NURS9710 Essay on Person Centred Dementia Care for Long-Term Illness

Dementia is a syndrome in which cognitive functioning of the brain deteriorates to the large extent that daily life of a person gets disturbed a lot. This is not a single disease, but the collection of impairments of cognitive functioning. Cognitive functioning includes, focusing abilities, thinking, learning different skills, visual insight, attention, and memory (Alzheimer’s Association, 2018). In terms of severity, dementia ranges from mild phase to the most severe phase. This all starts when neuronal functions of the brain get disturbed and connections of the brain cell break. With aging, neurons of the brain die, but patients with dementia experience this loss far greater than others (What Is Dementia? Symptoms, Types, and Diagnosis, 2017). 

Dementia is more common in aged people, and its causes vary from person to person and how a person’s brain reacts to the changes. Around 46.8 million people are suffering from this disorder worldwide, and this number is expected to be increased to three times by 2050 (Kim & Park, 2017). For the care of dementia patients, personalised care is very helpful, because it helps to ensure the needs of the patients. For this purpose, person-centred care (PCC) is used as a therapy to identify the unsaid and unmet needs of dementia patients and to manage their behavioural changes. In this therapy, patient-centred care is provided through thoughtful activities (Edvardsson et al., 2017). If provided correctly in terms of time and space, PCC is proved as a holistic approach of healing for dementia patients. This essay will discuss, how person-centred care can be utilised for the care of dementia patients.

Body

Literature Review

Fazio et al ( 2018), Kim & Park (2017), and Manthorpe & Samsi (2016) analysed the effectiveness of PCC and found it a holistic approach to treat dementia. Their vast studies have been utilised in this essay along with some other important set of studies. Fazio et al believe that PCC is a philosophy of patient care revolve around the needs of the patient and knowing him through interpersonal relationship. This therapeutic approach is found to be far effective than traditional treatments, since it is personalised according to the person, his needs, time, and behavioural changes (Fazio et al., 2018). Different studies and meta-analysis performed for dementia patients showed that PCC reduces anxiety, depression, neuropsychiatric issues, and improve the way of living. This therapy focuses on the abilities of the person rather than disabilities by studying his past history, and experiences, to provide holistic healing experience. Values, sentiments, and thoughts of the person are respected, behavioural and psychotic changes are considered meaningful to develop an interpersonal relationship (Kim & Park, 2017).

Stein-Parbury et al (2012) believe that PCC ensures that, despite of cognitive impairment, personhood can be established. It gives the freedom of expression and confidence to the person to interact with others. According to the Victorian Department of Health Services (2006), in PCC, a patient should take an active part in the journey of wellbeing with dignity and respect. Cultural values, and beliefs of the patient should be considered important and used as positive regard for the treatment. Study conducted among residential dementia care shows that, by implementing PCC into regular clinical practice, the effectiveness of the therapy can be enhanced to a large extent. And, this can be achieved by developing a friendly relationship with the patient, by keeping his secrets safe, and by maintaining that relationship (Barbosa et al., 2015). Another similar study conducted by Chenoweth et al (2019) showed that dementia patients tend to become anxious, when they do not find personalised contact with health care. So, it stresses upon the concept of the meaningful relationship between the patient and health care professional for the better healing journey. 

PCC works on the principle of respect, freedom of expression, dignity, and support. A patient in person-centred care should be given an open opportunity of integrating his thoughts, feelings, and plans. A medical intervention cannot work alone, until both the patient and the health care provider participate equally. Where, there is a concern that a patient should participate equally in the treatment process, there a health care professional should also respect the opinion and thoughts of the patient by relating them to his history and background in order to identify the causes of disease severity, so that proper treatment can be provided (Ekman et al., 2012).

Critical Assessment of the Literature Review

The reviewed literature on Person-Centred Care, provides a brief exploration of this treatment approach. It cannot be claimed that given literature review is the entire analysis of PCC and how this therapy should be considered for the care of dementia patients. However, this literature meets the requirements of this essay, which is to discuss the Person-Centred Care of dementia patients.

All the studies highlighted in the literature review show that, various factors are involved in the success of PCC. And this is what Ekman et al (2012) believe on that, participation of both patient and healthcare provider is required to establish a good patient-client relationship. Along with that, environment and time are also equally responsible for PCC therapy to be carried out. 

From the literature reviewed, it can be observed that success of PCC does not lie only in the planned intervention of personalised care, but a strong health system is also needed. A system with various flaws of health care setting cannot peruse PCC as a therapeutic approach to treat dementia patients. Main point to consider here, is that PCC therapy cannot be provided by untrained and naïve health professional, and in the fragmented health care setting. It usually occurs in developing countries, where strong health care systems are not present and long-term dementia cases are present in abundance. So, it is fair to say that success of PCC in such systems is subjective. Along with that, communication skills of health care staff, their training to deal the sensitive cases of dementia, and poor relationship among patient and health care staff, are also the challenges faced by PCC in a health care setting (Clissett et al., 2013).

Personal Commitment

While reviewing the literature, I am convinced to believe that PCC is not only a single therapy of a general disorder, but a wide collection of holistic approaches to treat range of dementia problems. This therapeutic approach cannot be carried out merely by the involvement of health care professional and patient. A pleasant and welcoming environment is also needed to interact with patient both personally and socially. The history of the patient should be discussed in a very personal way, by understanding it and considering it right without arguing with the patient. As a matter of fact, PCC therapy should not only rely on the single approach of treating, but involvement of various activities is equally needed. These activities should be incorporated in the therapy in such a way that patient can relate easily and opt that therapy whole heartedly. A peaceful physical, emotional, and the sociable environment should be created for all these activities. 

All in all, I believe that PCC is not a fixed and planned intervention, it should be a dynamic therapy which can change over time and space. Each patient is not alike, especially in dementia. Each patient has his own history and background, fixed protocol of PCC for treating each patient is not the right way. Things should be changed over time, patient, and environment. PCC can be designed as a dynamic approach via three ways- from the perspective of a patient, from the perspective of health care professional, and from the perspective of the space or organization, where care is given. Since, environment is one of the most important elements of PCC therapy, so an emphasis should be made on improving it. 

And in PCC, the good patient-client interpersonal relationship is necessary, which is developed through good communication skills. True efforts are needed to develop that very personal relationship, on which patient can believe and share his traumas, symptoms, and odd behaviours. These things can pave the ways of healing from this long-term disease. No intervention should be imposed into the patient, decision making freedom should be given to the patient itself. Lastly, to make PCC, a successful therapy for the care of dementia patients, it should be ensured that all the ends are met well. Efforts should be from all ends, from active participation of the patient to responsibility of health care professional and the environment of the therapy. Only in this way, PCC can be an all-inclusive approach for the healing of long-term disorder, dementia.

Future Implementation

For the care of the dementia patient with long term illness, I will implement all the lessons and teachings, I learned from the literature reviewed. I will employ philosophy of Fazio et al of caring dementia patient with utmost care and interpersonal and friendly relationship between the patient and health care professional. I will implement different ways of PCC therapy, including, developing, integrating and maintaining the privacy of the patient, quoted by Ekman et al (2011). In addition, I will use the insight of Kim and Park, of focusing the abilities of the dementia patient rather than disabilities in my clinical practice. I will develop personhood with the patient despite of their cognitive impairment to make a harmonised environment for therapy. I will respect the rights, beliefs and views of the patient and consider them important for the treatment. 

To overcome the challenges, which come in the way of PCC therapy through great leadership skills. There is a misconception that, PCC is nothing but wastage of resources, and efforts of care givers. To these misconceptions, I will provide direction that comprises of all the sides of PCC, as a health care provider. And this is possible, only when all the health care providers are trained enough. These include beliefs and feelings of the dementia patient and considering as persons not patients. By employing Chenoweth et al (2019), I will create a friendly environment for the treatment, by interacting well with the patient and their families. Also, I will give the opportunity to the patient’s families to participate in the treatment process, as much they can. Along with training, I will provide an emotional and physical support to the care givers, so that they provide PCC in the real sense. 

I will use all the insight and learning in my own training and development as well. First, I will develop a good patient-health care provider relationship by encouraging the patient and their families to narrate their stories, history and background, so that all these can be incorporated in the treatment process. All these stories, and experiences will provide me about the mental state of the patient, and the phase they are going through. In the second step, I will provide space for the patient and their families, to help working patient-health care provider relationship. I will provide an opportunity to the patient and their families to correct me where I am perceiving any point wrong. This will improve my practice and way of providing care to the dementia patients. At last, I will safeguard the relationship and experiences of the patient. This will strengthen the entire PCC therapy and also the trust of the patients on health care staff.

Conclusion

As the population ages, dementia is prevailing largely. This needs to be stopped before being a catastrophe. Different cares are provided to cure this disorder, and all these cares have their own working principles. PCC respects patient and their impairments. By the detailed analysis and literature review on PCC for dementia patients in this essay, it can be concluded that, it can improve the quality of life if administered correctly. Good interpersonal skills, training, and intensive care can lead to the success of PCC. This is the most significant therapeutic approach to treat long-term dementia. Unlike, other traditional treatment approaches, PCC does not emphasize on the medical management. This is entirely based on the personhood, and psychosocial paradigm. By understanding the  needs, culture of the patients, and by developing a friendly environment, the patient can involve in the PCC actively with whole heart and decide the best way of their healing.