2. Alzheimer's Disease Katie VanderVelde Ferris State University NURS 441

3. Introduction  Purpose Statement: “Practice collaborative leadership to advocate for quality nursing practice using evidence based practice.”  Alzheimer’s disease (AD) is a form of dementia that can cause many different personality and behavioral changes.  The research study conducted was on the effects of exercise on mood and affect in nursing home residents with AD.

4. Evidence for Care  Nursing Care Condition: There has been one study that has shown improved mood with exercise in AD patients.  The purpose of the study was to examine if exercise plays a role in the mood and affect with patients who have AD.

5. Evidence for Care  Nursing Theory: Operant conditioning by B.F. Skinner  Behavior modification  Justification for the basis of care: Reinforcement of exercises is needed to help mood and affect in AD patients.

6. Evaluation of the Evidence  Study Methods: Three groups of AD patients were randomly assigned to treatment groups including comprehensive exercise, supervised walking, and social conversation group.  Study Results: Patients with AD who participated in exercise had better outcomes of mood and affect compared to social conversation.

7. Evaluation of the Evidence  Article Critique: -Article is considered nursing research -Approved by the IRBs -Design: Randomized control trial -Level B evidence -Instrumentation and maturation threat to validity -Limitations: measures of disturbed behavior were not included. Physiological responses should be investigators along with more research on mood and AD. -Recommendations: shorter time period for study, more research on the subject. Disturbed behavior and physiological responses should be included in future studies.

8. Patient care Design  Situation:  75 year-old female patient at a long term facility who has AD and is very agitated and aggressive had participated in a few activities to increase mood after throwing silverware at another patient.  The 24 year-old registered nurse, who just started working at the long term facility has no experience working with AD patients. She found an article describing how certain exercises can help increase mood in AD patients. These activities included comprehensive exercise, supervised walking, and a conversation group.

9. Nursing Diagnosis: Risk for other-directed violence secondary to AD as evidence by throwing objects towards other patients and frustration with inability to remember present time and place.

10. Patient Care Design Identify -75 year-old patient -Has AD -Throwing object towards other pts. -Inability to remember time and place -agitated and aggressive -lives at the long term care facility Relate Primary Proposition: Patient throws silver wear at another resident due to aggressive behavior. Possible Assumptions: Patient does not know how to deal with aggression because of AD. Possible Confounding Variables: Nurse has trouble dealing with the situation because she has little experience with AD patients.

11. Patient Care Design Understand Proposition: Even though AD is a progressive disease and there is no treatment, certain activities can be achieved to hopefully decrease the aggression. Significance of Assumptions: Finding an activity that can re-direct the patient and enhance mood may be the only option to help with the aggressive behavior. Nurses need to be involved in the care due to the patient’s inability to think properly. Possible Confounding Variables: Since the nurse has little experience on the unit, collaborating with other staff may help solve ways to calm the patient down. In addition, nursing resources may help find evidence-based ways to enhance moods in AD patients.

12. Patient Care Design Explain Proposition: Explain to patient in a calm and clear manor the activities that can be performed. Participate with the client and help demonstrate, like touching the toes, putting cans in the cupboard, and taking walks down the hall. Assumptions: Re-direct and distract the patient with comprehensive exercises. One-on-one can be done by a CNA while completing comprehensive exercises. Patient may not understand the need to be away from other residents, so distraction may be a better option. Confounding Variables: Collaborate with the physical therapists and other nurses and explain to them how this research article supports comprehensive exercise and enhanced mood with AD patients. Explain the significance of using 10 minutes of strength, balance, and flexibility exercises followed by walking. Let them know that comprehensive exercise compared to just walking, or a conversation group has the best outcome on mood with AD patients.

13. Patient Care design Predict Proposition: If the aggressive mood is not resolved in the patient more violence towards other residents could occur. In addition, other residents could become aggressive due to the behavior. Assumptions: If patient is unaware of comprehensive exercise and ways to decrease aggressive mood, other residents could display aggressive behavior. Confounding Variables: If patient does not remember how to perform activities to decrease aggressive mood, the problem may not be resolved. If the nurse is new to the unit, help from other nurses and physical therapists may be needed to perform exercises to help enhance mood.

14. Patient Care Design Influence Proposition: Even though pt. may not understand the need for exercise, having a reward, such as going outside after the activity, can help enhance progression with activity. Assumptions: Influence other residents to participate in exercise as well. Having more residents complete the exercises could enhance mood on the whole unit. Confounding Variables: Collaborate with the physical therapists, occupational therapists, CNA’s and other staff involved in the patient’s care to start a care plan that involves 10 minutes of comprehensive exercise to influence positive mood changes. Control -Have patient complete comprehensive exercises daily.

15. Advocate Role  Significance to nursing practice: Using the research helps identify evidence-based practice skills that can help treat the symptoms of AD patients in long term care facilities.

16. Advocate Role  Providing empathetic, equitable care to AD patients includes using alternative treatment rather than medications.  Many of times medications do not fully treat mood symptoms in AD patients.  The nurse and other members of the healthcare team can interact more with the patient during comprehensive exercise.  AD patients have the chance to be a part of the behavior change.

17. Advocate Role  Nurse advocate: empathy and equity in care delivery allows the nurse to provide care that is meaningful to the patient.  Even though the AD patient has a lower ability to think properly, they still can recognize when a nurse truly cares.  Providing comforting alternative techniques helps the AD patient recognize that they are being taken care of.

18. References Armola, R. R., Bourgault, A. M., Halm, M. A., Board, R. M., Bucher, L., … Medina, J. (2009). AACN levels of /Research/01%20- %20AACN%20Evidence%20Levels.pdf evidence: What’s new? Critical Care Nurse, 29(4), 70-73. Retrieved from http://www.aacn.org/WD/Practice/Docs Colley, S. (2014). NURS 441 nursing theory 3. [Syllabus], School of Nursing, Ferris State University, Michigan, United States. Videbeck, S. (2014). Psychiatric-mental health nursing. Lippincott Williams & Wilkins. Williams, C. L., & Tappen, R. M. (2007). Effect of exercise on mood in nursing home residents with Alzheimer's disease. American journal of Alzheimer's disease and other dementias, 22(5), 389-397.