Giving Patients a Voice
Research sheds light on caring for,
communicating with dementia patients
Gretchel Gealogo, Ph.D., RN, remembers the moment when her dissertation topic was born—during a night shift on a hospital medical-surgical floor.
“I had a patient with a fractured arm who also had Alzheimer’s disease,” said Dr. Gealogo, a 2015 graduate of the Ph.D. program at The University of Texas Health Science Center at San Antonio. “Se had been agitated all day, but she couldn’t really verbalize that she was in pain.” Dr. Gealogo put a few clues together—notes from the previous shift, drawn curtains in the room, and the patient’s increased agitation—and tried a different approach. “I asked her, ‘Are you uncomfortable?’ and she said, ‘Yes, I’m really uncomfortable.’ ” Dr. Gealogo was able to treat the patient’s pain and help her sleep through the night.
“The next morning, she said to me, with tears in her eyes, ‘I know that I’m losing it.’ I cried all the way home,” said Dr. Gealogo. “It was a big ‘aha’ moment for me. I wanted to study more about how patients tell us they’re in pain and what we’re supposed to be paying attention to.”
Dr. Gealogo’s dissertation, “A Light in the Dark: Development of a Conceptual Model for Person-Engaged Dementia Care,” proposes a care model based on the premise that dementia patients are health care consumers who should contribute to their health care decisions—and that the role of health care providers is to help them.
To develop her model, Dr. Gealogo spent four months gathering data at a successful community-based adult day center. She rode the bus in the mornings, participated in activities, and interviewed patients, families and staff. The center was popular with participants because it employed an innovative model called parallel programming, in which patients of different cognitive ability levels are engaged together instead of being separated.
“Take a bingo game,” she said. “At one table, you have folks who need a lot of assistance, so a staff member is there to help with their cards and chips. At another table, you have fully functioning participants, and they may even be helping out lower-functioning participants. But everybody’s doing the same activity. It’s inclusive.”
Dr. Gealogo, who now serves as a postdoctoral fellow/research coordinator at Seton Dell Medical School Stroke Institute, believes that person-engaged alternative models can be used in many patient populations, and her job as a nurse is to help engage patients in their care, no matter how difficult that may be.
“At the end of the day, there’s a patient in that bed; a patient with some capacity to contribute to his or her care or intervention. We have a duty to help them do that,” she said.