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The management of health care facilities such as home care for the people with mental impairment requires a new form of training to equip caregivers’ with new knowledge that will promote health care ethos towards creating person-centered services. Because of the new demands for the people with mental challenges, the New CMS, DOH Long-term Care Regulations require that staff undergo training dementia management that focuses on management of behavior in non-pharmacy interventions and change model of care to person center approach. The introduction of new regulations and their implementation aim at improving health care services that help in the recovery of patients. The objective of the new management focuses on creating independence among patients through fast recovery due to their needs. On the other hand, patients with dementia referred to people who suffer from mental impairment or disorder, which might lead to the loss of memory and inability to perform their activities independently like walking. Because of increasing rate of patients who have dementia, this paper provides a person-centered care plan for the dementia persons to be adopted by Holly Patterson Extended facility in Uniondale, New York.
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Identification of a Management/Administrative Problem
The Holly Patterson Extended Facility in Uniondale, New York is a certified health care facility with qualified staff and duly complies with the New CMS, DOH Long-term Care Regulations requirement. The organization is committed to implementing person-centered approach technique to enhance patients’ recovery while in their facilities. Because of the need for person-centered and care for elderly especially those who have a mental disorder, the organization focuses on developing a care plan for dementia persons, thus creating a culture change seeking to realize health care ethos.
To develop a person-centered approach care plan for the dementia person, the organization support program derived from the theories of Tom Kitwood that shared the experience of living with dementia person. The use of Tom Kitwood’s theory is approved by Care Quality Commission as it considers the fundamental factors affecting patients with mental disorder. Kitwood defines the experience of living dementia as the outcome of an individual’s neurological impairment, their biography, the physical health, personality, social psychology and their environment (Mitchell & Agnelli, 2015, p. 21). Kitwood asserted that enhancing social psychology of the patients who have dementia creates an excellent opportunity to improve the experience of people living dementia. Therefore, Kitwood’s theory or doctrines are the tenets in which this care plan is developed to attain and promote the living standard or the patient to the standards of self-reliant or independence. While developing this care support program, the problem areas presented by the people living with dementia include safety, cognitive development, biography, personality, physical health, and environment. The organization’s PICO question that guided the formulation of this paper is the process of designing a person-centered approach for care plan of dementia person. The problem is divided into various areas highlighted by Tom Kitwood’s theory as shown below:
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This section emphasizes on risk assessment and wellbeing of clients in health care. At this stage, the staff will use this guideline to highlight significant, real danger relevant to the client. People living with dementia undergo different behaviors and therefore, health care might experience different responses from the patient. In this context, patient safety must prevail first before any activity commences or therapy began. Because of the mental disorder, a brief history from family members about the patient’s behavior must go into the record to ensure that hi/her safety prevails first. Most importantly, client’s engagement on what should prevail to keep him/her safe to promote patient’s best interest in person-centered approach as defined in Mental Capacity Act is fundamental.
Cognitive Ability of the Client
Assessing the cognitive ability of the person with dementia is paramount. The fact that people with dementia behave differently due to disparity on the type of dementia part of the brain affected and the stage of dementia requires that each patient undergoing therapy undergoes an assessment of their cognitive ability. The major focus of the evaluation focuses on the memory to provide a clue regarding memory lapses and skills such as the level of information remaining intact, thus helping in designing the support required. During the assessment, the problem is evaluated regarding visual processing, memory, body management, language, planning, as well as judging and controlling. On the other hand, the care plan will provide a precise explanation of the dementia stage and the part of the brain affected.
Biography of the Client
The causes of dementia are varied even though it is associated with old age (60 years and above). Before deciding on the support offered to the client, I will ensure that the client’s background information assessment commenced with immediate effect to help in determining whether the client is happy or distressed. The history of the customer is used to define the boundaries or activities that staff should engage on to keep the patient’s in sober moods. For example, staff activities in care home might trigger many feelings that relate to painful events in the client’s past life (Fiß & Hoffmann, 2013, p. 14). Therefore, through background assessment, the staff will gather clues on the patient’s life history that helps in providing explanations and appropriate solutions to the existing client’s problem. Additionally, the clues include life events or history that a person enjoys and the knowledge that an individual might retain. Therefore, such information will help the staff to make life in care home meaningful to the client and quicken his/her recovery. Such unjoyful memories might include the music played, video, games or sports and stories among others.
Assessment of Client’s Personality
The organization will assess client’s personality to understand whether the patient is outgoing, confident, or positive among others. This will help to know whether a patient enjoys trying new things in life, which can help her/her adapt quickly. This concept helps the staff to identify whether a person is organized or laissez-faire and more composed or relaxed.
Physical Health Assessment
Physical health assessment section emphasizes on the individual’s health needs which health homes must identify and plan for the best therapy to help patient’ recover. The evaluation should include issues such as bathing and wash to note where should the treatment start addressing (Miller & Mitchell, 2012, pp. 7-11). However, this section will require proper planning especially when the client undergoes pain, which requires apt management since people living with dementia might not be in a position to help recognize the pain or show such expressions. Therefore, interventions such as injections might be of great challenge.
The environmental assessment will include careful monitoring of the client within the care home to reveal how the surrounding supports the customers and promotes access around the home and to what limit the environment creates a barrier to the client. Through environmental assessment, the staff can understand how to support mobility and manual handling flexibility challenges experienced by the client. However, the introduction of person-centered care plan for the dementia person reinforce the mission, vision, and goals of the organization is it seek to improve service delivery. The use of person-centered approach is a milestone to achieve the organization’s vision and goal of client-oriented care homes. However, the problem conflicts with the goals in that it gives the clients power to help in identifying the best practices, which is a challenge especially when a person is profoundly affected and may not make a right judgment. On the other hand, decision-making tools and resources required to aid health care facility is in plenty, thus helping the organization to adapt new proposals. More the development of care plan for the dementia people borrows from the Tom Kitwood’s doctrine on the experience of individuals living with dementia.
Development of Interventions
Health intervention for the case of alteration of the thought process for people living with dementia will include; developing a routine with waking up times, exercise period, rest time, reading time, eating time and sleeping time. I will schedule for TV shows, storytelling, assign chores, re-orient client and encourage them to remain in Holly Patterson facility. On the other hand, patient response evaluation goals will include; adherence to routine, adapt to activities, time management and stays within the facility. The person-centered approach for care plan for dementia people will routinely include some of the aspects discussed below;
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First, patients will eat twice per day using the right nutritious food for the people living with dementia. Health intervention focuses on establishing food preferences, providing dietary supplements, well hydration and weight recording. The primary goals for evaluation will include involvement in selecting food choices, drink enough water (8 glasses daily), and increased body weight.
Second, the establishment of problem-related issues or patient’s safety assessment will require interventions such as; proper footwear/well-fitting shoe, use of aiding devices and supervision of activities. On the other hand, the evaluation of patient’s responses includes the ability of patients to wear shoes properly, use of walkers and cooperation during supervision (ottawainnercityhealth, 2017).
Third, assessment of the problems associated with depression, the experience of sadness, memory loss and history of head injury will attract health interventions such as; planned counseling sessions, evaluating progress with counselors and embracing expression of feelings. However, an excellent evaluation that includes assessment of; participations in counseling, reporting depressions, and ability to express feelings among others will help in determining the progress.
Development of the person-centered care plan for the people living with dementia is an outcome of the person-centered training approach of nurses. Constructing a support or care plan derives its doctrines from the Tom Kitwood’s theory addressing the experience of the people living with dementia. To create this person-centered care plan, the consideration of the requirement of the New CMS, DOH Long-term Care Regulations requires that staff undergo training dementia management acts as the focal guide for the home care’s mission. The need to need to create cultural diversity as an important ethos in nursing profession influenced the development of this project. On the other hand, the development of the project was based on the significant issues identified within the problem or procedural creation of the care plan for the people living with dementia. The main issue areas of focus included client safety, biography, cognitive ability, physical health, environment and client’s personality. Therefore, the areas above create the major issues that the organization must evaluate before prescribing service or method of treatment available for the patient.
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To implement the proposal, various health intervention plan, and analysis based on the requirement or health needs of the people living with dementia. On the other hand, the plan employed different strategies for developing a powerful image that aimed at soliciting the acceptance of the proposed changes by the New CMS, DOH Long-term Care Regulations. The strategies included the use of a person-centered approach that is universally accepted by Quality Care Commission. On the other hand, the actions affect the implementation since it requires thorough evaluation and assessment of the patient based on the principles of Tom Kitwood. In conclusion, I relied on other nurses to provide me with information based on their understanding and experience while attending to the people with dementia. On the other hand, their knowledge of person-centered training approach and nursing approach helped in proving strong base for the development of the care plan. Lastly, the concept of cultural diversity comes from health intervention stage where client’s involvement for dietary selection and proposal on what might work with him/her created the cultural diversity for both staff and patient.
- Fiß, T. T., & Hoffmann, W. (2013). Medication management for people with dementia in primary care: Description of implementation in the DelpHi study. BMC Geriatrics, 13(1). doi: 10.1186/1471-2318-13-121
- Miller, S. C., & Mitchell, S. L. (2012). Dying in US nursing homes with advanced dementia: How does health care use differ for residents with, versus without, end-of-life Medicare skilled nursing facility care? Journal of Palliative Medicine, 15(1). doi: 10.1089/jpm.2011.0210
- Mitchell, G., & Agnelli, J. (2015). Person-centred care for people with dementia: Kitwood reconsidered. Nursing Standard, 30(7). doi: 10.7748/ns.30.7.46.s47
- ottawainnercityhealth. (2017). Sample Dementia Care Plan. Retrieved from ottawainnercityhealth: http://ottawainnercityhealth.ca/articles/20