The present paper discusses a study which intends to improve the awareness of the Behavioral and Psychological Symptoms of Dementia (BPSD) in nurses and correctional officers working at a correctional institution. Modern research indicates that medical and other personnel tends to demonstrate an insufficient understanding of BPSD and its management (Spector, Orrell, & Goyder, 2013), which is particularly significant for correctional institutions since their patients are especially vulnerable (Feczko, 2014).
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Thus, the paper considers a safety and quality improvement practice change, which will involve the testing of a training program for the correctional institution staff (nurses and officers). The paper includes the presentation of the research question, its discussion from the perspective of chosen theoretical underpinnings, and a short review of the most significant piece of literature that frames the research.
Project Topic and Question Formats
BPSD refers to a complex of symptoms that tend to be difficult to diagnose and manage (Spector et al., 2013). Through personal experience, I realized that BPSD is often miscomprehended, especially by correctional officers who lack appropriate background knowledge. While the officers’ issue attracted my attention to the problem, additional research and investigation showed that nurses, including myself, also struggle with BPSD management.
The issue is further worsened by the fact that I know from observation and experience that BPSD has a very significant impact on the quality of life of patients and their relatives and caregivers. Thus, I came to view the lack of empirical knowledge on BSPD in nurses and correctional officers as a problem. The etiology of the issue seems to be complex: BPSD is difficult to diagnose and manage, but I can also personally report the lack of training in the area, and Spector et al. (2013) and Feczko (2014) support this view.
The etiology of the problem is important to understand since it demonstrates the ways for its resolution, and the proposed study is going to employ one of them. Therefore, the PICOT question can be formulated as follows: in nurses and officers working at the correctional institution in question, how does a BPSD training program affect the understanding and actionable knowledge on BPSD management as compared to those exhibited before the intervention?
Reflection on Nursing Science Underpinnings for Practice Change
The present paper considers the fundamental metaparadigms of nursing, Carper’s (1978) ways of knowing and Neuman’s (1996) systems model to discuss both the proposed research and the clinical issues related to it. The work intends to disclose and situate the key premises of the proposed study and demonstrate the interrelation of the mentioned theoretical underpinnings.
The four metaparadigms of nursing can be interpreted in a variety of ways (Dahnke & Dreher, 2015), but for the proposed research, the following definitions can be offered. The human being is a central metaparadigm for nursing that can be interpreted to include the patient, their relatives, and caregivers, which is true for BPSD management (Spector et al., 2013). The health is the continually changing state of the patient, which can be negatively and positively affected by diseases and nursing interventions. The approach to health that is proposed in the project is holistic, which is necessary in the case of BPSD.
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The environment metaparadigm refers to any elements of the surrounding environment that appear significant from the perspectives of health, person, or nursing. Nursing is the process through which the nurse maintains and improves the health of the patient by employing, modifying, and otherwise interacting with the environment through the use of pertinent knowledge. The latter aspect is particularly important for the proposed research, and it can be analyzed from the perspective of the Carper’s (1978) patterns of knowing.
Ways of Knowing
Carper’s (1978) patterns include the empirical, esthetical, personal, and ethical ways of knowing, and while all of them can be related to the practice change idea, the empirical one seems to be of particular importance. The empirical way of knowing refers to the evidence-based knowledge, which the proposed project is going to promote because it is apparently insufficient.
For example, correctional officers have been reported to use personal knowing with respect to BPSD patients (classifying BPSD behaviors as hostility) with negative outcomes for the latter because of the lack of empirical knowledge. While Carper (1978) views personal knowing from a positive perspective, in the provided example, the lack of empirical knowing results in detrimental personal knowing, which is why the proposed project is of exceptional importance. It is noteworthy that Neuman’s (1996) model also views research as an exceptionally important part and basis of the nursing profession.
Neuman’s (1996) model is one of the system models of nursing that can be described from the perspective of the four metaparadigms. Some of the major principles of the model include viewing the person (the patient) as a complex system that interacts with the environment, which contains stressors (Graham, Lindo, Bryan, & Weaver, 2016). The system includes defenses, which are meant to prevent the stressors from dis-balancing the system; the case of disbalance is viewed as ill health, and the function of nursing is to restore the balance. It is also important to note that nursing is viewed as a preventive measure, and it is supposed to include the primary, secondary, and tertiary prevention (Whetsell, Gonzalez, & Moreno-Fergusson, 2015).
Neuman’s (1996) model applies to BPSD. Indeed, Neuman’s (1996) model can be viewed as a very patient-centered approach that pays close attention to the environment; as a result, it can be a useful diagnostic and assessment tool as well as a technique for the development of nursing plans. Given the specifics of BPSD (Spector, Orrell, & Goyder, 2013), the model’s terminology can be viewed as applicable in the literal sense. For example, while my practice has never involved the direct use of the model, the work with BPSD patients is usually concerned with restoring their balance after a reaction to a real or imagined stressor and the prevention of future stress.
Moreover, Neuman (1996) highlights the fact that her system is evidence-based and can be used to gain evidence. In general, Neuman (1996) promotes the nursing research and suggests that her theory can be employed to determine the various elements of studies. The proposed study can employ Neuman’s (1996) model predominantly as an appropriate approach to BPSD management, but it can also back up its premises of the importance of empirical knowledge with the help of some of the rules promoted by Neuman (1996).
Development and Discussion
Before the introduction of the theoretical underpinnings, the proposed research lacked any similar basis. The review of the four metaparadigms helps to consider the central concepts of the study, especially nursing, which can be viewed as the object of the research. The analysis of the ways of knowing shows the significance of the proposed research, indicating that the current ways of knowing that are employed by the participants can be lacking.
Moreover, the ways of knowing analysis demonstrates that the aim of the study consists of providing the staff of the institution with a new way of knowing, which should enable and empower them to perform their duties better, thus improving the quality of the service. As for the Neuman’s model, it was chosen to discuss the issue of BPSD management and offer a way to conceptualize it.
The article that has played a particularly important role in the development of the problem is that by Spector et al. (2013). It is a systematic literature review on BPSD management training, which highlights the significance of my research and proves some of its premises. The study demonstrates that there is a need for the appropriate training of the staff that is involved in caring for BPSD patients and indicates that there is a lack of appropriately tested training programs (even though the programs themselves are being developed).
Moreover, it indicates that the training programs can be effective in improving the staff’s understanding and attitudes towards BPSD. Finally, the study states that it finds no correlation between the theoretical models employed by the programs and their effectiveness. Therefore, the article both confirms and advances my understanding of the issue and prepares me for the search for appropriate training programs for the proposed study.
The present paper reviews the theoretical underpinnings that can be applied to the proposed research and its clinical problem. The theoretical approaches that are discussed above improve my understanding of the issue and the proposed research. Indeed, the analysis of the way of knowing shows the objective of the study while the Neuman’s model helps to determine the four metaparadigms as they are likely to be interpreted by the proposed study.
Apart from that, the use of the model for BPSD management is shown to be appropriate, and the present literature review suggests that various theoretical models can be used to establish a training program. Thus, the discussion of the research from the perspective of the mentioned theories improves my understanding of its aims and methods.
Carper, B. A. (1978). Fundamental patterns of knowing in nursing. Advances in nursing science, 1(1), 13-24.
Dahnke, M., & Dreher, H. (2015). Philosophy of science for nursing practice. New York, NY: Springer Publishing Company.
Feczko, A. (2014). Dementia in the incarcerated elderly adult: Innovative solutions to promote quality care. Journal of the American Association of Nurse Practitioners, 26(12), 640-648. Web.
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Graham, M. M., Lindo, J., Bryan, V. D., & Weaver, S. (2016). Factors associated with stress among second year student nurses during clinical training in Jamaica. Journal of Professional Nursing, 32(5), 383-391.
Neuman, B. (1996). The Neuman Systems Model in research and practice. Nursing Science Quarterly, 9(2), 67-70. Web.
Spector, A., Orrell, M., & Goyder, J. (2013). A systematic review of staff training interventions to reduce the behavioural and psychological symptoms of dementia. Ageing Research Reviews, 12(1), 354-364. Web.
Whetsell, M., Gonzalez, Y., & Moreno-Fergusson, M. (2015). Models and theories focused on a systems approach. In J. Butts & K. Rich (Eds.), Philosophies and theories for advanced nursing practice (pp. 455-484). Burlington, MA: Jones & Bartlett Learning.