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  • 2. EVIDENCED-BASED NURSING PRACTICE University of Wisconsin, Green Bay Lorene Jaggi December 12, 2011
  • 3. INTRODUCTIONDementia is a complicated and involved disease process that includes behavioral changes and impaired language skills. As a result, it can make communication difficult.Some caregivers may be familiar with good communication techniques but may not know how to use them efficiently in practice.According to studies, ineffective communication can lead to high levels of expressed emotion, agitated behavior, loss of companionship, support from loved ones and eventually burn out.
  • 4. ABSTRACT If caregivers were able to learn at the very beginning of the disease process what to expect (signs and symptoms) according to the diagnosis (type of dementia), they would be better prepared for what would be waiting ahead. Communicating with someone with dementia is not an easy task and needs to be learned in order to avoid frustration and psychological morbidity as well as delaying institutionalization of the dementing person.
  • 5. EVIDENCED-BASED PRACTICE PICO QUESTION Can kin caregivers of patients with dementia lessen their stress level as well as enhance the quality of their relationship with their loved ones by improving their communication skills compared to caregivers that lack effective communication skills?
  • 6. REVIEWED RESEARCH ARTICLES Article: Optimal management of Alzheimer’s diseasepatients: Clinical guidelines and family advice.(Haberstroh, Hampel & Pantel, 2010) Purpose: To review current and internationally relevant guidelines to the given recommendations concerning caregivers and family advice. Design: Systematic review Subjects and sample size: Sample =125 unique articles published in English within the last five years describing clinical guidelines for the treatment of patients with AD. Method: Quota sampling method.
  • 7. REVIEWED RESEARCH ARTICLES (CONT.) Results: All of the considered guidelines agreed on the potentially positive ef fects of family advice on dementia patients and their family caregivers with medium range levels of evidence . Guidelines are often not applied in practice due to the lack of practitioners with special skills. For example, leading a psychoeducational training group. There is a clear need for research that addresses the implementation part of the clinical guidelines and evidence - based interventions in order to improve the management of patients with AD and their family caregivers.
  • 8. REVIEWED RESEARCH ARTICLES (CONT.) Ar ticle: Training in communication skills for informal carers of people suf fering from dementia: a cluster randomized clinical trial comparing a therapist led workshop and a booklet. (Done & Thomas, 2001). Purpose: The objective of the study was to evaluate whether a short training workshop in communication techniques is more ef fective than an information booklet for improving communication skills in informal carers of people suf fering from dementia. Design: Cluster randomized trial Subjects and sample size: N= 45 participants informal caregivers sharing specifics characteristics. Method: Weighted block randomization.
  • 9. REVIEWED RESEARCH ARTICLES (CONT.) Results: This studies concluded that the workshops were valuable when used at an early stage of the disease process when verbal communication occurred frequently as opposed to late stage of the disease. Outcome measures to specific issues to training targets showed clear benefits as opposed to general measures outcome such as quality of life and stress . After 6 weeks, caregivers following the workshop demonstrated a significantly greater awareness of communication strategies than the booklet -only caregiver group. However, both strategies (booklet and workshop) improved communication techniques.
  • 10. REVIEWED RESEARCH ARTICLES (CONT.) Ar ticle: Communicating with persons with A lzheimers disease: experiences of family and formal caregivers. (Bottenberg, Richter & Roberto, 1995) Purpose: Examined the communication processes used by caregivers in managing behavioral problems that commonly occur when caring for persons with Alzheimers disease, to identify successful communication strategies. Design: Descriptive comparative Subjects and sample size: Two groups of participants: 23 family informal caregivers and 22 certified nursing assistant caregivers. Method: Purposive sampling.
  • 11. REVIEWED RESEARCH ARTICLES (CONT.) Results: Strategies of fered by family and formal caregivers for communication with persons with Alzheimers disease (AD) suggest that strategies must be individualized as strategies can change and are not applicable for every individual with AD. The need to communicate continues throughout the course of the disease. Many of the caregivers dont have the training necessary to understand and take care of AD clients, which leads to a high turnover of healthcare personal in long -term facilities. As a result, there is a need for formal training programs to improve communication and care of persons with AD and other forms of dementia.
  • 12. “KOTTER’S PHASES OF CHANGE MODEL” Establish Urgency Create Coalition Develop Vision Communicate Vision Empower Action Generate Short-Term Wins Consolidate Gains/Produce More Anchor Approaches (Schmidt & Brown, 2009)
  • 13. INNOVATION TO BE IMPLEMENTED Speech/language therapist led workshop for caregivers of Alzheimer patients will be implemented.
  • 14. STAKEHOLDERS IDENTIFIED Caregivers of Alzheimer patients. Family members Speech language therapist Experts in old age psychiatry, geriatric medicine and clinical psychology Nurses
  • 15. POLICY AND PROCEDURES IDENTIFIED AS NEEDED OR UPDATED Clinical Practice Guidelines for Alzheimer’s disease and Related Dementia: as soon as a diagnosis of dementia is obtained, caregivers and loved ones would have the possibility of following a therapist led workshop in order to understand and learn how to communicate effectively with their loved ones.
  • 16. NATIONAL GUIDELINE CLEARINGHOUSE Major Recommendations: Support and Interventions for the Caregivers of People with Dementia: “Care plans for caregivers of people with dementia should involve a range of tailored inter ventions. These may consist of multiple components including: Individual or group psychoeducation. Peer-support groups with other caregivers, tailored to the needs of individuals depending on the stage of dementia of the person being cared for and other characteristics Support and information by telephone and online Training courses about dementia, services and benefits, and communication and problem solving in the care of people with dementia Involvement of other family members as well as the primary caregiver in family meetings.” (NGC, 2011)
  • 17. “KOTTER’S PHASES OF CHANGE MODEL”Student Name __Lorene Jaggi_________________________ Project Name Establish Create Develop Communicate Empower Generate Consolidate Anchor Urgency Coalition Vision Vision Action Short- Gains/Produce Approaches term More Wins Pilot: Develop a Assemble How does Develop a Team Survey Expand pilot EvaluationSpeech/language Power Team: this affect: Powerpoint work: available to additional monthly of therapist led Point Speech Caregivers of showing speech for clinics and caregivers workshop for presentation language Alzheimer procedures to therapist caregivers hospitals after satisfaction caregivers of as well as a therapist, patients, follow after with and 3 months. of the Alzheimer training experts in family the diagnoses nurses family workshop patients will be manual and old age members, of Alzeihmer for the member by speech implemented. other psychiatry patients, has been. first day to therapist materials and support staff Training of pilot. evaluate and trained supplied. geriatric and nurses. manuals. Audio- the nurses. medicine, Quality of Educational taping or usefulness Caregivers clinical life. forum. video- of the stress test psychology, Psychological taping sessions scale after a and nurses. well-being. group as well as month of sessions the worshop. and using instructor training of the manuals workshop. for the first month of the pilot.
  • 18. REFERENCES Bottenberg D. J., Richter J. M., Roberto K. A . (1995). Communicating with persons with A lzheimers disease: experiences of family and formal caregivers. Archives of Psychiatric Nursing, 9 279-285. Done D. J., Thomas J. A . (2001). Training in communication skills for informal carers of people suf fering from dementia: a cluster randomized clinical trial comparing a therapist led workshop and a booklet. International Journal of Geriatric Psychiatr y, 16 816-821.
  • 19. REFERENCES (CONT.) Haberstroh J., Hampel H., Pantel J. (2010). Optimal management of Alzheimer’s disease patients: Clinical guidelines and family advice. Neuropsychiatric Disease and Treatment Dove Press Journal, 6 243-253. National Guidelines Clearinghouse (NGC). (2011). U.S. Department of Health & Human Services. Guideline Summary. Retrieved from d ementia Schmidt, N. A ., & Brown, J. M. (2009). Evidence-based practice for nurses: Appraisal and application of research. Sudbury, MA: Jones and Bartlett.