Introduction
A case study of Andrew, a 78-year-old patient who was diagnosed with Alzheimer’s disease six years ago, is analyzed. The major concepts to be explored include cognitive dissonance theory, evidence-based approaches, and coping strategies. The deuteration of memory, cognitive abilities, and frequent forgetfulness characterize it. He was additionally diagnosed with osteoarthritis and finds climbing in and out of the bath more difficult.
For healthcare providers, the task is to develop the most effective, evidence-based intervention to alleviate the symptoms of dementia and ensure comfort and safety. The primary outcomes of this work are identifying strategies, critically exploring one’s psychological responses, and developing treatment approaches. Further, this is a fictional case study and will therefore not breach the confidentiality of any real patients, in line with the NMC (2018) code.
Communication
When communicating with the patient Andrew, who has dementia, nurses should consider a range of communication skills, models, and strategies. First, paying attention to verbal and non-verbal communication skills is necessary (“Dementia & verbal communication,” n.d.; VHA, 2021). In this case, focus on simple, understandable speech and, if necessary, repeat information. The nurse must act as a guide when speaking, especially if the patient becomes confused.
Non-verbal communication is particularly vital. Such interaction aims to provide an understanding of nurses’ interests and to offer reassurance (Alzheimer’s Society, n.d.). In addition, it ensures comfort and reduces stressors for Andrew. In the patient’s case, one can see that the man can become easily agitated. As a result, nonverbal communication can help relax the patient by using reassuring facial expressions, smiles, and a calm tone of voice to maintain the man’s respect.
It is also worth paying attention to communication theories, such as cognitive dissonance theory. According to the cognitive dissonance theory, people become psychologically uncomfortable when faced with contradictory thoughts (Bran & Vaidis, 2020). This emotional discomfort is more commonly understood to be a cognitive dissonance state, also known as an aversive arousal state (Bran & Vaidis, 2020). It is additionally defined that cognitive dissonance is a mental health discomfort that first prompts regulation before acting as an arousal state (Vaidis & Bran, 2019).
When applying the given theory to Andrew’s case, it becomes evident that the patient might experience cognitive dissonance when seeing the discrepancies between past and present abilities. Seeing how he used to be independent but now relies on his caregivers might make the patient feel frustrated. Moreover, the patient might be exposed to self-revaluation. However, the mentioned theory can help reduce the dissonance by recognizing the challenges and offering coping mechanisms, such as gentle reminders and explanations. By relying on the theory and using active listening, it is possible to allow the patient to express himself and offer reflective feedback.
There are several difficulties when working with patients with dementia. In this case, the main barrier to communication with individuals is resistance (Collins et al., 2022). It is directly related to the shame, stress, and attitudes of patients and can become a problem in the provision of treatment (Melinosky, 2022). Andrew was described as a person who is often aggressive and highly anxious. Therefore, resistance can be eliminated through empathy and validation rather than correcting the man, which could lead to further frustration. A patient-centered approach should be adopted.
For example, involving Anne, the patient’s wife, and acknowledging the man’s emotions will be helpful. Individuals can become more willing to engage in treatment by increasing trust and security, which is critically important (Kulińska et al., 2022; PMD, 2023). Another advantage of this approach is that it helps eliminate the patient’s main symptoms. These aspects include repetitive actions, fearfulness, anxiety, and difficulties in maintaining a train of thought. The main limitation of this approach is the time required to build a positive relationship with the patient.
Psychological Response
Patients such as Andrew with a dementia diagnosis may face a variety of psychological responses to the disease and the symptoms they encounter. In general, the common psychological responses of patients diagnosed with dementia are feelings of hopelessness, anxiety, grief, worry, and feelings of being overwhelmed (Dementia UK, 2022). For instance, it was noted that the patient is often aggressive and highly agitated when his caregiver, Anne, is not present. Moreover, the man’s family claims that he is often confused when not remembering things clearly, which demonstrates anxiety. Finally, social withdrawal and isolation are evident, given that the man does not communicate with anyone besides his caregivers.
In such cases, patients resort to coping strategies that represent self-management approaches. In this case, the most common approach is to keep a diary or journal. It is the keeping of records about oneself, one’s past, relatives, friends, and everyday life (Kim-Godwin et al., 2020). One advantage of this approach is engagement in cognitive activity (Radcliffe, 2023). In addition, it is a way for individuals to express emotions and experiences they accumulate (Dibdin, 2022).
Another coping strategy that should be involved in the patient’s case is connected to seeking support. As a result, connecting with others who experience similar issues can give Andrew a sense of belonging. Finally, individuals who have dementia and their non-professional caregivers should actively engage in information-seeking behavior (Soong et al., 2020). As a coping strategy, educating oneself and others on the condition can help one understand the progression of the disease. The strategies are positive and active since they involve proactive involvement and support.
There are several reasons why these approaches may be adopted. When it comes to symptoms and psychosocial factors, Andrew experiences short-term memory loss, confusion, anxiety, agitation, aggression, and exhaustion. Consequently, such manifestations of the condition can significantly affect his daily functioning and his ability to engage in activities he once enjoyed. Additionally, because of his frustration, his family might also be affected. In terms of lifestyle, perceptions, and beliefs, Andrew’s lifestyle has been affected by the diagnosis, with memory issues making him practically unable to enjoy his favorite pastime activities, such as walking in the park.
Additionally, his perceptions of his abilities can be challenged, as he is now dependent on his family. Finally, given his condition, the patient’s values and social roles, including being a husband, Air Force member, and community participant, are affected. Thus, a dementia patient has difficulty in “re-establishing their means of living a meaningful life” (Tsuda et al., 2022, 699). Thus, the mentioned strategies can be helpful not only for patients but also for health care providers.
At the same time, it is worth remembering that this coping strategy has negative sides. Research stated that it has a downside “where an individual more acutely realizes their deteriorating condition and regrets over their perceived loss of self” (Tsuda et al., 2022, 700). To limit the deterioration of the patient’s condition, it can help to involve a specialist or the patient’s relatives, who can provide reassurance and a sense of calm and security. The difficulty may also lie in the fact that journaling is an active coping strategy that requires behavioral follow-through (Storch, 2023). Because of this, Andrew may show resistance and unwillingness at first, but in the long run, it will help alleviate the symptoms and acceptance of the disease.
The Holistic Role of the Nurse
One of the most effective evidence-based interventions that can help manage the psychological response of a patient with dementia is narrative therapy. It focuses on uncovering individuals’ core values and skills to help them solve emerging problems. Moreover, research indicates that “narrative therapy provides an opportunity for elderly individuals to create an alternative narrative to help them change their life stories” (Bayram & Artan, 2020, p. 45).
In other words, this approach may be especially useful for elderly patients with dementia, as they experience high levels of confusion, as well as anxiety and fear about later life. It has been identified that grief is emerging as the leading factor in this context. Narrative therapy provides an opportunity to gain control over the situation occurring in these circumstances (Lero, 2024). As already mentioned, due to the feeling of losing oneself, the patient may be able to cope effectively with the current situation.
Another advantage is the ability to reframe Andrew’s experiences and create new narratives about his life. At the same time, the first step is to focus on the patient’s problems. In this case study, Andrew is faced with fear and anxiety because he gradually realizes the irreversibility of his health condition. Recognition and acceptance of what is happening are critical to achieving the most favorable outcomes (Alzheimer’s Association, n.d.). Using communication, verbal and non-verbal interaction, and various techniques, narrative therapy will also reassure the patient that it is possible to lead a normal lifestyle with his diagnosis.
Particular attention should be paid to the various guidelines and policies regarding the use of narrative therapy in the treatment of dementia. For example, the National Dementia Strategy for England is a policy started by the UK government in 2009 and focuses on improving awareness and boosting well-being (Department of Health, n.d.). Regarding protocols, the Department of Health (n.d.) stresses the importance of educating and training healthcare professionals when delivering care to patients with dementia. The National Institute for Health and Care Excellence (2019) emphasizes that involving patients in decision-making and providing enjoyable, health-enhancing activities are important for treating the disease.
The proposed intervention meets these requirements, as it directly takes into account individuals’ needs and desires, and is based on the information they provide and the participation they show. At the same time, based on the guidelines data, such limitations of the psychological intervention can be distinguished as requiring significant resources. To provide person-centered care, elderly patients may require the involvement of several specialists, which may not be feasible for everyone (Liao et al., 2023). In this case, it is necessary to create policies that expand accessibility to these services for individuals regardless of their socioeconomic status.
Conclusion
In conclusion, this work focused on several important considerations for treating patients with dementia. First, this study has shown that various approaches can be used to interact with individuals, thereby achieving the most effective outcomes. Communication skills, models, and strategies, such as non-verbal and verbal communication, patient-centered care, and assurance, are involved. One key learning gained from writing this case study was the value of journaling and narrative therapy as tools for treating and guiding patients with dementia.
Reference List
Alzheimer Association. (n.d.). Accepting the diagnosis.
Alzheimer’s Society. (n.d.). Non-verbal communication and dementia.
Bayram, Y., & Artan, T. (2020). This is not all your life but the pieces you talked about your life: The narrative therapy with the elderly. Turkish Journal of Applied Social Work, 3(1), 45-58.
Bran, A., & Vaidis, D. C. (2020). On the characteristics of the cognitive dissonance state: Exploration within the pleasure arousal dominance model. Psychologica Belgica, 60(1), 86–102.
Collins, R., Hunt, A., Quinn, C., Martyr, A., Pentecost, C., & Clare, L. (2022). Methods and approaches for enhancing communication with people with moderate-to-severe dementia that can facilitate their inclusion in research and service evaluation: Findings from the IDEAL programme. Dementia, 21(4), 1135-1153.
Dementia & verbal communication. (n.d.). Home Watch Caregivers.
Dementia UK. (2022). The emotional impact of a dementia diagnosis.
Department of Health. (n.d.). Living well with dementia – the National Dementia Strategy.
Dibdin, E. (2022). The mental health benefits of journaling. Psych Central.
Kim-Godwin, Y. S., Kim, S. S., & Gil, M. (2020). Journaling for self-care and coping in mothers of troubled children in the community. Archives of Psychiatric Nursing, 34(2), 50-57.
Kulińska, J., Rypicz, Ł., & Zatońska, K. (2022). The impact of effective communication on perceptions of patient safety—A prospective study in selected polish hospitals. International Journal of Environmental Research and Public Health, 19(15).
Lero, C. M. (2024). Rewrite the story of your grief using narrative therapy. Aspire Counseling.
Liao, L., Feng, M., You, Y., Chen, Y., Guan, C., & Liu, Y. (2023). Experiences of older people, healthcare providers and caregivers on implementing person-centered care for community-dwelling older people: A systematic review and qualitative meta-synthesis. BMC Geriatrics, 23(1).
Melinosky, C. (2022). Alzheimer’s disease and refusing care. WebMD.
National Institute for Health and Care Excellence. (2019). Dementia.
PMD. (2023). Enhancing patient trust and engagement: The secure communication approach.
Radcliffe, R. (2023). Simple activities like journaling, playing chess may reduce risk of dementia. Healthline.
Soong, A., Au, S. T., Kyaw, B. M., Theng, Y. L., & Tudor Car, L. (2020). Information needs and information seeking behaviour of people with dementia and their non-professional caregivers: A scoping review. BMC Geriatrics, 20(1), 61.
Storch, E. (2023). Journaling for mental health. Baylor College of Medicine.
Tsuda, S., Jinno, M., & Hotta, S. (2022). Exploring the meaning of journal writing in people living with dementia: a qualitative study. Psychogeriatrics, 22(5), 699-706.
Vaidis, D. C., & Bran, A. (2019). Respectable challenges to respectable theory: Cognitive dissonance theory requires conceptualization clarification and operational tools. Frontiers in Psychology, 10.
VHA. (2021). Non-verbal communication in dementia care.