Gibbs reflection on dementia care and sectioning decisions

Gibbs Reflective Cycle:

Reflection on personal experience in mental health assessment ward

Description

While working on a mental health assessment ward, I was asked to review the case of Ms. X, a patient sectioned under the Mental Health Act (Section 2) because of her worsening dementia. Until she was sectioned Ms. X had been cared for at home by her adult children and through weekly visits from a nurse, but because of her increasing difficulties in engaging in effective self-care, her children felt it necessary to seek professional redress.

Feelings

I felt very sad to see a formerly competent woman having to sacrifice her independence in her later years. I felt sympathetic towards the plight of her children. They had become increasingly concerned about leaving their mother alone for any period of time, given the sudden, rapid deterioration in her health. They were unable to provide the necessary 24-7 care Ms. X needed. She required monitoring to prevent injury, to ensure that she received the correct medications and treatments, and also to engage in the actions of basic self-care like dressing, washing, and going to the toilet.

Evaluation

In terms of the positive aspects of the experience, I was happy to see that Ms. X was able to get the care she required. I was happy to see that the system 'worked' in the sense that the spirit of the law was being carried out. Section 2 is designed to 'protect people from themselves' when they are no longer capable of judging their competency. Ms. X had been formerly able to function independently at home but with the passage of time, this was no longer the case.

The negative aspects of the experience lay in my sadness that Ms. X could not be cared for with home nursing staff or by her family. The children said that when she was competent Ms. X said that her preference would be to remain at home if at all possible during her golden years.

Analysis

Permanent care at a nursing home may not be necessary. A full evaluation is required of treatment options. Also, Ms. X's medications may need to be evaluated, given that over-medication can actually worsen the symptoms of dementia. While Ms. X likely needs more intensive care than can be provided at home, working with her children to arrange for more home visits from a nurse and family can be discussed before any final decisions are reached.

Conclusion

Making decisions about an elderly parent's competency to live at home is very difficult. The children's perceptions of what is the right thing to do may vary by personal preference, cultural orientation, economics, and past family history.