Psychological aspects of the "school for the care of elderly relatives". Organization of training of relatives in special skills of nursing at home

What to do when life brings surprises with a minus sign and dooms a person to permanent care for a sick relative? It is no secret that staying with an incapacitated person around the clock puts excessive pressure on the psyche of someone who has taken on the sacrificial and holy duty to help his neighbor. Are there ways to relieve yourself and all relatives involved in the process of caring for a seriously ill person from stress? This will be discussed in our next publication.

Sometimes people don't realize the severity of the consequences.

First of all, you need to correctly calculate your own strengths, both physical and emotional. After all, unfortunately, they are far from limitless. When misfortune occurs in the family, and one of the elderly relatives suddenly falls ill, at first it seems to the able-bodied member of the clan that he can endure everything. A person is perfectly aware that old age will someday become a reality for himself. He is trying to do what he would like his children to do with him in case of emergency. Therefore, it is no secret that people can sacrifice their promising careers, personal happiness, health, and well-arranged living conditions for a good cause. However, having never encountered such a situation before, it is rather difficult to imagine real consequences. That is why it is so important to have special knowledge, skills and relevant qualifications.

Seek help from a professional nurse

The most common option for getting rid of stress in caring for a seriously ill family member is to involve a professionally trained person as an assistant. It is easier for a patronage worker, as a person from the outside, to more adequately assess the situation, make a decision without being guided only by emotions, and medical skills will help out at the most crucial moment.

For some reason, in our society it is generally accepted that if someone resorts to the services of professionals in such a delicate and controversial issue, then he relieves himself of the burden of responsibility for his relatives or simply shows his disrespect to them. However, this is misleading. It is not necessary to take a nurse around the clock, it is enough to limit yourself to time for your own respite.

Shift schedule is a good idea

If you establish a kind of shift schedule for the supervision and care of a disabled family member, you can devote free time to restoring your own moral and physical strength or simply get distracted by changing the scope of activity for a while. It is also advisable to arrange with someone from other family members so that from time to time they replace the person who has taken on the main role of caring for the elderly or sick. The unity of the family, the pursuit of the interests of each of its members, is tested in such difficult moments.

Do not refuse help that strangers offer

Feelings and emotions that overwhelm relatives during a severe tragedy are almost always negatively emotionally colored. Pride, neglect of help offered, for example, by a zealous neighbor, can play a cruel joke. This situation is not from the category of those that are commonly referred to as “they themselves are not born,” so any outside help can be an excellent help for the patient’s recovery, or to alleviate the general situation. Embarrassment for the condition of the patient in front of his old acquaintances should not take place in the mind of a person who undertook to carry out basic care. In some cases, during the deterioration general condition the patient can also come to the aid of specialized institutions.

Learn how to properly relax

For a person who bears the main burden in caring for a seriously ill or elderly family member, it is extremely important in moments of rest not to go completely into oneself, not to plunge into even darker thoughts and experiences. It is better to be in public more, with your former friends, and also to do the usual things. Walking and pleasant communication will not let you lose your taste for your own life, no matter how hard it is during a given period of time. And in this case, any, even the most short-term switching and distraction will benefit.

How to deal with negative emotions?

Seeing how once cheerful and literally bursting with health close person slowly but surely fading away - an occupation not for the faint of heart. Even if the human psyche is hardened enough, it will still be subject to negative influence emotions, this is an inevitable moment. How to deal with the accumulated negativity? In any case, anger at fate, resentment, fear of the future and others negative emotions and feelings can not be kept in itself. The negative will accumulate in the cup of patience until it overflows the vessel and pours out on the head of a sick person in need of help. This state of affairs cannot be allowed under any circumstances. You can find a way out of the situation in talking about your problems with one of the strangers.

In order to gradually get rid of the accumulated negativity, you need to find like-minded people, people in different time coped with a similar situation, and ask them for advice. The invaluable experience of people who have gone through this is usually found in some online community, as well as in various groups mutual assistance. It must be remembered that all mentally depressing moments must be disposed of in a timely manner.

Psychological breakdowns will only exacerbate the situation.

All the moments that we have described in this publication, whether it is help in caring for a seriously ill person from the outside or communication in a group of like-minded people, will help in the future to avoid a psychological breakdown that will fall, first of all, on an incapacitated relative. At such moments, sick people who are not completely devoid of reason feel like a burden and want to say goodbye to life as soon as possible in order to stop burdening their relatives.

A person who has assumed the difficult responsible mission of caring for a disabled relative must remember that in no case should you show your impotence and tears. Also empty are the accusations of what happened to fate or, moreover, to the victim. Only cooperating with people who have similar experience seems to be a reasonable solution to the problem.

What can save a seriously ill

In addition to competent professional care, a good psychological atmosphere around, a family member who has lost his legal capacity can be saved by the care, attention and love of the household. It must be remembered that absolute love, coupled with boundless faith and devotion, can work real miracles.

Everyone wants to live as long as possible on this earth in good health and well-being. And it's great if we manage to live to a ripe old age. It is good if old age is warm, affectionate and cozy. People differ from animals in that children care for elderly parents and help them. The secret of eternal youth has not yet been found. Therefore, the time comes when we have to look after and take care of our relatives the way they once took care of us.

What character traits should a carer have?

Caring for the elderly is an extremely serious and very difficult task. It requires a lot of patience, strength and endurance, as well as the ability to contact the patient. Age and disease do not improve character. An elderly man who suffers from loneliness and feeling unwell has poor control over his mood swings.

Often, older people become more and more withdrawn into themselves, becoming overly suspicious and touchy. Most of such people suffer from depression.

In this regard, one who devotes himself to caring for a sick or elderly person must have stress resistance and considerable endurance, as well as be a sophisticated psychologist. But even this is not enough to properly and efficiently care for an elderly person or a bedridden patient, one must have medical skills and certain knowledge. Tactful and attentive care for your close elderly or sick person will help organize a boarding house for bedridden patients, where coziness and comfort will be provided to your loved ones.

What skills should a caregiver have?

Caring for the elderly requires an individual approach. A person who assumes the functions of caring for a sick or elderly person must be strong in physical plane, possess necessary knowledge nurses and be able to cook special diet food.

A person who performs the functions of a nurse must have the appropriate skills to carry out some medical manipulations, primarily injections and massage, as well as the necessary hygiene measures. Elderly people become absolutely helpless as a result of diseases, as well as age-related changes, and require constant attention almost around the clock. Adult young people have to practically be torn between work, arranging their personal lives and caring for the elderly. You should be prepared for the fact that with the passage of time the situation will worsen, which will require even more time, effort and attention from relatives. The most optimal way out of this very difficult situation is to entrust the care of the sick and the elderly to professionals.

23.06.2017

Care for mild to moderate dementia

The last article talked about what dementia is, how it occurs and develops. What to do with the patient if this misfortune happened, and the diagnosis was made by a doctor?

First of all, I want to know if it is possible to somehow slow down the development of the disease or even cure it. As already mentioned, in this moment There are no methods for curing dementia, that is, unfortunately, one must tune in to the fact that a person will irreversibly lose his mind and then die.

But it is quite possible to slow down the development of the disease. Especially those who fell ill with dementia quite late, after 80 and even more so 90 years, usually die from completely different causes or simply from old age. And to old man their last years spent more or less comfortably, and caring for him was not too burdensome, of course, I would like to keep his skills, memory and mind as long as possible.

There are drugs that clinical trials slow down the course of dementia. These are, for example, donepecil (arisept, donepegamma, etc.), galanthamine, memantine (aksura), nicergoline, nimodipine, piracetam, rivastigmine (exelon). The decision whether or not to give a patient medication should be made in consultation with the doctor, taking into account all side effects medicines.

In addition, there are non-drug methods treatment of dementia, of which the training of cognitive abilities and memory stands out in particular. The effect of such training, according to studies (https://www.iqwig.de/download/A05-19D_Abschlussbericht_Nichtmedikamentoese_Behandlung_der_Alzheimer_...), is well pronounced and, perhaps, not lower than the effect of drugs (although studies on direct comparison of these methods could not be found). Methods are also used to activate patients (we remember that apathy often accompanies dementia), emotionally oriented methods (we will talk about them later when it comes to communication), teaching relatives, occupational therapy, physiotherapy.

So, we figured out what medical measures can be taken to improve the quality of life of the patient and facilitate care for him.

But relatives and other caregivers have a lot of problems and questions related to the most common household chores around the patient. Because dementia changes everything! Nothing will be the same as before: food, toilet, sleep, movements, activities - all this looks completely different than in a healthy person.

Let's consider these problems using ordinary classification areas of life that are applied in the science of nursing (although I will take an arbitrary order to emphasize the important). Until we touch on the later stages of dementia, when everything changes again, and the care is already somewhat different.

1. Security.

The most pressing concern in caring for a person with dementia is to ensure their own safety and the safety of those around them.

In the early stages, when the patient still retains some adequacy, there is no such problem. As a rule, the tendency to run away (or, as it is now customary to say in German withdrawal, “the tendency to strive elsewhere”) is most often and primarily a threat to safety. Even before the patient has become inadequate, due to disorientation, he can easily get lost, following the usual route, so it is undesirable to let such patients go out alone on the street.

And then many develop a stage of anxiety, when the patient is constantly in motion. At the same time, some run from one end of the corridor to the other or reach the door, turn around and go back. The open air inspires fear in them. But others, unfortunately, go outside. Further, the "tendency to strive" appears when the patient builds his own world from fragments of memory and believes that "I must go to work, I'll be late!" or “my mother is waiting for me at home!” And accordingly, he leaves the room and goes “to work” or “to mom”.

In Germany, it is forbidden to keep people behind closed doors without a court order, and the court does not always give such permission. Supervision is not always possible due to the small number of staff. Therefore, heartbreaking things happen. For example, patient B. left the department unnoticed; her sisters noticed her absence only half an hour later, since they were just busy with morning care. They searched the whole house, then one of the sisters got into the car and drove around all the neighborhood in search of B. An hour later, a teenager called who saw a helpless old woman - she was lying in a ditch near the bus stop. The patient had problems with coordination. After walking about a kilometer in an indefinite direction, she lost her balance somewhere, fell into a ditch and hurt her forehead. A teenager passing by called "" and guessed to call another nursing home, located nearby. The patient had to have stitches on her forehead.

But everything could turn out even more tragically, especially in the city: the dementia patient K. left the house, and not being able to assess the situation on the road, went out onto the roadway and died under the wheels.

Naturally, to prevent this from happening, the patient needs constant supervision if there is anxiety, disorientation, lack of an adequate assessment of the situation. Relatives, of course, can simply lock the patient with a key, although this is not a very good solution to the problem.

In addition to the problem of running away, many other points must be taken into account, a safe living environment should be created in the house. All household liquids detergents, medicines, solutions and substances hazardous to health (for example, vinegar) should be inaccessible to the patient (best of all, locked with a key, and the key should be kept out of reach). In the kitchen, turn off the stove (turn off the gas). Forks and knives should also be kept out of reach. The same applies to needles, knitting needles, working tools and other sharp objects. Windows should not open entirely, only a window. Sockets must be safe (of course, the sick person is not a child and is unlikely to climb into them specifically out of curiosity, but if the socket dangles, this is dangerous).

Over time, the patient begins to have problems with coordination of movements, from this moment it is necessary to deal with the prevention of falls. Remove all obstacles on the floor, remove carpets and everything that can be caught on and tripped over. Put furniture so that there is no danger of running into an acute angle. Provide adequate lighting at all times.

Here's a little about medicines and treatment. Even in the early stages, when the grandmother is still quite in herself, but forgets a lot, one should not underestimate the danger and not control the medication. The best thing is to immediately take all the medicines to yourself, close them with a lock and give out pills in right time in the right amount. Not for the whole day, but only for one reception. The patient may begin to protest, one must try to find some explanation, for example, that this is being done at the direction of the doctor. Some, on the contrary, do not want to take pills, considering themselves healthy or suspecting others of the intention to poison. In this situation, it is necessary to control whether the patient actually swallowed the medicine or hid it behind his cheek and then spat it out. Tablets can be crushed and given with yogurt. Of course, the patient needs to be explained what these pills are for and why the doctor prescribed them, then trust and cooperation arise (for example, “if you don’t take this pill, your joints will hurt again. This is a pill for pain”).

2. Communication.

This is such an extensive topic that we will talk about it in a separate article. Here it is brief: the ability to communicate, of course, decreases along with general cognitive ones. But they persist for a very long time, or rather, until death. A common mistake is to think that the patient is “inadequate anyway”, and trying to understand him or explain something to him is “useless”.

Need to talk to the patient in simple words, in short sentences, loud and clear enough. The further the disease has gone, the less the patient reacts to the meaning of speech, but more to intonation. Therefore, the intonation should always be affectionate, calm, cheerful and confident. AT certain cases you can make the intonation tough, firm - but do not shout, do not be indignant and do not order (this will only offend the patient), but simply speak confidently and definitely.

It is possible and necessary to use non-verbal communication very widely, especially gestures, the understanding of their meaning lasts longer than the understanding of speech.

It does not hurt to provide the doors in the apartment with written instructions, for example, “toilet”. Patients can retain the ability to read for a very long time.

3. Movement.

Unfortunately, motor abilities will also deteriorate over time, so that this process goes slowly, it is advisable to work with the patient therapeutic gymnastics, more walking, walking (accompanied), you can drive to the pool. In a word, movement is always good, the patient should be encouraged to do this.

The theme of pain is closely related to movement - after all, often patients do not move simply because their joints hurt. For quite a long time, a dementia patient can report pain and its intensity, so the approach here is the same as for cognitively unaltered people, pain must be treated, relieved, it is not necessary to “endure”, because this leads to nervous, chronic pain.

There is nothing wrong with the constant use of painkillers, they can be taken for decades. Of course, by prescription and under the supervision of a doctor.

The problem arises when the patient can no longer report that he is in pain. In this case, they observe: the patient's facial expressions, a distorted face, groans and cries, under what conditions and movements it appears, sparing position of the body or limbs, changes in sleep and appetite.

5. Body care.

Patients lose the ability to care for themselves very gradually. Skills usually last longer than the ability to speak and think. Therefore, for quite a long time, the whole task comes down to motivating the patient to wash (often they don’t understand why this is necessary at all), bring them to the bathroom and give instructions (“here, take a brush and brush your teeth. Now rinse your mouth”).

For dementia mild degree this problem does not arise at all, the patient is washing and dressing himself, you can see once a week that he or she takes a shower and wash his hair or help with this.

And, finally, skills are lost, agnosia sets in (the patient does not know what Toothbrush) and apraxia (does not know how to use it, tries, for example, to brush his hair with a toothbrush). And at this stage, if you give the patient a sponge, lather it up and show him what to do, he can still partially wash himself. Or at least dry off with a towel.

Over time, a moment arises when the caregiver must completely take over the entire care: every morning and evening, wash and wash the patient, dry, care for the skin, dress. It is not necessary to bathe the patient in the shower every day (especially if the patient does not like and does not want to), although it is possible, of course. It is enough to wash the face and body with a damp sponge in the morning, shave the man. In the morning and evening, spend an intimate toilet, wash your hands with soap (also before eating), brush your teeth or remove and clean dentures. Wash your hair once a week, cut your nails (as they grow, of course).

It is better to choose clothes that are comfortable, not tight, and one that is easy to put on and take off. At the same time, it should be beautiful and pleasant; you should not dress the patient in hoodies and pajamas.

With regard to care and clothing, it is very important to maintain the independence of the patient as long as possible. If he can still wash his face, do not wash, but offer to do it yourself. If you can’t wash yourself, then give a towel to dry off - this action happens automatically, because it’s unpleasant to be wet. As long as the patient can choose their own clothes, ask what they would like to wear.

6. Food and drink.

It is very important to ensure that the patient receives at least 1.5 liters of fluid per day, in extreme cases, at least 800 ml (4 glasses) for very old people. True, soups and tea and coffee also belong to this liquid. Old people are often not accustomed to drinking water or juices on purpose, and it is difficult to convince them to do so. But no one will refuse to drink tea - just put a mug of tea and top it up periodically.

If the patient, especially in the heat of summer, does not drink enough fluids, and it is impossible to force him to do so, it is necessary to discuss this problem with the doctor. In such cases, droppers with saline are prescribed.

There is a disorder (often in Pick's disease) where the patient loses the feeling of satiety. He eats everything he sees, first edible, and then late stages can chew both napkins and candy wrappers. He can literally eat a mountain. It is clear that in such cases, food must be locked up and given strictly in portions 4-5 times a day.

However, much more often with dementia, the patient is threatened by loss of appetite and cachexia. Therefore, do not worry if the grandmother is full and eats well - let her eat, it is hardly worth keeping a figure at this age, and the harm to health from obesity is less terrible than the potential for cachexia. The patient must be weighed regularly, and with a persistent weight loss of more than 3-4 kg, and even more so when the weight is constantly decreasing, measures must be taken.

Dementia patients often do not want to eat, they have apathy, and as the disease worsens, the ability to taste is lost. A severe dementia patient can be given a bitter medicine, and he will not even wince, he will even say “tasty” sometimes.

It must be remembered that the ability to feel sweet dies last. Even at the final stage, dementias still taste sweet. In advanced institutions, only sweet dishes are specially prepared for dementia patients (cereals, puddings, pancakes, etc.)

It is necessary to feed the patient 5-6 times a day in small portions, it is useful to give a little food before bedtime or even at night - yogurt or fruit. If the patient does not eat, methods such as "eating on the go" (eating-by-walking), or "eating with fingers" (fingerfood, finger-friendly pieces, useful especially when the patient has forgotten how to use cutlery) are used. You can lay out tasty treats throughout the house, and let the patient regale himself when he wants - if he cannot properly feed at the table.

If no measures help, and the patient is still losing weight, you can think about high-calorie food supplements (there are special powders) or high-calorie drinks and puddings, such as Fresubin.

7. Toilet.

Over time, patients inevitably develop incontinence. It's hard to do anything here. Of course, "toilet training" is recommended - to drive to the toilet and land on the toilet every two hours. If you have time, you can do this. But - this is my personal opinion - there is no colossal sense in this, since over time this ability will fade anyway. The patient will no longer notice the urge to defecate and urinate. Training can, however, be beneficial in case of slow developing dementia, for example, vascular or mixed, when a person has been in the same state for years. In this case, of course, it is more convenient to take him to the toilet than just change the pads.

If incontinence has already set in, it is important to compensate for it with the help of properly selected pads or diapers, it is not necessary to take expensive options like diaper pants, you can wear tight-fitting underpants and large pads in them, which are relatively economical and protect no worse than the notorious diapers. Pampers make sense only in some individual cases. Naturally, pads should be changed regularly, always during bowel movements and when noticeably wet, checked at least every 3 hours, otherwise skin irritation in intimate areas, inflammation and other unpleasant consequences occur.

There are a variety of options here - insomnia, a shift in sleep time, when a person “walks” all night and sleeps all day, or such drowsiness when the patient sleeps day and night and wakes up only occasionally. It depends on the individual reasons and from the course of the disease. And you also need to approach this phenomenon individually. But we will talk about sleep separately.

9. Classes and mode.

A patient with dementia has a problem - he cannot structure his time himself. If a healthy person (or a physically ill person) himself reaches out for classes and finds them - he watches TV, knits, reads, walks, works in the garden, then a demented person, left to himself, will sit, staring blankly in front of him, or walk continuously. Not to mention the fact that he does not know when to eat, when to go to bed, in a word, he cannot organize his own daily routine. Caregivers should do it for him.

In the picture below - toys for old people.

It is impossible to overload the patient too much. Impressions and activities can only occupy little time, then the load on the brain becomes unbearable. For dementia patients, for example, the “10-minute activation” technique has been developed, when a social worker does something with dementia for 10 minutes - looks at photographs, objects from the past, pictures, draws, sculpts, sews, etc. Of course, with mild dementia a person is able to hold attention for much longer than 10 minutes, in severe cases he is not able at all, everything is individual here.

It is very important that the daily routine of a dementia patient is constant, even if it was not so before. But the fading mind is not able to cope with the irrational diversity, besides the loss of skills going faster if life is not regular. It is good if the patient gets up and goes to bed at the same time, eats at the same time, in the same place at the table.

10. Social contacts

just as important to a person with dementia as they are to healthy people. Common Mistake relatives - “She won’t recognize us anymore, so what difference does it make whether we visit her or not? Let hired nurses take care, but why should we?” But a demented person for a very long time, having forgotten the names of loved ones, can remember their touches, perceive them emotionally. A sensitive empathic person captures these moments and understands that "she is glad to see me." But even if it seems that the patient is completely indifferent about the presence of loved ones, nothing can be said for sure. Therefore, it is very important to visit such a patient, hug, say kind words. No professionals can replace the warmth of loved ones. It is not necessary to take care of yourself, of course (sometimes this is impossible), but it is still very desirable to communicate.

Having written this, I see that the scope of the article is too strong a limitation on this topic. And it was possible to say very little of what needs to be said. In the end, a lot of books have been written on this topic, which, unfortunately, have not been translated into Russian.

Let's hope that over time this gap will be filled.

The disease is named after the German scientist A. Alzheimer, who in 1906 described changes in the brain tissue of a 55-year-old woman who died, as was then believed, from an unusual mental illness. It is known that the disease is based on the gradual destruction of cells and tissues of the brain, especially those parts of it that are responsible for memory and thinking. Symptoms usually slowly but steadily progress. The disease usually lasts 5 to 10 years. Cognitive functions (memory, judgment, abstract thinking, mathematical abilities) are gradually lost. Decay is happening emotional sphere and the personality as a whole, motor skills and, especially, speech skills are lost. The patient ceases to recognize even relatives and friends, he is bedridden, unable to serve himself. The disease affects all social groups and is not associated with belonging to a certain stratum of society, gender, nationality and residence in a certain geographical area. Although the disease is most common in humans old age It also occurs among younger people.

Alzheimer's disease affects the different people. In many respects it depends on how the person was before the disease, that is, on his personality, physical condition, lifestyle. The disease creeps up unnoticed, determine its onset and distinguish it from the so-called senile forgetfulness that suffers great amount older people is very difficult. Which of us has not witnessed how people are looking for keys or watches that just a second ago lay before our eyes and suddenly fell through the ground, or to engage in such searches ourselves? It is well known that human memory deteriorates with age, but it must be understood that Alzheimer's disease is not just age change memory or showing signs of aging. Alzheimer's disease is insidious and yet incurable disease, at which the memory fails completely.

People around you need to be attentive to any signs of dementia and behavioral disorders in the elderly. The first signs of the disease can be noticed by relatives and family members of the patient, when he has problems with the choice of words in a conversation, when he has difficulty remembering recent events (what he did last night, what he ate for breakfast, etc.), loses interest in favorite activities, loses habitual skills. Timely appeal to specialist doctors early stage disease can contribute to the establishment accurate diagnosis, allows you to increase the effectiveness of treatment, properly organize patient care, improve the quality of his life, as long as possible to maintain his labor, professional and creative potential.

The main symptoms and signs of Alzheimer's disease

Early stage

The early stage usually goes unnoticed. Relatives, friends, and often professionals misattribute the symptoms of old age to the patient as a normal part of the aging process. Since the disease develops gradually, it is often difficult to determine exact time her start. Gradually, a person:

having difficulty choosing words in a conversation;
short-term memory worsens;
there are serious difficulties in making independent decisions;
perception is disturbed environment, recognition of objects, a person is easily lost, especially in an unusual environment;
there is disorientation in time;
understanding of complex and abstract thoughts is disturbed;
the initiative and motivation to act disappear, indifference and isolation are noted;
depression may develop, signs of aggression appear;
difficulty in performing complex homework(for example, cooking);
Loss of interest in their hobbies and other previously loved activities.

middle stage

With the development of the disease, the problems become more obvious and significantly limit the patient's activities. The patient has difficulty in Everyday life, for example:

becomes extremely forgetful, especially often forgetting recent events and people's names;
can get lost in familiar surroundings, at home or in society;
can't go on living alone without outside help;
cannot cook food, do house cleaning, go to the store;
needs help with going to the toilet, washing, dressing, etc.;
ceases to be aware of his disease;
experiencing increasing difficulties in communication;
exhibits abnormal behavior (eg, vagrancy);
may suffer from visual hallucinations.

late stage

But this stage the patient is completely dependent on those who care for him. Memory impairment is extremely serious, the physical side of the disease becomes noticeable.

loses the ability to speak and understand speech;
loses the ability to move, his limbs become rigid;
has difficulty eating, he has to be fed;
does not recognize relatives, acquaintances, friends and familiar objects;
not able to control natural departures;
behaves inappropriately in the presence of other persons;
confined to bed or wheelchair.

When the disease begins to progress, every opportunity should be taken to support the patient's ability to self-care, reduce his internal discomfort and isolation from others. New, better-fitting glasses, a better hearing aid, an easy-to-use radio, books with pictures and large letters can help. It is necessary to find a useful and affordable activity for the patient, taking into account his needs and the capabilities of the caring staff. A sick person constantly needs consolation and encouragement, you can’t scold him, make offensive remarks.

Factors that exacerbate symptoms of dementia

Caring for care, it is necessary to know the factors that worsen the functional abilities of the patient and, if possible, eliminate them. To known factors that exacerbate symptoms of dementia include:

unfamiliar places;
being alone for a long time;
excess amount external stimuli and stimuli (for example, meeting with a large number strangers);
darkness (suitable lighting is required even at night);
all infectious diseases(most common infection urinary tract);
surgical interventions and anesthesia is used only for absolute readings;
hot weather (overheating, fluid loss);
reception a large number medicines.

Patient care at home deserves special attention. It is important that relatives and others involved in the care of the patient know the main signs and symptoms of Alzheimer's disease, understand the nature of the progression of the disease, take into account the factors that increase the symptoms of dementia, and master the simplest practical techniques for caring.

Hospitalization for Alzheimer's disease is an expensive event, which sometimes has only a negative effect (accelerates the progression of the disease). With any change in the environment, caring staff, changes in drug treatment, the course of the disease, as a rule, worsens. Hospitalization is indicated for the selection of therapy, which is dangerous to carry out on an outpatient basis, in the absence of careful medical supervision of the patient, as well as in case of confusion, psychotic manifestations and antisocial behavior.

Caring for Alzheimer's patients can sometimes be very difficult. At home, caring for such patients, as a rule, falls on relatives who are subjected to severe emotional stress, constantly watching how the person close and loved by them degrades. The unpreparedness and helplessness of relatives in a situation of chronic stress will not only not help the patient, but can also have the most negative impact on their condition. own health. Nurses and physicians need to ensure psychological support caregivers at home to teach them special techniques that can help them cope with problems. Thus before medical staff important tasks are set for training and counseling the patient's relatives, providing them with effective psychological support.

Below are various teaching materials, which, we hope, will be useful not only for professional nurses, but also for those simply caring for sick people.

How to provide patient care at home

First of all, it is necessary to establish a certain daily routine for the patient, which will allow organizing and streamlining his complicated life and help him get rid of the need to make difficult decisions. The patient's daily routine should include activities that are familiar to him, this will help him maintain a sense of confidence and security. It is important to try to help the patient maintain self-esteem. In the presence of the patient, one should refrain from discussing his condition, since the words and actions of others can cause anxiety and resentment.

Physical exercises allow in many cases to maintain the functional abilities of the patient for some time, although it is better to turn to specialists for recommendations on the nature and complexity of the exercises. If before illness a person liked to work in the garden or in the country, he may enjoy using the skills that have been preserved. However, we must not forget that as the disease progresses, the abilities and interests of the dementia patient may change. Therefore, when caring for, it is important to carefully monitor the patient and make the necessary changes in the nature and content of his activities.

It is unacceptable to draw the patient's attention to his failures. Any conflict only leads to unnecessary stress for both the patient and caregivers. Showing anger, bitterness, or resentment will only worsen the situation and exacerbate the problem. Try to remain calm, try to laugh with (but not at) the sick person. Humor is often excellent remedy from stress!

Provide a safe environment

Memory loss and impaired coordination of movements in the patient increase the risk of injury. Try to make your home as safe as possible.

Remove piercing and cutting objects, household poisons and medicines.
Keep dangerous electrical devices away.
Shut off the gas supply when the patient is alone.
Install patient safety devices (eg, microwave oven for cooking).
Check the operation of the door locks, install locks on the windows.
Use locks that the patient cannot open.
Watch out for smokers.
Do not change the patient's usual arrangement of furniture.
Provide adequate general lighting, stair lights, nightlights in the bedroom and closet.
Control temperature regime indoors, avoid drafts, hypothermia or overheating, help select and put on clothes appropriate for temperature conditions.
Monitor the quality of products, do not allow the use of poor-quality or spoiled products.
Install handrails in the bath and toilet, the bottom of the bath and the floors should not be slippery, the locks on the door should also open from the outside.
The underfoot material in all rooms must be non-slip.
Furniture should be stable, chairs and bed should be high enough.

Keep in touch

As the disease progresses, communication between caregivers and the patient may become increasingly difficult. The patient's vision and hearing should be checked, if necessary, stronger glasses should be ordered, and the hearing aid should be replaced. When communicating, it is recommended:

respectfully address the patient by name (patronymic);
speak clearly, slowly, face to face with the patient, while keeping your head at the level of his eyes;
show love and warmth by hugging the patient, if it does not embarrass him;
listen carefully to the patient;
pay attention to non-verbal means of communication;
try to establish what gestures and word combinations, clue words are necessary to effectively maintain communication with the patient;
avoid negative criticism, disputes, conflicts;
before speaking, check whether the patient is listening to you.

Bathing and personal hygiene

The patient may forget to wash, not see the need for washing, or not remember how to do it. When offering your help to the patient, try to preserve his personal dignity.

When washing, try to stick to the patient's previous habits.
Try to make washing as pleasant as possible, help the patient to relax.
Showering can be easier than taking a bath, but if a person is not used to showering, this can be distressing.
If the patient refuses to bathe or shower, wait a while - the mood may change.
Let the patient do everything he can for himself.
If the patient is embarrassed when bathing or taking a shower, certain areas of the body can be left covered.
Don't forget about safety, such as securely fastened objects, handles or railings that you can grab onto, a rug that you can't slip on, and an extra stable chair.
If you run into problems every time you help a sick person wash, ask someone to help you.

Dressing

The patient may forget the dressing procedure, not see the need to change clothes. Sometimes in the presence of people, patients appear dressed inappropriately.

Put the patient's clothes in the order in which they are to be put on.
Avoid clothes with complex fasteners, use clothes with elastic bands, Velcro, zippers, etc.
Do not rush the patient when dressing, encourage him to act independently.
Shoes should be comfortable, non-slip, with rubber soles, loose, but not falling off the foot.

Toilet visits and incontinence

Patients may forget where the toilet is and what to do in it, they no longer feel when they should go to the toilet.

Encourage sick people to go to the toilet.
Set a specific visiting mode.
Mark the door to the toilet in large colored letters.
Leave the toilet door open to make it easier to find.
Make sure the patient's clothing can be easily removed.
Limit your fluid intake before bed as much as possible.
You can put a chamber pot next to the bed.
Use diapers if necessary.

Nutrition and cooking

People with dementia often forget to eat and may not remember how to use a fork or spoon. In the later stages of the disease, the patient needs to be fed. may appear and physical problems- lack of ability to chew and swallow food normally.

Remind the patient of the need to eat.
Give him food that he can eat with his hands.
Cut food into small pieces so that the patient cannot choke.
In the later stages of the disease, prepare pureed and liquid foods.
Remind you to eat slowly.
Do not forget that the patient may lose the sensation of cold and hot and get burned, so the food should be warm.
Do not give the patient more than one serving at once.
If you have problems with swallowing, seek the advice of a doctor who will introduce you to techniques that stimulate swallowing.
Ensure that the patient receives enough nutrients.

In the later stages of the disease, the patient may lose the ability to cook food. This can become a serious problem if the person lives alone. Poor motor coordination leads to heightened danger injuries such as burns and cuts while cooking. Try to provide the patient with ready-made food.

The patient does not sleep well

The patient can stay awake at night and interfere with the sleep of the whole family. For caregivers, this can be the most debilitating challenge. What can be done?

Try to keep the patient awake during the day.
A daily long walk may help. Let's get more physical activities during the daytime.
Make sure that the patient, going to bed, can feel comfortable and comfortable.

The patient often loses things, accuses you of stealing

The patient can often forget where he put this or that object. Often he accuses you or other people of stealing lost things.

Find out if the patient has a secluded place where he hides things.
Keep replacements for important items, such as a spare set of keys or glasses.
Check trash cans and baskets before throwing trash out of them.
Answer the accusations of the patient calmly, do not get annoyed.
Agree that the item is lost and help find it.

Vagrancy

Sometimes patients show a tendency to vagrancy, which causes a lot of anxiety and anxiety to relatives and caring staff. The patient can leave home and wander around the neighborhood, leave in an unknown direction and get lost, even end up in another city. If the patient leaves the house alone, it is necessary to take care of his safety.

Make sure that he always has some kind of identification document with him,
Have a note in the pocket of the dementia sufferer's clothing with the address and telephone number where the person's next of kin or caregivers can be contacted.
Make sure that all exits from the house are well locked, that the patient is safe in the house / apartment and will not be able to leave the house without your knowledge.
If, nevertheless, the patient is lost, control your emotions, speak calmly, do not scold the patient, try to express your support to him when he is found.
It's helpful to have a recent photo of the patient in case they get lost and you need other people's help in finding them.
To combat vagrancy, you can attach unbreakable mirrors to all doors: your own reflection in the mirror distracts the patient from the intention to open the door.

Delusions and hallucinations

Patients may experience delusions and hallucinations. Crazy ideas are characterized by the appearance of false beliefs in the patient. For example, it seems to the patient that they are persecuting him, they want to poison him, cause harm, etc. Crazy ideas are perceived by him as a reality, fearsome. The patient may have visual and auditory hallucinations, he may see or hear things that are not actually there, such as figures or voices of people talking in the room.

Do not argue with the patient about the reality of what he has seen or heard, because if he feels he must defend his own views, this may lead to an increase in delirium.
If the patient is frightened, try to calm him down: take him gently by the hand, speak in a soft, calm voice.
Distract the patient's attention from the hallucination by directing their attention to an object that is actually in the room.
Seek medical advice: perhaps the patient's condition is due to the use of drugs.

Aggressive behavior

A serious problem for caregivers can be the manifestation of aggressiveness and violence on the part of the patient. In such cases, the following tips may be helpful:

Try to remain calm, do not show your own fear or anxiety.
by all possible methods retaliatory aggressiveness should be avoided; an accusatory, threatening, or judgmental tone of voice may increase the patient's aggression.
You should not be too close to the patient, he may perceive this as a threat.
Try to switch the patient's attention to a quieter activity.
Try to determine what caused such a reaction of the patient, and make sure that these premises do not recur.
If the aggressive behavior of the patient is often repeated, it is necessary to seek help from a specialist.

How to deal with the stress of caring for the sick

Alzheimer's disease affects not only the patient, but the whole family. The heaviest burden is borne by those directly caring for the sick. Constantly exposed to stress, these people need to know how to help themselves.

Family

For some people caring for the sick, the family is the most the best assistant, for others - it brings only grief. Do not reject the help of other family members if they have enough time, and do not try to shoulder the burden of caring for the sick. Contact special services for help.

Don't keep your problems to yourself

You need to share your experience of caring for the sick with others. Keeping them with you makes your job difficult. Feeling that your emotions are a natural reaction in your position, it will be easier for you to cope with your problems. Do not reject the help and support of others, even if it seems to you that you burden them with this.

Leave time for yourself

You need to have time for yourself as well. This way you can see others, do what you love, and most importantly, enjoy life. If you need to leave for a while, try to find someone who can replace you so that you can rest.

Consider your limits

How long can you endure before the work becomes too much for you? Most people manage to set their own limits before caring for the sick becomes an overwhelming task for them. If you feel that you are overworked and that the work is beyond your strength, seek help to prevent a crisis.

Don't blame yourself

Do not blame yourself or the patient for the difficulties you have to face. Remember - they are only to blame for the disease. If you feel like you're losing touch with family and friends, don't blame them or yourself. Try to identify what is dividing you and discuss the issue with them. Do not forget that your relationships with other people can be an indispensable source of support for you, which is beneficial for both you and the patient.

It can be very helpful for you to seek advice from a specialist about changes in the patient.

Don't forget how important you are

Your condition is extremely important both for you and for the patient. In his life you are irreplaceable, without you the patient could not live. This is additional reason to take care.

Professor Perfilyeva G.M.
Nurse, 2002, № 1.
The article is printed with abbreviations.

Care for dementia caused by cerebrovascular disease

In this condition, patients suffer from memory loss, their mental disorders are aggravated. Unlike individuals with Alzheimer's disease, they are aware of their situation, their personality remains relatively intact. Caring for patients is difficult, but there are tricks that can make things easier:

establish a regime due to which the patient's life becomes more organized;
while observing the regime, try to keep the previously established routine of life as long as possible;
as long as possible maintain the independence, independence of the patient;
help the patient maintain self-esteem;
refrain from discussing his condition with other people in his presence;
avoid conflicts; remember: the disease is to blame, not the person;
take care to create conditions for the maximum manifestation of the patient's capabilities;
monitor changes in vision and hearing, determine if the patient needs to change glasses, purchase a hearing aid;
speak to him clearly, slowly, do not shout, communicate face to face;
watch the facial expressions, gestures, postures of the patient; All this serves as a means of communication for him.

T.G. Dasko, O.P. Ivanova.
Nurse, 2000, No. 6.
Printed with abbreviations.

In connection with the increase in the number of patients with chronic diseases (pathology of the cardiovascular system, respiratory organs, dysfunction of the musculoskeletal system), changes in the demographic situation - an increase in the number of elderly and senile people, medical workers are faced with the task of organizing and conducting care for seriously ill patients and immobile patients.

seriously ill is a patient who has significant dysfunctions of organs and systems, who needs medical care and intensive nursing care.

Some diseases are accompanied by a violation of motor activity (the consequences of a stroke, chronic heart failure, oncological diseases) or active movements are contraindicated for the patient (for example, with myocardial infarction), because. they can lead to deterioration in the patient's condition.

immobile patient- one who has impaired satisfaction of the need to move due to the severity of the condition or due to the prescribed regimen.

Problems of seriously ill and immobile patients

In a seriously ill and immobile patient, the satisfaction of the needs of:

in move;

in normal breathing;

in adequate food and drink;

in the excretion of waste products;

in rest, sleep;

in communication;

in overcoming pain;

in the ability to maintain their own security.

In this regard, the following problems are possible:

the risk of bedsores;

risk of respiratory problems congestion in the lungs);

risk of urinary disorders (infection, formation of kidney stones);

the risk of impaired appetite;

the risk of developing joint contractures, muscle hypotrophy;

risk of injury;

risk of lack of self-care and personal hygiene;

risk of constipation;

risk of sleep disturbance;

risk of lack of communication.

Organization and provision of care for seriously ill patients

A sick person often needs help with personal hygiene: washing, shaving, caring for the oral cavity, hair, nails, washing, taking a bath. And also in the implementation of life processes. In this part of care, the sister's hands become the hands of the patient. But, helping the patient, you need to strive as much as possible for his independence and encourage his desire.

Purpose of care:

Creation of the patient's physical, social, psychological comfort.

Decrease in severity clinical manifestations diseases.

Improving the quality of life of the patient.

Prevention of possible complications.

Establishment of psychological contact, identification of violated needs

Care principles:

safety (prevention of patient injury)

confidentiality (details of personal life should not be known to outsiders)

respect for dignity (performing all procedures with the consent of the patient, providing privacy if necessary)

communication (disposition of the patient and his family members to the conversation, discussion of the course of the upcoming procedure and the plan of care in general).

independence (encouragement of each patient to independence)

infectious safety (implementation of appropriate measures)

Carrying out the care medical worker should kindly and carefully ask the patient about what worries him, what he would like, and what hinders him.

During communication with the patient, it is important to carefully monitor him; often facial expressions, intonation, body movement will tell us more than words.

It is necessary to find out if he has pain (where and from what it occurs, when it passes), fever, chills, fear, discomfort, dizziness, whether the patient wants to drink or eat, etc.

It is necessary to monitor the main physiological indicators: temperature, pulse, blood pressure, respiratory rate, physiological functions. It must be remembered that sick people are often irritable, tend to rest, do not tolerate noise well, perceive information with difficulty, and easily get tired even from small efforts.

Often a sick person takes a forced position (lying down, inactive). It threatens all sorts of complications. Having received permission from the attending physician, it is necessary to activate the patient as much as possible. This is a light massage, gymnastics, physiotherapy exercises, changing the position of the patient in bed.

The doctor needs to know about the consequences of a long stay in bed, immobility of the patient, the negative impact on the patient of a limited motor regimen.

To prevent damage to organs and tissues when moving a seriously ill and immobile patient, it is necessary to observe the laws of biomechanics.

The doctor must be familiar with the rules of biomechanics, be able to apply them and teach the patient to use them to more effectively meet the needs of "move" and "avoid danger." A person can maintain the vertical position of the body in space only by maintaining balance.

At the direction of the doctor, the nurse, caring for seriously ill patient, must be able to maintain the balance of his own body and the body of the patient in order to avoid falls and injuries.

A seriously ill immobile patient has a high risk of developing pressure ulcers (as a result of prolonged soft tissue compression).

If the patient is moved incorrectly, when the nurse changes the position of the patient, not lifting him, but pulling him up on the bed, abrasions occur as a result of friction, there may be a rupture of muscle fibers and small vessels.

The formation of bedsores, injuries contributes to a damp untidy bed with folds and crumbs. The main reason for the formation of bedsores is bad care behind the patient.

Frequent shifting of the patient (after 2 hours) avoids the formation of decubituses, joint contractures, muscle hypotrophy, the formation of kidney stones, etc. in an immobile patient.

Criteria for assessing the quality of care for seriously ill patients.

1. Compliance with the standards of patient care technologies.

Compliance with the standards of technologies for performing manipulations and procedures.

Compliance with standards for maintaining medical records for patient care.

Timeliness and accuracy of medical appointments.

Compliance with the technologies of sanitary and anti-epidemic measures.

Compliance with deontological principles (taking into account the opinion of patients about a medical worker).

Types of modes of motor (physical) activity

Strict bed rest - the patient is forbidden not only to get up, but in some cases even independently turn in bed.

2. Bed rest - under the supervision of a nurse or an exercise therapy specialist, it is allowed to turn in bed, with a gradual expansion of the regime - to sit in bed, lower your legs.

3Ward mode - it is allowed to sit on a chair near the bed, get up, walk around the ward for a short time. Feeding, physiological administration are carried out in the ward.

4Common Mode - the patient independently serves himself, he is allowed to walk along the corridor, offices, walks around the hospital.

Violations of the motor regime (motor activity) can lead to severe changes in the patient's condition, due to organ dysfunction, up to death.

Purpose of bed rest.

1. Limitation of the patient's physical activity. Adaptation of the body to conditions of hypoxia in violation of the need to breathe, with a decrease in the need for cells in oxygen.

2. Reducing pain, which will reduce the dose of painkillers.

3. Restoration of strength in a weakened patient.

To give the patient a comfortable physiological position, a functional bed with an anti-decubitus mattress and special devices are needed: pillows of various sizes, rollers, diapers, blankets, foot supports that prevent plantar flexion.

Position of the patient in bed:

The position "on the back".

Position "on the stomach".

Position "on the side".

Fowler's position (reclining and half-sitting) with the head of the bed raised by 45-60 0.

The Sims position is intermediate between the "on the side" and "on the stomach" positions.

The concept of palliative care

Due to the rather large number of patients with an incurable or terminal stage of the disease, the issue of appropriate care for such patients, that is, palliative care, becomes relevant. The difference between radical and palliative medicine:

Radical medicine aims to cure the disease and uses all the means at its disposal as long as there is even the slightest hope of recovery.

Palliative medicine replaces radical medicine from the moment when all means are used, there is no effect, and the patient faces the prospect of death. "Palliative" comes from the Latin word "pallium", which means "veil". Thus, palliative care is to ensure that all the symptoms of a person's illness are "covered" and he can feel safe and warm.

Palliative care(WHO definition) is the active, multidisciplinary care of patients whose illness is untreatable. The primary goal of palliative care is to relieve pain and other symptoms, and to solve psychological, social and spiritual problems. The goal of palliative care is to achieve the best possible quality of life for patients and their families.

Principles of palliative care:

Maintain life and treat death as a natural process;

Do not bring closer or delay death;

During the period of approaching death, reduce pain and other symptoms in patients, thereby reducing distress;

Bring together the psychological, social, spiritual issues of patient care in such a way that they can come to a constructive perception of their death;

Offer patients a support system that allows them to remain as active and creative as possible until the very end;

Offer a support system for families to be able to cope with the problems caused by the illness of a loved one and arising during the period of grief.

The spectrum of patients in need of palliative care :

Patients with malignant tumors

Patients with irreversible cardiovascular failure

Patients with irreversible renal failure

Patients with irreversible liver failure

Patients with severe irreversible brain damage

AIDS patients

Ethics of palliative care – the same that exists in medicine in general: to preserve life and alleviate suffering. At the end of life, the relief of suffering is much more important, since it becomes impossible to save a life.

Features of caring for the seriously ill at home

A seriously ill person feels better at home. To organize effective targeted home care for a seriously ill patient, it is necessary to remember the basic needs and the severity of the patient's condition, as far as the patient himself is able to meet the disturbed needs. But often a seriously ill person cannot satisfy his needs for in full he becomes dependent on the people around him.

The caregiver must identify the violated needs, determine the real, possible problems of the patient and create the most favorable and comfortable conditions for the patient.

Caring for a seriously ill patient at home has its own characteristics. Has the meaning:

the severity of the patient's pathology and the ability to self-service

degree of need disorder

psychological situation in the family

nutritional features

observance of sanitary and hygienic conditions

relationship between people of different ages

social - living conditions

family financial resources.

The work of the nurse and caring staff should not be mechanical. The patient himself should be in the center of attention, thirsting for care and attention personally to himself. The patient needs to ensure the preservation of his individuality, his habits. The nurse, following the recommendations of the doctor, trains relatives using elements of the standards of care and the provisions of the “School of Nursing for the Seriously Ill”. Such traits as patience, tact, compassion are important. Establishing psychological contact implies the ability to adapt to the patient, to recognize and understand his characteristics. It is necessary to try to reduce the inconvenience faced by the patient, without prejudice to his initiative in the sense of self-service. There is no need to strive to make the patient "purely disciplined", to deprive him of his individuality, harmless habits, connection with the past. To suppress his will means to weaken his interest in life, his will to recover. The patient must be stimulated to take care of himself, to maintain attractiveness, neatness, to contacts with others.

Severely ill patients have a sleep disturbance, they may doze intermittently during the day, and night sleep may be disturbed. room ventilation, warm drink, light back massage - will contribute to a night's sleep. It is necessary to protect peace during sleep.

Some patients refuse to take liquids in the afternoon, in order to reduce diuresis. Dehydration of the body is highly undesirable and dangerous, as it leads to general intoxication. Must be carefully calculated water balance, given that the daily diuresis should be at least 1 liter.

Nutrition needs to be planned. Control the composition of food, the value of the presence of vitamins, minerals, the aesthetics of the design of dishes.

For a seriously ill patient, the regularity of physiological functions, the provision of a toilet and comfortable conditions are important.

The bed of a seriously ill person should be moderately hard, the blanket warm, but light. To prevent bedsores, the mattress must be elastic to avoid pressure on certain parts of the body.

In the room where the patient is located, there should be a minimum of furniture for the prevention of injuries and ease of cleaning.

As prescribed by the doctor, a complex of exercise therapy in bed should be carried out, the patient should strive to sit, walk.

In the daytime, it is necessary to organize the patient's leisure, communication. Moral support is an important element of treatment. The patient needs to be assisted in maintaining a decent appearance (shaving, hairstyle, skin, nails, makeup). Complete isolation of the patient is not considered correct. It is necessary to provide for his spiritual needs (watching TV shows, reading literature, etc.).

One of the main problems of dying patients is pain. Palliative care provides adequate, maximally complete anesthesia of hopelessly ill patients.

The degree to which pain is experienced is the result of various "pain thresholds"; with a low pain threshold, a person feels even relatively weak pain, while others, having a high pain threshold, perceive only strong pain. It is the "threshold of pain perception" - the point at which pain is felt.

Sharp pain - has a different duration, but not more than six months. Stops after healing and has a predictable ending.

chronic pain - persists for a longer time (more than six months), its manifestation can be reduced to such signs as sleep disturbance, lack of appetite, lack of joy in life, closure in illness, personality change, fatigue.

Features of the organization of care for agonizing patients

If the dying person is in the hospital because of the severity of his condition, then relatives can be involved in caring for him, teaching them the elements of care. They can, for example, feed the patient, fix the bed, and take some hygiene measures.

An incurable disease, the death of a loved one is a great psychological trauma for his family. They may get tired, they may develop irritation, depression, anger towards the dying person. Providing psychological assistance to the family of a dying person is an important part of the work of a nurse, who can support families even after his death.

Dying is in most cases not an instantaneous process, but a series of stages, accompanied by a consistent violation of vital functions.