Question:

Discuss nursing. This research proposal will illustrate how the nursing practices affect organizational factors in managing care homes for people with dementia.

Answer to Question: WNUR01 Nursing

Introduction

Senior citizens who reside in aged care facilities are often affected by depressing psychological signs (BPSD) (Cerejeira Lagarto & Mukaetova Ladinska (2012).

These symptoms include aggression, anxiety and aggression, violence, apathy and depression. Sometimes, hallucinations, disinhibition, euphoria, and hallucinations are also common. Backhouse, Killett and Penhale, 2016.

You will notice restlessness, anxiety, wandering and agitation as the main behavioral symptoms.

Patients suffering from BPSD will usually be recommended pharmacological therapy, which may include prescriptions of antipsychotic drugs as well as antidepressants.

As the elderly age, there are more comorbidities than usual, which can increase the chances of developing adverse drug reactions (Backhouse Killett Penhale & Gray (2016)).

The development of many non-pharmacological and complementary therapies has resulted in the creation of NPIs and other therapies to treat the behavioral as well as the psychosocial symptoms associated with dementia patients.

Many non-pharmacological therapies, such as aromatherapy (de Oliveira et.al. 2015), have been proven to help manage the behavioral and psychosocial symptoms.

This research is based on the fact that in many cases, dementia patients do not receive the necessary treatment that they need to improve their quality life.

Livingston et.al. (2012) highlighted the importance of alternative therapies for patients with dementia.

This study will concentrate on the effect of NPIs in individuals with dementia who reside in an aged care unit.

The research proposal will also demonstrate the effect of nursing care practices in managing care homes for seniors with dementia.

Research Question

Is it possible to use non-pharmacological intervention for the treatment of behavioral and psychological symptoms of dementia (BPSD), in the elderly residents living in aged care homes?

P- Elderly patients in aged care suffering from symptoms such as dementia (BPSD),

I-Non -pharmacological intervention

C- In comparison of the pharmacological treatments

O- Treating BPSD Symptoms

Literature Review

The term BPSD may be used as a general term to describe a variety of psychological and behavioral symptoms (Cerejeira Lagarto & Mukaetova Ladinska (2012)).

Psychotropic medication has a limited efficacy but may cause side effects (Brodaty-Arasaratnam, 2012).

Antipsychotic medication had been used to treat behavioral and psychological symptoms associated with dementia (BPSD).

Many studies have indicated the risk of these medications.

The majority of health care professionals are trained to administer BPSD medications, but few know about alternative treatments. (Brodaty & Arasitnam, 2012).

De Oliveira (2015) states that antipsychotic medications can cause side effects such as anticholinergic activity, parkinsonian activities, cardiac conduction disruptions, cognitive slowing or sedation.

These cases are when non-pharmacological therapies can be used. They have been found to be safer.

Brodaty & Arasaratnam (2012) claim that non-pharmacological therapies such as transcranial electric current stimulation can also be used for the treatment of LBD.

According to Koder Hunt & Davison (2014) cognitive behavioral therapy (CBT), has been shown to be helpful in managing anxiety in patients with dementia.

CBT is proven to be effective in reducing anxiety and depression in dementia patients by a randomized controlled study (Sadek Hoe & Orrell 2015.

Lyketsos (2011), Gitlin Kales and Lyketsos (2012) argued that music therapy is used frequently to treat anxiety and depression in dementia patients.

It triggers memories, feelings and sensations.

Since language was not invented, music has been shown to affect people’s responses.

Music stimulates many brain areas. Therefore, soothing music can trigger emotions in dementia patients.

It encourages social interaction, group activities and connects the person with the people around him (Groot et. al., 2016).

Studies have shown that mild to moderate exercise can help with the well-being and recovery of patients with dementia (Cerejeira Lagarto; Mukaetova Ladinska (2012)).

Although agitation in clinical practice is usually treated with medicines, the clinical outcomes of the cases have been disappointing (Cooper et. al. 2012).

These interventions are not always applied in aged care homes, which can lead to confusion about how they will be applied.

It is difficult to understand how these interventions are applied in aged care homes because there is not enough information (Brechin, 2013,).

There is little evidence of any meta-analysis, randomize control trial or systematic review. This has led to a weakening of the literature.

Other systematic reviews as well secondary literature were composed of inconsistent literatures that had insufficient sample sizes and statistically non-significant results. This increased the possibility of bias (Ma, et al. 2014).

The Methodology And Research Design

Four ethnographic cases studies were planned to be performed in four care homes.

The survey will be conducted via postal mail to identify the appropriate care homes.

The qualitative approach used in the proposed research will provide a better understanding of this problem.

This method has been chosen as it is able to address complex issues in real-life settings, such aged care homes. (Hymes, 2013,

Data Collection Method

The total of four case studies will comprise 384 hours in observation, 37 interviews and 40 staff with appropriate mapping for the psychotropic medication administration.

Data collection will continue until saturation.

Each home will receive observation for a period between five and six weeks.

The staff members will have one interview at a time convenient to them.

The interview will also be recorded and transcribed.

Before fieldwork commences, the Social Care Research ethics Committee reviews the case studies.

Each interview session would take between 40-60 mins. Participants will need to sign a consent document that details all the pros/cons of the study.Sampling

For the purpose of sampling the case studies, a postal survey is conducted.

All eligible survey responses will be analyzed.

The most likely patients who have BPSD will be found in the aged care facilities.

This will help the researcher get the relevant findings.

The researcher will send a permission letter to the organization, along with a followup call after a week, in order to discuss the study.

The potential participants will include staff from care homes who regularly work with residents suffering from BPSD.

The study will employ a purposive sampling methodology.

All employees will be informed by the use of a participant information form.Instruments

It will be possible to observe the participants by direct interaction.

An ethnographic case study is a collection of interviews and field observations that aims to give a deep understanding into the working environment and any individual.

Interviews with staff will require semi-structured interviews.

Bergh and Ketchen (2011) claim that interview is the most widely used method for ethnographic and qualitative research.

Interviews can be used to discover the beliefs, opinions, and experiences that each participant has.

Semi-structured interviews can be useful in helping to uncover specific areas of interest. They also allow the researcher to gain a more detailed understanding of a particular concept (Silverman 2016).

The semi-structured interview was chosen because it allows for an insight into the perceptions of informal caregivers regarding the use of psychotherapies such cognitive behavioral therapy.

Sometimes, tape recorders are used and sometimes video recording is possible.

Ethical Approval

Ethical approval for clinical trials and researches is important because it allows participants to withdraw at their own discretion.

All employees involved in the study are informed verbally and required to sign a consent document.

Each participant will be asked for their consent.

To provide advice on participants who are unable to consent, personal advisors will be identified.

Each individual participant will be asked to sign their written consent.

For the conduct of this study, the local ethics commission will give ethical approval.

Interviews should be kept confidential and protected.

All interviews Data and observations must be recorded electronically. It is important to use encrypted passwords to protect data from theft or unauthorised entry.

All data from the ethnographic study that has been written by hand will be stored in closed cabinets.

Data Analysis

Data will then be typed up, anonymized, and stored securely.

For the analysis of large quantities of quality data, a framework approach will be adopted.

After interviews have been conducted, a transcriber will record all recordings.

A transcriptionist will then combine the transcript with the recordings.

The transcripts will then be reviewed by statisticians.

This approach has five phases. The first is “familiarization”, in which you immerse yourself in the data to identify the key themes.

It will be used to gather ideas from the research questions.

“Indexing” is where ideas are assembled from the research question. It involves applying the thematic structure to the whole data set. “Charting” is when the data is mapped and interpreted.

Proposed Findings

Data analysis will give you a detailed breakdown of the data collected in each ethnographic study. This data can then be used for future dementia care.

An identified framework will yield multiple aspects.

This study will help to determine the associations between the findings, strategies and behaviors.

The observations will enable us to observe the activities that take place in aged care facilities every day.

The activities that will be mainly observed are: watching television, solving puzzles and other activities done by elderly persons without the assistance of caregivers.

Aged care residents will be screened for aromatherapy, massages reflexology, nail varnishing and doll therapy. This is for those who are at high risk of developing dangerous behaviors (Morrin, et al. 2016).

Activities like exercises, reminiscences and cognitive stimulation should be considered.

Group activities might include gardening and cooking.

NPIs should first be prescribed to residents who are suffering from psychological or behavioral symptoms.

The nursing staffs will benefit greatly from the final studies. They will see the whole thing through a nursing lens.

This research will provide information to nurses working in aged care about the non-pharmacological options for treating elderly patients.

This will allow caregivers to provide more support to older patients.

Individual interventions can be considered the first line for treatment of psychological and behavioral symptoms (McLaren LaMantia & Callahan (2013)).

Multisensory stimulation and music therapy are not always identified as the primary treatment options for patients by staff. But an ethnographic study could help identify any gaps in the activities.

Researcher who will be conducting the data collection should have a lot of experience in working with seniors.

The researcher will be able to cope with the emotional aspect of the work if they have such experience.

This will enable the researcher to build trust with the participant.

Conclusion

In conclusion, we can say that care homes for elderly are not adequate to address the many needs of dementia patients.

Therefore, it is important to improve the wellbeing of residents in nursing homes.

In the future, I plan to perform the data analysis and evaluation of the status following the research proposal.

This study is important for patients with dementia.

In this case, there is an evidence gap between the rhetoric and the practice. This needs to be rectified by the implementation activities that are specifically tailored for the residents.

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Four ethnographic case study studies provide evidence on the non-pharmacological treatment of dementia behaviours in care homes. Age and ageing, 45(6), 856-863. https://doi.org/10.1093/ageing/afw136Brechin, D. (2013).

Alternatives to antipsychotic medication. Psychological strategies for managing psychological or behavioural distress in persons with dementia.

British Psychological Society.Brodaty, H., & Arasaratnam, C. (2012).

Meta-analysis comparing nonpharmacological treatments for neuropsychiatric dementia symptoms. American Journal of Psychiatry, 169(9), 946-953. https://doi.org/10.1176/appi.ajp.2012.11101529Cerejeira, J., Lagarto, L., & Mukaetova-Ladinska, E. (2012).

The behavioral and psychological symptoms of dementia. Frontiers in neurology, 3, 73. https://doi.org/10.3389/fneur.2012.00073Cooper, C., Mukadam, N., Katona, C., Lyketsos, C. G., Ames, D., Rabins, P., … & Brodaty, H. (2012).

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