A REVIEW ON THE PROBLEMS ENCOUNTERED BY NURSES CARING FOR PATIENTS WITH DEMENTIA IN NIGERIA

CHAPTER ONE

INTRODUCTION

Background of the study

At present, more than 55 million individuals are living with dementia worldwide, and projections indicate that this figure will triple over the next thirty years as a result of the growing ageing population (World Health Organisation, 2021). Many individuals with disabilities often present with one or more co-morbid conditions, frequently including hypertension, diabetes, coronary artery disease, heart failure, and chronic obstructive lung disease (McGilton & Lemay, 2020). Individuals often encounter challenges in managing these conditions as a result of cognitive impairments and deficits in self-care. Consequently, individuals in this group exhibit a higher likelihood of hospitalisation due to unmanaged chronic conditions or related complications, in contrast to those who do not have dementia (McGilton & Lemay, 2020). Research indicates that individuals with disabilities constitute more than a quarter of all hospital admissions in developed nations (McGilton & Lemay, 2020), highlighting the significant presence of this population within healthcare facilities.

There exists a notable focus on dementia within the realms of health sciences and healthcare. This phenomenon can be attributed to the gradual rise in the incidence of dementia throughout the years. The contribution of health care professionals has become essential in the realm of medical care. Given that ageing is an unavoidable process, it is only logical that there is a growing interest in the nursing care of the elderly and individuals with dementia. The likelihood of developing dementia rises with advancing age, similarly to the chances of encountering chronic conditions like arthritis, diabetes, and issues related to cerebrovascular or respiratory health (Kravchenko, 2018). The provision of nursing care is essential and pivotal in the management of patients with dementia. At any given moment, a quarter of patients in a hospital may be living with dementia, and this population faces a significantly higher risk of re-admission and mortality compared to other patients admitted with similar conditions. The identification and care of individuals with dementia represent a vital duty for nursing professionals (Jenkins, 2019).

People experiencing dementia frequently belong to the older population, often presenting with long-standing health conditions, exhibiting intricate needs and symptoms, and posing challenges in their care management. Consequently, managing the care of these patients presents a challenging and demanding endeavour. The increasing number of individuals affected by dementia as a health issue necessitates careful consideration. The significant occurrence and extended durations of individuals with dementia in hospitals result in an increased need for nursing care in general wards (Tropea, LoGiudice, et al., 2017), particularly as numerous hospitals lack specialised dementia units (van Diepen et al., 2020). Furthermore, individuals with disabilities frequently encounter challenges such as memory loss, difficulties in communication to articulate their needs, and disorientation within hospital environments (Reilly & Houghton, 2019). Consequently, there is a significant reliance on nurses to recognise and address the care requirements of patients (Reilly & Houghton, 2019). 

Nonetheless, research suggests that there is a deficiency in the knowledge and skills of nurses regarding the care of individuals with disabilities, which leads to unmet care needs and complications acquired during hospitalisation, such as falls, infections, delirium, and declines in functionality (Gkioka et al., 2020). Moreover, the acute care setting frequently places significant demands on nurses, requiring them to prioritise the care needs of all patients in the ward simultaneously. This situation also restricts nurses' chances to collaborate with family carers and significant others (i.e., aged care staff who assist PWD before admission) in developing care plans to meet the needs of PWD (Kang & Hur, 2021). A survey indicates that 77% of family carers express dissatisfaction with the overall quality of care delivered to individuals with dementia in hospital settings (Dewing, 2018).

Moreover, the challenges associated with managing patients with dementia arise from the various manifestations of the disease, necessitating a high level of patience and compassion from carers, surpassing what is typically required for other health conditions. Nurses cannot provide adequate care for patients with dementia without the essential components of empathy (Digby, 2019). This matter holds significant importance, as it has been observed over time that those providing care for patients with dementia may experience heightened levels of frustration. Frustration and emotional exhaustion frequently arise in the nursing profession. Moreover, the strain experienced by nurses has been demonstrated to adversely affect the behaviour of individuals with dementia.

The connection between the individual with dementia and the nurse holds significant importance in clinical environments, particularly in the absence of familiar carers and family members to assist the patient. It is essential for nurses to employ effective interpersonal communication, demonstrate empathy, and utilise emotional intelligence to positively impact patients with dementia, thus underscoring the importance of this study.

 Statement of the problem

Nurses are essential in directing or managing the daily care of individuals with disabilities in hospital environments, owing to their unique role within the multidisciplinary care team and their close interactions with these individuals, their families, and significant others (Kang & Hur, 2021; Pinkert, 2018). The importance of nursing care in addressing the needs of individuals with disabilities and ensuring safe, high-quality care for those with dementia has been well recognised (Evripidou, 2021). Research suggests that nursing professionals are eager to enhance acute care for individuals with disabilities; however, the obstacles and insufficient support encountered within hospital settings hinder their effectiveness (Saxell, 2021).

As many as 75% of individuals living with dementia in hospital settings exhibit altered behaviour, primarily due to unmet or misunderstood needs (Gkioka., 2020). The altered behaviour of individuals with disabilities frequently presents as symptoms such as depression, anxiety, apathy, irritability, wandering, delusions, disturbances during the night, and both verbal and physical aggression (Hessler., 2018). It is widely recognised that unmet needs, such as unfamiliarity with surrounding individuals, altered routines, and the rapid pace of hospital settings, are linked to changes in behaviour among individuals with dementia (Dewing & Dijk, 2019). However, research has shown that healthcare practitioners, including nurses, lack adequate knowledge and skills to assess the unmet care needs of individuals with disabilities and to prevent and manage behavioural changes. Furthermore, insufficient attitudes and interactions towards individuals with disabilities by healthcare professionals have been shown to lead to altered behaviours (Tropea, LoGiudice, et al., 2017). Conversely, research indicates that providing care for individuals with disabilities who display altered behaviours creates considerable stress for nursing professionals, resulting in increased emotional and psychological strain (Spenceley, 2018). 

Regrettably, there is a scarcity of pertinent educational and counselling services designed to support nurses in managing stress, as noted by Turner (2017). The challenges associated with managing the stresses of dementia care lead to avoidance behaviours towards individuals with dementia, resulting in moral distress, burnout, absenteeism, diminished quality of care, and adverse effects on the health and well-being of nurses in the workplace (Hessler, 2018). The challenges are intensified by limitations in resources such as time constraints and staff shortages, which lead to inadequate care for individuals with altered behaviours and negatively impact the mental well-being of nursing professionals (Tropea, LoGiudice, et al., 2017). It is against this backdrop that this study will be reviewing the problems encountered by nurses caring for patients with dementia in Nigeria.

1.3 Objectives of the Study 

The primary objective of this study is to carry out a review on the problems encountered by nurses caring for patients with dementia in Nigeria. Specifically the study seeks:

To examine the impact of caring for dementia patients on nurses in Nigeria.

To identify the key challenges faced by nurses in providing care for patients with dementia in healthcare facilities in Nigeria.

To provide recommendations for improving nurse training, support, and working conditions to enhance the care provided to dementia patients in Nigeria.

1.4 Research Questions

The following research questions will be answered in this study:

What are the impact of caring for dementia patients on nurses in Nigeria?

What are the key challenges faced by nurses in providing care for patients with dementia in healthcare facilities in Nigeria?

What are the recommendations for improving nurse training, support, and working conditions to enhance the care provided to dementia patients in Nigeria?

1.5 Research Hypothesis

The stated hypothesis will validate this study:

Ho1: There are no significant problems encountered by nurses caring for patients with dementia in Nigeria.

Ha1: There are significant problems encountered by nurses caring for patients with dementia in Nigeria.

1.6 Significance of the study

First, improving healthcare delivery for dementia patients relies heavily on the capabilities of nurses, who are often the primary caregivers. By identifying the challenges they face, this study can provide insights into gaps in skills, training, and resources. For instance, nurses might lack specialized knowledge in dementia care, or they may be working under stressful conditions with inadequate staffing levels, which impacts the quality of care provided. Addressing these issues can lead to better care outcomes for dementia patients, improving their quality of life.

Second, this study will contribute to the development of tailored training programs for nurses, focusing on the specific needs of dementia care in Nigeria. Findings from this research can guide healthcare institutions and nursing schools in developing continuous professional education that equips nurses with the skills and emotional resilience required to care for dementia patients.

Moreover, the study is significant for policymakers and healthcare administrators in Nigeria. By highlighting the systemic challenges that nurses face—such as lack of resources, inadequate policies, and the absence of support structures—this research can help advocate for policy reforms. Such reforms could include increased funding for dementia care, establishment of specialized dementia care units, and better staffing policies. A well-supported nursing workforce would enhance patient outcomes and reduce nurse burnout, a common issue when dealing with complex and prolonged caregiving tasks.

Additionally, the findings from this study will contribute to the global discourse on dementia care by providing a Nigerian perspective, which is often underrepresented in the literature. Nigeria’s healthcare system operates in a unique sociocultural and economic environment, where traditional beliefs, stigmatization of mental health conditions, and limited access to healthcare services pose additional challenges. Insights from this study can help international organizations and partners to better understand these contexts and offer more appropriate support for dementia care in low- and middle-income countries.

Finally, for the nurses themselves, this study will serve as a platform for their voices to be heard. By documenting their experiences, this research aims to promote greater awareness of the need for emotional and psychological support systems for nurses. Implementing such support mechanisms will not only enhance nurses' well-being but also lead to more sustainable and compassionate care for patients suffering from dementia.

1.7 Scope of the study

The study examines a review on the problems encountered by nurses caring for patients with dementia in Nigeria. Empirically, this study assesses the impact of caring for dementia patients on nurses in Nigeria, the key challenges faced by nurses in providing care for patients with dementia in healthcare facilities in Nigeria, recommendations for improving nurse training, support, and working conditions to enhance the care provided to dementia patients in Nigeria.

1.8 Limitation of the study

Like in every human endeavour, the researchers encountered slight constraints while carrying out the study. The significant constraint was the scanty literature on the subject owing that it is a new discourse thus the researcher incurred more financial expenses and much time was required in sourcing for the relevant materials, literature, or information and in the process of data collection, which is why the researcher resorted to a limited choice of sample size. Additionally, the researcher will simultaneously engage in this study with other academic work. However in spite of the constraint all these constraint were downplayed to give the best.

1.9 Definition of terms

Nurses: Nurses are healthcare professionals who provide care, support, and medical assistance to individuals who are sick, injured, or in need of health services. They work in various settings, such as hospitals, clinics, and community health centers, and are responsible for tasks like administering medications, monitoring patients, and educating people on health management.

Dementia: Dementia is a general term for a group of symptoms that affect memory, thinking, and social abilities, significantly interfering with daily life. It is not a specific disease but a syndrome that can be caused by various conditions, with Alzheimer's disease being the most common cause. Symptoms may include memory loss, confusion, difficulty communicating, and changes in mood or behavior.

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