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Nursing people with dementia: the triangle of care

As many as seven-out-of-10 acute hospital beds are occupied by older people, and some 40% of those patients will have dementia (RCN, 2013). While acute general hospital settings are often not conducive to the needs of people with dementia (Alzheimer’s Society, 2009), nurses who offer compassion and person-centred care can – and do – make a difference.

Here are just a few of the ways you can help improve the lives of people with dementia, as well as their carers and families.

Find out about the person

Person-centred care is something every nurse strives to deliver, but in the case of people with dementia, it should be a priority.

‘Firstly, remember that each individual is different and their disease progression will vary,’ says Dawne Garrett, RCN’s Professional Lead for Dementia and Care of Older People.

‘Find out as much as you can about the person – make reference to family and friends and encourage use of documents such as “My Life” or “This is Me.”

These documents let health care professionals know about the needs, interests, preferences, likes and dislikes, of the person with dementia, so that you can quickly get a picture of the person and learn about the things that are important to them.

While forms play a part, speaking to the person and their carers and family is most important.

Tommy Whitelaw became a full-time carer for his mother Joan, from her diagnosis of vascular dementia in 2007 until her death in September 2012. He now campaigns to raise awareness of dementia and its impact on families.

Sadly, Tommy didn’t feel that his mother received person-centred care.

‘Nobody ever asked me who my Mum was,’ he says. ‘Nobody ever asked me what made her smile, what made her cry, what made her feel safe, what made her feel scared.

‘How can you care for someone from a diagnosis and an evaluation form? That engagement, that inclusion, partnership, kindness and understanding has to be there.’

Triangle of care

The Triangle of Care, originally developed for use in mental health services, is now being used to support a partnership approach to dementia care, particularly in hospital settings.

The Triangle of Care for Dementia recognises that the involvement of carers can lead to better care for people with dementia. In an ideal situation the needs of the carer and the person with dementia are both met.

‘Carers often possess crucial information as a result of their close relationship and contact with the person with dementia. Their early involvement will help provide the most accurate assessment on which to plan treatment and care,’ says Dawne.

‘Nurses need to be aware of and welcome the valuable contribution carers can make and be mindful of carers’ own needs as well as the needs of people with dementia. Understanding the carers’ perspective requires listening empathetically to their experiences and concerns and knowing how to respond.

‘You should never assume that by talking to the carer that you don’t need to talk to the person with dementia, both need to be included,’ adds Dawne.

Let carers know they’re doing a good job

Tommy provided personal care for his mother for two years because he couldn’t be guaranteed the same core people to care for her.

‘For the first six weeks, I bathed my mum with my eyes closed; I’d fill the bath up with bubbles so that just her head would stick out, to give her dignity.

‘One day, the district nurse came when I was in the middle of bathing Mum. I couldn’t stop crying because I didn’t really know what I was doing, and someone was going to see that I didn’t know what I was doing. The district nurse showed me how to bathe my Mum with dignity, she helped me lift her, she helped me get her on the bed, and dry her.

‘After, she sat me down and put her arm around me and told me I was doing okay. No one had ever said that to me, no one had showed me how to do these little things, and no one had reassured me. When she left, I had my chest out again, knowing I could bathe my mum as long as she needed me to.

‘That wasn’t a strategy or a policy. That was the kindness and understanding of another human being.’

Every five-minute conversation counts

People living with dementia and their carers can often feel lonely, isolated and afraid. How healthcare professionals engage with them is crucial.

Tommy says: ‘We had a big family but our life and chance to be part of a community was replaced by loneliness and isolation when Mum became ill. Most interactions we had over the years were when we visited a clinic, or a podiatrist, or the hospital, or when someone came to visit concerned with my Mum’s health. In between that, it was just the two of us.

‘The interactions we had with people were absolutely crucial. They’re not just about those 15 or 20 minutes – each meeting would decide what the next month or two would be like for us.

‘When a person like the district nurse walked out the door, we’d be lifted up and have the strength to carry on. When it went the other way, it knocked us back down.

‘People make such a difference – every word, every five-minute conversation has the ability to change someone’s life.’

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