Nursing Report: Self-Management of Clients with Dementia, University

This nursing report explores self-management strategies for clients with dementia, addressing the challenges posed by cognitive and coordination impairments. It begins with an introduction to dementia, its various forms (including Alzheimer's) and associated pathophysiological conditions, emphasizing the importance of self-management in daily life. The report then delves into health maintenance and promotion, highlighting the role of adaptive aids, environmental modifications, and memory training exercises. It underscores the significance of communication, rehabilitation programs, and promotional activities for encouraging client participation. Cultural safety is also emphasized, advocating for culturally competent care and sensitivity to diverse beliefs. The report further discusses empowerment strategies, such as purposeful activities, clear communication, and positive reinforcement, to enhance client independence. Finally, it examines the impact on carers, stressing the need for caregiver support and the creation of empowering environments to facilitate effective self-management. The report concludes by emphasizing the need for community nursing plans, rehabilitative programs, and culturally safe practices to support both patients and caregivers.

Running head: NURSING ASSIGNMENT
Self-management of client with dementia
Name of the Student
Name of the University
Author’s note

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Table of Contents
Introduction......................................................................................................................................2
Pathophysiology..............................................................................................................................2
Health maintenance and promotion.................................................................................................3
Cultural safety..................................................................................................................................5
Empowerment..................................................................................................................................5
Impact on carers...............................................................................................................................6
Conclusion.......................................................................................................................................7
References........................................................................................................................................9

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Introduction
Dementia is a neurodegenerative disorder that affects the brain. The symptoms are the
memory loss, difficulties in thinking, problem-solving. This affects the person coordination
movements and the abilities in everyday activities. Dementia is not a specific disease it is
progressive. Dementia is the affect of many other neurological disorders like Alzheimer's,
vascular dementia, Lewy body disease, Parkinson’s disease (Chen et al, 2016). This report
highlights on the self-management strategies perceived by the nursing staff to support their
clients with dementia. People with dementia face problems in managing the condition in daily
life. Thus the self-management will support the nurses to make effective interventions for
controlling the conditions of dementia in the client
Pathophysiology
Dementia is the symptom of other different structural diseases as well as several system
degenerations. Alzheimer’s disease is the real cause behind the pathophysiological conditions of
dementia. There is degeneration of the cortical and subcortical cholinergic neurons and the large
pyramidal cells present in the cerebral cortex. This results in the clinical symptoms due to
deterioration of the functions of the cortex .The pathophysiological cause of dementia includes
the structural lesions in the brain. Sometimes dementia may be caused by the nutritional and
metabolic disorders. Neuropathologically the amyloid plaques, pinched off cholinergic nerve
endings, lesions in the outer layers of cortical lobes contributes to the outcome. The
pathophysiological substrates are the neurofibrillary tangles (Barker et al, 2014). The tangles
consist of tau protein which actually functions in the maintaining the structure of nerve cell. The
attachment of phosphorus is required in the modification of tau protein. However, in dementia,

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there is excessive phosphorylation and it results in loss of function of the protein. The oxidative
stress or damage in the cellular structures by the free radicals also lead to dementia caused by
Alzheimer’s disease. The brain inflammation in old people is another pathophysiological reason
behind dementia (Fong et al, 2014). The abnormal genes that encode for amyloid protein and the
cholesterol bearing protein cause the pathophysiological conditions of dementia. There is
primary dementia caused by the irreversible changes of other neurological disorders and
secondary dementia caused by chronic meningitis, acquired immunodeficiency syndrome.
Looking into the pathophysiological condition of the patient with dementia, the self-management
strategies are to be developed that will help the nurses to tackle the problems of the everyday
life. The psychosocial interventions are to be served by nurses by teaching the patient with self-
management of the conditions (Ballard et al, 2013).
Health maintenance and promotion
The patients with dementia face daily cognitive problems like coordination impairment due to
loss of memory and perception. Activities of daily life are affected with dementia. The
difficulties that arise are due to difficulties in executive functioning like wash hair, dressing,
clothing. There are problems related to poor decision making, attention. All of these health issues
make everyday life challenging for the clients affected with dementia (Aguirre et al, 2014). Thus
self-management strategies adopted by nurses for health maintenance are extremely required. In
the health maintenance, nurses should teach some of the principles in self-managing skills to
tackle the everyday problems. The adaptive aids can be given to the patient that will define the
wide range of memory aids to bathing equipment and that will aim to minimize the impact of
physical, cognitive and sensory problems (Khanassov, Vedel, &Pluye, 2014). The low-level
technologies like computers and telecommunications can be used by the client to remember their

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task. This provision of adaptive aid given by the low-level technology would involve the person
with dementia and the carer in their own environment. The health maintenance can also be
facilitated with the modification of their own environment (Lavretsky et al, 2013). The memory
aids like calendar, diaries, schedules in books and electronic devices can be introduced. For their
health maintenance in self-management, they can be, taught to exercise that will be like memory
training. The memory training exercise with memory aid could serve as the powerful tool in
health. Thus exercise if done daily it can help them to manage their own mobility problems. The
health maintenance strategy that is to be brought to the patients is going to target the quality and
enhance the functional performance in improving cognition, mood, and behavior. The health
maintenance will also guide the accurate pharmacological interventions that the patients should
follow. They must be encouraged for attaining group based therapy mainly that will include
recreational and social therapies. . They can use telecare for getting the treatment when necessary
easily even if the patient stays in remote areas.
In the context of promotion of self-managing strategy for dementia, the nurses can
perform specific interventions for promoting independence. The promotional plan should be
designed based on the strength and the needs of the clients. The first thing that the nurses can
use as a tool in the promotion is the communication (Ducharme et al, 2013). Communication will
serve as the core for the psychosocial interventions. The communication skills may be effective
in ensuring the least amount of dependence care. This is done by using verbal and body
language, communication with pictorial form and memory books. The rehabilitation programs
can also be adopted that will teach the persons with self-management of their cognitive,
perpetual and mood elements (Trahan et al, 2014). The promotional programs will encourage
them in participation that will help the dementia clients to achieve pleasure and will help resist

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challenging behaviors. A good promotion of the management of the problems of dementia may
be helpful to prevent the early dementia .The promotion method targets the entire population as a
whole. This increases and enables the people to control over the health determinants of dementia.
Rehabilitation programs will create supportive environment for health and also develop personal
skills in managing the conditions.
Cultural safety
The clients belong to the culturally different background. Different people have different
cultural beliefs. Thus cultural awareness must be present in any strategy the nurses take to
support the self-management of the people with dementia. The cultural competence should be
maintained. There should be culturally safe dementia care. Suppose the nurses are planning for
any study of the recurrent conditions of the clients after they have been guided by the self-
managing strategies, they will make questionnaires in such a way that they do not breech the
personal beliefs and ethical issues of the old clients. The innovative community-based research
program can be formed that will be analyzed by the group of nurses and decision makers to
design the programs that will attract all the culturally diverse groups of people (Kirmayer, 2013).
Cultural safety in an environment is safe for all the people as there will no denial in the identity
and will ensure shared respect and knowledge. The nurses must first notice all the practices and
the cultural aspects of the clients on which the strategies are to be implied.
Empowerment
Empowerment is a part of an important task to improve the care of the persons with dementia.
There are several ways by which empowering can be done for the self-management. This could
be done by developing purposeful activities because negative outcome often leads to frustration.

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The nurses should speak face to face while delivering their teaching session or introducing any
rehabilitation programs (Hutchinson et al, 2016). They must try to gain the attention of the
person in the procedure. The things that the nurses are going to make notice to the client must be
conspicuous that is camouflage of what the nurses wish him to avoid. The items should be plain
and must develop positive responses to task. This is because the procedural memory lasts
longer. The nurses can establish their empowerment only thorough good communication with the
patients. In that case when the nurses wish to establish any points they must validate the
emotions they hear. The nurses should remember not to disagree with the patient's sense of
reality .The negative behavior of the client should be decreased while communicating with the
patient and making them understand the strategies of self-management in everyday life . It also
offers choices and thus empowering environment can be created. An empowering environment is
very essential to maintain the fruitful conversation with the clients affected with dementia. The
above ways of empowering the patients will be useful for them to live independently and self-
manage dementia. The process of evaluation and program based on rehabilitation is going to aim
at empowering the elder clients with early dementia. The education and counseling programs
can be also made likewise to empower both the patient and the family of the patient
(Bhattacharyya &Benbow, 2016).
Impact on carers
The self-management can be established only with the help of the carers. If the carers are
tired or stressed then it will become harder for the patients with dementia. It will thus be
important for the carers to continue the activities that keep them happy (Hou et al, 2014). The
impact of care while handling the patients could result in negative outcomes making them weary
at work. At moments carers can experience feelings of guilt loss or anger. The carers must

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themselves be skilled and relaxed and then teach the patients in self-managing their everyday
conditions. They must be very active in supporting the available care and provide the
empowering environment with practical assistance to the patients. The caregivers frequently
report of experiences of high level of stress. Understanding and supporting a person with
dementia could have both emotional and psychosocial impacts on the care givers. The care
givers, in this case, must recognize their problems and try to be supportive as possible.The
support should be sensitive to the person and must aim to focus on promoting the well being. It is
entirely dependent on the care givers to create the empowering environment for the patients so
that they can learn to self-manage their every-day problems (Moradi-Lakeh, & Vosoogh-
Moghaddam, 2015).
. Caregivers can face many obstacles while managing a dementia patient. The impact on care
givers is diverse and complex. There are many factors that exacerbate to their
impacts. Caregivers often face obstacles related with the problems in household,
depression and as a result they might not do their jobs properly. The family
conflicts that they face is due to the strains in personality, competence and
captivity role.
Conclusion
This entire report reflects on teaching self-management in patients with dementia. Since the
pathophysiological factors show that progressive dementia is ruled with complex cognitive and
coordinating disorders, self-management of dementia is the must. There are huge problems
associated with the patient in everyday life. Thus the community nursing plan will be made that
is going to assign rehabilitating programs and increased communication that is going to make the
client competent enough to handle their everyday life situations in dementia. The nurses can

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ensure the teaching and the promotional programs by mediating an empowering environment.
The environment will not only stimulate the clients in learning but will help to cope up with the
strategies that are given on them. The promotional program that is developed is not only going to
be helpful for the patients but also for the care givers. These programs must be scanned and
shielded with cultural safety. The nurses must be well aware of the cultures of the group of
people on which the program will be launched. Such a program can then attract the people.
While programs are made it must also be effective to help the care givers who face stress and
problems in handling the patients.

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