This reflection will discuss skills development, professional awareness and personal development over the past seven weeks whilst on placement with a Primary Care Dementia Practitioner. I will be using Rolfe’s model of reflection which describes the event and the facts, then goes onto discuss why this has been important with the use of an appropriate evidence base and finally to discuss what could be done in the future to improve future practice and make recommendations (Jasper )

What
Whilst working in the area described I was able to visit newly referred clients who may be experiencing short term memory difficulties. Our role is to initially visit the client and gain a background history including place of birth, school, past careers up until the problems experienced started. Most of the time a spouse or family member is with the client.
We then do a memory assessment by using the Addenbrookes Cognitive Examination – ACE-III (British Association of Occupational Therapists, 2012)
The results of this assessment are then scored and along with recent Dementia Screening Bloods and an ECG.(North West Dementia Centre,2005) I then liaise with a consultant to determine a diagnosis and treatment which may be suitable, and write to the clients GP detailing the history, presentation, assessment results, diagnosis and any treatment prescribed. This letter will also go to either the client if they have requested it or the care if the client has given permission as required on a Data Protection Act (1998) document, which must be signed by the client (Legislation.gov.uk 1988)
A subsequent visit may be necessary or the client will be handed over during an MDT meeting to the Community Mental Health team (CMHT)

So What
Conducting a memory assessment requires the use of many nursing skills, communication is paramount as you will be engaging with clients who have memory problems and may experience confusion and agitation if not clear on why you are there. I have been able to develop my communication skills by taking into consideration the importance of minimising distractions for example asking if the televisions could be switched off. Maintaing eye contact will help the client focus and if the client is sitting make sure you speak with them at their eye level as standing over someone can appear intimidating. Speaking with the client slowly and clearly in language they can understand will assist in communicating with the client and repeating myself if necessary whilst still respecting the client and ensuring their dignity at all times as this can be a distressing time for both the client and the carer or family who may be present also, so their feelings need to be respected also.
The Nursing standard (2011) suggest that “Communication is a fundamental requirement for all human beings. It gives substance to individuals lives and is essential for survival and growth and enhances a sense of belonging”. The process of communications may be complex expecially if the nurse is trying to engage with a client who has dementia. The Nursing standard (2011) suggests that “poor communication can compromise care, which can lead to undue anxiety and frustration on the part of the patient”. By practicing effective communication will allow a nurse to build a trusting relationship with the client. (Nursing Standard, 2011)
It is suggested that to encourage effective communications its advisable to speak clearly and slowly in a language the client understands, make eye contact with the client, and allow them to take time to process what you have said so not to make them rush into responding. Never patronise your client as a student nurse i have to adhere to the Nursing and midwifery code of Conduct which states that you must treat people with respect and not discriminate in any way. You must also treat people kindly and be considerate. You must also make arrangements to meet clients language and communication needs. (NMC, 2008)

My planning and observation skills have further developed, before visiting the client at home I need to gather all the appropriate paperwork and make sure I have everything organised this saves time when visiting the client and looks professional. Upon entering a clients home I am observing the surroundings, is the home in good repair, are there any strong smell which could be of urine highlighting a possible personal hygiene neglect or continence problem, it could be that due to poor mobility or confused state the client is unable to find or easily access the toilet. It is advisable to look at the layout of the home to assess whether the client may be at risk of falls due to rugs or coffee tables or any other obstructions and refer to the appropriate organisations if required.

During the assessment the client may feel anxious and it is important to observe any non verbal signs that the client is becoming distressed and taking time to explain to the client anything he/she is not clear on and if the client is still having problems understanding change the way you are explaining by using hand gestures or perhaps written instructions if this helps. (NHS, 2012) It is paramount that you respect the dignity of the client and do not want to make them feel inadequate at a time which is already distressing for them.
It is worth remembering that it can be frustrating if we cannot communicate effectively so be aware of utilising therapeutic touch such as a reassuring pat on the arm, and smile when appropriate as well as when you are speaking. (NHS, 2012)

I feel i have progressed with regards to my active listening skills and important skill to consider when engaging with a client who has dementia. It is suggested that you use eye contact, try not to interrupt the client, minimise distractions as previously discussed, speak clearly and check with the client that i have understood what they have been telling me.
Another important skill i feel i have developed is documentation such as a Non – CPA documentation. This document is for clients who do not have “complex” needs and/or where risk assessment indicates a less that significant risk to self or others. (NHS Suffolk, 2009) This adheres to the requirement s suggested by the NMC (2008) that you must keep clear and accurate records of discussion and assessments you make, and that records should be documented as soon after the event. It is also vital that all records are kept in a secure place to protect the confidentiality of the clients information (Data Protection)

What Now

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References http://www.cot.co.uk/news/successor-ace-r-now-available http://www.smhp.nhs.uk/SMHP/LinkClick.aspx?fileticket=wz%2BZnSij2Cg%3D&...

http://nursingstandard.rcnpublishing.co.uk/archive/article-effective-communication-with-people-who-have-dementia http://www.nhs.uk/Conditions/dementia-guide/Pages/dementia-and-communication.aspx http://www.alzheimers.org.uk/site/scripts/documents_info.php?documentID=1211&pageNumber=2 http://www.pssru.ac.uk/pdf/MCpdfs/Dementia_factsheet.pdf http://www.legislation.gov.uk/ukpga/1998/29/section/2