Formulating a Research Question for Improving Calmness in Dementia

Introduction

Walker and McNaughton ( 2018) citing an article published in British Medical Journal (BNJ) by Sackett et al, 2000:3 stipulated that evidence-based practice is referred to the implementation of best evidence collected through research along with clinical expertise and determining values of the patient to facilitate effective decision-making for the treatment of the individual. The Nursing Midwifery Council (NMC) (2015) suggested, supported and advocates that all practice must base on recent and best evidence to ensure safe and effective practice (Walker & McNaughton, 2018). It also promotes nurse's intervention and as well encourages critical thinking that improves the quality of care (Newhouse et al., 2007). The focus of this essay is the formulation of research question related to improving calmness in dementia by forming a clinical question using Population, Intervention, Comparison, Outcomes (PICO) framework (Aveyard and Sharp 2013). Utilising PICO framework as it is consequential and sympathetically provides specification of search term which is used to undertake literature review using database (Bethany -Saltikov 2012). To gather the research papers allied to the formed question, a search strategy was conducted, the uses of standardised appraisal tool will be used to critically analyse the selected papers. Subsequently, to evaluate the article findings and ascertain the recommendation and finally implementations for practice (Grennhalgh, 2018).

The essay aims to determine if giving baby doll (Doll therapy) to the elderly patient with dementia improve calmnessness?. The topic was chosen because the prevalence of dementia was higher in women than men and nearly doubled with every five years increase in age: in the group age 65-69 years. Dementia is one of neurological condition that affects the brain, characterised by a decline in memory, affecting their victim thinking and problem-solving skill, and then impact negatively on their activities of daily living (Grennhalgh, 2018) (NICE, 2018).

The study by Davison et al. (2016) informs that people with dementia are often found to be anxious and agitated which leads them to become restless and move around places. This makes the patients unable to rest as well as creates issues for the service providers to offer concentrated care to the patients as they being restless often deny accepting proper care. As argued by Ho et al. (2019), calming agitated dementia patients is necessary as it lowers their confusion and assists them to remain concentrated to receive proper care and rest. This helps in ensuring better health condition of the patients as well as eases the condition to offer care to the individuals by service providers as the individual accepts care without making any unnecessary objections. The study by Page et al. (2016) informs that medication used in dementia to calm patients have side-effects on the patient's health by making them feel drowsy, the experience falls and confusion. Therefore, this topic is essential to be explored to understand if doll therapy can assist elderly dementia patients to be calm so that effective care can be offered and their restlessness nature can be avoided which causes deteriorated effect on their health. This is because the therapeutic intervention compared to use of medication treatment for dementia patient would avoid the side-effects caused by the use of drugs in care. (Refer to Appendix 1)

Search strategy

Before the literature review, deciding on the research questions is significant (Holloway and Wheeler 2010). The research question was formulated through the PICO framework. PICO is one of the specialised frameworks that can be used to facilitate literature research and to form structured clinical questions (Holloway and Wheeler 2010). PICO search strategy promotes the evidence-based nursing practice and streamlines nursing research. Bethany-Saltikov (2012) suggested that a recognised framework like PICO decreases selection bias and increases the reliability of findings.

Table1. Population, Intervention, Comparison, and Outcome (PICO) analysis

Population (P): Elderly Dementia Patient

Intervention (I): Doll therapy

Comparison (C): Not applicable

Outcome (O): Improve calmness

Source: (Walker & McNaughton, 2018)

Key term and Boolean Operators

Brief research was done to establish there was enough evidence backing this topic before continuing with the literature search and review. (Higgins et al., 2011) acknowledged that if the search is outright, the systematic search along with the planning can begin. The keywords are doll therapy, elderly with dementia, calmness.

To make sure comprehensive and substantial search was done, the following databases were used in carrying out the search: Cumulative Index of Nursing and Allied Health Literature (CINAHL) as is the largest and most in-depth nursing research data-based and Medical Literature Analysis and Retrieval System (Medline) which is of great authoritative resource peer-reviewed for medical research as it allows the researcher to know where who conducted the research and who acknowledge the results. Applying these two databases makes searching to be systematically as this is an academic method of searching for relevant and important information (Gerrish and Lathlean, 2015).

The search was enhanced by using abstract including full-text articles, it was restricted to peer-reviewed, however,(Aveyard and Sharp 2017) suggested that peer review journals are not perfect but have high chances to contain relevant and reliable evidence, nevertheless, it is beneficial to use journal that follows the peer review processing. Academic journals from 2011 to 2020 were used to establish the literature searched and found is the most recent as the NMC (2015) instructed that all nursing care should be given based on the current evidence. Also, for the literature to be published in English to prevent language barriers.

The boolean operator was used to combining keywords after searching for the word synonyms individually. Each term has a specific role when using "AND "NOT" key terms were sourced by the database thus, the result was limit while the use of "OR "was applied, it broadens the search and include any suggested term article. The Boolean operator was included because it is believed to decrease the risk of excluding appropriate outcomes (Aveyard 2014). Furthermore, this literature review is based and specific on the search for doll therapy for the elderly patient with dementia. The key terms and Boolean operators used in this search is indicated in the table above.

At first, 4, 407 articles sorted out from Cinahl and Medline data-based search, but 3,020 articles were excluded, after setting limitation to the search, leaving 507 articles, another 406 articles were excluded as their titles were not closely related to the research question.

The remaining article's abstract 101 will then read and compared with. After this, 89 articles were excluded as they are not completely relevant to the question. The following 11 articles were read, three of these articles were closely relevant to the research question. The Three articles were included in the finding.

inclusion and exclusion Criteria

After the research, critiquing research is a systematically structured way of assessing the weakness and strength of an article which examines the way a study is conducted (Icheku & Graham, 2018). There are varieties of critiquing appraisal tools such as Caldwell, CASP to evaluate the distinctive worth of the research. Caldwell will be used to critique this article titled “Doll Therapy: A therapeutic means to meet past attachment needs and diminish behaviours of concerns in a person living with dementia”. This framework was chosen because it reviews in depth of how each step of the research was conducted, the trustworthiness, reliability and shows how research is accurately presented showing the weakness and the strength of an article. Hence, the framework can be used for a case study

According to Ryan et al (2007) the title of an article needs to be clear and precise. The paper is qualitative case study anticipating how needs of dementia patients can be met with means of non-pharmacological ways such as doll therapy (Ryan et al. 2007). The title of the paper reflects the content by clearly explained the paper by not using extraneous words or being too extensive. It directly informs the reader of the research aim without becoming boring. A good title of an article should be straight forward and provide the summary of the content. A poor article title confuses the reader (Centre for research writing resources 2012).

The authors of the paper are credible as each of them is found to have proper knowledge and skill in the medical field to determine the impact of doll therapy for dementia patients. The length and the content of the abstract meet the requirements of a good abstract as noted by Polit and Becks (2008) who says the abstract is sensible when is between 100 to 200 words. As mentioned by Denzin (2017), the presence of a proper abstract helps the researcher to inform to the reader at the initial position whether or not the article fulfils the requirements mentioned in the research topic. In this study, a clear abstract is mentioned which acts as its strength because it would lead the researcher to inform the readers the data to be collected by using the paper apart from ensuring the research topic have been properly explored. The author of the study has provided a proper overview and background of the topic which acts as the strength of the paper as it informs the reader in-depth existing data regarding doll therapy and its use in managing dementia patients. The aim of the study is mentioned in the clarified manner and its acts as strength of the study. This is because clarified aim helps the researcher to inform properly the data and facts to be covered in the study to explain the study topic, in turn, leading the reader to have effective understanding regarding the main purpose of the paper (Strandenæs et al. 2018).

The study informs that a single case study of a female patient is used to develop findings for the study and the data is collected by using qualitative as well as quantitative tools. The quantitative tool used for collecting data in the study is Aged Care Finding Instrument which measures the care level required by a particular patient on the basis of their behaviour, daily living and complex healthcare interventions (agedcare.health.gov.au, 2019). The use of the tool is beneficial for the study as it helped the researcher to determine to what extent the care needs of the patient changed with the use of doll therapy. The qualitative method used in the study is qualitative ethnographic techniques. The benefit of using this technique is that it allows the researcher to determine different context of daily life of the participants and collect visual data from the participants to determine their unarticulated needs (Parker-Jenkins, 2018). Therefore, the use of this technique acts as strength for the study as it allowed the researcher to develop information based on the behaviour and daily activities of the participant. In this study, proper ethical consideration is followed by marinating confidentiality of the participant. This acts as strength of the study as it leads it to avoid the researchers from facing legal issue during execution of the research (Ryen, 2016)

The findings of the study inform that doll therapy is effective and positive intervention for people living with dementia to control their emotional distress and confusion created as an impact of the disorder. This is evident a reduction in the anxiety level and agitation in the participant was seen after the introduction of the doll therapy for the individual. The findings also inform that doll therapy helps dementia patients to show better behaviour and improve communication along with social interaction with individuals. This is evident as the results indicated that the participant interacted as well as initiated communication with the nurses after the therapy without any form of stuttering which she was previously found unable to execute. In addition, after the introduction of doll therapy, the participant expressed less negative behaviour in performing everyday activities. The limitation of the study is that it used a single participant to determine the impact of doll therapy in the dementia patient. This leads the researcher to be unable to gather wide and diverse data regarding the study topic. Moreover, the results gathered are unable to be generalised as well as it is difficult to replicate and relate the findings with other patients (Tate et al. 2016).

Conclusion

A literature review is a summary of the existing paper which backup the needs of the recent study (Polit and Becks, 2008). The search focuses on online-based literature that was published for less than 10 years. The literature review is comprehensive and UpToDate. The rationale for the study is evidently mentioned. There is a clear statement of the aim of why research is being conducted in the paper analysed. The research method conducted was a qualitative case study to be precise. The study informs that doll therapy does have a positive impact on the elderly dementia patient to calm them and makes them show controlled behaviour.

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References

agedcare.health.gov.au 2019, Aged Care Funding Instrument (ACFI) Reports, Available at: https://agedcare.health.gov.au/tools-and-resources/aged-care-funding-instrument-acfi-reports [Accessed on: 07th December 2020]

Davison, T.E., Nayer, K., Coxon, S., de Bono, A., Eppingstall, B., Jeon, Y.H., van der Ploeg, E.S. and O'Connor, D.W., 2016. A personalized multimedia device to treat agitated behavior and improve mood in people with dementia: a pilot study. Geriatric Nursing, 37(1), pp.25-29.

Denzin, N.K., 2017. The research act: A theoretical introduction to sociological methods. London: Routledge.

Ho, R.T., Fong, T.C., Sing, C.Y., Lee, P.H., Leung, A.B., Chung, K.S. and Kwok, J.K., 2019. Managing behavioral and psychological symptoms in Chinese elderly with dementia via group-based music intervention: A cluster randomized controlled trial. Dementia, 18(7-8), pp.2785-2798.

Page, A.T., Potter, K., Clifford, R., McLachlan, A.J. and Etherton‐Beer, C., 2016. Medication appropriateness tool for co‐morbid health conditions in dementia: consensus recommendations from a multidisciplinary expert panel. Internal medicine journal, 46(10), pp.1189-1197.

Parker-Jenkins, M., 2018. Problematising ethnography and case study: reflections on using ethnographic techniques and researcher positioning. Ethnography and Education, 13(1), pp.18-33.

Ryen, A., 2016. Research ethics and qualitative research. Qualitative research, pp.31-46.

Strandenæs, M.G., Lund, A. and Rokstad, A.M.M., 2018. Experiences of attending day care services designed for people with dementia–a qualitative study with individual interviews. Aging & mental health, 22(6), pp.764-772.

Tate, R.L., Perdices, M., Rosenkoetter, U., McDonald, S., Togher, L., Shadish, W., Horner, R., Kratochwill, T., Barlow, D.H., Kazdin, A. and Sampson, M., 2016. The Single-Case Reporting Guideline In BEhavioural Interventions (SCRIBE) 2016: Explanation and elaboration. Archives of Scientific Psychology, 4(1), p.10.

Appendix 1:

Nurses have intervention roles to play in relation to supporting the use of dolls that have seen as a therapeutic intervention for patients suffering from dementia. Moreover, the use of doll therapy has been noticed continuously globally over a decade. (Mitchell and Templeton, 2014)

This topic is chosen in relation to Bowlby theory (1969) who suggested that attachment behaviour makes someone do something without the thought of it, by the conditions that threaten the achievement of proximity such as fear, insecurity and separation. All these mentioned above can be seen in the elderly patient with dementia. The rationale is doll attachment can occupy the attachment missed in some elderly patients with dementia which is non-pharmacological intervention with no side effect.

(Mitchell and Templeton, 2014) acknowledged that doll therapy can increase positive social behaviour, decrease medication, agitation and aggression, as well as enable the patient to express unmet needs and engage them with in activities.