Experiences of Tom and His Family Due to Hospitalisation

Discuss about the Proposal for Practice And Care Improvement.

Person-centred care allows the caregivers to build a psychological and emotional bonding with the patient and his or her family members. Like any other physiological and psychological issue it is also very helpful for dementia. The operational result of person-centred care for treatment and assessment procedure of Dementia is noticeably effective (Eggenberger, Heimerl & Bennett, 2013). This paper is focused on needs and application of person-centred care for a patient named Thomas. The focus of this paper is to identify the correct utilisation of PCC of Tom and to prepare a proposal for caring improvement for him during his time in the hospital.

Initially, the experiences of Tom and his family members due to his hospitalisation have been analysed. Then, the appropriate practices for person-centred care for Tom have been identified with potential effectiveness. The appropriate implementation policies for caregivers have been identified and evaluated. Tom has various psychological and physical symptoms of agitation, restlessness and aggressiveness. Therefore, various assessment methods have been critically examined, which are very effective to measure his physical and psychological functionality accurately.  Finally, his nursing needs also have been identified with proper guidance for caregivers including the requirements of physiotherapy and medication.   

Dementia has a strong impact on the psychological and emotional condition of the patient. When a person is diagnosed with dementia his or her family members and close relatives are also affected emotionally after hearing the news. Additionally, hospitalisation of the patient expands this psychological and emotional disturbance to the next level (Beard, 2012).

Tom’s experiences of admission to hospital:  

Tom is a 75 years old person possessing both Angina and dementia. He lived with his wife and had intense passion for woodworking. On the other hand, he has never been admitted to a hospital even after being diagnosed with Angina. Therefore, for Tom hospitalisation caused several psychological and emotional agitations. Like most of the other patients with dementia Toms also felt an extremely depressed having a negative picture of the future. In most of the cases, patients think that their life will not be same forever (Brownie & Nancarrow, 2013). These are the pre-hospitalisation psychological impact on Tom.

After admitting to the hospital Tom has been disconnected from his social activities and creative hobbies. The usual social and cultural state of Tom’s lifestyle has been hindered significantly that caused the resultant restlessness and usability of his mind. People with dementia often go through a hard time to adjust to new environment and persons in the hospital (Borson et al., 2013). On the other hand, the separation form his wife with whom he used to spend his entire day is causing additional discomfort, mental insecurity and anger. These dilemmas can switch other associated problems like mood swing, anxiety,   panic attack, depression and other that is causing his restlessness, agitation, and tendency to lash out.

The Five Factors of PCC for Dementia Patients

Experiences of Tom’s family due to hospitalisation: 

Tom has two sons, two daughters and four grandchildren who used to visit his house frequently. Tom’s hospitalisation also has a significant impact on his wife, his children and grandchildren. Usually, adult hospitalisations, especially in case of dementia the people who are closely connected with the patient often suffer from emotional disturbance and wariness (Verbeek et al., 2012). In case of Thomas, his wife can suffer from restless emotional state especially after hearing the agitated condition of her husband in the hospital. Tom’s sons and daughter are also feeling insecure because of the potential risk that can make the situation worst. Apart from that, his wife and children are also waring because of being unknown about the existing situation of Tom and the current approaches that have been taken by the hospital staffs.

The person Centred Care (PCC) is a healthcare approach where the health care facilities and services are provided by involving the patient and the family in any decision making process with proper respect and responsive nature. In PCC patient’s and his or her family’s needs, values and preferences are prioritised during the treatment procedure and rehabilitation. In order to provide PCC for a dementia process, the caregiving organisation has to take care of 5 factors of the patient namely, Personality, Biography, Health, Neurological impairment and Social psychology (Robinson et al., 2013). These five factors of each patient are unique. At the same time, the psychological attachment of the patient with the PCC approach differ according to their social and personal identity; a sense of self concerning the responsibilities; personality; relationships; memory and reasoning capabilities.

For Thomas, the PCC approach should be well organised by prioritising his social activities, passion with wood-crafting, the interaction with his wife and others. Apart from that, his wife and children should also be involved in any decision making process remerging his treatment procedures. These attachments and emotional interactions can retain his sense of belongings and sense of security (Knapp, Iemmi & Romeo, 2013). Despite that interaction between his family members and the caregivers can also build up his faith on the caregivers. The verbal and non-verbal cognitive, emotional, social and psychological interchange among the caregivers, Thomas and his family members also help the treatment policies to be more accurate and effective. At the same time, his family members can rely on the treatment process with ease.

Prioritizing PCC for Tom

Thomas also has Angina which needs regular medication and care. The type of care required for Angina also differs from patient to patient regarding their pathophysiological history (Chenoweth et al., 2012). PCC will allow the healthcare organisation to communicate with the patient as well as his family about his current and previous problems regarding Angina. In case of any other potential occurrence physical or psychological problem the healthy relationship among Tom, his family members and the caregivers can help the healthcare process to handle the situation easily. 

Communication process of the caregivers has a huge impact on the overall psychological and emotional condition of the patient. Being a patient with dementia Tom also needs some essential communication approaches and practices from his caregivers that can make the whole treatment and assessment procedure more efficient and effective. People with dementia frequently go through a traumatised stage with high agitation, anxiety and panics that make the patient more aggressive and restless (Moyle et al., 2012). As per the case of tom he is also showing some BPSD or Behavioural and Psychological Symptoms of Dementia. In this case, Tom’s care gives should treat him with more patience. The gentle, calm and trustworthy gesture of the caregivers can handle the situation by wasting very less amount of time and energy. In some cases, patients also suffer from hallucinations and delusions. Although Tom does not have any of these symptoms, lack of relaxing environment can deteriorate the whole situation.     

One of the steady and continuous psychological states of any patients with dementia is depression. After being diagnosed with dementia and sudden hospitalisation Tom has experienced a significant mental shock and hopelessness. This mental condition initiates a continuous depressive mood that also related the state of anxiety to some extent. Appropriate verbal and non-verbal communication and encouragement usually help to handle this type of situation (Tolson, Smith & Knight, 2012). The caregivers of Tom should maintain stable and calm eye contact with a peaceful smile during communicating with him. For any patients with very advanced dementia, non-verbal communication can be the only solution to communicate. The care givers should maintain a polite attitude while listening to the problems faced by patients without interrupting.

An optimistic attitude is another effective communication strategy, where the caregivers give mental and emotional support for not letting the patient feel hopeless and pessimistic about the future. Tom’s caregivers should always keep him motivated for his recovery to make him confident about his healthy and happy life in future. Introducing personalised intervention can be very helpful for Tom that includes listening to music, social interaction, increased daytime activities to reduce boredom and other (Edvardsson, Sandman & Borell, 2014). Apart from that, sleep-wake cycle is another important concern in the treatment of dementia.  Making a stable schedule for sleep timing is essential for Tom, where the caregivers can ensure that Tom is able to awake in daylight time. The stable and well scheduled sleep-awake cycle can also reduce Tom’s occasional aggression and loud vocalisation that can be caused by sleep deprivation.  

Communication Strategies for Caregivers

The patients with dementia should go through various diagnoses in order to identify his or her abilities, disabilities, strengths, weakness and potentialities in both physical and psychological state. The medical history of Tom should be examined to understand the possible difficulties that can be caused by being patient with Angina due to the problem coronary artery. Additionally, memory test, problem solving ability, attention, counting test and language test should be conduct along with some medical tests namely blood, urine, spinal fluid and a brain scan (Clissett et al., 2013). For a dementia patient like Tom, the Mini-Mental screening tool would be very helpful. Through these tools, his cognitive functions, orientation, memory, attention and all other psychological functionalities can be measured.

The assessment process can be divided into two parts namely psychological assessment and functional assessment.  As the functionality assessment, the most appropriate assessment tool would be the Barthel Index. In this assessment process, Tom’s physical and functional deficits will be the main focus while being observed for monitoring his independent cognitive approach, independent body movement and mobility. Tom is seventy-five years old man who has a cardiac disease name Angina. Therefore, identification of his physical capabilities and interrelate with his dementia symptoms is crucial (Fossey et al., 2014). From the Barthel index and scoring system, the weakness of Tom in regular activities can be identified. Henceforth, as per the scorecard, the further assessment and development procedure will be followed. Apart from that this assessment tool is also helpful during his treatment process where the caregivers can have the idea about the existing functionalities of Tom and which part needs to be more functional. Various physiotherapies and medication can help Tom to regain his functionality and body movement.

After admission, Tom became very agitated and restless. He is constantly showing loud vocalisation at nursing staffs. This symptom can be caused by severe anxiety and panic attack (Edvardsson & Innes, 2010). Though, sometimes these problems can be the early symptoms of psychotic tendency. Therefore, to gauge the practical condition of Tom’s psychology Cohen-Mansfield Agitation Inventory (CMAI) can be very helpful.  In CMAI assessment program 29 item scales can be used for systematical assessment for Tom’s agitation. The frequency of his emotional outburst can be measured to find his underlying psychological condition (Rokstad et al., 2015). Through this process, the caregivers can measure the frequency of occurrence and amplitude of physical and metal aggressiveness as well as non-aggressiveness and verbally agitated behaviours of Tom. The current and future medical needs of Tom can also be identified through this assessment process.

Assessment Process for Dementia Patients

Conclusion

From the above discussion, it can be said that person-centred care allows the caregivers to build a psychological and emotional bonding with the patient and his or her family members, which can be very helpful for a patient of dementia. This proposal has successfully analysed the needs and application of person-centred care for a patient named Thomas. It is also noticeable that dementia and its associated problems have a strong impact on the psychological and emotional condition of the patient. On the other hand, hospitalisation of Tom expands the psychological and emotional disturbance of both patient and their family members significantly.

In Person Cantered Care Tom’s and his family’s needs, values and preferences are prioritised during the treatment procedure in the hospital. The gentle, calm and trustworthy gesture of the caregivers can handle his situation with ease. Apart from that introducing personalised intervention can be very helpful for Tom. As functional assessment for Tom the most appropriate assessment tool would be the Barthel Index. On the other hand, to gauge the practical condition of Tom’s psychology Cohen-Mansfield Agitation Inventory (CMAI) can be very helpful. Moreover, PCC will allow the healthcare organisation to communicate with the patient as well as his family about his current and previous healthcare problems which can be very beneficial for Tom’s assessment procedures.

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