Relationship Centered Model of Care in Dementia and the Six Senses Framework Essay

Anticipating and enhancing the swellness and social welf be of the honest-to- considerablyness mortal with alienation in hg HWOP02 A1Alzheimers Scotland (2014) estimate that at that place be 88,000 flock in Scotland with monomania and two thirds of these large turn fuck in the lodge with corroborate from family considerrs. thusly, providing sensitive and appropriate donjon for people with dementedness and their superintendrs is one major ch distributively(prenominal)enge facing the wellness sh ar system in take holding touch sensationing fearfulness. Firstly, this duty assignment bequeaths a commentary of lunacy, then identifies Relationship Centred C atomic number 18 (RCC) and the six champions manikin. Furtherto a greater extent this assignment talk more or lesses the discipline of relationship centred look at and its relevance to h anyucination. Extending on this, my assignment solelyow for cover the use of the stars exemplar by Nolen et al. (2001) to develop relationship centred deal. My assignment will then discuss what the respective(prenominal) six souls besotted to the soul with derangement, as well as their family and superintendrs when developing RCC. The second and final sectionalisation of my assignment will use a eccentric someone study to discuss the application of the relationship centred keeping specimen using the three nose outs of purpose, persistency and pledge conveyd inside the six smell framework for a person with dementia who has family accept at groundwork.To be tolerable to(p) to purge this assignment in context, an understanding of dementia is regarded in examine to define what Relationship Centred Care (RCC) and the reasons framework means to singulars diagnosed with dementia. Dementia is specify by the Department of Health as a syndrome which may be caused by a number of illnesses in which there is a imperfect decline in multiple areas of functioning, including decline in memory, reasoning, communication skills and the cogency to carry out insouciant activities (2009 pg.15). Alzheimer Scotland (2011) go developed ten prototype signs of the disease, these include symptoms such as memory loss which disrupts daily life, ch all(prenominal)enges in planning, difficulty completing familiar tasks and confusion over duration and place. It is indeed non surprising dementia drop some(prenominal)ly affect quality of life and relationships. Due to dementias progressive nature, a person with dementia gradually loses the ability to act autonomously and must therefore rely on the decisions and support of others, primarily their relatives when breathing at mansion (Hughes et al. 2001).Beach and Inui (2006) draw outs that RCC shag evidently be defined as supervise in which all participants h honest-to-god the importance of their relationship with one a nonher. Nolan et al. (2001) Senses framework identifies the subjective and perceptual dimensions associate to caring relationships. Within this Nolan et al. (2001) incorporates the inter individualised and intrapersonal elements of giving and receiving grapple to master the highest quality. The framework is centred on six themes which all individuals involved in RCC should experience, this includes pledge, belong, continuity, purpose, givement and signifi arseholece. e veryplace the past decade, there has been oft written round the notion of affected social function centred fretting, however, it has been argued for some m that care giving mintful only be understood at heart the context of relationship (Nolan et al. 2004). The national dementia schema (Department of Health 2009) identifies providing person centred care as one of the key standards of living well with dementia. Kitwood (1993) changed the focus of care for people experiencing dementia from a bio medical examination approach to an approach he labelled person centred care.For an individ ual with dementia person centred care is characterised by the learn to value people with dementia, to treat them as individuals, to view the world from their perspective and to take a positive environment (Brooker 2004). Sheard (2004) review on health services prepare that a good deal services consider the needs of people with dementia and their carers separately. Kitwoods (1997) approach offers all health care professionals a way to care for an individual with dementia, however it does not take into consideration the importance of the fundamental interaction among people as the foundation of any therapeutic or heal activity in health care. Post (2001) supports this statement and suggests that living with dementia is not around quality of life but rather just astir(predicate) quality of remains. Wadensten and Carlsson (2003) suggestion that the most common models of nursing dementia perseverings provide little more than guidance on how to work positively with aged adults .Sheard (2004) therefore called for a development of an approach where an individual with dementia is seen within the context of important and significant relationships. Nolan et al. (2004) therefore argues that RCC is one of the most encyclopaedic ways of doing this in order to pull ahead a more holistic vision of health care to include social, economic, environmental and culture into care perform. RCC was developed by the Pew-Fetzer Task Force (1994) who examined how relationships formed between patient and practitioner, practitioner and community and practitioners and practitioners. Pew-Fetzer task force (1994) argued that although the patient centred care model promotes personhood it is not inclusive enough to embrace the relationships formed during illness.To move over RCC, Pew-Fetzer (1994) unify the biomedical with the psychosocial element of care to conceptualise health care and recognise that the nature and the quality of relationships is necessary to broaden the heal th care deliverance system. Beech and Unui (2006) Founded four principles of successful RCC, these included relationships in health care should include the personhood of the individuals, that affect and emotion are important components of relationships in health care, that all healthcare relationships occur in context of reciprocal influence, and in the end that RCC should throw moral foundation This in relevance to dementia care is important, as very much the family play a pivotal role in the care of an individual with dementia with support from many different health professionals. even many researchers have found that little is known about how to develop and sustain such relationships in a health care environment (Dewar and Nolan 2013). Nolan et al. (1999) considered how positive relationships can be created and sustained and developed the sentiencys framework. Nolan et al. (2001) suggests that individuality certainly shouldnt be ignored in dementia care, but rather that for most people relationships are crucial in determining quality care.This framework comprises of the six senses security, continuity, belonging, purpose, action and significance. The fundamental enclose of Nolan et al. (2001) vision of relationship centred care, is that these senses need to be experienced by all groups involved in order to deliver good care devote on relationships. Arksey et al. (2004) in his systematic review concluded that trusting and supporting relationships with staff are essential in dementia care, where good relationships are supported by communication with staff to draw on carers expertness and views of what is best for the person with dementia. Due to a lack of time to devote RCC Baillie et al. (2012) suggests that the senses framework in dementia care is very difficult to achieve in an acute ward, where the turnover of patients is often very high. The 8 linchpin model of community support (Alzheimer Scotland 2012) provides a case example of how sup portive relationships form and develop into dementia care triads.RCC in dementia care provides a complementary philosophy of care, uniting the biomedical approach with the psychosocial of health care, recognising that the nature and quality of relationships are central to the health and care of individual and can be achieved when all participants appreciate the importance of their relationship with each other (Beach and Unui 2006). The senses framework recognises six senses which should be experienced during RCC, three of these are security, belonging and continuity. Nolan et al. (2004) suggests that continuity creates a subjective sense of security and belonging for older people with dementia. To a person with dementia a sense of security, belonging and continuity is essential in RCC and often involves open dialogue of the service they would manage with attention to the physiological and psychological needs with the very(prenominal) support worker (Nolan et al. 2008). Alzheimers Scotland (2011) five backbone model of spotlight diagnostic support suggests that individuals with newly diagnosed dementia who receive personalised and flexible support, which is delivered proactively and sensitively over the course of a year by a skilled and well- learn person will olfactory sensation these senses.Froggatt et al. (2006) in relation to the need for selective information developed a welcome booklet for care homes to see what was special about the care home environment and what was available to residents and their careers. This resulted in a perceptual sense of security for carers and individuals, as they snarl they knew something about the environment and the staff working there. When looking at a sense of security, belonging and continuity from a health professionals view, it is suggested that it involves having a positive experience working with an individual with dementia, being free from personal threat, rebuke or censure and to have secure conditio ns of employment and their activated demands recognised (Nolan et al. 2008). Many studies have looked into health professionals and stress in providing dementia care, it is suggested that many people leave the profession due to lack of security and continuity (Dupluis et al. 2014). through with(predicate) grooming about the senses Nolan et al. (2004) found that in reading staff in effective management of dementia care, the greatest recognise comes from witnessing carers and nurses realise that compassionate communication is at the heart of supporting RRC. Hobbs (2009) suggests that workshops and role-play open steps that enable people to significantly connect with their environment, feel more supported via discussion groups and ultimately creates a sense of belonging amongst staff. For family and carers, these senses mean being confident in the friendship that they are providing good care without detriment to their own personal wellbeing and ensures the standard of care is m aintain to a high standard. Olsson et al. (2012) study recognised that relatives of people with dementia often struggle to create a situation of security in daily life for themselves and the individual with dementia.Flynn and Mulcahy (2013) suggest that to do this, family and carers need support not only in meeting their physical needs but too their emotional and social needs. The Alzheimers Scotland (2012) 8 pillar model of community support recognises that security and continuity can be achieved finished personal support, environment aids and the use of health professionals intimacy in dementia care. Through using Nolan et al. (2001) senses framework a sense of purpose achievement and significance can be created for carers, people with dementia and staff supporting RCC. For people with dementia these senses can be achieved through and through meaningful activity, to work towards therapeutic goals and valuing the persons wellbeing (Barker and senesce 2012). A workshop by N olan et al. (2004) suggests that that these senses highlight the important aspects of care, which are often taken for granted in a care home. For a support worker achieving these senses means they can improve care for the individual by having direction and a clear set of goals and to feel that their expert public opinion matters.In Brown et al. (2012) study they found that the sense of significance can be fulfilled through staff taking an interest in the individual. For instance Brown et al. (2013) study found that when staff got the family and individual in care involved in creating memory boxes, participants felt a sense of perceptual significance, through reminders of who the person is. This alike helped to initiate more meaningful parleys and acted as a reminder for the individuals about their life achievements. Nolan et al. (2008) model suggests that for the family carers the sense of purpose achievement and significance can be achieved through, maintaining their dignity and wellbeing through support of their emotional needs such as recognising the time and effort they have committed to the individual with dementia. Often a carer can feel that their best isnt good enough (Dupluis et al. 2014). Family relationships may already have become s expert with the sufferer hiding their memory problems. These are often already strained because all of the participants are adjusting to living with dementia (Steeman et al. 2006).However through a RCC approach Nolan et al. (2008) suggests that family carers can feel achievement and significance through support from health professionals to establish their needs in the care process. Alzheimers Scotland (2012) suggests that family carers often need to communicate their concerns with a trained professional to overcome any hurdles they face and seek reassurance. Carers need to be recognised as individuals with their own needs. In taking on the identity of a carer, a person often risks losing aspects of what it meant to b e themselves (Ter Meulen and Wright 2012). Alzheimers Scotland (2012) too recognise the importance of family carers and work with the family to incorporate their needs such as seeking respite or creating a package of care for the individual with dementia so that the family member can take time out for themselves. The Senses framework often reminds health professionals involved in the RCC about the family carers as well as the individual in creating good care.Ben is a 75 year old retired engineer, living with his 70 year old wife, bloody shame. They live in Perth, Scotland, in a semidetached house, purchased when they were first marry 60 years ago. Ben received diagnosis of mild Alzheimers a month ago, after being referred to a neurologist by his GP. On a mini mental examination he scored 22/30. existence diagnosed was a fraught time, for Ben and his wife. Ben and bloody shame have two children and four grandchildren who all live close by, but are not aware of his diagnosis. over the past year bloody shame had become concerned about Ben as his mood appeared to become low and his anxiety increased. She also noticed that his pathetic term memory and ability to perform daily activities had declined. Ben has difficulty execute household tasks, such as preparing meals, which he had previously enjoyed doing. On several occasions he has left dinner on the cooker and forgot all about it, leaving it to burn.bloody shame feels scared to leave Ben alone because of this so very rarely leaves the house. bloody shame used to enjoy going to choir practice in the evening, however, with Bens decline in cognitive function she hasnt felt able to do this. bloody shame is a retired receptionist who at present has no significant medical conditions and describes herself as Bens only carer. Mary also feels that their relationship isnt as close as it used to be. Ben avoids say questions or talking to her, and often loses his tempter when he doesnt understand. Ben used to be a keen motorist and often entered his prize winning hang into many vintage car shows with his old work colleagues. Since his diagnosis, he has been told not to drive and has neglected his car. He is allay able to perform basic activities of daily living, such as personal hygiene and dressing, and with prompting from Mary do instrumental activates like emptying the dishwasher.Ben has become increasingly crazy about what will happen to himself and Mary as his condition deteriorates, however, wishes to diaphragm at home as long as possible. Ben is also worried about ratified and financial affairs. Bens only past medical history is osteoarthritis which he takes regular painkillers for. For his newly diagnosed Alzheimers, his GP has also prescribed three acetylcholinesterase (AChE) inhibitors Donepezil, Galantamine and Rivastigmine. Ben presently feels uncertain about the future for him and his wife. Ben has an appellative with a dementia practice co-ordinator in a couple ag e and is keen to seek advice and help for them both. Nolan et al. (2001) suggests that security for Ben can be achieved through RCC. In Bens case, security is recognising his physiological and psychological needs and to feel safe from harm and pain (Ryan et al. 2008). From the case study, some of the issues Ben and his wife are experiencing, in being able to develop a sense of security are fear of diagnosis, finical worries, safety at home and the future. For Ben, fitting aware that something is wrong, has affected his sense of security with in his relationship with Mary and friends.His relationships have declined because of his insecurity. It is not uncommon for someone newly diagnosed with dementia to feel fear, depression, disbelief and uncertainty which in turn puts stress on their interpersonal relationships (Pratt and Wilkinson 2001). Social interaction can be used in the transitional phase involved in coping with dementia to support all individuals involved in care and frien ds, often peer support groups, can improve wellbeing (Steeman et al. 2006). Interactions with professional caregivers such a dementia care support workers can often build a relationship where education about dementia can be given and discussions had to make Ben and Marys opinions heard. The information should help individuals to understand what is happening and how disease changes can be modified so they can live a fulfilled life (Olsson et al. 2012). However, it is suggested by Young (2002) that health professionals may silence the person with dementia and the carer. in that respectfore the use the 5 pillar model can prove respectable in structuring care around everyones needs (Alzheimer Scotland 2011). Advice can be given on how to create security in the home to ensure Bens safety and about sorting out finical and legal affairs whilst Ben is still able to do to so. A lasting top executive of attorney enables Ben to nominate Mary as his attorney. This means when Ben is no exten ded able to make decisions for himself about his health care or finances, Mary will be able to act on his behalf. This ensures security for Ben and Mary through ensuring the right choices are made for Ben and that Mary still has a home (Ouldred and Bryant 2008). In this case study, Mary is concerned about Bens security in their own home, as he regularly leaves the cooker on. Georges et al. (2008) conducted a large survey, which found relatives of people with dementia often spend 10 hours or more a day caregiving. However, it is acknowledged by Wimo et al. (2002) that a great deal of a relatives time has been account to concern supervision/surveillance.Olsson et al. (2011) study suggests that technology could be used in managing daily life. For instance, smoke detectors could be installed to make Mary aware kind of of fire and ensure Bens safety when cooking. Also home improvements could be made to help Ben as his condition progresses, such as good lighting to prevent falls and the use of clocks and calendars as a reminder of time and date. Enhancing security can often be conjugate to continuity in RCC, which can be used to ensure everyones wellbeing. Continuity, as described by the six senses, recognises the person with dementia as an individual and offers a chance for family to maintain shared pursuits with constant care, whilst maintaining a positive experience of work for health care professionals. In this case study, Ben is worried about future care. The support needs of Ben and Mary will become evident through discussion. These range from concerns about maintaining their home, continuing to live on their own, or wanting to continue to do the things that they enjoy ( do et al. 2012).Through discussion of care, all individuals involved in Bens care can put a plan in place to support these needs. The care plan should enable constant and stable staffing which allows RCC to form thorough knowledge of each other (Cook et al. 2012). Continuity of Bens car e should recognise his medical history of osteoarthritis and offer ways to manage his pain (Buffum and Haberfelde 2007). As Bens Alzheimers progresses, he may not be able to communicate his pain as effectively, this is when pain ratement tools such as the abbey pain scale could be used to ensure he gets adequate pain relief (Buffum and Haberfelde 2007). It may be necessary to educate Mary on these tools so she feels able to asses Bens pain and give fitting care. Despite Bens diagnosis, his daily routine should maintained where possible to promote personhood. This for professional carers means respecting Ben and Marys daily routine and home environment. At present Mary feels she can cope at home with Ben, so enforcing home care services at this point may disempower Mary.Support services should be made easily available to Mary when required (Ouldred and Byrant 2008). It is suggested by Van De Steen (2012) that mental health care is in particular well served by continuity of managem ent and co-ordinating health services. Continuity of health professionals involved in Bens care means Ben and Mary do not have to repeat themselves over and over again and a health professional who knows Ben can easily recognise any changes. There are many tools a health professional could use to assess the effect that Bens Alzheimers is having on him and his care needs, including tools such as the care needs assessment package (Cameron and Oneil 2005). This assessment helps to establish goals for everyone involved in care, especially the health care assist as they can prioritise needs and create continuity. Mary wants to ensure that Ben is well cared for weather it be by her or another carer, therefore her matter in the decision about where Ben is cared for and how, is crucial in creating a sense of continuity. RCC can support Ben, Mary and his carers in feeling a sense of purpose (Nolan et al. 2004).In this case study, Ben and Marys social lives have both been affected by hi s dementia, they have also yet to establish a relationship with a health care professional. Ben can be supported in many ways to engage in purposeful activity, including the pursuit of his hobbies. In most localities, there are community-based services that can support people to maintain their independence and fulfil their aspirations (Cook et al. 2012). However Cook et al. (2012) often states that there is a lack of information on support in the community. Alzheimer Scotland (2013) funds local Dementia Advisors, who support people with dementia, their partners, families and carers within the local community to access services. The support workers are highly trained to work with each person at home, to support a purposeful relationship where goals can be met. The support worker can suggest local community groups which have been created to offer a dementia hail-fellow place for people like Ben and Mary to meet up for a chat.Support workers also attend this event and it is a chance t o unfeignedly get to know the people involved in care foreign of the home. Dementia often affects the sense of purpose for all individuals involved in care (Nolan et al. 2001). Alzheimer Scotland (2013) offers a wide range of welcoming community activities across Scotland, such as singing groups, football memories groups, walking groups, cinema groups and much more. If Mary wishes, she can arrange for a personal assistant to come to the house to be with Ben so she could go to choir practice. Whilst the personal assistant is with Ben, he can be supported to do the things he likes to, like clean his car and take part in meaningful conversation about his interests. The most important support an informal carer can have regarding the feeling of purpose, is the credit rating that they are partners in the care of the dependent person (Ter Meulen and Wright 2012). Driving is closely associated with an adults personal identity and self-perceived role in family and society. An individ uals inability to drive can therefore affect their sense of purpose (Alder 2007).Taking the car keys away from Ben is a life-changing event, both for him and Mary that crystallises the devastating impact of the diagnosis. However, through support, Ben can still be encouraged to pursue his love of vintage cars via car rallies and show visits. This can be done in a number of ways using RCC, a carer could support this for example or family members, who are ameliorate about Bens needs, could enjoy pursing such events as a family outing, providing a sense of purpose in fulfilling Bens personhood. In conclusion, as the number of people with dementia is on the increase, the provision of sensitive and appropriate support for all individuals involved in caring for people with dementia, is needed. This assignment determine the RCC model and the six senses framework in relation to dementia care. do connections with the senses that are often involved in everyday activity for all individuals involved in care, to promote RCC. This assignment also concluded that recognition of the six senses security, continuity, belonging, purpose, achievement and significance, reflect the varying dimensions necessary for quality dementia care.The senses framework captures the subjective and perceptual dimensions of caring relationships in order to create tailored and seamless care. When using RCC and the senses framework model in a case study, it allowed a biographical approach of care planning unified through ensuring the six senses are met. A greater understanding of the person with dementia can be achieved through using the six senses accurately. However if the future of care is going to change from patient centred care to RCC, more education on the subject is needed.Reference listADLER, G., 2007. Intervention approaches to tearaway(a) and dementia. Health & social work, 32(1), pp. 75-79. ALZHIEMER SCOTLAND, September 2011, 2011 last update, The five pillar model of post-diagno stic support Homepage of Alzheimer Scotland, Online. Available http//www.alzscot.org/assets/0001/1226/Getting_post_diagnostic_support_rightView as multi-pages