Roles and Tasks of Nurses Caring People with Dementia

(1)

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치매 환자를 돌보는 간호사의 역할과 업무

하주영

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Roles and Tasks of Nurses Caring People with Dementia

Ha, Ju Young

¹

1

College of Nursing Science, Ewha Womans University BK21 Post-doctoral Researcher

Purpose: The research aims to identify the roles of nurses at dementia clinics or geriatric hospitals to set their

tasks. Methods: This research has been conducted through literature review and focus group methodology. The field survey has been done for 195 nurses at 36 hospitals for the aged and dementia clinics from Oct. 9 to Oct.

28, 2006. Results: The nurses were identified to play eight roles as clinical specialists, educators, researchers, counselors, consultants, collaborators, leaders, managers, and advocators. They were also known to implement 27 nursing tasks and 104 nursing activities. Conclusion: The findings of this research could provide a foundation for the nursing care work as well as become a practice guideline for the nurses, at these hospitals, to implement versatile roles and tasks.

Key Words : Dementia, Nurse, Roles, Tasks

Corresponding address: Ha, Ju Young, College of Nursing Science, Ewha Womans University, BK21 Post-doctoral Researcher, 11-1

Daehyun-dong, Seodaemun-gu, Seoul 120-750, Korea. Tel: 82-2-3277-3293, Fax: 82-2-3277-2850, E-mail:

jyh1028@ewha.ac.kr

투고일 2007 2 6 심사의뢰일 2007 2 14 심사완료일 2007 6 11

(2)

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연구결과 III.

36 195 .

대상자의 일반적 특성 1.

33.8±7.98 20

42.6 %(83 ) 30 30.8%(60 ), 40

22.6% (44 ), 50 4.1%(8 )

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대상자의 간호 관련 특성 2.

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10 29.7%(58 ) 3-5

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Table 1. Nurse's roles, tasks and activities for dementia patients (N=195)

Nurse's role Nursing

task Activities by task Implement

N(%)

Not Implement Total Necessary

N(%)

Unnecessary

N(%) N(%)

1. Clinical specialist Health

assessment Health history check Physical check-up

Neuro-cognitive function assessment Daily activity assessment

Emotional state assessment

Social, economic, spiritual, sexual state assessment Problem behavior assessment

Assessment of family members and major nursing-caregiver

Support system assessment

192(98.5) 186(95.4) 152(77.9) 192(98.5) 183(93.8) 120(61.5) 177(90.8) 147(75.4) 113(57.9)

3( 1.5) 9( 4.6) 43(22.1) 3( 1.5) 12( 6.2) 75(38.5) 18( 9.2) 48(24.6) 82(42.1)

0(0.0) 0(0.0) 0(0.0) 0(0.0) 0(0.0) 0(0.0) 0(0.0) 0(0.0) 0(0.0)

3( 1.5) 9( 4.6) 48(22.1) 3( 1.5) 12( 6.2) 75(38.5) 18( 9.2) 48(24.6) 82(42.1)

Nursing

diagnosis Analysis and integration of health assessment data Related reasons and factors check

Nursing diagnosis in relation to actual health problems

Nursing diagnosis in relation to potential health problems

131(67.2) 150(76.9) 121(62.1) 95(48.7)

64(32.8) 45(23.1) 74(37.9) 100(51.3)

0(0.0) 0(0.0) 0(0.0) 0(0.0)

64(32.8) 45(23.1) 74(37.9) 100(51.3)

Nursing

planning Objectives setting for nursing care based on diagnosis

Nursing planning customized to the patient’s cognitive and physical function.

Nursing planning based on strengths and weaknesses of patients and their family members

Participation of patients or their family members in the nursing planning process to utilize the required resources

Nursing Planning based on the health belief, life style, cultural characteristics and nursing needs of patients

130(66.7) 141(72.3) 96(49.2) 81(41.5)

80(41.0)

65(33.3) 54(27.7) 99(50.8) 114(58.5)

115(59.0)

0(0.0) 0(0.0) 0(0.0) 0(0.0)

0(0.0)

65(33.3) 54(27.7) 99(50.8) 114(58.5)

115(59.0)

Providing advanced nursing

Providing nursing care based on critical thinking, and advanced nursing knowledge and skills

Consultation with specialists on the changing state of patients

Providing therapeutic activities (programs) to improve cognitive function

Offering therapeutic activities (programs) to manage and improve the behavioral symptoms (problem behavior)

Medication based on patient’s cognitive function and mental health.

Helping patients function better in their daily lives (personal hygiene, diet, bowel movement, etc.) Nourishment and kinetic ability management Providing safe environment(physical restraint use in conformity with guidelines)

Using up-to-date knowledge and skills Spiritual and hospice nursing care Emotional support for patients Emotional support for family members

147(75.4) 183(93.8) 148(75.9) 140(71.8)

192(98.5) 195(100) 183(93.8) 195(100) 114(58.5) 113(57.9) 186(95.4) 141(72.3)

46(23.6) 12( 6.2) 47(24.1) 55(28.2)

3(1.5) 0(0.0) 12( 6.2) 0( 0.0) 81(41.5) 82(42.1) 9( 4.6) 54(27.7)

2(1.0) 0(0.0) 0(0.0) 0(0.0)

0(0.0) 0(0.0) 0(0.0) 0(0.0) 0(0.0) 0(0.0) 0(0.0) 0(0.0)

48(24.6) 12( 6.2) 47(24.1) 55(28.2)

3(1.5) 0(0.0) 12( 6.2) 0( 0.0) 81(41.5) 82(42.1) 9( 4.6) 54(27.7)

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Table 1. Nurse's roles, tasks and activities for dementia patients(Cont.) (N=195)

Nurse's role Nursing task Activities by task Implement Not Implement Total

Necessary Unnecessary

N(%) N(%) N(%) N(%)

1.Clinical

specialist Evaluation Evaluation according to nursing planning (methods and process)

Evaluation of objective achievement

Joining of patients, family members and healthcare team in the evaluation process

Revision and complement of nursing care based on the evaluation

Keeping track of patients change

59(30.3) 49(25.1) 25(12.8) 56(28.7) 189(96.9)

136(69.7) 146(74.9) 167(85.6) 139(71.3) 6( 3.1)

0(0.0) 0(0.0) 3(1.5) 0(0.0) 0(0.0)

136(69.7) 146(74.9) 170(87.2) 139(71.3) 6( 3.1) Nursing

recording Prescription check and recording Nursing process recording

195(100) 175(89.7)

0( 0.0) 20(10.3)

0(0.0) 0(0.0)

0( 0.0) 20(10.3) Record

management Storage and management of patients’ record 174(89.2) 21(10.8) 0(0.0) 21(10.8) 2. Educator Patients

education Education on the health and progress of patients Education on nursing care and therapeutic activities (therapies)

128(65.6) 157(80.5)

62(31.8) 36(18.5)

5(2.6) 2(1.0)

67(34.4) 38(19.5) Education

for nursing personnel

Education for nursing personnel on the up-to-date technology for dementia treatment and

multidimensional nursing intervention Education for practice nurses as preceptors

100(51.3)

93(47.7)

95(48.7)

91(46.7)

0(0.0)

11(5.6)

95(48.7)

102(52.3) Education

for nursing- caregiver

Family education

Education for the major nursing-caregiver Healthcare team education

86(44.1) 106(54.4) 98(50.3)

109(55.9) 89(45.6) 94(48.2)

0(0.0) 0(0.0) 3(1.5)

109(55.9) 89(45.6) 97(49.7) Development

ofeducational materials

Development of educational materialsfor nursing personnel Development of educational and promotional materials for general population

Development of educational materials for patients and their family members

Development of educational materials for other healthcare teams

55(28.2) 34(17.4) 25(12.8) 19(9.7)

140(71.8) 161(82.6) 170(87.2) 173(88.7)

0(0.0) 0(0.0) 0(0.0) 3(1.5)

140(71.8) 161(82.6) 170(87.2) 176(90.3) 3. Researcher Research

activities Research matters check

Research on the checked matters

Participation in activities of related academic societies Presentation of research findings

Participation in interdisciplinary joint research

40(20.5) 37(19.0) 73(37.4)

37(19.0)

145(74.4) 148(75.9) 111(56.9)

150(76.9)

10(5.1) 10(5.1) 11(5.6)

8(4.1)

155(79.5) 158(81.0) 122(62.6)

158(81.0) Practical

application Critically review of the published findings and practical application of the relevant results.

Analysis of benefits and problems after practical application

34(17.4) 64(32.8)

153(78.5) 117(60.0)

8(4.1) 14(7.2)

161(82.6) 131(67.2) Research

support Supporting for the research of other departments Providing materials and information required for nursing care for dementia patients

46(23.6) 37(19.0) 77(39.5)

143(73.3) 143(73.3) 115(59.0)

6(3.1) 15(7.7) 3(1.5)

149(76.4) 158(81.0) 118(60.5) 4. Counselor Consultation

with patients and family

Consultation on health and disease

Consultation with family members on the progress of disease and countermeasures

Consultation on family problems Consultation of life termination

160(82.1) 142(72.8) 102(52.3) 111(56.9)

35(17.9) 53(27.2) 93(47.7) 84(43.1)

0(0.0) 0(0.0) 0(0.0) 0(0.0)

35(17.9) 53(27.2) 93(47.7) 84(43.1) Advice Offering advice for healthcare team

Offering advice for family members Offering advice for the local community

64(32.8) 63(32.3) 31(15.9)

122(62.6) 132(67.7) 155(79.5)

9(4.6) 0(0.0) 9(4.6)

131(67.2) 132(67.7) 164(84.1)

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Table 1. Nurse's Roles, tasks and Activities for Dementia Patients(Cont.) (N=195)

N(%) N(%) N(%) N(%)

5. Consultant

&

Collaborator

Cooperation Effective communication with healthcare team Continued cooperation with healthcare team Seeking advice from other institutions or specialists on dementia patients nursing care

Establishment of cooperation system

121(62.1) 109(55.9) 104(53.3) 70(35.9)

71(36.4) 83(42.6) 88(45.1) 122(62.6)

3(1.5) 3(1.5) 3(1.5) 3(1.5)

74(37.9) 86(44.1) 91(46.6) 125(64.1) Use of

recourses and information

Checking personnel and physical resources of healthcare team

Checking and connecting the resources of local community

Sharing and using information of healthcare team Organizing available resources

66(33.8) 36(18.5) 46(23.6) 28(14.4)

129(66.2) 159(81.5) 149(76.4) 167(85.6)

0(0.0) 0(0.0) 0(0.0) 0(0.0)

129(66.2) 159(81.5) 149(76.4) 167(85.6) 6. Leader Progress

promotion Standard development for professional works Development of practice guideline and protocol Development of occupational standard and criteria Development of guideline to manage dementia patients

Participation in policy development for dementia nursing care

Participation in development of professional nursing care for dementia patients

22(11.3) 55(28.2) 34(17.4) 61(31.3) 25(12.8) 55(28.2)

173(88.7) 131(67.2) 161(82.6) 134(68.7) 170(87.2) 140(71.8)

0(0.0) 9(4.6) 0(0.0) 0(0.0) 0(0.0) 0(0.0)

173(88.7) 140(71.8) 161(82.6) 134(68.7) 170(87.2) 140(71.8)

Role model Presentation of role model through offering

professional nursing care for dementia patients 34(17.4) 161(82.6) 0(0.0) 161(82.6) 7. Manager Resource

management Employment and management of high-quality nurse personnel

Management of cost-saving physical resources Management of medicines and facilities Various documents management Related information management

58(29.7)

97(49.7) 121(62.1) 124(63.6) 101(51.8)

137(70.3) 98(50.3) 74(37.9) 71(36.4) 94(48.2)

0(0.0) 0(0.0) 0(0.0) 0(0.0) 0(0.0)

137(70.3) 98(50.3) 74(37.9) 71(36.4) 94(48.2)

Safety

management Prevention and management of safety accident Prevention and management of medical malpractice Assessment of satisfaction of patients and family members

192(98.5) 186(95.4) 73(37.4)

3(1.5) 9(4.6) 122(62.6)

0(0.0) 0(0.0) 0(0.0)

3( 1.5) 9( 4.6) 122(62.6)

Nursing care quality management

Evaluation of nursing record

Monitoring of the quality of dementia patients nursing care

Strategy set-up for enhancing the quality of dementia patients nursing care

90(46.2) 67(34.4) 67(34.4)

105(53.8) 128(65.6) 128(65.6)

0(0.0) 0(0.0) 0(0.0)

105(53.8) 128(65.6) 128(65.6)

Casemanagement Examination of the patients of other departments Interdisciplinary works coordination

Coordination of the conflicts among family members Speaking for patients

Protecting the right to accept or deny the treatment (DNR: Do not resuscitate)

115(59.0) 50(25.6) 48(24.6) 119(61.0) 98(50.3)

80(41.0) 145(74.4) 147(75.4) 76(39.0) 94(48.2)

0(0.0) 0(0.0) 0(0.0) 0(0.0) 3(1.5)

80(41.0) 145(74.4) 147(75.4) 76(39.0) 97(49.7)

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5-7 21.5%(42 ), 1-3 15.4%(30 ), 7-10 9.2%(18 )

1 2.6%(5 ) .

2.44±2.14 , 1-3

43.1%(84 ) 1 26.7%(52 ),

3-5 16.4%(32 ), 5-7 12.3%(24 )

7 1.5% (3 )

. 71.3%(139

) ․ 28.7%(56 )

.

역할 타당도와 수행여부 조사결과 3.

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Table 1. Nurse's roles, tasks and activities for dementia patients(Cont.) (N=195)

N(%) N(%) N(%) N(%)

8. Advocate Protection Protecting the right to choose the treatment method Protecting patients from physical harm (of family members, medical

personnel, or residents of the local community) Protecting patients from linguistic violence (of family members, medical personnel, or residents of the local community)

86(44.1) 116(59.5) 116(59.5)

106(54.4) 79(40.5) 79(40.5)

3(1.5) 0(0.0) 0(0.0)

109(55.9) 79(40.5) 79(40.5)

Compliance with ethical rule

Examination and revision of ethical rules Application of ethical rules

36(18.5) 51(26.2)

159(81.5) 144(73.8)

0(0.0) 0(0.0)

159(81.5) 144(73.8)

Support for ethical decision-making

Identification of ethical conflicts

Encouragement and respect of the decisions Selection and evaluation of available options

37(19.0) 104(53.3) 65(33.3)

158(81.0) 91(46.7) 130(66.7)

0(0.0) 0(0.0) 0(0.0)

158(81.0) 91(46.7) 130(66.7)

Table 2. Acceptability and implementation by role of nurse for dementia patients (N=195)

Role

Acceptability Implementation

Yes N(%)

No N(%)

Yes N(%)

No N(%) Clinical specialist

Educator Researcher Counselor

Consultant & Collaborator Leader

Manager Advocate

195( 100) 192(98.5) 184(94.4) 192(98.5) 195( 100) 195( 100) 195( 100) 195( 100)

0(0.0) 3(1.5) 11(5.6) 3(1.5) 0(0.0) 0(0.0) 0(0.0) 0(0.0)

195( 100) 163(83.6) 91(46.7) 160(82.1) 141(72.3) 73(37.4) 162(83.1) 137(70.3)

0( 0.0)

32(16.4)

104(53.3)

35(17.9)

54(27.7)

122(62.6)

33(16.9)

58(29.7)

(9)

37.4% 46.7%

(Table 2).

업무별 수행여부와 필요성 조사결과 4.

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