Proposal for practice care improvement

Proposal for
practice/care
improvement
TOPIC:Care improvement for Tom Smith

Table of Contents
INTRODUCTION.................................................................................................................................. 1
Part 1: ‘Tom and his family’s experiences of admission to hospital’..............................................1
Part 2: ‘Person Centred Care (PCC)................................................................................................2
Part 3: ‘Caring for Tom’s BPSDs..................................................................................................... 4
Part 4: ‘Nursing care of Tom in an acute hospital’.........................................................................5
CONCLUSION...................................................................................................................................... 6
REFERENCES....................................................................................................................................... 7

INTRODUCTION
Dementia refers to a group of symptoms that are caused by disorders that affects the
functions of brain. People suffered from dementia may not be able to think precisely and
cannot do daily chores such as getting dressed or eating (Religa et.al., 2015, p. 45). They may
also lose the ability to solve problems and control their emotions. In this context, the following
report will focus on the care provided to the people suffered from dementia by referring to the
case of Tom Smith. He suffered from acute chest pain after Christmas. Tom is 75 years old and
lives with his wife Ann. Eight month ago he was diagnosed with dementia with not specific type.
Tom after admission in hospital shows agitated and restless behaviour. He frequently lashes out
at nursing staff and student when they came for observations. In this context, the experience of
Tom and his family will be examine during the process of hospital admission. The most difficult
aspect of experiences of family members and Tom will be assessed. The Person Centred Care
(PCC) approach that would be used in providing care to Tom in acute care setting will be
identified. The ways to minimise Behavioural and Psychological Symptoms of Dementia (BPSD)
will be determine in this assignment and eventually, the nursing care of Tom in order to
improve Angina with the help of two assessment tools will be developed in this report.
Part 1: ‘Tom and his family’s experiences of admission to hospital’
While being admitted to hospital, it can be imagined that both Tom and his family
members have a feeling of distress and anxiety. As Tom is aged person and chronic chest pain
can be considered as negative sign. Feeling of distress and anxiety are obvious in family
members as they are closely attached to Tom. The experience of both Tom and family members
was not considered to be good as they are being admitted to the hospital for treatment (Mol,
Moser and Pols, 2015). They show frightening behaviour and stays late in the hospital. This can
affects the psychology of Tom as because of him his family members are suffering. People
suffered with dementia have less cognitive ability and always shows sign of agitation and
frustration. The most difficult aspect of family members would be the drastic change of
behaviour of Tom during observation and nursing interventions. As it would be difficult for
anyone to see their dear one suffered in pain. Family members in this situation need to have

faith and belief in god and hospital administration (Talebzadeh and Lang, 2017, p. 175). Tom
and his family members have a feeling of despair and desperation due to hospitalisation of Tom
because of dementia and Angina. Family members are there for support and wants to join with
Tom in hospital by seating besides him during his hospitalisation period. The daily routines of
families and way of life were also very much affected (De Vleminck et.al., 2014, p. 119). The
most important way in which the hospital supported families was to keep them informed about
the patient's care and treatment. However, this was not possible without an active interest and
involvement on the part of family members themselves. Another most difficult aspect during
the experience of Tom to the family members was fear about the future. This was common as
family members were concerned about the future of Tom as per his present health status.
People suffering from dementia possess negative feelings which includes intense anger and
frustration (Mayeda et.al., 2015, p. 294), they lose confidence in their ability to carry out daily
chores and activities, loss of self esteem resulting in the feeling of uselessness and
unproductiveness. These are the feelings has been observed in Tom during his hospitalisation
process.
Part 2: ‘Person Centred Care (PCC)
Person-centred care is a way of thinking and doing things that sees the people using
health and social services as equal partners in planning, developing and monitoring care to
make sure it meets their needs (Thorn and Bloomer, 2015). Person centred care interventions
are effective in reducing symptoms associated with agitation, aggression, apathy, depression,
disinhibition, sleep disturbance and wandering. The Person Centred care approach can be
implemented in the hospital in order to provide effective and quality care to Mr. Tom Smith.
Person centred care can be considered to be optimum care for people suffering from dementia
(Domenig et.al., 2016). By maintaining effective relationship with Tom, the nurses and hospital
staff would be able to provide quality care to him. In this way, Tom would be able to recover
effectively and efficiently. There are certain principles in Person Centred Care which health care
professionals must follow by providing care to Tom. The first principle is to treat people with
dignity, compassion and respect. Here, the health care professionals at hospital must treat Mr.
Tom with dignity by considering his every needs and show compassion towards him in order to

enhance motivation of Tom. Patients often lose their independence when they enter care,
which puts their dignity at risk (Brooker and Latham, 2015). Thus, it is essential for the health
care professionals to show compassion and respect Mr Tom so that his agitation and
restlessness can be obliterated. The second principle in person centred care is to provide
coordinated care, support and treatment. To deliver quality and consistent person centred
care, the health care professionals needs to coordinate and collaborate with each other (van
der Steen et.al., 2014, p. 205 ). In order to provide quality care to Mr. Tom the health care
professionals in the hospital should work collaboratively and collectively so that effective and
efficient care can be given to him. The third principle suggests offering personalise care,
support and treatment. This principle is also considers as heart of person centred care approach
(Dewing and Dijk, 2016, p. 115). The hospital staff and health care professionals should use
standardised approach of care which could help in recovering or managing the condition of Mr.
Tom. Healthcare professionals needs to understand the circumstances and provide care
accordingly so that quality care can be provided to Mr. Tom. The fourth and last principle of
person centred care approach tells enabling service users to recognise their strengths and
abilities so that they can live independent and fulfilling life (Olivieri-Mui and et.al., 2018, p.
546). This can be done by involving patients in decision and assisting them to take action in
order to support themselves. Thus, The hospital staff can implement this principle in order to
provide quality care to Mr. Smith.
Part 3: ‘Caring for Tom’s BPSDs
BPSDs refers to Behavioural and Psychological Symptoms of Dementia. During middle
and later stages majority of people suffered from dementia experienced Behavioural and
Psychological Symptoms during their time of illness (Roehr et.al., 2015, p. 257). These
symptoms can identified by observation which includes wandering, agitation, loud vocalisation,
agitation, physical aggression and restlessness. In order to minimise the BPSDs in Tom, it is first
necessary to identify the symptoms he is suffering from. There are certain principles for
responding to BPSD. It is necessary for healthcare professionals to identify behaviour causing
distress. Rule out the medical causes. Non-pharacologic approaches are first line. Regularly
evaluate effectiveness of medication and review. In order to manage BPSDs symptoms of Tom,

management needs to formulate strategies in reducing negative behaviour and enhancing
positive behaviour (Kelley et.al., 2015, p. 730). As the BPSDs identified in Tom was agitation
and restlessness, the healthcare professionals must implement precise and effective strategies
to manage the symptoms of dementia. The healthcare professionals and nursing staff can
reduce negative behaviour of Mr. Tom by avoiding distraction, reinforce with other behaviours
and time out. The positive behaviour can be increase by making effective communication with
Tom. The symptoms can be managed by changing the social and physical environment of Tom.
By transforming the physical and social environment of Tom, the healthcare professionals can
reduce his agitation and restlessness and make his behaviour can be transformed drastically.
Healthcare professionals in order to manage BPSD can commence constant analgesia, ceasing
inappropriate medications, managing constipation and provide treatment for any infection
identified (Bail, 2016, p. 222). Through person centred care approach, the hospital staff and
nurses would be able to provide quality care and manage BPSD in Mr. Tom effectively and
efficiently. There is negative impact of dementia on communication as patient may find it
difficult to communicate with other person, patient may not be able express his or her
emotions. In this context, the healthcare professionals must show positive attitude towards the
patient. They must encourage both social and task oriented communication. In order to do that
healthcare professionals and nursing staff must get person's attention, maintain eye contact,
provide him personal space, should not argue and contradict with patient, lowers voice tone
and provide time to reply (Evans et.al., 2014, p. 970). Thus, by following these steps and
principles the management of hospital management, healthcare professionals and nursing staff
would be able to provide quality and effective care to Mr. Smith which helps in fast recovery
and managing BPSD effectively and efficiently.
Part 4: ‘Nursing care of Tom in an acute hospital’
From the analysis of case of Mr. Tom Smith it was identified that he was diagnosed with
Angina which is the kind of chest pain that caused by reduce blood flow in heart. This is chronic
and severe disease which affects aged patient drastically (Kraijo and et.al., 2014, p. 640). As he
was identified with both Angina and dementia it is essential for nursing staff and healthcare
professionals to provide precise and appropriate care to Mr. Tom. In order to manage other

acute issues it is essential and important for nurses to use precise assessment tools and
approaches which helps in reducing the pain and assist in improving the condition of patient.
Behavioural and psychological assessment tools can be used by nurses in present case of Mr.
Tom. Symptoms such as agitation, aggression, restlessness are common in dementia. To assess
the degree of symptoms, nurses and healthcare professionals behavioural and psychological
assessment can be very helpful (Jacob Bohlken and Kostev, 2017). They can utilise in order to
gain information about the agitation and restlessness of Mr. Tom. In order to improve the
quality of care, the nurses and healthcare professionals needs to devise precise strategies and
plans after carefully examining the condition of Mr. Tom. For diagnosing the chest pain or
angina, healthcare professionals can conduct electrocardiogram. In order to record the
electrical activity of heart, the assessment can be done on Mr. Tom. Through this healthcare
professionals will be able to acquire information about abnormalities in hear such as
arrhythmias or to show ischaemia (lack of oxygen and blood) to the heart. Nursing care plays
vital role in the improvement of patient health. People suffered from dementia required quality
care so that their recovery in health can be made effectively and efficiently. These assessment
tools are very helpful in the case of Tom. He suffered from dementia and acute chest pain
which worsen his condition (Poblador-Plou et.al., 2014). From these tests healthcare
professionals will be able to know more about the Tom and they will be able to articulate
nurses to prepare care plan which would be appropriate for Mr. Tom in improving his overall
condition.
CONCLUSION
From the above report, it can be understood that people suffered from dementia may
not be able to think precisely and cannot do daily chores such as getting dressed or eating. With
this context, by referring to the case of Mr Tom Smith who admitted hospital due to acute
chest pain that occurred few days after Christmas, this report helps in analysing the experience
of Tom and his family of admission to hospital. The most difficult aspect of family members
would be the drastic change of behaviour of Tom during observation and nursing interventions.
Another most difficult aspect during the experience of Tom to the family members was fear

about the future. Further, in this report the concepts and principle of Person Centred Care has
been discussed. By maintaining effective relationship with Tom, the nurses and hospital staff
would be able to provide quality care to him. In this assignment the management and control
of Behavioural and Psychological Symptoms of Dementia (BPSD) has been described in this
assignment. Eventually, the nursing care and two assessment tools which are useful for
examining Mr. Tom has been described in this assignment.

REFERENCES
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