Knowledge And Altitude On Care Of Patient With Damentia In Warri Central Hospital

Description

ABSTRACT

Approximately 3.2 million hospital stays annually involve a person with dementia, leading to higher costs, longer lengths of stay and poorer outcomes. Older adults with dementia are vulnerable when hospitals are unable to meet their special needs.

We developed, implemented and evaluated a training program for 540 individuals at 4 community hospitals. Pre-test, post-test and a 120-day delayed post-test were collected to assess knowledge and altitude of health workers on care of patient with dementia. This study was conducted in Warri Central Hospital.

The mean age of the sample was 46y; 83% were Caucasian, 90% were female and 60% were nurses. Upon completion, there were significant gains (p’s <.001) in knowledge and confidence in recognizing, assessing and managing dementia. Attendees reported gains in communication skills and strategies to improve the hospital environment, patient safety and behavioral management. At 120 days, warri central hospitals demonstrated maintenance of altitude.

TABLE OF CONTENT

TITLE PAGE

APPROVAL PAGE

DEDICATION

ACKNOWLEDGEMENT

ABSTRACT.

TABLE OF CONTENT

LIST OF ABBREVIATIONS

CHAPTER ONE

INTRODUCTION

• BACKGROUND OF THE STUDY
• AIM OF THE STUDY
• STATEMENT OF THE PROBLEM
• OBJECTIVE OF THE STUDY
• SIGNIFICANCE OF THE STUDY
• RESEARCH QUESTIONS
• SCOPE OF THE STUDY
• RESEARCH HYPOTHESIS
• DEFINITION OF TERMS.

CHAPTER TWO

REVIEW OF RELATED LITERATURE

• CONCEPTUAL FRAMEWORK
• THEORITICAL FRAMEWORK
• SIGNS AND SYMPTOMS OF DEMENTIA
• CAUSES OF DEMENTIA
• PREVENTION OF DEMENTIA
• MANAGEMENT OF DEMENTIA
• MEDICATIONS FOR DEMENTIA
• HISTORICAL BACKGROUND OF DEMENTIA
• GROWING DEMOGRAPHIC OF DEMENTIA

CHAPTER THREE

METHODOLOGY

• INTRODUCTION
• STUDY AREA
• RESEARCH DESIGN
• POPULATION OF THE STUDY
• INSTRUMENT
• SURVEY CONTENTS
• SURVEY METHODOLOGY
• STATISTICAL METHODS

CHAPTER FOUR

RESULT ANALYSIS

4.1.     RESULT ANALYSIS

4.2      DISCUSSION

CHPATER FIVE

CONCLUSION AND REFERENCES

• CONCLUSION
• REFERENCES

QUESTIONNAIRE

CHAPTER ONE

1.0                                                        INTRODUCTION

1.1                                           BACKGROUND OF THE STUDY

Alzheimer disease (AD), the most common cause of dementia affects over 5 million Americans.¹ In addition to cognitive and functional decline, AD and related dementias triple healthcare costs for individuals over age 65^2,3 and leading to increased morbidity and higher mortality.³ Studies suggest between 19–76% of patients with dementia are hospitalized 1.5–2 times per year.⁴ Using Medicare data, it is estimated that 3.2 million hospital stays involved a person with dementia in 2000, suggesting that up to a quarter of hospital stays of elderly persons were patients with dementia.⁴ In 2000, 9% of Medicare beneficiaries had at least one claim with a diagnostic code for AD (ICD-9: 331.0) or some other form of dementia, and these same individuals had three times more hospital stays than the average stays for all Medicare beneficiaries.⁵

The prevalence of dementia among persons discharged from acute care hospitals ranges from 4% to 27%.⁶ Current evidence reveals higher rates of hospitalization⁷ and levels of co-morbidity among patients with dementia than among cognitively intact patients,^8–12 with falls and behavioral problems being frequent causes of admission.¹³ AD and related disorders may be poorly recognized in community settings and if unrecognized may serve as a trigger for a host of undesirable adverse events upon hospitalization, including falls, unintended injuries, deconditioning, malnutrition, incontinence, nosocomial infections, over- or under-medication, and adverse responses to medications, leading to poorer outcomes.^6,14–17 Management of symptoms, particularly pain,¹⁸ is compromised, and disruptive, unsafe behaviors are common and often untreated.¹⁹ Thus, dementia appears to be associated with significant increases in functional disability, number of hospitalizations, lengths of hospital stay, rates of nursing home admission and death and health care costs.⁶

Given the aging population and the risks of dementia with increasing age, hospital staff can expect that the number of elderly persons presenting with memory problems in addition to medical and/or surgical problems when hospitalized will also increase. Dementia increases the burden of acute care systems and is associated with excessive use of nursing resources, higher complication rates, and longer stays.²⁴ Older adults, as well as their families and caregivers, are thus particularly vulnerable to systems of care that either do not recognize or are unable to meet their special needs.

Here we present the development, implementation and evaluation of a program entitled “Dementia-Friendly Hospitals: Care Not Crisis.” This program targeted nurses and other direct-care staff (social workers, pastoral care, discharge planners, physical therapists) working in hospital settings to provide them with information and resources to allow them to better care for patients with dementia from admission to discharge planning. The impetus for this program came out of the recognition that many of the Helpline calls received at the Alzheimer’s Association St. Louis Chapter dealt with the poor outcomes of hospital visits for patients with dementia.

most of the 850,000 people who have dementia in the UK live at home with their families (Alzheimer’s Society, 2014), and the difficulties associated with dementia mean nurses often respond to requests for support and advice from family carers. At the same time, nurses in all settings often have to manage patients’ co-existing health problems and assist with personal care.

Although most people with dementia live independently or with minimal sup- port, around a third live in care homes (Alz- heimer’s Society, 2014) and, while nurse education places high value on the attitudes and skills needed for best practice, this has not always been reflected in the care pro- vided on the ground. This series aims to provide an up-to-date guide to dementia and dementia care for nurses in any setting.

1.2                                                     AIM OF THE STUDY

The main aim of this work is to ascertain the level of knowledge and altitude of health worker (nurses and doctors) on the care of patients with dementia, using Warri Central Hospital as the case study.

1.3                                           SIGNIFICANCE OF THE STUDY

This study is important in that it focuses on the nurse’s role in managing dementia and highlights the importance of communication skills in providing high-quality care. It also discusses treatment options, such as medication and ensuring the patient’s nutritional needs are met, as well as the importance of dealing sensitively with behavioural problems that may mask pain or emotional difficulties. Finally, it explains how the care environment can make a huge difference to the lives of people with dementia, where aspects such as clear signage and assistive technology can contribute to dignity and quality of life.

1.4                                                   SCOPE OF THE STUDY

Dementia is a term for conditions that impact on the functioning of the brain. The National Dementia Strategy defined dementia as an “illnesses in which there is progressive decline in multiple areas of function, including decline in memory, reasoning, communication skills and the ability to carry out daily activities”.¹

Currently there is no cure for dementia, the focus of treatment is to slow the progression of the disease and enable the person with dementia to live well. Dementia is not a normal part of ageing, but the risk of developing dementia increases in old age.² The most prevalent form of dementia is Alzheimer’s disease, which accounts for 62% of cases. The cause of Alzheimer’s disease is referred to as plaques and tangles. Neurons within the brain develop abnormal amyloid plaques and their axons become tangled, preventing communication and eventually leading to the death of these cells.

Early signs of Alzheimer’s disease include problems with episodic memory, the loss of memory of past experiences, time and place. The disease progresses in a slow and steady nature, which is difficult to predict and is unique for each individual. Later stages include a wider disruption of a person’s functioning, reasoning, thinking, communication and visual perceptions.

 1.5                                             OBJECTIVE OF THE STUDY

The main objective of this study was to: ascertain the of the community knowledge and altitude towards emergency health situation in Warri Central Hospital. At the end of the study the students involve shall be able to:-

1. Ascertain the level of knowledge possessed by the health workers on care of patients with dementia in Warri Central Hospital
2. Determine the level of altitude/reaction/response of health workers on care of patients with dementia in Warri Central Hospital.
3. Ascertain the behavior of of patients with dementia in Warri Central Hospital

1.6                                             LIMITATION OF THE STUDY

Every research work require a thorough examination of the large pool of people and reading materials as it is a research that requires lots of one on one discussion from health workers of the hospital. This means that lots of questionnaires would be distributed the health worker of the hospital with questions designed to assess the level or number of patient with dementia. The above are the limitations of this research work namely the time constraints and financial inadequacies to cover wider grounds.

1.7                                                   RESEARCH QUESTION

This study is on knowledge and altitude on the care of patients with dementia in Warri Central Hospital, Delta State. To achieve this, the following specific research questions were asked.

• What are the levels of knowledge impacted on the health workers in Warri central hospital, Delta State.
• What are the levels of care the show on patient with dementia in the hospital?
• What is the strength of relationship between the knowledge and altitude of the health workers of the study?
• What is the level of knowledge and the altitude of the health workers of the study based on their levels of education, age and position in the hospital?

1.8                                                  DEFINITION OF TERMS

ALZHEIMER’S: DISEASE: A disability characterised by impaired memory & ability to learn new material, accompanied by a high level of stress and an acute sensitivity to the social & built environment.

ANOMIA: The inability to recall or recognise names of objects. As dementia progresses this problem intensifies and word substitutions are common. E.g. All 4 legged animals may be called a ‘dog’.

APATHY: Lack of interest, concern or emotion.

APP: Amyloid Precursor Protein. A large protein from which beta-amyloid is formed.

APRAXIA: The loss of the ability to carry out complex learned and familiar purposive movements. e.g. A dressing apraxia, difficulty in remembering the sequence associated with putting on clothes. e.g. putting a shirt on over a sweater.

ASSESSMENT: An evaluation of a person’s condition or personal needs to enable them to live as independently as is possible. Assessment is a process that is ongoing and is vital to therapeutic care & support of people with dementia.

AUTOPSY: A postmortem examination performed to determine the cause of death. Plaques & tangles, markers of Alzheimer’s disease are only visible following autopsy.

BRAIN: The centre of thought & emotion, responsible for the coordination & control of bodily activities & the interpretation of information from the senses. The brain has a number of lobes. Frontal, Temporal, Parietal, Orbito-Basal, related to different behavioural functions.

CHALLENGING BEHAVIOUR: Any type of behaviour deemed difficult to manage, harmful, potentially harmful, or disturbing to the person performing the action or to others. Such behaviour should be viewed as an attempt to communicate by the person with dementia.

DEMENTIA: An umbrella term for a range of symptoms which manifest a decline in intellectual functioning caused by a disease or other injury to the brain. The most common symptom involves loss of memory. From a psychosocial perspective dementia is a disability characterised by impaired memory & ability to remember, learn new material, a high level of stress & sensitivity to the social & built environment.

DEPRESSION: An abnormal emotional state characterized by feelings of worthlessness, sadness, emptiness, and hopelessness. When the primary diagnosis of the mental disorder is depression, it is potentially reversible but it may be extremely difficult to treat. It may be so severe that physical symptoms and symptoms of mental impairment (including short-term and long-term memory loss, confusion, delusions, and hallucinations) occur. When the symptoms of dementia appear but do not have an organic base, it is a pseudo-dementia. Depression is the most common pseudo-dementia. Alzheimer’s Disease and related disabilities, therapeutic drug use, and illegal drug use may all cause depression as a symptom of the primary condition.

DIAGNOSIS: The identification of a disease or condition by scientific examination of physical signs and symptoms, history, laboratory tests, and other procedures.

DRUGS: Aricept & Exelon are on the market since 1998 for use by people who have a mild /moderate level of dementia. Both work in a similar fashion, having an effect on one of the chemical pathways in the brain that is involved in storing memories. As dementia progresses, other pathways in the brain become involved so the effectiveness of the drugs becomes limited. The limitations of the drugs also relate to the fact that they do not directly affect the disease process; they are expensive and are not appropriate for everyone.

NEUROLOGICAL: Having to do with the nerves or the nervous system.

NEUROLOGY: The field of medicine dealing with the nervous system, composed of the brain and spinal cord with their cranial and spinal nerves.

NEURONS: Every single nerve contains bundles of nerve cells or neurons, i.e. the messengers of the nervous system. Each neuron consists of a control centre and fibres of varying lengths.

1.9      RESEARCH HYPOTHESIS

Hypothesis 1: There is significant need for developing good knowledge and altitude for health workers towards people with dementia

Hypothesis 2: There is no significant need for developing good knowledge and altitude for health workers towards people with dementia