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Dementia Patient Fiona: Music Therapy Session

Faculty of Health and Behavioural Sciences School of Nursing

SNPG 955 Dementia Care Across Settings

The aim of assignment is to construct an assessment of a person with dementias’ needs using a model of dementia and discuss how you have addressed one area of need.

The purpose of this assignment is to write a summary of your assessment of the person with dementia and their health care needs.

Below are guidelines for undertaking this assignment.

Please make sure you read through all the instructions for what you are required to do and submit and that you also read through all the supplementary guidance here.

The model we recommend you use for your assignment is The Dialectics of Dementia (Kitwood) and is summarized below:

D=P+B+H+ NI +SP
D = Dementia is viewed as the product of a complex interaction between the remaining five elements of the equation:
1. P = Personality, which includes coping styles and defences against anxiety
 2. B = Biography, and responses to the vicissitudes of later life
3. H = Health status, including the acuity of the senses
 4. NI= Neurological impairment, separated into its location, type and intensity
5. SP= Social psychology which constitutes the fabric of everyday life

You are asked to provide an evidence based summary of each of the five (5) elements above and show how each contributes to the dementia process.

For example:

1. describe in person-centred way the personality of the person with dementia;

2. outline major areas of the person’s life history, in particular how they have dealt with emotional challenges and crisis in their life;

3. describe the persons overall health status, including any age related changes with their senses;

4. describe their neurological impairment, separated into its location, type and intensity;

5. summarise the social psychology which surrounds the person in their every day life and in the current care setting.

You must include your appreciation of the person’s:

  • personhood and his/her communication abilities; 
  • importance of the impact of the care milieu/ environment on the person; 
  • malignant social psychology; 
  • people with dementia are seen as active agents; 
  • language/ behaviours have meaning; 
  • positive person work.current care setting.

When you have done this, you need to outline the person’s health care needs and critically discuss how you would respond to one (1) of the identified needs.

Remember when you consider what the persons needs are that these should reflect their priorities and not just yours. You will also need to provide a title for your assignment and one that reflects something about the person you are representing. 

Please note: if you are not currently working in a clinical area as a member of staff or a volunteer and think that you will not will be able to meet a person with dementia (who is not a friend or family member) you will need to inform that Subject Co-ordinator by Week Two and negotiate an alternative assignment, for example, basing your case study on the experience of dementia by Fiona in the movie ‘Away fromHer’.

Answer

Music Therapy and Dementia

1. Introduction

In today’s modern world, society has still not learnt to accept dementia patients in caring manner. Therefore, to reduce the risk of malignant social psychology for dementia patients, person-centered approach is required. It is very critical to provide right environment for dementia patients to recover. The aim of assignment to address the issues of dementia in patient Fiona and provide her music therapy with person-centered approach. The assignment is review of applied interventions and literature review of dementia.

Fiona is retired woman who is enjoying her old days with her husband Brant County, Ontario. Fiona’s history is discussed in assessment. Fiona is fictional character from the movie “away from her”. The assessment reflects the impact of music therapy on Fiona’s specially her depression. Fiona becomes very depenedent on her coping partner aubray. In the absence of Aubray, she used to sulk in depression.

2.Summary Biography

Fiona lives in Ontarion with her husband and enjoying her retirement days. She is married to academicians Grant. She has painful memories from her marriage. Her husband ignored her in her young days because of beautiful students. She is health person. However, she began to loose her memory. She used to keep pots and pan in fridge rather in cupbords. She begins to forget name of simple things.  At start, she enjoyed her memory loss also as it let her forget painful memory of her marriage. But, on later stage, it developed in AD. Grant decided to put her in facility home wehere she met mute patient Aubrey. She developed affection towards him and forget completely her husband Grant.

Grant felt insecure and guilty for his past behaviours. But, he decided to support his wife to recover. 

3.Patient profile

Personality-Fiona is a social person with a friendly nature. She is retired and spends most of her time with her husband Grant. She organizes dinners and lunches with her friends and tries to innovate some new dishes. 

Biography- She loves to sing and dance, so in her free time when nobody around she spends her time singing and dancing. A few time she entertain whole family with her beautiful voice. 

Health status-But she is facing troubles to remember, sometime feels lost, and these days she forgets even for smaller issues, and also experience a high level of insomnia. Her health condition become worse these days, she now become restless, wander here and there with no reason and no boundaries of time. 

Neorological Impairment-The reason for all these health problems is Alzheimer’s disease. This also impacted the daily life of Fiona. AD resulted in the reduction of the memory and affected the system of processing information. 

Social Psychology-There is immediate need for an intervention for Fiona so that she can again lead her life in a normal way. The intervention must be of type which can improve the quality of life and health issues. The diagnosis of the disease and timely treatment of the problem may help her in improving the conditions like agitation, withdrawal, fragility and restlessness. If the treatment is not given on time then there is risk of development of malignant psychology for Samantha and this might affect her personal life. 

There are several researches and medical histories that mentioned the interventions for the condition of dementia in old age people. 

4.Literature Review

Nair et al (2013) through their research found the relation between the dementia and music. According to the study, the dementia cases are increasing day by day. The reason for this is the increasing number of the aged population. According to the data archived from US census, in the year 2010, there were approximately 4.7 million people who were above 65 years of age and were suffering from Alzheimer’s disease. The people with dementia were found to have trouble in their social, economic and health. The study approximated that by 2050 the total number of patients with dementia will be 13.8 millions. There are two types of treatments that can be given to the patient with dementia viz. pharmacological and non pharmacological. Pharmacological treatments are not recommended as they were reported to have severe side-effects. Non pharmacological treatments include exercises, personal care programs, etc. It was reported through the research that the music therapy posed positive impact on the people with dementia. Change in behaviour can be noted easily in the patient with music therapy.  

According to research performed by Raglio et al (2014) music can be considered as an important resource that would help in achieving the goals of dementia which include psychological, cognitive and social goals. In this research, the relation between the music and dementia was analyzed. According to this research, there is a structured model of intervention that is proposed for the person having dementia. The model is known as Global Music Approach for the people having dementia. This approach state that there are different music therapies that can individually or in integration state can be implemented in order to improve the condition of dementia. The practical implementation of this model reported that people with dementia felt relaxed in their health and mental state. It is considered as the low cost non pharmacological intervention and therapeutic method for enhancing the capability of dementia patients. 

Johnson and Chow (2015) in their research impact of music on the brain and cognitive process. The dementia is a result of aging factor and so does hearing impairment. Thus, with the dementia the person may start facing the agitation. The hearing impairment may also result in the neurodegenerative disease with dementia called Alzheimer disease. Music found to enhance the processing of brain and create a sensation of hearing. Apart from Alzheimer disease, music also found to improve the condition of the patients of Parkinson’s disease. 

Reynish and Greasley-Adams (2015) prepared a conceptual framework by considering music and dementia as their major factors. According to the research the number of musical activities and singing groups are increasing day by day for the patients of dementia. They conducted a research according in which they indentified the factors act as medium for developing a relationship between music and dementia. The data for the study was collected through an online survey. The response for the research was majorly from the Scotland and other European countries were also reported. Most of the people reported that they were involved in the intervention, and musical projects which aimed at developing relationship between dementia and music. Several responses stated that hospitals were found to have set up for music. Different types of music interventions were also reported like cultural and personal activities, active engagement, generation/age specific music, special events, etc. The study concluded that the music is an integrated entity that can influence the life of a person at different stages. The implementation of the music into the life of the people with dementia will help in improving the life of people. 

Use of music for caring the person with dementia is quite common these days and different literatures were also prepared in support of the same. A literature review was presented by Lamparero-Plokhotnikov (2015). In this study the aim of the researcher was to develop a deeper understanding regarding the impact of the music on the people suffering from dementia. The study concluded that the music has positive impact on the life of the people with dementia. Music posed an impact as it resulted in the reduction of the level of agitation as it is relaxing and revitalizing in nature. Music can also affect the mood of the person, socializing nature of the person, cooperative nature, and enhance communication. The positive impact of the music on the daily life of the person can be noted. It is the best approach as it does not require any skilled personnel or training. Family members can also help the person with dementia with the music therapy. 

5.Implementation

Decision Making

For person-centred care, creating right environment was very important. Fiona’s husband Grant was also part of the decision making process. He  helped with team of  multidisciplinary and recreational experts. To reduce the dipression of Fiona and to help her to be  independent without her coping partner Aubrey was the top most priorotiyt of music therapy. Keeping in mind the personal  nursing care involved in John’s  care to design the conversation done in an effective manner.  It includes four elements like prerequisite,  caring environment, person centred process and expected outcome.  In the facility home, Many music activities are held. At first, Fiona was interested to join chior in local community. However, it was not possible. Hence, practionar convienced her to join music activiies in facility home. Therefore, it is important to apply both verbal and  non verbal communication about the choice of Fiona.  By making a time table of music intervention, it will permit Fiona to have a break period, lessen her dipression without her coping partner  and allow her to relax in facility home . Grant was very unsure at the starting of the session whether music would be good intervention. However, after seeing improvement in her 

Planning

While working with Fiona’s dipression, her facial expressions helps in judging which activity she liked the most. this is used and pasted in john’s room where she can see and identify her needs. Fiona can join the music activities alongwith dance according to her demand.  The dance and music of facility home provide her comfortable, friendly environment. And after two weeks,  John’s one of the favourite music was played for half an hour and documented about her behaviour. Grant wanted to know her progress through agitation so he thought of maintain a diary. It would be good idea to maintain when he make a visit to Fiona. By this way, he can  compare the progress in Fiona’s behaviour specially dementia while visiting her. Another way is noting John’s behaviour by nurse’s  on medical record after every visit. The Cohen Mansfield Inventory (CMAI) was also used, which help in knowing result from agitation in Older Person (Cohen Mansfield  1991).  The maintain of record and keep them up to date and Fiona’s  attitude was discussed. education was given to the nursing staff  for their engangement to Fiona’s case. Eliminating any social disorder whilst encouraging the care for the culture was very crucial. The objective should be to improve Fiona’s condition rather than dementia. Kitwood 1997(cited in Mitchell and Agnellia 2014) emphasis   negative attitude of society towards people suffering from dementia  are really barrier. Patients of dementia are rarely seen or accepted in the society. 

Evaluation Criteria

For proper evaluation, two critiera are set-up. The first one is to check the diary mainted by Grant and second is checking recors maintened by nursing staff. The time of evalaution is also decided. Wednesday of every second and forth week is kept for evalaution. The evalaution team will have nursing staff, Grant and senior experts. The diary maintained by Grant showed the regular activities observed by Grant. The diary reflects the psotive impact of music on Fiona. She used to sulk in dipression without Aubrey. But one incident in diary showed that Fiona’s facial expression was joyful while playing music even in the absence of Aubray. Another incident showed affectionate behaviour towards Aubray. It also reduced her nervousness also.

Records maintened by care staff is also evalauted. The recored showed that before music therapy, Fiona is very much dependent emotionally on Aubrey. She forgets so many critical things. She used to sit at one place. She becomes very irritable without Aubrey. However, because of loving environemnt provided by care staff and music therapy, there is positive changes in Fiona’s behavior. She seems happy. She likes to make eye contact. She respond back to simple hello of staff member. She likes to talk with staff members. Fiona accepted that she feels joyful during her music and dance activity. She told satff memebrs that her msuic sessions are best time in facility home.

6.Implementation of Practice

This practic  has shown the importance of staff being literate on various type of dementia. To upgrade  their interpersonal skill to be patience and to maintain a caring enviornemnt is critical.  Staff should  be aware of  psychological factor in context of dementia patients which are in conductive and in communication. Another aspect of intervention is to impelemnt intervention effectivaly alongwith regualr and effective monitoring with effective and realistic healthcare goals. It has been noted the importance of personal care and therefore focuses on promoting and illustrating how it can be put in use of different type of dementia situation. Maintaining records is an effective stratgey proven effective for care members without inetreperting the privacy of family members. The collaboration with Grant(Fiona’s Husband) throughout, has given an understanding on few things Fiona’s before dementia. The details about Fiona’s nature and behaviour before dementia helped care team to understand Fiona better and provide her caring environemnt. Downsn& Bowers(2014) shows  that the person is depressed and suffering in dementia, our research is to provide treatment on every bit of personhood who are suffering in dementia.

7.Conclusion

Music therapy has proved in this study which is non pharmacological intervention to rise emotional bounding through cognitive stimulation and interaction socially. It need daily evaluation and effort to bring new way of possibility in effectiveness as possible. The nursing staff plays a crucial role in bring out the identification through regular keeping and verbal communication with John and his family, important time when it is extremely vital to play music. To help the staff to know the john behaviour, environmental causes and any unimportant need which he experiencing in his behaviour whereas the intervention in John’s life has shown an improvement in improving his life quality building self esteem of John which helps in showing development in social and engagement of other activities. Which help him going and moving around the home and surfing to the dining area of his home. Music therapy over a period of time has played an important part in Fiona’s life aThe intervention has proved to be beneficial in John case it includes to recruit experienced trainer in the field of music therapy in the group so that one on one session on music to be conducted to upgrade the health condition and to get rid of the feeling of isolated from the society. Music therapist session which may add value in the health improvement and even from feeling lonely as it may include listening to the favourite music with the trainer. 

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