It is a simulation of a current situation in which an old lady goes to one health organization (to the Nursing outpatient consultation room at her local Health Center for Primary Care in Spain) with one person (who is her main caregiver and family/social support in daily life: her daughter) to be taken a blood sample and then feels disoriented in an Nursing outpatient consultation room where signs and symptoms appear (such as emotional lability, crying, feeling upset and confused, feeling aggressive, disoriented in time and space). At this point the students should start reflecting about what is happening, what to do, and the specific knowledge to solve this situation should come up.
Remind the goals.
Emotion phase:
• Ask about the feelings during the exercise: first the patient, then the caregiver and then the nurse.
Fact phase
• What happened – describe what happened step by step?
• What went well?
• Feedback from observers on verbal and non-verbal interaction and critical activities.
Analysis phase
• Why specific decisions were made?
• How it should / could be done (ideas are generated by students, the tutor leads to the conclusions)?
• What to do to make it better?
• Students’ questions.
• What do you remember from the exercise (each student says 1 item – preferably everyone should say something different)?
• What should happen (select 3-4 items here that should always be discussed with students regardless of whether they happened or not)?
• Point out step by step what the students’ behavior should look like – exemplary.
• Motivate students to think reflectively while deceiving strengths and correct paths.
Cultural competencies/Social and Cultural aspects to reflect about:
At this point please reflect and discuss on the cultural similarities and differences with your context according to the items exposed at the general introduction of this document keeping in mind what “culture” and “cultural aspects” are.
• How would you act when facing one situation like this in a context like this? (Imagine you are working in Spain as a Nurse)
• Is this situation something that could happen in your country? How would the scene be in your context?
• What type of knowledge would you reflect about in this situation (from a clinical, organizational, in terms of communication and attitude perspective?
• Who (other professional staff) would you include into this situation?
• Are there any specific resources in your current context that could act as an enabler or as a barrier?
• Could you think of similar situations currently happening in your country and health system? What differences and similarities would you point out?
• Could you think of enablers that could improve this situation? What health determinants (risk factors and protective factors) are you identifying in this situation?
• Which social and cultural aspects could be affecting positively and negatively this situation?
TOPIC
Early detection of signs and symptoms related with cognitive impairment and mental health diseases
PREBRIEFING
In this session we will see how Carmen is taken a blood sample and experiences some signs and symptoms potentially related with diseases associated with aging that could make the audience think of: a potential mental health problem, maybe part of her chronic diseases or even a cognitive impairment.
We are aware that the probability of living with any kind of dementia increases from 65 years old and especially in family-based cultures in which older adults usually have family support. Also in some cultures older population has the assumption that “not reminding things” is part of the ageing process (this is very common in Spain). It is of high importance to be aware that patients with multi-pathologies might be accessing to healthcare facilities for some specific reasons although they can experience any of the signs and symptoms related to any of the other pathologies they are currently living with. It is something that usually occurs with people that live with dementia in countries such as Spain and especially in rural areas where families are reluctant to send their older adults to professional contexts for specialized care.
Knowledge about its causes and consequences can help to improve disease management and early detection. The nurse has the opportunity to directly influence the patient’s actions. For this to be effective, the acquisition of knowledge, skills and social competencies is essential. By completing this scenario, you will consolidate your knowledge and acquire the skills needed to care for disoriented people in early stages. In today’s simulation class, you will learn how to recognise signs and symptoms and carry out appropriate tests and measurements on a dementia patient.
REFERENCES, MATERIALS FOR CLASSES
- Small, G. W. (1998). Differential diagnosis and early detection of dementia. The American Journal of Geriatric Psychiatry, 6(2), S26-S33.
- National Institute on Aging.(2021) Basics of alzheimer’s disease and dementia. What is dementia?
- Lillo-Crespo, M., & Riquelme, J. (2018). From home care to care home: a phenomenological case study approach to examining the transition of older people to long-term care in Spain. Journal of research in nursing : JRN, 23(2-3), 161–177.
- Riquelme-Galindo, J., García-Sanjuán, S., Lillo-Crespo, M., & Martorell-Poveda, M. A. (2020). Experience of People in Mild and Moderate Stages of Alzheimer’s Disease in Spain. Aquichan, 20(4).
- Riquelme-Galindo, J., & Lillo-Crespo, M. (2021). Developing a dementia inclusive hospital environment using an Integrated Care Pathway design: research protocol. PeerJ, 9, e11589.
- Tolson, D., Fleming, A., Hanson, E., de Abreu, W., Crespo, M. L., Macrae, R., … & Routasalo, P. (2016). Achieving prudent dementia care (Palliare): an international policy and practice imperative. International Journal of Integrated Care, 16(4).
- Lillo-Crespo, M., Riquelme, J., Macrae, R., De Abreu, W., Hanson, E., Holmerova, I., … & Tolson, D. (2018). Experiences of advanced dementia care in seven European countries: implications for educating the workforce. Global Health Action, 11(1), 1478686.
PREREQUISITES
The student has the knowledge and ability:
- To know and to understand the experience of suffering from a chronic process (or disease) and living with dependency.
- To base the interventions of Health Sciences professionals on scientific evidence and available means.
- To lead, manage and work within a team.
- To establish evaluation mechanisms, considering scientific, technical and quality aspects.
- To apply the necessary methods and procedures in your field to identify health problems.
The student has the skills:
- To carry out nursing care techniques and procedures, establishing a therapeutic relationship with patients and their families.
- To select care interventions aimed at treating or preventing health problems and their adaptation to daily life through proximity resources and support for the elderly.
- To provide care, guaranteeing the right to dignity, privacy, intimacy, confidentiality and decision-making capacity of the patient and family.
- To individualize care considering age, gender, cultural differences, ethnic group, beliefs and values.
- To know palliative care and pain control to provide care that allleviates the situation of advanced and terminally ill patients.
- Goal setting with older patients.
INTRODUCTION
Carmen is a Spanish 75-year-old widow lady (she lost her husband 2 years ago) who visits one health organization (one health center for Primary Care) with one person (who is her main caregiver and family/social support in daily life: her daughter) to be taken a blood sample and feels disoriented (she doesn’t know where she is) within the Nursing outpatient consultation room.
CURRENT CLINICAL CONDITION
Carmen is a 75-year-old widow lady who lives currently alone in a rural area in her own home. Her daughter, who lives next to her, is her main caregiver and daily visits her. Her daughter has observed that Carmen acts differently recently but she is reluctant to send her mother to a Day-hospital or a Residential home or Care home. Carmen’s daughter has one brother (Carmen’s son) but the daughter assumes her role as the main caregiver as it is something culturally-based in Spain for women. Carmen has not been diagnosed with dementia yet. She has other diseases such as diabetes and hypertension, well managed until the moment with oral medication. Carmen’s daughter has observed that her mother’s memory is failing during the last months.
INTERVIEW
The student should analyze the patient situation and make decisions based on his/her current knowledge. During the situation, Carmen is calling by the name of her friend Antonia (who passed away two years ago) to her daughter. She is not even recognizing her own daughter and has reminiscence to the past and old memory.
