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i need this assignment to be edited and added some more sentences, it should be the same amount of reference on one one full page and cover should one page below are what i already did.PLEASE RED THE COMMENT ON THIS PAPER

I just got the feed back from the Chair for my dissertation and she wants me to make some more changes and resubmit it so this is some of the instructions.

These are the instructions from the Chair:

1. The topic of the dissertation is way too broad

2. focus on the family caregivers only

3. focus and show the impact of stress on family caregivers

4. Use and explain the quantitative inventory that measures stress

5. What aspects of specific qualitative interviews are you going to use.

6. You must show the gap you are writing about.

7. Please read the comments from the chair in the attached paper.

2. focus on the family caregivers only

3. focus and show the impact of stress on family caregivers

4. Use and explain the quantitative inventory that measures stress

5. What aspects of specific qualitative interviews are you going to use.

6. You must show the gap you are writing about.

7. Please read the comments from the chair in the attached paper.

A Mixed Method Study of the Implications of High Stress among Caregivers for Patients with Alzheimer’s disease

Ph.D. Psychology Program – Clinical Psychology

Introduction and Background of the Study

The problem and burden of high stress among the caregivers of individuals with Alzheimer’s disease is paramount. This is due to the adverse economic impact and negative social changes on the families of the afflicted individuals and the society as a whole (Cuéllar-Flores et al., 2014The condition remains the only one among the top 10 causes of death in the United States of America that is not preventable. Moreover, Alzheimer’s disease cannot be cured, and its progression cannot be controlled.Citation? Over 5 million American of different ages suffered from this disease in 2015.Citation? This population includes over 5 million individuals between the age of 65 and above and an estimated 300,000 under the age of 65 with early-onset of Alzheimer’s disease (Hebert et al., 2013). Alzheimer’s disease ranks as one of the most costly and expensive chronic illnesses to the family of the afflicted as well as to the society. In 2015 alone, the immediate cost to the United States of America for providing care to individuals who have Alzheimer’s disease is projected to be over $228 billion, with over half of the cost expected to be paid by Medicare. Such a scenario is a crisis that requires immediate intervention; otherwise, this disease is already projected to cost the American society over $1.5 trillion in 2050.

Millions of family member of individuals who have Alzheimer’s disease provide caregiving services to their loved ones citation?and by so doing complement the efforts of the health care providers in the delivery of health care services. This project underscores the high level of stress, financial difficulties and economic hardships associated with providing care to these Alzheimer’s disease patients during their treatment phase. It is imperative to note that these family members or friends who act as caregivers to their loved ones are not professionals like physicians and nurses. According to Kemp (2015), they lack adequate coping and stress management skills necessary for the type of strains, devastating economic tolls and a variety of other unforeseen conditions to which they are exposed as caregivers. It has been strongly pointed out that, caregiving without the required training and skills are deleterious to the caregivers’ health to the extent that their continued safety and daily well-being need to be taken very seriously (Zehner Ourada & Walker, 2014). Compared to non-givers, they often experience psychological, behavioral, and physiological effects that can contribute to impaired immune system function, coronary heart disease, and early death ((Medrano et al., 2014; Ornstein & Gaugler, 2012). Need to include the number of individual caring for these patients……demonstrate the scope of the issue.

Problem Statement and Justification of the Study

It is essential to note that the process of care delivery is complicated. The process of disease management, especially in terminal cases, is associated with burnouts and psychological effects for nurses based on the environment of operation for the practitioners while interacting with patients.Citation? Little literature exists regarding the association between the Alzheimer’s disease and possible effects such as devastating hardship, suffering, stress, and financial difficulties for the caregivers of the patients with the disease.How do you know this? The research literature should support this claim. Other notable facts about the disease depict that in 2014 alone, there was over $10 billion in additional health care costs attributed directly to the physical and emotional problems associated with caregiving by the caregivers to those who have Alzheimer’s disease (“2014 Alzheimer’s disease facts and figures”, 2014).[RB1]Furthermore, Alzheimer’s disease has been identified as one of the top six leading cause of death across all ages in the United States of America. It is astonishing to realize that personal care to those with Alzheimer’s diseases is provided by family members and untrained caregivers, thereby resulting in enormous health and economic burdens and very high stressful lifestyle to those caregivers (Mioshi et al., 2013). [RB2]

Over 60 percent of the caregivers to those who have Alzheimer’s disease believe that the emotional stress of caregiving is very high. Over 40 percent believe that caregiving is responsible for their diagnoses of anxiety disorder, depression, and financial woes; however, a succinct evaluation of such sentiments is not comprehensive (Uren & Graham, 2013). Uren and Graham outlined the existence of high-level stress among the nurses but did not evaluate the implication on the professionalism and competence levels among the said nurses as they execute their duties. Besides, their study did not include the perspective of the victims regarding the quality of care they receive from the nurses (Uren & Graham, 2013). Therefore, this study is focused in filling this literature gap[RB3] .

Purpose of the Study

There is a need for a scientific study that will examine the relationship between the disease and the stress implications witnessed among the caregivers involved in care delivery among the patients suffering from the condition. Working with speculations and perspectives may not reveal the reality surrounding this notion. Therefore, this study seeks to carry out a qualitative and quantitative evaluation to ascertain the relationship between prevalence of high stress among caregivers and the care delivery process for patients with the Alzheimer’s disease. In this study, the objective stressors include physical disabilities of the patient, their problem behaviors, cognitive impairment, and the intensity of care given. In caregivers, the objective stressors result in impaired health behaviors, psychological stress, and excite physiological responses which lead to illness and mortality. It is not clear if you are focused on perceptions of the caregivers regarding the experiences of their patients or if you are focused on the experiences of the caregivers themselves. You need more literature support for your purpose.

Research Questions

Two primary questions will guide the study process. The first question will investigate the existence and nature of the association between the stress levels of the nurses and the manner in which they adhere to professionalism and competence in care delivery process. The second question will evaluate the existence and nature of relationship existing between the high-stress levels among nurses and the quality of care that the Alzheimer’s disease patients receive. Therefore, the following questions will guide the study.

RQ1 – What is the relationship between the prevalence of high-stress levels among nurses providing care to Alzheimer’s disease patients and their competence in care delivery process?

RQ2 – What is the relationship between the prevalence of high-stress levels among nurses providing care to Alzheimer’s disease patients and the quality of care services the patients receive?

[RB4] Significance of the Study

The evaluation of the scenarios existing within the healthcare delivery systems is a complicated process; however, the knowledge emanating from such findings is critical for the decision-making process and transformational changes in the provisions of services. It is essential to note that the adverse consequences of caregiving strain on caregivers [RB5] such as anxiety, isolation, anger, and many other emotional and psychosocial problems that influence negatively on the caregiver’s lifestyle (Roth, Fredman & Haley, 2015). Adverse economic impact (Feinberg, 2011) and the devastating toll of caregiving on the immune system and mortality (Lovell & Wetherell, 2011) have also been associated examined through research and offered practical solutions. These problem areas range from objective data that offer a big picture of personal care and activities of daily living (Lynn & Montgomery, 2015) to more standardized activities that prescribe caregiving for those who are afflicted with various diseases (Rokach et al., 2014). The understanding of the existing association between the stress levels of the nurses and the manner in which they adhere to professionalism and competence in care delivery process will help in creating intervention measures that will assist in generating corrective measures. The analysis of the quality of care that the Alzheimer’s disease patients receive will assist in creating new approaches that will enhance their experiences while receiving care.

Theoretical Framework

The theoretical framework for this study will be the Social Exchange theory. According to Mitchell, Cropanzano & Quisenberry (2012), Social Exchange theory is a psychological theory, which states that as human beings, we make all life social decisions depending on what we perceive to be the costs and benefits of the decisions to us. Regarding social relationships, this theory points out those individuals carefully consider all potential social interactions with respect to what they can get or lose by getting into them. Social exchange theory ascertains that the benefits and dividends associated with human relationships are anything positive that helps to elevate our ego or value such as gaining access to power, money, status, gratification, pleasure, and sex. Social Exchange theorists argue that equitable exchange minimizes informal caregiver stress and burden. It is their opinion that when care recipients return kindness or gratitude for the aid they are receiving, balance is created and caregivers will experience more satisfaction and less caregiver stress (Savage & Bergstrand, 2013). Hill’s theory has some relevance and applies to individual’s current situation, and circumstances (Peterson & Steinmetz, 2014). Nevertheless, the association with the social environment may also alter perceptions, the level of competence, and emotional stability based on the individual’s understanding and experience. The theory has been selected for this study since the research process seeks to investigate the implication of the interaction between nurses and patients with the Alzheimer’s disease while delivering their mandates based on the stress factor.

Methodology of the Study

The research will involve a mixed study approach. A quantitative design will incorporate research that will be based on providing answers to narrow questions objectively to arrive at a suitable conclusion. The method will mainly involve the collection of raw data through questionnaires and observation among other techniques. The quantitative part of this study will assist in getting the field information regarding the subject of the study, which will be expressed in the form of numerical representations. The study requires a higher level of validity and reliability since it involves a subject of global interest. Therefore, the approach will mainly depend on the application of statistical techniques to add value to numerical data existing in within the scope of the study. On the other hand, the qualitative method will be essential in getting the perceptions of stakeholders such as the nurses, the patients, and facility managers involved in the study where necessary based on their personal experiences. The mixed approach is essential in social research whenever the study seeks to present a wider perspective on the problem in question.[RB6]

Sources of Data

The study will involve a variety of techniques that will be used to gather data from the identified stakeholders. The use of interviews will be essential in collecting firsthand information such as the number and appraisal performance of nurses working with the Alzheimer’s disease patients. The interviews with the nurses will gather their views and perceptions regarding their working environment. The representative of the Alzheimer’s disease victims [RB7] will also be interviewed to reveal their opinion relating to the quality of care services their patients receive from the practitioners. The use of questionnaires will be substantial when gathering information from a larger sample. The surveys, which will incorporate the site seeing of the areas selected for the study, will be used to collect the information that the researcher will observe across the scope related to the study. Furthermore, this research will examine the available secondary sources to evaluate the correspondence of the study with previously discussed concepts related to practitioners’ competence and care delivery.[RB8]

References

2014 Alzheimer’s disease facts and figures. (2014). Alzheimer’s & Dementia, 10(2), e47-e92. http://dx.doi.org/10.1016/j.jalz.2014.02.001

Cuellar-Flores, I., Sanchez-Lopez, M., Liminana-Gras, R., & Colodro-Conde, L. (2014). The GHQ-12 for the Assessment of Psychological Distress of Family Caregivers. Behavioral Medicine, 40(2), 65-70. http://dx.doi.org/10.1080/08964289.2013.847815

Feinberg, L. (2011). Valuing the Invaluable. Washington, D.C.: AARP Public Policy Institute.

Hebert, L., Weuve, J., Scherr, P., & Evans, D. (2013). Alzheimer disease in the United States (2010-2050) estimated using the 2010 census. Neurology, 80(19), 1778-1783. http://dx.doi.org/10.1212/wnl.0b013e31828726f5

Kemp, C. (2015). Caregiving as a Public Health Issue: Framing Policy Discussions. Healthcarepapers, 15(1), 28-33. http://dx.doi.org/10.12927/hcpap.2015.24399

Lovell, B., & Wetherell, M. (2011). The cost of caregiving: Endocrine and immune implications in elderly and non elderly caregivers. Neuroscience & Biobehavioral Reviews, 35(6), 1342-1352. http://dx.doi.org/10.1016/j.neubiorev.2011.02.007

Lynn, J., & Montgomery, A. (2015). Creating a Comprehensive Care System for Frail Elders in “Age Boom” America. The Gerontologist, 55(2), 278-285. http://dx.doi.org/10.1093/geront/gnu175

Medrano, M., Rosario, R., Payano, A., & Capellan, N. (2014). Burden, anxiety and depression in caregivers of Alzheimer patients in the Dominican Republic. Dementia & Neuropsychologia, 8(4), 384-388. http://dx.doi.org/10.1590/s1980-57642014dn84000013

Mioshi, E., Foxe, D., Leslie, F., Savage, S., Hsieh, S., & Miller, L. et al. (2013). The Impact of Dementia Severity on Caregiver Burden in Frontotemporal Dementia and Alzheimer Disease. Alzheimer Disease & Associated Disorders, 27(1), 68-73. http://dx.doi.org/10.1097/wad.0b013e318247a0bc

Mitchell, M. S., Cropanzano, R. S., & Quisenberry, D. M. (2012). Social Exchange Theory, Exchange Resources, and Interpersonal Relationships: A Modest Resolution of Theoretical Difficulties. Handbook of Social Resource Theory Critical Issues in Social Justice, 99-118. doi:10.1007/978-1-4614-4175-5_6

Ornstein, K., & Gaugler, J. (2012). The problem with “problem behaviors”: a systematic review of the association between individual patient behavioral and psychological symptoms and caregiver depression and burden within the dementia patient–caregiver dyad. Int. Psychogeriatr., 24(10), 1536-1552. http://dx.doi.org/10.1017/s1041610212000737

Peterson, G., & Steinmetz, S. (2014). Pioneering Paths in the Study of Families. Hoboken: Taylor and Francis.

Rokach, A., Miller, Y., Shick, S., Abu, R., & Matot, I. (2014). Surgery and Caregiving: Loneliness of the Patients and Those Who Care for Them. OJMP, 03(03), 222-234. http://dx.doi.org/10.4236/ojmp.2014.33024

Roth, D., Fredman, L., & Haley, W. (2015). Informal Caregiving and Its Impact on Health: A Reappraisal From Population-Based Studies. The Gerontologist, 55(2), 309-319. http://dx.doi.org/10.1093/geront/gnu177

Savage, S., & Bergstrand, K. (2013). Negotiating the Unknown: The Role of Uncertainty in Social Exchange. Sociology Compass, 7(4), 315-327. http://dx.doi.org/10.1111/soc4.12029

Uren, S., & Graham, T. (2013). Subjective Experiences of Coping among Caregivers in Palliative Care. OJIN: The Online Journal Of Issues In Nursing, 18(2).

Zehner Ourada, V., & Walker, A. (2014). A Comparison of Physical Health Outcomes for Caregiving Parents and Caregiving Adult Children. Family Relations, 63(1), 163-177. http://dx.doi.org/10.1111/fare.12046

COMMENTS OF CHAIRMAN

Thank you for submitting your revised prospectus. Please refer to the prospectus template and make sure you are in complete alignment with how the prospectus should be formatted and with what sections.

Regarding the research itself, we really need to talk. I’m not sure what you are really doing based on the prospectus. Each section needs to be in alignment. I’m not finding the real gap in the research literature that you are addressing and the methods section is way too vague.

I. We need to get your prospectus out for official review this quarter to keep you on track.


[RB1]This is not in APA format

[RB2]This paragraph seems mostly redundant with what you have already stated above.

[RB3]Now I am confused…..are you researching the family non-professional caregivers or nurses?

[RB4]These questions will need to be revised. They are too vague and each question contains multiple parts.

[RB5]The term caregivers usually refers to family/friends who are caring for a patient. Use the word nurses if that is what you are studying.

[RB6]The methodology is entirely too vague. It must be complete. What exactly are you going to do, to whom, using what specific data collection instruments.

[RB7]Really bad word to use……use patients……why are you using a representative…..what about using the patients themselves?

[RB8]I don’t know what this means. Too vague and non descript.


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