What Are the Roles of Nurses in Dementia Patients?

 The majority of the UK's 850,000 dementia patients live at home with their families, and because of the challenges associated with dementia, nurses frequently react to requests for assistance and guidance from family caregivers. At the same time, nurses in all settings are frequently called upon to manage patients' co-existing health issues and provide personal care.

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Although the majority of people with dementia live independently or with minimal assistance, approximately one-third live in care homes. While nurse education places a high value on the attitudes and skills required for best practice, this has not always been reflected in the care provided on the ground. For nurses working in any context, this series seeks to offer an up-to-date resource on dementia and dementia care.

Relationships, knowledge base, and medication concordance

There are currently no therapies for dementia, however, four drugs have been approved in the UK to halt its progression. It is a part of the nurse's job to clearly explain drugs to patients and family members, including any potential adverse effects. This encourages informed consent since it helps with decision-making.

Nurses should also know where to get further information and how to refer them to additional resources. Since not everyone has access to the internet, they should also be familiar with local organizations.

Understanding how drugs operate is highly beneficial, especially when responding to queries from patients or family members. Acetylcholine, a neurotransmitter essential for cognitive function, is protected from degradation by cholinesterase inhibitors, which are used to treat dementia. Memantine, on the other hand, works by preventing the production of toxic quantities of glutamate, which destroy brain cells.

Because of their poor short-term memory, people with dementia sometimes have difficulty taking medications, which means they may forget to take them or have already taken them and accidentally take an additional amount. Inquiring about a patient's pills can help nurses determine whether they are taking them correctly; if they are, it is preferable not to meddle because they have a routine that works for them. It may be helpful to inquire about how they are managing their medications and that they try a dosing system, such as a blister pack provided by their local pharmacy, an assistive technology device, or the assistance of a family member, if there are too many or too few tablets remaining in the packet compared to prescription dates.

Physical well-being

Nurses can help persons with dementia by providing appropriate care planning and coordination with secondary care colleagues, or by counseling and supporting family caregivers in community settings.

Get enough fluids and nutrients.

Get some workout;

Use the restroom as usual (this will also help to ensure medication is metabolized effectively).

Nurses may assist individuals with dementia to participate in discussions and maximize their orientation and personal choice by performing modest steps such as ensuring persons with dementia bring personal items such as hearing aids and spectacles into the hospital or to appointments.

Physical and mental well-being are inextricably intertwined, and any effort to help one will have an impact on the other. For example, pain in persons with dementia is frequently under-recognized and under-treated, and it can lead to depression, making it more difficult for them to contribute to their care. Sometimes pain causes behavior that nurses find difficult to manage, such as yelling or punching out. Inability to convey pain verbally may result in behavior such as bodily protection, roaming, grimacing, or moaning.

If discomfort is detected, it is good to examine the reason with a member of the medical team; whether analgesia is recommended, patients should be examined regularly to see if they get calmer. Toothache can frequently cause aversion to eating, necessitating a visit to the dentist. The Pain Assessment in Advanced Dementia Scale assesses pain levels using nonverbal signs and might be beneficial for people who have speech issues.

Communication and caring abilities

The therapeutic relationship between the nurse and the patient is essential for providing high-quality nursing care. Warm communication, admiration for patients' individuality, and recognition of their abilities can help them feel included and appreciated. Simple changes that can help enhance communication with those who have short-term memory problems include:

• Using brief phrases

• Familiar terminology

• A kind tone

• Smiling when conversing

Allow time for them to react and listen carefully, responding to the emotion communicated if the content of the speech is unclear. Avoiding inquiries, especially if the patient is unlikely to know the answer, is preferable; instead, comments can enhance participation while not being overly demanding.

Environmental modifications

Hospital facilities are often loud and fast-paced, making it difficult for persons with dementia to cope. However, the environment itself may be utilized to give practical clues; for example, if toilets are plainly labeled, patients are more likely to remain continent. Changing the atmosphere, whether in the hospital or at home, can result in a more dementia-friendly setting. This includes the following:

• Slowing and quieting the pace of life, for example, via care planning, pausing to speak with patients, and avoiding hurrying while closing;

• Providing an abundance of light;

• Using soft furniture and subdued colors to ensure the design promotes safety and comfort;

• Orienting patients through clear signage for restrooms, bedrooms, and kitchen facilities.

• The use of contrasting colors to mark door frames and different regions can also enable patients to move around a unit or home without risk. 

• Similarly, placing personal belongings like photos by the bed and utilizing name signs on bedroom doors would assist children in identifying their place. 

• Assistive technology can help reduce unnecessary nighttime disturbances; for example, enuresis detectors and automated lighting allow staff to respond when needed while allowing patients and family caregivers to sleep.

Personal hygiene

Most individuals would rather not be exposed in front of a stranger, yet people with dementia are required to do so while receiving personal care. This can be made simpler if nurses employ a loving, soothing approach and cover the patient's whole body. It is also critical that staff members are assigned regularly so that they become acquainted with patients and develop an understanding of their personal care preferences, such as if they want their hair to be brushed in a particular way or have favorite attire.

Conclusion

Working with dementia patients is both demanding and rewarding. As the population ages, nurses will be required to provide excellent person-centered care in a variety of specialty domains for patients with dementia. Because of the aging population, dementia care skills have become essential. However, caring for patients with dementia demands patience, empathy, sensitivity, and devotion; as a result, nurses must care for themselves and one another via peer support and mentorship, and provide this assistance to multidisciplinary colleagues.

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