PERSONAL CARE OF OLDER PERSON AND CONTINENCE MANAGEMENT – INTRODUCTION AND AIMS
Aging is a universal, ongoing, and irreversible process that results in a steady loss of adaptation. Healthy older persons maintain their functioning, but as their ability and physical capabilities deteriorate, they become more susceptible to age-related illnesses and ailments, which can lead to fragility and reliance. The family, or a permanent caregiver, is the organization from which older persons should not depart, notwithstanding the care they require to satisfy their fundamental requirements due to their degree of reliance and/or incapacity.
When assisting an older person with personal care and continence management the aim is to promote a culture of respect and dignity for older people, as well as activities targeted at providing timely and high-quality care for them in terms of nutrition, education, culture, and recreation.
According to the Oxford dictionary Continence is “the ability to control the bladder and bowels” (continence noun – Definition, pictures, pronunciation and usage notes | Oxford Advanced American Dictionary at OxfordLearnersDictionaries.com, 2022)
TOILETING
I have been helping a patient with dementia to use the toilet and for that I prepare in advance all I will need to make it easier for the person. For this patient in specific I do a quick wash every morning so I prepare the following equipment.
Advance Preparation:
Check raised toilet sit with handles is dry
Walking frame
Gloves, Wipes
Sponges, Bowls or containers with warm water
Shower Gels, Shampoo
Wash cloths, Towels
Deodorant, cream or powder for nappy rash
Pads, clean clothes
Health and safety precautions taken:
I always verify there is nothing on the floor (clothes, water) that make my patient slip or just get distracted.
Check all the equipment walking frame and raised toilet sit are in good conditions.
Identify the needs of the client:
This specific patient needs the clothes very warm so I put her clothes and towels in the radiator some minutes before the washing to keep her warm and she will be happy to have a shower. All the information that I need about the patient I will find it in the Care Plan Book which is sent by the care company before to start with the patient, also there is a book in every patient’s house with all the care plan and routines to follow.
CONCLUSION AND EVALUATION
How did you promote positive attitudes in relation to care of the older person in the home or in a residential facility?
One of the best things to promote positive attitude is always talk to the patient about their likes (even in past or present), if a patient like to listen to classical music, listen to it with them and enjoying it, ask for their favourites meal and pamper them always following the care plan according to the patient’s diet. With this patient has been worked to keep her busy with some activities as crosswords, hospital TV programs as she was nurse.
Outline 2 recommendations how you can improve quality of the service provision in relation to the skills you demonstrated.
To improve the quality of toileting for this patient I should recommend to the family to have a complete bathroom downstairs for the patient to have a shower, as currently there is no shower in the small toilet downstairs and the patient will feel better having a real shower sometimes. A second recommendation could be acknowledging the patient about any concern and reassure that I am there to help.
Brief evaluation of your performance during the skill – how did you do and what did you learn?
I have consistently shown commitment and motivation ever since I started working with this patient with dementia. I have learnt how to have a good chat, communication and made the patient achieving some daily exercises.
2D). EATING AND DRINKING – INTRODUCTION AND AIMS
One of the main care we can offer to the people around us is to provide them with proper food and nutrition. Nutrition helps strengthen the immune system, which translates into contracting fewer diseases and, therefore, enjoying good health.
Proper nutrition and hydration are challenging for the patient since they typically have dysphagia, anorexia, reluctance to eat, or despair, which is especially problematic when it comes to family custom. Patients with severe illness are completely reliant on food and are at a great risk of choking and malnutrition. While the demands for minerals and vitamins are the same regardless of age, the needs for macronutrients (proteins, carbohydrates, and fats) may be somewhat (by 25%) lower in older individuals.
Given the difficulty with food that later stages of dementia bring, it is usual for individuals to become undernourished and/or dehydrated. Due to this, it is essential to prioritize the consumption of meals that are simple to chew, simple to assimilate, and extremely nutritious at this point.
SKILLS
· Title of Skill: Feeding (Solid and liquids)
· Advance preparation:
Follow the menu according to the diet of the patient by day
Follow the routine from breakfast with liquids and special breakfast
Remind the patient during the day to have a sip of water or tea to keep her hydrated.
Snacks in between meals, following diet.
Lunch and Dinner (chopped everything in small pieces)
· Identify the needs of the client:
This client in specific needs to drink more liquids but she always feels cold and does not want water, so according to the diet she needs to drink orange juice before breakfast and some fruits as snacks (melon) to keep her hydrated.
In the care plan I find the routine I need to follow with this patient.
The patient has dementia, and she is constantly asking if she has eating or what time is lunch, so I always explain to her what time is it and if the food is not ready, I will explain to her what she will get, sometimes I ask her what she prefers in order to give her independence and option to decide.
IMPLEMENTATION
This patient can eat by herself, but I do chop the food in small pieces to make it easy for her and to avoid any issues (choking), I give to her a glass of water of a cup of tea with the meal.
This patient does not like to eat in front of another person because she uses denture, so I always give her the food and explain to her that I would fold some clothes next to her, so I am not in front of her. I give her space to eat and independence if she needs something I am there, and she just asks me.
To communicate with this patient I always say her name and introduce myself, explain what I am going to do, how long I will be with her, I ask her if she is comfortable with the temperature as her mobile is not good, I always say I am going to make a cup of tea for me if she would like to have one with me, to promote the ingest of drinks.
CONCLUSION AND EVALUATION
If the patient cannot chew, it is important to cut the food into small pieces or grind the food so that it has a smooth and homogeneous texture. Feeding the patient with patience, love and within routine schedules. It is preferable to make several meals a day, about 6, with energetic and high-protein foods, respecting the previous tastes of the patient.
It should be remembered that proteins are found in milk, eggs, meat, fish, and legumes, and are especially important for strengthening muscle tissue and skin. The diet must be varied and must contain daily bread, rice, pasta, salads, vegetables, legumes, dairy products, fruits, meat, fish and eggs.
Recommendations to improve a good feeding for patients with dementia:
An example of a main meal menu would be a farinaceous food such as pasta, rice, legumes, potatoes, or bread, plus a raw or cooked vegetable in addition to meat, fish or eggs, followed by fruit or yogurt. It is recommended to cook with olive oil and use grilled or steamed cooking, with mild seasonings and to the patient’s taste. It is better to prepare purees than soups, and add protein to purees, which can also be enriched with cheese, egg white or milk.
Milk is a very interesting food nutritionally and very useful, since it can be used in both sweet and savory preparations, such as to reduce the flavor of minced fish. Be careful with the vegetables, which form threads, and with the skins of the legumes, it is important to pass them through the Chinese. The addition of olive oil also enriches and gives more flavor to purées. Fruits can be mashed with yogurt or honey and milk can be thickened with cereals or replaced with yogurts, custard, or cream.
Brief evaluation of your performance during the skill – how did you do and what did you learn?
I have learnt to be patient, caring and empathetic with dementia patients talking to them and explaining every task as they are adults and can make decisions, that has made my time with this type of patients more enjoyable and successful, as they feel comfortable, and they cooperate to do the task.
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