Dementia loss and behavioral problem by giving the

Dementia iscaused by pathological changes of brain cells. It is a degenerative brainsyndrome which affects one’s memory, comprehension, language, learning, calculationand judgment. Suitable activities for patients/residents with dementia not onlyhelp to delay their physical and cognitive decline, and enhance quality oflife, but may also improve their relationships with caregivers and relievecaring stress. Activities are common treatment modalities for patients/residentswith dementia. They can be in the form of individual, small group and largegroup.

Any group formed with two or more persons having the same treatment goalwhich may bring out group dynamics, is considered a therapeutic activity group.Through careful planning of meaningful and purposeful activities for patients/residentswith dementia, their physical, cognitive, social and functional abilities canbe improved. They may also gain a sense of satisfaction and abundance.

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RealityOrientation is a method of reducing confusion, disorientation, memory loss and behavioralproblem by giving the patients/residents different environmental cues so thatthey can master the important information such as time, person and place. When patients/residents are confused,getting them back on track as much as possible is a major part of their care.Reality Orientation is a technique based on the useful tool of repetition.Sometimes elderly people tend to withdraw from conversations as communicationbecomes more difficult. Try to draw them into conversation, using questions,pictures, or whatever may spark their interest. Ask only one simple question ata time, and allow time for response. First, get the patient/resident attention.

Always be patient, calm and kind. Speak slowly and clearly, using simple wordsand brief sentences. Allow time for processing information and response. Askquestions that can be answered with one word or gesture. Repeat and rephrase asoften as necessary. Repeat the person’s name often, and introduce yourself eachnew contact with the person. Repeat the day, date, and time often. Putcalendars and clocks where the person can easily see them.

Discuss familiarpeople, places, and events. Open the drapes during the day, and close them at night.Encourage the patient/resident to watch TV or listen to the radio. Maintain apredictable routine and be consistent.

Avoid changes don’t move the person’sbelongings or furniture. Encourage the person to enter social activity and donot permit them to isolate. Music can also be a very useful form of therapy, asit communicates with people on a non-verbal level. Music may stimulate memoriesof people, events, places and feelings.Observe and report resident’s levelof orientationMostof the time, nursing assistant spend their entire working time giving the careto the patients/residents. By doing that they observe the patients/resident andcan determine problems that needs to be solved as early as possible. Some ofthese problems need to be found out as early as possible to save thepatient’s/resident’s life.

It is necessary for nursing assistant to have theability to assess and observe changes in resident’s physical, emotional, mentaland social conditions. A patient/resident who might not be socializing wellwith others may have emotional problems or even deep depression thus noticingreporting it to the nurse can make a big difference in the resident’s outlookin life and well-being.Even if such changes maybe small, itis important to solve them early before they worsen and complicate thecondition of the patient/resident. Vital signs are equally important and shouldbe monitored vigilantly because a dramatic change might be a warning sign thatan infection, illness or depression is developing. Assessingthe patient/resident through his or her verbal statements without seeing aphysical sign is known as subjective assessment (SA).

SA confirms that there issomething wrong with the client due to its verbal signals, which can portraypain and emotional distress.You should keep in mind not to underestimate even the faintest signs of changebecause this can lead to devastating results in the residents’ healthconditions. Whenever in doubt follow your gut and intuitions based on theprevious encounters or experiences and perform a suitable course of action. Whencollecting important information regarding the status of resident’s health,keep in mind to immediately report a change in the resident’s present conditionto RN or supervisor. If unsure what the exact signs are, ask the patient torepeat himself/herself (subjective assessment) or measure/review the signsagain (objective assessment).

Physical changes can be usually seenin the skin in the form of lesions, bruises, rashes, swelling and others. Otherobjective signs that can be visually observed are body weakness, coughing,vomiting, mood changes. Documenting changes in patient’s/resident’s health isan important daily task and it requires skill, especially if the facility usescomputers and other devices in recording. The use of abbreviations should alsobe in accordance to the facility’s guidelines in using medical terms and abbreviations.If the facility requires observations to be written, use only blue or black inkin writing and print it in a way that they are clear, precise and complete. Allentries should be signed by the person documenting it and if corrections aremade then do it according to the guidelines of the facility. A resident’s/patient’s chart is a legalrecord, which has their medical information and condition, therefore do noterase or use an eraser in correcting them. To avoid such mistakes, youcan use first a scratch paper to serve as a draft.

To make sure that what youchart is correct and concise, you can get help from supervisors or nurses.Direct resident to recreational activitiesConsidera patient/resident who rarely sees family members and friends, and who has norelationships with other patients/residents in the facility. With whom can the patient/residentshare his/her feelings, stories and personal experiences? It is important thateach patient/resident has people to care about and people who care abouthim/her. Nursing assistance need to be aware of the importance of socialcontact in the lives of patients/residents. Whenever possible, interaction withother patients/ residents and with family members and friends should beencouraged. Such interaction can contribute to physical as well as mentalhealth. a nursing assistant should encouragesocialization among residents.

For some residents, adjusting to life ina personal care home can be very difficult, particularly when having limitedcontact with family members and friends. It is not always easy to make newfriends and adjust to new people, new stores, new food, new activities and anew routine. Some things a nursing assistant can do to encourage patients/residentsto socialize with one another: Introduce a new patient/resident to otherresidents. Introduce residents with shared interests. Promote activities in thepersonal care home. Constantly encourage and remind the patient/resident toparticipate in activities. Find and provide activities that the /residentenjoys. Talk with the patient’s/resident’s family and friends to find out moreabout his/her interests and hobbies.

Check the resident’s support plan forspecial interests. Encourage the patient/ resident to join interest groups,activity groups or social committees. Honor the patient’s resident’s rights tochoose activities.             A nursing assistant should payattention to the patient’s/resident’s abilities and interests. The more you getto know the patient/resident, the better you will be in recommending thathe/she participate in activities that match his/her interests. Find ways tosupport the patient’s/resident’s interests in various activities. Some staffpersons believe that their jobs are easier when patient’s/ residents are lessactive and not involved in activities. However, over the long run, the oppositeis the case.

An inactive, socially isolated patient/resident is more likely tobe dependent on staff attention and will miss out on the physical and mentalhealth benefits associated with being active with others. Nursing assistanthave an important role to play in terms of letting /patient/residents knowabout various activity options and in encouraging them to participate. Enlistthe support of the patients/ residents, other direct care staff persons, familymembers and community members in helping the resident to learn about and beable to participate in activities in the facility and in the community. Ensurethat the patient’s/ resident’s health and safety needs are met. A patient/residentmay be fearful of getting involved in a community activity due to concernsabout being able to get around, being able to take a rest when necessary andbeing safe.

Ensuring that the patient/resident will be safe and comfortable inthe activity is likely to increase his/her motivation to participate. Theactivities in which a patient/resident participates should be consistent withhis/her support plans.Orientresident and family to facility and roomWhenthe resident is admitted to a facility everything is new and unfamiliar. Thisnew environment is strange and frightening. In coming to the facility, thepatient/resident had to leave a home and a familiar environment. Also, theresident may have left the love and support of friends, a loving and faithfulpet, and pleasurable activities, such as gardening.

The decision to come to a long-termcare facility is a difficulty one It is not made easily. At the facility, thereis less freedom to come and go. Less responsibility for making simple decisionssuch as when to eat or what to eat. Less time alone, privacy, and fewer socialcontacts. The new patient/resident entering the facility may be sad andfearful. The nursing assistant may ne the first person the patient/residentmeets. Nursing assistants can make the patient’s/resident’s first impressionsof the facility more positive.

A friendly considerate, and caring attitude canhelp calm the patient’s/resident’s fears. An attitude of respect helps the newpatient/resident maintain self-esteem at a difficult time. the nursing assistantattitude can help make the patient’s/resident’s adjustment to his/her newsurroundings easier.Whenyou meet the resident, introduce yourself immediately.

Be cheerful, patient andsupportive. Understand that the resident needs time to adjust to his/her newhome. Let the patient/resident know you are there for them to help makeadjustment. Introduce the ne patient/resident to the roommate, if he/she hasone, explain the equipment in the room. Show he/she which items are theirs.Show he/she how to operate each piece of equipment.

Be patient. Thepatient/resident may be upset and not able to concentrate on what you aresaying. Always repeat information calmly. Give the patient/resident time tooadjust to their new surroundings. Always keep in mind that the patient/residentis in and unfamiliar place and may need encouragement. Change is alwaysdifficult.Whenadmitting a patient/resident was hands. Get everything you will need such asbedpan, urinal, emesis basin, and wash basin etc.

Fan-folded bed covers to thefoot of the bed if the new patient/resident is to be in bed. Leave the bedclosed if the resident will be up. Put the resident equipment away. Put gown orpajamas on the foot of the bed (it appropriate). Make sure room is meat.

Greet residentand introduce yourself to patient/resident and family members. Be certain youhave the right patient/resident. Check identification band. Ask resident how hewants to be addressed. Introduces resident to roommates.

Askpatient’s/resident’s family to leave room. Show them where they can wait. Tellthem when they can return. Tell them you will come to get them. Provideprivacy. Explain how call signals work and bed controls. Explain facility policies,such as visiting hours and mealtimes. Tell them about facility services available,such as activities, religious services, newspapers, library.

Explain how to usethe telephone, location of the bathroom and what you are doing to admit them.Ask patient/resident if there are any questions.Askpatient /resident to put on gown of pajamas if appropriate. Patient /residentmay want to keep their clothes on if permitted. Put all clothing in closet andpersonal items in bedside stand. Be sure that all personal items and clothingare identified and marked with the resident name. Check weight and height. Helpto bed if ordered put bed rails up.

If the patient/resident had valuables, makea list of jewelry, money and wallet. Have resident/relative sign the list.  Take and record vital signs. Obtain a urinespecimen if required. Complete admission checklist. Allergies, medication beingtaken, and food preferences and dislikes etc. Sign admission checklist. Prepareto leave the patient/resident and make sure the water pitcher is filled withwater.

Bed should be at the lowest level. Make sure bell is within reach. Makesure patient/resident knows how to use it. open privacy curtain. Tell thepatient/ resident after family leaves to answer any questions. Tell family theymay return to patient/resident room. Record information according to yourfacility’s policy. Wash hands.

(ShirleyA Badasch., Doreen S. Chesebro) Essentials for the Nursing Assistant in Long-termCareDuty F-ProvidingResident’s RightAssist resident inpersonal communicationsCommunicationis verbal and non-verbal.

Verbal communications are written and spokenlanguage. Non-verbal communications are body language, gestures, tone of voice,and facial expressions. Verbal communication can be hard for patients/residentsand the nursing assistant should be aware and alert for non-verbalcommunication to address the requests of each patient/resident.Patients/residents who speak a different language should be assisted with therequired needs.  Appropriate means couldbe a communication board or translator.

Patients/residentswill sometimes need help with personal communication tasks. A patient/residentmay ask a nursing assistant to open or read mail.  A patient /resident may ask you to write aletter of card due to a physical impairment. The nursing assistant must writeword for word what the patient/resident wishes and don’t edit or paraphrasewithout the patient/resident permission. A patient/resident may ask a nursingassistant to make a call for them. If asked, allow the patient/resident tomanipulate the phone as much as possible. A nursing assistant should assistonly when needed.

Before a nursing assistant assist with personalcommunication, make sure the tasks approved by the family and in the care plan.Demonstrateprofessional ethicsCodeof ethics is a set of guidelines, rules and standards for the proper care ofthe patients. These standards are prescribed by the nursing authority, andthese rules and regulations are obligatory to follow by all the nursingassistant while serving the patients/resident.

The importance of the code of ethics helps restore health of thepatients/resident. Eases sufferings of the patients/resident. Aids inpreserving life of the patient/resident.

Assists in maintaining andestablishing professionalism and high standards.It’sthe duty of a nursing assistant to serve all the patients/residents equally andprovide equal care. A nursing assistant should work towards improving thepatient health. They should not treat the patient/resident according to theirrace, age, religion, gender, medical condition. The nursing assistant is alsoresponsible for addressing the physical, emotional, spiritual and socialnecessities of the patients/residents.

Personal appearance ofthe nursing assistant is observed by the patient/resident each day. Yourhygiene and grooming should be at high level. Wear clean clothes and maintain aneat and clean environment. Your facial gestures and conduct also helps inearly recovery of the patients/resident. So, always have a smile on your faceand calmness in your behavior. A nursing assistant should betechnically prepared and must be attentive towards learning during in-serviceprogram to enhance and improve his/her technical skills.Anursing assistant should recognize his/her duties and responsibilities for allthe actions and activities. They should not work under the effect of alcoholand drugs.

Your personal accountability includes: Show promptness and arrive on time.Demonstrate honesty and display reliability. Work with a team, respect thecolleagues and maintain patient’s/resident’s confidentiality. Follow thework-related guidelines and exhibit professional behavior.

Theyshould follow the HIPPA (Health Insurance Portability and Accountability Act).The healthcare or nursing care professionals are not allowed to reveal thehealthcare information of the patient/resident to anyone. They can discuss thepersonal information only with the supervisors and caregivers, engaged in thecare of the patient/resident. All the information should be kept secured if thepatient’s/resident’s data or healthcare information is maintained on thecomputer. All the data including access codes, passwords and user names shouldbe protected according to HIPPA.  You are required to inform thesupervisor in case of breach of security.

  A nursing assistant must not beinvolved in altering the patient’s/resident’s record or falsifying it. Anursing assistant must provide the services to the patients/resident to thebest of his/her ability. A healthcare professional must pay attention towardsthe safety and welfare of the patients/resident. You are required to informyour supervisor in case the patient/resident care doesn’t meet the desiredexcellence standards.



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