Review of Dementia Care and Person-Centeredness

This assignment involves reviewing a collection of documents related to dementia care and person-centeredness. The review includes studies on measuring person-centered care, implementing national guidelines, communication skills training, and best practices for managing older people with dementia in acute care settings. It also covers the role of leadership in implementing person-centered care using Dementia Care Mapping and the components of best nursing practice in caring for acutely ill hospitalized older patients with coincidental dementia.

Running head: PROPOSAL FOR PRACTICE/CARE IMPROVEMENT
Proposal for Practice/Care Improvement
Name of the Student:
Name of the University:
Author Note:

1PROPOSAL FOR PRACTICE/CARE IMPROVEMENT
Table of content
Introduction................................................................................................................................2
Discussion..................................................................................................................................2
Part 1: Tom and his family’s experiences of admission to hospital.......................................2
Part 2: Person Centred Care (PCC)........................................................................................4
Part 3: Caring for Tom’s BPSDs’..........................................................................................5
Part 4: Nursing care of Tom in an acute hospital’.................................................................7
Conclusion..................................................................................................................................8
References................................................................................................................................10

2PROPOSAL FOR PRACTICE/CARE IMPROVEMENT
Introduction
Person-centred care allows the caregivers to build a psychological and emotional
bonding with the patient and his or her family members. Like any other physiological and
psychological issue it is also very helpful for dementia. The operational result of person-
centred care for treatment and assessment procedure of Dementia is noticeably effective
(Eggenberger, Heimerl & Bennett, 2013). This paper is focused on needs and application of
person-centred care for a patient named Thomas. The focus of this paper is to identify the
correct utilisation of PCC of Tom and to prepare a proposal for caring improvement for him
during his time in the hospital.
Initially, the experiences of Tom and his family members due to his hospitalisation
have been analysed. Then, the appropriate practices for person-centred care for Tom have
been identified with potential effectiveness. The appropriate implementation policies for
caregivers have been identified and evaluated. Tom has various psychological and physical
symptoms of agitation, restlessness and aggressiveness. Therefore, various assessment
methods have been critically examined, which are very effective to measure his physical and
psychological functionality accurately. Finally, his nursing needs also have been identified
with proper guidance for caregivers including the requirements of physiotherapy and
medication.
Discussion
Part 1: Tom and his family’s experiences of admission to hospital
Dementia has a strong impact on the psychological and emotional condition of the
patient. When a person is diagnosed with dementia his or her family members and close
relatives are also affected emotionally after hearing the news. Additionally, hospitalisation of

3PROPOSAL FOR PRACTICE/CARE IMPROVEMENT
the patient expands this psychological and emotional disturbance to the next level (Beard,
2012).
Tom’s experiences of admission to hospital:
Tom is a 75 years old person possessing both Angina and dementia. He lived with his wife
and had intense passion for woodworking. On the other hand, he has never been admitted to a
hospital even after being diagnosed with Angina. Therefore, for Tom hospitalisation caused
several psychological and emotional agitations. Like most of the other patients with dementia
Toms also felt an extremely depressed having a negative picture of the future. In most of the
cases, patients think that their life will not be same forever (Brownie & Nancarrow, 2013).
These are the pre-hospitalisation psychological impact on Tom.
After admitting to the hospital Tom has been disconnected from his social activities and
creative hobbies. The usual social and cultural state of Tom’s lifestyle has been hindered
significantly that caused the resultant restlessness and usability of his mind. People with
dementia often go through a hard time to adjust to new environment and persons in the
hospital (Borson et al., 2013). On the other hand, the separation form his wife with whom he
used to spend his entire day is causing additional discomfort, mental insecurity and anger.
These dilemmas can switch other associated problems like mood swing, anxiety, panic
attack, depression and other that is causing his restlessness, agitation, and tendency to lash
out.
Experiences of Tom’s family due to hospitalisation:
Tom has two sons, two daughters and four grandchildren who used to visit his house
frequently. Tom's hospitalisation also has a significant impact on his wife, his children and
grandchildren. Usually, adult hospitalisations, especially in case of dementia the people who

4PROPOSAL FOR PRACTICE/CARE IMPROVEMENT
are closely connected with the patient often suffer from emotional disturbance and wariness
(Verbeek et al., 2012). In case of Thomas, his wife can suffer from restless emotional state
especially after hearing the agitated condition of her husband in the hospital. Tom’s sons and
daughter are also feeling insecure because of the potential risk that can make the situation
worst. Apart from that, his wife and children are also waring because of being unknown
about the existing situation of Tom and the current approaches that have been taken by the
hospital staffs.
Part 2: Person Centred Care (PCC)
The person Centred Care (PCC) is a healthcare approach where the health care
facilities and services are provided by involving the patient and the family in any decision
making process with proper respect and responsive nature. In PCC patient’s and his or her
family’s needs, values and preferences are prioritised during the treatment procedure and
rehabilitation. In order to provide PCC for a dementia process, the caregiving organisation
has to take care of 5 factors of the patient namely, Personality, Biography, Health,
Neurological impairment and Social psychology (Robinson et al., 2013). These five factors of
each patient are unique. At the same time, the psychological attachment of the patient with
the PCC approach differ according to their social and personal identity; a sense of self
concerning the responsibilities; personality; relationships; memory and reasoning capabilities.
For Thomas, the PCC approach should be well organised by prioritising his social
activities, passion with wood-crafting, the interaction with his wife and others. Apart from
that, his wife and children should also be involved in any decision making process remerging
his treatment procedures. These attachments and emotional interactions can retain his sense
of belongings and sense of security (Knapp, Iemmi & Romeo, 2013). Despite that interaction

5PROPOSAL FOR PRACTICE/CARE IMPROVEMENT
between his family members and the caregivers can also build up his faith on the caregivers.
The verbal and non-verbal cognitive, emotional, social and psychological interchange among
the caregivers, Thomas and his family members also help the treatment policies to be more
accurate and effective. At the same time, his family members can rely on the treatment
process with ease.
Thomas also has Angina which needs regular medication and care. The type of care
required for Angina also differs from patient to patient regarding their pathophysiological
history (Chenoweth et al., 2012). PCC will allow the healthcare organisation to communicate
with the patient as well as his family about his current and previous problems regarding
Angina. In case of any other potential occurrence physical or psychological problem the
healthy relationship among Tom, his family members and the caregivers can help the
healthcare process to handle the situation easily.
Part 3: Caring for Tom’s BPSDs’
Communication process of the caregivers has a huge impact on the overall
psychological and emotional condition of the patient. Being a patient with dementia Tom also
needs some essential communication approaches and practices from his caregivers that can
make the whole treatment and assessment procedure more efficient and effective. People with
dementia frequently go through a traumatised stage with high agitation, anxiety and panics
that make the patient more aggressive and restless (Moyle et al., 2012). As per the case of
tom he is also showing some BPSD or Behavioural and Psychological Symptoms of
Dementia. In this case, Tom’s care gives should treat him with more patience. The gentle,
calm and trustworthy gesture of the caregivers can handle the situation by wasting very less
amount of time and energy. In some cases, patients also suffer from hallucinations and

6PROPOSAL FOR PRACTICE/CARE IMPROVEMENT
delusions. Although Tom does not have any of these symptoms, lack of relaxing environment
can deteriorate the whole situation.
One of the steady and continuous psychological states of any patients with dementia
is depression. After being diagnosed with dementia and sudden hospitalisation Tom has
experienced a significant mental shock and hopelessness. This mental condition initiates a
continuous depressive mood that also related the state of anxiety to some extent. Appropriate
verbal and non-verbal communication and encouragement usually help to handle this type of
situation (Tolson, Smith & Knight, 2012). The caregivers of Tom should maintain stable and
calm eye contact with a peaceful smile during communicating with him. For any patients
with very advanced dementia, non-verbal communication can be the only solution to
communicate. The care givers should maintain a polite attitude while listening to the
problems faced by patients without interrupting.
An optimistic attitude is another effective communication strategy, where the
caregivers give mental and emotional support for not letting the patient feel hopeless and
pessimistic about the future. Tom’s caregivers should always keep him motivated for his
recovery to make him confident about his healthy and happy life in future. Introducing
personalised intervention can be very helpful for Tom that includes listening to music, social
interaction, increased daytime activities to reduce boredom and other (Edvardsson, Sandman
& Borell, 2014). Apart from that, sleep-wake cycle is another important concern in the
treatment of dementia. Making a stable schedule for sleep timing is essential for Tom, where
the caregivers can ensure that Tom is able to awake in daylight time. The stable and well
scheduled sleep-awake cycle can also reduce Tom's occasional aggression and loud
vocalisation that can be caused by sleep deprivation.

7PROPOSAL FOR PRACTICE/CARE IMPROVEMENT
Part 4: Nursing care of Tom in an acute hospital’
The patients with dementia should go through various diagnoses in order to identify
his or her abilities, disabilities, strengths, weakness and potentialities in both physical and
psychological state. The medical history of Tom should be examined to understand the
possible difficulties that can be caused by being patient with Angina due to the problem
coronary artery. Additionally, memory test, problem solving ability, attention, counting test
and language test should be conduct along with some medical tests namely blood, urine,
spinal fluid and a brain scan (Clissett et al., 2013). For a dementia patient like Tom, the Mini-
Mental screening tool would be very helpful. Through these tools, his cognitive functions,
orientation, memory, attention and all other psychological functionalities can be measured.
The assessment process can be divided into two parts namely psychological
assessment and functional assessment. As the functionality assessment, the most appropriate
assessment tool would be the Barthel Index. In this assessment process, Tom's physical and
functional deficits will be the main focus while being observed for monitoring his
independent cognitive approach, independent body movement and mobility. Tom is seventy-
five years old man who has a cardiac disease name Angina. Therefore, identification of his
physical capabilities and interrelate with his dementia symptoms is crucial (Fossey et al.,
2014). From the Barthel index and scoring system, the weakness of Tom in regular activities
can be identified. Henceforth, as per the scorecard, the further assessment and development
procedure will be followed. Apart from that this assessment tool is also helpful during his
treatment process where the caregivers can have the idea about the existing functionalities of
Tom and which part needs to be more functional. Various physiotherapies and medication
can help Tom to regain his functionality and body movement.

8PROPOSAL FOR PRACTICE/CARE IMPROVEMENT
After admission, Tom became very agitated and restless. He is constantly showing
loud vocalisation at nursing staffs. This symptom can be caused by severe anxiety and panic
attack (Edvardsson & Innes, 2010). Though, sometimes these problems can be the early
symptoms of psychotic tendency. Therefore, to gauge the practical condition of Tom’s
psychology Cohen-Mansfield Agitation Inventory (CMAI) can be very helpful. In CMAI
assessment program 29 item scales can be used for systematical assessment for Tom’s
agitation. The frequency of his emotional outburst can be measured to find his underlying
psychological condition (Rokstad et al., 2015). Through this process, the caregivers can
measure the frequency of occurrence and amplitude of physical and metal aggressiveness as
well as non-aggressiveness and verbally agitated behaviours of Tom. The current and future
medical needs of Tom can also be identified through this assessment process.
Conclusion
From the above discussion, it can be said that person-centred care allows the
caregivers to build a psychological and emotional bonding with the patient and his or her
family members, which can be very helpful for a patient of dementia. This proposal has
successfully analysed the needs and application of person-centred care for a patient named
Thomas. It is also noticeable that dementia and its associated problems have a strong impact
on the psychological and emotional condition of the patient. On the other hand,
hospitalisation of Tom expands the psychological and emotional disturbance of both patient
and their family members significantly.
In Person Cantered Care Tom’s and his family’s needs, values and preferences are
prioritised during the treatment procedure in the hospital. The gentle, calm and trustworthy
gesture of the caregivers can handle his situation with ease. Apart from that introducing
personalised intervention can be very helpful for Tom. As functional assessment for Tom the

9PROPOSAL FOR PRACTICE/CARE IMPROVEMENT
most appropriate assessment tool would be the Barthel Index. On the other hand, to gauge the
practical condition of Tom’s psychology Cohen-Mansfield Agitation Inventory (CMAI) can
be very helpful. Moreover, PCC will allow the healthcare organisation to communicate with
the patient as well as his family about his current and previous healthcare problems which
can be very beneficial for Tom’s assessment procedures.

10PROPOSAL FOR PRACTICE/CARE IMPROVEMENT
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