Nursing Literature Review

Nursing Evidence Appraisal: A Systematic Review Essay
Abstract
This paper outlines the aspects of appraisal of nursing evidence. The paper uses a systematic review to outline these aspects. To effectively address the systematic review, the review has been structured into introduction, objective, research criteria and evaluation, methods of data collection, and the discussion of the findings. The main aim of this systematic review is to determine whether restraints are suitable for use on aggressive patients with dementia who are admitted to nursing homes. The systematic review on dementia and the restraints to be used will be addressed in PICO format, which will assist in determining the suitability of restraints in such situations.

Introduction
PICO components are useful in almost every clinical situation. PICO makes the practices that “involve evidence-based medicine” more efficient. The process of evidence-based medicine together with PICO involves a simple criterion. This paper describes the main components of PICO for a possible clinical condition of dementia and the best remedy for aggressive patients with dementia.

PICO
For patients with dementia in nursing homes at increased risk for falls; will restraints decrease falls as opposed to nonrestraints?

Discussion of Systematic Review for the PICO Components
Objective
The main objective of this systematic review was to collect and evaluate the information that relates to dementia and restraints by reviewing several kinds of literature.

Criteria and Search Strategy
The materials used for the review were academic journals obtained from various libraries. Even though many journals outlined the concepts of dementia and restraints, only those that were published between 2008 and 2012 were picked for the review. The journals were taken from American databases, especially the ones that specifically deal with nursing. The databases included MEDLINE, Cochrane Library, and Pubmed. After the search, the article “Placing physical restraints on older people with dementia” by Yamamoto and Aso was selected and used for the review.

Data Collection and Evaluation
The data that were used for the systematic review were exclusively obtained from the journal article. The information used in this review was scrutinized by an evaluation tool called Joanna Briggs Institute Qualitative Assessment and Review Instrument to ensure that it was valid and reliable. By using the tool and prior knowledge on the topic, the information obtained, which concerned dementia and restraints, was categorized by quality and reliability. The categories were used to construct the meta-synthesis for the review.

Synthesis of the Findings
Meta-Synthesis I: Patients with Dementia in Nursing Homes
Dementia is a condition that is caused by multiple changes in brain chemistry. Some of the changes are reversible while others are permanent. The most common symptoms of dementia include: neglecting personal safety, nutrition, and hygiene; feeling confused about time and people, and sometimes becoming lost about well-known places among others. The patients suffering from dementia lose their “psychological abilities” at different rates, which depend on the conditions in which they live.

Yamamoto and Aso (2009) in their journal article have conducted a study on patients suffering from dementia in Norwegian Nursing Homes. The study was conducted with a 12-month follow-up to ascertain the validity and reliability of the data. The main objective of the study was to investigate the natural course of neuropsychiatric symptoms in patients with dementia.

The data in this study was collected through structured interviews, which were followed by a 12-month follow-up. The patients who participated in the interview were drawn from 26 nursing homes. The information included in the review met the following criteria: it suggested the presence of neuropsychiatric symptoms and had follow-up frequencies (Yamamoto & Aso, 2009).

The study conducted by Yamamoto and Aso (2009) was effective and the data collected was valid and reliable about the objectives of the study. Out of the 1,163 participants, more than half had dementia. The study also found out that approximately 83% of the patients with dementia had neuropsychiatric symptoms. There was a persistent use of antipsychotics, psychotropic drugs, and antidepressants among patients with dementia (Yamamoto & Aso, 2009).

Meta-Synthesis II: Restraints
Although several people oppose the use of restraints on people suffering from dementia, the benefits of using them surpass the shortcomings. However, the decision to use restraints should be made by both the medical practitioners of the nursing home and the family members of the patient. There is a well-formulated policy that guides medical practices regarding the use of restraints. Restraints, as described by Yamamoto and Aso (2009) refer to the “physical materials” that are used to bar patients with dementia from movements that may hurt them or people around them (p. 193).

The main objective of the study that was conducted by Yamamoto and Aso (2009) was to investigate the coping nursing strategies used in general wards and the dilemma that the nurses face in restraining patients with dementia. The restraints are recommended in cases where the patients are perceived to be combative, aggressive and in cases where they are so confused that they can cause injury to themselves or the nursing staff. The patient’s family members who take their patients to nursing homes where they use restraints should consider the above points.

Yamamoto and Aso (2009) collected the required data directly from nurses working in general wards. There were about 272 participants in total from the general wards, where patients with dementia were taken care of. The authors used a questionnaire comprising 16 items to measure coping strategies. Any score between 1-4 points in the questionnaire would be considered as a better coping strategy. The factors that were difficult to interpret from the questionnaire were deleted to avoid obtaining unreliable information.

The contents included in the literature review were consistent and effective as they assisted to clear out the “misconceptions” that people normally have regarding the use of restraints. For instance, the results showed that restraints alone cannot keep patients safe and they are the only effective way of handling aggressive patients with dementia. The results also showed that excessive restraints can cause complications such as constipation, depression, and bone loss among others.

Meta-Synthesis III: Non Restraints
The restraining devices and techniques were used to restrict and restrain patients with dementia from movements that might lead to injuries. Therefore, the devices were meant to keep the patients from accidental injuries that were mostly caused by self-harm. The devices to an extent were used to keep the nursing staff from accidents that they could experience as a result of the aggressive patients. However, current studies such as the one conducted by Yamamoto and Aso (2009) prove that the patients are exposed to more dangers than benefits when they are restrained.

Yamamoto & Aso (2009) suggest that older people who suffer from dementia are at a higher risk of being restrained as compared to their younger counterparts. The study conducted the study proves that older patients with dementia face several psychological and physical problems when put on restraints. The study suggests that older patients should be put on non-restraining devices to avoid such problems. The method used to collect data for this study was purely a qualitative one. The data in the study was collected from other literature (Yamamoto & Aso, 2009).

Meta-Synthesis IV: Prevent Falls
Old people are generally susceptible to falls, which are worsened by psychological conditions such as dementia. Medical conditions such as cardiovascular and vision impairment may also contribute to the falls. The nurses who take care of patients with dementia find it difficult to prevent the old patients from falling. The restraints are used in cases where the patients fail to recognize the environmental hazards they are exposed to or forget to use their walking frames (Yamamoto & Aso, 2009).

The study conducted by Yamamoto and Aso (2009) suggested that falls are a common occurrence in old people with dementia and are known to cause disability and discomfort not only to them but also to the nursing staff. The authors collected the data for this study from an older man who was suffering from dementia and had experienced numerous falls, which gave rise to a hip fracture.

Yamamoto and Aso (2009) explain that many cases of falls can be prevented through restraints and other techniques. The techniques that can be used to prevent falls include putting bright lights in the rooms of the patients and ensuring that there are no “trip hazards” in the rooms. The nurses should also ensure old patients with dementia are reminded to walk with their walking frames whenever they feel like doing so.

Applying the Results to PICO Question in Clinical Situation
The clinical situation in the case study is beyond non-restraint mechanisms. The patient is so aggressive that he causes injuries to his own body owing to his funny behavior. The use of non-restraints in the patient’s case is even likely to expose the nursing staff to danger and as a result, other measures should be put in place to prevent the staff from such a risk (Yamamoto & Aso, 2009).

The behaviors observed in the 65-year-old patient warrants the use of restraints. The family of the patient should allow the nurses at the nursing home to keep the patient restrained. If the patient is restrained, he will be prevented from causing more injuries to himself, the staff members, and even the family. The benefits that the nursing home and the patient are likely to enjoy when he or she is restrained are superior to the shortcomings of the strategy (Yamamoto & Aso, 2009).

Conclusion
The clinical situation was about an observation made on a 65 year who had a wheelchair. The patient was suffering from dementia, a condition that seemed to have been worsened by agitation and restlessness of the patient. Her condition is in a very serious stage and therefore, requires the use of restraints. Non-restraints, in this case, are not adequate and cannot be relied upon in handling the patient. The information regarding the patients with dementia and the use of restraints to assist them was extracted from literature through a systematic review.

Reference
Yamamoto, M., & Aso, Y. (2009). Placing physical restraints on older people with dementia. Nursing Ethics, 16(2), 192-202.