Nursing Essay Example: Person-Centred Dementia Care

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Essay: Person-centred care of dementia patient

Executive Summary

This report describes the holistic assessment provided to an elderly dementia patient. The report describes the type of dementia care provided to the patient and what regulations are followed. An elderly male patient who had fallen on the sidewalk was brought to the ER. On assessment, a 3×3 skin abrasion on the patient’s left knee occurred due to falling. The patient was diagnosed to have impaired memory related to central nervous changes secondary to degenerative brain disease as evidenced by reported experiences of forgetting and inability to recall recent events.

The report also highlighted the NMC and NICE rules and regulations regarding the nursing care of dementia patients. The analysis of the file elaborates on how an elderly patient with dementia should be treated in the hospital and home setting.

Introduction

The current report is the depiction of holistic assessment provided to the elderly dementia patient. The report details the type of care provided to the patient and what regulations are being followed while caring for dementia patients. The file showcases the patient scenario, diagnosis, nursing outcomes, person centre care approaches and interventions. The current file is all about person-centred care and holistic assessment surrounding the patient.

Scenario/Background of selected case study

An elderly male patient who had fallen on the sidewalk was brought to the ER. On assessment, a 3×3 skin abrasion on the patient’s left knee occurred due to falling. Other than this, the patient is okay physically. He is unable to recall how he fell and what he was doing. The patient cannot remember anything so getting a health history is also not possible with his medicines. The patient’s vitals are the following VS: HR 80, BP 120/80, O2 Sat. 98% on RA, RR 16, and Temperature 98.6.

Diagnosis

“Impaired memory related to central nervous changes secondary to degenerative brain disease as evidenced by reported experiences of forgetting and inability to recall recent events”.

Upon initial assessment and diagnosis, some of the nursing outcomes have been planned that are as follows:

• The patient will be admitted to the hospital till all the injuries are treated.
• The patient will be provided with person-centred care in the hospital because this care method is observed to be very beneficial for the dementia patient.
• The patient will be set up with an agency that provides nurses or a carer for 2r hours so that patient can continue living at home under supervised care.
• The patient will be encouraged to be autonomous in daily life activities.
• The patient will be supervised and cared for so he does not fall again because falling; repeatedly can cause bigger issues.
• Pt will be reoriented when confusion presents itself.

Primary assessment and evaluation of patient

After the early diagnosis, proper detailed assessment and check-up take place to plan the entire caring process. For the assessment of the holistic patient assessment approach has been used. A holistic approach focuses on the four areas of elderly care: the environment, communication between the career and the patient, food and nutrition and physical; activities (Hung et al. 2009).

The holistic assessment covers all the aspects of the patient so that he can get full effective care. The hospital environment will be made secure and clutters-free for the patient.

Moreover, the living space for the elderly dementia patient should be installed with the safety features like handrails (Weller & Budson, 2018). The patient’s environment will also be free from unnecessary noises because too many noises can make the patient agitated. The carer for the elderly dementia patient should be good in verbal and nonverbal communication so that he or she can understand the moods and emotions of the patient; in cases where the patient cannot talk so, the carer must make visual material for the communication (Lourida et al. 2017).

In the current case, the elderly patient brought to the ER can talk and understand the instruction effectively but cannot recall anything. During caring for dementia patients, their nutritional plan is also important so that all their required nutritional needs are met; similarly, some physical activity is also necessary for the patients (Hyman et al. 2012). The carer must also organise a series of physical activities that can e physical and mental. Activities can also include questions-answer sessions, walking down memory lane, board games, etc.

Nurses play a great role in the assessment of patients. Another aspect that nurses cover is educating the family member of the carers of dementia patients (Yaffe et al. 2008). Dementia is an increasing disease which affects brain activity. The nurses support the patients to live a dignified life, as mentioned in the NICE guidelines and the equality act 2010. Nurses are also bound to treat the patient with dignity and respect due to the NMC code for nurses.

The brain cells of dementia patients may die and atrophy, but it does not conclude that the brain is dead (Lane et al. 2018); a dementia patient is highly respectable, just like every other elder. The patients suffering from dementia are well aware of their needs; however, they face difficulty making decisions. Therefore it is very important to provide them with support and assistance in such cases (Alzheimer’s Association 2018). The nurse aims to provide person-centred care to the patient with a holistic approach to meet all the needs of the patient. In the current scenario, the patient was admitted to the hospital, and a nurse was allocated to look after and care for him.

In the care process for nurses, four factors are considered to give high-quality care to patients suffering from dementia (Lloyd, 2010). The initial step in the nursing care process is the assessment process. Assessment is crucial because it showcases how a [person will respond and function within care.

In the assessment process, the nurses as personal details and case history. In the assessment process, the nurses check if the patient faces difficulty understanding communication, how he expresses his feelings etc. The assessment process also highlights the biological and social needs of the patients. It is very important that during the assessment process, the nurse must be well informed about the standard regulation of NMC and NICE. The nurses must be properly informed about the patients’ cleaning, mobilising and eating habits.

They should e aware of the patient’s daily routine, preferences, cultural values, habits etc. detailed information can be gathered from the caring people or the family members of the patients (Zimmerman et al. 2015). The assessment aids in planning the individual acre for the nurses. The nurses are bound to assess the mental capacity of dementia patients as per the regulation and standards stated in the mental capacity act (2005). The assessment process is in alignment with the NICE guideline, NMC codes and mental capacity act (2005) (Mental capacity act (2005)). Apart from these laws, the nurses also adhere to the equality act (2010) and the human rights act 1998 (Human Rights Act 2018).

These laws and regulations secure the patients’ rights and make them worthy of the required treatment and care. The assessment aids the nurses in developing an individualised nursing plan that caters to the needs and requirements of the patients. Every individual requires and has a right to treatment, and the hospital staff and carers are bound to provide equality in treatment as stated in the equality act (Equality act 2010)

The next thing to do is sketch up a care plan (Edwards et al. 2014). The overall effectiveness of the care plan depends on its clarity and readability to all parties engaged in the patient’s treatment. The nurse might choose to focus on either short-term or long-term objectives. The nurse’s assessment of the client’s current abilities and requirements should inform both the short-term and long-term objectives developed for the client with dementia.

In person-centred care approaches, changes to the surrounding environment are implemented to improve quality of life (Zaleta & Carpenter, 2010). It will help those with dementia make the most of their abilities while making up for their impairments (Linton et al., 2000). It might take longer for patients who can use utensils to complete their meals. Fearing for the patient’s dignity and the escalation of the dementia patient’s feeling of helplessness, which may lead to agitation and aggressiveness, caregivers should avoid the desire to speed up the feeding process or perform the duty themselves.

To be oneself, one must strive for autonomy, variety, and global engagement (My Home Life UK, 2012). People with dementia often take a long time and struggle through the decision-making process that the rest of us take for granted. Care for people with dementia that emphasises the patient’s ability to make decisions and express those decisions is called “person-centred care” (Zaleta & Carpenter, 2010).

The patient’s incapacity to express their preferences verbally to the nurse is an important factor to consider as dementia worsens. If the patient is unable to state a choice, the nurse may have to provide many alternatives and explain the rationale behind each one. Afterwards, the nurse may present a potential candidate and inquire, “Is this the one?” about certain attire. Use the second choice to prompt the question, “or this one?” Putting off investigating the link between poor nutrition and dementia might have disastrous results (My Home Life UK, 2012) and an understanding of the patient’s food and drink preferences and the degree to which the patient requires help. At the same time, eating is necessary for the nurse to fulfil her duty to satisfy the patient’s nutritional needs. Find out whether the patient prefers dining alone or with others.

Is there anything they can chew or swallow? Because of their importance, the nurse should give them plenty of thought. If the nurse does not take the time to prepare in advance, she may have trouble determining the client’s desires and requirements, deciding how to best satisfy those wants and needs, and taking the appropriate action.

The nurse must now make decisions on how to put the care plan into action. To honour the hard work of the interdisciplinary team, we will go on with implementing the care plan in its current state, which should make it quite straightforward to carry out (Zaleta & Carpenter, 2010). The nurse caring for a patient with dementia should only ask the patient directly, closed questions. No one should be automatically cast off as unable to change their tastes. Do not interrupt the patient if he or she is nodding, shaking their head, or making other nonverbal gestures of agreement or displeasure (frowning). When verbal communication with a patient is not possible, the nurse may resort to the use of visual aids (Wang et al., 2019). Someone with dementia may get confused by too many alternatives.

Last but not least, it is the nurse’s job to assess the plan’s effectiveness on a regular basis. The nurse may evaluate the strategy’s success using this method and make adjustments as necessary (Jennings et al. 2017). How effectively the patient responds to the treatment plan will be the basis for the assessment. If it is determined that further testing is necessary, it will be conducted. Also, it helps a lot to have updates from the caregivers of a person with dementia on a frequent basis so that you can provide that person with the best care possible (National Institute for Health and Clinical Excellence, 2012). A care plan is not something that can be done and put aside; rather, it is a set of recommendations that must be put into action, assessed, and modified as necessary.

Edwards et al. (2015) underlined the need to record the care provided in order to ensure its continuity. One of your primary duties as a nurse is to update the patient, their family, and the rest of the healthcare team on the patient’s condition and treatment plan. An important aspect of the nurse’s responsibility in assisting a person with dementia to have a normal life is the capacity to listen to others who are contributing to caring, report and document any care delivered, and interact with the individual.

NHS guidelines applicable for case study

Those dealing with dementia and their loved ones and caregivers may benefit from the expert guidance included in this article. The concepts of person-centred care, foundational to delivering good care to persons with dementia, form the basis of the suggestions. According to these guidelines (NICE guideline [NG97], 2018):

• The value of all persons living with dementia, regardless of age or degree of impairment.
• Dementia sufferers’ individuality, including how their traits and experiences shape their coping with the disease.
• Importance of one’s viewpoint
• Understanding the importance of social connections to those with dementia and how they might improve quality of life.

What is person-centred care?

Dementia patients may experience increased worry and tension when hospitalised due to the added burden of dependence and the novel living conditions. Patients may be negatively affected by the unfamiliar setting and their dependence on others. Difficult behaviours occur commonly in high-stress, task-focused acute contexts, which might hinder treatment. Therefore, PWDs must have access to high-quality healthcare. Quality care for individuals who are disabled (OFWs) has become virtually synonymous with both the patient care (PCC) method, which should be seriously examined (Molony et al. 2018). The use of Pca in assisted living facilities that put the needs of PWDs first goes beyond the scope of traditional medical and nursing services. PCC highlights the achievements of PWDs and acknowledges their right to make decisions about their own lives. Isolation and need-driven dementia-compromised behaviours can result from a lack of attention paid to people with disabilities’ emotional and social needs (McClendon Smyth, 2013).

Caregiving from a person-centred perspective seeks to meet the unique needs of people with disabilities by reorienting the care system to prioritise each individual. Positive patient outcomes, including increased quality of life and reduced agitation and challenging behaviours, have resulted from using PCC in LTC settings, while the need for antipsychotic drugs has decreased (Montine et al. 2012). Most studies on PCC’s efficacy have been done in nursing homes or similar long-term care institutions; comparatively, few have examined its usefulness in emergency rooms.

Administering PCC in private care can be challenging due to the high demand for diagnostic investigations, close monitoring, and prompt treatment initiation within brief patient stays (Marulappa et al., 2022). The purpose of this research is, therefore, to investigate the efficacy of PCC for the Elderly in the hospital setting.

A person-centred approach prioritises the needs, wants, and aspirations of the person being served. Care that is truly “person-centred” prioritises the patient’s perspective on their own health, disease, accident, or need. A person-centred approach can be achieved through, among other things (Molony et al., 2018), emphasising the importance of the patient’s values, preferences, and needs, encouraging open communication between the patient and healthcare providers and promoting the patient’s physical and emotional well-being.

Caregivers have a legal obligation to provide person-centred care to persons in need of protection, as stated in the Care Act of 2014. When nurses choose to act according to the principles, they must put the needs of their patients and their health first (Bethell et al., 2018). Nurses can best help vulnerable patients by empowering them to make their own decisions and choices. Person-centred Care that takes an approach considers each patient in its entirety and treats them as unique individuals.

The individual’s individuality, temperament, and personal character are all taken into account, which helps shape the individual’s character. It provides assistance for the person living with dementia in all areas, not just the natural ones. Several fundamental concepts are linked together in this method (Fazio et al. 2018).

There is some duplication between the two principles, and failing to adhere to either will make it harder for this strategy to be effective. Self-actualisation is a goal of this approach, and it helps seniors successfully navigate the inevitable changes that come with ageing.

The uniqueness of each person is what sets them apart. The sum of a person’s distinguishing features is what makes that person unique (Bodegard et al. 2019). Using this approach, one is encouraged to confront their own non-representational worldview. A person’s accomplishments, abilities, and preferences are taken into account when providing care, and the elderly are treated with the utmost respect and dignity at all times. When someone has a right, they have the legal prerogative to something, for him to have the freedom to choose what’s best for him in life, the plan centres on ensuring that the orders remain on the correct course (Bodegard et al. 2019). Allowing the patient to make his or her own healthcare decisions also exposes him to the possibility of making a “poor choice.”

• Taking a person-centred approach means empowering the elderly to make choices about how they want to live their lives and accepting the repercussions of those choices.
• The value of personal anonymity is paramount in this strategy. Confidentiality is strictly upheld at all times. Without the older person’s permission, sharing their values and beliefs is not appropriate. The personal data and any prior associations with the individual are included (Kim & Park, 2017). This is also why the doors to the rooms are always closed during care delivery to protect the confidentiality of the inhabitants.
• The ability to work without assistance from others is a hallmark of independence. For this reason, the care provider ensures a secure environment and provides aids like handrails to promote the individual’s development while preserving his or her capacity for autonomy. The elderly are allowed to leave the facility with proper identification and are allowed to do so if they are deemed capable of doing so.
• Respectability is a hallmark of dignity. In this situation, the person with dementia is recognised as more than the sum of his symptoms, and his values and beliefs are given due consideration. With this approach, the elderly can follow their moral compass (Brooker, 2003).
• The elderly are treated with the utmost respect in a person-centred approach, which values each person for his or her unique strengths, skills, and characteristics. The senior is not being criticised for having strong opinions. The person-centred approach greatly enhances the patient’s sense of agency. The term “autonomy” describes a system in which senior citizens are given agency and decision-making authority. So doing gives the old patient a sense of agency over his care. This is achievable if the older patient is provided with precise details regarding his diagnosis and course of treatment. According to NICE rules, this is also crucial information to have.
• In the person-centred approach, building a positive rapport with the patient is crucial. The nurse’s job is to make the patient feel at ease and cared for by seeing to all of his or her specific requirements. Transparency, openness, and empathy are the cornerstones of a healthy working relationship (Rathert et al., 2013). The nurses must adhere to the NMC’s standards of caring, candour, honesty, and fairness in the workplace.

Conclusion

The current essay highlighted the basic steps of the nursing care process and the importance of person-centred care with holistic assessment. The report also highlighted the NMC and NICE rules and regulations regarding the nursing care of dementia patients. The analysis of the file elaborates on how an elderly patient with dementia should be treated in the hospital and home setting.

References

Alzheimer’s Association. (2018). 2018 Alzheimer’s disease facts and figures. Alzheimer’s & Dementia, 14(3), 367-429. https://doi.org/10.1016/j.jalz.2018.02.001

Bethell J, Pringle D, Chambers LW, et al. (2018) Patient and public involvement in identifying dementia research priorities. J Am Geriatr Soc. 66:1608–12. https://doi.org/10.1111/jgs.15453

Bodegard H, Helgesson G, Juth N, Olsson D, Lynoe N. (2019). Challenges to patient-centredness – a comparison of patient and doctor experiences from primary care. BMC Fam Pract. 220:83.

Brooker D. (2003). What is person-centred care in dementia? Rev Clin Gerontol. 13:215–22.

Edwards R, Voss S, Iliffe S. (2014). Education about dementia in primary care: is person-centredness the key? Dementia.13:111–9. https://doi.org/10.1177/1471301212451381

Edwards R, Voss SE, Iliffe S. (2015). The development and evaluation of an educational intervention for primary care promoting person-centred responses to dementia. Dementia. 2015;14:468–82. https://doi.org/10.1177/1471301213499768

Equality act (2010), Legislation.gov.uk. Statute Law Database. Available at: https://www.legislation.gov.uk/ukpga/2010/15/contents (Accessed: October 30, 2022).

Fazio S, Pace D, Flinner J, et al. (2018). The fundamentals of person-centered care for individuals with dementia. Gerontologist. 2018;58:S10–9. https://doi.org/10.1093/geront/gnx122

Hung L, Son C, Hung R. (2019) The experience of hospital staff in applying the gentle persuasive approaches to dementia care. J Psychiatr Ment Health Nurs. 26:19–28. https://doi.org/10.1111/jpm.12504

Hyman, B. T., Phelps, C. H., Beach, T. G., Bigio, E. H., Cairns, N. J., Carrillo, M. C., … & Montine, T. J. (2012). National Institute on Aging–Alzheimer’s Association guidelines for the neuropathologic assessment of Alzheimer’s disease. Alzheimer’s & dementia, 8(1), 1-13.

Jennings LA, Palimaru A, Corona MG, Cagigas XE, Ramirez KD, Zhao T, et al. (2017). Patient and caregiver goals for dementia care. Qual Life Res. 26:685–93.

Kim SK, Park M. (2017). Effectiveness of person-centered care on people with dementia: a systematic review and meta-analysis. Clin Interv Aging. 12:381–97. doi: 10.2147/CIA.S117637

Lane, C. A., Hardy, J., & Schott, J. M. (2018). Alzheimer’s disease. European journal of neurology.

Lorida I, Abbott RA, Rogers M, et al. (2017). Dissemination and implementation research in dementia care: a systematic scoping review and evidence map. BMC Geriatr. 17:147.

Marulappa, N., Anderson, N.N., Bethell, J. et al. (2022). How to implement person-centred care and support for dementia in outpatient and home/community settings: Scoping review. BMC Health Serv Res 22, 541. https://doi.org/10.1186/s12913-022-07875-w

McClendon MJ, Smyth KA. (2013) Quality of informal care for persons with dementia: dimensions and correlates. Aging Ment Health. 17:1003–15. https://doi.org/10.1080/13607863.2013.805400

Mental capacity act (2005) NHS choices. NHS. Available at: https://www.nhs.uk/conditions/social-care-and-support-guide/making-decisions-for-someone-else/mental-capacity-act/ (Accessed: October 30, 2022).

Molony, S. L., Kolanowski, A., Van Haitsma, K., & Rooney, K. E. (2018). Person-centered assessment and care planning. The Gerontologist, 58(suppl_1), S32-S47. https://doi.org/10.1093/geront/gnx173

Montine, T. J., Phelps, C. H., Beach, T. G., Bigio, E. H., Cairns, N. J., Dickson, D. W., … & Hyman, B. T. (2012). National Institute on Aging–Alzheimer’s Association guidelines for the neuropathologic assessment of Alzheimer’s disease: a practical approach. Acta neuropathologica, 123(1), 1-11.

Overview: Dementia: Assessment, management and support for people living with dementia and their carers: Guidance (2018) NICE. Available at: https://www.nice.org.uk/guidance/ng97 (Accessed: October 30, 2022).

Rathert C, Wyrwich MD, Boren SA. (2013). Patient-centered care and outcomes: a systematic review of the literature. Med Care Res Rev. 70:351–79. https://doi.org/10.1177/1077558712465774

The Human Rights Act (2018) The Human Rights Act | Equality and Human Rights Commission. Available at: https://www.equalityhumanrights.com/en/human-rights/human-rights-act (Accessed: October 30, 2022).

Wang Y, Xiao LD, Ullah S, He GP, De Bellis A. (2017). Evaluation of a nurse-led dementia education and knowledge translation programme in primary care: a cluster randomised controlled trial. Nurse Educ Today. 2017;49:1–7. https://doi.org/10.1016/j.nedt.2016.10.016

Weller, J., & Budson, A. (2018). Current understanding of Alzheimer’s disease diagnosis and treatment. F1000Research, 7. doi: 10.12688/f1000research.14506.1

Yaffe MJ, Orzeck P, Barylak L. (2008). Family physicians’ perspectives on care of dementia patients and family caregivers. Can Fam Physician. 54:1008–15.

Zaleta AK, Carpenter BD. (2010). Patient-centered communication during the disclosure of a dementia diagnosis. Am J Alzheimers Dis Other Dement. 25:513–20. https://doi.org/10.1177/1533317510372924

Zimmerman, S., Sloane, P. D., & Reed, D. (2014). Dementia prevalence and care in assisted living. Health Affairs, 33(4), 658-666. https://doi.org/10.1377/hlthaff.2013.1255

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