Question

REVERSE CASE STUDY : Home Care for the Elderly Client With Dementia

Primary Character: Scenario:

Instructions:

Home health nurse

The home health nurse is making a visit to a 72-year-old client with dementia who is being cared for at home by a 75-year-old spouse/family member. They live independently in a two-story home in a small suburban neighborhood. The home health nurse is doing an initial home health assessment.

Create a history of the problem that could lead to this scenario, including the experiences and actions of the primary character involved; a list of other persons/characters (nurses, staff, patients, etc.) involved, including their roles and previous actions that led to the scenario outcome(s); and future actions the primary character may take to address the situation, as well as evaluation criteria for determining the effectiveness of these actions. This information may be presented in a concept map or narrative form, or in any form of the student’s or group’s choosing. A concept map template has been provided below. A narrative template begins on the next page.

Concept Map Template:

Narrative Template

Primary Character:

Primary Character Actions:

Secondary Character(s):

Secondary Character(s) Actions:

Scenario:

Additional Assessment or Other Data:

Primary Character Interventions:

Evaluation Criteria and Expected Outcomes:

Answer 1

Primary character: Beth, the home health nurse

Secondary characters: Mrs.Shawn, dementia patient, and her husband Mr.Shawn, staff at day centre, general practitioner

Being a home health nurse, Beth have taken care of many patients with dementia and Alzheimer's disease. As a nurse who regularly interacts with such patients, she learnt the proper ways to communicate with them. She knows that communication and how a person interacts with people who have dementia is vital to patient care outcomes. The idea is to give the patient the chance for independent thinking without overwhelming demands. This gives them control and minimizes frustration or anxiety.

One evening, she had received a call from Mr.Shawn, who had asked for a home health nurse after his wife, Mrs.Shawn recently had a violent episode in which he attempted to calm her down, but was in vain.

Jess found out that Mrs.Shawn is a 72 year old American woman with dementia. She has been residing in her own home, a two story terrace house, in a small suburban neighborhood for almost 40 years. She lives with her 75 year old husband, Mr. Shawn.

Beth's clinical notes written by her community mental health nurse states that she was diagnosed with dementia 12 years ago. Dementia is a brain disease that causes problems with memory, thinking and behaviour. Symptoms usually develop slowly and get worse over time, becoming severe enough to interfere with daily tasks .Her husband, Mr.Shawn, has been her main carer ever since. She attends a day centre once a week and has carers coming in twice a week to assist with personal care. The staff at the day centre has also reported that Mrs Shawn now showed no interest and was reluctant to comply with activities which showed that she had lost sense of pleasure.

Mr Shawn stated that before the diagnosis, there were several episodes when Mrs.Shawn got lost and was picked up by police to be returned at home. She became disorientated about where she was because of her dementia, and was confused about time. She will also miss her doctor’s appointments.She couldn’t even remember her son’s names, later on recognise her husband and would lose track of conversations.Mr Shawn stated that he made an appointment then to see the general practitioner who then referred them to the memory clinic where she was diagnosed with dementia.

Mrs Shawn is at high risk of experiencing falls. She has reduced awareness of the left side of her body and her ability to plan and process information has also been affected.  

Jess will assess patient’s ability for thought processing every shift, observe patient for cognitive functioning, memory changes, disorientation, difficulty with communication, or changes in thinking patterns. Changes in status may indicate progression of deterioration or improvement in condition.

Jess will then assess level of confusion and disorientation. Confusion may range from slight disorientation to agitation and may develop over a short period of time or slowly over several months. So, assessing the level may indicate effectiveness of treatment or decline in condition.

Jess will also demonstrate techniques to the patient and husband on how to improve memory. She will educate the Mrs.Shawn about using the call light for help and utilize the bed/chair alarm.

She will encourage the patient to be independent in activities of daily living. It is also good to provide opportunity for social interaction, but to do not force interaction. This will help prevent isolation, but forcing interaction usually results in confusion, agitation, and hostility. So, forcing should br avoided.

Jess's goal is to patiently work with Mrs.Shawn during this period. For caregivers,it may be an undoubtedly overwhelming experience. But, Jess has learnt to imagine how the patient must feel. Jess thinks that she has to be in their world, because they are no longer in ours. Their reality is real, and for others to say it is not will certainly cause a distress behaviour at some point.