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Evidence-Based Practice in Nursing and Healthcare

Introduction to Providing Palliative Care for The Dementia Patient

Dementia is a kind of illness in brain that cause memory loss, discerning and communication. Around 25 million people are suffering from dementia worldwide. Approximately 30% people are suffered from dementia and other 60% accounts by Alzheimer’s disease (Moretti, 2016). Moreover, people who are suffering for dementia are at higher risk of getting other long-term chronic diseases. Therefore, the prevalence rate of dementia is observed to be highly associated with other health conditions that lead to long term suffering. Dementia cause delusions, falls, clangs, corruption, infections, or ruptures (Melnyk and Fineout-Overholt, 2015). For those who are facing dementia, palliative care can work as a specialized medical care facility. In this treatment, doctors, nurses, or social workers combinedly work to provide extra support to the dementia patient. Palliative care is basically family-centred or person- centred care given to a person suffering from progressive and advanced diseases like dementia. These people have low life expectancy or about to die, providing value of life is the essential treatment for them (Palliative Care and Dementia, n.d.).

Target Audience and Rationale for Resource

The intended audience for this documentation is Third year undergraduate nursing students or graduate registered nurses.

In healthcare sector, it is important to provide quality care to the patients who are getting through serious illness. Palliative care is the utmost care therapy provided to the patients to deal with dementia. Dementia is a very common issue that occur with age, so it is necessary to know how to deal with this by providing palliative care to the patients.

Learning Objectives

The learning objectives of this document is as follows:

  • Understand about accessing and managing symptoms of dementia.
  • Understanding the purpose of providing palliative care to dementia patient.
  • Understanding the importance and principles of palliative care.
  • Understand about the National palliative care standards in relation with dementia.
  • The identification of process involved in palliative care.

How to Access and Manage Symptoms of Dementia?

Dementia patients face several challenges related to their health, such as cognition impairment, hallucinations, depression, insomnia, delirium, nausea, weight loss, and dyspnoea. In early and mid-stages of dementia, these symptoms can be identified and treated by help of medications and therapy. Whereas during late stages, priority should be given to provide the comfort care to the patient rather than focusing on unnecessary investigations. To reduce symptoms and occurrence of these disorders, pharmacological treatment is provided to the patient (Budson & Solomon, 2016). Antipsychotic medications like haloperidol is generally preferred due to its low cost, multiple routes administration, and efficiency. Dementia patients suffered from blunt pain, which cause mood swings, agitation or social withdrawal in them. This can be maintained by analgesic medications that would improve the behaviour of patients. Moreover, depression is commonly seen in early and middle stages of dementia and rarely in end stages. To treat this, antidepressant therapy or psychostimulant like methylphenidate is given to patients for few weeks (Mehta et al., 2020).

Providing Palliative Care for the Dementia Patient

Dementia is a commonly occurring brain disorder, which leads to fading of memory. It is important to get proper treatment and care for dementia, as it may cause other health diseases. The Australian Bureau of Statistics (2018), found that 95.1% person are suffering from dementia and had other chronic diseases associated with this.

Dementia disease is developed with slow progression for prolonged periods, due to which it is difficult to get accurate prognosis for treatment. This can also cause delirium and decrements in mental health of an individual. When it declines at severe levels, then it may affect the physical and cognitive functioning of the patient. So, it is important to maintain the overall care plan for dementia patient. Palliative care is integrated to care for dementia patients, because it provides the overall care plan from early diagnosis and maintained till death of the individual (Brody, 2016). Moreover, it also deals with the care of patient’s family as well as friends (Mehta et al., 2020).

What is the Importance of Palliative Care?

Speciality of palliative care should be available to the patients of varied ages suffered with incurable, developed or life-limiting sickness. When prognosticated results are weak, then sometimes palliative care is given combined with other potential therapeutic treatment. According to World Health Organization (2020), the quality life of patients along with their families that are going through situation of life-threatening illness can be improved by help of palliative care (Palliative care, 2020). This could be done by early identification, assessment, and treatment of disease by providing necessary prevention and relief measures. The overall aim of palliative care is to enhance the quality of life of dementia patient and their family. Palliative care approach provides potentially curative treatments that are beneficial at both initial stages as well as end of life care. Along with this treatment, patient can also undergo necessary medications to deal with other chronic diseases, such as hypertension, diabetes, or any other disease that cause discomfort and pain in the body of an individual (Importance of palliative care, 2020).

Principles of Palliative Care

There are six principles of palliative care based on research evidences. These principles are discussed below:

Principle 1- Patient, family and carer centred care: This principle says that the patients, carer and family are the cornerstone of palliative care. When they actively participate in the health system, then it eventually leads to the improved health and increased satisfaction of patient with less stress and more empowerment (Delaney, 2018).

Principle 2- Care provided based on the needs: Patient needs changes with time, and it is necessary to fulfil their requirements. Skilled clinical staff are required to meet the needs of patient, carers and their families, to ensure the right care provided at right time and right place.

Principle 3- Access of patient, family and carers to local and networked services to fulfil their needs: This principle intends to provide the access to local and networked services, as people living in rural and remote areas have limited access to these services. Moreover, during end stage of their life, they have limited access to primary care providers and palliative care services. To resolve this issue, this palliative principle is approached (NSW Ministry of Health, 2018).

Principle 4- Evidence based care that is clinically safe and effective: The primary concern while providing care to the patient is that care should be safe and effective, and it must be an evidence-based practice. Best practice recommendations, meaningful clinical data, quality care and support are needed to provide the safe and effective care to the patients (Yennurajalingam, 2018).

Principle 5- Integrated and coordinated care: Integrated care is required to enhance the outcomes for risk populations and vulnerable people with intricate health issues and social requirements. Coordinated care is required to provide timely support to patient with movable information across the agencies and authorities.

Principle 6- Care is equitable: Care is not equitable among aboriginal people, linguistically and culturally diverse background, disable or dementia patient, isolated people, and those people who are at stage of end-of-life. This principle intends to provide equitable care and support for all the community people living in rural and remote areas. (Palliative & end of life care, 2020).

What are the National Palliative Care Standards?

There are 9 National standards of palliative care, they are as follows:

Standard 1- Needs assessment: This includes assessment of social, physical, spiritual, psychological, and cultural needs of people.

Standard 2- Developing care plan: Care plan is developed by proper communication of patient, family and carer, to provide support and care.

Standard 3- Caring the caretakers: Caretakers including family and carers of the person can directly inform the provision to get guidance for their role or any other support.

Standard 4- Provide care: Care plan is provided according to the goals, preferences, values, and needs of the person.

Standard 5- Transitions within and between services care: Care is provided according to the experience of person to ensure unified changes within and between services.

Standard 6- Provide grief support: Family and carer have access to support services and also information regarding ay loss and grief.

Standard 7- Service culture: Service of person-centred palliative care is supported by the values, culture, philosophy, environment, and structure.

Standard 8- Improvement in quality: Improved research and quality to provide improved services.

Standard 9- Training and qualifications of staff: Qualified staff and volunteers and engaged in professional development and their roles. (National palliative care standards- 5th edition, 2018).

How National Palliative Care Standards Implemented to Provide Palliative Care for Dementia Patients?

As dementia is long and unpredictable disease with several difficulties of communication, decision making, and community understanding. So, dementia required variety of care approaches as compare to other diseases. National Palliative Care Standard services are needed to engage and work collaboratively to deliver person-centred quality care (Reed, 2019). These are helpful to manage the requirements of person suffering with dementia, and are not able to make decisions. The primary focus of these standards with respect to dementia is to ensure the requirements of patients while providing care and support them in decision-making. Moreover, other than moral and legal requirements patients should get the planned care and support from the carers (National palliative care standards- 5th edition, 2018).

Outcomes of Study

Dementia is a brain disorder that cause delusions, falls, clangs, corruption, infections, or ruptures. So, it is important to maintain the overall care plan for dementia patient. Palliative care is integrated to care for dementia patients, because it provides the overall care plan from early diagnosis and maintained till death of the individual. Palliative care approach provides potentially curative treatments that are beneficial at both initial stages as well as end of life care. Moreover, the principle says that the patients, carer and family are the cornerstone of palliative care. National Palliative care standards supports the palliative care for dementia patients and work collaboratively to deliver person-centred quality care.

A Question?

How often do you use palliative care to deal with dementia patients?

References for Providing Palliative Care for The Dementia Patient

Australian Bureau of Statistics. (2018). Retrieved September 04, 2020, from abs.gov.au/AUSSTATS/abs@.nsf/Latestproducts/4430.0Main%20Features222018

Brody, A. A. (2016). Dementia palliative care. Dementia Care, 247-260. doi:10.1007/978-3-319-18377-0_15

Budson, A. E., & Solomon, P. R. (2016). Pharmacological treatment of the behavioral and psychological symptoms of dementia. Memory Loss, Alzheimer's Disease, and Dementia, 226-234. doi:10.1016/b978-0-323-28661-9.00024-x

Delaney L. (2018). Patient-centred care as an approach to improving health care in Australia. Collegian, 25(1), 119-123.

Importance of palliative care. (2020). Alzheimer Society. Retrieved September 04, 2020, from https://alzheimer.ca/en/Home/Living-with-dementia/Caring-for-someone/End-of-life-care/Importance-palliative-care

Mehta, Z., Giorgini, K., Ellison, N., & Roth, M. E. (2020). Integrating palliative medicine with dementia care. Great Valley Publishing, 5(2), 18.

Melnyk, B. M., & Fineout-Overholt, E. (2015). Evidence-based practice in nursing and healthcare: A guide to best practice. Philadelphia: Wolters Kluwer/Lippincott Williams et Wilkins.

Moretti D.V. (2016). Update on dementia. Place of publication not identified: InTech.

National palliative care standards- 5th edition (2018). Australian Government- Department of Health. Retrieved September 04, 2020, from https://palliativecare.org.au/wp-content/uploads/dlm_uploads/2018/02/PalliativeCare-National-Standards-2018_web-3.pdf

NSW Ministry of Health. (2018). NSW health strategic framework for integrating care. NSW Health. Retrieved September 04, 2020, from https://www.health.nsw.gov.au/integratedcare/Publications/strategic-framework-for-integrating-care.PDF

Palliative & end of life care. (2020). Agency for Clinical Innovation. Retrieved September 04, 2020, from https://www.aci.health.nsw.gov.au/palliative-care-blueprint/the-blueprint/principles

Palliative Care and Dementia: Deterioration of Brain. (n.d.). Retrieved September 04, 2020, from https://getpalliativecare.org/whatis/disease-types/dementia-palliative-care/

Palliative care. (2020). World Health Organization. Retrieved September 04, 2020, from https://www.who.int/news-room/fact-sheets/detail/palliative-care

Reed, K. (2019). Does your services meet the standards of palliative care? The Australian Experience. doi:10.26226/morressier.5c76c8bde2ea5a7237612772

Yennurajalingam, S. (2018). Principles of hospice and palliative medicine and supportive care. Hospice and Palliative Medicine and Supportive Care Flashcards. doi:10.1093/med/9780190633066.003.0001

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