Initial Post While Working As A Registered Nurse On Alzheime

Initial Postwhile Working As A Registered Nurse On The Alzheimers Uni

While working as a registered nurse on the Alzheimer's Unit, you find Susan, a resident, wandering in the hallway. The assignment involves viewing videos of the client history and the hallway encounter, analyzing cues from these observations, and developing hypotheses related to her condition. Additionally, the task requires identifying additional information to gather through multiple inquiry modes—empirical, ethical, aesthetic, and sociopolitical—along with justifications. The final step involves prioritizing four hypotheses based on their relevance and supporting this order with rationales and evidence following APA 7 guidelines. The assignment emphasizes integrating evidence-based practice (EBP) dissemination strategies, addressing barriers, and supporting effective clinical decision-making through appropriate research sharing methods, all within a nursing context.

Paper For Above instruction

The case of Susan, an Alzheimer’s patient found wandering in the hallway, highlights numerous clinical and ethical considerations essential for nursing assessment and intervention. Understanding her cues, developing hypotheses, and integrating evidence-based practice are paramount in ensuring her safety, dignity, and well-being. This paper analyzes the cues identified from her history and assessment, explores additional data needs, formulates hypotheses, and discusses effective dissemination strategies within a nursing context.

Analysis of Cues and Clinical Concerns

From reviewing Susan's history and the hallway encounter, several cues emerge that are pertinent to her neurocognitive disorder. These cues include her apparent confusion, aimless wandering, potential agitation, and possible indications of disorientation. Her history may reveal prior episodes of confusion or wandering, medication side effects, or environmental triggers. Viewing her behavior in the hallway suggests possible unmet needs, such as thirst, hunger, discomfort, or unfamiliar surroundings exacerbating her disorientation.

Clustered based on relevancy, these cues highlight areas of concern such as her safety (risk of falls or elopement), cognitive fluctuations, emotional distress, and environmental factors. These factors are intertwined; for instance, her disorientation may be worsened by noise or crowding, and her wandering behavior poses immediate safety risks requiring prompt attention and tailored interventions.

Additional Information to Collect

Based on a multimodal inquiry, two types of additional information are essential:

  1. Empirical Inquiry: Detailed medication review and environmental assessment. Understanding her current medications, particularly those affecting cognitive function or causing sedation, helps identify medication-related causes of her wandering. An environmental assessment to identify potential triggers such as noise, lighting, or layout issues can inform environmental modifications to reduce her disorientation and wandering risk.
  2. Ethical Inquiry: Evaluating her autonomy and consent regarding safety interventions. Determining her capacity to participate in care decisions and balancing her safety with respect for her independence aligns with ethical principles like beneficence and autonomy. This inquiry ensures interventions do not infringe unnecessarily on her rights.

Modes of Inquiry Explanation

Empirical inquiry provides data-driven insights essential for targeted interventions, ethical inquiry ensures respect for patient rights, aesthetic inquiry considers her personal experience and dignity, and sociopolitical inquiry explores organizational policies and societal influences affecting her care. Incorporating these modes fosters holistic, patient-centered nursing practice.

Formulating and Prioritizing Hypotheses

Four hypotheses are proposed:

  1. Medication Side Effects Leading to Disorientation: Certain medications can impair cognition, thus contributing to wandering behaviors.
  2. Environmental Triggers Causing Anxiety or Disorientation: Noise or unfamiliar surroundings may provoke her wandering.
  3. Pain or Discomfort As Initiators of Wandering: Unaddressed pain might cause her to seek relief through wandering.
  4. Progression of Alzheimer's Disease Causing Cognitive Decline and Disorientation: Disease progression naturally leads to increased disorientation and wandering.

Priority order:

  1. Progression of Alzheimer’s Disease — This is often the primary driver of behavioral changes, requiring immediate management strategies.
  2. Medication Side Effects — Adjustments could reduce adverse effects contributing to her wandering.
  3. Environmental Triggers — Modifying the environment could significantly reduce her disorientation.
  4. Pain or Discomfort — Ensuring she is pain-free can prevent agitation prompting wandering.

This order is supported by evidence indicating that disease progression is the fundamental factor in behavioral symptoms, with medication effects and environmental factors being modifiable contributors (Cummings et al., 2019). Addressing progression requires ongoing assessment, while interventions targeting medication and environment can provide immediate benefits.

Dissemination of Evidence-Based Practice

Disseminating clinical evidence efficiently ensures nursing practices evolve to improve patient outcomes. Strategies include unit-level education, such as in-service trainings, which promote immediate knowledge transfer (Melnyk & Fineout-Overholt, 2015). Posters and champions within the unit reinforce use of evidence-based interventions, fostering a culture of continuous improvement. Overcoming barriers like resistance to change requires leadership support and staff engagement, emphasizing the benefits of EBP for patient safety and staff confidence (Kim et al., 2016).

In this context, I would prioritize disseminating findings related to environmental modifications and medication management to staff directly involved in her care. I would avoid broader dissemination efforts, such as national podium presentations, focusing instead on practical application within my organization. Challenges include staff reluctance and limited time, which can be mitigated through leadership involvement and providing accessible, concise training materials (Melnyk et al., 2011).

Conclusion

The management of Susan’s wandering behavior exemplifies the complex interplay of neurocognitive decline, medication effects, environmental factors, and ethical considerations. A comprehensive assessment utilizing multimodal inquiry, prioritization of hypotheses, and targeted evidence-based interventions are crucial. Effective dissemination of findings enhances care quality and safety, emphasizing the need for continuous education, organizational support, and patient-centered approaches within nursing practice.

References

  • Cummings, J. L., Morishima, R., & Zhong, K. (2019). Behavioral and psychological symptoms of dementia and their management. Dialogues in Clinical Neuroscience, 21(2), 139–149.
  • Kim, S. C., Stichler, J. F., Ecoff, L., Brown, C. E., Gallo, A., & Davidson, J. E. (2016). Predicators of evidence-based practice implementation, job satisfaction, and group cohesion among regional fellowship program participants. Worldviews on Evidence-Based Nursing, 13(5), 365–371.
  • Melnyk, B. M., & Fineout-Overholt, E. (2015). Evidence-Based Practice in Nursing & Healthcare: A Guide to Best Practice. Lippincott Williams & Wilkins.
  • Melnyk, B. M., & Fineout-Overholt, E. (2015). Implementing Evidence-Based Practice in Healthcare Organizations. American Journal of Nursing, 115(8), 55–63.
  • Huang, S., Martin, L. J., Yeh, C. H., Chin, A., Murray, H., Sanderson, W. B., & Thoma, B. (2018). The effect of an infographic promotion on research dissemination and readership: A randomized controlled trial. Canadian Journal of Emergency Medicine, 20(6), 875–882.
  • Zientek, L. R., Werner, J. M., Campuzano, M. V., & Nimon, K. (2018). The use of Google Scholar for research and research dissemination. New Horizons in Adult Education and Human Resource Development, 30(1), 39–46.
  • Huang, S., Martin, L. J., Yeh, C. H., Chin, A., Murray, H., Sanderson, W. B., & Thoma, B. (2018). The effect of an infographic promotion on research dissemination and readership: A randomized controlled trial. Canadian Journal of Emergency Medicine, 20(6), 875–882.
  • Huang, S., Martin, L. J., Yeh, C. H., Chin, A., Murray, H., Sanderson, W. B., & Thoma, B. (2018). The effect of an infographic promotion on research dissemination and readership: A randomized controlled trial. Canadian Journal of Emergency Medicine, 20(6), 875–882.
  • Zientek, L. R., Werner, J. M., Campuzano, M. V., & Nimon, K. (2018). The use of Google Scholar for research and research dissemination. New Horizons in Adult Education and Human Resource Development, 30(1), 39–46.
  • Kim, S. C., Stichler, J. F., Ecoff, L., Brown, C. E., Gallo, A., & Davidson, J. E. (2016). Predicators of evidence-based practice implementation, job satisfaction, and group cohesion among regional fellowship program participants. Worldviews on Evidence-Based Nursing, 13(5), 365–371.

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