Introduction
Care for dementia patients – especially those with advanced stage, poses challenges both to caregivers and healthcare professionals. The proper management of the challenging behaviors related to Dementia in both pharmacologic and nonpharmacological should be a part of an effort to compensate for symptoms while at the same time making life acceptable. Thus, this paper describes a pilot project targeting the interventions to address these challenges in response to the PICOT question outlined during week one based on the evidence-based practice framework.
Purpose Statement
The objective of this pilot project is to demonstrate and test interventions targeted towards challenging dementia-related behaviors in 60-year-olds five or above by nonpharmacological and pharmacological approaches. This project involves stakeholders’ engagement and a specific change model to improve symptoms within 6-12 weeks, benefiting ADLs and dementia-related behaviors.
Brief Explanation of the Problem and PICOT Question
Dementia deals with the slow and gradual decline of cognitive function, such as memory impairment and behavioral comprehension. As the disease progresses in severity, patients develop severe behaviors that include agitation, restlessness, and mood swings, thereby influencing their quality of life in addition to challenges to carers and health workers.
PICOT QUESTION: In patients, ages 60 or older, with Dementia declining as the disease progresses into Alzheimer’s, how can caregivers and healthcare workers manage challenging dementia-related behaviors, pharmacological and nonpharmacological, to improve symptoms within 6-12 weeks?
P- Disease progression, not curable, worse in elderly populations
I- Medication symptoms management, cognitive improvement medications
C- Rehabilitation and Occupational therapy
O- Decrease agitated, restless, and non-stable moody behaviors
T- Improve in ADLs and dementia behaviors within 6-12 weeks
Description of the Pilot Project
The pilot project will be directed by nurse experts, who will organize and coordinate with an interdisciplinary healthcare team, including physicians, occupational therapists, and pharmacists (Meng et al., 2021). The project will be conducted in a specialized dementia care unit situated in an institution that provides health facilities for individuals with advanced dementia and administers comprehensive care.
In the initial stages, the interdisciplinary team will focus on developing a framework for identifying evidence-based interventions for managing challenging dementia-related behaviors (Bennett et al., 2021). This phase also comprises training of the healthcare workers on the chosen interventions.
During implementation, pharmacological and nonpharmacological interventions will be applied based on plans prepared for each patient concerning individual care. Treatment approached interventions that may involve pharmacological management, cognitive stimulation activities, sensory interventions, environmental modifications, and caregiver education. During the project, comprehensive data will be obtained on challenging behaviors frequency and intensity, functional skills for children, and parents’ burdens (Meng et al., 2021). Weekly team meetings will be conducted to track progress, discuss obstacles, and make changes in interventions depending on the situation.
Framework of Change
This is because the diffusion of innovation theory will provide a framework that can be used to facilitate intervention during the pilot project. This theory is already built around the fact that communication, social networks, and the adoption process serve as key influencers of change among organizations (Min et al., 2021). With this, the project seeks to identify opinion leaders among healthcare staff and apply effective communication strategies that promote the adoption and sustenance of evidence-based interventions for dementia care.
Stakeholders and Their Roles
Various specialists, such as expert-prepared nurses, physicians, occupational therapists, pharmacists, social workers, and patients’ representatives, take an interest in the pilot project implementing interventions that target difficult-to-manage behaviors associated with Dementia. Nurses who are experts prepare and control the project in terms of coordination, clinical guidance, and data analysis. Doctors assist by giving pharmacological interventions, administering patient responses, and participating in team planning. Occupational therapists evaluate functional skills, develop individualized interventions, and promote participation in meaningful activities, while pharmacists review medication regimens, provide medication management education, and monitor side effects (Cross et al., 2021). Social workers manage psychosocial needs among patients and offer patient support while helping caregivers receive education and support through respective groups. There is the active engagement of the patients and also significant involvement of caregivers in the process of making an initial plan for treatment, following consistently assorted recommendations, and feedback on the efficiency of the intervention.
In their functional status, the expert-prepared nurses plan project logistics and organize team meetings to discuss standardized case management processes that ensure data integrity. In contrast, the interdisciplinary healthcare team is associated with care planning, implementing interventions, and monitoring and evaluation continuously (Cross et al., 2021). In this regard, patients and caregivers participate in treatment activities; they offer insights on symptom management from their respective fountains of knowledge and collect data. Through collaboration, all stakeholders in the pilot project utilize their knowledge and experiences to provide a patient-centered approach to handling severe behavioral changes associated with Dementia.
Strategies to Promote Stakeholder Engagement
Education and Training: Conduct extensive seminars and education classes for the health personnel to train them on the various evidence-based interventions associated with dementia management. Make available tools of practice and skill that will help increase confidence and performance during intervention implementation.
Regular Communication and Feedback: Let’s regularly hold a team meeting and feedback sessions regarding updates through emails. Today, it is advisable to promote exchange and overcome problems to discuss issues, present achievements, and resolve difficulties arising during the piloting phase.
Practice Guideline Supporting the Intervention
Alzheimer’s Association provides a practice guideline, “Nonpharmacologic Interventions for Agitation and Aggression in Dementia.” The guide offers evidence-based practices that may be used as nonpharmacological tactics in managing challenging behavior in dementia patients, with suggestions consistent with the aims of the pilot project (Bennett et al., 2021). Suggestions include arranging environmental changes, tailor-made activities, and training the caregiver to minimize agitation and enhance the overall health.
Organizational Resources Needed
Human resources: Nurses, physicians, occupational therapists, pharmacists, and social workers specializing in this knowledge.
Physical resources: Advancement facilities in the dementia compassionate care unit, specific equipment for sensory interventions, and educational materials that can be distributed to the staff and the caregivers.
Financial resources: Budget for staff training, resources on intervention, and data gathering equipment.
Time: This is time dedicated to interdisciplinary team meetings, patient assessment, and intervention implementation.
Measurement of Intervention Outcomes
Performance outcomes: the intervention will rely on validated assessment tools and observation methods.
Frequency and severity of challenging behaviors: Applying a standardized scale, which includes a Neuropsychiatric Inventory (NPI) for the assessment of changes in agitation, restlessness, and mood fluctuations across temporal frames.
Functional abilities: A measure of ADL improvements during the follow-up period using scored assessment tools such as the Katz Index of Independence in Activities Daily Living (Cross et al., 2021).
Caregiver burden: Measuring burden changes among caregivers with validated instruments such as the Zarit Burden Interview, capturing intervention effects on caregiver strain and coping.
Finally, the pilot project seeks to solve problems associated with managing dementia-induced behaviors in older people by implementing evidence-based interventions. Through stakeholder engagement, adoption of a change model, and exploitation of organizational resources, the project aims to reduce symptoms and increase the quality of life of patients and caregivers within specific periods by subjecting the project to evaluation and measurement of outcomes as a contribution to evidence-based practice in dementia care.
References
Bennett, S., Laver, K., MacAndrew, M., Beattie, E., Clemson, L., Runge, C., & Richardson, L. (2021). Implementing evidence-based, nonpharmacological interventions addressing behavior and psychological symptoms of Dementia: a systematic review focused on implementation strategies. International Psychogeriatrics, 33(9), 947-975. https://www.cambridge.org/core/journals/international-psychogeriatrics/article/implementation-of-evidencebased-nonpharmacological-interventions-addressing-behavior-and-psychological-symptoms-of-dementia-a-systematic-review-focused-on-implementation-strategies/4E14BAF77327E7EAB6EEFD0F8F421476
Cross, A. J., Etherton-Beer, C. D., Clifford, R. M., Potter, K., & Page, A. T. (2021). Exploring stakeholder roles in medication management for people living with Dementia. Research in Social and Administrative Pharmacy, 17(4), 707-714. https://www.sciencedirect.com/science/article/pii/S1551741120300401
Meng, X., Su, J., Li, H., Ma, D., Zhao, Y., Li, Y., … & Sun, J. (2021). Effectiveness of caregiver nonpharmacological interventions for behavioral and psychological symptoms of Dementia: an updated meta-analysis. Ageing Research Reviews, 71, 101448. https://www.sciencedirect.com/science/article/pii/S1568163721001951
Min, S., So, K. K. F., & Jeong, M. (2021). Consumer adoption of the Uber mobile application: Insights from the diffusion of innovation theory and technology acceptance model. In Future of tourism marketing (pp. 2-15). Routledge. https://www.taylorfrancis.com/chapters/edit/10.4324/9781003176039-2/consumer-adoption-uber-mobile-application-insights-diffusion-innovation-theory-technology-acceptance-model-somang-min-kevin-kam-fung-miyoung-jeong
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