Free Nursing Essays - Caring for Patients with Parkinson's Disease
Introduction
Parkinson's disease is the only chronic neurological degenerative disease process with a substantial range of medical and neuro-surgical treatments that have the ability to substantially reduce symptoms. It typically will present in the over 65 age range, but may occur as early as in the 40s. About 1 in 10 patients will receive the diagnosis before the age of 50. Being a chronic degenerative disease, it inevitably requires a substantial input of care from both healthcare professionals and the carers. (Aho K 2002).
The characteristic symptoms will typically develop slowly and with no clearly discernible pattern. It is often a matter of concern to both patients and carers that a comparison between two patients or between “their” patient and the textbooks, is often wildly disparate. Symptoms may evolve over many years or appear in rapid succession and run an aggressive course. (Baker MG et al. 1999).
The problems/needs of such patients which could be identified when the patient is assessed by a registered nurse
In terms of commonly identified needs the excellent article by Baker & Graham (2004) gives a humane and insightful overview of the disease process from the point of view of the patient. The obvious physical needs can be assessed by any competent nurse. Pressure areas, oral hygiene etc. are all part of the overall care that is applicable to any debilitated patient, (Yura H, Walsh M. 1998).
We however, shall try to focus on those areas which are more particular to the patient with Parkinson's disease. Baker and Graham point to five key areas where patients with Parkinson's disease commonly report a failing in their personal care plan and they are:
They need to be referred to a doctor with a special interest in this disease. They need a better telling of the diagnosis. They need access to the multidisciplinary team. They need continuity of care, and they need to participate in the management of their own illness.
Two important aspects of care to be chosen and the reasons for the choice to be explained;
In specific nursing terms we shall concentrate on two areas where the nurse can be of particular value to the patient. The doctor may tell them when the diagnosis is made but seldom has the time to explain fully all of the implications of the disease process. The nurse, with more frequent and timely contact with the patient, may well be much better placed to empathetically explore and address the patient’s concerns, worries and fears abut the disease itself. (Parker and Lawton 2003)
The second area where the professional role of the nurse is paramount is as the patient’s advocate in accessing the multidisciplinary team members of the primary or secondary healthcare team who are best able to help the patient with their specific problems (Hogston R & Simpson P. M. 2002)
The care to be explained making references to published sources and conclusions to be drawn as to what constitutes good practice
It is a common finding that patients comment that the diagnosis and accompanying information is given in such a way as it is not always easy to take in, to assimilate or even to adjust to. Many people are so shocked by the diagnosis that it may have to be repeated (The A et al. 2000).
A common reaction is “depression, denial, false optimism and then occasionally, acceptance.” (Jennings et al 1997). The nurse is clearly ideally placed to recognise each or any of these phases as they occur and respond to them empathetically.
In the time after the diagnosis, there is almost universally a time of great emotional turmoil. Patients hear what they want to hear and may actively get the wrong message altogether. The unwary healthcare professional may find themselves colluding in the self-deception as they try to allay the patient’s fears and thus be guilty of providing misinformation (Girgis A et al 1995).
It is vital to impress upon the patient that the disease is treatable and not to let them infer from that that the disease is curable. Honesty is the best policy, but one does not have to be brutal.(Kuhse & Singer 2001)
The second area identified is the multidisciplinary component of care. Because Parkinson's disease is a slowly progressive degenerative disease process, it is not common to come across the acute crisis which would trigger the involvement of another healthcare professional as a matter of course. The professional nurse can usefully anticipate such problems and endeavour to involve the other disciplines sooner rather than later. The list of potential team members is huge. Baker & Graham (2004) give us their list of the most commonly consulted healthcare professionals in the field of Parkinson's disease.
General practitioner
Neurologist
Gerontologist
Psychologist
Nurse specialist
Occupational therapist
Physiotherapist
Dietician
Speech and language therapist
Pharmacist
Social worker
Chiropodist
The patients usual reactions to the care
The Baker & Graham (2004) paper has been refered to several times in this essay and we note that it is useful as it is written by two ex-nurses from the patient’s perspective.
As a general rule, patients prefer honesty and would rather know the truth of a situation rather than to have it dressed up with platitudes. (Stowers K et al 1999)
Equally it is part of the professional remit of the nurse to make sure that the carers are also fully informed of the situation. They are so easily forgotten with all the attention and input being focused on the patient. If the carers are fully appraised and informed about the situation then they are also better placed to help the patient directly (Marks-Moran & Rose 1996)
On this point, we should note that it is a mistake to assume that suffering or a chronic diagnosis will always tend to bring people and families together. Not everyone is fortunate enough to be sustained by loving and secure relationships. A rocky or unstable relationship is not likely to be improved by the imposition of a chronic and incurable illness being imposed upon it. (Higginson & Carr 2001)
In terms of other professionals being actively involved, one of the Parkinson's disease patient’s commonest complaints is the fact that they are frequently dealt with by non-specialist healthcare professionals. (Say & Thompson 2003)
They are generally both delighted and reassured to have the member of the multidisciplinary healthcare team who has a specialist knowledge of the area required – such as the dietician or occupational therapist – to give them the particular information that they need. As we have already identified, the nurse is ideally placed to act as the patient’s advocate in these circumstances.
What skills are needed to care successfully for patients for Parkinson's disease?
Virtually all of the professional skills that a nurse has can be involved in the care of the Parkinson's disease patient. This is because the disease process itself, although it primarily affects the central nervous system, has implications that touch on virtually every aspect of a patient’s life (Roy C 1991). It can be argued that a thorough theoretical knowledge of the disease process combined with a sensitive, empathetic and practical approach are perhaps the best attributes that the professional nurse can bring to the aid of a Parkinson's disease sufferer. (Anderson S 2002).
Other sources point to the fact that many Parkinson's disease sufferers fear not only the disease process but the fact that they might have to face the problem alone.(PDS 2003) The nurse is therefore also ideally placed to provide the human resources of companionship and contact that may also help to ease the worries and the plight of the patient.
References
Aho K. 2002
Parkinson's disease: my constant companion a neurologist's experiences as a patient.
Brussels: European Parkinson's Disease Association, 2002.
Anderson S. 2002
Health is between your ears. Living with a chronic disease.
Hornslet, Denmark, Parkinson Info, 2002.
Baker MG, Marsden CD, Oxtoby M, Williams A, Moore L, Woodroffe D, et al. 1999
Parkinson's at your fingertips. 2nd ed.
London: Class Publishing 1999.
Baker MG and Graham E 2004
The journey: Parkinson's disease
BMJ, Sep 2004; 329: 611 - 614 ;
Girgis A, Sanson-Fisher RW. 1995
Breaking bad news: consensus guidelines for medical practitioners.
J Clin Oncol 1995; 13: 2449-2456
Higginson and Carr 2001
Measuring quality of life: Using quality of life measures in the clinical setting
BMJ, May 2001; 322: 1297 - 1300.
Hogston, R. Simpson, P. M. (2002)
Foundations in nursing practice 2nd Edition,
London: Palgrave & Macmillian.
Jennings, B. 1997
Individual rights and the human good in hospice.
Hospice J. 1997;12(2):1–7.
Kuhse & Singer 2001
A companion to bioethics
ISBN: 063123019X Pub Date 05 July 2001
Marks-Moran & Rose 1996
Reconstructing Nursing: Beyond Art and Science
London: Balliere Tindall October, 1996
Parker and Lawton 2003
Psychological contribution to the understanding of adverse events in health care
Qual. Saf. Health Care, Dec 2003; 12: 453 - 457.
PDS 2003
Parkinson's Disease Society. Parkinson's aware in primary care. London: PDS, 2003.
Roy C 1991
An Adaption model (Notes on the Nursing theories Vol 3)
OUP: London 1991
Say R and Thomson R 2003
The importance of patient preferences in treatment decisions—challenges for doctors
BMJ, Sep 2003; 327: 542 - 545 ;
Stowers K, Hughes RA, Carr AJ.1999
Information exchange between patients and health professionals: consultation styles of rheumatologists and nurse practitioners.
Arthritis Rheum 1999; 42(suppl): 388S.
The A-M, Hak T, Koeter G, Wal Gvd. 2000
Collusion in doctor-patient communication about imminent death: an ethnographic study.
BMJ 2000; 321: 1376-1381
Yura H, Walsh M. 1998
The nursing process. Assessing, planning, implementing, evaluating. 5th edition. Norwalk, CT: Appleton & Lange, 1998.
