GCNCP3 Clinical Project 2

Introduction

Dementia is a syndrome or a collection of various symptoms that affects the cognitive ability of elderly patients due to which they become unable to process their thoughts (Moyer, 2014). This syndrome could be chronic or progressive in nature and due to this, mild to severe effects are observed in their calculation, memory, thinking ability, learning capacity, analyzing skills and comprehensive orientation (Seitz et al., 2014). Further, with the commencement of deterioration process of cognitive ability, the patient’s starts developing emotional weakness that led become socially isolated (Moyer, 2014). As per the World Health Organization (2019), dementia is the primary reason for wide array of physical and mental disabilities among the elderly patients and it made them dependent on their family members as well as carers for activities of daily life. This results in increased consciousness, stigma and affects the care process by developing barriers where social, psychological and economic aspects prevail (Kasper et al., 2015).

In the United Kingdom, dementia has been emerged as a major concern for elderly population. With increased life expectancy and prevailing solitary lifestyle, more than 670,000 people in England are currently suffering from dementia and majority of them are above the age of 65 (Alzheimer’s Society, 2019). However, around the world, care process for dementia lacks even baseline requirements associated with lack of healthcare professionals, nursing professionals, infrastructure of care homes and Laws and regulations due to which majority of the patient are left unattended and their care needs are unmet (Alzheimer’s Society, 2019).

Therefore, as a care professional, specifically as a dementia care nursing professional, this has been chosen as the clinical area of nursing and improvement and acquiring skills for holistic and comprehensive care for the dementia affected patients has been chosen as the objective. In the paper, with the help of recent literatures and the researchers conducted, the gaps present in the care process of dementia affected patients will be found and then estimation will be drawn about the achievement of the extent of objectives so that those skills could be used to develop quality practice as a dementia care nursing professional (Moyer, 2014). Further, the benefits associated with this learning skills, barriers present in the learning of this skills and literature support present about the learning needs will be provided in the assignment. Finally, in the paper, the implication of the learning skills in the care process of dementia affected patient will be mentioned (Vaingankar et al., 2016).

Relevance of dementia related care

On 28^th February, 2012, The Telegraph (2012) provided a study details in which majority of the dementia care professionals were found agitated and disturbing while working with vulnerable dementia patients. This article mentions that majority of the nursing professionals working with dementia patients are not provided adequate training and skill development sessions and due to these, while working with older and vulnerable patients, they feel burn out or disturbed. Another news website The Conversation (2018) posted a report on January 13, 2018 that mentions the shortage of health care professionals in aged care centers due to which majority of the older patients affected with dementia are left unattended. It was mentioned in that news article that the shortage of nursing professionals in England are due to the high workload and increasing pressure due to increased life expectancy and increased number of older patients in the healthcare facility (Mitchell et al., 2017). Hence, these news articles published in reputed newspapers and websites points out towards the gap or lack present in the care system that increases difficulties for healthcare professionals while working with elder patients who are affected with dementia. Further, increased work pressure in the healthcare facilities and the lack of training or skills required for the care process of such patient’s increases the difficulties of nursing professionals due to which, patients, and their care needs remain unattended (Vaingankar et al., 2016). Therefore, from the above mentioned scenario, it is clear that gaps are present in the dementia care system and the gap is associated to the nursing professionals, their training and skill development because majority of them do not receive such training prior to join the healthcare facilities (Mitchell et al., 2017).

Reason for choosing this project

Dementia is known as a mental health condition, due to which people loses their ability to think comprehensively, to calculate the outcome of their action and can measure the impact of outcome of their actions (Gifford et al., 2014). Therefore, this mental trauma makes them vulnerable to minimum and negligible changes occurring around them. Further the care process of dementia should be inclusive of dignity, empathy, involvement of patients and they should be provided with ongoing support so that effective care could be provided. However, as per Science Daily (2017), in this age of globalization, healthcare sector is facing several issues related to nursing recruitment, their training and development. it has been seen in the research of Chinkhata (2016), that majority of the student and enrolled nursing professionals are forced to join the mainstream nursing force as the healthcare facilities are facing shortage of professionals. However, this early involvement of untrained and non-skilled nursing professionals is increasing the burden of care on the registered nursing professionals by increasing their responsibility of training them with ongoing care of patients (Chinkhata 2016). Due to this, burn outs, depression and agitation among nursing professionals have been witnessed. Therefore, these training and shortage of nursing professional’s related issues have been chosen as the topic of this assignment related to dementia patients. As it was mentioned in Fernández-Mayoralas et al. (2015) that while caring for dementia affected patients, nursing professionals should be acquired with specific training for communication, need assessment, psychological needs and medication administration of dementia patients.

Gaps that affect the process

As per an article published in the Science daily (2017), discusses about the gap present in the healthcare of dementia affected patients. It mentions that a majority of dementia affected patients, especially older women live alone during such illness and the number of such patients is increasing in high income countries. In Sweden, more than 45% patients affected with severe dementia or Alzheimer’s live alone in their homes and hence increasing risk factors in the course of their dementia could be witnessed. Hence, in this scenario, lack of adequate nursing professionals and the serious concern of the government for the care of dementia patients could be witnessed. On the other hand, Ford, Ford and Ford (2013) mention that lack of empathy and concern for the dementia affected people were present in the healthcare professionals due to whom they were unable to understand the needs or requirement of the patients. Besides that it was also seen that a majority of the healthcare interventions or care strategies applied by such healthcare professionals did not comply with the dementia care related standards, increased the reliability and validity related issues for the care process. Further, as per Brooker and Latham (2015), gaps associated to lack of nursing professionals in aged care facilities, increasing amount of burn outs and associated resignations of nursing professionals affecting the care process for dementia affected process (Zeilig, 2014). These gaps are important to meet for the improvement of the care process for the patients affected with dementia because such patients are very exquisitely specific about their requirements, their needs and about trusting the care facility. Hence, bridging the gaps has the ability to improve their health condition (Brooker & Latham, 2015).

Focus of this project

The primary focus of this project is to highlight the gaps present in the care process of dementia affected older individuals as Chinkhata (2016) mentioned that majority of the patients affected with dementia are not being able to utilize the available care provisions due to present social stigma and other barriers. Further, depending on the recent research evidences, the focus of this paper would be pointing out the nursing professional’s training and skill development as well as their burnout and increasing working pressure associated issues (Howlett et al., 2015). This would help to identify the reasons for the present gap in the dementia affected people’s care process and increasing number of unattended patient affected with dementia. After pointing out the gaps present in the process, this paper would propose the skills required to bridge the gap and its importance in the care process of dementia patient. Therefore, through this paper, the importance of skills development, effective communication and training required prior to attend a dementia affected patient would be provided (Elvish et al., 2014).

Objective of the project

The objectives that would be achieved after the completion of the project are as follows:

• It will be easier to identify the gaps in the dementia care for older adults.
• Lack of nursing professionals in the work force and associated training for dementia care interventions would be established as the primary reason for the gap in the dementia care process.
• Literature support would be present to validate the reasons for the lack.
• Training and educational sessions for the nursing professionals would be established as the primary and effective intervention to bridge the gap present in the care process of the dementia affected older adults so that their needs and healthcare process could be swiftly delivered by the care professionals.
• The implications of the skills and interventions learned in the educational and training sessions so that its effectiveness could be assessed and its effect on the care process for the dementia affected patients could be identified.

Benefits of providing training and skills for the dementia care for the nursing professionals

It was established in the previous sections of this paper, that majority of the nursing professionals are been added in the active care force due to the lack of nursing professionals in the care process and hence, they are not provided with training and skill development sessions (Chinkhata, 2014). These sessions and trainings are important for the holistic development of the nursing professionals as it equip them with the skills and strategies so that they can deal with different type of patients and their needs. Howlett et al. (2015) further mentions that every nursing professional have weaknesses in their individuality and it could reflect in their workplace activities. Therefore providing everyone with a skill set or training prior to deal complex nursing situations could help them to conduct their responsibilities properly (Elvish et al., 2014). This is because, training has the ability to bring nurses with different individual strengths to come at a single platform with similar skill set and abilities, using them they could understand the needs of the patients and modify the care process depending upon the preferences of the patient (Edvardsson, Sandman & Borell, 2014).

Further, Moyer (2014) mentions that dementia patients are different and complex than other patients with different ailments, because they are more vulnerable and affected with their surroundings, suffer from cognitive and psychological concerns and trusts exquisite amount of people for their needs. Therefore, it becomes important for the nursing professionals to develop a rapport with the patient so that patients could trust the nursing professional regarding their needs (Elvish et al., 2014). Hence, the nursing professionals should be provided with training of communication with older patients suffering from dementia and should be provided with skill set while dealing with their problems so that belief and trust could be reinforced in the care process. Further, Jensen and Inker (2015) mentions that majority of nursing professionals facing workload associated burnout or suffering from tremendous workload are becoming prone to resign from their healthcare facilities, because they are unaware about the coping skills and strategies to manage the burn out symptoms and hence, providing them with training could increase their chances of retention (Chinkhata, 2014). Therefore, due to the presence of this holistic scope of benefits, training and educational sessions of the nursing professionals would have been chosen as the learning needs for the nursing professionals so that the gaps present in the care process of the dementia affected patients could be bridged (Howlett et al., 2015).

Past learning experience

While working in the dementia patient ward in the past I witnessed and faced some moderate issues related to the care process of dementia affected patients. While working for the patient X (63) (pseudonym), I faced several concerns related to her diet, physiological, and psychological needs that stigmatized me for several occasions. She seemed very moody and aggressive at times and while communicating she used to stay quiet as she did not approve of my communication skills. Therefore, I felt that if I would have equipped with training for such situation or provided with several skills while dealing with such situation, I would have been able to develop a necessary rapport with the patient, to improve her care process. Further, I also felt there were several nursing professionals working in the ward who used to feel stigmatized or burn out while working with dementia affected older individuals. Therefore, providing us with training and skill development plan associated to care development for dementia patients would have improved our abilities to work with dementia patients and hence, this training session affected my ability to care for patient X.

Achievement of learning

As per Elvish et al. (2014), nursing professionals are the only care professionals who stay at direct contact with the patients and take care of every need and requirement of the patient to improve his/her health condition. Further, it is the duty of the nursing professionals to make the patient understand each healthcare process and obtain consent from the patient so that interventions could be applied on them (Karlin et al., 2014). However, in the absence of such abilities of the nursing professionals, it becomes difficult for the nurses to achieve the trust and belief of the patients as the patients are more stigmatized and vulnerable that they are unable to trust majority of the people in their surroundings (Elvish et al., 2014). Therefore, inclusion of such training and skill development process for the nursing professionals could provide the nursing professional with skills and abilities to include the patient in the care process and fulfill their psychological and pharmacological need to implement strategies of holistic care (Arnold et al., 2015). Further, Jutkowitz et al. (2016) also mentions that implementation of training could help the nursing professionals to cope with their limitations and inabilities and maintain the effectiveness of the care process. Therefore, these will be the achievement of the learning needs mentioned in this paper.

Implications of learning this skill in dementia affected patients

Implication of the proposed learning need that is the training needs and skill development associated educational session for the nursing professional will be associated to their connection with their dementia affected patients (Surr et al., 2016). Rycroft-Malone et al. (2014) noticed that good communication and connection with their nurses could improve the healthcare condition of dementia affected patients as they are able to discuss their emotional and psychological concern with the care professionals and using the pharmacological intervention, it becomes easier to relief their stress and anxiety associated symptoms (Jutkowitz et al., 2016). Hence, if the nursing professionals are equipped with the training for the communication with dementia affected patients, then they would be able to develop a good rapport with the patients (Laver et al., 2014). Ass well as, with good rapport, it will become easier for the nursing professionals to understand the need and requirement of the patient, related to their diet, activities and others. This will eventually, decrease their work pressure and their burn out related concerns would also decrease. Hence, providing the nursing professionals with training of dealing with dementia patients, could decrease the burn out of nursing professionals leading to decreased rate of resignation from aged care centers and the balanced ratio of nursing professional per patients could be improved (Elvish et al., 2014). Further, using training and skill development for student and enrolled nursing professionals would increase their ability to work with patients affected with dementia and after they commence their professional nursing career, they would be able to deliver effective care in aged and dementia care, increasing the efficiency of the hospital to deal with dementia (Surr et al., 2016). Hence, providing the nursing professionals working for dementia patients with skill development sessions and trainings would help the nurses to increase their efficiency and overcome their professional’s hindrances without any adverse condition (Elvish et al., 2014).

Conclusion

The primary aim of this project was to highlight the gaps and loopholes present in the care process of the dementia patients as the world health organization mentions, majority of the patients affected with dementia are left unattended all over the world. Further, evidences from Sweden were also provided where 45% patients, especially women affected with dementia were unable to avail healthcare interventions due to lack of nursing professionals in dementia care centers. Further, lack of training and education required for dealing with dementia patients created a lack in the efficiency of the nursing professionals due to which they were unable to cope up with the elevated stress, anxiety and burnout associated with dementia care, as well as increased the lack of nursing professionals in such facilities. Hence, this paper established these reasons as the primary gap of the dementia care process and implemented training and educational sessions for skill development of the nursing professionals as the sole interventions to increase the efficiency of the nursing process that could fill the present gap.

I implemented all these goals in my care process and seek help from the registered nurses, and supervisors so that I could understand the skills and training I would require for the dementia care. Further, I also learned from their experiences and developed evidence collection strategy by conducting literature review so that dementia care associated strategies could be obtained. Hence, it helped me to achieve all the goals. Further, conducting and implementing these processes in my daily activity, I was able to meet all these goals within the proposed time period which was 6 months after the commencement of the project.

However, it is important for the healthcare facilities and the health ministry of the local and national government to implement policies and strategies so that strong and developed interventions, with increased skill set could be used by the trained nursing professional while working with patients affected with dementia. Training and educational sessions should be organized by the healthcare facilities for student, enrolled and nursing professionals who lack experience in this area so that while working with dementia affected patients, they could use those strategies for quality and effective care practice.

References

Alzheimer’s Society. (2019). Facts for the media. Retrieved from https://www.alzheimers.org.uk/about-us/news-and-media/facts-media

Arnold, R. M., Back, A. L., Barnato, A. E., Prendergast, T. J., Emlet, L. L., Karpov, I., … & Nelson, J. E. (2015). The critical care communication project: improving fellows’ communication skills. Journal of Critical Care, 30(2), 250-254.

Brooker, D., & Latham, I. (2015). Person-centred dementia care: Making services better with the VIPS framework. Jessica Kingsley Publishers.

Chinkhata, M. M. (2016). Gender mainstreaming in nursing education: a study on the professional socialisation processes of Malawian student male nurses during undergraduate training (Doctoral dissertation).

Edvardsson, D., Sandman, P. O., & Borell, L. (2014). Implementing national guidelines for person-centered care of people with dementia in residential aged care: effects on perceived person-centeredness, staff strain, and stress of conscience. International Psychogeriatrics, 26(7), 1171-1179.

Elvish, R., Burrow, S., Cawley, R., Harney, K., Graham, P., Pilling, M., … & Keady, J. (2014). ‘Getting to Know Me’: the development and evaluation of a training programme for enhancing skills in the care of people with dementia in general hospital settings. Aging & mental health, 18(4), 481-488.

Fernández-Mayoralas, G., Rojo-Pérez, F., Martínez-Martín, P., Prieto-Flores, M. E., Rodríguez-Blázquez, C., Martín-García, S., … & Forjaz, M. J. (2015). Active ageing and quality of life: factors associated with participation in leisure activities among institutionalized older adults, with and without dementia. Aging & mental health, 19(11), 1031-1041.

Ford, S., Ford, S., & Ford, S. (2013). Hospital audit reveals lack of basic dementia training. Retrieved from https://www.nursingtimes.net/roles/older-people-nurses/hospital-audit-reveals-lack-of-basic-dementia-training/5061057.article

Gifford, K. A., Liu, D., Lu, Z., Tripodis, Y., Cantwell, N. G., Palmisano, J., … & Jefferson, A. L. (2014). The source of cognitive complaints predicts diagnostic conversion differentially among nondemented older adults. Alzheimer’s & Dementia, 10(3), 319-327.

Howlett, M., Doody, K., Murray, J., LeBlanc-Duchin, D., Fraser, J., & Atkinson, P. R. (2015). Burnout in emergency department healthcare professionals is associated with coping style: a cross-sectional survey. Emerg Med J, 32(9), 722-727.

Jensen, C. J., & Inker, J. (2015). Strengthening the dementia care triad: identifying knowledge gaps and linking to resources. American Journal of Alzheimer’s Disease & Other Dementias®, 30(3), 268-275.

Jutkowitz, E., Brasure, M., Fuchs, E., Shippee, T., Kane, R. A., Fink, H. A., … & Kane, R. L. (2016). Care?delivery interventions to manage agitation and aggression in dementia nursing home and assisted living residents: a systematic review and meta?analysis. Journal of the American Geriatrics Society, 64(3), 477-488.

Karlin, B. E., Visnic, S., Shealy McGee, J., & Teri, L. (2014). Results from the multisite implementation of STAR-VA: A multicomponent psychosocial intervention for managing challenging dementia-related behaviors of veterans. Psychological services, 11(2), 200.

Kasper, J. D., Freedman, V. A., Spillman, B. C., & Wolff, J. L. (2015). The disproportionate impact of dementia on family and unpaid caregiving to older adults. Health Affairs, 34(10), 1642-1649.

Kumar, P., Tiwari, S. C., Goel, A., Sreenivas, V., Kumar, N., Tripathi, R. K., … & Dey, A. B. (2014). Novel occupational therapy interventions may improve quality of life in older adults with dementia. International archives of medicine, 7(1), 26.

Laver, K., Cumming, R., Dyer, S., Agar, M., Anstey, K., Beattie, E., … & Dietz, M. (2016). Clinical practice guidelines for dementia in Australia.

Mitchell, G., Ford, M., Mitchell, G., & Mitchell, G. (2017). Advanced dementia patients ‘lack specialist nurse support’. Retrieved from https://www.nursingtimes.net/news/research-and-innovation/advanced-dementia-patients-lack-specialist-nurse-support/7021322.article

Moyer, V. A. (2014). Screening for cognitive impairment in older adults: US Preventive Services Task Force recommendation statement. Annals of internal medicine, 160(11), 791-797.

Rycroft-Malone, J., Burton, C., Hall, B., McCormack, B., Nutley, S., Seddon, D., & Williams, L. (2014). Improving skills and care standards in the support workforce for older people: a realist review. BMJ open, 4(5), e005356.

ScienceDaily. (2017). Gap in health care for Alzheimer’s disease patients who live alone. Retrieved from https://www.sciencedaily.com/releases/2017/06/170614170224.htm

Seitz, D. P., Gill, S. S., Gruneir, A., Austin, P. C., Anderson, G. M., Bell, C. M., & Rochon, P. A. (2014). Effects of dementia on postoperative outcomes of older adults with hip fractures: a population-based study. Journal of the American Medical Directors Association, 15(5), 334-341.

Surr, C. A., Smith, S. J., Crossland, J., & Robins, J. (2016). Impact of a person-centred dementia care training programme on hospital staff attitudes, role efficacy and perceptions of caring for people with dementia: A repeated measures study. International journal of nursing studies, 53, 144-151.

The Conversation. (2018). Shortage of nurses in UK is affecting patient care and threatening lives. Retrieved from https://theconversation.com/shortage-of-nurses-in-uk-is-affecting-patient-care-and-threatening-lives-89734

The Telegraph. (2012). Medical staff lack dementia training, new report finds. Retrieved from https://www.telegraph.co.uk/news/health/9110185/Medical-staff-lack-dementia-training-new-report-finds.html

Vaingankar, J. A., Chong, S. A., Abdin, E., Picco, L., Jeyagurunathan, A., Zhang, Y., … & Subramaniam, M. (2016). Care participation and burden among informal caregivers of older adults with care needs and associations with dementia. International psychogeriatrics, 28(2), 221-231.

Vasudev, A., Shariff, S. Z., Liu, K., Burhan, A. M., Herrmann, N., Leonard, S., & Mamdani, M. (2015). Trends in psychotropic dispensing among older adults with dementia living in long-term care facilities: 2004–2013. The American Journal of Geriatric Psychiatry, 23(12), 1259-1269.

World Health Organisation. (2019). Dementia. Retrieved from https://www.who.int/news-room/fact-sheets/detail/dementia

Zeilig, H. (2014). Gaps and spaces: Representations of dementia in contemporary British poetry. Dementia, 13(2), 160-175.