Managing difficult patients in healthcare settings

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People with dementia have a host of psychiatric and behavioral challenges that make dealing with them extremely difficult for their families and relations as well as for those involved with their care routine. Complications include some of the following: visual and auditory hallucination; anxiety; eating disturbances; and activity disturbance indicated inertia, apathy, or agitation. Other factors may be delusions (particularly of persecution or theft); aggression (such s resisting care) and emotional labiality.

9.Our investigation employed a comprehensive search of multiple sources.

Generated more results ranging from between 10,000 to 5,000 responses. By limiting the research to 'dementia management' alone, we received more appropriate results, approximating between zero to 300 hits. We selected articles that were relevant to patient management and to treatment of..

10 qualities of the nursing staff as well as the physical environment and supportive aspects of that environment..

1. Management of Confusion

Perimeters were developed for patients with acute confusion in order to help them with their delirium. Since delirium is a characteristic of dementia, these same guidelines can be appropriated to patients with dementia. Focus should be directed towards accentuating symptoms. Primary requirements are involvement of a multi-disciplinary supportive team that is involved in creating an effective sensory environment that includes effective lighting levels; conspicuous indications of orientation (such as clocks and calendars); clear explanation to patients and caregivers of provided treatment; and avoidance of intrusive physical restraint. Other factors included should be instruction that id given to patient and caregiver's level; assurance that sensory aids are in good working condition; continuity of care; assuring normal sleep patterns; and discouraging movement between wards. In other words, the patient's life should be kept as 'normal' and habituated as possible without nay major or undo change and little should be done to disturb him. All should be smooth-running and relayed in a way this comfortable with him and easily understood. Interruption and jarring to life should be avoided.

2. This extends to removal of irritating noise such as alarms. Constant care must be accorded to nutritional and psychosocial needs of patient ensuring that matters such as fluid balance and bowel / bladder elimination are seen to as well as that patient receives the necessary social support. Whenever possible, the relative should be informed regarding the existence and cause of the state of confusion. This is particularly so in the case when relations are asked to be involved in the care of the disturbed patient. The relatives should then be informed why and how their involvement is beneficial and how they may practically assist nurses in calming the agitated individual.

As regards wandering and agitated patients, they need to be carefully and closely watched in order to ensure that they do not wander out of the bounds of the circumscribed domains.

Persuasion and distraction is preferred to restraints or sedation and the relatives of the patient can be involved in helping the nurse deal with the agitated patient. The causes of agitation should be traced and seen to. These may include need for relieving oneself, hunger, or thirst.

Confused speech may also be a mark of the agitated patient.

In the case of confused speech, nurses are encouraged to adopt one of the following strategies: to change the subject, tactfully disagree, or acknowledge the patient's feelings.

Sedatives and dementia

Sedatives (particularly those with anticholinergic side effects) are often a causative factor in dementia, therefore sedatives and antipsychotics should be controlled and their use kept to a minimum.

Drugs may be necessary in the following instances when patients have to be prevented from endangering themselves or others; when used to reduce distress in a highly agitated patient; or when implementing relevant research.