Dementia Care in Nursing
Dementia care presents a huge challenge to health and social care both now and in the future. The number of those in the UK with dementia is expected to increase to 1.4 million in the next 30 years. Regardless of the field of nursing all nurses need to understand the experiences of a person with dementia and the issues related to their care. This book provides an introduction to dementia care for nursing students with an emphasis on humanizing care. Real life case studies show the person behind the patient and explore the ethical dilemmas that a nurse may face. Key Features • Linked to the latest NMC Standards and ESCs for degree-level education • Real life case studies link theoretical discussion to actual patient ...
- Front Matter
- Back Matter
- Subject Index
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© Sue Barker 2012
First published 2012
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Terry Pratchett, the well-known author who has publically discussed his own early onset Alzheimer's disease, has said:
The first step is to talk about dementia because it's a fact, well established in folklore, that if we are to kill the demon then first we have to say its name … Names have power like the word Alzheimer's; it terrorizes us. It has the power over us. When we are prepared to discuss it aloud we might have power over it. There should be no shame in having it yet people feel ashamed and people don't talk about it. (Alzheimer's Society, 2008a, p8)
This extremely well-written book will enable nurses not only to talk about it but also to act and care for those with dementia from a sound, knowledgeable basis that takes into account the many factors – physical, psychological and sociological – that impact on this distressing condition. Statistics about dementia feature more and more in the news. It is predicted that dementia in older people worldwide will experience an exponential rise in future years, yet more money is spent on cancer. Currently, there are 35.6 million people worldwide who experience dementia, a figure estimated to rise to 65.7 million by 2030 and 115.4 million by 2050. As nurses, we are in a key position to take on this challenge as we have close relationships with those in need of care.
Dignity and nutrition continue to be of concern in current NHS hospitals, as demonstrated in the Care Quality Commission report (2011), which identified that 50 per cent of hospitals were not providing adequate nutrition and dignity for older people. The authors, Sue Barker and Michele Board, have written a text that delves into all the aspects of nursing care that a 21st-century nurse needs to know to provide the highest standards of care for patients with dementia. They cover fundamentals, in nursing models of care, that includes compassion and caring, as well as person-centred care, and introduce a new model: humanising care (Todres et al., 2009).
The book deals with attitudes, culture and spirituality; personality and lifelong development; and assessment from a nursing perspective. Practical advice on how to manage dementia in an acute setting, including physical and psychological health, is clearly provided. All aspects of the phases of caring are covered and a very relevant final chapter on ethics and legal aspects considers issues of consent and management of complex legal scenarios and the protection of the vulnerable. The level of detail and evidence-base information in this text ensures this is one of the most readable and informative texts available on this challenging and increasingly significant condition.
We would like to thank our colleagues and the staff at Learning Matters who have supported us in our writing. We would, though, especially like to express our appreciation for all those we have worked alongside in our caring roles. While we have endeavoured to use ourselves to show care and support others, we have felt honoured to be part of their lives. Thank you to the people who have shared their lives with us and inspired our case studies. We have met some exceptional people and feel humbled.
The authors and publisher would like to thank:
The Open University Press for material used in Tables 3.1 and 3.2, from Kitwood, T. (1997) Dementia reconsidered, the person comes first. © Reproduced with the kind permission of Open University Press. All rights reserved.
Every effort has been made to trace all copyright holders within the book, but if any have been inadvertently overlooked, the publisher will be pleased to make the necessary arrangements at the first opportunity.
About the Authors
to misuse; to treat someone badly
a concept within Piaget's cognitive developmental theory meaning the development of a new schema when new information makes an old schema obsolete.
acute confusional state
acute: of short duration; a sudden or of short duration state of being confused or disorientated about time, place or person.
a type of discrimination based on the person's age – usually related to older age but can be used for younger ages too.
a person's ability to act for themselves; to undertake an action based on their free will.
the absence (a) of the ability to recognise or identify objects.
a group of medications primarily used to treat depression. There are different pharmacological categories, including tricyclics, specific serotonin reuptake inhibitors and monoamine oxidase inhibitors.
approved mental health practitioner (AMHP)
a mental health practitioner such as a social worker, mental health nurse or occupational therapist who has undertaken a further qualification to become ‘approved’ to conduct mental health assessments in order to complete an application for a person to be detained under the Mental Health Act.
the absence (a) of the ability to control bodily actions (movements).
a concept within Piaget's cognitive developmental theory, meaning the incorporation of new information into an existing schema; the information is assimilated.
a cardiac dysrhythmia, i.e. the heart is not maintaining its usual rhythm. This particular dysrhythmia is where the atria (the upper chambers of the heart) are not beating properly – they are fibrillating (flickering).
the emotional, cognitive and behavioural response to underlying beliefs and values of the person.
pertaining to the perception of hearing.
making one's own choices or decisions.
to do something or make a decision on someone else's behalf in order to facilitate what they would have done, if able, to promote their own health or well-being.
one of the positive person work interventions identified by Kitwood, where nurses provide the opportunity for the person to recognise and express a joy about something with other people.
the disregarding of personal attitudes and values to focus on the person and their concerns; to put the person at the centre. This can be done by controlling one's breathing and paying attention to the person.
the main, biggest, part of the brain and has two parts.
cerebral: brain; hypoxia: a lack of oxygen. The brain is receiving too little oxygen.
usually refers to a person who is struggling to process their thoughts.
the treatment of something or someone as a commodity that can be bought and sold.
an idea or collection of ideas that work together as a whole idea/thought/entity.
to make up a story/explanation; this term is usually associated with mental disorder, particularly Korsakov's syndrome.
the elements or parts of a theory.
a continuing string of items/ideas/thoughts where those next to each other are difficult to distinguish apart but each end of the string are opposing – the opposite of each other.
the finding that different things occur in the same situation. A statistical approach might seek correlations between certain behaviours, thoughts or attitudes, but if a correlation is found, it does not mean that the one caused the other to happen – only that they occurred together.
cortical: relates to the brain; encephalopathy: an abnormal structure or function of brain tissue. This condition is usually found in degenerative diseases. A disease of the outer part of the brain.
experientially dependent; it relates to the person's experiences and includes abilities such as knowledge for general information and verbal comprehension.
literally, the blue disease; this relates to a blueish colour to the skin due to lack of oxygen in the blood usually seen first in lips and nail beds.
reasoning or decision-making using rational and logical thought processes; working through a problem one step at a time.
in the context of the Mental Capacity Act someone appointed by the court of protection to make decisions for the person lacking capacity, ensuring the decisions are the least restrictive and in the person's best interests.
a different diagnosis; whether an alternative assessment of the person's problems can be made.
where decisions on how to respond to a person are made on the basis of a stereotype and the action has negative consequences for the person.
donees of a lasting power of attorney
under the Mental Capacity Act the persons who are legally appointed by the donor to make decisions for them when or if they lose capacity.
being in a state of always changing, moving or developing.
difficulty (dys) or absence (a) of speech.
I; the person's sense of themselves. In psychodynamic theory it is the part of the self that balances the needs and desires of the id against the social and moral codes of the superego.
a machine that measures the electrical activity of the heart.
a recognition that the social, psychological and spiritual person exists within a physical body, therefore all elements of the person need consideration in care situations.
the ability to recall specific situations; to remember separate episodes.
decisions about what professional behaviour or attitudes are right or wrong.
the study of animal behaviour and how it occurs in the natural environment.
clearly and fully defined, leaving nothing to be assumed or implied.
pertaining to the family, for example genetic disorders.
small fibres. Amyloidal fibrils: small fibres made up of insoluble proteins that impact on the functioning of brain cells in dementia.
physiologically dependent; it relates to the body's ability and involves activities such as perceptual speed and visual organisation.
able to fulfil its role; the body is working as it should.
the perception of something that is not present; can occur in all of the senses but is most commonly visual (sight) or auditory (hearing).
the predominance of one social class or ideology over others.
a part of the limbic system in the brain lying at the bottom of the lateral ventricles and involved in memory and emotions.
high blood pressure.
illness or disease due to medical intervention.
according to psychodynamic theory, the innate part of the personality that demands to have its needs/desires addressed immediately.
a set of beliefs or a worldview; a system of abstract views that address the social and aspirational needs of a group.
impaired higher cortical functioning
the reduced ability of the brain, particularly the frontal lobes, to undertake activities such as reasoning and problem solving.
implied, not stated clearly and unambiguously.
a term used within the model of care developed by Todres et al. (2009), which indicates that carers should recognise/understand what the person is experiencing in their perceptual world.
of slow onset.
something that is done by two or more disciplines working together.
where a decision is based on instinct rather than rational, logical, conscious reasoning.
where the fewest restrictions or limitations are placed on the person to facilitate the greatest amount of autonomy within the boundaries of the disease and resources.
concentric spheres made up of proteins.
the total experience of the person – their inner thoughts and feelings along with their social and interactional experiences.
a movement; a process that goes in one direction, one step after another.
one behaviour that is associated or linked with another.
malignant social psychology (MSP)
a concept highlighted by Kitwood when exploring the care of people with dementia. He found that carers behaved in ways that reduced the person's self-concept and self-esteem without intending to, through using accepted cultural responses.
occurs, happens, appears.
a number of meanings but in this context a type of average; a mathematical concept. There are three types of average: mode, median and mean. To establish a mean you need to add all the numbers up (e.g. 12 + 22 + 32 + 42 = 108) and then divide by the number of numbers (4); this gives the mean average (27 in this example).
mental defence mechanisms
a concept identified by Freud. They are coping strategies used by people when in psychological difficulty; in the short term they can be helpful, but in the long term they reduce the person's ability to get on with their life in a healthy manner.
the copying of the behaviour of one person by another.
an economy that utilises both public and private funds.
a proposed structure or way of organising actions.
personal decisions about what behaviour or attitudes are right.
refers to death, the incidence or number of deaths.
more than one dimension; more than one way of viewing something.
more than one infarct; more than one obstruction to the blood supply leading to the death of cells.
multiple higher cortical functions
many functions of the higher cortex: memory, thinking, orientation, comprehension, calculation, learning capacity, language and judgement.
the process of nerve cells being covered with myelin (made from cholesterol), which protects and speeds the nerve impulse.
damage to spinal cord.
not providing proper care, which could lead to harm to the person.
to reach an agreement through discussion.
neural fibrillary tangles
small fibres that develop from within the neurone. They interfere with the normal functioning of the neurone.
relating to chemicals that are found in or affect the nervous system.
the ability of nerves to adapt, develop and change.
diseases of neurones or the nervous system.
damage to nerves.
memory for how to do things that are difficult to declare or explain but easier to show, such as tying shoe laces or riding a bicycle.
doing no harm.
drugs developed from opium, such as morphine; they have strong pain-killing functions.
in the context of people, refers to an organ of the body; organic disease is a disease of a part of the body.
behaving in the right way according to set rules usually related to a religious belief system.
from the philosophy of phenomenology, which influenced the development of the humanising care model by Todres et al. It means to be and belong to one's self.
an ideology that promotes the acceptance of a ‘father figure’ or ‘powerful other’ such as the government who knows best and makes decisions on behalf of others without their explicit consent.
changes in the body's structure or functioning due to disease.
the person's experience of the world through their senses; the person's interpretation of their senses.
one of the elements of Todres et al.'s model of care referring to the individual nature of how a person progresses through life along with their understanding, desires and goals.
a number of different types of plaques can be found in the body. Most importantly for dementia are senile and atherosclerotic plaques. Senile plaques are a spherical group of amyloidal fibres in the brain and atherosclerotic plaques start from fatty deposits in the arteries.
the use of a number of medicines at the same time.
positive person work
a person-centred approach to care developed by Kitwood to address the problem of malignant social psychology.
[Page 166]preferred sense
the sense the person prefers to use, probably the one that functions best. A person who struggles with their sight might prefer to listen to information.
the number of people experiencing a certain condition at a given time.
in the context of memory, refers to the ability to remember how to do something.
the perceptual information from the senses that allow the person to identify where parts of their body are.
pathology: disease or ill health; psyche: of the mind; disease of the mind.
the experience of being at rest, free from tension or stress.
thinking about things that have already happened; thinking about the past.
saying what has already been said using different words.
an action occurring due to a stimulus.
something that could cause harm.
a person who acts out how things should or could be done for others to learn from.
a cognitive theory that knowledge and information (memory) is stored in the brain in packets or collections, together with elements that link one schema to another.
from the humanist approach, the experience of achieving one's potential, a peak experience. However, the person is not able to maintain this position and needs to start at the bottom of hierarchy again.
the belief in our ability to achieve our goals.
the worth or value we attach to ourselves.
memory or recall related to knowledge and understanding.
sense of place
a concept in Todres et al.'s model of care that refers to a sense of belonging; the experience of being at home.
the ability to hold information for short periods of time to allow manipulation or use of it.
where people are rejected or their worth is not acknowledged by their community or society, usually due to gender, age, religion, race or disability.
a concept from phenomenological philosophy that underpins Todres et al.'s model of care. It concerns a person's ability to understand their place in time and space; to understand their contextual situation both historically and in the present.
occurs at irregular intervals without an identified cause.
a progression of disease distinguished by a period of stability, then an acute step down to a reduced level of ability.
the application of certain characteristics to a group of people without reference to the individual differences between them.
to degrade a person due to a particular circumstance they find themselves in.
something that arouses or motivates a person to action.
an abnormal structure or function of brain tissue. Sub: under; cortical: brain, encephalopathy; this condition is usually found in degenerative diseases. It is therefore a disease of the inner part of the brain.
according to psychodynamic theory, the part of the mind that has developed from the environment and is known as the conscience. It tries to force the person to comply with rules and behave morally.
[Page 167]synaptic growth
synapses or links between neurones are being made, which facilitate increased brain function.
a group of signs or symptoms that when found in a collection are labelled together.
lobe in the brain on either side of the head. The brain has two cerebral hemispheres – one on the left of the body and one on the right – and these are further divided into lobes. The frontal lobe is at the front of the head, the occipital lobe is at the back of the head, the parietal lobe is in between and the temporal lobe is on either side of the head.
a concept from the philosophy of phenomenology that means existing in time, a relationship with time.
an activity as part of positive person work established by Kitwood. It refers to the need to experience the world through all of the senses: through touch, smell, sound, sight and taste.
a concept within the model of care by Todres et al. and refers to the need to experience the world with other people. This is also acknowledged by Kitwood.
the expected progress or journey of a condition.
refers to the skin's ability to return to its usual shape; its elasticity. If a person is dehydrated, the skin will not have its usual turgor and take some time to return to its usual shape when pinched.
to be distinct or different from others; to be one of a kind.
an ideology common in Western society that facilitates the ‘greater good’ when a moral or ethical decision is needed. The right choice is the one that achieves the most people being happy.
acknowledging a person's perspective and recognising its importance for them.
a type of something that differs from the usual.
pertaining to the blood vessels.
occurring indirectly or through someone else.
refers to the visual perception of the relationship between objects: the distance between objects.
relating to sight.
whole systems approach
an approach that looks at how all systems within a certain context work together, not focusing on individual ones – for example, with people, avoiding focusing on the biological system only.
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