Evidence Based Practice in Mental Healthcare: A Case Study of Alzheimer's Disease

This study focuses on evidence based practices (EBP) and its importance in mental healthcare, with a case study of Alzheimer's disease. Qualitative and quantitative evidence is analyzed to evaluate different intervention programs for the well-being and improvement of people suffering from dementia.

Running head: EVIDENCE BASED PRACTICE
Evidence based practice
Name of the student
University name
Author’s note

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Table of Contents
Introduction................................................................................................................................2
Background:...............................................................................................................................2
Qualitative evidence...................................................................................................................2
Quantitative evidence.................................................................................................................4
Evaluation..................................................................................................................................5
Conclusion..................................................................................................................................6
References..................................................................................................................................8

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Introduction
The current study focuses upon the aspect of evidence based practices (EBP) and its
importance in mental healthcare. The evidence base nursing care and practices have been
seen to improve the quality of nursing care. The EBP covers recent advancements in clinical
epidemiology, information science and biostatistics to produce a comprehensive approach
based upon which health and support care services are delivered by the physicians. Some
of the evidence based methods which find special applications in nursing care are
randomized control trials, cross sectional studies having the disorder. Thus, Evidence based
medicine, can be defined as the utilising the best possible remedy to take care of the patient.
(Sackett et al.1996). Organizations such as NICE and department of health are incorporating
the evidence based practice strategies in order to dispense better care to the patients. NICE
guidelines help the patients in getting quality care at a very pocket friendly and cost-effective
economic rate.
Background:
The current study focuses upon Leonora who is a 90 years old widow diagnosed with
Alzheimer’s disease. She is retired primary school teacher and had lived an active life.
Before her retirement she had kept herself mentally alert by reading actively and solving
puzzles and crosswords. However, recently the patient had been hit with Alzheimer’s which
reduced her concentration levels and led to muddled thinking. The care supporters would
often find the patient rhythmically tapping the side of her chair and murmuring to herself. The
carers thought that the patient might be suffering from auditory hallucinations and required
antipsychotic medications to calm her down. On the other hand, some group of carers were
of the opinion that the instead of anti-psychotic medications, non-pharmacological
interventions should have been provided to the patient. The condition of the patient has
been accessed through various evidence based qualitative and quantitative literatures.
Qualitative evidence
The qualitative research is a process of naturalistic inquiry which seeks in-depth
understanding of special phenomena in natural setting. It focuses on ‘why’ instead of ‘what’
and relies on the direct experiences of human beings. In this respect , evidence have been
gathered by the researcher from qualitative journal articles which focuses upon advanced
care planning (ACP) to improve end of life care in dementia patients. One of the main
issues which have been faced by the caregivers over here is that in patients suffering from
dementia; the decision making and communication capabilities gradually decreases as the

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disease progresses (Prince et al. 2016). This further makes the delivery of adequate care
services difficult. The disease may span over a long period of time making choosing of the
right time to discuss advanced care planning for dementia difficult. For the purpose of the
study, interviews were conducted with 12 patients and 8 care givers who had participated in
advanced care planning decision making. It was found from interview that majority of the
participants agreed that the advanced care planning served as a positive intervention which
helped them plan regarding the future (Clague et al. 2016). From further discussion it was
found that the advanced care planning could help in reducing the future anxieties within the
patients. The present piece of evidence could be linked with the case study of Leonora, who
is a 90 years old lady suffering from Alzheimer’s and needed immediate support care. As
mentioned by Poppe et al. (2013), involvement of the patient in the advance care planning
process could help in reducing the chances of any forms of dispute , which could arise in
the process of care delivery. Additionally, the ACP process helps in implementing a patient
centred approach (Ae-Ngibise et al. 2015). The ACP is in line with the policy of informed
decision making which provides the patient with sufficient opportunity to participate in their
care planning process and understand the treatment better. This is because at any stage of
the treatment process if the patient feels that they would not like to undergo the aggressive
treatment method they could decline it.
The evidence have been gathered from secondary databases such pubmed, goggle
scholar etc. the articles have been found applying strict filters such as extensive keywords
have been used for finding out the exact articles such as Alzheimer’s care, nursing
interventions in Alzheimer’s, qualitative review of Alzheimer’s care. Additionally, strict filters
have been applied such as articles which have been published prior to 2000 have been
excluded. The articles which have been published in regional language and generated as a
result of the search history have been excluded.
Though, advance care planning have been approved widely as an effective nursing
care plan for Alzheimer’s there a number of limitations are attached with it (Cummings et al.
2015). For example, it becomes difficult for the mental healthcare provider to determine at
which stage the patient is competent enough to discuss the care plan. This is because the
cognition and decision making skills are sufficiently challenged in a patient suffering from
progressive Alzheimer’s (Stokes 2017).
In order to provide the patient with alternative and non-pharmacological intervention
music therapy was considered over here as the patient Leonara had been found to
possess an inclination towards music. The patient had enjoyed playing piano in the past and
would often hum to herself in the absence of anyone. Hence, musical therapy was

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considered as an alternative therapy to pacify the patient. Music had been seen to increase
memory, engagement and improve social behaviour within a patient suffering from dementia
(Sherratt et al. 2014). This had been further evaluated through different study methods,
where 19 studies have employed direct observational methods such as momentary time
sampling (MTS) where the observer noticed that whether or not behaviour is occurring
exactly at the end of a specified time period. However as argued by Sherratt et al. (2014),
the true extent of discrete episodes of agitated behaviour within the patient may be
underrepresented.
For the current study, the researcher had used a number of secondary databases for
gathering of the related articles and journals. Some of the databases which have been used
by the researcher over here are Google scholar and pubmed etc. Google Scholar has been
used in order to access the scientific studies on evidence based practice in view of the
modern scenario. The references used for the study incorporates the year from 2013-2017,
in order to incorporate the latest studies that have been carried out in this field and ignore
the previous references as in the modern context, references older than 2013 are
considered to be obsolete. For finding out the relevant journals strict filtering have been
applied by the researcher such as use of effective keywords for zeroing in the right articles.
Some of the keywords which have been used over here are Alzheimer’s care, musical
interventions for dementia, and quantitative Alzheimer’s research. Additionally, strict filters
have been applied such as articles which have been published prior to 2008 have been
excluded. Moreover, only the articles which have been published in English have been
taken into consideration. The use of qualitative methodology and the views expressed are
accurate presentations of the carers, patients and staffs interviewed. The limitations which
are faced over here are the small sample size, which often affects the end quality of the
results (Ries et al. 2015). This is because the small sample size has often been associated
with confounding biases.
Quantitative evidence
The quantitative research is a structured way of collecting and analysing data which
are obtained from different sources. The researcher will use quantitative research over here
for relating to the case study provided. It uses computational tools to arrive at statistically
significant results. As mentioned by Couët et al. (2015), quantitative research provides a
structured cause and effect relationship between problem and factors. The Alzheimer’s
disease further adds considerably to the health burden of the population. As suggested by
Rabbitt et al. (2015), informal caregivers i.e. particularly the family members of a patient
play a considerable role in providing care and support in Alzheimer’s care and treatment

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process. The caregiver burden could be defined as the perception of the caregiver regarding
the physical, emotional, social and economic cost of the care giving relationship. Increased
burden on caregivers have been associated with increased hospitalization risk of the patient
along with staff burnout, ill health and absenteeism (Reed et al. 2014).
Some of the factors which resulted in burden within the adult children were living with
the patient, located at distance from the care service areas and patient with fall history;
whereas the factors which resulted in burden within the spousal carers were age and gender
of the caregiver along with the patient, level of attachment they felt for the patient and the
years of patient education (Beck et al. 2017). The factors which resulted in high care burden
in the support carers varied depending upon the level of knowledge or expertise of the
caregiver along with level of attachment with the patient (Chen et al. 2018).However, as
argued by Hanson et al. (2016), the care burden is subjective and could result from diverse
causes which affect each individual differently.
Evaluation
The evaluation focuses upon the different methods of nursing care delivery and its
effectiveness. For the current research, both qualitative and quantitative journal articles were
taken into consideration. The role of the evaluator is to analyse different prices of literature
and provide a comprehensive overview regarding the presented problem. The quantitative
articles focused upon the process of advanced care planning for a person suffering from
dementia (Poppe et al. 2013). The researcher here highlighted the various strengths and
limitations associated with the advanced care planning. The researcher truly referred that
the specific care planning discussed over here could relieve the anxiety in the patient
regarding future (Poppe et al. 2013). At the same time, it could empower the patient by
helping them choose their care procedures.
The second piece of literature analysed discussed regarding the amount of care
burden presented over specific target segment of the population. It was found that different
factors affected each target segment of the population differently. The researcher had rightly
presented the problems associated with extensive care giving practices such as burn out
due to excess work pressure presented over the care support population (Reed et al 2014).
However as argued by Stokes et al. (2017), there is a lack of effective intervention methods
which could reduce the rate of care burden within the support providers. Some of the
strengths associated with the study pattern over here were the large size of the sample of
the quantitative study design. Secondly the qualitative methodology used guaranteed the
appropriateness of the results through the use of open-ended questionnaire. The limitations

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faced in this regard were that the selected sample did not represent the broad spectrum
population, which could result in confounding biasness in the presented results.
In the third piece of literature, the researcher had analysed the impact of music
therapy in reducing the stress owing to dementia within the patient. As mentioned by
Pedersen et al. (2017), agitation had been directly related with dementia which reduces
positive social interaction and increases psychological burden. Group musical interactions
provide an opportunity for communication and social interaction which could shift the
attention of the patient away from emotional and environmental stress. As suggested by
Pedersen et al. (2017), musical intervention can help in interaction with the environment.
However, lack of sufficient evidences directs towards future research.
The current study focused upon different intervention programs, which could be
implemented for the well being and improvement in condition of people suffering from
dementia. Here the patient was suffering from Alzheimer’s and would occasionally sing or
murmur to herself. Though, musical interventions could be considered as an alternative
intervention strategy for the treatment of mental health problem in patient, there are
limitations. This is because Alzheimer’s causes progressive denegation of the nerves, which
could incapacitate the patients in the long run by affecting their thinking and decision making
abilities. Therefore, enriching opportunities for people with dementia could promote their
overall well being by reducing the levels of depression or anxiety. As mentioned by Brooker
et al. (2007), the enriched opportunities programmes aimed at possessing expertise to work
with vulnerable people and staff team to ensure that the residents reach their potential for
well being. It included some of the aspects such as individual assessment and case study
which could help in understanding the condition of patient Leonora. As suggested by
Brooker et al. (2007), the programme aimed toward optimal staff training through effective
leadership styles. Some of the important highlights of the enriched opportunities programme
are:-
 Improve levels of engagement in activities
 Improve the level of well-being
 Improve the quality of life
 Improve care quality
 Reduce the levels of depression and anxiety within the patient
 Control or reduce the use of psychotropic drugs
 Reduction in the number of hospital inpatient days

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The enriched opportunities program implementation could help in enhancing the
autonomy of service users like Leonora by making her less dependent on medication and
giving her sufficient opportunity to self manage her condition at the same time have the
freedom for decision making. As suggested by Brooker et al. (2007), the implementation of
the program could reduce the number of hospital inpatient days by making the patient more
willing and responsive towards their treatment procedures.
Conclusion
For the current research the different types of research evidence has been taken into
consideration such as qualitative research evidences and quantitative research evidences.
These have been further linked with the case study to understand the advantages provided
by them in nursing care and management. Past studies have suggested that the clinicians
fail to access the reliable and bias free resources which lead to a gap between research and
clinical practice. Therefore, evidence based studies helps to cope up with the research gaps
and help in the development of quality care practices. From the studies, it was found that
musical interventions based upon the preferences of the patient were seen to reduced
agitations and frustrating behaviours within an individual (Winblad et al. 2016). Hence, it
could be implied as evidence based method for dementia care.

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