Clinical Practice Involving the Dementia Patients: An Analysis

This essay delves into the clinical practice of caring for dementia patients, examining the condition's impact on individuals and their daily lives. It explores the challenges faced by these patients, including memory loss, speech difficulties, mood swings, and the psychological effects of their condition. The essay highlights the importance of understanding these experiences to improve care, emphasizing the need for patient-centered approaches and adherence to guidelines such as those from NICE. It discusses various care strategies, including the involvement of families, the implementation of dementia-friendly environments, and the role of healthcare professionals in providing holistic support. The importance of partnership among healthcare providers, social workers, and families is also emphasized to ensure comprehensive and continuous care. The essay provides insights into the experiences of dementia patients, strategies for improved care, and the importance of collaboration among healthcare professionals to improve the quality of life for individuals living with dementia.

Running head: CLINICAL PRACTICE INVOLVING THE DEMENTIA PATIENTS
Clinical Practice Involving the Dementia Patients
Name of the student
Name of the University
Author note

1CLINICAL PRACTICE INVOLVING THE DEMENTIA PATIENTS
The purpose of this essay is to identify a long-term condition (dementia), and
discuss how it affects individuals and their experiences, in order to develop an
understanding. This essay will cover the key issues of a long term condition (dementia)
and how it influence the well-being of individual using the dementia alliance
international, NICE guidelines and books that will be mention in the essay along the
line. Also, I will be discussing about implication for practice and the role of healthcare
professionals working in partnership with patients, carers and their families. I will then
talk about what I have learnt and how this essay will influence my future practice.
The reason for selecting this topic is based upon statistics from United Kingdom,
which shows that there are currently, 850,000 people who have dementia and these numbers
are likely to rise over one million by the year 2025 (Alzheimer's Society 2018). One in six
people over the age of 80 years develop dementia. The Fifth edition of Diagnostic and
Statistical Manual of Mental Disorders (DSM-V) has reclassified dementia as a
neurocognitive disorder, which has a varying degree of severity (Brooker et al. 2014).
Chertkow et al. (2013) defined dementia as a clinical syndrome where the decline in
cognition occurs, sufficiently severe to interfere with occupational or social functioning.
Therefore, to improve their living conditions and provide better care as a Nursing Assistant
(NA), it is important to study the experiences of individuals living with the condition. The
following essay focuses on dementia patients and their daily life experiences. First we will
discuss the onset of dementia. Also, knowledge of this condition and associated experience
will allow better diagnosis and assistance for dementia patients. Additionally, knowledge
provided to patients can allow them to be better equipped to understand their condition better
and manage them more efficiently. Both of which can improve outcomes of the care and

2CLINICAL PRACTICE INVOLVING THE DEMENTIA PATIENTS
treatment, and hence emphasizes the necessity for developing knowledge about this disease
as well as long term conditions by both the nurse and patient.
The onset of dementia involves the damage of the nerve cells within the brain, which
can happen in different areas. Dementia affects the cognitive ability of every other person
differently as it depends on the area of affecting the brain (Laforce 2013). Dementia also can
be grouped by its cause as there are some dementias, which are caused by the reaction of
vitamin deficiencies, and this can be improved if treated. In addition, there are progressive
dementias as Alzheimer’s, vascular dementia, Frontotemporal dementia, Lewy Body
dementia and mixed dementia (Sadowsky and Galvin 2012). The experiences of dementia
patients and their challenges are discussed in the subsequent section.
Dementia patients experience a number of key challenges while receiving
care from healthcare professionals. The personal details in the story will be rephrased for
maintaining the confidentiality of patients. Considering the issues experienced by Maggie, a
72-year-old dementia patient, the major concern had been the ability to retain any memory of
her previous life or existence (dementiaallianceinternational.org 2018). The incapability of
retaining any memory often incorporates agitations and helplessness in the patients and
Maggie had been a victim of all these challenges. Patients with dementia experience mood
swings, delusion, aggressiveness, guilt and low self-esteem (Rohrer, Rossor and Warren
2012). Dementia patients with depression experience trouble with decisions or memory,
preoccupation with death and feeling of clinginess. This interferes with their ADLs and
worsens their mental wellbeing. Physical wellbeing is also affected as depression is risk
factors for heart attack, weight fluctuations and weakened immune system. Such long term
condition can also become a financial burden due to cost of care as well as the effect on
employability or sustenance of employment (Alzheimer-europe.org 2018; Sakata and

3CLINICAL PRACTICE INVOLVING THE DEMENTIA PATIENTS
Okumura 2017). This brings us to reflect upon our understanding of the implication of such
experiences.
Reflecting on the experience of another patient, Mr. Schmidt, an 82-year-old
dementia patient was completely dependent on the healthcare provider. He suffered from
extreme speech difficulty, which restricted him from being able to express his particular
needs and preferences. The inability to express his preferences and grievances led to extreme
frustration in the patient, which eventually led to depression, helplessness and non-
cooperation with the healthcare professionals. Along with agitation, depression, speech
difficulty and memory loss, patients with dementia experience paranoia and aggression.
Madison, a 70-year-old woman had been living with vascular dementia for last five years;
and along the course, she had developed a fatal inclination towards dependability and
temperament. The extreme dependability of the patient on the care provider indicates the
absolute lack of independence and empowerment that eventually led to paranoia and extreme
aggression in the patient. It has to be understood that dependability and helplessness affects
the mental health of a patient profoundly and hence the onset of paranoia and aggression
is inevitable (dementiaallianceinternational.org 2018). Although there is a need for care,
critical requirements of the dementia patients should also be taken into consideration so that
these challenges can be avoided or managed accordingly. Speech difficulty is one of the
earliest issues, which can be seen in the dementia patients. They can often forget a word or an
entire conversation. As dementia progress, the patients can forget the common phrases and
words frequently and it is possible that the small set of language which they could remember
at one time, can be lost to them, as they no longer could remember them. In later stages of
dementia, the patients communication level is impaired and at one point of time, the patient
might lose his or her speech completely (Warren, Rohrer and Rossor 2013). Due to speech

4CLINICAL PRACTICE INVOLVING THE DEMENTIA PATIENTS
difficulty, dementia patients fail to express their thoughts and emotions with loved ones and
family members. As a result, it affects their social wellbeing as their family members fail to
address their care needs. The caregivers should be present with the dementia patients at the
point of time as one might not recognize the people around him, or her but can recognize the
tone of the voice of the caregiver. These aspects highlights the key issues that a dementia
patient psychologically and physically faces, and their inter relation. With the understanding,
we can next discuss how to improve care.
Listening to the experiences of dementia patients greatly help to improve the care
giving process (Prorok, Horgan and Seitz 2013). Living with dementia can have a
psychological, social, emotional and practical impact on the individual (Johannessen and
Möller 2013). Individuals with dementia experience these impacts as severe losses and they
find it challenging to adjust with the condition. Dementia patients experience problems with
thinking and memory difficulties that in term affect their confidence, self-esteem, autonomy,
independence, social relationships and most importantly, their ability to perform ADLs.
Therefore, it can be deduced that this condition greatly affects their overall health influencing
their psychological, social and physical wellbeing. In such cases, NAs should understand the
feeling of the patients and try to see things from their perspectives as far as possible. This
helps to offer support and make them feel valued and included. Next we shall discuss the care
strategies for dementia.
The UK government has established a new strategy named National Dementia
strategy, published in 2009, set new standards for the dementia care. The dementia challenge
groups are working with many organizations such as NHS England, Health Education
England and the Royal Medical College (Brooker and Latham 2015). The goal of the strategy
is to get 20 cities, towns and villages in England are to create awareness about dementia.

5CLINICAL PRACTICE INVOLVING THE DEMENTIA PATIENTS
Another goal is to create at least 1 million Dementia friendly people. As of 2013, as many as
35.6 million families have a patient suffering from dementia (nice.org.uk 2018). Involvement
of these families in decision-making is necessary for the everyday care, medical treatment of
the patient. The decision making process most of the time is involved with complex ethical
and legal dilemmas. Mostly, these dilemmas arise due to the lack of the involvement of the
patient about their care. Therefore, person-centered care is important as per NICE guidelines.
From the case study, it was found that the patient is suffering from memory loss. As
the patients with dementia find trouble in remembering things, they cannot remember the
recent events around them. They cannot remember the name of the people and even forgets
them. They can remember some events of the past and often are caught up on these events.
During the last stage of dementia, there is loss in memory (Khan et al. 2015). The caregiver
has to remember that they have to keep every spare copy of information of the important
items. The NA should implement patient-centered care model as a part of (National Institute
for Clinical Excellence) NICE guidelines, UK. The caregivers should respect the dignity of
the patient regardless of cognitive impairment and respect their life experiences and unique
personality. Moreover, the caregiver should be close enough to the patient to understand their
life experiences. The NHS guidelines help health and social care workers to support people in
mild-life approaches to prevent or delay the onset of dementia (nice.org.uk 2018). The reason
the above mentioned strategies are selected is based on the recommendation of the NICE
guidelines. Moreover, such strategies can also improve the sociological well being of the
patient, furthering the positive effects on their mental well being.
According to NHS, the patients with an early and middle stage of dementia can be
involved in their care, as they can think and communicate. The medical practitioners such as
doctors and the nurses can care for them by involving their families and primary caregivers to

6CLINICAL PRACTICE INVOLVING THE DEMENTIA PATIENTS
form a partnership. The health promotion strategies for the dementia patients help the
caregivers to know more about the condition. It helps them to know the strategies and
interventions, which helps the patients to lead a normal life like others (Eggenberger, Heimerl
and Bennett 2013). Empowering dementia patients can help to involve them in the provision
of care making them feel valued and socially included. There should be development of
purposeful activities to avoid negative situations and gain their attention through empathetic
communication. There should also be validation of the heard emotions and simplify every
instruction as confusion can trigger negative behaviors.
Nurses also should be capable of working across the boundary of their
responsibilities, and helping the other caregivers in partnership to elicit better care for the
patients. This also allows integration of services. This involves workforce boundary spanning
to create workforce that can exist within and across health and social care requirements. Such
principles can be the foundation of integrated care pathways. Such partnership can exist
within primary care setup between the healthcare staff and care homes through in-reach and
outreach services; first contact care and management by nurses, pharmacists supporting
general physicians. Nurse care coordinators can be specifically assigned to monitor effective
coordination (Gilburt 2016)
Working in partnership essentially means the delegation of care responsibilities
through various job roles and responsibilities, based on specific expertise. It also involves
efficient coordination (sharing of information or research data) and ensuring uninterrupted
and continued care for the patient. This is especially important for lifelong conditions, which
necessitate long term care. For dementia care, partnership with social care worker,
pharmacist, general physician, mental health practitioners, care support workers and family is
required. This can allow providence of a holistic, patient centric care, and also reduce

7CLINICAL PRACTICE INVOLVING THE DEMENTIA PATIENTS
fragmentation of local service delivery (Tait and Shah 2018). Working with different
professionals like social care personnel (sharing care information, care needs, health status to
enable continuation of support beyond healthcare setup), physiotherapist (with health reports
and clinical findings and assist the patient to maintain, increase and improve mobility),
psychologist (sharing health reports and analysig the mental health condition and
requirements of the patient, to ensure patient experience is maintained positive) helped be
understand better about effective coordination and communication. A significant challenge to
this process however is to comprehend all the information shared across these professions.
Advancing knowledge to these domains therefore is important for nurses to be able to
understand the data and share them systematically and efficiently, without jeopardizing
confidentiality of the information. Providence of infrastructure to communicate with the
diverse professionals greatly helped me in this process, for which I am thankful to my
organization.
This learning from the case studies and the key issues are important as it helped me to
learn about the experiences, which arises while caring for the dementia patients. It is
important to know about the interventions and the importance of involving the families of the
patients into care. It also helped me to create awareness about dementia that can make the
caregivers understand the needs of the dementia patients. As an NA, to study the experiences
of individuals with dementia can be a potential way to change their ways of living in the
future. While caring for a patient with dementia I was able to coordinate care across various
professionals, and was effectively managing the coordination of the care to ensure continued
and unfragmented service. I was also monitoring the experiences of the patients. The
principal benefit is to understand their feelings and signpost subsequent care pathways for the
dementia patients so that they are able to live to their full potential like others and also to

8CLINICAL PRACTICE INVOLVING THE DEMENTIA PATIENTS
share key findings with the healthcare team. I was also involved in educating the patient
about their conditions that helped them understand their conditions better. Additionally, I was
motivating, empowering and helping the patients live an independent life. For the long-term
care, this learning can be helpful as NAs can provide direct care to patients with advanced
dementia. Additionally, I was able to understand how long term condition can affect the
mental health of patients, and their experiences, and how through long term care and
involvement of healthcare partnership (involving care professionals from different fields),
working across boundary can help the patient. I understood how caring for dementia involved
social care workers and other healthcare personnel with whom I had to share progress reports
and clinical finings. Such experiences have better equipped me to provide a more efficient
care and coordination of services. Additionally, I have learnt the necessity to educate the
patients about their own conditions that can later help to manage their conditions better.

9CLINICAL PRACTICE INVOLVING THE DEMENTIA PATIENTS
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