...Outcome (1) For John and his family to attend weekly Monday meetings for review and discussion. Treatment and upcoming discharge plans for John where his family feels involved in his care and where they have an opportunity to ask questions and discuss his care. John's family to get the necessary support once he is discharged. (2) For John’s mental health to stabilize. John has been diagnosed with dementia. (3) John has difficulty communicating verbally. (4) Offer John 1-1 times daily to facilitate and express his thoughts and feelings. Staff to monitor his mood and sleeping patterns. (3) Staff to be constantly vigilant when around John as he can lash out and becomes physically aggressive at times even without triggers. Nurse in charge...
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...Case Study: Treating a Patient with Vascular Dementia Grand Canyon University Case Study: Treating a Patient with Vascular Dementia Vascular dementia is one of the most common causes of dementia, Alzheimer being the most common. Vascular dementia causes around 10% of cases while Alzheimer causes around an estimate of 60% to 80% of cases. NHS Choice (2015) defines dementia as “a loss of mental ability (cognitive impairment) associated with gradual death of brain cells” (para. 2). Vascular dementia occurs when the blood flow to the brain is reduced and usually happens from strokes, it also can be caused by a variety of diseases and damages that affects the brain. One of the most common type of vascular dementia is the Multi-infarct dementia which is caused by minor strokes or (which sometimes are called “mini strokes” or silent strokes”) that at times could go unnoticed. Unlike Alzheimer's disease, there are no licensed treatments for vascular dementia (O’Brien and Thomas, 2015) Multi-infarct dementia is more common in older men than women around the ages of 60 to 75 years old. Vascular dementia is really rare in anyone younger than 65. Global, 48.5 million people have dementia, about 70% of that is Alzheimer’s and around 10% are vascular dementia, there are 7.7 million new cases every year. This case study looks further into Vascular Dementia and the people who have them and shows how a great care system and collaboration can help the patient. A case study will be conducted...
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... Identification of Research Topic Over the past five years while working in a residential care home for people with dementia, the researcher has observed that incidents of violence and aggression both physical and verbal towards health care staff happened regularly. The incidents of aggression affected staff mentally and physically but the majority of incidents went unreported. The nursing staff, registered nurses and nursing assistants in this environment both acknowledged the seriousness of this on-going problem to them. However the reluctance to report the aggression is because they considered the aggression to be part of the job despite them acknowledging it as a problem. England is an ageing society and as the population ages, health care providers, government, communities and families are faced with the burden of caring for people with dementia (Cubit, 2010). According to Access Economics (2005), dementia is becoming increasingly predominant to the aging population worldwide. A survey of over 15000 care homes in England and Wales found that 78% of residents were cognitively impaired (Bowman et al, 2004). In addition the Alzheimer`s Society (2007) reported that there are around 750 000 people in United Kingdom with a dementing illness. A more recent survey by the Alzheimer`s Society (2009) reported that around one third of older people with dementia in UK live in residential home care settings, representing 200 000 individuals. According to Leonard et al (2006); Zuidema...
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...CLINICAL ISSUES Acute care management of older people with dementia: a qualitative perspective Wendy Moyle, Sally Borbasi, Marianne Wallis, Rachel Olorenshaw and Natalie Gracia Aim and objectives. This Australian study explored management for older people with dementia in an acute hospital setting. Background. As the population ages, increasing numbers of older people with dementia are placed into an acute care hospital to manage a condition other than dementia. These people require special care that takes into account the unique needs of confused older people. Current nursing and medical literature provides some direction in relation to best practice management; however, few studies have examined this management from the perspective of hospital staff. Design. A descriptive qualitative approach was used. Method. Data were collected using semi-structured audio-taped interviews with a cross section of thirteen staff that worked in acute medical or surgical wards in a large South East Queensland, Australia Hospital. Results. Analysis of data revealed five subthemes with the overarching theme being paradoxical care, in that an inconsistent approach to care emphasised safety at the expense of well-being and dignity. A risk management approach was used rather than one that incorporated injury prevention as one facet of an overall strategy. Conclusion. Using untrained staff to sit and observe people with dementia as a risk management strategy does not encourage an evidence-based approach...
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...believe there would be, less adverse effects and better patient outcomes for this group of people and better satisfaction with their families. B There are many people associated with proposing the change within the facility. First would be to go through the assistant nurse manager and nurse manager who would then bring the proposal to the nursing and medical directors for the ER. The ANM and NM would have to decide whether the proposed change would be beneficial for the patients and their outcomes and do further research which they would then propose to the directors. From there, they would decide whether the research was sufficient enough to implement a change. C Full APA citation for at least 5 sources | Evidence Strength (1-7) and Evidence Hierarchy | 1. H., Bell, J., Karttunen, N. M., Nykänen, I. A., M., & Hartikainen, S. A. (2013). Analgesic Use and Frailty among Community-Dwelling Older People. Drugs & Aging, 30(2), 129-136. doi:10.1007/s40266-012-0046-8 | 2 and Experimental | 2. Haasum, Y., Fastbom, J., Fratiglioni, L., Kåreholt, I., & Johnell, K. (2011). Pain Treatment in Elderly Persons With and Without Dementia. Drugs & Aging, 28(4), 283-293. doi:10.2165/11587040-000000000-00000 | 2 and Experimental | 3. Nipp MD, R., Sloane MPH, R., Rao MD, A., Schmader MD, K., & Cohen MD, H. (2012). Role of pain medications, consultants, and other services in...
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...ELDER ABUSE IN NURSING HOMES: THE IMPACT OF DEMENTIA/SPECIAL CARE UNITS BY CHRISTINA KAY FALK THESIS Submitted in partial fulfillment of the requirements for the degree of Master of Science in Community Health in the Graduate College of the University of Illinois at Urbana-Champaign, 2013 Urbana, Illinois Adviser: Stephen J. Notaro, Ph.D. ii ELDER ABUSE IN NURSING HOMES: THE IMPACT OF DEMENTIA/SPECIAL CARE UNITS By: Christina K. Falk Elder abuse is a topic that impacts everyone in America at some point in their life. Special care units also called dementia units are protected areas in a nursing home that are specially designed for dementia/Alzheimer patients. This thesis reviewed how a special care unit in a nursing home affect the number and severity of deficiencies reported to Medicare. The data was collected from Medicare’s Nursing Home Compare system and the Illinois Public Health Department. This study reviewed 770 nursing homes in Illinois were reviewed, 141 had special care units during the time of data collection. The facilities had a range of total deficiencies from one to 74 with Level of Harm ratings ranging from one to four on a four-point scale. The results showed that residents in a nursing facility that has a special care unit are at a greater risk of a higher Level of Harm but no difference in the number of deficiencies. Possible causes of this greater risk are due to the intrinsic nature of the population in special care units, the need for policy and procedural...
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...Dementia Article Review The amount of time that exists between the onset of dementia and the diagnosis of the disease is a key component in the efficacy that the disease will have in taking over the brain of the patient. Early diagnosis can lead to the patient enjoying many extra years of a happy, quality life. The problem that arises is that it is difficult to diagnose dementia when the patient first contracts it as the tests that determine the onset of the disease are not advanced enough to catch it at its earliest stages. Generally, physicians will have to use a number of closely related factors to determine if a patient runs a high likelihood of coming down with the disease or if they will avoid it in their lifetime. Perhaps the most important factor of determining the early stages of dementia is the behavior that someone who is close to the patient will notice. Work done by Jansen et al. found that informal caregivers in a community of older adults were able to identify behavior in older people that indicated that the person was on their way to suffering from dementia, but that case management does not have a significant effect on combatting or staving off the effects of dementia. When older people are left alone and they are developing dementia, it is imperative that nurses check for any signs that the patient seems to be stricken with the condition. If it appears so, then intervention will be necessary. de Witt, Ploeg and Black (1705) indicate that doing this will...
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...family caregivers of those with Alzheimer’s disease and related dementias. Today’s college students will be asked to fill both of these roles in the future. This study examined the level of knowledge of Alzheimer’s disease among college students. Two-hundred college students at a mid-sized midwestern university completed an online survey that included the Alzheimer’s Disease Knowledge Scale (Carpenter et al., 2009). Although most participants knew that people with Alzheimer’s remember things from the distant past better than more recent events, many college students were unfamiliar with risk factors and average life expectancy. Implications and recommendations for educational programs and curriculum are discussed. Alzheimer’s disease and related dementias are significant health concerns affecting our older adult population (Sullivan & Muscat, 2007). As our population continues to age and our demography shifts to higher proportions of elders, the number of individuals diagnosed with Alzheimer’s and dementia continues to increase. Although the causes of dementia are numerous, Alzheimer’s disease, which is irreversible and ultimately fatal, is the most common cause of dementia. About 70% of dementias in the United States are caused by Alzheimer’s disease (Brookmeyer, Evans, Hebert, Langa, & Herringa, 2011). This percentage increases to nearly 80% among those 90 years old or greater who have dementia (Brookmeyer et al.,...
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...Ageism. In this assignment I will discuss my learning outcome from the group discussion and the collaboration of the poster and mind mapping, I will also critically analyse and discuss the public attitude, and my personal perception towards ageism. To gain knowledge of different relationships and how ageism affects society, I will also discuss key concepts in relation towards the inequality and discrimination expressed towards this group of the population. I will examine how the health service and social care professionals conduct themselves towards care of the elderly, and the actions they take to resolve discriminatory practices to reduce social inequality in respect of the elderly. Patch1 After reflecting on my own attitudes regarding my understanding of the elderly, I found that I held similar views in that once an elderly person had reached a particular age they can be easily disregarded as a useful member of society, however my views were not based on any known facts or any valid experience that I had encountered, but rather on my personal interpretation and general stereotype towards the elderly, after our group discussion and after reading relevant literature concerning ageism my opinion has changed. Ageism was introduced by Robert Butler (1969) suggesting it was a process whereby an older person was systematically stereotyped with prejudicial attitudes directed towards them. This was deemed as discrimination. According to (McGlone...
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...individuals who are unable to achieve adequate nourishment orally because of various medical problems. However, the delivery of nutrients by tube feeding can cause ethical dilemmas in cases where the effectiveness of tube feeding diminishes and medical complications increase. The decision to tube feed is often influenced by regional and cultural preferences, as well as the high cost of providing mealtime assistance. The effectiveness and appropriateness of tube feeding has been the subject of much debate as it applies to those with severe cognitive impairments and those who are in a persistent vegetative state (PVS). Recent research shows that in these vulnerable populations, tube feeding alone does not necessarily prevent malnutrition and risk of infection or improve functional status and comfort. While advanced directives allow an individual to make decisions about his or her care at the end of life, court cases and religious doctrine examine the individual’s right to autonomous decision making in opposition to preserving the sanctity of life. As long as the outcome of this debate is largely undecided, the process of dying may be prolonged for those who can no longer advocate for themselves. Keywords: Enteral feeding, tube feeding, ethics, persistent vegetative state, dementia, palliative care Introduction Nutrients are introduced into the body in two ways: by enteral feeding through the digestive tract, and by parenteral feeding through a tube inserted in...
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...Dementia and Palliative Care Thomas Edison State College Introduction According to the Palliative Medicine article “global prevalence of dementia is almost 36 million people and the numbers are expected to double every 20 years (Ryan, Gardiner, Bellamy, Gott & Ingleton, 2011). With this in mind, in seems dementia is just as prevalent as cancer but these patients do not seem to receive the same end of life care or palliative care. The World Health Organization defines palliative care as An approach that improves quality of life in patients and families facing problems associated with life threatening illness, through prevention and relief of suffering by means of early identification, impeccable assessment and treatment of pain and the problems with physical, psychosocial and spiritual. ("Who definition of," 2013) The two article summaries that follow will help healthcare staff understand the great need for palliative care in dementia, from the diagnosis to death. Annotated Bibliography Ryan, T., Gardiner, C., Bellamy, G., Gott, M., & Ingleton, C. (2011). Barriers and facilitators to the receipt of palliative care for people with dementia: The views of medical and nursing staff. Palliative Medicine, 26(7), 879-886. doi: 10.1177/0269216311423443 Tony Ryan and colleagues discuss how “people with dementia often receive too little care whereas end of life care is often characterized by too much” (Ryan, Gardiner, Bellamy, Gott &...
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...Elderspeak is a common communication method that is used in nursing homes, acute care hospitals, and other settings where elders reside. It is also frequently used when we speak to older adults, regardless of the particular setting. This style of speech is characterized as being much slower, having an exaggerated intonation, elevated pitch and volume, greater repetitions, and incorporates a simpler vocabulary and grammar than normal adult speech. Research has shown that the speech pattern used typically with the elderly is based on stereotyping and myth as opposed to the reality of the aging process. A number of researchers have conducted studies where a brief educational program was designed to increase the awareness of Certified Nursing Assistants (CNAs) regarding their use of elderspeak and strategies that could potentially enhance communication. No research studies can be identified that include Registered Nurses (RNs) and their understanding and use of elderspeak. Educating nurses about elderspeak may serve to enhance the development of a positive relationship between the Registered Nurse and the older client, which could result in an improved therapeutic relationship and improved health status. Social interactions, in all healthcare settings, can potentially make the difference between an individual who is able to be self-sufficient and the one who becomes a dependent member of the community. Social relationships have been described by Abraham Maslow’s hierarchy...
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...Long-term care facilities are defined as a facility that offers rehabilitative, restorative, and ongoing skilled nursing care to patients who are in need of assistance and help with activities of daily living. Long-term care facilities consist of nursing home, rehab facilities, inpatient behavioral health facilities, and long-term chronic care hospitals (Definition of Long-term care facility, 2012). The purpose of this case study was to explain the activities and participation of individuals with Dementia who are residing in long-term care facilities. An exploratory descriptive research study was performed on 329 individuals who were medically diagnosed with Dementia was led in the central area of Portugal. Socio-demographics were gathered...
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...Organizational Systems Task 1 Western Governors University Task 1 A. Nursing-sensitive indicators By understanding nursing sensitive indicators, the nurses in this case could improve the structure, process, and outcomes of their nursing care. The structure of nursing care is indicated by the supply of nursing staff and the skill level of the nursing staff. By the nurses having increased knowledge of the issues hip fracture patients are prone to having, such as decrease mobility, increase need for surgical intervention, and increase risk of falls, could help improve the quality of patient care. A patient with decrease mobility is at higher risk for pressure sores. The nurses in this case may have prevented the one by proper padding and repositioning every 2 hours. The nurses in this case should aim to prevent surgical complications and infection (Sauls, 2013). With proper knowledge of dementia, fall prevention, restraint prevalence could lead to improved patient safety and satisfaction. Maybe with an understanding of dementia the patient could have been reoriented, medicated, moved to a room across from the nurses desk, or had a CNA sit with the patient to prevent the need for restraints. If the patient was drowsy there is a good chance the restraints in this case were not medically indicated. Dementia patients are more prone to weight loss and inadequate nutrition which could lead to other risk. In this case the staff should have offered a variety of foods the patient like...
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...situation it is important to consider nursing-sensitive indicators and how this is an indicator of quality patient care. It is also important to note how this creates an ethical issue and to learn from the situation companywide. Many situations like Mr. J’s happen every day and are swept under the rug. Patient care should always involve patient needs along with cultural considerations while maintaining consistency with evidence based medicine practices. Nursing sensitive indicators assist to identify potential issues related to quality that may come about during patient care. Identifying nursing sensitive indicators allows nurses to improve the quality of patient care which results in increased patient satisfaction and improved patient outcomes. The American Nurses Association (ANA) is a great resource and wealth of information to assist in identifying specific indicators to apply to patient care. Nursing sensitive indicators bring light to specific patient needs. In the case of Mr. J several nursing sensitive indicators can be identified; his recent fall resulting in a hip fracture, he has dementia, cultural and religious values, immobility, pressure ulcer risk, the use of restraints, and pain management techniques. The diagnosis of dementia identifies that Mr. J is unable or has limited ability to reason with sound judgment along with the added use of pain medications. All of these indicators can lead to quality patient care if nursing applies them correctly and it is taken...
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