Person-Centered Care (PCC)
Discuss about the Delivering Dementia Education or Training.
Reduced blood flow in heart is responsible for chest pain in older people. In the given scenario it is stated that the patient is a 75 years old person living with his wife. He has four children and four grandchildren’s. They used to visit him occasionally. Mr Thomas Smith was admitted to the hospital and reported to have pain in chest area. He was previously diagnosed with angina and nonspecific dementia which might be the reason of pain occurred in patient’s chest (On et al., 2018). He used to work most of the time as he is an active person. The patient is found to be agitated, restless and irritated especially when nurse’s visits him for observation. In this essay all the essential nursing interventions will be discussed that are beneficial for the patients with this type of problems. The experience they faced at the time of admission, approaches that can be applied and improvements in patient care services that are necessary to achieve health goals for the patient will also be discussed in this paper. The leanings in management of dementia and assessment tools that can be used to reach to the health goal in this case will be included in this essay.
Dementia refers to a condition associated with complex progressive degeneration that affects patient’s cognition like memory, judgement language and attention (Herron & Rosenberg, 2016). It cannot be denied that the family of patient with dementia also suffers a lot because the behavioural changes occur in patient.
Various problems have been occurred to the patient and their families at the time of admission in hospital such as:
Admission to the hospital is the emotional time for family members because they were the primary care giver for the patient and now they will no longer be required. This may cause a feeling of helplessness and lost. This might be faced by both Anna and Tom
When the patient is admitted to hospital the family caregiver, who assisted the patient before the admission and responsible for all caring is not needed anymore. This might be the reason of loss of control and feeling of disempowered in a family member. In this this case Anna was the primary caregiver for Tom so it is possible that she faced the same problem at the time of admission (Burgstaller, Mayer, Schiess, & Sasex, 2017).
Caring for Tom’s BPSD’s
The symptoms of dementia includes loss of memory, lack of communication, lack of concentration, irritation, fear etc. so it is hard to gain accurate health information from the patient. The patient might be feared because of the environment change. At the time of admission patients has been asked to answer some health related condition to prepare the assessment sheet which is required at the time of treatment and to provide better interventions for them. But in dementia nurses have to rely on patient for information but the patient is not able to address the health situation (Saunders, 2014).
Sometimes the family members experience negative feeling related to the patients stay in hospital because they do not feel positive about the quality of care provided in hospitals. This might cause feeling of strain and exhaustion in family members (Brodaty & Donkin, 2009).
Among all the above mentioned aspects the most difficult aspect was losing control and feeling undervalued. Irritation might be occurred in patient due to leaving their families. Tom and Anna were living together for a long time and it was difficult for both to leave each other. In this case negative feeling about the hospital care may also occur.
Person centred care is an approach providing interventions by including the family caregivers and relatives to achieve a health goal already set fit the patient. The values, desires, situations and lifestyle need to be considered in this approach. PCC ensure that the person with dementia is taking part in activities that they enjoy the most like their hobbies. The negative psychological and behavioural changes occur due to dementia can be prevented by this approach.
According to a study published by Webster (2011) the acute hospitals has complex environment which makes care difficult for the patient with dementia. Person centred assessment are necessary to collect the information and it has the ability to increase the quality of intervention for persons with dementia and improve health outcomes. It was also stated in that study that it needs to be included as a clinical and managerial priority in normal nursing interventions in acute hospitals setting. Some of the aspects of PCC are: peoples need and preferences should be noticed, coordination should be there to integrate favourable care, health providers and family members should work together by ensuring good, communication, exchanging information and education, safety and comfort of patient should be the priority, emotional support should be provided to them, family and friends should be included in interventions, the continuity between services should be ensured.
Person centred care is very important because it ensures that people are involved in care provided to the patient. It has been studied that PCC is adapted widely and becomes priority in past few years. Some underlying principles of person centred care are: The patient is considered as expert of their health, the families are included whenever necessary, the accessibility, flexibility is ensured, it ensured the supportive behaviour of staff, Making sure that the environment provided to the patient is favourable.
Mr Smith was facing negative behavioural changes like lashes out on nurses most of the time. The main reason behind this behaviour could be unfavourable environment and distance from his family members. By providing person centred care persons mood can be changed and make him feel like home. As mentioned in the given information of the patient that the patient were not cooperating and aggressive at the time of observation. By involving his family member it is possible and beneficial for him to stay calm. It has been studied that involving patient to healthy activities can help to improve their health.
BPSD (Behavioural and psychological symptoms of dementia) occurs after the admission of the patient to hospital. Some of the behavioural and psychological symptoms of dementia are: Aggression, agitation, shadowing, hoarding, delusions, anxiety and depression. It is common in dementia patients and affects nearly 90% of the patient with this disease.
People with dementia are hard to communicate but by using some methods it could be easy to have conversation with them. When talking to a patient caring attitude should be there. Flexibility should be there and they should be given more to respond. Using orienting names could be helpful in this case. It was studied that the by touching dementia patient they respond well (Suzuki et al. 2010), so this can be aided while communicating with them to keep their attention. Calmness should be there with gentle behaviour. The gestures and facial expressions should be used so that they can understand well. The environment should be favourable and avoid loud sounds like TV or radio. As discussed in initial report of Mr Tom, he has been never admitted to the hospital before this event, so it important and effective to provide him and favourable environment (Lesley et al. 2014). Some things that should be avoided like: argument should not be there while talking to the person with dementia, do not tell them that what is prohibited for them. Instead of it tell them what they can do, ask limited direction questions to the patient, do not discuss about other persons in front of them.
Behavioural and psychological symptoms of dementia can be managed by using some pharmacological methods and no pharmacological therapies. Pharmacological treatments should be avoided in initial stage and should not be administered until it is necessary and prescribed by physical. Some of the medicines that can be used to treat patient with dementia are: Gabapentin, Melatonin, and Antidepressants etc. According to Kim (2008) gabapentin can be used clinically to treat BPSD. The agitated behaviour can be improved by using Melatonin (Jonghe, 2011). It was reviewed by Henry (2014) that antidepressants are effective in treatment of patient with BSPD and it is generally tolerable for the older patient. Some of the non-pharmacological therapies can be applied to the patient are: Music therapy (Mcdermott, Crellin, Ridder, & Orell, 2012) by discussing the topic of patient’s interest, by increasing the day time activity to improve night sleep, Aromatherapy; by applying lavender aromatherapy oils to decrease agitation.
Other issues that needs to be considered in acute care of patient with dementia are: unhygienic behaviour of patient, cognitive impairment that can be occurred by delirium or stroke and improper assessment, lack of training about dementia among the staff members who are also assisting the patient, exclusion of carers from consultation and their decisions in acute setting of hospital, the unfavourable physical environment of hospital also leads to confusion, disorientation, contributing to distress in patient. These aspects can be improved to deliver an adequate health intervention to achieve health goals set for the patients. By providing training to the staff members it is possible to assess the patient properly and results in health improvement (Surr & Gates, 2017). It has been studied that by providing healthy and favourable environment to the patients leads to health improvements (Padilla, 2011). By using effective communication and polite behaviour with patient it is possible to convince them for maintaining hygiene and their aggressive behaviour. This can also be helpful in Tom’s case.
Some of the assessment tools can be used in Mr Smith’s case are: CPCOG and Mini-cog. The general practitioner assessment of cognition or CPCOG is based on DSM-4 diagnosis where patient will be asked some questions to examine their memory power. Questions related to date, time, recent activity, recall etc. will be asked to the patient and score is given after analysing their answers. If the person with dementia scores 9 it means there is no significant impairment and further testing will not be required, if he scores between 5-8, it means that more information’s needed and if scores reported between 0-4 it indicates that cognitive impairment is required and standard investigations needs to be conducted. After the treatment six more questions asked to the patient where the patient is compared with the pre-treatment situation and post treatment condition. Scores are recorded where if the patient scores 0-3, this indicated that cognitive impairment is there and further investigation needed (Brodaty et al. 2002). This test needs to be used in Tom’s case because he analysed with some behavioural changes at the time of admission and this screening will analyse that his negative behaviour has been changed or not. Another test that can be used in Mr Smith’s case is Mini-Cog test; it is based on independent clinical diagnosis of dementia. This is also similar to the CPCOG where some tasks have been given to the patient. The person is asked to recall three worked that are said before him, they are asked to draw a clock. And the sores are provided on the basis of their response. Word recall task scored0-3 and clock draw task scored 0 to 2. If the score is examined 0, means the patient is abnormal. Total score from both tasks also recorded (Borson, Scanlan, Chen, & Ganguli, 2003).
Conclusion
This study concluded that the patient have some negative behavioural changes like irritation, anxiety and aggression. Patient and his family faced difficult experience like leaving their loved one to the strange place which may leads to losing control at the time of admission. Some pharmacological and non-pharmacological treatments found to be beneficial for Tom. And after reviewing various articles it can be concluded that non-pharmacological treatments are more favourable in this case. It was found that person centred care are result oriented approaches to achieve health goals in this case. Person with behavioural and psychological symptoms dementia should be dealt with well communication and polite behaviour to minimise or prevent the symptoms. It can also be concluded that providing a healthy and favourable hospital environment to the patient is very helpful for the patient to recover fast. Some other issues that found to be considered like unhygienic behaviour, lack of training among the staff can be improved by various services like provide training to the staff and help patient to maintain hygiene. The assessment tool like CPSOG and MIG-cane assessment tools also found to be necessary to assess the patient and to compare their previous behavioural changes with the current situation.
References
Borson, S., Scanlan, J. M., Chen, P., & Ganguli, M. (2003). The Mini-Cog as a screen for dementia: validation in a population-based sample. The journal of American geriatrics society, 51(10), 1451-4.
Brodaty, H. & Donkin, M. (2009). Family caregivers of people with dementia. Dialogues in clinical neuroscience, 11(2), 217-228.
Brodaty, H., Pond, D., Kemp, N. M., Luscombe, G., Harding, L., Berman, K., Hupert, F. A. (2002). The GPCOG: a new screening test for dementia designed for general practice. Journal of the Americal geriatrics society, 50(3), 530-4.
Burgstaller, M., Mayer, H., Schiess, C., & Sasex, S. (2017). Experiences and needs of relatives of people with dementia in acute hospital- A meta-synthesis of qualitative studies. Journal of clinical nursing, 27(3), 502-515.
De Jonghe, A., Korevaar, J. C., van Munster, B. C., & de Rooji, S. E. (2010). International journal of geriatric psychiatry, 25(12), 1201-8.
Herron, R. V., & Rosenberg, M. W. (2016). “not there yet”: Examining community support from the perspective of people with dementia and their partners in care. Social science & medicine, 173, 81-87.
Hnery, G., Williamson, D., & Tampi, R. R. (2011). Efficacy and tolerability of antidepressants in the treatment of behavioural and psychological symptoms of dementia, a literature review of evidence. American journal of Alzheimer’s disease & other dementias, 26(3), 169-83.
Kim, Y. (2008). Use of gabapentin in the treatment of behavioural and psychological symptoms of dementia. Drugs and aging, 25(3), 187-196.
McDermott, O., Crellin, N., Ridder, H. M., & Orrel, M. (2012). Music therapy in dementia: a narrative systematic review. International journal of geriatric psychiatry, 28(8), 781-794.
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Padilla, R. (2011). Effectiveness of environment-based interventions for people with Alzheimer’s disease and related dementias. The American journal of occupational therapy, 65(5), 514-22.
Saunders, P. (2014). Hospital care for people with dementia: conversation 2014. Retrieved From: https://www.dementia.org.au/files/SA/documents/Hospital%20Care%20for%20People%20With%20Dementia%20Conversations%202014.pdf
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Surr, C. A., & Gates, C. (2017). What works delivering dementia education or training to hospital staff? A critical synthesis of the evidence. International journal of nursing studies, 75, 172-188.
Suzuki, Mi., Tatsumi, A., Otsuka, T., Kikuchi, K., Mizuta, A., Makino, K., Kimoto, A., Fujiwara, K., Abe, K., Nakagomi, T., & Saruhara, T. (2010). Effects of 6 weeks tectile touch intervention on elderly patients with demetia and nurses administrating tactile touch. The journal of the Alzheimers’s association, 6(4), 335.
Webster, J. (2011). Improving care for people with dementia in acute hospital: the role of person-centred assessment. Quality in ageing and older Adults, 12(2), 86-94.
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