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PRACTICE COMMENT

'Wise use of our resources will improve hospital dementia care'

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By paying attention to people with dementia, hospital nurses can find that workloads are reduced, not increased, argues June Andrews

Staff have been given dementia awareness training in many hospitals, making it easier for them to empathise with patients who are affected. Unfortunately this does not help them to deal with the common problems that arise for people with dementia in acute settings.

Because there has been such an improvement in the recognition and management of dementia in general hospitals wards, it seems churlish to complain about how things are now. Nurses have a lot to deal with, so asking them to do even more is problematic. But the truth is that dementia care in hospitals is still not good enough. Nevertheless, the encouragement for nurses should be that doing dementia care well makes your life very much easier than if you do it badly. By paying attention to people with dementia you can find that workloads are reduced, not increased.

The difficulties in caring for someone with dementia are increased when the patient is dehydrated, tired, over- or under-stimulated, hungry, sleep deprived or subjected to noise. For some of these problems there are system solutions.

Is it possible, for example, for patients who have dementia to be kept in complete darkness at night? We humans have biologically evolved to sleep when it is dark, so why would you expect anyone to sleep with the lights on?  

Is it possible for the ward to be completely silent when people are sleeping? Even quiet noises will give rise to disturbance, as patients with dementia may get up to investigate what the murmuring is or, worse still, call out loudly to find out what is going on, waking up other patients on the ward.

If it is impossible to keep the place dark and silent at night, nurses have the problem of what to do with the consequences of that. Sedation is an undesirable option, so a better one is to provide someone who will console and comfort the waking person with dementia. At current staffing levels this needs to be a family member or other volunteer. Realistically, this is difficult to provide unless the patient is in a single room but, if there is one available, a folding cot will allow a companion to sleep in the room, available to wake in the night to quickly and quietly soothe the patient.  

Many wards will not have a room available and many patients will have no relative who can do this, but we must make use of all the space and all the volunteers available to us as a matter of course, to avoid making unnecessary extra work for nurses.

When I hear of dementia champions being appointed, I expect their training to include the negotiating skill to make this sort of arrangement (and others) a standard process. For example, organisations should give them the status to command the respect of bed managers so they can be consulted about where people with dementia are placed, taking their special needs into consideration. Without power, the dementia champion is in an impossible position.

June Andrews is international dementia expert and author of “Dementia: The One Stop Guide”. 

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