Research Methods: Quantitative vs Qualitative

Research Characteristics

• Quantitative research: focuses on numerical data, statistical analysis, and objective measurements to test hypotheses and predict outcomes
• Quantitative research characteristics: uses surveys, questionnaires, and experiments to collect data, often with large sample sizes
• Qualitative research: focuses on non-numerical data, exploring meanings, and gaining in-depth insights into phenomena
• Qualitative research characteristics: uses interviews, observations, and content analysis to collect data, often with small sample sizes

Value of Quantitative Research

• Provides generalizable results due to large sample sizes
• Allows for precise predictions and forecasts
• Enables comparison across different groups and populations
• Facilitates the identification of causal relationships between variables

Value of Qualitative Research

• Provides rich, contextual, and nuanced insights into phenomena
• Enables an in-depth understanding of participants' experiences and perspectives
• Facilitates the generation of new theories and hypotheses
• Allows for exploration of complex, multifaceted issues

When to Use Each Type of Research

• Use quantitative research: when testing hypotheses, predicting outcomes, or comparing groups
• Use qualitative research: when exploring new topics, gaining in-depth insights, or developing theories

Comparing Value

• Both quantitative and qualitative research have unique strengths and weaknesses
• Neither type of research is inherently more valuable than the other
• The choice of research type depends on the research question, goals, and context

Cognitive Disorders, Alzheimer's, and Dementia

• Cognitive disorders: characterized by disruption of thinking, memory, processing, and problem-solving abilities (ATI Chapter 17: Neurocognitive Disorders)
• Types of cognitive disorders:
  • Delirium
  • Mild neurocognitive disorder
  • Major neurocognitive disorder (dementia)

Delirium

• Short-term and reversible
• Risk factors:
  • Physiological changes (e.g., Parkinson's, Huntington's)
  • Metabolic disorders (e.g., hepatic or renal failure)
  • Cardiovascular or respiratory diseases
  • Infections (e.g., AIDS/HIV)
  • Surgery
  • Substance abuse or withdrawal
  • Older age
  • Multiple co-morbidities
  • Polypharmacy
  • Aphasia
  • Change in client environment
• Expected findings:
  • Rapid onset (hours or days)
  • Impairments in memory, judgment, ability to focus, and ability to calculate
  • Disorientation and confusion often worse at night and early morning
  • Fluctuating levels of consciousness
  • Four types: hyperactive, hypoactive, mixed, and unclassified
  • Restlessness, anxiety, motor agitation, and fluctuating moods are common
  • Personality change is rapid
  • Perceptual disturbances (e.g., hallucinations and illusions) may be present
  • Can cause vital signs to become unstable, requiring intervention
  • Reversible if diagnosis and treatment of underlying cause are prompt

Neurocognitive Disorder (NCD)

• Gradual onset (months or years)
• Risk factors:
  • Advanced age
  • Lifestyle factors
  • Metabolic syndrome
  • Diabetes
• Expected findings:
  • Impairments in memory, judgment, speech, and ability to recognize familiar objects
  • Impairments in executive functioning (e.g., managing daily tasks) and movement
  • Gradual personality change
  • Stable vital signs unless another illness is present
  • Cognitive deficits not related to another mental health disorder
• Subtypes of NCD:
  • Alzheimer's disease
  • Traumatic brain injury
  • Parkinson's disease
  • Other disorders affecting the neurologic system

Defense Mechanisms

• Denial: refusing to believe that changes are taking place
• Confabulation: making up stories or events to fill gaps in memory
• Preservation: avoiding questions by repeating phrases or behaviors

Diagnostic Procedure

• No specific lab test to diagnose NCDs
• Testing is done to rule out other pathologies that could be mistaken for NCDs
• Screening and assessment tools:
  • Confusion Assessment Method (CAM) for delirium
  • Neelon-Champagne (Neecham) Confusion Scale for delirium
  • Functional Dementia Scale for ability to perform self-care and extent of memory loss
  • Brief Interview for Mental Status (BIMS) for clients in long-term care settings
  • Mini-Mental Status Examination (MMSE)
  • Functional Assessment Screening Tool (FAST)
  • Global Deterioration Scale
  • Blessed Dementia Scale

Nursing Care

• Best way to manage delirium is to minimize risk factors and promote early detection
• Perform self-assessments regarding anger or frustration when performing ADLs for a patient with progressive cognitive decline
• Protect the client from injury
• Provide a safe and therapeutic environment
• Cognitive support:
  • Provide compensatory memory aids
  • Keep a consistent daily routine
  • Maintain a consistent caregiver
  • Cover or remove mirrors to decrease fear and agitation
  • Encourage physical activity
• Physical needs:
  • Monitor neuro status
  • Assess skin integrity
  • Monitor vital signs
  • Promote sleep measures
  • Ensure adequate food and fluids
• Communication:
  • Use a calm, reassuring tone
  • Use positive words
  • Reinforce reality
  • Make eye contact
  • Minimize the need for decision-making

Medications

• Delirium:
  • Medications can be the underlying cause
  • Recognize medication reactions before delirium occurs
  • Focus on treatment of underlying cause
  • Antipsychotic or antianxiety medications may be prescribed
• Neurocognitive Disorders:
  • Cholinesterase inhibitor medications (e.g., donepezil, rivastigmine, galantamine)
  • Contraindications and interactions with other medications
  • Memantine for moderate to severe Alzheimer's disease

Nursing Administration

• Start with a low dose and gradually increase
• Monitor for adverse effects
• Taper medications
• Assess patient swallow
• Administer at bedtime with or without food

Alzheimer's Disease

• Progressive and irreversible
• Most common type of NCD
• Stages of Alzheimer's disease:
  • Stage 1: No apparent symptoms
  • Stage 2: Forgetfulness
  • Stage 3: Mild cognitive decline
  • Stage 4: Mild to moderate cognitive decline
  • Stage 5: Moderate cognitive decline
  • Stage 6: Moderate to severe cognitive decline
  • Stage 7: Severe cognitive decline

Other Neurocognitive Disorders

• Vascular NCD: characterized by significant cerebrovascular disease
• Frontotemporal NCD: caused by shrinkage of the frontal and temporal anterior lobes of the brain
• NCD due to traumatic brain injury: caused by amnesia
• NCD due to Lewy Body disease: similar to Alzheimer's disease but progresses more rapidly### Learning Theory
• Learned Helplessness: individuals who experience numerous failures learn to give up trying, leading to depression and feelings of lack of control over their life situation.
• Object Loss: experiences of loss of a significant other during the first 6 months of life can predispose individuals to lifelong periods of depression.
• Cognitive Theory: views depression as a cognitive rather than affective disorder, characterized by three cognitive distortions:
  • Negative expectations of the environment
  • Negative expectations of self
  • Negative expectations of the future
• Transactional Model: combines genetic, biochemical, and psychosocial influences on an individual's susceptibility to depression.

Childhood Depression

• Symptoms:
  • Infancy (<3 years): feeding problems, tantrums, lack of playfulness, and emotional expressiveness, failure to thrive, delays in speech and gross motor skills
  • Toddlerhood (3-5 years): accident proneness, phobias, excessive self-reproach
  • Early school age (6-8 years): physical complaints, aggressive behavior, clinging behavior, lack of social skills
  • Late childhood (9-12 years): morbid thoughts and excessive worrying, lack of interest in playing with friends
• Treatment: alleviating symptoms, strengthening coping and adaptive skills, and preventing future psychological problems through parental and family therapy.

Adolescence

• Symptoms:
  • Anger, aggressiveness, running away, delinquency, social withdrawal, sexual acting out, substance abuse, restlessness, and apathy
• Treatment:
  • Supportive psychosocial intervention
  • Antidepressant medication

Senescence

• Bereavement overload
• High percentage of suicides among the elderly
• Symptoms of depression often confused with symptoms of neurocognitive disorder
• Treatment:
  • Antidepressant
  • Electroconvulsive therapy
  • Psychosocial therapies

Postpartum Depression

• Lasts weeks to months
• Associated with hormonal changes, tryptophan metabolism, or cell alterations
• Symptoms:
  • Fatigue, irritability
  • Loss of appetite
  • Sleep disturbances
  • Loss of libido
  • Concern about inability to care for infant
• Treatment:
  • Antidepressants
  • Psychosocial therapies

Nursing Process/Assessment

• Severe depression marked by distress that interferes with social, occupational, cognitive, and emotional functioning
• Four spheres of human functioning:
  • Affective
  • Behavioral
  • Cognitive
  • Physiological

Group and Family Therapy

• Group therapy:
  • Stress management, substance abuse disorders, medication education, understanding mental illness, and dual diagnosis groups
• Group process: verbal and nonverbal communication, how members interact with one another
• Group norm: the way the group behaves during sessions and over time
• Phases of group development:
  • Orientation phase: purpose and goals of the group
  • Working phase: problem-solving skills
  • Termination phase: end of group sessions

Brain Stimulation Therapies

• Electroconvulsive therapy: can enhance the effects of neurotransmitters (serotonin, dopamine, and norepinephrine) in the brain
• Transcranial Magnetic Stimulation: a noninvasive therapy that uses magnetic pulsations to stimulate the cerebral cortex of the brain
• Vagus Nerve Stimulation: implanted on the client's chest, similar to a pacemaker device, to increase neurotransmitters and enhance the action of antidepressant medications.