Suffering from Dementia in a Tertiary Care Hospital (Essay Sample)

A Performance Improvement Plan to Ensure Safety and Patient Satisfaction in Individuals
Suffering from Dementia in a Tertiary Care Hospital
Background
Effective Performance Improvement is a Vision of Organizational Leaders, who through a proper goal organized mission, tries to encroach upon. They do so by clearly defining their mission statements to each and every member in that organization and ensure that best practices must be implemented for organizational success. Thus performance improvement is not just a task, a skill or a program, but it is an orientation of all members in that organization towards a common vision which can be achieved by sharing best practices and improving knowledge levels (Kinlaw, 1992) (LaRossa, 2008).
Performance Improvement Plan is intended to communicate and instil a philosophy amongst the members of an organization which aims to implement cost-effective, robust and constructive operational plan that improves performance and benefits an organization as a whole. Performance Improvement encompasses the earlier phrases like Total Quality Management, Quality control, and Quality improvement (Kinlaw, 1992) (LaRossa, 2008).
With regard to health care settings, performance improvement aims to identify and implement such opportunities that increase quality of life of patients through effective care, and ensures safety of patients at all times. Resident care improvements are those, which decrease the episodes of accidental falls and medication errors, leading to minimum casualties. Performance Improvement aims to inculcate better processes, proper screening and orientation of employees towards the direction of institution’s mission. This includes adapting to modern and new technologies, enhancing capital improvements and more importantly the skills to accept and manage change amongst their employees (Kinlaw, 1992) (LaRossa, 2008).
Dementia care has been one of the key issues not only in our organization but in different health care settings. The incidence of fall related accidents in this condition, limits optimal care giving, and is associated with high levels of dissatisfaction amongst patients and their families. Our performance improvement plan will focus, upon improving care in these individuals. We would be guided by our vision statement, mission statement and value added statement in this endeavour. The statements are briefed as below:
Vision Statement: To be amongst the top 2 organizations in the territory with regard to terminal care of patients suffering from Dementia.
Mission Statement: To develop requisite skills and knowledge amongst concerned personnel associated with dementia care, along with the development of "State-Of-Art" infrastructure, which will cater to these patients for leading a quality life.
Value Added Statement: The patients and their families will carry peace of mind, and will develop a high degree of trust, and confidence in our care giving process.
Literature Support for the proposed Performance Improvement Plan
Dementia represents a broad category of brain diseases, where an individual fails to retrieve either short term or long term memory or both. This condition affects daily functioning in the life of an individual. The symptoms that are commonly associated with dementia are impaired cognitive, and communication skills that leads to episodes of forgetfulness. Dementia or the act of chronic forgetfulness can occur due to various reasons, and the most common causes are the neurodegenerative changes associated with ageing. Dementia often occurs as a concurrence to Alzheimer’s disease, which represents the patho-physiological basis associated with the condition (Cunningham, 2006).
The hippocampus and its associated structures of limbic system, play a significant role in the development of emotion, and the formation of memory. Whenever any neuronal pathways to these structures are damaged or become redundant, memory formation and retrieval of old memories becomes compromised. In Alzheimer’s, there is a significant functional loss of cholinergic neurons, in the Nucleus Basalis of Meynert, due to the development of neurofibrillary entangles around these neurons. As a result, acetylcholine is not formed and cannot carry information to the hippocampus for the development of new memory. Since these neurons are a component of the Papetz circuit, retrieval of memory becomes difficult, which forms the basis of forgetfulness (Cunningham, 2006).
Dementia is a global issue and affects around 36 million individuals worldwide. The problem of dementia increases with age and it has been reported that 3% of individuals in the age group of 65-74 years, 19% individuals in the age group of 75-84 years and 50% individuals in the age group more than 85 years suffer from Dementia. During 2013, approximately 1.7 million deaths occurred globally, as a consequence of Dementia (Larson, Yaffe & Langa, 2013).
Managing patients with Dementia impose certain challenges on care providers, especially on the nursing the staff. The challenges are related to communication skills and person centric care which has been well recognized through various guidelines. Inadequacy in communication and person centric care delays health outcomes in these individuals. Moreover, these individuals become prone to accidents and suffer from episodes of anorexia, which prolongs their hospital stay. Hence, inculcation of proper skills and knowledge related to communication and person centric care are of crucial importance, for care providers, in managing individuals with dementia (Larson, Yaffe & Langa, 2013).
Evidence from literature search indicates communication skills and person centric care are very important factors for care providers, in ensuring patient satisfaction and health outcomes in individuals suffering from dementia. Patients all across the globe are usually satisfied with the care approach as per the therapeutic context; however satisfaction with supportive care is not uniform across the dimensions of care giving. These issues are related to ambience of the hospital environment including wards, operation theatres, and communication with physician and support staff. Satisfaction is also related to the perception of nursing care and the billing/discharge processes (Melnyk, 2011).
The definition of patient satisfaction has changed over the years and encompasses a positive evaluation of specific dimensions of health care system. Approach of nursing care is one of the important dimensions, that influences overall patient satisfaction, during their stay or admission in the hospital. Evidenced Based Nursing is witnessing radical changes to ensure patient satisfaction and especially in the care of individuals suffering from dementia. The objective of Evidenced Based Nursing is to collect appropriate data, and analyse the same to formulate action plans, that enhances patient satisfaction and improves health outcomes (Melnyk, 2011).
A systemic review indicated that development of proper skills related to communication and non verbal gestures, through education and training, in care providers associated with managing patients with Alzheimer’s disease, improved health outcomes in them. The review further suggested, that caregiver training was strongly associated with improved ability of conversation with patients and improved active listening skills in care providers. The reflection of such improvement was translated in enhanced spoken ability of patients, improved self-expressivity and improved quality of daily living for those affected individuals. Further, the review also indicated that increased intervention of education and skill development, led to either an increase or decrease in the professional burden on care providers (Zientz & Rackley, 2007).
Even the Commission for Social care Inspection (CSCI, 2008) did recognize the inadequacies in communication, and person centric approach in care providers associated with the management of Dementia. The commission recommended ensuring high quality care through skilled communication and person centric approach, for individuals suffering from Dementia. NICE guidelines (2006) also recommended that person centric approach must be given due importance, in all patients suffering from Dementia irrespective of cultural or ethnic diversity (Larson, Yaffe, & Langa, 2013).
It was observed that effective communication by care providers, ensured happiness in patients with dementia, and was associated to their relaxed state of mind. Further it was noted, that such improvement in happiness increases cognitive ability, in those compromised individuals. Studies suggested that although care giving follows a professional approach, but due to professional pressures, often care providers tend to miss out the sensitive needs of the patients (Cunningham, 2006). Cunningham (2006) suggested that practicing and implementation of non verbal skills and gestures, by care providers induced an inclusive environment, which expedited cognitive behavior and well being of patients. He concluded that ensuring effective communication, maintenance of privacy and confidentiality of individual patients, improved patient-care provider relations increased treatment compliance and reduced their stay in the Hospital.
As literature survey indicates, there is no doubt that effective communication and person centric approach should be a priority for care givers while managing patients suffering from dementia. However, the set of communication and non-verbal skills that are required remains vague and no study concretely concludes as to which aspect of communication or gestures that should be practiced to ensure quality of life for the individuals suffering from Dementia.
This is important because nursing staff are burdened with various stressors like catering to the need of di...