The Dialectics of Dementia (Kitwood)
Discuss about the Assessment Of Persons With Dementia And Their Health Needs.
The assignment explains The Dialectics of Dementia (Kitwood) with a summary of each of its five elements that contributes to dementia process. To meet the person’s health care needs, person-centered care the intervention technique developed by Professor Tom Kitwood has been adopted to carry out the client assessment (Karlsson & Bleijlevens, 2015). Evaluation of the chosen intervention technique has been carried out to identify the effectiveness of person-centered care on clients with dementia. Different techniques have been taken into account in relation to the integration of person-centered care into practice. The assignment undertakes a case study of a patient with dementia.
Katherine is an 85-year-old and has dementia. She has been living in a care home for about four years and required some support and assistance in carrying out most of her day-to-day activities such as washing, dressing, eating, drinking, etc. Allen is a clinical practitioner who is supporting her in having lunch. The nurse asks Katherine to have all the vegetable that she has not taken. However, Katherine is unwilling to have any more food while she comments that she does not like vegetables. Despite Allen’s proposal to help her having the vegetables, as those are good for Katherine’s health, she is not ready to finish the food.
According to the dialectics of dementia (Kitwood), dementia is considered as a very complex equation that depends on five elements like the personality, biography, health status, neurological impairment and the social psychology (McCabe & You, 2016). Personality factor in dementia indicates the coping style or defense against anxiety, which the nurse discovers is a direct refusal (Kelley & McGarry, 2015). Allen, who is the medical practitioner for Katherine asks her to take vegetables, but she directly says that she does not like vegetables. The second element of dementia is a biography, which speaks about the vicissitudes of later life. Her sudden dementia along with her separation from the family is aggravating the reaction of dementia.
The third element is the health status, which is quite poor due to her age and also due to her medical condition of dementia that involves the decrease of her acuity of the senses (Toms & Quinn, 2015). So, her disliking vegetables might be triggered by her negative response towards taste as her disease might not make her response to her taste buds. She is there for four years in the care home, which indicates an acute stage of dementia on the basis of which it can be said that it becomes very difficult to understand the food that is good to her health.
Case study of a patient with dementia
The social psychology is also an important parameter for the client assessment. Katherine has been living in the care home for four years, and she needs assistance to do her work regularly (Mozley, 2017). The care provider has been trying to win her opinion about helping her feed aswell as finish all the vegetables. Although vegetable intake has a significant positive impact on Katherine’s health outcomes, encouraging her to forcefully finish that vegetable may have a detrimental impact on her psychological aspects. Naturally, the separation from her family members coupled with a long time at the care home makes her a lot homesick. In the same way, Katherine cannot perform her regular activities and needs support for everything, which makes her more depressed because her chances of going home are decreasing day-by-day. Under such circumstances, not wishing to eat vegetables for good health is quite normal, and her depression and anxiety over her life is prominent.
All the five elements, personality, biography, neurological impairment, health status and social psychology are found to contribute to the dementia process of Katherine. Based on the evaluation of Kitwood, the role of dialectic interplay that explains socio-logical factors along with the neurological system that influences mental health functioning of a person (Neville & Beattie, 2015). Therefore, in the context of the give case study, separation of Katherine from her family and patient in the acute stage of dementia have been leading the care users deprived of personhood (Love & Pinkowitz, 2013). Being deprived of her personhood, Katherine’s health care issues are not met efficiently, nor are her health needs not prioritized to develop the treatment plan. Kitwood has argued that an understanding of dementia must be less deterministic and more comprehensive. With more comprehensive and less deterministic approach Katherine is likely to have more optimistic and personal view of caregiving. Her personhood has not been encouraged or valued while providing cantered patient care and all the five elements have led to the progression of dementia in Katherine.
The client assessment of Katherine indicates that she needs person-centered care as an intervention for development of her health. Otherwise, normal treatment with the help of medications will make her more depressed and anxious about her future. The person-centered care would concentrate on her depression and anxiety, and tolerate her issues to a great extent. For example, in a person-centered treatment, Katherine would be explained very politely that the vegetables are good for her health, and the doctor Allen wanted her to have more vegetables for the overall improvement. Her self-dependence would also be fostered by the person-centered development.
Outline of five elements of dementia process and its impact
According to the dialectics of dementia (Kitwood), her social psychology makes her depressed because she is losing chances of returning to her family (Nyman & Szymczynska, 2016). Most of the time, she is within the care home dependent on others, and she understands that her dependence on other people is completely related to her increase of anxiety of not returning to her family. So, the person-centered care would help her in understanding that her eating of vegetables would help in her recovery, which is very essential for her release from the care home. Most importantly, her cognitive development would be done by making her play some card games.
The client assessment also makes it clear that her taste buds are not proper due to her neurological impairment, which is making her feel that the vegetables are tasteless. Person-Centred care can impact the patient by disclosing about her neurological impairment, which is making her lose the taste of vegetables. However, she should also be convinced with a politeness that it is important for her recovery. A slow increase in the consumption of a healthy diet along with the medications and the cognitive games would help her improve dementia, which will give her confidence of recovery, and get in touch with her family members.
From the client assessment, it is understood that she cannot perform her regular activities like dressing, eating, washing and drinking without the help of someone else. So, the care worker in person-centred care would understand her problem, and try to help her as much as possible. In addition to that, her self-dependence should also be stressed upon like letting her work as much as she can. Open communication with her related to her improvement in regular activities by providing minimum support would increase her confidence, and help her in recovering from dementia.
Holistic dementia care is most often referred to person-centred care, which is dependent on a number of sources comprised of social psychology professor Tom Kitwood (Wilber & Mosqueda, 2016). Person-centred care has emerged against the traditional culture of care and treatment practice (Kitson, et al., 2013). Person-centred care proposed by Tom Kitwood is focused on persons’ independence, value-driven and care users empowerment of families and individuals with dementia in contrast with the old care culture that used to consider dementia as a biomedical phenomenon, depending on control technique by including physical and chemical restrains, administering unnecessary medications and devalues individuals with dementia (Terada, et al., 2013).
Understanding a person’s health care needs for a particular one
The persons are helped to feel supported, valued and socially confident with the integration of person-centred care. In relation to the chosen case study of Katherine who is with dementia. Person-centred care is adapted to provide care to Katherine in the care home. In the given case study, responsible nurse of the health care settings values the care users choice by complying with the principles of personhood those are individual’s life experiences, different personality types, and relationships while providing care. According to Kitwood, personhood is a status that is bestowed upon an individual by others to develop recognition, trust, and respect (Kogan, et al., 2016). Good dementia care has been proposed to develop to maintain personhood against the diminishing mental abilities.
In the given case scenario of Katherine, clinical practitioner integrates personhood in the care provision process and offers to encourage patient to increase daily vegetable intake. Encouraging patients positively to undertake activities that have a positive impact on their health outcomes are known as advocating. Allen has adopted advocated practice in the given case study. On the other hand, dementia care that treats patients as a passive object, treatment does not meet care users personhood and concentrates only on the illness is detrimental to the patient (Lines, et al., 2015). Person-centered care has developed the ethic that every user is of absolute value and needs to be respected where no consideration must be taken into account of their disability.
Person-centred care has been developed to focus on what persons with dementia need and Kitwood (1997) found that love is at the center of five different components, attachment, comfort, inclusion, identity, and occupation (Li & Porock, 2014). Kitwood has suggested that the focus should be on the person who is receiving care and in the case study Katherine is the care receiver. Healthcare staffs as per the person-centered model of Kitwood are an essential part of maintaining self in people with dementia. Personhood is based on others learning about self, find ways to maintain self and recognising that selfhood exists (Maslow, 2013;). In the case, study selfhood is maintained through interaction and conversations carried out by the clinical practitioner where she has integrated that are the fundamental components of patient-cantered care.
The nurse is trying to encourage Katherine in increasing her daily food intake and thus advocated practice is evident from the given case scenario where no signs of abuse or negative intentions of the clinical practitioner are evident from the given case scenario. The nurse is implementing advocated practice in encouraging Katherine to finish all her vegetables that are good for her health. Person-centred care has been acknowledged as very effective intervention process that leads to minimize challenging behavior in people with dementia (Love & Pinkowitz, 2013). However, no challenging behaviour is demonstrated in the given case study, but they client is not willing to have her food even when the nurse is offering her to help to finish with those. (Barbosa, et al., 2015) Have pointed that person-centred approach comprised of social activities, past activities and pleasures have strong relation with improved quality of life in individuals with dementia. When Care centered approach is implemented in health care settings to treat people with dementia, it develops a positive relationship between caregivers and the patients, and consequently leads to minimisethe level of psychological well-being, depression and productive behaviours among the care users (Lines, et al., 2015).
Impact one intervention on an individual with dementia
Person-centered care is used to handle in reducing levels of agitation and sleep patterns in people with dementia with the selection of person-centered care approach. According to (Kitson, et al., 2013) patient-cantered approach allows the opportunity for self-expression which enables people with dementia improve their self-esteem while reducing their anger, anxiety, depression, and grief.
Although different studies have identified a number of positive effects of person-centred care on health outcomes of the patients, the approach can also have a detrimental impact when not implemented accurately and efficiently by the clinical practitioner. Katherine is a trained staff member who has been trying to encourage her by adopting patient-cantered care approach. However, the conversation that occurs between Kathrine and Allen, the nurse of the health care settings demonstrates malignant social psychology, number of times that affects David’s personhood adversely. Disempowerment can be witnessed from the case scenario as Katherine is able to eat and drink without any assistance. However, the scenario demonstrates Allen proposing her to help to finish her lunch. Ignorance is pointed out from the case as Allen did not acknowledge or accept the feelings of Katherine’s disliking of vegetables. Allen treated Katherine like a child thus Infantilisation is evident from the case when the clinical practitioner asks her to open mouth an offering with the food to finish. Imposition also has been evident as Allen imposed that Katherine would not finish her vegetables.
With the adoption of patient-centered care, clinical practitioners are required to promote signs of personhood so that the care users is valued, respected and cared. Patient-centered care is based on the ethics that all human beings are opting to be valued and they are worthy of respect, irrespective of their disability. To implement patient-centered care in practice, specific strategies to be adopted by the health care professionals are discussed as below:
Identify the careful choice of Katherine and her family members in the assessment process so that health needs of the patients with dementia can find out. Assessment of the clients’ choice of treatment and health needs should be nonjudgmental and focus on building trust and rapport between the caregiver and the care receiver, Katherine. In this context, it can be stated that strong relationship and rapport between the clinical practitioner and Katherine can again contribute to a right assessment of health needs and the right choice of care that meet the health needs of the care user. However, health care practitioner’s judgemental attitude may minimize the value and respect that the care user is likely to receive, irrespective of her disability. In order to provide adequate care to Katherine, in line with patient-centered care, needs to provide culturally sensitive service where the nurse will show no pressure or infantilisation (Mitchell, et al., 2015)when the care users state about her disliking and likings. To have right care plan and procedure, continuous evaluation of inclusion of care users as well as her family members in the care planning that ensures care provision is designed as per the health needs of Katherine. In the given case scenario, Allen was found to impose on Katherine would not finish her vegetables, however, to ensure effective patient center care integrated into healthcare practice Katherine’s disliking of vegetables would have been accepted.
The practitioners in a care home are bound to follow the policies and regulations of NHS related to the dementia care. According to the Health & Social Care Act (2012), it has been found that the records of every patient should be maintained coupled with the cleanliness in the rooms, and building rapport with the patients for reducing inequality (Quinn & Clare, 2015). So, the care worker should always try to improve the relationship with Katherine and help in keeping the room where Katherine stays completely neat and clean. The voice of Katherine is important for reduction of inequality, and Katherine must be convinced to have vegetables in a polite manner rather than doing it by force.
According to the Equality Act (2010), no individual in a healthcare unit can be differentiated on the grounds of sex, religion, ethnicity, class or age (Camic & Baker, 2015). So, Katherine is an old woman with dementia, and she should not be differentiated from the other patients, and her needs must be addressed in a proper manner. If possible, Katherine’s favourite food must be asked, and the vegetables should be given in order to make her taste her favourite food in a small quantity for convincing her. The carer should always be asked to put forward their own opinions about improving the patients’ lifestyle because they are observing the patients very closely.
According to the Social Value Act (2012), the person-centred care must be given to all the persons suffering from dementia at the care home (Shidhaye & Lund, 2015). The regulation also states that the healthcare center should allow the constant visits from the NHS department for checking of whether the levels of care are proper or not. So, the levels of care must be maintained to an excellent level for getting good quality of health care. The integrated care must be achieved for Katherine by taking opinions from the other healthcare center workers, and by sharing the case study with the medical board. So, the interrelatedness between the medical practitioners will help in developing the best caring method for Katherine.
In the same way, the interrelatedness of the care workers helps in understanding similar case study, and the way such patients are improved in order to develop the integrated care for helping the patients like Katherine. Similar cases like that of Katherine can be collected from other hospitals for treating Katherine in a proper way.
Conclusion:
It can be concluded from the current assignment that patient-centered intervention has a number of effectiveness in improving health outcomes, minimising challenging behaviour and agitation while regulating sleep patterns through the strong improved quality of life and social activities. Patient-cantered care is based on the concepts, persons’ independence, value-driven and care users empowerment of families and individuals with dementia that gain lead to strong rapport and relationship between care user and clinical practitioners. The strong relationship between client and care providers contribute to right assessment care users health needs, and care plan can be developed with patients and their family members inclusion so that the pan meet health needs of patients.
From the overall analysis, it can be said that the person-centred care is the best way for treating people with dementia. The dialectics of dementia (Kitwood) helps in understanding how far the five elements help in doing the client assessment, and how the patient-centred therapy helps in the client recovery in a proper way.
References
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