Healthcare Assignment: Gender Specific Solutions For Dementia Patients
Question
Task:
Purpose ofHealthcare Assignment
To have you think carefully about key elements of ethical health research, and how you may work towards including these in your work.
Brief Project Description
Fewer men enter aged care facilities compared to women, and are less likely to enter permanent residential aged care. It is not unusual then, for activity programs in residential aged care facilities to reflect a variety of feminine-based interests. Moreover, over half of permanent aged care residents have a diagnosis of dementia, which makes creative activities designed for both men and women essential to the provision of quality dementia care and treatment.
It has been estimated that on average 24% of cognitively impaired aged care residents show agitation or aggression. Male aged care residents are also more likely to exhibit disruptive behaviour compared to women. Such behaviour can cause family members and friends to visit less often, add to stress in health care providers and increase health costs. Patients displaying disruptive behaviours are more likely to be given psychotropic drugs and be physically restrained. However, access to meaningful activities that stimulate a person’s skills and abilities can help to lessen disruptive behaviours and increase quality of life, particularly for men with dementia.
Alzheimer’s Australia NSW has been exploring initiatives to introduce more meaningful activities into residential aged care for men with dementia. Their “Every Bloke Needs A Shed” trial in the Hunter Region of NSW illustrated that men with dementia would participate in targeted gender-specific activities, designed to increase communication and interaction, and which focused on capacity rather than incapacity.
How to address this
Specifically, this project will capture experiences of residents and family of how residential aged care facilities can best engage with male residents and enhance their quality of life.
We will conduct pilot interviews with consenting staff, male residents and their family members to explore the need for gender-based activities tailored for men, and to ascertain which activities would be most suitable to trial. Of particular interest is whether the “men’s sheds” philosophy provides an opportunity within an aged care setting for delivery of meaningful activities for men with dementia to foster healthier behaviours.
Project aims
The overall aim of this project is to examine current perceptions and practices in a pilot aged care facility, of gender-specific activities for men with dementia, living in residential aged care facilities.
Specific Project Details
a] Research plan
This pilot project will carry out a case study exploration of activities at one selected Aged Care facility. Rigour will be increased through triangulation of source (i.e. published literature, survey data, facility staff, residents and family) as well as method (i.e. combining personal interviews, pictures and observation).
b] Ethics
Ethics approvals will be sought from the University of Newcastle Human Research Ethics Committee and Hunter New England Human Research Ethics Committee. Site-specific approval will also be sought from the participating Aged Care facility.
c] Method
Case study
The purpose is to conduct an in-depth case study of the experiences of staff and male residents. Gender can have a significant effect on the level of participation in activities offered in aged care, with female residents more likely to find them appealing and to take part more often than men. Our in-depth exploration will augment the limited amount of research available into men in aged care, through focusing on identifying staff and residents’ perceptions and experiences of current facility activities and opportunities for male gender specific engagement.
This case study will involve interviews with consenting staff, to learn of the current activity program for residents, and how staff view issues of gender specific activity programs. Interviews would be conducted in private, follow a semi-structured format and be audio-recorded. Opportunity for informal unstructured talk would be provided, and the interview guide would be informed by existing literature review results.
Individual meetings with male residents at Calvary with mild-to-moderate dementia will be held. Participants will need to understand and express themselves in English, engage in a conversation and respond to questions. A colour pictorial flipchart will be used portraying different objects and activities, to which the men can respond and/or discuss. Pictures could include different shed tools, work environments, aircraft, old telephones, gardens and plants, parks, sports and social clubs, buses, engines, and household objects. Level of interest in any picture will then be explored further. A period of observation by the researcher will allow information to be collected for men with dementia who are unable to communicate. A ‘moderate participation’ approach will be taken whereby the researcher will be known to staff the facility, and perhaps also some of the residents through interview appointments. For each male resident observed, notes will be made of non-verbal expressions, body movements, use of facility space, interactions between residents, interactions with staff, communication and time spent on various activities.
Consenting family members who have male relatives in residence will also be interviewed, regarding their impressions of activities available at the facility and whether they are deemed suitable for male residents with dementia.
d] Timeline
Twelve months total (processes overlap): Ethics (2 months), sampling frame compilation (1 month), online survey development and deployment (2 months), online survey data retrieval, checking and analysis (1 month), development of interview schedule and conduct of interviews with staff (1 month), interviews and/or flipchart meetings with male residents at Calvary (1 month), interviews with family members (1 month), transcription and analysis of audio-taped interviews and field notes (2 months), write up and recommendations (2 months).
Anticipated Outcomes
Information about the meaning and use of gender specific activities is essential to the provision of quality dementia care and treatment. This study will provide an understanding of current practices from the perspective of staff, residents and family, and provide insights into how gender specific activities for men with dementia can be introduced into the residential aged care setting.
The main outcomes will be testimony as to the presence or absence of meaningful activities for men with dementia in residential aged care and a framework for how to best engage male residents using the ‘men’s sheds’ philosophy for positive health outcomes.
Aged care management and staff will benefit from information as to the appropriateness of current activities for male residents, and the types of innovative targeted activities which could provide male residents with a greater sense of involvement and level of comfort.
This pilot study will identify potential barriers to more creative activity programs for men with dementia in residential aged care, and which key components of the ‘men’s sheds’ workshop-based program could be modified for ‘translation’ into the aged care setting to benefit male residents with dementia.
Ethical considerations
a] Please highlight four out of 19 possible ethical considerations listed below, that you feel are most important to address in the proposed study. Then address these in section [7b] below.
Informed Consent
Voluntary participation
Do no harm
Confidentiality
Anonymity
Only assess relevant components of interest
Privacy
Sampling
Recruitment
Risk management
Boundaries for observation
Working with children
Vulnerable populations
Providing incentives
Recruitment
Coercion
Participant withdrawal
Recruiting through a ‘gatekeeper’
Accessibility of study information
b] Using the four ethical considerations you highlighted above, discuss each in turn, as to:
i. why they are important in this proposed study
ii. what steps/actions you could take in this study to observe ‘best practice’ for your four ethical considerations
Answer
A brief analysis of the study
The given case study analyzed within this healthcare assignment focuses on surveying with the help of researchers for facilitating the patients who are confronted with dementia and entered into the residential aged care. The study has concentrated on the gender-specific solution. Only men with dementia who are taking the aged care facility have been focused in this regard. This research will depend on the existing literature and the argument that focuses on identifying residents' perceptions and the staff. The primary objective of this particular study is to determine the gender-specific activity for enriching the health quality of dementia patients for men. Therefore some ethical consideration is needed to take in this regard for the betterment of the conduction of the research. The factors which need to be adopted as an ethical consideration have been described and addressed in the upcoming segment of this paper.
Relevant ethical considerations need to take
Ethical consideration in research can be described as a set of principles that guide research practices and design (Jacobsen and Landau, 2003). Multiple factors are associated with the ethical consideration given in this particular brief. This paper has identified four significant aspects that have to be maintained in this particular research after assessing the given case scenario. The four ethical considerations are
Informed consent
Do not harm
Confidentiality
Only assess relevant components of interest
The significance of all ethical consideration
The significance of "Informed Consent."
Consent is defined as a research process of information that can be exchanged between the human participants and the researcher in the research (Brazell, 1997). It ultimately protects the human participants in the research and the people who monitor and educate researchers for conducting the research, especially the health research, to ensure the great quality of the ethical standards (Bird, 2022). The case scenario mentioned that the interview will concentrate on the consenting staff. It will ultimately identify the current activities and programs for the residents. Therefore the consent from the staff must be taken by the researchers in this regard so that it can be the healthy participation by them without any pressure. They can provide better information about the conditions and activities that are taking place in Alzheimer's Australia NSW. In addition to that, the consent of the family members of the aged resident people should have to incorporate this particular backdrop so that they can participate with their perception. This will also be advantageous for the family members of the residents to tell about how the caregivers can improve the facilities in the residential care home to fight dementia.
The significance of "Do no harm."
Ham can be both psychological and physical. That is the reason it can come out in the form of anxiety, stress, pain, invasion of privacy, and not the presence of self-esteem (Bhandari, 2021). Most of the people who are confronted with dementia have merely lost their memories. In addition to that, depression and confusion are also other prevalent areas in this particular case (Mayo Clinic, 2021). In this particular case, it should be ensured that the patient with dementia is taken into the interview with maintaining safety and security. It will help to assure that no injury related to the body part will be taking place in future. For example, it can be better if the interviewer can take the interview from the place where the present is staying instead of they would be taken into the interview place. On the other hand, the interviewer should provide adequate time to them to give the answer and the mental support needed.
The significance of "confidentiality."
Confidentiality defines that the information is not available or can be accessed by anyone except the program coordinator. it also ensures that the information is excluded from any public documents and any reports. It should always be concentrated that the name of the respondents who are willing to participate in the research not be disclosed in front of anyone (Burles and Bally, 2018). In this case scenario, the name of the staff or caregivers in the residential home care, the male patient, the family member and the people who have given other administration support must be concealed. It is already known that people with dementia suffer from multiple mental health problems that ultimately emerge another problem, such as lack of confidence. Therefore it is most important to maintain confidentiality to be in rapport with the dementia patient for following ethical integrity.
The significance of “only assess relevant components of interest”
The only assessment for the relevant component of interest refers to the relevance of initiatives that are being conducted. There is a certain risk if the research does not consider the relevant people for the specific interview. It is most significant to evaluate the possible and focused solution of what type of data will be gathered and from which sources. That is the reason the source will be relevant and legitimate for accessing the only relevant components of interest. Sometimes not considered the relevant component of interest is the creation of some risks where the researchers have the chance to get the wrong information. it will ultimately lead to the situation of the vulnerable study where the wrong output can come. In this present analysis, the researchers should focus on the people, especially men with dementia, who are being studied with the help of the researchers. In addition to that, the researcher should consider the staff, administration, and caregivers of "Alzheimer's Australia" to study and determine the possible outcome from the research.
The action that would be taken to observe the best practice in this specific research
There are some actions in terms of measures that will be taken in this particular study in order to succeed in the research conduction without any issues and hazards.
The action should be taken for taking the consent.
The consent form will be provided to each respondent so that they can read the guidelines. The same concept will be provided for the respondents who will be participating in the offline and online platforms. Moreover, it will mention all respondents' conditions to agree upon. They will be given enough time to decide whether they should participate in the interview or not. The conditions are -
The treatment remains experimental
This is the clinical research that is associated with dementia. Therefore it will allow both safety and effectiveness of the treatment.
The waiver of consent, especially the family member, should speak about the previous condition of the male dementia patient (Manti and Licari, 2018).
The waiver of the consent from the residential home such as staff and administration team should provide information regarding the present condition of the patient and the activities which are followed.
The researchers will contact the representatives who are legally authorized.
The action would be taken for "do no harm."
Some action would be taken in this regard for maintaining the safety and security of the dementia patient along with the other participants are-
It will limit the potential distraction.
The patient will be treated with pleasant gestures
It will provide enough time to the respondents for giving the answer
No such object will keep in a room where the interview will be taken for avoiding the destruction
It would also take care of the outside noise, which can create the problem among the dementia patients
The patient will be taken safely to the interview destination for avoiding the physical injury
No such statement will be entertained that will create the emotional breakdown of the dementia patient, their family members and the staff, and the administration of the residential care.
No negative comments will be entertained by the researcher team for the interview purpose.
The action would be taken for maintaining confidentiality.
Here are some activities for maintaining the confidentiality for conducting the research program that includes -
The agreement policies would be created for maintaining confidentiality.
The secured digital machine will be used to take the respondents' information.
The audio will be recorded through a secure digital device, and it will not be disclosed to anyone.
The name, sex, address, professions, and other respondents' information will not be disclosed to anyone.
The data and information which can be gathered from this research will not be accessible by the illegitimate people.
The information and outcome of the study can only be used for academic and research purposes. In this particular case, the name of the respondent will not be disclosed. Before publishing any documents regarding the research, it will take the consent from all those respondents who are relevant in this regard.
The action would be taken for assessing the relevant component of interest.
In this particular case, it is most crucial for this particular research.
Some of the action which has been taken for assessing the relevant component of interest are-
Medical professionals who have more than five years of experience in treating dementia patients have been considered.
The family members of male patients who have spent most of the time with that patient will be invited to the research program so that they can provide adequate and correct information to the interviewer.
Conclusion
This particular analysis has concentrated on the ethical considerations that the researchers take for determining the activity of dementia patients. It can be concluded that ethical considerations are the most important and significant areas in clinical research that will ultimately help to get an appropriate outcome.
Reference List
Bhandari, P. (2021). A guide to ethical considerations in research. [online] Scribbr. Available at: https://www.scribbr.com/methodology/research-ethics/#:~:text=considerations%20in%20research%3F-.
Bird, S.M. (2022).Medical research, data sharing, and properly informed consent.Significance, 19(1), pp.4–5.
Brazell, N.E. (1997). The Significance and Application of Informed Consent.AORN Journal, 65(2), pp.377–386.
Burles, M.C. and Bally, J.M.G. (2018). Ethical, Practical, and Methodological Considerations for Unobtrusive Qualitative Research About Personal Narratives Shared on the Internet. International Journal of Qualitative Methods, [online] 17(1), p.160940691878820. Available at: https://journals.sagepub.com/doi/full/10.1177/1609406918788203.
Jacobsen, K. and Landau, L.B. (2003). The Dual Imperative in Refugee Research: Some Methodological and Ethical Considerations in Social Science Research on Forced Migration. Disasters, 27(3), pp.185–206.
Manti, S. and Licari, A. (2018).How to obtain informed consent for research.Healthcare assignmentBreathe, 14(2), pp.145–152.
Mayo Clinic (2021).Dementia - Symptoms and causes. [online] Mayo Clinic. Available at: https://www.mayoclinic.org/diseases-conditions/dementia/symptoms-causes/syc-20352013.
