I will present the scholarly product in the form of an oral project summary and evaluation report. The report will be supplemented by a postcard that depicts the stages of development and implementation of the program using the logic model (see Appendix D) as a guideline for the postcard. A copy of the RAID scale (Appendix E) and the CMAI-short form scale (see Appendix F) will also be provided as references for the assessment tools I used. The target audiences for dissemination of the product include foundations, organizations, and stakeholders of dementia residential care facilities. These audiences may also include stakeholders associated with dementia and geriatric scholarly journals and publications, ideally in an open conference setting.
Analysis of Self
The process involved in developing and implementing this program has enlightened me to the multifaceted obligations of an advanced-practice nursing scholar. As a primary practitioner in academia, I gained insight into the clinical and non-clinical roles that contribute to the ongoing daily clinical management of dementia residents. I gained a renewed appreciation for the balance that is required to negotiate pharmacological as well as non-pharmacological approaches to the management of the complex process of dementia. This project has fostered my professional growth by helping me realize the AACN Essential II: Organizational and Systems Leadership for Quality Improvement and Systems Thinking. (AACN, 2012). This essential states that DNP graduates must be proficient in quality improvement strategies and in creating and sustaining changes at the organizational and policy levels.
As a scholar, I have developed my ability to research current scholarly literature that is relevant to the subject matter of dementia, and improve on my scholarly writing practices in order to communicate in a clear and concise manner beneficial to the target audience. As a project manager, I learned the importance of creating a strategic plan that was clearly outlined in a step-by-step approach and using a scholarly model that would fit the project implementation based on the proposed goal of the project. Throughout the journey of planning and implementing this capstone project, I have developed into a scholar practitioner with the ability I displayed in conceptualizing a music intervention project for dementia residents in a long-term care setting. My ability to review the relevant and current literature using an evidenced-based approach and to choose a suitable model and theory as a framework for the program has marked my growth through this process. The positive response from the facility staff and the improved behavioral outcomes of the participants have further motivated my long-term professional goal of sharing the outcomes of this project to a wider audience through publishing, and facilitating replication of the program in similar dementia residential communities.
The journey towards completion of the project included some challenges that were intrinsic to the implementation of the music therapy sessions. The staff of the dementia unit played a pivotal role in ensuring that the participants were present in the dining room for the sessions, some of whom were resistant to leaving their rooms, even for meals. On two occasions when this occurred, the solution was to delay the start time of the music listening session. It was important not to coerce or force the participants into the dining room in order to prevent or provoke an exaggerated
response that could be manifested in exaggerated anxiety or agitation. This experience validated the importance of the DNP-prepared scholar to be able to evaluate delivery of care approaches based on a specific patient population to effect social change and produce a better quality of life.
Summary
Dementia is a cognitive degenerative process that results in changes in personality and behaviors that include agitation and anxiety. My goal in this project was to implement and evaluate a group music intervention program to assess a potential decrease in anxiety and agitated behaviors in the participant group of residents in a long-term residential care setting. The project entailed planning,
developing, implementing and evaluating the music therapy program. I used the RAID scale to evaluate anxiety and the CMAI short form to assess agitation. Music
intervention has been shown to decrease the occurrences of anxiety and agitation in individuals with dementia residing in long-term care settings.
A successful quality improvement program provides a framework for
evaluating outcomes in practice. I implemented this program to determine the efficacy of music therapy for reducing anxiety and agitation in residents with dementia in a residential long-term setting. The success of the program was not only realized in the objective assessment of the responses from the assessment tools, but also was
supported by the positive feedback from the stakeholders of the facility. The results of this program evaluation are beneficial to family members and caregivers of individuals with dementia. Foundations and organizations with a vested interest in the care and improvement of quality of life for the dementia-afflicted are the audiences that would
be appropriate for dissemination of the results of this project. The adaptation and implementation of evidenced-based practices and a theoretical framework of reference was paramount in achieving the results and positive outcomes of this project. The results of this program have contributed to the body of knowledge and provided a framework for reducing anxiety and agitation in residents with dementia who live in long-term care settings.
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Appendix B: Informed Consent CONSENT FORM
All caregivers at this facility are invited to take part in data collection to help evaluate a music therapy program for the dementia residents in long term care.
This form is part of a process called “informed consent” to allow you to understand this study before deciding whether to take part.
Sonia Brown, RN, is a researcher who is inviting caregivers on the dementia unit to volunteer to participate in the data collection for this program evaluation project. You may already know her from her role as a practicum student from Walden University but this is separate from that role.
Background Information:
The purpose of this program is to determine if there is a change in behaviors of anxiety and agitation in dementia residents in long term care when music therapy is
implemented. Procedures:
If you agree to participate in this study, you will be asked to:
• During a four-week time period, observe residents who have dementia and are receiving music therapy. Observations will occur twice weekly during the 30 minutes music listening sessions conducted by the facility during lunchtime in the dining area.
• Provide responses to questions based on observation of resident behaviors for a baseline observation data and following the second session every 2 weeks during paid time (initial baseline and once every 2 weeks equaling a total of 3 times).
Voluntary Nature of the Study:
This study is voluntary. Everyone will respect your decision of whether or not you choose to participate in the study. If you decide to join the study now, you can still change your mind later. You may stop at any time.
Being in this type of study involves some risk of the minor discomforts that can be encountered in daily life, such as fatigue, stress or becoming upset. Participating in this study would not pose risk to your safety or wellbeing.
Financial responsibility /Compensation: None. Privacy:
Any information you provide will be kept confidential. Your name or anything else that could identify you or residents will also be kept confidential. Data will be kept secure by Sonia Brown, RN. The information will be collected initially on paper and then transferred and stored electronically on a portable disc and locked in a personal safe for at least five years.
Contacts and Questions:
You may ask any questions you have now. Or if you have questions later, you may contact Sonia Brown via phone (561) xxx-xxxx. You will receive a copy of this consent form to keep for your records.
Statement of Consent:
I have read the above information and I feel I understand the study well enough to make a decision about my involvement. By signing below, I understand that I am agreeing to the terms described above.
Facility Participant Name __________________________ Facility Participant Signature __________________________ Researcher Signature __________________________ Date of Consent __________________________
Appendix D: Logic Model
Situation: Dementia is associated with behavioral disturbances including anxiety and agitation that pose a challenge for family members or caregivers in an alternate home or care-related facility
INPUTS OUTPUTS OUTCOMES
Activities Participants Short Term Medium Term Long Term
-Administrator time -Restorative therapy director -Dementia unit staff time -Assistant DON -Nurses -CNA’s -Music selection of familiar genre -Develop and implement group music intervention program that includes: -Educate staff participants on RAID and CMAI (short form) tools -Collect baseline data using RAID and CMAI (short form) -Group music listening twice weekly for 30 minutes over a one month period -Collect data every 2 weeks -Dementia unit resident subjects -Direct caregivers of the selected residents -Decrease in anxiety and agitation behaviors in the selected residents Implementation of music therapy as non- pharmacological intervention to reduce anxiety and agitation in dementia residents in long term care Replication of music therapy program in settings locally, (South Florida) Nationally and globally to reduce anxiety and agitation in dementia residents in long term care.
Fig. 1: LOGIC MODEL: Music Intervention Program Implementation and Evaluation for anxious and agitated dementia residents in long term residential setting
Appendix E: RAID Scale
Rating for Anxiety in Dementia (RAID) (Shankar et al 1999)
Patient's Name: Date Of Birth: Male/Female: Rater's Name: Occupation: Date:
Patient's Status at Evaluation:
1. Inpatient 2. Outpatient 3. Day hospital/day center patient 4. Other (specify) ...
Scoring System:
U=unable to evaluate, 0=absent 1= mild or intermittent 2=moderate 3=severe