Partnership in dementia care
Description
DEFINATION
Dementia is not a regular part of aging it’s an umbrella term, which explains a set number of symptoms that affect the brain. Contributing to memory loss, the ability of not being able to perform essential daily day to tasks. There are many types of dementia, Alzheimer, Lewy body, vascular and frontotemporal. Alzheimer’s Society, {2017}
Dementia is not a specific disease. It’s an overall term that describes a group of symptoms associated with a decline in memory or other thinking skills severe enough to reduce a person’s ability to perform everyday activities. Alzheimer’s disease accounts for 60 to 80 percent of cases. Vascular dementia, which occurs after a stroke, is the second most common dementia type. But there are many other conditions that can cause symptoms of dementia, including some that are reversible, such as thyroid problems and vitamin deficiencies. Dementia is often incorrectly referred to as "senility" or "senile dementia," which reflects the formerly widespread but incorrect belief that serious mental decline is a normal part
While symptoms of dementia can vary greatly, at least two of the following core mental functions must be significantly impaired to be considered dementia:
• Memory
• Communication and language
• Ability to focus and pay attention
• Reasoning and judgment
• Visual perception
People with dementia may have problems with short-term memory, keeping track of a purse or wallet, paying bills, planning and preparing meals, remembering appointments or traveling out of the neighbourhood. Many dementias are progressive, meaning symptoms start out slowly and gradually get worse. If you or a loved one is experiencing memory difficulties or other changes in thinking
The 1940s, Carl Rogers present notion of a person-cantered approach, formally knowing as ‘non-directive. Dementia has a progressive condition which is while it can be helpful in planning by having an awareness of the likely progression of a person living with the disease.
Over the past several decades, we have lost sight of the real intent behind Roger’s relational approach, settling instead on well-intended but often paternalistic attitudes that place patients or clients at the centre of care, but rarely, if ever, actively involve them in decision-making. A person affected with Alzheimer’s and other dementia-related misinterpretation of lack of capacity to be involved in their care. Serving moving on our experience directly with persons with dementia, family members and professionals, and systematic research on many mutual partnership initiatives, the purpose of this work is to present an alternative approach of one that views persons with dementia as equal partners in the context of dementia care, support, and regular services of their essential.
Introduction:
With close reference to the above definition, the context of this essay is conduct an assessment of a gentleman; Tom is an anonymised identity for patient confidentiality according MNC (2015). The essay will identify risks factors, put together appropriate plans to mitigate against those risks, bring together all relevant professionals to deliver a patient centred care for Tom. A process of implementation will occur, and timeframe set up to conduct an evaluation that will set a stage for follow up implementation and project continuity in Tom’s care. Allowance will be made to conduct carer’s assessment on Tom’s wife and daughter who are both currently carers at home. This easy will align itself with the relevant theories and or models i order to bring to light the current trends in the treatment of Alzheimer’s disease as one of the challenging health conditions in the UK and other parts of the Globe.
This assessment is based on VIPS FRAMEWORK as suggested by Brooker (2007) . VIPS stands for: valuing people with dementia(V), individualized care(I), understanding the world from the resident’s perspective(P) and providing a social environment that supports the needs of the resident(S) which was relevant in the assessment of Tom’s physical, emotional and practical care. Tom is an adopted name in this case to disguise the actual to ensure patient confidentiality is maintained at all times, Nursing and Midwifery Council (NMC) (2015). Tom is 85 years of age who lives with his wife and one adult child in a semi detached house. Tom was diagnosed with Dementia- Alzheimer’s Disease (AD) about five years ago by his General Practitioner (GP) In addition to this, Tom also has begun to struggle with his mobility due to difficulties with coordination which is directly rooted to the gradual degeneration of this brain cells as indicated by Kelly and Newton-Howes (2004). Also Tom has started experiencing incontinence issues with urine which causes him a great deal of distress. This is also supported by Rau (1993)
Medication: Tom is prescribed Haloperidol -1.5mgs, analgesics i.e., Paracetamol 500mgs to take as and when required (PRN), and initially Benzodiazepine was considered but discontinued due to his age.
Daily living activities: Dressing, Bathing, Eating and Grooming as stated in Rau (1993) Tom is unable to attend to his personal hygiene and therefore requires a lot of support from both healthcare professionals and family – mostly his older daughter who still lives at home as his wife is also struggling with type 2 Diabetes. Cognitively Tom is not able to retain short term memory, and recall information short term information, hence he does require a lot of verbal prompting and support with communication. The impact of this on Tom is that he can easily become agitated and frustrated when his communication needs are not immediately met. This process is consistent with Kelly and Newton-Howes, (2004) .Also it is stated in Marshall (2006) that the progressive degeneration of a family member through Alzheimer’s disease can be challenging and tough.
Formal Care Arrangement: Currently Tom is partly receiving former care at home with carers coming in twice a day (BD) Package of care, and partly informal care mostly by his older daughter. The current care does not appear to be sufficient for Tom. The twice a day formal care from the local Authority is not adequately meeting his care needs and his daughter is in full time employment and hence she is at times not able to meet her own responsibilities towards Tom . Tom’s older daughter has made several appeals to the local Authority to increase care package from BD to full package, and QD package of care ,however, this has not happened .This intervention will explore all of these and plan accordingly.
Social history: Tom is the second child of three, was born and raised in the Northern part of England , went to both primary and secondary schools in the North and came down South to attend University and studied History and following his University education he decided to stay in the South where he has lived up to now. Reported no abnormal childhood but shared that he was not an easy person to get along with. Tom met his wife at University and they have three children and they are all adult and two are live in Australia and the older child lives with him and her wife in England. Tom’s siblings are old and live in the North of the country and contact with them is very seldom nowadays.
Physical care needs: Tom is diagnosed with Alzheimer’s disease, incontinent of urine, decreased mobility, hearing difficulties, and limited communication and coordination. In light of these seemingly complex health conditions, Tom presents with the following care needs.
1, Risks of falls
2. Risks of self harm
3. Risks of self-neglect and neglect by others this can lead to a range of problems and in extreme cases it can result in sudden death can occur and this indicated in Huang and Liao (2013),
4. Risks to others especially his ageing wife who is diabetic. It is suggested that risks to others especially family can take the form of shouting, being rude and at times physical contact. This is high lighted in Chater and Hughes (2012)
5. Risks of compromising his dignity when in public places.
Social, emotional and psychological needs:
1. Isolation, withdrawal from society, loss of status, and role in life
2. Emotionally, Tom presents with low mood and at times he reports feeling sad and hopeless.
3. Psychologically Tom presents with negative thoughts, and ruminates for a lot of the time and stressed and or frustrated due to problems with his cognition, and communication difficulties.
Care planning:
Planning care for Tom took into account the following: Initial consultations with Tom and family, current care providers, and his GP based on the care needs listed above. The following care schedule was planned and agreed by all stake-holders.
1. The care planning was done in three categories: Immediate; To assess his home environment to establish if there is a need for adaptation of the house and this will help Tom navigate his environment at ease, and to feel comfortable at home. This is to be funded by social care. This can be facilitated by Occupational Therapist (OT) to help Tom to adapt to his need-lead environment in order to regain his confidence, feel empowered, and adjusted.
To increase his current care package from twice a day to 4 times a day and the local social service to take lead in this area. Within this arrangement medication management can be done by the carers and GP
2. Intermediate: GP to refer Tom to the local Improving Access to Psychological Treatment (IAPT), this will ensure that Tom is supported to deal with his psychological issues and address problems with low mood this can lead to Tom engaging with his community and others in his environment which is stressed upon by Morton (1999).GP to refer him to the audiology department to assess for hearing support. Physiotherapist to help Tom with his mobility and increase his functionality. Intermediate care is also indicated in Marshall (2005).
3. Long term: General adaptation of his need lead equipment, housing issues i.e. to establish if Tom will continue to live in his house or be located to a residential accommodation.
4. End of life care and arrangements: This can be facilitated by social services and also can be explored in Psychological interventions through IAPT,( Kitwood, 1997) and (Killick and Alan, 2001)
Care coordination: The main service provider here is social services with close collaboration with the GP. All other healthcare professionals are expected to work closely with the each other in a seamless manner as this will enhance holistic intervention for the benefit of Tom, and family. The main care coordinator is Tom’s social worker who liaises with everyone involved with Tom’s care. This arrangement ensures that everyone is aware of their limitation and hence able to seek support from other professionals, as when needed. Tom will be able to channel his concerns through a well coordinated process and this can have positive effect on Tom’s family. This can reduce potential frustration, distress, and bureaucratic bottle neck in delivering care to Tom.
Monitoring and evaluating care: Reviewing care is the business of everyone but this can done in a well coordinated manner in which progress is gauged periodically and provisions are made for improvement in areas that are in need of further work. Training needs are frequently assessed to help all professional and even identified family members to keep up with the ever growing needs to improve on things and keep up with local, national and global trends in healthcare. This indicated in Hudson (2003).
References:
Chater, K. and N. Hughes. "Strategies To Deliver Dementia Training And Education In The Acute Hospital Setting". Journal of Research in Nursing 18.6 (2012): 578-593. Web. 26 Jul. 2018
Brooker, D. (2007). Person-Centred Dementia Care: Making Services Better. 1st ed. London: Jessica Kingsley.
Huang, H. & Liao, C. (2013). "A Case Study on Duty of Care in Professional Nursing", Hu Li Za Zhi, vol. 60, no. 4, pp. 76-85
Hudson, R. (2003). Dementia Nursing. Milton: Taylor & Francis.
Kelly, C. and Newton-Howes, G. (2004). Guide to assessment scales in dementia. London: Science Press.
Killick, J. & Allan, K. (2001), Communication and the care of people with dementia, Open university Press, Buckingham.
Kitwood, T. (1997), Dementia reconsidered: the person comes first, Open University Press, Buckingham Philadelphia.
Marshall, M. (2006). Perspectives on rehabilitation and dementia. London: Kingsley.
Morton, I. (1999). Person-centred approaches to dementia care. Bicester: Winslow.
Rau, M. (1993). Coping with communication challenges in Alzheimer’s disease. San Diego, Calif.: Singular Pub. Group.
Thanks for the submission of your 3000 case management plan.
On successful completion of this learning for CW2, and this module, you will be able to:
Demonstrate an understanding ofmultidisciplinary perspectives ofDementia and approaches to care.
The front page contains all the relevant information and the word count is evident. You are required in the introduction to introduce the assignment first and essentially the learning outcomes for this assessment – this is not evident. Overall unsatisfactory with some sound aspects. Little or no evidence of focus on the task, with a consequent failure to meet the learning outcomes – particularly LO2 subjectively discussing a care plan with no evidence to support PCC within a case management plan &LO 3 in the main body discussing underpinning policy. Throughout your work you are repeating your case study which is not what is required – this should have been applied to an appendix. Work is either insufficient or incomplete and does not address those elements essential to success.
The assignment has been produced in a flawed format that does not communicate its contents to the required standard with ideas unclear and incoherent and very descriptive in parts – please see in text comments.
Not well researched. Essentially no evidence / reference is provided for MDT / partnership working & CMP instead care plan is referred to . There is little or no attempt to use valid supporting texts or resources and, subsequently, no real evidence of reading in the work from the module content. The majority of work is outdated literature being applied. Sources are not cited correctly, and the similarity match of 23% on turnitin – is a concern as there is a total of 15% match with UK essays & home care guide within the main body.
Inadequate critical analysis and evaluation, no evidence of originality. Knowledge is either sparse or non-existent, with little evidence of engagement with course material and concepts. Opinions are presented rather than arguments supported by sound sources. Some significant errors and misunderstandings.
Overall, this is a fail at level 6.
3 areas for improvement:-
1) More evidence and evidence which is ‘current’ within the last 5 years from a breadth of sources is required to support your work particularly at level 6. There is limited reference to learning unit material in your work.
2) Harvard referencing format needs to be applied consistently throughout your work in text & reference list to support point raised
3) Ensure you understand what is required for future re submission as the 3 learning outcomes have not been addressed equally in the main body of your work and the writing style is personal / subjective with no academic evidence to support your assumptions / views from a PCC case management plan perspective
Finally, in order to meet Learning Outcome 2 you are required to consider recommendations that could be made for future practice taking into account underpinning policy.
4. Feedback, marking criteria and grading of your assessment
This section tells you how the marker will assess your work fairly. All markers aim for our feedback to be: timely, individual to you, helpful, empowering and manageable.
They will also offer you opportunities to discuss the marking criteria they intend to use, and the type of feedback they intend to give you. You should create a shared understanding of this with them and your peers during the course of the module. They may also give you opportunities to assess your own work and the work of your peers. Look out for these opportunities.
Assessment markers can give you feedback and allocate marks to you using a range of methods and tools that are appropriate to the specific module and assessment. The marker may make comments within your script (in bubbles) and may also give you written comments in the long box. They may give you a form of audio or video feedback.
When they give you feedback on your assessment, as a minimum, your marker will tell you:
* if and how you have met the relevant learning outcomes
* the areas within which you did well in this assessment (they will commend you)
* the areas you could have improved in this assessment (they will make suggestions)
* what activities you can work on to help you in your next studies (you can take these ideas forward with you, and may discuss them with your Personal Tutor. You can also build them into your Action Planning.
5. Assessment Presentation
When marking this assessment, the markers will also be looking for the following.
* Legible presentation.
* Good use of spelling, grammar and language throughout.
* Appropriate focus, meeting learning outcomes/assessment criteria.
* Logical progression and structure of arguments.
* Evidence of a range of relevant supporting reading.
* Use of accurate, evidence based information to support the arguments made.
* Follow normal Academic Regulations in terms of Academic Offences, style and language.
* Use of the appropriate system of referencing and may include a bibliography that lists all resources referenced.
This is the main assignment i posted the lecturer comment and the work that was previously done
A 3,000 word report examining case management planning, showing in detail how person-centred needs will be met and exploring how the practitioner will work to meet those needs. Recommendations for practice incorporating underpinning policy should be considered.
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