Policy And Politics In Nursing Care For Dementia Patients

Literature Review

Explain Policy and politics in nursing.

Dementia is a neurodegenerative disease characterized by impairment of cognitive skills. It is known to be caused by various disease conditions affecting several Americans and millions of people worldwide (Beerens et al., 2013). There is no cure for dementia presently. The most common form of dementia includes Alzheimer’s disease which is observed in 80% cases and other includes mixed dementia, Frontotemperal dementia, Parkinson Dementia or Creutzfeldt – Jakob disease. There are several experimental treatments, which are under animal and human trials and seem to be promising. However, a permanent cure or a specific approach to stop the disease progression will requires several more years of research.

Earlier researchers found that there are several issues faced by nurses while taking care of patients with dementia. The major issue is the problematic patient behavior, which not only affects nurses but also families and hospital roommates. Therefore, along with patients, their relatives also require nursing care. Consequently, the problems worsen with the repetition of such problematic behavior and unsuccessful parent’s assistance. 

There are unique challenges presented in therapeutic process by the dementia patients in rehabilitation. It is mostly because of cognitive changes and associated memory loss with the disease (Brooker & Latham, 2015). Therefore, nurses actually have to work with these patients in a burdensome cycle. In addition, lack of nursing experience, inadequate training, and lack of cooperation among health professionals exacerbate this cycle (Beerens et al., 2013). Nurses take effort to adapt to this cycle by taking precautions. Therefore, healthcare must come up with protection plans to implement and decrease liability issues. In this section, the identified nursing issues related to dementia are outlined and policies and politics relating to the subject are discussed.

Patients with these mental disorders have difficulty in complying with the norms of medical treatment and the environment of the hospital. It is due to the unfamiliar atmosphere that patients suffer anxiety. Being surrounded with strangers, receiving painful treatment and physical restrictions gives rise to problematic behaviors. However, they calm down and feel secured when their families and friends spend time with them (Kenner, 2002). During medical treatment, these patients show dangerous conduct, uncontrolled and unhygienic behavior. They find difficult to abstain themselves from food. Nurses alone cannot control this kind of behavior. Therefore, it requires efforts and cooperation from families of the patients as well (George et al., 2013).

Protection Plans to Eliminate Liability Issues

Research by (Newcomer & Harrington, 2001) showed that irrational behavior of such patients relates to their trouble in perceiving circumstances. Nurses take responsibility in such situations but are unsuccessful in preventing such dangerous behavior. As the major problem in US currently is the “shortage of nurses”, it has become difficult and hindered the care provided to the patients without dementia. Even if sufficient nurses were available, due to multiple other demands on their time, they could not provide sufficient care. According to the survey of (Downs & Bowers, 2014) nurses usually find it difficult to extract out cooperation from the relatives of the patients.

Sometimes the problem is that the nurses cannot access informed consent in regards to patient’s treatment and care when they do not have family or if the patient is older. The other issue includes frustration and abusive behavior of parents or family members of dementia patients causing problem in the hospital. The major hindrance to the medical treatment of such patients is the lack of understanding (Prince et al., 2013).

In addition, lack of nursing is the major factor-playing role in adding to the above issues (Cahill et al., 2012). Nurses tend to identify the early signs of problematic behavior as early as they can. It includes observing the regular behavior, any changes in performing daily activities and comprehensive analysis of examination results. Due to difficulty in understanding the symptoms of dementia patients, the detection and prevention of incidents of problematic behavior happens to lag behind (Le Couteur et al., 2013). Nurses tend to seek knowledge from their seniors in terms of handling dementia patients. Other than this, they are left with no option to seek knowledge and advice regarding this disease. Issues could not be settled inspite of attending conferences, discussing critical cases. Sometimes even this discussion was not possible due to the time barrier. Hence, it leaves the nurses all alone to tackle dementia care themselves. Therefore, they deal with it as they occur. It is indicative of the organizational problems including insufficient cooperation among health professionals (nurses, psychiatrists and hospital security staff) and lack of infrastructure (Downs & Bowers, 2014). (Prince et al., 2013) stated that “Because the nurse call button is not connected to a personal walkie-talkie system, it cannot be heard when nurses are administering care to a patient in a room far from the nurses’ station. Doctors’ understanding of patients with dementia is limited. Therefore, even if a nurse asks for a psychiatric consultation, the doctor might say that a consultation is not necessary for that level of dementia and refuse to conduct one.”

Advancements in Technology in Healthcare

Every hospitals must take the protection plans to eliminate the liability issues. According to () patients are admitted who can go somewhere after discharge or have a family to take care. These measures help maintain the nursing positions. (George et al., 2013) believes that the “nurses feel a gap between the ideal situation and the reality of a negative atmosphere”. He says that nurses have extra pressure on their mind especially those working on acute care hospital. Due to lack of time the communication with patients is insufficient which was infact necessary for their cognitive improvement. Thus, doctors blame them when patients fall, even if they take precautions to prevent the same.

Advancement in technology has bought great changes in the healthcare. Studies by (Le Couteur et al., 2013) show that there is a positive impact of consumer interaction and education. Increase in social media, television commercials helped patients in educating about several health issues and consequences. Increased use of technology has become a nursing trend since several years. Presently there is more focus on telemedicine, with more reliance on “portable and mobile technology” (Newcomer et al., 2001). Implementing Electronic health records tool has made easy sharing of patient’s data and improved outcomes. However, it increases the theft of patient’s private data. Recently there is increase in online nursing education to help nurses further their careers without any compromise. In order to become well equipped with latest technology, softwares for using effectively, nurses will highly collaborate with colleagues and others. Hence, collaborative nursing and care (social worlers, dentists, psychiatrists etc.) is expected in near future.

According to (Cahill et al., 2012) UK and US has strong political lead in increasing the diagnosis of dementia and treating more number of patients. (Prince et al., 2013) believes that increasing the rate of diagnosis will generate mass awareness in the community. According to Affordable Care Act, health insurances are now accessible by millions of Americans. Hence, it will address healthcare challenges of patients without insurances earlier. To overcome nurse shortage problem the retirement age for nurses have been increased. It helps in new nurses to be trained from experienced ones. Healthcare is becoming more “facility-focused” and community based nursing is slowly coming back again (Downs & Bowers, 2014).

Conclusion

The study has detailed about dementia, the current issues in nursing in care for dementia and various trends emerging in nursing with an insight into different policies and changes in the health services. A thorough literature search gave a clear concept on this subject and was a thrilling experience.

References

Beerens, H. C., Zwakhalen, S. M., Verbeek, H., Ruwaard, D., & Hamers, J. P. (2013). Factors associated with quality of life of people with dementia in long-term care facilities: a systematic review. International journal of nursing studies, 50(9), 1259-1270.

Brooker, D., & Latham, I. (2015). Person-Centred Dementia Care: Making Services Better with the VIPS Framework. Jessica Kingsley Publishers.

Cahill, S., O’Shea, E., & Pierce, M. (2012). Creating excellence in dementia care: a research review for Ireland’s national dementia strategy.

Downs, M., & Bowers, B. (2014). Excellence in dementia care: research into practice. McGraw-Hill Education (UK).

George, J., Long, S., & Vincent, C. (2013). How can we keep patients with dementia safe in our acute hospitals? A review of challenges and solutions.Journal of the Royal Society of Medicine, 106(9), 355-361.

Innes, A. (2002). The social and political context of formal dementia care provision. Ageing and Society, 22(04), 483-499.

Kenner, A. M. (2002). Securing the Elderly Body: Dementia, Surveillance, and the Politics of” Aging in Place”. Surveillance & Society, 5(3).

Le Couteur, D., Doust, J. A., Creasey, H., & Brayne, C. (2013). Political drive to screen for pre-dementia: not evidence based and ignores the harms of diagnosis. BMJ Online.

Newcomer, R. J., Fox, P. J., & Harrington, C. A. (2001). Health and long-term care for people with Alzheimer’s disease and related dementias: policy research issues. Aging & mental health, 5(S1), 124-137.

Prince, M., Bryce, R., Albanese, E., Wimo, A., Ribeiro, W., & Ferri, C. P. (2013). The global prevalence of dementia: a systematic review and metaanalysis. Alzheimer’s & Dementia, 9(1), 63-75.