Shortcomings Of The Biomedical Approach
Brain imaging, sampling of cerebrospinal fluid and biomarkers although important in diagnosing specific causes and types of dementia do not account for all the clinical aspects of disease onset and progression . For example, a diagnosis of Alzheimers disease is made through evidence of neuronal atrophy, injury and biomarkers . However, the plaques and tangles that are commonly found in the brains of people with Alzheimers disease are not pathognomic : nearly 50% of very old people with dementia lack the typical brain neuropathy that would explain their cognitive symptoms, while high levels of Alzheimers pathology have been found in one-third of very old people without dementia .
The focus of the biomedical approach on shortfalls rather than capabilities ignores the aspect of brain resilience and heightens the sense of despair associated with dementia . The dominance of the biomedical approach, and a lack of clarity around the concept and benefits of person-centred care and how to put it into practice have resulted in a lower quality of care for people with dementia . While work has been undertaken to define person-centred care and its benefits , many organisations lack a person-centred culture, which results in uncertainty about how to put it into practice for people with dementia .
Pharmacy Support For Patients With Mild Cognitive Impairment Who Forget Their Medicines
Pharmacists and pharmacy teams can offer support to patients with mild cognitive impairment in a number of ways, some of which are included in the Greater Manchesters dementia friendly pharmacy framework.
Whether the support takes the form of providing extra help with prescription ordering, collection and delivery, helping find solutions to help with medicines adherence or signposting patients to additional services or organisations who may be able to provide more specialist help, it is important that the approach is individualised to each patient. Box 1 provides additional guidance on how pharmacists can support patients with mild cognitive impairment who forget their medicines in practice.
Box 1: How to support patients with mild cognitive impairment who forget their medicines in practice
- Is continuity of supply a problem?
- Is the patient forgetting to order?
- Is the patient forgetting to take medicines?
- Is the patient unable to remember that medicines have been taken?
- Pharmacists should ask patients about their good days and bad days any solution to these problems has to work on the bad days.
2. Consider if there are any potentially reversible causes of confusion or poor memory present.
- Examples include: history of alcohol use, signs of acute infection, anticholinergic drug therapy, hyponatraemia or recent head trauma
- Pharmacists may need to refer patients to an appropriate practitioner.
Dementia A Person Centred Care Approach Nursing Essay
|Paper Type: Free Essay|
The brain is made up of billions of nerve cells. Messages are passed along and between cells through tiny electrical impulses and chemical messages. This is how the brain controls what a person does, think and feel. The cerebrum or cerebral cortex is the largest part of the brain and it consists of four lobes namely frontal, parietal, temporal and occipital . The frontal lobe is responsible for parts of speech, reasoning and judgment. The parietal lobe is supplementary in interpreting information from senses, sequencing and spelling. The temporal lobe is mainly responsible for short term memory. The occipital lobe is responsible in recognising colours, shapes and movements. When too many brain cells start to die, the condition is dementia .
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There are many types of dementia nonetheless the most common type is Alzheimers disease. In 1907, German neurologist Alois Alzheimer first described Alzheimers disease. Typically, the brain cells have the largest area affected by protein deposits called as plaques and tangles. This person may find difficulty on recognising between day and night, repetition of speech or behaviour, struggles to concentrate and be alert however the earliest symptoms are short-term memory difficulties. The symptoms should be present for at least six months .
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How Do You Respect Client Privacy
Ask the client what name they prefer to be called. Identify people such as carers, family or friends, in conjunction with the client. Show an awareness of the client’s views, beliefs, culture and language. Consider the client’s preferences in all decision-making and goal setting for care and treatment.
Is This Different For Patients With Dementia Compared To Others
No absolutely not! It is often concerning to me that we somehow view person-centred care in the context of dementia care as somehow different from other types of care provision. Of course it is different in that people living with dementia have particular care needs arising from the effects of dementia on their life, and this needs care to be provided in particular ways to meet these needs.
However the fundamental principles of person-centredness still apply to suggest otherwise would imply that people living with dementia are a different kind of person that would be a dangerous statement to make and could negatively impact on the lives of people living with dementia.
As dementia advances, people do become more vulnerable. However, we sometimes confuse this increasing vulnerability with a lessening of personhood, in other words, becoming a lesser person in the eyes of others.
We then adjust our meanings of key caring principles rather than adjusting the application of those principles in the way that we work and engage with people. It is this adjustment that needs the great skill in working effectively with people living with dementia and their families/care partners and that needs care workers who are knowledgeable and skilled in dementia care.
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What Is The Importance Of A Person Centred Approach
In person-centred care, health and social care professionals work collaboratively with people who use services. Person-centred care supports people to develop the knowledge, skills and confidence they need to more effectively manage and make informed decisions about their own health and health care.
Why Is Dignity Important For The Elderly
Dignity was found to capture three themes: autonomy, identity, and worthiness. … It is suggested that these themes of dignity provide a frame of reference in elder care they shape the understanding of when health issues become a concern for health-promoting care for the elderly patient and what goals should be defined.
What Is Mds In Health Care
The Minimum Data Set is part of the federally mandated process for clinical assessment of all residents in Medicare and Medicaid certified nursing homes. This process provides a comprehensive assessment of each residents functional capabilities and helps nursing home staff identify health problems.
From Person Centeredness To Personalization
One substantial organizational reform of the care and support of older people is that of cash for care schemes which are allocations of funding to meet eligible individuals care needs. Terms such as consumer-directed care are used to cover similar changes in countries such as Australia and the US while, in Scotland, the term self-directed support is more commonly used. These reforms are affecting the lives of many older people with dementia in need of care and support and the lives of their family carers or caregivers. In England, personalization is the key mechanism to transform the care system. Underpinning this are aspirations that it will affect the whole system of care and support by enabling greater numbers of older people to live at home for longer, with tailored support, and that it will be more cost-effective than buildings-based services, such as residential care homes or day care centers. The redirection of resources directly to end users through personalization has been greatly influenced by the disability movement, by consumerism, and by political anxiety about the costs of ageing populations to the public purse. More recently, policymakers have decided to extend the key tenets of personalization to NHS health care to meet a similar range of aspirations.
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Encourages Feelings Of Independence And Dignity
No-one wishes to feel imprisoned within their own body particularly those who are mentally or physically restricted. It can be all-too-common a feeling, though, for those whore less able and its by no means any more acceptable.
You can give a sense of independence and control back to your loved one by offering person-centred care. Wherever you can, encourage your loved one to venture outdoors. Additionally, you can try involving them in a new hobby such as knitting or gentle yoga. Be sure to relay the benefits of engaging in such practices, but make sure to respect their response.
Why Nonpharmacological Interventions Do Not Work
I struggled with this concept for many years, as evidenced by the title of my 1997 lecture. I gave many seminars on nonpharmacological interventions and incorporated them into care plans for many people living in the homes where I practised. What I found in the vast majority of situations was that they simply did not work in the long term. And yet, just as we have continued to prescribe antipsychotic drugs, seemingly blind to their lack of efficacy, so do we continue to teach about the importance of nonpharmacological interventions, even in the face of scant evidence of benefit.
My conclusion is that nonpharmacological interventions as they are most commonly applied are attempts to provide person-centred care from a biomedical mindset. As such, it is only a half-hearted paradigm shift, and so it falls short .
How do our typical nonpharmacological interventions fall short? Let me count the ways:
First, they are often reactive, used in response to an expression that is determined to be distressed or undesirable . As such, these interventions may distract or calm a person in the short term, but usually do not provide any insight into deeper issues.
Second, they are often applied at intervals, like doses of pills and just like pills they have a limited period of effectiveness and need to be reapplied. In other words, they may calm a persons distress in the moment, but usually fail to prevent that distress from recurring again and again.
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Key Components Of Person
Researchers have worked to find commonalities among models and practices of person-centered dementia care. conducted a literature review and found several commonalities among models and practices including supporting a sense of self and personhood through relationship-based care and services, providing individualized activities and meaningful engagement, and offering guidance to those who care for them. conducted an extensive literature review for definitions of person-centered care. They identified 15 definitions, addressing 17 principles or values. They found that the six most prominent domains were holistic or person-centered care, respect and value, choice, dignity, self-determination, and purposeful living. In all, it was clear that there is a shift in focus away from the traditional biomedical model in favor of embracing personal choice and autonomy.
A Combined Biomedical And Psychological Approach
The biomedical approach helps care practitioners understand the type of dementia with which a person is diagnosed and any behavioural issues that may present a psychosocial approach helps in the tailoring of individual interventions . A combined approach can, therefore, help with effective symptom management, predicting disease progression and planning for care . When talking to people with dementia, understanding dementia as a disease and its symptomatology helps to develop a therapeutic relationship to support them throughout the care process .
High-quality dementia care depends on care practitioners having appropriate skills. The bio-psychosocial model can:
- Enhance positive carer attitudes
- Increase carers sense of role competence and job satisfaction
- Help carers devise personalised, appropriate interventions that meet individual needs .
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Three Facts Worth Knowing
1. The person-centred approach was developed in the UK by Professor Thomas Kitwood, a pioneer in the field of dementia care in the 1980s and has since received worldwide recognition and praise.
2. Person-centred care has been shown in studies to reduce agitation and aggression in people with dementia.
3. Another study of person-centred care showed it significantly reduced the number of people with dementia needing hospital treatment or anti-psychotic medication both of which can be the result of aggressive behaviour.
Where Should Information Utilized For The Assessment Of A Care Area Come From
4 10. Where should information utilized for the assessment of a care area come from? From direct interview with the resident.It should be limited to information collected during the look-back period.It should include current evidence-based, expert endorsed research and clinical practice guidelines/resources.
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What Is An Example Of Person Centered
Examples of person-centred care Approaches Being given a choice at meal time as to what food they would like. Deciding together what the patient is going to wear that day, taking into account practicality and their preferences. Altering the patients bed time and wake up time depending on when they feel most productive.
What Should I Say To Someone Living With Dementia
It is important to know what to say to someone living with dementia, this way they wont get as confused or frustrated.
- Do not ask multiple questions one after the other.
- Stick to just one idea at a time.
- Make information manageable by breaking it down.
- Ask closed questions that can be answered with just yes or no when the individual is being asked to make a decision.
- Rephrase something rather than repeating it.
- Try not to contradict and correct someone who is confused about what is real and what isnt such as happens in later stages of dementia.
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How Do You Maintain Privacy And Dignity To A Patient
Some examples of ways in which you can work that respect individuals’ dignity are:
Medicines To Slow Their Cognitive Decline Or Manage Behavioural And Psychosocial Problems
Patients living with more advanced dementia are more likely to be using medicines to slow their cognitive decline or manage behavioural and psychosocial problems associated with cognitive decline and these medicines bring their own challenges to prescribing and pharmacy practice,.
The use of memory drugs such as donepezil, galantamine, rivastigmine and memantine have increased for a number of reasons including a growing level of awareness among the general public, partly a result of campaigns like the Department of Health campaign for earlier diagnosis of dementias, the off-licence use of these drugs and a recent significant financial investment in research into memory problems.
When a patient stops taking their memory drug, or misses a few doses because of inaccurate medicine reconciliation at transfer of care, their rate of cognitive decline increases. Once cognitive function is lost, it can never be regained and many hospitals treat memory drugs as critical medicines that must not be missed.
Box 2: Anticholinergic burden of medicines
Long term use of medicines with anticholinergic side effects by older people can impair cognition and increase falls risk, morbidity and, possibly, mortality. It can also cause constipation and urinary retention. Each person is susceptible to anticholinergic side effects to a different degree but people living with mild dementias appear to be more susceptible to the cognitive side effects.
ACB score 1 :
- beta-adrenoceptor blockers
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What Does Carl Rogers Mean By Congruence
Congruence: Congruence is the most important attribute, according to Rogers. This implies that the therapist is real and/or genuine, open, integrated andauthentic during their interactions with the client. … The therapist may not approve of some of theclient’s actions but the therapist does approve of the client.
How Do You Explain Person Centred Therapy To A Client
Client-centered therapy operates according to three basic principles that reflect the attitude of the therapist to the client:The therapist is congruent with the client.The therapist provides the client with unconditional positive regard.The therapist shows an empathetic understanding to the client.
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The Key Points Of Person
- Treating the person with dignity and respect
- understanding their history, lifestyle, culture and preferences, including their likes, dislikes, hobbies and interests
- looking at situations from the point of view of the person with dementia
- providing opportunities for the person to have conversations and relationships with other people
- ensuring the person has the chance to try new things or take part in activities they enjoy.
Family, carers and the person with dementia should always be involved in developing a care plan based on person-centred care.
Their knowledge and understanding of the person is extremely valuable to make sure the care plan is right for them.
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How Does A Person
Topic: How does a person-centered approach compare against a non-person centered approach in dementia care?
A person-centered approach is found on the ethic that all human beings are of absolute value and worthy of respect, no matter their disability, and on the conviction that people with dementia can live fulfilling lives. Non-person centered approach does not give importance to the likes and dislikes of people with dementia.
Comparison between person-centered and non-person centered approach in dementia careFeatures of Person-Centered Approach:Looking at the person as a unified wholeFeatures of Non-Person Centered Approach:
Dictating the form of care to be usedLack of choiceNot recognizing the individuals needs and uniquenessExclusionNot allowing individuals to participate in decision-makingNot allowing individuals to exercise their rights
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