NURSING PEOPLE
WITH DEMENTIA – THE WAY FORWARD
Bahagia Zakaria
TOPIC OVERVIEW
• DEFINITION
• SYMPTOMS
• UNDERSTANDING SYMPTOMS
• NURSING PRINCIPLE
DEFINITION
• Dementia is a syndrome in which there is deterioration in memory, thinking, behaviour and the ability to perform everyday activities.
• Alzheimer's disease is the most common cause of dementia and may contribute to 60–70% of cases
Common Cause of Dementia
SYMPTOMS
• Memory Loss Short-Term Long-Term
• Communication (dysphasia/aphasia) Vocabulary shrinking
Unable find the right word
Difficult to understand what is said
• Dyspraxia/Apraxia
Difficulty in carrying out with sequencing or daily activity
SYMPTOMS
• Concentration
Difficulty to concentrate for periods of time
• Recognition
Difficulty to recognize familiar people, objects, sight, places, sounds
• Orientation
Difficulty with finding ways, time, date etc
• Perception
Misinterpreting or misjudging things or seeing things that is not there
• Psychological Changes
Irritable, withdrawn or depressed
UNDERSTANDING THE SYMPTOMS
IMAGINE….
“I wake every morning and see unfamiliar
faces, voices and places. I hate the fact that I can’t tell people that I do not want have shower early in the morning. I feel so irritable as my
knees are aching most of the times. The people
around me do not understand me and accusing
me to be difficult and cranky…”
DEMENTIA PATIENT MAY FEEL
DEMENTIA
Miserable In pain
Unwell Medication
Effect
Frustrated Unable to communicate
Worried Health Problem
Scared Too Noisy Background
Confused People speaking too
quickly Uncomfortable
Light too glary Feeling Lost
Unfamiliar people and environment
NURSING PRINCIPLE
• SKILLED, SUFFICIENT STAFFING
• PARTNERSHIP WITH FAMILY CARERS
• ASSESSMENT AND EARLY IDENTIFICATION
• PERSON- CENTRED CARE/INDIVIDUALISED CARE
• ENVIRONMENT FRIENDLY
Skilled, Sufficient Staffs
SKILLED, SUFFICIENT STAFFS
Registered Nurse
• Diploma or Degree of Nursing
• Post Basic In Gerontology Nursing
• Nurse Practitioner in Dementia Care
Carer
• Certificate in Aged Care
Personal Care Assistant/Nursing Aides
SKILLED, SUFFICIENT STAFFS
Diversional Therapist
• Certificate in Health and Leisure
• 18 months ( or longer)
• Diversional Therapy recognizes that leisure and
recreational experiences are the right of all individuals
• Diversional Therapists promote the involvement in
leisure, recreation and play by reducing barriers to their client's participation and providing opportunities where the individual may choose to participate
SKILLED, SUFFICIENT STAFF
Resident 1
• Name : Mr X
• Age : 84 years
• Gender : Male
• Diagnosis : NIDDM, HPT, CCF, Dementia with Wandering Behaviour and Hallucination, Urine and Faecal
Incontinence
• Mobility : Walks with walking Aids
SKILLED, SUFFICIENT STAFF
Resident 2
• Name : Mrs Y
• Age : 87 years
• Gender : Female
• Diagnosis : Fracture neck of femur, DHS done – 1/52 ago, OA both knee, Dementia, Depression, Urine and Faecal Incontinence
• Mobility : Immobile
SKILLED, SUFFICIENT STAFF
• Why?
• Accurate assessment
• To support complex needs and numbers of residents
• Good understanding of condition
• Good Communication
• Well-being and better quality of life
• Prevent staffs burnouts
SKILLED, SUFFICIENT STAFF
• How many is sufficient?
• Depends on
Number of residents
complexity of care ( ADL, Health Complex and behaviour)
• Staff : Resident Ratio in Private Health Care Act 2006 for Geriatrics Care 1 : 4 with 40% Registered Nurse
SKILLED, SUFFICIENT STAFF
• Important to Remember
• Organization Philosophy Of Care/ Vision And Mission Statement
• WHAT IS YOUR ORGANIZATION PHILOSOPHY OF CARE?
• DOES YOUR CURRENT STAFFING STATUS MOVING FORWARD TO ACHIEVE THE PHILOSOPHY?
TRAINING AVAILABLE
• Post Basic / Professional Certificate in Gerontology Nursing
Duration : 6 months
Institution : Ministry of Health & KPJ University College
• Care Assistant : 4 months ( General )
Institution : KPJ University College , JB Branch/
Private Nursing College
• Courses and Seminar on Dementia Care : Various Organization
• Upcoming Course :
Certificate of Aged Care ( Carer) Duration : 3 months
Institution : KPJ University College, Nilai
PARTNERSHIP WITH FAMILY CARERS
PARTNERSHIP WITH FAMILY CARER
• Carers provide us :
• Background Information to help solve problem
• Histories, routines, stories, interests
• Previous routines and hints for personal care
• Consent for treatment / management
• Carers require:
• Emotional support
• Open communication
• Be involved in patient care
• Information on care, services throughout the organization
• Recognize their expertise
PARTNERSHIP WITH FAMILY CARER
• Why Partnership with family carers is important?
• Assist to achieve our mission or philosophy of care
• How?
• Sharing what they have learned through their experience of caring
ASSESSMENT & EARLY
IDENTIFICATION
ASSESSMENT AND EARLY IDENTIFICATION
Fundamental to good care
To be performed by skilled, knowledgeable practitioner To ensure appropriate care and treatment
ASSESSMENT AND EARLY IDENTIFICATION
• Assessment Tool usually comprises of :
Routine blood investigation
Midstream Urine if delirium if suspected
Cognitive assessment :
Attention and concentration
Orientation
Short and long-term memory
Language
Executive function
Common Assessment Tool
• Mini Mental State Examination ( MMSE)
• Montreal Cognitive Assessment
PERSON-CENTRED CARE
PERSON-CENTRED CARE
• An individual care or person centred approach
• Appreciate the uniqueness of dementia patient
• Improve quality of life
• Try to understand dementia patient and issue matters to them
• Treat the person not the disease
PERSON-CENTRED CARE
- CENTRE
- ACCEPT - RESPECT - ENABLE
C
A
R
E
CENTRE
• Centre on the person
• Explore :
• Retained ability and skills
• Culture
• Relationship
• Health
• Likes and Dislikes
• Disability
• Tailor care accordingly
• Consider cultural and belief
ABOUT MY SELF AND HOW I WISH TO BE TREATED
40, Malay, Muslim
Married, 3 children
Food Picky
Loves to sleep in dark room Does not believe
in superstition Loves Red
Colour Go to bed late,
late riser Does not like many visitors
Loves reading
Dislikes watching TV
ACCEPT
Frontal Lobe
Planning, organizing, judging, initiating, insight Parietal Lobe
Pattern( Putting steps together to complete task),communication, Spatial awareness
Temporal Lobe
Filing System, Memory Limbic System
Sleep, Appetite, Emotion
DECLINING BRAIN FUNCTION
ACCEPT
• Accept Patient disabilities
• Accept that what ever they do is undeliberate
• Do not take what they say or do personally
• What work to one person may not work for another
• Spend time to solve problem
DOES THE SAME TREATMENT WORK
FOR BOTH OF THEM?
RESPECT
• Treat patient as an adult
• Treat patient not the disease
• Be patient, flexible and creative
• Maintain dignity
• Involve patient in meaningful and purposeful activity
ENABLE
• Maintain skills, ability, dignity and self-esteem
• Maintain safety and feeling of security
ENVIRONMENTAL FRIENDLY
ENVIRONMENT FRIENDLY
• Minimal movement between ward
To reduce stress due to unfamiliar environment
• Appropriate flooring
Less glaring surface
• Adequate lighting
Less glary
Evenly illuminated
• Easy to navigate facility
Lighting, personalized room, adequate illuminated eye level signage
ENVIRONMENT FRIENDLY
• Familiar/Personalised Bed Area
Allow personal familiar item e.g. photo, bedding, small furniture, books
• Space to support activity and stimulation
Quiet Room, Activity room
• Family Area
Family visit and activity
ENVIRONMENT FRIENDLY
• Dementia with Wandering Behaviour
Closed and secured area e.g. locked spacious area with combination lock system
Spacious indoor area
ENVIRONMENT IS NOT MERELY BRICKS AND MORTAR
• Tailored to suit need
Eye level signage
Turn on toilet light at night
Open toilet door
• Reduces stress/trigger
Minimal background noise
Play relaxing music
Create homely environment
• Encourages activity to maintain skills and ability
Good staffs communication
Provides suitable facility
SENIOR LIVING CARE CENTRE
• Another new venture by KPJ Healthcare Berhad
• Latest expansion of Tawakkal Health Centre
• Concept of Care :
Provides comprehensive treatment by Medical, Nursing and other Healthcare Professionals and Providers for elderly.
The facility will adopt as much as possible homelike
environment i.e. providing home like bed with resident’s choice of deco and momentos with opportunity to
healthy socialization and recreational activities
No of : 45 beds
Target of Date of Operation : 1st Quarter of 2014
