SNPG 955 Dementia Care: Kitwood's Model for Client Assessment

This case study provides a client assessment of an 85-year-old dementia patient named Katherine, utilizing Kitwood's Dialectics of Dementia model. The assessment considers five key elements: personality, biography, health status, neurological impairment, and social psychology. The study explores how these elements contribute to Katherine's dementia process and identifies person-centered care as a suitable intervention. It evaluates the impact of person-centered care on Katherine, focusing on improving her well-being, cognitive function, and self-dependence. The intervention aims to address her depression, anxiety, and feelings of isolation, ultimately enhancing her quality of life and fostering a more optimistic caregiving approach. The case study highlights the importance of valuing Katherine's personhood and prioritizing her health needs to develop an effective treatment plan. The role of the clinical practitioner is also discussed in the context of advocating and integrating patient-centered care.

Assessment of persons with dementia and
their health needs
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Table of Contents
Introduction:.......................................................................................................................2
Taken Case study..........................................................................................................3
Outline of five elements of dementia process and its impact:...........................................3
Understanding a person’s health care needs for a particular one:...................................4
Impact one (1) intervention on an individual with dementia:.............................................6
Impact of the one (1) intervention on a person with dementia:.........................................7
Effects and demonstration of one (1) intervention and example of person-centered care
in practice:..........................................................................................................................8
Demonstration and the inter-relatedness between the impact of the intervention:...........9
Conclusion:......................................................................................................................10
References.......................................................................................................................12
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Introduction:
The assignment explains The Dialectics of Dementia (Kitwood) with a summary of each
of its five elements that contributes to dementia process. To meet the person’s health
care needs, person-centered care the intervention technique developed by Professor
Tom Kitwood has been adopted to carry out the client assessment (Karlsson &
Bleijlevens, 2015). Evaluation of the chosen intervention technique has been carried out
to identify the effectiveness of person-centered care on clients with dementia. Different
techniques have been taken into account in relation to the integration of person-
centered care into practice. The assignment undertakes a case study of a patient with
dementia.
Taken Case study
Katherine is an 85-year-old and has dementia. She has been living in a care home for
about four years and required some support and assistance in carrying out most of her
day-to-day activities such as washing, dressing, eating, drinking, etc. Allen is a clinical
practitioner who is supporting her in having lunch. The nurse asks Katherine to have all
the vegetable that she has not taken. However, Katherine is unwilling to have any more
food while she comments that she does not like vegetables. Despite Allen’s proposal to
help her having the vegetables, as those are good for Katherine’s health, she is not
ready to finish the food.
Outline of five elements of dementia process and its impact:
According to the dialectics of dementia (Kitwood), dementia is considered as a very
complex equation that depends on five elements like the personality, biography, health
status, neurological impairment and the social psychology (McCabe & You, 2016).
Personality factor in dementia indicates the coping style or defense against anxiety,
which the nurse discovers is a direct refusal (Kelley & McGarry, 2015). Allen, who is the
medical practitioner for Katherine asks her to take vegetables, but she directly says that
she does not like vegetables. The second element of dementia is a biography, which
speaks about the vicissitudes of later life. Her sudden dementia along with her
separation from the family is aggravating the reaction of dementia.
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The third element is the health status, which is quite poor due to her age and also due
to her medical condition of dementia that involves the decrease of her acuity of the
senses (Toms & Quinn, 2015). So, her disliking vegetables might be triggered by her
negative response towards taste as her disease might not make her response to her
taste buds. She is there for four years in the care home, which indicates an acute stage
of dementia on the basis of which it can be said that it becomes very difficult to
understand the food that is good to her health.
The social psychology is also an important parameter for the client assessment.
Katherine has been living in the care home for four years, and she needs assistance to
do her work regularly (Mozley, 2017). The care provider has been trying to win her
opinion about helping her feed aswell as finish all the vegetables. Although vegetable
intake has a significant positive impact on Katherine’s health outcomes, encouraging
her to forcefully finish that vegetable may have a detrimental impact on her
psychological aspects. Naturally, the separation from her family members coupled with
a long time at the care home makes her a lot homesick. In the same way, Katherine
cannot perform her regular activities and needs support for everything, which makes her
more depressed because her chances of going home are decreasing day-by-day.
Under such circumstances, not wishing to eat vegetables for good health is quite
normal, and her depression and anxiety over her life is prominent.
All the five elements, personality, biography, neurological impairment, health status and
social psychology are found to contribute to the dementia process of Katherine. Based
on the evaluation of Kitwood, the role of dialectic interplay that explains socio-logical
factors along with the neurological system that influences mental health functioning of a
person (Neville & Beattie, 2015). Therefore, in the context of the give case study,
separation of Katherine from her family and patient in the acute stage of dementia have
been leading the care users deprived of personhood (Love & Pinkowitz, 2013). Being
deprived of her personhood, Katherine's health care issues are not met efficiently, nor
are her health needs not prioritized to develop the treatment plan. Kitwood has argued
that an understanding of dementia must be less deterministic and more comprehensive.
With more comprehensive and less deterministic approach Katherine is likely to have
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more optimistic and personal view of caregiving. Her personhood has not been
encouraged or valued while providing cantered patient care and all the five elements
have led to the progression of dementia in Katherine.
Understanding a person’s health care needs for a particular
one:
The client assessment of Katherine indicates that she needs person-centered care as
an intervention for development of her health. Otherwise, normal treatment with the help
of medications will make her more depressed and anxious about her future. The
person-centered care would concentrate on her depression and anxiety, and tolerate
her issues to a great extent. For example, in a person-centered treatment, Katherine
would be explained very politely that the vegetables are good for her health, and the
doctor Allen wanted her to have more vegetables for the overall improvement. Her self-
dependence would also be fostered by the person-centered development.
According to the dialectics of dementia (Kitwood), her social psychology makes her
depressed because she is losing chances of returning to her family (Nyman &
Szymczynska, 2016). Most of the time, she is within the care home dependent on
others, and she understands that her dependence on other people is completely related
to her increase of anxiety of not returning to her family. So, the person-centered care
would help her in understanding that her eating of vegetables would help in her
recovery, which is very essential for her release from the care home. Most importantly,
her cognitive development would be done by making her play some card games.
The client assessment also makes it clear that her taste buds are not proper due to her
neurological impairment, which is making her feel that the vegetables are tasteless.
Person-Centred care can impact the patient by disclosing about her neurological
impairment, which is making her lose the taste of vegetables. However, she should also
be convinced with a politeness that it is important for her recovery. A slow increase in
the consumption of a healthy diet along with the medications and the cognitive games
would help her improve dementia, which will give her confidence of recovery, and get in
touch with her family members.
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From the client assessment, it is understood that she cannot perform her regular
activities like dressing, eating, washing and drinking without the help of someone else.
So, the care worker in person-centred care would understand her problem, and try to
help her as much as possible. In addition to that, her self-dependence should also be
stressed upon like letting her work as much as she can. Open communication with her
related to her improvement in regular activities by providing minimum support would
increase her confidence, and help her in recovering from dementia.
Impact one intervention on an individual with dementia:
Holistic dementia care is most often referred to person-centred care, which is
dependent on a number of sources comprised of social psychology professor Tom
Kitwood (Wilber & Mosqueda, 2016). Person-centred care has emerged against the
traditional culture of care and treatment practice (Kitson, et al., 2013). Person-centred
care proposed by Tom Kitwood is focused on persons’ independence, value-driven and
care users empowerment of families and individuals with dementia in contrast with the
old care culture that used to consider dementia as a biomedical phenomenon,
depending on control technique by including physical and chemical restrains,
administering unnecessary medications and devalues individuals with dementia
(Terada, et al., 2013).
The persons are helped to feel supported, valued and socially confident with the
integration of person-centred care. In relation to the chosen case study of Katherine
who is with dementia. Person-centred care is adapted to provide care to Katherine in
the care home. In the given case study, responsible nurse of the health care settings
values the care users choice by complying with the principles of personhood those are
individual’s life experiences, different personality types, and relationships while
providing care. According to Kitwood, personhood is a status that is bestowed upon an
individual by others to develop recognition, trust, and respect (Kogan, et al., 2016).
Good dementia care has been proposed to develop to maintain personhood against the
diminishing mental abilities.
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In the given case scenario of Katherine, clinical practitioner integrates personhood in
the care provision process and offers to encourage patient to increase daily vegetable
intake. Encouraging patients positively to undertake activities that have a positive
impact on their health outcomes are known as advocating. Allen has adopted advocated
practice in the given case study. On the other hand, dementia care that treats patients
as a passive object, treatment does not meet care users personhood and concentrates
only on the illness is detrimental to the patient (Lines, et al., 2015). Person-centered
care has developed the ethic that every user is of absolute value and needs to be
respected where no consideration must be taken into account of their disability.
Person-centred care has been developed to focus on what persons with dementia need
and Kitwood (1997) found that love is at the center of five different components,
attachment, comfort, inclusion, identity, and occupation (Li & Porock, 2014). Kitwood
has suggested that the focus should be on the person who is receiving care and in the
case study Katherine is the care receiver. Healthcare staffs as per the person-centered
model of Kitwood are an essential part of maintaining self in people with dementia.
Personhood is based on others learning about self, find ways to maintain self and
recognising that selfhood exists (Maslow, 2013;). In the case, study selfhood is
maintained through interaction and conversations carried out by the clinical practitioner
where she has integrated that are the fundamental components of patient-cantered
care.
Impact of the one intervention on a person with dementia:
The nurse is trying to encourage Katherine in increasing her daily food intake and thus
advocated practice is evident from the given case scenario where no signs of abuse or
negative intentions of the clinical practitioner are evident from the given case scenario.
The nurse is implementing advocated practice in encouraging Katherine to finish all her
vegetables that are good for her health. Person-centred care has been acknowledged
as very effective intervention process that leads to minimize challenging behavior in
people with dementia (Love & Pinkowitz, 2013). However, no challenging behaviour is
demonstrated in the given case study, but they client is not willing to have her food even
when the nurse is offering her to help to finish with those. (Barbosa, et al., 2015) Have
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pointed that person-centred approach comprised of social activities, past activities and
pleasures have strong relation with improved quality of life in individuals with dementia.
When Care centered approach is implemented in health care settings to treat people
with dementia, it develops a positive relationship between caregivers and the patients,
and consequently leads to minimisethe level of psychological well-being, depression
and productive behaviours among the care users (Lines, et al., 2015).
Person-centered care is used to handle in reducing levels of agitation and sleep
patterns in people with dementia with the selection of person-centered care approach.
According to (Kitson, et al., 2013) patient-cantered approach allows the opportunity for
self-expression which enables people with dementia improve their self-esteem while
reducing their anger, anxiety, depression, and grief.
Although different studies have identified a number of positive effects of person-centred
care on health outcomes of the patients, the approach can also have a detrimental
impact when not implemented accurately and efficiently by the clinical practitioner.
Katherine is a trained staff member who has been trying to encourage her by adopting
patient-cantered care approach. However, the conversation that occurs between
Kathrine and Allen, the nurse of the health care settings demonstrates malignant social
psychology, number of times that affects David’s personhood adversely.
Disempowerment can be witnessed from the case scenario as Katherine is able to eat
and drink without any assistance. However, the scenario demonstrates Allen proposing
her to help to finish her lunch. Ignorance is pointed out from the case as Allen did not
acknowledge or accept the feelings of Katherine’s disliking of vegetables. Allen treated
Katherine like a child thus Infantilisation is evident from the case when the clinical
practitioner asks her to open mouth an offering with the food to finish. Imposition also
has been evident as Allen imposed that Katherine would not finish her vegetables.
Effects and demonstration of one (1) intervention and
example of person-centered care in practice:
With the adoption of patient-centered care, clinical practitioners are required to promote
signs of personhood so that the care users is valued, respected and cared. Patient-
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centered care is based on the ethics that all human beings are opting to be valued and
they are worthy of respect, irrespective of their disability. To implement patient-centered
care in practice, specific strategies to be adopted by the health care professionals are
discussed as below:
Identify the careful choice of Katherine and her family members in the assessment
process so that health needs of the patients with dementia can find out. Assessment of
the clients’ choice of treatment and health needs should be nonjudgmental and focus on
building trust and rapport between the caregiver and the care receiver, Katherine. In this
context, it can be stated that strong relationship and rapport between the clinical
practitioner and Katherine can again contribute to a right assessment of health needs
and the right choice of care that meet the health needs of the care user. However,
health care practitioner’s judgemental attitude may minimize the value and respect that
the care user is likely to receive, irrespective of her disability. In order to provide
adequate care to Katherine, in line with patient-centered care, needs to provide
culturally sensitive service where the nurse will show no pressure or infantilisation
(Mitchell, et al., 2015)when the care users state about her disliking and likings. To have
right care plan and procedure, continuous evaluation of inclusion of care users as well
as her family members in the care planning that ensures care provision is designed as
per the health needs of Katherine. In the given case scenario, Allen was found to
impose on Katherine would not finish her vegetables, however, to ensure effective
patient center care integrated into healthcare practice Katherine’s disliking of vegetables
would have been accepted.
Demonstration and the inter-relatedness between the
impacts of the intervention:
The practitioners in a care home are bound to follow the policies and regulations of NHS
related to the dementia care. According to the Health & Social Care Act (2012), it has
been found that the records of every patient should be maintained coupled with the
cleanliness in the rooms, and building rapport with the patients for reducing inequality
(Quinn & Clare, 2015). So, the care worker should always try to improve the relationship
with Katherine and help in keeping the room where Katherine stays completely neat and
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clean. The voice of Katherine is important for reduction of inequality, and Katherine
must be convinced to have vegetables in a polite manner rather than doing it by force.
According to the Equality Act (2010), no individual in a healthcare unit can be
differentiated on the grounds of sex, religion, ethnicity, class or age (Camic & Baker,
2015). So, Katherine is an old woman with dementia, and she should not be
differentiated from the other patients, and her needs must be addressed in a proper
manner. If possible, Katherine’s favourite food must be asked, and the vegetables
should be given in order to make her taste her favourite food in a small quantity for
convincing her. The carer should always be asked to put forward their own opinions
about improving the patients’ lifestyle because they are observing the patients very
closely.
According to the Social Value Act (2012), the person-centred care must be given to all
the persons suffering from dementia at the care home (Shidhaye & Lund, 2015). The
regulation also states that the healthcare center should allow the constant visits from
the NHS department for checking of whether the levels of care are proper or not. So,
the levels of care must be maintained to an excellent level for getting good quality of
health care. The integrated care must be achieved for Katherine by taking opinions from
the other healthcare center workers, and by sharing the case study with the medical
board. So, the interrelatedness between the medical practitioners will help in developing
the best caring method for Katherine.
In the same way, the interrelatedness of the care workers helps in understanding similar
case study, and the way such patients are improved in order to develop the integrated
care for helping the patients like Katherine. Similar cases like that of Katherine can be
collected from other hospitals for treating Katherine in a proper way.
Conclusion:
It can be concluded from the current assignment that patient-centered intervention has
a number of effectiveness in improving health outcomes, minimising challenging
behaviour and agitation while regulating sleep patterns through the strong improved
quality of life and social activities. Patient-cantered care is based on the concepts,
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persons’ independence, value-driven and care users empowerment of families and
individuals with dementia that gain lead to strong rapport and relationship between care
user and clinical practitioners. The strong relationship between client and care providers
contribute to right assessment care users health needs, and care plan can be
developed with patients and their family members inclusion so that the pan meet health
needs of patients.
From the overall analysis, it can be said that the person-centred care is the best way for
treating people with dementia. The dialectics of dementia (Kitwood) helps in
understanding how far the five elements help in doing the client assessment, and how
the patient-centred therapy helps in the client recovery in a proper way.
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References
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Appendix: Case Study
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