Care Methodology For The First Stage of Dementia Essay

Evidence-based practice (EBP) is heavily promoted in the NHS since this helps nurses and other healthcare practitioners apply findings of recently published literature to one’s current and future practice. The Nursing and Midwifery Council’s (NMC, 2008) code of conduct also emphasises that healthcare decisions should be evidence-based and supported by published literature and current guidelines. Developing the ability to critically analyse literature is essential when developing evidence-based care (Greenhalgh, 2010; Aveyard, 2014). There is a wealth of information from published literature and current guidelines. Determining the relevance and quality of these findings will help inform nurses whether findings are credible and valid before they are applied to current practice.Care Methodology For The First Stage of Dementia Essay

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As part of community nursing, I am interested in improving my current practice in order to deliver quality care to my patients. The recent policy on community care from the Department of Health (2013a) emphasises the importance of allowing patients with chronic conditions and their carers to self-manage their conditions, achieve self-efficacy and lessen admissions in hospital settings. This policy, “Care in Local Communities-District Nurse Vision and Model’ (Department of Health, 2013a) emphasises the role of nurses in supporting patients and their carers to improve their health outcomes. While it is acknowledged that patients with chronic illnesses may never recover from their condition, nurses have the responsibility to help patients or their carers manage signs and symptoms of the chronic illness.Care Methodology For The First Stage of Dementia Essay As a nurse in community setting, I have cared for patients with dementia. I saw how this condition impacts the patient’s quality of life and even increase the risk of depression amongst their carers (Talbot and Verrinder, 2009). I always had an interest in caring for patients with dementia. However, I noticed that most pharmacologic treatments have little effect in delaying the progression of cognitive impairments amongst these patients (Miller, 2009). These treatments are also costly and place a considerable burden on the family members and the NHS (Department of Health, 2013b). Hence, I thought that familiarising myself with non-pharmacologic interventions and their effects on cognition or memory of the patient would be important in my role as a community nurse.

A number of non-pharmacologic interventions to preserve memory or delay cognitive decline have been developed in the last two decades. Studies (Spector et al., 2010; Hansen et al., 2006; Vink et al., 2004; Teri et al., 2003) show that these interventions range from motor stimulation, exercise programmes, sensory stimulation and cognitive training. Amongst these interventions, music therapy has been suggested to be least harmful and relatively effective. Some investigators (Fornazzari et al., 2006; Cuddy and Duffin, 2005) have shown that even in patients with severe dementia, music memory seemed to be preserved. However, some studies (Ménard and Belleville, 2009; Baird and Samsom, 2009) suggest otherwise and explain that some patients with Alzheimer’s disease (AD) suffer from impaired music memory.Care Methodology For The First Stage of Dementia Essay One study (Baird and Samson, 2009) however, explained that procedural memory, specifically for musical stimuli are not affected in persons with dementia. With the acknowledgement that most pharmacologic interventions have limited ability to treat the symptoms associated with dementia, it is essential to consider how non-pharmacologic interventions, such as music therapy, alleviate symptoms of this condition. In order to enhance my current and future nursing practice and to increase my understanding on the relevance of music therapy to dementia care, I have decided to research this topic further.Care Methodology For The First Stage of Dementia Essay

Literature Search
A search of literature from academic databases such as the Cumulative Index of Nursing and Allied Health Literature (CINAHL) and Pubmed was done to retrieve relevant studies. CINAHL indexes more than 5,000 nursing and allied health sciences journals and contains almost 4 million citations. The depth of research articles indexed in this database makes it a database of choice for research on the effects of music therapy on patients suffering from dementia. Meanwhile, Pubmed was also used to search for academic literature. This database also contains millions of citations and indexes nursing and allied health journals.

A quick search for ‘music therapy AND dementia’ was done in Pubmed since this database focuses on nursing and allied health journals. This search yielded 20 articles, most of which were available as full text journals. The same keywords were entered in the CINAHL database. The search yielded 14 articles, with almost all articles available as full text articles. A review of the abstracts of all articles was done to select only primary research studies conducted in the last five years. Polit et al. (2013) state that retrieving journal articles in the last five years will ensure that the most recent evidence is used to inform current and future nursing practice. Literature older than five years old may be outdated. However, this also increases the risk of excluding landmark studies (Aveyard, 2014). For the present review, the selection of studies was only restricted to the last five years to ensure that more recent evidence on music therapy were evaluated and critiqued. There was also no restriction on the place where the studies were conducted since dementia affects people of different ethnicities. Learning from the experiences of other nurses or healthcare practitioners on the use of music therapy for dementia patients would also help improve nursing practice in the UK. The following articles were chosen for critique and evaluation:Care Methodology For The First Stage of Dementia Essay

Simmons-Stern et al. (2012) ‘Music-based memory enhancement in Alzheimer’s disease: promise and limitations’

Sakamoto et al. (2013) ‘Comparing the effects of different individualized music interventions for elderly individuals with severe dementia’,

Dermot et al. (2014) ‘The importance of music for people with dementia: the perspectives of people with dementia, family carers, staff and music therapists’

As previously stated, I am interested in how music therapy could help me assist my patients delay the progression of dementia and help them and their carers self-manage the signs and symptoms of dementia. Hence, all articles are relevant my work as a community nurse. To critique these studies, the Critical Appraisal Skills Programme (CASP, 2013) tool for critiquing qualitative studies was utilised. For the quantitative studies, Long et al. (2002) critiquing framework for quantitative studies was used. Both critiquing frameworks are easy to use and help researchers investigate the quality and rigour of research articles.Care Methodology For The First Stage of Dementia Essay

Study 1: Simmons-Stern et al. (2012
A review of the title of the study shows that it reflected the main aim and objectives of the study. The title was concise and provided information to the readers that the study aimed to present the limitations of music-based memory enhancement as well as its possible application to nursing practice. Polit et al. (2013) emphasise the importance of creating a concise and clear title in order not to mislead readers and to inform stakeholders if the article is worth reading. A review was also done on the author’s background and shows that all had extensive background on dementia research and healthcare. This was essential since credibility of the authors’ background could increase the reliability of the findings of the study (Long et al., 2002). However, Hek and Moule (2011) emphasise that the authors’ background is not the sole criterion in assessing the credibility of the findings of the study.Care Methodology For The First Stage of Dementia Essay

The abstract of the study failed to mention the type of study design used. While the abstract summarises the aims and main findings of the study, it did not follow the usual structure of an abstract in a journal article where the methodology or methods used are explicitly stated. Ellis (2010) reiterates that an abstract should provide a brief summary of the study’s background, aims and objectives, methodology, results and conclusion. Although it was difficult to determine why the researchers of this study failed to present the methodology in the abstract, readers of the study could have benefited from an abstract that states the methodology of the study. Reading of the body of the article would show that the quantitative study design was used. The study aimed to investigate the effects of music on the memory of patients suffering from Alzheimer’s disease, one of the diseases grouped under dementia. Simmons-Stern et al. (2012) made excellent use of literature and related findings from previous studies with the current study.Care Methodology For The First Stage of Dementia Essay

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Apart from the excellent use of literature, there was also a very good review of the previous studies and a gap in literature was clearly presented. Hence, the literature review of the study was well written and provided the readers with good background on why there is a need to carry out the present study. Polit et al. (2013) emphasise that a well-written review of literature should be able to provide context to the study’s aims and objectives and argue why there is a need to address the gaps in literature. Importantly, Simmons-Stern et al. (2012) avoided the use of jargon when writing the paper. Burns and Grove (2013) explain that the use of jargon should be avoided since this excludes readers of the article that have no nursing or medical background. A good paper is one that is written for a general audience and not only for a scientific community (Burns and Grove, 2013). A total of 12 participants who were diagnosed with Alzheimer’s disease and 17 healthy controls gave their informed consents to participate in the study. Brown (2009) states the importance of obtaining the informed consent of participants before commencing the study. This would not only protect the rights of the participants but also ensure that the nurse researchers are observing the Nursing and Midwifery Council’s (NMC, 2008) code of conduct in protecting the patients or participants from harm.Care Methodology For The First Stage of Dementia Essay Part of obtaining an informed consent is the presentation of the study’s aims and objectives, possible side effects or benefits when participating in the study (Brown, 2009). An informed consent will also ensure that debriefing is provided to the participants to avoid any harm and psychological distress to the participants (Oermann, 2010).

Apart from getting the informed consent, it was also crucial that an ethics committee has evaluated and approved the study protocol. An evaluation of the study reveals that this was observed and an ethics committee approved the study. On reflection, the study has a very small sample size (n=12 experimental group; n=17 control group). This would have taken a randomised controlled study design since a control group was used to compare the effects of music therapy on the patients with a healthy control. However, the investigators specifically state that this study was comparative. An inclusion and exclusion criteria were used when recruiting the patients, suggesting that participants were not randomly selected. Since the study was quantitative and employed the experimental study design, random sampling of the participants who have been more applicable (Crookes and Davies, 2004). It should be noted that it would also be difficult to randomise participants since this study was only conducted in one healthcare setting and it was crucial that participants have developed AD. While randomisation of participants was not observed, it is noteworthy that the investigators stated how many of the participants were excluded from the study and the reasons of their exclusion. This was essential since failure to explain why participants who gave their informed consents to participate in the study but were later excluded in the actual experiment would make the data collection process unclear (Moule and Goodman, 2009).Care Methodology For The First Stage of Dementia Essay

Ageing brings with it changes in number of domains, including behaviour, health, self-image, human relationships, position, generational changes, erotic functioning and an awareness of their time and mortality. These basic themes all shows up regularly in specialized medical work with the elderly as they come to conditions with the realities of old age or condition. (Wattis and Curran, 2006)

The National coverage on older individuals confers the status of senior to somebody who has attained age 60 years (Ministry of Social Justice website). Around 77 million people or 7. 7 percent of the populace are senior citizens (Help Era India website) Many of our aged senior citizens live with their own families. Hence any physiological and psychiatric changes have an effect on these family. (Handbook of Psychiatric Community Work, 2007)Care Methodology For The First Stage of Dementia Essay

Understanding Dementia
The expression dementia can be an umbrella term which represents a serious deterioration in mental functions, such as storage area, language, orientation and judgement. Numerous meaning of dementia has been advised. Roth proposed that it’s ‘an purchased global impairment of intellect, memory space and personality’. A more comprehensive explanation has been recommended by McLean, specifically, ‘an acquired decline in a variety of cognitive talents (memory, learning, orientation and attention) and intellectual skills (abstraction, judgement, Understanding, language and calculation), associated with modifications in personality and behaviour which impair daily performing, cultural skills and emotional control. There is no clouding of consciousness, and other psychiatric disorders are excluded. ‘Care Methodology For The First Stage of Dementia Essay

Dementia usually comes with an insidious onset, with most people developing symptoms steadily over a period of years. The progression of these diseases is basically unpredictable for every single person. How and what symptoms develop rely upon what elements of the mind are affected by which illness, and the initial characteristics of every person. Dementia has a life changing physical, mental and mental impacted on the influenced person and their key caregiver and family. Dementia is a neuropsychiatric condition in elderly, disabling illness lately life, which really is a hidden problem in India, demanding immediate attention from experts (Shaji & Iype, 2006).

Different type of dementia:

Some types of dementia are irreversible and progressive. This is not true for all types of dementia, especially if detected early.

Types of dementia include:

Dementia of the Alzheimer’s Type

Approximately 50 percent of most conditions of dementia are brought on by Alzheimer’s disease.Care Methodology For The First Stage of Dementia Essay

Vascular Dementia

Vascular dementia is cause by small strokes that stop blood flow to parts of the brain.

Dementia Due to Other Standard Medical Conditions

Medical conditions that can cause dementia include HIV, brain stress, Parkinson’s disease, Huntington’s disease, Pick’s disease, Creutzfeldt-Jakob disease, metabolic disorders, and hypoglycemia.

Substance-Induced Persisting Dementia

The use of any compound such as liquor or the unexpected withdrawal from a chemical can cause dementia. That is diagnosed only when the symptoms last beyond normal withdrawal time for the element.

Dementia Not Often Specified

This is the category for dementia that doesn’t fit in an above category.

Dementia differs from delirium, which is seen as a circumstances of sudden distress. Dementia is not area of the normal maturity process neither is it mental retardation or psychosis. You can find medications and treatments that can help control the symptoms of the disease, making life easier for the patient and his/her family.Care Methodology For The First Stage of Dementia Essay

Dementia of Alzheimer’s Type (DAT):
Alzheimer’s disease is the most typical form of dementia. Alzheimer’s Disease is named following the German Psychiatrist, Alois Alzheimer, who in 1906 first defined the changes brought on by the condition. The diagnostic criteria for DAT as mentioned in DSM-IV-TR:

A. The introduction of multiple cognitive deficits manifested by both (1) ram impairment (impaired capacity to learn new information or even to recall previously learned information) (2) one (or even more) of the following cognitive disturbances:

(a) aphasia (vocabulary disturbance)

(b) apraxia (impaired ability to handle motor unit activities despite intact electric motor function)

(c) agnosia (inability to recognize or identify things despite intact sensory function)

(d) disruption in executive working (i. e. , planning, arranging, sequencing, abstracting)

B. The cognitive deficits in Conditions A1 and A2 each cause significant impairment in sociable or occupational working and represent a significant decline from a past level of functioning.Care Methodology For The First Stage of Dementia Essay

C. The course is characterized by gradual starting point and carrying on cognitive decline.

D. The cognitive deficits in Standards A1 and A2 aren’t due to any of the following:

(1) other central anxious system conditions that cause intensifying deficits in ram and cognition (e. g. , cerebrovascular disease, Parkinson’s disease, Huntington’s disease, subdural hematoma, normal-pressure hydrocephalus, brain tumor)

(2) systemic conditions that are known to cause dementia (e. g. , hypothyroidism, supplement B or folic acid deficiency, niacin deficiency, hypercalcemia, neurosyphilis, HIV infection)

(3) substance-induced conditions

E. The deficits do not occur exclusively during a delirium.

F. The disruption is not better accounted for by another Axis I disorder (e. g. , Major Depressive Instance, Schizophrenia).

Code based on presence or lack of a medically significant behavioral disruption:Care Methodology For The First Stage of Dementia Essay

294. 10 Without Behavioral Disruption: if the cognitive disruption is not combined with any clinically significant behavioral disturbance.

294. 11 With Behavioral Disruption: if the cognitive disturbance is along with a medically significant behavioral disruption. (e. g. , wandering, agitation)

Specify subtype:

With Early Onset: if onset is at get older 65 years or below

With Late Onset: if starting point is after time 65 years

ICD-10 diagnostic conditions for dementia:
The primary requirement for the examination is evidence of a decrease in both and thinking which is enough to impair personal activities of daily living. The impairment of memory space typically affects the registration, storage space and retrieval of new information, but recently discovered and familiar information may also be lost, specifically in later stage. Dementia is more than impaired recollection. Addititionally there is impairment of considering and of reasoning capacity, and a reduction in the stream of ideas. The handling of information is impaired, for the reason that the individual detects it ever more difficult to wait to more than one stimulus at a time. (e. g. taking part in a conversation with several people), and to shift the concentration of attention in one topic to some other. If dementia is the only real diagnosis, proof clear consciousness is required. However, a double identification of delirium superimposed on dementia is common. The aforementioned symptoms and impairments must have been obvious for at least half a year for a self-confident clinical prognosis of dementia to be made.Care Methodology For The First Stage of Dementia Essay

Alzheimer’s disease (F00)

In ICD-10, Alzeheimer’s disease (AD) is divided into ‘Dementia in AD with early onset’ (F00. 0) and ‘Dementia in Advertising with late onset’ (F00. 1). These categories include the classification of dementia discussed above. For ‘Dementia in AD with late starting point’, onset is following the age 65years. Advertising has an insidious onset with a continuous drop in the mental level, Memory complications, especially in regards to to new remembrances, are usually the first symptoms to be noticed. Storage problems may be related to ‘old years’ or ‘absent-mindedness’. The onset is so progressive that even a close relative living with the patient the first stages, past personality may strongly influence the demonstration. Patients with a trend to be dubious of others or even to deny their own limitations may upset carers by accusing them of stealing misplaced items. Others may react to these early on changes by becoming extremely dependent on relatives, particularly if family patterns of behaviour encourage this. Mood disturbance is not a diagnostic feature of AD. It may also be common in more complex AD. Here it might not be reported by the patient, but may be inferred from behavioural changes and reaction to treatment with antidepressants. The individual usually lacks understanding, and as the disease progress their behaviour could become more erratic. Disorientation in regards to to time, place and person will also increase, usually for the reason that order. The mixture of disorientation with time and place and topographical disorientation could cause the patient to wander, resulting in considerable distress for the family, risk to the individual and the engagement of neighbours, other individuals and the police, and also require to bring the patient home.Care Methodology For The First Stage of Dementia Essay Patients may get up in the early hours believing that it is time to visit work or get the kids ready for university. Hallucinations (usually aesthetic) are rather common, but are not usually noticeable except through the information of employment opportunities (e. g ‘he spends a lot of time picking right up imaginary food from thr floor’). As the disease progress, the patient will become unable t recognise their family, who often confirms this distressing. The patient will then become distressed, as they could think that their spouse or kid in a intruder. In addition, the patient may neglect to recognise him or herself, and this can also cause extensive problems. Carers often realize that taking away mirrors solves the situation. Other problems with modest to severe impairment include apraxia, which presents with issues in dressing and washing and other jobs relating visuo-spatial skills. Dysphasia (inability to express oneself in words or to understand words) can result in severe stress when coupled with every one of the other impairments and distress. Incontinence (both urinary and faecal) usually advances late in the disease and for many carers is the ‘final straw’. Eventually the main point is reached when the patient struggles to or anything from him- or herself including the following: dressing, personal health, domestic jobs, toileting and feeding.Care Methodology For The First Stage of Dementia Essay

There are characteristic changes in the mind: a marked reduction in the population of neurons, specifically in the hippocampus, substantia innominata, locus ceruleus and temporopareital frontal lobe cortex; appearance of neurofibrillary tangles manufactured from paired helical filaments; neuritic (argentophil) plaques, which consist mainly of amyloid and show a particular development in their development (although plaques without amyloid are recognized to can be found); and granulovacular systems. Neurochemical changes have also been found, including designated reduction in the enzyme choline acetyltransfearse, in acetylcholinse itself, and in other neurotransmitters and neuromodulators.Care Methodology For The First Stage of Dementia Essay

Causes of AD
AD is a primary degenerative cerebral disease of unfamiliar etiology, with characteristics neuropathological and neurochemical features. The precise aetiology of Advertising is poorly understood. However, it’s important because such an understanding may have implications for both avoidance and treatment. The partnership between cause and impact may be difficult to establish, particularly with regard to neurotransmitter deficits and the characteristics of neuropathological changes that have emerged in AD. On the basis of epidemiological research, the most crucial risk factors for Advertisement are old age and a family history of dementia and Down’s symptoms.Care Methodology For The First Stage of Dementia Essay

Alzheimer’s and the Brain

Alzheimer’s disease causes nerve cell fatality and tissue reduction throughout the brain. As the disease progresses, brain tissues shrinks and the ventricles (chambers within the brain that contain cerebrospinal liquid) become much larger. The destruction disrupts communication between brain skin cells, crippling memory, talk, and understanding.

Alzheimer’s Medications
There is no cure for Alzheimer’s disease, and no known way to decrease the nerve damage within the brain. But there are a number of medications that may actually help maintain mental function and slow the disease development. If these treatments are given during the early stages of Alzheimer’s, your loved one might be able to remain impartial and perform daily tasks for a longer period of time.Care Methodology For The First Stage of Dementia Essay

Prevalence of Dementia:
Global Impact:

Worldwide, there is a new circumstance of dementia every seven secs. By 2008, there are an estimated 30 million people who have dementia worldwide. By 2050, it is projected that shape will have risen to over 100 million. A lot of the increase will be in developing countries. Already more than 60% of men and women with dementia live in producing countries, but by 2040 this will surge to 71%. The quickest growth in older people population is taking place in China, India, and their southern Asian and traditional western Pacific neighbours. (Ferri et al, 2005)Care Methodology For The First Stage of Dementia Essay

Stages of Dementia/AD
Knowing a person’s disease stage helps medical researchers to determine the treatment approach and supports communication between health providers and caregivers. Sometimes the stage is simply referred to as “early on stage”, “middle stage” or “late-stage” dementia, but often a more exact stage is assigned, predicated on a person’s symptoms. Geriatric people is more affected by dementia of Alzheimer’s Type (DAT) or Alzheimer’s Disease (Advertising) 60-65 % and other related disease. Therefore, when choosing a suitable involvement model for dementia you have to bear in mind periods in dementia, context and situation, as care and attention needs fluctuate with level to best help both elderly people and their own families.Care Methodology For The First Stage of Dementia Essay

The below stand shows the changes in people with Alzheimer’s disease and related disorders that usually occur during the progression of the health problems. As patients undertake levels, family issues are also changing. The sort of clinical intervention that is most appropriate and effective for a particular family should be dependant on the types of issues and problems the family must address.

Despite the small sample size, the demographic characteristics of the two groups were not significantly different when t-test was done. There were no significant differences in prior musical training, formal or informal, years of education and age between the participants of the two groups. This allowed the investigators to determine if there were differences after the study, this might have been due to the intervention employed. Care Methodology For The First Stage of Dementia Essay After informed consents were taken, the authors of the study declared that they paid the participants for the hours spent during the study. Compensating the participants for the time is considered as ethical since considerable time has been taken away from the subjects for their participation in the study (Hek and Moule, 2011). The interventions were clearly stated. This increased the rigour of the study since a clearly stated research method would help other investigators replicate the methods in future studies and verify whether similar findings are obtained (Hek and Moule, 2011). Simmons-Stern et al. (2012) also specifically outlined the lyrics used and where these were obtained and how music memory of the participants was tested. Results section of the study clearly presented the main findings of the study. Appropriate statistical tests were also utilised to test the hypotheses of the research. Polit et al. (2013) emphasise that statistical tests should be appropriate to the study’s aims and objectives and should rule out any biases in interpretation of the findings.Care Methodology For The First Stage of Dementia Essay

Despite having a small sample size, the researchers were able to establish that music in patients with AD enhances memory in terms of familiarisation of sung lyrics but not in spoken stimuli. This suggests that in patients with AD, they can enhance their memory when familiarising with the lyrics or listening to music but not when they hear spoken language. There were also no significant differences in the healthy control and experimental groups in terms of memory after hearing the lyrics of a song compared to hearing the lyrics as a spoken stimuli. Since this study has a small sample size, the applicability of the findings to a larger and more heterogeneous population would be difficult (Burns and Grove, 2013). Although a control was used, it should be noted that participants in the experimental group are in the early stages of AD. This could have affected the findings of the study since it is unclear if patients with severe dementia would also yield similar reactions and results. At present, the findings are applicable to the sample population of the study and importantly, only on individuals in the early stages of dementia. While there were several limitations of the study, findings are noteworthy since these show that music therapy is promising as a non-pharmacologic intervention for enhancing memory in individuals with early stage dementia.Care Methodology For The First Stage of Dementia Essay

The conclusion of the study was clearly presented and summarises the key points presented in the study. Although the discussion states future areas of study, there were no clear recommendations in the conclusion. Specific recommendations could have been made at the end to help future researchers identify areas of investigation. There were also no implications for future nursing and other healthcare practitioners’ practices. Despite the lack of clear recommendations, readers can still read through the study and identify areas that need further investigation. For example, there is a need to replicate the study in a larger and randomly selected sample population to strengthen the validity and reliability of the findings. There is also a need to compare findings with patients suffering from moderate to severe dementia to determine if music still has similar effects on the memory of those in advanced stages of the illness. There are a number of implications of the study in nursing practice. Nurses can use music to help enhance memory or prevent deterioration of memory amongst individuals with early stages of the disease. It is essential to consider the acceptability of music therapy in those suffering from dementia. As a whole, the study was of high quality and effort was made to reduce bias within the study. Although the investigators failed to blind assessors to the study, findings were presented objectively. It is also difficult to blind assessors because of the very small sample size (Burns and Grove, 2013). All investigators were familiar with the background of the participants and blinding them to the intervention was difficult since these investigators were also responsible in implementing the interventions. Finally, there were no conflicts of interest (Polit et al., 2013), ensuring the readers that bias in presentation of findings was avoided.Care Methodology For The First Stage of Dementia Essay

Study 2: Sakamoto et al. (2013)
An evaluation of the study’s title reveals that it was concise and clearly reflects the study’s aims and objectives. This was essential (Long et al., 2002) since this would present to the readers the main aim of the study. The type of study design chosen to answer the study’s aims was also appropriate. A quantitative study design would help investigators answer the research aims and objectives through experimentation, surveys or a randomised controlled trial (RCT) (Brown, 2009). In Sakamoto et al. (2013), the randomised controlled study design was used. Compared to other quantitative study designs, a RCT reduces risk of selection bias and bias in interpretation of findings (Moule and Goodman, 2009). Selection bias occurs when participants are not randomly selected and do no have equal chances of being assigned to a control or experimental groups (Crookes and Davies, 2004). This is avoided in RCT since all participants are randomly assigned to an experimental or control group. On the other hand, bias in interpretation of findings is lessened especially if investigators and assessors are blinded to the interventions and standard treatment (Oermann, 2010).Care Methodology For The First Stage of Dementia Essay

A critical analysis of the study shows all participants in the study were randomly assigned to the treatment and standard care groups. However, a major limitation of this study was its relatively small sample size (n=39). It would be difficult to transfer findings to a larger and more heterogeneous group due to the representativeness of the sample population (Ellis, 2010). While it is difficult to transfer findings to other settings due to the relatively small sample size, community nurses may consider the applicability of the findings to their own practice. It is noteworthy that it would be difficult to recruit participants in the advanced stages of dementia since their ability to give their informed consent is severely limited (Department of Health, 2009). Further, their participation requires that their carers or immediate family members are aware of the study’s aims and objectives and should be able to assist the participants during the the study. While an ethics board approved the study and informed consents were taken from the respondents or their representatives (Burns and Grove, 2013), involving individuals who suffer from severe cognitive impairment would be difficult. This also carries some ethical issues since their ability to understand the procedures of the study is compromised (Hek and Moule, 2011). Although the Mental Health Act in the UK acknowledges that carers can act in behalf of the individual with mental health condition, ethics regarding their participation in research studies remains debatable (Department of Health, 2009).Care Methodology For The First Stage of Dementia Essay

Despite the possible ethical issues surrounding the study, investigators of this study used other means of evaluation to assess the participants’ responses to the interventions. For example, they used the Faces Scale (Sakamoto et al., 2013) to determine the emotions of the participants. A review of the study’s aims and objective shows that these were clearly presented in the beginning of the study. The introduction and review of literature also made excellent use of previous studies. It is also important to note the gaps in practice in recent studies were highlighted in the literature review section (Ellis, 2010). A good literature also argues why there is a need for the new study and how this could be applied to current healthcare practices (Ross, 2012). Methodology and methods used were also appropriate for the research question. Since the study aimed to determine the effectiveness of music therapy, it is appropriate that a RCT is used to compare music therapy with standard care. Comparing music therapy with standard care is ethical (Ross, 2012) since all patients in the study received interventions. It would be unethical to withdraw treatment or assign participants to a control group that would receive no intervention (Crookes and Daives, 2004).Care Methodology For The First Stage of Dementia Essay The evaluation tools used to measure the responses of the patients were appropriate and have been previously validated and standardised. This was necessary to convey to the readers that validated measurement tools were used in the study (Moule and Goodman, 2009).

A clear description of the research methods was presented. This would allow future researchers to replicate the present study (Oermann, 2010) and determine if similar findings could be observed. This also increases rigour of the study (Burns and Grove, 2013) since it is essential for other researchers to also test the hypothesis of the study and ensure that results are consistent across different healthcare settings. Results of the study were well presented and appropriate statistical tests were used. The discussion section of the study presented the strengths and limitations of the study. Polit et al. (2013) emphasise that presenting the limitations of a study will help inform other researchers on areas that need further improvement and presents areas for further research. Since weaknesses of the study were presented, readers and other healthcare practitioners can determine the extent in which the findings can be applied to current and future nursing practice (Burns and Grove, 2013). The conclusion of the study succinctly captures the main points raised in the research study. This helped the researchers identify the main highlights of the study (Ellis, 2010). However, recommendations for other researchers and areas of improvement of the study were not cited. While the discussion section presented these limitations and areas for future studies, brief recommendations at the end of the study could have added rigour to the research study. Importantly, there were no conflicts of interest. This assured the readers that bias in reporting of data was reduced (Ellis, 2010).Care Methodology For The First Stage of Dementia Essay

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Findings of this study have important implications in nursing practice. All participants received either the passive or interactive music intervention while the control group received no music intervention. There was careful choice of music in the interactive group. For example, healthcare workers assigned to the interactive group helped investigators choose music for the patient participants. Music played during the intervention all had special meaning to the participants. All interventions were given individually for 30 minutes per session at once a week for 10 weeks. Those in the interactive group were allowed to clap, sing or interact with the music. Meanwhile, those in the passive group only listened to the music. The music chosen for the passive group also had special meaning to the participants. Those in the control group sat in silence for 30 minutes during the once a week session. Interestingly, findings show that music associated with special memories led to significant changes in the parasympathetic nervous system of the participants.Care Methodology For The First Stage of Dementia Essay

Investigators note that music significantly increased relaxation of the individuals immediately after intervention when compared to baseline data. However, these were not noted in the control group. Significant changes were also seen on the emotional states of the participants in the interactive and passive music intervention groups. Music appeared to elicit pleasant emotional states. However, when passive and interactive groups were compared, the latter was significantly more relaxed following the music intervention. It should be noted that patients with severe dementia are more sensitive to environmental stimuli and may experience stress when placed in a new environment (Morris and Morris, 2010). Further, patients with cognitive impairments may express feelings of stress and fear through disruptive behaviour (Morris and Morris, 2010). The difficulty in verbalising their emotional needs could aggravate their responses to their surroundings (Department of Health, 2009). Hence, the study of Sakamoto et al.Care Methodology For The First Stage of Dementia Essay  (2013) may have important implications in nursing care for patients in community settings. Nurses can encourage family members to play music that have special meaning to their loved ones suffering from dementia to illicit positive emotional states. The calming effect of music could be an advantage for patients cared in home or care settings since this would not only prevent stress but also allow patients to enjoy quality of life.

Study 3: Dermot et al. (2014)
A review of the study’s title shows that it also reflects the main aims and objectives of the study. Readers could easily understand that the study explored the experiences of individuals with dementia, their carers, staff and music therapists when music interventions are employed. The CASP (2013) tool for qualitative studies contains three screening questions that should be used to determine if a study is worth reviewing. The study of Dermot et al. (2014) suggests that music can help maintain the person’s interconnectedness and their quality of life. Findings have important implications in nursing practice since music intervention (Miller, 2009) is not costly and could yield positive results for patients suffering from early to advanced stages of dementia. Further review of the study shows that aims and objectives of the research were clearly stated. The main aim of the study was to explore the meaning of music in the lives of individuals suffering from dementia. Investigators of this study state that there is limited knowledge on why or how individuals find music beneficial to their wellbeing. Understanding the role of music according to the perceptions of the patients and their carers will help inform nursing practice on the relevance of music in the lives of people with dementia.Care Methodology For The First Stage of Dementia Essay

A qualitative research methodology was appropriate for the study’s aims since the research aims to interpret the subjective experiences of individuals with dementia. Parahoo (2006) emphasises that a qualitative study allows researchers to explore the experiences and perceptions of individuals in more detail and depth. Since open-ended questions are used, investigators can use probing questions (Burns and Grove, 2013) to help participants articulate their experiences. One of the strengths of this study was the inclusion of participants’ family members, care home staff and music therapists. Individuals suffering from dementia were recruited from care homes and those living in the community. This allowed Dermot et al. (2014) to compare the perceptions of people with dementia living in care homes or in the community and determine if settings of the individuals impact their experiences with music therapy. Recruitment strategy employed was also appropriate for the research aims. There was also a clear explanation on the methods of data collection. Semi-structured interviews and focus group discussions were done. In the former, this would allow researchers to investigate perceptions of participants in more detail (Parahoo, 2006). However, this requires more time to complete especially if there are many participants in a study. A focus group discussion, on the other hand, requires little resources and could be completed in one setting (Polit et al., 2013). However, if a dominant member would be included in a focus group discussion, interactions would be limited (Burns and Grove, 2013).Care Methodology For The First Stage of Dementia Essay

This could be avoided with a facilitator who knows how to redirect the discussion to all members of the focus group. A stregnth of the study of Dermot et al. (2014) is the presentation of a rationalisation on why they used a combination of focus groups and in-depth interviews. It should also be noted that participants with dementia might display cognitive impairments, depending on the stage of their illness. Hence, requiring these patients to explain their experiences in more depth might be challenging. However, the investigators tried to mitigate this challenge by including carers of the patients as part of the study participants. Inclusion of carers could provide researchers with more detailed information on how music impacts the wellbeing and quality of life of the patients since these carers are more acquainted with the individuals suffering from dementia (Miranda-Castillo et al., 2010). Care Methodology For The First Stage of Dementia Essay It is also noteworthy that music therapy was individualised to the patients in the study. This suggests that comparison of music therapy received by the patients was not done. Instead, investigators focused on the impact of music therapy on the patients’ wellbeing. In addition, the study did not take into account the differences in music interventions and whether this shaped the individual’s reaction to music therapy. Despite the differences in music intervention, it was common for the music therapists to use songs that were well-known to the patients. They also supported active music therapy with exploratory improvisation. Dermot et al. (2014), however, failed to explain what is exploratory improvisation or how this was done during music therapy.Care Methodology For The First Stage of Dementia Essay

There was also an explanation on the content of the guides used for the in-depth interviews and focus group discussions. This was essential to demonstrate the coverage of the interview guides and whether each guide reflects the aims and objectives of the study (Moule and Goodman, 2009). However, the relationship between the researchers and the participants was not thoroughly discussed. If the participants knew the investigators, this might lead to potential bias especially if the researchers hold positions of power (Oermann, 2010). Despite this limitation, Dermot et al. (2014) emphasise that only one facilitator guided the focus group discussions. There were changes in the methods used during data collection. For instance, where a focus group discussion was initially decided, this was then changed to individual interviews in the second group of patients and healthcare workers. Dermot et al. (2014) explain that the severity of dementia of the patients was considered in the choice of data collection. In-depth interviews were used when patients had severe dementia.Care Methodology For The First Stage of Dementia Essay

There were also sufficient details on how participants were recruited and whether ethical standards were observed. Polit et al. (2013) state that ethics in research is crucial to ensure that the rights of the participants were observed and they were not subjected to undue stress or negative experiences during data collection. Confidentiality was also observed in the study and all participants remained anonymous. Approval was also sought from an ethics board in the community settings. Data analysis of qualitative data could be extensive and time consuming (Parahoo, 2006). Informing readers how data was analysed would help increase the rigour of a qualitative study. Dermot et al. (2014) provided an in-depth description of how data was analysed. Thematic analysis was also used to present the main findings of the study. There was also a clear description on how categories and themes emerged. For instance, the long-table approach was used during analysis of data. Verbatim transcripts were used to support the main themes. This ensures validity and credibility of the main themes generated in the study (Polit et al., 2013). Contradictory data were also taken into account. The researchers also critically examined their own roles in the research process and the potential bias that might arise during analysis of research data.Care Methodology For The First Stage of Dementia Essay

While respondent was not done, validity and credibility of the data were observed through constant comparison of categories and themes. More than one researcher was involved in the analysis of data. Professors and doctoral students of the Doctoral Programme in Music Therapy were also consulted during thematic analysis and were involved in identifying categories. Importantly, findings were discussed with reference to the original research question. A discussion was also made on the relevance of the study to dementia care. Findings of this study suggest that music is a medium that is readily accessible to patients with dementia. Many of the patients, their carers and healthcare staff admitted that music promotes mental stimulation and is an emotionally meaningful experience. Almost all participants also remarked that song lyrics with personal meanings helped patients remember their personal history. It is also perceived to reinforce personal and cultural identity. Music is also perceived to promote connectedness and building and sustaining of relationships. In addition, music has immediate effects on the mood of the patients. Most of the staff members who participated in the focus group discussions remarked that agitation of the patients decreased as a result of music therapy.Care Methodology For The First Stage of Dementia Essay

It is also shown to promote a relaxing environment in the care homes. On the other hand, listening to music in the lounge area could be challenging since care home residents might have different music preferences. Hence, it would be a challenge for healthcare workers to address all the music preferences of the patients. Since the study was qualitative, transferability of the findings to a larger and more heterogeneous population is impossible (Polit et al., 2013). However, other healthcare practitioners could use findings to help build a peaceful environment for patients suffering from dementia. A further review of the study also shows that the conclusion summarises the main points raised in the study and provides recommendations for other researchers to consider in similar studies in the future.Care Methodology For The First Stage of Dementia Essay

Implications of Findings in Nursing Practice
Findings of this literature review could be used to improve nursing practice when caring for patients with dementia. All three studies (Simmons-Stern et al., 2012; Sakamoto et al., 2013; Dermot et al., 2014) included in this literature review demonstrate the impact of music therapy on patients with dementia. Music therapy could improve health outcomes and quality of life of the patients from early to advanced stages of the disease. In the latter, patients who have difficulty communicating their needs, react positively to music therapy. Many of the patients with severe dementia show less agitation when exposed to music that was once relevant to them before they suffered from dementia. This suggests that music therapy could even not only promote positive mood of the patients but might even reconnect them to ‘who they are’ (Dermot et al., 2014). This holds important implications in nursing practice in community settings. Music therapy could be introduced to families caring for a loved one with dementia and could be used to calm the patient, reconnect with their family members and create an environment that is less stressful for the individual with dementia.Care Methodology For The First Stage of Dementia Essay

The type of music therapy, however, will be dependent on the preferences of the individual (Sakamoto et al., 2013). This is consistent with patient-centred care (Department of Health, 2009) where patient preferences are considered when creating a care plan or introducing healthcare interventions. It is suggested that interactive music therapy (Simmons-Stern et al., 2012; Sakamoto et al., 2013) might be more effective than passive music therapy in improving memory and mood of the patients with dementia. As a community nurse, I need to be aware of the different non-pharmacologic interventions for people with dementia. I can use findings of this review when caring for patients suffering from dementia. Music therapy is relatively easy to carry out and entails very little cost. Importantly, it has positive short and long-term impacts on patient’s mood, memory and quality of life. Hence, considering this type of intervention could also help ease the burden of carers who provide care to these patients on a daily basis. I could use information from this literature when conducting patient education. I can inform my patients and their family members of the benefits of music therapy and the sustainability of this type of therapy over time. I can also encourage family members to consider music therapy to help alleviate the mood of the patients and provide a calm environment.Care Methodology For The First Stage of Dementia Essay

Conclusion
This literature review has shown the feasibility and promise of music therapy in promoting wellbeing, improving memory and quality of life of patients with dementia. As a community nurse, music therapy could be employed with the help of a music therapist in community settings. Families and carers could be taught on how to use this type of therapy to improve the mood of the patient or to calm the individual when agitated. This type of therapy holds some promise in long-term care for people with dementia. As shown in the review, individuals with severe dementia still have the ability to respond positively to music therapy. However, consideration should still be made on the applicability of the findings of the three studies to a larger and more heterogeneous population. Care Methodology For The First Stage of Dementia Essay All studies recruited a relatively small sample size that might not be representative of the experiences of a wider group of people with dementia. Although this limits applicability, findings can be tailored to the needs of individual patients. Considerations should also be made on the preferences of the patients and their family members on whether music therapy is acceptable to them. Since there is a need to practice patient-centred care, nurses have to determine if patients or their family members are willing to employ music therapy. It should ne noted that this literature review is only limited to reviewing three studies. Literature on the acceptability of music therapy was not evaluated. Despite this gap in the present literature review, the positive responses generated after music therapy should help patients and their family members consider music therapy. Care Methodology For The First Stage of Dementia Essay