Training Requirements for Nurses Working with Dementia Patients

As a minimum, training for nurses should include:

• Introduction to aging focusing on both biological and psychological factors. Content should include discussion of normal aging, theories, psychosocial aspects of aging, age-associated losses and reactions to loss, and ethnic/cultural issues.
• Cognitive functioning in the aged. Normal cognitive function should be contrasted with abnormal functioning and progression of the disease process, and physiological changes associated with dementia. Accompanying reasons for corresponding cognitive deficits should be discussed, as should changes associated with reversible and irreversible dementias. Nurses should also be trained in the use, scoring, and interpretation of various assessment tools to measure cognitive function.
  
• Behavior and nursing care problems such as dressing, bathing, and grooming; problems with incontinence, immobility, and eating; and assessment and identification of concomitant diseases and disorders. Nurses should be provided with techniques and interventions regarding behavior problems such as catastrophic behaviors, wandering, withdrawal, depression, nighttime restlessness, agitation, and combativeness.
  
• Use of psychotropic drugs, including an in-depth discussion of types of medications, their appropriate use, and side effects. Nurses should be trained to identify both the need for a particular drug and inappropriate prescribing. Side effects (especially of neuroleptics) should be outlined and alternative therapies discussed.
  
• Environmental restructuring, including the need for structure, consistency, and modified stimuli. Methods for providing a safe and secure environment should be set forth.
  
• Social and emotional aspects of dementia, including the role of the nurse in providing support for the family and the dementia patient. Interventions, community resources, hospice and institutionalization should be discussed, as should possible reactions of the patient and the family members to various care options. Training should include an understanding of how best to obtain information about the social support network and social history of the patient and should provide knowledge regarding ways to facilitate continuity of care among various levels of care (from the home to the hospital or long-term care facility).
  
• Methods for recognizing and preventing excess disability, including the causes of excess disability - fatigue, physical causes (pain, illness), medications, change in environment or caregiver, stressors, sensory impairment, and psychological factors such as depression. Alternatives to the use of physical and chemical restraints should be included.
  
• Methods for training, supervising and evaluating nursing assistants in care of dementia patients.

Compiled by the Lincoln/Greater Nebraska Chapter of the Alzheimer's Association, 1999.