Life In The Slower Lane

Here is the PICO analysis for the twenty-third uploaded article:

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✅ PICO Analysis

Full Article Title:

A Critical Analysis and Adaptation of a Clinical Practice Guideline for the Management of Behavioral Problems in Residents with Dementia in Long-Term Care

Type of Study:

Scholarly project—critical analysis and adaptation of existing clinical practice guidelines

Journal and Year:

Nursing Clinics of North America (2014); 49(1):105–113

Author: Nanette Lavoie-Vaughan

DOI not listed in source, but full reference: Lavoie-Vaughan NN. Nurs Clin North Am. 2014;49(1):105–113.

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P – Population

• Setting:
  • Long-term care (LTC) facilities in the United States
• Participants:
  • Older residents with dementia and associated behavioural problems
• Practitioner Focus:
  • Nurse practitioners (NPs) and psychiatric consultants providing care in LTC facilities in North Carolina and Tennessee
• Burden:
  • Behavioural problems affect up to 80–90% of residents with dementia in LTC settings 

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I – Intervention

• Nature of Intervention:
  • Adaptation and development of an evidence-based clinical practice guideline (CPG) for managing behavioural symptoms of dementia
• Process Included:
  1. Literature review and guideline synthesis (using AGREE II, PRISMA, CONSORT frameworks)
  2. Selection of a base CPG from the American Medical Directors Association
  3. Incorporation of non-pharmacological interventions:
     • Music therapy
     • Aromatherapy
     • Pet therapy
     • Light therapy
     • Sensory enhancement
     • Massage, therapeutic touch
     • Structured activities
     • Montessori methods
  4. Inclusion of staff education modules focused on communication, behavioural assessment, and environmental modification
  5. Theoretical underpinnings:
     • Wiedenbach’s Helping Art of Clinical Nursing
     • Progressively Lowered Stress Threshold (PLST) model 

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C – Comparison

• Comparator:
  • No direct empirical comparison or control group was used
  • Rather, the adapted guideline was compared against existing, often pharmacologically focused guidelines that lacked detail on implementation, staff training, or environmental tailoring

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O – Outcomes

Intended/Implied Outcomes (no empirical measurement in this paper):

1. Staff Behavioural Change
   • Greater use of person-centred, non-pharmacological approaches
   • Improved communication and de-escalation skills
   • Increased staff confidence in behaviour management
2. Resident Outcomes
   • Reduced use of antipsychotics and chemical restraints
   • Improved management of behavioural and psychological symptoms
   • Enhanced quality of life and person-environment fit
3. Process Outcomes
   • Availability of a structured, evidence-informed guideline for nurse practitioners in LTC
   • Incorporation of guideline into psychiatric practice consultations
   • Development of a platform for future replication, implementation, and evaluation 

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Outcome Classification

• Person-centred outcomes:
  • Guideline aims to reduce behavioural symptoms through personalised interventions, improving resident comfort and safety
• Process outcomes:
  • Development of an advanced practice-ready guideline integrating environmental, behavioural, and educational strategies
• Health system outcomes:
  • Potential to reduce psychotropic use and regulatory violations (F222, F329), though not empirically evaluated in this project

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Summary Conclusion

This article presents the critical adaptation of a clinical practice guideline for the non-pharmacologic management of behavioural symptoms in long-term care residents with dementia. Drawing from existing guidelines, the author integrates empirical evidence, alternative therapies, and nursing theory (Wiedenbach and PLST) to design a person-centred, implementation-ready model. While outcomes are not tested, the project offers a comprehensive, theoretically grounded roadmap for future empirical validation and system-wide application in psychiatric consultation and advanced nursing practice .

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