A study is planned by several palliative care doctors around how prepared patients, health carers and patients’ families are for end-of-life care with patients diagnosed with dementia

The following scenario is important information and is referred to throughout the whole paper. You will be referred back to these patients during the paper.

Read the following scenario and answer the questions at the end of the scenario.
A study is planned by several palliative care doctors around how prepared patients, health carers and patients’ families are for end-of-life care with patients diagnosed with dementia. Anecdotally, preparing families for the end stage of life has not been going well at this facility. Healthcare workers with limited experience of this patient group have often been required to deliver upsetting information to families. The study plans to survey and interview patients and family members about the topic with a view to improving processes. A representative from this group of palliative care doctors has approached you as an RN asking for your support to recruit participants, and potentially interview patients and their families. The doctors feel that as a nurse involved in these patients’ care you will have the trust of the participant groups, and they will be more open with you. You are unsure about the request and whether you should be involved, and whether this data-collection approach is the right one for this group. You consider asking your RN colleagues to support you, but only yesterday at the morning meeting many of the nurses working with patients with dementia were expressing their feelings of overwhelm. Added to the challenges of caring for patients with dementia, was the expectations of the families for RN’s to provide practical and emotional support to loved ones. Now with the added burden of end-of-life care for some patients, many of the nurses are experiencing extreme stress and exhaustion. Just when you think the situation is complex enough, one of the senior doctors advises you that two of your patients with dementia needing end-of-life care, Henry and Christine, have been selected for a novel trial to test a new drug they hope will reduce depression and improve cognitive functioning for dementia patients. The doctor insists that no consent is required and that the treatment for Henry and Christine will begin immediately.
Questions 1-2: (You may type your answer below each question)

  1. How could this nurse deal with the different doctors’ research plans in this scenario? (2 marks)

 

  1. Identify the ethical principles involved in this scenario and explain why you think each one is relevant. (8 marks)

END OF SECTION A
SECTION B
DATA ANALYSIS (Total of 20 marks)
(NB: If you cannot see the picture of the data below due to your computer settings, or for an enhanced view, go to the Final exam tab In Bb where you can find a PDF containing a copy of the data).
You discover that Henry and Christine were included in a Clinical Trial for Gingko biloba to test its effectiveness in dementia sufferers regarding cognition, depression, deterioration and quality of life. The data is generated and published (as seen below). As an RN with Evidence Based Practice skills you decide to review the data to see what success patients like Henry and Christine might expect from this intervention.
Review the data below and answer the questions.
Questions:

  1. From the data provided, identify the type of publication it has come from and level of evidence. (2 marks)
  1. Looking at the data provided, what can you say about the confidence of the researchers in the outcomes they mention, and the statistical significance of the findings? (8 marks)
  2. From the data provided, what clinical recommendation could be made, and what specific considerations would need to be taken into account with regard to implementation? (5 marks)

 

  1. With your patients (Henry and Christine from Scenario A) in mind, which primary study (or studies) used in the data provided indicate/s a benefit to the original participants? Do you think it was beneficial overall to Henry and Christine to be included in such a study based on the results shown here? (5 marks)

END OF SECTION B
SECTION C
EVIDENCE BASED TREATMENT OPTIONS (Total of 20 marks)
As a conscientious RN you are motivated to promote better outcomes for the patients with dementia and your stressed-out colleagues who are carers with you. You use your knowledge of Evidence Based Practice to take an evidence-based and holistic approach.
Questions: (Type your answers below the questions and complete the template)

  1. How do the RN Standards seek to promote Evidence Based Practice among Registered Nurses (RN)? (2 marks)

The following question refers to the familiar article by Barbosa (2017) on dementia you have prepared. A full citation and link to this article can be found on the Assessment tab for the final exam if you wish to refer to it.

  1. Using the qualitative information from the article by Barbosa et al. (2017) TOGETHER WITH the quantitative data in section B above, identify the best potential combined intervention/s for the carers and their patients with dementia, and state reasons for your choices. (8 marks)

 

  1. Complete the template below by writing two (2) examples for each area to demonstrate how you might apply the RN Standards to your actions as the RN responsible for achieving the best outcomes for your dementia patients and their families. (10 marks)

 

Type of action required by RN Relevant RN Standard/s (N&MB, 2016) Examples of how RN might act to improve outcomes for Maisie
Professional Development
  1. accesses, analyses, and uses the best available evidence, that includes research findings for safe quality practice

4.2 uses a range of assessment techniques to systematically collect relevant and accurate information and data to inform practice
6.5 practises in accordance with relevant nursing and health guidelines, standards, regulations and legislation

?
­­­­­­­­­Inform 2.4 provides support and directs people to resources to optimise health related decisions
3.2 provides the information and education required to enhance people’s control over health
?
Educate 3.2 provides the information and education required to enhance people’s control over health ?
?
Advocate 5.1 uses assessment data and best available evidence to develop a plan ?
Empower 2.4 provides support and directs people to resources to optimise health related decisions
3.2 provides the information and education required to enhance people’s control over health
5.1 uses assessment data and best available evidence to develop a plan
?
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