Nursing Essay in Dementia: Evidence Based Practice and Caregiver Management

This essay evaluates nursing practice and its relation to dementia care in Australia. It focuses on evidence-based practice and caregiver management. The study uses the PICO strategy to develop a searchable question and reviews five articles. The essay concludes that evidence-based research is useful for generating evidence-based practice, which is essential for improving patient care and wellbeing. Nurses play an important role in adapting recommendations for patient care through the implementation of evidence-based practice and delivery of care and treatment based on the latest information available from systematic research and clinical experiences.

Nursing Essay in Dementia
The study evaluates the nursing practice and how it relates with provision of care to a person
suffering from dementia as per the areas of priority subjected to delegation by the Government of
Australia as the National priority areas (NHPAS), according to their disease burden contribution
in the nation. The scope of the study takes its departure through an introduction about dementia
as a disease, continue by giving its overall burden globally, and finishes by narrowing to
Australia as the area of study. After the introduction, it focuses on the role that evidence based
practice plays in clinical decision making generally and specifically in dementia related matters.
The PICO strategy is used to develop a searchable question, under which searching and
discussion of related literature takes place. The essay ends in a conclusion which summarizes the
major findings got from the articles.
Dementia is a condition, which diminishes the cognitive ability that is very severe to interface
the day to day life of an individual1. It is not a specific disorder but a term that represents a
combination symptoms associated with diminished memory any other severe cognitive ability
that undermines the capability of a person to perform activities of daily living2. Alternatively,
dementia can be defined as a syndrome led by a chronic or progressive brain disease featured by
disturbed higher cortical function. These function include, thinking, comprehension, orientation,
memory, learning capacity, judgment, language as well as calculations. Without the clouding of
a person’s consciousness, the impaired mental functioning is associated with emotional control
deterioration, motivation and social behavior. 3.
1 https://www.alz.org/alzheimers-dementia/what-is-dementia
2 https://www.nia.nih.gov/health/what-dementia
3 International statistical classification of diseases and related health problems, 10th Revision. Geneva, World
Health Organization, 1992

Alzheimer’s disease (AD) is one of the common form of the disorder and a good example of the
condition is memory loss. Approximately, 60-70% cases globally result from the Alzheimer’s
disease dementia, with vascular dementia and dementia with Lewy bodies being the consecutive
causes. Though not a normal feature of the ageing process, the condition majorly affects the aged
persons. Individuals over the age of 60 years is estimated to reach an overwhelming figure of 2
billion by the year 20504, thus reflecting a proportional increase in the situation. In the year 2011,
the total number of persons suffering from the disease was 35.6 billion and is projected to
increase to 115.4 billion by the year 20505. In Australia the dementia patients are approximated
to be over 400, 000 with an approximate of 1.2 million persons who care for the dementia
patients in the country. Researchers have reported an expected rise of these patients with
dementia to 1 million by 2056. The former American president Barack Obama, in regard to the
dementia disease on elderly persons was quoted saying, “Alzheimer’s disease burdens an
increasing number of our nation’s elders and their families and it is essential that we confront the
challenge it pose to our public health”6.
Among the persons aged 65 years and above, dementia is the leading cause of disability. It is the
second in leading deaths and also its rankled third as a disability burden.7 The global cost of
dementia recorded a rise of up to 604 billion and also the medical cost of providing care to
dementia patient’s accounts for 16% of the worldwide cost. Additionally, despite so many
therapies done by specialists, there is no any cure foe dementia syndrome that exists. Nowadays,
4 World Population Ageing 2009. New York, NY, United Nations, 2009
(http://www.un.org/esa/population/publications/WPA2009/WPA2009_WorkingPaper.pdf
5 World Alzheimer’s Report 2009. London, Alzheimer’s Disease International, 2009
6 http://www.aaacap.org/The%20White%20House_National%20Alzheimer’s%20Disease%20Awareness%20Month,
%202011_Proclamation.htm
7 https://www.healthdirect.gov.au/dementia-statistics

the interventions that exists involve ways of improving the quality of life for the patients using
optimal management of the health status of the patients.
To provide care for patients with dementia, practitioners have used the existing evidences to
develop caring plans. More so, the use of Evidence Based Practice, which is an approach of care
that focuses on use of the best available evidences, and their critical use and application to the
individuals care plan in clinical practice8. In a nut shell, Evidence Based Research, incorporates a
critical sourcing and evaluation of existing evidences like clinical guidelines, research papers,
individual’s professional experience in clinical practice, as well as needs of the patient and the
clinical values that apply in maintaining the clinical health status of the patient9. In dementia
issues, EBP play an important role in equipping health practitioners with various care strategies,
their evaluation as well as care plan development putting into consideration the patient’s
preferences and the available clinical interventions. Continuous research and investigations are
ongoing globally to counter the increasing rates of dementia with solutions. Intervention
strategies are nowadays published in journals and other media concerning the intervention
strategies applicable. It’s the role of the clinical practitioner offering care to a dementia patient to
employ EBP in their care practices. Health care professionals evaluate the reliability and validity
of various research findings in relation to the health of their patients and apply them in their
client’s needs. 10.
Research Question
8 https://www.caresearch.com.au/caresearch/tabid/1590/Default.aspx
9 Melnyk, B. M. & Fineout-Overholt, E, (2014). Evidence-based practice in nursing & healthcare: A guide to best
practice, 3rd Edition.Philadelphia, PA: Lippincott Williams & Wilkins.
10 http://brainxchange.ca/Public/Files/Evidence-based-Health-Care-Sources/Promoting-Excellence-in-Dementia-
Care.aspx

Evidence Based Practice majorly focuses on the establishment of a well a structured research
question that aims in benefiting both the patients and clinical officers. For the question to be
relevant and to allow easy search of the relevant literature, it should be patient centered and well
phrased11. The PICO strategy standing for, Patient, Intervention, Comparison, and Outcome, is
one of the method that can be used to develop an excellent clinical question. These are the most
important elements of an EBP question and as per this strategy a complete question should bear
all these aspects. This study has this clinical question, “What is the effectiveness of the non-
pharmacological management in the caregiver for patient with dementia.”
The PICO criteria used in the creation of this question is; the Population (P), involving the
patients of dementia and the care givers, the Intervention (I) being the psychological intervention
like, cognitive behavioral therapy. The comparison aspect is not available for this study. The
outcome (O), is stress management as well as psychological disturbance among Dementia care
givers.
Literature searching involved online databases such as Cochrane, PubMed, CINAHL, as well as
MEDLINE. These are the best online sources for the study in nursing and health field, and they
are rich in qualitative evidence sources12 (Lam and Mc Diarmid, 2016).
The parameters used during the search for information included the advanced search option,
limitation of the search to articles published between the years 2008-2018. Key words such as
dementias, caregivers, non-pharmacological interventions, and systematize review were used.
I also used Booleans Operators which include, “AND”, “Not” and “OR” for combining the key
terms and obtaining relevant result. According to Brown (2013), I have made selection of five
11 http://www.jdas.in/article.asp?issn=2277-
4696;year=2017;volume=6;issue=2;spage=55;epage=55;aulast=Palaskar#ref
12 https://www.ncbi.nlm.nih.gov/pubmed/27822149

literature ranked as level, 1, 2 or 3 EBP. All of them contain systematic revie evidences, form
relevant fields13.
Articles Used in the Study and its classification for evidence;
Article 1
“Cognitive Behavioral Therapy for Depression, Anxiety and Stress in Caregivers of Dementia
Patients: A Systematic Review and Meta-Analysis14”.
The article is a meta-analysis and systematic review that done by Hopkinson et al., (2018) which
evaluates the cognitive behavioral therapy for Depression (CBT), as well as Anxiety and Stress
Dementia for Care givers. Two independent reviewers evaluated a total of 25 studies involved in
the study. The Meta-analysis focused on assessment of the usability of the interventions in
depression anxiety, and alleviation of stress. The conclusion finding of the study was that a small
but significant alleviation of the depression, anxiety and stress in dementia care givers existed.
Article 2
The article entitled “Effectiveness of Cognitive Behavioral Therapy for Caregivers of People
with Dementia: A Systematic Review and Meta-Analysis”15. It involved a systematic review
including randomized trials evaluating the how cognitive behavior therapy was important to
dementia careers (Kwon et al., 2017). Screening of 263 articles was done and incorporated with
12 randomized trials. A statically analysis as well as a meta-analysis got performed for the study
for the heterogeneity of the participants of the study. The study found that CBT is an effective
intervention tool useful in down warding emotional challenges among caregivers of dementia.
13 https://www.amazon.com/Evidence-Based-Nursing-Research-Practice-Sarah-Brown/dp/1449697496
14 https://www.ncbi.nlm.nih.gov/pubmed/29529290
15 https://www.ncbi.nlm.nih.gov/pubmed/29057632

Article 3:
“Caring for the carer: A systematic Review of Pure Technology-Based Cognitive Behavioral
Therapy (TB-CBT) interventions for dementia carers”16
It includes a systematic review with meta-analysis for the selected outcome measures from the
extracted random controlled trials. The researchers reviewed pure TB-CBT trials that led to the
inclusion of 2 trials that were randomized and two controls that were waitlists (Scott et al.,
2016). The conclusion of the study was that pure TB-CBT is an effective and economical
intervention to the delivery of psychological interventions to the care givers to dementia patients.
Article 4:
“Effectiveness of Supporting Informal Caregivers of People with Dementia: A systematic
Review of Randomized and Non-Randomized Controlled Trials”17.
According to Vandepitte et al., (2016) the article is a in a systematic review format that focuses
on providing evidences concerning to the effectiveness of various supportive interventions. The
assessment include a total of 53 studies which follow the exclusion of the irrelevant studies by
the author. The focus of the researcher on bias elimination and eligibility of the research articles
led to the elimination. The study found that other than the inconsistency in methodological
aspect, supportive interventions focusing on the carers and the [patients, there is need for further
research on the cost –effectiveness of the respite care.
Article 5:
“Cognitive Reframing for Carers of people with Dementia”18.
16 https://www.ncbi.nlm.nih.gov/pubmed/25978672
17 https://www.ncbi.nlm.nih.gov/pubmed/27079704
18 https://www.ncbi.nlm.nih.gov/pubmed/22071821

According to Vernooij-Dassen et al., (2011) the study involved a systematic review of controlled
trails that are randomized. They employed cognitive reframing of the relatives who acted as
caregivers in the family level. Both the Cochrane Dementia and Cognitive Improvement Group
methodology were employed by the study for the search and identification of the randomized
controlled trial. The review generally concludes that cognitive reframing intervention for the care
giver is effective when reducing stress and psychological morbidity, not tempering with the
carers burden and coping appraisals.
On the analysis of the above research articles, all were generally addressing the evidence based
articles criteria which is useful for the generation of Evidence Based Research. EBP provides
professional and nursing practitioners with the ability to make decisions for improving the
patient care and wellbeing of the individual’s suffering from dementia in the clinical setting19. A
well, nurses in the day to day practice should ensure that they are well equipped with the current
evidence based research as well as balance their theoretical knowledge and practice19. Many
evidence based researches are evident in the national websites. They are helpful to both the care
givers and the patients and focused on the wellbeing of the patients by providing control
measures and preventive measures for diseases. Nurses, play important role in the adapting the
recommendation for patient’s care through implementation of the evidence-based practice and
delivery of care and treatment based on the latest information available from the systematic
research and clinical experiences20. There are barriers that prevent the administration of nursing
practice. The clinicians, researchers and policy makers as well as administrators create this gaps
19 https://web.a.ebscohost.com/abstract?
direct=true&profile=ehost&scope=site&authtype=crawler&jrnl=08878625&AN=123698143&h=PTj7A3emf5ERlKKN
%2fJ2m7l4wJ97OXUFuWHzt8Rjjo6mI8sRPu6kPBiHwAEiHR0kOuYXrEQ1MRDVb1pqIWZ5YPg%3d
%3d&crl=f&resultNs=AdminWebAuth&resultLocal=ErrCrlNotAuth&crlhashurl=login.aspx%3fdirect%3dtrue
%26profile%3dehost%26scope%3dsite%26authtype%3dcrawler%26jrnl%3d08878625%26AN%3d123698143
20 https://www.ncbi.nlm.nih.gov/pubmed/25753736

through unavailability of information, publishing false information about practice for patient
care. This is mainly due to communication gap and issues associated with research distribution
such as poor finance, lack of public awareness and unsupportive political environment21 (Brower
2017).
Limited resources, lack of relevant skills as well as lack of time to explore researches, and lack
of confidence while implementing changes undermine the EBP. Others are in line with the
research quality, supportive colleagues, policies and training opportunities for translation of
evidence into practice limits the applicability of research into practice22 (Brower, 017).
Conclusion:
The assignments aim was to grasp a clear understanding of the impact of research finding on
clinical practice. The research focused on Dementia form NHPA. In this study, I used PICO
criteria to search relevant articles which provide evidence based research on the selected topic
used. The benefit that I gained from this study is that it enabled me to get a proper cognition of
research and literature finding skills for my profession. The barriers and gaps that prevent proper
implementation of research into the clinical practice.
21 https://www.researchgate.net/publication/311433056_Barriers_to_implementing_evidence-
based_practice_in_a_private_intensive_care_unit_in_the_Eastern_Cape
22 https://www.researchgate.net/publication/311433056_Barriers_to_implementing_evidence-
based_practice_in_a_private_intensive_care_unit_in_the_Eastern_Cape