An 82 year-old lady called Carmen is hospitalized after a severe urine infection during Covid Pandemic. She was diagnosed of Alzheimer disease 7 years ago and she has been under control in a mild phase of Alzheimer’s disease. During her hospitalization, she is disoriented and her condition of living with Alzheimer was not taken into consideration in the emergency room. Thus, her medication for Alzheimer disease was discontinued for 5 days and she is fluctuating between agitation and disorientation states and sleep due to the current prescription. You are part of a Neurology specialist team that evaluates and orientate general practitioners in order to identify potential unmet needs.
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 communicate with the older person in this case?
• What sort of improvements would you make to overcome the situation lived by the older person by taking the caregiver into account?
• What documents would be necessary either to create or to identify in this situation?
• Who (other professional staff) would you include into this situation?
• What type of knowledge would you connect with this situation (from a clinical, organizational, in terms of communication and attitude perspective?
• Have you missed any professional intervention that you may apply in your own context?
• How do you think this situation occurs in other cultures/countries? Would you include any metrics?
• Could you reflect about how this situation described happens in your own country and health system? What are the main ethnic groups living in your country? Where do they come from? How this situation would have been in those cases? What information about their cultural characteristics do you have? Is this information based on scientific or qualitative evidences?
• How do you think this situation occurs in other cultures/countries? Any scientific evidence that could support your decisions?
• Could you think of any type of social support that you could recommend to Carmen and her daughter in your country? Any Norms or Legal aspects related?
TOPIC
Interprofessional collaboration in pharmaceutical care with older population
PREBRIEFING
In this session we will see how Carmen is hospitalised due to a urine infection that has caused her a difficult situation at home.
We are aware that the probability of living with any kind of dementia increases from 65 years old. 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, It is something that usually occurs with people that live with dementia. Knowledge of its causes and consequences can help to improve disease management. 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. However, conditions of people with dementia are not usually taken into consideration when they are hospitalised by other reason such as urine infection. During this scenario, the student should help a team in order to adapt pharmaceutical and non-pharmaceutical intervention to the person living with Alzheimer.
REFERENCES, MATERIALS FOR CLASSES
- European Directorate for the Quality of Medicines & HealthCare, EDQM (20112) Pharmaceutical Care. Policies and Practices for a Safer, More Responsible and Cost-effective Health System.
- e Baetselier E,Van Rompaey B, Batalha LM,et al. EUPRON: nurses’practice in interprofessional pharmaceutical care in Europe. A cross-sectional survey in 17 countries. BMJ Open 2020;10:e036269. doi:10.1136/ bmjopen-2019-036269.
- De Baetselier, E., Dilles, T., Feyen, H., Haegdorens, F., Mortelmans, L., & Van Rompaey, B. (2021). Nurses’ responsibilities and tasks in pharmaceutical care: A scoping review. Nursing Open.
- Dijkstra, N. E., De Baetselier, E., Dilles, T., Van Rompaey, B., da Cunha Batalha, L. M., Filov, I., … & Sino, C. G. (2021). Developing a competence framework for nurses in pharmaceutical care: A Delphi study. Nurse Education Today, 104, 104926.
- Pacquiao, D., & Purnell, L. (Eds.). (2018). Global applications of culturally competent health care: guidelines for practice. Springer International Publishing.
- 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.
- Lillo-Crespo, M., & Riquelme-Galindo, J. (2018). Case Study: Culturally Competent Strategies Toward Living Well with Dementia on the Mediterranean Coast. In Global Applications of Culturally Competent Health Care: Guidelines for Practice (pp. 215-220). Springer, Cham.
- Lillo-Crespo, M., Riquelme-Galindo, J., De Baetselier, E., Van Rompaey, B., & Dilles, T. (2022). Understanding pharmaceutical care and nurse prescribing in Spain: A grounded theory approach through healthcare professionals’ views and expectations. PloS one, 17(1), e0260445.
- Riquelme-Galindo, J., & Lillo-Crespo, M. (2021). Designing Dementia Care Pathways to Transform Non Dementia-Friendly Hospitals: Scoping Review. International Journal of Environmental Research and Public Health, 18(17), 9296.
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.
- Ability 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.
INTRODUCTION
An 82 year-old lady called Carmen is hospitalized after a severe urine infection during the Covid Pandemic. She was diagnosed of Alzheimer disease 7 years ago. During her hospitalization, she is disoriented and her condition of living with Alzheimer was not taken into consideration at the emergency room as she arrived with an ambulance and the communication with her daughter has been always by telephone. Thus, her medication for Alzheimer disease was discontinued for 5 days and she is fluctuating between agitation and disorientation states and sleep due to the current situation. Each day and shift the patient is attended by different nurses and physicians in an internal medicine in-patient hospitalization unit. Suddenly the team managing the patient realizes of her condition of living with Alzheimer as the daughter, tired of communicating by telephone (as she is not allowed to enter the Hospital) to the staff that her mother is missing her Alzheimer medication, decides to write a claim in the client support station. After that, the current internal medicine team performs an exhaustive anamnesis identifying missing medication that was not prescribed and other needs that were not met from Carmen such as following some of her daily routines while she is living at home (in an low income urban area). The current internal medicine team wrote an inter consultation to the Neurology unit in order to adapt the care and medication prescription guideline. Afterwards, the Neurology team (physician and nurse) visits Carmen, allowing her daughter to be present and the internal medicine team in order to build a new plan based in Carmen’s current situation. Carmen and her daughter are Latin-Americans and do not count with support from the state in order to cover some treatments required for Dementia. They arrived in Spain illegally 10 years ago. Her daughter is worried because it seems Carmen’s Alzheimer Disease phase is worsening and an accident could occur at home.
CURRENT CLINICAL CONDITION
Carmen lives alone in an urban low income area. Her daughter is the main caregiver. She was diagnosed of Alzheimer disease 7 years ago. She has other diseases such as diabetes and hypertension, not too well managed at this moment with oral medication that she skips as she forgets to take the medication by her own. Currently she was found at home where she lives alone with high temperature, not oriented and dehydrated. Her daughter called the Pre-emergency services and Carmen was transferred to the Hospital alone as the daughter was not allowed to go with her due to Covid restrictions.
INTERVIEW
The student should analyze the patient situation, caregiver situation and organize with the specialist team she or he is part the new guideline to be followed in order to adapt the pharmaceutical and non-pharmaceutical prescription to Carmen needs and current status.
