Evidence-based Interventions for a Patient Suffering from Dementia

IntroductionEvidence-based exercising has been heightend in whole wellnesscargon levels in the NHS (surgical incision of health, 2012). This is done to ensure that interventions argon certifyed by up-to-the-minute proof in health negociate and birth been found to be effectual for most tolerants (Pearson et al., 2009). The use of license-based practice is rooted in the spirit that longanimouss should simply call for theatrical genial occasion interest (Pearson et al., 2009). The same approach is apply when compassionate for unhurrieds with psychological health conditions. In the policy, No wellness without affable wellness (Department of wellness, 2012), the NHS has emphasised that uncomplainings hapless from cordial health conditions should nail select and demonstrate-based c are.This brief aims to critically discuss the case of an 80-year old woman who is suffering from delirium and the varied work outs of interventions that could be applied to the case. Consistent with the Nursing and obstetrics Councils (NMC, 2008) code of conduct, a pseudonym go forth be employ to hide the identity of the patient. This brief discusses the purpose of usher-based practice in managing patients with a progressive condition such(prenominal) as lunacy. An investigation on the different realises of evidence-based interventions and their potential impact for promoting cellular inclusion would withal be presented. A word of honor on interventions as means to develop a shared instinct of the patients needs would besides be done. Legal, ethical and socio-political factors that deviate the intervention cover would in addition be explored. Finally, the last part discusses my role as a nurse in the intervention process.Using Evidence-based Interventions for Patients with alienationThe Nursing and Midwifery Councils (NMC, 2008) Code of Conduct has stressed the importance of delivering quality evidence-based address that is patient-centred. Fitzpatrick (2007a) emphasised that the medieval model of evidence-based intervention relies plainly on current evidence from literature to support clinical decisions. trustworthy studies that are of high quality are often used to declare current practices. Fitzpatrick (2007b 2007c) exmphasised that nurses and some other health care professionals should have the skills to critically assess the quality of a field of study and determine whether the findings are applicable to ones current and future practice. Evaluating the strength of the evidence presented in a look 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 commentary has included best practices, personal experiences of healthcare professional on providing care, experiences of colleagues, opinions of experts and current guidelines on a health condition (Fitzpatrick, 2007a 2007b, 2007c Greenh algh, 2010). This new 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 in that respect is reliance on good evidence from published studies, including the experiences of nurses, expert opinion and best practices to aid decision-making would ensure that patients receive quality care.Communicating evidence from published literature is likewise all- consequential(a) in serving patients decide on the best spurt of intervention. Morrisey and Calighan (2011) emphasises that stiff communication is needed to convey findings of a study in a manner that is understandable to the patient. Successful use of evidence depends first on the quality of relationship surrounded by 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 p atients should be strengthened first. Kizer (2002) observe that, this intimate relationship is the median(a) by which information, feelings, fears, concerns, and hopes are exchanged between caregiver and patient (p. 117).In the UK, The National Institute for Health and clinical rectitude ( priggish, 2006) and the National Collaborating bone marrow for genial Health (2007) have provided evidence-based guidelines on how to care for patients with alienation. 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 veridical name). She is 80 years old with dementia, a condition that is progressive and characterized by deterioration of mental state, strong-growing behaviour and zymosis (Department of Health, 2009). A psychiatrical consultant oversees the management of her condition. Sh e has been receiving medications for her dementia nevertheless her GP and psychiatrist are discussing alternative drugs to reduce her anxiousness level and regulate her quiescence patterns. She is diagnosed with vitrine 2 diabetes and is mobilised with a frame following a broken hip. mend 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 now showing signs of advanced dementia (NICE, 2006). This could be a challenge since her index to spurn treatment or engage in healthcare decisions is severely reduced (Department for match Affairs, 2007). In the UK, the genial Health Act 2007 (UK Legislation, 200 7) 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 plant guardian (Department for Constitutional Affair, 2007). Since dementia is a progressive condition that could eventually lead to palliative care, the nurses have to ensure that the patient receives steal support during the trajectory of the condition. In my patients case, she needs immediate interventions for misgiving and sleep disturbance. She is overly currently taking medications for her type 2 diabetes. The NICE (2006) guideline has stated the use of psychological intervention for patients with dementia. These include cognitive behavioural therapy, which will incl ude the patients carers, animal-assisted therapy, reminiscence therapy, multisensory remark and utilization.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 exploit could improve the mobility of patients following hip surgery. Most of these studies use the randomised controlled psychometric test study endeavor, 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 walk out 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. Con berthring that Laura is also suffering from anxiety, I counseled with the carer that we capacity con sider an exercise intervention 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 merged walking exercise. Meanwhile, cognitive behavioural therapy (Kurz et al., 2012 Hopper et al., 2013) has also been shown to be effective in reducing 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 squad are considering on alternative pharmacologic therapy to regulate sleeping behaviour and anxiety of the patient. While this might have a dictatorial effect on the patient, it should be noted that medications for anxiety have side effectuate. For instance, the acetylcholinesterase inhibitors such as rivastigmine, galantamine and donepezil are known to have side make on the cognit ion of patients (Porsteinsson et al., 2013 Moncrieff and Cohen, 2009). As a nurse and part of the squad, I suggested to the team to consider the cause 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 recount 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 muscular evidence from a systematic redirect examination (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 ladders in the hie rarchy of evidence (Greenhalgh, 2010). Findings of Filan and Llewellyn-Jones (2006) also reveal that it can promote favorable behaviour amongst patients. This form of therapy was initially considered in Lauras case due to its possible personal effects on the sleep behaviour of the patient. However, current evidence is still indecipherable on whether the effects could be sustained for prolonged periods. In screening to my patients case, the use of animal-assisted therapy might be difficult to jam 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. Similar to animal-assisted therapy, there is also strong evidence on the effectiveness of music therapy in managing anxiety, low gear and aggression 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 p rocess (Repper and Perkins, 2003). In cognitive behavioural therapy, the patient and her carer receive support on how to manage anxiety and sleeping behaviour. Since carers are highly involved during CBT, there is a higher chance that the intervention would be successful (Hopper et al., 2013). It has been shown that carers of patients with degenerative conditions such as dementia are also at risk of exposure of developing depression and anxiety (Department of Health, 2009). Smith et al. (2007) explain that this might be due to the realisation that the patient would not recover from the illness. Further, these carers have to construct themselves for the patients end-of-life care. All these realisations could entice the carers own mental health (Smith et al., 2007). Hence, it is important that interventions are not only holistic for the patient, exactly 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. Pharmacologic 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 superior risk of malnutrition due to the aging process (Department of Health, 2009). Patients with dementia could experience eating behavioural problems. When patients are admitted in hospitals, the new environment and wishing 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 stay 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 sufficient diet. This is seen as a challenge in Lauras case since she could experience supply problems due to loss in cognitive abilities. For instance, she might be reminded on how to chew nutrient or why she needs to eat (Department of Health, 2009). In patients with severe forms, the main aim of feeding is now focused on comfort feeding rather than allowing patients to eat the proper amount of food (Department of Health, 2009). Hence, managing Lauras type 2 diabetes through proper feeding would be an added challenge to her care.Legal, Ethical 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 hear impulsive admission to hospitals and leave whenever they want. This Act also states that patie nts could only be constrained 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 authorise to act for own benefit and to choose appropriate interventions. Apart from the sanctioned aspects that influence the delivery of interventions, ethical issues should also be observed. In the morality principle of beneficence, nurses and other healthcare practitioners should ensure that the interventions would be honorable 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 accede 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. Justice 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 should 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 currency 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 sufficient 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 care rs are available. This is essential since supporting carers is also a priority in the NHS (National Collaborating pore for Mental Health, 2007).Role of the Nurse in the Intervention ProcessOn reflection 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 stage in the patients disease trajectory or could be one of acceptance and pacification for the family. As a nurse, I have to ensure that int erventions are appropriate to the stage of dementia that the patient is experiencing. Since nurse 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 uncanny 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 pity for a patient with declining cognitive abilities, I should ensure that her self-worth would be maintained (Baillie and Gallagher, 2011). As part of my future learning using, I will attend courses on h ow to conduct end-of-life care for patients with dementia. Through Laura, I acquire that a patients dignity should always be observed. It is recommended that in my future and present practice, I will traverse 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 abet and ensure her safety during the trajectory of the condition. For 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 modify 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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