Sunday, March 2, 2008

Advanced Dementia Nursing


Not too many years ago, millions of Americans would have been diagnosed with senile dementia, which was considered a normal part of aging, but now it’s recognized as a degenerative, irreversible, and incurable brain disease that progresses over 15 to 20 years, increasing dependence on others for routine care (Schweiger, 1999). Approximately 4 million people currently have Alzheimer’s Disease (AD), and this is expected to triple by 2050. So in total, an estimated 12.1 to 15.5 million Americans have some type of dementia – AD, stroke, Parkinson’s disease, Huntington’s disease, or traumatic brain injury (LoboPrabhu, Molinari, & Lomax, 2006). You may already have been directly or indirectly affected by dementia which takes people away from families in a very emotional and heart-wrenching way. After completing nursing school and successfully becoming a registered nurse, you will be able to help care for the growing number of Alzheimer’s patients by pursuing work in acute medical services, long term care services, nursing homes, or housing services; all of which includes dementia care.


Should there be extra education given to nurses who take care of patients with Alzheimer's Disease? More education for nurses will enable better care for patients with dementia, although it would increase the funds needed for nursing education. This poses a problem as nursing schools have a limited amount of educators, which is primarily due to the seemingly incessant nursing shortage. Coates’ (2002) found that nurses need to have better skills for detection of dementia in the early stages, especially as more patients enter hospitals with AD in addition to other health problems. Nurses with an expertise in AD should be trained to understand nonverbal signals of patient discomfort and pain, issues related to nutrition when patients can’t regulate their intake, and increased confusion, constipation, and dehydration (Coates, 2002).


This brings up the ethical principles of beneficence and nonmaleficence because with the extra education, nurses would be able to increase the quality of patient care, thus benefiting the patient. Nurses would avoid causing harm through increased understand
ing of what dementia is, especially when patients with dementia may not be like other patients as “it is a population who can’t communicate” (Coates, 2002). According to Cook-Deegan (1987), there are a number of concerns identified with services for persons with dementia, such as inadequate staffing, poor staff training, and service designs that emphasize acute medical care and cost efficiency at the expense of humane care, quality of life, and patient dignity. The last concern contradicts the whole point of the nursing profession.

Language and memory affected by AD (Pharma Gazette, 2007)


The most appropriate strategy for management of advanced dementia may be palliative care (Volicer, 2007). The nursing goals of palliative care in nursing homes are to maintain the patient’s quality of life, dignity and comfort (Volicer, 2007). If nurses do not appropriately care for patients with AD, they not only decrease the patient’s dignity, but potentially lose their own as well (Purtilo, 2004). As nurses, we will face the conflict of stopping a patient with dementia “from doing something that appears to be silly” (Purtilo, 2004, p. 201) in nursing homes. Nurses would either say “no” or use some kind of deception to stop the strange behavior when it is a burden to others. This brings in the principles of beneficence, autonomy, and veracity. When there is a risk for the AD patient, should a nurse set limits on the patient’s freedom? The principle of nonmaleficence may outweigh the patient’s autonomy, but is it still morally right to deceive the patient with AD? This is why the UCLA School of Nursing includes an ethics class in their curriculum to enable future nurses to use their knowledge in a similar case.






References
Coates, Karen J. (2002). Understanding Alzheimer’s. Retrieved November 24, 2007, from
http://www.nurseweek.com/news/features/02-05/alzh_web.asp.

Cook-Deegan, R. M. (1987) Losing a million minds: confronting the tragedy of Alzheimer’s disease and other dementias. Washington, DC: Congress of the United States, Office of Technology Assessment.

LoboPrabhu, S.M., & Molinari, V., Lomax, J.W. (2006) Supporting the caregiver in dementia: a guide for health care professionals. Baltimore: Johns Hopkins University Press.

Purtilo, R. B., & Have, H. ten. (2004). Ethical foundations of palliative care for Alzheimer disease. Baltimore: Johns Hopkins University Press.

Schweiger, Joyce L (1999) Alzheimer's Disease. Nursing. Retrieved January 19, 2008 from
http://findarticles.com/p/articles/mi_qa3689/is_199906/ai_n8848508.

Volicer, L. (2007). Goals of care in advanced dementia: quality of life, dignity and comfort. Retrieved November 25, 2007, from
http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=17985063&ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum.