Critical Literature Review Introduction Introduction Towards Effective Dissemination of Information on Mental Health Nursing in Wicc

Article 1- The DECIDE Study: Dementia carers making informed decisions Article 2- The global prevalence of dementia: A systematic review and meta analysis Article 3- Systematic review of the effective components of psychosocial interventions delivered by care home staff to people with dementia P In this research, the researcher has focused on the problem of losing decision making capacities among dementia wherein individuals having dementia, healthcare professionals and family carers have been incorporated in the study (Lord, 2016). This study focused on individuals aged 60 or more than 60 (Prince

Critical Literature Review
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Introduction
Ascertaining the effectiveness of chosen literatures in disseminating information on particular
topic is essential. It avoids the risk of relying on unauthentic sources. This makes it essential to
critically review the chosen sources. For this purpose Critical Appraisal Skills Programme
[CASP] checklists can be effective.
Considering the above discussed aspects, the present assignment would focus dealing with the
topic of mental health nursing in which dementia will be focused upon. In this context, 3 articles
will be chosen which would be analyzed with the help of CASP model.
Problems and questions addressed in the Literature Review
For the purpose of analyzing the problems and questions which are being addressed in the
literature review in the chosen articles, the PICO structure will be used.
Article 1- The DECIDE
Study: Dementia carers
making informed decisions
Article 2- The global
prevalence of dementia: A
systematic review
and meta analysis
Article 3- Systematic
review of the effective
components of
psychosocial
interventions delivered
by care home staff to
people with dementia
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P In this research, the
researcher has focused on the
problem of losing decision
making capacities among
dementia wherein individuals
having dementia, healthcare
professionals and family
carers have been
incorporated in the study
(Lord, 2016).
The article focused on
increasing global prevalence
of dementia wherein 21
Global Burden of Disease
regions has been chosen.
This study focused on
individuals aged 60 or more
than 60 (Prince et al.,
2013)..
The study has focused
analyzing the impact of
interventions on care
services delivered by care
home staff to individuals
with dementia (Rapaport
et al., 2017).
I DECIDE manual Planning, policy-making
and allocation of health and
welfare resources.
Psychosocial interventions
C Comparison of baseline
measures of the individuals
who completed it as
compared to non-
participants.
Comparison between 21
GBD regions and Western
European population
structure has been made in
the study (Prince et al.,
2013).
Comparison has been
made between staff
receiving knowledge of
restraint use, intervention
and dementia as compared
to staffs within the
compared group (Rapaport
et al., 2017).
O The research outcome
established the fact that
DECIDE manual was
effective in minimizing
decisional conflict (Lord,
2016)
The outcome of the research
was the fact that the number
of individuals with dementia
in 2010 globally was 35.6
million which is expected to
rise by 115.4 million by
2050. It also reflected the
fact that a majority of the
population with dementia
were present in middle or
The study came up with
the outcome that
psychosocial interventions
can result in enhanced
residents and staff
outcomes in case of
individuals with dementia
in care homes.
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low income countries
establishing the correlation
between income level and
occurrence of dementia
(Prince et al., 2013).
For the purpose of searching these papers, the researcher researched for the articles with the help
of using certain key words associated with the topic of specialty practice. The search focused on
retrieving studies which are focused on mental health with particular emphasis on dementia. The
keywords which have been used on the part of the researcher are, dementia, decision making,
intervention and care training, prevalence.
This systematic search for the purpose of collecting the articles has been done with the help of
Google search engine. It has also been carried out with the help of bibliographic databases like
CINAHL and Medline (Subirana et al., 2007).
For the purpose of conducting this research, theme of keywords have been developed in which
the first theme is based on the issue of dementia, the second theme was based on impact of the
condition, loss of the ability of decision making and third theme focused on the ways of
managing the condition and associated intervention.
In the process of conducting the search, on the part of the researcher Boolean Operator ‘and’ ‘or’
‘not’ has been used which helped in either broadening or limiting the search result (Holloway &
Galvin, 2016). In the process of searching the articles manual search has also been used which
provided with the scope of reviewing the articles in which the article’s abstract, list of references
and title was evaluated in order to determine if the particular study should be included or not. For
the purpose of collecting the desired articles, certain exclusion and inclusion criteria have been
used for effectively determining of the article is supposed to be included or not.
The inclusion criteria are as follows:
 If the particular study focused on the issue of dementia?
 Does the study include the issues or impact associated with dementia?
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 If the study deals with a particular intervention for further developing certain aspects
associated with the condition?
 The article has been published with in a period of 2007-2018
 The article being published in English language
 The study is a full text study
The exclusion criteria are:
 The articles not focusing on dementia as its focus of mental health condition
 It has not been published which has been published before 2007
 The study not available in full text study
With the help of Medline the first search was conducted. In this first search, 5 articles were
retrieved. These 5 articles to some extent seemed to be in alignment with the chosen theme. In
context to same theme the second search was carried out with the help of CINAHL database
which provided 7 relevant articles (White, 2014). On following the limiting factors a total of 5
articles were chosen.
All the chosen 5 articles were manually reviewed basing on inclusion and exclusion criteria. On
the basis of the review, 3 articles successfully matched the inclusion criteria which finally were
considered for the review.
For the purpose of appraising the chosen articles CASP will be used as the tool (Voss, &
Rehfuess, 2013). It is with the help of using this tool in order to evaluate the articles that would
help in determining the validity, relevance and results of the articles.
Article 1- The DECIDE Study: Dementia carers making informed decisions
Yes Can’t Tell No Comments
1. Did the
review
address a
clearly
focused

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question?
2. Did the
authors look
for the
right type of
papers?

3. Do you
think all the
important,
relevant studies
were included?

4. Did the
review’s
authors do
enough to
assess quality
of
the included
studies?

5. If the results
of the review
have been
combined, was
it
reasonable to
do so?

6. What are the
overall results
of the review?
The study
came up with
outcome of the
fact that
DECIDE
manual was
acceptable and
useful on the
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part of the
carers. The
study further
stated that all
the participants
found the
manual to be
relevant and
useful in the
decision
making
process.
However, the
carers were of
the opinion
that DECIDE
manual failed
in addressing
disagreement
among the
family
members along
with
negotiating
services.
7. How precise
are the results?
The fact that
the result of the
study was
precise in
nature can be
stated on the
basis of the
fact that the
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study clearly
mentioned and
included its
confidence
intervals
wherein in case
of hospital
anxiety CI was
[-251, 305, p=
846],
depression
scores was CI
[- 133, 3.98],
p= 319. This
clearly
specifies the
preciseness of
the result.
8. Can the
results be
applied to
the local
population?

9. Were all
important
outcomes
considered?

10. Are the
benefits worth
the
harms and
costs?

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Article 2- The global prevalence of dementia: A systematic review and meta analysis
Yes Can’t Tell No Comments
1. Did the
review
address a
clearly
focused
question?

2. Did the
authors look
for the
right type of
papers?

3. Do you
think all the
important,
relevant studies
were included?

4. Did the
review’s
authors do
enough to
assess quality
of
the included
studies?

5. If the results
of the review
have been
combined, was
it
reasonable to

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do so?
6. What are the
overall results
of the review?
The research
came up with a
clear outcome
in which it
specifies that
within the age
group of ≥60
years differed
in narrow
band. It was
5%-7% in
majority of the
world regions
having higher
prevalence in
Latin America
that was seen
to have lower
prevalence in
sub-Saharan
African
regions. It
further
provided with
statistics that
as of 2010.
35.6 million
Individuals
were living
with dementia
across the
world which is
expected to
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rise to 115.4
million by
2015. Thus it
clearly
establishes the
fact that the
research
provided with
a clear
outcome.
7. How precise
are the results?
The data
provided in the
study can be
stated to be
precise in
nature. It can
be established
with the help
of the fact that
in case of
studies that
reported
unweighted
prevalence the
researcher
extracted 95%
of confidence
intervals.
8. Can the
results be
applied to
the local

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population?
9. Were all
important
outcomes
considered?

10. Are the
benefits worth
the
harms and
costs?

Article 3- Systematic review of the effective components of psychosocial interventions
delivered by care home staff to people with dementia
Yes Can’t Tell No Comments
1. Did the
review
address a
clearly
focused
question?

2. Did the
authors look
for the
right type of
papers?

3. Do you 
11 | P a g e

think all the
important,
relevant
studies
were
included?
4. Did the
review’s
authors do
enough to
assess quality
of
the included
studies?

5. If the
results of the
review
have been
combined,
was it
reasonable to
do so?

6. What are
the overall
results of the
review?
The study
provided with
the outcome
that
psychosocial
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intervention
can turn out
to be effective
in enhancing
the outcome
of the
residents and
staff with
dementia in
care home. It
establishes
the fact that
the researcher
has been
effective in
providing
with a clear
outcome of
the research.
7. How
precise are
the results?
The
specification
or preciseness
of the
information
or data
presented in
the study is
questionable.
It is due to the
13 | P a g e

fact that the
author has not
provided with
any
information
regarding
confidence
intervals
associated
with the data
that has been
used in the
study.
8. Can the
results be
applied to
the local
population?

9. Were all
important
outcomes
considered?

10. Are the
benefits worth
the
harms and

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costs?
The synthesis of the chosen 3 articles would be done on the basis of the evaluation of CASP tool.
Article 1- The DECIDE Study: Dementia carers making informed decisions
The validity of the results of the review
Was the review successful in clearly focusing on a specific area of question?
The clear specification of the particular literature on a particular focused question can be seen
from the fact that the study focused on family carers, associated with dementia patients along
with individuals with dementia. In this context, in the process of recruiting the participant, it
clearly focused on 41 carers (21 control and 20 intervention) (Lord, 2016). The study clearly
focused on the implementation of the intervention of DECIDE manual and the associated impact
on decisional conflict. On the basis of the fact it may be stated that the study is effective in
addressing a specifically focused area of question.
Has the researcher been successful in opting for the right types of paper?
In this context the success of the study can be clearly observed by the fact that for the purpose of
developing the DECIDE manual, the researcher had conducted a systematic literature review,
performed individual interviews with individuals providing care services to healthcare
professionals, family carers along with individuals with dementia. Followed by piloting, on the
part of the researcher the chosen intervention i.e. DECIDE manual was evaluated with the help
of randomized control trial wherein, family carers providing with support for decision making
process in case of dementia patients were also incorporated (Taylor et al., 2015).. This clearly
established the success of the researcher in effectively addressing question of the researcher and
opting for the appropriate study design reflecting the success of the researcher in choosing the
right type of paper.
Is it worth continuing?
Has the researcher successfully included relevant studies?
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The fact that, for the collection of studies on the basis of which the study would be conducted,
the researcher relied on Medline databse, set certain inclusion and exclusion criteria along with
updating the search on 15th January 2016. On the basis of these facts it may be stated that the
researcher was successful in choosing authentic and relevant studies which has needed for the
purpose of conducting the study (Falagas et al., 2008).
On the part of the researcher, was there enough focus on evaluating the quality of the included
studies?
The researcher has clearly emphasized on replicable and rigorous process in formulating
DECIDE manual. In this process, individuals with dementia, care professionals, family carers
were also included. Thus, on the basis of this fact it may be stated that aim of the study which
was evaluating the acceptability and feasibility of decision aid has been effectively evaluated
along with the population included . It may be stated that the quality of the included studies has
been effectively focused on the part of the researcher.
Has the result of the reviews been combined and if it was reasonable to do so?
In comparison to the present study, in context to other studies it may be observed that most
studies asked purposive or convenience samples of family carers regarding inevitably and
decision making, those which volunteer discussed regarding their individuals experiences may
systematically differ from who did not. In addition to that, in case of qualitative studies focus can
be seen to be given on collecting data about the complexity associated with decision making
(Torpy et al., 2009). In this process, certain contexts of decisions which were reported in studies,
inevitably gets lost. In regards to this study it may be observed that focus has been given on
context of decisions that were reported by the participants. Thus the difference in various studies
and absence of combining the results is noticeable in the chosen literature.
What was the total outcome of the review?
The study came up with outcome of the fact that DECIDE manual was acceptable and useful on
the part of the carers. The study further stated that all the participants found the manual to be
relevant and useful in the decision making process. However, the carers were of the opinion that
16 | P a g e

DECIDE manual failed in addressing disagreement among the family members along with
negotiating services.
To what extent was the result of the study precise in nature?
The fact that the result of the study was precise in nature can be stated on the basis of the fact
that the study clearly mentioned and included its confidence intervals wherein in case of hospital
anxiety CI was [-251, 305, p= 846], depression scores was CI [- 133, 3.98], p= 319 (Lord, 2016).
This clearly specifies the preciseness of the result.
Is the result of the study applicable in the local population?
The result of the study put forward the fact that carers found DECIDE manual useful and
relevant. It further stated that carers found the manual to be acceptable. In order to come to this
conclusion the researcher had used responses of care users with dementia, family carers and care
professionals (Livingston et al., 2010).. This makes the result of the study applicable for local
population as well.
Has the study considered all the important outcomes?
Though the research provided with the outcome or response of the carers and professionals, an in
depth focus on the response of the care users i.e. dementia patients with the implementation of
the manual would have helped in collecting different responses of individuals with dementia care
services making the response complete.
Are the benefits associated with DECIDE manual worth the costs and harms?
There is no particular harm associated with implementation of DECIDE manual. However, due
to the DECIDE manual may result in costing more money due to the fact that it may facilitate
more individuals in decision making for shifting their relatives to a care home but its
incorporation would help in minimizing the issue with decision making in case of dementia
patients (Samsi & Manthorpe, 2013).
On evaluating the study it may be observed that it comprised of certain strengths and limitation.
Strengths Limitations
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 Use of replicable and rigorous process
in formulation of DECIDE manual
 Use of mixed method approach for
feasibility randomized controlled trial
 Independent randomization
 Absence of observer bias
 small sample size of the trial
 loss of follow up
 lack of effective blind of the
participants in the study
 Lack of data collection from carers
relatives with dementia
Article 2- The global prevalence of dementia: A systematic review and meta analysis
The validity of the results of the review
Was the review successful in clearly focusing on a specific area of question?
The researcher has given clear emphasis on individuals affected with dementia, for which
individuals aged 60 or more belonging from Global Burden of Disease regions that included 21
countries have been focused on the part of the researcher (Prince et al., 2013). This reflects the
success of the researcher in having a clear focus on specific aspect of the topic of research.
Has the researcher been successful in opting for the right types of paper?
On the part of the researcher the focus of the research was to conduct a systematic review of
global literature regarding the prevalence of dementia along with establishing the prevalence rate
of dementia among the 21 nations in Global Burden Disease regions. The entire study has
focused on the chosen area of research which was aimed on the part of the researcher. It is for
this purpose the researcher included 135 publications associated with the area of research. Thus,
it puts forward the fact that the researcher was successful in choosing the right type of paper for
the research.
Is it worth continuing?
Has the researcher successfully included relevant studies?
For the purpose of conducting the study, electronic databases have been relied upon in which
M.P. and C.F. analyzed abstracts of the chosen publications. In addition to that guidance of
expert consensus group for ADI/Lancet estimates were taken into consideration (Prince et al.,
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2013). In addition to that for the purpose of choosing the needed article inclusion and exclusion
was also set on the basis of which the article were chosen. On this basis it may be stated that the
researcher was successful in including relevant studies.
On the part of the researcher, was there enough focus on evaluating the quality of the included
studies?
In this study no specification regarding the rigor of the research can be seen to have been
specified on the part of the researcher which questions the emphasis on evaluation of quality of
the included studies.
Has the result of the reviews been combined and if it was reasonable to do so?
In this study, on the part of the researcher it may be observed that various studies were identified
in each GBD world regions. The study reflected a reasonable coverage for 11 of the 21 GBD
regions. It can be seen to be clearly specified on the part of the researcher in E1.
What was the total outcome of the review?
The research came up with a clear outcome in which it specifies that within the age group of ≥60
years differed in narrow band. It was 5%-7% in majority of the world regions having higher
prevalence in Latin America that was seen to have lower prevalence in sub-Saharan African
regions. It further provided with statistics that as of 2010. 35.6 million Individuals were living
with dementia across the world which is expected to rise to 115.4 million by 2015 (who, 2012).
Thus it clearly establishes the fact that the research provided with a clear outcome.
To what extent was the result of the study precise in nature?
The data provided in the study can be stated to be precise in nature. It can be established with the
help of the fact that in case of studies that reported unweighted prevalence the researcher
extracted 95% of confidence intervals.
Is the result of the study applicable in the local population?
In this particular study, the researcher focused on the age group of individuals 60 years or above
belonging from 21 Global Burden of Disease regions for the purpose of determining age
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standardized prevalence rate of dementia (Prince et al., 2013). On the basis of the chosen
population for this study it can be seen to be implementable in the local population as well it is
due to that the fact that it is within the chosen population of the specific age in which the
prevalence of the condition is seen to be high. This makes the paper applicable in the local
population as well.
Has the study considered all the important outcomes?
In the present study, the researcher has highlighted on 21 Global Burden of Disease regions for
the purpose of determining the prevalence of dementia wherein the specifications associated with
every region has been highlighted upon. This was an integral aspect of the study for the purpose
of understanding the scenario of the included regions. Thus it may be stated that the essential
aspects associated with the study has been taken into consideration.
Can the benefits associated with the intervention mentioned in the study worth the harms and
costs?
This study focused on planning, policy formulation along with allocation of health and welfare
resources in regards to dementia care (Moreiran et al., 2014). In context to the above mentioned
interventions focused on the part of the researcher in this study has no particular harm associated
with it. However, if the policies and practices of the government is formulated effectively and
planned on the basis of the projections of the study, it would result in shift in allocation of
resources to the care services of the older people which would help in minimizing the prevalence
of dementia (O’Connor et al., 2007). Thus it will not be wrong to state that the intervention
specified in the study is cost effective.
On evaluating the study it may be observed that it comprised of certain strengths and limitation
Strengths Limitations
 Use of meta-analysis provides the
researcher with the scope of
considering the aspects of various
studies.
 Use of systematic review enhances the
 Lack of effective inclusion of evidence
base in various world regions
 Number of studies included having
poor quality
 Heterogeneity of prior estimates
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scope of consideration of high form of
evidence.
 Systematic review has also been
effective for the researcher considering
the topic of research, helps in
understanding the trend of dementia.
 Effective identification of research
gap.
between studies in different regions
 Quality of prevalent study raising scope
of bias.
Article 3- Systematic review of the effective components of psychosocial interventions
delivered by care home staff to people with dementia
Was the review successful in clearly focusing on a specific area of question?
The researcher clearly focused on 49 paper which emphasized on care services provided by care
home staff to individuals with dementia (Rapaport et al., 2017). In this research, the researcher
focused on psychosocial intervention as its major point of emphasis. Thus, it clearly establishes
the fact that the researcher was successful in giving a clear focus on the chosen area of research.
Has the researcher been successful in opting for the right types of paper?
On the part of the researcher, in this study focus has been given on the different aspects
associated with psychosocial intervention which result in enhanced outcome of the care users
with dementia like DCM intervention and its impact (Livingston et al., 2014). In this context if
the research question is analyzed it may be noticed that the researcher aimed at having an
understanding of the elements of psychosocial intervention which is associated with enhanced
outcomes of dementia patients. In addition to that the researcher, for the purpose of opting
quantitative studies which are high in quality emphasized on the fact that if the chosen paper
allocated its control groups through independent randomization (Bowen, 2009). Thus it reflected
the fact that researcher of this paper was success in choosing the right paper.
Is it worth continuing?
Has the researcher successfully included relevant studies?
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In this particular research, on the part of the researcher, electronic databases like EMBASE,
PsychINFO and MEDLINE has been used. In this regard, for the purpose of choosing quality
articles which is relevant to the topic of research operationalised checklists which was derived
from standard criteria has been used (Badia, 2011). On this basis it will not be wrong to state that
the researcher was successful in inclusion of relevant studies needed for successful completion of
the study.
On the part of the researcher, was there enough focus on evaluating the quality of the included
studies?
In this study no specification regarding the rigor of the research can be seen to have been
specified on the part of the researcher resulting in question the focus of the researcher in
examining the quality of the included studies.
Has the result of the reviews been combined and if it was reasonable to do so?
The result in this research can be seen to be combined with different other studies as well. It can
be clearly observed with the help of the fact that staff engagement was seen to be associated with
reduced aggressive behavior and agitation in different studies (Andrews et al., 2009). The
significance of on-site support for putting skills into practice was also observed to be common in
different studies. Thus it is due to this alignment with the findings from different studies which
resulted in incorporation of this information in this study.
What was the total outcome of the review?
The study provided with the outcome that psychosocial intervention can turn out to be effective
in enhancing the outcome of the residents and staff with dementia in care home. It establishes the
fact that the researcher has been effective in providing with a clear outcome of the research.
To what extent was the result of the study precise in nature?
The specification or preciseness of the information or data presented in the study is questionable.
It is due to the fact that the author has not provided with any information regarding confidence
intervals associated with the data that has been used in the study (Rapaport et al., 2017).
Is the result of the study applicable in the local population?
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The study focused on impact associated with implementation of psychosocial interventions
among care home staff, who provides with care services to dementia patients (Signe & Elmståhl,
2008). In case of local population as well local population seeks care services from care home
staff making the study applicable to local population as well.
Has the study considered all the important outcomes?
The study main focused on the opinions and perspectives of the staffs, care worker and
organization. However, it lacked any specification about the opinion or experience of the care
users with implementation of psychosocial intervention (Dewing, 2007).. Thus, the inclusion of
the experiences of the care users with implementation of psychosocial invention would have
resulted in consideration of all the essential aspects of the study.
Can the benefits associated with the intervention mentioned in the study worth the harms and
costs?
No significant harms are associated with psychosocial intervention. However, with the help of
implementation of psychosocial intervention the quality of life of the care users can be enhanced
along with minimizing the care cost associated with dementia by reducing the complexity of the
condition (Moniz-Cook et al., 2008). Thus the benefits associated with psycho-social
intervention can be stated to be cost effective.
Strengths Limitations
 Reviewing studies on examining wide
range of interventions with the help of
quantitative and qualitative method.
 Due to the heterogeneity of the research
method, meta-analyze quantitative data
was not possible.
 Exclusion of high quality of RCT,
reducing the scope of having insight to
the research question.
 The lack of consideration of the effects
of intervention on staff and residents
would result in creating issues in
understanding ways in which altering
staff practices effects care home
23 | P a g e

residents.
Conclusion
On the basis of review of the above chosen 3 articles it may be stated that, three articles
contributes to the knowledge of dementia. With the help of Article 1, the impact associated with
implementation of DECIDE manual in the decision making process of dementia patients may be
gained, similarly article 2 helps in understanding the prevalence rate of dementia globally and
associated impact of policies on the condition and with the help of article 3 the impact of
psychosocial intervention in care services of dementia patients can be perceived. Thus it will not
be wrong to state that the chosen 3 articles helps in gaining knowledge associated with dementia
care.
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References
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strategies to facilitate aged care staff engagement in evidence-based practice. International
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Badia, G. (2011). Statistical Measures Alone Cannot Determine Which Database (BNI, CINAHL,
MEDLINE, or EMBASE) Is the Most Useful for Searching Undergraduate Nursing
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Bowen, G. A. (2009). Document analysis as a qualitative research method. Qualitative research journal,
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Dewing, J. (2007). Participatory research: a method for process consent with persons who have
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and behavioural interventions for managing agitation in older adults with dementia. Health
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Livingston, G., Leavey, G., Manela, M., Livingston, D., Rait, G., Sampson, E., ... & Cooper, C. (2010).
Making decisions for people with dementia who lack capacity: qualitative study of family carers
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