Dementia Centred

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By Professor June Andrews

May 12th, 2014

International Nurses' Day

Let’s all raise a glass to International Nurses’ Day!  We should celebrate good nursing care whenever we can.

And on May 12th which is Florence Nightingale’s birthday it is good to remember the things that she said which resonate still today.  She said “How little can be done under the spirit of fear.”  Even today we can see people who are afraid to speak out about what they see happening in health care, even when there is no real risk of harm.  My personal favourite is when she says, “I think one’s feelings waste themselves in words; they ought all to be distilled into action which brings results.”

One of her most quoted statements was about hospitals…”The very first requirement in a hospital is that it should do the sick no harm.”  In fact she was deriving this advice from the Hippocratic Oath that is meant to underpin the work of doctors.  Hospitals and what happens there is as much about nurses and other health workers, as it is doctors.

“First, do no harm.”  In Miss Nightingale’s day, dementia was less common than now.  In general people did not live long enough to get dementia.  Dementia is something that affects us in old age mainly even though working age people and children can suffer from diseases that cause dementia symptoms.  In her day not so many people, particularly women, reached old age.  But we do now.  Lots of us are going to be 100 one day.  Lots of the old ladies in that cohort will have dementia – the current estimate is around 50%.

“First do no harm.”  There are few fundamental things that a nurse can do to a patient with dementia that are guaranteed to cause them harm.  But the most dangerous practice is to dehydrate your patient.  Hospitals are hot places and the patient in bed may not be accustomed to such temperatures.  Of course the person may have been shivering for a bit in accident and emergency but the ward area is likely to be warmer.  At home an old lady might help herself to pots of tea and take juice and milk throughout the day.  In hospital she might be asleep when the one cup of tea comes and when she wakes up it is not to her taste.  Milk and juice may not be on the menu except at meal times. There may be a jug of water, but it may well be out of her reach and it might be invisible even if she can reach it, because it is a clear liquid in a clear vessel and she’s not got her specs on. Have you tried drinking hospital water that has been lying around in a jug yourself?  Is it palatable?

With dementia and dehydration, delirium will soon follow.  If an old person in hospital gets delirium it is bad news.  Florence Nightingale would count it as doing harm if you don’t avoid that at all costs.  The causes of it include pain and medication, constipation and lack of stimulation, but hydration is really important.

So what can nurses do in hospitals?  Every time you see a person with dementia suggest raising a glass.  Water really is the stuff of life for them.  Pour a glass and offer it as you make their bed.  Do the same as you fill out charts.  Offer a sip before you wash and dress them.  Give them some to drink after they wash their hands after using the toilet. Offer a toast to Florence Nightingale.

So here is the toast to International Nurses' Day.  Here’s to nurses everywhere…just for pity’s sake,  keep the water flowing.

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