This assignment is a case study for which you are asked to apply your learning around a person-centred approach to care. It enables you to translate evidence to a particular set of circumstances for the person with dementia, family and staff, using your readings and any relevant literature or practice documents that are available. The topic convenor has provided a series of questions to assist you in what to consider as you read through the case study.
Using the evidence from the literature on a person-centred approach to care, consider the following scenario and answer the questions to demonstrate how attention to personhood through a person-centred approach to dementia care would have ensured a better outcome for all. (No more than 1500 words).
Think about this scenario in relation to your perspective as a management/staff member and from Dottie’s perspective and from her family’s’ perspective-
Dottie, an 82 year old widow with an early onset dementia was admitted to the residential facility 4 years prior. She loved talking about her golf, how many holes she could play in a day and had an extensive knowledge of all things to do with gardening, she would spend her day weeding and hosing the communal garden and telling fantastic stories about her golfing days to anyone who would listen. As Dottie’s dementia worsened so did her memory, gait and balance; one day while she was hosing the garden she tripped and fell sustaining a large laceration to her scalp that required sutures and a black eye. Staff were concerned that she may break a hip so hip protectors were bought for Dottie and staff were instructed that they must supervise her while in the garden. This did not suit Dottie she refused to wear the hip protectors and because staff set times for when she could go outside she kicked up quite a fuss. Staff asked Dottie to let them know when she was going outside however 8
because of her poor short term memory she would forget. She continued to perform her gardening duties unsupervised and had another fall this time she broke her hip and sustained many skin tears to her arms and legs. Staff were very concerned that Dottie may well sustain further serious injury should she continue to go walk around unsupervised; it was decided that she be placed into a chair with a table insert to reduce her walking around and to prevent further harm. Dottie’s behaviour changed she became very agitated, her dementia was worsening and her speech was becoming harder to understand. Staff were concerned about this change in behaviour and consulted with her treating doctor who prescribed Dottie a tranquilliser to calm her. Over time Dottie stopped talking altogether and sat in her chair often motionless for hours, her days of gardening and storytelling had come to an end.
To guide your discussion, consider the following questions:
• Could the risk of falling have been minimised earlier without undue impact on Dottie’s activities in the garden? If so, what strategies should have been in place?
• Based on the information above, what other person centred alternatives to the activities putting Dottie at risk might have been worth trying?
• What were the expectations of staff and Dottie following the first fall? Were these expectations realistic? While still adhering to a person centred approach, would it be possible to meet both staff and Dottie’s expectations? If so, how? If not, why not? Are there alternative actions that could have facilitated a better outcome at that stage?
• Despite ongoing decline as a result of the dementia, at what other points in this scenario would a person centred approach to interventions been different to what is described and why?
• In what ways might family, friends, volunteers or others have been involved to facilitate a better outcome?
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