Challenges for professional care of advanced dementia The research purpose of this study was clear, as it was intended to report on the challenges for health professionals in caring for people with advanced dementia living in long term care facilities. This study used a qualitative methodology based on action research. “Action research collects information from key stakeholders and provides ongoing feedback to participants, thereby facilitating change that improves practice. ” (Chang et al. , 2009, p. 42).
The essence of the study aimed to expose the challenges for key professional providers of care for people with advanced dementia. “Descriptions of these challenges provide professional carers and policy makers with insights into the unique needs of the person with advanced dementia”. (Chang et al. , 2009, p. 42) Participants were selected from professional providers in Australia from 2003-2006. All of the participants cared for patients with advanced dementia in their profession. They brought a comparative perspective to the success of the study.
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There were several focus groups compiled that included general practitioners, palliative care speciality staff, palliative care volunteer managers and volunteers, aged or dementia specialist health care professionals, and residential aged care facility staff. All participants were highly qualified with all having more than ten years experience in their field. The sample was non-random, interviewing 13 participants that were recruited from staff of 10 residential aged care facilities.
There was a total of 20 in-depth interviews. Within the sample, five of them large high care facilities, two medium-sized high care (51-74 beds), one small high care (< 50 beds), one medium sized low care (hostel) facility and one small low care facility. The Director of Nurses nominated the the staff for the interviews. “The sampling was purposive, with expertise in palliative dementia care of the selection criterion”. (Chang et al. , 2009, p. 43) The data collection process was adequately described.
It may have been beneficial with respect to gaining deeper personal insight, if the researchers had sought to answer more probing questions in the approach. The researchers used semi-structured questions with focus groups that lasted 1. 5-2 hours. The role of the researcher was to find question that were critiqued by an expert panel. The questions seemed to be based on pre-defined information given to the researcher agreed on by the panel. The information was gathered by interview questions in the focus groups. The uestions seemed to be based on pre-defined information given to the researcher agreed on by the focus groups. The ethical considerations of participants were followed using standard procedures and approved by area health service ethics review committee. Informed consents were used as well as anonymity of patients and participants. “The data analysis was by constant comparative method”. (Chang et al. , 2009, p. 43). They used five focus groups (total n = 24) and 20 follow-up individual interviews (Chang et al. , 2009, p. 41).
The concepts collected were organized and compared with other ideas that emerged from the data. Regarding the background of the study, it was noted that there are many behavioural symptoms and comorbiditics associated with advanced dementia. In the last 12 months of life, it also was noted that many symptoms occur that need to be managed by decision makers such as family members. The researchers noted that during this time, the complex care decisions, such as whether to administer antibiotics and whether to place the patient in a facility or hospital are important decisions that must be validated.
There are a number of other factors that could effect the study, yet were not addressed by the researchers. The catagories, themes and findings presented a whole picture and yielded a meaningful picture of the study by attesting to the complexity of caring for people with advanced dementia living in residential aged care facilities, and the challenges of professionals. Participants did agree that assessing a verbally non-communicative person is difficult. Physicians found that examining patients also was difficult.
Skills deficit were noted. One-third of participants noted a reluctance to use appropriate amounts of analgesia regarding pain. There was a clear connection between the data and the participants regarding the management of dementia-related behaviors. The data collected did attest to the complexity of caring for patients with advanced dementia who reside in residential care facilities and the challenges that they bring to health care professionals. Researchers identified the philosophical and theoretical basis for the study. Educating aged care professionals about early palliation might improve care outcomes for residents”. Aged care staff need a strong rationale for their decisions. ” (Chang et al. , 2009, p. 45) This study highlighted the challenges in meeting the demands of caring for patients with advanced dementia who reside in residential care facilities. The researchers found there was a number of factors that could effect the aged care of residents with advanced dementia; however challenges will always remain.
All of the participants found that is was very difficult to assess patients with advanced dementia. They found that these patients were unable to report symptoms such as pain and exhibited many different behavioral issues. There were study limitations regarding the sample size and the non-random sampling. The sample size was small and not representative of a population owing to that size. Other challenges and limitations may have been noted if different questions had been asked of the patients.
In conclusion, the researchers found that it may be crucial to use continuity of care when caring for these patients. According to some of the participants, their lack of knowledge about palliative care was limited. This study did highlight the challenges that key professional care encounter when caring for patients with advanced dementia. Increase in education will provide a better understanding of the needs of patients with advanced dementia. Key professional will be able to initiate an appropriate care plan if the clinical progress of dementia is described.
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