Identifying Gaps in Dementia Care

This assignment focuses on identifying the gaps in the care process of dementia affected older individuals. It highlights the lack of nursing professionals and their training as the primary reason for the gap. The paper proposes the skills required to bridge the gap and emphasizes the importance of training and skills development for nursing professionals in providing effective care for dementia patients.

Running head: CLINICAL PROJECT ASSIGNMENT
IDENTIFYING THE GAPS AND LOOPHOLES IN DEMENTIA CARE
ID number:
Unit code and title: GCNCP3 Clinical Project
Title of assignment: CLINICAL PROJECT
Unit Coordinator:
Word count:
Date:

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Introduction
Dementia is a syndrome or a collection of various symptoms that affects the cognitive
ability of elderly patients due to which they become unable to process their thoughts (Moyer,
2014). This syndrome could be chronic or progressive in nature and due to this, mild to severe
effects are observed in their calculation, memory, thinking ability, learning capacity, analyzing
skills and comprehensive orientation (Seitz et al., 2014). Further, with the commencement of
deterioration process of cognitive ability, the patient’s starts developing emotional weakness that
led become socially isolated (Moyer, 2014). As per the World Health Organization (2019),
dementia is the primary reason for wide array of physical and mental disabilities among the
elderly patients and it made them dependent on their family members as well as carers for
activities of daily life. This results in increased consciousness, stigma and affects the care
process by developing barriers where social, psychological and economic aspects prevail (Kasper
et al., 2015).
In the United Kingdom, dementia has been emerged as a major concern for elderly
population. With increased life expectancy and prevailing solitary lifestyle, more than 670,000
people in England are currently suffering from dementia and majority of them are above the age
of 65 (Alzheimer's Society, 2019). However, around the world, care process for dementia lacks
even baseline requirements associated with lack of healthcare professionals, nursing
professionals, infrastructure of care homes and Laws and regulations due to which majority of
the patient are left unattended and their care needs are unmet (Alzheimer's Society, 2019).
Therefore, as a care professional, specifically as a dementia care nursing professional,
this has been chosen as the clinical area of nursing and improvement and acquiring skills for

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holistic and comprehensive care for the dementia affected patients has been chosen as the
objective. In the paper, with the help of recent literatures and the researchers conducted, the gaps
present in the care process of dementia affected patients will be found and then estimation will
be drawn about the achievement of the extent of objectives so that those skills could be used to
develop quality practice as a dementia care nursing professional (Moyer, 2014). Further, the
benefits associated with this learning skills, barriers present in the learning of this skills and
literature support present about the learning needs will be provided in the assignment. Finally, in
the paper, the implication of the learning skills in the care process of dementia affected patient
will be mentioned (Vaingankar et al., 2016).
Relevance of dementia related care
On 28th February, 2012, The Telegraph (2012) provided a study details in which majority
of the dementia care professionals were found agitated and disturbing while working with
vulnerable dementia patients. This article mentions that majority of the nursing professionals
working with dementia patients are not provided adequate training and skill development
sessions and due to these, while working with older and vulnerable patients, they feel burn out or
disturbed. Another news website The Conversation (2018) posted a report on January 13, 2018
that mentions the shortage of health care professionals in aged care centers due to which majority
of the older patients affected with dementia are left unattended. It was mentioned in that news
article that the shortage of nursing professionals in England are due to the high workload and
increasing pressure due to increased life expectancy and increased number of older patients in
the healthcare facility (Mitchell et al., 2017). Hence, these news articles published in reputed
newspapers and websites points out towards the gap or lack present in the care system that
increases difficulties for healthcare professionals while working with elder patients who are

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affected with dementia. Further, increased work pressure in the healthcare facilities and the lack
of training or skills required for the care process of such patient’s increases the difficulties of
nursing professionals due to which, patients, and their care needs remain unattended (Vaingankar
et al., 2016). Therefore, from the above mentioned scenario, it is clear that gaps are present in the
dementia care system and the gap is associated to the nursing professionals, their training and
skill development because majority of them do not receive such training prior to join the
healthcare facilities (Mitchell et al., 2017).
Reason for choosing this project
Dementia is known as a mental health condition, due to which people loses their ability to
think comprehensively, to calculate the outcome of their action and can measure the impact of
outcome of their actions (Gifford et al., 2014). Therefore, this mental trauma makes them
vulnerable to minimum and negligible changes occurring around them. Further the care process
of dementia should be inclusive of dignity, empathy, involvement of patients and they should be
provided with ongoing support so that effective care could be provided. However, as per Science
Daily (2017), in this age of globalization, healthcare sector is facing several issues related to
nursing recruitment, their training and development. it has been seen in the research of Chinkhata
(2016), that majority of the student and enrolled nursing professionals are forced to join the
mainstream nursing force as the healthcare facilities are facing shortage of professionals.
However, this early involvement of untrained and non-skilled nursing professionals is increasing
the burden of care on the registered nursing professionals by increasing their responsibility of
training them with ongoing care of patients (Chinkhata 2016). Due to this, burn outs, depression
and agitation among nursing professionals have been witnessed. Therefore, these training and
shortage of nursing professional’s related issues have been chosen as the topic of this assignment

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related to dementia patients. As it was mentioned in Fernández-Mayoralas et al. (2015) that
while caring for dementia affected patients, nursing professionals should be acquired with
specific training for communication, need assessment, psychological needs and medication
administration of dementia patients.
Gaps that affect the process
As per an article published in the Science daily (2017), discusses about the gap present in
the healthcare of dementia affected patients. It mentions that a majority of dementia affected
patients, especially older women live alone during such illness and the number of such patients is
increasing in high income countries. In Sweden, more than 45% patients affected with severe
dementia or Alzheimer’s live alone in their homes and hence increasing risk factors in the course
of their dementia could be witnessed. Hence, in this scenario, lack of adequate nursing
professionals and the serious concern of the government for the care of dementia patients could
be witnessed. On the other hand, Ford, Ford and Ford (2013) mention that lack of empathy and
concern for the dementia affected people were present in the healthcare professionals due to
whom they were unable to understand the needs or requirement of the patients. Besides that it
was also seen that a majority of the healthcare interventions or care strategies applied by such
healthcare professionals did not comply with the dementia care related standards, increased the
reliability and validity related issues for the care process. Further, as per Brooker and Latham
(2015), gaps associated to lack of nursing professionals in aged care facilities, increasing amount
of burn outs and associated resignations of nursing professionals affecting the care process for
dementia affected process (Zeilig, 2014). These gaps are important to meet for the improvement
of the care process for the patients affected with dementia because such patients are very
exquisitely specific about their requirements, their needs and about trusting the care facility.

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Hence, bridging the gaps has the ability to improve their health condition (Brooker & Latham,
2015).
Focus of this project
The primary focus of this project is to highlight the gaps present in the care process of
dementia affected older individuals as Chinkhata (2016) mentioned that majority of the patients
affected with dementia are not being able to utilize the available care provisions due to present
social stigma and other barriers. Further, depending on the recent research evidences, the focus
of this paper would be pointing out the nursing professional’s training and skill development as
well as their burnout and increasing working pressure associated issues (Howlett et al., 2015).
This would help to identify the reasons for the present gap in the dementia affected people’s care
process and increasing number of unattended patient affected with dementia. After pointing out
the gaps present in the process, this paper would propose the skills required to bridge the gap and
its importance in the care process of dementia patient. Therefore, through this paper, the
importance of skills development, effective communication and training required prior to attend
a dementia affected patient would be provided (Elvish et al., 2014).
Objective of the project
The objectives that would be achieved after the completion of the project are as follows:
 It will be easier to identify the gaps in the dementia care for older adults.
 Lack of nursing professionals in the work force and associated training for
dementia care interventions would be established as the primary reason for the
gap in the dementia care process.
 Literature support would be present to validate the reasons for the lack.

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 Training and educational sessions for the nursing professionals would be
established as the primary and effective intervention to bridge the gap present in
the care process of the dementia affected older adults so that their needs and
healthcare process could be swiftly delivered by the care professionals.
 The implications of the skills and interventions learned in the educational and
training sessions so that its effectiveness could be assessed and its effect on the
care process for the dementia affected patients could be identified.
Benefits of providing training and skills for the dementia care for the nursing professionals
It was established in the previous sections of this paper, that majority of the nursing
professionals are been added in the active care force due to the lack of nursing professionals in
the care process and hence, they are not provided with training and skill development sessions
(Chinkhata, 2014). These sessions and trainings are important for the holistic development of the
nursing professionals as it equip them with the skills and strategies so that they can deal with
different type of patients and their needs. Howlett et al. (2015) further mentions that every
nursing professional have weaknesses in their individuality and it could reflect in their workplace
activities. Therefore providing everyone with a skill set or training prior to deal complex nursing
situations could help them to conduct their responsibilities properly (Elvish et al., 2014). This is
because, training has the ability to bring nurses with different individual strengths to come at a
single platform with similar skill set and abilities, using them they could understand the needs of
the patients and modify the care process depending upon the preferences of the patient
(Edvardsson, Sandman & Borell, 2014).

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Further, Moyer (2014) mentions that dementia patients are different and complex than
other patients with different ailments, because they are more vulnerable and affected with their
surroundings, suffer from cognitive and psychological concerns and trusts exquisite amount of
people for their needs. Therefore, it becomes important for the nursing professionals to develop a
rapport with the patient so that patients could trust the nursing professional regarding their needs
(Elvish et al., 2014). Hence, the nursing professionals should be provided with training of
communication with older patients suffering from dementia and should be provided with skill set
while dealing with their problems so that belief and trust could be reinforced in the care process.
Further, Jensen and Inker (2015) mentions that majority of nursing professionals facing
workload associated burnout or suffering from tremendous workload are becoming prone to
resign from their healthcare facilities, because they are unaware about the coping skills and
strategies to manage the burn out symptoms and hence, providing them with training could
increase their chances of retention (Chinkhata, 2014). Therefore, due to the presence of this
holistic scope of benefits, training and educational sessions of the nursing professionals would
have been chosen as the learning needs for the nursing professionals so that the gaps present in
the care process of the dementia affected patients could be bridged (Howlett et al., 2015).
Past learning experience
While working in the dementia patient ward in the past I witnessed and faced some
moderate issues related to the care process of dementia affected patients. While working for the
patient X (63) (pseudonym), I faced several concerns related to her diet, physiological, and
psychological needs that stigmatized me for several occasions. She seemed very moody and
aggressive at times and while communicating she used to stay quiet as she did not approve of my
communication skills. Therefore, I felt that if I would have equipped with training for such

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situation or provided with several skills while dealing with such situation, I would have been
able to develop a necessary rapport with the patient, to improve her care process. Further, I also
felt there were several nursing professionals working in the ward who used to feel stigmatized or
burn out while working with dementia affected older individuals. Therefore, providing us with
training and skill development plan associated to care development for dementia patients would
have improved our abilities to work with dementia patients and hence, this training session
affected my ability to care for patient X.
Achievement of learning
As per Elvish et al. (2014), nursing professionals are the only care professionals who stay
at direct contact with the patients and take care of every need and requirement of the patient to
improve his/her health condition. Further, it is the duty of the nursing professionals to make the
patient understand each healthcare process and obtain consent from the patient so that
interventions could be applied on them (Karlin et al., 2014). However, in the absence of such
abilities of the nursing professionals, it becomes difficult for the nurses to achieve the trust and
belief of the patients as the patients are more stigmatized and vulnerable that they are unable to
trust majority of the people in their surroundings (Elvish et al., 2014). Therefore, inclusion of
such training and skill development process for the nursing professionals could provide the
nursing professional with skills and abilities to include the patient in the care process and fulfill
their psychological and pharmacological need to implement strategies of holistic care (Arnold et
al., 2015). Further, Jutkowitz et al. (2016) also mentions that implementation of training could
help the nursing professionals to cope with their limitations and inabilities and maintain the
effectiveness of the care process. Therefore, these will be the achievement of the learning needs
mentioned in this paper.

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Implications of learning this skill in dementia affected patients
Implication of the proposed learning need that is the training needs and skill development
associated educational session for the nursing professional will be associated to their connection
with their dementia affected patients (Surr et al., 2016). Rycroft-Malone et al. (2014) noticed that
good communication and connection with their nurses could improve the healthcare condition of
dementia affected patients as they are able to discuss their emotional and psychological concern
with the care professionals and using the pharmacological intervention, it becomes easier to
relief their stress and anxiety associated symptoms (Jutkowitz et al., 2016). Hence, if the nursing
professionals are equipped with the training for the communication with dementia affected
patients, then they would be able to develop a good rapport with the patients (Laver et al., 2014).
Ass well as, with good rapport, it will become easier for the nursing professionals to understand
the need and requirement of the patient, related to their diet, activities and others. This will
eventually, decrease their work pressure and their burn out related concerns would also decrease.
Hence, providing the nursing professionals with training of dealing with dementia patients, could
decrease the burn out of nursing professionals leading to decreased rate of resignation from aged
care centers and the balanced ratio of nursing professional per patients could be improved
(Elvish et al., 2014). Further, using training and skill development for student and enrolled
nursing professionals would increase their ability to work with patients affected with dementia
and after they commence their professional nursing career, they would be able to deliver
effective care in aged and dementia care, increasing the efficiency of the hospital to deal with
dementia (Surr et al., 2016). Hence, providing the nursing professionals working for dementia
patients with skill development sessions and trainings would help the nurses to increase their

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efficiency and overcome their professional’s hindrances without any adverse condition (Elvish et
al., 2014).
Conclusion
The primary aim of this project was to highlight the gaps and loopholes present in the
care process of the dementia patients as the world health organization mentions, majority of the
patients affected with dementia are left unattended all over the world. Further, evidences from
Sweden were also provided where 45% patients, especially women affected with dementia were
unable to avail healthcare interventions due to lack of nursing professionals in dementia care
centers. Further, lack of training and education required for dealing with dementia patients
created a lack in the efficiency of the nursing professionals due to which they were unable to
cope up with the elevated stress, anxiety and burnout associated with dementia care, as well as
increased the lack of nursing professionals in such facilities. Hence, this paper established these
reasons as the primary gap of the dementia care process and implemented training and
educational sessions for skill development of the nursing professionals as the sole interventions
to increase the efficiency of the nursing process that could fill the present gap.
I implemented all these goals in my care process and seek help from the registered
nurses, and supervisors so that I could understand the skills and training I would require for the
dementia care. Further, I also learned from their experiences and developed evidence collection
strategy by conducting literature review so that dementia care associated strategies could be
obtained. Hence, it helped me to achieve all the goals. Further, conducting and implementing
these processes in my daily activity, I was able to meet all these goals within the proposed time
period which was 6 months after the commencement of the project.

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However, it is important for the healthcare facilities and the health ministry of the local
and national government to implement policies and strategies so that strong and developed
interventions, with increased skill set could be used by the trained nursing professional while
working with patients affected with dementia. Training and educational sessions should be
organized by the healthcare facilities for student, enrolled and nursing professionals who lack
experience in this area so that while working with dementia affected patients, they could use
those strategies for quality and effective care practice.

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References
Alzheimer's Society. (2019). Facts for the media. Retrieved from
https://www.alzheimers.org.uk/about-us/news-and-media/facts-media
Arnold, R. M., Back, A. L., Barnato, A. E., Prendergast, T. J., Emlet, L. L., Karpov, I., ... &
Nelson, J. E. (2015). The critical care communication project: improving fellows'
communication skills. Journal of Critical Care, 30(2), 250-254.
Brooker, D., & Latham, I. (2015). Person-centred dementia care: Making services better with the
VIPS framework. Jessica Kingsley Publishers.
Chinkhata, M. M. (2016). Gender mainstreaming in nursing education: a study on the
professional socialisation processes of Malawian student male nurses during
undergraduate training (Doctoral dissertation).
Edvardsson, D., Sandman, P. O., & Borell, L. (2014). Implementing national guidelines for
person-centered care of people with dementia in residential aged care: effects on
perceived person-centeredness, staff strain, and stress of conscience. International
Psychogeriatrics, 26(7), 1171-1179.
Elvish, R., Burrow, S., Cawley, R., Harney, K., Graham, P., Pilling, M., ... & Keady, J. (2014).
‘Getting to Know Me’: the development and evaluation of a training programme for
enhancing skills in the care of people with dementia in general hospital settings. Aging &
mental health, 18(4), 481-488.

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Fernández-Mayoralas, G., Rojo-Pérez, F., Martínez-Martín, P., Prieto-Flores, M. E., Rodríguez-
Blázquez, C., Martín-García, S., ... & Forjaz, M. J. (2015). Active ageing and quality of
life: factors associated with participation in leisure activities among institutionalized
older adults, with and without dementia. Aging & mental health, 19(11), 1031-1041.
Ford, S., Ford, S., & Ford, S. (2013). Hospital audit reveals lack of basic dementia training.
Retrieved from https://www.nursingtimes.net/roles/older-people-nurses/hospital-audit-
reveals-lack-of-basic-dementia-training/5061057.article
Gifford, K. A., Liu, D., Lu, Z., Tripodis, Y., Cantwell, N. G., Palmisano, J., ... & Jefferson, A. L.
(2014). The source of cognitive complaints predicts diagnostic conversion differentially
among nondemented older adults. Alzheimer's & Dementia, 10(3), 319-327.
Howlett, M., Doody, K., Murray, J., LeBlanc-Duchin, D., Fraser, J., & Atkinson, P. R. (2015).
Burnout in emergency department healthcare professionals is associated with coping
style: a cross-sectional survey. Emerg Med J, 32(9), 722-727.
Jensen, C. J., & Inker, J. (2015). Strengthening the dementia care triad: identifying knowledge
gaps and linking to resources. American Journal of Alzheimer's Disease & Other
Dementias®, 30(3), 268-275.
Jutkowitz, E., Brasure, M., Fuchs, E., Shippee, T., Kane, R. A., Fink, H. A., ... & Kane, R. L.
(2016). Care‐delivery interventions to manage agitation and aggression in dementia
nursing home and assisted living residents: a systematic review and meta‐
analysis. Journal of the American Geriatrics Society, 64(3), 477-488.

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Karlin, B. E., Visnic, S., Shealy McGee, J., & Teri, L. (2014). Results from the multisite
implementation of STAR-VA: A multicomponent psychosocial intervention for
managing challenging dementia-related behaviors of veterans. Psychological
services, 11(2), 200.
Kasper, J. D., Freedman, V. A., Spillman, B. C., & Wolff, J. L. (2015). The disproportionate
impact of dementia on family and unpaid caregiving to older adults. Health
Affairs, 34(10), 1642-1649.
Kumar, P., Tiwari, S. C., Goel, A., Sreenivas, V., Kumar, N., Tripathi, R. K., ... & Dey, A. B.
(2014). Novel occupational therapy interventions may improve quality of life in older
adults with dementia. International archives of medicine, 7(1), 26.
Laver, K., Cumming, R., Dyer, S., Agar, M., Anstey, K., Beattie, E., ... & Dietz, M. (2016).
Clinical practice guidelines for dementia in Australia.
Mitchell, G., Ford, M., Mitchell, G., & Mitchell, G. (2017). Advanced dementia patients ‘lack
specialist nurse support’. Retrieved from https://www.nursingtimes.net/news/research-
and-innovation/advanced-dementia-patients-lack-specialist-nurse-support/7021322.article
Moyer, V. A. (2014). Screening for cognitive impairment in older adults: US Preventive Services
Task Force recommendation statement. Annals of internal medicine, 160(11), 791-797.
Rycroft-Malone, J., Burton, C., Hall, B., McCormack, B., Nutley, S., Seddon, D., & Williams, L.
(2014). Improving skills and care standards in the support workforce for older people: a
realist review. BMJ open, 4(5), e005356.

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ScienceDaily. (2017). Gap in health care for Alzheimer's disease patients who live alone.
Retrieved from https://www.sciencedaily.com/releases/2017/06/170614170224.htm
Seitz, D. P., Gill, S. S., Gruneir, A., Austin, P. C., Anderson, G. M., Bell, C. M., & Rochon, P.
A. (2014). Effects of dementia on postoperative outcomes of older adults with hip
fractures: a population-based study. Journal of the American Medical Directors
Association, 15(5), 334-341.
Surr, C. A., Smith, S. J., Crossland, J., & Robins, J. (2016). Impact of a person-centred dementia
care training programme on hospital staff attitudes, role efficacy and perceptions of
caring for people with dementia: A repeated measures study. International journal of
nursing studies, 53, 144-151.
The Conversation. (2018). Shortage of nurses in UK is affecting patient care and threatening
lives. Retrieved from https://theconversation.com/shortage-of-nurses-in-uk-is-affecting-
patient-care-and-threatening-lives-89734
The Telegraph. (2012). Medical staff lack dementia training, new report finds. Retrieved from
https://www.telegraph.co.uk/news/health/9110185/Medical-staff-lack-dementia-training-
new-report-finds.html
Vaingankar, J. A., Chong, S. A., Abdin, E., Picco, L., Jeyagurunathan, A., Zhang, Y., ... &
Subramaniam, M. (2016). Care participation and burden among informal caregivers of
older adults with care needs and associations with dementia. International
psychogeriatrics, 28(2), 221-231.

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Vasudev, A., Shariff, S. Z., Liu, K., Burhan, A. M., Herrmann, N., Leonard, S., & Mamdani, M.
(2015). Trends in psychotropic dispensing among older adults with dementia living in
long-term care facilities: 2004–2013. The American Journal of Geriatric
Psychiatry, 23(12), 1259-1269.
World Health Organisation. (2019). Dementia. Retrieved from
https://www.who.int/news-room/fact-sheets/detail/dementia
Zeilig, H. (2014). Gaps and spaces: Representations of dementia in contemporary British
poetry. Dementia, 13(2), 160-175.