Dementia Care Practice - Essay Example

Dementia Care Name Course Name and Code Instructor’s name Date Introduction Health plays an important role in the functionality and productivity of populations in an economy. Poor health translates to low supply of labour and increased budgetary expenses directed towards health curative measures, which would have otherwise been allocated in other sustainable social and economic developments. Owing to the significance of health, majority of global economies have acquired and allocated substantial amounts of its resources to health promotion and health prevention initiatives to ensure they sustain healthy nations. Overall, good health and wellbeing of an individual entails total functioning of the body systems where all dimensions of life of an individual, that is, emotional, social, physical, spiritual and psychological aspects are operating effectively and efficiently (Volicer, 2007). Therefore, when one aspect of an individual does not operate optimally, it is critical that suitable diagnosis, treatment and management are provided. This is coupled with easy access to quality care, equipments and a safe and secure health environment to ensure the individual recovers or if they do not, they are able to lead full lives or die gracefully for that matter. Among health conditions, that requires access to quality care and favourable health and living environment is dementia (Alzheimer’s Society, 2011). Often, individuals who are diagnosed with dementia are confined in health residential settings in order to better care for them and provide an environment where their needs are catered for adequately. Resident care offered to dementia patients require that the kind of dementia care offered to the patients is not only quality and holistic but also, acceptable, available and affordable, which has not always been the case (Campbell & Guzman, 2004). This forms the foundation of this report, which intends to evaluate the resident care plan in dementia care. Background Dementia is a psychological condition where an individual loses their power and capacity to think and remember as defined by Hudson (2003). The condition results in a reduction in psychological competence which impact on concentration, reasoning, solving problems, making decisions and perceptions (Tilly & Reed, 2005). Among varied types of dementia include Alzheimer, Lewy Body dementia and vascular dementia. There are known causes for the condition, which includes normal pressure hydrocephalus, frontal lobe dementia, post-traumatic, medications, Huntington disease, AIDS, Parkinson disease with dementia, Cretzfeldt-Jacob disease and frontal lobe dementia among others (Werezak & Morgan, 2003). Individuals diagnosed with dementia are more prone to other health conditions such as depression, high stress levels, falls due to their gait, inability to judge and identify hazards and visual space perceptions, delirium and incontinence as highlighted by Alzheimer’s Society (2011). According to Keane & Shoesmith (2005), due to such intricacies and diverse issues and challenges associated with dementia, it is imperative to establish an organized, multifaceted and adequately resourced care programs that are able to address individual needs of all dementia patients and their care providers. Since majority of dementia cases are well managed and catered for in resident care settings, evaluating the resident care plan for dementia patients is vital. The decision to care for dementia patients in resident care homes is influenced by the degree of disability and functional harm, socio-demographic attributes of the patient, accessibility to family based care and availability of pertinent community services. Hudson (2003) states that effective dementia care in residential settings is determined by how the facility addresses individual needs for each resident, which is often not easy to do. Resident care plan approach in dementia care The establishment and implementation of resident care plan approaches is among the most sustainable and effective ways for caring for individuals with dementia and more so for the elderly. A good resident care plan is able to enhance the function of the dementia patient, minimize occurrences and effective management of destructive responsive behaviour, reduce stress for the patient, family and the care providers and enhance holistic an patient-centered care which is characterized by community engagement and commitment (Robinson, 2007). Alzheimer’s Society (2011) notes that a comprehensive and an effective resident care plan approach ensure dementia patients are able to lead full lives. The underlying core principles for a resident care plan approach includes respecting the rights and inclinations of individuals with dementia. It also includes provision of holistic care, support for care providers and emphasis on home care solutions, basing funding on care requirements and not the other way round, care accessibility determined by need and not on income and outcome goals underlying provision as mentioned by Werezak & Morgan (2003). Campbell & Guzman (2004) indicates that every interaction that a care provider has with an individual with dementia in resident care needs consistency, which improves the trust, self-esteem, safety and security of the individual. Among ways consistent interactions can be maintained is through communication where care providers hold talks and discussions with the residents, they seek and consult the residents on decisions regarding their health and they are able to respect preferences, rights and choices of the persons with dementia (Tilly & Reed, 2005). Essential elements of a high-quality residential care plan In order to determine what is viable and effective in resident care and what is not, it is important to identify essential elements that constitutes to a high quality resident care plan which includes Use of individual –centered care Important aspects that a quality resident care plan for persons with dementia should have are diverse and include provision of individual centered care where the care provider focuses more on the individual than on his ailment and competencies they have lost as discussed by Volicer (2007). In addition, care givers move beyond treating symptoms and dealing with responsive behaviours to taking into account the person’s unique skills and abilities, needs, preferences and interests and treating them with due respect and dignity in order to ensure holistic dementia care (Goldsmith, 2002). Support from management and competent care personnel The other aspect is adequate support and commitment from the management of the residence and the care personnel. The management implements the right culture and makes available adequate resources to facilitate quality dementia care while care personnel are trained and equipped with skills in effective management of symptoms and behaviour such as aggressiveness, wandering, anger and irritability among others and dementia care (Blasi, et al., 2002). The care personnel and the management need to co-operate in developing a facility environment that does not only produce a home-away-from home experience but also a safe and secure environment. Aligning resident care plans with cultural dimensions of residents Due to in adequate resources and lack of adequate skills and abilities by the care staff and the management on dementia care, majority of resident care plans designed for persons with dementia are often ineffective when they are not culturally suitable and fit for individual patients (Werezak & Morgan, 2003). Therefore, high-quality dementia cares plan whether meant for inpatient care or in residential care should be designed in such a way to accommodate the cultural dimensions of each resident to enhance acceptability. Among ways this can be achieved is through communication of care interventions through understood language and generation of a culturally- familiar living environment in terms of foods and practiced religion (Campbell & Guzman, 2004). Active engagement of family and other social support system Although the person with dementia may have lost their initial abilities to remember, reason and perceive different things, it is essential that they are accessible to their family or social support systems who can be engaged by consulting them during designing care plans and reviews. (Bell & Troxel, 2001) indicates that active engagement with the resident’s social support systems, as part of the residential care plan is integral in overall wellbeing of persons with dementia. Nevertheless, it is important to respect the social preferences of the resident especially when they request for solitude (Volicer, 2007). Effective management of pain Pain management is an integral part of any care plan for a person with dementia. Managing pain for these persons is often complex due to the fact that they cannot eloquently express it and the care givers have to be keen in noting a change in behaviours of patient to understand the patient is in pain (Warden, et al., 2003). Gessert et al. (2000) notes that effective management of pain therefore, constitutes to a good resident care plan since it helps minimize over reliance on psychotropic prescriptions, helps safeguard against probable destructive behaviours and it minimizes suffering for the resident. A high-quality resident care plan should highlight varied methods and strategies of assessing and managing pain and should ensure the methods of managing pain are aligned to the individual needs, risks, life circumstances and conditions of every resident as suggested by Blasi, et al. (2002). Autonomy of the resident and access to specialists care Due to the erratic behaviours of persons with dementia such as wanderings, falls and irritability, which may cause harm on themselves or to other residents or care providers, this may necessitates some degree of restrain (Schulz et al., 2004). However, this should not be the norm and should only be applied in extreme or special cases. Persons with dementia can be restrained using physical tools such as straps, vests, splints, restraining belts, isolation rooms, bed rails and binders among others or using chemical restraints such as sedatives and tranquilizers. According to Tilly & Reed (2006), a high-quality resident care plan should have strict regulations and policies in administration of either restraints and ensure each care personnel are equipped with the knowledge on the procedures and instances when they should be used. Apart from generating an environment where the resident has the autonomy to interact effectively and has personal space, it is essential that care plans fosters access to specialists care where residents can be evaluated and counsel sought on the best way to manage their condition (Keane & Shoesmith, 2005). Among specialists that should be incorporated in the care plan, include psychologists, speech pathologists, physiotherapists and nutritionist among others (Warden, et al., 2003). Best practice principles that forms the basis for quality resident care plans for persons with dementia includes flexible scheduling of care delivery, defined care philosophy, professionally equipped personnel, holistic assessment, regular care reviews and limited distractions and restrictions (Chochinov, 2002). In addition, emphasis on retained abilities and present preferences and choices, acknowledgement of former abilities, development of a familiar environment, engagement of family, effective leadership, effective pain management and effective guidelines on behaviour management as echoed by Warchol (2004). Nutrition is essential for overall health of individuals and inadequate use of food and fluids has a direct impact on the wellbeing of a resident. Nutrition issues among persons with dementia includes olfactory dysfunction, apraxia, lose of weight, inability to chew and swallow unassisted and forgetting when to consume food or fluids as indicated by McCann-Beranger (2004). Often, residents with dementia either want to eat more than necessary while others need support to encourage them to eat which enhances the need to develop resident care plans that caters for nutrition which generate effective screening and preventive mechanisms for nutrition care, making available proper nutrition based on preferences of the residents and encourage healthy eating habits (McCann-Beranger, 2004). The outcomes of the evaluation and the main reasons for carrying out the evaluation The evaluation of resident care plan approach in dementia care is fundamental in ensuring that persons with dementia who are catered for both short and long term are able to access quality and personalized care and at the same time, ensuring the care providers are duly supported with the required resources in terms of funding, trainings and remunerations. The main outcomes of the evaluation is to help establish what the key critical success factors for a residential care plan are and identify what constitutes to a best practice resident care plan in dementia care. Among the major reasons for carrying out the evaluation are to identify ways in which caregivers can offer quality and holistic care for persons with dementia in residential facilities, analysing the prevailing challenges to effectively carrying out residential care plans and assessing how care interventions can be focused on individual needs of persons with dementia in a residential facility. It is imperative that persons with dementia under resident care be holistically assessed in terms of their mental, behavioural, physical, sensory, cognitive, cultural, spiritual, personal needs. In order to develop suitable care plans and provisions, devise appropriate communication and behavioural strategies to address communication and behavioural changes respectively and generate a favourable nursing home environment that enhances community (Alzheimer’s Australia, 2010). Important also to remember is that care givers need to ensure that any changes to care interventions and changes from the familiar environment should not only adhere to existing applicable laws and regulations. Also should be introduced with the awareness of the residents or introduced gradually to ensure it does not ignite worry and distress for the residents as echoed by Tilly & Reed (2006). The evaluation is intended to highlight resident care best practices and address holistic and patient –centered approach in dementia care, which will help validate current practices and generate recommendations for practice change for residential care. The evaluation is informed by the increased focus given to delivery of patient centered and holistic care for other chronic conditions in residential care, which is not evident in management of persons with dementia. Issues that need addressing in care provision for residents with dementia are varied and ranges from effective pain management, appropriate handling of responsive behaviours, decision making in relation to medical interventions and challenges of delivering patient-centered care. There is the challenge of paternalism when developing care plans that take into account the preferences and rights of the resident and their best interest as thought out by the care provider. According to Bell & Troxel (2001), it is fundamental that the care plan takes into account the aim of the care and order of priority of survival, comfort and functionality goals. The evaluation on holistic and patient centered approach in resident care plan is important because the overall wellbeing of a person with dementia most of whom are confined in residential facilities depends entirely on the type, diversity and quality of care they receive. Failure to have a high-quality holistic and individual- centered resident care means residents will not only be unable to lead full lives and at worse fail to access suitable care when they need it which has disastrous consequences such as death or self injuries (Warchol, 2004). The evaluation of the resident care plan in dementia care is critical, as it will help residences and care staff to better deliver quality care to their clients and develop an environment where their needs as professionals and those of their patients are effectively and efficiently met and satisfied. Methodology The evaluation is a highlight of perspectives and evidence based findings generated by medical professionals, researchers and policy makers involved with dementia. The evaluation process entails a comprehensive analysis of previous literatures on the subject matter and broad discussions with relevant stakeholders associated with dementia care. Among relevant stakeholders consulted include representatives of home help service providers, The Alzheimer’s Society, representatives of families of persons with dementia living in resident care settings and medical specialists in dementia. It is expected that the researcher will carryout the evaluation by collecting data using both quantitative and qualitative research techniques where questionnaires and unstructured interviews shall be applied respectively. Secondary data shall be gathered from previous literature findings. Prior to the actual meetings, one page outline of the range of questions and issues to be covered will be sent to prospective respondents as a framework for the actual research that will be carried out. The main issues to be addressed include dementia diagnosis, reinforcement for care providers, resident care, holistic care and the benefits of individual-centered dementia care. For the secondary data, the inclusion criteria are that the publications are primarily covering issues pertaining to effective resident care for persons with dementia, the content are evidence based and the publications are peer reviewed journals and books, reports and publications from government and NGOs and standards of care guidelines. In addition, the secondary materials has to be written within the last twelve years since the year 2000, is published in English and are from countries with advanced residential care facilities. The exclusion criteria are any literature materials published prior to the year 2000 and did not meet the above-mentioned criteria. In addition, any publications on dementia that did not specifically focus on resident care in dementia care The evaluation shall incorporate relevant qualitative researches, which will be beneficial in helping in the selection of result measures and in development of valid research hypothesis and assist in gaining comprehension on heterogeneous outcomes. Among ethical considerations are that participants to quantitative research shall be assured of anonymity and guaranteed that the research findings will be for evaluation purposes only. The main limitations are that the findings of the evaluation shall only be confined to English published materials, which mean secondary materials published in other languages such as German, French, and Arabic among other languages that may have enriched the research portrait will not be included. The amount of publications available that meets the criteria are substantial which will make the evaluation process all the more intricate since it will require more time and resources to review literature materials that have met the criteria and it will be the discretion of the researcher to determine those excluded despite having met the inclusion criteria The main intention of the evaluation is to minimize the gap between quality of life and dementia care experienced by dementia patients presently, with what these persons may optimally obtain with a more individual centered and holistic approach to service delivery which is achievable by helping persons with dementia to develop their abilities within the constraints imposed by dementia. Analysis and dissemination of findings The data that will be collected from the discussions held with relevant stakeholders shall be recorded and later the data shall be cleaned, processed and analysed. Data analysis shall be done using the Microsoft Excel, as a data analysis tool. Among key issues that shall be analysed include what best practice in residential dementia care are and assess whether holistic care and individual-centered approach of care are considered as part of best practice in dementia care. In addition, the analysis will focus on identifying what role majority of the participants think that holistic approach of care plays in resident management of dementia and how applicable is individual-centered approach is in caring for persons with dementia living in residential facilities. In regards to the unstructured interviews, the same analysis process shall be used. For the analysis on secondary data from secondary sources, the analysis will entail comparing and contrasting views and findings of varied included literature and a summary of the similarities and dissimilarities noted. The focus will mainly be on assessing what the authors and researchers have to say and recommend on delivery of quality dementia care for persons with dementia at residential facilities. After a comprehensive analysis of the findings, the findings shall be disseminated to key stakeholders who are actively engaged in dementia management and care such as ministry of health, Dementia-related institutions and more importantly, distributed to nursing homes or residences that care for persons with dementia. The findings of the evaluation shall be presented in form of a report highlighting the main findings of the study and distinct recommendations on the significance of holistically designed and individually- centered approach in residential dementia care. To ensure all relevant stakeholders with or without research experience understand the evaluation findings, the information findings shall also be presented in pictorial formats such as pie charts, tables, histograms and graphs. Recommendations The main objective of the evaluation is to identify evidence based best practices in dementia care particularly in resident care in order to help develop effective resident care plans that will inform current practices and provide recommendations for practice change for residential care. Since resident care for persons with dementia does not receive comprehensive holistic and individual-centered care as much as other chronic ailments such as cancer do, the evaluation seeks to establish areas in which care can be both holistic and individually centered. Therefore, the recommendations given are ways in which residents can be cared for to ensure the care is both individually centered and holistic at the same time. The recommendations are Holistic assessment and regular care reviews Delivering quality care to each individual resident that is individually centered and holistic mean carrying out holistic assessment of the individual from their physical, emotional, social, spiritual, cognitive statuses, to their cultural status, their individual needs and present abilities as echoed by NCF (2007). In addition, engaging the resident’s family or social networks in order to gain better understanding of the individual and consulting with them when reviewing care interventions (Warden et al. 2003). This also involves acknowledging lost abilities and respecting the rights and preferences of the resident on the type of care and personal space among others, which is crucial in designing resident care plan that are aligned to individual needs and abilities of the resident as suggested by Alzheimer’s Australia (2010). Holistic assessment and regular care reviews can be achieved through effective communication and close correlations between the care provider and the resident where the former is able to listen and understand the latter by being keen to verbal and non-verbal communication and they actively play their role as advocates and are careful not to enhance paternalism (Goldsmith, 2002). Integrating individual-centered approach After identifying what the individual needs, abilities, and preferences of the resident are based on the holistic assessment done, it will be crucial that those individual needs are effectively and efficiently met and the abilities are adequately developed. This means focusing on the individual rather than controlling his behaviours and treating the dementia symptoms, respecting them for who they are now and acknowledging their lost abilities, involving them in decision making processes and providing an environment that fosters communication, autonomy, safety and security for the resident (Blasi, et al., 2002). Supporting and developing the care personnel The goals to deliver holistic and individually centered resident care is only achievable by having care staff who are well equipped with knowledge and skills of handling residents with dementia and are knowledgeable on matters pertaining to the importance of delivering holistic care (Warchol, 2004). The management is charged with the responsibility of supporting its staff in their work by developing an organizational culture that foster learning and growth of staff. According to NCF (2007), through collaboration between the staff and the management, the resident becomes the priority and is therefore given care that best suits them. Delivering holistic and individually centered resident care in dementia care is easier said than done and it requires commitment, engagement and participation, adequate resources and knowledge. Conclusion In health, delivery of individually centered and holistic care is the key to ensuring the care plans and programs implemented are able to meet individual needs and preferences of the client/ patient/ individual, which results in efficient recovery or sustaining one’s well being. Individual-centered and holistic care for persons with dementia are as much important in ensuring the residents are able to lead full lives where they have access to their social networks, they are exposed to familiar environments and they easily develop their present abilities which makes controlling behaviour and treating symptoms much easier. The report has evaluated the resident care plan in dementia care. It is clear that quality, accessible, affordable, acceptable and available resident care for persons with dementia is effectively delivered when the approaches adopted are holistic and individually centered. Therefore, resident care plans should be based on holistic and individually centered approach of care. References Alzheimer’s Australia. (2010). Good care in a residential facility. Queensland: AU Government. Accessed from http://www.alzheimers.org.au/services/good-care-in-a-residential-facility.aspx Alzheimer’s Society. 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