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IDENTIFYING THE CARE NEEDS OF OLDER PEOPLE WITH MENTAL ILLNESS

IDENTIFYING THE CARE NEEDS OF OLDER PEOPLE WITH MENTAL ILLNESS

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In 2001, the UK government developed the National Service Framework (NSF) meant to promote the well-being of older people with mental disorders and illnesses. The framework was issued with the aim of mitigating age discrimination in both social and health care (Tsaroucha et al., 2013).  It also sets specific standards that define the delivery of social and health care to older people diagnosed with mental illnesses. The NSF provides that healthcare staff should possess appropriate skills to enable them to meet the care needs of older people with mental health conditions (Dening et al., 2013). On the basis of this understanding, this essay presents a discussion of skills healthcare providers should have to be effective in caring for and treating older people with dementia. The focus of the essay is the skills necessary for appropriate nursing care and treatment of dementia among older adult patients.

According to Tsaroucha et al (2013), nurses should have the ability to understand dementia in the context of the management of clinical syndromes. This means that effective nurses should view dementia beyond the illness itself. Hoe and Thompson (2010) explain that providers who view dementia as a clinical syndrome are effective in identifying and meeting the needs of affected patients. In addition, nurses are able to uphold the dignity of older people with dementia when they believe that it is beyond simple illness (Thune-Boyle et al., 2010). Cowdell (2010) argues that providers who manage dementia as a clinical syndrome are able to distinguish between its causes. This is important because it enables nurses to develop and implement effective plans for care for older patients affected by dementia.

The National Health Service (NHS) provides skill sets and standards for nurses caring for treating older people affected with dementia. For instance, nurses are required to understand dementia in the context of its etiology and symptoms, including the cognitive changes that are exhibited by affected patients (Traynor et al., 2011). In addition, nurses are required to understand the implications of dementia for nursing and the most appropriate care strategies for older patients with the condition. Sampson (2010) argues that nurses are able to adopt and implement effective skill sets in dementia care when they approach the illness as a clinical symptom rather than a mere disease.

Traynor et al. (2011) indicate that effective providers understand how older patients are affected by mental illnesses and associated symptoms. Therefore, nurses caring for older adults with dementia should be able to understand how the psychological, physical, and cognitive changes related to the illness affect patients. In this sense, nurses should enable older patients to make sense of dementia-related changes. Dening et al. (2011) indicate that providers who understand the impact of dementia on affected patients are able to deliver dignified and compassionate care.

According to Tsaroucha et al. (2013), nurses understand the impact of dementia on older patients when they are able to describe the emotional and psychological implications of the illness on the patient. More importantly, nurses should apply research evidence to inform their understanding of the impact of dementia on affected patients (Dening et al., 2013). Ryan et al. (2012) argue that effective nurses are those who are able to explain the experiences of older adults with dementia, especially those who have lost a sense of self. Goodman et al. (2010) note that community nurses should understand the effects of social isolation which often affects patients with dementia. This understanding enables them to effectively address the social and emotional needs of affected patients, as demonstrated by Cowdell (2010).

Thune-Boyle et al. (2010) demonstrate that nurses should appreciate and learn from carers with a the goal of becoming more effective in the care of older patients suffering from dementia. Notably, carers are individuals who help older adults cope with their dementia, such as family members and friends. Learning from carers enables nurses to understand the needs of patients who are unable to meet their own needs due to mental or physical disability. Dening et al. (2013) indicate that learning from carers is important for nurses because it allows them to deal with mixed emotions and stress that are often associated with caring for older patients diagnosed with dementia. Notably, nurses should learn from carers the challenges they expect so that they can be adequately prepared to address the emotional issues related to dementia care (Dening et al., 2011). According to Hoe and Thompson (2010), nurses who learn from carers understand and appreciate caregiving roles and the valuable expertise of caregivers, which is useful in informing nursing care processes in dementia. In addition, learning from carers enables nurses to understand that it is important to be compassionate to both family members and patients in all stages of the care process.

Tsaroucha et al. (2013) demonstrate that effective communication is a vital skill in dementia care. It entails being sensitive to the needs of patients and carers in the implementation of the nursing care process. Notably, communication in dementia care is often frustrating and challenging (Traynor et al., 2011). Cowdell (2010) illustrates that older patients having dementia, especially those who are agitated or suffering from delirium are specifically hard to communicate with. Ryan et al. (2012) recommend that nurses should ensure that they do not limit communication processes to verbal words. This means that non-verbal cues should also be used to appropriately communicate with older adults with dementia. Therefore, nurses should have an adequate understanding of forms of communication and how to appropriately apply them in dementia care, as illustrated by Dening et al. (2011).

Tsaroucha et al (2013) note that dementia care is associated with a varied range of communication processes, including talking to patients, friends, relatives, and carers. Therefore, nurses should be able to appropriately employ the principles of effective communication to engage in effective and sensitive communication processes with all people they interact with in dementia care. Hoe and Thompson (2010) demonstrate that it is important for nurses taking care of older adults with dementia to be active listeners.  Dening et al. (2011) explain that nurses should have the competency of assessing the communication needs of older patients having dementia. This is important as it informs the design and implementation of the nursing care plan.

Hoe and Thompson (2010) assert that nurses need to understand the person-centered model in line with its application in dementia care. This indicates that nurses should not approach dementia from the medical perspective alone. They should address the unique concerns of each patient related to the effect of dementia on their emotional and psychological well-being (Traynor et al., 2011). Traynor et al. (2011) explain that the person-centered model allows nurses to understand older patients beyond their dementia diagnosis. Notably, person-centered care provides nurses with opportunities to individualize the care processes with the goal of promoting the overall well-being of older patients suffering from dementia (Dening et al., 2013).

According to Dening et al. (2011), nurses should apply their thoughtfulness with a view of putting themselves in the place of patients with dementia. Tsaroucha et al. (2013) explain that it is the thoughtfulness of nurses that makes them effective in providing personalized care. Goodman et al. (2010) add that a person-centered approach is the prerequisite to compassionate and dignified care. Thune-Boyle et al. (2010) assert that nurses should have an understanding of the individual elements that affect dementia care so that they can deliver effective and safe care to their patients.  Furthermore, nurses should be able to apply appropriate person-centered strategies, such as recognizing needs, and supporting and encouraging older patients with dementia in order to promote independence.

Sampson (2010) asserts that nurses need to be sensitive to the specific unmet needs of older patients suffering from dementia. Ryan et al. (2012) explain that omissions in nursing care are avoided by nurses who are able to recognize the needs of each patient. These needs should then be integrated into the care plan, as illustrated by Ryan et al. (2012). Hoe and Thompson (2010) assert that providers should be specifically sensitive in the care process to ensure that they meet the essential needs of older patients having dementia, such as hydration, hygiene, comfort, and nutrition. In many cases, older patients suffering from dementia fail to communicate verbally about their essential needs. In such cases, nurses should learn from the behavior of patients (Dening et al., 2011). Dening et al. (2013) indicates that nurses who are able to interpret the behavior of older adults with dementia are effective in addressing unmet needs.

Traynor et al. (2011) recommend that nurses should allow for further investigations when older patients suffering from dementia exhibit unexpected behaviors, such as resisting care or shouting. Cowdell (2010) shows that the role of a nurse as an investigator is important in dementia care because it allows for the identification of specific unmet needs. Therefore, nurses should be aware of the whole spectrum of needs in dementia, including spiritual, emotional, psychological, and physical needs.  Traynor et al. (2011) argue that nurses should understand why the specific needs of older patients having dementia may be hard to meet. Furthermore, effective nurses are able to apply appropriate approaches, such as Cohen-Mansfield’s model of unmet needs to guarantee high-quality care for older patients suffering from dementia (Dening et al., 2013).

Ryan et al. (2012) show that nurses should be able to apply meaningful interventions meant to respond compassionately to the needs of older patients having dementia. Tsaroucha et al (2013) explains that compassionate care is possible when providers develop a desire to alleviate the pain or suffering of their patients. This means that recognizing the suffering of older patients diagnosed with dementia is not enough. Hoe and Thompson (2010) explain that nurses should consider all alternative strategies to appropriately alleviate the suffering of their patients. According to Ryan et al. (2012), the strategies nurses adopt and implement to provide compassionate care should be focused on promoting the humanity of nursing. Therefore, nursing interventions in dementia should be meaningful to patients and helpful in enabling them to overcome the stressful and difficult situations that they often face.

Cowdell (2010) demonstrates that nurses need to engage in continuous self-reflection meant to advance humanity in nursing through the implementation of compassionate care strategies for older patients having dementia. Notably, nurses can share positive interests and experiences depending on their assessment of the impact of dementia on the emotional and psychological well-being of patients. However, nurses are required to set realistic goals designed to reflect on the expected outcomes of dementia. Dening et al. (2011) add that self-awareness and sensitivity to older patients diagnosed with dementia allow nurses to take appropriate actions meant to improve patients’ well-being in the holistic sense.

Goodman et al. (2010) reveal that effective nurses are those who safeguard patients and are able to understand the vulnerabilities of older patients having dementia. This is aligned with the fundamental role of nurses in protecting patients. Therefore, nurses should be able to safeguard older patients having dementia from any kind of abuse or harm, as demonstrated by Cowdell (2010). For example, nurses have a duty to ensure that patients are not subject to inappropriate restrictive interventions, such as physical confinement. Cowdell (2010) explains that nurses should apply the best-interests approach to ensure that effectively safeguard older adults with dementia in consideration of all their vulnerabilities. Notably, patients having dementia may be unable to make safe choices due to impaired mental capacity. Dening et al. (2013) recommend that in such cases, nurses play the role of advocating for the needs that serve the best interests of patients.

Safeguarding patients also includes upholding their human rights. Sampson (2010) explains that nurses safeguard their patients when they understand the link between mental capacity and cognitive impairment. Nurses should also be able to recognize any circumstances that would lead to the deprivation of the liberty or rights of patients having dementia, as illustrated by (Dening et al., 2011). More importantly, nurses should understand their professional and personal obligations in dementia care. This includes an understanding of ethical concerns related to dementia care, such as withholding treatment, restraint, discriminative care, diagnosis, and threats to autonomy (Hoe and Thompson, 2010). Nurses should also be able to determine how to effectively address ethical dilemmas related to care for older adults having dementia.

In conclusion, the NSF requires nurses to have specific skills that make them effective in providing appropriate, safe, personalized, and evidence-based care to older adult patients having dementia. Notably, nurses should be able to view dementia beyond the medical perspective. They should also understand how older patients are affected by dementia. Additionally, nurses need to learn from carers and appreciate their important contribution to care at the community level. More importantly, nurses should be effective communicators and able to assess the needs of older adults with dementia for proper planning and implementation of personalized care interventions. Nurses should also understand the person-centered model and its important application in dementia care. Furthermore, nurses are required to be sensitive to the needs of older patients having dementia by responding with compassion during the care process. They should also safeguard patients by advocating for their rights and ensuring that the care they receive is safe and appropriate.

References

Cowdell, F., 2010. Care of older people with dementia in an acute hospital setting. Nursing Standard, 24(23), pp.42-48.

Dening, K.H., Jones, L. and Sampson, E.L., 2011. Advance care planning for people with dementia: a review. International Psychogeriatrics, 23(10), pp.1535-1551.

Dening, K.H., Jones, L. and Sampson, E.L., 2013. Preferences for end-of-life care: a nominal group study of people with dementia and their family carers. Palliative Medicine, 27(5), pp.409-417.

Goodman, C., Evans, C., Wilcock, J., Froggatt, K., Drennan, V., Sampson, E., Blanchard, M., Bissett, M. and Iliffe, S., 2010. End of life care for community dwelling older people with dementia: an integrated review. International journal of geriatric psychiatry, 25(4), pp.329-337.

Hoe, J. and Thompson, R., 2010. Promoting positive approaches to dementia care in nursing. Nursing standard, 25(4), pp.47-56.

Ryan, T., Gardiner, C., Bellamy, G., Gott, M. and Ingleton, C., 2012. Barriers and facilitators to the receipt of palliative care for people with dementia: the views of medical and nursing staff. Palliative medicine, 26(7), pp.879-886.

Sampson, E.L., 2010. Palliative care for people with dementia. British medical bulletin, 96(1), pp.159-174.

Thune-Boyle, I.C., Sampson, E.L., Jones, L., King, M., Lee, D.R. and Blanchard, M.R., 2010. Challenges to improving end of life care of people with advanced dementia in the UK. Dementia, 9(2), pp.259-284.

Traynor, V., Inoue, K. and Crookes, P., 2011. Literature review: understanding nursing competence in dementia care. Journal of clinical nursing, 20(13‐14), pp.1948-1960.

Tsaroucha, A., Benbow, S.M., Kingston, P. and Mesurier, N.L., 2013. Dementia skills for all: A core competency framework for the workforce in the United Kingdom. Dementia, 12(1), pp.29-44.

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