- NURS 601 Assignment 3.1 Critique a Clinical Practice Guideline.
AGREE II Score Sheet (Scope and Purpose of the Clinical Practice Guideline)
Dementia is brain deterioration and a process of getting worse in cognitive abilities. In this case, this decrease in function impacts the patient’s movements and resultant self-care since they cannot perform most of the attendant activities of daily living single-handedly. This disease manifests itself in many neurological ways and the patient’s psychological and behavioural state, depending on the stage the patient is in. These symptoms translate into the need to undertake activities using particular guidelines for practice.
- Dementia Care Guidelines Overview
The goals of the dementia guidelines are described in detail by the American Psychiatric Association (APA) in their clinical practice guidelines. The following guidelines are very well laid down to assist healthcare providers in identifying and documenting the various manifestations of dementia. They contain specific and complete guidelines for managing patients on certain drugs and the appropriate dosage of therapies (Gale et al., 2021). In this way, the guidelines propose a specific framework for managing patients’ evidence-based care appropriate to individual patients’ requirements.
This is the position of the American Psychiatric Association, which has pointed out that the primary aim of these guidelines is to enable the development of sound strategies for managing the group of patients with dementia. The guidelines include all possible forms of management for dementia, including medical and non-medical management, because dementia is a diverse condition. This comprehensive approach is intended to increase patients’ quality of life by decreasing symptoms, decreasing the rate of disease progression, and improving functionality.
The guidelines also focus on the need for patient-centred care plans. Every individual’s condition and symptoms are considered, and the medications and therapies given to the patient are suitable and beneficial for the specific condition. Such an approach is vital when treating a disease like dementia that presents such heterogeneity in its manifestations and progression.
Stakeholder Involvement
This clinical practice guideline, of course, acknowledges all the disciplines involved in the preparation of this document, such as Aaron Gale, MD, Kirsten Stoesser, MD, Katherine Fortenberry, PHD, and Dominik Ose, DRPH, MPH, University of Utah, Salt Lake City, Utah, in the Systematic Review Group. These clinicians aimed these guidelines, particularly at utilizers of antipsychotics in dementia patients’ experiences with agitation or psychosis (Gale et al., 2021).
Rigor of Development
Some of the features considered when developing this document are stated below. The absence of conflict of interest can be achieved by making the review group members declare any conflict of interest before the review, during the review, and when the guideline is published.
- Interdisciplinary Review and Development
The guideline writing group, which is a pluralistic group of interdisciplinary specialists, was involved in the review of the draft guideline and provided the perspective of the patients and their families; the APA Council and workgroup provided the experts’ point of view on data collection systematic review methods, the systematic review in the present work, the diagnosis of BDS is defined by the APA board of trustees (Mühlbauer et al., 2021).
This guideline has been developed systematically with the help of the guideline work group members. Thus, a snowball survey technique was used to capture the most informed participants. This strategy entailed the provision of information to the researchers to help them select and enrol specialists who have been shown to have a good track record in managing dementia patients, especially those with aggression or paranoid symptoms.
- Compliance with Medical Standards
These guidelines were developed in compliance with the procedures outlined in the Institute of Medicine’s (2017) six proposed actions. The guidelines were produced following methodologies described by the Institute of Medicine, the Council of Medical Specialty Societies, and the Agency for Healthcare Research Quality. These principles underline the importance of the methodological approach, the accountability, and the stakeholders’ engagement in clinical practice guidelines. To develop enhanced guidelines, The American Psychiatric Association offered the following principles to ensure the guidelines are of a high standard.
NURS 601 Assignment 3.1 Critique a Clinical Practice Guideline
The second document regarding the guideline is the guideline document, where a subsection starting on page 6 outlines the benefits that were generated and procured during the development of the guideline. All of these recommendations are presented systematically, and the quality of each is evaluated using the GRADE system.
- GRADE Framework in Guidelines
GRADE (Grading of Recommendations Assessment, Development, and Evaluation) is an internationally accepted framework that can be used to award the quality of the guidelines based on the recommendations made by the authors on how to apply the intervention in practice considering the balance between benefits and harms (Mühlbauer et al., 2021). Therefore, the systematic approach to recommendations allows for basing them on the results of a systematic review and favourable outcomes in patient management.
The implementation plan for each recommendation is described in detail in each section of the document, along with the level of evidence supporting the recommendation. The last part, with the subtitle “Rating the Strength of Research Evidence and Recommendations,” contains a detailed summary of the research evidence and recommendations, discussing the merits of the research and possible drawbacks. This straightforward approach aids the users of the guidelines in knowing the rationale for the recommendations made, thus enabling them to make proper decisions about their application.
The methods of identifying experts through the snowball survey, following the recommendations of the Institute of Medicine and the GRADE system for the review of evidence, helped develop a high-quality clinical practice guideline. This guideline is well-placed to maintain or increase the quality of management and care for patients with dementia.
Applicability
In the “Proper Use of Guidelines” section, the American Psychiatric Association highlighted that APA Practice Guidelines are evaluations of existing literature employed for educational purposes and should be treated as such, not as a standard (Psychiatry Online, 2023). The guideline contains headings such as “Rating the Strength of Supporting Research Evidence”, which is seen on page 29; “Rating the Strength of Recommendations”, also on page 29; Practical Barriers to Measure Development on page 25.
- Organizational Control & Evaluation
and “External Review”, on page 30. Silence and Wheatley’s paper “It is the way you play the game” identifies the ways that organizational control influences work. The paper shows that complexity and uncertainty reinforce using organizational control as a persuasive account (Keepers et al., 2023). The APA indicates that when evaluating each recommendation, scientific evidence is attached to it by level and strength.
Conclusion
Regarding the sub-sections in NURS 601 Assignment 3.1 Critique a Clinical Practice Guideline, each contains a section that states whether a particular organization or center has received funding or not and an area in each that addresses publication bias. Finally, I would give the overall quality of this guideline on the AGREE II Score Sheet a score of 6 out of 7, where 0 is the least quality, and 7 is the highest quality.
I found that the guideline discussed nearly all of the grading points of the AGREE II Score Sheet and conducted good quality evidence-based research with qualified clinicians and evidence-based research data. As for me, I would like to apply this guideline with no changes. The data retrieved in this guideline will have a favourable effect on the management of antipsychotics in dementia patients.