The patients are in their own world patients on general wards are more frequently given medication to sedate them or they are physically restrained he says which can trigger a delirium episode an acute decline in brain function We have other options in the David Ward Kügler explains It s 6 00 a m in the morning Nurse Svenja arrives to take over ward duty from the night shift along side two of her colleagues and a trainee nurse While the others sit around a table drinking coffee the night nurse reports on the patients explains which beds she had to put clean sheets on multiple times and tells the morning shift which patients she had to pacify when they woke up screaming Suddenly they hear a voice from next door Hello One of the patients is already awake She stands at the open door of the nurses office in her bathrobe they smile and greet her back With one exception the patients in the David Ward are over eighty years old To make the patients more comfortable many areas of the ward are set up to remind them of their younger days The posters on the corridor walls feature the smiling faces of German and international celebrities of the past Heidi Kabel Freddy Quinn Hans Albers Hum phrey Bogart and The Beatles The doors to the rooms are painted in different colors and labeled with large numbers so that the patients can find their way around more easily The staff have a trick to prevent patients from leaving the ward there is only one exit which is located directly behind the nurses office and it is disguised as an aquarium There is a real aquarium built into the wall of the corridor in another spot the living room is visible through the glass This common room could be mistaken for a little museum of Ger man interior design There s a short wave radio from the 1950s the two lamps are replicas of the classic Poulsen PH5 from 1958 and the striped wallpaper with roses is rem iniscent of the 1970s At 7 00 Ms Dierkes and Ms Brinkmann are sitting in the dining room for breakfast There are no fixed mealtimes for anyone if patients want to sleep in and eat later they can Photo page 12 Pooch pays a visit Rhodesian ridge back Kate cheers up some of the patients without saying a word Left Even patients who are barely mobile are brought into the dining room so they can participate in ward life Below Nurse Svenja is the head of the David Ward and has worked here right from the start Today s date is hanging in extra large format on the wall between the windows beyond which are a blos soming tree a few apartment build ings and the radiant blue sky Ms Dierkes refused to eat when she was first admitted but a trainee nurse is now patiently feeding her porridge spoonful by spoonful Ms Dierkes doesn t speak but after nearly every spoonful she purses her lips and raises her shoulders You re making a face like it s sour says the trainee but it couldn t be any sweeter She gently strokes the cheek of the old woman with short white hair and explains to her that some medication she needs is mixed into the porridge The trainee and her charge are on a first name basis nurses only use the patients first names if the patients or their families request it Ms Dierkes doesn t respond Does she under stand It takes twenty minutes for her to finish her breakfast Time is a decisive factor in en suring that dementia patients are treated with care and respect Even in the advanced stages of dementia patients still have their own will and the ability to understand and co operate In order to learn what the patients want Dr Kügler explains we need to get to know them We need to take the time to observe their behavior It requires a great deal of tact and good instincts Andreas Kruse concurs he is the Director of the Institute for Gerontology at the University of Heidelberg and has been Chairman of the German Bunde stag s Aging Report Commission since 2003 He has done extensive research on this subject Any attempt to ignore their will to disregard their autonomy can cause a dementia patient to become unsettled agitated and yes can even lead them to protest and reject the care being offered he says It s vital for us to learn to read a dementia patient s expressions and gestures if we can do that we can reliably determine when the patient is responding to a given situation posi tively negatively or neutrally This gives the staff a sort of compass for de ciding which situations the patient can handle and which situations they can t he says Nurse Svenja has been called to room seven it s the first time today Report 15THE MAGAZINE 1 19

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