Evidence-based Interventions for a Patient Suffering from Dementia

interpolationEvidence-based pr answerice has been promoted in all wellnessc be levels in the NHS (Department of wellness, 2012). This is d hotshot to undertake that interventions atomic number 18 leap outed by underway evidence in wellness tutors pelvis and require been found to be movementive for most long-sufferings (Pearson et al., 2009). The part of evidence-based rule is rooted in the belief that forbearings should only uplift lineament care (Pearson et al., 2009). The same accession is used when caring for forbearings with mental health conditions. In the policy, No Health with give away psychical Health (Department of Health, 2012), the NHS has emphasised that forbearings suffering from mental health conditions should receive quality and evidence-based care.This brief educates to critically discuss the case of an 80-year hoar woman who is suffering from dementedness and the polar acts of interventions that could be applied to the case. Consistent with t he care for and Midwifery Councils (NMC, 2008) code of conduct, a pseudonym allow for be used to hide the identity of the patient role role. This brief discusses the aspiration of evidence-based practice in man age patients with a progressive condition such as dementia. An investigation on the different functions of evidence-based interventions and their potential impact for promoting inclusion would besides be presented. A discussion on interventions as mover to develop a shared understanding of the patients needs would similarly be done. Legal, ethical and socio-political factors that influence the intervention process would also be explored. Finally, the last part discusses my role as a nurse in the intervention process.Using Evidence-based Interventions for Patients with DementiaThe Nursing and Midwifery Councils (NMC, 2008) edict of take on has stressed the importance of delivering quality evidence-based care that is patient-centred. Fitzpatrick (2007a) emphasised tha t the past model of evidence-based intervention relies only on authoritative evidence from literature to support clinical decisions. Current studies that are of senior high school quality are often used to inform current practices. Fitzpatrick (2007b 2007c) exmphasised that nurses and different healthcare professionals should cave in the skills to critically assess the quality of a study and determine whether the findings are applicable to ones current and future practice. Evaluating the energy of the evidence presented in a research study would require understanding of the search process and whether themes or findings from the study are credible or trustworthy (Polit and Beck, 2010). In recent years, this definition has intromitd trump practices, personal experiences of healthcare professional on providing care, experiences of colleagues, opinions of in effect(p)s and current rule of thumbs on a health condition (Fitzpatrick, 2007a 2007b, 2007c Greenhalgh, 2010). This new- fangled definition embraces other sources of evidence that could be used to help healthcare practitioners and patients make decisions regarding their care. Greenhalgh (2010) specifically points out that while there is reliance on good evidence from published studies, including the experiences of nurses, expert opinion and outperform practices to aid decision-making would ensure that patients receive quality care.Communicating evidence from published literature is also inhering in helping patients decide on the best form of intervention. Morrisey and Calighan (2011) emphasises that effective communication is needed to contri preciselye findings of a study in a manner that is understandable to the patient. Successful use of evidence depends startle on the quality of relationship between the healthcare providers and the patients (Croker et al., 2013. Kizer (2002) argued that for better care, the relationship between the healthcare professionals and the patients should be strengthen ed first. Kizer (2002) observe that, this intimate relationship is the medium by which information, feelings, fears, concerns, and hopes are exchanged between primary care provider and patient (p. 117).In the UK, The content wreak for Health and Clinical Excellence ( skilful, 2006) and the bailiwick Collaborating sharpen for moral Health (2007) devour provided evidence-based guidelines on how to care for patients with dementia. These guidelines along with current literature, my own and my colleagues experiences, expert opinion and the experiences of my patient and her carers will form evidence on the best form of interventions for the patient. My patients name is Laura (not her certain name). She is 80 years old with dementia, a condition that is progressive and characterized by deterioration of mental give tongue to, vulturine demeanor and agitation (Department of Health, 2009). A psychiatrical consultant oversees the management of her condition. She has been receiving medications for her dementia but her GP and headhunter are discussing alternative drugs to reduce her fretting level and regulate her quietnessing patterns. She is diagnosed with type 2 diabetes and is mobilised with a frame following a broken hip. succession she is still lucid and can communicate clearly, it is a challenge to care for her during nighttime when she becomes more anxious and shows signs of confusion.Patients with dementia suffer from progressive cognitive impairments (Department of Health, 2009) that could have an impact on how they receive information from their healthcare professionals and carers and in their adherence to medications. In the case of my patient, she is like a shot showing signs of advanced dementia ( expert, 2006). This could be a challenge since her ability to refuse treatment or engage in healthcare decisions is severely reduced (Department for Constitutional Affairs, 2007). In the UK, the genial Health incite 2007 (UK Legislation, 2007) and the Mental Capacity Act (Department for Constitutional Affairs, 2007) serve as guides on how to care for patients with mental health conditions such as dementia. These acts serve to protect the rights of the patient by locating a representative of the patient who could decide on her behalf. Hence, any interventions introduced for the patient should be agreed by the patients immediate family members or appointed guardian (Department for Constitutional Affair, 2007). Since dementia is a progressive condition that could eventually chip in to palliative care, the nurses have to ensure that the patient receives appropriate support during the trajectory of the condition. In my patients case, she needs immediate interventions for anxiety and sleep disturbance. She is also currently taking medications for her type 2 diabetes. The NICE (2006) guideline has stated the use of psychological intervention for patients with dementia. These admit cognitive behavioral therapy, which will includ e the patients carers, animal-assisted therapy, reminiscence therapy, multisensory stimulation and exercise.Evidence-based Interventions and Potential Impact for Promoting InclusionA number of studies (Casartelli et al., 2013 Monaghan et al., 2012 Ewen et al., 2012) have shown that exercise could remediate the mobility of patients following hip surgery. Most of these studies use the randomise controlled trial study design, which ranks high in the hierarchy of evidence (Greenhalgh, 2010). This type of design reduces selection bias of the participants and increases the credibility of the findings of the study (Polit and Beck, 2010). The NICE (2013) guideline for fall also supports exercise intervention for improving patients mobility. My patient Laura is using a frame to aid her walking following a fall and an exercise intervention would improve her mobility. Considering that Laura is also suffering from anxiety, I counseled with the carer that we might consider an exercise interve ntion to both manage anxiety and improve mobility of the patient. This was well-received by the carer who expressed that they could help the patient with a structured walking exercise. Meanwhile, cognitive behavioural therapy (Kurz et al., 2012 Hopper et al., 2013) has also been shown to be effective in cut back anxiety amongst patients and in regulating sleep behaviour. This form of intervention was also introduced to Laura and her carer. A programme was created where she would receive CBT on a weekly basis.It should be noted that the psychiatrist and the GP in the healthcare police squad are considering on alternative pharmacological therapy to regulate sleeping behaviour and anxiety of the patient. While this might have a positive effect on the patient, it should be noted that medications for anxiety have side effects. For instance, the acetylcholinesterase inhibitors such as rivastigmine, galantamine and donepezil are know to have side effects on the cognition of patients (Por steinsson et al., 2013 Moncrieff and Cohen, 2009). As a nurse and part of the team, I suggested to the team to consider the effects of pharmacologic interventions on the patient. Further, the NICE (2006) guideline also states that only specialists, that include GPs specialising in elderly care or psychiatrists, should initiate pharmacologic interventions. This guideline also emphasises that the Mini Mental State Examination (MMSE) score of the patient should be between 10 to 20 points. In Lauras case, she is progressing from moderately severe dementia to its severe form. Introducing pharmacologic interventions might only worsen the cognitive state of Laura.Meanwhile, there is strong evidence from a systematic review (Filan and Llewellyn-Jones, 2006) on the effectiveness of animal-assisted therapy in reducing psychological and behavioural symptoms of dementia. A systematic review also ranks as high as randomised controlled trials in the hierarchy of evidence (Greenhalgh, 2010). Findi ngs of Filan and Llewellyn-Jones (2006) also reveal that it can promote social behaviour amongst patients. This form of therapy was initially considered in Lauras case due to its possible effects on the sleep behaviour of the patient. However, current evidence is still unclear on whether the effects could be sustained for prolonged periods. In application to my patients case, the use of animal-assisted therapy might be difficult to carry out since the patient has to depend on a carer for her daily needs. However, our team decided on using music therapy for the patient. comparable to animal-assisted therapy, there is also strong evidence on the effectiveness of music therapy in managing anxiety, depression and antagonism amongst patients with dementia (Sakamoto et al., 2013 Wall and Duffy, 2010).Importantly, cognitive behavioural and music therapies and exercise interventions all promote inclusion of the patient in the care process (Repper and Perkins, 2003). In cognitive behaviour al therapy, the patient and her carer receive support on how to manage anxiety and sleeping behaviour. Since carers are passing involved during CBT, there is a higher determine that the intervention would be successful (Hopper et al., 2013). It has been shown that carers of patients with chronic conditions such as dementia are also at risk of developing depression and anxiety (Department of Health, 2009). Smith et al. (2007) explain that this might be due to the actualisation that the patient would not recover from the illness. Further, these carers have to prepare themselves for the patients end-of-life care. All these realisations could influence the carers own mental health (Smith et al., 2007). Hence, it is important that interventions are not only holistic for the patient, but should also include the carers in the process. Hence, implementing CBT would promote inclusion in practice (Wright and Stickley, 2013).The patient in my care is also suffering from type 2 diabetes. Pha rmacologic interventions would include metformin and insulin therapy (NICE, 2008). Non-pharmacologic interventions include exercise, behavioural modification and diet. This presents a complex problem for Laura since it has been shown that elderly patients are also at greatest risk of malnutrition due to the aging process (Department of Health, 2009). Patients with dementia could experience feeding behavioural problems. When patients are admitted in infirmarys, the new environment and pretermit of social interaction with peers could act as triggers in behavioural problems (Department of Health, 2009). Since patients might lack the cognitive ability to express themselves, this might present as aggressive behaviour (NICE, 2006). Hence, ensuring that Laura receives appropriate nutrition during her hospital occlusion could be influenced by changes in her behaviour.It is important that patients with type 2 diabetes do not only receive pharmacologic interventions but should also have ade quate diet. This is seen as a challenge in Lauras case since she could experience feeding problems due to loss in cognitive abilities. For instance, she might be reminded on how to chew food or why she needs to eat (Department of Health, 2009). In patients with severe forms, the main depend of feeding is now focused on comfort feeding rather than allowing patients to eat the proper fare of food (Department of Health, 2009). Hence, managing Lauras type 2 diabetes through proper feeding would be an added challenge to her care.Legal, respectable and Socio-Political Factors that Influence the Intervention Process Decisions on the care and interventions received by the patient are influenced by several factors. First, the Mental Health Act 2007 (UK Legislation, 2007) states that patients with mental health condition could seek voluntary entre to hospitals and leave whenever they want. This Act also states that patients could only be forced to receive treatment in hospital settings if they are detained under this Act. Laura and her carer could refuse treatment or interventions at any point of her care and my team and I would respect her decision. Observance of this provision under the Mental Health Act would also be consistent with patient-centred care where patients are empowered to act for own benefit and to choose appropriate interventions. unconnected from the legal aspects that influence the manner of speaking of interventions, ethical issues should also be observed. In the ethics principle of beneficence, nurses and other healthcare practitioners should ensure that the interventions would be beneficial to the patient (Beauchamp and Childress, 2001). In Lauras case, all the interventions cited previously have been shown to be beneficial to the patient. Only the pharmacologic interventions are associated with adverse and side effects for the patient (Popp and Arlt, 2011). Hence, as a nurse, I lobbied for inclusion of non-pharmacologic interventions instead of reliance on anticholinergic drugs to control the patients behaviour.In addition to beneficence, Beauchamp and Childress (2001) also add the ethics principles of autonomy, non-maleficence and justice. In Lauras case, her autonomy would be respected. Allowing patients to inscribe in the decision-making process is crucial. However, patients with dementia suffer from cognitive impairments that could influence their decision-making ability (Wright et al., 2009). In accordance with the Mental Capacity Act 2005 (Department for Constitutional Affairs, 2007), the carers of Laura could be appointed to act on her behalf. In non-maleficence, the main aim of the interventions is to promote the health of the patient. There are no known side effects of the psychosocial and exercise interventions. nicety will be observed if Laura receives tailored-interventions that would address her needs. It is important that regardless of the patients background, religion, race, gender, ethnicity, she shou ld receive healthcare interventions fit for her needs. This ethics principle is observed since a healthcare team has been addressing Lauras healthcare needs.While all interventions are patient-centred, socio-political issues that could influence the interventions include the recent changes in the NHS structure where local health boards are primarily responsible for allocating funds to healthcare services (Department for Constitutional Affairs, 2007). Hence, if dementia care is not a priority in the local health board, health programmes for dementia might not receive suitable funding. This could pose considerable problems for the elderly who are dependent on the NHS for their care. Laura has been receiving sufficient support for her mental health condition. This demonstrates that dementia care remains a priority in my area of care. A survey of the support system in my community reveals that support groups for carers are available. This is essential since supporting carers is also a priority in the NHS (National Collaborating Centre for Mental Health, 2007).Role of the Nurse in the Intervention ProcessOn facial expression of the case, I have a role to coordinate care with other team members and to ensure that the patient receives patient-centered care. As a nurse, I have to adhere to the NMCs (2008) code of conduct and observe patient safety. Recognising that dementia is a progressive condition, I should also focus on interventions that not only addresses the current behavioural problems of the patient but also on preparing the carer and Lauras family members on palliative care. The NICE (2006) guideline has stated that nurses have an important role in preparing patients of dementia and their family members on end-of-life care. This could be a highly stressful tip in the patients disease trajectory or could be one of acceptance and peace for the family. As a nurse, I have to ensure that interventions are appropriate to the stage of dementia that the patient i s experiencing. Since care for is a continuing process, I have to inform the family members that the patient will increasingly lose her cognitive abilities and would have difficulty feeding in the last stages of the condition (National Collaborating Centre for Mental Health, 2007). I have to ensure that the patient receives both spiritual and physical support at this stage.Evidence-based care is crucial in ensuring that patients receive the appropriate intervention. In my role as a nurse, I have to ensure that interventions are acceptable to the patient. I should also consider the preferences of the patient, their past experiences and their own perceptions on how to best manage their condition. Since I would be caring for a patient with declining cognitive abilities, I should ensure that her hauteur would be maintained (Baillie and Gallagher, 2011). As part of my future learning development, I will view courses on how to conduct end-of-life care for patients with dementia. Throug h Laura, I realised that a patients dignity should eer be observed. It is recommended that in my future and present practice, I will slip away to rely on literature on the best form of interventions of my patient. I will also consult with my colleagues, seek expert opinion and the patients experiences on how to choose and deliver interventions.ConclusionEvidence-based practice is important in helping patients achieve quality care. In this case, Laura is an 80-year old patient with dementia. She exhibits the moderate form of the condition but is beginning to show signs of advance dementia. As her nurse, I have the duty to observe ethics in healthcare and to seek for interventions that are evidence-based. However, I also realised that other factors also influence the delivery of interventions. These include socio-political, legal and ethical factors. As a nurse, I have to protect the patients rights, act as her advocate and ensure her safety during the trajectory of the condition. F or future practice, I will continue to practice evidence-based practice. I will also encourage others in the mental health profession to always consider the patients preferences when caring for patients with dementia. When patients are unable to decide for their own care, the carer of the patient could act on her behalf. Finally, as a mental health nurse, I should constantly update myself with the best form of interventions for patients with dementia. This will ensure that my patients will receive evidence-based interventions.ReferencesBaillie, L. & Gallagher, A. (2011). 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