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).

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

The Code, 2015)

Your Bibliography: The Code. (2015). [ebook] Nursing and
Midwifery Council. Available at:
https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdf
[Accessed 26 Apr. 2018].(McClain and Buchman, 2011)

McClain, G. and Buchman, M. (2011). After
the diagnosis. [Clifton Park, N.Y.]: Delmar Cengage Learning.

Gardner, P. (2003). Nursing process in
action. Australia: Thomson, Delmar Learning.

Prince, Martin, Comas-Herrera, Adelina, Knapp, Martin,
Guerchet, Maëlenn and Karagiannidou,

Maria (2016) World Alzheimer report 2016: improving
healthcare for people living with dementia:

coverage, quality and costs now and in the future. Alzheimer’s Disease International (ADI), London, UK

(Kaplan, 1996)  Kaplan, M. (1996). Clinical practice with caregivers of dementia patients. Washington, D.C.: Taylor & Francis.

(Patient experience in adult NHS services: improving
the experience of care for people using adult NHS services, 2012) Patient
experience in adult NHS services: improving the experience of care for people
using adult NHS services. (2012). NICE.

Ellis, M. and Astell, A. (2017). Adaptive interaction and
dementia.

Brooker, D. (2007). Person-centred dementia care. London:
Jessica Kingsley Publishers.

(Bhardwa, 2015) Bhardwa, S. (2015). Barriers to dementia care. Independent Nurse.

(Cna-aiic.ca, 2018)Cna-aiic.ca. (2018).
Barriers to Nursing. [online] Available at:
https://cna-aiic.ca/en/nursing-practice/evidence-based-practice/barriers-to-nursing
[Accessed 26 Apr. 2018].

Collins, J. and Hughes, J. (2014). Living and dying with
dementia in England: Barriers to care. London.


 

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