PGDip mental Health Nursing (2yr) Unit Name: Mental Health, Wellbeing and Humanized Care in Later Life Credits: 20 Assignment Title: Written coursework assessment Feedback method: written/online Weighting of this assignment: 100% Intended Learning Outcomes being assessed: 1. Describe the potential impact of ageing on the wellbeing of an individual 2. Define dementia, and its meaning for the individual and their carer 3. Identify humanised approaches to the care of people with dementia 4. Demonstrate an understanding of fundamental nursing care skills 5. Explore strategies that help to support families and carers 6. Demonstrate an awareness of the ethical and legal issues surrounding people with dementia Overview of Assignment: Discuss the issues that affect people in later life in the context of the impact of ageing. Define dementia and discuss how it is experienced by the person and their family. Discuss humanized care and how it aims to improve the experience of care for those involved. Identify a care crisis and decide a plan to support the person with dementia and their family, identifying ethical and legal issues. Specific Marking Criteria • The person in your essay should be over 65 years old. Your discussion should focus on their understanding of their situation, including their social supports and whether the care offered to them was satisfactory to them. Relate the theories of humanized care and wellbeing to the person’s situation. Justify your selection of one aspect of wellbeing for deeper discussion. How do you understand the care provided to this person in terms of humanisation? Justify the aspect of humanisation you have selected for more in depth discussion. Tips for assignment: Split the assignment into three sections • Section 1: Discuss the issues that affect people in later life in the context of the impact of ageing and dementia. • Section 2: Define wellbeing and discuss how it is experienced by the person and their family. • Section 3: the care crisis (using the case study) to demonstrate humanized and ethical care Section 1: Discuss the issues that affect people in later life in the context of the impact of ageing and dementia. • In this section you are setting the context and demonstrating your understanding of the general issues that affect older people. We cover these in day one and two – so consider loss and bereavement, social isolation, co-existing conditions like physical health issues. • Then make the discussion more dementia specific. How many people are affected by dementia? What are the key issues if you have dementia and care for a person with dementia. Make sure you provide a definition of dementia. • Introduce the case study you are using here and tell the marker who the case study is. Do choose one of the case studies provided on day one. They are all real people from research studies. This enables you to focus on demonstrating your knowledge rather than having to explain who the person is and what is happening for them. Section 2: Define wellbeing and discuss how it is experienced by the person and their family • So in this section, refer to the work we covered in day two. Provide a definition of wellbeing. • Here you will be able to use two or three of Nussbaum’s capabilities and apply them to your case study. When you do so, you will be able to refer to literature about those specific issues in relation to the research that has been done – making your assignment evidence based. Section 3: the care crisis (using the case study) to demonstrate humanized and ethical care • In this section you are going to use Ledgerd’s work on care crisis (day two) to outline which care crisis potentially applies to your chosen case study. • Then, to demonstrate ethical care, you are going to describe interventions that you could agree that would help prevent the crisis. • Discuss the application of the mental capacity act to your case study – in particular how you would approach the assessment of mental capacity in this case. Further tips: • Identify your case study • Identify the capabilities • Identify the care crisis • Identify the issues for carers • Search the literature to find out and read widely about each topic that comes up • Ensure to use the provided academic journals and textbooks. Sources should be within the last 10yrs, 2010 – 2020 • Provide a detail analysis of the subject • Word count is 3000, but the 10% rule apply meaning 3300 word excluding references • Include page number in the intext citation and this should be in tune with sources referred. • Critical analysis of the subject Nussbaum’s capabilities: • Capabilities are central to the achievement of wellbeing. The idea is that if capabilities are enabled, then wellbeing is enhanced. • Nussbaum’s capabilities are intended to be global and universal – this means they can be applied to any group of people. • In this course, we are going to consider wellbeing and capabilities in the way that they apply to people with dementia. For example, take the Agnes and Nancy video. Consider how wellbeing is enhanced for Nancy and Agnes since their diagnosis of dementia. • Nussbaum’s capabilities will be useful in your assignment as you can apply two or three to your case study to consider how to improve their life. NUSSBAUM’S CAPABILITIES INCLUDE: • 1. Life – Able to live to the end of a normal length human life, and to not have one’s life reduced to not worth living. • 2. Bodily Health – Able to have a good life which includes (but is not limited to) reproductive health, nourishment and shelter. • 3. Bodily Integrity – Able to change locations freely, in addition to, having sovereignty over one’s body which includes being secure against assault (for example, sexual assault, child sexual abuse, domestic violence and the opportunity for sexual satisfaction). • 4. Senses, Imagination and Thought – Able to use one’s senses to imagine, think and reason in a ‘truly human way’–informed by an adequate education. Furthermore, the ability to produce self-expressive works and engage in religious rituals without fear of political ramifications. The ability to have pleasurable experiences and avoid unnecessary pain. Finally, the ability to seek the meaning of life. • 5. Emotions – Able to have attachments to things outside of ourselves; this includes being able to love others, grieve at the loss of loved ones and be angry when it is justified. • 6. Practical Reason – Able to form a conception of the good and critically reflect on it. • 7. Affiliation – A. Able to live with and show concern for others, empathize with (and show compassion for) others and the capability of justice and friendship. Institutions help develop and protect forms of affiliation. B. Able to have self-respect and not be humiliated by others, that is, being treated with dignity and equal worth. This entails (at the very least) protections of being discriminated on the basis of race, sex, sexuality, religion, caste, ethnicity and nationality. In work, this means entering relationships of mutual recognition. • 8. Other Species – Able to have concern for and live with other animals, plants and the environment at large. • 9. Play – Able to laugh, play and enjoy recreational activities. • 10. Control over One’s Environment – A. Political – Able to effectively participate in the political life which includes having the right to free speech and association. B. Material – Able to own property, not just formally, but materially (that is, as a real opportunity). Furthermore, having the ability to seek employment on an equal basis as others, and the freedom from unwarranted search and seizure. • Consider two or three of the capabilities that apply to your case study. • Justify why you have chosen those capabilities to focus on • Research the literature on the topics you have chosen in relation to dementia to find relevant research in this area CASE STUDIES: • Albert Albert was 84 years old and lived at home with his wife until he was admitted to hospital with a chest infection. Although he was medically fit for discharge he was unable to be discharged as his wife refused for him to return home. Albert was not diagnosed with dementia but had become increasingly confused as time went on and was worried about where he may go. With some discussion, eventually his wife agreed to have him back at home, but this was on the understanding that she was going to separate and divorce Albert, and that she refused to care for him. You are Albert’s CPN. There is a need to resolve the living situation for Albert. The options seem to be for him to have adjustments made to the house to help him while he remains there, so you refer to an OT. Albert’s wife is not keen on letting this happen as her preference is that he moves out so she does not have to care for him in any way, and to reinforce that it is him that has to move. You also ask Albert about moving out of the house and although he is refusing to move, you arrange some viewings of various properties including sheltered housing, and a residential care home. Albert is incandescent with rage when taken to the care home. On assessment his mental state is deteriorating, and h is low in mood and anxious. He is also forgetful at times. A case meeting is held and as Albert’s wife is refusing to move out of the house, Albert reluctantly agrees that he would look again at sheltered housing. When he knows what that costs he states he can’t afford it. Albert agrees to move into a rented sheltered housing complex for three months while the house is sold. Albert becomes suicidal and states that he just wants to die. He constantly states his disappointment with his family situation, and that he will kill himself. ON assessment he does not have a plan and had not taken any further action, but is clearly very unhappy. He has been prescribed antidepressants but refuses to take them. Albert has one son, Fred, who is supporting his mother. He says that they have had a terrible relationship all their lives and that he is not surprised that his mom has had enough of his dad, that he had treated her badly and that if he had been a better husband perhaps she would have looked after him. When you meet Albert’s wife, she has had a new lease of life, and describes being much happier with her life. She has arranged to move away to live closer to her son about 40 miles away. You continue to look after Albert, he refuses medications and appears to become more confused. When he is assessed for capacity he repeatedly states that life should not be like this for him, that he worked hard all his life to support his family and now they have abandoned him. He refuses to answer any questions. The outcome is that his capacity cannot be judged. His low mood is making his self-care more challenging and the next steps of care are to be decided. • JAMES AND SARAH James, 62, has early onset dementia which was diagnosed when he was 58. Sarah, has longstanding agoraphobia and is unable to go out of the house. She has also recently had treatment for cancer, and is in remission. Her physical health is generally poor. They live in a town centre in a two bedroom retirement flat that has a balcony and a cafeteria downstairs. They sold their home recently and moved in and are finding it great, although quite a change from before. James is very active and goes out every day to walk, fish and do the errands. He worked in the town and having recently retired, still pops in to see his colleagues when out and about during the day. He goes fishing at a local lake, and now needs help to do that, but will go with any willing volunteer. He keeps bait worms on the balcony, which he also tends to every day. Twice, James has got up and gone out at night. He has been given a GPS which he loves, as it means that someone can find him if he is lost when out. He does not mind getting lost, as he has always spent a lot of time out and figures nothing too bad will happen. The GPS means that Sarah can track him on her laptop, and she phones the police and they go and pick him up. She was worried last time as he was out in the student area at 1.30am on Thursday night and she thought there would be lots of drunk students about who would not understand what was happening to him. Previously he had got on public transport and been brought back by the police too. As well as going out every day, James continues to meet friends in the evenings, which he enjoys. Every Friday he meets an old friend at the pub. Their CPN ensures that he is taking the medications, and he participates in research which means that they see a psychiatrist regularly. The research is about early onset, and he is keen to make the future better for others. They have one son who lives in New Zealand and who they see every two years. James has been out to visit him a few times, but not recently. James and Sarah want to continue their lifestyle as long as possible, and stay together. They are really worried that James’ dementia may progress quickly as he really does not want to go into a home, but he does not want to be too much of a burden on Sarah either. He is also worried about Sarah as she is unable to go out and he does not know how she will cope if he can’t help her. • JEFF AND MARG Jeff and Marg live in a small house with many animals including three dogs, two cats and numerous guinea pigs and rabbits. Jeff is 75 and has been retired for some time with a small pension. Marg is 63 and works 30 hours a week as an administrator. Jeff has dementia, and requires supervision, but they cannot afford for Marg not to work. When you visit to see how Jeff is doing, you notice more animals have joined the household. In reply, Marg tells you that their daughter, Annie, died in childbirth last month. She is very distressed. They have taken the animals so that their son in law can manage the new baby and their other three children who are aged between 9 and 3. They live 30 miles way and it takes an hour to get there. Jeff is no longer able (allowed) to drive and Marg can’t drive so she feels like she is not able to help out enough. Jeff can see that Marg is distressed and tries to comfort her, but she pushes him away and becomes angry with him. You offer to see what help you may be able to get them through the Alzheimer’s Society volunteer scheme and to arrange a social care assessment. You agree that it would help them to have a person to supervise Jeff for her to have some time to go and help her some in law, or to have the children stay with them. Together you come up with the ideal plan which is time for Jeff on Saturdays and Sundays. Unless voluntary help is available, this is unlikely to be available from social care. When you investigate, no help is available at the weekends, so it is decided that the best way forward os for Jeff to go into respite care. Jeff is willing, although it is questionable whether he understands what he is agreeing to do. You complete a MCA and it is clear that he does not understand as he can not repeat the information back to you. In order to ensure his agreement, it is necessary to gauge his reaction when taken to the care home, and he is immediately upset, asking for Marg and to go home. The respite care is abandoned on the second day when he has not been able to settle. Marg has been to see the family and from their discussions decided her responsibility is to the children and asks for Jeff to move into a home permanently so that she can house two of the grandchildren for the foreseeable future. You have referred Marg to the GP to assist her with her grief by accessing counselling, and perhaps medication. Other assessments show Jeff has declined and, as he lacks capacity the move to residential care is planned. • SOPHIE AND RUSSELL Sophie and Russell live in Swanage in a large house with a swimming pool. Russell has early onset dementia. He is now 66 and was diagnosed at age 62. Russell worked as an executive, they have no mortgage and describe themselves as well off. Sophie used to be a teacher and guide leader, and is still active as a school governor. Their dream for their retirement was that they would travel extensively, and they have been able to do that for the past few years but this is getting ever more difficult for Russell. Sophie travels with friends sometimes, but leaving Russell is getting harder too. They have three children, one son in Australia, one daughter in London and one daughter who lives locally. The daughter who lives locally spends much time with them, and they support her financially so that she can help out. She has three children who spend a lot f time with their grandparents at the house and this makes Russell very happy. Russell takes antidementia medication, and tries his best to remain in good spirits. When you assess him however, you note that describes very high levels of anxiety, especially in social situations. He is afraid of looking foolish in front of others, and becoming more and more dependent. He is starting to revise whether he continues with some activities he does, such as going to a local golf club, as he is now just walking around with the other players as he has lost his coordination skills to join the game. They are very welcoming to him, but he feels increasingly out of place. Sophie has offered to accompany him to help, but he thinks this would change things too much. He is almost breathless when explaining this, and it takes him a long time to tell you about it. He is baffled at the way the dementia is affecting him. He can hold a good conversation but can’t dress himself. He can walk to the shops but finds it very difficult to use money. He is generally scared if he is out on his own. He asks you about how the dementia is going to progress, and seeks reassurances about his own abilities. You offer reassurance but are unable to predict the future. Russell and Sophie moved to Swanage from London a few years ago in preparation for their retirement and while they have made some friends and know lots pf people through Rotary, they are not sure they made the right choice. • VERONICA Veronica, 82, has dementia and is the matriarch of a large family. She is Jamaican and arrived in the UK in the 1950s. Veronica was a nurse at Bournemouth Hospital, where she led the medical ward for 30 years. She has seven children, and 16 grandchildren all of whom live close by. Her husband died 15 years ago. When you visit Veronica there is always someone with her. Usually this is one of her daughters, but increasingly her grandchildren frequently visit. She loves company and to have others around her. When anyone enters the house, she calls out ‘are you one of mine?’ She is generally in a pleasant mood most of the time, although her arthritis and pain in her back make her complain when she stands up. She walks around the house but finds it difficult to go out unless taken somewhere. Along with the frequent family visits, Veronica has help with personal care three time a day, gets meals on wheels five days a week and attends a day centre. When at the centre she takes charge of the place and begins to issue orders, which some of the other attenders find rude. She enjoys going there and takes part on all of the activities she can. The day centre manager contacts you about Veronica. She says that she feels Veronica is deteriorating, and that her dementia has taken a sharp downturn where she is much less able to remember and participate in activities. She raises a question hat has been bothering you for some time, and that is whether she is safe at home on her own at all. She is certainly a risk of falls and the centre manager says she has stumbled but not fallen there. She wonders in particular how she gets on at night and whether she is safe at home as she would be prone to letting anyone in who knocks her front door, believing as she does that everyone there belongs to her. You have expected that this would be raised at some point but have considered the impact that moving from home would have on Veronica and her family. Her family are adamant that they can provide the care she needs and that she will never have to move into a home. You have visited other people with dementia in the local area and wonder how those local homes would cope with such a large family presence. On assessment, Veronica has advanced dementia and is unable to make decisions about her future placement. Her vision is impaired, and she takes medication for her pain and heart conditions. Her daughter has power of attorney, and Veronica has made an advanced decision plan which includes staying at home. Submission Format 3000 words
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