Investigating a Critical Practice Question Through a Literature Review paper

Investigating a Critical Practice Question Through a Literature Review paper

Dementia is a chronic and progressive condition that results in adverse health effects such as deterioration in memory, thinking, behavioral disorders, and compromised ability to participate and complete daily activities. Dementia is a primarily age-related disease that leads to disability and dependency. According to Livingston et al. (2020), around 50 million people live with dementia, which is a leading cause of mortality and morbidity. Further, the authors contend that global healthcare systems incur an estimated annual cost of about $1 trillion to combat dementia and its health effects. With the number of people with dementia expected to increase to about 150 million by 2050, it is essential to implement evidence-based practice and proven interventions to ensure patient safety and improve medical outcomes. Therefore, this literature review consolidates evidence from scholarly articles to answer the critical clinical question: How do caregivers keep dementia patientia patients in home-based care settings?

Literature Review

Undoubtedly, strategies for improving safety and improving medication outcomes for patients with dementia are topics of research interest and literary scrutiny considering the adverse health effects of this chronic, age-related condition. In this sense, many scholarly studies propose individual, organizational, and collaborative interventions for eliminating harm and addressing safety concerns that compromise the health of the susceptible patient population. Although plenty of external evidence sources provides proven suggestions regarding ideal interventions for promoting patient safety and eliminating harm, it is essential to ensure that the selected sources are credible and consistent with the critical question. Therefore, I applied the CRAAP (Currency, Relevance, Authority, Accuracy, and Purpose) test to appraise 11 sources for answering the critical question “how to ensure safety for patients with dementia.” Further, I categorized suggestions from the literature into various themes, including physical, emotional, psychological, and economic safety, to guarantee effective synthesizing of external evidence.

Physical Safety

Patients with dementia are susceptible to various sentinel events that compromise their physical safety. For example, patient falls prevail in in-patient and outpatient settings, including hospitals, skilled nursing facilities, nursing homes, and community-based care centers. In a qualitative study, Haikio et al. (2019) argue that patients with dementia face various safety issues, including falls, food safety, wandering around disoriented, and polypharmacy. These concerns result from deterioration in memory, cognition, awareness, and the ability to execute daily operations effectively. When considering the potential effects of the notable safety concern, healthcare professionals are responsible for embracing interdisciplinary collaboration with patients, families, relatives, and social workers to implement evidence-based approaches for averting physical harm.

Following an in-depth qualitative analysis of suggestions by 23 family caregivers for older people with suspected or diagnosed dementia in Norway, Haikio et al. (2019) present three sub-themes containing ideal approaches for preventing physical harm for susceptible patient population: preventive presence, tailored use of protective aids, and monitoring by healthcare professionals (p. 4). Preventive presence entails practical approaches for averting harm and helping patients to avoid adverse safety events such as accidents and falls. Notably, family members, relatives, and social workers encourage preventive presence due to their proximity to patients. Haikio et al. (2019) extend this contention by arguing that people living in the same household as the patient with dementia can help them complete daily activities such as grooming, organizing meals, eating, and accessing roads by guiding them when walking around the house and outside. Eventually, these interventions are consistent with improving patients’ safety and health by reducing individual susceptibility to environmental hazards and risks.

Although maintaining preventive presence is often a non-pharmacologic intervention, healthcare professionals have a significant role in helping community-based caregivers to prevent endogenous and exogenous threats to physical safety. According to Zucchella et al. (2018), expert-led exercise and motor rehabilitation improve patients’ physical health, reduce frailty, lower the risk of depression, and enhance short-and-long-term cognitive functions. Further, a narrative review by Zucchella et al. (2018) reveals that exercise and motor rehabilitation improve health and well-being for patients with dementia by reducing behavioral and psychological symptoms of dementia (BPSD) and via enhancing their ability to perform activities for daily living (p. 3). Although exercise and motor rehabilitation are essential approaches for bolstering physical safety, they must embrace a contingency plan to accommodate other interventions for comprehensive, individualized care.

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Tailored use of protective aids and monitoring by healthcare professionals

Alongside exercise and motor rehabilitation, the existing literature is consistent with other evidence-based approaches for preventing medication errors, polypharmacy, patient falls, and other forms of events that result in physical harm for patients with dementia. Haikio et al. (2019) contend that protective aids such as stove guards, electronic calendars, portable alarms, and single-dose medication containers can address polypharmacy, medication errors, and patient falls. Further, the researchers recommend GPS tracking systems, camera surveillance, and other forms of real-time observation systems for persons living with dementia in their households (p. 4). These technologies are vital in enabling timely observations and identification of vital signs for medication adherence and any sentinel event.

Similarly, Poulos et al. (2017) recommend physical non-pharmacologic approaches to improve cardiovascular performance, reduce metabolic risk, improve balance, and reduce fall risks. These interventions include environmental modification, task simplification, or assistive technologies such as bathing equipment, mobility aids, medication organizers, and personal emergency systems. Although these measures prove effective in preventing physical harm and enhancing the health of persons with dementia, families grapple with the challenges posed by poverty and resource constraints. As a result, it is complex to achieve the comprehensive implementation of these approaches. Consequently, healthcare professionals’ frequent visits and monitoring activities are important ways for promoting care continuity. Haikio et al. (2019) argue that health professionals are central to training family caregivers and sharing information regarding appropriate ways of implementing physical safety safeguards. When considering how the existing literature supports strategies for preventing physical harm, it is vivid that they are justifiable and proven guidelines for improving health for people with dementia in in-patient and outpatient care settings.

Emotional Safety

Physical safeguards are insufficient to guarantee patient safety when caring for dementia patients because they focus on addressing physical harm. Dementia patients face various challenges beyond physical concerns, including emotional deficiencies, cognitive deterioration, and social deficits. In this sense, providing emotional care is a profound component of the contingency safety plan for improving wellness and health. Kuske et al. (2021) define emotional safety as “the experience of people (in the context of dementia) on a continuum between feeling safe and feeling threatened in the context of subjectively perceived inner and outer conditions” (p. 356). This definition presents two vital considerations for providing care to dementia patients; the feeling of safety and threats.

Patients with dementia face emotional challenges due to chronic and progressive deterioration in memory, cognition, awareness, and social aspects. As a result, the disease inflicts perceptions of loneliness, negative feelings, withdrawal from social activities, and a sense of exclusion (Haikio et al., 2019). As a result, providing individualized care and emotional support improves wellness and health for people with dementia.

Many scholarly studies propose evidence-based practices and proven interventions for eliminating emotional threats. In a qualitative study of the perspective of family caregivers from four nursing homes in the city of Oslo and the surrounding county of Akershus, Sagbakken et al. (2017) support measures for restoring and preserving patients’ dignity when suffering from dementia. According to the researchers, humans have two forms of dignity; absolute and relative. However, dementia compromises human dignity by affecting relationships, hampering the ability to make autonomous decisions, and the freedom to participate in social activities. In turn, these factors result in feelings of insecurity, emotional struggles, and stress. Haikio et al. (2019) suggest various interventions for preventing emotional harm for patients with dementia, including maintaining respect and dignity, preventing loneliness, averting negative feelings, and promoting good moments for patients.

Maintaining respect and human dignity.

As noted earlier, dementia results in detrimental health consequences, including cognitive and behavioral deteriorations. Further, these issues compromise personal dignity by hampering decision-making capacities, autonomy, and the ability to complete daily activities. As a result, caregivers are responsible for eliminating the feeling of insecurity and emotional stress by implementing evidence-based practice and proven approaches. Haikio et al. (2019) argue that respecting patients and promoting integrity when caring for patients with dementia is a profound strategy for promoting human dignity. It enhances the perception of value and equity despite their behavioral and cognitive changes due to the challenges posed by the disease. Finally, respecting patients and enhancing their participation in care models and activities translate to improved service quality and patient satisfaction. Therefore, it is crucial to emphasize approaches that value individual rights and anchor human dignity.

Preventing loneliness and promoting happy moments

Patients with dementia deserve equal opportunity for interacting with caregivers, family members, and communities. In a systematic review of literature, Grobosch et al. (2020) reveal that many scholarly studies support the plausibility of guaranteeing emotional safety by improving everyday situations, orientation in public spaces, and enabling people living with dementia to establish relationships with other people, including caregivers. Further, this study proposes the “inner security” and patient-centered care models to enhance the feeling of emotional safety and eliminate issues that result in terminal apathy and despair (p. 15). In the same breath, Haikio et al. (2019) contend that dementia patients face difficulties accepting their declines in daily functioning, a factor that results in depression and sadness. As a result, it is vital to create happy moments by preventing boredom, the feeling of worthlessness, and emphasizing social interactions. Eventually, these approaches are crucial in eliminating negative feelings, aggression, restlessness, and boredom.

Psychological, Behavioral, and Cognitive Safety

Undoubtedly, embracing strategies for promoting cognitive and psychological safety for patients with dementia is a profound strategy for improving health and well-being. According to Thyrian et al. (2017), dementia results in neuropsychiatric symptoms and caregiver burden, increasing the likelihood of lengthy hospitalization and patient institutionalization. As a result, health professionals must embrace evidence-based pharmacologic and non-pharmacologic approaches for bolstering psychological safety. Zonsius, Cothran & Miller (2020) propose sensory stimulation as an essential intervention for improving patients’ cognition, memory, and psychological stability. According to researchers, nurses can introduce activity kits, such as sewing cards, word search puzzles, adult coloring books, and towel folding to promote social interaction and bolster cognition and awareness.

Similarly, Zucchella et al. (2018) present a list of ideal cognitive and psychological therapies that can improve the health and well-being of patients living with dementia. These therapies include cognitive stimulation (CS), cognitive training (CT), and cognitive rehabilitation (CR). The researchers define cognitive stimulation strategies as activities for enhancing patients’ general cognitive and social functioning. On the other hand, training interventions focus on mental functions such as attention, memory, language, and executive functions. Finally, rehabilitative approaches are tailored guidelines with realistic goals for helping dementia patients and their families in everyday activities. Undoubtedly, CT, CS, and CR measures form the basis for behavioral, psychological, and cognitive therapeutic measures.

Healthcare professionals have plenty of options to ponder when delivering psychological, cognitive, and behavioral therapies to patients with dementia. Cheng et al. (2019) propose psychoeducation, counseling and psychotherapy, and mindfulness-based care interventions for bolstering psychological awareness and strength. Psychoeducation entails teaching caregivers adaptive skills for coping with caregiving demands and stress associated with the complexities of delivering care to dementia patients (Cheng et al., 2019, p. 3). As a result, the education model should contain sub-themes such as improving communication, anger management, thought modification, event schedule, and time management.

On the other hand, counseling and psychotherapy entail training caregivers and enhancing their competencies for stress management. According to Cheng et al. (2019), counseling and psychotherapy improve mental health and enable caregivers to reduce dysfunctional thoughts about caregiving. Finally, mindfulness-based interventions enable caregivers to reduce stress by paying attention to present momentary experiences, thoughts, emotions, and behaviors. Therefore, it is essential to eliminate judgmental perceptions and thoughts that compromise quality care delivery. Arguably, it is possible to ensure psychological, behavioral, and cognitive safety by combining patient-centered interventions with caregiver-oriented approaches for preventing stress, managing anger, and eliminating judgmental perceptions.

Economic Safety

Although dementia affects cognitive, psychological, and behavioral aspects, the resulting consequences result in multiple effects on economic sustainability for patients with dementia. According to Haikio et al. (2019), people living with dementia struggle with the inability to handle financial information, including personal identification numbers (PIN codes), internet banking, and other transactions that require memory and awareness. As a result, this patient population is susceptible to the potential threat of economic harm, including the likelihood of theft and misuse of personal information affiliated with economic wellness. Therefore, Haikio et al. (2019) suggest three interventions for enhancing economic safety: practical assistance, monitoring and preventing unnecessary spending, and taking full responsibility for economic security.

Practical assistance and monitoring unnecessary spending

Family members, relatives, and caregivers should uphold integrity and trustworthiness when helping patients with dementia manage finances. In this sense, they are responsible for assisting patients to complete transactions and oversee spending patterns to prevent unnecessary spending activities that increase the likelihood of economic harm (Haikio et al., 2019, p. 6). Further, family members should obtain legal guardianship to assist and monitor economic activities for their ailing relatives to prevent uninformed economic decisions.

Importance of Ensuring Patient-centeredness When Promoting Safety for Patients with Dementia

The existing literature emphasizes the essence of promoting physical, cognitive, behavioral, psychological, and economic safety for patients living with dementia. However, the likelihood of achieving these interventions depends massively upon patient engagement and process individualization. According to Handley, Bunn & Goodman (2017), it is essential to embrace experiential learning and create empathy to encourage reflection for care responsibilities. Staff training is vital in improving awareness and preventing negative concepts that hamper good dementia care. On the same breath, Clemson et al. (2017) urge nurses and other healthcare professionals to ensure patient-centeredness when delivering care to dementia patients. It is possible to deliver patient-centered care by educating and training staff members, restructuring environments to cater to patients’ physical and social needs, engaging patients in care interventions, and embracing tailored approaches for preventing physical, emotional, psychological, cognitive, and economic harm.

Conclusion

Dementia is a chronic condition that results in multiple health ramifications such as cognitive and psychological deteriorations, behavioral disorders, and compromised capacity to complete activities for daily living such as grooming and eating. As a result, it is a leading cause of global mortality and morbidity. Healthcare professionals such as physicians, nurses, social workers, psychologists, and behavioral therapists should collaborate with patients and community-based caregivers to eliminate physical, emotional, psychological, and economic harm to guarantee patient safety. Although many scholarly studies recommend evidence-based practices and proven interventions that touch on these priority areas, it is essential to ensure that approaches for safeguarding patient safety comply with thresholds for patient-centered care, including patient engagement, autonomy, respecting individual values, and upholding beliefs and perceptions.

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References

Cheng, S., Au, A., Losada, A., Thompson, L., & Gallagher-Thompson, D. (2019). Psychological interventions for dementia caregivers: What we have achieved, what we have learned. Current Psychiatry Reports, 21(7), 1-12. https://doi.org/10.1007/s11920-019-1045-9

Clemson, L., Laver, K., Jeon, Y., Comans, T., Scanlan, J., & Rahja, M. et al. (2018). Implementation of an evidence-based intervention to improve the well-being of people with dementia and their carers: Study protocol for ‘Care of People with dementia in their Environments (COPE)’ in the Australian context. BMC Geriatrics, 18(1), 1-11. https://doi.org/10.1186/s12877-018-0790-7

Grobosch, S., Wolf, F., Juchems, S., & Kuske, S. (2020). Emotional safety of people living with dementia: A systematic review. Journal Of Mental Health, 1-22. https://doi.org/10.1080/09638237.2020.1739241

Häikiö, K., Sagbakken, M., & Rugkåsa, J. (2019). Dementia and patient safety in the community: A qualitative study of family carers’ protective practices and implications for services. BMC Health Services Research, 19(1), 1-13. https://doi.org/10.1186/s12913-019-4478-2

Handley, M., Bunn, F., & Goodman, C. (2017). Dementia-friendly interventions to improve the care of people living with dementia admitted to hospitals: A realist review. BMJ Open, 7(7), e015257. https://doi.org/10.1136/bmjopen-2016-015257

Kuske, S., Borgmann, S., Wolf, F., & Bleck, C. (2021). Emotional safety in the context of dementia: A multiperspective qualitative study. Journal Of Alzheimer’s Disease, 79(1), 355-375. https://doi.org/10.3233/jad-201110

Livingston, G., Huntley, J., Sommerlad, A., Ames, D., Ballard, C., & Banerjee, S. et al. (2020). Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. The Lancet, 396(10248), 413-446. https://doi.org/10.1016/s0140-6736(20)30367-6

Poulos, C., Bayer, A., Beaupre, L., Clare, L., Poulos, R., & Wang, R. et al. (2017). A comprehensive approach to reablement in dementia. Alzheimer’s & Dementia: Translational Research & Clinical Interventions, 3(3), 450-458. https://doi.org/10.1016/j.trci.2017.06.005

Sagbakken, M., Nåden, D., Ulstein, I., Kvaal, K., Langhammer, B., & Rognstad, M. (2017). Dignity in people with frontotemporal dementia and similar disorders — a qualitative study of the perspective of family caregivers. BMC Health Services Research, 17(1), 1-11. https://doi.org/10.1186/s12913-017-2378-x

Thyrian, J., Hertel, J., Wucherer, D., Eichler, T., Michalowsky, B., & Dreier-Wolfgramm, A. et al. (2017). Effectiveness and safety of dementia care management in primary care. JAMA Psychiatry, 74(10), 996-1004. https://doi.org/10.1001/jamapsychiatry.2017.2124

Zonsius, M., Cothran, F., & Miller, J. (2020). CE: Acute care for patients with dementia. AJN, American Journal of Nursing, 120(4), 34-42. https://doi.org/10.1097/01.naj.0000660024.45260.1a

Zucchella, C., Sinforiani, E., Tamburin, S., Federico, A., Mantovani, E., & Bernini, S. et al. (2018). The multidisciplinary approach to Alzheimer’s disease and dementia. A narrative review of non-pharmacological treatment. Frontiers In Neurology, 9, 1-22. https://doi.org/10.3389/fneur.2018.01058

Module 4 Assignment Instructions

Module 4 Assignment: Investigating a Critical Practice Question Through a Literature Review

This week you will begin your Module 4 Assignment, which is intended to inform and support your planning for your DNP Project in your program of study. This Assignment has two parts: a literature review in the Walden Library of research to address the critical practice question that you framed in Week 7, and a critical assessment of your search outcomes in which you synthesize the evidence. Both Parts 1 and 2 will be due by Day 7 of Week 10. Plan your time accordingly.

Photo Credit: [Steve Hix/Fuse]/[None]/Getty Images

To prepare:

• Analyze your critical practice question from the Week 7 Discussion. Based on feedback from colleagues and your Instructor, revise your question, as necessary, to ensure a clear and relevant focus for your literature search.
• Review the Learning Resources to support your search.
• Access the Individual Evidence Summary Tool Template document from the Learning Resources. This is a fillable PDF document that you will complete with at least 10 scholarly articles relevant to your critical practice question. Scan the template to ensure you understand how to enter information for each article you identify.
• Use the Week 8 Discussion to guide and clarify your search process and to pose any questions related to the template categories, search terms, or others.

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The Assignment

Part 1: Literature Review (10+ scholarly articles)

Using the Walden Library as your source, search to select at least 10 scholarly articles that represent current literature (i.e., published within the previous 5 years) with evidence that addresses your critical question and could inform a practice change initiative for quality improvement. Using the Individual Evidence Summary Tool template document, complete all sections for each article.

Part 2: Critical Assessment (7+ pages)

In a paper of at least 7 pages, plus cover page and references page, include the following:

• Write a critical assessment of your search outcomes that synthesizes the evidence from your literature review.
• Demonstrate clear connections between the practice problem that informs your critical question, your appraisal of evidence that addresses the critical question, and resulting clarification on the need for a practice change initiative focusing on quality improvement. Be specific and provide examples.

Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center provides an example of those required elements (available at https://academicguides.waldenu.edu/writingcenter/templates/general#s-lg-box-20293632). All papers submitted must use this formatting.

There is no submission due this week.

Complete Parts 1 and 2 of your Assignment by Day 7 of Week 10.

 

The Assignment
Part 1: Literature Review (10+ scholarly articles)
Using the Walden Library as your source, search to select at least 10 scholarly articles that represent current literature (i.e., published within the previous 5 years) with evidence that addresses your critical question and could inform a practice change initiative for quality improvement. Using the Individual Evidence Summary Tool template document, complete all sections for each article.
Part 2: Critical Assessment (7+ pages)
In a paper of at least 7 pages, plus cover page and references page, include the following:
• Write a critical assessment of your search outcomes that synthesizes the evidence from your literature review.
• Demonstrate clear connections between the practice problem that informs your critical question, your appraisal of evidence that addresses the critical question, and resulting clarification on the need for a practice change initiative focusing on quality improvement. Be specific and provide examples.
Critical Question: How do we keep dementia patients safe in the healthcare setting and in their homes?