Evidence-based Interventions for a Patient Suffering from Dementia

Introduction Evidence-based practice has been promoted in all healthcare levels in the NHS (Department of Health, 2012). This is done to ensure that interventions are supported by current evidence in healthcare and have been found to be effective for most patients (Pearson et al., 2009). The use of evidence-based practice is rooted in the belief that patients should only receive quality care (Pearson et al., 2009). The same approach is used when caring for patients with mental health conditions. In the policy, No Health without Mental Health (Department of Health, 2012), the NHS has emphasised that patients suffering from mental health conditions should receive quality and evidence-based care. This brief aims to critically discuss the case of an 80-year old woman who is suffering from dementia and the different forms of interventions that could be applied to the case. Consistent with the Nursing and Midwifery Council’s (NMC, 2008) code of conduct, a pseudonym will be used to hide the identity of the patient. This brief discusses the purpose of evidence-based practice in managing patients with a progressive condition such as dementia. An investigation on the different forms of evidence-based interventions and their potential impact for promoting inclusion would also be presented. A discussion on interventions as means to develop a shared understanding of the patient’s needs would also be done. Legal, ethical and socio-political factors that influence the intervention process would also be explored. Finally, the last part discusses my role as a nurse in the intervention process. Using Evidence-based Interventions for Patients with Dementia The Nursing and Midwifery Council’s (NMC, 2008) Code of Conduct has stressed the importance of delivering quality evidence-based care that is patient-centred. Fitzpatrick (2007a) emphasised that the past model of evidence-based intervention relies only on current evidence from literature to support clinical decisions. Current studies that are of high quality are often used to inform current practices. Fitzpatrick (2007b; 2007c) exmphasised that nurses and other healthcare professionals should have the skills to critically assess the quality of a study and determine whether the findings are applicable to one’s current and future practice. Evaluating the strength of the evidence presented in a research study would require understanding of the search process and whether themes or findings from the study are credible or trustworthy (Polit and Beck, 2010). In recent years, this definition has included best practices, personal experiences of healthcare professional on providi ng care, experiences of colleagues, opinions of experts and current guidelines on a health condition (Fitzpatrick, 2007a; 2007b, 2007c; Greenhalgh, 2010). This new definition embraces other sources of evidence that could be used to help healthcare practitioners and patients make decisions regarding their care. Greenhalgh (2010) specifically points out that while there is reliance on good evidence from published studies, including the experiences of nurses, expert opinion and best practices to aid decision-making would ensure that patients receive quality care. Communicating evidence from published literature is also essential in helping patients decide on the best form of intervention. Morrisey and Calighan (2011) emphasises that effective communication is needed to convey findings of a study in a manner that is understandable to the patient. Successful use of evidence depends first on the quality of relationship between the healthcare providers and the patients (Croker et al., 2013. Kizer (2002) argued that for better care, the relationship between the healthcare professionals and the patients should be strengthened first. Kizer (2002) observe that, â€Å"this intimate relationship is the medium by which information, feelings, fears, concerns, and hopes are exchanged between caregiver and patient† (p. 117). In the UK, The National Institute for Health and Clinical Excellence (NICE, 2006) and the National Collaborating Centre for Mental Health (2007) have provided evidence-based guidelines on how to care for patients with dementia. These guidelines along with current literature, my own and my colleagues’ experiences, expert opinion and the experiences of my patient and her carers will form evidence on the best form of interventions for the patient. My patient’s name is Laura (not her real name). She is 80 years old with dementia, a condition that is progressive and characterized by deterioration of mental state, aggressive behaviour and agitation (Department of Health, 2009). A psychiatric consultant oversees the management of her condition. She has been receiving medications for her dementia but her GP and psychiatrist are discussing alternative drugs to reduce her anxiety level and regulate her sleeping patterns. She is diagnosed with type 2 diabetes and is mobilised with a frame following a broken hip. While she is still lucid and can communicate clearly, it is a challenge to care for her during nighttime when she becomes more anxious and shows signs of confusion. Patients with dementia suffer from progressive cognitive impairments (Department of Health, 2009) that could have an impact on how they receive information from their healthcare professionals and carers and in their adherence to medications. In the case of my patient, she is now showing signs of advanced dementia (NICE, 2006). This could be a challenge since her ability to refuse treatment or engage in healthcare decisions is severely reduced (Department for Constitutional Affairs, 2007). In the UK, the Mental Health Act 2007 (UK Legislation, 2007) and the Mental Capacity Act (Department for Constitutional Affairs, 2007) serve as guides on how to care for patients with mental health conditions such as dementia. These acts serve to protect the rights of the patient by locating a representative of the patient who could decide on her behalf. Hence, any interventions introduced for the patient should be agreed by the patient’s immediate family members or appointed guardian (Depart ment for Constitutional Affair, 2007). Since dementia is a progressive condition that could eventually lead to palliative care, the nurses have to ensure that the patient receives appropriate support during the trajectory of the condition. In my patient’s case, she needs immediate interventions for anxiety and sleep disturbance. She is also currently taking medications for her type 2 diabetes. The NICE (2006) guideline has stated the use of psychological intervention for patients with dementia. These include cognitive behavioural therapy, which will include the patient’s carers, animal-assisted therapy, reminiscence therapy, multisensory stimulation and exercise. Evidence-based Interventions and Potential Impact for Promoting Inclusion A number of studies (Casartelli et al., 2013; Monaghan et al., 2012; Ewen et al., 2012) have shown that exercise could improve the mobility of patients following hip surgery. Most of these studies use the randomised controlled trial study design, which ranks high in the hierarchy of evidence (Greenhalgh, 2010). This type of design reduces selection bias of the participants and increases the credibility of the findings of the study (Polit and Beck, 2010). The NICE (2013) guideline for fall also supports exercise intervention for improving patient’s mobility. My patient Laura is using a frame to aid her walking following a fall and an exercise intervention would improve her mobility. Considering that Laura is also suffering from anxiety, I counseled with the carer that we might consider an exercise intervention to both manage anxiety and improve mobility of the patient. This was well-received by the carer who expressed that they could help the patient with a structured walking e xercise. Meanwhile, cognitive behavioural therapy (Kurz et al., 2012; Hopper et al., 2013) has also been shown to be effective in reducing anxiety amongst patients and in regulating sleep behaviour. This form of intervention was also introduced to Laura and her carer. A programme was created where she would receive CBT on a weekly basis. It should be noted that the psychiatrist and the GP in the healthcare team are considering on alternative pharmacologic therapy to regulate sleeping behaviour and anxiety of the patient. While this might have a positive effect on the patient, it should be noted that medications for anxiety have side effects. For instance, the acetylcholinesterase inhibitors such as rivastigmine, galantamine and donepezil are known to have side effects on the cognition of patients (Porsteinsson et al., 2013; Moncrieff and Cohen, 2009). As a nurse and part of the team, I suggested to the team to consider the effects of pharmacologic interventions on the patient. Further, the NICE (2006) guideline also states that only specialists, that include GPs specialising in elderly care or psychiatrists, should initiate pharmacologic interventions. This guideline also emphasises that the Mini Mental State Examination (MMSE) score of the patient should be between 10 to 20 points. In Laura’s case, she is pro gressing from moderately severe dementia to its severe form. Introducing pharmacologic interventions might only worsen the cognitive state of Laura. Meanwhile, there is strong evidence from a systematic review (Filan and Llewellyn-Jones, 2006) on the effectiveness of animal-assisted therapy in reducing psychological and behavioural symptoms of dementia. A systematic review also ranks as high as randomised controlled trials in the hierarchy of evidence (Greenhalgh, 2010). Findings of Filan and Llewellyn-Jones (2006) also reveal that it can promote social behaviour amongst patients. This form of therapy was initially considered in Laura’s case due to its possible effects on the sleep behaviour of the patient. However, current evidence is still unclear on whether the effects could be sustained for prolonged periods. In application to my patient’s case, the use of animal-assisted therapy might be difficult to carry out since the patient has to depend on a carer for her daily needs. However, our team decided on using music therapy for the patient. Similar to animal-assisted therapy, there is also strong evidence on the e ffectiveness of music therapy in managing anxiety, depression and aggression amongst patients with dementia (Sakamoto et al., 2013; Wall and Duffy, 2010). Importantly, cognitive behavioural and music therapies and exercise interventions all promote inclusion of the patient in the care process (Repper and Perkins, 2003). In cognitive behavioural therapy, the patient and her carer receive support on how to manage anxiety and sleeping behaviour. Since carers are highly involved during CBT, there is a higher chance that the intervention would be successful (Hopper et al., 2013). It has been shown that carers of patients with chronic conditions such as dementia are also at risk of developing depression and anxiety (Department of Health, 2009). Smith et al. (2007) explain that this might be due to the realisation that the patient would not recover from the illness. Further, these carers have to prepare themselves for the patient’s end-of-life care. All these realisations could influence the carer’s own mental health (Smith et al., 2007). Hence, it is important that interventions are not only holistic for the patient, but should also include the carers in the process. Hence, implementing CBT would promote inclusion in practice (Wright and Stickley, 2013). The patient in my care is also suffering from type 2 diabetes. Pharmacologic interventions would include metformin and insulin therapy (NICE, 2008). Non-pharmacologic interventions include exercise, behavioural modification and diet. This presents a complex problem for Laura since it has been shown that elderly patients are also at greatest risk of malnutrition due to the aging process (Department of Health, 2009). Patients with dementia could experience feeding behavioural problems. When patients are admitted in hospitals, the new environment and lack of social interaction with peers could act as triggers in behavioural problems (Department of Health, 2009). Since patients might lack the cognitive ability to express themselves, this might present as aggressive behaviour (NICE, 2006). Hence, ensuring that Laura receives appropriate nutrition during her hospital stay could be influenced by changes in her behaviour. It is important that patients with type 2 diabetes do not only receive pharmacologic interventions but should also have sufficient diet. This is seen as a challenge in Laura’s case since she could experience feeding problems due to loss in cognitive abilities. For instance, she might be reminded on how to chew food or why she needs to eat (Department of Health, 2009). In patients with severe forms, the main aim of feeding is now focused on comfort feeding rather than allowing patients to eat the proper amount of food (Department of Health, 2009). Hence, managing Laura’s type 2 diabetes through proper feeding would be an added challenge to her care. Legal, Ethical and Socio-Political Factors that Influence the Intervention Process Decisions on the care and interventions received by the patient are influenced by several factors. First, the Mental Health Act 2007 (UK Legislation, 2007) states that patients with mental health condition could seek voluntary admission to hospitals and leave whenever they want. This Act also states that patients could only be forced to receive treatment in hospital settings if they are detained under this Act. Laura and her carer could refuse treatment or interventions at any point of her care and my team and I would respect her decision. Observance of this provision under the Mental Health Act would also be consistent with patient-centred care where patients are empowered to act for own benefit and to choose appropriate interventions. Apart from the legal aspects that influence the delivery of interventions, ethical issues should also be observed. In the ethics principle of beneficence, nurses and ot her healthcare practitioners should ensure that the interventions would be beneficial to the patient (Beauchamp and Childress, 2001). In Laura’s case, all the interventions cited previously have been shown to be beneficial to the patient. Only the pharmacologic interventions are associated with adverse and side effects for the patient (Popp and Arlt, 2011). Hence, as a nurse, I lobbied for inclusion of non-pharmacologic interventions instead of reliance on anticholinergic drugs to control the patient’s behaviour. In addition to beneficence, Beauchamp and Childress (2001) also add the ethics principles of autonomy, non-maleficence and justice. In Laura’s case, her autonomy would be respected. Allowing patients to participate in the decision-making process is crucial. However, patients with dementia suffer from cognitive impairments that could influence their decision-making ability (Wright et al., 2009). In accordance with the Mental Capacity Act 2005 (Department for Constitutional Affairs, 2007), the carers of Laura could be appointed to act on her behalf. In non-maleficence, the main aim of the interventions is to promote the health of the patient. There are no known side effects of the psychosocial and exercise interventions. Justice will be observed if Laura receives tailored-interventions that would address her needs. It is important that regardless of the patient’s background, religion, race, gender, ethnicity, she should receive healthcare interventions fit for her needs. This ethics principle is observed since a healthcare team has been addressing Laura’s healthcare needs. While all interventions are patient-centred, socio-political issues that could influence the interventions include the recent changes in the NHS structure where local health boards are primarily responsible for allocating funds to healthcare services (Department for Constitutional Affairs, 2007). Hence, if dementia care is not a priority in the local health board, health programmes for dementia might not receive sufficient funding. This could pose considerable problems for the elderly who are dependent on the NHS for their care. Laura has been receiving sufficient support for her mental health condition. This demonstrates that dementia care remains a priority in my area of care. A survey of the support system in my community reveals that support groups for carers are available. This is essential since supporting carers is also a priority in the NHS (National Collaborating Centre for Mental Health, 2007). Role of the Nurse in the Intervention Process On reflection of the case, I have a role to coordinate care with other team members and to ensure that the patient receives patient-centered care. As a nurse, I have to adhere to the NMC’s (2008) code of conduct and observe patient safety. Recognising that dementia is a progressive condition, I should also focus on interventions that not only addresses the current behavioural problems of the patient but also on preparing the carer and Laura’s family members on palliative care. The NICE (2006) guideline has stated that nurses have an important role in preparing patients of dementia and their family members on end-of-life care. This could be a highly stressful stage in the patient’s disease trajectory or could be one of acceptance and peace for the family. As a nurse, I have to ensure that interventions are appropriate to the stage of dementia that the patient is experiencing. Since nursing is a continuing process, I have to inform the family members that the patie nt will increasingly lose her cognitive abilities and would have difficulty feeding in the last stages of the condition (National Collaborating Centre for Mental Health, 2007). I have to ensure that the patient receives both spiritual and physical support at this stage. Evidence-based care is crucial in ensuring that patients receive the appropriate intervention. In my role as a nurse, I have to ensure that interventions are acceptable to the patient. I should also consider the preferences of the patient, their past experiences and their own perceptions on how to best manage their condition. Since I would be caring for a patient with declining cognitive abilities, I should ensure that her dignity would be maintained (Baillie and Gallagher, 2011). As part of my future learning development, I will attend courses on how to conduct end-of-life care for patients with dementia. Through Laura, I realised that a patient’s dignity should always be observed. It is recommended that in my future and present practice, I will continue to rely on literature on the best form of interventions of my patient. I will also consult with my colleagues, seek expert opinion and the patient’s experiences on how to choose and deliver interventions. Conclusion Evidence-based practice is important in helping patients achieve quality care. In this case, Laura is an 80-year old patient with dementia. She exhibits the moderate form of the condition but is beginning to show signs of advance dementia. As her nurse, I have the duty to observe ethics in healthcare and to seek for interventions that are evidence-based. However, I also realised that other factors also influence the delivery of interventions. These include socio-political, legal and ethical factors. As a nurse, I have to protect the patient’s rights, act as her advocate and ensure her safety during the trajectory of the condition. For future practice, I will continue to practice evidence-based practice. I will also encourage others in the mental health profession to always consider the patient’s preferences when caring for patients with dementia. When patients are unable to decide for their own care, the carer of the patient could act on her behalf. Finally, as a mental health nurse, I should constantly update myself with the best form of interventions for patients with dementia. This will ensure that my patients will receive evidence-based interventions. References Baillie, L. & Gallagher, A. (2011). ‘Respecting dignity in care in diverse care settings: Strategies of UK nurses’. International Journal of Nursing Practice, 17, pp. 336-341. Beauchamp, T. & Childress, J. (2001). Principles of biomedical ethics. 5th ed. Oxford: Oxford University Press. 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How Biofuels Benefit the Economy - Research Paper Example Production of biofuel is an advantage to the economy because it helps the economy in different aspects (Environmental and Water Resources Institute U.S. 3). It is a cleaner source of energy compared to the other sources for instance the petroleum sources. This indicates that the environmental concerns are taken care of and the health of individuals is not at risk. Many people spend a lot of their income by paying for their health facilities but, with the use of biofuels, one is able to save the amount of money he or she earns. The saved funds can be channeled to other uses among them investment, a situation that would have otherwise not occurred. Health care provisions to cater for complexities that result from forms of energy used are expensive. On the same note, meeting health care insurance premiums may prove difficult because the insurance firms often deny covers to people with pre-existing conditions. Making the right choices of energy; in this case biofuels rules out such occur rences. When compared to other conventional sources of energy, biofuels are the best because they offer cleaner gases than the rest (Yeo 52). The economic benefits of biofuels fall into two categories. They are the benefits which outsmart the fuel production by fossil fuels and the economic benefits that establish a viable and sustainable biofuels industry which uplifts the developing countries (Worldwatch Institute 132). Whichever the case, the benefits of biofuels in the economy cannot be refuted. It is important to note that challenges and opposition have been raised against the use if this type of fuel. However, the central point of argument revolves around what biofuels will do for the economy. The economy is not a stand-alone aspect in the context of this analysis. Both social and environmental aspects fall into place in the evaluation of the benefits of biofuels. The government also must be accounted for, given the fact that it plays a central role in determining the pace of economic growth and development. All these factors are therefore intertwined, and the benefits of biofuels to the economy are felt across all the aspects identified. Energy security for countries like the United States which uses a lot of energy annually is safe from expensive purchase of oil as an energy source from other foreign companies. This is because reliance on imports makes the country suffer a great deal of its income by purchasing a commodity they can produce, given the resources available in the country. The economy of the country hence preserved for taking care of other concerns in the country (Keystone BioFuels Inc.). What this means for an economy that uses biofuels is that, domestic capacity utilization is maximized, thereby triggering high economic performance. Resource allocation to the energy sector is undercut, allowing for increased allocations to other sectors of the economy that previously received lesser allocations in a bid to finance fuel importation. First generation biofuels save up to sixty percent of carbon emissions, which are a, risk to the environment and health art large. The second generation biofuels save up to eighty percent of carbon emissions, which reduces the, health risks by a great percentage. Economy benefits greatly from the biofuels because they create an expansion of more job opportunities (Environmental and Water Resources Institute U.S. 3). Due to this technological advancement country has wanted to

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MBA Admission essays - Essay Example Many students plagiarize and are caught. The truth is that in order to provide depth of research, a writer will need to combine primary and secondary sources. In the sciences, for example, raw data is important, but how that data has been interpreted by others, over the years, is also very significant. You need to cite that work and not merely present it as your own. It is important to use academic libraries, online databases such as ProQuest, and Google Books and Scholar, in order to find these sources and put them into action. Beware collecting or holding on to irrelevant information, which is sometimes a temptation. It is easy to get sidetracked and create a â€Å"bulge†Ã¢â‚¬â€a part or paragraph of the essay that has no real connection with the thesis. It is also easy to forget where your work starts and where someone else s begins. That is how a lot of plagiarism begins. You copy a lot of quotes into your paper hoping to use them and cite them properly, but over the week s you begin to forget what work is yours and what work is not. There are many examples of this happening to students (Richardson). An article by Sue McGowan and Margaret Lightbody provides a lot of useful information about plagiarism and its consequences. The authors of this paper are deeply concerned about it. They suggest that instead of threatening to punish students who plagiarize work, a more effective approach is to educate them about the affects and consequences of plagiarism. The authors describe an experiment to help educate accounting students. The study asked students a number of important questions relating to plagiarism. For example, when is it necessary to cite references. What does it mean to paraphrase? What are the potential punishments or disciplinary actions for performing an act of plagiarism? The authors concluded that providing students with an incentive to put references in their work is a good way to avoid acts of

Mercedes Benz Essay Example | Topics and Well Written Essays - 4000 words

Mercedes Benz - Essay Example The growth of this particular car has not only altered the popularity and mechanics of the car. It has also enabled the identity of the company and the brand to build a stronger reputation and to create the necessary components to creating the ideal car for a specific social group. The result is the brand image being able to enhance the growth and strengths of the company while attracting a specific type of consumer to the car. This paper will examine the brand performance of the car as well as how it is continuing to affect the performance of the company. Overview of Mercedes Benz The Mercedes Benz is often referred to as a luxury car and is noted as an international car that carries style and class. The manufacturer is based in Germany and is noted for making cars, buses, coaches and trucks. The primary company is Daimler AG with the Mercedes Benz being a division of the company, specifically because of the style and make of the car. The first car was built in 1926 by Karl Benz but links back to 1886 with Kent Benz’s first introduction of the automobile. This particular model was combined with the Mercedes, created in 1901 by Wilhelm Maybach, both which were combined and patented in 1926 for the Mercedes Benz model. The first features which were noted included the approach to safety with the model as well as the approach of using the latest technology for the vehicle. The introductions which were initially created have led to the automobile becoming one of the most popular and distinguished vehicles as well as the oldest model that is still made and up graded with cars today (Mercedes Benz, 2011). The Mercedes Benz is not only noted for the different components with the history but has also developed a strong reputation which has led to growth within the branch of the company. There are currently three divisions of the Mercedes Benz, including the AMG, McLaren and Studebaker – Packard. The difference between each of these is based on the car production which is offered as well as the designs which are used. The main company is the AMG, which consists of the older make and model. The McLaren expanded this into the luxury vehicles that are based on sports cars and specialized engines which can be used for racing. The third branch, Studebaker – Packard, was in existence until 1986 and consisted of the US division of the company and car models which were used. Each division is noted for the high – quality materials which are used with factories being placed in over 10 regions throughout the world, all which lead t o the cars being rated above average and five star quality. The innovations that are combined with this include upgrades to engines, fuel efficiency, safety cell construction, traction control, electronic stability programs and power engines. This has allowed the Mercedes Benz to keep a strong reputation with innovation and safety as the main features that are associated with the car (Mercedes Benz, 2011). Competitors The competitors that are associated with the Mercedes Benz have the same approach to innovation, safety and a high – quality, luxury car that is used. BMW, Audi, the Porsche, Cadillac and Lexus are the top five competitors that Mercedes Benz is known to compete with. Currently, the BMW and Mercedes Benz are fighting for the top award in luxury vehicles at an international level. However, the Porsche and Audi are well – known through various social circles as being of luxury and containing specific features that are able to compete with the high –