Emily Vance Ferris State University

 What is Dementia?  Treatments Medications/Side Effects Non-pharmacological  Doll Therapy  The purpose of this assignment is to “practice collaborative leadership to advocate for quality nursing practice using evidence based knowledge”

Nursing Problem  Is this therapy effective in treating distress in dementia patients?  Is it ethical to use?

 Nursing Theory Katharine Kolcaba – Comfort Theory John Bowlby – Attachment Theory

 1 st study Mixed methods design to collect observational data Used Likert Scale 14 residents  2 nd study 66 residents Examined case notes  3 rd study  Bradford Dementia Group Wellbeing Profiling too  4 th study Questionnaires to 46 care staff 37 residents  Results All showed some decrease in agitation and wandering However, some caregivers found it “demeaning…patronising…babish” Methods

Article Critique  Nursing Research British Journal of Nursing Authors’ are nurses  Qualitative Study Mainly anecdotes from other studies  Limitations Sample sizes Studies only done in UK and Japan Not enough research! Ethical concerns

 Nurse Leader Nursing staff  In-services and other training options Family  Counseling, support groups Social Worker Behavioral Therapists Physical/Speech Therapy

TRUEPIC Situation: Mrs. T is a 78 year old dementia patient that is newly admitted to a locked dementia unit of a nursing home. She is accompanied by her daughter who is having a hard time coping with her mother’s illness. After the daughter leaves, Mrs. T. is seen pacing the halls and entering other patient rooms. Mrs. T is easily agitated when staff try to redirect her. She is confused and keeps asking how her daughter will find her. The nurse is a 26 year old BSN prepared RN with 1 year experience working on a ortho med-surg unit. She has no experience dealing with patients with moderate to severe dementia. 1.Identify… 78 year old female Dementia/confused New admit Easily agitated Wandering Looking for young daughter 3. Understand… Proposition: “If the pt’s agitation is not controlled she could injure herself or others.” Significance of Assumptions: “If pt is unaware of why she is here and doesn’t socialize then she can become depressed.” Possible Confounding Variables: “If pt is unable to be redirected then she will be unwilling to take medication to help with other health issues.” 2. Relate… Primary Proposition: “Pt is agitated because family left her in a nursing home.” Possible Assumptions: “Pt doesn’t participate in regular social activities.” Possible Confounding Variables: “Pt has moderate dementia and is difficult to redirect.”

TRUEPIC 4.Explain… Proposition: In a meaningful way, explain where her family is and why she is here. Assumptions:. Explain to her the importance of social activies Confounding Variables: Explain to family how dementia works. 5. Predict… Proposition: if agitation continues the pt will hurt herself, staff, or other pts. Assumptions: if she does not participate she could get depression and her dementia could worsen Confounding Variables: if pt is unable to be redirected she could injure herself 6. Influence… Proposition: Make sure staff knows how to deal with her agitation. Assumptions: Make sure staff provides activities she likes Confounding Variables: Make sure to educate staff and family about dementia. 7. Control… - Nurses will calm pt with the use of nonpharmacologic methods such as reality orientation, aromatherapy, music therapy, or doll therapy (if allowed) Nursing Diagnosis Risk for injury: Risk Factors: confusion, agitation.

 Educate Staff/family/patients  Treat patients with dignity  More Research  Significance to Nursing Practice Better patient compliance Holistic nursing

 Colley, S. (2014). NURS 441 Nursing theory 3 [spring 2014 course syllabus]. Retrieved from eset.jsp?tab_group=courses&url=%2Fwebapps %2Fblackboard%2Fexecute%2Fcontent%2Ffile %3Fcmd%3Dview%26content_id%3D_510231_1 %26course_id%3D_8632_1%26framesetWrapped%3Dtrue  Comfort Theory by Katharine Kolcaba. (n.d.). Comfort Theory by Katharine Kolcaba. Retrieved January 26, 2014, from y_Kolcaba.html  Mitchell, G. & O’Donnell, H. (2013). The therapeutic use of doll therapy in dementia. British Journal of Nursing, 22(6),  Videbeck, S.L. (2014). Psychiatric-mental health nursing (6 th ed.). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.