Individual Patient Care in Dementia

A nurse’s role focuses on the help, care and support given to their patients whilst treating people as individuals and upholding their dignity (The NMC code, 2015). In this essay I will discuss the ways in which nurses can ensure that patients with dementia receive individualised patient care. The aim of this essay is to demonstrate how care is implemented to patients with dementia and how nurses ensure care is individualised to meet the patients’ needs and wants.

Nurses can identify the individual needs of the patient by following the nursing process.  The nursing process is a series of stages intended for nurses to demonstrate excellent care. It consists of five phases: Assessing, diagnosing, planning, implementing and evaluating.  This process is client centred. These stages mean that nurses should individualise what is needed for one patient.  A patient needs, and problems is identified through these steps. The Assessment phase is the first step in which it allows nurses to identify what the patient’s needs are. The nurse collects information from the patient by asking them questions and running physical examinations. They dissect the information that is gathered in this stage in which it is further analysed which requires in dept thinking. The Diagnosing Phase is the next phase in which the nurses make an overall diagnosis about the information that was collected in the assessment phase (Gardner, 2003). It is stated that patients tackle a medical diagnosis with what mental health professionals name an anticipatory anxiety. They are nervous and scared as to what they are told and how it may change their day to day life for them and their close ones (McClain and Buchman, 2011).  The diagnosis of dementia entails of examination, cognitive testing and assessment. Nurses informing patients that their memory and cognitive function is beginning to change can be challenging and difficult to hear hence it is crucial that nurses should uphold their dignity and inform them of the treatment that will be applied and to give them the help and support they need. (Prince and Martin, 2016). The planning phase lets the nurses create a plan of action in which ongoing treatment will be discussed. This phase allows the nurses to address patient’s needs. The implementing phase is when nurses carry out the plan of action. For dementia patients their symptoms tend to go worse. It is vital that nurses demonstrate great care in which they can them support with daily activities e.g. washing and dressing them. They should also monitor the patient and focus on the improvements made by the patients. It is vital that the nurses care, monitor and support that is given to the patients is continuous. The care that is received by the patients with dementia is much lower as to those patients without dementia hence it is fundamental that the nurses ensure that care is individualised to the patients’ needs and wants.  For the last evaluation phase, it is crucial that nurses complete an evaluation to see if the treatment that was carried out is working and if any changes happen. If the treatment isn’t working nurses can support the client, analyse and understand as to why it didn’t work (Gardner, 2003).

Nurses should respect the patient’s beliefs and prevent making assumptions mainly grounded on their appearance or other personal quality. They must listen and consider patient concerns. It is vital that the nurse is non-judgmental and open minded towards the patient. Nurses can ensure care is individualised when it comes to fulfilling the nutrition, pain management and personal needs of the patient. If the patient cannot manage or is unable to regulate their nutrition, then the nurse should support and encourage the patient by placing food within their reach (Kaplan, 1996).

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Providing care to a patient who suffers from dementia is vital as the patient does not have the ability fully understand their diagnosis. As a nurse, it is encouraged to introduce yourself to the patient to create a therapeutic relationship during treatment. Patients who have dementia are no longer able to maintain their individuality and personhood hence why it is important that nurses can try and uphold and preserve it for them. Patients value nurses recognizing their individuality. Nurses reassure patients that one is not living a horrible and unhappy life by implementing the worth and value to their life by trying to get to know the person behind the patient. Nurses can ensure that care is individualised as they could get to know the individual, their values, likes and dislikes and hobbies as this gives the patient an individuality whilst always showing compassion and respect (Collins and Hughes, 2014). This is most valued and appreciated by patients as it allows the nurses to know the characteristic and the personality of the patient.  Nurses can show recognition to the patient by acknowledging their needs and wants and providing care that is customized and adapted to it. It is important that nurses try and build an insight of the patient’s world and how to bond with them. When communicating and engaging with them they must always say their name unless the patient wishes a different way of being addressed.  Nurses can consider the patients perspective when demonstrating care that is exclusively personalised to their needs.  Giving recognition to the patient allows the relationship to build much stronger as you are giving your attention and time to them.  Nurses would give the patients the choice and responsibility to make their own decisions when it comes to their choice of food, clothes they want to wear, getting involved in activities etc. Allowing the patients to make decision like this lets them know that they are comfortable. It also gives them a sense of involvement and participation to express their qualities and personality. However, when the discussion of making clinical discussions arises and the patient is unable to make the decisions due to cognitive abilities declining, the family and doctors will be more involved. Nurses should allow the patients to create their own pace in which you shouldn’t push the patients over their limits. It would be much of a benefit to focus on the improvements made by the patients even if it’s something small. This would motivate and drive the patient building their self-esteem. When a nurse is caring for a patient who has dementia it is important that you do not patronise them. Respect for the patient is a main aspect nurses must implement in their duty of care. Nurses can ensure that the care and treatment given to the patients is with both respect and compassion (The NMC code, 2015). Socialisation and interaction is fundamental for patients as it allows the patients to maintain a social life and form relationships. Allowing the patients to experience and be around company will progress their communication skills. Nurses should recognise that all patients including people with dementia is built in relationships and that dementia patients require a healthy social environment to promote opportunities for personal and mental progress.  Dementia affects the way a patient communicates. People suffering from dementia can find difficulties responding back to question (NICE, 2012).

 When conversing with patient with dementia they may also find problems to maintain the information during a discussion. Nurses must validate and shouldn’t dismiss what is said by the patient. They must try to understand and take notice of what the patient expresses to them.  Nurses can communicate in a calm and respectful way in which they should speak directly to the patient. It can be frustrating for a patient with dementia to communicate their needs and wants hence it is vital that nurses are supposed to remain calm and patient if the patient becomes agitated (Ellis and Astell, 2017).  When a patient’s conditions begin to deteriorate, health and social care needs begin to increase causing them to require more help and personal care. When nurses are relaying information to a patient they should give the patient both oral and written information, so it can be fully understood and so it can encourage and boost their communication skills in their care and treatment. When released from hospital, people with dementia are likely to suffer a serious loss of individuality, and increased needs for help and support. So, it is important that the care is demonstrated to patients not only during hospital but when they arrive home.  Nurses can try and view the world from the viewpoint of the person with dementia, distinguishing that everyone’s experience has its own psychological validity, that people with dementia act from this outlook (Brooker, 2007).

The ageing population is exponentially increasing resulting in challenges to nurses in coping and treating the conditions and health needs that arise with old age (Bhardwa, 2015). These barriers that I will be explaining are obstacles that prevent the pace of excellent care being demonstrated by nurses. The barriers to demonstrating care to dementia patients is that they receive poor quality in which nurses tend to focus on other patients with severe illness and diseases.  Another barrier would be ineffective advance care planning. Some people with dementia receive a delayed diagnosis which can result in them not having the mental capacity to attain decisions. A lot of patients find it difficult to vision their self-getting better due to their current state. Nurses can ensure that the care that is provided to people with dementia is quality care during the duration of their treatment. Hospice use is incredibly low for dementia patients. The people with dementia that get transferred to a hospice can result in confusion and distress at a state in which the person is unable to handle change. Also, they have completely different needs compared to cancer patience’s. It is crucial that both staff and nurses have the training required to deliver care to individuals with dementia. Age discrimination is also a barrier that elderly patients face in which the symptoms demonstrated to doctors and nurses is referred to a getting old. Nurses are failing to spot and notice the symptoms of dementia in a lot of patients which creates a poor rate of diagnosis (Collins and Hughes, 2014). The organization like the National Health Service also create barriers resulting in patients not receiving the care they need. They have limited access to resources, lack of time, heavy patient workloads and insufficient staffing. Nurses have a contribution when it comes to the barriers of providing care to patients. Some nurses have a lack of interest, lack of confidence in critical appraisal skills, lack of knowledge and them feeling overwhelmed (CAN, 2018). Dementia patients experience behavioural and personality changes. Patients that specifically have advances dementia tend to be physically aggressive, have hallucination and get agitated. These symptoms can result physical and emotional distress to both the patient and the nurse. There is also hostile treatment for dementia patients that is very familiar in which it consists of tube feeding and antibiotic treatment for infections. This treatment is known to be wrong and does not improve survival. Families of the patient shows great dissatisfaction against the aggressive treatment that is demonstrated to the patients. Nurses can implement excellent care by concentrating on improving patients comfort and increase in advance care planning (Collins and Hughes, 2014).

The points I explained in this essay show how providing and offering care to people with dementia can be complex and there can be a lot of boundaries that come along with it however when the when the needs, wants, choices and problems is focused and centred around the patient that’s when care is at its best. Nurses should always put the patient first. Nurses can value patients with dementia by promoting their self -worth and treating them as individuals.

References

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