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Major report calls for better nurse training in dementia care


Anonymous | 17-Dec-2011 9:42 pm Our NHS unit is a specialist, mixed sex, inpatient dementia unit for the severely cognitively impaired with complex needs, and as you say this is a very specialist and specific. We nurse patients who cannot be placed anywhere else because their behaviours cannot be managed, as they usually present with challenging, aggressive behaviours. The client group is getting younger it appears from my experience. I am assuming that patients with dementia admitted to a general ward have been admitted with a diagnosis of dementia already in place and have a physical illness that has brought them onto a general ward that needs to be addressed. Dementia patients with a UTI infection for example may also have a toxic confusional state which exacerbates their dementia and until this is resolved may be harder to manage. Then there are the falls, broken hips etc., It also all depends on the severity of their dementia, whether it is mild, moderate or severe, someone with a UTI who previously had a mild to moderate dementia could present as severe. Elimination of a physical cause is always the first rule of psychiatry. We always treat any physical complication as best we can on our unit, but sometimes acute conditions need to go to a general hospital for treatment. I don't think general wards are able to cope with the demands of a disruptive dementia patient but cope as best they can, and mostly they do the best they can for our patients whilst they are in their care. Education in dementia is fundamentally required to have a better understanding but specialist input is totally required. From the outside looking into our unit we would appear to be in daily chaos, but dementia is a chaotic condition and we enter into the reality of our patients condition rather than unrealistically expecting them to enter into ours. This requires we see the meaning behind the words and the feelings behind the words, as words become less important and the meaning behind the words and the behaviour and non verbal cues become more important our clues. We try wherever possible to have the 'life story' of our patients so that we can relate to where they may be coming from and the moment in time they are living or re-living. A general ward is as it says a general ward and not specialist in dementia but i would at least expect that every clinician has some education in dementia but it is vital that they can call on specialist knowledge. It would be impossible to educate someone in a day/week/month with all the knowledge that is required on how brain damage to specific parts of the brain affect behaviours. As our consultant said 'you see one dementia patient, you see one dementia patient'. Everybodys presentation will be unique. Although different types of dementia may present in different ways it is always the person behind the illness that we are ryring to connect with. It is a wonderful moment when you make that connection at some deep level which may be only fleeting but so rewarding. As none of us know how we will end up or who will be able to care for us in the future we are daily reminded that ultimately that could be us and hope that the NHS will still be there to provide the quality care our loved ones or we ourselves need. It keeps us very grounded.

Posted date

18 December, 2011

Posted time

12:03 pm