Case Study of Infection Control Mr Jones

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Mr. Jones is a 72 year old Gentleman who was cared for in an acute medical setting, to ensure patients confidentiality is maintained (NMC2009) his name has been changed.

Infection control is a fundamental aspect of a nurse’s role, as well as the responsibility of everyone who works within healthcare systems (Department of Health (DH) 2006a).

Infection control and the prevention of all infection remains a major goal within all healthcare settings, and lies with all healthcare professionals and personnel’s responsibility to ensure this is achieved. The NHS and healthcare systems have specialised infection control teams to ensure an effective infection control programme has been planned and implemented, also regularly evaluate the effectiveness of programmes and update their findings. The infection prevention and control team provides advice about the prevention and management of infection including outbreaks of diarrhoea and vomiting, as well as promoting education and awareness to patient’s and carers. They work closely with staff and senior members of the healthcare setting to ensure that correct policies and procedures are adhered to. (www.nhs.uk/infection-prevention-and-control/).

Healthcare consists of a multi disciplinary team and all professionals must work together in order to encourage the effectiveness of the infection control programme is achieved. Microbiology has become an advanced science in the investigation of infections and the management of their control in the hospital setting, the study of living organisms that are so small that can not be seen by the naked eye, Microbes are everywhere, they are able to survive in almost every conceivable environment(J.Wilson). Many species of bacteria exists as well as virus and other micro organisms, but thanks to advance scientific findings a very small proportion cause disease and infection (J.Wilson).

The student nurse acted appropriately and was aware of following the NMC guidelines at all times within the clinical area of placement, and adhering to confidentiality guidelines and ethical policy.

The student nurse was called to assist Mr. Jones who had alerted the staff on the ward that he was in need of assistance in the toilet. When entering the room it was obvious to the student nurse that Mr. Jones was distressed. Mr. Jones had been incontinent and defecated on to the floor of the toilet and surrounding area. The student nurse gave reassurance to Mr. Jones to encourage the relief of his anxiety and distress, making the care of people your first concern, treating people kindly and considerately. (NMC2009).

According to the Bristol stool chart the stools that Mr. Jones had passed were type 7, the Bristol stool chart shows seven categories of stool and was developed by K.W Heaton and S.J Lewis at the University of Bristol and first published in the Scandinavian journal of Gastroenterology in 1997. Types 5-7 according to the Bristol stool chart may indicate diarrhoea and urgency, with stools passed watery with no solid pieces which presents entirely liquid.

The Bristol stool chart is an extremely useful guide as having a reference to adhere to gives the healthcare professional a better understanding and descriptive way of passing on information regarding their patient, a great deal of information can be learnt by the consistency of the patients stool as to indicate if their is any cause to be concerned, Clostridium difficile is an infection which is seen within the healthcare setting such as the hospital or care home, and was first recognised in the late 1970s, it does not present a problem in a healthy person but can present a problem in people who have been taking long term antibiotics, as this can interfere with good bacteria within the gut which can encourage C.difficile bacteria to multiply and produce toxins which causes diarrhoea and vomiting, C.difficile is more common in the over 65 age group, and can be spread through cross contamination from patient contact, via healthcare staff or via contaminated surfaces within the environment. (www.nhs.uk/conditions/clostridium-difficile). Healthcare environments are constantly battling against outbreaks of infection with implementing effective control measures which the infection control teams have implemented in guidelines from policy and procedures, in many cases time of outbreaks can not be determined but effective control measures can prevent the spread of infection to other areas, Norovirus which can present huge problems and stress to the healthcare setting can usually be determined to present in the winter months, vomiting and diarrhoea can present any time outside this time frame and procedures will be a duty of care to adhere to, to minimise the risk of the spread of infection. An outbreak within the clinical setting may be defined as ‘two or more cases of the same infection which are linked in time and place’ and any suspicion of an outbreak must be reported and documented to the relevant departments. (The Health Act 2006).

Having identified the risks of potential cross contamination and infection the student nurse intentions were to ensure that the necessary precautions were adhered to. Protective clothing such as gloves and aprons should be worn in accordance with the standard universal precautions policy. Staff can be at risk of infection or transference of pathogens if they do not comply with good infection control practices. “Essential skills clusters for nurses”.

The student nurse prior to assisting Mr. Jones any further made sure adequate protective clothing was worn with putting gloves and apron on. Wearing uniforms or protective personal clothing is affected by current legislation. (Health and Safety at work Act 1974). The student nurse had made the decision not to wear ‘added’ protective clothing as in this situation her personal judgement did not feel it necessary, face masks and eye protection are not always necessary for most intervention or activity to prevent cross infection, however, when there is a likelihood of accidental splashes from blood, body fluids, secretions and excretions to the face they must be worn. (Arrowsmith 2005, p.81, Pratt et al.2007).

The first priority of the nurse is the patient, so that they feel comfortable and less distressed about the situation, Make the care of people your first concern, treat people as individuals and respect their dignity (NMC 2009). It is a general legal and ethical principle that valid consent must be obtained before starting treatment or providing personal care for a patient. Explaining clearly the student’s intentions to Mr. Jones was important to ensure that Mr. Jones was informed and consented to the student nurse helping with personal care he was to receive, you must ensure that you gain consent before you begin any treatment or care (NMC2008). Mr. Jones mental capacity was at a satisfactory level to have the ability to understand what had just occurred and made the informed personal choice that the student nurse could assist him with resolving the situation that he had found himself in, For consent to be valid, it must be voluntary and informed, and the person consenting must have the capacity to make the decision.( www.nhs.uk/conditions/consenttotreatment).

The hygiene needs of Mr. Jones were met, using soap and water and clean underwear and gown was supplied. Hygiene needs are an important fundamental role of the nurse, and the protection of the skin and ensuring the patients skin is left clean and dry. Skin care is critically important, remembering to cleanse and protect the skin, especially if the skin has been exposed to urine or stool, also being aware of damaged skin, which can lead to infection, especially serious among the elderly. As well as infection it is essential to promote the prevention of skin breakdown, again, especially within the elderly. The presence of urine and faeces on the skin increases the normal PH of 4.0 -5.5 and makes the skin wet. The rise of PH and excess moisture increases the risks of tissue breakdown and infection. (Ersser et.al.2005). This also ensured that cross contamination of any possible infection did not pass onto any person on the ward and contamination of the surfaces at Mr. Jones bed space. Bacteria may multiply rapidly to create a source of infection, provided that a suitable vehicle transfers them to a susceptible site on the patient. (Infection control in clinical practice, J.Wilson).

Appropriate handling of infected items is the key to minimise the risk of transmission and cross contamination within the clinical area and responsibility of the student nurse and all other staff within the clinical areas, removal of gloves and aprons after use should be exposed of in the nearest clinical waste bin and soiled linen placed in a red linen bag. Contamination of the environment is a necessary duty of the nurse and the relevant domestic staff on the ward was informed of the area of risk, NHS Infection control precautions policy states, that spillages of faeces and/or vomit must be cleaned up immediately using detergent and water. The area should then be disinfected using a hypochlorite 10,000ppm (Antichlor Plus) solution. Prior to the student nurse escorting Mr. Jones back to his bed space within the ward necessary and crucial hand washing was carried out thoroughly and encouragement for Mr. Jones to carry out the same precautions were implied, by doing so this action discouraged transmission of pathogens and possible cross contamination. Hand decontamination is a low tech clinical intervention that can prevent transmission of infection (DH2006b). Unclean hands have been shown to be a significant vehicle for the transmission of micro organisms and contribute to outbreaks of infection in healthcare environments. (Pratt et al 2007).

A healthcare professionals role and responsibility is to collaborate with those their care at all times and to encourage education and understanding about their individual promotion of health and wellbeing, NMC, Standards of conduct, performance and ethics states that, you must support people in caring for themselves to improve and maintain health, and recognise and respect the contribution that people make to their own care and wellbeing. The student nurse encouraging Mr. Jones to wash his hands and help with his personal care can encourage promoting Mr. Jones independence and mental wellbeing as well as encourage the understanding of the importance of discouraging of cross contamination within the environment.

A senior member of the nursing staff was immediately informed regarding the situation with Mr. Jones as the information was important with the care he was currently receiving and relevant to any future care that he was about to receive, as well as the possible risk of infection as type 7 stool poses to the environment. The need to respect peoples confidentiality is a duty of care to the patient so it would be necessary to ensure the patient was informed that any information passed on was in their best interest, NMC 2010 states, you must ensure people are informed about how and why information is shared by those who will be providing their care and you must disclose information if you believe someone may be at risk of harm, in line with the law of the country in which you are practising.

In the areas of nursing and public health, the focus is on improving health.

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In the areas of nursing and public health, the focus is on improving health.

A leader has the ability to combine commitment for improvement with knowledge regarding how to exercise influence and engage support (Dickson & Tholl, 2014). In the areas of nursing and public health, the focus is on improving health. Porter-O’Grady and Malloch (2015) noted several major tasks of 21st-century healthcare leaders. Applying essentials of leadership, to the task listed below and discuss how you would exercise influence and engage support for each of your selected task.
-Helping others adapt to the demands of a value-driven health system.

A leader has the ability to combine commitment for improvement with knowledge regarding how to exercise influence and engage support (Dickson & Tholl, 2014). In the areas of nursing and public health, the focus is on improving health. Porter-O’Grady and Malloch (2015) noted several major tasks of 21st-century healthcare leaders. Applying essentials of leadership, to the task listed below and discuss how you would exercise influence and engage support for each of your selected task.
-Helping others adapt to the demands of a value-driven health system.

Relationship between Health and Education

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Health Care Where People Live and Work

The World Health Organisation (WHO) originally proposed a definition for health literacy that was later adapted by Nutbeam (1998) as ‘the cognitive and social skills which determine the motivation and ability of individuals to gain access to, understand and use information in ways which promote and maintain good health’. Health literacy is essential in health care, as it allows individuals to access available health services and actively participate in the decisions and management of their health and wellbeing (Institute of Medicine, 2004).

In recent years there has been an increase in chronic illness largely associated with an ageing population. This is placing immense pressure on health systems throughout Australia (Department of Health and Ageing, 2012). Addressing the barriers to improved health literacy in older adults would lead to better health and wellbeing outcomes, while simultaneously reducing the level of dependence on the health care system. The health professional plays an important role in assisting elderly patients to develop a greater understanding of their specific health conditions, and therefore, allowing elderly people to take an active role in the management of their health conditions.

Health literacy is more than possessing the ability to read and write, it encompasses an active role in accessing available health care services, self-care of chronic conditions and maintaining an adequate level of general health and wellbeing (Institute of Medicine, 2004). According to the Australian Bureau of Statistics (ABS) report on social trends (2009), 59% of Australian adults have inadequate health literacy levels, and this figure is even higher in the Tasmanian population (63%). This essentially means that the majority of people, even those with university degrees or higher education, fail to understand basic health information, such as, safe drug and alcohol use, disease prevention, first aid and sustainable wellbeing (Australian Bureau of Statistics, 2009).

Poor health literacy affects patients in various ways including; inability to accurately remember information provided by health professionals, less knowledge of the causes of ill-health, less likely to use health services designed to prevent and detect conditions (e.g. cancer screening, childhood health assessments and immunisations), and are more dependent on healthcare providers (e.g. hospitals and emergency services) (Australian Bureau of Statistics, 2009). Numerous tests have been developed to determine an individual’s level of health literacy, such as, the Newest Vital Sign (NVS), a nutrition label based test that takes approximately three minutes to complete. Other general indications of poor health literacy are; avoiding paperwork, using appearance to identify medications rather than labels, and a reluctance to complete forms.


See also:


Effects of Low Health Literacy

Health literacy is an essential component of Primary Health Care (PHC). PHC aims to promote health, develop communities, act as an advocate for health services, provide rehabilitation, prevent illness, and care for the sick. (Australian Primary Health Care Research Institute, 2006). Health literacy can be improved by implementing various PHC strategies that are concentrated on addressing the social determinants of health, such as, social support, unemployment, early life and the social gradient (Wilkinson and Marmot, 2003). These strategies are focused on the promotion of health literacy skills and educating those in need, for example, free access to general practitioners (GP) and better health education in early schooling, are crucial programs in achieving improved education and health literacy outcomes.

The relationship between education and good health is well established in the literature and is documented in a wide variety of research articles (Black, 1980). Education leads to improved general and health literacy, which creates a greater chance of better health and wellbeing in an individual. However, it is important to note that, as Nutbeam (2000) explains, while an individual may have access to education and possess high general and health literacy levels, this does not guarantee better health outcomes. Older adults in the Australian population are among those with the highest rates of chronic illness and lowest rates of health literacy, therefore, improving health literacy is essential to better manage chronic illnesses (Australian Bureau of Statistics, 2007-08).

Older adults are among the most dependant on the health care system with some of the lowest levels of health literacy. This is due to a number of barriers including, education and literacy training, the technicality and complexity of health information, and the natural ageing process (Centre for Disease Control and Prevention, 2011). The National Assessment of Adult Literacy (NAAL) found that 80% of older adults had difficulty using documents, such as, forms or charts (NAAL, 2006). Poor health literacy in the older adult population can seriously interfere with the day-to-day care of chronic illnesses, such as, ischemic heart disease, which is the leading chronic illness and cause of death in the Australian older adult population (Australian Institute of Health and Welfare, 2008).

Ischemic heart disease (IHD), or coronary heart disease, is the most common form of heart disease and cause of heart attacks (Mount Sinai Hospital, 2014). IHD is caused by plaque build-up on the walls of coronary arteries, narrowing them and restricting blood flow to the heart (Dorling, 2009). In Australia, approximately 10,000 people die from heart disease each year (Australian Bureau of Statistics, 2007-08). IHD is a generally preventable disease. There is no single cause of IHD, there is however, numerous contributing factors that increase the risk of developing the disease (Heart Foundation, 2011). The first step, and perhaps the most fundamental, in preventing IHD in older adults, is educating individuals on the risk factors relevant to them.

The Australian Heart Foundation (2011) provides a list of two varieties of risk factors, modifiable and non-modifiable. Non-modifiable risk factors include; age, ethnic background, family history of heart disease. The modifiable (preventable) risk factors include; smoking, high cholesterol, high blood pressure, diabetes, sedentary lifestyle, obesity and lack of social support/social isolation (Heart Foundation, 2011). Health literacy is crucial in the management of IHD, as aforementioned, the majority of contributing risk factors are dependent on the lifestyle choices of the individual, meaning that with the right motivation and knowledge, the disease can, for the most part, be prevented.

Improving health literacy is the responsibility of the individual, the community, the government, and the health professional. The health professional has a direct and significant role in improving health literacy as they are the primary source for information, education and have the greatest level of patient contact. During interviews with older adults conducted in a study by the Department of Health and Ageing (2012), it was found that post hospitalisation patients were largely left confused with only their own resources to cope with the challenges of their condition. The patient needs to be provided with the resources, education and support necessary to provide a foundation for building health literacy, leading to better self-management and improved patient outcomes (Department of Health and Ageing, 2012).

Supporting development of behaviour change, implementing a patient-centred approach, providing patients with positive reinforcement and creating an environment that allows for progression and constructive change, are among the responsibilities of the health professional (Institute of Medicine, 2004). The patients’ responsibilities are to engage in treatment plans, follow self-management instructions and cooperate with health professionals in the best interest of their health and wellbeing (Nutbeam, 2000).

Improving communication is fundamental to increasing health literacy. Health professionals can improve communication by using methods, such as, the talk back technique, which is when the health professional asks the patient to repeat the information provided, back to the health professional, demonstrating their understanding (Stein-Parbury, 2013). Using various physical materials to visualise information, such as, charts, graphs, and instructions, is another useful method to improving communication of information and increasing the patients’ level of understanding (Stein-Parbury, 2013). Using effective communication methods and techniques, the health professional can empower the patient to access the necessary resources and become active in managing their own health needs (Nutbeam, 2000). This is exceedingly important in the management of IHD, as patient decisions are crucial in reducing the risk factors contributing to the disease.

In conclusion, health literacy is fundamental to providing effective health care. Patients, health professionals, communities and governments all play an important role in health literacy, whether it be empowering patients or funding educational programs. A rising quantity of evidence supports the importance of communication in professional health care. Some groups are predisposed by social determinants to have poor health literacy levels, such as the elderly. Elderly patients suffer greatly from preventable illnesses, such as, ischemic heart disease. It is therefore, understandable that it is necessary to provide comprehensive education and focus resources on improving health literacy in all communities.


References

Australian Bureau of Statistics, Social Trends 4102.0 (2009). Available at:

http://www.dhhs.tas.gov.au/__data/assets/pdf_file/0011/101117/poh_fact_sheet_DHHS_health_literacy_20120630.pdf

[Accessed 20 May. 2014].

Australian Bureau of Statistics (2001).4364.0 National Health Survey: summary of Results, 2007-08; 3464.0 National Health Survey: summary of results, 2001. Available at

Australian Bureau of Statistics (www.abs.gov.au)

[Accessed 23 May. 2014].

Australian Institute of Health and Welfare (AIHW) (2008).

Australia’s health 2008

. Cat. no. AUS 99.

Canberra: AIHW. Available at:

http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=6442453674

[Accessed 26 May, 2014]

Australian Primary Health Care Research Institute (APHCRI) (2006).

ADGP Primary Health 42

. Care Position Statement 2005, also included in the Australian Medical Association Primary Health Care position paper, 2006.

Black, D.(1980)Inequalities in Health: Report of a Research Working Group. Available at:

http://www.sochealth.co.uk/history/black.htm

. [Accessed 20 May. 2014].

Centre for Disease Control and Prevention (CDC) (2011).

CDC – Importance – Health Literacy for Older Adults – Audiences – Develop Materials – Health Literacy

. Available at:

http://www.cdc.gov/healthliteracy/developmaterials/audiences/olderadults/importance.html

[Accessed 19 May. 2014].

Department of Health and Ageing (2012).

Improving Health Literacy in Seniors with Chronic Illness

. National Seniors Productive Ageing Centre (NSPAC). Available at:


http://www.productiveageing.com.au/userfiles/file/ImprovingHealthLiteracy%20Low%20Res.pdf

[Accessed 22 May. 2014].

Dorling K. (2009) ‘Coronary heart disease’ in

The human body book: An illustrated guide to its structure, function and disorders

, Dorling Kindersley Publishing, Inc., London, United Kingdom.

Heart Foundation (2011).

Data and Statistics

. Available at:

http://www.heartfoundation.org.au/information-for-professionals/data-and-statistics/Pages/default.aspx

[Accessed 23 May. 2014].

Institute of Medicine (2004).

Health Literacy: A prescription to end confusion

. Nielsen-Bohlman L, Panzer A, Kindig DA, editors. Washington, D.C., National Academy Press 2004.

Mount Sinai Hospital (2014).

Heart Attack – Coronary Artery Disease Treatment

. Available at:

http://www.mountsinai.org/patient-care/service-areas/heart/areas-of-care/heart-attack-coronary-artery-disease

[Accessed 22 May. 2014].

National Assessment of Adult Literacy (NAAL) (2006).

2003 National Assessment of Adult Literacy

. National Centre for Education Statistics. Available at:

http://nces.ed.gov/pubs2006/2006483.pdf

[Accessed 18 May. 2014].

Nutbeam, D.(1998)

‘Health promotion glossary’

, Health Promotion International,13:349-64.

Nutbeam, D.(2000)

‘Health literacy as a public health goal: a challenge for contemporary health education and communication strategies into the 21st century’

, Health Promotion International,15(3):259-67.

Stein-Parbury, J. (2013).

Patient and person

. 5th ed. Sydney: Elsevier Churchill Livingstone.

World Health Organisation (WHO) (1998)Health Promotion Glossary. Geneva:WHO.

Wilkinson, R., and Marmot, M. (2003).

‘World Health Organization’

. The solid facts retrieved from:

http://www.euro.who.int/__data/assets/pdf_file/0005/98438/e81384.pdf

[Accessed 22 May. 2014].

Identify the importance of the IOM “Future of Nursing” report related to nursing practice, nursing education and nursing workforce development.

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Identify the importance of the IOM “Future of Nursing” report related to nursing practice, nursing education and nursing workforce development.

In a formal paper of 1,000-1,250 words you will discuss the work of the Robert Wood Johnson Foundation Committee Initiative on the Future of Nursing and the Institute of Medicine research that led to the IOM report, “Future of Nursing: Leading Change, Advancing Health.” Identify the importance of the IOM “Future of Nursing” report related to nursing practice, nursing education and nursing workforce development. What is the role of state-based action coalitions and how do they advance goals of the Future of Nursing: Campaign for Action?

Explore the Campaign for Action webpage (you may need to research your state’s website independently if it is not active on this site): https://campaignforaction.org/states

Review your state’s progress report by locating your state and clicking on one of the six progress icons for: education, leadership, practice, interpersonal collaboration, diversity, and data. You can also download a full progress report for your state by clicking on the box located at the bottom of the webpage.

In a paper of 1,000-1,250 words:

Discuss the work of the Robert Wood Johnson Foundation Committee Initiative on the Future of Nursing and the Institute of Medicine research that led to the IOM report, “Future of Nursing: Leading Change, Advancing Health.”
Identify the importance of the IOM “Future of Nursing” report related to nursing practice, nursing education and nursing workforce development.
What is the role of state-based action coalitions and how do they advance goals of the Future of Nursing: Campaign for Action?
Summarize two initiatives spearheaded by your state’s action coalition. In what ways do these initiatives advance the nursing profession? What barriers to advancement currently exist in your state? How can nursing advocates in your state overcome these barriers?

What is the phenomenology of illness and disease (i.e. the personal ?what it is like?)?

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What is the phenomenology of illness and disease (i.e. the personal ?what it is like?)?

 

Max Points: 5.0 Refer to the GCU Introduction, The Death of Ivan Ilych by Tolstoy and the three concepts of the ?healing environment? found in chapters 7-9 of Called to Care: A Christian Worldview for Nursing. What is the phenomenology of illness and disease (i.e. the personal ?what it is like?)? Cite references from your reading to support your answer. What is a personal analysis of your own experience with illness and disease and how several factors colored that experience? How can you relate to The Death of Ivan Ilych?

Socw 6311-wk10a- designing a plan for outcome evaluation | SOCW 6311 – Social Work Practice Research II | Walden University

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Social workers can apply knowledge and skills learned from conducting one type of evaluation to others. Moreover, evaluations themselves can inform and com`plement each other throughout the life of a program. This week, you apply all that you have learned about program evaluation throughout this course to aid you in program evaluation.

To prepare for this Assignment, review “Basic Guide to Program Evaluation (Including Outcomes Evaluation)” from this week’s resources, Plummer, S.-B., Makris, S., & Brocksen S. (Eds.). (2014b). Social work case studies: Concentration year. Retrieved from http://www.vitalsource.com , especially the sections titled “Outcomes-Based Evaluation” and “Contents of an Evaluation Plan.” Then, select a program that you would like to evaluate. You should build on work that you have done in previous assignments, but be sure to self-cite any written work that you have already submitted. Complete as many areas of the “Contents of an Evaluation Plan” as possible, leaving out items that assume you have already collected and analyzed the data.

Submit a 4- to 5-page paper that outlines a plan for a program evaluation focused on outcomes. Be specific and elaborate. Include the following information:

The purpose of the evaluation, including specific questions to be answered

The outcomes to be evaluated

The indicators or instruments to be used to measure those outcomes, including the strengths and limitations of those measures to be used to evaluate the outcomes

A rationale for selecting among the six group research designs

The methods for collecting, organizing and analyzing data

Required Readings

Dudley, J. R. (2014). Social work evaluation: Enhancing what we do. (2nd ed.) Chicago, IL: Lyceum Books.Chapters 9, “Is the Intervention Effective?” (pp. 213–250)Chapter 10, “Analyzing Evaluation Data” (pp. 255–275)

McNamara, C. (2006a). Contents of an evaluation plan. In Basic guide to program evaluation (including outcomes evaluation). Retrieved from http://managementhelp.org/evaluation/program-evaluation-guide.htm#anchor1586742

McNamara, C. (2006b). Reasons for priority on implementing outcomes-based evaluation.In Basic guide to outcomes-based evaluation for nonprofit organizations with very limited resources. Retrieved from http://managementhelp.org/evaluation/outcomes-evaluation-guide.htm#anchor30249

Plummer, S.-B., Makris, S., & Brocksen S. (Eds.). (2014b). Social work case studies: Concentration year. Baltimore, MD: Laureate International Universities Publishing. [Vital Source e-reader].Read the following section:“Social Work Research: Planning a Program Evaluation”

Hand Hygiene Reminder System

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Quantitative Article:

Ellison, R. T., Barysauskas, C. M., Rundensteiner, E. A., Wang, D., & Barton, B. (2015). A Prospective Controlled Trial of an Electronic Hand Hygiene Reminder System

.




Open Forum Infectious Diseases

,2(4). doi:10.1093/ofid/ofv121


Background or Introduction

This study was conducted to find ways to raise the number of times hand hygiene is completed. The study used three phases to accomplish/measure the outcomes. The study is easy to follow and well organized.


Review of the Literature

Prevention and education were  key points made by the author. We already have many excellent sources of education material that has been completed by reputable sources such as the CDC, WHO and Joint commission. Unfortunately, even when health care facilities implement infection control efforts there is a large discrepancy in the actual completion of hand hygiene. In completing this article the writer researched 36 other articles. This gave plenty of research to complete the study.


Discussion of Methodology

This clinical study was controlled and used two different ICU’s. The ICU’s were comparable in census, size, and admission demographics. They ICU’s did have one mentioned variable. One ICU had one less bed available. An automatic hand hygiene system was installed. When staff entered or exited a room they were both monitored and reminded by the machine to perform hand hygiene. This study was a quantitative study.


Data Analysis

The Study lasted 4 months – one week. The results of the study were set side by side. The number of uses of the hand sanitizer against how often the alarm sounded when coming in or going out of a room. Ratios were figured and recorded.


Researcher’s Conclusion

During the trial when the chime reminded staff to complete hand hygiene it was noted that there was a 24% increase in compliance but throughout the washout phase health care workers tended to regress back to their baseline. The increase in hand hygiene compliance shows that a reminder di have a positive impact on hand hygiene.  Education was also reviewed. The negative impact that not complying with hand hygiene has on both patients,  hospital staff and the general population. Research such as this helps to show the importance of simple things such as hand washing in general overall health.



Researcher’s Conclusion

An increase in hand hygiene was noted with supervision and electronic monitoring. Conclusion shows an increase in compliance. This study allowed around the clock examination of the focus group. This proved to be a benefit compared to observational only studies. These are often completed only during business day hours.   Using already known material from the Joint Commission, CDC, and WHO assisted with educating educate the researchers giving them reasons why hand hygiene and HAI’s continue to remain around the same compliance. The ICU’s continued the study for 25 weeks. It showed that reminder systems do have a positive impact.




Protection of Human Subjects and Cultural Considerations

The author did not use any specific staff for completion of this research study. The study was mostly done by using working hospital staff and was measured by entry and exit alarms and automatic hand hygiene reminders.  Since we know that observation alone can cause deviations, an automatic system was used to increase reliability and conclude the study with factual results. Throughout this study it did not matter who the staff person was. This was not needed in the study so identities were not shared. Consent forms were not an issue in this study as people were never identified.


Strengths and Limitations

The study took 25 weeks to complete this is a relatively long time and assisted with the ability to obtain more accurate ratios. The sample size used was small.  An ICU with 15 available beds and one with 16 available beds. It was also noted  that the door alarm counts cannot fully noted as 100% accurate. For example staff can step in the doorway to converse with patients or family or can leave one room, sanitize, and go into the next room. Evaluating hand hygiene activity was the most influential component of this study. The conclusion shows that answers were obtained  about the  effectiveness of electric hand hygiene monitors.


Evidence Application


to Nursing Practice

This study can affect a hospice nurse. Our patient population often have weakened immune systems and not remembering to complete hand hygiene can be detrimental to the patient’s last days and in having the time to complete the goals and life experiences that they are able to finish. Hand Hygiene also affects hospice nurses as we are often exposed to an increase in body fluids and infections. In order to keep ourselves safe and healthy we must remember hand hygiene. This study shows us that we have a lot of work to do when it comes to hand hygiene. It shows that the electronic monitors does increase use of  hand hygiene practices, but also shows that without reminders we do not continue the hand hygiene practice at the high percentage.  The study was also able to keep anonymity among healthcare workers, this may or may not have a positive impact on infection control.




Qualitative Article:

Jain, S., Edgar, D., Bothe, J., Newman, H., Wilson, A., Bint, B., . . . Harris, J. (2015). Reflection on   observation: A qualitative study using practice development methods to explore the experience of being a hand hygiene auditor in Australia.

American Journal of Infection Control

,43(12), 1310-1315. doi:10.1016/j.ajic.2015.07.009


Background or Introduction

The article was written with the intention of trying to understand barriers to hand hygiene. The study witnessed persons coming into and going out of a patient’s room. The study used a focus group. Results of this study give healthcare workers a better view of the influence observation has when it comes to hand hygiene and the influence we have on each other in the regard of hand hygiene.


Review of the Literature

The study is trying to lessen the spread of staphylococcus aureus bacteremia. It was completed by hospital staff  washing their hand or using alcohol-based sanitizer more often.  Observation was used  by the researchers to formulate concepts and establish obstacles that could cause hospital employees not to complete hand hygiene. There were  27 reference articles utilized by the authors.


Discussion of Methodology

The researchers used an observational approach when conducting this study.  The outcome was to figure out how to improve the health care staff’s  compliance with hand hygiene when going into or leaving a  patient’s room. This study was conducted by using 25 hand hygiene auditors.  The auditors  were divided into three groups. Assigning members to different focus groups plus using people who didn’t have immediate  involvement with the study helped to give a more widespread idea of findings. The focus groups took comprehensive notes of what they saw.  The study was concluded after 2.5 hours. Ideas and suggestions were then talked about in a large group conversation. This discussion came up with ideas about how to make hand hygiene more compliant and reasons as to why it is missed.


Data Analysis

The researchers used focus groups and observations to gather knowledge.. Information was gathered from the focus groups. it was conclusive, because there was only a small amount of differences among the different  groups. Facts were analyzed and information recorded then the group talked about the study and recorded the findings.


Researcher’s Conclusion

The goal in this study is to reduce focusing a study on this topic is to reduce staphylococcus aureus bacteremia by use of frequent hand hygiene. Taking a group approach and discussing the barriers that were found to not performing hand hygiene especially since hand hygiene is the main prevention tool to decrease these infections.




Researcher’s Conclusion

It is important to utilize infection control staff and monitor hand hygiene in health care facilities. It is in the best interest of both patients and employees to complete hand hygiene.   A study like this one helps us figure out why hand hygiene is getting missed and helps figure out how to change practices within a facility so that it will not be missed.

The authors that wrote this article are able to make conclusions because they  gathered data that showed that this process improves hand hygiene compliance. It is also know that compliance will not likely stay this high after the study. It will probably drop down closer to baseline after time.

Including cliniations in studies could make them feel they have more input in infection control. It may encourage increased hand hygiene.  If staff are satisfied they often participate in hospital policies more.




Protection of Human Subjects and Cultural Considerations

The auditors part in this study was a volunteer mode. They were able decline prior to the making of the study groups. Screening and invitations were delivered by  e-mail. Focus groups were told that results would be posted and they would not  be hidden.  Consents were not required.




Strengths and Limitations

Observation was the primary  approach to gather data on the use of hand hygiene.  the small size of the auditors could have skewed the results of this study. With such a small group things could have been missed.  This problem could have been improved if more people would have agreed to participate.  initially, 150 people were asked to be auditors but only 25 agreed. It would be difficult to monitor if more than one staff member were exiting or entering a room at the same time or friends or relatives would need to be identified from hospital staff.  Distractions throughout a busy day can also skew results.




Evidence Application to Nursing Practice

The results of this study prove that if proper hand hygiene is used, conversations happen and plans are made it is possible to conquer the hurdles of not using hand hygiene. Hand Hygiene does lead to lower rates of staphylococcus aureus bacteremia.  In Hospice nursing many patients are immunocompromised. Hand Hygiene is very important in not spreading infection from patient to patient.  Many of our clients also have drains, lines and wounds which can easily introduce infection into the body. Hand hygiene is the number one barrier to keep both patients and health care staff healthy.

These kinds of studies are needed. Hospital staff need continued education and reminders as to why hand hygiene is important. Short cuts happen when staff get busy. We often need to be reminded why it is so important to be compliant with hand hygiene.




References

  • Ellison, R. T., Barysauskas, C. M., Rundensteiner, E. A., Wang, D., & Barton, B. (2015). A Prospective Controlled Trial of an Electronic Hand Hygiene Reminder System.

    Open Forum Infectious Diseases,2

    (4). doi:10.1093/ofid/ofv121
  • Jain, S., Edgar, D., Bothe, J., Newman, H., Wilson, A., Bint, B., . . . Harris, J. (2015). Reflection on   observation: A qualitative study using practice development methods to explore the experience of being a hand hygiene auditor in Australia.

    American Journal of Infection Control,43

    (12), 1310-1315. doi:10.1016/j.ajic.2015.07.009

Ventricular Septal Defect: Diagnosis and Treatment

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Adunola Iyinolakan


Holly Jones-Taggart


Ventricular Septal Defect

Ventricular septal defect is a structural heart defect and one of the most common congenital cardiac malformations caused by an opening in the intraventricular septum-the wall between the ventricles (lower chambers of the heart) that causes a left-to-right ventricular shunt of blood through the septum. VSDs can be congenital or acquired; they may be single or multiple and vary in size, location and clinical presentation; this variance helps in its diagnosis, treatment and prognosis. Anatomically, the ventricular septum is made up the membranous septum – which is made up of thin fibrous tissue at the superior part of the septum and the muscular septum-which is mainly muscles at inferior part of the septum, with three components: the inlet septum, the trabecular septum, and the outlet (or infundibular) septum. Defects in the membranous septum often extend into the muscular septum, these are called the perimembranous defects. The membranous defects make up the majority of VSDs- though they almost invariably also involve the muscular septum. VSD appears either as an isolated cardiac defect or with several complex malformations such as pulmonary hypertension, pulmonary stenosis or aortic regurgitation- which all play a role in the pathophysiologic consequence of the disease. This review will cover anatomy of VSD, with a focus on the diagnosis and treatment options available as seen from the authors’ point of view and in related reviews of Ventricular Septal Defect.


Heart Anatomy-The Ventricles

The heart has four chambers: a right and left upper atria which are separated by the atrial septum and a right and left lower ventricles which are separated by the ventricular septum. The septum prevents mixing of blood between the two sides of the heart. In normal heart function, oxygenated blood is ejected from the left ventricles through the aorta to the rest of the body. With VSD in early systole, ejected oxygenated blood from the left ventricle (LV) will be shunted through the VSD into the right ventricle where it mixes with deoxygenated blood. Hence oxygenated blood is pumped back to the pulmonary circuit instead of the body.


Diagnosis


Auscultation:

Most VSDs are identified by auscultation depending on its size; location; and associated complications. Small or restrictive defects are associated with a palpable thrill in the third or fourth intercostal space. VSD produces a loud pathognomonic holosystolic or pansystolic murmur, heard best at Erb’s point. Small defects are often asymptomatic due to mild ventricular outflow or shunt lesion. Large defects however leads to an increase in mitral inflow which could generate a diastolic rumble at the apex.


Electrocardiography:

Electrocardiogram (ECG) reflect the hemodynamic changes by coping the shunt size and the extent of pulmonary hypertension. Restrictive VSDs usually produce a normal tracing, a wide notched P wave due to left atrial overload is the characteristic of Medium-sized VSDs produce, and large VSDs shows hypertrophy of the right ventricle with right-axis deviation. With further progression of the defect, the ECG shows biventricular hypertrophy; P waves may be notched or peaked. This techniques is limited because small defects are difficult to image; and hence, only visualized by means of color Doppler examination.


Echocardiography:

Echocardiography evaluate the anatomy and physiology of the heart using sound waves to determine the size, pattern and volume of blood flow through the VSD. Two-dimensional (2D) and Doppler color-flow mapping are used to identify VSD type. Septal dropout in the area adjacent to the septal leaflet of the tricuspid valve and below the right border of the aortic annulus are seen in Perimembranous VSDs. Muscular defects may appear anywhere throughout the ventricular septum. The anatomic localization of all VSDs is facilitated by coupling 2D sonograms with a Doppler system and by overlaying a color-coded direction and velocity of blood flow on the real-time images.


Chest radiography:

The chest radiograph reflects the magnitude of the shunt and the extent of pulmonary hypertension. Patients with a small VSD have a normal cardiac outline and pulmonary vascularity. Medium-sized VSDs, show minimal enlargement and a borderline increase in pulmonary vasculature; in large VSDs, the chest radiograph shows comprehensive hypertrophic cardiomyopathy with prominence of both ventricles, the left atrium, and the pulmonary artery. The pulmonary vascular markings are increased, and frank pulmonary edema, including pleural effusions, may be present. Cardiac catheterization: Angiography assesses pulmonary vascular resistance (PVD) of complicated VSDs. It is only performed when: (a) uncertain about shunt size after clinical evaluation; (b) laboratory data contradicts clinical findings; or (c) PVD is suspected. Oximetry show high level of oxygen in the right ventricle due to streaming (blood ejection almost directly into the pulmonary artery). Small VSDs are connected with normal right-sided heart pressures and pulmonary vascular resistance. Large, nonrestrictive VSDs are characterized by equal or near-equal pulmonary and systemic systolic pressures. Pulmonary blood flow may be two to four times above the systemic blood flow.


Magnetic Resonance Imaging:

The current clinical role of MRI is to supplement the information acquired with echocardiography. The volumes, mass, and function of ventricles may be assessed by using cine MRI. Shunts volume, valvular function, and pressure gradients across the valves and conduits may be projected by the use of velocity-encoded cine MRI (velocity-flow mapping). In studies in which the results of MRI were corroborated with those of angiography and/or 2D echocardiography, an accurate anatomic diagnosis of anomalies was mostly achieved.


Treatment Options


Medical Management:

Small sized VSDs are often asymptomatic and need no medical treatment, but monitoring. However, treatment for large VSDs include –

  1. Increased caloric density of feedings to ensure adequate weight gain/growth in babies.
  2. Angiotensin-converting enzyme inhibitors to reduce afterload in systemic and pulmonary pressures (the former to a greater degree), thereby reducing the left-to-right shunt.
  3. Digoxin can also be given for its inotropic effect- to increase the strength of the heart’s contractions and keep the heartbeat regular.
  4. Diuretics such as furosemide is administered to relieve pulmonary congestion – long-term use of furosemide results in hypercalciuria, renal damage, and electrolyte disturbances.
  5. Antibiotics-administered to patients whose large VSD causes a low blood oxygen level or to patients at highest risk of complications from infective endocarditis or Surgery.

  • Surgeries.

Cardiopulmonary bypass in VSD surgeries replace heart and lungs function to provide a stable surgical field. Pulmonary Artery banding, is mostly done to critically ill infants with many VSDs or for those with associated complex cardiac malformations. Most perimembranous VSDs are repaired using a trans-atrial surgical method. VSDs in the outlet septum are approached through the pulmonary valve. Muscular VSDs, proximal to the apex, are complex to treat; hence, an approach through initial pulmonary banding through apical left ventriculotomy, to close the defect with a single patch is often used as a standard technique.


  • Transcatheter closure

This approach may be used for multiple VSDs. The doctor inserts the catheter into a blood vessel and guides it to the heart, then uses a specially sized mesh device to close the hole. Muscular VSDs have been closed with transcatheter devices for ages now. Perimembranous VSDs, can be difficult to close percutaneously because of its proximity to the aortic valve resulting in potential aortic valve damage. The patient is often under general anesthesia and with transesophageal echocardiographic guidance during procedural closure. Reported complications have included aortic and tricuspid regurgitation, device embolization, transient left bundle-branch block, complete heart block, hemolysis, small residual shunts, and perforation.


Conclusion

Based on the review of, Although VSD murmur is one of easier murmurs to recognize, sometimes an innocent physiological murmur can be mistaken for a VSD. Occasionally patent ductus arteriosus and pulmonary stenosis are mistaken for a Ventricular Septal Defect. Hence, it is imperative for clinicians to thoroughly understand the anatomy of congenital and acquired ventricular septal disease, and the ways they affect cardiovascular hemodynamics and performance. Diagnosis is subject to physical examination like auscultation to determine the presence of VSD; even such that are asymptomatic. Surgical and medical expertise is also essential and these help in the understanding and care of patients with cardiac malformations because these patients, can live productive lives when cared for appropriately.


References

Anjum Gandhi. (2015). Professional Reference: Ventricular Septal Defect

Retrieved from https://patient.info/pdf/2916.pdf

Prema Ramaswamy. (2015).Drugs & Diseases, Pediatrics: Cardiac Disease and Critical Care

Medicine, Ventricular Septal Defects Treatment & Management. Retrieved from

http://emedicine.medscape.com/article/892980-treatment#d9

Wang, J., Zuo, J., Yu, S., Yi, D., Yang, X., Zhu, X., Yang, J. (2016). Effectiveness and safety

of transcatheter closure of perimembranous ventricular septal defects in adults. The American Journal of Cardiology, 117(6), 980-987. doi:10.1016/j.amjcard.2015.12.036

Vibhuti N Singh. (2015). Drugs & Diseases, Radiology:

Ventricular Septal Defect Imaging.

Retrieved from http://emedicine.medscape.com/article/351705-overview#showall

Naser M. A, Carole A. W. ( 2001). American College of Physicians-American Society of

Internal Medicine

. Ventricular Septal Defects in Adults. Ann Intern Med. 2001;135:812-

824. Retrieved from

https://www.uthsc.edu/cardiology/articles/VSD%20review.pdf

https://doi.org/10.1161/CIRCULATIONAHA.106.618124.Circulation. 2006;114:2190-2197

Originally published November 13, 2006


http://pediatricct.surgery.ucsf.edu/conditions–procedures/ventricular-septal-defect.aspx


http://circ.ahajournals.org/content/114/20/2190


https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4569244/


https://en.wikipedia.org/wiki/Ventricular_septal_defect#Diagnosis


https://www.cincinnatichildrens.org/health/v/vsd

http://pubmedcentralcanada.ca/pmcc/articles/PMC2019978/pdf/archdisch01558-0006.pdf

For this assignment you will create a practice plan that will prepare you to take your place as a clinical mental health counselor who serves a selected population in your community.

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For this assignment you will create a practice plan that will prepare you to take your place as a clinical mental health counselor who serves a selected population in your community.

Completing this assignment will require you to think about the context in which you will someday serve clients—the historical context, the network of mental health services currently available to clients in your community, and the labor market context that may influence your selected area of practice. This assignment will also invite you to envision yourself participating in a professional organization that supports clinical mental health counselors and the counseling profession.

Benefits of Music Therapy for Dementia Patients

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Introduction

Music has the ability to bring you back in time. You are able to relive moments from your past and feel all the emotions as you did when the event first occurred. When hearing a particular tune, you find yourself going back in time to that vacation you took to Florida with your friends, or to the time when you were 5 years old dancing around the kitchen with your grandfather, banging pots and pans while singing at the top of your lungs. While you are remembering those happy times in your life, your grandparents may be beginning to lose their memories from the past as a result of dementia.

Music has many benefits to offer those who are living with a dementia diagnosis. Within the early stages of the disease, music can be used to help recall important life events. “Musical memories are generally often longer preserved than non-music memories” (Vink, 2013). Music therapy has also been known to provide a relaxation to those in the more advanced stages of dementia. It can be seen as a way of reducing anxiety and creates a calming lullaby. In the last phases of dementia, music “is one of the last cues which can be perceived” (Vink, 2013). A Musical therapist’s job would be to sing and play music for their patients and observe their heartbeats to see if the client is responding to the music, whether it is relaxing them or creating a verbal response such as talking about memories from the past.

The purpose of this research is to understand what music therapy is and its ability to create expression in cognition, social and emotional functioning, where it gives a voice within groups of people in any stages of dementia. Also, how musical therapy is a potential non-pharmacological treatment for the behavioral and psychological symptoms of dementia within a health care setting.

 


What is Music Therapy and How does it help dementia patients?

To begin, the definition of music therapy is “the skillful use of music and musical elements by an accredited music therapist to promote, maintain, and restore mental, physical, emotional, and spiritual health” (Canadian Association for Music Therapy, 1994). Over the centuries, music has been used in a therapeutic manner. While in a health care setting, music is provided for relaxation purposes or to relieve pain in some cases. Back in World War II, musicians were asked to play for the wounded soldiers within the crowded hospitals and played for recreational purposes. The music was known to bring forward emotions within the soldiers and since that time, music has been used therapeutically.  Music therapy has been used to improve the health and wellbeing of patients who are diagnosed with a variety of disorders which include Alzheimer’s disease and dementia as well. This therapy has been seen to evoke positive responses to its listeners. Some positive outcomes include “increased self-esteem and motivation, enhanced socialization and communication, improved expression of emotions, and improved transference of information related to relaxation” (Mays, Clark and Gordon, 2008). Traditionally, music therapy is conducted by a music therapist and is often combined with other types of care. However, some programs do not use a music therapist to implement the activities. This method allows patients to listen to their own music of something they would be able to recognize and enjoy.


Music Therapy for Elderly People with Dementia

In 1906 when dementia was first diagnosed, Alzheimer’s disease was considered a rare disorder. Today, “Alzheimer’s disease is the most common cause of dementia” (Vink, 2013), and it affects more people each day due to the increase in life expectancy. There have been many medical tests on patients diagnosed with dementia, where it reduces the major behavioral issues that are associated with the disease. Due to this, there has not been much research done on the non-pharmaceutical approaches like music therapy. Svansdottir and Snaedal (2006), and Vink (2013), recommend music therapy within geriatric care as it reduces the need of taking medications that are paralyzing to patients. It is also important to look at other methods such as improving the quality of life for those patients and the amount of contact dementia patients have with other patients, support networks and health care staff. According to Vink (2013), “Music therapy is believed to be an effective intervention which can improve the quality of life and can relieve the major behavioral symptoms associated with this disease” (Vink, 2013).

Many musical abilities seem to be preserved in dementia patients while their language and cognitive functions deteriorate over time. Even within the last stages of dementia, patients seem to continuously respond to music and continue to sing those songs from memory, dance the way they used to, and remember past times all while listening to a familiar tune. Finding factual information about this discovery is difficult and many aspects of what effects music has on older persons with dementia are unknown. According to recent day research, what is known is that music therapy benefits elderly people with dementia. Dementia patients “lose their verbal skills first, but both general musical and rhythmic skills remain for a long time” (Brotons and Koger, 2000). In relation to cognition, social and emotional functioning and behavioral disorder, the following overview will describe these studies in the area of music therapy.


Music Therapy and Cognition, Social and Emotional Functioning

A study was conducted where behavior was observed and recorded to determine the effects music therapy had on patients with dementia and their behavioral patterns. The conductors of the research were Gerdner and Swanson (1993), and they discovered that when they compared baseline levels of agitation with agitated levels during music therapy, it was shown that there was a reduction in agitation when music was playing. More so when it was music that patients recognized from their past. These results showed that there was some delay to the intervention and many patients reacted hours after the study took place. They concluded that this was because Alzheimer’s patients have a delay in reaction time and take a substantial amount of time to process the music. How musical memories are stored in our brains have a significant effect on those elderly patients with dementia. With interpreting music and listening to the sounds and lyrics, it involves all cognitive functions of our brain. Both language and music are complex processes that are affected by dementia. Vink (2013) speaks about our two cerebral hemispheres and how each hemisphere “receives sensory information and controls movement on the side of the body opposite its location” (Vink, 2013). Music skills are often preserved where care takers and health professionals note that music seems to stimulate verbal functioning as well.

Dementia causes a progression in language deterioration including comprehension and production. It is unclear if it is direct or indirect due to short term memory. “language may become emptier in persons with dementia because of short-term memory deficits, reflected by an increase in perseverations” (Brotons and Koger, 2000). According to authors Broton and Koger (2000),  and Vink (2013), the type of language that relies on needing a strong cognitive processing are the first to decline and therefore programs that involve prolonging this decline should incorporate music therapy to promote speech interaction and reading of music and lyrics to keep a strong connection towards language skill development.

It is difficult to engage with dementia patients and create a pleasant environment for them, nursing staff and care givers. As dementia progresses, it become difficult to have patients be a part of the social activities or interact with others. Incorporating music within these patients care plans can help bring them out of their shell and engage them within the activities. “Music provides an opportunity for people to engage socially, from which persons who are not able to speak any more can benefit too” (Vink, 2013).  Patients who have lost the ability to speak are often seen as being able to still sing and remember lyrics from that particular song. It is therapeutic to sing a familiar song especially during programs with other patients or with staff during one-on-one therapy sessions. These results conclude that music therapy has a positive effect on the emotional well-being that helps to increase social responses and prevent social isolation with the elderly in all stages of dementia.


Music Therapy and Behavioral and Psychological Problems

“Music therapy increases the level of tolerance to stressful environmental stimuli that may trigger symptoms” (Gallego and Garcia, 2017). Music is seen as a pleasant stimulus where those who are also living with anxiety and depression along with dementia, evokes positive emotions. There is an occurrence of behavioral and psychological issues, and it is a major concern within all stages of dementia. Usually, symptoms of behavioral or psychological distress is treated with pharmaceutical medications including “neuroleptics, sedatives, and antidepressants” (Raglio, Bellelli, Traficante, Gianotti, Chiara, Villani, Trabucchi, 2008), however, there are many side effects. Nonpharmaceutical approaches are known to be more of a useful treatment method such as music therapy for those with moderate to severe dementia. “It is based on the systematic use of musical instruments to improve communication between music therapist and patient” (Raglio, Bellelli, Traficante, Gianotti, Chiara, Villani, Trabucchi, 2008). Music therapy is now seen as a useful method of treatment towards those patients with dementia, mostly with those who are agitated or are aggressive. There are flaws towards music therapy that limits research found to this approach, however there are trials that are used to evaluate the effectiveness of music therapy among subjects with moderate to severe dementia.

One of many behavioral issues with dementia patients is wandering behavior. Patients are seen pacing in nursing home within the hallways. Within these care facilities, doors need to be locked and supervision is on a 24-hour loop. Wandering patients are more prone to falling and injuring themselves, especially when they gain access to areas that they are not familiar with. This behavior is only a small section of the many behavioral problems associated with dementia. Music therapy has been used for this behavioral issue where during therapy sessions, patients were remaining in their seats and did not move while the music was being played. Several studies were conducted on this theory where the wandering behavior decreased due to music intervention and therapeutic programming.


Conclusion

Music therapy affects identities, behavior, communication, social interaction, emotions and psychological functioning. There is no doubt that health practices are rooted in everyday activities and the non-pharmacological practices are based around arts and culture. The evidence presented shows that music is important in human development and influencing individual’s health conditions. Therefore, when it comes to patients with dementia, incorporating non-pharmacological methods should be considered as a universal resource to promote the health and well-being of others. Music therapy can be incorporated within a wide variety of client populations and developed through many mechanisms. It can be a unique implementation to each individual’s preference and acts as a stimulus towards feelings and emotions causing mental and emotional responses towards the body and mind. However, it is recognized than their needs to be more research conducted on the effects and benefits of music therapy with specific conditions. The research presented shows a glimpse of the effect’s music therapy has, however it is not something that is set to cure the disease fully, only prolonging the symptoms. The implementation of music programs is not used in many care facilities due to the lack of evidence-based research.  Music therapy has the ability to create expression in cognition, social, and emotional functioning where it gives purpose to dementia patients in any stages of the disease and provides evidence in promoting positive mental health, even if it is for a short period of time. Within those moments, the disease does not defy the individual and somewhere deep down, they are still who they used to be.


References