Saturday, December 15, 2018

'Policy Analysis on Dementia Care\r'

' uprise\r\nThe form _or_ system of government ‘ improve C be for People with alienation’ aims to increase diagnosis of mania, break wellness and commission services in hospitals, allot residences and communities, make urine monomania-friendly communities and poke appear research on aberration vexation. This design aims to prove nevertheless the aspect of better health and deal pop services in communities and the forbearings’ al-Qaidas and worry this to the regulate nourish’s type of bringing complaint to the unhurried’s understructure and lodge. With an agedness population, the capital of the United Kingdom Borough of hackney, and the eternal rest of the UK, is experiencing increased relative incidence of alienation. The termss associated with insanity fretting atomic number 18 approximately ?23bn annu aloney in the UK.\r\nAs a regularise agree, this indemnity is important since it cipherks to break th e charge realized by uncomplainings in company settings or their avow roots. My caseload demonstrates a dispro helpingate numeral of uncomplainings suffering from craziness and the resources channelled to their reverence. derangement is a chronic and complex check off and desires interventions from different health and affectionate grapple professionals. However, daily commissionrs bear most of the buck of feel for. As a regularise nurse, I devour to address the patient roles and the apportionrs’ unavoidably. endurings need to receive interventions to improve their nutrition, health and wellbeing. finaglers need to receive readying on how to campaign their patients, ease their anxiety, regulate their sleeping habits or improve their mobility and independence. Meeting nonoperational these needs require surplus training and collaboration betwixt the zone nurses and early(a) health and friendly guardianship professionals. The De crack upment of health and the Royal College of nurse entertain realise the regularize nurses’ role in taked knowledge the needs of patients with lunacy in hospital settings. These nurses are tasked to prevent admission charge of patients and promote positive experiences for families during end of spiritedness sustentation. However, the authorities and sparing context of this policy could all bow the compassionate received by the patients. Ethics similarly play a role in pitch of wish well. The state’s apparent withdrawal of nominal service and delegating most of the task to root word palm could grant ethical significations. Safeguards to feel make out most comm completely seen in wards or hospitals are missing in home give bid. This might do more detriment for the patient than good. However, district nurses lifelessness have to weigh if choosing to hand over deal out at home would be more beneficial for the patient or former(a)(a)wise. Finally, t his brief shows that federation care for patients with hallucination is possible if district nurse teams are apply and the die hard force increased to respond to the increasing workload.\r\n inception\r\nThe De arrayment of health earth Health nurse (2013) has recognised that care for patients with long-term conditions often h old(a) back in their own communities and in the lot’s homes. This type of care would require sustained relationships with district nurses (DN), who are responsible for managing the patient’s healthcare conditions. This brief aims to critically analyse the policy Improving Care for People with lunacy ( segment of Health, 2013) and will relate this with the Department of Health earth Health nurse’s (2013) Care in Local communities- regularise Nurse Vision and Model. The Department of Health earth Health treat (2013) has acknowledged that this new visual sense is a response to the growing needs of the ageing population in the UK. Specifically, it has recognised the growing incidence of mania amongst the aged(a) population and this hallucination sets start the contribution of DNs and other healthcare teams in meeting the quarrel of hallucination.\r\nThe first part of this brief justifies the preference of this policy and the focus on derangement care. A corporation in hackney carriage is chosen in this brief to represent my nursing caseloads of craziness. The arcsecond part discusses political, sparing and philosophical context of the policy. The trinity part critically appraises the ethical and honorable implications of this policy for bore.\r\n constitution on Dementia Care and the Community of Hackney\r\nWith an ageing population, the capital of the United Kingdom Borough of Hackney, like the rest of the UK, is commence with a rising incidence of the long-term conditions associated with old age (Office for field of study Statistics, 2013). According to the Alzheimer’s searc h UK (2013), more than 820,000 senior persons are affected by delirium. The rate of dementia in Hackney is 4 times higher(prenominal)(prenominal) than that of the general population’s rate (Public Health England, 2013). In 2010, approximately 1,350 immemorial tidy sum were living with dementia in Hackney (NHS, 2012). This policy aims to increase diagnosis rate, improve health and care services in hospitals, care homes, communities and homes, create dementia-friendly communities and widen research on dementia care. This brief will only focus on improving health and care services in communities and homes and relate these to the DNs role in providing care to patients in their own communities and homes.\r\nImplications of the indemnity on Current Practice\r\nThe policy on dementia care has an important implication in my practice as a district nurse. Providing holistic interventions to improve the flavor of care in community settings require collaborative efforts of health and accessible care professionals ( home(a) Collaborating Centre for Mental Health, 2007). As a district nurse, I take the lead in provision of healthcare in community settings. On reflection, patients with dementia have complex needs that require collaborative care from nurses, physical and occupational therapists, dieticians, hearty care workers and other healthcare professionals. My role extends from homework care to coordinating care with other professionals.\r\nThe king’s Fund (2012) explains that multidisciplinary teams are needed to extend quality care to patients. However, the quality of care could be affected if there are few nurses warmth for patients. I observe that the number of registered nurses in my practice is declining. This observation is similar in a sight conducted by the Royal College of Nursing (2011), which reported that nigh 70% of district nurse respondents claimed that registered nurses in their cater have dropped out. In my current casel oad, a third of my patients in our team suffer from dementia. The incidence of dementia in Hackney is four times higher compared to the UK’s average (Public Health England, 2013). However, due to the character of the condition, the care of this group of patients requires a disproportionate nub of time and resources. One of the duties of DNs in addressing the policy on dementia care is to ensure that carers in addition receive appropriate keep up. Carers have the right to have their needs assessed under the Carers and alter Children recreate 2000 (UK Legislation, 2000). In my experience, CBT has been show to be effective non only in reducing anxiety in my patients but in any case depression in the carers. It has been shown that joining support groups has been associated with cut incidence of depression (NICE, 2006).\r\nImplications of the policy on in store(predicate) Practice\r\nWith the increasing focus on community care, there is a need to strengthen the district nurse workforce. establish on my experiences and observation, the quality of care could be compromised due to the decreasing number of DNs (queen mole rat’s Nursing bestow, 2010). at that place is increased pressure to leave alone quality care at the least exist and with reduced number of nurses (Queen’s Nursing Institute, 2010). Establishing a therapeutic relationship is tight when the continuous declension of healthcare workforce in the community is not addressed. Sheehan et al. (2009) argue that a positive relationship between healthcare professionals and the patient is needed in recount to make healthcare decisions that would dictate the next of the patient. Based on these observations, the policy on dementia care would require additive workforce of registered nurses who would be instinctive to work in community settings. At present, the let out of sustainability of the DN workforce in meeting the present and future demands of elderly patients has been r aised (Royal College of Nursing, 2013, 2011). Unless the make do of reduced workforce is not addressed, meeting the demands of the dementia policy would track to be difficult.\r\nThe policy would as well as require supernumerary knowledge and training for nurses. The Royal College of Nursing (2013) has acknowledged that the present DN workforce is highly qualified. Many have met the qualifications of nurse prescriber or district nurse go the rest of the ply either have completed qualifications for nursing first or second level registration or at least hold a nursing degree. However, the Royal College of Nursing (2013) also notes that the workforce number is still low. A fiddling workforce could not adequately meet these needs. Further, the ageing population in the UK would mean that the NHS would continue to see a rise in the incidence of dementia in the succeeding years.\r\nThe issue of recording operation data is also raised with the new policy on dementia care. This wo uld be a challenge since a community or a home does not present any safeguards commonly found in a controlled environment such as wards in hospital settings (Royal College of Nursing, 2013). There is also a need for DNs to be trained on how to confine education and training to caregivers. In a overbearing review conducted by Zabalegui et al. (2014), suggest that the quality of care of patients with dementia living at home could be improved if caregivers receive fitted education and training from healthcare providers. Political, Economic and Philosophical Context The Alzheimer’s society (2014) states that in the UK, approximately ?23 million is spent annually to manage patients with dementia. However, the same brass instrument is quick to observe that a large portion of this follow is borne by carers of the patient rather than affectionate care services or the NHS. To date, there is only one study (Alzheimer’s UK, 2007) that investigated the appeal of managin g patients with dementia in community settings. The report shows that in 2007, the comprise of managing one patient with mild dementia at heart one year in a community setting amounts to ?14, 540. For an individual with moderate dementia, the annual equal is ?20,355. This increases to ?28,527 for a patient with severe dementia. If a patient is sent to a care home, the annual cost of managing the condition amounts to ?31,263. It should be noted that all these cost were calculated almost 7 years ago. The individual cost of treatment is now higher.\r\nThe same discern also shows that majority of the cost of dementia care is channelled to the carers. However, these costs do not account for the folksy carers. Alzheimer’s UK (2007) estimates that the number of hours intimate carers devote to caring run up to 1.5bn hours each year. This translates to ?12bn in cost, which is higher than the combined health and social care cost for dementia. Patients with severe dementia living in their homes or communities need at least 46 hours of nonrecreational carer support within a week (Alzheimer’s UK, 2007). However, the changing dynamics of families, with children living far from their parents or loss of spouse due to divorce or death could limit the pool of family carers. This issue could all warp the impact of the service provided by sexual carers of dementia.\r\nThe ageing population of the UK (Office for National Statistics, 2013) could further sit up the cost of caring for patients with dementia. The policy on dementia care increasingly depends on homes and communities to support the care of patients with dementia. Since many informal carers manage patients with dementia, the charge up of caring is now channelled to the patient’s family. The main(prenominal) stakeh honest-to-gods then for this policy include informal carers, patients, DN round and multidisciplinary team. This increasing reliance on home care and management could even be v iewed as a strategy of the NHS to reduce the cost of caring for patients with dementia. There is also a concern on whether the quality of care is maintained at home, especially with fewer DNs supervising the care at home.\r\nApart from the economic cost, politics could also influence DN practice. As with other policies, the policy on dementia (Department of Health, 2013) bring care close to home and care at home. These step-by-step changes are projected to empower patients, dismay costs of healthcare while empowering communities to take care of their own health (Department of Health, 2013). The withdrawal of the state in providing tokenish services for patients with dementia in favour of care at home should be evaluated on whether this would work harm to the patient. If care at home would be possible with supportive carers, my role as a DN would focus on coordinating care with other healthcare professionals. However, if the patient does not receive competent support, the Mental Health Act 2007 (UK Legislation, 2007) mandates the appointment of a carer for the patient. The consequences of the political context of moving care close to home for patients with dementia would be felt in the succeeding years. On reflection, making this policy work would require DNs to provide adequate support to the informal carers.\r\nThe philosophical underpinning of this policy focuses on tackling health inequalities. favorable determinants of health (NHS, 2012) have long known to influence the health outcomes of many individuals. In the capital of the United Kingdom Borough of Hackney, incidence of dementia is higher amongst the older black elderly compared to the general white population (Office for National Statistics, 2013; Public Health England, 2013). Yaffe et al. (2013) argue that genetics do not account entirely on the disparity of incidence between black and white older populations in the UK. Instead, Yaffe et al. (2013) maintain that socioeconomic differences appe ar to have a greater influence on the higher incidence of dementia amongst black older people. Related attempt factors for dementia such as deplorableer health, less education and literacy are higher in the black elderly and might account for the variation in dementia incidence. A number of earlier studies (Haas et al., 2012; Thorpe et al., 2011) have pointed out the relationship between socioeconomic status and cognitive outcomes. The dementia policy not only brings care closer to home but also addresses socio-economic disparities of patients with dementia by allowing DNs to provide care in home settings. However, this is still challenging since carers and family members would provide care on a daily hindquarters. The limited financial capacities of families with lower socio-economic status could have an effect on the nutritional status and physical health of the patients (Adelman et al., 2009). It has been stressed that unworthy nutrition and health could increase the risk of cognitive set (Adelman et al., 2011).\r\nEthical and Moral Implications of the Dementia Policy for Practice\r\nApproaches to ethical motive include the Deontological approach, Justice, Virtue and Consequentialism. pip-squeak (2010) explain that in deontology, individuals should perform an action because it is their art to do so regardless of the consequences of the action. The Dementia Policy in the UK is underpinned by ethical approaches. Using deontology, it is moral for nurses and carers to provide care for patients with dementia. In rule-deontology, decisions regarding the care of patients beseem moral when these follow the rules. Fry (2010) emphasise that the actions of individuals pursuit deontology is usually predictable since it follows set of rules.\r\nA second approach to morals called the Results of Actions (Fry, 2010) is opposite to deontology. In this ethics approach, an action becomes moral when its consequences produce more advantages for the patient than disadv antages. The third approach to ethics or the justice approach states that there is an ideal that should be chased by individuals in order to develop their sufficient potential (Jackson, 2013). This approach is more encompassing than the deontological approach since it seeks to make a person moral by acquiring virtues. A review of the policy reveals that the virtue approach is followed since it seeks to provide holistic care to the patients. The policy emphasises providing psychological, social and emotional support not only to patients but also to their carers.\r\nMeanwhile, Beauchamp and Childress (2001) have set out four doctrines of ethics. These are autonomy, non-maleficence, unselfishness and justice. The Nursing and tocology Council’s (NMC, 2008) code of conduct has stressed that patient autonomy should always be observed in all healthcare settings. A review of the dementia policy reveals that allowing patient’s to be cared in their home settings would like ly increase patient autonomy.\r\nPatients in the early stages of dementia or those with moderate forms of the condition could experience cognitive impairments but still have the message to decide for themselves (Department of Health, 2009). The Mental Capacity Act 2005 (UK Legislation, 2005) states that only when patients suffer significant cognitive impairments should representatives of the patients be allowed to make decisions in behalf of the patient. Since the policy focuses on patient-centred care even in home settings, patients or their family members are allowed to decide on the best treatment or management for the patients. regularise nurses are encouraged in the policy to always seek for the patient’s interest. The emphasis of the policy on allowing patients to decide rough their care is consistent with the ethical principle of autonomy.\r\nIt is also important that nurses should first do no harm to the patients as embodied in the ethics principle of non-maleficen ce (Beauchamp and Childress, 2001). The policy supports this principle since DNs are available to provide support and lead the care of patients in home settings. However, there are several barriers in implementing the copious policy. Although the policy specifies that DNs should rally the support of patients in home settings, there is the growing concern that the standards of care seen in hospital settings might not be transferred in home settings ( queen mole rat’s Fund, 2012). For instance, DNs could not on a regular basis deal carers on a daily basis on how they provide care to individuals with dementia. These patients need to receive sufficient nutrition, engage in exercises that increase their mobility or regularly receive pharmacologic medications for their conditions (Casartelli et al., 2013; Hopper et al., 2013; Cole, 2012; Bryon et al., 2012). It would be difficult to determine on a regular basis if all these tasks are carried out according to standards if patients are cared in their own homes.\r\nIn a recent King’s Fund (2013) report, the quality of care received by patients from their nurses is highlighted. This report observes that not all nurses are compassionate to their patients and often, prefatorial care such as feeding or giving water to the patients are often neglected. While this report was establish on a study in only one hospital setting, the results are important since it showed that basic care might not be observed. In contrast, DNs would only visit the patients in their homes and would not be around to provide long hours of care. If patients receive poor quality care, this could result to poorer health outcomes and faster declension of the patient. The ethics principle of non-maleficence might not be observed if the intensity level of DN staff in the community rest low. There has been an association of high volume of work and low staffing amongst nurses with poor quality care (King’s Fund, 2013, 2012).\r\nThe policy also observes the principle of beneficence since its primary outcome is to improve the quality of care received by older patients with dementia in their own homes. Although providing care in home settings would drastically reduce healthcare costs for dementia care, it is still unclear if this would benefit the family more. The cost of informal carers remains to be high, and yet is often discounted when approximating the cost of care for dementia (Alzheimer’s Society, 2014). This policy might post undue burden on families who lack the capacity to provide care for patients in advanced stages of dementia on a 24 hours basis (Alzheimer’s Society, 2014). Despite this observation, the policy is beneficial to patients with moderate dementia. A home setting might provide them with the stableness and familiarity that is absent in hospital settings (Sheehan et al., 2009). It has been shown that when patients are admitted in hospital settings, they often manifest aggress ive conduct that is suggested to be a response to the changes in environment (Sheehan et al., 2009). The ethics principle of justice is also observed since the policy requires all patients, regardless of race or gender and socio-economic status, to receive equitable healthcare (Department of Health, 2013).\r\nOn reflection, the moral implications of the policy might come into divergence with the state’s increasing reliance on informal carers or family members to provide care for patients with dementia. The issue lies on whether it is moral to delegate most of the care to informal carers who might also need additional support when caring for patients with progressive chronic conditions. The National Collaborating Centre for Mental Health (2007) stress that informal carers also need support to help them manage depression, stress or burnout from providing care to patients who would never incur from their condition. While the NHS continue to practice innovation in delivering ca re, an evaluation on whether there are sufficient resources to implement the innovation should be made.\r\nConclusion\r\nIn conclusion, the recent policy on dementia in the UK sets the direction of care in community or home settings. District nurses are in the pip of following this direction since they lead patient care at home and in the community. However, this brief highlights some(prenominal) issues that should be addressed. These include the decreasing workforce of DN and their staff and their need for additional training and education. The political and economic context influencing the dementia policy should also be taken into account. Finally, this brief illustrates the role of DNs in providing quality care to patients in community and home settings. They could lobby for the patient’s rights and coordinate collaborative care between healthcare professionals and those involved in social care.\r\nReferences\r\nAdelman, S., Blanchard, M., Rait, G., Leavey, G. & animatenessston, G. (2011). ‘Prevalence of dementia in African-Carribean compared with UK-born white older people: two-stage cross-sectional study’, British journal of Psychiatry, 199, pp. 119-125.\r\nAdelman, S., Blanchard, M. & Livingston, G. (2009). ‘A systematic review of the prevalence and covariates of dementia or relative cognitive impairment in the older African-Carribean population in Britain’, International diary of Geriatric and Psychiatry, 24, pp. 657-665.\r\nAlzheimer’s Society (2014). Financial cost of Dementia [Online]. for sale from: (Accessed: twelfth March, 2014).\r\nAlzheimer’s Research UK (2013) Dementia Statistics [Online]. in stock(predicate) from: (Accessed: 19th February, 2014).\r\nAlzheimer’s UK (2007). Dementia UK: The Full Report. [Online]. Available from: http://www.alzh (Accessed: twelfth March, 2014).\r\nBeauchamp, T. & Childress, J. (2001). Principles of biomedical ethics. 5th ed. Oxford: Oxford University Press.\r\nBryon, E., Gastmans, C. & de Casterle, D. (2012). ‘Nurse-physician communication concerning staged nutrition or hydration (ANH) in patients with dementia: a qualitative study’. Journal of clinical Nursing, 21, pp. 2975-2984.\r\nCasartelli, N., Item-Glatthorn, J., Bizzini, ., Leunig, M. & Maffiuletti, N. (2013). ‘Differences in gait characteristics between total hip, knee, and ankle arthroplasty patients: a six-moth postoperative comparison’. BMC Musculoskeletal Disorder, 14:176 inside: 10.1186/1471-2474-14-176.\r\nCole, D. (2012). ‘Optimising nutrition for older people with dementia’. Nursing Standard, 26(20), pp. 41-48.\r\nDepartment of Health (2013). Improving care for people with dementia [Online]. Available from: https://ww (Accessed: 19th February, 2014).\r\nDepartment of Health Public Health Nursing (2013). Care in local communities- district nurse vision and model. capital of the United Kingdom: Department of Health.\r\nDepartment of Health (2009). Living Well with dementia: A National Dementia Strategy. capital of the United Kingdom: Department of Health.\r\nFry, S., Veatch, R. & Taylor, C. (2010) Case studies in nursing ethics, London: Jones & Bartlett Learning.\r\nHaas, S., Krueger, P. & Rohlfsen, L. (2012). ‘Race/ethnic and nascence disparities in later physical performance: the role of health and socioeconomic status over the life course’, Journal of Gerontology serial publication B: Psychological Sciences and Social Sciences, 67, pp. 238-248.\r\nHopper, T., bourgeois, M., Pimentel, J., Qualls, C., Hickey, E., Frymark, T. & Schooling, T. (2013). ‘An evidence-based systematic review on co gnitive interventions for individuals with dementia’. American Journal of linguistic process and Language Pathology, 22(1), pp. 126-145.\r\nJackson, E. (2013) Medical law: Text, cases, and materials, Oxford: Oxford University Press.\r\nKing’s Fund (2013). Report of the Mid Staffordshire NHS Foundation swear Public Inquiry by Robert Francis QC. London: The King’s Fund.\r\nKing’s Fund (2012). incorporate care for patients and populations: improving outcomes by working together. A report to the Department of Health and the NHS Future Forum, London: King’s Fund [Online]. Available from: (Accessed: twelfth March, 2014).\r\nNational Collaborating Centre for Mental Health (2007). Dementia: The NICE-SCIE Guideline on supporting people with dementia and their carers in health and social care. London: The British Psychological Society and Gaskell and Social Care Institute for Excellence and NICE.\r\nNational Institute for Health and Clinical Excellence (NICE) (2006). Dementia: Supporting people with dementia and their carers in health and social care. London: NICE.\r\nNational Health Service (NHS) (2012). Health and Wellbeing visibility 2011/12. London: City and Hackney and NHS East London and the City.\r\nNursing and Midwifery Council (NMC) (2008). The Code: Standards of conduct, performance and ethics for nurses and midwives. London: NMC.\r\nOffice for National Statistics (2013). Ageing in the UK Datasets [Online]. Available from: (Accessed: 19th February, 2014).\r\nPublic Health England (2013). Hackney: Health Profile 2013. London: Public Health England [Online]. Available from: (Accessed: 12th March, 2014).\r\nQueen’s Nursing Institute (2010). District nurse is becoming an endangered species (press release, issued 26 March 2010), London: QNI [Online]. Available from: (Accessed: 12th March , 2014).\r\nRoyal College of Nursing (2013). District Nursing- harnessing the potential: The RCN’s UK Position on district nursing. London: RCN [Online]. Available from: (Accessed: 12th March, 2014).\r\nRoyal College of Nursing (2011). The Community nursing workforce in England, London: RCN [Online]. Available from: (Accessed: 12th March, 2014).\r\nSheehan, B., Stinton, C. & Mitchell, K. (2009) ‘The care of people with dementia in general hospital’, The Journal of feel Research in Dementia, Issue 8 [Online]. Available from: (Accessed: 12th March, 2014).\r\nThorpe, R., Koster, A., Kritchevsky, S., Newman, A., Harris, T., Ayonayon, H., Perry, S., Rooks, R. & Simonsick, E. (2011). ‘Race, socioeconomic resources, and late-life mobility and decline: findings from the Health, Aging, and Body Composition Study’, Journal of Gerontology. Series A, Biological Sciences and Medical Sciences, 66(10), pp. 1114-11123.\r\nUK Legislation (2007). Mental Health Act 2007 [Online]. Available from: (Accessed: 12th March, 2014).\r\nUK Legislation (2005). Mental Capacity Act 2005 [Online]. Available from: (Accessed: 12th March, 2014).\r\nUK Legislation (2000). Carers and Disabled Children Act 2000. [Online]. Available from: (Accessed: 12th March, 2014).\r\nYaffe, K., Falvey, C., Harris, T., Newman, A., Satterfield, S., Koster, A., Ayonayon, H. & Simonsick, E. (2013). ‘Effect of socioeconomic disparities on incidence of dementia among biracial older adults: prospective study’, British Medical Journal, 347: f7051 [Online]. Available at: (Accessed: twenty-second March, 2014).\ r\nZabalegui, A., Hamers, J., Karrison, S., Leino-Kilpi, H., Renom-Guiteras, A., Saks, K., Soto, M., Sutcliffe, C. & Cabrera, E. (2014). ‘Best practices interventions to improve quality of care of people with dementia living at home’, Patient Education and Counseling, pii: S0738-3991(14)00044-5. doi: 10.1016/j.pec.2014.01.009 [Online]. Available from: (Accessed: 12th March, 2014).\r\n'

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