Module 2 expands on the content presented in Module 1. It humanises the broader understanding of dementia and discusses how a dementia diagnosis affects the patient, their family and friends. Many health professionals do not have opportunities to see their patient outside their workplace. That is, working in an acute healthcare facility may limit a nurse’s view of patients and carers and their everyday experiences. Likewise, community workers may not have the opportunity to see the patients’ acute healthcare experiences. While communication between health services is core to service provision, and each service interfaces with the others, the opportunity see the services and the transitions between them from a consumer perspective is rare and valuable.
The theoretical knowledge gained from this module is enhanced by additional learning opportunities. The content of this module is linked to examples in Ed’s narrative, activities and learning strategies to better understand the concepts
The activities and resources for each module are suggestions. However, many of these are suitable for use with other modules, and you may choose to mix and match to suit your need.
Journal excerpt | Points to consider & suggested activities |
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Journal excerpt 2.1: The most important thing for me now is to give caring for her (Mary) top priority Our younger daughter has come to live with us to care for her mother. When she was a child she would tell her mother, "Mummy when you get old I'll look after you". Her kindness is so much appreciated. Upon becoming a carer, major changes took place in my lifestyle. –I’m not resentful - not much anyway - because I believed I owed much to Mary - a loving wife and devoted mother to our children for over 50 years. I wanted to repay her for her kindness and provide care to help soften the problems arising from her dementia. The most important thing for me now is to give caring for her top priority - to be available when needed, to share humorous episodes with her, to help with activities that Mary can no longer handle alone and to cry with her when she is depressed, and in doing so to try to keep myself calm and healthy and most importantly to do all of this in our own home environment until such time when we accept that she would receive better treatment in a residential nursing home than we could possibly provide at home. Initially home care did not seem very onerous. Mary's main symptoms included hallucinations at night involving attacks by snakes. In repelling this imaginary attach [sic], Mary sometimes injured her arms or legs. As a result of a special problem, Mary was prone to falling and to having difficulty in reading and writing. |
2.1 Points to consider: What is happening here? 2.1 Suggested Activities: Individual and group activities to identify and explore the concept of roles and responsibilities. Consider the challenges and potential impact caring for the person who once cared for you Jigsaw classroom– Students gather the evidence for best practice and present their findings to the group Identify the key points from Ed’s insights. How could this important information be used to develop action plans for Mary’s care that support Ed, Maree and Mary? Using an example of a ‘typical’ home where you live as a guide, consider the support services, alterations and potential challenges to providing care. Mary’s symptoms would be managed differently in a hospital/aged care facility. Consider the strategies that may be implemented in a care facility to meet Mary’s needs. What advice would you give Ed? |
Journal excerpt 2.2: Fortunately Mary showed no inclination to wander, nor become angry. Her short-term memory deteriorated yet her long-term memory remains, and she has little problem in recognising people and objects. So in the early years of Mary's dementia, my caring role was not too demanding or stressful. However, as the years passed and Mary's condition slowly deteriorated, it became more demanding, especially at night when it became necessary to get up and assist her to the toilet. This was when I noticed that my broken sleep pattern was taking (a) toll on my body both physically and mentally. I became fatigued easily and was losing interest in participating in social activities which I (had) previously enjoyed. I began to worry, and wondered if my symptoms resulted from my caring role or from some yet undiagnosed more serious health problem. I decided to seek the advice of my GP, and made an appointment. We explored the situation. My doctor appreciated the situation from caring could sometimes result in the carer showing signs of depression. However, he wished to explore all possibilities and suggested a range of blood tests as a first step. I agreed and made another appointment to discuss the results. |
2.2 Points to consider: 2.2 Suggested activities: Divide a page into three columns: Jigsaw classroom – |
Journal excerpt 2.3: Wednesday, 9 January 2008 |
2.3 Points to consider: 2.3 Suggested Activities Discuss (in groups) |
Journal excerpt 2.4: Mary says she knows that she shouldn't interfere with our lives - we have our own lives to lead. I assured her that there is nowhere else I want to be and that she is not affecting anyone's life! |
2.4 Points to consider: 2.4 Suggested activities: |
Journal excerpt 2.5: Monday June 2008 In this period - showed photos to friends but could not recognise her relations - Grandchildren etc., upset. |
2.5 Points to consider: 2.5 Suggested Activities: Discuss questions the nurse might use to clarify (with Ed) what is happening |
Journal excerpt 2.6: Wednesday, 15 October 2008 Saturday, 18 October 2008 Mary having delusions about being out somewhere (at races - Caulfield Cup) and having to get home before it becomes dark. We have no drivers [sic] licence to drive bus. Quite a dilemma. Can't walk about in somebody's house without an invitation (Mary heard M. walking in our house). Mary finds it hard to realise that we are in our own house all the time. |
2.6 Points to consider What should the Student nurse know? What principles does Ed need to understand (e.g. touch technique)? Health Management & Managing delusions What is the difference between hallucination and delusion?
2.6 Suggested Activities: |
Journal excerpt 2.7: Monday, 20 October 2008 Saturday and Sunday, 25 and 26 October 2008 |
2.7 Points to consider Assessment When home care/community nurse is not easily accessible, what does the carer need to know? Assessment & Management (medication) Diversional technique 2.7 Suggested Activities: Role Play: –Sleep assessment |
Journal excerpt 2.8: Monday, 28 October 2008 |
2.8 Points to consider: Fluctuating levels of insight 2.8 Suggested activities: Research, discuss, share with group
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Journal excerpt 2.9: Sunday, 12 December 2008 Saturday, 24 January 2009 Has UTI, very tired and has been quieter than usual the last couple of days. |
2.9 Points to consider: What effect does Mary’s depression have on Ed? Building /supporting resilience: 2.9 Suggested Activities: Develop/adapt physical / psychological assessment |
Journal excerpt 2.10: Tuesday, 29 January 2009 Sunday, 1 February 2009 Tuesday, 3 February 2009 6 February 2009 |
2.10 Points to consider: The process of physical and mental deterioration Change Increased physical load to the carer 2.10 Suggested activities: Research & Group Discussion/s – |
Journal excerpt 2.11: 11 February 2009 Later on Tuesday she told Kalab. that she 'put on an act' this morning and later in the day asked me 'what did I think when she acted as she did this morning. Mary is more confused now. Asks a lot as to 'what is going on' and is obviously more confused. Cries a lot and complains that 'she is useless'. Still says at times that she 'wants to die'. She is much quieter during the day and doesn't speak and enjoy the day as much as she used to. Also with longer hours in bed 7:30 pm to 10 am (14 1/2 hours) she is more restless during the night. 22 February 2009 |
2.11 Points to consider: 1. What’s happening with Mary? 2. Depression in Dementia |
Journal excerpt 2.12: Saturday, 14 March 2009 Saturday, 25 April 2009 Little change in Mary's condition. Appeared once or twice to recognise someone but could not be sure. Unable to talk. |
2.12 Points to consider: Role of spirituality in care? Reflect on own beliefs and attitudes |
Journal excerpt 2.13: Some decision (or suggestion) will be forthcoming from the medical staff on Tuesday 28th 10 am to 12 pm. Tuesday, 28 April 2009 |
2.13 Points to consider What evidence would the HP /team use to inform decision? 2.13 Suggested Activities: Debate the pros and cons arguments /solution for ‘where to from here?’ |