Management of Dementia Patients in the Acute Care Setting - Essay Example

Best practice for the management of dementia patients in the acute care setting Introduction Managing dementia patients in the acute settings is often a challenging task to the health professionals. Sometimes nurses find it difficult to communicate effectively with the patients, or are faced with ethical challenges while administering medication. This has often resulted in frustration of the health professional and further compounded the problem. For instance, cases of neglect and abuse of dementia patients by nurses while providing care have been reported. The hospital settings and routines have neither been supportive of the nursing process. Evidence has revealed that given these challenges and facts about patient with dementia it is not possible to provide adequate care through the traditional approach. The proposition is a shift to a person- focused multidisciplinary approach that looks at the patient as a whole person, and not only the medical needs. In addition, research suggests that proper and specialized education should be provided to professionals providing care to these patients. The traditional approach to providing care to dementia patients in the acute care setting has been inadequate. The approach has mainly centred on the nursing routines and clinical perspective and neglected a number of important aspects in care of such patients (Goff, 2000). Goff (2000) and Codwell (2010) indicate that the traditional approach is characterised by nurses focusing only on the basic medical and physical needs of the patient. This approach to care of dementia patients has often come into conflict with the needs of the dementia patients. A research by Codwell (2010) has shown that dementia patients are often distressed by the current procedures of care delivery where nurses aim at fulfilling routines. The blame may not be solely on nurses given the high work loads and time constraints. However, these challenges have often led to frustrations, which have further compounded the problem. It is known that nurses have sometimes administered medication against the will of patients, especially when faced with an ethical dilemma (Eriksson and Saveman, 2002). Misconduct of the dementia patients and unclear communication has also made nurses to neglect their patients (Goff, 2000). Christie and Cunningham (2009) have also noted cases of neglect and abuse of dementia patients during care provision by nurses. In a research on nurses’ experience of abusive caring for dementia patients Eriksson and Saveman (2002) have highlighted the disorderly behaviour of patient, ethical dilemma, and organization of medical care as factors contributing to neglect and abuse of patients by nurses. It is true that not only do persons with dementia have social, physical, and psychological challenges associated with their diagnosis, but they also present a number of problems to the care giver (Goff, 2000). For instance, these patients fail to communicate their needs and often respond negatively to their carer. Christie and Cunningham (2009) admit that nurses have traditionally viewed dementia patients as the problem. It is these factors that make the unitary approach of treating dementia patients in the acute care setting inappropriate. Thus, focusing on the disease alone and neglecting these other aspects of the patient may not yield much result. An alternative to providing care to these patients is therefore imperative. A number of literatures have proposed a shift to a multidisciplinary, person-centred approach in treating patients with dementia in acute hospital settings (Christie & Cunningham, 2009; Codwell, 2010; Edvardsson & Nay, 2009; Eriksson & Saveman, 2002; Goff, 2000; Pearson & Chalmers, 2004). The nurses’ experiences and occurrences highlighted above necessitate that nurses be competent in providing care to dementia patients. As opposed to the traditional clinical approach, a person-focused approach aims at understanding the patient in whole (Christie & Cunningham, 2009). There is need for the health professionals to change their attitudes towards persons with dementia and include empathy in their practice (Christie & Cunningham, 2009; Goff, 2000). Empathy is an essential aspect in treatment of people with dementia since it allows care givers to understand the patients’ feelings and experiences (Codwell (2010, p.46). Nurses should seek to understand the disease process and know the person better (Goff, 2000). In fact, a complete assessment of dementia patient should be done to determine their care needs. This should include appreciation of the patient’s “background and cultural needs” (Goff, 2000, p.2). Codwell (2010) suggests that nurses should base their philosophies of care on evidence as opposed to their personal beliefs. These philosophies should be patient-centred. Moreover, attaching great value to the care they provide to dementia patients is an important aspect (Codwel, 2010). Immediate carer and family members should be involved to provide information about the patients so that nursing professionals can have a quick reference in times of difficulties, or to avoid these difficulties altogether (Christie & Cunningham, 2009). Another measure that would contribute towards effective care of dementia patients is minimal use of stimuli. Research has revealed that nurses often administer hypnotic medicine or sedatives in order to control dementia patients and attend to other patients (Eriksson & Saveman, 2002). However, avoiding stimuli is important to allow the patients to contend with their environs and ease dysfunctional behaviour (Goff, 2000). Pearson and Chalmers (2004) have noted that drugs such as antipsychotics and antidepressants have adverse oral effects in adult patients with dementia. They advise that oral health should be observed by these patients. It is also vital that nurses communicate appropriately with the patients and avoid expressions and gestures that may scare the patient (Eriksson & Saveman, 2002) Nurses should also strive to devote more time to these patients, an aspect that will increase their understanding of the patient’s problem. It is important that the nurses involved in care of dementia patients in the acute care setting have proper and specialized education. A number of research studies have identified proper education as a vital component in management of these patients (Codwell, 2010; Eriksson & Saveman (2002; Goff, 2000). However, Eriksson & Saveman (2002) highlights that this specialized education for nurses in geriatric nursing is lacking, a factor that is hindering appropriate provision of care to these patients. Edvardsson and Nay (2009) have revealed that nurses often make every effort to provide good care to patients with dementia but are set back by lack of education and training needed to provide a holistic person-centred care. Therefore, it should be a requirement that nurses providing care to dementia patients in acute care settings should have proper education and training. The education and development programs for these nurses should engage them both cognitively and affectively so that nurses can get an understanding of, and knowledge about the experiences and feelings of dementia patients (Codwell, 2010). Education that involves nurses emotionally provides a starting point through which they can change their attitudes towards persons with dementia (Codwell, 2010). Goff (2000) has also admitted that specialized education is necessary for nurses involved in care of dementia care. Francke and Erken (1994) have viewed the inclusion of the affective and cognitive domain in nursing education as an amalgamation of “the learning of the head with the learning of the heart.” Indeed, nurses are generally required to have a heart towards their patient in order to provide care effectively. Evidence has shown that the conventional knowledge-based approach to education of nurses has not been effective in addressing cases of dementia (Codwell, 2010; Francke & Erken, 1994). The importance of appropriate education should be emphasized in management of dementia patients in acute care settings. Christie and Cunningham (2009) also advocates for commitment and strong will by trainers of nurses providing care to dementia students. The specialized education allows health professionals to reflect on their nursing practice and eliminates the opportunities for blame on the system (Christie and Cunningham, 2009). It is also important that nurses document their experiences and cases of dementia to offer a foundation upon which research on the development of the nursing practice can be based. Nurses should often aim to acquire more knowledge in their field of practice. Conclusion The essay has highlighted the management of dementia patients in the acute settings to be a challenging task nurses. It has highlighted the various challenges that nurses face with these patients as well as the problems that the patients face and present. Through these challenges the inadequacy of traditional approach in nursing care of these kinds of patients has been exposed. Thus care of dementia patients in the acute settings requires a holistic approach that puts the experience of the dementia patient at centre stage. Besides being able to address the medical needs of the patients, nurses also need to understand their psychological, cultural, and social needs. Empathy should be an integral aspect in their care provision. The essay also highlights the importance of proper and specialized education for professionals providing care to these patients. This education should stress on both affective and cognitive aspects to allow nurses to understand the dementia patients better. Reference list Christie, J., & Cunningham, C., 2009. Caring for people with Dementia in Acute Care Settings - a resource pack for staff. Stirling: University of Stirling. Codwell, F., 2010. Care of older people with dementia in an acute hospital setting. Nursing Standard. 20(23), 42-48. Edvardsson, D., & Nay, R., 2009. Acute care and older people: challenges and ways forward. Australian Journal of Advanced Nursing. 27(2), 63-69. Eriksson, C., & Saveman, B., 2002. Nurses' experiences of abusive/non-abusive caring for demented patients in acute care settings. Scandinavian Journal of Caring. 16, 79-85. Francke, L.A., & Erken, T., 1994. Confluent education: an integrative method for nursing (continuing) education. Journal of Advanced Nursing. 19(2), 254-361 Goff, M., 2000. Caring for a person with dementia in acute hospitals. Australian Nursing Journal. Pp. 1-4. Pearson, A & Chalmers, J., 2004. Oral hygiene care for adults with dementia in residential aged care facilities. Best Practice Information Sheet. 8(4), 1329 - 1874. Read More