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Mrs. Simpleton:Evidence-Informed Decision-Making (Case Study Sample)

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NURS 1067 – Evidence Informed Decision Making Assignment
The purpose of this assignment is for students to learn to apply and value using current, relevant evidence to inform their nursing practice.
RNAO BPG on Delirium, Dementia and Depression: Assessment and Care (2016)
Website: https://rnao.ca/sites/rnao-ca/files/3Ds_BPG_WEB_FINAL.pdf
Case Study 8 – Mrs. Simpleton
The RPN is working at a Long-term care (LTC) facility during the pandemic. Fortunately, the LTC facility where the RPN works has not been too badly affected by COVID-19 and infection control measures have gotten more effective along with the supply of personal protective equipment (PPE). However, the RPN has noticed and the PSW staff have reported, that one of the residents, Mrs. Simpleton, who has dementia, has demonstrated increasing responsive behaviours throughout the last four months. She used to be quite pleasant and sociable, but now seems angry most of the time, often yelling at staff and being resistant to receiving care, although her appetite is still good.
Looking at the Practice Recommendations for dementia, choose THREE that you could utilize to help Mrs. Simpleton.
For each of these three Practice Recommendations, please complete the following;
a) Describe what the Practice Recommendation entails and explain why you feel this Practice Recommendation is appropriate for this particular client’s situation.
b) Summarize or discuss the evidence which supports each of the THREE Practice Recommendations.
c) Describe how you would apply each of these THREE Practice Recommendations to this particular client’s situation.
d) Demonstrate evidence of Reflection or insight about what you learned from these Practice Recommendations or this RNAO BPG and how you might utilize this learning in your future practice as an RPN.
The following format is required for this assignment;
1. This assignment should be 3-4 pages in length, typed, double spaced, 12 font Arial.
2. Please use the following subheadings in your paper;
a. Practice Recommendations
b. Evidence for Practice Recommendations
c. Application of Practice Recommendations
d. Reflection about Learning – one paragraph overall about insight you gained from this assignment
3. Please ensure to include a Title page which clearly identifies which Case Scenario you have been assigned.
4. Follow APA format (7th) edition which means citing the specific RNAO BPG in text and in the Reference list at the end.

source..
Content:


Case Study 8 – Mrs. Simpleton: Evidence-Informed Decision-Making Assessment and Care for Dementia Patients
Authors Name
Institution
Author Note
Case Study 8 – Mrs. Simpleton: Evidence-Informed Decision-Making Assessment and Care for Dementia Patients
Dementia can be defined as a medical condition that affects the brain and impairs learning, memory, and cognitive functions. Based on the current nursing practices, the following practice recommendations are relevant to patients suffering from dementia.
Practice Recommendations
Under the Registered Nurses Association of Ontario (RNAO), its advisable to the Registered Practical Nurse (RPN) to use recommendation 6.3 that states “Systematically explore the underlying causes of any behavioral and psychological symptoms of dementia that are present, including identifying the persons' unmet needs and potential triggers. Use an appropriate tool and collaborate with the person his/her family/care partners and interpersonal team” (p.56).
The second practice recommendation is based on RNAO advice on the use of recommendation 7.1 that states, “Develop an individualized plan of care that addresses the behavioral and psychological symptoms of dementia (BPSD) and or the personal care needs. Incorporate a range of non-pharmacological approaches, selected according to the person's preferences, the assessment of the BPSD, the stage of dementia, the persons need during personal care and bathing, consultation with the persons family/care partners and the interprofessional team, and ongoing observations of the person” (p.59).
The third recommendation is based on RNAO advice on the use of recommendation 8.1 that states, “Implement the plan of care in collaboration with the person, his/her family/care partners and the interprofessional team” (p.62).
Evidence for Practice Recommendations
Under recommendation 6.3 it is evident that there are underlying causes for BPSD. Symptoms of BPSD include changes in mood, agitation, and disinhibition. (Corbett et al., 2012). To observe and document trends and monitor BPSD symptoms, screening and assessment tools have been developed to assist healthcare providers. The first approach for assessment is based on the functional analysis that entails the assessment of changes in behavior and evaluates them to offer an intervention plan. The second evidence-based approach is the use of dementia care mapping that entails based on noting down all the trigger factors that promote BPSD symptoms and also noting down all the factors that promote well being of the patient living with dementia.
Based on the impacts of BPSD symptoms both to the patient and care partner, an effective plan for management should be put in place to prevent family breakdown, depressive isolation, and overdose of medication. Given the positive impact of both functional analysis and dementia care mapping approach, the adaptation of the two approaches has been seen to promote both short- and long-term solutions for aggressive and agitation behaviors in dementia (Livingston et al.,2014).
Under recommendation 7.1 personal care and bathing are important as they can act as triggers for behaviors such as grabbing, screaming, and cursing in some patients (Konno et al., 2013). In managing BPSD various non-pharmacological approaches have been found effective. Some of the approaches include developing an individualized plan of care and stage of dementia. Not all approaches that are put in place tend to be effective for everyone hence selection must be person-centered (Cabrera et al., 2015). Manage of BPSD using non-pharmacological approaches can be used since they are more effective than medications. The non-pharmacological approaches have been seen to have a positive impact such as the reduction in agitation which in the long run reduces stress in caregivers thus enhancing a conducive working environment (Livingston et al., 2014).
Under recommendation 8.1, after a plan of care for patients with dementia has been developed the plan put in place must collaborate with the person and members of the inter-professional team. The RNAO practice recommendation has also put in place a list and description of programs that are centered on helping older patients deal with dementia. The programs just to mention a few include behavioral support Ontario that deals with behaviors associated with dementia for older adults and the Canadians coalition for senior’s mental health whose main aim is to enhance and promote mental health in seniors.
Application of Practice Recommendations
The case study of Mrs. Simpleton is a good example of a dementia patient that was once calm but later started showing BPSD symptoms. As an RPN, to understand the sudden onset of BPSD symptoms in Mrs. Simpleton, assessment through the utilization of mini-cog, Montreal cognitive assessment, and mini-mental status examination will be able to capture both the psychological, functional, and physical status of Mrs. Simpleton. Based on the strength-based approach, I will focus on her remaining ability which is the good appetite to identify her needs and her goals. By utilizing the assessment tools, it is evident that her behavioral changes have been caused by stress on the ongoing pandemic that has brought in depressive disorders. To create a care plan for her, the plan should factor in include non-pharmacological approaches that are person-centered which include the use of functional analysis and dementia care mapping that have been seen to deal with agitation and aggression both in the short

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