Posted at 10.11.2018
Caring for older people highlights many special and difficult issues for nurses and carers, such as separation, illness, loneliness, fatality and how to provide continued treatment (Morrissey et al, 1997). This essay talks about the strategies of care delivered for an older person with dementia during my recent clinical placement. Discussions will focus on normal ageing process considering the relevant natural, sociological and physiological perspectives and the impact this experienced upon this individual's life experience. Ropers' model is used as a framework work where cae is supplied. Other related issues to be looked at include the role of informal carers and the impact this acquired on him. Confidentiality is managed together with NMC 2010 code of do. Thus a pseudonym (Scot) is adopted where in fact the client's name is mentioned.
Scot is a 70 yr old man with a long-term background of psychosis. Recently he previously been identified as having dementia. He previously been well supervised on quiatiapin until he previously stopped taking the medication and his psychosis had worsened. And scheduled to his drop in his state of mind, he has also been refusing usage of his carer (his partner) and was vulnerable to self neglect.
Dementia is a problem manifested by multiple cognitive problems, such as impaired ram, aphasia, apraxia and a disturbance in occupational or sociable functioning, Howcroft (2004). Disruptions in executive working are also seen in the loss of the capability to think abstractly, having difficulty doing responsibilities and the avoidance of situations, that involves handling information. Scot is suffering from Alzheimer's disease, a kind of dementia, which impacts the brain cells and brain nerve transmitters, which carry instructions around the mind. The brain shrinks as gasps builds up in the temporal lobe and hippocampus. The ability to think, speak remember and make decisions is interrupted (ADS, 1997).
The national technique for carers (1999) defines an informal carer as 'someone providing attention without repayment for a relative or friend who is disabled, sick, prone or frail'. Scot and his wife had been wedded for over 50 years when scot developed dementia. In the beginning his wife handled well, but as time went by and the dementia worsened, she found it ever more difficult to look after her partner, do her home chores and have any life for herself. She cannot leave him only while she shopped, and it was too difficult to take him along. Eventually the stress, the low morale and the irritation of caring for Scot started to toil on her.
Fitting et al (1986) found that women more often feel obliged to provide attention than men and have more difficulty in coping with the dependency of these dementing comparative. What appeared to have been the last straw for Scots partner was when he started squatting in sides and urinating on to the floor. Scot started out to gradually have less interest inside and outside home, which is highlighted by intellectual, mental and memory disturbances of dementia ( Dexter et al, (1999). The deterioration again led him to becoming absent- minded, forgetting visits, forgetting about his dishes and forgetting things he has left inside your home. It further progressed to extreme cases where he would recall past incidents of his vibrant days however, not about the recent happenings. He would also get up in the center of the night wandering throughout the house, which resulted in many comes and incidents to himself. This major storage area disturbance led to manifestation of misunderstandings influencing his daily framework and routine of life.
On this current admission his care and attention plan was developed to meet his must keep on activities of daily living. Because of his state of mind at that time his examination was done in discussion with his better half which highlighted four main regions of concern, specifically his personal cleanliness, nutritional intake, protected climate and sleeping (Roper et al, 1996). The degree of Scots safety was assessed credited to his potential risk of falling and leading to injury to himself. In relation to sleeping, it was recognized that he has unstructured and lesser sleep patterns which really is a contributing factor to his restless and agitations throughout the day. He also offers difficulty in hearing. All the recognized needs of scot were integrated into his treatment plan strategy and the appropriate interventions were taken.
The care and attention plan was for scot to be given one to one counselling consultations every day and encouraged to go over subject areas related to simple fact such as current affairs, his family, home life or communal life. The rationale for this action is supported by Schultz and Videbeck (2002), who assert that knowledge of, and rely upon workers can decrease a client's doubts and suspicions, resulting in decreases anxiety. Talking about familiar issues also stimulates patients to keep up contact with real life and their place in it (Stuart and Laraia, 1998). He's to be checked on his medication and a state of mind for him to maintain optimum level of physical and mental well-being. This was to add exercise, sociable group activities and a good balance of substance and diet. He was also to be motivated and take part in social activities during the day to help him have adequate sleep at night time. It had been also included that Scot should be on major observation to ensure his security on the ward.
To promote protected climate for Scot, all potential unsafe things were removed, sand that familiar objects including pictures, calendars, activity sheets were rather put in destination to orientate him to his surroundings. To bolster this he was talked about using what was occurred around him. All conversation with Scot also engaged communicating obviously about one theme at the same time so that he is not confused with abnormal information (Holden et al, 1982). He was presented with hearing help equipment, which was constantly examined for proper performing. This is emphasised with effective verbal and non verbal communication. During these times it was vital to use modulation of voice that was conductive to his reading, appropriateness of touch, good eyes contact, gestures and allowing Scot to express his anxieties and needs, all within an atmosphere of acceptance and reassurance. This is to create a rapport and maintain a trusting healing marriage with him (Egan 2002). To lessen some of the night time disruptions, Scot was involved with a sleep cleanliness programme which included maintaining regular times for growing and going to bed, steering clear of stimulants such as alcoholic beverages and tobacco and using the bedroom only for sleep. Taking him for a walk, attending OT periods and other interpersonal group activity also increased his daytime activity. Rest and breathing exercises was part of the caring process for Scot, which were intended to give him mastery over his symptoms particularly when he became troubled or unable to sleep. And although there appeared to be no significant process being created by Scot on the respiration exercise, the program continued to be reassessed and analyzed.
His care program also took into consideration some of the normal ageing process associated with later years including the presence of pathology influencing the overall functioning of the average person. For example, during Scots analysis for dietary intake it was important to take into account the fact that many the elderly have a lower life expectancy food intake as result of being less lively and reduced lean muscle mass which causes a low consumption of nutrition such as vitamins and minerals (Norman, et al 1997). An additional factor considered was that of the medication which when used to treat certain conditions can in fact cause depressive disorder, which is bought on by the toxicity of the drugs. 'The elderly are more susceptible to toxicity because of their impaired absorption, metabolism, and excretion of drugs' (Cosgray and Hanna, 1993). It really is imperative to remember that the older person have a tendency to take medication errors such as omission of dosages and incorrect dosage when they are self administering a drug and many seniors tend to take a number of different drugs for different illnesses which causes further misunderstandings. This all non-prescription medications such as bottles, out of date prescription items were also taken off the reach of Scot. This is to avoid Scot access probably dangerous medication and inadvertently taking them improperly. Until his condition advanced, his medication was given to staff on the ward. However, he continued to be educated to permit himself to self medicate on discharge.
Furthermore, diagnosis of other age group related physiological and subconscious degeneration of vision, auditory, conversation, impaired cognition etc are essential for baseline diagnosis and understanding the effects of physical and mental capabilities of a mature person (Kenny, 1989).
Scot constantly bought up the issue of dying during every one to one time with him. Although he didn't want to get rid of his present condition by committing suicide, he accepted loss of life as an invertible end, which he anticipates will inevitably come soon for him. His priority was to have the ability to work and spend amount of time in his garden again on release before he passed away. However, he have have the inclination to be somewhat stressed out of what he views as not doing much in his perfect times to fulfil his ambitions. This sometimes brings on a sense of guilt and sadness to Scot.
The countrywide Service Platform for older people (DoH, 2001) emphasised the need to support carers in their role. Scot's wife was therefore informed about how to handle the decline capabilities of her husband including how to provide protected climate for Scot and help him with respite programs that gives her a rest from her care-giving tasks. Scot's partner also received education and information about how precisely and why her man behaves in his condition and exactly how she can reduce the feelings of stress and anxiety, tension and lack of control that has resulted from the impact of Scots deterioration.
By the end of my placement, evaluations exhibited that although there have not been significant changes in Scots mental and physical point out, it is also imperative to note that he has been reinforced and managed well to transport some of the daily activities of living. Whilst Scots worry plan continued to be reviewed, there is also an ongoing support and educational programs for his better half, which will allow her to effectively care for Scot. Having gained experience working with older people, I've understood that whenever you care for a person especially the aged person, one must take a holistic view of the individuals physiological and emotional and social scenario to be able to provide effective and ongoing care.