Initial Request to Get Access to the Patient Form

This form served as my initial request to get access to the patient. Since my subject could not give her own consent, I consulted with her eldest daughter. First, I explained my reasons for my interest in her mother. Second, I explained the benefits of my intervention.

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Part 1: Consent Explanation

I am a nursing student doing a study on caring for Alzheimers patients. I wish to get involved in caring for a member of your family who is having dementia. My involvement is limited to social, medical and psychological support, meaning that I will be actively engaged in treatment of your family member.

The benefits of my intervention will be both to you and your patient. You will get a medical advice on caring for your patient as well as psychological support during this period. I will teach you how to give medicines and what danger signs to look for in the patient. Your patient will get five hours of my attention daily. He/she will get the best medicine and psychological counseling while required

Part 2: Seeking For Consent

I ..in my desire to get medical and social support for my patient accept your request for participation in the patient care of my.. (Indicate family relation). I believe that the participation is intended to help the family and the patient in the care process.

Signature..

Date..

References

Alzheimers Australia. 2014. Dementia care in the acute hospital setting. Issues and strategies

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Hinrichsen, G. A., & Niederehe, G. (1994). Dementia management strategies and adjustment of family members of older patients. The Gerontologist, 34(1), 95-102.

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Schulz, R., & Martire, L. M. (2004). Family caregiving of persons with dementia: prevalence, health effects, and support strategies. The American journal of geriatric psychiatry, 12(3), 240-249.Sorensen, S., Duberstein, P., Gill, D., & Pinquart, M. (2006). Dementia care: mental health effects, intervention strategies, and clinical implications. The Lancet Neurology, 5(11), 961-973.

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van der Steen, J. T., Radbruch, L., Hertogh, C. M., de Boer, M. E., Hughes, J. C., Larkin, P., ... & Koopmans, R. T. (2013). White paper defining optimal palliative care in older people with dementia: a Delphi study and recommendations from the European Association for Palliative Care. Palliative medicine, 0269216313493685.Wegerer, J. (2103). Empathy for Alzheimers: The Validation Method. Alzheimers.Net

Zarit, S. H., Anthony, C. R., & Boutselis, M. (1987). Interventions with care givers of dementia patients: comparison of two approaches. Psychology and aging, 2(3), 225.