Weighing the Evidence

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In Caring for Patients with Dementia, Is It More Effective to Provide One on One Staffing Versus Utilizing Lock Door Units to Reduce Injuries?

Adenike George

Walden University

Determining the Most Appropriate Means of Caring for Dementia Patients. Between One on One Staffing Versus Utilizing Lock Door Units to Reduce Injuries

The intent of this paper is to analyze and describe five sources that offer evidence on the PICOT question. The paper uses articles categorized as level 1 and 2 according to the quality of information available. There are three level 1 papers and 2 level 2 papers. The PICOT question states that in an acute Mental Health unit, what is an effective treatment plan to prevent injuries and promote safety for the demented patients? A review of previous research is imperative for best practice and evidence-based practice and is in line with the sentiments expressed by Polit and Beck (2017).

Article #1

The first article is research conducted by Sampson et al. (2014) that focuses on investigating the prevalence of behavioral and psychiatric symptoms among individuals with dementia. According to the researchers, dementia is often experienced among older persons who are admitted to acute hospitals. Understanding the behavioral and psychiatric symptoms of these patients can be vital in reducing the challenges experienced by hospital personnel in caring for these patients. Sampson et al. (2014) used a longitudinal cohort approach that involved 230 individuals suffering from dementia. All participants were above seventy years and had acute illnesses. The study found that there was high impairment of the respondents. Seventy-five percent of the respondents were found to have behavioral and psychiatric characteristics that made it difficult for the hospital personnel to offer services. Most showed aggression, activity disturbance, sleep disturbance, and anxiety. Sampson et al. (2014) conclude that the hospital staff could benefit from specialist psychiatric services. The study can be categorized as level 1 due to the use of primary data and a significant population study that guarantees the results were representative of what happens in the hospital setting.

Article #2

The secord paper by Ziegenbein, Anreis, Brüggen, Ohlmeier, and Kropp (2006) allude that hospital emergency departments often offer services to individuals with psychiatric problems. In this context, the medical staff working in emergency rooms are faced with the challenge of deciding whether to admit or treat these people as outpatients. The study used the Central Interdisciplinary Emergency Department (CED), which provided data on psychiatric treatments in the Medical University of Hannover. The research is imperative in understating how the patients are admitted and how the students are engaged. The study found that among the 2632 patients who visited the Medical Centre for psychiatric treatment, 51.4% ended up as inpatients. Additionally, patients with dementia were often admitted compared to other psychiatric illnesses. According to Ziegenbein et al. (2006), the patients were admitted due to the high probability of them committing suicide. The findings show that restraining measures and acute conditions also influenced the rate of patients being admitted. The study can be categorized as a level 1 source due to its use of credible data that has been collected over a long period.

Article #3

The third study by Lyketsos, Sheppard, and Rabins (2000) was focused on investigating the prevalence of dementia in a general hospital setting to identify the reasons why individuals with dementia are admitted and the link that exist between the illnesses and length of stay in the hospital, costs, and in-hospital mortality rate. Lyketsos et al. (2000) used data from the hospital database gathered between 1996 and 1997. The study focused on patients above sixty years, who totaled up to 21,251 patients. The investigators found that the prevalence of dementia among the discharged individuals was at 3.9% and age influenced it. The patients stayed in the hospital for a mean of 10.4 days, and their expenses were $4000 more compared to other patients. The study concluded that dementia is widely experienced among patients admitted to the general inpatient units. Lyketsos et al. (2000) suggest that early identification of dementia can be imperative in improving caregiving and reducing costs for the patients. The study can be categorized at level 1 due to the quality of data used. It also does not offer imperative information on the financial implications of dementia, which have not been widely explored by researchers.

Article #4

The fourth research by Spencer, Foster, Whittamore, Goldberg, and Harwood (2013) is focused on examining the perspectives, attitudes, and experiences among caregivers for individuals with dementia in the general hospital. The researchers compare a Specialist Medical and Mental Health Unit (MMHU) with normal health care center wards. Spencer et al. (2013) employ a qualitative approach implemented using randomized controlled trials. Semi-structured interviews were employed to gather information among the caregivers handling patients with mental illnesses admitted to the institution. The study was conducted over four months, and it involved forty participants. The researchers found that the main themes emerging from the research that was related to family caregivers touched on issues of boredom, practice skills and experiences, self-respect, vital care, hospital setting, and low of information between the medical personnel. Caregivers from the specialized unit showed that they were aware of appropriate management of dementia. Also, they were aware of the need for improvements in offering services, the ward, and staff knowledge. Nevertheless, the research found that communication and engagement of family caregivers were perceived to be insufficient. Spencer et al. (2013) conclude that specialized care is more effective in offering the best practice services and improving the environment for the medical personnel. The research can be ranked at level 2 as it explores the issues faced by the patients and the best approach for staff to engage in offering services.

Article #5

The fifth study conducted by Fukuda, Himizu, and Seto (2015) identifys that dementia is a major public health problem, which has led many people to be admitted to acute care hospitals. The researchers focused on the challenges faced by caregivers to offer services for patients with dementia in acute care institutions in Japan. The study used a qualitative approach that included focus group interviews among six acute hospitals in the country. The respondents were nurses working in surgical and internal medicine wards except those in intensive care units. The study was conducted between February and December 2008. Fifty nurses were engaged in the research. Fukuda et al. (2015) identified seven groups of issues that faced patients with dementia. The issues included problematic patient behaviors, a recurrent problem, and issues affecting various individuals that ended up forming a burdensome cycle. The issues were attributed to the lack of experience and challenges in the organization in the hospitals. The nurses coped with these issues by developing protection plans for themselves and the institution. Conclusively, Fukuda et al. (2015) suggest that issues in offering services for dementia patients are due to interactive issues that become burdensome. Nevertheless, the caregivers reported that they did their best to adapt to these conditions. The paper can be ranked as level 2 due to the quality of data that offers a clear indication of the situation in caregiving for dementia patients.

Consistencies Inconsistencies and Contradictions

All sources show that dementia is a key issue affecting patients and their families. Additionally, dementia patients pose significant challenges to the medical personnel. The issues faced by the caregivers are associated with patients being admitted to the hospital, and the investigation is carried out using different research approaches. While other studies address dementia among different ages, Sampson et al. (2014) and Lyketsos et al. (2000) offers a specific approach that focuses on dementia among the elderly. The researchers in the two studies concluded that dementia is highly experienced by older people. Unlike other studies that gather primary data or use secondary sources for the research, the research work by Ziegenbein et al. (2006) and Spencer et al. (2013) utilizes the information provided by hospitals to conduct their investigations. Despite the rich data available for these studies, the data is from different periods and involves a huge population, increasing the chances of errors occurring. Additionally, the data might have been compromised by other stakeholders. Nevertheless, the information is imperative because it provides a wider perspective on how admitted patients interact with the staff and the challenges faced, which have not been highlighted by other studies selected for the paper. Fukuda et al. (2015) used a different approach than other studies by focusing on issues faced by the nurses by engaging them directly. The study offers a fresh perspective by gathering data from the caregivers who interact with the patients on a daily basis. Unlike other studies, this study offers a better approach in understanding the importance of nursing in offering care for the Dementia patients.

Summary

The literature review and these sources are key in answering the PICOT question In an acute Mental Health unit, what is an effective treatment plan to prevent injuries and promote safety for the demented patients? All sources show consensus that dementia is a major challenge among patients admitted in the hospital. There are many issues that emerge from admitting these patients that make it hard for caregivers to engage in the practice appropriately. The issues include behavioral and psychiatric problems among the patients. Although nurses try to deal with these issues, they are often challenging making it appropriate to seek specialized care. In this light, specialized institutions and personnel offer the best care for dementia patients. In this light, a one on one approach to care giving is much better in caring for dementia patients to prevent injuries compared to other approaches proposed.

References

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 and Well-Being, 10(25828)), 0–13.

Lyketsos, C. G., Sheppard, J. E., & Rabins, P. V. (2000). Dementia in Elderly Persons in a General Hospital. The American Journal of Psychiatry, 157(May), 704–707.

Polit, D. F., & Beck, C. T. (2017). Nursing research: Generating and assessing evidence

for nursing practice (10th ed.). Philadelphia, PA: Wolters Kluwer Health/ Lippincott Williams & Wilkins.

Sampson, E. L., White, N., Leurent, B., Scott, S., Lord, K., Louise, J. R., & Jones, L. (2014). Behavioural and psychiatric symptoms in people with dementia admitted to the acute hospital: Prospective cohort study. British Journal of Psychiatry, 205(3), 189–196.

Spencer, K., Foster, P., Whittamore, K. H., Goldberg, S. E., & Harwood, R. H. (2013). Delivering dementia care differently — evaluating the differences and similarities between a specialist medical and mental health unit and standard acute care wards : a qualitative study of family carers ’ perceptions of quality of care. BMJ Open,3(12).

Ziegenbein, M., Anreis, C., Brüggen, B., Ohlmeier, M., & Kropp, S. (2006). Possible criteria for inpatient psychiatric admissions: which patients are transferred from emergency services to inpatient psychiatric treatment? BMC Health Services Research, 6(1), 150.