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What Are the Steps to Become a Nurse?

If you’re interested in pursuing a trusted, compassionate career in health care, you might be wondering “what do I need to become a nurse?” Though not necessarily as time consuming as becoming a doctor, becoming a nurse does require specific education and careful planning.

Step 1: Get a Reality Check

Nursing is a highly respected profession, but it isn’t an easy path to take. If you’re looking for a quick way to get into a job, nursing probably isn’t right for you. Most nurses need at least two years of formal education before they’re qualified, and that education usually involves a lot of highly technical scientific topics. You also should consider whether the job is right for your personality. Nurses typically need to be patient with difficult people, calm in a crisis and willing to work long hours.

Step 2: Decide What Kind of Nurse You Want to Be

There are several different nursing profession roles, ranging from certified nursing assistants (CNAs) (who require the least education) to highly specialized nurse practitioners or registered nurses (RNs) (who often have formal degrees and may even obtain graduate-level educations in their fields). Beyond simply choosing what level of nursing education is right for you, it might also be a good idea to consider what area of nursing is most appealing (whether it’s assisting in surgery or working in a pediatrician’s office) before you pursue education.

Step 3: Get Educated

Each level of nursing has its own educational requirements. You may be able to work as a CNA with just a certificate, while RNs and nurse practitioners may need bachelor’s degrees or higher. Some nurses who are on track to obtain high-level credentials may work as certified nursing assistants while they’re in school to gain practical experience and learn more about the field.

Step 4: Get Licensed

Nurses typically need an official license to get a job and practice nursing. Licensure requirements usually vary by state. The Ohio Board of Nursing, for example, may not have the same education requirements or licensure exam process as the California Board of Nursing.

Step 5: Apply for Jobs

As with any other career, nurses typically need to go through a job application process to actually practice their profession. Unless you get very lucky with a referral or a connection through networking, you’ll probably need to look at job postings, send in applications and go through an interview process. You may need to apply for more than one job before you find your place in nursing, and it may be necessary for you to emphasize important skills or experiences in addition to your education in order to succeed.


nursing essay on dementia

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Care Needs for Patient with Dementia

Info: 5670 words (23 pages) Nursing Essay Published: 11th Feb 2020

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Fallon, M., & Hanks,G ABC of Palliative Care. British Medical Journal. Blackwell Publishing.

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Show More The purpose of this essay is to critically discuss the nurse’s role in caring for older persons in relation to dementia care. Dementia is an umbrella term used to describe conditions which involve progressive cognitive impairment and is associated with continuous deterioration in memory and ability to carry out activities of daily living (Department of Health, 2014). There is no known cause of dementia and as a result no known cure (Cahill et al, 2012). Person-centred care is one of the guiding principles of nursing practice. Person-centred care involves putting the patient at the centre of their care and including them in decision making and planning their care. Person-centred care requires the ability to develop good relationships with patients and focus on getting to know the patient as an individual (Manley et al, 2011). In dementia care, it is important to adopt this principle and build a relationship with the individual as this allows them to familiarise themselves with you. Getting to know a patient with dementia may take extra time than with any another patient but will lead to a better nurse -patient relationship and as a result better care for the patient (Baillie et al, 2012). …show more content… This may be due to medications to delay cognitive decline becoming available as well as public campaigns promoting awareness (Boyd, 2013). Early diagnosis allows patients and practitioners to collaborate when setting goals and planning care. It enables individuals to learn about their condition and prepare for its progression. Delaying cognitive decline also delays the individual from being admitted to long term care and therefore decreases healthcare costs for both the individual and their carers (Szymczynska et al, 2011). As a result, those receiving early diagnosis are generally younger and less cognitively impaired compared to those attending old age psychiatry services (Boyd,

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will play an important role in caring for older adults in the hospital setting. This demographic shift will mean that that nurses will care for adults over 65 more than any other patient group (Van Leuven, 2012). It is important for nurses to take the opportunity to think critically about the specific complex needs of older Australians and ensure they are practicing in a way that is safe, considered best practice and is aimed at bringing the patient back to health. This Essay, using the case study…

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Alzheimer and Dementia Patients Nursing Care

Nurses working with, and caring for patients suffering from dementia will oftentimes realize the difficulty of the task. It can be an exhausting and frustrating work. One of the reasons why it is extremely challenging to work with patients suffering from Alzheimer is that they do not retain explanations or instructions.

Thus, it is important for the nurses and the caregivers to learn patience, especially when it comes to giving instructions. Nurses have to deal with the impact of frustration, especially in the absence of positive response or feedback from the patients. Nurses can minimize the effects of caring for patients with dementia by conveying negative feelings with other health workers or caregivers. However, the best way to prepare for encounters with Alzheimer’s patients is to learn more about the nature of the disease.

What is Alzheimer’s?

Dr. Alois Alzheimer from Frankfurt, Germany was one of the first physicians to figure out the scientific framework that helps people identify the onset of the said disease. Thus, this mental health problem was named in his honor. Dr. Alzheimer was one of the first physicians to discover that this particular medical condition is progressive. He also discovered that Alzheimer’s is a fatal disease of the brain.

In fact, it is a degenerative disease of the brain that leads to a condition called dementia (Lu & Bludau, 2011). The term dementia was coined to describe the significant loss of memory and mental abilities of the patient (Lu & Bludau, 2011). In most cases, the problems relating to memory loss and impaired mental capabilities are severe enough to affect daily life.

There are other diseases that can cause dementia. However, Alzheimer’s disease is the most common type of dementia, and it accounts for at least 60 percent of all cases regarding dementia. As a result the word dementia is oftentimes used interchangeably with the said mental ailment.

It is important to highlight the significance of dementia. In order to experience the fullness of life, an individual needs to perform basic activities such as eating, changing clothes, and going to the bathroom. People suffering from Alzheimer’s disease lose the capability to perform these basic skills.

The problem is exacerbated by significant memory loss. It is not just an ordinary memory loss, like the inability to remember the name of America’s first president or the name of a distant relative. In many cases, patients are unable to remember the name of their spouses and children. They cannot remember how to go home to their own place of residence.

Important Information About Alzheimer’s Disease

Alzheimer’s disease occurs more frequently in older adults. In other words, it is highly unlikely for children and teenagers to be diagnosed with this mental health problem. It is important to point out that it is very expensive to take care of patients with Alzheimer’s disease. The cost of nursing home care is also escalating.

In order to minimize problems related to Alzheimer’s disease, it is imperative to have an early diagnosis. However, occasional bouts of forgetfulness are not enough to diagnose the problem with certainty.

Look for telltale signs such as cognitive problems, language problems, mood changes, personality changes, and physical symptoms (Smith & Kenan, 2004). Cognitive symptoms include any significant changes that lead to the impairment of the patient’s capability to “think, speak, reason, remember, plan and exercise reasonable judgment” (Smith & Kenan, 2004, p.28).

It is also important to remember the risk factors associated with Alzheimer’s disease. The number one risk factor is age. As a person gets older, he or she increase the probability of developing Alzheimer’s disease. In fact, 1 out of 10 individuals over the age of 65 and half of those over the age of 85 have greater chances of developing the said mental ailment (Gogia & Rastogi, 2011).

It is also interesting to point out that head injury or brain trauma increases the likelihood of developing this medical problem. The list also includes genetics, Down syndrome, environmental toxins, and Parkinson’s disease (Gogia & Rastogi, 2011). Early diagnosis is possible. However, the patients’ relatives, family members and health workers must be familiar with at least ten warning signs of Alzheimer’s disease.

These warning signs are listed as follows: 1) problems with abstract thinking or reasoning; 2) frequently misplaced things; 3) changes in person’s mood or behavior; 4) changes in personality; 5) loss of initiative; 6) memory loss problems; 7) difficulty performing familiar tasks; 8) language problems; 9) disoriented about the current time and place; 10) poor or decreased judgment (Smith & Kenan, 2004).

When it comes to diagnostic criteria or nursing assessments, it is important to point out that depression in older adults is the disorder frequently confused with dementia (Halter, 2014). At the same time, dementia, depression, and delirium can coexist. Therefore, nurses should know how to assess the important differences in order to ascertain that the patient is suffering from Alzheimer’s disease. They need to have this capability in order to rule out other pathological conditions (Halter, 2014).

Nurses can utilize technology, such as, brain imaging with CT scan, position emission tomography, and other scanning technologies that can help them rule out other conditions. A misdiagnosis can lead to the formulation of an inappropriate treatment strategy. In most cases, misdiagnosis can lead to detrimental results (Lu & Bludau, 2011). It is critical to perform a thorough evaluation before making any conclusions regarding the medical condition of the patient.

Once diagnosis has been made, it is time to look into pharmacological and non-pharmacological interventions. Unfortunately, there is no cure for this dreaded disease. The focus of treatment is to delay the progression of the disease. In terms of using medication, drugs like rivastigmine, galantamine, and donepezil have the capability to slow the progression of the said disease (Videbeck, 2011).

These drugs can slow the progression of dementia for about six months. Drugs like antipsychotics, antidepressants, and benzodiazepines can help manage the symptoms. However, these drugs have no effect on the progression of dementia.

With regards to non-pharmacological interventions, there is a need to take care of the person as a whole. Caregivers must learn how to keep the patient physically well, socially engaged, and mentally stimulated (Lu & Bludau, 2011). Therefore, aside from giving medication, the caregiver must look after all the aspects of the individual.

Aside from pharmacological and non-pharmacological interventions, it is important to consider the psychosocial aspect of providing care. It is imperative to address issues regarding safety, interpersonal involvement, and social interaction (Videbeck, 2011). One has to keep this in mind, most clients receive care at home.

A spouse or adult child often assumes the caregiver’s role. Due to the challenges that they face on a daily basis, they need ongoing education and support from health care professionals such as a nurse. Nurses must teach them to address other issues, such as, nutrition, as well as different methods on how to handle symptoms as they arise. The main goal is to maintain overall health of the patient suffering from the said disease.

Gogia, P. & Rastogi, N. (2009). Clinical Alzheimer rehabilitation.  New York: Springer.

Halter, M. (2014). Varcaroli’s foundations of psychiatric mental health nursing.  CA: Elsevier.

Lu, L. & Bludau, J. (2011). Alzheimer’s disease. CA: ABC-CLIO.

Smith, M. & Kenan, M. (2004). Alzheimer’s for dummies. New Jersey: Wiley Publishing.

Videbeck, S. (2011). Psychiatric-mental health nursing. New York: Kluwer.

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Dementia Case Study Essay – 3500 words


The Case Study

Previous History: Social

The case study chosen is that of a 74 year old male patient with a history of challenging health issues. John (an assumed name in order to protect the patients identity in accordance with the Code of Professional Conduct as per the Nursing & Midwifery Council, 2006) has been happily married for 54 years and does not have any children. He does belong to a large extended family – he has twelve siblings. He has spent his working life as a plumber. He has been a sociable person enjoying the company of friends and family. Before admission to the Dementia ward he was living with his wife in their family home. His wife is finding it increasingly difficult to deal with John’s behaviour and condition as recently he has become significantly cognitively impaired. On admission, John was clean and tidy and it was obvious that his wife takes very good care of him despite the considerable effort that is required by her. During his stay on the ward John did receive regular visitors and his family and friends showed a great deal of affection for him.

Previous History: Medical

On admission it was noted that John has a long history of ill health.

His main conditions are:

Multi-Infarct Dementia: “MID is a common cause of memory loss in the elderly. MID is caused by multiple strokes (disruption of blood flow to the brain). Disruption of blood flow leads to damaged brain tissue.” (NINDS). This was diagnosed three months ago after John exhibited trademark symptoms such as short term memory loss, confusion, shuffling feet. He also started losing bladder and bowel control. MID is usually found within the 60 – 74 year age group, more often in men than women. A MRI scan showed up this condition.

Cardiac Diverticulitis: a rare congenital heart malformation

Aortic Aneurysm


These conditions cause John great pain and distress. He is currently being administered several pain relieving medications – Morphine, Sevradol, Diclofenic and paracetamol. He also received medication for the hypertension.

John was told 15 months ago that the prognosis for the treatment of his Aortic Aneurysm was not good and it was anticipated that his life expectancy was six months.

The severity of the pain experienced by John results in very aggressive physical and verbal behaviour. This aggression is very difficult for his loved ones to deal with.

He was admitted to the dementia ward for a six week assessment with a view to providing suitable pain relief which could then lessen his challenging behaviour to an extent.

Care assessment

On admission to the ward, John was attended by psychiatric staff who carried out an evaluation on John’s memory. This is known as a Mini Mental State Examination. The MMSE indicates the importance of cognitive stimulation therapy that can be consistently offered to the patient. (Weavers (2007, p.1) (see Appendix 1). The MMSE is a series of questions and tests designed to establish whether a drug treatment would be appropriate. NHS guidelines state that the patient should score 12 points or more out of a maximum of 30 points to be considered for medication. The tests cover orientation to time, registration, naming and reading skills. (Alzheimer’s Society information sheet 436).

John was also assessed in terms of diet and sleep.

The Discomfort Scale-Dementia of the Alzheimers’s Type (DS-DAT) was carried out with John. DS-DAT measures discomfort in elderly patients with dementia who are losing cognitive capacity and communication skills and are increasingly reliant on nursing staff. It was originally conceived to measure discomfort but it can be used to assess pain.

Assessment on John revealed that when he is in pain he is prone to be more aggressive. Staff worked with him to find strategies he could use to alleviate the pain. He received psychological assistance from the Pain Management Specialists. According to research on care of the elderly pain assessment is always an important aspect of what is done to take care of patients with dementia. The pain manifestation in John’s case has been a concern for everyone involved in his care. This is supported by Smith (2005) who says that it is important for healthcare providers to make correct assessment in the treatment of elderly people. There are many deterrents to making correct assessment. The fact that our culture looks at dementia as a disease that is only in the mind and that people with dementia do not experience pain can create a problem because often doctors may not see symptoms as belonging to dementia. Also, as patients begin to lose the ability to understand their internal states, they cannot identify easily “sensations, feelings and experiences” (Smith 2005 p.2). This will also lead to a time when they may not be able to verbalise what they are feeling. When the condition gets to this stage it is important to take care of the comfort needs of the individual. Many healthcare providers assess this by means of a Comfort Checklist. Smith (2005) was able to show professionals that there are several assessment tools that can be used to assess pain levels in patients with dementia.

Kaasalainen (2007) presents another idea of how to assess the pain of patients with dementia by using behaviour observation methods. This literature supports that pain is “underestimated and undertreated” in the older population. Assessment then becomes even more important.

Early pain assessment is important because the patient may start to lose the cognitive ability to let their discomforts be known. A system of behavioural observation would be useful. In order for this to be accurate a system of criteria for behaviour indicators can be set. Some indicators include “rapid blinking and other facial expressions, agitation or aggression, crying or moaning, becoming withdrawn and guarding the body part “

(Kaasalainen, 2007 p.7).

When John starts getting aggressive  it can be an indication that he is in pain. “ It is important to find out how patients with dementia communicate about their pain and to determine relevant background information about their pain needs.” McClean (2000) cited in Cunningham (2006) p.5. In order that a full assessment could be made of John and his pain communication and management, he was allocated a nurse to be with him all of the time to achieve an accurate record.

The Discomfort Scale for Patients with Dementia of the Alzheimer’s Type (DS-DAT) previously referred to has been challenged by Kaasalainen (2007). Some of the challenges she stated include:

“ * some of the items measured may be due to other situations and not only dementia.

·         the way the tools are scored can be difficult and therefore not easy to use in the clinical setting

·         most of the new tools (and other DS-DAT) are in preliminary stages and need more testing

·         there is lack of consensus on how pain should be assessed with older adults so verbal reports continue to be used in most situations.

·         The concept of discomfort may be due to other facts like infection, hunger, depression or anxiety which means that behavioural observations cannot be the sole basis for giving medication.” (Kaasalainen, 2007 p.8)

Gloth (2001) presented information about pain management in older adults. He stated that it is difficult to make sure that older patients are getting enough medication to manage their pain adequately. Most older patients have at least one chronic condition and take multiple medications which make it harder to tell what they require. For some healthcare providers it becomes more frustrating to make sure the pain is managed properly. Gloth (2001 p.188).

It is important to understand when giving medication that drugs have a different reaction in older adults that they have in younger patients. This must be taken into account when prescribing. When pain is managed well an individual will have ‘secondary gain’ whereby he will feel better and it will help family members stay and visit longer. All of this will help the patient manage his pain. (Gloth 2001 p.189). Gloth (2001) also suggests that clinicians use a variety of methods for pain management including no interventions and alternative therapies where possible.

In the ward the environment is kept as quiet as possible as it is policy not to administer neuroleptic drugs unless really necessary. Pharmacological treatment options are recommended only if behaviour poses an immediate risk to the individual or to others Weaver (2007), McShane et al (1997) cited in Narzarko (2007 p.118) states that researchers have found that people with dementia who are treated with neuroleptic drugs deteriorate more quickly than those who are not treated with such drugs.

Besides having his own individual nursing care, John is offered activities to help him stay as active as possible. It was reported in Jacques et al (2000 p.366) “offering patients the appropriate activity, i.e. Games, exercise, sitting and chatting can reduce boredom and agitation.  John responds well to this individual attention and it does have a settling effect. During his working life, John was always working with his hands so he is keen to participate in games and exercise. He does try to engage in social contact with other patients but unfortunately this interaction has not been reciprocated so it has caused him upset and frustration and after a few attempts he now only talks with the nurse caring for him. His physical activity is also hindered by his pain.

John has lost a lot of weight recently so he has been seen regularly by the dietitian who is ensuring that he is eating a healthy nutritional diet. He does have a good appetite.

John’s sleep pattern has been erratic the last several months. “Many people with dementia are restless at night and find it difficult to sleep. Dementia can affect people’s body clocks so that they might get up during the night, get dressed or even go outside. Ensure that the person has enough exercise during the day and that they use the toilet before bed.(Alzheimer’s information sheet 525). John was gently reminded that it was night-time and that he should go back to sleep. A sleep diary was also kept to record the level of restlessness.

There are two types of carers involved in looking after John – those who work within the clinical setting and those family members who must care for a chronically ill family member. The family member is predominately John’s wife.

Rasin and Kautz (2007) carried out a study that focused on caregivers in assisted living facilities. The National Centre for Assisted Living (NCAL) estimates that “42% to 50% of residents in assisted living facilities have dementia and 34% of them exhibit behavioural symptoms of dementia at least once a week.” NCAL (2006) cited in Rasin and Kautz (2007 p.2). They found that caregiver training was different depending on the state in which the individual lived and many were not formally trained to work with dementia patients – instead they received training either on the job or through life experience. The study used focus groups for data collection. Carers said that there were two types of knowledge that caregivers had that were effective in dealing with dementia patients: behavior centred knowledge – knowing recommended approaches to use with specific behavioural symptoms of dementia and person centred knowledge – knowing the residents well enough that they could look beyond the behaviour of the person (Rasin and Kautz. 2007 p.33-34).

They felt that the person centred knowledge was the strongest and most effective in caring for a person with dementia. From this study they made several recommendations for nursing:

·         get to know the resident so you can determine what might be causing the disruptive behaviour.

·         Giving individualised care for the residents can increase their quality of life.

·         Caregivers should be taught how to incorporate patients life stories into their treatment plans to help them understand why the behaviour is being exhibited.

·         Caregivers who understand and use person centred knowledge need to be acknowledged (Rasin and Kautz p.36).

A person centred approach was used in John’s treatment. He was encouraged to talk about his past and his wife was able to provide a lot of useful details which allowed John to be seen and treated as a ‘whole person’. It did also allow staff to make sense of some of the behaviour displayed by John.

Hepburn et al (2007) researched another way of effectively educating family members. They looked at a transportable psycho-education program geared towards helping to reduce caregivers stress. Several programs are spotlighted in this article. What they found was that a one to one behaviour management program given by home support team help to reduce the burden on caregivers and help to reduce depression. This program combined education with counselling. With the knowledge given to families, it was possible to delay the hospitalisation of the patient with dementia. (Hepburn et al, p.31-35)

Most caregivers are women, at least partly because it is a role that all women are expected to play in most societies. Doress-Wortens (1994) researched the effects of caregivers’ stress on women who already had multiple roles. They found that the stress in certain types of care giving situations were higher than others – e.g. when the caregiver involved personal care or dealing with a family member with dementia, they tended to experience more stress. A family member who was physically frail and needed minimal help was less stressful. John’s wife stress levels decreased with experience of looking after him – this information was apparent from reading of previous case notes. From this study it was apparent that women handle many different situations and they need coping strategies when they add the care of an ill family member to the set of tasks they perform.


It is important to evaluate John’s care plan with regard to establishing the best possible attention for him. This has been done with reference to the National Institute for Health and Clinical Excellences (2006). According to NICHE (2006) there were 700,000 cases of dementia in the United Kingdom and there are approximately a million caregivers for them. As a result of these figures NICHE provided recommendations for those dealing with patients who have dementia.

NICHE Recommendation 1 : A coordinated and integrated approach between health and social care to treat and care for patients with dementia and carers.

John’s care : John has received the care of a specialist team who are trained to coordinate the day to day assessment and management of his condition. This comprised doctors, nurses, psychiatric team. Each professional provides guidance and support both for John and his family. His wife receives education and assistance with techniques on how to handle his aggression at home. Because she is his main carer at home, she has been given details of support groups where she will be able to get additional advice.

NICHE Recommendation 2 : The needs of carers should be assessed and support should be offered as part of the overall plan.

John’s care : It is important for staff from the dementia ward to offer support and help John’s wife deal with his physical and verbally aggressive behaviour. Caplan, G.A. Et al  (2006) states that families need to be given clear information about the disease trajectory , complications of dementia and limited treatment available.

John and his wife have been married for 54 years and have no children. The emotions of the medical prognosis need to be dealt with. Schulz et al (2003) cited in Ouldred and Bryant (2008) has found that the progression of dementia confronts families with difficult decisions and they need to be supported through this difficult period. It is important to receive pre-bereavement counselling which can lead to better adjustment post-bereavement. Bright (2008) researched the quality of elderly care of those who have dementia as they move into end of life situations. He pointed out that palliative care is not as developed for dementia as it is for cancer so levels of care will vary between different geographical regions.

It is difficult for John’s wife to deal with the stress that comes from living with a man she has known for so many years as his life deteriorates. She has been advised where to gain support where needed. Support groups can bring enormous relief and help to deal with some of the challenges of the caring role.

NICHE Recommendation 3 : Memory assessment should be given to all patients with dementia.

John’ care :  The Pain Management Team kept close observations using the Abbey Rating Scale and weekly evaluations on John were used to get his pain under control (see attachment 2). Wood (2002) states that the nurse’s role in pain management is vital, therefore, nurses should be fully educated and trained to recognise when patients are in pain.

NICHE Recommendation 4: People with dementia should not be denied services they need because of their age.

John’s care : The dementia ward is staffed by healthcare workers who are trained to work with patients with dementia and there is an understanding of what is required in each situation. This works on the person centred approach. Staff work with John on a regular basis and many get to know him well. The staff can see when he is getting anxious and angry and can intervene as appropriate. As stated by Fitzpatrick and Roberts (2004) healthcare professionals caring for older people require a range of core skills and knowledge, with explicit attention to the principles of patient and family-centred care, promoting autonomy, dignity and respect, along with good communication skills.

In conclusion, there has been a positive outcome after John’s assessment on the dementia ward. Aggressive outbursts are less frequent and this makes a better quality of time for John with his wife, family and friends. He still tries hard to be independent.

nursing essay on dementia

Alzheimer’s Society Information sheet 436, 525. Available to download from:


Bright, L. (2005).  Palliative care for people with dementia.  Management Matters   Available to download from

http:// . [28 March2008}

Bephage, G. (2005).  Quality sleep in older people: the nursing care role.  British Journal of Nursing.   Vol. 14 (4) pp.205-210

Bephage, G. (2007).  Care approaches to sleeplessness & dementia.  Nursing & Residential Care.  Vol. 9 (12) pp. 571-573.

Caplan, G.A., Meller, A., Squires, B., Chan, S., Willet, W. (2006).  Advance care planning and hospital in the nursing home.  Age Ageing. Vol. 35 (6) pp. 581-585.

Chambers, M. & Conner, S.L. (2002).  User-friendly technology to help family carers cope.  Journal of Advanced Nursing . Vol. 40 (5) pp. 568-577.

Cook, A.K., Niven, C.A., Downs, M.G. (1999). Assessing the pain of people with cognitive impairment.  International Journal of Geriatric Psychiatry .  Vol. 14 (6)  pp.421-425.

Cunningham, C. (2006). Managing pain in patients with dementia in hospital.  Nursing Standard.   Vol. 20 (46) pp.54-59

Doress-Wortes, P.B. (1994).  Adding elder care to women’s multiple roles: a critical review of the caregiver stress and multiple roles literatures.  Journal of Research . Vol. 31. pp.1-6.

Fitzpatrick, J.M. & Roberts, J.D. (2004). Challenges for care homes: Education and training of healthcare assistants.  British Journal of Nursing . Vol. 13 (21) pp.1258-1260

Gloth, F.M. (2001). Pain management in older adults: prevention and treatment. Journal of the American Geriatric Society. Vol. 49 (2) pp.188-199.

Jaques, A. Jackson, G.A. (2000) Understanding Dementia 3 rd ed Churchill, Livingstone, London. pp.235-269, p. 336

Hepburn, K. Lewis, M. Tomatore, J. Sherman, C.W. & Bremner, K.L. (2007). The savvy caregivers program: The demonstrated effectiveness of a transportable dementia caregiver psycho education program. Journal of Gerontological Nursing. (2007)

Vol. 33 pp. 30-37.

Kaasalainen, S. (2007) Pain assessment in older adults with dementia: Using behavioural observation methods in clinical practice. Journal of gerontological Nursing Vol. 33 (6) pp. 6-10

Lewis, M.M. & Trzinski,A. (2006). Counselling older adults with dementia who are dealing with death: Innovative interventions for practitioners. Death Studies . Vol .30 (8)npp. 777-787

National Institute for health and Clinical Excellence (NHS) and Social Care Institute for Excellent (SCIE) (2006) NICE SCIE guidelines to improve care of people with dementia.  Available to download from [Assessed 13/03/08]

National Institute of Neurological Disorders and Stroke NINDS Multi-Infarct Dementia Information Page. Available to download from http:/

Nazarko, L. (2007).  Behaviour that challenges: types and treatment. British Journal Of Healthcare Assistants . Vol. 1 (3) pp116-119

Ouldred, E. & Bryant, C. (2008).  Dementia Care. Part 3:  end-of-life care for people with advanced dementia. British Journal of Nursing.   Vol. 17 (5) pp. 308-314

Rasin,J & Kautz, D. (2007). Knowing the resident with dementia: Perspectives of assisted living facility caregivers. Journal of Gerontological Nursing. Vol. 33 (9) pp.30-36.

SA Carers. (2005). Understanding the role of the family carers in healthcare. Available to download from . [Assessed 15/03/08]

Scottish Intercollegiate Guidelines Network (2006) Guideline 86: Management of Patients With Dementia. Edinburgh, SIGN.

Smith, M. (2005). Pain assessment in nonverbal older adults with advanced dementia. Perspectives in Psychiatric Care.   Vol 41 Available to download from

Stokes, G. (2000). Challenging Behaviour In Dementia. A Person Centred Approach. Oxon Winslow-press Ltd.  pp.206

Weaver, D. (2007).  Behavioural Changes: Dementia & Its interventions.  Nursing & Residential Care.   Vol. 9 (8) pp. 375-377

Woods, S. (20020. Nursing care & implications for nursing. Nursing Times. Vol. 98 (40) pp. 39-42


Abbey, J. (2004).The Abbey pain scale: a 1-minute numerical indicator for people with end-stage dementia. International Journal of Palliative Nursing.   Vol.10 (1) pp6-13

DeWaters, T. & Popovich, J. (2003). An evaluation of clinical tools to measure pain in older people with cognitive impairment.  British Journal of Community Nursing.   Vol. 8 (5) pp226-234

Dingwall, L. (2007).  Medication issues for nursing older people (part 1). Nursing Older People. Vol. 19 (1) pp25-35

Evers, C. (2008). Positive dementia care: taking perspective.  Nursing & Residential Care.  Vol. 10 (4) pp184-187

Hobson, P. (2008).  Understanding dementia: developing person-centred communication.  British Journal of Healthcare Assistants. Vol. 2 (4) pp162-164

Kirkwood, T. Dementia Reconsidered: A person comes first. (2004). Open University Press U.K.

94 Dementia Research Topics & Essay Examples

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Care, Compassion And Communication for Patient with Dementia

In this essay I will use the Rolfe’s Reflective Model (Rolfe et al. 2001), which by asking three question what, so what, then what, will help me to self-reflect on my nursing practise. I will also focus on using 3Cs from the 6Cs framework launched by Department of Health in 2012 (Baillie, 2017), as they are essential in nurses work. The 3 C’s which chose to focus on are communication, care and compassion .The 6Cs are the values which empower health care professionals to deliver the highest quality care to patients, help people to stay independent, maximise their well-being, improve health, build and strengthen leadership, and provide a positive experience of care (NHS,England,2015) . I will discuss about how professional or unprofessional use of this values can positively or negatively impact on patients psychological, and physical wellbeing.

The first C that I will focus on is communication which is an essential component in nursing and in providing the patients with high standards of care (Papagiannis, 2010). The second C is compassion, and how important it is to provide high quality care based on empathy, respect and dignity (Clarke ,2014) Third C that I will focus on is care, as we need to make sure that care is right for patients, and consistent, and that we provide patient-centred care, as good care can improve health (NHS, England, 2015).

Nursing and Midwife Council ( NMC) (2018) code declares the need to respect people’s confidentiality and this is a reason for me to not use patient’s real name in my essay, I will use pseudonym or just call them as a patient or service user.

While working as an EU adaptation nurse on General Surgical Ward I met a patient with Alzheimer Dementia who was diagnosed with bowels obstruction and admitted to my ward. With the late stage patient condition change and patient started to received End of Life Care(EOL) Patient was bed bound and patient needs help with all activities of daily living such as washing, dressing, feeding, administration of medication. I was looking after this patient and provide care to him. While communicate with patient I spoke in slow and short sentences, with smile on my face and I remain calm. I was observing patient reaction because I was not sure whether patient understood what I am saying. I was repeat what I have already said.

At first, I was scare and quite nervous when I interacted with the patient. I was already aware of his condition; hence, I was in a dilemma as to how I can communicate with patient.This experience helped me realise that communication is truly an important part of nursing practice. Rimal et all (2009) state that communication is the way that people exchange information. The most commonly used is verbal communication but there is also non-verbal communication like written or electronic communication, body language, gestures, and sign language . Webb (2011) indicate that communication is an important tool use to deliver a high standard of care, which enable patient to voice out their needs, engage in the care, help to build a therapeutic relationship and to comply with their treatment. Kourkota &Papathansiou (2014) declare that good communication is vital to effective nursing and successful outcome of nursing care of patient. Communication skills and technique such active listening, questioning and appropriate use of verbal or non-verbal communication are crucial. It is important as well to being friendly, cheerful, and being an effective listener (Stein-Parbury,2013). However I realised that communicating with a patient with dementia is more difficult than I have actually expected. Dementia affects the ability to communicate (Nazarko,2015). Service user condition was definitely the barrier that hindered effective communication. Even though I spoke in clear, short and simple sentences, there were still instances when the patient did not understand what I said . McNamara (2016) point out that communication with people with dementia in 90% is nonverbal. I release how important is to spend the time with this patient, talk to him, listen him, observe him and use physical touch as a form of non-verbal communication to give service user reassurance ,comfort and breaking down barriers (Gleeson and Higgins,2009). The experience also led me to realise the importance of valuing non-verbal communication. This experience shows me that observe patient’s bodily gesture, facial expression, presence or absence eye contact can help to interpret a patient’s feelings, mood and also attitude towards the nurse and the intervention given by the nurse(Videbeck,2010). I learned how important is that nurse is able assess not only patient who can verbalise but also those with non-verbal communication signs and the nurse can truly understand patient feelings and needs.

nursing essay on dementia

I need to improve my communication skills with patient with dementia or learning disabillity or even with aggressive patients. I would like to take a part of training about communication skills in different situation to make sure I will be able to communicate and understand my patients and their needs.

When patient with dementia was admitted to my ward ,he was looking like he is struggling with personal hygiene. Patient had strong odour and patient did not have shave for long time. Patient was refusing any personal care . The situation was difficult for me as there was the barrier with communication because patient suffer dementia .I was trying to be empathic and do understand patient feelings ,trying to put myself in patient’s shoes and I was trying to go through with that situation with my patient. However this was the first time for me to be with patient at the end of patient life .I was not sure what should I do and what not to do. I feel lost in this situation.

Everyone who became ill, they became particularly vulnerable, most of the time they need assistance from others ,in these situation, patients want to be treated with care and compassion (Proctor et al,2013).Compassion is the ability to feel for another living being., sees the suffering in others, and it is motivation to help others and wishes to heal the emotional. physical and spiritual hurts (Johnson,2008;McConnell,2015) . Bradshaw (2011) point out that Florence Nightingale said that compassion is one of certain virtues and qualities in good nurses character . The most vulnerable moments and intimate experience nurses share with people they look after.(Daly et al,2010). However, according to Gilbert (2013) we should remember that to express compassion we need to transpire sympathy(being able to feel for others) and empathy (being able to understand others feeling).

Compassion is important however t when health care provider working in busy environment, with lack of staff , with lots of pressure from management and in stress make them be struggle to work and not to be able to provide high quality care (Nolte et al,2017) . Potter et al (2013) state when a nurse displays the more empathy with patient ,there is the higher risk of compassion fatigue ,where the emotional effort required to show compassion is exhausted. It is the emotional and psychological distress that creates because of continuing self-sacrifice coupled with long exposure to difficult situation. Compassion fatigue makes a person to reduced feeling of compassion towards suffering person (Bush, 2009; Cocker & Joss, 2016). Compassion fatigue is often linked with the study of burnout. Maslach(2001) and Stamm(2010).state that burnout is a syndrome including emotional tiredness, depersonalization and a reduced sense of individual achievement (Maslach, 2001; Stamm,2010). While compassion fatigue is fast beginning, burnout is a slowly continuing condition generally seen in a heavy organisational environment (Slatten et al, 2011).

When I spend time with my patient I was helping him with personal care, assisted with meals, hold his hand , I spend time with patient, I was reading patients favour book. The situation was new for me ,I was not sure if I show compassion in care I provide, I would like to read and learn more how to show compassion . I would like to learn how to help myself to deal with stress, trigger situation to not feel burnout and to make sure I am showing compassion .

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Integrated Care Study Essay



The following essay is based on the case study of 80-year-old Agatha (not her real name, in keeping with the NMC's principle regarding patient confidentiality (Nursing and Midwifery Council 2015).  Agatha was accompanied to the clinic by her son to assess her cognitive decline. Over the past 10 months, Agatha has manifested short-term memory problems, and this has been a real concern to her family. Agatha had a fall 8 months ago; following that fall, her son reports that she began asking the same questions repeatedly. 5 months ago, Agatha had a second fall, as well as several episodes of dizziness over the past 3 months. Following these incidents, Agatha's her been seen to have suffered a further decline in her cognition. As recently as 3 weeks ago, her son reports that Agatha has become increasingly suspicious of his wife, and has began to hoard things. Agatha has also lost her enthusiasm in undertaking her daily activities. She often does not remember to incorporate the correct ingredients while cooking. Agatha has also been on medication for her hypertension for the past 10 years, and she also suffers from Osteoporosis and osteoarthritis. Her son and the rest of the family have to constantly remind Agatha to take her medication. Her son has also starting assisting in the management of Agatha's finances. People living with dementia along their carers often find it extremely hard to circumvent the intricate pathways of care required to receive the care and support that they deserve (Pratt, Clare & Kirchner 2006). For this reason, people with dementia, along with their carers, frequently lack a continuity of care. According to Bamford and Bruce (2004) this is likely to promote a level of confusion and anxiety in the already intricate day-to-day lives and activities of individuals with dementia and their carers. To avoid this, Glendenning et al. (2009) has proposed a more flexible and responsive form of integrated care capable of supporting the varied needs of dementia patients

Dementia care: Multidisciplinary team approach

            Health care professionals in clinical practice setting are advised to adopt a multidisciplinary and integrated approach in the diagnosis, care and management of dementia. This is because no single healthcare professional possess the knowledge and expertise required to address the intricate range of physical, emotional, physical, and social challenges  linked to dementia (The British Psychological Society 2014). The practicing clinician is often faced with unique challenges in trying to manage dementia. For this reason, it is important to embrace a collaborative team approach as it has been proven vital in providing effective care to people with dementia. A collaborative team approach relies more on integrating various types of therapies drawn from diverse community professional and healthcare providers, as opposed to over-reliance on standard pharmacological practice (Department of Health 2009).

            In order to implement the multi-disciplinary approach, it was important first for the clinician attending to Agatha to fully comprehend the disease processes, how the patient clinically presented with the condition, and to acknowledge the caregiving experience and its impact on patient care. In addition, the clinical had to first establish the resources available to the multidisciplinary team to enable it fulfil the social, emotional, and medical needs of Agatha within the family and community setting. While reliance on a multi-disciplinary team approach is quite intricate, on the other hand, it benefits the patient as well as the clinician.  For example, it enables clinicians to pay more attention to the issues that they deem as being most suited to their area of expertise, in addition to aiding in the management of the problems facing the patients and that could necessitate significant healthcare resources (Crooks & Geldmacher 2004).

             In caring for dementia patients, it is advisable to include support from diverse sources. Such sources could entails parallel, integrated, or a blend of the two. Caregivers and patients are also advised to seek for a mix of multi-disciplinary services consisting of various social service agencies, healthcare providers, as well as other professionals drawn from beyond the healthcare field.

            Multidisciplinary teams differ terms of their composition. Additionally, the structure of multidisciplinary teams could either be informal or formal. However, team construction is often determined by resources such as finances, time, availability, as well as geographical location. Irrespective of the structure, some of the key elements of successful teams include an acknowledgement of the role played by each team member and a shared commitment to providing quality care (Verhey et al. 1993; Keough & Huebner 2000). In line with the foregoing arguments, the multidisciplinary team attending to Agatha was largely determined by the availability of service resources as well as the cultural and social setting of the community (Crooks & Geldmacher 2004). In this case, team members who attended to Agatha included a neurologist, a neuropsychologist, nurse practitioners, social workers, occupational therapist and a nutritionist.  

            The neurologist was charged with the key role of making a formal diagnosis on Agatha's condition using validated practice guidelines and criteria. After diagnosis, the neurologist had to determine a prognosis and thereafter, formulate a treatment plan that would deal with the condition and its underlying symptoms (Crooks & Geldmacher 2004). In the event that the neurologist encounters certain uncertainties while making a diagnosis, it may be necessary to refer Agatha to a subspecialist who would proceed to refine the diagnosis, thus developing a workable care plan. Some of the dementia subspecialists include geriatric psychiatrists, behavioural neurologists, or neuropsychologists. In the case of Agatha however, it was not deemed necessary to  enlist the services of a dementia subspecialist because the neurologist was bale to arrive at a conclusive diagnosis. 

            The neuropsychologist helped to intepret the patient's quantitative cognitive performance data as drawn from the outcomes of a psychometric test. In addition, the neuropsychologist was also involved in offering continued support and therapy to Agatha and her family members (Manning 2004).

            The nurse practitioner attending to Agatha was charged with the primary role of assessing the patient's condition, in addition to managing her and the responses of the caregivers regarding the disease process. In particular, the practice nurse had to monitor Agatha's symptom presentation, respond to any issues on the patients medication, offer education and related information to the patient's family members, and helping them to get prepared for diseases progression.

            Since dementia often leads to reduced physical conditioning, immobility, poor coordination, and loss of tone and muscle strength, it was deemed necessary to include a physical therapists to the multidisciplinary team. Impaired ambulation is also reportedly common among dementia patients, and it increases the patient's risk of injury and falls. Considering that Agatha had fallen several times in recent months, the inclusion of a physical therapists would assist her to optimize her physical conditioning, in addition to maintaining safe mobility. Additionally, physical therapists can also reduce the dementia patient's need for institutionalisation by aiding in their prolonged independent living (Grand, Casper & MacDonald 2011). 

            In caring for dementia patients, social workers hinges their practice on the understanding that the person with dementia is a part of a larger system. In this case, the social workers assisted Agatha and her family to identify and obtain the resources required to manage the condition (Acton & Winter 2002). In virtually all cases, dementia patients and their caregivers shall need to access social services, including respite care, community programming, counseling support groups, financial services, and crisis management. Consequently, it is frequently recommended that a social workers be involved as part of the multidisciplinary team attending to a dementia patient once a formal diagnosis has been made (Crooks & Geldmacher 2004). In this case, the social worker helped to anticipate the patient's future needs, aided in the acquisition of services, and to helped the patient and her family navigate through the healthcare system.

            It was also necessary to include an occupational therapist as part of the multidiscpinary team attending to Agatha. This was deemed important as the occupational therapist would assist the patient and her caregivers to adapt to her diminished capacity to handle the challenges she is likely to encounter in her daily life.  For example, Agatha and her carers needed help in the use of various devices to assist her with eating, dressing, toileting, as well as with home management. An occupational therapist thus assists with enhancing the patient's independence and in this way, thus reducing the burden on the caregiver (82). Dementia is also associated with cognitive impairment, and this places the patient at an even greater risk for dehydration and malnutrition. The patient could also experience sensory motor impairments in the advanced stages of dementia, leading to the loss of ability to swallow and eat unaided. This leads to weight loss (Caron, Ducharme & Griffith 2006). For these reasons, it is necessary to also include a nutritional as part of the multidisciplinary team attending to the care and management of a dementia patient.

             Considering that Agatha also suffers from hypertension and osteoarthritis, it was deemed necessary to include  a nutritionist in order to address her dietary management concerns.  NICE (2006) recognises the principles of person-centred care as a fundamental component of good practice in caring for dementia patients. This is evidenced by the numerous recommendations that the guideline entail.  The fourth principles underscores the importance of taking into account the needs of carers in dementia care, be they family, paid care-workers or friends, in addition to also considering various means of supporting and improving their input to dementia patients. NICE (2006) has identified this as a form of 'relationships-centred care'.

             In treating and caring for Agatha, the multi-disciplinary team considered her needs and preferences. It is important to grants individuals with dementia an opportunity to make informed choices regarding the kind of treatment and care they receive. In this case, the multidisciplinary team acted as facilitators in ensuring that Agatha made an informed choice. The views of persons with dementia regarding who ought not and ought to be involved in providing care are essential and ought to be respected. With the consent of the individual with dementia, relatives and carers should get an opportunity to partake in decisions regarding treatment and care.  In the event that the patient is deemed to lack the capacity to made such informed decisions, it is recommended that the multidisciplinary team follow the advice on consent as spelt out by the Department of Health  namely, that all health care professionals should ensure that they obtain valid consent from patients regarding any examination, care or treatment that they seek to undertake (Department of Health 2009).

            The 2005 Mental Capacity Act recognises that every adult possess a right to make individual decisions but in the event that there is an impairment in their capacity to make decisions as often happens with patients with advanced dementia, the Act recognises that every adult reserves the right to receive reasonable support and help in making their own decisions (Office of the Public Guardian 2013). However, a capacity assessment conducted by Agatha's GP revealed that she had the capacity to make decisions. The social and health staff attending to Agatha made sure to consider the views of her family and carers as they described behaviour that might be relevant to dementia. Such information, along with an assessment of the patient, played a key role in making a diagnosis for Agatha, and in deciding on the kind of care that the patient received. The multidisciplinary team saw to it that good communication was maintained between care providers, the patient, their carers, and family. This was aimed at ensuring that Agatha received the support and information that she needed. It is important to ensure that evidenced-based information is provided in a way that is designed to fulfil the needs of an individual patient.

            My involvement in taking care of a patient with complex needs has made me appreciate the significance of a multidisciplinary team approach in patient care delivery. Working as part of the multidisciplinary team has enabled me to appreciate the need for team effort in providing the right care to the patient, at the right time and at the right place. Besides, the multidisciplinary team that I worked with consisted of among others, a neurologists, nurses, social workers, occupational therapist, and a nutritionist. Each of these professionals possess their own skills and expertise that is essential in managing and caring for a patient like Agatha with multiple health needs.  With a multidisciplinary team approach, we were in a better position to guarantee the patient and her family continuity of care, in addition to being able to undertake a holistic and comprehensive view of the patient's needs. It was also easier to attend to the patient's diverse needs because the multidisciplinary team attending to her possessed diverse educational and professional skills, and mutual support.

            Being part of this multidisciplinary team made me realise that such collaboration is not only beneficial to the patient, but also to the individual members of the team. For example, I realised that I could relate with some of the health care professional in the team on a professional and personal level because the multi-disciplinary team approach helped to break the communication barriers that usually exist between various health care professionals, thereby aiding in improved cooperation. Consequently, we were in a better position to provide better management and care to the patient, thus resulting in improved patient outcomes, increased job satisfaction, and improved patient, family, and carer satisfaction with service delivery. Taking into account these and other benefits of an integrated multidisciplinary approach in dementia diagnosis, management and care, it is recommended that such a practice be adopted widely. This is important considering that no one medical specialty possess the expertise required to cope with the intricate range of physical, social, and mental issues that usually accompany dementia.  While most clinicians find it quite challenging to share responsibility and integrate their professional expertise, a multidisciplinary approach results in enhanced continuity of care and management of patients with dementia, thus resulting in improved patient satisfaction.

Acton GJ & Winter MA (2002),' Interventions for family members caring for an elder with dementia', Annu Rev Nurs Res ., vol. 20, pp. 149-179.

Department of Health (2009). Living Well With Dementia: a national dementia strategy . [Online]. Available at: [Accessed 14 Dec. 2016] 

Department of Health (2009). Reference guide to consent for examination or treatment (second edition). [Online]. Available at: [Accessed 13 Dec. 2016]

Bamford C, Lamont S, Eccles M, Robinson L, May C & Bond J (2004),' Disclosing a diagnosis of dementia: a systematic review', Int J Geriatr Psychiatry , vol. 19, pp. 151-169.

Caron CD, Ducharme F & Griffith J (2006),' Deciding on institutionalization for a relative with dementia: the most difficult decision for caregivers', Can J Aging . Vol. 25, no. 2, pp. 193-205.

Claire AG, Wolfs, AK, Dirksen CD, Severens JL, Verhey FRJ (2008),'Integrated multidisciplinary diagnostic approach for dementia care: randomised controlled trial', The British Journal of Psychiatry , vol. 192, no. 4, pp. 300-305.

Crooks EA & Geldmacher DS (2004),' Interdisciplinary approaches to Alzheimer’s disease management', Clin Geriatr Med ., vol. 20, no. 1, pp. 121-139.

Glendinning C, Arksey H, Jones K, Moran N, Netten A & Rabiee P ( 2009). Individual Budgets Pilot Projects: Impact and outcomes for carers.  York, United Kingdom: Social Policy Research Unit.

Grand JHG, Caspar S & MacDonald SWS (2011),'Clinical features and multidisciplinary appraches to dementia care', J Multidiscip Healthc ., vol. 4, pp. 125-147.

Keough J & Huebner RA (2000),' Treating dementia: the complementing team approach of occupational therapy and psychology', J Psychol. , vol. 134, no. 4, pp. 375–391.

Manning C (2004),' Beyond memory: neuropsychologic features in differential diagnosis of dementia', Clin Geriatr Med ., vol. 20, no. 1, pp. 45-58.

Office of the Public Guardian 2013. Mental Capacity Act Code of Practice . [Online]. Available at: [Accessed 12 Dec. 2016]

NICE. 2006. Dementia: supporting people with dementia and their carers in health and social care. Care guideline. In Clinical Guideline . National Institute for Health and Clinical Excellence (NICE) and Social Care Institute for Excellence: London, UK: National Institute for Health and Clinical Excellence.

Pratt L, Clare L & Kirchner V (2006),' It’s like a revolving door syndrome’: professional perspectives on models of access to services for people with early-stage dementia', Aging and Mental Health , vol. 10, no. 1, pp. 55-62.

The British Psychological Society (2014).  Clinical Psychology in the Early Stage Dementia Care Pathway . [Online]. Available at: [Accessed 12 Dec. 2016]

Nursing and Midwifery Council (2015). T he Code Professional standards of practice and behaviour for nurses and midwives [Online]. Available at: [Accessed 14 Dec. 2016]

Verhey FR, Jolles J, Ponds RW, et al. (1993),' Diagnosing dementia: a comparison between a monodisciplinary and a multidisciplinary approach', J Neuropsychiatry Clin Neurosci., vol. 5, no. 1, pp. 78–85.



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