Patients suffering from dementia have a brain disorder that makes them have difficulty in remembering things. Their thinking skills are also affected while depression becomes common to them as a result (Royal College of Psychiatrists, 2011). Diagnosis of the condition will be important in organizing the best care plan. With an increasing fear of losing their identity and respect, the health care plan would revolve in boosting the confidence of the patients. Utilizing methods that improve the sense of self identity in patients must be involved in care plans of patients. While employing these methods, there will be a need to maintain communication with the patients and co-workers, and consider both legal and ethical guidelines within the framework you will be providing your services.
A family is very important to a patient who is suffering from this condition. Health care providers will have to ensure that family bondages are still maintained. Care plans are different for different members and families play a very important role in providing the patient history of the patient. They are the closest people hence when they are involved in care plans; it will enhance reduction of the symptoms of dementia.
Dementia Patients have feelings. These emotional characteristics are expressed in different ways. Some become aggressive, violent, calm and sad or swing their moods spontaneously. Any type of mental health care plan should consider how it can manage these feelings. It will involve doing activities with the patient, using family members or make use of safe external intervention.
Dementia is a brain condition that affects memory and thinking abilities of individuals. Reasoning is also affected as result. Effective tools that will involve monitor the cognitive behaviour of individuals; improve their thinking and triggering their memory should be used consistently.
Mental health care plan for the dementia condition will therefore involve psychiatrists and psychologists who are capable of diagnosing patients that suffer from it. The family will help in understanding the patients especially during assessment procedures. The nurses and other mental health care experts will help in providing care and carrying out the medical instructions of the doctors. They will also have to form close relationship with the patients in the course of the condition until there is an improvement in the health of the patients. The government and other health bodies will have a duty to ensure that health care and services given to the patients and management support to the health workers are done under the provision of laws, health Acts and ethical requirements.
Provision of mental health care within legal and ethical framework is clearly described in the made and amended laws. There are two most important guidelines that explain how, when and to whom should mental care be given. These are the Mental Health Act 2007 and the mental capacity Act 2005. The Mental Health Act 2007 states that an approved mental health professionals, approved clinicians and Section 12 approved doctors be the only people who can provide mental health care. The approved mental health professionals are approved by the local social services authority for 5 years at a time.
The health workers are demanded to fully involve the patients in planning their treatments and also to consider their wishes. Family members and other carers must be involved unless the patients refuse. Any type of treatment or care plan carried out must be less restrictive to the patients. During examination of a patient for diagnosis, the Act requires me to take into account my observations and any evidences that I find reliable in helping me diagnose a person. The Act requires me to be aware of the effects for administering medication and prescribing minimum medication to allow patients communicate adequately with his advocate who will present him in a mental health inquiry. I am further restricted from administering dosage that, under the professional standards, is excessive and inappropriate.
The mental capacity Act 2005 presumes that all patients are able to make their own decision hence any action must first be discussed with the patients before it is executed. The patients referred as adults have the right have the right to be supported to make decisions and the right to make unwise and strange decisions (Jenkins, 2012). Decision will only be taken if all practical steps to help them make decisions fail. When making decisions for these patients the Act gives the following checklist of things that must be taken into account. I should not make assumptions based on age, appearance, condition or behaviour, not make a decision on patient’s end-to-life plan with a desire to end their lives, considering the patient’s wishes and opinions, considering views of other carers and people who had interest in the welfare of the patients and making a decision in the best interest of the patients.
Before interacting with dementia patients I set a positive a mood. Persons with dementia experience periods where their personality and behaviour change. They may respond in a way that might look unpleasing or aggressive. While trying to reach them and offer health care services, I have learnt to have a positive attitude towards them. My body language on the other hand communicates what I want the patient to know. It includes facial expression to show how happy I am for him, my tone of voice being very soft while showing affection by physically touching him.
Dementia conditions cause people to be less focused and attentive. Maintaining a conversation with them and hence ensuring that I achieve my objective of getting information has not been easy. External distraction from noise sounds and movements will disrupt communication with them. When I want to talk or explain something to them, I always employ all factors that will catch their full attention. The surrounding in which I will work with my patients must be very silent. I first turn off any media tools, shut the door or close the curtains to prevent the patients from being distracted by movement of other patients and staff. I have learnt to address them with names (Roberts, 2012) every time I talk to them, or use some of their favourite phrases that they like to respond to. In some cases I use gestures like moving my hands to illustrate something, move around, sitting down, eye contact and emotional expression to show empathy.
While talking to them I talk less using few words that will provoke them into making long statements. The patients cannot store a lot of information in their brains. They easily lose track of the words made in long sentences. I have realized that the only way you can maintain a conversation is by using simple and easy to understand words which convey a clear message. The patients will show signs of not understanding the message you have tried to give them. In this case the question asked or the message given is rephrased. One study by the Department of Health (2011) found that dementia patients stay longer in hospitals compared to people who do not suffer from any kind of cognitive impairment. Therefore, I have learnt to be very patient in these situations because different patients with diverse conditions of dementia have different levels of understanding. Therefore, I rephrase and interpret some information many times before the patients understand. Sometimes no progress is made and the patient fails to understand messages intended for them.
Working in the dementia wing comprising many dementia patients, I have found that each patient has his or her own special needs apart from the general needs that we have knowledge about. There are different levels of dementia. Some are severe such as the Alzheimer’s disease. In order to understand them and provide them with a proper health care plan, I involve all my sense organs when assessing these patients. As long as they talk, I ensure that I lend my ears to them and capture everything they say. No understatement should be made concerning the importance of listening to people living with dementia (Cullen & La Fontaine, 2012). My eyes will also be involved in observing them during assessment or how they respond to questions or medication. While interacting with them at this time I have to have a ‘heart’, meaning that I should show affection to the patients when they express any kind of emotion.
People living with dementia tend to have low-esteem characters. They feel less worthy hence become stigmatized. To help them build more confidence of themselves and of the things that they do, I involve them in creative activities. I assist them in either painting, poetry, making textiles or storytelling. These activities have been found to restore their self-esteem, identity and thus maintaining communication between them and the carers (Killick & Craig, 2011). During these activities they usually open up to people and lead to establishment of trust. Music and creative writing is part of other creative activities that I use to understand the feelings, needs and fears that a patient goes through (Buchalter, 2011).
During working with the patients and all parties that are involved in provision of mental health care, I have faced complex and challenging situations. Not every patient responds positively to the health care plan. Some of them form aggressive behaviours that are believed to have arisen as a result of taking some medication hence an expression of side effects. Due to the general risks of a possible alteration of the brain functions, the patients acquire abnormal characters that are violent. I have witnessed some patients who only respond aggressively (Roberts, 2012)when they are presented with a particular thing, see a person, are distracted or feel that they are either restrained or forced to do something. Their reason to react in this way should be in no way regarded to be a deliberate action but instead to be understood to a result of brain action decline. I have learnt that these type of patients can be helped by giving them time and space to behave that way, they can be asked to go for a walk, a change in topic can help them deviate their actions or can be given something that arouse their interest and in turn lower their aggressive actions.
In most cases dementia patients are very restless. They like moving around their rooms take anything in sight which they might break or play with. This is as a result of being bored or tired of being where they are. Some will wander far away from where they are receiving their care plan which can be at home or in hospitals. We have cases where some have gone missing. The best way I have learnt to minimize restless is by taking them for a walk regularly outside their care centers. This refreshes them and they will become occupied throughout their time because the idle period of time that they usually spend on their own would have been reduced.
The longer they suffer from the disease the more the negative effects and of the symptoms of the disease are exemplified. The patients forget more. Patients with mild cognitive impairment have been found to develop dementia and an increase in memory loss over a period of time (Okonkwo, Griffith, Copeland, Belue, Lanza, Zamrini, Harell, Brockington, Clark, Raman & Marson, 2008). In many scenarios patients have asked me a question many times and I had to give answers every time they ask. This has helped me to become very patient. I had to give some instructions repeatedly. I have discovered on several occasions that these instructions have not been followed. I have managed to solve this challenge through making posters with instruction or message written on it then sticking them at strategic points that I know my patients will come across them. In some cases I rephrase some instructions or repeat them but after a period of time to avoid invoking any negative response or behaviour from my patients. Supervising them and monitoring their actions has also helped me into guiding them into performing some important tasks hence they have felt good about themselves.
Working in mental clinic or department in the hospital can put the health workers at risk of suffering from stress, exhaustion and other mental conditions. Teri, McKenzie & LaFazia (2005) have reported higher levels of mental and physical stress in health workers. I have formed a very good working relationship with my co-workers and authorities. While serving the patients I have gained an important skill of constantly keeping accurate records about the progress of patients. I have understood that I am only put on somebody care during my shift under people take shifts. Recording accurate information is an ethical responsibility that I am required to observe. It is among the other ways that I am able to convey a message to another health worker whom I would not know but will have a responsibility of caring a patient that was put under me.
I have in some cases been burden with stresses and information from some patients that I could not manage. One study reported that care givers are pressed down with workload to an extent that it precluded sustained interactions with their counterpart residents whom they worked with (Ward, Vass, Aggarwal, Garfield & Cybyk, 2008). I have devised a way in which I can relive some of the pain and stress that I go through. I communicate it with a psychologist who has helped me a great deal in resuming my duties. I have also recognized their importance by seeking help from them when dealing with patients. Whatever I do to the patients or I take a break I usually inform the relevant staff member so that the patient does not lack any health service.
Working in a mental health setting requires medical practitioners having knowledge of the legal and ethical requirements of their roles. I understand that dementia condition is just like any other disease. It does not discriminate the person to attack. I provide non-discriminate care to people with dementia the same way I would to people who are cognitively well (DoH, 2009). In addition to equal medical care, I observe quality standards of health care to all patients as one of the objective requirements of Department of Health (DoH, 2010). The care quality Commission is responsible for ensuring quality and proper care (Mental Health Act 2007)
As a practicing nurse towards provision of care to the dementia patients, I am very much informed and an effective member of the workforce that I work with. These are requirements that are defined in the thirteenth objective of the national Dementia Strategy (DoH, 2009). I believe that I have fully accomplished this requirement by having skills, knowledge and understanding that I can properly and ethically use to provide quality health care to people with dementia. In addition, I have the approval of local social services authority which is another requirement in the Mental Act 2007.
Royal College Nursing (2011) states some of qualities that I possess and others that health workers must have in provision of quality health care. It includes being fully trained and educated, having senior management support and showing some leadership skill but generally I need to possess these five principles that will ensure I provide good dementia care. They involve being skilled and have time to care, partnering with careers, ability to perform assessment and early identification, providing individualized care and ensuring that I work with patients in a dementia friendly environment (Thompson, 2013).
Working with the dementia patients would need monitoring of the services and development that you are making as a nurse. Jasper (2003) sees the importance of reflective practice as a way of development and when trying to communicate with patients. This will help me in monitoring my progress and effectiveness of the care that I give to my patients. A good feedback will encourage me to keep on providing even better care while a negative feedback will help me change my methods and health care services that I have been using. Critical reflection will enable to add up more knowledge and experience hence my understanding and personal qualities will continue to develop (Titchen, 2004). Clinical supervision can also influence change in practice and development of knowledge and skills in clinical settings as a result of reflective practice (Mann, Gordon & MacLeod, 2009).
I am required under the healthcare regulations to provide both the patients and their families with information regarding the health status. The patients are made aware of their decision making rights before any treatment action is taken by the medical team. This will include medical procedures and tests. In addition, I am required to help in preparation and planning the end-of-life care discussions with both the patients and the family (Alzheimer’s Association, 2009). They would also need to be aware what the health facility will do during this period.
I have been given a right to socialize and interact with dementia patients and also showing them some affection when it is necessary. Under these guidelines I understand the boundaries when making these advancements. While showing affections to patients, I ensure that my actions feel right and are done in good faith. These actions should only provoke necessary information instead of inappropriate feelings.
Through full understanding of the medical guidelines and requirements, I have understood the importance of having medical handbooks that specifically describes the code of practice of medical personnel. One such rule that has completely stuck in my mind and I usually apply it is making use of my professional knowledge, judgment and skills before execute a medical action based on “evidences for best practice and person’s best interests (NMC, 2009). Reading these books have made me have great interest and curious to read even more handouts that update on the medical practice. The more I read, the more I want to practice them. This has enabled me to have more experience, interact and network with a lot of people.
Alzheimer’s Association (2009). Recommendations for Professionals Working in a Home Setting; Phase 4. Gould, E, Tilly, J. & Reed, P. (Eds). Alzheimer’s Association
Buchalter S. (2011). Art Therapy and Creative Coping Techniques for Older Adults Jessica Kingsley Publishers
Cullen, L. & La Fontaine, J. (2012). “Reflections on Establishing and Delivering a Dementia Adviser Service.” Journal of Dementia and Mental Health Care of Older People. Volume 16, Issue 3
Department of Health (2009) Living well with dementia, A National Dementia Strategy, London
Department of Health (2010) Quality outcomes for people with dementia: Building on the work of the National Dementia Strategy, London
Department of Health (2011). Common Core Principles for Supporting People with Dementia. A guide to training the social care and health workforce. London
Jasper, M. (2003). Beginning reflective practice. Nelson Thornes Ltd., Cheltenham
Jenkins, K. (2012). Mental Capacity and the Mental Capacity Act 2005: A literature review. Colechurch House 1 London Bridge Walk London: Mental Health Foundation
Killick J. & Craig, C. (2011). Creativity and Communication in Persons with Dementia. A Practical Guide. Jessica Kingsley Publishers
Mental Capacity Act 2005: Code of Practice Issued by the Lord Chancellor on 23 April 2007 in accordance with sections 42 and 43 of the Act. London: TSO
Mental Health Act 2007 No 8. New South Wales
Nursing and Midwifery Council (2009). Accountability. Available at: http://www.nmc-uk.org/Nurses-and-midwives/Advice-by-topic/A/Advice/Accountability/
Okonkwo, O. C., Griffith, H. R., Copeland, J. N., Belue, K., Lanza, S., Zamrini, E. Y., Harell, L. E., Brockington, S. C., Clark, D., Raman, R. & Marson, D. C. (2008). Medical decision-making capacity in mild cognitive impairment. Neurology, 71: 1474-1480
Roberts, J. (2012). Dementia care – How to deal with the challenges of communication. England: United Kingdom Homecare Association Limited
Royal College of Nursing (2011) Dignity in dementia: transforming hospital care. A summary of findings from survey of professionals March 2011, London
Teri, L., McKenzie, G., & LaFazia, D. (2005) “Psychosocial treatment of depression in older adults with dementia.” Clinical Psychology: Science and Practice. Vol. 12 Issue 3, pp. 303-316.
Titchen, A. (2004) Helping Relationships for Practice Development in McCormack, B., Manley, K. & Garbett, R. (eds) Practice Development in Nursing. Blackwell Publishing, Oxford.
Royal College of Psychiatrists (2011). Report of the National Audit of Dementia Care in General Hospitals.Royal College of Psychiatrists, London.
Thompson, R. (2013). Dementia: Commitment to the Care of People with Dementia in Hospital Settings. 20 Cavendish Square, London: Royal college of nursing
Ward, R., Vass, A., Aggarwal, N., Garfield, C. & Cybyk, B. (2008). “A Different Story: Exploring Patterns of Communication in Residential Dementia Care.” Ageing & Society. Vol. 28, Issue 5. pp. 629-651