Potential Clinical Problem..
Why cognitive behaviour therapy?.
Dementia is a brain disorder that cause loss in memory, thinking and communication. There are 25 million people in this world who are suffering from dementia. In low- and middle-income countries, dementia accounts for 30% of the prevalence and rest 60% accounts for Alzheimer’s disease (Moretti, 2016). Various types of psychosocial interventions are provided for treatment of dementia, such as counselling, psychotherapy, cognitive behavioural therapy (CBT) or music therapy. To improve the mood and reduce the agitation music therapy and counselling are undertaken in dementia patients, which acts as supportive therapy for CBT. The purpose of this assignment is to study about the cognitive psychosocial interventions used for treatment for people with dementia. The structure includes the potential clinical nursing problems and a PICOT framework clinical question.
Dementia cause high risk of illusion, falls, motor vehicle crashes, decadence, contagions, or fractures. Family caretakers also go through financial and emotional pressure while dealing with dementia patient (Melnyk and Fineout-Overholt, 2015). It has been observed that most of the individuals suffering from dementia are also affected by other long-term health conditions. For instance, 95.1% of the individuals living with dementia had accompanied by at least one other long-term health condition. Apart from that, it was also found that more than one individual out of six are living with nine or more health conditions for long term. To improve the health of dementia patients, cognitive behaviour therapy comes into role. The critical thinking of both patient and nurses is enhanced by developing proper communication and understanding. However, nursing staff face several issues while dealing with a dementia patient. Medical administration for dementia patients is a tough duty for the nursing staff. Majorly they face interactive issues with elderly patients. Moreover, another major issue faced is to identify and prevent the comorbidities amongst the patients who has dementia. Early detection and facilities to care by nursing members or healthcare workers has become difficult at early stages (Fukuda et al., 2015). This is due to different factors such as during general practice incidence deficiency of dementia, or late observations in patients and their family members of the dementia symptoms (Yates et al., 2019). Another difficulty is the low number of treatment facilities available. Lack of knowledgeable doctors can also become a major concern, because before nursing interventions doctor’s approval is necessary. However, lack of knowledge of the doctors has led this situation to be undetected for a very long period of time. This hampers coordination of the healthcare.
One of the major problems that are faced in nursing practice is appropriate interaction with the patients which leads to a cycle creating extreme burden for the nurses. It is due to the lack of communication skills of the patients suffering from dementia due to cognitive impairments (Moreno-Poyato et al., 2018). Recovery of dementia patient is difficult because sufficient strategies are not available for intervention of the patients to deal with the situation. To provide required healthcare facilities on time is not possible due to late diagnosis or late referral of patient to the healthcare unit. According to a study by Ameel et al., (2019), patient care journey is emphasised in evidence-based practices which cause mental stress among individuals and ultimately cause behaviour changes with the patient. This kind of behaviour changes can lead to confusion or trauma situation in the patients, which is also a significant nursing issue with dementia patients. However, this can be maintained by providing proper health education. For early recognition of cognitive impairment, it is required that decision making is taken into consideration for the treatment (Polit & Beck, 2018). Although, financial or medical or social decisions are difficult to be made by nursing staff, as it may lead to confusion in treatment process due to the undetected cognitive issues in major cases.
Research Question: “Does cognitive behaviour therapy improve the mental health of dementia patients compare to other therapies such as counselling or music therapy?”
P (Problem or Patient or Population): Dementia patient; I (intervention/indicator): Cognitive behaviour therapy; C (comparison): Other solution such as counselling or music therapy; O (outcome of interest): Improved mental health.
The elements included in PICO framework, such as people with dementia, cognitive behaviour theory, care, and improved compliance to treatment are all corelated with each other. Dementia is a common issue with people over the age of 65, but sometimes it also affects the younger age people. This affect the mental health of a person and can be maintained by early diagnosis and treatment. Intervention is the therapies used to treat the mental health of a patient, which includes counselling, psychotherapy, cognitive behavioural therapy (CBT) or music therapy (Manthorpe & Moniz-Cook, 2020). For treatment of a patient suffering from dementia, it is needed to change the thoughts or divert the mind of the patient, which eventually improve mental health of patient. Cognitive behavioural therapy is helpful to improve the cognitive working of dementia patient. Outcome of this study suggest about the improved mental health of the individual. This research question clearly aimed to provide Cognitive behavioural therapy to the dementia patients to improve their mental health. This question is selected for development of clinical practices like Cognitive behavioural therapy and other therapies mentioned earlier. Moreover, these clinical questions also aim to acknowledge the clinical problems faced by nursing staff with dementia patient.
The individuals suffering from dementia lose their cognitive abilities with time. Cognitive behavioural therapy can be provided to the patients suffering from dementia in order to bring improvement in cognitive abilities. CBT is more effective as compare to other therapies, because it includes combination of all required treatments for dementia patient. Relaxation training, behaviour therapy, exposure therapy, and cognitive restricting are the sub parts of CBT. Counselling or music therapy is used to treat the aggressiveness in the patient, which acts as supportive approach for CBT (Orgeta et al., 2014).
From this assessment, it is clear that the non-compliance of dementia patient like their aggressive nature can cause several difficulties for the nursing staff during treatment. This issue can be sort by using different therapies such as cognitive behaviour therapy, music therapy, and counselling. These therapies are provided by the healthcare staff which ultimately helps to maintain the mental health of patients. Moreover, cognitive behaviour therapy or CBT has broad scope and is proved to be beneficial for the nursing interventions. CBT can be useful in various environments along with the physical and mental health improvements. This therapy will help to produce better outcomes and improved compliance to treat the mental health of dementia patients.
Ameel, M., Kontio, R., &Välimäki, M. (2019). Interventions delivered by nurses in adult outpatient psychiatric care: An integrative review. Journal of Psychiatric and Mental Health Nursing,26(9-10), 301-322. DOI:10.1111/jpm.12543
Fukuda, R., Shimizu, Y., & Seto, N. (2015). Issues experienced while administering care to patients with dementia in acute care hospitals: A study based on focus group interviews. International Journal of Qualitative Studies on Health and Well-being,10(1), 25828. DOI:10.3402/qhw.v10.25828
Manthorpe, J., & Moniz-Cook, E. (2020). Timely psychosocial interventions in dementia care: Evidence-based practice. London: Jessica Kingsley.
Melnyk, B. M., & Fineout-Overholt, E. (2015). Evidence-based practice in nursing and healthcare: A guide to best practice. Philadelphia: Wolters Kluwer/Lippincott Williams et Wilkins.
Moreno-Poyato, A. R., Delgado-Hito, P., Suárez-Pérez, R., Lluch-Canut, T., Roldán-Merino, J. F., &Montesó-Curto, P. (2017). Improving the therapeutic relationship in inpatient psychiatric care: Assessment of the therapeutic alliance and empathy after implementing evidence-based practices resulting from participatory action research. Perspectives in Psychiatric Care,54(2), 300-308. DOI:10.1111/ppc.12238
Moretti D.V. (2016). Update on dementia. Place of publication not identified: InTech.
Orgeta, V., Qazi, A., Spector, A. E., & Orrell, M. (2014). Psychological treatments for depression and anxiety in dementia and mild cognitive impairment. Cochrane Database of Systematic Reviews, (1).
Polit, D. F., & Beck, C. T. (2018). Essentials of nursing research: Appraising evidence for nursing practice. Philadelphia: Wolters Kluwer.
Yates, L. A., Yates, J., Orrell, M., Spector, A., & Woods, R. T. (2019). Cognitive stimulation therapy for dementia: History, evolution and internationalism. London: Routledge.
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