A lady in her 83 years called Carmen is hospitalized after a severe urine infection. She was diagnosed of Alzheimer disease 8 years ago. She is a transgender lady that transitioned 29 years ago (she was one of the first transgender surgical interventions in Spain). She is also HIV positive and had problems with drugs more than 35 years now. She is going to be hospitalized to be treated with intravenous antibiotics. Now you have to perform the “getting to know me” questionnaire in order to know more about the person that is going to be admitted in the hospital and explain how her process will be within a dementia-friendly hospital.
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? Do you think this could be possible? Would you include any metrics?
• How would you refer to the patient? What sort of legal and ethical aspects would you keep in mind?
• Could you figure out the complexity of this case in terms of clinical, organizational, social and cultural aspects?
TOPIC
Compassionate care for older population
PREBRIEFING
In this session we will see how Carmen (an older transgender lady) is hospitalised due to a urine infection that has caused her a difficult situation at home and has complicated her health due to the chronic diseases she is experiencing.
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 multipathologies 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. Moreover HIV has been related with dementia in scientific literature. Knowledge of its causes and consequences can help to improve disease management. The nurse has the opportunity to directly influence the patient’s and other healthcare staff 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. However, this hospital is dementia-friendly and counts with a dementia care pathway that includes as a first step once the person is known to live with any type of dementia, that the healthcare staff needs to perform “getting to know me” questionnaire. Thus, it is easier to work with the patient and family from a compassionate care and person-centred care perspective approach.
REFERENCES, MATERIALS FOR CLASSES
- Wasserman, I. C., & McNamee, S. (2010). Promoting compassionate care with the older people: a relational imperative. International Journal of Older People Nursing, 5(4), 309-316.
- Smith-MacDonald, L., Venturato, L., Hunter, P., Kaasalainen, S., Sussman, T., McCleary, L., … & Sinclair, S. (2019). Perspectives and experiences of compassion in long-term care facilities within Canada: a qualitative study of patients, family members and health care providers. BMC geriatrics, 19(1), 1-12.
- National Institute of Care Excellence (2018) Dementia: assessment, management and support for people living with dementia and their carers.
- Alzheimer Scotland (2018) Getting to know me.
- 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.
- Tolson, D., Holmerova, I., Macrae, R., Waugh, A., Hvalič-Touzery, S., de Abreu, W., … & Hanson, E. (2017). Improving advanced dementia care: an interprofessional Palliare learning framework. Journal of the American Medical Directors Association, 18(7), 561-563.
- Riquelme-Galindo, J., & Lillo-Crespo, M. (2021). Developing a dementia inclusive hospital environment using an Integrated Care Pathway design: research protocol. PeerJ, 9, e1
- 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), 9296.1589. Brew, B. J., & Chan, P. (2014). Update on HIV dementia and HIV-associated neurocognitive disorders. Current neurology and neuroscience reports, 14(8), 1-7.
- Brew, B. J., & Chan, P. (2014). Update on HIV dementia and HIV-associated neurocognitive disorders. Current neurology and neuroscience reports, 14(8), 1-7.
- Valcour, V. G., Shikuma, C. M., Shiramizu, B. T., Williams, A. E., Watters, M. R., Poff, P. W., … & Sacktor, N. C. (2005). Diabetes, insulin resistance, and dementia among HIV-1–infected patients. Journal of acquired immune deficiency syndromes (1999), 38(1), 31.
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.
INTRODUCTION
A transgender lady being 83 years old and called Carmen has repetitive episodes of urine infection and at the emergency room the nurse that is following up the patient needs to perform the “getting to know me” questionnaire in order to know more about a person with dementia. She has been attended recently in different hospitals though this one has just implemented a dementia-friendly initiative. Thus, there are many actions towards adapting the setting and actions to the person living with dementia. This hospital also counts with a dementia care pathway and the first step after knowing that the patient is going to be hospitalized is to know more about him or her. The nurse is asking questions to Carmen and her caregiver (who is a Latin American non-professional caregiver) in order to know more about the following items. As soon as the nurse ask her from her sons, she disclaims that she does not want any visit from her sons as they only want her heritage and because they do not accept her (for being transgender). After performing this questionnaire in a very familiar way in an isolated room from noise, the nurse realizes of the amount of information she was missing from the patient as it was the first time she was performing the “getting to know me” questionnaire.
CURRENT CLINICAL CONDITION
Carmen is a 83-year-old transgender lady who lives alone in a rural area. She became a woman 29 years ago being one of the first transgender surgeries in Spain. Her caregiver knows her from 4 years now when Carmen’s male couple died. She was diagnosed of Alzheimer disease 8 years ago. Carmen has two sons from a previous relationship (when she was a man and had not transitioned yet). She has other diseases such as diabetes and hypertension, well managed at this moment with oral and subcutaneous medication. Her caregiver is living with her. She is also HIV positive in a stable situation. She has been rehabilitated from drug addiction more than 35 years now.
INTERVIEW
The student should analyze the patient situation and caregiver situation and know more about the patient in order to guide the rest of the team that will manage her during hospitalization. Through this questionnaire the nurse will be able to identify critical issues that will help nurses and physicians better manage Carmen during hospitalization, making her more comfortable in a dementia-friendly environment.
