peggy nodded. The 13. Calnan (2005), states as a health care professional you must take permission form the client before giving any treatment. I took Peggy’s temperature, which was 37.5, the nurse explained to Peggy that she was “a bit hot” and that she would sit with her for a while in case she was sick again, Peggy asked if she could have a drink. The nurse explained to Peggy that she could have a few sips of cold water in case it made her sick. I pulled a chair up next to the bed and sat on it holding Peggy’s hand, at this point Peggy was sick again, into the bowl, the nurse kept talking to Peggy in a calm reassuring voice whilst rubbing her back. This time Peggy was not quite as distressed as before and the nurse once again sponged Peggy’s face with a cold flannel. She once again got hold of her hand and asked her in a calm low voice if Peggy had been to the toilet to open her bowels that day, Peggy said yes, I then asked was it “looser” than normal? Peggy said she did not know. I asked somebody to go and get Peggy’s notes from the office, the attendant returned with the notes, which the nurse read. After reading these she turned to Peggy and said to her that “she had been put on to some new tablets for a urine infection and that it looked like they did not agree with her” she would go and ring the doctor and get some new tablets that would make her feel better. Peggy answered the nurse and said, “Oh thank god for that” the nurse knelt on the floor next to Peggy and moved her hair out of her eyes and told her “not to worry she would feel better soon”. As I spoke to Peggy I was holding her hand and rubbing the top of Peggy’s hand with the other one, she then turned to me and said that Peggy had seen the doctor the day before and he had given her some antibiotics for a urine infection and it looked like Peggy was having a reaction to them. I said I would not give any more of the tablets to Peggy and that once she had settled down she would contact the doctor. I sat with Peggy holding her hand and talking to her, reassuring her until she fell asleep, she then spoke to the doctor explain what the problem was, and the doctor prescribed different medication for Peggy who was feeling better the next day when I came on shift. I felt great empathy for Peggy I felt that I was doing the best I could in that situation; as I do not think I could have anything to prevent her from vomiting. The nurse in my opinion handled the situation extremely well. Wondrak (1998), States that empathy is an important communication skill for nurses. In addition, is an integral skill in developing a therapeutic relationship with patients? Rosa etal (1998) also confirms this by stating that the basic requirement for being empathetic, are the ability to listen and imagine what it is like for that person, understand and not to judge, and the ability to communicate and understand. I maintained Peggy’s autonomy and handled the situation in a very empathetic manor. I knew that since I was a nurse to address all the problems of the patient and set goals to solve those problems, for example, taking Peggy to her room so to maintain her dignity so that if she did vomit she was not in front of the other clients (which could distress them), I reassured her that it was alright to vomit, and that the mess did not matter, I showed compassion when cleaning Peggy and my communication skills were excellent. According to West (2001) “There are many different areas of communication. Examples of these are, nonverbal communication, verbal communication, and symbolic communication. Nonverbal communication is very important when nurses have to handle old age people as both facial expressions as well as body motions are included in the process (Ellis , Gates & Kenworthy 2003) The Emotional meaning the patient takes from the nurse is by these expressions and bodily gestures. Conclusion In my opinion think I helped the patient manage her in a professional but empathetic manor. The only thing I would do differently in this situation would be to check on Betty every half an hour, because she became very distressed when she vomited, and in case her condition worsened. I now understand after this experience body language and communication skills, how important the way we present ourselves to our client is, and how it can make a great difference to the situation. If the nurse had a not been as empathetic, reassuring, or had used body language that was not appropriate, the situation could have been a lot different and the client could have become a lot more distressed (Sully & Dallas 2006) If the situation arose again, I hope that in my nursing practice, I will be able to demonstrate good communications skills and empathy with all my patients, and that my communication skills will develop as my training progresses. Reference Argyle, M. (1990). Bodily communication (2nd edition). New York: International Universities Press. Ashcraft, M. H., 1994; Human memory and cognition 2ed; HarperCollins College Publishers, New York Beers, M. H., Berkow, R., Joynt R. J., 2003; The Merck Manual of Geriatric; Merck & Co., Inc., Whitehouse Station, NJ, USA Buck , R. (1984). The physiological bases of nonverbal communication. In W. Waid (Ed.) Sociophysiology. New York: Springer Verlag Calnan, M (2005). Views on dignity in providing health care for older people. Nursing Times. 101 (33): 38-41 Ellis RB, Gates B, and Kenworthy N (2003). Interpersonal Communication in Nursing: Theory and Practice, 2nd edn. Churchill Livingstone, London Golde, T., 2001; Biology of ageing: The American Federation for Ageing Research Hilgard, E. Atkinson, R. & Smith, E. (1987) Introduction to psychology. New York: Harcourt Brace Jovanovich. Hudson, R. (2003). Dementia nursing : a guide to practice. Ascot Vale, Vic. : Ausmed Publications Ortega RM et al, 1998;AGE-ASSOCIATED MENTAL IMPAIRMENT http://www.lef.org/protocols/prtcl-003.shtml (web4) Roper, N., Logan, W.L. & Tierney, A.J. (2000). The Roper-Logan-Tierney model of nursing: based on activities of living. Edinburgh: Churchill Livingstone. Rosa Linda, Rosa Emily; Sarner Larry; Barrett Stephen (1998)A Close Look At Therapeutic Touch JAMA. 279:1005-1010. Snyder M, Egan EC, Burns KR (1995);. Interventions for decreasing agitation behaviors in persons with dementia. J Gerontol Nurs.;21(7):34-40, 54-55. Stickley T and Freshwater D (2006). The art of listening in the therapeutic relationship. Mental Health Practice, 9(5), 12–18. Sully P and Dallas J (2005). Essential Communication Skills for Nursing. Elsevier Mosby, London. Tarnow, E. (1997). Bodily language is of particular importance in large groups. Retrieved May 4, 2009 , from http://cogprints.org/4444/ Thompson N (2003). Communication and Language. A Handbook of Theory and Practice. Palgrave MacMillan, Basingstoke West, L. (2001). Early stage dementia : reassurance for sufferers and carers. Sydney : Hodder Headline Australia Williams K, Kemper S, and Hummert L (2004). Enhancing communication with older adults: overcoming elder speak. Journal of Gerontological Nursing, 30(10), Winker Margaret (2002); Aging in the 21st Century: A Call for Papers Arch Neurol. 59: 518-519. Wondrak, R.F. (1998). Interpersonal skills for nurses and health care professionals. Oxford: Blackwell Science. Read More