The North Dakota Nurse - July 2022

July, August, September 2022 The North Dakota Nurse Page 11
Psych Therapies Compared
to Medication
Appraised by:
Taylor Painter & Mackenzie Duval
Clinical question: How do psychological
therapies, such as animal therapy or cognitive
therapy, compare to medication therapies in
calming dementia patients?
Articles:
Carrion, C., Folkyord, F., Anastasiaduo, D., &
Aymerich, M. (2018). Cognitive therapy for
dementia patients: A systematic review.
Dementia and Geriatric Cognitive Disorder, 46(1-
2), 1-26. https://doi.org/10.1159/000490851
Madhusoodanan, S. & Ting, M.B. (2014).
Pharmacological management of behavioral
symptoms associated with dementia. World
Journal of Psychiatry, 4(4), 72-79. https://doi.
org/10.5498/wjp.v4.i4.72
Muller-Spahn, F. (2003). Behavioral disturbances in
dementia. Dialogues in Clinical Neuroscience,
5(1), 49-59. https://doi.org/10.31887/
DCNS.2003.5.1/fmuellerspahn
Sheikh, A.B., Javed, N., Leyba, K., Khair, A.H., Ijaz,
Z., Dar, A.A., Hanif, H., Farooq, A., & Shekahr,
R. (2021). Pet-assisted therapy for delirium
and agitation in hospitalized patients with
neurocognitive impairment: A review of
literature. Geriatrics (Basel), 6(4). https://doi.
org/10.3390/geriatrics6040096
Synthesis of evidence:
It is estimated that anywhere from 30 to 90
percent of dementia patients experience some
form of psychological or behavior symptoms
(Muller-Spahn, 2022). It is important to treat
these symptoms in order to maintain the safety
and quality of life of the patient and those
around them. This review focuses specifically on
symptoms and behaviors that impact patient
calmness, such as anxiety, agitation, and
aggression.
There are two forms of intervention that
can be utilized: pharmaceutical and nonpharmaceutical.
Pharmaceutical interventions
use medications such as antidepressants,
sedative hypnotics, cholinesterase inhibitors,
mood stabilizers and antipsychotics. Because
these medications can result in adverse
effects, the possible risks and benefits must be
weighed carefully. It is also recommended
that pharmaceutical interventions are not
used unless non-pharmaceutical therapies
have failed or the patient’s symptoms require
immediate treatment (Madhusoodanan &
Ting, 2014). There is a wide variety of nonpharmaceutical
treatment options, but this
review focuses on cognitive therapy and
animal-assisted therapy. Cognitive therapy
utilizes a combination of reality orientation and
skills training in an attempt to reverse or slow the
development of cognitive impairment (Carrion
et al., 2018).
Bottom line:
Many existing studies have found the use of
cognitive therapy to be beneficial to patients
while others have found it to have no effect. The
same can be said for animal-assisted therapy,
although some studies have found animal
exposure can exacerbate symptoms in severe
cases. Due to small sample sizes, inconsistent
study designs, and lack of randomizedcontrolled
trials, results are inconclusive at this
time. It is currently unclear if psychological
interventions are more effective at promoting
patient calmness than pharmaceuticals,
although they have proven to be less risky.
Once the better intervention has been
determined, more randomized-controlled
trials are needed to determine the number
of sessions, length of sessions, and duration of
intervention that give the best results.
Implication for nursing practice:
Dementia can cause a wide variety of
symptoms, some of which pose a threat
to patients and those around them. It is
important to try and combat these symptoms
in a way that maintains quality of living for
the patient, while also keeping everyone
involved safe. Pharmaceutical intervention
can be an effective treatment but can also
cause other symptoms, decrease quality of
life, and increase patient mortality. Cognitive
and animal-assisted therapy have produced
inconclusive results in terms of effectiveness but
have not shown to have negative impacts on
patients. When working with dementia patients,
non-pharmaceutical interventions should be
attempted first as they are less likely to cause
harm to patients.
NDNA’s Highlight a
Nurse!
Meet Megan Teske, BSN, RN
Nursing Specialty: Family
Practice Nursing
By Joylyn Anderson, APRN, BSN
What sparked your interest
in nursing?
As a freshman in high
school, I had a family
member suffer a medical
illness that required
hospitalization for several
weeks. The nurses (in the
same facility I now work
in) showed so much love
and compassion in the
care they delivered that
it created a drive in me to
do the same for others.
Although that experience
wasn’t particularly a good
one, I am so grateful for it for leading me into this
profession of caring for others.
What does a typical day look like for you?
I work part-time in a rural health clinic
specializing in allergy and family practice. It is a
busy facility that provides care to people of all
ages. Every day is different, which is one of the
things I like most.
What do you find challenging?
Insurance companies. Seeing this side of
nursing has shown me how difficult and frustrating
it can be for patients to get the services they need
in a timely manner.
The past two years of the pandemic have been
challenging for nurses. What self-care advice
would you give to new graduate nurses?
As a mom of three, self-care can be difficult
to come by as is… but even more so as a nurse.
Sleep is one of the most important things for my
personal self-care at this stage of my life… it is
hard to function and think critically without it.
It is so important to make time for yourself & the
activities you enjoy. It’s impossible to pour from an
empty cup.
The Quest for Excellence
Karen L. Zimmerman, MSN, RN
Have you ever found yourself in a position
of asking if where you are is where you want
to be? What are your aspirations and more
importantly, how hard are you willing to work
to get to where you want to be? As humans,
we often unknowingly place a filtered lens
(aka rose colored glasses) over our eyes that
protects us in such a way, that we may be
blinded by the reality of a situation. Humans
were developed with that protection in part,
to shield us from the impact of trauma. That
becomes problematic when we are blinded to
areas of opportunity. This filtered view may lead
to complacency and/or blocking behaviors
when changes are necessary. John Kotter
(1996) author of Leading Change, states that
“complacency, is supported by the very human
tendency to deny that which we do not want to
hear” (p. 43). This is especially problematic in a
work environment when trying to drive change
because “life is usually more pleasurable
without problems” (Kotter, 1996, p. 43).
If I were to ask you if you wanted to be known
for excellence or mediocrity, you would likely
look at me like I had two heads. Most of us do
not desire to be average, yet there are times
in our life, personally or professionally, that we
find ourselves in that very place. Maybe fear is
preventing us from challenging the status quo
because we are afraid to confront someone or
something that is blocking forward movement.
Maybe we are too tired to expend the effort
it will take to move from a place of comfort.
Maybe we want to make changes or be part
of the solution, but we do not know how and
are afraid to show our vulnerability and ask for
help due to fear of being judged or accused of
being an imposter. Maybe we are afraid of our
own judgment. Or just maybe doing the right
thing is too difficult because of potential barriers
or backlash.
I issue the following challenge to each of us:
1. Do not accept mediocrity.
2. Strive for excellence wherever you are.
3. Be part of the solution not the problem.
4. Hold others accountable if you see
deficiencies in their practice (i.e. seeing
someone not performing hand hygiene).
5. Join a committee or ask how you can
contribute to an effort of change or
improvement.
6. Do not get defensive if someone coaches
you.
7. Do NOT be a blocker.
Colin Powell once stated, “if you are going to
achieve excellence in big things, you develop
the habit in little matters. Excellence is not an
exception; it is a prevailing attitude.” Rather
than saying “no,” say “how” and make an effort
to ensure your attitude is such that you support
change and strive for excellence instead of
accepting mediocrity.
Kotter, J. (1996). Leading Change. Harvard Business
Review Press.
The North Dakota Department of Health has seen
a decrease in the number of immunized children
(regular immunization) as a result of not having
access to care during the pandemic. Is this
something that you are seeing in your rural area?
We have definitely seen a decrease in our
immunization rates due to the pandemic. Our
rates are normally fairly high thanks to scheduled
well child visits and our Public Health Nurse
offering immunizations to children in our school
systems. However, people were not scheduling
routine exams for their children during the height
of the pandemic, nor was there much time for
our Public Health Nurse to offer routine screenings
and visits to the schools.
If so, is there anything that you recommend doing
to help promote timely immunizations?
We have a traveling Pediatrician that visits our
facility once a month. She has been seeing a
significant increase in the number of patients she
sees when she visits our facility. We advertise on
Facebook & our weekly newspaper to alert the
community of her scheduled visits and for routine
vaccination.
Nursing Faculty position
Beginning August 2022
Teaching Mental Health and
Medical Surgical Nursing
For more details,
visit www.uj.edu/employment.