Importance Of Evidence-Based Practice In Nursing Research On Mild To Moderate Dementia During Pandemic

Introduction to evidence-based practice and nursing research in the nursing profession

Evidence-based practice or nursing research is important in the nursing profession because it helps nurses keep current, advance in their specialty, and give space for improved patient care (Abu-Baker et al., 2021). The research’s findings help nurses improve their practical skills while also assisting them in efficiently developing their competences. Nurses can use EBP to evaluate research in order to learn more about the risks and efficacy of diagnostic tests and treatments (Ackley et al., 2019). According to the usage of evidence-based practice, nurses may now include patients in their care plans (Abu-Baker et al., 2021). In this study, an exploratory pilot study will be done based on the topic of dementia which occurred among the healthy population as well as because of a long-time exposure to pandemic as well as restriction like lockdown. Dementia is a general term for a loss of ability to remember, think, or make decisions that interferes with daily activities (Duong, Patel & Chang, 2017). In the situation of COVID-19, regular life was put on hold, and people were either quarantined to their homes to avoid infection or were admitted to hospitals if they were infected. In all cases, the people’s mental health was significantly impacted, which will be the study’s main focus (Xiong et al., 2020). The research will be done on the basis of formulated a research question, which is “How mild to moderate dementia developed among patients during pandemic in hospital setting compared to home-based setting?”

It is critical for nursing researchers to design a specific search strategy based on the research question or research topic by creating suitable key keywords or search words and an appropriate strategy to search evidences by entering those words into databases. If the researchers create search phrases or related phrases, they will be able to find the necessary evidence to support the research topic. In this pilot study to search the evidences the key phrases that would be entered into databases will be “Mild dementia”, “Moderate Dementia”, “Pandemic”, “COVID-19”, “Home-based settings” and “Hospital settings”. The Boolean operator will be employed in the following phase of the search word generation to successfully use the search terms in the search engine of the databases chosen. Furthermore, the Boolean operator aids investigators in finding specific study publications so that evidence-based practice can be implemented efficiently. The Boolean operators which could be used to search the results effectively in the databases are ‘AND’, ‘IN’, “AMONG” and ‘OR’. There are various databases that usually used by the researchers and in this EBP study the databases chosen are NCBI, Cochrane Database, PubMed, CINAHL, BMJ nursing as well as Psych Info. After analyzing the database, the papers were selected from Napier Library so that the research papers could be conveniently accessed. There were certain criteria for inclusion of the research articles in this pilot study. Those were: the research articles must be published in English and must be published within the period of 2016- 2021 and focused on dementia patients. The articles which were published before 2016 and in other languages than English were excluded.  The articles that matched the inclusion criteria were selected to review for this study. The search terms were entered into the library’s search box, which yielded approximately 8,600 results. The inclusion criteria were created, which pointed out that only papers published in 2015 were considered, and that resulting in a total of 6,550 publications. All of the evidences were thoroughly examined and determined to be appropriate for the keywords. A total of 60 papers were reviewed to see if they were appropriate for this research. Six of the twenty papers chosen from the library were used in this literature evaluation. Using the PRISMA format, the selection of research and review has been demonstrated: 

Connection between dementia and pandemic, and COVID-19 impact on mental health

In this exploratory pilot study, the research will be done by creating a specific research question. In other words, developing a research question and research objective will guide the collection of data as well as process of data analysis is significant to the success of the pilot study (Malmqvist et al., 2019). The present research question was created as a part of comparative study. In this study, the research question is “How mild to moderate dementia developed among patients during pandemic in hospital setting compared to home-based setting?”

To conduct the pilot study, the researchers must rely on the research question that has been formulated and follow a precise plan in order to acquire the desired results. Researchers can do research using a qualitative study design, a quantitative study approach, or a blended technique to get the suitable response (Ferguson & Brophy, 2017). The ideal or optimal research approach for this subject would be a qualitative study, given the data needed to advance is based on recent mental health experiences of patients or nurses. A considerable information and theme about the measured factors are obtained by conducting a qualitative study, which aids in understanding the effect of the chosen intervention on participants (In, 2017). In this case, a qualitative research approach will provide an in-depth idea of mental health perception, dementia and lived experience of individuals in both home-based-settings and hospital settings. The qualitative research will include interview to collect the qualitative information about the experience of participants in the pandemic.

This qualitative research approach will be based on COVID isolation ward a hospital in where the responses of the nurses appointed in the care of patients. Another response would be collected from the patients who were isolated at home to measure the dementia level in home-based settings. The gender choice could be both male and female. The parameters will be level of anxiousness and dementia, mental health problems, and quality of life.

In a pilot study, the technique through which all respondents must be recruited in order to attain the intended conclusion is referred to as participant selection (Jesmani et al.,2020). The major goal of this pilot project is to include volunteers who have recently encountered mental health difficulties such as dementia as a result of isolation, lockdown, or hospitalisation during a pandemic. The individuals’ replies were collected from both home and hospital settings. According to Davies and Fisher (2018), quantitative researchers had to focus on systematic sample selection when it came to selecting populations that accurately represented the community. The probabilistic sampling method ensures that everyone has an equal opportunity to participate in the study. Moreover, in qualitative research methods inclusion of random sampling method largely eliminates the selection bias and assist researchers to aim on smaller population (Taherdoost, 2016). 

To get the best results from the study, the researchers must follow a few criteria while introducing random sampling into the sample. The development of inclusion criteria is critical in a pilot study because it is critical for researchers to not only define the appropriate criteria for inclusion and exclusion, but also to realize how the evidence will affect the validity of the results both internally and externally (Garg, 2016). The patient who encountered mental health concerns, notably dementia, during lockdown, whether in a hospital or at home, would be the inclusion criteria for the participants in this study. Furthermore, the language was a part of the inclusion criteria. Only patients who speak English are included in the study because the survey questions are written in English. Patients who did not speak English were not allowed to participate. Participants might be anywhere between the ages of 18 and 70 years.

Search strategies employed and databases used to locate research publications on dementia in English language from 2016-2021

Identifying, analyzing, and understanding patterns and themes in textual information, as well as evaluating how these patterns and themes serve in addressing the research questions at hand, are all part of qualitative data analysis (Ngulube, 2015). As more information becomes available, the study is expected to change and adapt. This method can also be used with the help of in-depth interviews that have been produced (Busetto, Wick & Gumbinger, 2020). The qualitative research method can be used in this study by selecting a research group and creating interview questions that will be asked of the participants, with the data collected and recorded for future research.

There are a variety of methods for obtaining data from research participants when conducting a qualitative research study. Data collection processes include probability sampling, online or off-line interviews, and document analysis (Kabir, 2016). The optimum strategy for this pilot study would be an in-depth interview. Reading the participant’s expression, mental health experience, causes of mental health problems, and body language would be extremely beneficial to the researchers (Farooq & De Villiers, 2017). Furthermore, utilizing software tools used in qualitative research methods, the data from the participants was recorded for the purposes of data analysis.

The data analysis is the most important phase in a study after collecting information from respondents. It has been observed that qualitative research data is frequently rich, subjective, and may contain in-depth information that is commonly offered in the form of words (Ravindran, 2019). According to Bengtsson (2016), the method of evaluating qualitative data entails searching a large number of recordings for commonalities and differences, then identifying themes and creating categories. Data analysis is the method of meticulously searching and organizing interview transcripts, participant observations, and other non-textual resources obtained by the researcher in order to better understand the phenomenon in qualitative studies (Ravindran, 2019).

For a qualitative study, the first data analysis approach would be used. The data collected from the participants can be analyzed using thematic analysis (Nowell et al., 2017). Thematic analysis, according to Nowell et al., (2017), is a sort of qualitative methodology that comprises reading over a set of data (such as transcripts from in-depth interviews) and looking for patterns in interpretation. Various themes such as mental health issues kind, duration of mental health issue (dementia), actual reason for dementia development, and other associated information were investigated in this pilot study by using thematic analysis.

The NVivo 12 software, that can be used to analyse interview findings, is the next method of data analysis (Woods et al., 2016). NVivo 12 is a sort of software programme that is frequently used in qualitative and mixed-method research. This computer-assisted qualitative data analysis software, also known as CAQDAS, was developed by QSR International (Zamawe, 2019). Interviews, focus group discussions, questionnaires, social media, and journal articles, among other things, are frequently used to evaluate unstructured text, video, audio, and image data (Zamawe, 2019). The use of NVivo in this study would be acceptable since it would aid the researchers in organizing, analyzing, and finding insights from unstructured or qualitative data.

The most essential phenomenon when performing qualitative, quantitative, or mixed research methods is to maintain research ethics or clinical ethics, such as not compromising autonomy, justice, beneficence, non-maleficence, and privacy (Fleming & Zegwaard, 2018). Maintaining autonomy and confidentiality are the most crucial ethical considerations. The researchers must prioritize the participants’ opinions, respect their willingness, and provide them with the option to withdraw from the study at any time. Furthermore, the researchers must seek informed consent from the respondents before include them in the study. A trust agreement between the researcher and the participants could be seen as informed permission (Kadam, 2017). The researchers must also make sure that all of the participants are at ease, since this will help them acquire the respect of the participants. Furthermore, it is critical for researchers to mention any potential health risks associated with their research. If health risks associated with engaging in research are not stated, it will be considered a breach of integrity, honesty, and deception. As a result, after explaining the study’s health hazards, notably the sharing of personal information, participants will agree to take part. To maintain privacy, the data will be saved using security and a password in the system (Petrova, Dewing & Camilleri, 2016). Another crucial aspect of research ethics is ensuring the secrecy of the patient’s data, as violating privacy could severely harm the researchers’ reputation.

It is expected to entail communicating and conversing with a broader policy and health provider audience, while taking into account the intended audience and the setting in which the research findings are implemented, and, if necessary, in a way that allows study participants to participate (Hoddinott et al., 2017). Effectively disseminating research findings, on the other hand, needs careful planning, appraisal, targeting, and communication with target audiences (Rickinson, 2017). The gap between writing down study findings and paying close attention to someone else is significant. When disseminating a study finding, it is crucial to figure out or measure how the target audience can be reached, depending on who the researcher intends to reach. The audience’s conventions should be taken into consideration when selecting strategies. Scientific journals, for example, offer author-submitted criteria that clearly describe the prerequisites for anyone wishing to publish their work in this journal. To spread the findings, it is critical to incorporate some data points from crucial discoveries (Skolarus et al., 2017). The relationships between numbers are critical when illustrating trends and comparisons.

While disseminating the findings of the evidence of a pilot study, the researchers might experience certain barriers that would hinder the dissemination and implementation process. Agreeing with the research conducted by Magdalinou et al. (2019), it can be added that the growing volume of various evidences, less accessibility of the new evidences, the practical competencies to appraise the evidence quality, time to find as well as read evidence, and the ability to apply the evidence are few major dissemination barriers (Koorts et al., 2020). Other barriers include lack of education and knowledge about the research as well as audience, less skill among the practitioner. Timeline of the research as well as the perceived cost also act as barriers of the dissemination of the research.

Integrating several of the necessary activities to disseminate the findings include early dissemination as well as application within academic training, as well as a system-wide realignment of educational performance and financing systems to promote and enable D&I research (Koorts et al., 2020). Knowledge of the researchers about finding the relevant audience of the research, enhancing the accessibility of the research, improving the knowledge about the depth of the research topic and ability of the researchers to apply the evidence could be other factors that would help to disseminate the evidence successfully (Derman & Jaeger, 2018).  

Conclusion

The focus of this study was on dementia and psychological impairment that developed during the COVID-19 epidemic and as a result of social isolation. Dementia is a wide word for a loss of capacity to remember, think, or make judgments that interferes with daily activities. Regular life was put on hold in the case of COVID-19, with people being confined to their homes to avoid infection or admitted to hospitals if they were sick. The evidence-based practice was carried out in response to a well-defined research question. To find evidence, a well-defined search strategy was created using the PRISMA format and the inclusion criteria, after which the literature was searched. According to the research review, dementia development is caused by more than just psychological issues. People have also reported slight cognitive impairment as a result of the lockdown in a pandemic event. When compared to before the pandemic, many of the included studies’ respondents said that the epidemic increased their overall anxiety levels, as well as their feelings of loneliness and isolation. Later in the project, a pilot study was established to assess the effectiveness of the chosen intervention, and qualitative research analysis utilizing an in-depth interview, thematic analysis, and the NVivo software was recommended as part of the research process. To disseminate the research findings, only a few key points from the primary findings should be used. Because the most significant parts are in the interactions between data and visuals, it is critical to use when displaying trends or drawing analogies. Another fact to consider is that researchers must prioritize the participants’ opinions, respect their willingness, and provide them with the rights of withdrawing from the study. As a conclusive statement, it can be added that the health professionals must take this problem with high priority and work on to reduce the mental health issues among patients admitted in hospital or people residing at home by using various innovative activities. 

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