Spirituality_and_Nursing

LO1: Define a mental health condition that affects a resident in your placement A condition that affects a resident in my placement is dementia. There are currently 700,000 people with dementia across the UK and that number is expected to rise to over one million by the year 2021 (Knapp et al, 2007). Dementia is a disease that carries a massive personal, family, social and economic cost (Department of Health 2009). Dementia is the progressive loss of the powers of the brain (Alzheimer Scotland 2009). Alzheimer’s disease is the most common kind of dementia, which is caused by a build up of protein in the brain, but there are many more types of this illness. Other types of dementia include vascular dementia, which is caused by problems in the supply of blood to the brain cells. There are other forms of dementia, which are less common. They include dementia with Lewy body, Pick’s disease, Huntington’s disease, HIV/AIDS and alcohol related dementia. It is estimated that up to ten per cent of dementias are related to alcohol (Department of Health 2009). Dementia usually affects people in older age groups, but can affect people as young as 30 years old. The illness affects both men and women, although due to the longer life expectancy of women, more women than men have dementia. Each individual who has dementia is different. Depending on which area of the brain is damaged will determine how the illness will affect them. One of the most common symptoms of dementia is memory loss. People with this illness can forget all sorts of things, including names of family members and friends. They can also fail to recognise family members and other people. They can also become disorientated and forget where they are, what they are doing, if they have eaten or not. The disorientation and memory problems associated with dementia mean that people with the illness may do things that carry risk – cooking, dealing with heating and other electrical and Gas appliances, managing money, road safety and getting lost (Gilmour et al, 2003). People with dementia burn pans or leave things in the oven because they have forgotten they were making a meal. Another worrying symptom of dementia is losing awareness of time and not knowing which day, week, month or year it is. They can easily get lost in a familiar place because they do not know where they are. Confusion is another symptom of dementia, and people with the illness can often be confused. Their ability to think, to reason, to calculate can all be damaged (Alzheimer Scotland 2009). Dementia can also cause a person’s behaviour and personality to change and this can be very distressing and upsetting for family and friends. Before having dementia a person that would normally have been well mannered may become very rude and aggressive due to the illness, which would be out of character. For the person with dementia and the family there is are a lot of changes to adapt to. Brooker, (2007) highlights that for many people the onset of dementia and the resulting disability result in some people having to relinquish the roles they had held previously in life such as a carer or provider. The prognosis for people with dementia is not good, as eventually they will need help in most if not all activities of daily living, as all areas of the brain will be affected gradually. Dementia is progressive and degenerative. The care needs of the people with dementia increase as the disease progresses (Brooker 2007). Dementia is put into three categories – mild, moderate and severe. In mild dementia people might have difficulties with decision-making, they may forget important things for example forgetting they had an appointment, forgetting to pay the bills or forgetting to put the bins out. They might struggle with complicated aspects of their work and hobbies. In moderate dementia people may forget who people are, even family members and they may not recognise familiar places. They may struggle with daily activities such as washing and dressing. Also at a moderate stage in dementia this is when behavioural changes may occur. In the third stage of dementia, which is the severe stage, people usually have difficulty in communicating and their physical abilities will be affected. In this stage memory loss is severe. (Alzheimer Scotland 2009) There is no cure for dementia at present, however there are drugs that have been developed which can sometimes delay the progress of the symptoms of dementia. There are various psychological treatments that can help people cope with the symptoms of dementia, and slow them down. Cognitive stimulation is used which involves participating in activities designed to improve memory, problem solving skills and language ability. There is also behavioral therapy that uses a problem solving approach where possible motivations and reasons for troublesome behavior have been identified. Another therapy used is Reality orientation therapy is used to reduce the feelings of mental disorientation, memory loss and confusion, while promoting self-esteem. Also Multisensory stimulation is used and it aims to lesson the feelings of confusion and restlessness people have with dementia. This therapy also improves mood and language skills. Finally exercise therapy is used, which is a structured fitness programme, designed to improve physical mobility, mental function and mood (NHS 2009). Although there is not a cure for dementia there is a clear medical focus on optimizing the individual’s health and promoting quality of life. Word count 894 LO2: State the related care needs of this resident, and how the nurse might attempt to meet these For the purpose of this learning outcome I will name the resident Agnes, which is not the real name of the resident. Agnes has stage three dementia, which is severe dementia. I have chosen to use the Roper-Logan-Tierney model of nursing - activities of living, as a framework to explain relevant care strategies. The purpose of activities of living is to promote maximum independence, through complete assessment leading to interventions to support independence in areas that are difficult or impossible for the individual to do on their own (Wikipedia 2009). The model assesses the individual’s independence and potential for independence, which ranges from complete dependence to complete independence. In Roper, Logan and Tierney’s model of nursing the activities of daily living are: - Maintaining a safe environment, Communication, Breathing, Eating and Drinking, Elimination, Washing and Dressing, Controlling body temperature, Mobilisation, Working and Playing, Expressing sexuality, Sleeping and Death and Dying (Roper et al 2000). Maintaining a safe environment Agnes cannot maintain a safe environment due to the fact she is disorientated at times and often lacks self-awareness. Agnes must be supervised at all times and not left on her own. Communication When communicating with Agnes she can sometimes feel threatened, undermined and confused, which can in turn cause her to act in a negative manner and increase her agitation. Agnes should be approached and spoken to in a calm and slow manner at all times. Agnes responds better to the use of simple and direct statements and questions, and carers must not give her more than one set of instructions at a time. Carers should sit down next to Agnes when communicating with her, or bring themselves down to her level so that she does not feel threatened in any way. Breathing Agnes’s breathing can become fast when she is upset, agitated or worried about something. Agnes should be calmed down and reassured by carers and her breathing monitored. Agnes can become breathless when mobilising so cares should encourage her to take her time and stop for a rest when walking to the toilet and the dinning room. A wheel chair may be offered to Agnes at anytime during periods of breathlessness. Eating and Drinking Agnes enjoys her food at meal times but does need help to eat her meals, as she can often just stare and play with her food. Carers need to prompt Agnes to eat her food and put food on her fork for her. Carers should encourage Agnes to eat independently but may offer to feed her if she is not eating by her self. Sometimes Agnes will refuse to eat by herself and refuse to be fed if she is feeling in a low mood. Agnes has lost a small amount of weight due to spells of not eating so carers must weigh Agnes weekly. If weight loss is moderate then she should be referred to the dietician. Agnes can drink fluids on her own when given a cup with a lid and two handles. Cares should offer hot and cold drinks regularly and record how much fluid she has drank through out the day. Elimination Agnes is incontinent of urine and faeces as she forgets to ask for the toilet due to her dementia. Agnes must wear a large pad¬ during the day and at night time. Agnes must be toileted regularly during the day and checked during the night. Washing and Dressing Agnes needs full care with washing and dressing and her dignity respected at all times. Water must be nice and warm for Agnes as she can become distressed if it is not warm enough. Controlling Temperature Agnes’s temperature is stable most of the time and she will shout out if she is feeling too hot or too cold. It is a good idea to dress her with layers of clothes so she can take off or put on a layer if she feels hot or cold. Mobilisation Agnes is mobile with aid of a walking frame and one carer. Agnes must be supervised at all times as she tends to want to get up from her chair constantly and could be at risk of a fall. Agnes can get breathless during mobilisation, so carers must monitor her breathing. Working and Playing Agnes does not like to join in with activities in the home, but prefers to look at her memory books and photo albums. Agnes has two cuddly toy cats, which she likes to have with her during the day and likes to stroke them for comfort. Carers must remember to bring them down to the lounge in the morning to avoid Agnes getting upset and distressed. Expressing Sexuality Agnes is a widow, but was married three times. She has no family. Agnes likes to sleep in a single room. Sleeping Agnes is a poor sleeper and needs medication to help her sleep. She likes to have a sidelight on during the night and carers must ensure this light is kept on throughout the night. Agnes should be checked on at regular intervals during the night and must be reminded about the buzzer system and where it is, for reassurance. Death and Dying Agnes is a Catholic and when her time comes, the priest must be contacted as early as possible to allow time for the priest to give Agnes her last rights. It is important to base a care plan on a model of care. Nursing models are used to help nurses assess, plan and implement patient care by providing a framework within which to work (Wikipedia 2009). Word count 928 LO3: Outline one outside source of support available to a person with the chosen mental health condition, or their carers/relatives The outside source of support I have chosen is ‘Alzheimer Scotland’. Alzheimer Scotland is a registered charity that provides help and support for people who have dementia and their carers and family. Alzheimer Scotland has a very informative website which provides useful information, support and guidance on dementia. There is also a free phone 24-hour helpline for people with the illness or anybody who would like information on dementia. The charity provides local services all over Scotland. Services include day centres where people can go and socialise with other people who have dementia, and take part in a whole range of activities. Another service provided by the charity is Home Support, allowing the carer to have a break, while the person with dementia is being cared for. Alzheimer Scotland also provide drop in centres giving people with dementia and their cares a chance to socialise. There are support groups for people affected by the illness and their carers. Alzheimer Scotland offers education for carers to help them learn the facts on dementia and give tem coping strategies. Other services include one-to-one support, a welfare rights service and information and advice on a wide range of dementia related subjects (Alzheimer Scotland 2009). Alzheimer Scotland aims to be the “national voice” of and for people with dementia and their carers and families (Alzheimer Scotland 2009). It also aims to improve public policies for people with dementia. The charity strives to provide high quality services for people affected by the illness. Alzheimer Scotland represents people with dementia and their carers. The charity campaigns for increased services, which are more flexible, higher standards of care, improved protection for legal and human rights for people with dementia. Also the charity is campaigning for greater financial help. Alzheimer Scotland relies heavily on fundraising as it accounts for almost a fifth of their total income. The charity depends on fundraised income for their information and helpline services, courses for carers and their campaigning activities. Alzheimer Scotland has many charity shops including an ebay shop and an online charity shop. Alzheimer Scotland accept payroll giving and will gifts, they organise various fun events and tribute events. Alzheimer Scotland is always looking for more volunteers to join the team, it is rewarding for the volunteer to know that they are making a difference. Alzheimer Scotland could not exist with out the help of their volunteers. They help run the 24-hour helpline, run day centres and drop in centres, volunteer as drivers or escorts, and promote awareness and provide information. Volunteers also befriend people in line with the “Forget-me-not” project. This purpose of this project is for people with dementia to be visited every week by a volunteer, who will play games with them, chat to them, look through photo albums and magazines with them and in general give them a bit of company. They may even take part in activities with them, such as gardening or baking. One of the goals of Alzheimer Scotland is to raise awareness of dementia through their awareness raising campaigns. The charity highlights that only 50% of people with dementia know that they have the illness. The campaign highlights the need to overcome the stigma that surrounds the condition. It is thought that there is so much under diagnosis due to the stigma and lack of understanding of dementia, that it may prevent people from seeking help. It is important that people get an early diagnosis of dementia so that help and advice can be given, to help them get the necessary medical help and attention. Word count 592 References Alzheimer Scotland (2009) Information about dementia Retrieved 18/12/2009 from http://www.alzscot.org/pages/info/index.htm Brooker, D. (2007) Person-centred Dementia Care: Making Services Better, London: Jessica Kingsley Department of Health (2009) Living well with dementia – the National Dementia Strategy Joint commissioning framework for dementia Retrieved 20/12/2009 from http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_100837.pdf Gilmour, H, Gibson, F and Campbell, J (2003) ’Living alone with dementia’, Dementia, Vol. 2, (3), 403-20 Knapp, M. et al (2007) Dementia UK: Report to the Alzheimer’s Society, Kings College London and London School of Economics and Political Science NHS (2009) Treating Dementia Retrieved 20/12/2009 from http://www.nhs.uk/Conditions/Dementia/Pages/Treatment.aspx Wikipedia (2009) Roper-Logan-Tierney model of nursing Retrieved 18/12/2009 from http://www. http://en.wikipedia.org/wiki/Roper-Logan-Tierney_model_of_nursing#Activities_of_living