course material

1. CAREGIVER BURDEN IN PATIENTS WITH ALZHEIMER'S DISEASE
CAREGIVER BURDEN IN PATIENTS WITH ALZHEIMER'S DISEASEStructure and
Application of Contemporary Nursing Knowledge Model Selection and Critical Analysis For
this assignment you will explore, identify, and critically analyze, a model that could be used
as a guide for directing a practice change related to the future actions you identified in the
Ways of Knowing assignment (Caregiver Burden In Patients With Alzheimer's
Disease).CAREGIVER BURDEN IN PATIENTS WITH ALZHEIMER'S DISEASEORDER A
PLAGIARISM-FREE PAPER HEREIn addition, you will professionally reflect on your critical
analysis and describe how selection and use of an appropriate model could positively
influence implementation and sustainability of a practice change project at your
professional organization. Note: The content of this assignment could serve as draft for a
discussion related to ”Evidence-Based Practice Change Model” in Chapter 3 of the final
capstone document. Assignment Guidelines: To begin this assignment you will first select a
model (i.e Stetler model, iowa model, PARIHS, ARCC, JHNEBP, STAR model). After you select
the model, you will address each of the items below in a written scholarly paper. The items
reflect critical questions to ask when selecting a model as described in Schaffer, M. A.,
Sandau, K. E., & Diedrick. L. (2012).CAREGIVER BURDEN IN PATIENTS WITH
ALZHEIMER'S DISEASE Evidence-based practice models for organizational change:
Overview and practical applications. Journal of Advanced Nursing, 69(5), 1197-1209. 1.
Begin this assignment with an introduction. The introduction should include a discussion
that provides: • A brief succinct overview of the professional experience and future actions
discussed in the Way of Knowing. • A statement that explains the purpose of the assignment
(e.g., The purpose of this assignment is to……). 2. After your introduction, discuss the
following content using appropriate APA level headings: • Description of the Model –
Provide the name of the model. Then, identify the author of the model, and the date the
model was established. Utilize primary rather than secondary resources. • Purpose of the
Model – Provide a descriptive summary of the purpose of the model. In your summary
specifically speak to the context and situations in which the model is useful. In your
summary clearly identify how the purpose of this model is linked to the future actions you
identified in the Ways of Knowing assignment. • Classification of the Model – Provide a clear
description of the structure of the model (choose from the option of individual use or
organizational processes as discussed by Schaffer et al.). In your description clearly identify
how you arrived at your conclusion. • Key Features of the Model – Provide a descriptive
summary of the key features of the model. In your summary clearly identify how the key

2. features of this model support the future actions you identified in the Ways of Knowing
assignment. • Steps of the Model – Provide a descriptive summary of the steps of the model.
• Relationships in the Model – Provide a descriptive summary of the linkages among and
between the steps associated with the model. • Assumptions in the Model – Provide a clear
description of the assumptions associated with the model. In your description clearly
identify why the accepting of the assumptions is necessary for successful application of the
model to a practice change project. • Application to Professional Practice – Provide a
descriptive summary of your critical analysis findings. In your summary thoroughly discuss
the application of the model for a practice change project at your professional organization
regarding the future actions you identified in the Ways of Knowing assignment. 3. End your
paper with a conclusion. The conclusion should present a brief summary of the key
takeaway points of the paper. The conclusion should not present any new information.
Scholarly Writing Guidelines: 1. Grammar, spelling, and APA writing style will be graded
according to doctoral level expectations. Please proofread carefully. 2. Your paper should be
double-spaced with one inch margins, and include: a. A title page and a reference page
(Note: all in-text citations and sources listed on the reference page should be according to
APA 6th edition). b. Times New Roman 12 pt font throughout entire document. c. Page
numbers. d. A running head. e. APA 6th edition formatted subject level headings.CAREGIVER
BURDEN IN PATIENTS WITH ALZHEIMER'S DISEASEApplying the Iowa EBP Model to
Reduce Caregiver Burden in PatientsWith Alzheimer’s diseaseOccupational therapy,
spiritual therapy and behavioral interventions are some of the most recommended actions
that can reduce the burden experienced by caregivers of patients with AD. Occupational
therapy purposes to improve the functional and physical ability of patients diagnosed with
AD and increase their ability to engage in activities of daily life (ADL) with minimal or no
assistance despite having a limited cognitive function.CAREGIVER BURDEN IN PATIENTS
WITH ALZHEIMER'S DISEASE.Spiritual therapy strengthens caregivers' and patients'
intrinsic belief systems to give them comfort and hope and to promote coping. Behavioral
interventions are the most effective in reducing the problems associated with mental-health
such as caregiver anxiety and depression, which are the most common among family and
nursing home caregivers of patients with AD. Behavioral interventions can be in the form of
CBT, caregiver training, psychoeducation, case management or general support to improve
overall well-being, the ability to make decisions, resolve conflicts and solve problems when
caring for AD patients.To realize successful outcomes following implementation of the
aforementioned actions in practice, it is vital to embrace the guidance of evidence-based
practice models as they influence the use of an evidence-based approach to solving clinical
problems (Nilsen, 2020). Therefore, the purpose of this paper is to discuss the Iowa EBP
model, its purpose, classification, key features, steps, relationships, and assumptions. It also
includes a description of this EBP model can facilitate the implementation of a practice
change in reducing the burden and improve the overall wellbeing of caregivers caring for
AD patients.CAREGIVER BURDEN IN PATIENTS WITH ALZHEIMER'S DISEASEDescription
of the ModelMarita G. Titler developed the Iowa EBP model the year 1994 when she was a
Director for Outcomes Management and Quality in the patient care and nursing services
department at the University of Iowa Hospitals and Clinics (Brown, 2014). Its primary

3. purpose was to give guidance to nurses and other professionals on how best to utilize
findings from to promote care. The model was later revised in the year 2002. Since its
inception, it has been used in different settings to improve care. It focuses on collaboration
and organization and incorporates the use of research alongside other types of evidence.
The model enhances nurses’ ability to concentrate on problem or knowledge-focused
triggers and strive to improve care using current research findings.CAREGIVER BURDEN IN
PATIENTS WITH ALZHEIMER'S DISEASEPurpose of the ModelThe Iowa model assists
nurses to apply research findings in actual clinical practice in the clinical setting, to improve
patient outcomes. It particularly highlights the significance of incorporating an entire
healthcare system starting with a healthcare provider and patients to infrastructure and
utilizing research to make decisions in practice (Buckwalter et al., 2017). This clearly
illustrates that the EBP concept in the Iowa model goes beyond a patient and nurse to
become part of the culture of an organization characterizing a multiple system-level
commitment.CAREGIVER BURDEN IN PATIENTS WITH ALZHEIMER'S DISEASE The model
is particularly useful in quality improvement initiatives where nurses establish ways of
reviewing the findings from the literature to determine their clinical significance and
relevance to specific populations using a PICO framework (Buckwalter et al., 2017). For
instance, in this context, the Iowa EBP model will direct and promote the search and
implementation of evidence that supports the use of CBT (cognitive behavioral therapy) to
reduce the burden and promote the wellbeing of caregivers of patients with AD. The model
will use the PICO format to formulate a clinical question to aid in searching for the
appropriate literature.Classification of the ModelIowa EBP model is a process model that
clearly describes how to translate research into practice. More particularly, it is a
knowledge-to-action model that depicts a linear and rational process to transfer research to
clinical practice by giving practical guidance on planning, execution, and implementation.
An action model elucidates the significant aspects to consider during implementation to
improve clinical outcomes and the steps to follow when translating research findings into
practice. Therefore, it is best suited to improve both organizational processes.CAREGIVER
BURDEN IN PATIENTS WITH ALZHEIMER'S DISEASEKey Features of the ModelThe Iowa
EBP model provides a framework to implement change using a standard approach through
the PICO process. This standard approach promotes easy communication and allows the
ability to capitalize on existing strengths to improve outcomes (Buckwalter et al., 2017).
This PICO framework will be used to search for evidence to support the use of CBT to
reduce caregiver burden. The concept that underlies this trigger to engage in EBP is a
constant reminder of the opportunities that nurses have to re-examine and improve
practice (Doody & Doody, 2011). Moreover, the model’s graphic representation apart from
its sequential and logical steps are not only comprehensible but also easy to use The model
emphasizes teamwork and contributions made by experts from other healthcare disciplines
and how this can affect each phase of the EBP process. In case the evidence found is
insufficient to answer a clinical question and guide changes in practice, the model still
provides nurses with the option to use the research process. In case of some clinical
questions that remain unanswered, they can be translated into research questions inspiring
nurses to progressively explore a scientific backing for practice.CAREGIVER BURDEN IN

4. PATIENTS WITH ALZHEIMER'S DISEASESteps of the ModelStep 1: Selecting a TopicThe
topic usually emanates from a knowledge or problem-focused trigger to influence change.
The latter can either be an issue related to risk management or a clinical problem. On the
other hand, knowledge-focused triggers could emanate from a new practice guideline or
research findings.CAREGIVER BURDEN IN PATIENTS WITH ALZHEIMER'S DISEASEStep 2:
Team FormationThe team should comprise of different members tasked to look for,
appraise and implement evidence. This team should primarily comprise of healthcare staff
within and beyond a unit to facilitate multidisciplinary collaboration (Buckwalter et al.,
2017).CAREGIVER BURDEN IN PATIENTS WITH ALZHEIMER'S DISEASEStep 3: Retrieving
EvidenceThe team should gather and analyze the evidence found about the expected change
in practice. For a clearer focus, the team should formulate a PICO question to aid in the
search strategy in this step.Step 4: Grading EvidenceThe team critiques, synthesize and
grades the evidence found to establish if the proposed change is scientifically sound.Step 5:
Development of an EBP StandardInvolves determining if the evidence found is adequate or
inadequate to implement a practice change.CAREGIVER BURDEN IN PATIENTS WITH
ALZHEIMER'S DISEASEStep 6: EBP ImplementationRunning a pilot program where a
single or two units are considered for evaluationStep 7: EvaluationInvolves ongoing
evaluations to establish if the change is feasible and produces improved outcomes. The
evaluation also involves determining the appropriateness of a change for long-term
adoption within the organization. If the researchers find that the outcomes ate not feasible,
it will be necessary to continue evaluating new research and care for new information.
(Buckwalter et al., 2017). However, if it is found to be feasible, they will continue to
introduce the change across the organization and continue with observations, evaluations,
and analysis of the outcomes.CAREGIVER BURDEN IN PATIENTS WITH ALZHEIMER'S
DISEASEAssumptions in the ModelThe Iowa EBP model has the following assumptions:A
strong belief that the best knowledge and practice change comes from scientific literature
with well-defined research processes. Therefore, it focuses on using scientific evidence from
both qualitative, quantitative and mixed-methods studies with different study designs
(Brown, 2014).CAREGIVER BURDEN IN PATIENTS WITH ALZHEIMER'S DISEASEIt
prescribes the tangible steps to follow in every stageIn the evidence grading stage, there is a
discussion about the relative merits of the data collected and common grading criteria that
are used that bases on feasibility, effectiveness, and appropriateness. Feasibility
encompasses the wider environment of intervention and if it can be implemented.
Effectiveness relates to if an intervention attains the expected outcomes and
appropriateness relates more with the psychosocial features of care (Buckwalter et al.,
2017).CAREGIVER BURDEN IN PATIENTS WITH ALZHEIMER'S DISEASEIt is essential to
accept these assumptions for the successful application of an identified intervention in
practiceApplication to Professional PracticeSince it is clear that caregiver burden is an
essential topic to explore that needs a practice change, a team that comprises of a nurse, a
mental health nurse practitioner, and other healthcare professionals will be formed to help
with change implementation. It will search for scientific evidence to determine if behavioral
interventions such as CBT is effective in reducing the caregiver burden of patients with AD
using the PICO framework. To help with the search for supporting evidence before analysis,

5. synthesis, and implementation in practice, the team will formulate a PICO question as
follows:CAREGIVER BURDEN IN PATIENTS WITH ALZHEIMER'S DISEASEPICO Question:
Among AD caregivers (P), does CBT (I) compared to usual care (C) improve well-being and
delay patient admission to nursing homes (O).The team members will then evaluate the
studies found, analyze and synthesize to determine if they are adequate to support the
implementation of CBT. If the evidence found will be adequate, a pilot test will be
implemented and thereafter actual implementation in routine practice.ConclusionIowa EBP
model is a perfect example of an EBP model that can be used to translate the findings of
research in practice to promote change and improve outcomes. This model utilizes the
PICO framework to search for evidence that supports the implementation of an EBP change.
In this project, it will be used to search for evidence that supports the use of CBT into
routine practice to reduce the burden and promote the wellbeing of caregivers for patients
with AD. CAREGIVER BURDEN IN PATIENTS WITH ALZHEIMER'S DISEASE Caregiver
Burden In Patients With Alzheimer's DiseaseAlzheimer’s is a degenerative brain disorder
that causes cognitive impairment resulting in changes in behavior and reduced functional
ability. Its prevalence in people aged 60 years and older in the United States is
approximately 2.7-11.1%, with $20-$100 as the estimated annual costs (Elif, Taşkapilioğlu
& Bakar, 2017). With the rapid growth of the prevalence of AD, its burden to the society,
families, and the nation continues to increase, more explicitly, primary caregivers
experience the most difficulty since he or she suffer from financial, physical and
psychological stress. As a result, caregivers decide to institutionalize AD patients early,
resulting in an increased burden in social and health services. This explains the essence of
focusing on the burden experienced by caregivers as it influences the individual dementia
burden and social costs.According to Reed et al. (2014), caregiver burden is the perception
of caregivers in terms of social, physical, economic, and emotional costs of a caregiving
relationship. Currently, existing evidence highlights several factors linked to caregiver
burden. For instance, severe psychiatric symptoms, the quality of life of patients, and
behavioral disturbances are strongly linked to the burden experienced by caregivers, which
tends to increase with increased severity of AD.This paper explores, analyzes, and reflects
on the burden experienced by AD patients’ caregivers. It also explores the values, beliefs,
and assumptions of the burden experienced by caregivers of patients suffering from AD. It
uses the empiric and moral knowing of Carper as the benchmark to escalate knowledge on
this subject and guide future decision making. Empiric knowing uses evidence-based
practice and refers to study findings to change nursing practice. Ethical knowing guide
individual actions and helps to develop individual moral codes to know right and wrong.
Nurses make ethical decisions in daily practice and are obliged to respect and safeguard
human life.CAREGIVER BURDEN IN PATIENTS WITH ALZHEIMER'S DISEASEProfessional
ExperienceImpact On Patient Outcomes And Population HealthGenerally, caregiving is a
very complex task that is underplayed. Emotions of resentment about effort and time,
sympathy, the expected loss of income, or a loved one usually contribute to mental,
financial, and physical stress among caregivers. The ultimate changes in the goals and
lifestyles of caregivers comprise a significant reorganization of priorities such as neglect of
hobbies and friends and lots of free time, which manifests as social isolation and a resultant

6. decrease in caregivers' and patients’ quality of life (Ridzuan et al., 2018).CAREGIVER
BURDEN IN PATIENTS WITH ALZHEIMER'S DISEASEPrevious analysis have revealed that
patients with AD suffer from mental problems that are directly associated with the hours of
care, psychological and physical illness scores. This may lead to emotional stress and
ultimately increase the risk of hospitalization, influence faster institutionalization, and,
eventually, death (Yu et al., 2015). As the disease progresses, there is a significant increase
in the needs of patients and reduced quality of life. Poor quality of life increases the risk of
medical illnesses, further psychological impairment, increased mortality risks, and
disruption of personal roles.CAREGIVER BURDEN IN PATIENTS WITH ALZHEIMER'S
DISEASEAssociated Values, Beliefs, and AssumptionsTwo major beliefs associated with this
subject are: it is a process of repaying past caregiver debts, and children are expected to
take responsibility for their aged parents in adulthood. These beliefs mainly exist in Latin
American culture, where caregiving is considered a positive gesture (Ridzuan et al.,
2018).CAREGIVER BURDEN IN PATIENTS WITH ALZHEIMER'S DISEASEThe values of
familism and religiosity can also be associated with this subject. Among Latin Americans,
familism is being firmly committed to the family as a support, assistance, and socialization
system. Therefore, there exists a relationship between perceived familial duty and
caregiving (Yu et al., 2015). Even with a bad premorbid relationship, caregiving for the
family is a natural family life aspect. On the other hand, familism may be responsible for
deficits in awareness among caregivers. Religiosity is also a value to be considered since it is
a strong motivator for caring for disabled individuals. Latin-Americans are often engaged in
positive religious coping in comparison to other cultures since it enables a person to find
meaning in the process of caregiving and influences higher incidences of caregiver strain
and burden. Therefore, positive religious coping helps to find meaning for caregiver tasks.A
significant assumption associated with this subject is that the motivation to provide care for
AD patients determines the awareness of caregivers on the associated caregiver burden.
Motivation in this context may emerge from internal beliefs and desires and external
pressures (Ridzuan et al., 2018). These factors have a significant role in determining the
social caregiver burden, discrimination, and stigmatization.Ways of KnowingEmpiric Way of
KnowingEmpiric knowledge aims at describing, explaining, and predicting social and
natural phenomena. Apart from the traditional hypothesis testing as a way of inquiry, it
incorporates phenomenology descriptions, deductive, and inductive reasoning (Llanque et
al., 2016). Knowledge is expressed in the form of conceptual models, theories, organized
descriptions, and facts that predict and explain relationships.CAREGIVER BURDEN IN
PATIENTS WITH ALZHEIMER'S DISEASEEthical Way of KnowingCarper describes ethics as
the moral element of nursing, which incorporates a fundamental pattern of knowing that
goes beyond ethical codes to include individual characteristics, motives, intentions, and
moral judgments. Therefore, ethical knowledge is expressed through standards, codes,
ethical decision making, and ethical theories. Ethics is judged by justifying responsibility
and rightness, while empirics can be assessed on credibility (Ridzuan et al.,
2018).CAREGIVER BURDEN IN PATIENTS WITH ALZHEIMER'S DISEASERelation to
Caregiver Burden in Patients with Alzheimer’s diseaseEmpiric research suggests that most
people are deficient in the knowledge that AD significantly affects caregivers. Caregivers are

7. individuals who are responsible for taking care of patients with AD by assisting them with
activities of daily life, which can become a full-time commitment. As ones spends most of
the time caring for patients with AD, most of them suffer emotionally, physically, socially,
and psychologically. This results in the caregiver burden concept. Physical, emotional, and
mental impairment among AD patient caregivers results in patients' and caregivers' poor
quality of life and increases the risk of early institutionalization (Ridzuan et al., 2018). To
understand the major variables and relationships associated with caregiver burden,
Leonard Pearlin suggested a stress process model that particularly highlights the primary
and secondary stressors. While the former may arise from the burden of symptoms such as
functional loss, memory loss and problems in behavior, the latter can extend to as far as
how a caregiver perceives the burden in terms of commitments, responsibilities and coping
strategies to manage the accompanying stress (Ridzuan et al., 2018).Its primary defining
attributes are uneven distribution of responsibilities; the burden is progressive in nature
and life-threatening. The antecedents are lack of formal and informal support, constricted
social life of the caregiver, care recipient with a chronic illness who expresses problematic
behaviors, caregiving duration, the functional and cognitive status of the those receiving
care (Ridzuan et al., 2018). The consequences of caregiver burden are anxiety, poor health
status, cognitive disturbance, and depression, among others.CAREGIVER BURDEN IN
PATIENTS WITH ALZHEIMER'S DISEASEFrom an ethical perspective, caregivers are an
integral part of the health system who work in collaboration with other healthcare
providers and patients. Most patients suffering from AD can rely on caregivers to negotiate
interactions, especially as the disease continues to advance, and the roles of a caregiver
continue to increase. According to Llanque et al. (2016), caregivers are intrinsically vital
since they bring depth and meaning to fundamental human relationships. Families are
defined by relationships, which are established by commitment, blood, or marriage, and
their obligations to one another are moral rather than legal. However, the majority receive
limited financial, emotional, and mental support, which makes them overwhelmed with
many responsibilities resulting in poor health outcomes.Future ActionsAD patients should
undergo occupational therapy to improve their physical and functional ability to perform
activities of daily life despite their limited cognitive function. Research suggests that
occupational therapy promotes caregivers' and patients' quality of life and reduces the
burden experienced by caregivers (Reed et al., 2014). Spiritual therapy is another
alternative for reducing the caregiver burden and the difficult task of caring for AD patients.
Caregivers should undergo spiritual therapy to strengthen their intrinsic belief system,
which assists in coping, giving comfort, and hope. Behavioral interventions can also be used
to reduce mental-related problems, such as depression and anxiety. Alternatively, as
suggested by Llanque et al., (2016), a psycho-educational approach that aims at educating
caregivers to equip them with effective coping strategies in decision-making, conflict
resolution and problem-solving when caring for AD patients is commendable.ConclusionAs
the elderly population continues to grow, Alzheimer’s will continue to be a widespread
condition of public health significance. Most Alzheimer's disease caregivers are
overwhelmed with caregiving roles and responsibilities, emotionally burdened, are
mentally and physiologically impaired, and have a poor quality of life. The weariness,

8. incapacity, despair, and loneliness that they experience are other invisible parts of the
iceberg.CAREGIVER BURDEN IN PATIENTS WITH ALZHEIMER'S DISEASETwo major
beliefs associated with the burden experienced by caregivers for AD patients are that it is a
process of repaying past caregiver debts and that in adulthood, children should take
responsibility for their aging parents. The values of familism and religiosity also contribute
to this subject since family is considered a support and socialization system that is closely
related to a familial duty and caregiving. Religiosity influences individuals to find meaning
in the process of caregiving and influences higher incidences of caregiver strain and
burden.Empiric and ethical ways of knowing improve the overall understanding of this
subject through ethical knowledge, conceptual models, theories, organized descriptions,
and facts that predict and explain relationships. Future actions to address caregiver burden
in patients with AD should include occupational therapy, spiritual therapy, psycho-
educational coping strategies, and behavioral interventions.CAREGIVER BURDEN IN
PATIENTS WITH ALZHEIMER'S DISEASE