"Enhancing Dementia Patient Care through Integrative Nursing Practices
Introduction Of Leading And Empowering In Integrated Nursing Practice Assignment Sample
Get free written samples from expert assignment writers and academic writing services in UK.
Integrated-type of nursing practices refers to the system of providing healthcare to the patients based on the patient-centered type of approach. It effectively addresses the development of personal and professional skills by the nurses along with better knowledge levels. There are 4 different key concepts that outline the effectiveness of integrative nursing practices. These include purpose consideration. Self-reflection and skill development for meeting the patient care goals. This study introduces the communication skills required by the nurses to ensure effective care of a dementia patient. The requirements are interpersonal skills and interprofessional type of working skills. In this study, the skills development and the theories based on care and communication with dementia patients are effectively aligned with part 3 of NMC nursing standards.
Description of Case scenario
The case scenario is based on a person named Hilary suffering from dementia. I am a practicing nurse providing quality care to my patients. The setting is based on the nursing home where Hilary is admitted to the general ward. Hilary has problems recognizing his close relatives and faces difficulties communicating his basic needs. I am looking forward to developing a therapeutic relationship with my patients and providing care in an accountable, compassionate and safely. I ensure that I abide by Part 3 of the nursing registrations outlined by NMC standards. I have taken care of this patient during my course of clinical placement. I also try to promote the dignity and maintain the rights of dementia patients by raising awareness and guiding my teammates, which help me to deliver comfort to Hillary.
Importance of interpersonal skills for delivering healthcare
Working in a clinical setup as a nurse requires inter-professional skills such as responsibility, self-awareness, trust, accountability, communication and respect. The importance of these skills can be demonstrated by the fact that it helps improve the experience and satisfaction of the care receivers, promotes the collectiveness of the team of nurses, fills the gaps in communication and empowers the nurses. The effectiveness of the communication styles demonstrated by a nurse helps improve the attitude of the nurses in providing the best care. As opined by Evripidou et al. (2019), the knowledge level of the nurses is very important for the treatment and care of dementia patients as it ensures the effective use of interpersonal skills. With the effective implementation of interprofessional type of skills, the perception s of the nurses is enhanced, and it also promotes the retention of clinical knowledge. The NMC code derived from the promotion of trust and professionalism is linked to this skill as it helps guide the nursing practices through active team cooperation, knowledge sharing and health promotion (NMC, 2022). I act with integrity and honesty and have a professional boundary while delivering care services. The skills of teamwork of the nurses are also enhanced by the creation of improved workplace behaviours and knowledge sharing (George & Quatrara, 2018). The skill of decision-making of the nurses is crucial for ensuring the safety of the patients. It can be considered a fundamental concept in nursing in which care is provided by the assessment, evaluation, interpretation and better management of the clinical situations based on specific patients. According to Walsh et al. (2022), the skill of making correct and timely decisions by the nurses is crucial for the safety of the patients. This is particularly important in cases where the treatment of the patient is done through the use of drugs and medicines. Inaccurate amounts of dosage of injections or medications to the patients in higher or lower amounts can deteriorate the health of the patient and interferes with safety concerns. I can link this with one case in my hospital where the administration of a higher dosage of the medicine than prescribed by the doctor resulted in the loss of consciousness of the patient. Hence, I always ensure I am attentive and alert while administering medications to my patients. Decision-making by the caregivers is the most effective when it is done in a shared manner with the input and viewpoints of the team members (Davies et al., 2019). The NMC code based on preserving the safety of the patients helps in the competition of the training program before engaging in clinical experience and reducing the chances of patient harm resulting from negligence (NMC, 2022).
A person-centred type of care is important in a clinical context as it effectively addresses the diverse needs of an individual patient. It is based on the maintenance of core values such as rights, individuality, privacy, independence, choice, respect, partnership and dignity of the patients. . As opined by Chenoweth et al. (2019), a person-centred type of care delivered to dementia patients results in improving the nurse's capacity through skills and knowledge development and supporting the autonomy and dignity of the patient suffering from dementia. It also helps in promoting the factor of teamwork and collaboration while delivering cares to ensure the well-being of the patients. This results from the enrichment of interpersonal relationships with the nurses. During my practice, I have also observed that as per the requirements of this patient, an evidence-based type of care is also crucial for ensuring the effectiveness of the care intervention.
Evaluation of the communication skills
The responsibility of the nurses while assisting a dementia patient is mainly based on assisting in daily activities such as eating, hygiene, and toileting and medicines administration. Nurses are also accountable for keeping a note of the safety of these patients and avoiding the incidences of self-harm, injuries and accidents resulting from cognitive impairment (Nurse Journal, 2022). I have experienced that dementia patients also need encouragement for socialization and management of behavioural issues. Hence, the development of effective communication skills is a major prerequisite for nurses. Along with verbal communication, I have felt that a non-verbal type of communication is equally important for delivering specific care to the patient (Alzheimer’s Society, 2022). Integrated care of dementia patients is based on the promotion of well-being as well as promoting the dignity of these patients by raising awareness. I have effectively developed communication skills that include taking in a slow pace, providing gentle encouragement to the patient for engaging in their conversation and showing respect for the views of the patient. As opined by Raeissi et al. (2022), the emotional intelligence of the nurses is directly associated with their communication skills. It is suggested that the nurses who possess sound communication skills are better able to handle the job pressure and stress.
Emotional intelligence plays a key role in the development and the displaying of interpersonal skills of communication as these results from the enhanced ability of the nurses to control the emotions and present logical responses. I have witnessed that emotional intelligence is particularly significant in emergency departments and has a positive effect on providing job satisfaction. The impact of displaying respect for the beliefs and values of the patient helps in gaining the dementia patient's trust. Development of the sense of empathy, sensitivity and increasing awareness are crucial for the treatment and care of these patients (Campbell et al., 2021). As per the standards of the NMC for the pre-registration programs in nursing, it is mentioned that training and the education of the nurses are crucial to ensure that the services offered are of high quality and new to the patient's needs. The first step in the pre-registration journey of the students is based on the selection and admission into the program. It takes into account that the student has English language proficiency, demonstrates the values as per the NMC codes and has the capability in technological and digital literacy for attaining the program outcomes (NMC, 2020).
Linking with the theories of communication and inter-professional working
Interprofessional working in a clinical setup is based on the skills of the nurses that include accountability, responsibility, communication, coordination, assertiveness, autonomy, cooperation, respect and mutual respect. The socio-political type of drivers involved in interprofessional working is based on nurses' participation in the health policy formulation. According to Fernández, Parra-Giordano & Gutiérrez (2022), nursing practices are deeply associated with their participation in the formulation of health policies and this is a great opportunity to strengthen their strategic position in the context of care referents on healthcare systems.
Based on my personal nursing experiences, nurse also has a role in scaling up the effectiveness of a health program. Their active engagement in political matters is based on the organizational, legislative and normative changes in the context of the health environment. The clinical experience of the nurses is crucial for ensuring the success of the health policies and hence has an indirect role in determining the health status of a country. The legal drivers for the nursing practices include the regulations and the rules that help in regulating the social conduct of the nurses, and these are basically rule made by human that is formally prescribed and acts in a manner that is legally bound. The legal framework is based on the rules of the nursing and midwifery council in UK (NMC, 2022). Some of them are ‘healthcare professions act, 2003’, ‘Nurses profession regulations’, ‘mental health act 2011’, ‘nurses scope of practice’, ‘professional boundaries for nurses and midwives and ‘healthcare act 2013’ (Deputy Prime Minister, 2022). With the help of a regulatory and a legal framework, the incongruence existing between the nursing practices and the legislation can be reduced. This also helps in better management of the intra-professional and inter-professional types of conflicts, frustration, uncertainty, stress and exploitation of the nurses. It also helps in ensuring that the safety of the patients is the most important aspect of delivering care-related services to the patients (Feringa, De Swardt & Havenga, 2018).
‘Peplau’s interpersonal relations theory is based on the role of communication skills of the nurses for the development of therapeutic and interpersonal relationships with patients. The importance of this theory can be explained by the fact that it prepares the nurses to interact with the patients and the interpersonal competencies assist them in providing high-quality healthcare services. As opined by Shirley & Phan (2019), the therapeutic type of communication skills possessed by the nurses is effective in achieving the goals of patient-specific care needs. It is suggested that Peplau's theory is based on the development and the maintenance of interpersonal relationships with dementia and other patients. With the application of this theory, the nursing interventions are more effective in understanding the health problems and specific requirements of the patients. This theory is based on the four main phases of developing the interpersonal relations between patients and nurses. These phases are orientation, identification of the needs, exploitation and taking a resolution.
Another relevant theory based on the providing of person-centred type of care services to the patient is the Leningerscultural care theory. This theory is based on dealing with the limitations of lack of care in treating patients. It is suggested in this theory that a lack of care knowledge and cultural knowledge is a major gap in nursing practices. With effective incorporation of cultural as well as care knowledge, the variations in the care of different patients help in promoting compliance, wellness and healing. Leininger also introduced the concept of transcultural nursing as part of this theory. Transcultural nursing is based on nursing practices that are focused on integrating the beliefs, values and practices of culturally different patients and promoting their well-being (Nursing theory, 2022).
The NMC code based on the prioritizing of the people helps in upholding the values and rights of the patients. This includes treating the patients with respect, kindness and compassion. It also aids in avoiding personal assumptions and helps in recognizing the individual patient's choice and diversity (NMC, 2022). The cultural competence of nurses refers to the ability of the nurses to deliver the best healthcare along with an effective demonstration of cultural awareness of the patients based on their values, race and belief system. Its importance can be indicated by the fact that it is helpful in planning with dietary considerations, administration of a drug and its possible substitute, increasing the patient's participation, and fostering respect, trust and improved understanding, all of which result in increasing quality care and safety of patients. As outlined by Wang et al. (2018), the competence of the nurses providing care for dementia patients can be evaluated by their cultural competence developed by them. This is based on integrating cultural awareness. In the study, it is found that nurses who are bilingual and have regular networking and social connections are related to greater scores on measures of cultural competence.
Kitwoods theory for the effective care of dementia patients is based on caring for and supporting dementia patients by keeping in mind the six major psychological needs of a human. These are comfort, love, identity, inclusion, occupation and attachment. It is a holistic approach that facilitates care in a humanistic, morally ethical and dignified manner (Harper, Oltean & Baker, 2020). The clinical manifestations of dementia increase the significance of the person-centred type of care. As opined by Terkelsen, Petersen & Kristensen (2020), Kitwoods theory is based on a theoretical contribution to the interaction between neurological and psychological factors in the context of dementia patients. As per the theory of Kitwood, the biomedical approach to treating dementia patients is criticized stating that this approach has insufficient understanding related to the emotional and mental health of the patient. Hence, Kitwoods theory is based on the ethical and humanistic approach that is crucial for a dementia patient.
Skill development and theory application
Communication skill is a significant attribute of a nurse as they facilitate knowledge sharing, fosters relationships with the team members and the patients, better management of complex and challenging clinical situation and improves the positive outcomes of the treatment process. I feel that the most important skill to be possessed by a nurse for the care of patients suffering from dementia is communication skill. The effectiveness of communication with patients with dementia can be improved by employing verbal communication abilities. The first step in engaging in an effective conversation with dementia is making the patient comfortable and thinking about the possible conversation topics. It is also crucial to be attentive and listen to them and express with the help of facial expressions and body language (Alzheimer’s Society, (2022). As a student of nurse, I ensure that I use simple and short sentences and communicate in a calm and clear manner with my patient suffering from dementia.
Peplau’s theory is based on the enhancement of interpersonal relations with dementia patients is helpful in increasing the satisfaction of the customers by positively influencing the health outcomes. I have applied Peplau's theory in my practice of nursing by distinguishing my progress in relationship building in the four distinct phases. In the first phase, called the orientation phase, I engage in treating my patient and promote asking questions and providing suitable explanations to my patient. I have observed that this stage is crucial in gaining my patient's trust. In the second phase called the identification phase, I make sure that the patient is an active role in the care plan. In the third phase called the exploitation phase, I provide an opportunity to my patient to take benefit of the offered care services to meet the treatment goals. In the last phase called the resolution phase, I assess if the needs of my patient are adequately met and determine the impact of communication skills on the outcomes of the care services. I try to make the patient independent and capable of self-care, and this marks the end of this phase. This can be linked to the development of my observation skills, listening skills, and communication skills. I have also assessed that my decision-making abilities are improved from the experience of personal interaction with my patients. The decision-making capabilities of a nurse are crucial in the management and assessment of pain problems of dementia patients. These behavioral changes in the case of dementia patients can be effectively addressed by having thought knowledge about the patient and having an idea about the patterns of daily and habitual behavior. This is possible only through the development of interpersonal relations with patients who need special care and attention (Jonsdottir & Gunnarsson, 2021).
Kitwood’s theory is linked with the care of dementia patients and considers the concept of personhood important in the care plan. I have employed the Kitwoods theory in my nursing practices by understanding and communicating the importance of personhood with my team members. This has resulted in enhancing the level and the standards of quality care delivered to the patient in my team. Application of this theory has also helped me develop a weekly type poor discussion group in which the team engages in knowledge and experiences sharing. Through this discussion, I have learned the importance of developing positive relations with the patients that increase the social engagement of my dementia patient and improved his connectedness, feeling and sense of belonging. This has positively impacted his health, and I have witnessed a significant reduction in aggressive behavior. However, I have also faced a challenge related to the active participation of my team members. I have addressed this challenge by making use of my interpersonal skills in persuading and convincing my team members to participate in the discussions. According to Gwernan?Jones et al. (2020), the implications of a knowledgeable nurse are beneficial for the long-term and fruitful engagement with the patients. It also plays a role in reducing the responsible type of behavior of dementia patients including vocalization and aggressiveness. I emphasized the importance of the non-verbal type of communication such as facial expressions, gestures and touch to help in encouraging the self-expression of the patients, covey their emotions, prevent agitation and confusion and improve their condition.
The Culture theory has helped me significantly in planning the care based on the preferences of the patient and at the same time developing my socio-cultural skills for effective communication. For developing my cultural competence and integrating it into my nursing practice, I have ensured that I increase my knowledge about the language and cultural aspects of my patients.
Integrative nursing is based on the incorporation of the interprofessional and interpersonal skills of the nurses to deliver care services to the patients. The culture care theory, Kitwoods theory and Peplau's theory are discussed along with the alignment with the NMC standards for nurses. It can be concluded that interpersonal skills such as communication skills, teamwork abilities, decision-making abilities, and listening skills are cultural competence is crucial for nurses to deliver safe and effective care to dementia patients.
Alzheimer’s Society, (2022), Communicating and dementia, https://www.alzheimers.org.uk/about-dementia/symptoms-and-diagnosis/symptoms/communicating-and-dementia
Campbell, D., Lugger, S., Sigler, G. S., & Turkelson, C. (2021). Increasing awareness, sensitivity, and empathy for Alzheimer's dementia patients using simulation. Nurse education today, 98, 104764.https://doi.org/10.1016/j.nedt.2021.104764
Chenoweth, L., Stein-Parbury, J., Lapkin, S., Wang, A., Liu, Z., & Williams, A. (2019). Effects of person-centered care at the organisational level for people with dementia. A systematic review. PloS one, 14(2), e0212686. https://doi.org/10.1371/journal.pone.0212686
Davies, N., Schiowitz, B., Rait, G., Vickerstaff, V., & Sampson, E. L. (2019). Decision aids to support decision-making in dementia care: a systematic review. International psychogeriatrics, 31(10), 1403-1419.https://discovery.ucl.ac.uk/id/eprint/10075287/1/Davies_SALSA%20systematic%20review_accepted%20version.pdf
Deputy Prime Minister, (2022), Legal Framework, https://deputyprimeminister.gov.mt/en/department-of-health-services/nursing-services/Pages/legal-framework.aspx
Evripidou, M., Charalambous, A., Middleton, N., & Papastavrou, E. (2019). Nurses’ knowledge and attitudes about dementia care: Systematic literature review. Perspectives in psychiatric care, 55(1), 48-60. https://doi.org/10.1111/ppc.12291
Feringa, M. M., De Swardt, H. C., & Havenga, Y. (2018). Registered nurses’ knowledge, attitude, practice and regulation regarding their scope of practice: A literature review. International Journal of Africa nursing sciences, 8, 87-97.https://doi.org/10.1016/j.ijans.2018.04.001
Fernández, M. A. S., Parra-Giordano, D., & Gutiérrez, T. M. (2022). Nursing participation in Public Policies, why is it important? Integrative review of the literature. Enfermería Global, 21(1), 607-624.https://doi.org/10.6018/eglobal.455361
George, K. L., & Quatrara, B. (2018). Interprofessional simulations promote knowledge retention and enhance perceptions of teamwork skills in a surgical-trauma-burn intensive care unit setting. Dimensions of Critical Care Nursing, 37(3), 144-155.DOI: 10.1097/DCC.0000000000000301
German?Jones, R., Abbott, R., Lorida, I., Rogers, M., Green, C., Ball, S., ... & Thompson Coon, J. O. (2020). The experiences of hospital staff who provide care for people living with dementia: A systematic review and synthesis of qualitative studies. International journal of older people nursing, 15(4), e12325.DOI: 10.1111/opn.12325
Harper, L., Oltean, A., & Baker, D. (2020). Person-centred care for people with learning disabilities: the application of Kitwood’s theory. Learning Disability Practice, 23(3).DOI: 10.7748/ldp.2020.e2014
Jonsdottir, T., & Gunnarsson, E. C. (2021). Understanding nurses’ knowledge and attitudes toward pain assessment in dementia: a literature review. Pain Management Nursing, 22(3), 281-292, https://doi.org/10.1016/j.pmn.2020.11.002
NMC, (2020), Standards of proficiency for registered nurses, https://www.nmc.org.uk/standards/standards-for-nurses/standards-of-proficiency-for-registered-nurses/
NMC, (2022), Our Legal Framework, https://www.nmc.org.uk/about-us/governance/our-legal-framework/
NMC, (2022), Standards, https://www.nmc.org.uk/standards/
Nurse Journal, (2022), Tips & Resources for Nurses, https://nursejournal.org/resources/nursing-care-patients-with-alzheimers-dementia/#:~:text=Nursing%20Duties%20and%20Responsibilities&text=Assist%20with%20patient%20self%2Dcare,or%20deficits%20in%20motor%20functioning.
Nursing Theory, (2022), Culture Care Theory, https://nursing-theory.org/theories-and-models/leininger-culture-care-theory.php
Raeissi, P., Zandian, H., Mirzarahimy, T., Delavari, S., Moghadam, T. Z., & Rahimi, G. (2022). Relationship between communication skills and emotional intelligence among nurses. Nursing Management, 29(3). DOI: 10.7748/nm.2019.e1820
Shirley, N., & Phan, L. T. M. (2019). Therapeutic Communication Skills of Nurses Towards People With Dementia.https://www.theseus.fi/handle/10024/227487
Terkelsen, A. S., Petersen, J. V., & Kristensen, H. K. (2020). Mapping empirical experiences of Tom Kitwood's framework of person?centred care for persons with dementia in institutional settings. A scoping review. Scandinavian journal of caring sciences, 34(1), 6-22,DOI: 10.1111/scs.12709
Walsh, B., Dahlke, S., O’Rourke, H., & Hunter, K. F. (2022). Exploring acute care nurses’ decision?making in psychotropic PRN use in hospitalised people with dementia. Journal of Clinical Nursing, 31(13-14), 2024-2035.
Wang, Y., Xiao, L. D., Yan, P., Wang, Y., & Yasheng, A. (2018). Nursing students' cultural competence in caring for older people in a multicultural and developing region. Nurse Education Today, 70, 47-53.https://doi.org/10.1016/j.nedt.2018.08.012