Dementia Care Nursing for Apathetic Older Patients: A Qualitative Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Design
2.2. Sampling and Recruitment
2.3. Data Collection
2.4. Data Analysis
2.5. Ethical Considerations
3. Results
3.1. Initiating Patient Engagement
“When apathy is mentioned, I first think of loss of appetite. For instance, a patient may have been talking normally and energetically upon admission but became unresponsive after surgery. Despite thorough examinations, nothing appears wrong, prompting the staff to inquire ‘What is happening with them?’” (DCN 7)
“I strive to discern whether the decline in activities of daily living stems from physical conditions or mental factors such as inability to focus or take actions to fulfill one’s needs”. (DCN 3)
“Do they really not want to call us, do they not want to be involved with us, or are they unable to call us?… I always try to pay attention to those who cannot speak up”. (DCN 10)
“First, they are treated for hypoactive delirium, after which the physical symptoms calm down and the delirium improves, but if the lethargy or lack of motivation persists, then it’s assumed that apathy is still present. Differentiation is also very difficult”. (DCN 1)
“Before hospitalization, I gather information about the patient’s preferences and habits regarding eating. For those who tire easily or require assistance with eating, I use this knowledge to facilitate mealtimes effectively”. (DCN 10)
3.2. Care Methods for Patients
“I try to communicate with patients, especially after completing care, by expressing gratitude for their cooperation or explaining forthcoming medical procedures such as starting an intravenous drip. I encourage our staff to do the same”. (DCN 1)
“I encourage the inclusion of items such as letters, message cards, photos, or other personal mementos to strengthen the patient’s connection with their family. Such stimuli can improve their daily life. I often request family members to bring these mementos because I think they might have positive effects”. (DCN 1)
“I try to ensure timely consultations with physical and occupational therapists to identify welfare equipment that enhances the patient’s independence. I believe that a single piece of equipment can make a significant difference”. (DCN 5)
“I would like to ask staff to tap patients’ shoulders at a certain time in the morning, even if their eyes are closed. In addition, I do not want to force patients to sit and eat if they are tired, but I would still like staff to try asking patients to do so because it is important for them to sit and eat”. (DCN 8)
“We also consider how to get them out of bed; of course, we do general things, such as getting them in a wheelchair for a short time and getting them some morning sunlight”. (DCN 10)
3.3. Continued Engagement and Support for Patients and Their Families
“I closely monitor patients’ eating behavior and gauge their reactions. Even in the depths of apathy, when asked about their preferences, they display subtle signs, such as eye movement, nodding, or gesturing. I consider their past favorite foods and suggest starting with those”. (DCN 3)
“I value smiles and greetings! I try to visit patients at different times throughout the day. Even a brief appearance can make a difference, particularly if they have been in bed since lunchtime. At times like that, I go (to the patient’s bed) and say, ‘I’m here again’; often, I come back and say, ‘Please listen to me’, or ‘I have something to say’. Even if I just show my face a little, I think it makes a difference; therefore, I want to create a relationship where they feel like it is okay to talk to them for a while”. (DCN 8)
“Well, no matter how much support we give, we need to understand that it won’t necessarily be successful… we need to understand that this is the normal state of the person”. (DCN 3)
“Caring for the patient extends beyond patient care; family is equally vital. The family’s emotional and physical well-being impacts the patient, so we have to care about them. We ask about their well-being and sleep quality and, if necessary, connect them with other professionals for support”. (DCN 5)
“Patients lose their spontaneity. When that happens, it’s very hard on the family caring for them, so they hold these gatherings to let off some steam and talk about it. I think it would be better if there were more outlets for the family members to release their stress… I can talk with them at the outpatient clinic”. (DCN 6)
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Demographic Variables | n (%) | ||
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Age | 30–39 | 2 | (20.0) |
40–49 | 3 | (30.0) | |
50–59 | 5 | (50.0) | |
Sex | Male | 4 | (40.0) |
Female | 6 | (60.0) | |
Affiliation | Hospital general ward | 6 | (60.0) |
Ward for mental health | 1 | (10.0) | |
Regional healthcare network office | 1 | (10.0) | |
Clinic | 2 | (20.0) | |
Years of experience as nurses, mean ± SD (n = 9) | 21.7 ± 6.7 | ||
Years of experience as DCN, mean ± SD | 6.3 ± 2.6 | ||
Days of working as a DCN | Yes | 7 | (70.0) |
Frequency for engaging patients experiencing apathy | More than once a week | 4 | (40.0) |
More than once a month | 4 | (40.0) | |
More than once a year | 2 | (20.0) |
Theme | Category (Category No.) | Sub-Category (Sub-Category No.) |
---|---|---|
Initiating patient engagement | Initiate patient engagement when their physiological or daily life problems become more pronounced (1) | Obtain/accept consultation from the staff when a patient’s physiological and daily life problems become more noticeable (11) |
Increase involvement for patients having a poor response, long hospital stay, or sharp decline in food intake (12) | ||
Assess and identify the causes of decreased motivation from multiple perspectives (2) | Assess the causes of low motivation by considering the patients’ mental and physical conditions (5) | |
Collaborate with multiple professionals to assess patients if they show signs of apathy, hypoactive delirium, or depression (8) | ||
Assess patients from multiple perspectives to determine the best way to start supporting them (3) | Explore the patient’s life and preferences prior to his/her hospitalization from diverse perspectives to determine the required support (9) | |
Assess the patient’s problems from multiple perspectives: physical, mental, and social (6) | ||
Care methods for patients | Provide reassurance through basic dementia care (4) | Continue to actively talk to the patient and explain the situation so that the patient feels secure during the care (20) |
Communicate with patients using the methods of reality orientation and humanitude (21) | ||
Provide reality orientation by all staff members constantly (23) | ||
Incorporate the patient’s interests, lifestyle, and familiarity into the hospital room environment (25) | ||
Minimize environmental changes after discharge by informing caregivers about the patient’s responses and reactions during hospitalization (34) | ||
Incorporate pleasant stimuli into the hospital environment (5) | Use devices, photos, and visits by family members to stimulate the patients (24) | |
Provide an environment where patients can consider aspects besides their treatment (26) | ||
Use media such as photographs and other objects that the person likes or treasures as a way to communicate with other staff members (19) | ||
Touch patients’ hands, shoulders, and back to bring their awareness to the outside world (22) | ||
Provide care based on patients’ circumstances and abilities by collaborating with multiple professionals (6) | Provide care using the patient’s strengths and abilities (14) | |
Collaborate with rehabilitation staff to implement rehabilitation and cognicize that the patient can perform (30) | ||
Work on improving their food intake by considering their oral conditions, chewing ability, and food preferences by collaborating with dietitians and speech-language-hearing therapists (32) | ||
Intentionally involve multiple professionals and staff members with the patients (31) | ||
Use information from the rehabilitation staff for the patient’s assessment and care (33) | ||
Approach patients based on the degree of their disease and cognitive functioning (7) | ||
Administer basic nursing care, extending beyond addressing apathy (7) | Adjust the basic rhythm of patients’ lives using available opportunities and adjusting the environment for leaving the bed and sitting during the daytime as well as communicating more (10) | |
Talk to, observe, and respond to patients, which are basic ways of interacting with patients (29) | ||
Continued engagement and support for patients and their families | Evaluate patients’ responses and modify the nursing approach accordingly (8) | Employ certain strategies to engage, involve, and encourage patients to respond, even if the response is minuscule (1) |
Provide verbal and non-verbal reinforcements when apathetic patients respond to increase the frequency of their responses (2) | ||
Identify pleasant stimuli by evaluating the patient’s responses and incorporate them into the relationship (3) | ||
Do not force patients by engaging with them to prevent unpleasant reactions (4) | ||
Identify and create ways of involving the patients that motivate and energize them by assessing their reactions to the approach (15) | ||
Maintain long-term involvement with patients without giving up (9) | Be involved with patients while keeping in mind that it is difficult to show marked improvement despite implementing the approach (13) | |
Continue to be involved with patients without giving up even if they do not respond (16) | ||
Patiently observe the changes in patients over time (18) | ||
Establish a true relationship by visiting their room repeatedly and talking to them even if they do not respond (27) | ||
Share time with patients to understand their thoughts and feelings even if no words are used (17) | ||
Support the physical and mental well-being of patients’ families by collaborating with multiple professionals (10) | Cooperate with multiple professionals to provide mental and physical support to the family (35) | |
Share the patient’s responses with their family to motivate them to become involved in the care (28) |
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© 2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Doi, M.; Tanaka, A.; Nemoto, N.; Watanabe, T.; Kanoya, Y. Dementia Care Nursing for Apathetic Older Patients: A Qualitative Study. Geriatrics 2024, 9, 106. https://doi.org/10.3390/geriatrics9050106
Doi M, Tanaka A, Nemoto N, Watanabe T, Kanoya Y. Dementia Care Nursing for Apathetic Older Patients: A Qualitative Study. Geriatrics. 2024; 9(5):106. https://doi.org/10.3390/geriatrics9050106
Chicago/Turabian StyleDoi, Mana, Asumi Tanaka, Nanae Nemoto, Tenna Watanabe, and Yuka Kanoya. 2024. "Dementia Care Nursing for Apathetic Older Patients: A Qualitative Study" Geriatrics 9, no. 5: 106. https://doi.org/10.3390/geriatrics9050106