Research in Nursing - Assignment PDF

Running head: RESEARCH IN NURSING
RESEARCH IN NURSING
Name of the University
Author Note

RESEARCH IN NURSING
Introduction
Elderly people living in the aged care facilities and suffering from dementia often
suffers from depressing psychological symptoms (BPSD) (Cerejeira, Lagarto & Mukaetova-
Ladinska, 2012). The clinical manifestations of this condition are aggression, anxiety,
aggression, violence, apathy, depression, irritability and rarely hallucinations, disinhibition
and euphoria (Backhouse, Killett, Penhale & Gray, 2016). The behavioral symptoms that are
generally observed are restlessness, agitation and wandering. The patients with BPSD are
normally recommended with several pharmacological therapies, including prescription of
antipsychotic drugs and antidepressants. The elderly population are presented with multiple
comorbidities, thus increasing the chance of adverse drug related conditions (Backhouse,
Killett, Penhale & Gray, 2016). This has led to the development of the several
complementary therapies and non –pharmacological interventions (NPIs) to treat the
behavioral and the psychosocial symptoms in dementia patients. Several non-
pharmacological interventions like aromatherapy, art therapy, behavioral therapy, tailored
activity, reality orientation and physical exercises have shown promising results in managing
the behavioral and the psychosocial symptoms of the BPSD (de Oliveira et al., 2015). The
main rationale behind this research is that, in many cases the needs of the dementia patients
remain unaddressed that deteriorates their quality of life. Several studies like Livingston et
al., (2012), have discussed about the importance of the alternative therapies on the dementia
patients. This study aims to focus on the use of NPIs on the individuals residing in the aged
care unit and experiencing behavioral and the psychosocial symptoms of dementia.
Additionally, this research proposal will illustrate the effect of the nursing care practices on

RESEARCH IN NURSING
the organizational factors, managing the care home environment for the elderly people
suffering from dementia.
Research question
Does non-pharmacological interventions helps in treating behavioral and psychological
symptoms of dementia (BPSD) in the elderly residents in the aged care settings?
P- Elderly patients in the aged care setting suffering from symptoms of dementia (BPSD)
I-Non –pharmacological interventions
C- In comparison to the pharmacological interventions
O- Treating BPSD symptoms
Literature review
The term BPSD can be used as an umbrella term to describe a heterogeneous group of
behavioral and psychological symptoms (Cerejeira, Lagarto & Mukaetova-Ladinska, 2012).
Psychotropic medicines have modest efficacy, but is associated with several side effects
(Brodaty & Arasaratnam, 2012). Antipsychotic medicines had been in use to manage the
behavioral and psychological symptoms of dementia (BPSD). There are studies that have
suggested the potential risk associated with these medications. Most of the health care
professionals are trained in the application of medicines to the BPSD patients, but very few
clinicians are informed about the alternative treatments to avoid the delirious side effects
(Brodaty & Arasaratnam, 2012). According to de Oliveira et al., (2015), some of the side
effects related to the antipsychotic medications are anticholinergic action, parkinsonian
events, cardiac conduction disturbances, cognitive slowing, sedation and reduce bone mineral
density. Hence, in such cases it is better to use the non-pharmacological treatments, which

RESEARCH IN NURSING
have been proven to be a safe alternative treatment. Brodaty & Arasaratnam, (2012) have
stated that non-pharmacological interventions like transcranial direct current stimulation can
be used in treating aged patients with LBD. According to Koder, Hunt & Davison, (2014),
cognitive behavioral therapy (CBT) has been found to useful for treating anxiety in dementia
patients. A randomized control trial has proved that CBT has been found have caused a
significant reduction to the anxiety and depression in the dementia patients (Sadek, Hoe &
Orrell, 2015). Gitlin, Kales and Lyketsos, (2012), has opined that music therapy are often
used to treat anxiety and depression among the dementia patients. It does so by evoking the
feelings, memories and sensations. People have been found to be responding to music ever
since language has not developed. Music accesses several parts of the brain and soothing
music might evoke emotional reaction in the dementia patients, especially those suffering
from acute memory loss. It helps the person to connect to the people around them and also
encourages social interaction and promotes group activities (Groot et al., 2016). Studies are
there that have proven that mild to moderate exercises can be useful for the wellbeing of the
patients with dementia (Cerejeira, Lagarto & Mukaetova-Ladinska, 2012). Currently, in the
clinical practice, agitation is normally treated with the help of medicines but the clinical
outcomes have been found to be poor (Cooper et al., 2012). However, there had been
uncertainties about how these interventions will be applied in the aged care homes for helping
the individuals suffering from the behavioral symptoms. Due to the lack of understanding
about the effective application of the interventions, its application in the aged care homes are
limited (Brechin, 2013). The literature that has been present is weak in nature due to the
absence of any meta-analysis or randomize control trials. Other systematic reviews and the
secondary literature that consisted of research of inconsistent literatures with inappropriate
sample size and statistically in-significant results, thus, increasing the chance of bias (Ma et
al., 2014).

RESEARCH IN NURSING
Research design and the Methodology
Method and design
Four ethnographic case studies were intended to be conducted in four care homes.
This will be done by doing a postal survey to choose the suitable care homes. The propose
research will employ a qualitative approach that will help to give a better understanding of
the problem. This method was chosen, as it will be suitable for examining the complex
problems in the real life, setting like aged care homes (Hymes, 2013).
Data collection method
In total, the four case studies will include 384 hours of observation, 37 interviews
with 40 staffs with suitable mapping of the psychotropic medication administration. Data
collection will be continued until saturation is reached. Observation will be conducted over a
period of 5- 6 week period in each of the care homes. There will be one interview with the
staff members at time that will be convenient to the staff members. The interview will be
recorded and transcribed. The case studies will be reviewed by the Social Care Research
ethics Committee before the commencement to the fieldwork. The duration of each of the
interview sessions would be for 40-60 minutes, where the participants will be made to sign a
consent form containing all the pros and cons of the study.
Sampling
Postal survey will be conducted to select the care homes for the sampling of the case
studies. All the eligible responses of the survey will be analyzed and sorted. The aged care
facilities that will be included will most likely to contain patients experiencing the BPSD.
This will helps the researcher to get the relevant findings.

RESEARCH IN NURSING
The researcher will approach the organization by a letter of permission with a follow-
up call after a week later aiming to discuss about the study. The care home staffs working
closely with residence experiencing BPSD will be chosen as the potential participants. A
purposive sampling method will be used for the study. All the staff members of the
organization will be informed about the study by providing with a participant information
sheet.
Instruments
Observation of the participants through direct interaction will be used. The main aim
of ethnographic case studies is to get a deep insight in to any individual and the work
environment, by a series of interviews and field observations. In case of interviewing the
staff members, semi-structured interview will be taken for interrogating the staffs. Bergh and
Ketchen, (2011) have stated that, interview is the most common method of qualitative and
ethnographic researches. Interviews helps in exploring the views, beliefs, experiences of each
of the participants. The usefulness of the semi -structured interviews lies in the fact that it
helps to discover the specific areas of interest and helps the researcher to get an in-depth
detail about a specific concept (Silverman, 2016). The main rationale for choosing the semi-
structured interview is that it helps to provide an idea about the perception of the informal
caregivers about the application of psychotherapies such as cognitive behavioral therapy.
Tape recorders and in some cases, video recording might be used.
Ethical approval
Ethical approval is an important part of each clinical trials or researches as it gives
authority to the participants to withdraw from the study as per their will.

RESEARCH IN NURSING
All the staff members of the study will be informed verbally about the study and will
be made to sign a consent form. Consent will be taken from each participants individually.
Personal consultants will be identified and contacted for providing advice about those
participants who does not have personal capacity to consent. Written consent will be taken
from each of the individual members. Ethical approval for the study will be taken from the
local ethics committee for the conduction of this study. Privacy and confidentiality should be
maintained during the conduction of the interviews. All the interview Data and observations
should be recorded electronically and should be maintained by using encrypted passwords for
avoiding data loss due to unauthorized entry or theft. Hand written data for the ethnographic
study will be maintained properly in closed cabinets.
Data analysis
Data will be typed up, anonymised and then stored securely. A framework approach will be
taken for analyzing the extensive quality data set.
After the interviews had been conducted, a transcriptionist will make a transcript of
all the recordings. The generated transcript will be tallied thoroughly with the recording.
Finally, a statistician will analyze the transcripts. This approach has five phases-
“familiarization” that involves immersion in the data for recognizing the key themes. A
thematic framework will be used where ideas will be assembled from the research question.
“Indexing” that involves the application of the thematic framework to the whole data set and
finally “charting” them, which involves summarization of the data under each of the themes
with reference to the source data and finally mapping and the interpretation of the data, where
the structures and the patterns will be identified and the key concepts will be examined.

RESEARCH IN NURSING
Proposed findings
The data analysis will break down the collected data in to each of the ethnographic
case study and for their future use in the dementia care. Several aspects will be generated
from a given framework. This study will be able to show the association between the
findings, strategies, behaviors and the theme. The observations will be able to show the
actions that are conducted in every day’s life in an aged care facility. The activities that will
be observed mainly are – watching of televisions, solving the jigsaw puzzles and other
activities of the elderly people that are being done without the help of the caregivers. The
aged care will be screened for the activities like aromatherapy, massage, reflexology, nail
varnishing, doll therapy and more for the residents experiencing high-risk behaviors (Morrin
et al., 2016). Group activities such as exercises, reminiscence, cognitive stimulation, art and
craft, music therapy, entertainment and church services has to be considered (de Oliveira et
al., 2015). Some of the activities such as gardening or cooking might also be considered as
group activities. The residents experiencing psychological and the behavioral symptoms for
which NPIs should be recommended as the first line of treatment. The final studies taken
place will assist the nursing staffs, as the whole study will be done on a nursing perspective.
This study will help the nurses of the clinical staffs about the various non-
pharmacological treatment that can be administered to elderly residents of the aged care. This
will help to increase the level of support that the caregivers are providing to the elderly
patients. Individual interventions can be considered as the first line of treatment for treating
the behavioral and the psychological symptoms (McLaren, LaMantia & Callahan, 2013).
Treatments like, multisensory stimulation, music therapy, long massages, might not be
identified by the staffs as the major activities for treating patients, but such an ethnographic
study can point out the gaps left in the activities (Ueda, Suzukamo, Sato & Izumi, 2013,

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McDermott, Crellin, Ridder & Orrell, 2013). The researcher who will conduct the data
collection method for the study should have several years of experience of paid care work
having experience working with the older people. Such experience will assist the researcher
for coping up with the emotional aspects of the work. This will help in the development of
good rapport and trust between the participant and the researcher, which will help in
increasing the credibility of the data (Backhouse et al., 2016).
Conclusion
In conclusion, it can be said that interventions for the elderly people in the care homes
are not enough for meeting the various needs of the dementia patients. Hence, improvement
is required for elevating the general wellbeing of the residents in the nursing homes. In
future, I intend to run the data analysis part of the training for evaluating the status post the
research proposal. This study will be potentially important for those suffering from
psychological and the behavioral symptoms as such a study will be helpful in pointing out,
which of the interventions are more useful in treating the dementia patients. There lies an
evidence gap between the practice and rhetoric in this case that requires to be addressed by
the implementation of the activities that are customized intervention especially for the
residents.

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