Exploring the Usefulness of a Recovery-Based Approach to Dementia Care Nursing
Gavan, Joan, Contemporary Nurse : a Journal for the Australian Nursing Profession
Exploring new approaches to dementia care nursing is vital to enable services to cope with the expected rise in demand for healthcare due to an ageing population. A comparison between the current person-centred care approach in aged care and recovery-based approach that underpins mental health nursing was reviewed in the literature to determine which is more useful to dementia care nursing. The recovery model is the conceptual framework that underlies the recovery-based approach. It broadens the current person-centred care approach through the fostering of hope, facilitative rather than directive care, and enhances autonomy. This promotes positive outcomes for older people with dementia through empowerment to make choices in the way they wish to live within the community. This essay proposes that the recovery-based approach is more useful to dementia care nursing than person-centred models.
Keywords: dementia; nursing; attitudes; diagnosis; recovery; person-centred care
In Australia the population is ageing, with a projected increase from 230,000 in 2008, expected to rise to 465,000 in 2030 and to over 730,000 in 2050 (Access Economics, 2009). As a consequence of this, there is expected to be a significant rise in the number and proportion of people with dementia (Access Economics, 2009). This raises the prospect of an increased demand for healthcare services (Access Economics, 2009). Dementia has now been recognized as a major health concern and a national health priority. Initiatives are now being taken to research effective approaches to prevention, management and service provision to people with dementia (New South Wales (NSW) Department of Health, 2006).
Dementia is a chronic, progressive condition that causes a decline in multiple areas of cognition such as memory, judgment, communication and ability to carry out activities of daily living (NSW Government, 2010). Behavioural and psychological symptoms of dementia (BPSD) include depression, psychosis, agitation, aggression, disturbed sleep patterns, disinhibition and apathy (Lowery & Warner, 2009). Up to 90% of people with dementia will display distressing BPSD which often precipitate admission to a residential aged care facility (RACF; Crombie, Snell, & Boyd, 2008). In a RACF, a lack of specialist care results in disempowerment and diminished quality of life for the person with dementia (Lowery & Warner, 2009). Disempowerment results from stereotypical attitudes that surround old age and have led to marginalisation of older persons, and those with dementia suffer a double blow (Clarke, 2005).
Marginalisation renders persons with dementia as a silent, invisible and vulnerable population, thus preventing their needs from being acknowledged or addressed adequately (Collier, 2005). This presents the challenge of finding new and innovative ways for services to respond effectively so that people with dementia can live life to their fullest potential. Older Persons Mental Health (OPMH) is a service that has been designed to respond to the needs of older people with dementia, and other mental illnesses. Nurses working in OPMH are in a position to seek and implement ways to effectively meet the needs of older people with dementia, and reduce demands on healthcare services.
APPROACHES TO DEMENTIA CARE
Services to people with dementia in mainstream health are primarily concerned with the personcentred care approach, while mental health services promote a recovery-based approach (Adams, 2010). This approach broadens the person-centred approach through the fostering of hope. It is an underlying concept in the recovery model that underpins mental health nursing (Caldwell, Sclafani, Swarbrick, & Piren, 2010). In the recovery model, hope is fostered within a therapeutic relationship by the optimistic pursuit of empowerment for persons with dementia. This enables elderly people with dementia to make choices and enhance positive aspects in their lives. …