Integrative Review: Nursing Experiences with Dementia Patients

This report is an integrative review focusing on the challenges nurses face when caring for older adults with dementia, particularly those exhibiting responsive behaviors in acute care settings. The review synthesizes findings from multiple research articles, exploring nurses' perceptions of providing care to this patient population and identifying strategies for improving dementia care. The study highlights the prevalence of behavioral and psychological symptoms of dementia (BPSD), such as aggression and agitation, and their impact on nursing practice. It examines the difficulties nurses encounter, including workforce challenges, and explores interventions like Marte Meo counseling to enhance nurses' understanding and ability to manage these behaviors. The report aims to address the gaps in previous research by expanding the scope of target populations and interventions, ultimately seeking to improve patient outcomes and job satisfaction for healthcare professionals. The methodology includes a systematic review of relevant literature, incorporating search strategies, database collection, quality appraisal, data abstraction, and synthesis to provide a comprehensive overview of the current state of knowledge and identify areas for future research and practice improvements.

Running head
TITLE
TITLE
Name of the student
Name of the university
Author note

1TITLE
Abstract
A group of symptom causing behavioral abnormalities and called dementia and prevalent in
older population. The disorder leads to unpredictable behavior of the patient that include
violence make their treatment challenging for nurses. The paper is a review article based on
the six selected articles that are relate to dementia and the treatment challenges concerning
the aggressive behavior. The study will give a detailed knowledge about the background and
the gaps of the previous studies that are expected to fill up by the review article. The review
article also include the standard search strategy, database collection, methodology and quality
appraisal.
Keywords: Dementia, BPSD, Nursing challenges, Quality, Older patient

2TITLE
Table of Contents
Introduction:...............................................................................................................................3
Background:...............................................................................................................................4
Discussion of the problem:.....................................................................................................4
The review:.................................................................................................................................5
Aim:........................................................................................................................................5
Design:...................................................................................................................................5
Search Method:......................................................................................................................5
Search outcomes:...................................................................................................................6
Quality appraisal:...................................................................................................................7
Data abstraction:.....................................................................................................................7
Synthesis:...............................................................................................................................7
References:.................................................................................................................................8

3TITLE
Introduction:
Dementia is defined by cognitive disabilities which include memory, reasoning,
organizing, critical thinking, and social and emotional functioning. Behavioral and
psychiatric signs of dementia (BPSD), such as fatigue, distress, aggression / agitation, and
apathy. Dementia prevalence rises with age, and a substantial percentage of medical patients
suffer from dementia. Older patients are more often referred to hospitals than most other age
categories and up to 70% of individuals in hospital who need emergency medical treatment
are over 65 years of age. Ninety-seven per cent of nurses admitted that taking care of patients
with dementia is most frequent due to the higher number of patient. In 2016, nearly 56,000
people suffering with dementia were admitted to Canadian clinics, with 75% exhibiting
insensitive behaviors. Responsive activities are expressions or acts that are used to convey
one's desires can be wandering, shouting, punching and agitation. Healthcare practitioners
consider these aggressive habits as a difficulty when caring for individuals with dementia.
The review will focus on the gaps and limitation of the previous studies based on the
behavioral obstacle in dementia patient affecting the quality of care. The relevance and the
importance of the study can be understood considering the huge number of patient admitted
in the hospital with dementia and the self-reported reaction with the health service provider
about the challenges they face while giving care to the dementia patients due to their
destructive behavior.
The review will address an extensive research on the quantitative data keeping on
mind the liability of the data, which will serve as the background study of the review. The
study aimed to solve the ongoing conflict between the caregiver and the dementia patient to
ensure effective treatment for patients and job satisfaction for health professionals.

4TITLE
I selected the topic as to right my review article as I find the topic very much relevant
to the present day situation and to ensure the wellbeing of the older people with dementia it is
crucial to identify the core issue.
Background:
Discussion of the problem:
Physical agitation, shadowing, aggressive vocalization, agitation, treatment
avoidance, wandering, and sexual activity are typical in moderate or severe stage dementia
behavioral symptoms. these behavioral and psychological are the Clinical manifestations of
dementia (BPSD) that are clarified by the disruption to brain systems and the subsequent
gradual, regional mental decline making it difficult for the nurses to give effective care
(Nolan, 2006). A research tried to explain the perspectives of patients caring for individuals
with BPSD in LTC, and approaches utilized by clinicians to resolve such symptoms. And the
finding endorse the low workforce related challenges faced by the nurses in the field of care
giving to dementia patients (Fukuda, Shimizu & Seto, 2015). Another research notes that care
for the elderly with dementia in a positive way was viewed as involving a friendly interaction
with the individual as an individual and not as only a patient (Ostaszkiewicz et al., 2015).
However, the challenge lies for the nurses in the skill development as there has no enough
skill development courses that can be acquired while working in a hospital. The applied
intervention for solving is issue is considered as the MMC in a recent report. Marte Meo
counseling (MMC) is a approach introduced in recent years to facilitate understanding and
enhancement of workers 'internal contact and engagement with dementia patients. The result
is promising as it is found that the MMC participant nurses shared a deeper understanding
and recognition of the difficulty of dealing with people with dementia and the value of
actively integrating supportive roles while engaging with them (Einang Alnes, Kirkevold &
Skovdahl, 2011, Pinkert et al., 2017).

5TITLE
The review study aimed to fill the gap of the background support literatures by
expanding the range of target people and application of multiple program like MMC to
identify the most effective program. The previous researches are based on a selected patient
type and considered only any particular type program to enhance the nursing Capability. This
gap should be filled as multiple factors needed to draw a sharp and standard research study.
Research question 1: What are the core issues associated with the Behavioral and
physiological symptoms of dementia or BPSD and related challenges of nurses?
Research question2: How much the programs like MMC will improve the understanding of
nurses about the aggressive behavior of dementia patient?
The review:
Aim:
The aim of the study is to identify the to understand the effectiveness of interventions
such as MMC to enhance nurses 'awareness of the violent behavior of patients with dementia.
The huge literature review supports the claim of nurses about the challenges they face to give
care to the dementia patient during caregiving. The further aim of the paper is to understand
the primary factors and factors associated with the BPDS of dementia patient to resolve the
problem from the root.
Design:
The article chosen for the literature review must be scientific and published in liable
journals. The design are based on conceptual Review by selecting some related article to
dementia, BPSD and nursing challenges. The whole study is primarily a systematic review
considering both the qualitative meta analysis and quantitative analysis.

6TITLE
Search Method:
The database collected are dependent on the secondary data collection available in the
electronic media or as printed and published form. The keywords used in the process are
dementia, nursing challenges, Behavioral and physiological symptoms of dementia, BPSD,
older population with dementia, hospital admission, aggressive behavior, and so on. The
search is limit was set by customizing the date to take only recent literatures and renowned
publications.
Search outcomes:
By applying the limitation filters I got 100 articles related to the topic. From the 100
articles I again applied three key words that are dementia, BPDS, Nursing challenges of
dementia, older people with dementia. The outcome is 30 articles. The final six article is
selected by reviewing the abstract section of each article and six most relevant articles are
chosen.
Search Outcome: Flow
Diagram
Name of Databasen = x Name of Databasen = x Name of Databasen = x
Total number of articles
identified by search strategy
n = x
Total number of articles
retained after removal of
duplicates
n= x
Title & Abstract
ReviewNumber of articles
retained n=x
Full Text Review
Number of articles retained
n=x
Quality Appraisal
Number of articles
rejectedn=x
Exclusion Criteria Used::
i.ii.Iii. etc
Number of articles rejected
n=x
Exclusion Criteria Used:
i.ii.Iii. etc
Number of articles rejected
n=x
Research articles from
manual searchn = x

7TITLE
Quality appraisal:
The study used qualitative and quantitative data and the data are dependent on the
scholar articles published in liable sources like sage and PubMed. They are also peer
reviewed articles. The question framed as research questions are also vital and valid
concerning presence scenario and background study. There are less possibility of error as the
study excluded the that article lacking nursing priorities, old and not peer reviewed.
Data abstraction:
Data abstraction primarily focused on the reduction of keywords and limiting the time
scale to recent years.
Synthesis:
The final outcome is six article matching all the criteria including the keywords and
the time scale.
Number of articles = X

8TITLE
References:
Einang Alnes, R., Kirkevold, M., & Skovdahl, K. (2011). Insights gained through Marte Meo
counselling: experiences of nurses in dementia specific care units. International
Journal of Older People Nursing, 6(2), 123–132.
https://doi-org.ezproxy2.library.usyd.edu.au/10.1111/j.1748-3743.2010.00229.x
Fukuda, R., Shimizu, Y., & Seto, N. (2015). Issues experienced while administering care to
patients with dementia in acute care hospitals: A study based on focus group
interviews. International Journal of Qualitative Studies on Health & Well-Being, 10,
1–N.PAG. https://doi-org.ezproxy2.library.usyd.edu.au/10.3402/qhw.v10.25828
Nolan L. (2006). Caring connections with older persons with dementia in an acute hospital
setting -- a hermeneutic interpretation of the staff nurse’s experience. International
Journal of Older People Nursing, 1(4), 208–215.
Ostaszkiewicz, J., Lakhan, P., O'connell, B., & Hawkins, M. (2015). Ongoing challenges
responding to behavioural and psychological symptoms of dementia. International
nursing review, 62(4), 506-516.
Pinkert, C., Faul, E., Saxer, S., Burgstaller, M., Kamleitner, D., & Mayer, H. (2017)
Yous, M.-L., Ploeg, J., Kaasalainen, S., & Martin, L. S. (2019)