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Elisabeth Serrano
Dementia
Definition: Dementia is a syndrome (a group of related symptoms) that is associated with an ongoing decline of the brain and its abilities. These include: memory thinking language understanding judgement People with dementia may also become apathetic, have problems controlling their emotions or behaving appropriately in social situations. Aspects of their personality may change or they may see or hear things that other people do not, or have false beliefs. Most cases of dementia are caused by damage to the structure of the brain. People with dementia usually need help from friends or relatives, including help in making decisions.
Definition taken from NHS, available at: http://www.nhs.uk/Conditions/Dementia/Pages/Introduction.aspx
Types of dementia
1. 2. 3. 4. Alzheimers Disease Vascular Dementia Lewy Body Dementia Other rarer causes of Dementia
Alzheimers Disease
Most common cause of dementia Symptoms: gradual decline in thinking abilities. Nearly all brain functions (memory, movement, language, judgement, behaviour, and abstract thinking) are eventually affected.
Alzheimers Disease
As the disease progresses patients are more limited in their daily activities. Emotions and behaviour are also affected. Patients may become disorientated, suffer delusions. During the later stages patients lose the ability to control motor functions (swallowing, bowel and bladder control)
Elisabeth Serrano Prieto
Alzheimers Disease
On average, patients with Alzheimer's disease live for 8 to 10 years after they are diagnosed. However, some people live as long as 20 years. Patients with Alzheimer's disease often die of aspiration pneumonia because they lose the ability to swallow late in the course of the disease.
Ethical Issues
1. Driving 2. Competence or capacity 3. Valid consent
2. Competence/Capacity
General criteria for competence: A person should be able to: Understand information relevant to the required decision Use the information rationally, e.g. make a risk/benefit comparison Appreciate the situation and its consequences Communicate choices
In legal and medical jargon the terms are different but mean the same: COMPETENCE (MEDS), CAPACITY (LAWYERS).
3. Valid consent
Health and social care professionals should always seek valid consent from people with dementia. This should entail informing the person of options, and checking that he or she understands, that there is no coercion and that he or she continues to consent over time. If the person lacks the capacity to make a decision, the provisions of the Mental Capacity Act 2005 must be followed.
Elisabeth Serrano Prieto
The ethics of consent in delirium studies Journal of Psycvhosomatic Elisabeth Serrano Prieto Reseach 65 (2008) 283-287
COMMUNICATION
NICE Guidelines
http://www.gmc-uk.org/guidance/index.asp
Consent:
http://www.gmc-uk.org/static/documents/content/Consent_0510.pdf
NICE GUIDELINES
Patients who show a Mild Cognitive Impairment, should be assessed as soon as possible, as most patients who show MCI, have a 50% chance of later developing dementia.
VERA Framework
VERA FRAMEWORK
Published as an article to offer guidance for student nurses communicating with patients with dementia. The framework is based on 4 key concepts: validation, emotion, reassurance, activity. Framework was developed in response to students who said they find it useful to have structured guidance on how to interact with people who have dementia. The VERA framework offers a means of interpreting communication and responding appropriately.
Elisabeth Serrano Prieto
Validation
A genuine acceptance of the client at face value and includes an empathic search for justification of the clients experience. Validation therapy does not attempt to impose a current reality in
terms of dates or times; rather, the therapist explores the underlying meaning of the clients
behaviour and speech. This approach offers helpful communication techniques and can assist practitioners to develop an understanding of what may appear to be confused and inappropriate behaviour. Validation therefore is the act of giving value to a persons behaviour rather than assuming it is merely a symptom of a degenerative brain condition. It challenges the notion that actions with no apparent meaning or significance should be ignored or responded to behaviourally. Acceptance of the person, regardless of behaviour, is central to the development
Emotion
This step in the vera scheme develops the idea of paying attention to the emotional content of the communication, rather than the unintelligible verbal content. Paying attention to the emotional content underlying an attempt to communicate ensures that meaning is extracted from communication that is difficult to understand. Experienced and skilled practitioners are able to respond and make a connection with people who are confused, even when the words the person uses to express him or herself are unintelligible or out of context. This is achieved by listening for and acknowledging the emotional content of the communication and finding a matching emotional response to it. To develop an understanding of a persons emotional communication health carers need to be skilled listeners and observers, and pay attention to body language, vocal tone and facial expression all of which communicate a message about a persons emotional state at the moment. This has to be accompanied by a GENUINELY felt verbal sentiment, genuine interest in the person and a belief in ones ability to make a connection with the patient. By trying to reach an understanding of how a patient perceives the world, healthcare professionals avoid the CONFLICT that could be caused by insisting that their view is one that must be accepted.
Elisabeth Serrano Prieto
Reassurance
Reassurance is any verbal or non-verbal communication that seeks to reduce a persons distress by demonstrating kindness and optimism. Reassurance can be conveyed by saying it will be ok, or through a kind smile or a moment of hand holding. (Teasdale 1989).
Humanistic traits, skills and attributes, and what the patient is being
told create an experience of TRUST between the patient and the health professional. Reassuring interactions have been coupled with
an assertion of optimism.
Reassurance implies action.
Elisabeth Serrano Prieto
Activity
The activity should be an attempt to engage the person in a more structured activity that offers a degree of occupation. The activity that emerges may link to an understanding of the confused behaviour or could be designed merely to create social interaction with other people as an act of joining with the person as a human being.
Elisabeth Serrano Prieto
After Activity
Recording positive or negative outcomes Discussing the effect of the interaction with other members of the team Moment of reflection on the practitioners responses to the four elements of the VERA framework.
Marge Coalman. The invisible population. The Journal on Active Aging. Issue September 2002 Elisabeth Serrano Prieto
Conclusion
Effective communication is one of the key points for excellent healthcare. Remember VERA! Read Good Medical Practice Guidelines Good luck!