Training Requirements for Nursing Assistants Working with Dementia Patients

All curricula for nursing assistants should include:

• A basic overview of normal and abnormal aging. Content should compare and contrast normal age associated memory changes and abnormal changes associated with dementia and discuss stereotypes and myths of aging and general principles to utilize when working with the elderly.

• Overview of Alzheimer's disease and other dementias, including theories of the cause(s) of ADRD (Alzheimer's disease and related dementias) as well as those related to cure. The pathophysiology and medical diagnosis of ADRD (Alzheimer's disease and related dementias) should be discussed simply and briefly.

• Overview of symptoms of Alzheimer's disease and related dementias and methods to treat these symptoms. Symptoms to be discussed should include, but not be limited to, depression, anxiety, sleeplessness, incontinence, and misinterpretation of external stimuli.

• Management of difficult behaviors through:
  
  • Use of communication skills in dementia patient management. This includes use of short simple sentences, eye contact, physical and verbal cues, and touch. Techniques to assist the aide in handling patient preservation (repetitive requests and actions) should be taught.
  • Prevention of and treatment for catastrophic reactions, agitation, hallucinations, and paranoia. Techniques, such as touch distraction and use of logs to record possible precipitating causes should be provided. The relationship between physical problems and behavioral problems should be noted.
  • Examination of causes of and interventions for care problems such as wandering, eating problems, bathing and grooming problems, and sleep difficulties.
  • Discussion of chemical and physical restraint use, including detrimental effects of both types of restraints and the need to develop more humane nursing interventions. Detrimental effects of physical restraints include psychological trauma, restlessness, dependency in ambulation, and potential for injury. Detrimental effects of chemical restraints include increased falling, extrapyramidal and anticholinergic reactions, tardive dyskinesia, and sedation as well as the tendency of caregivers to neglect the needs of a chemically sedated patient.

• Safety measures. Because of poor judgment, dementia patients may attempt to drink poisons, misuse objects such as knives or scissors, or place themselves in dangerous positions. Nursing assistants working in long-term care facilities should learn of common hazards (such as shampoo, cleaning supplies, silverware) in the facility and learn techniques to alleviate those dangers. Home/health aides must become aware of safety hazards in the home, such as kitchen utensils and stoves, and learn creative ways to eliminate any danger to the patient.

• Prevention and treatment of excess disability, including understanding of 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. Methods to avoid and/or eliminate these factors should be emphasized.

• Emotional and psychological aspects of Alzheimer's disease, including patient and family response to the disorder. Training should cover the losses felt by both patient and family and the distress resultant from those losses.

• Respite care and self-care. Caring for a person with dementia can be emotionally and physically draining, and the nursing assistant must be trained in methods for reducing stress and burnout and dealing with feelings of guilt.

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