Evidence-Based Practice: A Critique of Dementia Care Literature

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This essay provides a critical review of literature concerning evidence-based practice in dementia care, focusing on the improvement of nursing competencies to enhance primary and patient-centered care. It examines three key articles, a systematic review identifying core competencies, a qualitative study exploring patient and carer perspectives, and a program development initiative implementing best practices. The analysis justifies the evidence by highlighting the need for better training and skill enhancement of dementia care staff, while also acknowledging limitations such as the lack of patient perspectives in some studies and the small sample size in others. The essay concludes by discussing the relevance of the evidence to nursing practice and the barriers to implementation, including resource availability and staff cooperation, emphasizing the importance of comprehensive dementia knowledge and patient-centered approaches in care delivery.
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Running head: EVIDENCE BASED PRACTICE ESSAY
Evidence based practice essay

Name of the student:

Name of the university:

Author note:
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EVIDENCE BASED PRACTICE ESSAY

Assessment 3

Introduction

Dementia can be considered as a group of conditions that are characterized by

eventual impairment of the brain tissues (Foley & Swanwick, 2014). As per the statistical

data, one Australian adult aged 65 and above are diagnosed with dementia and there have

been 11000 deaths identified caused by dementia. Hence, dementia is easily the second

leading cause of death in Australia and as per the data of 2016, there have been 354000

people reported to be suffering from dementia (Aihw.gov.au, 2018).

Hence, dementia is a potent clinical issue for Australian health care system, and the

lack of best practice dementia specific nursing competencies is a grave concern (Hopkins,

2017). Hence, this topic has been chosen for this assignment. As a nursing student myself

with aged care as my speciality area, the alarming situation of dementia is of imperative

importance to me. The research on the effectiveness of the best practice dementia nursing

competencies on improving primary and patient centred care will help me improve my

practice.

I hoped to compare the effectiveness of dementia nursing competencies or best

practices by nurses in improving primary and patient-centred care offered to dementia

patients

Best Evidence

Best Practice
Level of
Evidence

Study Design
In-text Citation in
CDU APA 6
th Format
Valuing dementia

patients and their

caretakers to enhance

patient-centered care

Level 1
Systematic
review

(Tsaroucha, Benbow,

Kingston, & Mesurier,

2013).

Assisting dementia

patients to engage in

various activities.

Level 6
Qualitative
study

(Mary Benbow,

Tsaroucha, Ashley,

Morgan, & Kingston,

2011).

Interdisciplinary
Level 7 Expert opinion (Robinson, 2007)
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EVIDENCE BASED PRACTICE ESSAY

collaboration,

assessment, and

development of personal

care plan for dementia

patients.

Annotated Bibliography

Tsaroucha, A., Benbow, S. M., Kingston, P., & Mesurier, N. L. (2013). Dementia skills for

all: a core competency framework for the workforce in the United

Kingdom.
Dementia, 12(1), 29-44. doi: 10.1177/1471301211416302.
This systematic review attempted to identify the relevant frameworks in order to

identify a set of generic core competencies informing a competency based curriculum that

meets the needs of improved dementia training and education. The authors have been

engaged in research in the Stanfordshire university. They have taken the assistance of key

databases including PubMed, CINAHL, Proquest, and Google scholar to research articles

of the timeline 1999 to December, 2009. 18 competency frameworks had been identified

and a set of 8 core competencies along with 87 knowledge
technical and attitude/
behavioural skills. Four key elements had been identified based on which the core

competency framework had been developed that fit to the equation based theory of person

centred acre by Brooker and Latham (2015). Hence, the authors identified
valuing
dementia patients and their caretakers
and viewing the world from their perspective, and
creating a positive social setting for those patients the most important need.

Mary Benbow, S., Tsaroucha, A., Ashley, M., Morgan, K., & Kingston, P. (2011). Patients'

and carers' views on dementia workforce skills.
The Journal of Mental Health
Training, Education and Practice
, 6(4), 195-202. doi:
10.1108/17556221111194536.

This qualitative study had aimed to explore the skills that the dementia patients and

their carers perceive as the most needed to be acquired by the care workforce, especially

for the West Midlands dementia workforce (
Mary Benbow, Tsaroucha, Ashley, Morgan, &
Kingston, 2011
). Susan Mary Benbow is a Professor of Mental Health and Ageing, Anna
Tsaroucha is a Post-Doctoral Research Fellow, Maurice Ashley is a Service User, Kathleen

Morgan is a Service User and Honorary Lecturer and Paul Kingston is a Director of the
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EVIDENCE BASED PRACTICE ESSAY

Centre for Ageing and Mental Health, all in the Faculty of Health, Centre for Ageing and

Mental Health, Staffordshire University, UK. The study took the assistance of focus group

analysis, a carers’ group and memory group who contacted the people living from

dementia and their carers to through cafes where they were interviewed, the data analysis

had been qualitative taking the aid of thematic analysis. The data findings revealed six

major themes, knowledge regarding dementia, person centred care, communication,

relationships, support and helping people engage in activities. Although the authors

selected the first theme, knowledge regarding dementia as the best practice of interest,

further affirming our hypothesis of need of best practice dementia training and knowledge,

which can be implemented in future practice to improve the quality and patient

centeredness of the primary care.

Robinson, J. G. (2007). Utilizing best practice in dementia care.
Canadian Nursing
Home
, 18(1), 21. Retrieved 19th August 2018, from,
https://www.broadmeadcare.com/sites/default/files/documents/best%20practices

%20dementia%20care%20-%20cnh.pdf.

The primary aim of the article had been to develop a clinical program development

using the best practice principles to implement them in the daily practice of The Lodge at

Broadmead, focusing on the small-group living lodges. The procedure involved team

building, identifying feasible best practice principles, and implemented the principles into 6

aspects of care, organization, Resident assessment, Family and friends, Care provision,

Environment, and Education. 20 best practice principles had been identified and

implemented the program evaluation identified resident assessment to be the most

important aspect. Hence this had been the article that provided the most extensive data and

in a very systematic and easy to implement manner (Robinson, 2007).

Justifying the Evidence

In justification of the strengths and limitations of the identified best evidences, it has

to be mentioned that all of the papers indicated at one key element of the dementia care, the

need for better training and skill enhancement of the dementia care staff. The first article by

Tsaroucha, Benbow, Kingston, and Mesurier (2013) highlighted patient centred acre to be
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EVIDENCE BASED PRACTICE ESSAY

one of the core elements of the core competencies framework for the dementia care. It has

to be mentioned this systematic review unidentified 8 core competencies, and most of

which depend on training and skill enhancement. The authors have discussed that the major

contributor to the stress and burnout among the dementia care staff is associated with lack

of staff knowledge, abilities and resources. In support, Westendorf, Vaughn and Duffy

(2018) have opined that the even the staff acknowledges knowledge playing a contributing

role in understanding the patient needs and addressing the needs. The research design

selected is apt to the research question which attempted to summarize the available

literature to develop an integrative framework to act like a best practice element, although

the only limitation of the study had been no taking into account the patient perspective into

consideration.

The second article by
Mary Benbow, Tsaroucha, Ashley, Morgan, and Kingston
(2011), had been a qualitative study which contacted the dementia patient and carers

through the cafes and interviewing them. The interview based setting helped capture the

exact perception and emotion of the patients and carers which is commendable. The study

helped in identifying what skills the patient perceived the care force to master and where

the carers struggles the most. The patients and the carers identified knowledge about

dementia, person centred care, communication, relationships, support, and helping people

engage in activities. The target group identified the issues faced in care being due to lack of

knowledge and compassionate approach among the care staff which further supported our

primary aim that knowledge and training can enhance quality of the care. The only

limitation had been the response being strictly on the system as the respondents

experienced which can differ drastically among different patients and lack of systems

knowledge of them regarding dementia care.

The last article focused on developing a best practice framework for a particular setting

of the The Lodge at Broadmead for the small-group living lodges only. The authors

discussed 20 extensive best practice principles into 6 categories of care delivery, education,

environment, care provision, family and friends, resident assessment, and organization. It

has to be mentioned that the primary focus of the authors remained on the resident

assessment category which requires the nurses to advocate
interdisciplinary collaboration,
assessment, and development of personal care plan for dementia patients, all of which

indicate at the need for focussed training and skill enhancement of the nurses. Strengths of

this article undoubtedly will be the 20 principles identified and integrated into 6 broad

categories of care delivery. The only limitation of the study had been the very small sample
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EVIDENCE BASED PRACTICE ESSAY

size or setting used for the implementation which could have altered the relevancy and

transferability of the findings (Turner, Eccles, Elvish, Simpson & Keady, 2017). Hence, all

three of the studies helped in the identification of three different aspects of how best

practice can be implemented in the care practice can improve nursing competencies and

will the acquisition of these best practice skills improve the quality and patient

centeredness of the care interventions, hence the articles have been selected.

Relevance to Nursing and Barriers to Practice

The evidence identified in the activity all indicate at three interrelated yet different

aspects of care. The first article by
Tsaroucha, Benbow, Kingston, and Mesurier (2013)
indicates there is need for 8 core competencies to be able to provide best patient centred

practice to the patients, in order to acquire the competencies and provide a high quality

dementia care, a comprehensive level of dementia knowledge and understanding is must

among the care providers. This study incorporated best possible clinical evidence from a

systematic research addressing the clinical expertise criteria of evidence based practice

which can be easily implemented in future nursing practice (Dang & Dearholt, 2017).

The second article by
Mary Benbow, Tsaroucha, Ashley, Morgan, and Kingston (2011)
focused on identifying the patient and their carers’ perceptions regarding the skills that the

nurses need to develop. This evidence focused on evidence collected and evaluated which

when implemented into practice can lead to higher patient outcomes as per their

expectations and experience, addressing the patient values component of EBP (Hallberg et

al., 2016).

Lastly the article by Robinson, (2007) identified 20 best practice principles,

implemented them into 6 categories of care delivery practice. Although with a smaller

sample size, this article addressed by far the most extensive data findings and best possible

systematic recommendations for practice. Hence, the third chosen article can be considered

to address the relevant context of evidence for the research study. Furthermore the articles

identified and discussed also provide three very important aspects of dementia and

summarizes the best available research evidence that can be implemented in practice (Dang

& Dearholt, 2017).

Although, a few barriers of implementation in practice includes resource availability,

infrastructure and support from the local and national health authorities in creating the

opportunity for such extensive skill enhancement and training for the dementia nursing
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EVIDENCE BASED PRACTICE ESSAY

workforce. Along with that, another barrier to practice implementation will be the lack of

co-operation from the existing care staff to participate in the education.

References

Aihw.gov.au, (2018).
Dementia Overview - Australian Institute of Health and Welfare.
Australian Institute of Health and Welfare.
[online] Available at:
https://www.aihw.gov.au/reports-statistics/health-conditions-disability-deaths/

dementia/overview [Accessed 10 Oct. 2018].

Brooker, D., & Latham, I. (2015).
Person-centred dementia care: Making services better
with the VIPS framework
. Jessica Kingsley Publishers. Retrieved from
https://books.google.co.in/books?

hl=en&lr=&id=Z8CpCgAAQBAJ&oi=fnd&pg=PA3&dq=why+training+is+required+for+xeme

ntia+nurses+&ots=L3DbjYjo65&sig=Xa2W1lIlt6XRxQPy8XQQxmsOeJE#v=onepage&q=why

%20training%20is%20required%20for%20xementia%20nurses&f=false

Dang, D., & Dearholt, S. L. (2017).
Johns Hopkins nursing evidence-based practice:
Model and guidelines
. Sigma Theta Tau. Retrieved from
https://books.google.co.in/books?

hl=en&lr=&id=SZU6DwAAQBAJ&oi=fnd&pg=PP1&dq=three+pillars+of+evidence+based+p

ractice+clinical+exoertise+patinet+values+&ots=_glSztQpz7&sig=7VvZjMHSMUcNt1N_lVU

6FIaJrfE#v=onepage&q&f=false

Foley, T., & Swanwick, G. (2014). Dementia: diagnosis and management in general

practice.
Irish College of General Practitioners. Quality in Practice Committee.
Retrieved 18
th August 2018, from,
https://www.demenzemedicinagenerale.net/pdf/ICGP_QIP_DementiaJuly2014.pdf.

Hallberg, I. R., Cabrera, E., Jolley, D., Raamat, K., Renom-Guiteras, A., Verbeek, H., ... &

Karlsson, S. (2016). Professional care providers in dementia care in eight European

countries; their training and involvement in early dementia stage and in home

care.
Dementia, 15(5), 931-957. Doi: 10.1177/1471301214548520
Hopkins, W. (2017). Evaluating Nurses' Self-Efficacy in Caring for Patients with

Dementia. Retrieved from

https://scholarworks.waldenu.edu/dissertations/3450/

Mary Benbow, S., Tsaroucha, A., Ashley, M., Morgan, K., & Kingston, P. (2011). Patients'

and carers' views on dementia workforce skills.
The Journal of Mental Health
Training, Education and Practice
, 6(4), 195-202. DOI:
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10.1108/17556221111194536.

Robinson, J. G. (2007). Utilizing best practice in dementia care.
Canadian Nursing
Home
, 18(1), 21. Retrieved 19th August 2018, from,
https://www.broadmeadcare.com/sites/default/files/documents/best%20practices

%20dementia%20care%20-%20cnh.pdf.

Tsaroucha, A., Benbow, S. M., Kingston, P., & Mesurier, N. L. (2013). Dementia skills for

all: a core competency framework for the workforce in the United

Kingdom.
Dementia, 12(1), 29-44. DOI: 10.1177/1471301211416302.
Turner, A., Eccles, F. J., Elvish, R., Simpson, J., & Keady, J. (2017). The experience of

caring for patients with dementia within a general hospital setting: a meta-synthesis

of the qualitative literature.
Aging & Mental Health, 21(1), 66-76. Retrieved 18th
August 2018, from,

http://eprints.lancs.ac.uk/76132/1/Lit_review_ed_revised_submitted_clean_1_.pdf.

Westendorf, S., Vaughn, N., & Duffy, C. J. (n.d). Causes of dementia.
Cerebral
Assessment Systems, Inc
. Retrieved 18th August 2018, from,
https://pdfs.semanticscholar.org/7196/01a2a793c5028cd315d1573a8719e8bf0015.p

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