Introduction
The needs of patients have prompted specialization in nursing (Boyd and Nihart, 2008). There is need for the patients to be empowered and a nurse-patient relationship to be built for the success of the nursing sector (Ruel, & Motyka, 2009). In order to achieve this, there is need to put emphasis on how the nursing workforce can be developed, healthcare to be adopted in a collaborative way, nursing to be based on research and the success of this sector to be evaluated in order to determine the success of nursing care (Kruger & Gannett, 2003). This paper supports the concept of specialization in nursing basing evidence on the benefits that patients acquire and the contribution it makes to the multidisciplinary team (Ebersole &Theris, 2005).
The concept of specialization in nursing has not gained full support and is considered as not realistic and instead multidisciplinary health care has been preferred (Boyd and Nihart, 2008). In support of this concept McCormack and Garbett (2003) argued that “Practice development is a continuous process of improvement towards increased effectiveness in patient-centre care (Styles, 1989).). This is brought about by helping health care teams to develop their knowledge and skills and to transform the culture and context of care.”
Specialization in nursing is of major benefits to the patient because the patient acquires patient-centred care which is specific to the kind of the disease the patient could be suffering from. (Gardner, Chang & Duffield 2007) have supported this in their journal by narrating how specialization in nursing has yielded significant positive results to a health sciences professor who suffered from Alzheimer (Styles, 1989). The professor received nursing care from Rear Admiral Faye Glenn who had been serving in the Public Health Service of the United States for so long (Warren, 1998). The nurse positive results could be attributed to her interest in helping people and her specialization in nursing since she had served in the military arm health service for most part of her adulthood (Chaska, 1990). In addition to this, this nurse had studied many degree courses but in employment, she specialized in nursing and for most of her life she worked for the government for the implementation of United States health Service Scheme (Bevis, 1999).
The importance of specialty in nursing has been emphasized by many authors (King, & Watt, 1995). For example, Geriatric nursing was an area in nursing that had been neglected in the United State until it was discovered that a combination of this and two other fields (mental health care and paediatric nursing) resulted to good mental health to children who had bad mental health (Elsom, Happell & Manias, 2006). When the society agreed to eliminate the mental problems in children, specialized nursing of this nature was very successful to bring out this outcome. According to Elsom, Happell & Manias (2007) “specialty of geriatric nursing will have a strong enough base to develop in subspecialties similar to paediatric nursing with its subspecialty of neonatal nursing”. This supports that every discipline in nursing aught to be specialized in order to ensure that there is full attention to health care of patients.
The concept of specialized nursing can be helpful in attending the health care needs of a patient if it is combined with knowledge from other experts. Kotzer (2005) argued that “advanced nursing and other expert’s knowledge are required to deliver coordinated care and build collaborative relationships within the health care system”. Advanced nursing is able to improve strategies of bringing medical practitioners, nurse midwives, nurse anaesthetics and case mangers together to provide a collaborative approach to health care. This has been supported by authors like (McGee & Castledine, 2008; Warren, 1998). who argued that “all the major competencies of advanced practice nursing: direct clinical practice, consultation, coaching/guidance, research, leadership, collaboration, and ethical decision-making ensure all the stakeholders in health care work towards a common objective which is delivery of quality health care.”
Advanced nursing has been demonstrated in many parts of the world. Countries like Jamaica, Fiji and Botswana have shown their appreciation of the role played by nurses in health care provision (Hamric et al, 2005). The international council of nurses provided forum in 2000 for the sharing of information, research and good practice in recognition of the role specialization in nursing plays in the provision of health services (Campbell, 2001).
Dementia
Recent researches have shown that the current practice for care of dementia patients is not the best (Kovach & Wells, 2002). Bio-medical care for dementia practice is deficient because the staffs lack clinical and practical practice to address the needs of the patients (Bryant-Lukosius & DiCenso, 2004: Katherine, Judge and Whitlatch, 2010). This section will focus on why early identification of dementia following an acute hospital admission is important for a patient with undiagnosed dementia and current best practice in the management of a patient who has dementia (Willick, C. & Willick, R., 2001).
Dementia is a form of medical-condition that causes interferences with the functioning of the brain (Nolan, 2006). According to Nolan (2006), “dementia manifests with symptoms such as; paranoia, anxiety, lack of initiative personality changes, and also a patient develop difficulties acquiring new skills.” Hudson (2003) stated that “besides Alzheimer’s disease, some other types or causes of dementia include: alcoholic dementia, depression, delirium, HIV/AIDS-related dementia, Huntington’s disease (a disorder of the nervous system), inflammatory disease (for example, syphilis), vascular dementia (blood vessel disease in the brain), tumours, and Parkinson’s disease”.
Notable symptoms of this disease are: lack of the ability to recognize objects, loss of memory in use of some simple objects, problems in speaking (Saunders, 1995).
There is a deviance in the mood and personality of an individual when he or she develops this disease. The patient experience agitation problems, the memory performance of the patient also fails, the patient develops unusual behaviours due to lack of good judgement. However not everyone who experience such symptoms has dementia, this is because anyone can have memory lapse but when these symptoms become serious then the likelihood of dementia are high and its is advisable to take a medical examination of the disease in order to determine its presences at an early stage.
According to Keady, (2003) “many patients in hospitals have never been diagnosed with dementia.” Normally if patients are diagnosed with dementia these records are not well stored in hospitals (Tanya, Mohammed, Kabeto, Plassman and Langa, 2010). There is need to diagnose this disease early because those patients who are admitted to the hospitals with dementia are at very high risks as compared to any other disease. Hudson (2003) supported this by saying that, “they are more likely to wander, to exhibit agitated and aggressive behaviours, to be physically restrained and experience functional decline that does not resolve following discharge.” Demographic studies in the United States showed that the number of people aged 65 years and above is higher than those aged 15 years and below. Dementia was found to attach 15% of those aged 65 years and above (Bryant-Lukosius & DiCenso, 2004).
The best practice for the management of dementia is through specialized nursing. McGee & Castledine (2008) stated that “acute-care nurses caring for dementia has not had specialized education in gerontology nursing, they are not prepared to recognize and manage the difficulties people with dementia experience when they are hospitalized”. Patients with dementia find it difficult to understand what they are told and they are also not able to express themselves (Nolan, 2006).). The best test for dementia is specialized and is called the mini mental state examination (Strachan, Jarrad, & Nankivell, (2003). This test involves a set of eleven questions which try to establish five aspects of the brain function (Miller and Prohaska, 1998). There is there for need for specialization in nursing care for the dementia because not every one can be able to carry out this test (Saunders, 1995).
Care giving is an important element in managing dementia. Gruneir (2007) asserts that, “there are many activities that can be carried out in the care for dementia; the care involves adapting the patients to the home activities, environment and schedule, this help to accommodate the cognitive skills which keep on declining.” Patients with dementia have sudden changes in behaviours as a result of variability in days and therefore the level of care needed vary overtime due to this unpredictability. McCloskey (2004) on the other hand asserts that, “common problems that trigger these changes are; dehydration, constipation, injuries due to falling, bladder infection and any other information that the patient cannot be able to pass to the ones to care of him/her.”
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