Exploring the Usefulness of a Recovery-Based Approach to Dementia Care Nursing
Gavan, Joan, Contemporary Nurse : a Journal for the Australian Nursing Profession
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. Working within the recovery model encourages nurses to look for ways to provide more optimistic outcomes for people with dementia.
PERSON-CENTRED CARE APPROACH TO DEMENTIA CARE
Nursing in mainstream health employs a personcentred care approach to address the needs of older people. This approach is similar to the recoverybased approach in mental health nursing, in that it recognises the centrality and interdependence of the older person (Nolan, 2001). Implicit in the person-centred approach is the importance of partnership and trust between the nurse and older person. In dementia care nursing, personcentred care is supported by crucial elements that are encompassed within this approach.
Elements include valuing people with dementia and those who care for them, treating people as individuals, looking at the world from the perspective of the person with dementia, and a positive social environment in which the person can experience relative well-being (Brooker, 2009). …