Portfolio Assignment
The purpose of skilled nursing and long-term care is to ensure that patients record positive health outcomes. However, the duties of the two categories are distinct from one another. Skilled nursing deals with patients who need treatment that can only be achieved by licensed nurses. The skilled nursing facility includes meal preparation, senior care, and offer non-medical assistance. The institutions have specialized professionals such as rehabilitation specialists, audiologists, and speech-language pathologists. Therefore, these services are provided to rehabilitation patients who do not require long-term care services. On the other hand, the long-term professionals offer both medical and social services that are designed to support the needs of patients affected by chronic health problems, which hinder their ability to perform daily activities. The services offered by long term care include medical, housing, and social. This illustrates that the goal of the two medical departments is to ensure that patients record positive outcomes, but their duties in the healthcare industry are different because they deal with different kind of sick people.
Selected Problem
Nurses are required to learn and master evidence-based practice to enable them to provide quality care to patients thus leading to positive health outcomes. Evidence-practice is beneficial in the profession because it allows for the registered nurses with the ability to research and formulate the best practices and to consider patients’ needs and preferences while undergoing treatment. Therefore, nurses are required to adopt evidence-based practices in clinical decision making (Majid et al., 2011). However, the professionals face numerous challenges in their quest to teach evidence-based practice in their line of duty. The major barriers to adopting evidence-based practices in the line of duty are inadequate time, inability to understand the statistical terms used, inability to understand the jargon used in the research documents, inadequate authority to change patient’s care procedures, and lack of qualified clinical personnel in the long-term care unit. The last two are the major problems facing the facility. Hence, it is impossible for a nurse to adopt and implement evidence-based practices in a facility that resists such policies (Majid et al., 2011). When the leaders of the nursing department have no authority to adopt practices that lead to positive outcomes because of resistance from corporate personnel this adversely affects health outcomes. Therefore, the management of hospitals should allow nurses to formulate and implement policies that are geared towards registering positive results.
The purpose of long-term care services is to meet both the medical and non-medical needs of individuals who have a disability or chronic diseases. The heads of such facilities are typically registered nurses who understand the needs of the patients. However, in the station, the head of the home is not a registered nurse (NFA FAQs). Therefore, the policies of the leader are likely to align by the needs of the patients. Moreover, it is unlikely that the facility implements evidence-based practices because the manager of the area does not understand the needs and the advantages associated with the approach. The long-term care patients need close attention and policies that favor their health. Consequently, the facility should have individuals who are qualified and able to protect and promote positive health outcomes.
Five Questions
- How does the implementation of evidence-based practices affect patients’ outcomes?
- How does the conflict between hospital management and nurses affect health outcomes and policy implementation in healthcare facilities?
- What are the roles of skilled nurses and long term care facilities?
- Long term homes offer both medical and non-medical services to their patients. What is the impact of such a facility not being managed by a registered nurse?
- What are the significant challenges that nurses face in the implementation and adoption of evidence-based practices?
The five questions are centered on skilled nursing, long term care, the impact of the type of leadership in various healthcare facilities, and the implementation and adoption of evidence-based practices. In determining the feasibility of the questions, I considered my experiences are working as an in the two sectors in the healthcare industry. Therefore, the questions were based on daily challenges that nurse face as leaders and how they impact on the possible health outcomes (Person Centered Care). The issues are practical because they reflect the ongoing debates in the nursing industry about the importance of leadership and implementation of evidence-based practices to improve the health outcomes in various hospitals across the country. The primary goal of health facilities and nurses is to register positive results. These outcomes are directly affected by the institution’s leadership and the ability of the personnel to adhere to the required evidence-based practices when treating their patients.
Preliminary Picot Question
The initial question is: For residents in long term care (P) does evidenced-based practice care (I) compared to patient-centered care (C) provide the best clinical outcomes (O) for residents who have made the long-term care facility their home (T)?
The question centers on long term care patients. This means that the issue is specific to people suffering from chronic diseases or disability which hinder them from conducting their daily activities. Therefore, they are subjected to live in care homes. The dependent variables in this question are the long term patients while the independent variable is the clinical outcomes that are generated from the long term care facilities (State and Federal Statutes and Rules). The process illustrates that evidence-based practices can influence the health outcomes of patients in long term care facilities. Therefore, evidence-based practices also fall within the dependent variables. The variables form the PICOT question because they highlight the patient (who are residents of a long term facility), intervention that may change the health outcome (introduction of evidence-based practice for long term care patients), comparison (how it affects long term care residents or patient-centered care), outcome of the process (whether it will lead to positive outcomes). Therefore, the variables in the question focuses on the results that can be obtained from long term care residents when evidence-based practice is implemented.
Keywords
The ten possible keywords for the question include:
- Long term care patients
- Evidence-based practices
- Patient-centered care
- Clinical outcomes
- Skilled nursing
- Registered nurses
- Nursing homes
- Chronic diseases
- Non-medical services
- Social services
The goal of experienced nurses and long-term care may be the same, but they serve different kind of patients. Their goal is to register positive health outcomes, but experienced nurses offer services that require the assistance of qualified registered nurses while long term care facilities are centered on people with disability and chronic diseases. Long term care provides both medical and non-medical services to their patients. Therefore, the staff is made of people from different professional backgrounds. Moreover, nurses should implement evidence-based practices because they lead to positive outcomes in facilities. The significant barriers to the implementation and adoption of this kind of practices are the conflict between the management of hospitals and departmental leaders. Nurses should be allowed to formulate regulations and policies that are meant to encourage positive outcomes.
Literature Review
Skilled-Nursing and Long-Term Care
In most healthcare facilities, there are specific services offered to rehabilitation patients who do not require long-term care services. These services include social services, occupational therapy, and medication and can only be offered by skilled professionals who understand the dynamics of the practice. Skilled nursing deals with patients who need treatment that can only be offered by registered nurses. The paper discusses skilled nursing and long-term care as a way of ensuring that patients record positive outcomes and that they follow all the medical prescriptions.
Sanford, A., Orrel, M., Tolson, D., Abbatecola, A., Arai, H., Bauer, J….,& Vellas, B. (2015). An international definition for “nursing home”. Journal of the American Medical Directors Association, 16 (3), 181-184.
According to the article, nursing home care has evolved, and the type and extent of care provided are quite diverse. The article states that most nurses understand that patients should stay in a safe environment and that there is a need to provide quality care services as a way to conform to Sustainable Development Goals agenda (Sanford et al., 2015). Healthy citizens are more likely to engage in productive activities. The article further states that it is the role of healthcare professionals to offer care designed to support the needs of patients affected with different health challenges. Healthcare practitioners are also tasked to focus on providing a supportive and safe environment while assisting residents to maintain functional status. With the culture change movement, nursing homes can now offer a prescriptive set of practices, organizational and human resource practices, and design of the physical environment (Sanford et al. 183). However, according to the article, it is not clear whether functional support and care should be provided to people who need assistance with ADLs. The article gives a contradictory statement about the need to provide long-term care and rehabilitation as part of facilitating early hospice discharges.
McGilton, K., Chu, C., Shaw, A., Wong, R. & Ploeg, J. (2016). Outcomes related to effective nurse supervision in long‐term care homes: an integrative review. Journal of Nursing Management, 24(8), 1007-1026.
The article states that patients at skilled nursing facilities receive counseling on their dietary needs, and at the facility, they are provided with specialized therapy to address their individual needs (McGilton, et al., 2016). Determining whether skilled nursing is the best option depends on the amount of care one needs. In most cases, this has to do with the severity of illness and patients may be advised to seek complete levels of care they can find. In-home skilled nursing care providers are tasked to help with wound care, health monitoring, and train family members to perform certain procedures. Similarly, they help with occupational, speech, and physical therapy (McGilton et al., 2016). Patients who do not require long-term care services should visit healthcare facilities and ask about the current policies and routines that will ensure quality care.
The authors state that effective nurse supervision has significant positive associations with different organizational and regulated nursing outcomes. However, it is not clear whether nursing managers in long-term care are only tasked to promote improvements in nursing care supervision performance or just to focus on decision-making and turnover reduction.
Driessen, J., Nicholas, G., Castle, & Steven M. (2018). Perceived benefits, barriers, and drivers of telemedicine from the perspective of skilled nursing facility administrative staff stakeholders. Journal of Applied Gerontology, 37(1), 110-120.
According to the journal, it is evident that even if patients do not need much attention, but still need much care that cannot be provided at home, it is prudent to consider personal care or assisted living (Driessen, Nicholas & Steven, 2018). While at the facility, patients will get services enough to attain and maintain their highest predictable mental, physical, and psychosocial well-being. Unlike other sectors, nursing homes are required by the law to have an explicit statutory requirement for providing person-centered care (Driessen et al., 2018). In mandating person-centered care, providers are obliged to break away from the prevailing nursing home model which does not represent the current health care approach. Specific practices and structures that are meant to improve care services should be designed to more homelike.
However, this article does not give the rationale of supporting care delivery in some instances. For instance, when it comes to care and resident-related activities, the focus should be on the resident. In this regard, residents should be offered choices and encouraged to make their own decisions about the things personally affecting them. Patients are also advised to focus on the healthcare practices that will ensure that they get quality care at an affordable cost. The article recommends that for such patients to look at reviews the family members of the previous patients left about the facilities online. From the reviews, one will get to know whether the facility is the right place to visit or whether to consider other alternatives.
Hakkarainen, T., Arbabi, S., Willis, M., Davidson, G. & Flum, D. (2016). Outcomes of patients discharged to skilled nursing facilities after acute care hospitalizations. Annals of Surgery, 263 (2), 280.
The article states that it is prudent for the management of any healthcare facility to enable collaboration and decentralized decision-making (Hakkarainen et al., 2016). Also, by adopting participatory management systems, it will be possible to enhance staff turnover and performance. Typically, skilled nursing does not include long-term care needs and hospice care services. If one requires frequent care as ordered by a healthcare professional, the person is usually expected to go and receive care. On the other hand, if a patient is housebound, government programs and insurance are more likely to cover the costs.
In this article, it is evident that the recovery of patients who do not require long-term care services depends on a number of factors including their physical and emotional well-being. Some inconsistencies are also evident here. For instance, in as much as healthcare professionals are tasked to provide quality care even to patients who do not require long-term care services, it is not clear whether these patients should be allowed to enroll in other programs such as tertiary care and hospitalization and quaternary care. Patients who are hospitalized need a higher level of specialty care within the facility (Hakkarainen et al., 2016). There are some people who do not require hospital level care. These people do not suffer from serious illnesses that might require more attention.
Nurses should ensure that the environment in the nursing home is conducive and that it meets their social needs. Normally, self-determined interventions effectively treat serious challenges such as depression. The ability of patients to participate in the design of their recreational programs is critical in addressing the cognitive challenges which can impact the outcome. Just like other care professionals, nursing home residents need to anticipate and engage in activities that can make the sick comfortable during the therapy process. The individualized recreational program is the best way to engage patients.
Ruhl, A. P., Huang, M., Colantuoni, E., Lord, R. K., Dinglas, V. D., Chong, A., … Needham, D. M. (2017). Healthcare Resource Use and Costs in Long-Term Survivors of Acute Respiratory Distress Syndrome: A 5-Year Longitudinal Cohort Study. Critical Care Medicine, 45(2), 196–204.
The article focuses on the fact that each type of long care setting should provide different services including in-patient rehabilitation and skilled nursing facilities. In-skilled nursing facilities, patients who are chronically ill but medically stable are cared for (Ruhl et al., 2017). These patients do not require frequent evaluation by a healthcare professional and require specific services such as physical and emotional therapy. However, it is not clear whether these patients should only receive residential care or both residential and nursing care.
Normally, nursing home residents have medical conditions associated with depression. Depressed patients need specialized treatment. Residents with comorbid dementia require primary care. Primary care is typically responsible for coordinating the care for any other condition. Programs such as Medicare and Obamacare outline the circumstances under which or fail to cover skilled nursing facility costs. For instance, if a patient leaves a nursing facility after some time, Medicare will not cover skilled nursing costs if the same patient returns to the facility. In such cases, it is advisable to seek alternative care services at home or in other healthcare facilities at a cost. The circumstances under which a patient enters medical care may affect whether the existing plan (Medicare) pays for skilled nursing costs. Skilled nursing facilities must meet strict criteria and are subject to frequent inspection to ensure that quality standards are followed at all times.
Summary of Literature Review
| Citation | Setting | Key Concepts/Variables | Findings | Hierarchy of Evidence Level | |
| Hakkarainen, Timo W., et al. “Outcomes of patients discharged to skilled nursing facilities after acute care hospitalizations.” Annals of surgery 263.2 (2016): 280.
|
Type of Study:
Meta-Analysis Design Type: Correlational Framework/Theory: Deductive |
Hospital | Concepts:
Acute care, Hospitalization, skilled nursing Independent Variable: Skilled nursing Dependent Variable: Acute care Controlled Variable: Readmission
|
ü The management of any healthcare facility to enable collaboration and decentralized decision-making
ü Patients who are hospitalized need a higher level of specialty care within the facility. |
Case Reports
Case Control
Cohort Studies |
| Ruhl, A. Parker, et al. “Health care resource use and costs in long-term survivors of ARDS: a 5-year longitudinal cohort study.” Critical care medicine 45.2 (2017): 196.
|
Type of Study:
Longitudinal cohort study Design Type: Descriptive Framework/Theory: Deductive |
Concepts:
Health care resource, long-term survivors, primary care Independent Variable: Long-term survivors Dependent Variable: In-patient rehabilitation Controlled Variable: Skilled-nursing |
ü In-patient rehabilitation facilities care for those recovering from acute illness and surgery
ü Residents with comorbid dementia require primary care |
Case Controlled Study
Case Series
Expert Opinion
|
| Citation | Study
Design Type Framework/Theory |
Setting | Key Concepts/Variables | Findings | Hierarchy of Evidence Level |
| Driessen, Julia, Nicholas G. Castle, and Steven M. Handler. “Perceived benefits, barriers, and drivers of telemedicine from the perspective of skilled nursing facility administrative staff stakeholders.” Journal of Applied Gerontology 37.1 (2018): 110-120.
|
Type of Study:
Meta-Analysis Design Type: Correlational Framework/Theory: Deductive |
Hospital | Concepts:
Coordination of care, enhancing access to providers Independent Variable: Care quality Dependent Variable: Readmissions Controlled Variable: Telemedicine in SNFs |
ü PAHs of nursing facility patients are common and costly.
ü Nursing homes are required by the law to have an explicit statutory requirement for providing person-centered care |
Case Series
Case Reports
Case-Control
Cohort Studies |
| McGilton, Katherine S., et al. “Outcomes related to effective nurse supervision in long‐term care homes: an integrative review.” Journal of nursing management 24.8 (2016): 1007-1026.
|
Type of Study:
Case-Control Study Design Type: Descriptive Framework/Theory: Deductive |
Hospital | Concepts:
unregulated nurse, Effective supervisory performance. Independent Variable: Staffing level Dependent Variable: Effective Supervisory performance Controlled Variable: Turnover as a way to improving resident outcomes
|
ü In-home skilled nursing care providers are tasked to help with wound care, health monitoring, and train family members to perform certain procedures.
ü There is a relationship between effective supervisory performance and unregulated nursing. ü Skilled nurses are tasked to promote improvements in effective nurse supervision performance. |
Systematic review
Case-Controlled Study
Case Series
Expert Opinion
|
| Sanford, Angela M., et al. “An international definition for “nursing home”.” Journal of the American Medical Directors Association 16.3 (2015): 181-184.
|
Type of Study:
Randomized Controlled Trial Design Type: Quasi-experimental Framework/Theory: Correlational |
Hospital | Concepts: Long-term care, care home,
Independent Variable: Skilled Nursing Dependent Variable: Nursing Home Controlled Variable: Institutional nursing
|
ü Skilled nursing deals with patients who need treatment that can only be offered by registered nurses.
ü Healthcare professionals are tasked to offer care designed to support the needs of patients affected with different health challenges |
Randomized control trial
A corporative study
A Systematic Review
|
Research Methodology
Critiquing Quantitative, Qualitative, or Mixed Methods Studies
Critique of a Quantitative Study
Research Problem and Purpose
The number of cases of dementia has significantly grown across the world. The major disorder associated with dementia includes Alzheimer’s disease. Hence, the increased prevalence of Alzheimer’s illness is said to promote the frequency of dementia. Although the condition has drawn the attention of several researchers, there is little information concerning it in Pakistan (Seetlani et al., 2016). Therefore, investigating the frequency of dementia will help to address the increased cases of the disease. In this backdrop, the research aimed to establish the frequency of Alzheimer’s and vascular dementia among aged, ill individuals.
Hypotheses and Research Questions
The study does not mention its hypothesis. However, the research documents its objective, which is; to determine the occurrence of Alzheimer’s and vascular dementia in aged patients.
Literature Review
While the literature review is suitable for the research work, some of the sources used are not current. Moreover, the authors do not analyze the content of the literature selected. Despite these weaknesses, the researchers provide a good synthesis of the literature review, which leads to the identification of the research gap.
Theoretical or Conceptual Framework
The authors of the survey did not employ any framework.
Population
The sample population entailed patients in Ziauddin Hospital Karachi who exhibited symptoms of dementia for over six months. Besides, a consecutive sampling method was used to select participants, leading to a sample size of 422 subjects (Seetlani et al., 2016). While there are no measures undertaken to protect humans involved, Seetlani et al. (2016) obtained permission to conduct the study from the hospital ethical committee. In addition, the researchers obtained written consent from the participants.
Research Design
The study employed a descriptive research design, which was appropriate since the study sought to find out the current state of the phenomenon (Jha, 2014). The situation in question was the occurrence of Alzheimer’s and vascular dementia among sick and aged people.
Instruments and Strategies for Measurement
Participants of the study underwent brain CT scans to determine the presence of Alzheimer’s dementia (Seetlani et al., 2016). However, the research did not provide information regarding the reliability of its data collection instruments.
Data collection
The study reported the use of consecutive sampling method in data collection.
Data Analysis
Seetlani et al. (2016) employed SPSS. Besides, the researchers computed mean and standard deviation for various elements, including age and duration of signs of dementia. In particular, the use of SPSS in data analysis was appropriate since the research applied a quantitative approach with numerical data.
Interpretation of Results
The results of the study indicated that the incidence of Alzheimer’s illness and vascular dementia had a strong correlation with diabetic mellitus and hypertension. Besides, the prevalence of Alzheimer’s illness was substantially high among sick individuals aged between 81 and 85 years (Seetlani et al., 2016).
Discussion of Findings
The analysis of the outcomes of the research was in line with the research work’s framework which sought to determine the occurrence of Alzheimer and dementia in Pakistan.
Limitations
Seetlani et al. (2016) opine that the study was conducted in one health facility, hence not generalizable. Besides, the CT scan alone without additional examination cannot diagnose vascular dementia.
Implications
The survey’s outcomes warrant the interpretation and conclusion that the researchers made since they are consistent with the methodology applied to the research work.
Recommendations
The researchers recommend the need for multiple centers and double-blind surveys to determine the risk classification and diagnose Alzheimer and dementia in the Pakistan community.
Research Utilization in Your Practice
The findings of the study are relevant to my practice and inform the need for early diagnosis and treatment to alleviate the burden of dementia in societies.
Mixed-Methods Research Critique
Research Issue and Purpose
The research aimed to determine the efficiency of an e-learning education intervention that can facilitate self-guided schooling and access to education resources by healthcare professionals taking care of elderly patients, especially those with dementia (Jones & Moyle, 2016).
Researcher Pre-understandings
The study has a review of the researchers’ pre-understanding of the research question. In particular, Jones and Moyle (2016) opine that a training program offered to health workers will improve the quality of the care they provide to elderly patients with dementia.
Literature Review
The study has a comprehensive literature review, which not only reports previous findings on the topic but also critiques the literature.
Theoretical or Conceptual Framework
The survey’s researchers did not employ any framework.
Participants
Participants in the survey entailed students pursuing nursing, enrolled nurses, workforce offering individualized care, diversional therapists, and registered nurses from Griffith University, who offer low and high care to aged individuals with dementia in both Northern New South Wales and Brisbane (Jones & Moyle, T2016).
Protection of Human Research Participants
No measures were taken to safeguard human subjects.
Research Design
The researchers employed a sequential mixed-methods design.
Instruments, Data Collection, Data Generation Methods
The study employed an online questionnaire and an individual semi-structured interview to collect data (Jones & Moyle, 2016). No explanation was given concerning the reliability of the data collecting tools.
Credibility
The generated data were credible because questionnaires and interviews are valid data collecting instruments.
Data Analysis
A Wilcoxon signed-rank test was applied to analyze the data following the use of the Aging Sexual Knowledge and Attitude Scale to compute the participant’s sexual knowledge (Jones & Moyle, 2016).
Findings
The eLearning intervention enhanced the knowledge level of the participants. Besides, the attitudes of the participants were increasingly tolerant toward the display of sexuality by individuals with dementia residing in the aged-care facility (Jones & Moyle, 2016).
Discussion of Findings
In particular, the review of the outcomes was in line with the framework employed in the research work. Besides, the findings were as expected as they established that the eLearning intervention enhanced the knowledge of the participants regarding the aged people’s expression of sexuality (Jones & Moyle, 2016). These outcomes corroborated with findings from previous research work.
Limitations
The study identifies the nature of the topic of education as the major limitation as its mode of delivery does not have capabilities to facilitate interaction, discussion, and support for change in practice.
Implications
The deduction and implications of the study are justified by its revelations as they offer a method of increasing nursing staff’s knowledge regarding the sexual expression of aged people with dementia.
Recommendations
The research does not recommend an area for further study.
Research Utilization in Your Practice
The findings of the research are relevant to my practice as they inform the importance of delivering education to health workers to enhance their attitudes and knowledge of sexuality and older individuals with dementia. Before its implementation, further research needs to be done to determine the most effective mode of providing education to nurses and staff taking care of aged people.
Analyzing the two articles has been significantly insightful. For instance, I have realized that the design adopted by a study is influenced by the purpose of particular research and the intended degree of validity and credibility. In the mixed-method study design, the qualitative part provided a contextual understanding of the phenomenon being investigated. The ASKAS scale converted the qualitative data into scores that could be compared to previous studies, leading to a better understanding of the findings of the study (Jones & Moyle, 2016). Besides, a mixed-method study enhances the validity of a research process. Moreover, I have understood that a quantitative study is relevant when a survey seeks to establish the frequency of a particular variable.
A major advantage of a quantitative design over a mixed-methods method is the large sample size. For instance, the quantitative study had a sample size of 422 participants (Seetlani et al., 2016). Contrary, the mixed-methods had a sample size of 42 subjects (Jones & Moyle, 2016). Therefore, a quantitative study results in generalizable results. Moreover, significant merit of a mixed-methods methodology is that it overcomes the limitation of both a qualitative and quantitative design. For instance, the qualitative aspect of the mixed method provided an in-depth understanding of the participants’ knowledge and attitudes towards older people’s expression of sexuality. The quantitative part of the mixed method allowed the use of statistical methods that enhanced the reliability of the results.
From this article reviewing process, it is evident that the argument that a qualitative study model is not a real science does not hold. In particular, a qualitative design facilitates a detailed comprehension of the phenomenon of interest (Creswell, 2013). Similarly, a quantitative research design is important since it enables the use of large sample size (Houser, 2014). Large sample sizes enhance the generalization of research findings. Therefore, while both qualitative and quantitative study designs have different approaches, they are all valuable in research work as they allow the understanding of a particular aspect in different dimensions.
Summary
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Patients require different approaches from professionals who provide care. Many patients who visit healthcare facilities suffer from chronic illness, such as cancer but occasionally exhibit medical stability. Accordingly, patients need services that require the attention of a qualified nurse to administer treatment. The paper demonstrates the inconsistencies in the services offered by skilled nurses and long-term health professionals in various fields. Further, the paper illustrates that long-term professionals provide social and medical approaches to patients in chronic health challenges while skilled nursing responds to patients who require professional nurses with specific attention in primary health facilities. Therefore, the paper outlines the service variances of clinical and non-clinical professionals working on a setup that implement the two models to enhance the experience of patients.
While defining the specific impact of the two models, the paper focuses on leadership as a significant tool that anchor success in the two approaches. For instance, the paper demonstrates that nurse leaders can identify patient needs and classify them appropriately to achieve enhanced health outcomes. Additionally, the paper establishes that conflict between hospital management and nursing departmental leadership can impact health approaches negatively. Hence, nurses should have the autonomy to generate policies and guidelines that influence positive health outcomes of patients.
The paper investigates the frequency of dementia in Pakistan with specific attention to vascular dementia and Alzheimer’s in aging patients. The paper employs secondary research to launch its investigation and analyze the merits and demerits in the publications and peer-reviewed journals utilized. The study also relates the methodologies and approaches applied in the sources utilized and their consequential effects on the findings. Finally, the paper analyses the impact of skilled nurses and long-term health professionals in the management of vascular dementia and Alzheimer’s in aging patients in Pakistan.
