Best Practice for the Management of Dementia Patients in the Acute Care Setting - Literature review Example

Best Practice for the Management of Dementia Patients in the Acute Care Setting. Introduction Dementia has been known to greatly interfere with the human intellectual functions. It consists of various types, ranging from Primary dementia, Multi-infarct dementia, Lewy body dementia, alcoholism-related dementia, dementia due to brain-structure abnormalities, to infection-related dementia. This disorder can crop up in any individual at any age especially due to head injuries, dietary deficiencies, oxygen deprivation, metabolic disorders, and inherited diseases. Its prevalence increases faster with age and it is mostly common in older people, where after the age of 60 its impacts have been known to double, as such it is the chief reason for institutionalization of the aged. The care needed by these patients and the best practice for managing these patients in the acute health care setting, especially considering their cognitive deficits, is therefore of paramount consideration. Some best practices for managing dementia in the settings include ensuring proper communication, drawing proper conclusions (getting full details), and maintaining high standards of hygiene. Best management practice for dementia in the acute care setting. According to Norberg (1994), the nurses have a responsibility of conducting proper communications with the dementia patients in these settings. This is because without proper communication the treatments are most likely to be ineffective. It is worsened by the fact that the nurses may go against the integrity of the people. This comes as a result of the real nursing situation, where the nursing staff might sometimes force themselves upon the dementia-suffering people in order to ensure they perform their duties. The most given reason for such actions from the nurses is due to the fact that the patients may sometimes refuse help from the staff, and as such the nurse may use force to help them. The impacts of miss-communications between the nursing staff and the dementia patients are quite adverse. An instance is when patients with diminished communication capacity relay their emotions or feeling to the nurses through projection, which consequently makes the nursing staff very uneasy and frustrated. As such therefore, as argued by Byrne (1997), the duty of providing good care to the patients might be stressing, this stress can then be easily transferred to the patients suffering from dementia, hence worsening their already existing poor health conditions. Proper communication is also vital for nursing practice since the nurses are able to allocate enough time for basic care of the patients. Miss-communications have often led to the nursing staff devoting very little time in caring for the dementia patients because most of the nursing staff often work according to their routines, as opposed to working in accordance with the dementia patient’s needs. Long (2009) on his part notes that some patients are often neglected due to communication difficulties between the nursing staff and the patients, as the patients have difficulties in expressing themselves and would require much time for their body language to be interpreted. In as much as the idea that the dementia patients may communicate as well as play a vital role in their care is greatly challenging to a majority of the health-care providers, various studies carried out provide sufficient evidence showing that people suffering from dementia always retain their communication skills. Therefore, since this kind of communication relies much on whether nurses believe it is possible or not, the nurses should strive to ensure they develop proper communication strategies, get as much information from the patients as possible and use such to advance the care they give to the patients (Goldsmith, 1996). Morton (1999) suggests that the individuals having the disorder of dementia always need a lot if assistance to ensure they are clean and maintain high hygiene standards. This is due to the fact that, with the progress of the disorder, the ability of manipulating objects like the combs and the toothbrushes are always lost and as such they are incapable of doing such activities on their own. Sometimes the patients with the disorder do forget what the objects are, hence most importantly, which activities are the objects used for. They as well often forget that they have a responsibility and sometimes always have a notion that the task has been performed. Such patients always lose the interest of cleaning themselves as well as the interest of looking good. However, in as much as the patients require help, they sometimes don’t appreciate getting the same, and as such always refuse help hence lead to a lot of struggle. Sometimes the patients resent being dependent on the nurses, in addition to feeling their privacy is being invaded by the nurses. Worst still, the patients may feel that washing regularly, or caring for their appearance, is not important. As such high levels of hygiene should be ensured by nurses in the acute care settings as this also tends to eliminate other infections in the setting. Provision of oral hygiene to the patients is one of the most crucial hygiene steps, especially for the elderly who are cognitively impaired, where such hygiene is quite a great challenge, as argued by Rosewarne et al (2000). Such challenges arise from the fact that the elderly have a reduction in their physical dexterity apart from having sensory functions that are impaired. These challenges are further worsened by the cognitive deficits, behavioural and communication problems that the patients have. Polypharmacy as well as co-morbid medical conditions have been known to have both direct and indirect impacts on the oral health and the oral hygiene care. The drugs with such oral effects include the anti-psychotics and the anti-depressants. Oral problems might affect the general health of the patients, for instance plaque accumulation in the teeth and aspiration pneumonia are quite related, and the same also applies to periodontal diseases and the cardiovascular diseases. This implies that in order to avoid further deterioration of the condition of the patients, it is necessary for the nursing staff to maintain high hygienic standards and providing appropriate assistance for the changing needs of the patient while respecting their integrity (Bellchambers, 2007). While handling the cases of dementia, it is crucial for the nurses to avoid rush, undetailed conclusions. Kitwood (1998) also claim that it is very important for the nursing staff to realize that lack of adequate information concerning the patient may result in worsening of the already existing problem. This can as well lead to the application of inappropriate interventions for the care of the patients. Thus, the nurses should ensure they obtain complete information which is necessary for the treatment of the patients so as to avoid assumptions and jumping in to conclusions. The nursing staff can do this through asking the relevant questions in a slowly manner, yet loudly, while giving the patients adequate time to respond to the questions. This will help the nursing staff to improve their chances of attaining the information that has been requested, as some few minutes of the interviewing may direct the nursing staff to a better conclusion, as opposed to reaching a conclusion that there is no useful history that can be provided by the patients. It is also vital for friends or the family members to be included in this interview since they are often well aware of the situation and are a potential source of information which cannot be provided by the patient. The family members as well as the friends of the dementia patient can furnish the nursing staff with a great quantity of valuable information and skills, as Rosewarne (1996) puts it. The information that the nurses might get from the friends and the relatives of the patients, and which is most crucial to the care process, is the information on the history of the individual. Other relevant information that can be provided to the dementia care process include the information on the individual requirements of the patient, information on the values of the patient, information on the patient beliefs and also information on the interests of the patient. Fully detailed information about the patients greatly aids the nurses in easily caring for the dementia patients apart, from ensuring they provide the patients with personalized care. As such, a full understanding of the patients is very crucial in providing the patients with quality care. The nursing staff is therefore expected to know and comprehensively understand the family networks, the social networks, the activity preference of the patients, as well as the cultural background and personal history. All these information are very useful to the general process of dementia care (Parker & Penhale, 1998). Conclusion Dementia care, as has already been discussed above, needs a lot of cautious actions, better understanding of the condition, more knowledge, humility and much tolerance in order to be effective. As such, it presents a lot of complexity to nurses who might sometimes find this very stressing and decide to act irresponsibly. Although, with proper nursing practices, the nurses are guaranteed to handle dementia cases within the acute care settings in a very professional and successful way. Therefore, the best practices for managing dementia patients in the acute care settings, as known to date, are very numerous. Although The most effective practices for managing this disorder within the acute care settings have been recognized by various health researchers as providing the patients with the best standards of hygiene, getting complete details of the patients (including their backgrounds and illness history), and maintaining proper and effective communication between the patients and the nursing staff. Bibliography Rosewarne, R., Opie, J. R., & Ward, S. M., 2000, Dementia Specific Care in Australia: An Overview and Future Directions in Special Care Units, Serdi Publisher, Paris . Norberg, A.,1994, Ethics in the care of the elderly with dementia. In Principles of Health Care Ethics, JohnWiley & Sons Inc, New York . Rosewarne, R., 1996, Care Needs of People with Dementia and Challenging Behaviour: Literature Review, Commonwealth Department of Health and Family Service, Canberra. Morton, I., 1999, Person-centred Approaches to Dementia Care, Speechmark Publishing Limited, England. Goldsmith, M., 1996, Hearing the Voice of People with Dementia. Opportunities and Obstacles, Jessica Kingsley Publishers, London Northington W. 2007, Caring for the Aged: The pathophysiology of aging & and it’s significance applications for prehospital care.26: 194-198. Byrne, G., 1997, Communicating with patients who have dementia using a symbolic interactionist perspective. J Adv Nurs Vol: 99, Issue: 48, Page: 42 Kitwood, T., 1998, Improving Dementia Care, Hawker Publications, London. Long, S., 2009, Living with dementia. Communicating with an older person and her family. Nursing Ethics, Int J for Health Care Professionals. 6: 23-36. Parker, J., & Penhale, B., 1998, Forgotten people: Positive Approaches to Dementia Care, Ashgate, Aldershot. Read More