Cerys Perrin

From a carers perspective it is detrimental that we recognise patient’s wishes, values and needs with respect. Therefore, when a patient like Mrs Jones declines an item that relates to what she values most (her appearance). We must question as carers as to why she is declining to wear her wig, to justify her actions when monitoring her care. By insisting Mrs Jones to wear her wig and pearls even after declining is not appropriate, as this will only make matters worse. Causing distress not only for her but for her family.

I believe, our preferences change over time, and this can happen to an individual with dementia. In this case maybe Mrs Jones maybe did not want to wear her wig, or she may be trying to communicate something which translates to something different e.g., her declining to wear her wig may translate to feelings of low self-esteem on her behalf due to feeling embarrassed to having to wear a wig at a special occasion. It is difficult to determine cause of action of these complex situations, however as a carer we have a duty to be compassionate to patients at their most vulnerable and be vigilant to changes in behaviour. As well as being mindful to what patients may be feeling and any potential changes in needs and preferences. To achieve person-centred holistic care, responding to psychological and spiritual needs. Overall, always working in the best interest of the patient.

I would approach this situation by notifying colleagues for extra support for Mrs Jones, as well as calling the daughter and letting her know of what has happened. The daughter may state that this happens often, then we can act accordingly to her instructions. However, if this is a new issue then we would document this occurrence and ensure the daughter is notified. To establish trust and a meaningful relationship between Mrs Jones and the carer, I would suggest using the Blackhall et al (2011) “VERA” framework. As this ensures we can collaborate with Mrs Jones clearly in a way that validates her emotions in the present time. Justifying these instances with the fact that she has “dementia”, is not dignified. Although it does contribute to this situation, it does not solve the root of her confusion. As a result, this will ensure good quality care is delivered to Mrs Jones, respecting her condition and rights to care.