| BGS
Newsletter Online |
| Creating a caring environment for hospitalised patients with dementia |
| Email your comments The latest Essence of Care benchmark (Dept of Health, 2007), published as part of the Department’s privacy and dignity programme, focuses on the care environment. Part of the standard is concerned with how the care environment ‘feels’ (page 8) :
In caring for older people in an acute hospital setting, the ‘problem’ of patients with dementia comes to the fore, time and time again. How to care for patients with dementia in the strange, confusing, busy, complex environment of a hospital? How to treat and care with dignity and respect? Does a recent report from the Alzheimer’s Society focused on care in care homes hold some of the keys? Findings from the report can be translated to the hospital setting, for example :
With the Essence of Care benchmark in mind, I would like to consider ‘communication’ with people with dementia – communication that would give back dignity, and humanity, as far as possible, rather than dementia becoming a label behind which all other things are lost. How can we help people with dementia to express themselves in the strange environment of clinical care? How do we help them to ‘find shape’ – even express distress, discomfort, pain, or (perhaps hopefully) wellbeing? How can we, as clinicians and carers, develop our response to people with dementia as individuals – that is ‘inclusive’ rather than ‘exclusive’? People who behave strangely are upsetting – and they upset the ‘equilibrium’ of the hospital setting. They don’t suit the routine! We struggle to ‘understand’ them and their behaviour – so we ‘do’ for them, because communication seems impossible. We treat what we can, and get frustrated when they don’t eat or drink, or at perceived challenging behaviour. I would suggest that, in part, it’s our perceptions that need to change; and our actions that need to follow. John Killik and Kate Allan (2002) suggest that we need to shift our perspective from ‘deficit and deterioration’, to uncover ‘everything the person is and does’ (page 17) : who they are; how they understand and experience their world; what they need to maintain a sense of self. They reference the work of Tom Kitwood who suggests that we consider the dementia-sufferer in the light of ‘a PERSON with dementia, rather than a person with DEMENTIA’ (Kitwood T., 1997 – page 7). Personhood is made real through relationship. Central to relationship, is communication. Don’t ignore the AD sufferer, engage - look, listen, watch for the non-verbal communication and clues that emerge from deprivation of verbal communication. With a culture heavily dominated by verbal communication, we need to adapt as carers to the limitations of our clients, and study the faintest visual evidence clues : eye contact; changes in facial expressions; touch; body posture; and how the person with dementia attempts to use the environment around them. Underneath their dementia, the person is more similar to us than they are different. By focusing on that we can begin to move towards providing an environment that is safe and reassuring (as far as that is possible in the complexity of an acute setting); or at the least, more responsive and considerate to their needs. Frances Grant (BSc; MSc) References Alzheimer’s Society (2007) Department of Health (2007) Killik J.; Allan K. (2002) Kitwood T. (1997). Dementia Reconsidered BGS Newsletter, December 2007
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