Latoya Mckie
Abstract
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There are numerous of behaviors to observer in a nursing home. Many of the behaviors are related to mental impairment, loss of memory or aliments such as dementia, delirium, Alzheimer’s disease and Parkinson’s diseases. A lot of residents have been diagnosed with aliments; these various mental impairment conditions are concurrent conditions which may overlap. In many cases the impairment gets misdiagnosed outside a nursing home care facility because normally people do not know the symptoms or trained to differentiate the diseases or conditions. Therefore, it is essential that the caregivers and all other professionals are knowledgeable and fully aware of the residents’ cognitive levels to effectively assist them with their daily living. Many seniors and family prefer to go to nursing home facilities due to personalized care seniors receive. It is also difficult for some seniors that are not in nursing home or retirement facilities or neighborhood that are not tailored to their needs.
Behaviors exhibited by the residents
I witnessed an array of behaviors at the nursing home, intern site. Most of the residents were energetic and full of life, despite their age. In the department that I mostly worked with consisted of people with memory loss. The group mostly was consisted of women, and had only two men. The women were all on different cognitive levels, but they all were well educated and lived successful lives in their younger age.
One of the residents use to be a school teacher, how seemed to lose her memory and it seemed to be very difficult for her to recall any activities she did earlier that day. She and I would do puzzles or art activity. On one occasion I asked her to sign the back of a sheet we were working on. An hour after she left went to her room and came back and could not recognize the picture as the one we both completed earlier although I showed her the back and explained to her that I assisted her to complete it that day. What I realized with her and other residents in that group is that although they had memory loss they were still very intelligent and able to complete mathematical computation when tested. It was also remarkable that most of the residents I worked with can recall early memories from their lives although they had a hard time recollecting what they did earlier that day.
There was also one lady who loved to listen to old music from the 60’s and classical music all day; she also walked around with a toy doll most of the day. This lady also never spoke much and not social with the other residents, she liked keeping to herself. The men on both sides of the facility did not come out much except for when they went to the dining area to eat, go to church services, exercise class or outings on the town. The residents were primarily engaged in fun activities and socials. They enjoyed having other people to talk to and having family member visiting them. A number of them were particularly concerned with their health and exercise most mornings, as a result the seemed more energized and happier than the residents who stayed in their rooms all day. I exhibited only two residents who seemed lonely. One of the two was always saying nobody cares about her and she is always walking around all day. At times the other residents look at her and regard her as a crazy person. The other lady who seems to be a loner has had her husband passed away recently, she seems to be sad at times, but she keeps herself occupied with engaging in activities and helping other residents who are on a lower cognitive and physical level than her.
Another female resident in the dining room that is always shaking; I believe she has Parkinson disease her behavior varies a lot with the day. She can start arguing for any reason, then nice the next minute. Nobody normally sits at her table at the dining area when it is time to eat. One day someone came in late and sat there and she started to curse the other lady out and the whole time she was shaking the table. Her hand shacking is so bad that most of the time she has to ask one of the dietary aides to assist her in pouring out condiments because she often makes a mess because she cannot control her hands from shaking due to her having Parkinson disease.
Explanation for the residents’ behaviors
Most of the residents in nursing home suffer from memory loss diseases such as dementia, Alzheimer’s disease and delirium. They also experience other ailments such as Parkinson’s disease. A significant proportion of this elderly population will have dementia (Hartwell, 2013). One in five people over the age of 65 has dementia. The number is expected to double every 20 years (Hartwell, 2013; Potocnik, 2013).
Dementia. Dementia is incurred mass impairment of a person’s memory, personality and intelligence who is normally attentive (Potocnik, 2013). It is adequately acute to interfere with social and occupational functioning. In the lack of a stroke or quickly growing cerebral tumors among other factors, the onset is normally progressive and the cognitive decay is always gradual (Potocnik, 2013). In the absence of a remedy for the disease, non-pharmacological concoctions and the careful use of pharmacotherapy may not solely aid the person and ease the stress on the caregiver (Potocnik, 2013). Residents with dementia almost always show neuropsychiatric symptoms (NPS), such as disturbances in mood with psychotic and vegetative symptoms among other spectacles.
Dementia affects a large portion of the senior population. Dementia of the Alzheimer’s type is characterized by memory impairment, the inability to learn anything new or recall information which was previously acquired, and one or more cognitive disturbances such as aphasia, apraxia, agnosia or executive function disturbances (Potocnik, 2013). The resident who could not recall the artwork she and I worked on earlier in the day suffers from dementia of the Alzheimer’s type.
Alzheimer’s and dementia is presents in 90% of seniors who expressed their feelings of being lonely or socially isolated (Wilson et al., 2001). The resident who was always walking around saying nobody cares about her suffers from dementia. The characteristic she exhibits was loneliness and isolation from the other residents. This explains why she might have developed dementia.
People with early Alzheimer’s disease can benefit from exercise. The hippocampus of the brain plays a vital role in memory (Birmingham, 2008). Brain scan research shows that seniors who are physically active have less brain shrinkage; while those who are less active have up to four times brain shrinkage (Birmingham, 2008). Therefore, exercise is important to counteract Alzheimer’s disease in the residents. The senior resident’s behavior to exercise is accepting. They like to engage in physical activities because they know it improves the way they feel, their physical health as well as their mental health.
Parkinson’s disease. The female resident who is always shaking the dining table and screaming at other resident for no reason has Parkinson’s disease. Parkinson’s disease is a gradual and degenerative neurological disease, one of a group of conditions called motor system disorders (Carruthers-Czyzewski & Dewar, 1998). The four primary symptoms are shaking or trembling in hands, arms, legs, jaw and face; firmness or rigidity of the limbs and trunk; bradykinesia or slowness of motion; and postural instability or impaired balance and co-ordination. As these symptoms become more prominent, patients have complexity walking, moving or accomplishing other regular activities. They may additionally experience migraines, joint pain, periodic respiratory problems, back ache, allergy symptoms, insomnia, mood swings, fatigue, distortion and chronic ailment such as digestive difficulties and arthritis.
Modified diet is helpful to seniors with Parkinson disease. Their diet typical includes chlorella, milk thistle, kyolic garlic, and vitamin C (Carruthers-Czyzewski & Dewar, 1998). I suspect that is they reason why the lady in the dining hall never misses meal time and she take her nutrition very seriously. Someone with Parkinson disease can also benefit from detoxification as her behavior is normally characterized as confused, fatigue and having mood swings (Carruthers-Czyzewski & Dewar, 1998).
Delirium. Delirium is a medical crisis characterized by severe onset and impulsive course that is displayed by incisive changes in a person’s cognitive level and function (Gillis & MacDonald, 2006). Symptoms includes allayed attentiveness of surroundings with diminished capability to focus or sustain attentiveness; changes in cognition; collapse of higher order functions; psychomotor changes varying from hyperactivity to hypoactivity; emotional turbulences; sleep/wake duration disturbances; nocturnal spasm; hysterical affect, mood and behavior; perceptual disruptions comprised of delusions and fallacies; paranoia; and multilayered etiology (Gillis & MacDonald, 2006). The lady who is always walking around at all hours has exhibits the characters of delirium. Although she is diagnosed as having dementia, people with similar behaviors can have delirium as well. Therefore, delirium is often misdiagnosed. Approximately 70 percent of elderly patients hospitalized have delirium although expert nursing care facilities typically are able to identify the symptoms (Gillis & MacDonald, 2006).
There are three classifications of delirium which are: hyperactive, hypoactive, and mixed. Hyperactive, also referred to as agitated delirium, is described as being anxious and delusion. Hypoactive delirium (quiet) is regarded as a declined sensorium or amplified sedation. The mixed delirium interchanges between the frantic and the sedated type. Nevertheless, no matter how it is exhibited, delirium may be difficult to distinguish, as it can be multifactorial and easily mixed up with dementia, restfulness, and near-death awareness. In many circumstances, delirium is reversible, thus careful assessment is necessary (Rogers, 2006). Judicious nursing observation of a resident’s capabilities to execute activities of daily living can reveal much about the resident’s mental level. A variety of assessment tools are available. A common tool is the Confusion Assessment Method (CAM) (Inouye et al., 1990), which takes about five minutes to conduct, it is steadily reliable and is appropriate in a number of settings, including acute care (Rogers, 2006). .
Aging Typical alters the body’s ability to metabolize medications, tally to the threat for drug reactions. Although any medication may add to delirium in seniors, sedatives, antipsychotics, histamine receptor antagonists and anticholinergics raise the risk for delirium (Hanley, 2004) (Rogers, 2006). Furthermore, seniors have body fat percentage is higher and lower water which effects the fat-soluble drugs by being more concentrated and lasting longer (Rogers, 2006).
Environmental adjustments should encourage optimal cognitive functioning, a realism between calmness and activity and consistent nursing care. A numerous of environmental modifications decrease the risk of delirium incidences and facilitate resident independence such as: maintaining the physical surroundings constant and sustain routines, allowing conformity of staffing for accurate assessment of the resident’s health status and continuous patient care, including family in care and having orientation done often to promote a good perception of well-being. Visits should be declined if hyperactive delirium appears to be onset by the visits, use volunteer sitters if family members are not available. Avoid bedroom changes whenever possible, Use a no-restraint or least-restraint procedure to reduce deterioration of cognitive loss. Remove unnecessary hospital devices, such as urinary catheters and IV pumps. Make sure that the call bell, personal items, glasses and hearing aids in easy reach. Encourage the use of personal items, such as pillows and bed set, to promote familiarity and reduce stress. In addition Have the rooms well-lit, sustain room temperature between 21.1 C and 23.8 C. and diminish noise levels on the nursing unit.
Why people go to nursing home
Seniors with mental ailment frequently have complicated needs because of the many co-complex needs because of disability, physical illness and social issues (Reynolds et al., 2000). Effective evaluation of long-term and multiple issues may be long-term and multiple problems may be particularly complex without standardized approaches intended at inclusive and methodical assessment of needs. However, certain needs are proposed to be `collective to all humans in general (Maslow, 1954), diverse areas of the population will have more specific kinds of need (Reynolds et al., 2000).
Isolation is a difficult problem; the solutions need to be individualized (Owen, 2007). Even seniors who have a widespread social network of friends and family are at jeopardy of being isolated. Anything can easily happen; a senior can slip or fall, loss of their hearing or sight (Owen, 2007). They can also lose a loved one which can completely diminish their self-assurance in and cause conflicts in doing their daily activities. Over a period, social isolation and loneliness can bring on depression and withdrawal. This can also cause an intense drop of self-esteem and confidence (Owen, 2007). Active effort is needed to support seniors to discover the solutions to their social isolation and rejoined with their friends and family socially. Many senior engage in going to day centers, lunch clubs and home visiting services as they provide them with vital way to interact with other people (Owen, 2007).
Caregivers and family often resort to nursing home facilities because of the time, cost and stress dealing with an elderly whose memory has deteriorated. Some seniors might feel neglected by their families. Some may exhibit low self-worth as a result of being alienated by their family. Caregivers and family often resort to nursing home facilities because of the time, cost and stress dealing with an elderly whose memory has deteriorated. Some seniors might feel neglected by their families. Some may exhibit low self-worth as a result of being alienated by their family.
Some seniors also live in the assisted living section of the nursing home because they want to feel secure as the age that someone is there to help them if they need assistance with anything whether it is health needs or social ones. Living in regular communities tends to make life complex as local services for the seniors might not be available. Most nursing home facility offers numerous benefits such as companionship, availability of services tailored to the seniors, access to around the clock heath care and numerous activities.
Benefits of Internship and Supervision
Completing the internship course provided a guideline on what I should expect and what should expect to gain from my experience from the intern site. The supervision I received from the intern supervisor and workers were great. They were very detailed in what I needed to get done and how to carry out the task most of the time. Other tasks were self-explanatory.
Recommendations for future interns and professionals in the setting
I believe education is always good. I think it is especially important when it is to benefit others. Therefore, it is imperative for healthcare professionals and other workers in the nursing home facility to be educated and current on all the new advancement that can benefit the elderly such as therapeutic techniques, and other health related advancements. It is also good to know all safety procedures when in a nursing facility like wearing protective gloves, how to properly disguard hazardous objects, and wearing proper shoes for your safety.
The only drawbacks as an intern was not being able to do as much activities as I would have hoped, but that was fine. I assumed senior residents liked to do things they are accustomed better than trying new activities. Although it is not my choice, I would incorporate some new activities for the senior residents who are more active. It seems that all the people who work with the residents are fully aware of their conditions and know how to deal with them. Therefore, I assume they are educated on their mental disorders and cognitive level.
Personal Growth Experienced
The internship has opened my eyes to all that goes on in a nursing home. Before going in to complete my internship, I thought that the operation of running a nursing home was easy. After having arrived, and starting to get in the routine I found out it was not so easy after all. There are numerous residents to care for with different kinds of needs. It is also challenging to get everyone where the need to be and having a variety of activities to cater to each individual’s preferences. That is also the case with almost everything with these residents from their dietary needs to their religious services. Everything has to be done in a multiple or diverse way to ensure everyone is catered to, and their needs are meet.
I thought overall I had an enriched experience at the nursing home site. What I have gained from this internship is to be patient, how to multitask and use my time wisely. I also have learned to take initiative and to be a team player, helping out in whatever way I can in order to make things run smoother at the worksite. With the exposure I received I think I am now capable and comfortable working at a health care facility or similar setting.
References
Birmingham, K. (2008 ). Exercise slows Alzheimer’s progression. Nursing Older People, 20(7), 4. Retrieved from http://go.galegroup.com
Carruthers-Czyzewski, P., & Dewar, J. (1998). Seniors’ health: Parkinson’s disease.CPJ.Canadian Pharmaceutical Journal,131(3), 34. Retrieved from http://search.proquest.com
Gillis, A. J., & MacDonald, B. (2006). Unmasking delirium. The Canadian Nurse, 102(9), 19-24. Retrieved from http://search.proquest.com
Hartwell, H. (2013). Dementia.Perspectives in Public Health,133(3), 134. doi:10.1177/1757913913485334
Owen, T. (2007). Working with socially isolated older people.British Journal Of Community Nursing,12(3), 115-116. doi:10.12968/bjcn.2007.12.3.23038
Potocnik, F. C. V. (2013). Dementia. South African Journal of Psychiatry, 19(3), 141. Retrieved from http://go.galegroup.com.
Reynolds, T.,Thornicroft, G., Abas, M.,Woods, B., Hoe, W., Leese,M., & Orrell, M. (2000). Camberwell Assessment of Need for the Elderly (CANE): Development, validity and reliability BJPsych 176, 444-452. doi:10.1192/bjp.176.5.444
Rogers, S. K. (2006). Delirium in the Home Care Setting. Home Healthcare Nurse: The Journal for the Home Care and Hospice Professional, 24(6), 366–367. doi:10.1097/00004045-200606000-00006
Wilson, R. S., Krueger, K. R., Arnold, S. E., Schneider, J. A., Kelly, J. F., Barnes, L. L., & Bennett, D. A. (2007). Loneliness and Risk of Alzheimer Disease. Archives of General Psychiatry, 64(2), 234. doi:10.1001/archpsyc.64.2.234
