Non-pharmacological Nursing Interventions Literature Review

5 METHODOLOGY

A literature review is defined as a critical analysis of a segment of a published body of knowledge through summary, classification, and comparison of prior research studies, reviews of literature, and theoretical articles.

In addition to that a literature review will be used for conducting the research. According to Fink (2010), literature review is an evaluative report that is a systematic, explicit and reproducible method for identifying, evaluating and synthesizing the existing body of completed and recorded work produced by researchers and scholars. In this literature review the main focus was to search the existing literature on non-pharmacological nursing interventions in order to be able to describe and analyze the similarities, differences, consistencies and inconsistencies and issues within the research topic.

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5.1 Inclusion and exclusion criteria

Inclusion criteria are characteristics that proposed subjects must possess in order to be integrated in the future study. On the other hand, Exclusion criteria are characteristics that help the researcher to eliminate subject from being integrated in the study. A clear comprehension of the inclusion and exclusion criteria ensures that the research yields accurate and genuine results (Fink 2010). The inclusion and exclusion criteria of this literature review are described below in table 1.

TABLE 1. Inclusion and Exclusion criteria

4.3 Data collection

The research articles for the literature review were limited to a time frame between 2006-2015. The information was gathered using different computerized databases such as Ebrary, CINAHL, Ovid, SAGE Premier and Science Direct, to find scientific journals. Moreover web based publications such as WHO, kaypahoito and Terveyden ja Hyvinvoinnin Laitos were also used.

In addition to that numerous articles were gathered from well known scientific journals such as Journal of Advanced Nursing and Journal of Nursing Education. Keywords used in the search were focused on the research topic, they included Geriatric Depression, non-pharmacological interventions and Signs of geriatric depression. The key words and the time frame were combined in order to constrict the range of articles; the materials obtained for this study were in both English and Finnish.

4.4 Data analysis

The collected data will be analyzed through content analysis of the collected articles, journals and electronic web pages. All the collected data related to the topic will be divided into different groups to make analysis easy.

5 ETHICS AND RELIABILITY

High ethics will be maintained throughout the research process. I will also consider a good scientific conduct to ensure that the research is ethically acceptable. The authors in the references will be respected and thus referred accurately. The research project is about finding out the effectiveness of non- pharmacological treatment methods when dealing with geriatric depression. I plan to follow the set thesis guidelines of Centria University of Applied Sciences while carrying out my research. Reliability will be ensured by only referring to recent research materials available concerning geriatric depression. The articles and other materials will be obtained from reliable electronic sources and the school’s library databases to ensure that valid results are obtained that can be used in the future.

6 FINDINGS

6.1 Non-pharmacological nursing interventions

Physical Exercise

In a study by Park, Han and Kang (2014), it was found that regular exercise for older adults suffering from depression increased their social contact and improved their self efficacy. Physical activities also had inverse relationship with depression among the elderly. This meant that older adults engaging in physical exercises were found to have improved mental and physical health. (Lee, Brar, rush and Jolley 2014.)Regular physical exercises reduced depressive symptoms and anxiety associated with aging and other predisposing factors such as chronic ailments. In additional to that, older adults involved in physical activities ended up having some positive thoughts and opinions on their own aging process. (Park et al 2014.)

As a result of physical exercise physical exhaustion was also highly reduced as a result of improved cardiovascular activity, immune system and the endocrine system. These also translated to reduction of depressive symptoms and an improvement in psychological well being. (Tsang, Fung, Chan, Lee, and Chan, 2006). In another study by Stanton and Reaburn (2014), it was confirmed that aerobic and non aerobic exercises including outdoor walking and stationary cycles demonstrated a reduction in depressive symptoms among the elderly. Exercises were conducted three times a week for a total duration of twelve weeks. (Stanton et al 2014.)

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Furthermore, regular physical activities among the elderly were found to improve their quality of sleep. Poor sleep quality and related sleep disturbances were attributed to in active lifestyles and repetitive daily routines, which further lead to cases of depression, anxiety, agitation, fatigue and daytime drowsiness. In a related article by Cheng, Huan, Li and Chang (2014), found that elderly people who engaged in physical activities such as the senior elastic band exercise reported improved sleep quality and significant decrease in depressive symptoms. In additional to that, Chen et al (2013) developed the wheelchair-bound senior elastic band (WSEB) exercise program, which granted the depressed older adults bound on wheel chairs an opportunity to exercise too. (Chen et al 2013.)

Cognitive Exercise

According to a study by Khatri, Blumenthal, Babyak and Krishman (2001), it was determined that physical exercise impacts positive effects on the cognitive functioning among elderly people suffering from depression. The study was carried out on two different groups of randomized participants: medication group and the aerobic exercise group. All the groups underwent the tests for duration of four months. In the medication group they received antidepressants while the exercise group underwent aerobic training. In addition to depression cognitive functions were also assessed, for example memory, executive functioning, concentration and psychomotor speed. Assessment tools used in the study included Beck Depression Inventory (BDI) and Wechsler Memory Scale (WMS). It was established that participants in the exercise group exhibited greater improvements in both memory and executive functioning than those in the medication group. Furthermore, the exercise group also showed better improvements in the Wechsler Memory Scale visual reproduction delayed recall scores. However there were no significant differences in the verbal memory and concentration. (Khatri et al 2001.)

Vasques, Moraes, Silveira, Deslandes and Laks (2011), found that despite physical exercise having significant effects on depression it also exhibited positive effect on the brain function. During their study neuropsychological tests were performed in the forms of Mini Mental State Examination (MMSE), the Digit Span Test (DST)and the Stroop Color-Word Test (SCW) to assess the cognitive functions of their elderly participants suffering from major depressive disorder. After the participants walking on the treadmill for half an hour cognitive tests were performed before, during, after and 10-15 minutes after the training session.

Similar cognitive tests were also performed on the control group but without exercise. There were no significant differences for both the control and the exercise group on the Digit Span Test. However in the Stroop Color-Word Test, the exercise group had improvements in their results when compared to the control group. The improvements were a clear indication that physical exercise had a positive effect on the cognitive functions of the depressed participants. (Vasques et al 2011.)

According to Nicholas et al (2006), nurses used Problem solving therapy to help patients with depression to improve their cognitive functioning. Individuals were assigned certain tasks to handle in the form of games which varied from cheap to hard. This helped the individuals to think in a structured way which in turn improved their cognitive functioning. In additional to that it helped relieve depressive symptoms. (Nicholas et al 2006; Haggerty 2006.)

Family Therapy

In another study by Tanner, Martinez and Harris (2014), to examine the functional and social determinants of depression on community dwelling older adults it was concluded that support from family showed an improvement in general functions and a decrease in loneliness. In additional to that, family support satisfaction scale (FSSS) was used on the older adults to assess satisfaction with support received. The instrument consisted of 13 questions constructed to investigate the participant’s satisfaction with the family support they received from family members. The participants were expected to respond with either agreement or disagreement. It was found that those participants who had higher support scores had decreased levels of depression.

Loneliness was also identified as one of the main causes of depression in addition to other predisposing factors. Older adults who were satisfied with the family support they received confirmed that it helped them cope with depression as well as chronic illnesses. (Tanner et al 2014).

Nurses were found to play a crucial role in helping elderly people dealing with depression developed as a result of social isolation or bereavement. It was discovered that leaving these psychosocial factors not dealt with it made it difficult to make a lasting or complete recovery. (Hughes 2005). Nurses were found to play an important role in guiding, supporting and encouraging elderly people dealing with depression to keep contact with their family members. (Parello 2012.)

According to a study by Merema (2014), it was found that older adults with good social network between them and their family members had higher levels of self esteem and self worth. In additional to that they were less likely to attempt suicide when compared to their counterparts with little or no social network at all.

Music therapy

According to a research carried out by Chan, Mok and Tse (2009), to determine the effects of music on depression levels in elderly people. The study was conducted on 47 elderly people (23 using music and 24 controls), majority of who were 75 and above. It was pointed out that music exerts psycho-physiological responses through influence on the limbic system. The limbic system is involved in our feelings of pleasure and emotions such as fear, anger as well as motivations. Therefore the limbic system is mostly affected by music rhythm as well as pitch and is also responsible for processing the music stimuli. It was found that music expends its effects through entertaining the body rhythms. In this context entertainment can be described as a tendency by two bodies locking together and vibrating in harmony. When an elderly person is going through a depressive phase they tend to experience mixed feelings of discomfort or agitation which in turn disrupts their body rhythms. The Body rhythms is disrupted through change in breath, blood flow and heartbeat which further lead to changes in blood pressure levels and oxygen saturation. (Chan et al 2009).

The music interventions used included four different types of music which included western classical, western jazz, Chinese classical and Asian classical. Each type of music was played for a duration of 30-min once per week for a duration of four weeks. The participants listened to the music without any interaction with the therapist. At the end of the study the depression levels of the experimental group had significantly decreased from form mild depression to normal levels. On the contrary there was no change in the depression levels for the control group within the four weeks. (Chan et al 2009).

Furthermore, the physiological measures monitored including systolic and diastolic blood pressure, heart rate and respiratory rate of the elderly in the experimental group had reduced significantly in comparison to those of the control group. The findings demonstrated the benefits music has on older people suffering from geriatric depression. Music had a soothing physiological and Psychological effect on the elderly suffering from geriatric depression. This also support that music has the capability of to resonate with the listeners feelings. (Chan et al 2009).

It was discovered that giving participants an opportunity to choose their music led to effective treatment. Chang, Wong and Thayala (2011), suggested that when the participants chose their own music it facilitated the entertainment process because the listener was in tune with their music of choice. The effects of music listening did not occur after one or a few sessions. In contrary to that, significant decrease in depression levels were reached after the participants had music listening sessions for a few weeks. In additional to that it was found that different kinds of music had similar effects on depressive symptoms among the elderly depending on the listener’s preference of music. (Chang et al. 2011).

Music therapy was found to reduce irritability, agitation, and problem behaviors in people with geriatric depression. In additional to that it was also found that music therapy improves the sleep quality of people dealing with geriatric depression. (Rice et al 2010).

Social activities

While going through recent randomized trials it was found that social activities were effective interventions which improved depression outcomes among the elderly. (Merema 2014.) Social activities were provided in form of recreational group events such as day meetings, group outings and visits from family. These social activities generated social interaction and support among the elderly. (Hsu and Wright 2014).

In additional to that it was found that through social activities the elderly were able to establish enduring relationships which in turn provided an effective method of reducing or limiting the severity of depression. It was also established that social activities improved the sleep quality and the cognitive functions of the elderly people. Social activities had a direct effect on the levels of loneliness faced by elderly people with depression. Furthermore it was discovered that depressed old adults felt much better when they were around other people. (Merema 2014.) Engagement in social activities was found to reduce cases of social isolation thus limiting worsening in the severity of depression. (Hsu et al 2014.)

In a study by Hsu et al (2014), it was indicated that meaningful and enjoyable social activities lead to a decrease in depressive symptoms among institutionalized elderly living with depression. Social activities that were interesting to the elderly dealing with depression showed a decrease in depressive symptoms. It was found that a large number participated in social activities in the institution due to the positive emotions they experienced or out of personal interest. (Merema 2014.) The reduction in depressive symptoms was as a result of the psychosocial mechanism which includes a positive feedback where there is an improved mood due to pleasant events. Surprisingly it was found that institutionalized depressed elders participated more in social group activities. The institutional environment offered them an opportunity to participate in activities that led to more positive mental attitude and a decrease in depressive symptoms. (Hsu et al 2014.)