Reinventing palliative care for patients with dementia

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Unfortunately, certain diseases make it difficult for health professionals to deliver care in optimal ways.

Those diagnosed with dementia have trouble thinking clearly and putting their thoughts together.  They tend to have trouble remembering past events clearly and may find themselves disoriented and confused.

The experience of dementia can often be painful not only for those living with dementia, but also for their family and friends.  Because dementia disrupts the cognitive abilities of these individuals, it can make it difficult for clinicians and caregivers to deliver care that meets the needs of these patients.

MORE: THE ASSISTED DYING DEBATE

Mental health researchers at St. Joseph’s Healthcare Hamilton are working towards the best ways to deliver care to geriatric patients with dementia.  Dr. Carrie McAiney and her research team are currently working to improve palliative care and treatment at St. Joseph’s Healthcare Hamilton for this group of patients.

“Providing palliative care to patients living with dementia, especially those at more advanced stages, can be especially challenging because it’s difficult for staff to understand patients’ needs,” states Dr. Carrie McAiney, Director of Evaluation and Research, Seniors Mental Health at St. Joseph’s Healthcare Hamilton, and Associate Professor at McMaster University.

Dr. Carrie McAiney and McMaster Bachelor of Health Sciences student Colin Ngan recently conducted a qualitative study that strives to explore the internal experiences of nurses that deliver palliative care to patients with dementia.

“The way that palliative and end-of-life care is delivered by clinicians is shaped by the perceptions that they have towards life and death,” explains Dr. McAiney.  “Understanding how nurses think and feel about delivering palliative care to geriatric patients with dementia will help us know how best to support staff, thereby providing better care to our patients.”

MORE: PROVIDING EQUITABLE PALLIATIVE CARE TO DIVERSE COMMUNITIES

The researchers found that major challenges in delivering palliative and end-of-life care to patients with dementia were based around communicating with them and their families.  This presented a significant challenge in recognizing pain and having conversations about death and dying.

Researchers also addressed the emotional struggles of staff in their study – noting how nurses also often undergo a grieving process when they provide end-of-life care.

“Staff form strong connections with the patients they care for, and with their families”, explains Dr. McAiney. “Because of this, staff need support when patients die and this relationship ends.”

The study involved interviews conducted with nurses working in the Harbour North unit of our West 5th campus.

Since the new facility at the West 5th Campus opened its doors to patients in 2014, the Margaret and Charles Juravinski Centre for Integrated Health transforms the way in which we deliver care for patients diagnosed with mental health and addictions.

However, the new Centre also transforms the way in which mental health-related research will take place within St. Joe’s.  Our researchers and clinicians work side-by-side – increasing both collaboration and research translation.

MORE: PUTTING PATIENTS AT THE HEART OF END-OF-LIFE CARE

As the study was conducted from within St. Joseph’s Healthcare Hamilton, Dr. McAiney and Colin Ngan were able to share the results of the study with our nursing teams.  They were able to pass on what they found to be the greatest challenges, and work with our clinicians to discover ways that these challenges could be overcome.

As a result of this research, one of the improvements being considered is the implementation of Comfort Care Rounds, a process of debriefing with staff about patients who are currently receiving palliative care and those who have recently passed away. Having a structured debrief process enables staff to identify the positive aspects of the care they provided and how to make care even better in the future.

Working directly with clinicians allows our researchers to make direct improvements to the quality of life that our patients experience.

By reinventing the ways in which palliative care is delivered to geriatric patients, our researchers help to renew the promise of providing optimal care to all members of our community.

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