Modeling and Evaluating Evidence Program †Free Samples to Students

Question: Discuss about the Modeling and Evaluating Evidence Program. Answer: Introduction World Health Organization initiated "Health for All" by 2000. It is the global strategy, in response to which, the Australian health ministers advisory council established the National Health Priority Areas. This is the collaborative effort involving Commonwealth, State and Territory governments. There are nine priority areas under AIHW (Australian Institute of Health and Welfare) including cancer control, cardiovascular health, mental health, injury prevention and control, diabetes mellitus, asthma, arthritis and musculoskeletal conditions, obesity and Dementia (Lam et al. 2015). This paper will particularly focus on Dementia. These priority areas have been initiated and have recognised that the disease burden can be reduced by implementing holistic strategies. The strategies should be for prevention and through to treatment and management. In response to this priority area, the paper discusses the significance of the health issue regarding the incidence and prevalence, influence on individual and health care system, morbidity and mortality, and financial costs. It significance to nursing is also discussed. The research evidence in regards to this issue is described briefly. The paper comprehensively describes how research informs practice including the research-practice gap. It involves the major evidence based practice recommendations and the research practice gaps. Dementia is the umbrella term for 100 different diseases, diagnosed in ageing people. Dementia is characterised by the impairment of brain functions. It includes loss of memory, perception, cognitive skills and personality. People living with Dementia have profound consequences for the health and quality of life. It also increases the economic and emotional burden on the family and friends. Dementia is the progressive disease with irreversible symptoms (Withall et al. 2014) Dementia is the significant outcome of the increase in the ageing population. The focuses on the aged group 80 years and above. In Australia, the estimated cases of dementia by 2050 are 900,000. It is the major health issue in Australia. Currently, there are 342,800 cases of dementia in Australia. In 2015, 10% of the Australian population aged 65 and above were diagnosed with dementia and 35% of them diagnosed were aged 85 and above. The Australian government funded aged care facilities, and 50% of the permanent residents were diagnosed with dementia in 2013-14. Dementia is the second leading cause of death in Australia. It is responsible for 10.6% of the female and 5.4% of the male deaths in Australia (Australia 2013). The impact of dementia on the health care is devastating. The projections of the Australian survey informs about the greater need for carers in the community (255,800). The number of the carers may be doubted by 2050. The healthcare cost of dementia is expected to rise to $18.7 billion in present condition. By 2056, the cost may rise to $36.8 billion (Prince et al. 2013). Nursing can make the significant difference to this heath issue. They can deliver specialised care that is needed for dignified treatment. Dementia nursing care is underpinned by the holistic model. This model addresses the physical, emotional, social and mental health aspects when caring for the dementia patient. Dementia patient needs intimate care. Thus nurses have to spend intensive periods with the client to establish the therapeutic relationships. Nurses are accountable to deliver evidence based practice to generate optimal health outcomes. Nurses have inherent obligation to deliver patient advocacy. They are responsible for informing society to develop habits and environment that hinder the advancement of dementia (Fielding et al. 2016). Dementia as the national priority area of AIHW was recognised by performing thorough literature research. To extract information about this topic, various bibliographic databases were used. These databases are commonly used for scientific research and accessing the wide range of literature. These databases are useful for retrieving full-text articles. The inclusion criteria for the articles search are- peer reviewed article, published in the period 2010-2017 and the English language. These inclusion criteria will help search the articles meticulously. Articles are screened initially by the title followed by abstract and lastly full-text article (Van Beynen 2013). The search terms used for the database search and retrieval of articles are Dementia, dementia care Australia, heath care, nursing, Australia dementia prevalence, dementia impact, dementia research gap, EBP recommendations. Boolean operators AND and OR were used to use to narrow the search. For example- Dementia and nursing; Dementia OR mortality OR prevalence. These operators were applied as per the search method for each database to streamline the search in the correct direction (McGowan et al. 2016). Starting with 25 articles and applying the inclusion criteria, the total number of articles retrieved was 10. A summary of six of them is given below. Articles Database Level of evidence Classification Stregth (Schnemann et al., 2014) Reason Testad et al. 2016 Cochrane Library Level II Primary research High Evaluated evidence?based continuing education program in nursing home dementia care. Useful for the training of staff Murphy et al. 2016 Medline Level VI Primary research High Dementia guidelines that are useful to be implemented in the general practice McKenzie and Brown 2014 CINHAL Level VI Primary research Moderate Highlighted the perceptions of the nurses in the dementia care useful for intervention Livingston et al. 2014 CINHAL Level I Secondary research High Highlighted the Non-pharmacological interventions for agitation in dementia Laver et al. 2016 Medline Level VI Clinical practice guidelines High Provided useful practical guidelines for dementia care that will eliminate the gaps Three of the six articles McKenzie and Brown 2014, Laver et al. 2016, were extracted from CINHAL. Two of the articles Murphy et al. 2016 and Laver et al. 2016 were extracted from Medline. One article by Testad et al. 2016 was taken from the Cochrane library. Using the level of evidence framework by Burns et al. (2011) the articles in the level I are the evidence from the systematic review of the randomised control trials. The articles in the level II are the evidence obtained from one well-designed RCT. Qualitative analysis, RCT and its systematic review give high level of evidence, as they are mainly primary researches conducted by the author. Secondary researches are the review of primary research studies and are considered to be of moderate strength. However, strength of the chosen systematic review is of high strength due to well description of all the parameters (Munn et al., 2014). Research practice gaps According to the International Association of Gerontology and Geriatrics that conducted global agenda for clinical research and quality of care in long-term care homes, identified that there is research gap in knowing the concerns related to present state of nursing practice in long-term care. According to the consortium, there is a little action taken in regards to defining the registered nurses competencies. There is a poor understanding of the leadership style that is required to enhance the effectiveness of the registered nurses in improving the staff, resident and the family outcomes. There is a need for creating the long-term care home like environment in training facilities and hospitals so that the registered nurses can practice to their full scope. There is also research gap in the area of understanding the impact of the nursing and organizational models (McGilton et al. 2016). As per the Murphy et al. (2016), the major barriers to implementing the evidenced based recommendations are lack of use of the validated tool to assess co-morbid depression. There is a general misconception that depression can be adequately assessed using general clinical indicators. Most professionals belief that only a little information can be obtained by the validated tools. There are many GPs who feel discomfort in using validated tools. This condition was due to the limited training and confidence among the care providers. Further, the researcher also found that there was the poor awareness on conducting the depression assessment which is also one of the evidenced based practice (McGilton et al. 2016). On those practitioners could well conduct the assessments and were in consistent with the evidence-based recommendations, which have necessary skills, confidence, an appropriate level of awareness as well as time and resources. Restrain, and agitation has been recognised as the m ajor barriers in practising the evidence based recommendations. Thus, there is a need of change in the design of information to develop practice in line with dementia guidelines (Livingston et al. 2014). To identify the gaps in evidenced based recommendations and practice the WHO ministerial conference initiated global action against dementia. With the help of the systemic international process, the research priorities identified are the prevention of dementia, identification of dementia risk factors and strategies for reduction of risk. Further priorities include improvement in the quality and safety of care delivered to dementia people. Other research priorities were related to biomarkers, diagnosis, understanding the disease mechanism, treatment development, and need of greater public awareness and understanding of dementia (Shah et al. 2016). Evidence based recommendations Firstly, Provision of patient centred care by the health and the aged care professionals. They must use the ten principles of dignity in care. The professionals should respond to the individual preferences and needs. Secondly, referral of patients to comprehensive assessment or the memory assessment specialists. Thirdly, all the practitioners should be honest and respectful towards patients and use individualised approach when communicating with them and their families about the diagnosis. Fourthly, health system planners to be more responsible for ensuring that the patients have access to care coordinators. Fifthly, dementia care training should be provided to all the aged care staff. It must include attitude, skill development and attitude. Training must allow the care workers to optimise care for dementia patients. Staff must be trained in the principles of patient centred care (Laver et al. 2016). These recommendations will eliminate the gap between what is known to be effective and what is practice. Sixthly, occupational therapy interventions should be given to the dementia patients. It must include environmental assessment, prescription of assistive technology, tailored intervention to promote independence in activities of daily living. Seventhly, the comprehensive assessment should be offered for patients developing behavioural and psychological symptoms. The assessment may include pain and discomfort, physical and mental health,side effects of medication, an impact of spiritual beliefs and cultural norms, physical environmental and interpersonal factors,and form of communication (Prince et al., 2013). Further, the recommendations involve respite care for dementia patients and programs for carers and families to be implemented so that can optimise the care. These programs should be individualised and multifaceted to eliminate the gap. Lastly, the antipsychotic medication should not be prescribed to patients with mild-to-moderate behavioural and psychological symptoms of dement ia. However, in many cases it was found to be administered (Laver et al. 2016). According to Testad et al. (2016), the reduction in the use of restraint in the care homes can be achieved by the tailored 7-month training intervention also called as Trust Before Restraint. These interventions will prevent the use of restraint, agitation, and antipsychotic medications in care home residents with dementia. This intervention will help focus more on the patient centred care. There is a gap in implementing the patient centred care as there is no effective tool to reduce agitation in care homes, Further; there is no assessment of the long-term implementation of activity and sensory interventions. It indicates that there is a need for further research in the home care setting (Livingston et al. 2014). Thus, it suggests the need of non-pharmacological interventions for agitation in dementia. McKenzie and Brown (2014) suggested that the educational providers should target students who are passionate about dementia care and look for greater work intentions in dementia care such as age and positive ageism. Further, there is a need for identifying the barriers as it indicates possible areas of improvement. Once identified and addressed it will attract number of care providers and students to this field of practice. By examining alternate strategies to engage younger nursing students, self-care practices can be induced. It is suggested by this article that curricula should be adopted to incorporate successful communication skills with dementia people. Thus these gaps should be covered as soon as possible. According to Livingston et al. (2014), barriers to applying the research into practice include lack of sufficient pharmacologic treatments available for dementia, lack of commercially available imaging tool for the technician poor diagnostic accuracy. The advanced imaging tools that are currently available have limited clinical applications. These tools are primarily reserved for research. There is a greater focus on the early stages of neurodegeneration, and the risk factors that might be present in the patient even years before the appearance of clinical symptoms. There is a lack of acknowledgement of the risk factors. There is still a gap in determining the early identification of the possible clinical disease trajectory. The area of the health and the insurance coverage is the other major barrier that is not letting the gap between the research and clinical practice to be closed. For instance not all the insurances cover the cost of differential diagnosis particularly for PET (Wi cklund Gaviria, 2011). Conclusion Dementia is the major health priority in Australia. This health issue is significant to nursing. Nursing can make the significant difference to this health issue. Nurses can deliver specialised care that is needed for dignified treatment. Dementia nursing care is underpinned by the holistic model. This model addresses the physical, emotional, social and mental health aspects when caring for the dementia patient. Dementia patient needs intimate care. Thus nurses have to spend intensive periodswith the client to establish the therapeutic relationships. Nurses are accountable to deliver evidence based practice to generate optimal health outcomes. Nurses have inherent obligation to deliver patient advocacy. There are several evidenced based clinical guidelines and recommendations developed for improving health outcomes of dementia patients. The main recommendation being the implementation of patient centred care. All the practitioners should be honest and respectful towards patients and use individualised approach when communicating with them and their families about the diagnosis. Dementia care training should be provided to all the aged care staff. However, there are a research practice gaps which is mainly attributed to poor diagnosis, not understanding the disease mechanism, poor treatment development, and poor public awareness and understanding of dementia. Further reasons involve preference to agitation and restraint in long term care homes. In conclusion as a result of the evidence based practice, the clinical practice changes. References Australia, A., 2013. Statistics: Summary of dementia statistics in Australia. Burns, P. B., Rohrich, R. J., Chung, K. C. (2011). The levels of evidence and their role in evidence-based medicine.Plastic and reconstructive surgery,128(1), 305. Fielding, E., Chenoweth, L., Beattie, E., Moyle, W., Maria, O., Robinson, A. and He, W., 2016, November. PROVIDING DEMENTIA CARE: NURSING HOME STAFF ATTITUDES, SATISFACTION AND STRAIN EXAMINED. InGERONTOLOGIST(Vol. 56, pp. 744-744). 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