Experience of Nurses and Care Workers with Challenging Behaviour of Dementia Patients

This dissertation explores the experience of nurses and care workers dealing with challenging behaviour of dementia patients. It discusses the prevalence and projection of dementia in the UK, impact on nurses and care workers, and strategies to minimize challenges faced by them. The PICO framework is used to identify the population, intervention, comparison, and outcome.

Dissertation & Ph.D.
Thesis

Table of Contents
TITLE..............................................................................................................................................4
CHAPTER 1: INTRODUCTION AND BACKGROUND (1500).................................................5
Introduction............................................................................................................................5
Experience of nurse and care worker with dementia people..................................................5
Prevalence and projection.......................................................................................................6
Impact on nurse and care worker experience due to challenging behaviour of dementia people
................................................................................................................................................6
Strategies to prevent challenge faced by nurses and care worker while dealing with dementia
people.....................................................................................................................................7
Rationale of the research........................................................................................................7
PICO framework....................................................................................................................8
CHAPTER 2: LITERATURE REVIEW (4000).............................................................................8
Overview of dementia............................................................................................................8
Role of nurses and care workers while dealing with people with dementia........................10
Challenges of the nurses and care workers dealing with challenging behaviour of people with
dementia...............................................................................................................................13
Ways and strategies to minimize the nurses and care worker experience while dealing with the
challenging behaviour of people with dementia...................................................................15
CHAPTER 3: METHODOLOGY (1000).....................................................................................18
CHAPTER 4: METHODS (3000).................................................................................................21
Research aim........................................................................................................................21
Research objective................................................................................................................21
Research questions...............................................................................................................22
Research hypothesis.............................................................................................................22
Eligibility criteria..................................................................................................................22
Search strategy......................................................................................................................24
Study selection process.........................................................................................................25
Quality appraisal of included studies...................................................................................25
Risk of bias assessment........................................................................................................26

Data extraction and synthesis...............................................................................................26
CHAPTER 5: RESULTS (2000)...................................................................................................28
Description of the studies.....................................................................................................28
Risk of bias in included studies............................................................................................29
Risk of bias in review process..............................................................................................30
Effect of intervention............................................................................................................31
CHAPTER 6: DISCUSSION (2500).............................................................................................32
Summary of main results......................................................................................................32
Certainty of evidence............................................................................................................33
Potential bias in the review process......................................................................................34
Agreement and disagreement with other studies..................................................................35
Generalisability.....................................................................................................................36
CHAPTER 7: CONCLUSION AND RECOMMENDATION (1000)..........................................36
Implication of practice..........................................................................................................36
Implication for research........................................................................................................37
REFERENCES..............................................................................................................................39
APPENDICES...............................................................................................................................49
Appendix A: Ethical approval..............................................................................................49
Appendix B: Missing data....................................................................................................51
Appendix C: CASP table......................................................................................................52
Appendix D: PRISMA chart................................................................................................53

TITLE
"Nurses' and care workers' experience while dealing with challenging behaviour of people with
dementia."

CHAPTER 1: INTRODUCTION AND BACKGROUND (1500)
Introduction
Dementia is defined as the loss of function related to the cognitive aspect that includes
thinking, remembering, and reasoning. Moreover, it helps to show the interference with the
person related to the person's daily activity. In addition, some people with dementia usually do
not control their emotions and the personalities that may change. The range of dementia is based
on the severity from the mildest stage when they are started to affect the person, which may
affect the person's functioning based on various severe stages. Most of the people 850,000 in the
United Kingdom face the issue of dementia and live at home with their families (Amador et al.,
2018). More often, they are facing various difficulties which are related to dementia means
nurses are usually laid a vital role in supporting and providing care. They also face multiple
challenges due to the behaviour of dementia people. At the same time, the nurses used to focus
on all settings, which is relatively managing the patient who is usually coexisting health issue
and used to assist with the personal care. In addition to this, most people live with dementia
independently and require minimum support and maintenance. Whereas, the nurse and care
worker experience various challenges when dealing with dementia people in some regions while
performing them regular activities and many more related to basic life things (Bolt et. al., 2019).
Experience of nurse and care worker with dementia people
In addition, the care worker also shares their experience when dealing with people facing the
issue of dementia. Moreover, caring for the person dealing with the advanced stage of dementia
can evoke various emotions. While taking the context of example for the clear understanding, it
can usually feel unrewarding and upsetting to look after the people who appear and live in
another world for all intent and purpose. It is a duty to provide support and care to people with
dementia. The need and requirements are used to undertake, and also care workers assist them in
eating, washing, and dressing to support the person with such activity. In addition to this, the role
is challenging, which can often help lead both family and professional care workers to become in
the position of burnout (Bourbonnais et. al., 2020).
The nurse and the care worker experience may be worst sometime due the improper
behaviour form the patient with dementia. In addition, the patient used to create challenge for the
nurse and care worker when they are providing support and care. It may have related with the

diagnosis, treatment or the intake of medication as per the schedule time that associated with the
dementia patient. They mostly refuse to take the treatment and diagnosis for the longer period. It
is act as a task for the nurses and care worker to deal and manage the patient and get them ready
for the diagnosis and treatment. The patient become aggressive and used to perform such
activities that harm the nurse or care worker on the physical level is also a challenge. These all
are experience which is related with the nurses and care worker (Jensen et. al., 2019).
Prevalence and projection
The study is based on the care worker and nurse experience which is usually focus on the
aspect that focus on the number of delivery of care that provided to dementia people. With this
contrast, the study is usually focus on the aspect that provide the data and information which is
relevant to challenge that faced by care worker while dealing with dementia people. The total
population is usually help to provide the prevalence which is among the 65s is approx. 7.1
percent which is based on the year of population data 2013 in the UK. Therefore, it is usually
equal one in the every 79 of 1.3 percent of the entire population in the UK, moreover, the entire
UK population and the 1 in every 14 of the population ages in the 65 years and over. The
projection of the arising cases is more than 20 percent with the above age group of 50 to 65
years. In addition, the dementia people have wider range of concept which provide diversity of
challenge with the patient with dementia (Brazil et. al., 2018).
Impact on nurse and care worker experience due to challenging behaviour of dementia people
Major challenges: In this, the major challenge which is faced by nurse and care worker on
the separate way are, the dementia people usually refuse to take proper medication and diagnosis
that render the delivery of services. In addition, due to the poor communication and interaction
with dementia patient, they used to create issue while convince them for the activities and
interventional care plan. the other major challenge of the nurses and care worker usually face
issue when the same diagnosis or therapy used to provide with the person with dementia on the
repetitive way that they are agitated and angry which may create major challenge with nurses to
deal with such circumstance. The other associated issue is problematic behaviour that include
angry, abusive tendency of the patient and lack of focus that also act as a barrier in the delivery
of support and care to the dementia patient (Haugland, & Reime, 2018).
Impact on nurses: The nurses usually face issue due to the behaviour which is problematic
as per the vision of people with dementia. They suffer violence and continuous stress due to

behaviour of the dementia people which is abusive and full violence generate stress and
frustration among the nurses and care worker. The wellbeing and resilience are completely
render due to the offensive and non-societal behaviour without any cooperation in the care and
support. Therefore, it creates impact on the health of nurses and care worker with reference to
patient with dementia (Jennings et. al., 2018).
Strategies to prevent challenge faced by nurses and care worker while dealing with dementia
people
There are several of strategies which is followed under as an intervention to reduce the
complication and consequence that associated with the challenging behaviour of dementia
people. The majority of the ways to deal with such challenge which may arise while dealing with
dementia people with the creation of relationship bond with appropriate communication and
interaction with patient. In addition, the nurses and care worker used to follow various aspect in
such a way which create bond with the help to communication and interaction and they lead the
relationship as a friend and so on. Therefore, it reduce the chance of unnecessary problematic
behaviour of dementia towards the nurse and the patient who used to provide support and care all
the time. The other interventional scenario is use of polite manner, take care action plan and
create understanding which is based on emotional and cognitive level (Manthorpe et. al., 2018).
Rationale of the research
The rationale of the research is a valuable aspect that provides some of the signs related to
the topic that includes core aspects for professional and personal development. The issue is
usually associated with studying the experience of nurses and care workers with dementia.
Personal development allows people to gain some of the core knowledge associated with the
term and factor of dementia and people's experience, especially nurses and care workers. The
incident by nurses or the care worker helps build adequate knowledge while practising and
dealing with them as per professional needs. In addition, it helps to provide quality based support
and knowledge for the professional level for the profession. In addition to this, the personal
development is also included when the experience is used to underlying which is related with the
dementia people. therefore, the people with the extended factor about personal development and
growth (McDonald, Lolich, Timonen, & Warters, 2019).

PICO framework
Population/ problem Nurses and care worker that they face issue with the behaviour of
dementia people. In addition, the issue is problematic behaviour of the
dementia people with the major of time due the short term memory and
enhanced level of illness.
Intervention Use right approach of communication and interaction that develop bond
of friend and many more.
Comparison Polite and effective way to create understanding among the dementia
people based on the emotional level.
Outcome Provide quality of life for the patient with dementia. In addition, the
nurse and care worker feel relaxed and make right care plan to provide
support and care.
CHAPTER 2: LITERATURE REVIEW (4000)
Overview of dementia
Dementia is defined as the loss of cognitive functioning, thinking, remembering and the aspect
of loss of memories which is related with the function. In addition, in such extent that they
critically interfere the person daily routine which is related with the end of life and with this,
such activities are usually restricted due to the dysfunction of brain. Usually, it is defined as the
thinking which is based on the group and social symptoms which usually render the daily
functioning and personalities. Therefore, some people with the core context of dementia that
cannot control their emotions and their personalities which is showing some of the fraction
which is change accordingly (Leocadie, Roy & Rothan-Tondeur, 2018). As per this, some of the
common warning sign which is related with the dementia are:
 Memory loss which may affect the day-to-day abilities.
 Difficulty in such a way which affect in performing the familiar task.
 In addition, they also create the issue which is related with the language.
 Therefore, the people with the dementia also facing the issue which is related with the
aspect of disorientation associated with the time and space.

 Moreover, it also used to show some of the context that is related with the impaired
judgement.
 Problem with making and abstracting the thinking which is be related with study that is
related with the dementia.
 In this, they are also showing the proper aspect with the misplacing of things.
While taking the contrast of pathophysiology of the dementia which is not completely
understood. In addition, there are most of the dementia, except the vascular dementia are usually
caused due to the accumulation of native protein which is based on the function of brain.
Usually, the disease is characterised by the widespread atrophy of the cortex and the deposition
of amyloid plaques and tangle which is based on the hyper phosphorylated tau protein in the
neuron which useful in the contribution of degeneration. The Lewy protein in the context with
dementia is with intracellular accumulation that associated with the Lewy bodies which is
insoluble with the aggregation of the alpha synuclein which is associated with the neurons that
found in the cortex. In addition, the frontotemporal dementia which is usually characterised by
the disposition of the ubiquitinated TDP 43 and hyperphosphorylated tau protein in the frontal
and the temporal lobes which is leading to the dementia, that is showing the context of early
personality and behavioural change and aphasia. In addition, the vascular dementia is usually
caused by the ischemic injury to the brain which is majorly include stokes that is leading to the
permanent death of neuronal death (Watt et. al., 2019).
In addition to this, there are prescribed medication which is provided to the individual
who is facing the issue of dementia. It includes Donepezil with the tradename of Aricept that is
show their mechanistic property related with the cholinesterase inhibitor which is most
commonly associated with disease of dementia. In this, the people used to approve in order to
treat the all stage of disease. Rivastigmine with the tradename of Exelon is usually approved for
the mid to moderate cases of dementia as well as they also associated with the other disease
which mainly include Alzheimer and Parkinson disease. As per the current research on the
dementia used to state about the brain disorder which is known as LATE. It is also help to show
some of the moderate and similar symptoms that related with the disease but they are appear by
the building up of the toxin protein that named as TDP-43 (Watt et. al., 2019).

Role of nurses and care workers while dealing with people with dementia
There are several patients of patients who used to face the situation of dementia. In
addition, the number of dementia people worldwide was approximate 24 million in 2001, with
the expected to double every 20 years. Moreover, the number of patients with dementia is
growing continuously, showing the impact in the prevalence of dementia among the older adults
that more than 65 years was 7.5 percent, showing approximately 1.90 billion people dealing with
such condition. Many patients with the issue of dementia are admitted to the long-term care
factor or the facilities or psychiatric wards. Nurses in acute care healthcare settings offer
elements that cannot provide adequate care that meets patients with dementia. Moreover,
dementia is usually measurable, showing the aspect or importance of nursing support. Regarding
outcome, 65 percent of the dementia inpatients usually offer the element based on the psychiatric
wards, and it is also estimated that 25 percent of recuperation facilities. Therefore, the nurse in
the acute care hospital had few opportunities to care for patients with dementia until recently. In
addition, they are usually associated with the study of issues and difficulties in caring for patients
with dementia (Monthaisong, 2018).
It is essential to recognize dementia, and after that, the nurse creates a care plan according
to it. The vital aspect related to the nurse's role is to analyse and observe the patient's report with
any sign and symptom of underlying dementia. Therefore, the early diagnosis of dementia is
helpful to provide the lead in a better way that promotes a safe environment with the help of
nurses. In addition, the nurse used to provide better treatment options that create effective
decisions for the study of ways recommended by the nurse as their role to provide compliance
and a safe environment. The advanced decision-making towards the condition is currently
underdiagnosed. In addition, the assessment process and procedure that is more complicated
because of the various complex factor. It includes the behavior of being unfamiliar environment,
having a high temperature, or constipation, which can create a state of delirium and depression
with overlapping symptoms that are entirely misinterpreted. In such a condition that shows
significance, the patient is withdrawn, anxious, seems lonely, and has no appetite, which is
agitated and repetitively asks the same question. However, the sign could indicate delirium or
depression and the issue of dementia. It also creates possibilities that have more than one
situation concurrently (Nowak et. al., 2018).

In addition to this, there is a wide range of duties that nurses perform for dementia people.
This include:
Relationship, knowledge base, and medication concordance: At the current time, there is
no present cure for dementia. As per the studies, some of the medication licensed in the UK may
show slow progress. Moreover, it is also part of the nurse's role to elaborate medication together
with their side effects and adverse effects on the patient and their family members. There is
always a clear explanation that the nurse circulates with the aid of decision-making, which has
the basis of informed consent. In addition, the nurse always knew the find further information.
For example, it helps to show the British National formulary online and provides aspects to
direct the people to gain more knowledge and support. Therefore, it is crucial to be familiar with
the online source. They should also know about the local guideline that is helpful to provide
information access by authorized people.
To create an understanding regarding the medicine work that is extremely useful, mainly
showing some of the responses to the patient or the family member question. The medicine
usually works by preventing the breakdown of the neurotransmitter acetylcholine required for the
function related to the toxic level of glutamate, which usually damages the brain's cells and
disturbs the operation of the brain. The cholinesterase inhibitor is mainly used in dementia,
including donepezil, galantamine, and more. People with dementia usually take medicine due to
short-term memory, which indicates that they forget things after a short period, which may be
events, factors, or so on. Asking to see to the patient medicine usually helps the nurse gauge
which is adequately taken them. In addition, it may also be helpful to ask the patient how they
are coping with their medicine and recommend that they consider the aspect of the dosage
system. However, there are various tablets left in the packet when compared with the date of the
prescription. They majorly include blister packs arranged by their local pharmacy shop and
require assistive technology devices which help the family member (Pennbrant, Hjorton, Nilsson,
& Karlsson, 2020).
In addition, people with diabetes who used to take care of their condition effectively for
years may find doing so more difficult, which helps formulate memory related to dementia. They
also show various aspects that forget to eat properly or take the medication in the routinize which
is made for the proper therapeutic effect. Therefore, they usually fail to eat and do their regular

activities, whereas; they also do not recognize the sign of hypoglycaemia or communicate their
needs effectively (Brims and Oliver, 2019).
Provide personal care: In this, the number of people does not recommend to exposed in
front of a stranger, so the people who used to face the issue of dementia usually ask to do this
when they need help with their personal care. In addition, this can be made with the various
aspects associated with the approach and help ensure the patient. It is essential to understand the
excellent example, which includes hairdressing, brushing, and wearing favourite clothes
(Behaviours that challenge when supporting a person with dementia, 2019). It is also essential
that the staff or the other member are allocated to become more familiar to the patient and
appreciate their personal care preference (Prato et. al., 2019).
Care and communication skills: It is essential to develop a therapeutic relationship
associated with the patients, which is related to the high quality of nursing care. Moreover, they
are communicated in a friendly way and show appreciation of the patients based on individuality
and recognising their strength, which can help others feel included and valued. In addition to
this, some simple adjustments can help improve communication and proper interaction with the
patient facing the short-term memory issue. It includes:
 Using short and simple sentences.
 Using such a word which is familiar vocabulary.
 Using polite and warm tones.
 Smiling during warm tone.
 Try to smile while making conversation with the dementia patient.
In addition, care workers also play a role in supporting and providing care to the number of
people who usually face the issue of dementia. Several people who lived their lives with
dementia require support where the care worker used to provide aid effectively. The support and
care which may need to organize produced through NHS and the adult for the social service
show the department of the local council. In addition, the service is used provided by charities is
also essential. The care worker used to help the dementia people in several ways, including carer
are used to help with the washing and dressing of the people dealing with dementia (Spreadbury
& Kipps, 2018).
Moreover, they also provide laundry service to dementia people and meals on the wheel that
also act as beneficial aspects for the development of quality service related to dementia people.

In addition, aids and the adaptation and access today centre also generate quality role from the
care worker to support the people with dementia. Therefore, the national health service also acts
as a helping hand for dementia people by providing treatment which includes physiotherapy,
hearing care which is known as audiology, eye tests called optometry; foot care is well known as
podiatry, the speech, and language therapy is also provided by NHS in order to provide support
and care to the people. All this is well monitored and handed with the care worker. The
appropriate permission from the older people mental health team is also reviewed within this.
Challenges of the nurses and care workers dealing with challenging behaviour of people with
dementia
People with dementia face various issues and challenges to impact the service delivery of nurses
and care workers both. The nurses used to meet some of the challenges associated with dementia
people. In addition, the nurse and care worker used to fulfil the need of people with dementia and
due to the various issue they create unwanted challenge for the nurse and care worker (Vassbø et.
al., 2019). It includes:
When the dementia patient refuses to accept their diagnosis: It is very difficult for the nurses
and the patient if they usually receive a diagnosis but do not acknowledge their importance.
Moreover, it may affect the patient and enhance the risk of memory loss, issues, or other
dynamic changes to their behavior. Most commonly, they change the subject if they try to
mention their situation and condition.
Overstress due to caring: Regular care for people with dementia and their behavior may stress
the nurses. In addition, due to the short-term memory, people with dementia do not remember the
thing or the events for a more extended period which may create an issue of the nurse revising
the same thing and again that lead to cause stress and frustration. In this situation, the nurse must
take a break when dealing with people with dementia for a long time. Moreover, the nurses who
usually care for someone with dementia will need to rest for their own health-related mental and
physical health. It is a valuable aspect to develop and formulate wellbeing and resilience among
nurses when they take a break. In this, try to look themselves and provide some of the
replacement care that enables care with dementia people (What is the effectiveness of the support
worker role for people with dementia and their carers? A systematic review, 2016).
The person's behavior changes: While providing care to people with dementia faces some of the
problematic aspects that started with the change in behavior in ways that include various factors.

It may be challenging for the person with such a condition and focus on the person caring for
them. Multiple methods are helpful to manage such situations. It is done by using proper
communication and interaction with the patient to know the issue or their cause and promise to
fulfill and resolve the issue (Wolff-Baker & Ordona, 2019).
Aggressive behavior of dementia people: It is complicated to face such a situation. People with
dementia show aggressive behavior from the person with dementia taking care of the patient. In
addition to this, it isn't easy to manage to see things from the person, which shows the person's
standpoint. Usually, the aggressive behavior that helps communicate the critical message usually
meets the person's need and usually prevents the condition that is happening again and again.
Issue related to the use of the toilet: In addition, people with dementia may experience
difficulties with their continence for various reasons. These issues are usually associated with
producing strong feelings in the person, including embarrassment and anxiety. In contrast, they
are using such a complex activity related to the specific problem that can be addressed through
the understanding associated with the difficulties faced by an individual on the various level
(Dementia 4: the nurse's role in caring for people with dementia, 2016).
Problematic patient behaviour: The nurses experienced issue while provide care to patients with
dementia such as fear, anxiety and frustration due to problematic behaviour of patient that
include crying, wandering, biting, throwing objects, repetitive talking and other complex
behaviour that is agitation, anger, and physical attacks. It creates challenge for the nurses to deal
and provide proper care and support to dementia people.
The strange hospital surroundings: The various situation arises due to the changes that leads to
create anxiety in the patients because they are not familiar with some of the face at the hospitals.
The various type of physical limitation originates issues in the patient such as feeling and
wandering in the absence of patient family member. This situation create issue with the aspect of
nurses for providing appropriate support and care.
During the treatment, patient get angry and abusive: The reason of getting angry and abusive
because patient feel unsafe and insecure in the absence of their family member and due to the
repetitive treatment. The nurses require help from the patient families to deal with aggressive and
abusive behaviour of patient and unsanitary activity. Nurses do not have adequate knowledge
about dietary routine of patient. It leads challenges for a nurses in the care of dementia patient.

The problems attendant to patients with insanity: The issue in the handling of patient with
dementia, nurses faced problem such as when a patient becomes angry and shows harmful act at
any time. Due to such kind of behaviour the nurses are not able to provide care to other patients.
It is challenging for a nurse during the care of dementia patients (Deardorff, & Grossberg, 2019).
The lack of cooperation and communication: The lack of cooperation and communication
between psychiatrists, nurses and security staff create problematic situation because the
healthcare setting is not systematic and deficient to meet the requirements of the patients with
dementia. The lack of effective inter-professional bonds magnifies the risk of ambiguous
miscommunication and can compromise patient care and patient safety. The ineffective
communication leads to the patient dissatisfaction, misdiagnosis, delayed treatment and
medication errors. Due to the lack of fulfilment of the basic needs of the patient get agitated and
angry that create challenge for the nurse (Larnyo et. al., 2022).
Lack of protection plans for the nurses: Due to the regular violence in the dementia care unit
with reference to abusive and aggressive behaviour of people with dementia. The healthcare
setting require protection plan and equipment to restrict such event. The lack of protection plan
for the nursing work can damage the health both acutely and in the long term. These health
outcomes include musculoskeletal injuries disorders, infections, changes in mental health in the
longer term, it is very challenging for the nurses in the care of dementia patients. The work
related stress with dementia patients, sometime create conflicts with their families is challenging
aspect for the nurses (Haugland & Reime, 2018).
Ways and strategies to minimize the nurses and care worker experience while dealing with the
challenging behaviour of people with dementia
The challenging behaviour of the people with the dementia may cause the issue with the
support and care which is provided by the nurse and care worker. In addition, the nurse and the
care worker used to provide support and care to dementia people and with this, they face issue
regards with behaviour which create difficulties. Therefore, there are some of the simple ways
which is effective for the short term to handle the behaviour of dementia while providing care
and support. Whereas, the dementia is defined as the devastating diagnosis. The characteristic
issue which is related with the memory, thinking and the language are usually the major aspect
of challenge that is faced by nurse and care worker. In this, there are also behavioural and
psychological symptoms which is related with the dementia. It includes agitation, aggression,

wandering and many more. these symptoms are usually very upsetting for the people with the
care of dementia as well as their loved one which is help to show some of the reason towards the
people who are usually admitted for the long term care (Cheng et. al., 2019).
Due to such behaviour, the healthcare professional also used to recommend and provide
proper medication that is related with the antipsychotic, antidepressant and anti-anxiety and
many more which is useful drug in order to help calm the patient but there are some of the issue
which is related with drug use that include side effect which lead to cause the serious health
issue. However, there are some of the evidence which is well recommended that they have their
own shift in the such a way which help to manage the challenging symptoms of dementia that
value non drug approach which help to calm and reassure with the first treatment of step (Soong
et. al., 2020).
Person centred care: While taking the contrast of the patient with dementia, the approach
which is involve with the individualised person centred model of the care which show the aspect
of person background, likes and dislikes, values, culture and abilities which is usually taken into
the account in order to develop the communication and care strategies which encourage the
positive responses and interaction. It is helpful term when it is applying on the people with
dementia because the proper care and support is useful aspect in order to promote the quality of
health and quality of life with the patients (Bessey & Walaszek, 2019).
Sensory stimulation: In this, there are various type of sensory stimulation which is usually
known as hand massage that can help in order to improve the behaviour and wellbeing that is
associated with the people with the aspect of dementia (Haugland, and Reime, 2018).
Music to soothe and relax: Many people are used to enjoy the aspect of uplifting and
relaxing which is based on the qualities of music. The relaxing music is also an intervention
which is taken in order to promote the cooperation which is associated with the meal time.
Listening to the music of their choice that receive one to one personal care that is bathing. It may
also use to improve the behaviour among the people with the dementia used to more resistant in
order to care (Bolt and et. al., 2019). In addition, they are used to receive five and more session
in order to involve with the music based therapy which act as a strategy which is possibly useful
in order to reduce the complication that is related with the sign and symptoms of depression and
help to improve the overall behavioural approach as an issue among the people with the aspect of
dementia who is related with the long term of care setting. Therefore, the other drug free

intervention is usually studied in order to create impact on agitation among the nursing home
which include resident that focus on the bright light therapy, doll therapy, pet therapy and
aromatherapy. In addition to this, the appropriate consideration which is related with enhance
rate of dementia which is used to make the toll it takes towards the individual families, caregiver
and the health care system. It is also an aspect which is not surprising which show the expert that
is relayed with the intent to explore and test the new intervention for the dementia people and
also for the reduction of challenge that is faced by the nurse and the care giver usually in the
department. So, the accurate treatment or the new intervention usually play vital role in the
healthy outcome of the patient with complication of dementia which is drive with the help of
new treatment and therapies (Nguyen and et. al., 2021).
In order to provide proper assistance with the aspect or the vision from the caregiver is that
they are assisted with help of various aspect. There are some of the assistive approaches which is
taken by caregiver for the dementia people is usually include:
 Always stay calm and do not confront the challenge which is related with the individual
and this can useful to create feeling which is more distress and promote wellbeing.
 Communicate clearly and also listen their though and motivate them for the that they are
thinking that indirectly create the vision which is healthy in term of communication when
taking the aspect with the people with the dementia (Kwame and et. al., 2021).
 In this, they are usually show the listening skill which is important to determine the issue
which is at hand. Moreover, it is quite crucial when they are taking into the vital aspect of
people to resolve their issue in the appropriate ways (Timmins and et. al., 2022).
 In addition, they used to determine and rectify the issue in the term of environment which
is comfortable that develop resilience and wellness when they are taking into the account
with people of dementia (Walsh and et. al., 2018).
 Moreover, it is also analysing that the people are used to try to remember some events.
As a caregiver try to remember them for their good events which is happen in their day to
day life. They are try to help the individual to in order to recall something which is good
from their task which is based on the aspect of music that they listen for the longer which
is based on memorable events (Bartlett, Milne, and Croucher, 2019).

 As the caregiver, the aspect of education is the major important mark which is provided
to the dementia people. In this, the use of ABC charts is help to determine the possible
triggers which is based on behaviour which is challenging (Kierkegaard and et. al., 2021).
 They usually focus on the alternative therapies which is provided for the dementia people
that include aromatherapy, music, dance and many more. Therefore, the strategies are
useful in such a way which help to develop quality of approach which is identify the issue
of dementia people (Ta Park and et. al., 2018).
 They usually try in order to access the person with the aspect to dementia is any pain as
this may be cause the some of the behaviour which is challenging due to the aspect of
inability in order to express this, moreover, there are some of the tool such as the Abbey
pain tool which is helpful in order to determine the possible sign of the pain where an
individual used to unable to communicate and interaction with this (Campbell-Enns and
et. al., 2020).
 In addition, the use of person centred approach which is fulfilled with the aspect of
documentation that help to determine the things that is unique and play role within the
individual.
 Therefore, they also use some of the distraction technique which is usually follow with
the help of books especially with storyteller that help to determine the unique towards the
individual (Dowson, and Schneider, 2021).
CHAPTER 3: METHODOLOGY (1000)
Methodology is defined as the set of procedure, process, method, tool and technique that is
follow within the research process for the proper collection and selection of data which is related
with the selected research topic (Azizoddin and et. al., 2021). The data collection is also referring
as the technique which is followed within the research with the reliable source that provide
evidence and proper study. This section is usually focus on the different aspect that provide the
data which is related with the study design, data method, data collection method, data extraction
method and so on. Therefore, the data collection and information gathering is defined as the
technique or method that is reliable in order to collect the appropriate data that relevant with the
conducted study. Moreover, the research process carries different phase which is related with the
ontological perspective, epistemological perspective, research approach and method which is
useful for the collection of data (Millet, 2019).

Ontology: The ontology is defined as the branch of philosophy which is usually related with the
aspect of scientific approach that include what is, of the kind and structure of the object. In the
simple word, it is usually seeking the classification and the explanation that is associated with the
entities. Considering the chosen research topic, the nurse is usually face the wide range of
challenge and impact while dealing with dementia people. therefore, in such way, the ontology
provides a brief appearance of nurse that have impact among the society with the scientific factor
that provide relevance of nurse and care worker within social group and community in term of
care and support. In this research process, the constructivism is used as an ontological
perspective (Lombard, Nolan and Heron, 2021).
The constructivism shows the relevance while selecting within the ontological process
because they are specific and used to derive the phenomena, continually, researcher and
accomplishment that is impactful within the constructivism. In addition, constructivism is
defined as the theory which is about the leaner that construct the knowledge rather than then
taking the aspect which is passive take in information. The nurse with the hospital or health care
setting used to experience challenge and they also reflect those experience in order to construct
the information and knowledge regarding the behaviour and through. Usually, it helps to build
the characteristic with representation and incorporate in such a way which provide information
into their pre-existing knowledge which is gain by nurse during the academic phase.
Epistemology: The epistemology is the vital perspective which is usually followed within the
research which provide appropriate vision for reality. Therefore, epistemology is the defined as
the theory of knowledge. Moreover, it is usually showing the concern with the relation to the
phase of reality. These are the basic question which is defined the consideration that follow the
epistemology that is defined as old philosophy itself. In consideration with research topic, the
topic is reliable to formulate authentic source that validated for the appropriate information and
data. In addition, they preface the study of knowledge, theory of knowledge and many more that
is associated with the knowledge development (Riney, Browne and Markenson, 2021).
With contrast to research philosophy, interpretivism usually show the aspect which is related
with the study that provide aspect of theory about the knowledge of the world. These usually rely
the phase of understanding that provide the aspect of meaning which is based on the human that
attach with their actions. The selection of interpretivism provide the vision for the research topic,
it helps to develop truth out there which is discovered. Therefore, the nursing is a profession that

is related with study that focus on the characteristic that they support and care to the families as
well as patient with the same time (Movsisyan, Rehfuess and Norris, 2020).
Methodology approach: The research approach is defined as the plan and the procedure which is
usually consist of step or broad assumption to detail the method collection, analysis that is based
on the analysis and interpretation that is associated with the nature of the research issue that is
being addresses in the effective ways. The research process is usually associated with the plan
and procedure for the research that span the step which is based on broad assumption that is
related with the method of data collection that is selected with the appropriate ways. While
taking consideration in research, the indicative approach is used to taken that follow the aspect of
qualitative aspect of data collection and selection.
Therefore, the proper study regard with the use of inductive approach within the article is
useful for the involve with the search for the pattern from observation and development of
explanation which is based on the pattern through the aspect of series of the hypothesis. In
addition, the resemblance and the regularities in the term of experience used to place within the
aspect that follow the pattern and theory that is related with chosen topic that is nurses usually
face the issue while dealing with dementia people (Vusio, Thompson and Birchwood, 2021).
Method: In order to study and for the collection of data and information the qualitative research
method is used to source the evidence based data that is related with the topic. The chosen
research topic for the study and for the data collection is nurses experience while facing the
challenging behaviour of people with dementia. Therefore, the major approach which is follow
the term that related with qualitative method which is helpful to support the data that is collected
with aspect of concept, model, theories and so on are used that provide proper qualitative factor.
Usually, within the research process, the three most common used qualitative research method
are used such as in depth interview, focus group discussion and observation. Overall, the
qualitative research usually aims the study which is associated with the natural setting that make
sense of the phenomena in the term of meaning towards the people. The nurses experience that is
collected in such a way which help to provide proper knowledge and concept development that
create positive effect on others (Moriña, Puig and Navarro, 2021).

CHAPTER 4: METHODS (3000)
Research aim
“To understand the nurses and care worker experience while dealing with the challenging
behaviour of people with dementia.”
Evidence based: The evidence based signify the proper relevant in text that refer the data source
and their resource which is usually collected as per the method or approach which is used to the
data collection (Eidemüller and et. al., 2019). In addition, the study is usually configuring the
nurses and the care worker experience while dealing with the people with dementia that follow
various challenging behaviour that create hindrance for the nurses and care worker to provide
support and care.
Systematic: The approach which is taken within the research process is usually follow up the
lead which is regarding the experience of care worker and nurse while dealing with dementia
people and their have various aspect of challenge that is retrieve the force to develop systematic
approach (Lim and et. al., 2021). Therefore, the studies are usually conducted with the aspect
which follow phase of aspect that focus on systematic review on qualitative manner that produce
authentic approach towards the chosen topic (Wilson, Mikahere-Hall, and Sherwood, 2021).
Value for research: The value of the research is used to indicate the approach and strategies
which is beneficial in order to reduce the complication that is faced by wide range among the
nurse and care worker. The complication is usually related with challenging behaviour of
dementia people. Therefore, research usually focusses on the experience and challenge which
impact the nurses and care worker. The research is reliable and validated in term of progression
that hold the data and information which is evidence based. The research process and their data
or information is appropriate for the developing knowledge and skill towards the general
population taking the concern of nurse and care worker (Berg and et. al., 2021).
Research objective
 To identify the role of nurses and care workers while dealing with people with dementia.
 To examine the challenges of the nurses and care workers dealing with the challenging
behaviour of people with dementia (Tuomainen and et. al., 2018).
 To evaluate the ways and strategies to minimize the nurse's and care workers' experience
while dealing with the challenging behaviour of people with dementia.

Research questions
 What is the role of nurses and care workers while dealing with people with dementia?
 What are the critical challenges of the nurses and care workers dealing with the
challenging behaviour of people with dementia?
 What are the ways and strategies to minimize the nurses and care workers experience
while dealing with the challenging behaviour of people with dementia?
Research hypothesis
Null hypothesis (Ho): Nurses and care worker have positive experience while dealing with
people with dementia.
Alternative hypothesis (H1): Nurses and care worker have negative experience while facing the
dementia people (Frost and et. al., 2020).
Eligibility criteria
Inclusion criteria: For the appropriate research conduction, the inclusion criteria are used to
follow which help to derive the information and data that is related with process of research. The
inclusion criteria are usually defined as the key feature which is helpful for the target population
that used to interrogate in order to find the article with their research questions. The inclusion
criteria usually consider those who are qualify the research process and included in the study
(Tirupati and et. al., 2021).
Exclusion criteria: While conducting the research, it is well analysed that the research process
require proper aspect for the included study and they also take approach which is practice which
is do not considered within the study (Régis and et. al., 2019). In addition, the exclusion criteria
usually derive the set of predefined factor which make approach towards the use of
determination of subject who will be not included in the study or who will have to withdraw
from the study that is related with the research. The precision is usually depending on how they
are ascertained. The exclusion study must ensure the aspect which is do not counted or taking
during the research process.
Inclusion and exclusion criteria table:
Inclusion criteria Exclusion criteria
 In addition, the nurses and care worker
are included in the study.
 The qualitative method is chosen for
 English language is not required.
 Quantitative method is excluded from

the research process.
 PICO framework is also included in the
study.
 English language is required.
 The dementia people are included in the
study (Te Ava and Page, 2020).
 The people with the challenging
behaviour such as Alzheimer patient,
Schizophrenia patient and many more
that is related with challenging
behaviour and require support and care
to deal with the complexities.
study (Chang and et. al., 2020).
 Statistical data, mathematical graph and
chart related with calculation is
excluded from the study during the
research process.
 Conceptual framework is usually not
included within the study while
conducting the research.
 The cardiac patient, hepatic patient,
diabetic patient and many more are
excluded within the study (Patterson
and et. al., 2019).
 The experience of healthcare
professional, healthcare practitioner and
healthcare medical staff such as general
ward boy or girl is not included in the
study.
Population or type of participants and characteristic: The selected participants for the study is
dementia people with their challenging behaviour. The nurses and care worker is selected as the
dependent variable whereas the people with dementia is selected as the independent variable.
The included hypothesis for the study is their negative experience that suffer while providing
care and intervention to minimise the risk or consequence that they face for the longer period
(Schmalbach and et. al., 2020).
Type of intervention: In addition to this, the non-pharmacological intervention is used to
selected as the strategies for the nurses and care worker to deal with behaviour of patient.
Therefore, the non-pharmacological ways are extrinsic which follow management that include
channel of communication, proper interaction approach and various that follow to manage and
deal with the challenging behaviour of people with dementia (Dakoff, and Medina, 2020).
Evaluation of outcome: The outcome of the study is usually providing a detailed analysis that is
suggest the proper communication and interaction with the friendly approach with the dementia

people may reduce the chance of complication. Therefore, the study is usually focus in the
different aspect which is based on experience that is formed after the concern of dementia
people. the evaluation state that they must configure the outcome with the rationale that focus on
the prevalence that show a wide range of people is suffer from dementia and they focus on
various factor that is contributed with the people with dementia. In addition, the
communicational strategy usually provides the aspect that reduce the barrier which may be
generative for the low outcome (Kramarenko and et. al., 2022).
Search strategy
The search strategy within the research process and procedure is appropriate for the data
collection and information gathering. The search strategy defines the source which is evidence
based for the data collection that provide a reference with the huge base of database. Therefore,
the proper set of data and information is essential for the research process whereas, the
interpretation of the data from the various source are difficult so the proper extraction source are
usually help to play vital role that provide cumulative aspect for the data collection. In addition,
the search strategy which is analyse within the research process are PubMed, Cochrane,
EMBASE, PubMed central and UpToDate. Therefore, these all are work as search strategy for
the data collection that is functional and appropriate for the study that is based on research
process (Cook and McCarthy, 2018).
PubMed: The PubMed is the number one source for the information gathering which is help to
turn the source for the information. It is also analysed that the PubMed is usually hosted by the
national institute of health that is known as the NIH and it also help to provide the information
that showing bibliographic aspect that include abstract and linked for the full text publisher
related with the website for the more than 28 million articles (Ta Park and et.al., 2018).
EMBASE: EMBASE is defined as the Excerpta Medica database which is chosen as search
strategy’s because they usually include the corpus PubMed. It is also analysed that it is accessed
by the provider which is known as the Ovid. It is usually cover approx. 38 million of article.
Moreover, the abstract, reference, and related article is included within the EMBASE that is
provide a detail overview of publisher contact and subscription also as a service (Karbasi and
et.al.,2018).
Cochrane library: The Cochran library is usually known as the best platform which is useful for
the systematic review. In addition, there are 53 review group which is based around the world

that is published review and they are high quality evidence-based article that is updated over the
aspect of time that is related to reflect the new research. The coverage usually includes the
several of thousand high quality reviews. The inclusion related with the abstract, related article
and references (Waterfield and et.al., 2018).
Study selection process
The study selection process used to define the necessary aspect which is followed within
the process that provide relative review that state the study is conducted and selected that provide
appropriate function. While considering the research, the study selection is the vital stage that is
include within the review process and they should play role when the conduction of research
used to ensure the result which is credible and useful in informing health care policy, clinical
practice and the research which is based on future. The instrument is usually appraising the
evidence that is different from the review of qualitative evidence (Gerritsen and et.al., 2021).
The nurse is usually facing the high risk of challenge due to the negative behaviour of
dementia people. the study selection process helps to provide the proper aspect which is may
contributing role within the health and social care sector. The study selection process usually
follows the some of the criteria which is beneficial for research to present the data and
information in the ethical manner (Kleemola Leino-Kilpi and Numminen, 2020). Usually, the
selection criteria can also use as a form synonym which is based on the eligibility of studies.
Therefore, the characteristic which is used to decide the whether the people are usually show
their eligibility to participate within the study. Within such context, the difficulty is also
assuming when the information is collected due the positive and negative aspect of patient that
may create null hypothesis for the study. With this, the proper data that is showing negative
attribute towards the topic is shown with the context of challenging behaviour are selected for
the study (Negrin, and et.al., 2022).
Quality appraisal of included studies
The quality of the studies is usually related with the measurement of strength of the
evidence for the recommendation which is usually made for the systematic review. While taking
the consideration of research, it is well evaluating the research process focus on systematic
qualitative review (Nunez and et.al., 2018). The chosen topic is the aspect that related with the
quality appraisal of the include show the minimum of two independent view which show
dementia people and their challenging behaviour. with the context of chosen topic, the critical

appraisal helps to provide evidence that is related with the examining which is systematic
towards the process that provide the aspect which is trustworthiness and show the value and
relevance in the context with singular manner. The checklist and the CASP tool is usually
described in the appendix at the last of report that provide the effectiveness which is related with
selected topic (Kontos and Grigorovich, 2018).
Risk of bias assessment
While conducting the research process, the well-known aspect which may render the
quality of information that is bias study. In addition, the risk of bias assessment which is also
called as the quality assessment is usually useful within the research which is place on nurse and
care worker experience that they face issue while dealing or facing the challenging behaviour of
patient with dementia. Therefore, it helps to play the transparency of evidence synthesis that is
related with result and finding. The risk of bias assessment is usually performed for the study
which is particular and taking each study in consideration to improve the quality that focus as an
assessment. Moreover, the evidence synthesis usually strives in order to eliminate bias in their
finding. Within context to research topic, the nurses and care worker are used to select as a study
focus and dementia people are variable which is group that is review with their challenging
behaviour. The challenging behaviour of the patient with dementia is usually treated by the
nurses and care worker with their skill and knowledge that may play vital role within the support
and care (Mkhonto and Hanssen, 2018).
The research process that is based on medical field has less chances to face the issue of
bias assessment. The major data is based on the people health and their illness which cannot
render or manipulated in distinct way. In order to judge the risk of bias with the study with
medical core aspect, then primary approach is to understand and review the process of choice
with proper epistemological ways, in addition, the identification is an appropriate risk which is
based on the tool and try to avoid the jargon which may be raise the issue that is shows the
prospective. In addition, the nature of the reality used to configure the aspect which show
minimum aspect of biasness that may include within the study (Johnson and et.al., 2018).
Data extraction and synthesis
Missing data: The missing data or the missing value also taking into the consideration that is not
included in the study or stored within the study. Moreover, the set of data is usually prepared
with the context of nurses and care worker experience that provide authentic information that is

related with the study and play vital role within inclusion of data. The missing data are that
information which is not authentic as per the review which does not play relevance in the chosen
topic or missed due to context of inappropriate fact. In addition, the missing data is the society
also face the issue due to the challenging behaviour of dementia people. The challenge within the
social group and community may enhance the difficulties among the people due the mood swing
and aggressive behaviour (Reljić, Pajnkihar and Fekonja, 2019).
Measure of intervention: The intervention which is above discussed are usually show the aspect
that is helpful in order to control the complication which may be arise due the challenging
behaviour of mental health patient. The approved intervention which includes and play vital role
in the managing of patient with the brain issue are establishment of proper communication and
coordination which is beneficial in order to develop relation that reduce the complexities of
aggressive behaviour that usually shown among some people (Yous and et.al., 2020). In this, the
proper communication and coordination is beneficial to create the aspect of friendship where the
care worker or nurses used to educate them for their medication and check-up which is usually
followed to normalise the situation. The other associated intervention such as acknowledging the
need and requirement of people such as daily activities that is useful in order to serve as support
and care to perform. The care worker always plays supportive role with major level among the
dementia patient by providing help in bathing, walking and many more which is associated with
the day-to-day activities. The nurses usually focus on the helping and supporting with the
activities which may include healthy diet, medication and proper exercise with good habit which
may help to dilute the complex situation that may formulate the issue with the aspect of dementia
people (Kaewwilai and et.al., 2022).
Data synthesis: The data is usually synthesis from the various o source which may include the
use of website which is appropriate because it usually collect different website that follow in
order to generate the aspect for data collection. In addition, the research process for the
collection or the synthesis of data follow some of the vital platform also that include book and
journals. With the data process and collection, the data and information for the book, journals
regard with study of nursing experience who usually share in term to deal with such consequence
which may be arise and create the issue with the people (Wilfling and et.al., 2019). the nurses
and care worker both play vital role in providing the role and responsibility by following the
standard and appropriate standard operating procedure to create comfort for people with

dementia. With this all factor, the data is usually synthesising from such source that is equivalent
in order to promote the health approach for the people with dementia (Hoang and et.al., 2018).
Sensitivity analysis: The sensitivity analysis of the intervention or ways which is taking under
the consideration for redsuction of complex challenge which may be arise in front of nurses and
care worker. Therefore, the analysis helps to define the effect and impact of strategies that is
applied within the chosen research to overcome the situation (McCloskey and et.al., 2020). The
effect is prolonging and help to reduce the complication which is may be arise due the
challenging behaviour that include aggressive behaviour, forgetfulness of thing and activities, do
not perform their regular activities and the major risk which is related with the medication
administration where the chance of error is higher that create side effect and adverse effect. This
all condition and situation are taking into the control with the help of proper intervention that
followed with aim to control such factor that formulate issue with the nurse and care worker
while providing care or dealing with dementia people (Meyer and O’Keefe, 2020).
CHAPTER 5: RESULTS (2000)
Description of the studies
The study used to elaborate about the issue and problem which is undertaken and the aim
to enhance the comfort among the dementia people with help of nurses and care worker. The
dementia people usually facing the wide range of issue which is associated with the mental
health problem. The brain usually starts dysfunction and at a certain period of time, the issue of
dementia is become critical among the people and they require proper support and care. While
taking the context of mechanism of dementia, they used to create critical issue among the people
who used to take care the aspect of dementia (Varik, Medar and Saks, 2020). The dementia is a
neurodegenerative disease which is progressive disease and cause the problem with function of
brain. The dementia is usually causes due to the damage or destruction of brain cell. The damage
may cause the interference with the context with ability which is related with brain cell to
communicate and interact with each other. Therefore, the brain cell which cannot communicate
in the normal ways which is based on thinking, behaviour and the feeling which is usually
affected. With the analysis case study that is associated with the people of dementia, it is
evaluated that brain have number of parts and the regions each is responsible for the different
function. For example, memory, judgements and movements (Bolt et. al., 2019).

In addition, it is also help to show the effect on the particular regions which is damaged
that the region which is cannot carry out the function on normal basis. In addition, there are
different type of dementia are usually categorised and they are eventually characteristic with
their impact and rate of progression. In this, they also associated with particular type of brain cell
that damage the particular area or regions of the brain. while taking the contrast of example, the
Alzheimer disease, they are high level of certain protein inside and outside of the brain cell that
is make it hard for brain cell in order to stay healthy and to interact with each other (Evripidou et.
al., 2019). Therefore, brain region which is taking participation with the disease is hippocampus
in the centre of leaning and the memory in the brain and the cell of brain in this region are often
first which is usually damaged. So, the mechanism is completely interrupted and due to this the
memory loss is often started win the first phase. Overall, the study of the dementia that is related
with pathophysiology which help to configure the function with aspect of memory loss. In term
of such aspect, they used to follow the prevention and intervention technique that is helpful for
the patient in order to control the behaviour that occur due to the failure of brain regions. In
addition, due the change in behaviour as per the dysfunction of brain activity, the people
unaccepted the change and become aggressive. In addition, at the same time they require support
and care which may generate the issue due the challenging behaviour of patient. Overall, the
study usually focusses on impact due to the challenging behaviour of people and the experience
of nurses and care worker who is ready to provide the support and care. the intervention is
usually followed to overcome the situation that is related with the difficulties that is formulate by
dementia people while nurses or care worker used to deal with this (Adolfo et. al., 2022).
Risk of bias in included studies
In the study of research process with the association of chosen topic, there are various of
article or journals used to show the biasness. In addition, there are number of studies which is
usually follow for the appropriate data selection and collection. With this aspect, the risk of bias
information of data that is elucidated with study may create the improper respect toward the
research (Haugland and Reime., 2018). In addition, there are some of aspect which is followed
within the research process which is help to provide the summary of bias in included studies. The
risk of bias assessment is useful in order to established the transparency towards the evidence
synthesis that is related with the result and their finding. Moreover, the risk of bias assessment
may be useful and helpful in order to perform the each included study within the process of

review. The bias study changes the meaning of chosen topic which is taking under the process. In
addition, in the other words, the risk of bias is the more likelihood that show the aspect of feature
or characteristic of the study design or they are relatively conduct of the study which is misled
the result (Webster et. al., 2020).
In this research, the bias study is based on the dementia people, where not all the patient
shows the challenging behaviour and research usually focus on approach towards the such
people who used to create the issue with their challenging behaviour among the nurse and care
worker. Overall, the study focusses on the dementia people and only with those who is create
difficulties in taking the support and care (Lee et. al., 2019). The data and information which is
selected for study used to show aspect that focus only those patients who is aggressive and show
difficulties in taking the care. While conducting the study in term of data collection and
selection, they usually prefer the approach which is based on chosen research topic. Whereas, the
study associated with experience of nurses and care worker with reference to behaviour of
dementia people. The risk of bias in included studies are deliberately lower as compared with the
information that taken within the research with appropriate evidences (Dobbs et. al., 2018).
Risk of bias in review process
The risk of bias review process within the research process is relatively associated with
error. This error is predominantly related with the risk of systematic error or a deviation from the
reporting the truth or an appropriate finding of evidence. It is majorly happening when the
systematic flaws or the accurate limitation in the study is that based on the design and conducting
of study. While conducting the research process and procedure, the review process is sometime
become bias that is due to the implied complication and consequence that may arise when the
nurses and care worker follow their duties and regulation that focus on the development of
authentic and reliable source for the review process (Mulders et. al., 2018). In addition, the
review is compulsory with the aspect of research because the risk of bias information is re
validated and excluded from the study. Therefore, reliable data or the information are used to
follow within the chosen topic that help to acknowledge about proper and reliable source of
information that used to review with the proper intervention. The review process helps to retard
the issue of biasness that is associated with the selection bias, information bias and cofound bias.
Therefore, it helps to explore within the context of paper of the systematic review of the
observational studies provide study which is along with possible strategies that help the

researcher in order to overcome the situation. This bias risk may usually affect the information
reliability with chosen research process. In addition, the study used to focus on the different
aspect that follow the appropriate motive along with the evidence that provide suitability and
reliability (Spelten et. al., 2022).
Effect of intervention
Achievement of excellence response: In addition, the effect of intervention is discussed earlier
within the appropriate section of literature review. The effect or impact of intervention help to
play influential role that reduce the arising complication which may be changing behaviour of
patients. Therefore, the intervention is usually focus on the different aspect that follow the
coordination and communication with patient with dementia with the purpose to reduce the
complexities such as aggressive tone, forgetfulness, shouting, wandering, biting, throwing object,
repetitive talking, destroying possession and other object, agitation and the general anger,
physical attack on their and waking other at the night. These all behaviour are usually termed as
the challenging behaviour which provide the context to dementia (Pfeifer et. al., 2018). The
intervention or the strategies are used to follow in the appropriate ways which help to restrict
such behaviour and provide aspect of healthy and positive behaviour with the help of nurses and
care worker. In addition, the intervention usually include communication, coordination,
developing relationship and many more. In the extended way, there are some of the aspects
which is followed within the aspect that provide assurance which consider the person-centred
care and communication, sensory stimulation and listening to the music which is collected as the
evidence based therapies which can help to reduce the agitation and other challenging behaviour
that is suitable with people with dementia (Oppert, O'Keeffe and Duong., 2018).
In this, the given that antipsychotic drug in the form of prescribed medication usually play
vital role in the treatment but they also used to show various of side effects, effective non drug
strategies which is further consider first. There are some of the ways which is taking under
consideration and followed with the aspect which is focus on assist with those with the dementia.
In addition, always calm and do not confront the challenge which is related with the individual
and this help to make the feeling with the more distressed. Therefore, the use of proper ABC
chart is helpful in order determine the trigger for the behaviour that make the challenges more
competent (Dahlke et. al., 2020). They use to adopt the alternative therapies such as music, dance
and the various meditation approach which help to provide the relaxation which minimise the

risk of arising issue of complexities with the behaviour of dementia people. It is essential to
consider the potential of physical illness and pain which is particularly in the occurrence of older
population that is likely living with the co-morbidity situation. Therefore, behavioural pain
which is particularly in an older population which is likely with the help of assessment tool such
as the Abbey pain tool which help to detect the wider concept of the distress and also it helps to
show the important in order to rule out the other cause of the distress which is associated with the
assumption of the pain that use to cause the fact which is unless there are obvious physical signs
(Brossard Saxell, Ingvert and Lethin., 2021). In addition, the distress is usually detected using
the tool which is appropriate for the ABC chart that help to determine the potential cause of the
condition that may be physical pain or the discomfort, psychosocial or emotional or the
combination of these. In addition, it is very difficult to determine the distress which subtler and
that showing the approach towards the behaviour assessment tool which is useful as well as
information which is gather from the those which is knowing the well condition (Prunty and
Foli., 2019).
In addition, the intervention is usually focus on the main aim which help to avoid the people
with dementia feeling undervalued, vulnerable, with their right and loss of dignity. It is also
showing the aspect which shows the reduction in the likelihood of living in an environment
which is usually poor, chaotic hostile with the little opportunities for the positive interaction or
the positive routine (Han, Kim and Hong., 2020).
CHAPTER 6: DISCUSSION (2500)
Summary of main results
The outcome of the result used to express the term and concept that is related with
dementia. In this, the nurses and care worker used to focus on the different aspect with their
knowledge and skill that make relevance in the treatment of dementia people. Due to this, the
people with the dementia faces various complication that is predominantly focus on the support
and care which is provided to the patient in the effective ways. It is also evaluated that the people
with dementia have several difficulties which entirely focus on the suffix that is require proper
support and care that is associated with the people with mental disorder. The dementia has the
wide range of factor which may related with the study that based on nurses and care worker
experience who is usually facing the issue due to the complex situation that may arise due to the

challenging behaviour of people with dementia (Cronin and Ojo., 2022). They usually become
aggressive, shouting, running and many more behaviour which may be challenging for the nurses
and care work to calm down and provide them appropriate support to make it effective in term of
their health. It is also analysing that the proper care and attention is helpful for the number of
people with dementia to reduce the complexities (Butcher., 2018). Therefore, depending on the
progression of dementia, it is also analysing that there is various level of challenging behaviour
which is vary and the individual that is applicable with the context towards the background that
may also use to explain their frustration. It is also analysing within the context which is based on
the aspect of position if they cannot communicate with the verbal level or they do not understand
them, in addition, the proper communication and interaction with the people is the primary
aspect which show the appropriate mechanism towards the nurses and care worker to deal. It is
usually looked at the behaviour which is based on the challenges which is cause the issue of
distress, establishing some stress that led to cause the issue. it shows response in reducing the
distress with the relation to person of individual (Allen et. al., 2020).
In addition, there are wide range of intervention with the relation to clinical practice are
used to made. In addition, they usually include some of the intervention such as pharmacological
and non-pharmacological intervention. The intervention is used within the care treatment and
also help to support the people who is facing the issue of dementia can be both pharmacological
drug and non-pharmacological (Herron and Wrathall., 2018). The section used to follow that
help to elaborate the with the inclusion of environmental and behavioural modification. The
summary of the outcome is help to elaborate about the issue which is conflicting as per the vision
of nurses and care worker. The outcome helps to show the proper communication with the aspect
to relaxation play vital to neutralise the section that initiate complex situation among the
individual. In addition, the researcher used to focus on the different aspect which is showing
attribute and vision for the development of quality of health among the people by declining the
issue with the help to nurses and care worker who used to work within the dementia wards and
manage situation appropriately (Rivett, Hammond and West., 2019).
Certainty of evidence
The certainty of evidence with the process of research provides a mean that the investigator
is very confident that they can show the effect which is found across the aspect of studies which
is close to the show the true effect. In this, it is also showing the factor that is related with the

mean which is lower and they have little confidence in the term of effect. The certainty of
evidence within this research is also applicable for the intervention which is provide the
confidence that the true effect that is within the particular range or the relative to the threshold.
Therefore, the main domain which is usually analyse while conducting the research is showing
the assess that is based on the risk of bias, inconsistency, indirection and publication bias. In
addition, the certainty is also showing the risk factor which may be helpful in order to determine
the path which is based on the level (Ritchie et. al., 2021). It is usually showing the aspect of
four grade that is very low, low, moderate and the high. The research showing the subjective
phenomena that is based on the integration that help to create the logical exploration which is
reported for the research topic. The level of certainty is usually following the moderate level
because they are usually following the aspect which is functional and play the vital role within
the process of research (Hext, Clark and Xyrichis., 2018). In addition, the moderate level of
evidence usually collects essential concept and follow the approach, model and theory that is
related with the selected evidence that is informed during the collection and gathering of data
which is formulating evidence because they are collected from different website, books and
journals. In this, the discussion is used to made up of various attempt that is helping the support
and care that is essential as per the view point of nurses and care worker. The evidence plays
vital role in the development of appropriate conduction towards the subjective or phenomenal
data that is based on the study of evidence (Dahlke et. al., 2019).
Potential bias in the review process
Evidence selection bias toward the review which process and usually occur when the
systematic review does not follow the context that identify all the available data on the related
topic. It is also showing the aspect which is arise from the aspect of publication bias where the
data is used to focus on the statistically significant that is related with the studies which is more
likely to be published than the those which is not statistically significant. In addition, the trend or
deviation which is related with the data or information is based on the truth of data collection,
analysis, interpretation and the publication which is also called as the bias. Bias causes false
conclusion and it is potentially misleading. Therefore, it is well analysed that they have immoral
and unethical to use to conduct the biased research (Saj et. al., 2022). The review process within
the research is appropriate that is helpful to provide the quantification regards with the data and
information which is reliable or not. In addition, they also focus on the biasness that occur

sometime while focusing on the validation of research process. The review process is useful in
order to identify search bias information and provide a scope of exclusion within the research.
Deliberately, it plays a vital role to creating the scenario which is functional and appropriate after
the completion of research to determine the factor which may create hindrance in the proposition
of excellence research process (Koren et. al., 2018).
Agreement and disagreement with other studies
While taking the context of studies within the research process, they usually follow some
of the aspect that include agree and disagree with the search strategies that may be useful for the
collection and gathering of appropriate data. In addition, the agreement and disagreement with
the studies urgently happen within the research process while taking the contrast of most reliable
and validated article for the review. Within the inclusion of study and review process the study
of article are conducted that focus on the information that is reliable and show their evidence in
the appropriate manner after the completion of research. The agreement studies are usually
defined as those studies which is relevant and follow the concept of research question with the
appropriate hypothesis (Dafny and Beccaria., 2020). Therefore, the agreement studies are taking
into the inclusion for the written data or information that provide evidence with the conduct in
research. Whereas, the disagreement is also seen within the research process and it is usually
occurred due to the such impact which neglect the studies and create inappropriate structure or
pattern which is must avoided. This includes unnecessary topics, models, concept, thesis,
hypothesis and jargons that act as a barrier within the research that may create impact for the
reader or researcher while they are studying (Karimi et. al., 2020). The disagreed studies are
usually excluded from the research information because it creates conflict due to the dual
statement. Moreover, such information is do not place any relevance within the research. In
addition, the chosen topic within the research is based on the reality that focus on the authentic
and reliable data or information due to the epistemic behaviour of the research. Therefore, the
inclusion and exclusion protocols are used to be followed in such a manner which provide
appropriate activity that is functional and focus on the criteria of exclusion and inclusion. So, the
disagreement of the studies is beneficial to conduct in order to provide validated information
(Scerri and Scerri., 2019).

Generalisability
Within the research process the generalizability is an essential component which is helpful to
provide the information that is related with the finding. Moreover, it also useful to provide the
impact of that finding are applicable on other settings. In addition, the chosen topic for the
research within the report clearly provide experience of nurses and care worker regards with the
dementia people. These studies are also play an important role within the all-mental patient who
is facing Alzheimer, schizophrenia, Parkinson and many more disease that is related with the
mental disorders using the data or information which is collected for the dementia people.
Predominantly, the information which is gathered for the dementia people are also applicable to
the various department of mental health patient when the generalization of challenging behaviour
arises (Kimzey and Mastel-Smith., 2021). Moreover, the health care professionals and medical
staff are also facing such experiences within the healthcare settings while dealing with mental
patient. As per this, the information and data are appropriate for such practices that play a
reliable source and provide authentic validation among the people who is creating such kind of
challenging behaviour. Within the healthcare settings, the generalizability of this chosen topic as
appropriate and place within the various healthcare settings while dealing with challenging
behaviour of population due to the unpredicted issues. Moreover, the research information is
useful to taking under the consideration with the complication or consequences that is associated
with the challenging behaviour of patient within the department or wards (Digby, Lee and
Williams., 2018).
CHAPTER 7: CONCLUSION AND RECOMMENDATION (1000)
Implication of practice
While conducting the research, the implications of the practices arise which is providing
visibility for the future references and also for the enhancement of knowledge and skills regards
with the researching. The researcher who is taking the step-in order to create research question
and identify proper information and data is usually have an objective to create knowledge on the
personal and professional level among the population. The main purpose to conduct such
research in order to provide the standpoint of nurses and care worker for their roles and
responsibilities. They used to pursue such behaviour which is threatening for their life but they
are playing their responsibilities in such a way which help other to improve their life and

standard. The researcher used to focus on the real time experience is on the proper time frame
with the accountability of honour and visibility towards the standard that fulfilled by nurses and
care worker while dealing with such behaviour.
Implication for research
The implication of research is usually focused on the various aspect that followed while
conducting the research in the appropriate way. It helps to allow creating understanding which is
related with the study design, study method, and selection of appropriate data for the chosen
topic. Moreover, the research is usually conducted with an appropriate tool and assessment that
focus on the evidence-based data that's show relevance. According to the ethical committee of
research, they provide proper respect towards the research in order to selecting of participants
and fulfilling the criteria that there is a beneficial outcome. While conducting the research within
medical field, it requires epistemology to create better understanding who was the reality.
Moreover, the nurses and care worker are used to there's a wide range of challenges by providing
treatment to the dementia people. This research usually focusses on the experience towards the
dementia people that clearly state about the tools and techniques with respect to reality that they
literally face. Moreover, the study also provides the conclusion with the help of intervention by
reducing the impact that arises due to inappropriate behaviour of dementia people. The
challenges are usually justified due to lack of brain functions that create issues with their
thinking and feeling that create consequences by providing care from the nurses and care worker.
Moreover, it is also recognised that the research followed various ethics that include do not harm
participants, maintaining privacy and confidentiality and many more. It is wider research that
follow continuous process of retrieving the data and interpret in appropriate way the research is
based on the reality show the exclusion is difficult. In addition, the strategies and choices are
appropriate that focus on the secondary research with the qualitative aspect that provide a
formulation of systematic review that is beneficial within the potential review process and
included studies. It is also analysed that the intervention is play vital role by declining the issues
of the challenges that is arising behaviour of people facing the issues of dementia the research
also provides an aspect which is based on the rationale of the research that conducted in the
appropriate way. The research is usually beneficial for the future aspect because it helps to
develop the knowledge regarding the dementia and attribute which is followed in order to reduce
the challenging behaviour of people which is unintentionally happens due to the malfunction of

brain activity. Moreover, the research has their own sentences and they a helpful for the
generation in order to achieve the knowledge which is based on the nursing practices and their
experiences while dealing with dementia people.

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APPENDICES
Appendix A: Ethical approval
Section 1: Basic details:
Project title: Nurses' and care workers' experience while dealing with challenging behaviour of
people with dementia.
Student name:
Student ID number:
Programme:
College Name:
Section 2 Project summary
Please select all research methods that you plan to use as a part of your project:
 Interviews Yes No
 Questionnaires Yes No
 Observations Yes No
 Use of personal records Yes No
 Data Analysis Yes No
 Action Research Yes No
 Focus Groups Yes No
 Others (Please specify) : Secondary research
Section 3: Data Storage and Security
Confirm that all personal data will be stored and processed in compliance with the Data
Protection Act (1998)

Yes No
Who will have access to the data and personal information?
During the research:
Researcher
Where will the data be stored?
In computer system
Will mobile devices such as USB storage and laptops be used
Yes No
If Yes, please provide further detail
ls:
After the research:
Researcher
Where will the data be stored?
In computer system
How long will the data and records be kept for and in what format?
The data and records will be kept may be 6 months in computer system.
Will data be kept for use by other researchers? Yes No
Section 4: Ethical Issues
Are there any particular features of your proposed work, which may raise ethical concerns? If so,
please outline how you will deal with these:
It is important that you demonstrate your awareness of potential risks that may arise because of
your research. Please consider/address all issues that may apply. Ethical concerns may include,

but are not limited to the following:
 Informed consent.
 Potentially vulnerable participants.
 Sensitive topics
 Risk to participants and /or researchers
 Confidentiality/anonymity
 Disclosures/ limits to confidentiality
 Data storage and security, both during and after the research (including transfer, sharing,
encryption, protection).
 Reporting
 Dissemination and use of your findings.
Section 5: Declaration
I have read, understood and will abide by the institution’s Research and Ethics Policy:
Yes/No
I have discussed the ethical issues relating to my research with my Unit Tutor:
Yes/No
I confirm that to the best of my knowledge:
The above information is correct, and this is a full description of the ethical issues that may
arise in the course of my research
Name: Date:
Appendix B: Missing data
Missing data mechanism
Missing completely at random
Missing at random

Missing not at random
Amount of missing data
Percent of cases with missing data
Percent of variable having missing data
Percent of data values that are missing
Pattern of missing data
Missing due to design
Missing data pattern
Appendix C: CASP table
Critical questionnaire/
authors
Andrew
Grey,
2020
Goeman,
Emma and
Koch, 2016
Berg and
et. al., 2021
Lim and et.
al., 2021
Dakoff
and
Medina,
2020
(Selection bias) Random
sequence generation
✓ ✖ ✓ ✖ ✓
Binding of participant and
personal information
✖ ✓ ✖ ✓ ✖
Protection of participant
privacy and confidentiality
✖ ✖ ✓ ✖ ✓
Binding of outcome ✓ ✖ ✖ ✓ ✖
Review of outcome ✖ ✖ ✓ ✖ ✓
Other bias ✖ ✓ ✖ ✓ ✖

Appendix D: PRISMA chart
Records identified from*:
Databases (n = 220)
Registers (n = 120)
Records removed before screening:
Duplicate records removed (n =
45)
Records marked as ineligible by
automation tools (n = 50)
Records removed for other
reasons (n = 30)
Records screened
(n = 110)
Records excluded**
(n = 25)
Reports sought for retrieval
(n = 60) Reports not retrieved
(n = 15)
Reports assessed for eligibility
(n = 40)
Reports excluded:
Reason 1 (n = 10)
Reason 2 (n = 15)
Reason 3 (n = 30)
etc.
Studies included in review
(n = 75)
Reports of included studies
(n = 35)
Identification of studies via databases and registers
Identification
Screening
Included