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Headline

Major report calls for better nurse training in dementia care

Comment

“The study said the encounter between staff and patients “is mainly task-related and delivered in a largely impersonal manner”, while the hospital environment is “often impersonal”.” WHY? “Staff do not always greet or talk to patients during care, explaining what they were doing or offering choice. Sometimes they do not respond to patient requests for help.” WHY? “People with dementia can become agitated, distressed or aggressive while in hospital due to the hospital environment, aspects of care, illness or injury, or their dementia getting worse.” AND DISORIENTATED. OBVIOUSLY, THESE ARE ALL SYMPTOMS OF DEMENTIA. “NHS guidance says the use of antipsychotics to control these symptoms should be a last resort, but many hospitals still use them.” WHY? “Only 74% of wards had a system to ensure enough staff to help dementia patients eat at mealtimes and only 5% of hospitals had mandatory training in awareness of dementia for all staff.” WHY? “Overall, less than a third (32%) of staff said they had sufficient training or learning in dementia care.” WHY? “Recommendations in the report include providing basic dementia training for all staff, with some ward staff receiving higher level training.” When I qualified in the mid-80s care of the elderly and those with dementia was included in training with assignments on geriatric and psycho-geriatric wards. When I worked in a rehabilitation clinic we were given further and more in-depth training in dementia which provided a useful insight into this group of disorders and identifying and meeting the needs of patients with this group of disorders. There are different types of dementia of which Alzheimer’s is one type. Although most common in the elderly, dementia can also occur in younger individuals. I looked after two in their 40s both diagnosed with Alzheimer’s. One was a female dentist with an advanced form who I looked after in psycho-geriatrics where her husband also supported her during much of the day. The other was a male patient, on a general medical and mental health ward of a rehabilitation clinic for medical or surgical patients after discharge from hospital and mental health patients with problems such as severe depression or burnout who did not wish the stigma of being hospitalised for these disorders. This was the reason that this patient came to us. It was quickly seen that this open ward with single or double rooms was not suitable for a patient with advanced Alzheirmers as he was totally disorientated and wandered off. With one staff member on duty at certain hours, and especially at weekends when there were fewer staff in the clinic, it was impossible to attend to him and to other patients as well although as usual the response from management was that it was up to us to manage our work properly! A very convenient response from those who are totally out of touch with work on the wards. It was a constant concern for the staff who needed to know where he was at all times. One day he was eventually found in a café with a bottle of red wine in front of him. Staff had had to go out in their cars at lunch time searching for him! Fortunately it was a time when there were several on duty. At the weekend when I was alone on the ward I had to go and help an elderly lady to the bathroom and change her pampers which obviously took quite a few minutes. I had to ask him to wait outside and left the door ajar. I knew he didn’t really understand and one couldn’t reason with him (sometimes it worked for a few minutes) but I didn’t see any other options the lady was unable to wait and I didn’t want the risk of her falling. After a few minutes he came into the bathroom much to the wrath of this lady’s husband against me and no explanations were acceptable to him. I really did understand his point and was very uncomfortable about it but my duty was towards the duty of both patients and at the same time! When I needed to go to the loo myself (having waited as long as I possibly could!) I phoned a colleague on the floor just upstairs, the nearest ward, and was delivered a very severe lecture by her of her responsibilities and not being able to leave the ward for five minutes. She was right too but fortunately she did come down (just before it was too late!) but was extremely angry with me which didn’t help me very much as a newcomer trying to make some sort of impression. Fortunately other staff spoke with the doctors and managers and it was agreed on the Monday to move this patient to a centre specialised in dementia. This is to illustrate that these patients, depending on the severity and advancement of their disorder, often need one to one nursing care and a general medical ward where other patients often need urgent attention and care, and with limited staffing, is not always a suitable place for them. Even in old people’s homes where several residents need care at the same time, and limited staff, it is difficult to deal with one or more patients with dementia who are able to do little for themselves, who may be agitated, who do not understand explanations or that they are being asked to wait and who have a propensity to wander off. With the training I received I find it helpful in gaining some insight into patients with dementia and their needs and possibly sufficient for looking after a single patient on a general ward but consider it is a field which needs highly trained and specialist staff in purpose built facilities in order to look this group of patients/clients/residents successfully. “A senior clinical lead for dementia should also be in place in each hospital, with dementia champions in each department and at ward level.” I find this an excellent idea but think it is one thing having patients with dementia in hospital for medical and surgical reasons or possibly to carry out an assessment and diagnose dementia (in a specialised unit for this group of disorders or for care of the elderly) but I do not think dementia should be a reason for hospitalisation where more suitable facilities are required where patients are supported to carry on as far as they are able with their own daily living functions. Most are capable of quite a lot and should not be left in bed, in a chair or to their own devices all day long unless it is clear this is what they and their families want. Prolonged hospitalisation may exacerbate disorientation in patients with dementia and may accelerate deterioration and further loss of function which it is important to try and preserve for as long as possible.

Posted date

17 December, 2011

Posted time

9:58 am

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