Management Of Dementia Patients In Acute Care Setting
Prevalence Of Dementia In Australia
Dementia is a major health problem worldwide and nurse working in acute care setting are expected to reduce the aggravation of dementia through adequate care provisions. However, nurses faced many issue while administering care to people with dementia in acute care setting. This is evident from the scenario of Mr. A, a 68 year old man who was admitted to the hospital when he was unable to carry out his activities of daily living due to loss of memory and task disorientation. The nurse assigned for the care of Mr. A was feeling stressed out she reported difficulty in understanding the blocked message of patient. Apart from this, the routine care and intervention could not be provided as he lost track of activity due to his failing memory. This scenario reflects the obstacles for health professionals and nurses increase mainly due to impairment in language and memory skills of dementia patients. With this context, the purpose of the report is to analyse the health issues and management of dementia patients and find best available literature that contributes to the better understanding regarding the issues faced by nurse in caring for dementia patients Management Of Dementia Patients In Acute Care Setting.
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Dementia is a chronic and persistent mental disorder associated with cognitive decline symptoms like personality changes, impaired reasoning and social skills, mood disorder and memory loss. Clinicians diagnose dementia based on examination of careful medical history, presenting conditions and behavioral related changes in affected person. According to the current data on the prevalence of dementia in Australia, more than four lakh Australians are living with dementia. The number of people with dementia is expected to go up to 5, 36,000 cases by the year 2025. It has become the second leading cause of death and with the increase in ageing population in Australia, the number may increase to 9 lakh cases by 2050.
Currently, dementia is being managed by means of clinical practice guidelines which emphasizes on timely diagnosis, managing symptoms, promoting better living with dementia, delaying functional decline and using non-pharmacological approach to care. However, the current problem in management is that there is delay between the onset of symptoms and diagnosis of dementia. Dementia has poor prognosis as inconsistent result has been found following a diagnosis particularly in men and younger patents. Hence, more consideration needs to be given on timely and proper daily management of dementia patients to improve poor prognosis. It is recommended to adapt a systematic approach to diagnosis of dementia by means of cognitive assessment, medication review, blood test and computed tomography to confirm the disease. The desired outcome for to measure the success of the management of dementia include delayed cognitive decline, high practical level of personal functioning, decreased frequency of Neuropsychiatric Symptom and better knowledge and comfort with dementia care Management Of Dementia Patients In Acute Care Setting.
Clinical Practice Guidelines For Managing Dementia Patients
The research question in relation to the scenario of nurses caring for dementia patient is- ‘ How do nurses caring for clients with dementia (P) communicate with clients effectively (E) or perceive their communication with their clients (E) in order to establish a therapeutic relationship (O) during the hospital stay period (T)?’.
Using the PI/ECOT question for the study, the key search terms include ‘dementia patients’, ‘communication with dementia’, ‘nursing communication with dementia’, ‘perceived communication with dementia patients’, ‘therapeutic relationship with dementia patients’ and other interchangeable key terms. The relevant articles for the topic of review were selected from the CINAHL, MEDLINE, EMBASE, PROQUEST, Cochrane library and google scholar. The inclusion criteria for the literature search include selecting English peer-reviewed high quality journal articles published within the year of 2007 to 2017. Other criteria for the selecting the articles is to select those articles that give information on communication related challenges in caring for dementia patients. The search strategy was to review the abstract of the articles and then amplifying the search process by means of exclusion criteria. For instance, the research literature, which focused on specific intervention for dementia patients instead of communication, related issues are excluded. Secondly, the search process was further amplified by reviewing the detailed methodology and results of the selected research article. The included paper and its information were evaluated by means of PRISMA tools. Out of 30 articles, selected in the initial phase, the final extraction process yielded 5 article for literature review Management Of Dementia Patients In Acute Care Setting.
Table 1 : Annotated Bibliography 1
Wang, J. J., Hsieh, P. F., & Wang, C. J. (2013). Long-term care nurses’ communication difficulties with people living with dementia in Taiwan. Asian Nursing Research, 7(3), 99-103.
Article 1: Long-term care nurses’ communication difficulties with people living with dementia in Taiwan
| Author and title | Year | Journal | Country | Population | Comment |
| Wang, Hsieh, & Wang.
Title- The title attracts attention as it is relevant to the research question which was to analyse nurses perspective regarding communication with dementia patients and the title suggest that this article covers detail on difficulty faced by nurse in communication. Wang-Jing-Jy- has experience as an assistant professor, research assistant and clinical supervisor of different school of nursing in USA. This author work has been cited in other research articles related to cognitive skills and innovative communication education program for nurse-patient[i]. Pei-Fang Hsieh- contribute to the research with the experience in risk management and insurance and cited in research related to pricing strategies and Taiwan trade[ii]. Wang-Chi Jane- with her experience and knowledge in nursing and public health contributes to the research and extensively cited in research related to dementia patients[iii].Management Of Dementia Patients In Acute Care Setting |
2013-
This research article was published in the year 2013 and it has significance for nursing practice because the approach used in the research would be in compliance with current practice guidelines. It will promote organization to generalize the finding in actual practice setting as it will be based on current challenges and scenario in nursing practice. |
Asian Nursing Research- It is the official peer-reviewed journal of Korean Society of Nursing Science and it is renowned for wide range of research in nursing practice, nursing education and issues related to nursing practice. It is being published in different databases since 2007[iv]. | The research was conducted in Taiwan. Australia has public-funded universal health care system along with private health system[v]. The health care system in Taiwan is different from that of Australia. It has a single-payer system known as the National Health Insurance (NHI) characterized by good accessibility, population coverage, low cost, short waiting time and national health data bank for planning health services. However, weak quality of care is seen in the country[vi]. | The research investigated the population group of nurses working in long-term care facilities in Southern Taiwan. Due to the complexity of nursing job, there are there is demand of highly qualified and competent staff nurses in Taiwan[vii]. Nurses in Taiwan follows the code of ethics developed by Taiwan Nurse Association, on the other hand, nurse in Australia follows the standard of practice laid down in Nursing Midwifery Board of Australia | This research article has been selected as it is specific to the research questions and highlights the challenges faced by nurse in communicating with dementia patients and promote development of future communication related education for nurses. |
Johnson, A., Chang, E., Daly, J., Harrison, K., Noel, M., Hancock, K., & Easterbrook, S. (2009). The communication challenges faced in adopting a palliative care approach in advanced dementia. International Journal of Nursing Practice, 15(5), 467-474.
Article 2: Communication challenges faced in adopting a palliative care approach in advanced dementia
| Author and title | Year | Journal | Country | Population | Comment |
| Johnson et al., (2009).
Title- It reflects the main area of investigation and content of the paper which is related to communication challenges faced by nurse in adaptive palliative care approach in advanced dementia care. Amanda Johnson- a lecturer in the School of Nursing, University of Western Sydney, Australia., hence she has enough experience and understanding about nursing issues. With her knowledge and experience, she enhances the quality and validity of the research study. Her work is highly cited in research related to nursing practice[i]. Chang E.- The researcher has worked in the area of psychological well being and professional care of advanced dementia patients. Daly J.- His work is highly cited in research work consisting of landscape for dementia care[ii]. Harrison K.- His work highly cited in research work for dementia and challenges associated with care. Noel M.- He is renowned for his contribution to the field of memory of young children[iii]. K. Hancock –The author is involved in informative work for care givers of dementia patients[iv]. S. Easterbrook- The author is highly cited in research work related to dementia care[1]. |
2009-
The article is an old publication, however still it contributes to the research questions as it provides information on communication related challenges in dementia care. |
International journal of nursing practice- It is a reputable international publication, which publishes work of nurse authors, editors and reviewers. It publishes original scholarly work that contributes to understanding of the development in nursing professions and academic disciplines. Along with research papers, methodology papers, literature review and discussion papers are also published in this journal[v]. | The research was conducted in Australia by taking semi-structure interview with participants in one geographic region of Sydney, Australia. The Australian setting is an advantage because it is done in local context and it is evident that nurses working in Australia can directly relate it to their practice setting. The health care system of Australia is already discussed and the result finding will be consistent to system of work in Australian health care. | This research focuses on the experience of health care professionals such as palliative care staff, dementia specialist staff and nursing specialist staff. Although the focus is on all type of health professional, however still this article has been selected for the literature review because nurses are part of study and communication challenges has been investigated. | The article has been selected as it contributes to the research question and it is done in local context (Australia) which maximizes the generalisability and applicability of the research. |
Baillie, L. (2012). Caring for older people with dementia in hospital. part one: Challenges. Nursing Older People, 24(8), 33.
Article 3: Challenges in caring for older people with dementia
| Author and title | Year | Journal | Country | Population | Comment |
| Baillie, (2012)
Title- It reflects the essence of the paper and it contributes to answering the research question by research in the area of challenges in caring for dementia patients Author- Lesley Baillie is an experienced registered nurse, educator as well a researcher. With her interest in improving clinical practice and dignity in care, her research studies promotes clinical practice development. Therefore, the work of the author has high credibility[i]. Her work has been cited in research studies related to clinical practice, patient dignity and education of staff regarding dementia care[ii]. |
2012-
The inclusion criteria for the research article was article published within the year 2007 to 2017. As it is a recent published article, it has the advantage of applicability on nursing setting. This is because the research is focused on current challenges in care and the changes can be applied after five years too. |
Nursing Older People journal- While considering the position of the journal in clinical world, it has been found that is the leading specialist journal for nurses involved in care of older people. It unraveled solutions and issues for all type of work under aged care. Hence, the journal published in this journal are of extensive knowledge in relation to ageing population issues. As dementia is highly diagnosed in older population, it can also give useful insight into the objective of this literature review. | This research was done with nurse in the University of England (UK). This research setting is different from that of Australia. UK has government-based universal health system called the National Health Service The health care system in UK is mostly funded by separate government and private sector provision. The NHS gives more power to patient, large availability of beds, improved service and shorter waiting time[iii]. | The research population for the study included nurses working in care of dementia patients. This population group has relevance for the research question as it many dementia patients are found to give slow response to stimuli and environment. In such situation, the patient may fail to understand their needs and communicate it to nursing staffs. Hence, investigation in the area of challenges can help to get answer specific to the research question. | This research has been selected for the analysis as it promotes the understanding in the area of challenges faced in care of dementia patients. As this research stressed on the need to understand patients in relation to illness and deterioration of symptoms, it can contribute to identify specific communication skills in nurses. |
Franzmann, J., Haberstroh, J., & Pantel, J. (2016). Train the trainer in dementia care: A program to foster communication skills in nursing home staff caring for dementia patients. Zeitschrift Für Gerontologie Und Geriatrie, 49(3), 209-215. doi:10.1007/s00391-016-1041-1
Cognitive Assessment, Medication Review, And CT Scan For Diagnosis
Article 4: Training program to foster communication skill in nurses caring for dementia patients
| Author and title | Year | Journal | Country | Population | Comment |
| Franzmann, Haberstroh, & Pantel.
Title- The title ‘train the trainer in dementia cares answers the research question by stating what approach will help nurses to foster effective communication with dementia patients. J.Franzman- Experienced and working in the University of Frankfurt, Deustschland. With their experience in understanding the social world and skills, they have the credibility to produce a high quality research study. J. Haberstroh- He has been estensively cited in research work related to tools required for dementia care[iv]. J. Pantel- Citations seen in research work related to advancement in dementia care. |
2016-
This is very current and research focused in addressing the problem of disadvanatageous working conditions and lack of skills in nursing home staff caring for dementia patients. Furthermore, recently published general will ensure applicability of the research in real practice setting as this study design is based on current challenges and development in nursing practice and dementia care. |
The article is from the Gerontologie Geritarie, a European journal of Geriatrics. This journal has credibility in publishing research papers in the field of geriatric medicine and ageing. All the articles are mostly published on behalf of the European Union Geritaric Society. This journal is renowned for new developments in geriatric medicine as the focus is on publishing original journal articles[v]. | The research has been conducted in Germany and the country is known for its excellent research. Compared to universal health care system in Australia, German has multi-payer health care system funded by two types of health insurance-first is the Statutory Health Insurance and other is the Private Health Insurance. Hence, different players control the health care system and promote development by the principle of solidarity and self-governance[vi]. | The research study focused on the aged people with dementia and their carers. This was mainly because of the high risk of emotional exhaustion faced by the German nursing staffs while giving care to geriatric patients. Poor working conditions such as lack of adequate staff, poor communication skill and time pressure and lack of support from seniors creates stressors for carer in their job. Similar problems and challenges are also faced by Australian nurses in caring for dementia patients[vii]. | The purpose of selecting this research article for the literature review is that it contributes the research question regarding improving communication skills in nurses caring for dementia patients |
Beer, L. E., Hutchinson, S. R., & Skala-Cordes, K. K. (2012). Communicating with patients who have advanced dementia: Training nurse aide students. Gerontology & Geriatrics Education, 33(4), 402-420. doi:10.1080/02701960.2012.702165
Article 5: Training regarding communication with advanced dementia patients
| Author and title | Year | Journal | Country | Population | Comment |
| Beer, Hutchinson, & Skala-Cordes,
Title- As other articles identified challenges associated with dementia care, this title reflect the solution to address communication issue with advanced dementia patients. As research question mainly focus on communication difficulties dementia patients, this title catches attention. Laura E. Beer- She is credible researcher with many important piece of research in advanced dementia care and creative therapies across culture. Susan R. Hutchinson- She is renowned for her research on performance based functional ability in dementia patients. K. Skala-Cordes- His work is highly cited in gerontolology and geriatrics education journal reflecting the reflecting expertise in understanding of health issue for elderly people[i]. |
2012
The year of publication has relevance because it is not updated and can be taken as a piece of evidence to inform practice area in nursing and dementia care |
he research article has been taken from the Journal of Gerontology & Geriatrics Education journal. It is an official journal of the Gerontological Society of America and it has the credibility of raising awareness regarding the best practice and resource for gerontology. The journal provides superior exploration of research results, evaluation and recommendation to inform geriatric practice. | The U.S health care system is neither a single player system like Australia nor a multi-player universal health insurance fund. It is a hybrid system with investment coming from private funds, state and local government. | The population of interest in the study was student nurse working in community college in the Rocky Mountain region. Selection of this population group is commendable because newly placed nursing staff mostly struggle in interpreting message of dementia patients and giving training to them during nursing education might help in increasing their confidence in working with dementia patients. | Although this research do not directly provides detail about the communication problem experienced by nurses, however it contributes to improving their skills in communicating with dementia patients. Hence, the research as relevance in accordance to the research question. |
Table 2: Annotated Bibliography 2
| Authors, year and design | Research question | Sample size and profile | Outcome | Comment |
| Wang, Hsieh, & Wang, (2013)
Design- In-depth interview using the Phenomenological approach to qualitative research |
The main objective of the study is to analyze the difficulties faced by nurse in interacting and communicating with dementia patients | In-depth interview was done with 15 nurses from long-term care facilities in Southern Taiwan. Purposive sampling method was used to select the sample for the study. However, no consideration was done for power calculation. | The findings of the study resulted in two themes of communication difficulties faced by nurses. Firstly, difference in language and dialect created difficulty for nurses in interpreting message of patients.
Secondly, due to memory and cognitive impairment n patients, nurses fail to respond to patient’s behavior. Hence, this created difficulties in understanding the needs of patients and acted as a barrier in establishing therapeutic relationship. The findings of this study are clinically meaningful as it provides the strategies needed to develop dementia communication programs for nurses. This will promote patient-centered communication instead of task-oriented action and promote therapeutic relationship with patients too. |
The scientific study has great significance and implication as it can contribute to bringing improvement in nursing performance by means of effective therapeutic relationship while caring for dementia patients. However, some limitation of the study is that it was done with young and inexperienced nurses and hence the homogeneity of sample reduced the quality of research. Furthermore, this research focused on difficulties of nurse in communication, however in order to establish therapeutic relationship with dementia patient, experience of patients in communication is also necessary. These areas can be investigated in future studies. |
| Johnson et al., (2009).
Design- Survey method by means of focused group interview |
This research identifies the potential barrier to the implementation of palliative care for people with dementia and communication was seen as a major deficit in the provision of care. The purpose of this study is to explore communication challenges in advanced dementia care and contribute to future model of care to identify need of dying person with dementia. | The focus group sample consisted of 34 participants consisting of family carers, dementia specialist staff, general practitioner and area health staff such as specialist nurse and counselors. Although this study includes many other health professionals, this article has been selected as it included nurse in the study too. Although the sample size is low, however still it is significant as it takes all groups of health professionals involved in caring for people affected with dementia. | The findings of the research showed that complexity of advancing dementia presents many challenges for health professionals, however the focus on assessment of symptoms, communication and management skills helped to provide better outcome for patients. Better outcome for patients indicates that therapeutic goal in patient-nurse relationship was established.
The lack of staffs ability to communicate led to deterioration of cognitive functions of participants which consequently increased the stress level in the job too. In case of nurses, it was found that no one tried to explain the patients and their family members that functional decline was common in dementia. The study is valuable as it gave the idea that high level of communication skill is necessary to ensure continuity of care. |
The research article is reliable as clinical piece of evidence and health care organizations can take lessons from it regarding the factors contributing to poor communication and decision-making difficulties in life care setting. It will contribute to the future development of programs involved in improving the knowledge and skills for advanced care directives. |
| Baillie, (2012)
Design- Survey by means of focus group participation |
As nursing students are often placed in care of patients with dementia, it is necessary to provide them quality experience as part of their clinical professional placement. Hence, to achieve this, the purpose of the study was to nursing student’s experience of caring older people with dementia. | Nursing students in the University of England who had experience of one placement in caring for older patients with dementia was included in the study. The total sample size was 464 and focused groups study was done with second and third year students. This sample size is accurate to get enough data and analyze the different challenges of nurses. However, the researcher in the study mentioned no power calculation. | The study outcome suggest that apart from physical environment and organizational culture, nurses struggle to provide care and communicate with patients due to knowledge and skills deficit and negative attitude in nursing students.
Different focus group revealed that often they have to work with staff who have no knowledge and skills in dementia management and they felt clueless in such situation. Apart from challenge areas in nutrition and mobilizing dementia patients, communication with patient was difficult due to lack of time, over emphasis on physical condition of patient. Difficulty was also seen in interaction of patients were aggressive and seriously agitated. Hence, many limitations of health care organization and staff is seen and the study contribute to identifying areas of improvement in promoting high quality care and building therapeutic relationship with patients. |
The study finding has validity and credibility as it efficiently describes the challenges faced by nurses in health care setting. Through the analysis of this research, nursing facilities can identify areas of improvement to establish therapeutic relationship and work to develop supportive hospital environment where nurses get the opportunity of practices based education and skill development. |
| Franzmann, Haberstroh, & Pantel, (2016).
Design- Randomized controlled design for Module based assessment |
The main objective of the study was to evaluate the impact of a training program in dementia care for fostering communication skills in nursing staff | The participants in the program consisted of 35-intervention group (got training by multiplicators) and 81 control group (got training by project coworkers) registered nurses who received 120 minutes training every 2 weeks. The trainers for the program mainly included senior nurses from different nursing homes in Germany. There is no power calculation regarding the estimation of sample appropriateness for the study. | The TANDEM (Training modules to promote communication skills in geriatric caregivers attending to dementia patients) training program given to German nursing staff resulted in improved dementia-related communication skills both in intervention and control groups.
Apart from this, there was remarkable reduction in mental stress and occupational stress in intervention group compared to the control group. The uniqueness and the strength of the study design is that it focused on including experienced German nursing staff as multiplicators of the program, which resulted in positive therapeutic relationship and improvement in social competencies, and mental stress of carers for dementia patient. |
The research finding and the focus of the study is clinically important for nursing field because the researcher gave the concept that dementia specific training program like TANDEM should include permanent employee and nursing staff to deliver and supervise the training modules to nurses on regular basis. This approach would help to implement long-term communication skill in practice setting. |
| Beer, Hutchinson, & Skala-Cordes, (2012).
Design- Experimental randomized control group design |
As dementia is increasingly seen in older adults, there is a need for new skill development in staff to recognize symptoms of pain and manage behavior of dementia patients. With this need in dementia care, the purpose of the study was to evaluate how educational module can aid nurse in understanding cognitive abilities of dementia patients and promote effective communication with patients. | The Nursing aid students from community college was selected for the study and they were given training on geriatric care and direct clinical experience in advanced dementia care. The total sample size after including three nursing aid students from different class was 49. The small sample size can lead to poor statistical power for the study. Hence, it reflects power calculation regarding sample size was not considered. | After providing educational training to dementia patients, the result indicated that this training was effective in supporting nurse to understand cognitive abilities of dementia patients and communicate accordingly. However, no benefit was seen in nurse comfort level and perceived skills in working with dementia patients.
This finding depicts the need to further bring improvement in communication training techniques so that nurses can become confident in caring for dementia patients and maintaining the desired therapeutic relationship with patients. |
Despite the limitation of sample size, the study has clinical significance because it supports the concept that communication training can yield better outcomes in responding to the needs of advanced dementia patients. The applicability of the research in real context is high as training helped nursing student to realize the emotional and cognitive deficits in patient. Hence, the educational module provided better skills to dementia patients. The weakness of perceived skills of nurse in care can be improve of future training focuses on role playing and skill development to enhance the confidence of nurse under care for people with dementia |
Part 5: Conclusion
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From the review of peer-reviewed journal articles on the topic of communication difficulties and perceived communication challenges faced by nurses in establishing therapeutic relationship with dementia patients, many areas of weakness of nurses as well as nursing facilities was identified. The key findings from the research literature is that patient-nurse language difference, cognitive impairment in patient, lack of communication and management skills, negative attitude and poor environment support aggravated the difficulties of nurse in interpreting verbal and non-verbal message of participants. The perceived experience of participants was seen from research articles that evaluated the impact of training programs on communication related outcomes of nurses with dementia patients. Apart from identifying the improvement areas needed for enhancing the skill of nurses in practice, it also contributed to the research by stating how communication training can be further improved to increase the confidence of nurses in this particular field of practice. All the five research has been conducted in different setting, however as the focus of attention is on promoting therapeutic relationship with dementia patients, it contributes to understandings of limitations and barriers leading to communication difficulties. Trainers and nurses can gain useful clinical benefits from this research study and use it in a productive way to modify the clinical environment surrounding dementia care Management Of Dementia Patients In Acute Care Setting