Dementia is a chronic condition amounting to disorder in the mental process which persist in affected patient. The causes of this chronic condition includes diseases of the brain or any injury to the brain. Dementia patients are characterised with impaired reasoning, changes in personality and memory associated disorders. This paper will focus on scoping literature of recent times covering on dementia as a national health priority. In doing so, the importance of a condition such as dementia to the practice of nursing will also be outlined. This will eventually improve the understanding of the condition in practice of nursing.
Clinical Question
Having identified Dementia as the problem for discussion in this paper, among the clinical questions that the paper will attempt to explore further include; what is the (population) affected by the disorder? What are the (interventions) to the problem? What are the (control) mechanisms? And what are the possible (outcomes)?
Method and Rationale for Locating and Retrieving Evidence-Based Nursing Literature
In locating the materials for this paper, a three step strategy was considered. First, various search tools for nursing literature were identified. Secondly, the materials found on such search tools were sourced from scholarly sites that had only peer reviewed articles so as to gauge the credibility of some of the materials from the search tools and lastly, only papers that were eligible based on the topic of study were picked after a scrutiny of the content they presented.
For the first step, search tools for nursing literature that were considered include Nurse Portal, All Nurses, National Institute of Nursing research and Nursing World. For Nursing Portal, a number of journals were published on the site containing materials relating to dementia. Additionally, there were a lot of links directing to other sites that would contain related information. National Institute of Nursing Research contained information on the various developments in nursing with regards to how conditions such as dementia was handled in nursing practice. For Nursing World, guidance on handling various situations in nursing were presented and this including dealing with patients with dementia as a condition. Additionally, health care policies as regards to handling chronic conditions such as dementia were availed at Nursing World. Lastly, All Nurses, publications by other nurses who shared their experiences on nursing practice including handling conditions such as dementia were availed.
The second step was looking up for identified related materials from academic sites that comprised of peer reviewed articles. Sites including Google Scholar, Eric Education resource Information Centre, Academic.edu and Willey Online Library were considered. From this a variety of literature were considered from which the final stage of literature location would be identified so as settle on ten literary materials to present a paper on dementia as a chronic condition in relation to the practice of nursing.
Lastly, the abstracts of each article identified were considered so as to settle on those articles that would be instrumental to the writing of the paper. A number of literary materials on dementias as a condition and handling of the same in the practice of nursing were settled on.
The selected literary materials were a representation of data on dementia and thus there was further need to settle on the data that would be used for the purpose of writing a paper on dementia. Some of these papers represented various types of studies on dementia as condition and this included quantitative and qualitative studies. Qualitative studies was preferred to quantitative studies because this presented finer data and thus would explain information related to dementia as opposed to mere representation of data.
A PICO question had been developed as the basis for conducting research on dementia as a condition. Data settled on had to in a way or the other answer the PICO question represented. This formed the criteria on which data presented in materials was accepted or discarded for the purposes of presenting a paper on dementia.
Author/Date/Country
Key aim(s)/OBJECTIVE
Ethical Consideration
Data Search Strategy
Funded
Analysis and synthesis
Chenoweth et al, 2010 (AU)
To show the various factors that attract nurses to care for dementia patients.
N/A
Literature Review
NO
Analysis described factors that make nurses take up care for the aged and those with dementia.
Mitchel et al, (2004) US
To establish the cause of death of patients with advanced dementia.
N/A
Qualitative study
NO
Analysis of management and educational strategies for improvement of advance dementia.
Sloane et al, (2004) US
To find out the safest and most effective methods to care for dementia patients during baths
NO
Qualitative study focusing on nurses caring for dementia patients
NO
Analysis of care practices for dementia patients.
Mitchell et al, (2004) US
To establish the mortality of dementia patients living in nursing homes
N/A
Qualitative study focusing on care for patients in nursing homes.
NO
Analysis of prognostic guidelines.
Engel et al, (2006) US
To furnish ways in which care for patients with advanced dementia can be improved.
N/A
Qualitative study of practices involving patients with advanced dementia
YES
Analysis of nursing practices including communication practices among nurses when handling dementia patients.
Fessey, (2007). UK
To find out the understanding of adult nurses handling dementia patients in wards and the implication of the same on these patients.
YES
Qualitative studies of nursing practices in hospital wards
YES
Analysis of understanding of nurses on handling patient centred dementia care.
Husebo et al, (2011) UK
To illustrate ways through which agitation among dementia patients can be reduced in nursing homes
N/A
Literature review
NO
Analysis of approaches to management of pain in dementia cases.
Cunningham & Archibald, (2006) UK
To establish the needs of patients living with dementia as a condition.
N?A
Qualitative study of nursing care practices
NO
Analysis of demographic changes and the adaptation of hospital care to the same.
Hansen et al, (2008) AU
To establish diagnosis practices in dementia cases; barrier to early diagnosis
N/A
Qualitative study on Australian general practitioners.
YES
Analysis of the processes involved in diagnosing and delays in such cases
Chang et al, (2009) AU
To identify challenges experienced by nurses caring for patients with advanced dementia cases.
N/A
Qualitative study on professional practitioners
Analysis of policies, nurses’ knowledge and skills in handling advanced dementia.
Collated, Summarised Report
The articles illustrated in the table above present a number of key findings on dementia as a subject of relevance to the practice of nursing and go a step further by giving recommendations that are key to the practice of nursing. Looking at Mitchel et al, (2014), a finding is made to the effect that most of the patients who die in nursing homes from advanced dementia conditions do not receive palliative care. It is recommend that nursing homes taking care of advanced dementia cases consider employ both educational and management strategies in advanced dementia care cases so that patients at this stage can have better care reducing the rate of mortally as establish by the research (Mitchel et al, 2014).
Chenoweth et al, (2010) posit that the various rewards that nursing practitioners get from caring for patients is what attracts them to taking care of patients with advanced dementia. For better care, continuous training and supervision of nurses who undertake to handle advanced dementia patients cases in recommended (Chenoweth et al, 2010).
According to Sloane et al, (2004); agitation in cases of advance dementia is reduced by putting patients through person focused showers and towel bath. This is pointed out as one of the ways to reduce pain during baths in cases of dementia. Additionally, recommendations to the effect that reducing interactions resulting to aggression should be avoided in order to ensure the comfort of the patients with dementia is given (Sloane et al, 2004).
Mitchell et al, (2004) in another article found out that a number of factors outside the prognostic guidelines for dementia in nursing homes determine the mortality of patients with advanced cases of dementia. Engel et al, (2006) on the other hand point out to factors such as proper communication between nurse and patients in nursing homes and the comfort of the patients within the nursing homes as key to statistics on mortality of patients with advanced dementia. Recommendations are further given for specialized care for patients with advanced dementia in nursing homes so as to improve their conditions (Engel et al, 2006).
Some of the literary work present studies that shows demographic trends in advanced dementia cases. One of these is Fessey, (2007), pointing out that cases of advanced dementia increases with increase in age. This thus increases the probability of patients admitted to hospital wards with cases of advanced dementia to be of advanced ages. This additionally requires certain type of care from the nurses who attend to these patients (Fessey, 2007). Fessey, (2007) recommends that training programs be set up for nurses as to be able to effectively handle cases such as advanced dementia as most probable to show up among persons of advanced ages who besides dementia may be affected by a number of psychological factors.
Husebo et al, (2011) makes findings with respect to reduction of agitation for dementia patients in nursing homes. I tis pointed out that developing systematic approaches to the management of agitation in such homes go a great extent into managing such kinds of agitation that are experienced by the patients (Husebo et al, 2011). It is further recommended that pain should be managed effectively in these patients in order to reduce the agitation that they often feel (Husebo et al, 2011).
Cunningham & Archibald, (2006) focuses on the various needs of patient with dementia as a condition. It is pointed out that the rising needs for dementia patients are caused by a demographic changes (Cunningham & Archibald, 2006). Thus, it is pointed out that there is need for hospitals and nursing homes to develop mechanisms or ways through which acute care for such patients can be effectively carried out within the hospitals (Cunningham & Archibald, 2006).
Delayed diagnosis of dementia cases leads to worse conditions among patients of dementia; can lead to acute conditions (Hansen et al, 2008). It is thus probable for responsible authorities and bodies to work closely with nurses and all persons involved in taking care of dementia patients to ensure that all barriers to early diagnosis are done away with to ensure proper case for dementia cases at various stages (Hansen et al, 2008).
Chang et al, (2009) identifies the various challenges experienced professional healthcare providers in cases of dementia. What is identified as a common challenge is policies around professional healthcare providers which limit or restrict them in a way or the other in handling cases of dementia (Chang et al, 2009). The importance of including specialists in such cases is stressed together with establishing ways through which knowledge leading to the development of skills for professional healthcare providers in dementia cases can be ensured (Chang et al, 2009).
As noted, most of the literary materials reviewed on dementia help identify critical issues in relation to handling of the same especially among patients with advanced dementia. They further proceed to give recommendations as to how some of the findings should be remedied. However, there are gaps that needs to be filled through further research; especially on how some of the recommendations put across can be effected. To illustrate this, there are literature that call for training of nurses so as to acquire knowledge and skills to handle dementia cases; it is necessary to carry out further research to establish details such as the content and the mode of the training leading to acquisition of requisite knowledge and skills. This literary articles relating to dementia as a condition in nursing have the requisite strengths illustrated in their findings and recommendations to necessitate a research on dementia.
As to the PICO question, the literary materials reveal that dementia majorly affects people of old age and thus points to a target population for a research study. Interventions and control mechanisms are revealed in the recommendations provided in the literary sources as illustrated in the discussion in this part of the paper; calling for interventions and control mechanisms for dementia cases based on the findings. Lastly, all the articles point out to improved care for dementia cases; if the provided interventions and control mechanisms are put into practice.
Conclusion
To conclude on this paper, various which materials through an intense and keen process, have been considered and they touch on how cases of dementia are handled in nursing homes and hospitals. Shortcomings are noted and ways through which the status quo can be improved are given.  Based on what is presented in these materials, further research on dementia and how the cases on dementia can be properly handled so as to improve the conditions of patients can be carried out. This will help improve the conditions of patients as well as the experience for nurses dealing with such cases.