Long-term Condition Dementia - Essay Example

of Dementia The aim of the essay is to provide an assessment for my patient’scondition. Firstly, the essay will provide a brief scenario for my chosen patient. The next part of the essay will elaborate upon the rationale for choosing that particular patient and her condition. Following that, the epidemiological data, nursing frame work (Roper Logan model) and the required care for my patient’s condition will be discussed. Under the NMC (2008) code of conduct, a pseudo name, ‘Sara’ will be used to maintain her confidentiality.  The paper aims at selecting a patient from a certain area and undertake a thorough analysis of his/her condition to assess the problems that patients with that particular disease have to face in order to draft out a specific plan on how they are to be taken care of, and to be assisted in coping with the environment in order to ease their living. The writer aims to assess the condition of the patient Sara, who happens to be a patient of dementia. The writer is a practicing nurse at the hospital where Sara is admitted. The patient under consideration for this paper was going through a very critical time in terms of coping with the environment as the her condition of dementia had reached a point that had rendered her quite incapable of going through the day without someone to look out for her. The case of Sara refers to such a disease that renders some of the brain functions as inefficient, making the patient with this ailment incapable of coherent behavior. This in turn, not only makes the behavior of the patient unsuitable for a normal setting but also makes it difficult for others in their vicinity to deal with their condition. This goes on to imply that professional medical care for such patients is critical and for some cases, such as Sara’s, there has to be someone to take care of the patient 24 hours a day. The analysis of the patient’s condition has been done in such an order that the first section will first shed light on the background of the ailment that the patient Sara is suffering with. The next part will assess the patient’s condition and the effects it is having on her daily life and environment. Having covered this, the paper will then attempt to give suggestions and propose a way that is to be employed for her care, also discussing how similar cases are to be handled. To begin with, the scenario of the patient is elaborated along with a brief overview of her condition. Sara had been a teacher for the most part of her life. Having invested around 25 years of her life in this profession, she had established herself well in the field and had eventually been promoted to the position of the Vice Principle in a school. She has lived with her husband, and has two married daughters. Despite being quite capable in her line of work, Sara, now 64 years of age, had to take an early retirement because of her declining health. Sara had started suffering from memory loss some ten years back but initially it was merely thought of as a reaction to her early retirement in terms of de-motivation. She had been living with one of her daughters up till recently but had to be admitted to the hospital when her condition started taking a serious turn towards dementia. Dementia is the condition that is particularly difficult to deal with as it affects all spheres of a patient’s life. It is however, particularly difficult for patients, such as Sara, who are at the initial stages of dementia and are aware of their declining health and deteriorating functionality. The patient with this disease was particularly chosen by the writer because of the critical role that her profession plays in the everyday routine of the patients’ life. It is not an illness that can be checked and treated only once in a while but is in fact a sickness that requires constant monitoring on part of the caregivers for the patients. These patients not only require assistance in getting through the day but are also in great need of moral support to ease all the confusion and the eventual aggression that comes with this disease. Sara had been admitted on ward under the care of doctors because she had not been normal for some time. She seemed confused most of the times and didn’t know where she was and why she was there. Though she did remember and recognized her immediate family and friends and also remembered the events taken place years ago, but she would often forget what she was doing at a particular time in the immediate setting. Sometimes she would find it difficult to retain something that happened minutes earlier. There were times when she would become disoriented to time and place and would wander off around the hospital. Since she was almost at the initial stages of the ailment, whenever she felt that she was losing track of something happening around her in particular, she would start to panic. Sometimes, her inability to keep track of things made her feel quite helpless, in reaction to which she would sometimes lash out in aggression. Sometimes, she would also zone out even while someone was talking to her, which indicated that her attention span had declined. She also started to have language issues and often found it hard to put her thoughts into words. The realization that aging was taking a toll on her both mentally and physically, Sara had started taking too much stress and was often depressed for her condition. She had also started avoiding meeting people, instead resorting to social withdrawal so as not to get embarrassed because of her condition. Such behavior is quite common in people suffering from dementia as was also observed in a study carried out by Brataas et al (2010). In order to provide a rationale for choosing this particular disorder, following two reasons can be highlighted: Dementia is a mental disorder that not only affects the physical wellbeing of the person but also has a great influence on the psychological and social aspects of the person’s life as has been stated by McCabe (2008) cited in McVeigh (2009). A person suffering from dementia is not stable in the sense that s/he might remain confused and disoriented from the surroundings (Cayton, 2008) and hence, always need someone (particularly the nurses) to keep an eye on them and to assist them through the day. This goes on to show that it is a disorder that requires a high level of involvement on part of the healthcare service providers and is hence, quite related to the field of this assignment (Nord, 2004). As was the case with Sara; her dementia was still at a developing stage, and hence, she was having a hard time dealing with it. She felt very helpless and underwent major depressive and aggressive episodes which would then require assistance from the nurses to calm her down or to keep a watch on her when she got disoriented. This goes on to show how important a role the nurses play in the lives of this domain of patients. On the other hand, another rationale for choosing this domain of illness is that it is a field that has a lot of potential for the nursing profession. Therefore, the students coming into this field also need to have a better understanding of dementia so that they are able to better deal with such patients when they are assigned to them. By studying this disease, fresh nurses would be able to emphasize its importance and this is precisely why this domain of disease was chosen. Due to the crucial role that the nurses play in the lives of patients with dementia, it is equally important for the nursing professionals to gain and give out an in-depth knowledge of the disorder in order to be able to effectively give the care they require (Lawson and Peate 2009). Dementia deprives the person from coherent behavior. By selecting this particular disease, the writer attempts to bring to attention the significance of this particular domain of disorder. The writer specifically chose this condition so as to better decipher the characteristics of patients of dementia through the first-hand experience. Having actually spent time with Sara, the writer was greatly influenced in terms of realizing how critically such patients need assistance especially from nurses. Having to interact with Sara on a first-hand basis was a learning experience for the writer as well as an experience that redefined her preconceived notions related to the patients of this disease. With the increase in aging population, the number of people being inducted in healthcare services because of dementia is also on the rise. However, despite the crucial role that nurses play in this field of disorder, there are many in this profession that remain limited in their knowledge in relation to this domain and are not able to effectively deliver the care that the patients rightly require (Robinson and Cubit 2007). Sara’s condition had particularly been selected by the writer for this very purpose because dementia is a field for nurses that has a lot of scope for greater learning and is also a line of work that needs attention. The new nurses being assigned to take care of dementia patients should accordingly be briefed about the implications of this disease for the patients in order to be prepared to care for them (Robinson and Cubit 2007). The writer herself was a bit hesitant when she got assigned to Sara as she had similar concerns, but having to interact one-on-one with the patient and getting to know her core issues, changed her perspective of the whole scenario indeed. Epidemiological data relating to Sara’s condition shows that there can be numerous factors that lead to dementia, the most prominent of which is the age factor. A similar case was diagnosed with Sara; her brain tissues had weakened and that was considered as her triggering factor of dementia. Although, dementia cannot be characterized as a subsequent disease of aging, however the risk of various forms of dementia significantly increases with age. Hence, the case of Sara could be considered as caused by such similar implications of aging. If some specific genetic mutations run in the family, the person would be at a greater risk to develop dementia, but it cannot be generalized. This is due to the fact that many people with a family history of dementia don’t get to encounter this disease and there are also many that suffer from it despite having no one in the family with the same illness. Sara’s case, however, relates to the former. On analysis of her family history, it was found that her sister, who had passed away a few years back, had also been a subject to this disease, while none of her parents had suffered from it. The sister had developed it after she was 70 years of age, which shows that Sara has comparatively been a subject to it at an earlier age than her sister. People having developed the Down syndrome when they reach middle age are also likely to develop dementia-related tendencies in the future. Other than that, it is also believed that an increased abuse of alcohol and smoking can also lead to dementia. Statistics relating to dementia found out by a research carried out by Personal Social Services Research Unit (PSSRU) at the London School of Economics and Institute of Psychiatry at King’s College London (2007) show that there were around 700,000 patients of dementia in the UK in 2007, while the forecast shows that there will be over a million people with this disease in the same region by the year 2025. The ratio of this disease among males and females is as such that two thirds of the population with this disease comprises of women. This goes on to show that Sara is just one of the many women with this disease. Dementia has been considered as the cause of death for 60,000 people in one year. The study also shows that the overall financial cost of dementia in the year 2007 was 17 billion pounds a year to the UK. It also shows that around 64% of the people living in care homes are subject to dementia. More studies further show that currently there are 750,000 people with dementia in the UK, which makes 1 among every 82 people of the population. The cost of this disease in the UK has also gone up to 20 billion pounds a year (Brought to My Senses, 2011).  It is therefore, of crucial importance for the healthcare professionals to develop a thorough understanding of this disease in order to be able to deliver the required care effectively. Among all the other healthcare workers, it is the nurses that play the most important role in the lives of patients with dementia (Traynor et al, 2010). Observations of Sara’s case show that sometimes she seemed really distorted and had no clear sense of where she was or what she was up to. Just like the description of her condition, most of the patients also suffer from similar symptoms of dementia. Brotchie (2003) cited in McVeigh (2009) that such patients most often suffer from memory loss, shorter attention spans, confusion and disorientation, which sometimes lead to depression, stress and aggression. Generally speaking, patients with dementia can be classified into three categories, older patients with long term dementia, older patients with mild cognitive impairment, and older patients with acute onset confusion (Moyle et al. 2010). It is believed that Sara’s case belonged to the second category of mild cognitive impairment. Many of the patients with dementia are mostly admitted to healthcare settings that can better provide them with care around the clock. The patients might require constant monitoring as they might wander off in confusion, or their condition might be so acute that would make them incapable of doing their routine tasks. For such patients, it is necessary that nurses be present to assist them even for tasks such as changing clothes, taking baths, and use of incontinent pads in order to maintain personal hygiene (Volicer and Hurley 2004). Sara’s case was no different as despite having not reached the critical stage of her disorder yet, she still needed 24 hours supervision for her care which was then catered to by the nurses. Dementia is an ailment that cannot be taken care of with just the run of the mill procedures. Nurses dealing with the patients under this domain of disorder have to be properly trained for specialized care of these patients. They have to be briefed on all the symptoms, causes, and aftermath of this disorder. They should also be employed with techniques and the caring procedures that have to be followed over the varying types of patients of dementia (Qizilbash, 2002). The new entrants in this field should also be briefed by the old, well experience nurses who are better at dealing with such patients. This would help the new nurses to be able to better deal with the situation when they encounter hands-on patients (Jones & Miesen, 1997). Having decided to take up this particular disorder for study, the best option to further elaborate on the topic was decided to be the Roper-Logan-Tierney Nursing Model, considering it would enable the writer to study every aspect of Sara’s life that is influenced due to this disorder/dementia. The model focuses on the everyday activities of the patients’ life and analyzes the domains in which the patient care might be assessed, as has been verified by Roper et al. (2000) cited in Alexander et al. (2006). This model was chosen because of the fact that dementia is a very subtle form of disorder that has a deep impact on the brain functioning of the patients, which in turn triggers a diverse set of reactions. This type of model can be quite suitable for effectively getting to the core of issues that the patient has, as it analyzes all aspects of the living of the patient. In terms of biological assessment in accordance to Roper et al (2000) cited in Alexander et al (2006), the model would help analyze the problems that this dementia disorder is causing in Sara, be it in her communication, breathing, washing and dressing, sleeping, mobilization, and communication etc. The Roper-Logan-Tierney Nursing Model is essential because when applying the model to practice, there is a danger that some nurses may use it simply as a 12-point checklist for their guidance as well as to assist them in subsequent aspects of care. Since Sara had difficulties with mobility, hence fall prevention assessment tool was used because of her instability and history of falls. The tool was used to assess her progress in mobility which was then recorded in her falls-care plan. The use of bed rails’ assessment tool was made after it was assessed by physiotherapist/occupational therapist after Sara’s arrival into the care; she was found eligible for use of bed rails (cot sides) and it was established that it will be best for her to minimize the falling. Moreover, the dependent/independent continuum nursing framework was also found applicable to Sara’s condition in order to assess the level of assistance that she might require from caregivers. As Sara was slightly wobbly on her feet, hence she did need some assistance in her daily activities. This framework is quite important in the nursing context because it verifies the extent to which the patients can handle themselves as well as the sort of assistance they might require. The paper will now give a brief insight into the daily activities of Sara, the understanding of which is crucial for the effective application of the model and for drafting the required care considerations for this patient. On arriving at the hospital, after she was shifted to the ward, it was made sure that Sara had her medication regularly as prescribed by the doctor, and was cared for properly by the staff due to her issues of encountering confusion, memory loss, and aggression. Safety was maintained at all times with close supervision when she was handed over to the healthcare professionals, including the writer. In terms of food intake, her appetite was not so good, as is the case with many similar patients (Mahoney, 2000) and hence, she was encouraged to take plenty of fluids to decrease dehydration. She was of a normal weight, and nutrition assessment was recorded daily in order to assess her weight loss. She was observed while eating to prevent any choking. She also needed assistance with dressing and cutting her food. Moreover, she was partially dead/blind and needed to be provided with hearing aids and glasses in order to hear and see properly. Hearing aids/glasses were removed before she went to bed, and upon waking up were put back on. Such sensory disabilities have a high probability of occurring when it comes to dementia (Pace et al, 2011). Sara was prescribed laxatives medication to help with her bowel movement as she was constipated at times. In this context, Burns & Winblad (2006) also verify that constipation is a problem that is quite related to the dementia patients. In order to deal with this, Sara was also encouraged to take plenty of fluids. A bowel chart was recorded daily even though she didn’t use it; however it still indicated bowels not opened on her chart. She was incontinent of urine and feaces and wore pads to decrease her incontinence. MSRA screening and urinarlysis test was also done on her arrival as she had UTI and was hence, encouraged to drink plenty of fluids. She was also assessed through psychotherapy after her admission in the hospital and was classified as independent with zimmer frames, though she was wobbly/not stable on her feet, and needed close monitoring; a commode was put besides her bed in case she needed to use it. Weakening of mobility is likely to occur in dementia condition as stated by Marshall (2005). Observations for checking the body temperature were carried out daily to check if the temperature was hypo or hyper. In case of anomaly, further precautions were carried out for medication and fluid’s intake. It is universally crucial to maintain hygiene, but it is something that can barely be managed by patients who are mentally instable on their own, and hence, often require assistance in this matter (Cayton et al, 2002). Sara’s personal hygiene was vigorously maintained with the assistance of two staff members as she was aggressive at times. The above mentioned daily activities had specifically been chosen for the purpose of the fact that they are the most defining areas in which Sara required assistance and care from medical staff. Such an insight can help analyze the level of dementia the patient is suffering from and also help draw a conclusion on how serious the situation is for the patient. The issues of the patients of dementia are not just restricted to the physical domain and that is precisely why this model has been found most suitable for its assessment, as it also takes into consideration the biological, psychological, sociocultural, environmental and politico-economic aspects of their situation (Roper et al, 2000). The model would help analyze the scope of the patient’s illness and its impact on the overall health. It is also anticipated to consider the psychological implications being caused by dementia, as well as the emotional instability, depression and/or stress being caused by the patient being caused by it. Along with that, the model will shed light on the environmental implications on the dementia patients. In Sara’s case, the writer assessed her situation in accordance with the above model. As the extent of her dementia had not completely rendered her incapable of functioning, it was suggested that the patient be sent home to her family. There were, however, a number of issues that had to be taken care of. The writer, being the nurse appointed to Sara, personally got involved in the discharging process of Sara, to be better able to sort out what might be needed to her for assistance. As Sara was still very close to her family, she recognized and felt more comfortable with them, hence the question of her not being able to live at her home was sorted. However, as she often got disoriented from her surroundings, the family was instructed to have someone by her side at all times for monitoring. It was also recommended that a specific structure of consistent daily activities be set for her routine to help her develop a sense of structure and familiarity. It was suggested that specific time slots be specified for activities: such as waking up, bathing, meals, receiving visitors, and bed time etc. According to Russel et al (2011) the establishment of such routine tasks can greatly help in orientating the patient. As Sara was increasingly getting more aware of her inability to keep track of things, it was advised that she be kept busy at all times so that there’s lesser probability of her wandering off in confusion. Studies show that it is best to involve such patients in different activities from day to day so as to stimulate different senses of sight, touch, smell, or hearing (Russel et al, 2011). A specific schedule had also been handed to her family members so as to keep Sara busy with activities that would take her mind off of disorder for some time. The writer also arranged a district nurse referral to check on her every couple of days to make sure she was fine. Specific health care center options had also been given to the family and Sara, in case her situation worsened or if her family were unable to manage Sara at home. In addition to that, other arrangements were made at home, for example the arrangement of cot sides to reduce the risk of falling off the bed. An occupational therapist arranged a hospital bed for her after the assessment for that very purpose. Before her discharge, the psychotherapists involved in her care did a final assessment on her mobility and concluded that it was okay for her to be discharged. Since she was previously living with her husband, she wanted to go back to the same place upon discharge. The occupational therapy was conducted at her own house; since she had no carers, it was concluded unsafe for Sara to be left with her husband as they were both old in age. Therefore, she was referred to social services for care package and was assigned to a district nurse for other checks up. The doctor had prescribed a list of medication and one of them was (donepezil-aricept) which was advised to take home for continuing treatment for dementia and other related symptoms. Advice and support were given to Sara on the number of times she should take her medication a day; they had written this advice on a piece of paper with clear instructions in case she forgets or the carers/husband have to dispense to her. She was advised on eating habits; a well-balanced diet was encouraged. Continent pads were also given on discharge to control her incontinence at home. In coherence with the results of the study by the National Institute on Aging (2007), the primary caregivers of Sara were also instructed to watch for signs of agitation or frustration in the activities of her routine and to deal with the situation accordingly. They were motivated to involve her into the activity procedures as much as possible in order to develop her interest or to gain her consent in doing a certain task. If Sara started getting agitated, the staff was instructed to be patient and polite with her and to distract her gently. It was also advised that exercising be made a regular part of her routine in accordance to the physical activities that she enjoys: such as walking, swimming or gardening etc. However, it was emphasized that she is not over exerted. In order to deal with sleeping issues, it was asserted that Sara be involved in physical activities during the day and that her caffeine intake should be restricted during the latter part of the day. At night time, a peaceful and quite environment was advised to be set around her to encourage sleeping. Developing a specific bedtime is also a great help in such cases. To avoid the patient from going out of the house while wandering, it was advised that the doors be kept locked so as to reduce the risk of her going out and getting lost. In conclusion we can state that Dementia is a disorder that has been observed to be on a constant rise. It is a matter of serious concern, not only to those suffering from it, but also their families. Dementia patients are very sensitive and cannot be left on their own due to their disorientation and confusion. This is why nursing plays a very important role in their lives; even more than doctors, it is chiefly the nurses who assist them most in easing their living and pain. Due to the crucial role that nurses play in the lives of dementia patients, it is equally important for the nursing professionals to gain and to give out an in-depth knowledge of the disorder so as to be better able to effectively give the care that they rightly require (Lawson & Peate, 2009). The writer, that is a practicing nurse, having being assigned to Sara’s case for care, found this whole experience very enlightening. She gained and learned a lot from directly interacting with Sara. The writer learned that these are the patients that not only require medical support from the helping professions but are also in need of moral support and assistance. As a student adult nurse, the writer found this whole learning experience completely invaluable. Her placement with Sara opened her eyes to a whole new dimension of the nursing profession in terms of actually looking after those in need by caring for them, and not merely attending to the duties. The writer hopes to be capable of carrying forward all that she has learned, and henceforth, be better able to cater to patients with such disorders in a more effective manner. Catering to adult patients of mental disorders such as dementia can be considered as a significant domain of career opportunity for those pursuing nursing profession. These are the patients that require varying degrees of observation that the nurses cater to through various mediums: such as in hospitals, health care homes, and at their own homes etc. However, there is a need for nurses to be better trained in such a domain of disorders, so that essentially when they come face to face with such patients, they are better prepared to deal with the situation. Bibliography: Brataas HV, Bjugan H, Wille T & Hellzen O (2010), Experiences of daycare and collaboration among people with dementia. Journal of Clinical Nursing 19: 2839-2848. Brought to My Senses, 2011. 2011 Dementia Statistics in UK. 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