Critical Review of Dementia Service User’s Experience of Care

Title A 3000 words es recount critically reviewing a service white plaguers journey through their figure of trouble In this essay I will critically evaluate a resident by the recognise of Tom Journey with lunacy. He suffers from Alzheimers mono humankindia and watchs in r kibosher ho use. I will explore issues surrounding edible intake, wandering, intercourse, incontinence and the environment that affect the client, family and module. I will then hear at the assessment process, c are meanning, implementing and valuation.I will explore patient sentry duty, preventive and the processes that managers and professionals brace to undertake when managing individuals with dementedness. These interventions and approaches adopted are vital when planning per male child centred precaution. In addition, due to the policy of confidentiality I would non mention the name of the organisation and psyches involved. The essay will end with a conclusion and a summary. harmonize to M athers and Leanardi (2000), Dementia is a syndrome ca phthisisd by a range of illnesses and currently many a(prenominal) are incurable, and drift progressive, irreversible brain damage.They include Alzheimers infirmity (the well-nigh common cause), vascular disease, frontal lobe dementia and Lewy Body disease. Symptoms of dementia evoke include repositing loss, difficulties with language, judgement, insight and failure to recognise citizenry, disorientation, liking changes, hallucinations, delusions, and the gradual loss of ability to perform all tasks of daily animated(a),( Mathers and Leanardi, 2000). Mace and Rabin (1999) high decipherableed that, the word dementia originated from two Latin words which entertain away and mind. This can indicate a loss of memory inability to function effectively, which can result in mental amazement. motherfucker is a seventy year old man with dementia. He lives in sheltered housing. He has four children two sons and two daughters. He was move from his spot into sheltered accommodation after the death of his wife Mary. His direct deteriorated very apace and he take extra support to live at home safely. The family was unable to adequately provide for dumps call for, so they decided to re-house him. The family brought doodly-squat with them to view the politic onwards he was moved in. This allowed shucks the opportunity to meet the supply and arse about persistent-familiar with the newfound environment. He was brought in by is son and daughter, but his son stayed with him in the guest way for a few days to get him settled and feel comfortable. Jack was showing early markers of dementia as his communication was not clear at measure and often his speech was muddled. Further much(prenominal), his memory was poor at first as he kept asking for his wife repeatedly for examples, where am I, whose house is this, and wherefore am I here. Also his nutrition was an issue as he was not ingest his meal s and often said he was not hungry or he would eat later. He would some periods say take it away and feed the pigeon.Food would turn up in respective(a) places exchangeable bins, in drawers and even in his bed. Mace and Rabins (1999) mentioned that eating alone can contribute to or worsen their confusion. Incontinence was besides a big concern for staff as he was incessantly wet and soiled with can. He would choose places not suitable to use for toileting, removing his protective clothing. He was also hiding dirty soiled vesture in inappropriate places. Moreover, getting his soulal reverence done was a big task as he was not cooperative. Beatie et al, (2005) stated that mountain with dementia do not know that they are not being cooperative with certain basic tasks.This could be related to my client as I incurd these issues on many occasions. All these disciplines acquire been highlighted by (Kitwood, 1997). With regard to incontinence, Parker (2000) supported that becau se of the dying of the brain cells, a somebody resembling Jack will not be able to independently tell the message the brain is conveying about the bowel. This problem was identified with Jack. Jack, as supported by Parker (2000) should be encouraged to use the toilet before and after consuming meals and drinks and should also have a well-ordered swan change.Parker 2000 also cited that when any psyche in a state like that of Jack is constipated or having sluggish bowel movement, they should be stumbleered medication like suppositories and if this does not work they should be supported by contemplation. When traffic with Jack who does not have mental capacity it is burning(prenominal) to observe his actions. When he is in need of toileting he can exhibit the hobby actions which are non verbal such(prenominal) as pulling down or removing pants, or opening his fly. These actions are likely to suggest that he wants to use the toilet.Mace and Rabins (1999) argued that it can be very difficult for practitioners to achieve appropriate assessments when they are dealing with persons who are living in an independent setting. My assessment highlighted many problems such as personal solicitude, poor memory, poor nutrition intake, urinary incontinence, poor communication and wandering about all the time. However, this was more enounce in the evenings. Morris and Morris (2010), Kitwood, (1997) and Algage (2006), have highlighted this problem to be sundown syndrome.According to Leblance (2011) he depict this as onset of confusion that occurs in late afternoon and wickedness time. Algage (2006) get ahead stated that wandering is a way of communicating in a non verbal form by using action to jeer with others. Moreover Beatie et al, (2005) argued that patients with dementia whitethorn not be able to skim signs. For example factors like the environment may cause them to be infelicitous and powerfulness empower them at take chances, (Hodgkinson et al, 2007). about residents like Jack may have limited communication ability to verbalise what they want to do, so they just show action as a way of communicating.For example, the sign posts, symbols and photographic pictures might not appeal to them because of their limited ability to instruction on details, (Hodgkinson et al, 2007). Beatie et al, (2005) and pull someones leg and Wilson (2007) have highlighted that living in a sheltered housing environment can be a lonely experience for many patients and this can make them feel isolated. More so, Beatie et al, (2005) mentioned that these factors might cause a patient to wander because if they feel lonely and anxious for a long period of time. They might want to find something to engage in.A person with dementia might find it difficult to sit down. For example in my observations I feel that Jack was living in a club where he had friends and family to socialise with and moving to a new place was someway upsetting for him. Likewise changes mi ght have ca utilize Jacks more loss of memory and this could be another reason why he failed to adjust to his new surrounding as cited in Mace and Rabins (1999). Moreover, in this sheltered housing there are no facilities like shops and amateurish facilities as it is in a secluded area.Knockers (2000) mentioned about daily living activities that could have been useful to a patient with dementia like Jack. In my opinion, this would have inclined Jack the opportunity to engage with other residents. This would have been a great way of socialising, chatting, enjoyment and given him a think in life and most of all engaging his time and regress him from wondering so frequently. According to Cheston and Bender (1999) and Innes et al, (2000) the DCM (Dementia dread Mapping) is a on the button framework that is important to assess patients with dementia.The DCM (Dementia Care Mapping) is an observational tool which is used in a professional setting. This tool could have been useful to Jack if he was living in suitable housing that meets his postulate (Kitwood 1997, Shels 2007 and Fox and Wilson, 2000), Mace and Rabins (1999) mention that MME (Mini Mental Examination) also know as the mini mental is one of the tools that are used to screen an individuals mental ability at the onset of dementia. This tool is also known as the performance tool that allows five minutes to perform a set of detailed tasks.This entails a maximum score of thirty answers to questions given. Some of the questions are, do you know what day it is, date, month and the time, do you know what boorish you live, and the town. Can you spell the word world backwards, can you write a sentence. Likewise, In Jacks faux pas he was assessed using this tool to get a precise answer to see what he can independently do for himself. In addition, Fox and Wilson (2007) argued that the assessment processes should be compiled into a feedback statement. This nurture should be given at the beginning and end o f the assessment.Chester and Bender (2000) mentioned that feedback should be given in both oral and pen statement. This is necessary for the patient and their family to adjust and come to terms with their illness, and deal with their emotions. According to Carmody and Forester (2003) the main areas of consider planning are assessment, planning, evaluation, implementation and evaluation. Care plans are legal documents which should be reviewed on a regular terra firma for accuracy. Jacks concern plan contains some important information such as his name, date of birth, squall and all information save was signed and dated.Likewise, May et al (2003) mentioned that a care plan should be compiled and put together the persons unavoidably and deeds. Jacks care plan was fully supported and some of the information included was his life history, lifestyle, health, personality, and preferences, point and future wishes. Jacks capacity, cognitive ability and the stages he was at present were documented. Jacks care plan contains three columns. The leftfield column was to record Jacks needs, the middle column gives precise information for cares to comply with, whilst the right column is to record information, sign, date and reviews (May et al, 2003).May et al, (2003) pro comprise that the enriched care planning was developed from the enriched model of dementia by (Kitwood, 1997). Jack care plan consists of five core areas which are reviewing, profiling, implementation, identifying needs and documenting needs. Jack care plan was fully supported by the carers. In Jacks crusade his care plan was reviewed with the social worker, general practitioner, occupational therapist, dietician, warden, care manager and family and myself who is his key worker. This set out clear instructions for staff on how to personalise care for Jack.This includes, monitoring and assessing changes in his toileting, nutritional intake, communication, health and wandering. Four main calls were put in place for his main meals and regular checks to stop him from feeling lonely. Jack care plan was reviewed and implementation of safety devices was put in action to keep Jack safe. This involves the implementing of stunning aid and equipment that will help to keep him safe at all times and especially during the nights. This included a bed sensor and door activator that goes off when he gets out of bed and when he leaves his flat.This equipment was most useful during the nights. meditative lighting was also put into place. It would come on at a certain time in the evening. The door bell flashing light let him know when someone was entering his flat. Picture coding garble was put on his fridge door and bedroom door to instigate him where to go and what to do. Jacks family were in complete denial about his condition and they would often get very upset with him. They thought that their dad was exhausting to get back at them for moving him. One daughter was ever fussing over him and telling him off.This do it quite difficult for staff and anxiety to get the assessment process started. The other barrier was the staff members that were not able to support Jacks family appropriately, as they were not apt adequately in dementia care. Jacks condition deteriorated rapidly and staff was finding it quite difficult to cope with his demanding and stressful behaviour. Jack was given tablets to keep him calm, however, this medication in my observation was too quick for him and often he would sleep for long periods of time.Staff would have to wake him up for meals and before he finished his meals he would be fast asleep. In work places which are independent based, these facilities are not designed to conciliate slew with certain forms of dementia and for this reason it took a long-lived time for Jacks needs to be reassessed. Jacks needs were finally met and then he was admitted to a dementia unit where he was housed, (Carmody and Foster, 2003, Jacques and Jac kson, 2000). These factors can become a barrier for professional when implementing care for muckle living with dementia, (Jacques and Jackson, 2000).In Jacks case he could have benefitted from the evaluation tool to stimulate communication amongst staff and himself. This would have prompted his alerting and encouraged communication at meal times as discovered by Shiels (2007). With reference to evaluation this process is necessary to get a direct result of Jacks illness. This will establish how utmost his condition has deteriorated and the extent of his impairment and surgery. Moreover, this will identify other health problems, so that the necessary treatment and planning can be put in place to channelize his needs, (Mace and Rabin 1999).Jack had to undertake this evaluation and many political campaigns such as CBC (Complete blood count) which includes a blood chemistry test, checking the liver-colored and kidney for signs of diabetes, vitamin B12 and thyroid level . The VDRL check for syphilis and LP (lumbar puncture) investigates the central nervous system. atomic number 63 (electroencephagram) measures the brain activities. CT scans, MRI scans, PET scans, SPECT scans which are all important tests can identify the presence of a stroke. Jack was also given a neuropsychological test or the cortical test where they test his memory for writing and reasoning ability, and coordination (Mace and Rabin 1999).A psychiatric and psychosocial evaluation was also conducted by way of interviews with Jacks family and his friend. This was vital to planning and development of care and this was also supported by a family evaluation to assess and to address their emotional, financial and physical needs, (Carmody and Forster 2003). Jacks condition has deteriorated even further and he has started leaving the set forth through the back door. There is sensory equipment which is now in place in order to monitor his movements.Jack sometimes presses the button and it raises an alarm with the central control office. The control room staff will then contact the staff on duty to go and attend to Jack and see whether there is anything he needs. In most cases when the staff gets there, Jack will be assay to leave the premises not properly dressed. Examples being dressed in his pyjamas and bed room slippers, wearing a vest without his shirt or wearing his trouser inside out. When the staff try to get Jack to return to his flat he becomes very aggressive, shouting and hitting the staff and refusing to go back.The constabulary on many occasions are called to search for him. AGASE (2006) indicated that wandering is associated with risk factors of getting lost and falls. As highlighted by Hodgkinson et al ( 2007) gridlines placed on front door exits, door handles, panic button bars might be an effective way to addresses Jacks wandering and curtail the risk of escaping. Carmody and Forster (2003) suggest that a person like Jack can benefit from ADL (Activities o f Daily Living) as this will help test his functioning abilities and performance.With regards to communication and Jacks outburst Phillips and Penhale (1996) argued that some people with dementia like Jack might have poor memory, limited communication ability with others. Jack is unaware of his aggression towards staff. This is not done advisedly as his brain cells are dying. Jack is unaware that he is create harm to any one as he is simply trying to communicate. Jack will be trying to say why are these people stopping or preventing me from going to see my friends. In my observation Jack was finding it difficult to say the right word, as he was not able to understand what is being said to him.Carmody and Forster (2003) Fox and Wilson (2000) highlighted that the person who is undertaking a communication assessment needs to be a good listener and a competently trained professional. This person needs to have experiences of in dealing with different cases of dementia and know the diff erences between the different types. Fox and Wilson (2000) mentioned that a person with counseling skills might be able to address the needs of a person with dementia more efficiently. In my opinion, these skills are important when working with customers with dementia.In Jacks case this would have been more beneficial if staff dealing with him had appropriate counselling skills. They would have been in a position to understand how to communicate with Jack as to achieve effective results. In the long run Jack was finding it more difficult to cope with every day activities. He had suffered a relapse and his condition deteriorated very rapidly and he needed more specialist care. He was not coping well and his health and safety was at risk. Jack needs were reassessed and he was no longer capable to live independently any more.Management and social worker were in the process of getting him relocated when he suffered a fall. He was taken to hospital and then he was moved into a resident ial home that cares for people with dementia. In conclusion, the presidential term acknowledges dementia as a developing problem and has put strategies in place to care for people with dementia. To address Jacks needs appropriately his care should be person centred. Jack was moved to a new home and this might have contributed to his wandering. His new setting was secluded and he had no friends to communicate or socialise with.This factor could have led to further confusion and made him feel lonely and even depressed. Although Jack was fully supported by the planning, assessment, implementing and evaluation process, his needs were slow to be addressed by the family and this posed as a barrier to Jack getting the care he required. However, the assessment procedure and progress for independent living have to be organised by many professionals. It appears in Jacks case it was not recognised and dealt with appropriately at times. For example, the process to get a person assessed for de mentia in independent housing took a long time.There were other issues and barriers that Jack faced on his journey, even though the government had put these strategies in place to address the needs of people with dementia. In order to address Jacks needs and that of other people with dementia the professionals need to adapt a person centred approach. Staff needs to be competently trained in dementia care so that they can support family and friends when a person is diagnosed with dementia. Reference Algase,D. L. (2006) Whats new about wandering? An assessment of recent studies 226 -234 Available at www. reo. beds. ac. uk. (Accessed 3/10/ 2011). Beatie,E. R. A. Song, J. And LaGore, S. 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