Best Practice for the Management of Dementia Patients in the Acute Care Setting - Term Paper Example

 Best Practice for the Management of Dementia Patients in the Acute Care Setting Introduction Research has found that most informal and non professional care givers struggle so much in giving care to the dementia patients. This is mostly due to the difficult behaviours that are usually unpredictable among the dementia patients. These behaviours call for institutionalization of the dementia patients so that they can receive the best care practices. Most caregivers experience difficulties and this also gives problematic care giving outcomes. To address this issue of care giving among the dementia patients, it is important for the caregivers to understand the best nursing practices that give out desirable outcomes in management of dementia. Problems associated with dementia patients One of the main problems associated with dementia is feeling of pain. Studies carried out in the United States have indicated that most dementia patients, especially the elderly experience a lot of pain and it usually have intense impacts on their lives. Continuous pain is associated with considerable morbidity at the late ages which includes decline in their functionality, depression, anxiety and increased demand for health care attention. Pain may also come as a side effect of the medication used in dementia. Most of the dementia patients have cognitive problems and are therefore unable to tell any changes in their experience of pain. This cognitive impairment makes it difficult for the elderly patients to report pain and are unable to participate in pain management. It is therefore important for the caregivers to focus on pain during their management activities. The other common problem for the dementia patients is the side effects on the medications. These include constipation and pain. However, the patients may not be able to distinguish between the pain which is as side effect or failure of the treatment. It is therefore important for the caregivers to monitor the side effects of various types of medication (Kelley, Siegler, & Reid 2008). The other main problem is delirium. This is a neuropsychiatric condition characterised by acute onset and changing courses of loss of attention and general behaviour disorganization. This is very common for dementia patients and one may experience serious complications. This condition may deteriorate the prognosis of dementia. This may also change its medical course may eventually lead to poor management outcomes such as hospitalization and death. Older people suffering from dementia may also experience wandering behaviour which is a great concern for the caregivers. This behaviour may be due to impaired cognitive ability. Even though some policies say that pled people must be allowed autonomy and independence, those suffering from dementia can only be left alone under assistive devices such as personal alarms and monitoring devices. Challenges faced by Nurses in dealing with dementia patients and their roles in managing dementia Management of pain is the most challenging in management of dementia in the acute care setting. This is due to the fact that most dementia patients are cognitively impaired such that they are unable to explain their feelings of pain. One of the challenges of pain management in dementia is that the patients are unable to explain various aspects of the pain felt and this often results in wrong diagnosis or delayed diagnosis. Nurses are therefore required to critically assess likely aetiologies of pain and keep reviewing their treatment to see whether it is right. Another challenge is that medication for the pain may result to side effects which may increase the sufferings. On the other hand, patients may not be able to tell of their experiences to the care providers. This means that the care provider must keep checking the signs of side effects on the patient. The role of a nurse in such a situation is to foresee the side effects and find ways of relieving them. The other challenge is that dementia patients have difficulties in distinguishing various levels of pain. The caregiver may thereof be unable to determine the effectiveness of the treatment given. Sometimes it may result to overtreatment where the patient is unable to tell any improvement on the pain he or she is feeling. In such a situation, the nurse has the role of facilitating non verbal communication with the patients so that he or she can be bale to read the signs given by the patient. The other challenge is where the nurse is dealing with an elderly dementia patient who has difficulties explaining their experiences. The nurse may experience difficulties in identifying the exact cause of their problems and also in determining the effective treatment for the condition. This also calls for non verbal communication between the nurse and the patient. Best practices for management of dementia patients in the acute care setting The best practices in management of dementia are those that focus on the problems associated with the condition and also those that can overcome the challenges faced in its management. These practices are facilitated by the nurse who is usually the caregiver for dementia patients. One of the recommended practises in improving the outcome of dementia management is the assessment of home environment. Assessing the home environment enables the caregiver to identify some of the environmental factors that may be causing some behaviour in the patient. Such environmental factors may include things such as stress at home, cultural influences, and safety at home. Some of the behaviours that are experienced with dementia patients are as a result of influence by the environmental factors. After the caregivers have evaluated the home environment, it is important for them find strategies that may help in managing these problems. After they are identified, it is important to find ways of improving the safety at home. Home assessment also helps to improve the mastery of the care giver (Connor, et al., 2008). The other practise would be in dealing with the pain and the side effects experienced by the patients. Caregivers are supposed to keep the patients informed of the possible side effects of his or her condition so that they are able to recognize them. This will help in quicker treatment and prevent adverse effects. Dementia patients may experience side effects such as constipation and retention of urine. At the same time, the patients may not be able to tell their experiences to the caregiver. To achieve the best nursing practices for these patients, it is important for caregivers to anticipate the possible side effects and take the right measures at the right time. These measures may include instituting a bowel regime. In managing pain that is related with some treatment activities such as dressing and injections, it is important for the clinicians to give medication for relieving pain the painful activities. For patients who are completely unable to communicate, the care giver must develop non verbal communication abilities so that he or she can be able to tell what the patient needs. Proper nursing care practices are also required for dementia patients who have a wandering behaviour. The adopted practise in this case should aim at preventing harm to the patient and others around him. The caregiver must also ensure that the patient’s right of autonomy are maintained. The care givers must ensure that they take the responsibility of acting top the interest of the patient and also other members of the society. The best care practices in such a situation involve focusing on more person-cantered approach to wandering dementia patients. The first step in this involves screening for the wandering behaviour in the patient, and then if it is identified, the care giver should assess the environment and the individual to see the possible harm that he may cause. A person who may be likely to cause harm to others around should be denied the autonomy to ensure safety of others around him (Robinson, et al. 2007). Dementia patients experiencing delirium also need to be taken care of with the best nursing practices. Delirium in dementia requires non pharmacological nursing intervention which involves the support of the family members and facilitating improved communication in the family. There should be minimal use of medications but the caregiver should ensure that the patient is adequately hydrated (Fick, Agostini, & Inouye, 2002). The patients might experience sensory problems such as loss impaired sight or hearing which the caregiver should attend to. Delirium mostly comes after the patients have developed dementia. It may get worse where the dementia has gone unnoticed for a long time. In preventing it from occurring, it is important to ensure that it is recognized early so that it can be treated. Early recognition on a dementia patients helps in early prevention measures and this helps in providing improved nursing care practices. This reduces the complications that comes with it and hence the cost of hospitalization especially on the elderly patients (Laurila, Pitkala, Strandberg, & Tilvis, 2004). Conclusion The best nursing practices in management of dementia in acute care setting involves those practices that deal with complications of dementia. These are complications such as wandering behaviour, management of pain, impact of home environment on the behaviour of the patient and delirium among others. These are the conditions that lead to too much strain by the caregivers of the dementia patients. Therefore offering the best management practices involves addressing the behaviours associated with dementia. Bibliography Connor, K., McNeese-Smith,D. Vickrey, B., Servellen, G., Chang,B., Lee, M., Vassar, S., & Chodosh, J., 2008, Determining Care Management Activities Associated with Mastery and Relationship Strain for Dementia Caregivers, Journal of American Geriatric Society 56:891–897. Kelley,A., Siegler, E., and Reid, C.,2008, Pitfalls and Recommendations Regarding the Management of Acute Pain Among Hospitalized Patients with Dementia, Pain Medicine. Volume 9, (5). Robinson, L., Hutchings, D., Corner, L., Finch, T., Hughes, J., Brittain, K., & Bond, J., 2007, Balancing rights and risks: Conflicting perspectives in the management of wandering in dementia, Health, Risk & Society; 9(4): 389 – 406 Laurila, J., Pitkala, K., Strandberg, T., & Tilvis, R., 2004, Delirium among patients with and without dementia: does the diagnosis according to the DSM-IV differ from the previous classifications? International Journal of Geriatric Psychiatry, 19: 271–277. Fick, D., Agostini,J., & Inouye, S., 2002, Delirium Superimposed on Dementia: A Systematic Review, Journal of American Geriatrics Society. 50:1723–1732. Read More