Evidence Based Nursing Research Ministry of Health

Question: Describe about the Evidence Based Nursing Research for Ministry of Health. Answer: Introduction Dementia is defined by the Ministry of Health as the condition of gradual loss of mind function as a result of changes in brain structure. Living with dementia currently requires one to get support from friends and family to cope up with relatively lifestyle changes (Barnes, M. Brannelly, T. 2008). There are many dementia models that have been proposed based on person, service or care delivery to the persons with dementia. It is critical for a single model to be implemented in the dementia-friendly care rooms such as toilets and bathrooms. Implementation of the best model takes into account project implementation cycle (Lynne M. 2012). Implementation of dementia model requires consideration of demographic, socio-cultural, environmental and ethical factors as described by Lou, F. (2012). The following is literature review on models of dementia and with aim identifying one model that can be implemented in dementia-friendly ward. Dementia models Dementia has become an everyday issue that has received attention nationally and internationally. There are numerous researches that have been conducted to improve on conditions in and around dementia care facilities. There are many models that have been proposed to help care for dementia patients. According to Mental Health Commission (2012), some models are the social model of dementia care, person center model, palliative care model, nursing home care model, dementia environmental friendly model, and supportive model. Person-centered model is a model that is based on 4 key factors namely value, individual, social and perspective. Firstly, the model works on the value of the person with dementia (Christie, J. Cunningham, C. 2011). The value of person suffering from dementia should be accepted and respected in the society. Secondly, individual part of the model refers people with dementia as special individuals. Thirdly, social aspect holds to the environment of individuals with dementia. Finally, person-centered dementia model according to N.T.G. (2012) has perspective aspect that shows peoples the perspective of dementia patients. In addition, Sampson, L. (2010) indicate that person-centered model uphold the personhood, the status that encompasses human being and social being. Similar model by David, S. (2015) termed the person-centered model as butterfly model. Butterfly model implies helping dementia people, being friendly and providing everything to them. Social care model of the dementia is defined by Clare, L et al (2008) as the element of cognitive or rather than medical. The main aim of this model as stated by Molnar, J., et al. (2012) is to instill the sense of belonging on dementia so as to stimulate their mind for cognitive responses. Moreover, home like furniture offers the best way to make dementia person to feel social and free while dull hospital furniture is removed to increase social activities. Taking care of the dementia persons according to social model means restoring personal responsibility and place in the society. A study conducted by (Palliative Care Council of New Zealand 2012) in New Zealand shows that through funding of District Health Board DHB realize the importance of instituting social units called residential care for dementia persons. Furthermore, assessment is done to verify persons suitability for residential care centres in case they can no longer survive at home. Similar study was conducted in Austral ia by Carroll, M. (2008) and found that different social groups are made to facilitate movement from one continuum to another. Some of the social groups are Well Aged group, Transition group and Frail Aged group. The study further highlights self management, service flexibility and addressing the care complexity. Palliative care model of dementia care is another dementia care model described by Kelly, F. Innes, A. (2010). Palliative care model emphasize on life affirmation, pain relief and holistic care to persons with dementia. Similar study conducted in England by Ryan, T., et al (2002) shows that palliative care for dementia is important as nurses had to provide care support to person at any place including washrooms. The study further set the goal of quality life for patient. On holistic care, psychological, spiritual, biological and social care is readily given to the dementia person. Much care is taken to avoid sickness for people taking care of dementia patients as care givers often falls sick and even die from exhaustion (Palliative Care Council of New Zealand 2012). The environments model focus on designing dementia-friendly wards such as bathrooms and toilets. The environmental friendly model focuses on designing and innovatively coming up with toilets and bathrooms that does not cause distress to the dementia people but instead help them accesses this rooms. Study conducted by Chenoweth, L., Jeon, Y. (2007), indicate that toilets are the places that still pose challenge to the dementia patients either in hospitals or any other care facility. Designing of toilets and bathrooms consider factors described by Brawley, E. (2006) such as colors, non slippery floor mats, toilet seats and handrails are in the easy and accessible to persons with dementia. To innovatively use these factors, firstly, colors should be contrasting to enable these patients see the different parts of toilets such as walls and toilet seat. Secondly, Fleming, R. Bennett, K. (2014) describes floor of ward to have non slippery mat or rough tiles to prevent them from falling. Supportive model of dementia include provision of all the necessary care the dementia person need in the course of their life. Supportive care can also means giving care to the whole person that includes psychological, spiritual and social at the practical level. Bell, V. et al (2008) defines supportive care as the model that work to provide persons preference, desires, and personality to realize the good quality of life. A study conducted in the UK by Christie, J. Cunningham, C. (2011) explains the supportive care model as responding to individuals dementia care need in supporting them. This study concurs with environment friendly model on providing personal preferred environment to patient. Nursing care model also refers to greenhouse care model is concerned with application of nursing principles of care in taking care of dementia patient at any care facility. Some of the principles that are used in nursing care model include communication, eating bathing, walking and handling of behaviors. Firstly, research conducted by Alzheimer society (2016) indicates that since dementia normally has effect on persons communication ability. Therefore, nursing care is needed to help dementia patients respond to different elements of communications. Secondly, eating is one of the basic elements of care that the patient need to have as per the study by Nolan et al (2002). This implies that nurse should be able to assist the patient to know how to eat and drink. Thirdly, another research by Dewing, J. (2007) shows that it is important to assist the patients with dementia to walk and move around as excises. Environmental friendly model Based on the above study of models the model that can be used in my current workplace is environmental friendly model is the most applicable. Based on Sherry L. et al (2011) study, the dementia-friendly environment model focus on innovation design of toilets and bathrooms to assist dementia patients to feel cared for and loved. Dementia-friendly environment model is person based dementia model. According to Aud, A. (2004), environmental friendly model is currently the best model to use in dementia-friendly care facilities. In addition, environmental friendly model is applied to building and construction of newly developed hospitals and other health care facilities across the country (Brawley, E. 2006 and Brawley, E. 2008). The model needs to be implemented because of some reasons which are termed as principles of model. There are some principles cited by Fleming, R. and Bennett, K. (2014) for environmental friendly dementia wards. Some of these principles are risk reduction, movement support, familiar space, community link, environmental audit, interaction with other people and cost effectiveness. The dementia-friendly environment model applies principle of risk reduction in care facilities. Designing of the toilets or washrooms require the architecture that has absolute risk free environment that is friendly to dementia patients. A similar study conducted in Australia by Leibrock, C. (2000) shows that fitting of toilets grills should be done in the safest way to minimise risk as possible. Furthermore, door of washrooms should be designed to keep opening to easy the movement of patients in and out of the room. Floor should be non slippery with ideal rough mat to allow movement without any risk of falling for patients (Brawley, E. 2008). The dementia-friendly environment model applies the principle of free movement of the dementia patient. The location of the toilet should be easily accessible for patients at all time hence they can move at a very easy way without challenge or risk. This implies that toilets or washrooms should be clearly visible from other rooms where the patients stay or spend most of their times. The doors of toilets or any other rooms need to open in simplest way that supports movement of these patients. According to Davis, S. et al (2009), the environment where patients leave should be friendly enough to show the patients good quality of life necessary. Lighting of the path to toilets needs to be passive infra red that is ease to detect by patients. The main ideas of the dementia-friendly environment model are to provide person-centered care to the dementia patients. Familiar space is another principle that support environmental friendly model of dementia care. Brawley, E. (2006) study describe the space where the dementia patients to be normal, familiar which is easy for the dementia persons to adapt to without struggles. Familiar space also applies the element of colours in designing rooms so as to reduce challenges for mastering room furniture and paths. Familiar space can also be designed using contrasting paint colours to identify objects for these dementia patients. Brawley, E. (2008) shows that mirror reflections should be avoided as they bring confusion to the dementia patients when they glare at the mirror. If there is any mirror in the washrooms, those mirrors are covered by blind colours that look like other colours in the space. Linking the dementia patients with the community around is one of the key features of environmental friendly model that makes use of dementia-friendly community care services. WHO. (2012) study state the like of the dementia people with community as based on respect, understanding mutual support. This claim is further explained as upholding of the dignity of patients and respecting them with the view to delimiting their connection with community or other people in their surroundings. The Alzheimer Society (2016) also shows that the community needs to understand dementia people, their choice, and control of their lives. It therefore, means that these dementia people should find their own way and feel safe. Community link also make patients feels the sense of belonging to the society as oppose to alienation. Environmental care audit is another principle that also works in dementia-friendly model to help dementia patients feel comfortable. Environment audit assists in looking at various environmental plans available for designing of dementia-friendly rooms. Dementia Enabling Websites (2016) has come up with the easiest way to assess the ward or any other care facility for the requirement to make it friendly to the dementia people. Dementia enabling environments offers important information on care, audit tools, principles and designs for dementia-friendly environments. One of the basic principles of dementia environmental friendly model is people interaction. Interactions of the dementia people as per MacRae, H. (2011) take various angles such as care giver-patient, patient-patient and patient-community levels. The nursing in charge of dementia-friendly facility initiate a friendly environment with maximum patient caregiver interaction. This interaction makes the dementia patients feel comfortable and any necessary assistance is readily provided. When designing dementia-friendly toilets the architect should be in such a way the maximize interaction will minimizing any challenging moment that reduce freedom of patients (Brawley, E. 2008). The dementia-friendly environment model is person based model and considers the following factors: toilets and bathroom, room design, flexibility to adapt, contrasting colours. Firstly, designing of toilets and bathrooms require professional knowledge in understanding the nature of dementia patients (Brawley, E. 2008). Dementia-friendly toilets should be safer and have ability to take care of rising dementia conditions populations in the currents society. Secondly, the flexibility of the toilets is important as it had to allow patient to easily adapt to the environment. Thirdly, calours of the walls and floor is good for dementia-friendly environments (Brawley, E. 2006). Cost-effectiveness of model focus on low cost of implementing the model according to Delavande, A., et al (2013), when commenting on the implementation highlighted that the dementia-friendly environment approach has only innovative design without many other requirements. The main reason behind cost-effectiveness of the model lies on the development phase of implementation. Furnishing of buildings can be done without necessarily constructing new buildings. MacRae, H. (2011) argues that depending on the size of current dementia-friendly ward, renovation can be done fitting the new features such as hand grills, new toilet seats, repairing of floors and repainting of wall. Moreover, the new wards just commence work immediately after renovation. This did not contradict similar research done by Delavande, A., et al (2013) that state that to reduce the higher cost of constructing new wards the old rooms need to be renovated with view to continue using them. Implementation phase of the dementia-friendly environment Implementation of the dementia-friendly environment model makes use of normal factors that affect any new technology or idea. Based on the research available it is critical that environmental friendly model be implemented in current dementia environmental friendly workplace that include toilet (Mental Health Commission 2012). Implementation takes six basic stages that include initiation, definition stage, designing stage, development stage, actual testing of project. Initiation stage of dementia-friendly environment At the initiation stage the model is introduced to the management team upon the conviction and evaluation, the proposal for its importance. The management team has to decide whether the model can work in the current workplace or not (Hornillos, C et al 2012). Based on the available knowledge the hospital management team evaluate on the funds required to develop and implemented. Stakeholders or partners are also identified at the initiation stage with the aim of familiarizing them with the project to be implemented. Upon the evaluation the hospital management had to decide on financing the proposal. According to Davis, S. et al (2009), initiation stage determine whether the program will continue, should be improved or the program does not work. Terms of operation under which the project will run are set at this initiation phase. As nursing professional in the dementia-friendly environment that need improvement I will write and present the proposal to the hospital management team. Definition stage of implementation At the definition stage objectives of the project are clearly out lined and stakeholders roles are clearly outlined. The definition stage of the implementation of dementia-friendly environment model involves bringing together stakeholders that are part of the project. Aud, A. (2004) indicates that various stakeholders such as architects, health care officials, health managements and community are invited to share the idea to be implemented. Firstly, architects are the key stakeholders as they are involved in the next phase of implementation of the model. Secondly, health care officials normally take care of patient and therefore are part of the implementation of the model. Thirdly, management team is the decision makers that give the recommendation on funds needed and go ahead to implement the model (Barnes, M. Brannelly, T. 2008). Fourthly, creation of awareness in the community around on the importance of the project and bringing them on board is important part of implementation s tage of the model. In addition, the community should also be given chance to give their opinion on the project. Designing phase The designing phase of implementing model involves developing of building plan or renovation plans that is necessary for developmental stage. Innovative designers are involved in designing or developing of plans that give location and the way dementia-friendly ward look like. A good plan is equivalent to the expected result or outcome of the program. According to Brawley, E. (2006) and Brawley, E. (2008), after drawing of building or renovation plan, the plan needs to be put into the reality through actual renovation or construction. Development phase Construction or renovation involves building new ward if the funds are available or renovation of the existing buildings to reduce cost of construction. At this stage application of contrasting colours, fitting of grills and toilets seats are done that assist dementia patients to use these wards. This stage of implantation takes into account factors that have been proved to influence designing and building of any public buildings. There are various factors that are considered when implementing or designing of environmental friendly ward such toilets as a way of implementing dementia friendly environment model. These factors are socio-cultural factors, demographic factors, environmental factors and ethical consideration. Lou, F. (2012), describes age as the main demographic factors that are applied in designing of the dementia-friendly toilets. The research further indicates that toilets should be designed in such a way that minimise any absolute risk associated with dementia patients while in the washrooms. Similar research by Brawley, E. (2008) also shows that old dementia people need carefully designed toilets to minimize any reflection on surfaces by the use of contrasting colors. This is due to the fact that old patients has high risk of losing vision and need clearly designed objects. Health care facility with older dementia patients requires toilets that are flexible to adapt to as compared to the relatively younger patients. In addition, as Hoof, J. (2009) put it that toilets for different age groups among patients is important since it reduces any unnecessary controversies that arises during interaction of dementia patients. As Brawley, E. (2006) and Brawley, E. (2006) makes a clear understa nding that in Australia a total of 20 dementia patients were used and proved to effectively use a single friendly toilet. Socio-culturing factors play a critical role in implementation of environmental friendly model of dementia. Firstly, socio-cultural behaviour of the local community is important as the patients need to have a connection with their communal practices so as not to feel alienated. Accessibility of water in the toilets as a way of cleaning after using the toilet according to Kontos, P. (2004), study is equally important. Position of water taps and toilet sits is important as various groups prefer different location depending on socio-cultural beliefs of individual. Secondly, socio-cultural influence on dementia-friendly architect done in India shows that community behaviour influences patients preferences in terms of washrooms they need or prefer to use (Parimita, R et al 2015). According to this study, community belief and customs influence roof type, doors and personal adaptation to rooms they use. Thirdly, Brawley, E. (2006) concluded that habit, cultural beliefs, gender and sanitatio n rituals affect the design and adaptation of various facilities in dementia-friendly environments. Environmental factors such as land appearance, the location of facilities, space and accessibility are important in implementing dementia-friendly model (Barnes, M. Brannelly, T. 2008). Firstly, appearance of the land where toilets are located should not pose risk to the dementia patients but instead should be good enough for ease of accessing with minimal help. Secondly, location of the dementia-friendly toilet is key to those elderly patients has difficulty in walking around without support of the caregiver. Various clues should be use that is easy to remember and follow even after a long time by these dementia patients. Dementia Care, (2015) cite environment as one of factor that influence adaptability of the patient to their wards. Thirdly, space in the dementia-friendly rooms also play role in helping patients used various facilities. According to Lou, F. (2012), familiar space as environmental factor offers friendly moment for patients to use at their own way. Finally, accessi bility of dementia-friendly ward or toilets makes it easy for orientation and adaptation of patient to their environment. Execution phase Execution phase is further divided into two that include opening or launching of the wards and patients admission into the dementia-friendly wards. A study on improvement of dementia-friendly ward by Sherry L. et al (2011) further shows that the two sections of execution can also work simultaneously. Opening or launching of dementia-friendly ward The third stage of implementing the model involves launching or opening of buildings after renovation. Lynne M. (2012) notices that launching of the project is important as it involve bring community around for effective use of the project. Launching can take the angle of public awareness direction. Creation of awareness has been effective way to mobilize the community around the facility as a goal to reach dementia patients wherever they. As stated by the ministry of health the main aim of the dementia-friendly environment is to serve as many clients as possible. In addition, another research conducted by Hornillos, C et al (2012) shows that bringing community as awareness strategy initiates connection between the health care and the public that can be exploited for development purposes. Furthermore, community serves as source of employment of other required non-medical staffs. At advance level Jolley, D., Benbow, S. (2000) describe that community offers linkage to dementia patient s that make them feel comfortable as oppose to alienation. Patient admission into the dementia-friendly wards Patient admission is the part of the execution phase of the project as it involves testing the effectiveness of the project. At this stage Weuve, J., et al (2013) highlight that there is the need for providing guidelines based on the professional training the healthcare officials have learn so as to assist patients. Some socio-cultural factors about patients are also considered at this stage to ensure they are comfortable with the new systems. Changes in the management of the dementia-friendly wards and quality improvement strategies Sherry L. et al (2011) when commenting on the improvement of dementia care describe that the primary change that needs to done by management is the perception of dementia condition by health care management. There have been different theories put forward to bring changes according to Chenoweth, L., Jeon, Y. (2007). Some of the most highlighted changes include monitoring and evaluation of dementia-friendly ward, initiation of early interventions, development of interRAI assessment, training of caregivers and development of advance care plan Initiation of early interventions as strategy need to be developed to help appreciate the programs upon dementia diagnosis. Management has to initiate the necessary interventions that are done to patient after being diagnosed with dementia. According to the Ministry Of Health (2013), early interventions are meant to offers support to newly diagnosed dementia patient through enrolling them to the dementia-friendly ward. In addition, the patient is introduced to the family unit within the dementia community with the aim of sourcing financial support to use while caring for patients. Development of clinical assessments plans (interRAI) is another change that is adapted by the hospital management team. According to Murray Alzheimer Research and Education Program (PAREP) (2011), there is need for development of comprehensive clinical assessment plan. Clinical assessment is meant to identify medical needs of the dementia patient for the medical team to offer any medical care needed. I would play role of promoting my professional experience during clinical assessment dementia patient within the dementia-friendly ward. For the time I have worked in dementia-friendly ward the experience I have developed and this I will promote to assist clinicians to come up with solution to risk associated with dementia condition mostly in elderly patients. In addition, I have identified patients weakens that is important in designing their environments. Development of advance care plan Management process of the dementia-friendly wards needs articulation of advance care plan. Advance care plan as defined by the Ministry of Health (2013) plan developed incorporating patients goal, choice and preference during good care practice. The management of the ward ensures that the elements of care that the client needs are documented for future reference (Gibson, G. (2007). Any medical treatment to be provided to the client also uses the documented advance care plan to identify patients medical needs. This implies that there is need for improvement of documentation as strategy to ensure there is high quality of service delivered to patients. Advance care plan as per Cheston, R. et al (2000), therefore serves as a good planning tool to help effectively manage dementia patients. Development of advance care plan also requires family of the dementia patient to be involved in decision making and how the patient will be supported. As part of management process and quality improvement strategy, training of care givers and other health care officials that has role to play in dementia-friendly ward is important. According to the Local Government Association (2015), training of care givers on new outlook of dementia phenomenon is key management strategies that have worked in United Kingdom. The secret behind the success involves orientation of caregivers on the features of new dementia-friendly environments. Some of the areas that are improved are the general appearance of the ward in terms of colours and texture of both walls and floor. Care givers need to learn the importance of contrasting colours such as that are used for easy identification of objects. Personally I can assist in training of care givers on importance of new furniture and other materials such as mat used in floors to cover slippery spaces so as to reduce risk of fall to patients. As a professional nurse I have a critical role to play in the implementation of dementia-friendly environment model in my workplace. Nursing profession has a strong connection to the care of dementia patients hence it will be easy to participate in implementation. My role specifically include: offering evidence that need improvement, promoting my professional experience on dementia conditions (Bell, V. et al 2008). According to Brawley, E. (2006), as professional nurse based on the knowledge I have accumulated in the past working with dementia patients I would recommend areas that need to be improved in the dementia-friendly ward. Leibrock, C. (2000) stated that implementation when construction is rarely required can take one year. Similarly, in India three years has been effective for implementation of dementia-friendly environment model. The scope of this model covers time frame of one year to maximize its usefulness while minimizing delay to the community. Therefore, the best time frame for the development and implementation of the new dementia model in the hospital can take the form shown below Conclusion In conclusion, there are many models that have been developed to advance knowledge on dementia care. Literature offers dementia-friendly environment as the best model that can be used to improve methods and feature of dementia care system in hospitals and other health care facilities. Upon implementation of environmental friendly model nursing professions act as a good care giver within the dementia-friendly ward such as toilets. The implementation of the dementia-friendly environment proves to be cost effective as it presents the chance of renovating the currents structures as alternative to building new structures. In conjunction, there are also changes in the hospital management process that need to make to ensure quality improvement. 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