Effective communication is the foundation of any successful medical process between a healthcare provider and the patients. However, among patients with neurodegenerative diseases such as Dementia and Alzheimer’s Disease, communication can become challenging. For these patients, since their communication is degenerating, it is always essential to find the means through which their communication can be improved. In such cases, the health care provider has to adopt new strategies that can effectively help them communicate efficiently with the patients. Such strategies involve the use of Augmentative and Alternative Communication (AAC) devices to maintain effective and functional communication and facilitate the adoption of individualized communication strategies that enhance their communication abilities. During my practicum hours, I engaged in the exploration of the use of augmentative and alternative devices in the management and treatment of patients with dementia, with a special focus on Alzheimer’s disease (AD). This paper provides a critique of the project in regard to the facilitators and barriers that I encountered in the project, how the challenges I faced were addressed, and the examination of the role of the Advanced Practice Nurses (APNs) in facilitating the effective use of the AAC devices among patients with AD.
Background and Significance
Dementia and Alzheimer’s disease (AD) are common diseases that mostly affect people in old age. Currently, the prevalence of neurologically degenerative conditions has become a major health issue throughout the world. Statistics show that between 6 and 10% of all individuals aged above 65 years and 33-40% of individuals by the age of 90 years develop AD. In the US, the number of individuals with AD is estimated to rise to 13.2 million (Yousaf et al., 2020). Also, according to the World Health Organization (WHO), there are more than 55 million people with dementia throughout the world, with more than 60% of these people living in low- and middle-income countries. The prevalence of these conditions brings with them more significant challenges, including increases in healthcare costs. The cost economies for dementia were 1.3 trillion US dollars in 2019, with half of these expenses being attributable to care provided by informal carers. Similarly, in 2020, the healthcare costs for AD in 2022 were $321 billion, which is projected to hit over $1 trillion by 2050 (Nandi et al., 2024). These two conditions currently make up the greatest healthcare burdens.
For people with neurodegenerative disease, one of the most difficult challenges is the insidious onset of communication impairments. Alzheimer’s disease (AD) and dementia are some of these neurologically degenerative conditions that are majorly characterized by a decline in a person’s attention, memory, problem-solving, and language. Among these individuals, the use of Augmentative and Alternative Communication (AAC) plays an essential role in supporting their communication among patients to facilitate effective management and treatment (Kujawa, 2021). The use of AAC among patients with AD or dementia helps them continue maintaining social connections, express their needs and preferences, and also participate in decisions regarding their care. The use of AAC is an external memory strategy whereby lexical retrieval and language production are supported by the use of low-to-high-tech devices. Since the 1990s, experimental examinations of AAC for persons with degenerative conditions emerged, with various studies showing that the use of external memory aids can significantly improve communication with people suffering from neurodegenerative conditions.
Understanding how the AAC works and how APN nurses can participate in ensuring its effectiveness is essential in contributing to the already existing knowledge of the effectiveness of the use of devices when interacting with patients suffering from dementia and AD (Brown, 2023). With the high health burdens posed by people with dementia and AD, understanding how AAC can be used to enhance communication and, thus, the ability to treat and maintain the conditions plays a crucial role in the healthcare system. Research in these areas shows how the patients, their families, and the healthcare providers, including policymakers, can most effectively develop communicative strategies that can enhance their communication with individuals with dementia or AD, thereby enhancing the ability of the healthcare providers to address the health and the mental challenges faced by patients with AD. Although these devices are available, their use from patient to patient may differ according to their personal conditions and challenges that need to be addressed for them to be capable of addressing the communicative challenges experienced by people with AD. Therefore, the project will be important in ensuring that the effectiveness of the use of AAC among patients with AD is enhanced by taking into consideration individual aspects, including strengths and challenges, and highlighting the role of the APNs in ensuring that the effectiveness of the communicative strategy is enhanced.
Research Project Critique
This section entails the critique of the entire project. Here, the enablers, the barriers, and the strategies for the development and implementation of the use of the AAC are examined. The enablers discussed in this section will be the factors that made the project possible and the barriers that were encountered in the course of the project. A response will also be given on how the challenges encountered in the course of the project were addressed to ensure the success of the project. The expected outcomes of the project will also be evaluated, with a clear description of the role of the APN in ensuring the success of the project.
Enablers, Barriers, and Strategies
The decision to conduct the project was primarily informed by the increased number of individuals living with neurogenerative conditions such as AD and dementia. With the increased number of people living with AD and the projected increase in the numbers, exploring how AAC devices can be used to enhance communication with them. The existing statistics show that these conditions are increasingly becoming a challenge to the healthcare system, society, and the economy; hence, there is a desire to explore how AAC could be utilized to address the challenges that this population brings with it. Through interactions with patients with AD, I recognized how challenging it was to interact with the patients and the amount of effort it took to hold a meaningful conversation with them. In most cases, these individuals had lost their semantic memory or lacked access to the words that are essential in formulating specific messages, making it difficult for them to communicate specific information or decisions regarding their care (Yousaf et al., 2020). Although therapeutic interventions have mostly been used to enhance their ability to communicate, the neurodegenerative nature of the conditions makes therapeutic interventions unsuccessful, hence the continued difficulties with communication. Besides, I also had access to high-quality research that exposed me to the challenges experienced by individuals with AD and the interventions that had been put into place to enhance their communication. These studies have identified communication with AD patients as a major challenge that is best addressed with the use of internal and external memory strategies, including the use of AAC devices.
Throughout the project, there were significant barriers, particularly in regard to the accessibility of the AAC devices. However, the study revolved around the use of these devices and access to the various devices needed to successfully conduct the research (Ambegaonkar et al., 2021). The available devices were limited and could not provide the desired alternatives to enhance the communication process, especially when deciding to use the AAC compensatory strategy approach and the restorative treatment paradigm. Notably, the devices for use in differing situations need to be ascertained and acquired, and when not available, can pose a challenge to addressing the identified communicative needs (Brown et al., 2021). Besides, the recruitment of participants in the project was a great challenge, especially since I had to convince the family members of how the project would help them enhance their communication experiences with the patients. The technologies required to enable communication and facilitate care support for patients with AD and dementia are also affected by the lack of knowledge on their uses and usefulness, which affects their acceptability to the members of the population (Ambegaonkar et al., 2021). This became a major challenge in the attempt to recruit participants for the study.
To address these challenges, various interventions were adopted. One of these interventions was seeking alternative funding sources in order to increase the accessibility of AAC resources. Here, the number of available devices was significantly increased and gave the desired alternatives to ensure that the patients/participants had access to the desirable devices that met their communication needs. Besides, collaborating with healthcare providers and social workers, among other stakeholders, to enhance awareness of the role of AAC devices in enhancing communication with patients with AD and dementia played a major role in enhancing the ability to recruit participants for the study. Raising awareness among the members of the population on how the use of AAC devices could play a major role in enhancing effective communication with patients with neurodegenerative conditions was the primary aspect that facilitated efficiency in the recruitment process.
Expected Outcomes
When completed, the project is expected to enhance the communication experiences with patients suffering from AD and dementia, among other neurodegenerative conditions. By exploring the use of AAC devices, the project seeks to enhance their effectiveness and thus increase effectiveness in their use to enhance communication with individuals having AD. Currently, the use of the devices has been found to be essential in making communication more efficient, but there is knowledge and awareness among the members of the public on how these devices can effectively be used to enhance communication outcomes with people suffering from AD and dementia. For effectiveness, it is essential to ensure that these communicative aids have the required symbolization, accuracy, and automaticity to ensure that the communication experiences are streamlined, hence the ability to enhance the communication outcomes (Brown et al., 2021). Besides, the project is expected to minimize the burden on the healthcare system that is caused by the challenges brought about by patients suffering from neurodegenerative conditions. By enhancing communication with the patients, the project will make it easy for healthcare providers and the patients to engage in meaningful communication and thus the making of efficient decisions regarding the health goals and approaches of the patients, thereby minimizing the need for continuous care, which adds the workload for the healthcare providers.
Contributions of the Project
The project will have significant contributions to consumers, healthcare professionals, administrators, and policymakers. Among the patients, the project is expected to improve their communication, particularly regarding their needs, and make health decisions, thereby enhancing their general well-being. With the current communicative challenges, it is difficult for the patients to fully express their needs and concerns to the family members and the healthcare providers, thereby limiting their ability to provide comprehensive care. The project will facilitate streamlined communication with patients among healthcare providers. This will significantly reduce the workload for the healthcare providers, as they will not have to struggle to understand the needs of patients due to their limited communication capabilities. Among the policymakers, the project will inform the best practices that can be utilized to enhance communication with patients with AD and examine the impact of their use, as well as the role of the various stakeholders in facilitating communication with patients with neurodegenerative conditions. The project will also facilitate the development of effective policies that can enhance communication with patients suffering from AD. More importantly, the project will facilitate the delivery of quality care and enhance the adoption of a person-centered approach in dealing with patients with neurodegenerative conditions, and it will form the basis upon which future research on AAC can be based (May 2020).
Role of the Advanced Practice Nurse
In the research project, the role of the APN was central, and its effectiveness was ensured. Notably, the APN was responsible for ensuring that the design and implementation of the project were effective, that it was in line with the nursing code of conduct, and observed all the ethical provisions that guide nursing practices. Through their expertise, the APNs are aware of the challenges with communication that people with AD usually experience, as well as the possible communication approaches and strategies that can be utilized using AAC devices. Normally, the APN ensures the provision of individualized care for persons with intellectual disability, and this makes their involvement in the examination of the use of AAC devices central (Torrens, 2022). Also, the APN played a major role in informing the patients about the devices that were required to address the communicative challenges that the patients with AD exhibited. Notably, patients with AD will need different devices that address their specific communicative needs, which is why the APN got involved in identifying the major devices that the patients had to use to ensure they communicated.
Besides, the APN also plays a major role in ensuring effective collaboration among the stakeholders to facilitate effectiveness in the entire project. With the project requiring care coordination with the family members and the healthcare providers, it was essential for the APN to ensure that each stakeholder was aware of what was expected from them and how to provide the required support to bring out the best outcomes (Al‐Maaitah, 2020). Without proper coordination of the project activities and the coordination with the families and the care providers, the use of the AAC providers can become ineffective, especially when the patient does not have the required expertise and knowledge to use them. The APN also played a role in providing the necessary support to the patient, such as facilitating the involvement of therapists and social workers in providing the patients with the desired support. In addition, the role of the APN in the project was to ensure that the project aligned with the use of evidence-based research to facilitate positive outcomes.
Reflection
Throughout the semester, conducting the research significantly challenged me while also enhancing my skills. In particular, the project provided me with an opportunity to identify challenges in the real world and address them in a manner that reflected a high degree of proficiency. To effectively do this, I had to rely on my research and problem-solving skills to ascertain and come up with interventions to address the challenges that people with neurodegenerative conditions experience. Through the project, I realized that any research activity is guided by ethical considerations that should be observed when interacting with vulnerable populations, access to equipment, and the required resources. Whenever a person experiences these challenges, it is always important to collaborate with other stakeholders to ensure that the project does not violate the established ethical considerations. Also, for the project to be successful, I learned that collaboration is essential, especially since the project could not be conducted successfully by a single person. This experience helped me appreciate the role of collaboration and care coordination in healthcare to address complex healthcare challenges that face the diverse members of the population. In collaboration, every participant has a role to play, and the success of the care coordination plan relies on the ability of all the stakeholders to perform their roles effectively.
While conducting the project, I was exposed to the challenge of having to convince the patients and their families to participate in the project. This was primarily due to the fact that they were not aware of what AACs were and what role they could play in enhancing their communication experiences. This made me collaborate with the APN and other stakeholders to raise awareness of the role of AAC devices in enhancing communication experiences among patients with AD and dementia. Through this, it became easier to recruit the participants for the project as they were now aware of the significance of the approach. Overall, my experience with the research has been highly rewarding in enhancing my ability to provide quality care to patients with dementia and AD.
Conclusion
With the current increasing incidences of dementia and AD, communication challenges in healthcare settings are considerably increasing, making it difficult for healthcare providers to provide quality care. This, in return, increased the healthcare costs. However, with the use of AAC devices, communication with patients suffering from neurodegenerative conditions can be enhanced, facilitating the delivery of quality care among the patients. Without effective communication strategies, it becomes difficult for patients to make decisions regarding their health, and this can influence the quality of care that they receive, as well as their ability to express their needs and desires. Conducting a research project on this population provides deeper insights into their challenges and the role that the use of AAC devices can play in streamlining communication experiences. Conducting the project was facilitated by the availability of extensive research on the field and interaction with people with AD and dementia, while the challenges experienced included the lack of sufficient resources and difficulties in recruiting the participants. Throughout the course of the project, the APN played a central role in organizing and ensuring the success of the project.
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