ASSESSING NURSES’ KNOWLEDGE ON THE MANAGEMENT OF PATIENTS WITH DEMENTIA: THE CASE OF LAQUINTINIE HOSPITAL DOUALA

Abstract

The study investigated “An Assessment of the Knowledge of the Nurses in Dementia and its Nursing Management”.

The study aimed at identifying nurses knowledge on dementia and its nursing management.  The study particularly sought to identify how nurses manage patients with dementia.  The study was conceived due to the high number of patients with dementia.  The non-experimental survey was used to conduct the study.  Data was collected from 25th January 2015 to 6th February 2016 using structured questionnaires from 20 nurses of psychiatry unit of the Laquintinie Hospital Douala in the Littoral Region. 

The data was analysed using computerised system and presented on frequency distribution tables and charts. The study establised that majority 12(60 %) of the nurses were females and 9(45 %) nurses were SRN with majority 9(45 %) nurses had been working fr 0 – 5 years.  Furthermore, more majority of the respondents 12(60 %) knew the correct nursing care to be rendered to a patient with dementia; more so, majority 11(55 %) did not know how pressure sore can be prevented in dementia patient.

The study recommends that the Director of Laquintinie Hospital should educate the nurses on health issue including dementia and its nursing management and to encourage the nurse to increase their knowledge through training, and seminars and even allow them to return to school.

CHAPTER ONE

INTRODUCTION

1.1  Background

According to W.H.O (2012) dementia is a syndrome in which there is deterioration in memory, thinking, behavior and ability to perform everyday activities. According to Barbara (2014) dementia is not a defect of a specific disease instead, dementia describes a group of syndromes affecting thinking and social abilities severely enough to interfere with daily functioning.

Dementia can present in many different forms or types include vascular dementia, Parkinson’s disease (abnormal aggregates of protein that develop inside nerve cell and frontotemporal dementia (abnormal pressure hydrocephalus).  Barbara, 2014.

Dementia is caused by a variety of diseases and injuries or a medical condition such as stroke which progressively affect the brain cell.  Certain substances including drugs and excessive intake of alcohol; congenital causes, severe injuries on the head are other causes of dementia (Inouye, 1998).Dementia has many signs and symptoms which include memory loss; personality change and impaired intellectual function resulting from disease or trauma to the brain.

These changes are not part of normal aging and are severe enough to affect daily living, independence and relationship.  There is also noticeable decline in communication.  These changes may occur quickly or very slowly over time.  Other symptoms include problems of motion and balance; neglect of personal care and safety; hallucination, agitation, confusion; failure to recognize people, just to name (Willy, 1994).

Dementia has many complications.  Some complications may be the result of the underlying illness that is causing dementia while others may arise from dementia itself.  General complications of dementia regardless of its causes includes loss of ability to function or care for self; loss of ability to interact with others, forgetting recent conversation, delusion, inability to recognize danger ;( Guislain 1995).Dementia started in America in 1860 and culminated in early 1900 with the consolidation of the “cognitive paradigm”, that is the view that dementia is only an irreversible disorder of intellectual function.

Historical analysis shows to have limited value in resolution of problem and this restrictive definition of dementia resulted more from theoretical change than observation; that is why this «cognitive paradign” has been shown to have limited value in resolution of problems such as the identification of early symptoms; explanation of the variety of non-cognitive symptoms and behaviors that accompany dementia, Berrior, 1990.

There is no cure for some type of dementia.  For people with such types of dementia including those who care for them, many measures can improve their lives.  Cognitive and behavioral interventions such as reassuring the patient may be appropriate in such types of dementia.  Education and providing emotional support to the care givers is important (Allan, 2005).

However, certain types of dementia can be treated or reversed if recognized in time.  The first step is to understand what is and what not normal memory loss is; the cause of cognitive decline, and how to identify the different types of dementia. The more the health personnel understand the dementia, the more he/she can carry out intervention to improve and control the symptom of patients with dementia, Allen, 2005.

Dementia patients need proper care.  The patient and their families need emotional care and reassurance.  The nurse who is with the patient more than other members of the hospital team is often in the best position to give this support but most of them usually neglect such patients (Woody, 2008). According to Salome 1995; the nurse has a great task in caring for patients with dementia; in identifying the range of symptoms of cognitive decline in the early onset to the more troubling behavioral symptoms of the later stage of this disease so that prompt intervention could be established.  It is therefore important that the nurse has knowledge on the potential and actual physiological, psychological and economic impact on care givers and social problems the patients face.

It has been investigated that about 756 million people in the world have dementia and that about 58 % of people globally die each day all over the world from dementia and its complications, (W.H.O, 2002).

Jones 1986 stated that direct nursing care for most critically ill and has hospitalized patients should be rendered by nurses but instead, patient’s relatives have stepped in caring for their patients which implies that the nurses are neglecting their duty and thus causing harm to these patients. Theodore 2002, reported that about 3 is 0% of patients with dementia were admitted in various hospital in South Africa and 15% died due to poor nursing care.

Kelly 2000, reported that from the majority of patients with dementia admitted each year in Kenya, most ended up with serious complications and some died because of poor nursing care.

1.2 Statement Of The Problem

Dementia is an emerging public Health problem in the world. Disease in the elderly are major public health problem globally, especially in the Cameroon Dementia deaths in reached 2.031 or 0.96 °/° of total deaths.

Someone in the Cameroon develop Dementia every seconds and more than 7 are hospitalized every day and 2 die a day because do not receive a timely diagnosis and face poor quality of life and loss of independence and poor nursing care. There are over 1.2 million people in Cameroon living with dementia. Every year, there nearly 2400 mile new cases. The estimated proportion of the general population aged 60 and over with dementia at a given time is between 2-4°/°.

In Cameroon, dementia is not widely known or understood. A large portion of those suffering from dementia are referred to as witches and wizards. They are often abandoned by their children and family, and they are seen roaming the streets, eating from dump sites, and they suffer abuse from community members.

Such patients in my country die miserably because of a lack of care. Even their corpses are treated as trash; dementia has physical, psychological, social and economic consequences for people with the disease, but also for healthcare workers, families and society in general.

The investigator came across a case in Laquintinie Hospital Douala where a dementia patient with incontinence was neglected and abandoned without being supervised by nurses and he ended up with bed sores.  The bed sores later become so severe and got infected, such that the patient had to spend a lot of money.

The investigator also came across a case in Laquintinie Hospital Douala where a patient with dementia was left to eat alone by the nurses without been supervised.  As a result the patient ended up chocking due to food passing through the air way.  He finally died.

All these above situations disturbed the investigator and prompted her to carry out this study to find out the nurses knowledge on the management of patient with dementia.

1.3 Research Questions

1. What is the level of nurses’ knowledge of dementia?
2. Do nurses have adequate knowledge of the management of dementia patients in Laquintinie Hospital Douala?
3. Can nurses properly manage a démentia patient in Laquintinie Hospital Douala?