Preserving Identity and Planning for Advance Care

Question: Discuss about the Preserving Identity and Planning for Advance Care. Answer: Introduction: Person centred care is recently practiced by large number of healthcare professionals due to the evidences of its success in recent researches. While treating dementia, its effectiveness has been already proved in tailoring a patients care according to their interests, abilities, personality and history. Patient centred care helps such a patient by treating him with dignity and respect. It also helps in visualising a situation from the patients point of view and also involves understanding of the culture, lifestyle, history and personal preferences like their hobbies, interests and others (Swartz et al. 2014). It also helps the patients in engaging in conversation with families and friends. It also ensures that the person can take part in regular activities and try new things (Reuben et al. 2013). This results in maintaining a quality life by the patients even while suffering from dementia. This essay will contain a brief reflection of a conversation with a dementia patient and the o bservation swill be backed up by conclusions from literatures. It will also discuss the person centred approach that would help such patient so that they can have better lives. While communicating with the old patient suffering from dementia and living his life in the community healthcare setting, I realised that more than medical treatment of the patient they need love, care and affection. This is because more than physical complicacy, they suffer from emotional breakdown mainly due to different barriers they face in everyday activities. I noticed that his biggest issue was his short term memory loss that has affected his relationship with not only his family but also with friends. Often he was finding difficulty in finding the right words in expressing himself. I also noticed that he was also having frequent changes of mood, he also had grown apathy in his hobbies of performing arts, practicing his singing skills and others. He had also been apathetic towards his family and friends. While conducting the session, I also observed that he had difficulty in doing regular activities like eating, drinking, going to toilet and others. He was always getting confu sed about what he had to say or do in order to express himself. He was being repetitive in his words and was failing miserably to link his situations. From his words, I understood he was struggling enough to adapt to his new changes. From the entire discussion I came to understand, that such a patient can never be treated with the physician medication- biomedical model of treatment. His treatment should be customised according to his needs so that he can develop the conduction of his life, it can only be achieved by person centred care. Perke et al. ( 2016) had conducted experiments in order to show the effectivity of person centred care in treatment of patients with dementia. He had suggested self empowerment tool to be more effective in reducing unintentional harm than traditional practices in emergency department in hospitals. Self empowerment, advocacy and communication tools act as better support for reducing the communication gaps that traditional treatment have. They have also supported that better information sharing reduced the chances of unintentional harm of the patient. Knowledge about person likes and disliking reduces the potential of unmet need of the patient and prevents functional loss. Researchers like Down and Murna have also conducted various systematic review in 2013 which had helped them to get over the debate about the success rate of person centred care. They have suggested that development of communication skill by the carers is very important. They also paid significance to principles like respect, dignity, learning life story, individualistic activities yield better result. They suggested that often being sensitive to an individuals religious beliefs, spiritual needs and cultural identity helps to provide better result in person centred treatment. Focusing on quality of life of the patient and setting a benchmark for acquiring high quality relationship with patient should be practiced by carers. Stranz and Sorensdotter had conducted an observational and interview studies in 2016 where it was seen that the environment of the nursing care centres are also important for providing the best care for patients. They compared two hospitals where it was seen that different environments proposed different styles of person centred care. One of them paid importance to shrinking world issue of patients and therefore stimulation technique was proposed. In the other, carers tackled agitation and anxiety with calmness and quiet environments. Therefore it urged the necessity of a nat ional policy by the government in person centred approach to dementia care. Doyle and Rubinstein conducted an observational study in a nursing home in 2014 which stated that cultural complicacies mainly acted as a barrier that prevented person centred care to be practices in case of dementia patients. The nursing aids mainly created an environment of us versus them with the patients. This was mainly because the staff members promoted the concept of othering because their focus was based on biomedical aspects of dementia. Besides, functional decline and aggression were other factors. They also viewed the patients behaviours as problems which impaired their nurturing relationships. Thereby scientists recommended engaging the patients and training the nurse in best way possible can help in establishing a person centred approach in treatment of dementia. Wheeler and Jan. in 2010 have conducted researches where they have said that staffs first need to empower patients, spend time with them by interacting with them, and know the residents individually and others. They should engage patients and work as a team with other managers, carers and others so that patient feel included within the environment. They should also understand the importance of family in care plans and keep them inform ed through communication. Desai et al. had conducted a systematic review along with systematic reviews on treating aggression in dementia patient. He had suggested interventions like pet therapy, music therapy, exercise and others beside effective communication and creating proper relationship between patient and caregiver. Various literatures in the above section have thereby had placed person centred care as the most important approach for the treatment of dementia in old patients. They have stated that a proper environment is necessary in dementia care setting or in homes (Kruger et al. 2016). Important principles like effective communication, information gathering, relationship building, maintaining dignity and respect of patients and other will provide fruitful results. Besides, attending the spiritual and emotional needs of the dementia affected people is also very important as they tend to be affected due to the social exclusion that they experience when they get affected by dementia. Different therapies like pet therapy, music therapy and art therapy are also helpful (Hilgeman et al. 2014). Cultural and educational barriers should be overcome by caregivers through proper training and right morals and ethical virtues. Patient centred care assures that aggression gets reduced in dementia which is the most harmful effect for both patients and caregivers (Jennings et al. 2016). It is also found that it is highly important for the government to promote the concept of person centred healthcare among different organisations. To achieve this successfully, a proper national policy should be introduced. This would be helpful to the different healthcare professions as the guidelines will act as consort which they will follow in their practices (Constand et al. 2014). Person centred approach to old people suffering from diseases like dementia have provided best results in treatment success. It has been found that the principles of patent centred care like effective communication, information gathering, relationship building, maintaining dignity and respect of patients and other have been fruitful. A number of barriers like improper education of carer, cultural complicacies and many others often create interruptions in proper caring of patients. However, a caregiver have to overcome the barriers and provide the best evidence based patient centred caring to patients for giving them a better quality life and help them live well. References: Constand, M.K., MacDermid, J.C., Dal Bello-Haas, V. and Law, M., 2014. Scoping review of patient-centered care approaches in healthcare.BMC health services research,14(1), p.271. Desai, A., Wharton, T., Struble, L. and Blazek, M., 2017. Person-Centered Primary Care Strategies for Assessment of and Intervention for Aggressive Behaviors in Dementia.Journal of Gerontological Nursing,43(2), pp.9-17. Downs, M., 2013. Putting people-and compassion-first: the United Kingdom's approach to person-centered care for individuals with dementia.Generations,37(3), pp.53-59. Doyle, P.J. and Rubinstein, R.L., 2014. Person-centered dementia care and the cultural matrix of othering.The Gerontologist,54(6), pp.952-963. Hilgeman, M.M., Allen, R.S., Snow, A.L., Durkin, D.W., DeCoster, J. and Burgio, L., 2014. Preserving Identity and Planning for Advance Care (PIPAC): Preliminary outcomes from a patient-centered intervention for individuals with mild dementia.Aging mental health,18(4), pp.411-424. Jennings, L.A., Hays, R., Wenger, N., Ramirez, K. and Reuben, D.B., 2016. Identifying and Prioritizing Patient-centered Goals for Dementia Care.Journal of the American Geriatrics Society,64, p.S119. Krger, R., Hilker, R., Winkler, C., Lorrain, M., Hahne, M., Redecker, C., Lingor, P. and Jost, W.H., 2016. Advanced stages of PD: interventional therapies and related patient-centered care.Journal of Neural Transmission,123(1), pp.31-43. Parke, B., Hunter, K.F., Schulz, M.E. and Jouanne, L., 2016. Know meA new person-centered approach for dementia-friendly emergency department care.Dementia, p.1471301216675670. Reuben, D.B., Evertson, L.C., Wenger, N.S., Serrano, K., Chodosh, J., Ercoli, L. and Tan, Z.S., 2013. The University of California at Los Angeles Alzheimer's and Dementia Care Program for Comprehensive, Coordinated, Patient?Centered Care: Preliminary Data.Journal of the American Geriatrics Society,61(12), pp.2214-2218. Schwartz, D.B., DiTucci, A., Goldman, B., Gramigna, G.D. and Cummings, B., 2014. Achieving patient-centered care in a case of a patient with advanced dementia.Nutrition in Clinical Practice,29(4), pp.556-558. Stranz, A. and Srensdotter, R., 2016. Interpretations of person-centered dementia care: Same rhetoric, different practices? A comparative study of nursing homes in England and Sweden.Journal of Aging Studies,38, pp.70-80. Wheeler, N.L. and Oyebode, J.R., 2009. Dementia care 1: Person centred approaches help to promote effective communication.Nursing times,106(24), pp.18-21.