Evidence Based Practice: Qualitative And Quantitative Research

Evidence based practice (EBP) is "the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence-based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research" (Sackett et al, 1996). This definition takes into consideration the need to delve into the professional’s clinical knowledge (Burns, 2007) as well as looking into the best evidence to support the professional. Clinical practices may become out dated if new evidence is not sourced and professionals should be aware of appropriate evidence that can be integrated into their practice (Aveyard & Sharp, 2013). EBP is important

in nursing practice as it is used to defend the professional’s practices, and show rationale for the actions that they have taken. EBP has facilitated many aspects of redesigning practices over the years, to make sure that they are effective (RCN, 2013), safe, and efficient. EBP can also have a number of implications for trust policies, staff training and services within mental health (Mental health foundation, 2009). Mental health nurses use four types of evidence; Empirics, Aesthetics, Ethics and Personal evidence (Barker, 2009). This enables them to be aware research as well as a theoretical basis for their practice.
Leonora is a 90 year old widow who is residing in residential care and has a diagnosis of Alzheimer’s disease. Since being admitted to “The Croft”, Leonora’s AD has progressed and her mental state has deteriorated. Staff have observed Leonora tapping away on the side of her chair, rolling up a newspaper and murmuring to herself, which has split the staff’s opinion on what Leonora is experiencing.
One group of staff have concluded to think that she has been having episodes of hallucinations, resulting in agitation and distress towards her carers. The staff fear that the newspaper may one day be used as a weapon in a state of agitation. This group of staff propose the use of an anti-psychotic with the view it will calm her through the day and relieve her of hallucinations.
The other group of staff feel that Leonora’s experiences is a way of expressing herself and self-stimulating herself due to lack of interventions on offer to her. They argue that an anti-psychotic isn’t justified until other non-pharmacological interventions have been tried. They also argue that the newspaper may provide a sense of contentment to Leonora, and has yet to show any signs of using it as a weapon. This group of staff propose that interventions of music therapy are to be trialled to see if it has an effect on her wellbeing.
Leonora has a background of teaching and has had a life-long association with literacy and music. Leonora played the piano through her teaching career, and although she was not a regular home player, she would occasionally gain relaxation from playing quietly at home. However her past does not indicate any signs of interest in listening to music.
This essay will present three pieces of evidence to which will assist the staff in their decision making in regards to Leonora’s care; Qualitative, Quantitative and Audit.

All evidence was found via ‘Google scholar search’ or ‘UWE Library search’ using key words of ‘music’, ‘therapy’, ‘Alzheimer’s’, ‘dementia’ and ‘anti-psychotics’.
Qualitative is a term which is used to describe the quality of something in size, appearance and value (Oxford University Press, 2015). The first piece of evidence focuses on the importance of music for people with dementia, covering their perspective, and also from the families, carers, staff and music therapists. It expresses how music helps connect people with life and memories, exploring the concept that music therapy can help stimulate the brain. It explores how music therapy is invasive, and cost effective in its delivery.
A qualitative study was conducted using focus groups that was formed of patients, carers, staff and families. This helped develop insights into the musical experiences of people with dementia and explore the meaning of music within their lives (McDermott et al, 2013). The results signified that the accessibility of music for people at all stages of dementia has close links with music, personal identity and life events. It also highlighted the importance of relationship building through music as valuable tool. The evidence concludes that the effects of music reduce behavioural and psychological symptoms and that sustaining

musical connections would help value the individual and maintain their quality of life.
The results show that the groups that was involved with music therapy had been able to build therapeutic relationships with each other and was able to connect with their life and past experiences. Patients that had history of agitation within their care setting did not show any signs of agitation throughout the music session, arguing music can be a factor of reduction in behaviours. Individuals become more stimulated to their surroundings throughout the session and started communicating more with others around them, promoting their social psychology. The music appeared to have an uplifting effect on the individuals. Because this study only focuses on patients with moderate to severe dementia, it is unable to be generalized to all dementia patients. Patients with early stages of dementia would have to be incorporated into the study to make the findings more reliable. A Strength of this study is that music is cost effective and is easily accessible making it a desirable method for many of the staff.
The results from this study have strong similarities to Hays and Minichiello (2005), who conducted interviews and focus groups examining the meaning and role of music. These studies found that the impact of music was positive, promoting sense of self and helped to protect the individual’s identity. The studies also concluded that music lessened the feelings of isolation and loneliness, helping develop relationships with other people (Hays and Minichiello, 2005). A limitation of this study is that it doesn’t state that any of the participants had any cognitive impairment. Therefore this makes the evidence ungeneralizable.
Because of the strong similarities between the two studies, it highlights that music is a form of identity of an individual. It also presents the need for shared meaningful musical experiences and how it is retained through the ageing process, even in the context of dementia (McDermott, 2013).

The results show that the groups that was involved with music therapy had been able to build therapeutic relationships with each other and was able to connect with their life and past experiences.

The music groups had also increased their Quality of Life (QOL) scores, which was measured by a questionnaire at the beginning and end of the session. As the QOL scores increased, individuals become more stimulated to their surroundings and started communicating more with others around them. Communication can aid interpersonal relationships and help maintain wellbeing for an individual (Lavender, 2010). McDermott (2013) argued that music can reduce

depression.