Nursing care for people with frontal-lobe dementia – difficulties and possibilities

Abstract

Nursing care in this context involves ethical issues whereby the residents' integrity must be balanced against a safe and secure environment. Nursing care is a sensitive but also demanding task, where nurses' actions can reduce the negative effects of the disease. It is therefore important to support staff in nursing care so they are able to manage their work and reduce the risk of emotional exhaustion.

A Meta-Ethnography of Paid Dementia Care Workers’ Perspectives on Their Jobs

“…(26,30,38–40) Lack of education/training was linked to negative feelings such as nihilism, frustration, and irritation, with staff feeling unequipped to deal with the emotional impact of the behaviors and loss that they observed. (41–43) Insufficient or inconsistent training impacted staff’s ability to deal with challenging behaviours, or to even understand what that term meant, (44) with some describing staff with less training as more likely to respond inappropriately. (25,34) Education was credited with allowing staff to depersonalize challenging behaviours and respond more appropriately when they occurred.…”

“…Despite many staff saying that offering care was meaningful to them, some admitted that the nature of the care can provoke negative feelings: (25,36,41,49) “ … the assistant nurses described feeling that they were only actually meeting the residents’ most basic physical needs.” (49) Nursing assistants talked about how difficult they found it to “leave the job at work” (i.e., that it occupied their minds at home), while nurses in another study spoke of how death of patients in their care can provoke in them a fear of their own death. (26,50) They described coping with this emotional impact through support from co-workers, families, the patient’s families, and strategies such as humour, adjusting expectations for treatment (comfort, not cure), and sharing the work tasks.…”

“…Adequate staffing levels were linked to job satisfaction, and a failure to provide this often resulted in descriptions from staff of a lack of quality care, and a conveyor belt approach. (23,26,38,41,48) Burnout and feelings of stress related to the work were linked to understaffing. (48) In one case, management’s lack of understanding of the specialized needs of dementia patients was related to understaffing: “Patients with dementia can often appear to be physically well.…”

“…(29,41,42) Money was also cited as a resource that could impact job satisfaction, not only in terms of pay but also in benefits and tuition support. (6) …”

“…(42,47) Assistant nurses described feeling valued by the residents of their institution, and how this meant a great deal to them: “Some said that at times the elderly residents were also very grateful and that they gave them a great deal in return.” (49) This positive relationship was also discussed in terms of provision of care, (41) and specifically of the intertwined nature of this relationship between the patient and the carer. (32,54) …”