Staff Nurse. Ruth Breslin
The dementia support we offer is for people of any age – here it’s given so that sufferers can stay in their own homes as long as possible, living their lives as fully as possible. At this day hospital we provide specialist assessment, nursing support and O.T activities for people with various types of dementia. We hope this will prevent the need for a hospital admission and allow relatives / carers some much needed respite.
There are many different types of dementia. Some are related to diseases such as Alzheimers or vascular conditions such as strokes. Depending on the illness, people might have short-term memory problems, disorientation, be anxious or agitated or develop problems such as disturbed patterns of sleep.
We also support people with less common illnesses such as fronto-temporal dementia which can involve very challenging symptoms such as obsessive-compulsive behaviours or marked personality changes. At all stages of the person's journey through dementia there are hurdles to overcome, for both the individual and their loved ones.
Our role is to help people understand what they are going through, and together find positive, constructive ways to look to the future. This may involve helping people to come to come to terms with their diagnosis and explore their feelings and anxieties. For example, some people may feel angry and need emotional counselling. Others may need practical support to understand their symptoms or treatment plan. Educational support is also vital. Certain dementia symptoms may require special consideration in carers; for instance, Alzheimers can cause problems with visuo-spatial awareness which affects a persons' recognition of depth, distance and what an object is. Someone with this problem might walk from a carpet onto lino and think that they should be taking a step up, when the two surfaces are actually flat beside each other. This can cause them to stumble or fall.
We also see many kinds of language difficulties. People might remember songs, or recite poetry, but be limited in other uses of words. I knew a gentleman who could recite Shakespeare in any accent you like, but his own self-expression was stunted.
Individuals can sometimes get lost in the illness and we fight that by helping them create books that tell the history of their own lives. The patient is transformed from an anonymous old lady into someone who has flown planes, who has lived an amazing life. A book like this is very valuable, especially when someone is in long-term care; it becomes a memory guide to the person and a prompt for staff. It’s an anchor for the patient and it’s a point of contact, a talking point.
You need background to understand people. Local history, personal reminiscences, things to hang a conversation on. From there you get to know them more deeply. Everyone’s needs are so different. Some people actively seek help, others are more reluctant to ask for it and we have to gradually earn their trust.
We achieve a lot once we’ve got trust. Its very rewarding to see people getting happier and growing in confidence every day.
Many people who are referred to us understand that they have a diagnosis of dementia. Because of that you can be honest and trust can then build. People start to understand who you are, they open up to you, which is vital because dementia is in the mind.....unseen, it has to be talked about before we can treat it. It is so valuable for the person to know that the scary things that are happening to them, such as hallucinations, are part of their illness and that we will work hard to find the right medication to ease them. It is a partnership.
The care philosophy we use is based on the work of the late Tom Kitwood, who pioneered the person-centred care movement. Kitwood once said that to treat people as if they were objects or consumer durables like a TV is "grotesque". But, in the current ecconomic climate, it is easy for healthcare to reduce people to numbers or statistics. Dementia care nursing has, historically, been under-valued and overlooked as a specialist area of practice. But the nature of our patients' needs and their vulnerability demands that we need more - not less- skills to work in this area. There is a lot of emotional giving in dementia care. The reality of person-centred care is that we have to go the extra mile. Our client group need people to spend quality time with them and they deserve committed, compassionate, well-trained staff who understand their needs. That’s what keeps the patients safe and physically / emotionally well. We work hard to keep the atmosphere calm and uplifting, from the music we play to the activities we undertake. We also have good relationships with the people around the client too, relatives, doctors and other health workers. Close teamwork is essential.
When people move on, we miss them terribly because we’re very much a community. We get relatives coming to visit at our Christmas Fairs, people from the past pop in to say hello. I always say: “Have a cuppa if you’re near, let us know how you’re doing.”
There are days when the job can be tiring and demanding, but it’s never to do with the patients. They keep us going on the tough days! It is the politics, red tape and paperwork that causes the most frustration.
We never forget though, that however difficult our days can be, it is the carers who have the hardest job of all. They never cease to amaze us at how they keep going- sometimes under extreme pressures and even with their own health problems. When we come off duty, we can relax and re-charge our batteries. Our carers are on duty 24/7.
