Alzheimer's

Disease
Katie VanderVelde
Ferris State University
NURS 441
Introduction

Purpose Statement: Practice collaborative
leadership to advocate for quality nursing
practice using evidence based practice.
Alzheimers 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.

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.

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.
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.
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.

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.

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.

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.
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 patients 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.
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.

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.
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,
CNAs and other staff involved in the patients
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.


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.
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.
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.
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: Whats
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.