How Lack of Knowledge by Nurses Dealing With Dementia Patients Creates a Stressful Working Environment

Motivation for this Topic

My nursing training has led me to work with elderly patients suffering from different ailments, and one thing that I have realized from my observation some of the loneliest and sad patients are the ones suffering from dementia. I have noticed that a majority of the nurses tend to avoid taking care of these patients unless they have been forcefully assigned to take care of them. It seems more of a punishment, rather than duty. They cannot attend to the patients' needs effectively because they do not understand the condition well, have poor communication skills, are stressed and lack the empathy to provide optimal care. It may seem that they do not care, but I honestly believe that they feel overburdened and stressed. It breaks my heart seeing a patient sitting by his or herself for the most part of the day doing nothing, looking lost and confused. Poor quality care means the high progression of the disease. I recently watched the movie, Alive Inside: A Story of Music and memory by Michael Rossato-Bennett and it really inspired me. The film basically follows a social worker Dan Cohen who visits patients suffering from Alzheimer's disease and provides them with music therapy (playing them their favorite or preferred music using headphones). A majority of the patients who were in a comatose state began becoming very expressive as the music played such as moving their feet, smiling, others were crying tears of joy, and even they were others dancing. It gives me hope that using simple technology such as an iPod or music player, I can have a positive impact on the lives of these patients, make them feel alive again. I want to study the challenges that nurses experience when caring for patients with dementia and how they can effectively be addressed.

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Description of the Topic

The improvement of healthcare globally has led to an increase in life expectancy around the world, and therefore the population percentage of the geriatric population has increased. In developed regions such as the European Union, the population percentage of people who are over 60 years is currently at 21% of the total population, and this is expected to rise to 33% by 2050. Also, in developing countries such as Nigeria, adults aged 65 years currently comprise 4.3% of the total population. The increase in life expectancy is attributed to the following factors: better nutrition, improved health care and advancement of technology that has led to early detection and treatment of diseases and health conditions that were previously perceived to be fatal. However, Nitta et al. (2003) argue that even though aging is a physiological process, the prevalence of diseases among the elderly population is greater than that of the general population (Nitta et al., 2003).

Trueland (2014) states that members of the geriatric population are likely to be admitted into hospitals at a higher rate and stay for longer periods than is the case for the other demographic populations (Trueland, 2014). Herman (2010) agrees with this notion and points out that over 50% of these patients are diagnosed or living with one or more cognitive impairment (Herman, 2010). According to the Alzheimer's Society (2014) report, it indicated that approximately 97% of hospital staff in the UK have attended to and provided nursing care to patients that were living with dementia at least once in their careers (Alzheimer's Society, 2014).

Hospital care professionals assume that a health care facility is the safest and most appropriate place for a person with dementia. However, geriatric patients who are suffering from this condition have complex needs, which can present challenges for a hospital to deliver effective nursing care. The reason for this is that, despite advances in healthcare technology and practices, older adults who are suffering from Dementia are highly likely to suffer from progressive cognitive decline, functional decline and challenging behaviors that have a negative impact on the quality of their lives. Furthermore, even though nursing education places high precedence on attitudes and skills that are required for best practice, this is not always applied. A majority of elderly patients living with dementia are exposed to sub-optimal healthcare, which has a negative impact on the quality of their lives.

Problem Statement

Poor quality care for this group of patients has been observed to be a growing health problem that affects the patients, their family members, the existing healthcare systems and society. The patients are exposed to inadequate healthcare mainly because a majority of the healthcare providers that they encounter or who attend to them lack the proper understanding of the medical condition that they have been diagnosed with and therefore have misperceptions of the problem. The result of this is that the patients tend to stay in hospitals for a longer period, they become more independent of the healthcare staff and are more likely to engage in disruptive behavior. Chrzescijanski et al. (2007) note that the medical problem that may have initiated their hospital admission in the first place, may not only become harder to treat, but the patient's everyday functioning and sense of independence may also be adversely affected (Chrzescijanski et al., 2007).

According to Alzheimer's Australia (2014) report, hospital staff lacking adequate knowledge in dementia care and limited available training is seen as a contributor to the problems that have been noted when caring for patients with dementia (Alzheimer Australia, 2014). Tullo and Allan (2011) found out that there are no effective and available training programs that can assist nurses in their overall healthcare of people with dementia. These researchers noted that nurses and even doctors who take care of dementia patients are not required to have pre-qualification dementia training before attending to a patient (Tullo&Allan, 2011). Also, although pre-qualification training is available it depends on specific factors such as an employer's policy requirements of the staff and patient-staff ratio in a health facility. If a hospital does not have enough hospital staff, it may not be able to release staff to attend training as the remaining attendants may be overwhelmed while attending to the patients.

Zimmerman et al. (2005) noted that a majority of nurses that care for patients with dementia are both physically and mentally strained. There are various factors that contribute to these strains such as conflict of interest by the nurse. A nurse may be required to provide physical care and also safety to a patient against his or her will (Zimmerman et al., 2005). For instance, a patient may not be willing to eat and the nurse knows that if he or she let this problem persist, the patient will be exposed to other conditions such as malnutrition that will be detrimental to his or her health. Such conflicts can result in a nurse being able to provide the patient with the level of care required to improve his or her quality of life.

Communication problems between nurses and their patients can also lead to sub-optimal care. The patients due to their condition may not be able to effectively state their needs to their caregivers. On the other hand, nurses with poor communication skills will not be in a position to effectively attend to their patients' needs. The patients will not be satisfied with the level of care that they are provided and nurses will not be able to provide effective health assessments. The result of this is that the health of the patients will not progress in a positive manner. It is also important to point out that nurses who possess weak communication skills may sometimes resort to aggression when taking care of their patients.

The aim of the Study

The aim of this research is to investigate the challenges experienced by nurses who take care of geriatric patients who are suffering from Dementia. The researcher will seek to identify how various factors such as lack of knowledge-nursing care and communication skills contribute to stress and therefore sub-optimal patient care.

Objectives of the Study

To assess how lack of knowledge by nurses dealing with dementia patients creates a stressful working environment and has a negative impact on the level of care a patient is provided

To prove that the level of communication skills affects the type of patient care

To highlight that nurses can only be able to provide optimal care to dementia patients if they are empathic

To establish that if geriatric patients are subjected to sub-optimal care, the progression of their condition will occur at a faster pace than for patients who are provided with high-quality care

Hypotheses

1. If nurses are provided with the right training and scholarly requirements for dealing with geriatric patients with dementia, then it will have a positive impact on the level of care they provide to a patient

2. Nurses who have effective communication skills provide better care than the ones who have poor communication skills to elderly patients with dementia

3. Geriatric patients with dementia who are subjected to sub-optimal care experience a high progression rate to the different stages of the condition than patients who are exposed to effective healthcare by the nurses

4. Empathetic nurses provide better care for geriatric patients suffering from dementia than nurses who are not empathetic

Background Information

It is estimated that by the year 2030, there will be 65.7 million people suffering from Dementia worldwide. Approximately 17% of these people will spend the final stages of their lives in nursing homes or health care facilities requiring repeated hospitalization. Therefore, providing optimal care for the geriatric population suffering from cognitive and functional decline is becoming an increasing concern for healthcare professionals and policymakers.

Dementia

According to WHO (2013), Dementia is defined as a syndrome that is progressive in nature. Patients suffering from dementia will exhibit the following symptoms: deterioration in their memory, thinking, and behavior (WHO,2013). They will also face communication challenges, comprehension of what is happening around them, impairment of their judgment, language and learning capacity. National Health Institutes (2014) note that Dementia is not a specific disease but a set of symptoms that tend to affect the human brain leading to a decrease in the thinking power of patients (National Health Institute,2014). One of the major and most recognized symptoms of people suffering from Dementia is memory loss. However, it is important to point out that not all people who have memory loss will be diagnosed with dementia. Dementia patients experience a high decline in their cognitive abilities than normal aging individuals, although Dementia is common among the elderly population. Diseases such as stroke have been found to be causative factors to Dementia. It is important to note that people who have been diagnosed with Dementia tend to experience difficulties in fulfilling routine activities such as dressing or eating.

As has been noted before, Dementia is a set of symptoms that are determined by a decline in an individual's abilities and functions of the brain. The affected patients tend to experience a decline in their memory, cognition ability, thinking, language skill, judgment, and understanding. The patients also tend to be unable to control their emotions and behavior, and therefore are highly dependent on the assistance provided by their families and nurses to perform their daily tasks and also make a viable decision.

There are various risk factors that are associated with Dementia such as...