An article in the March 2012 issue of the Journal of American Medical Directors Association titled "Is Your Nursing Home a Battlefield?" address the issue of dementia-related agitation in skilled nursing facilities. The article makes the analogy that nursing homes are often comparable to battlefields when dementia patients experience episodes of agitation and refuse care from nurses. Because this issue creates a negative dynamic between nursing home residents, their families, and the staff, it is extremely important to address the issue and understand the solutions that this article suggests.
The first solution is as simple as the elimination of words with negative, violent connotations. Words like "aggressive" and "assaultive" reinforce the idea that the resident intends to harm the caregiver. In actuality, patients who have episodes of agitation are not being violent; rather, they feel the need to defend themselves due to a lack of understanding as to what the intentions of the caregiver are and what purpose his or her actions serve. As a nurse, especially those who handle dementia patients, it is crucial to provide clearly articulated explanations to residents undergoing any form of care or treatment in the facility.
Secondly, the article emphasizes the importance of educating the facility's staff. This includes nursing aides, directors of nursing, charge nurses, and even the nursing home's administrators. In addition to having a staff that provides quality care, the skilled nursing facility needs to be adequately staffed. There is a strong correlation between quality and quantity with regard to staffing in nursing homes. Without an adequate amount of staff, it is nearly impossible to meet the high standard of care that each patient needs and deserves.
Nursing homes have strict guidelines and policies to which all patients and nurses must abide. However, the article recommends that the facility maintain a certain degree of flexibility in implementing their policies and guidelines. This openness to modifying certain policies allows for care plans that are more individualized and receptive to the patient's specific needs. For example, if a patient tends to resist care early in the morning, perhaps the facility staff should consider a later wake up time.
The article also suggests that nursing home facility's give nursing aides more significant roles in decision-making. The abilities of nursing aides are often undermined, as it is often assumed that they are merely expected to carry out tasks assigned to them by directors of nursing. However, those who make these assumptions overlook the fact that nursing aides provide the most direct care to patients and interact with them on a daily basis. Therefore, the article recommends that nursing aides be included in care plan meetings. As they are most familiar with patients' needs and preferences, allowing nursing aides a role in decision-making will result in more effective care plans.
Lastly, the article asserts the importance of treatment for patients who reject care. Often, rejection of care is a sign of pain, delirium, delusions, or depressions. Therefore, patients must be carefully evaluated so that they can receive the proper care, before symptoms become more serious. As with every recommendation that the article has made, training of the facility's staff is instrumental in this step. Previous studies have shown that nurses often fail to recognize symptoms until it is too late and complications have progressed too far. Recognizing and diagnosing delirium poses and especially difficult challenge for nurses. For this reason, nurses must be trained to be observant and recognize the signs of various health complications that arise in skilled nursing facilities.
In addition to ensuring that the nursing home is adequately staffed, you should also be wary of the use of antipsychotic drugs to chemically restrain residents who suffer from dementia. Other than this being a direct violation of the Patients' Bill of Rights, it is also extremely dangerous and has been proven to actually aggravate episodes of agitation.