The assignment is just like the sample below. Choose any interesting nursing topic and write 500 words with reference list at the end.

The assignment is just like the sample below. Choose any interesting nursing topic and write 500 words with reference list at the end.

Please do it as per the example blow using PICO.NC

Example 1 ( original post):

In order to establish a clinical research question, I employed the PICO framework. The aim was to examine appropriate goals of care for patients living with dementia established through quantitative research. Four key references were drawn upon for analysis with conclusive data determining the recommended outcome.

Having exposure within acute medical nursing, I often witness pharmacological intervention utilised as first-line behavioural and psychological symptoms of dementia (BPSD) reduction tool. The aforementioned question provides opportunity to delve deeper and gain insight regarding shortterm and long-term outcomes with such actions. Research from Douglas et al. (2018) signifies that the use of pharmacological approaches, namely, anti-psychotics medications, often are embraced as first-line interventions, despite the wealth of evidence demonstrating adverse repercussions that ensue.

P = Patients living with dementia

I = Pharmacological intervention

C = Non-pharmacological intervention

O = Effective behaviour management

Research question: In patients living with dementia, is pharmacological intervention compared to non-pharmacological intervention more effective in behaviour management?

To generalize dementia, the gradual decrease in cognitive function resulting in widespread multifactorial dysregulation of the physiological and health related quality of life (HRQL).

Dyer et al. (2017) reinforces that resultant of a deterioration in ones ability to communicate, unmet needs may be reflected in changed behaviours, or increased BPSD. Kongpakwattana et al. (2018) extends on this with postulating that eighty percent of dementia-affected persons exhibit BPSD. Dyer et al. (2017) constructed a systematic review of randomised controlled trials (RCT) on pharmacological and non-pharmacological BPSD interventions. The information conveyed fifteen systematic reviews, listed eighteen different interventions and had a standardized mean surveying dementia-affected adults through avenues such as musical therapy, analgesic therapies, antipsychotics, and cholinesterase inhibitors. The report revealed that the effect size for most interventions was considered small, whereas pharmacological interventions yielded a larger result. Non-pharmacological and functional analysis-based interventions (FABI, interventions modelled on expectant reasons behaviours are elicited) demonstrated significant improvement in regards to BPSD with fewer adverse risks involved.

Healthcare providers should consider examining physical illness including infections, dehydration, constipation and sleep disturbance as precipitants for behavioural change and apply relevant FABI (Douglas et al., 2018). The authors further discuss incident of inappropriate prescribing amounting to forty percent of dementia-affected persons not requiring anti-psychotic drugs.

Through RCT meta-analysis, Ballard et al. (2016) researched sixteen care homes, including three hundred participants over a nine month period to determine if a reduction in anti-psychotic use improved HRQL. To summarise, the review conferred a significant fifty percent reduction in antipsychotics contributed to nil significant increase in BPSD. There was also a thirty percent reduction in adverse effects for those receiving both anti-psychotics and social interaction. In this study, Ballard et al. (2016) also alarmingly discovered that anti-psychotic medication worsened HRQL by a factor of 4.54 points. A significant secondary finding demonstrated non-pharmacological interventions improved HRQL by 6.04 points.

Examining the benefits of engaging in non-pharmacological and FABI, Douglas et al. (2018) revealed that both have similar effects with a higher degree of HRQL for patients than pharmacological intervention whilst providing a lower risk of adverse events. Therefore, policy and standards of practice should embrace interventions that produce the least harm. Given the frequent emergence of evidence supporting steering away from pharmacological interventions, only specific situations should warrant such interventions such as immediate risk of harm and severe distress (Kongpakwattana et al. 2018)

Example 2 ( original post):

Opioids in Pain Management Among Older Adults

Patient falls are a common occurrence among older adults and can greatly affect their health and wellbeing. Patient falls affect 29% of older adults resulting in 0.67 falls per individual annually and can cause 21-39% of such people to develop the fear of falls (Ganz & Latham, 2020). About 10% of individuals who experience falls suffer from injuries such as fractures, sprains, joint dislocations, and concussions, which results in 2.8 million visits to the emergency department and $49.5 billion used to treat such patients in the U.S. annually (Ganz & Latham, 2020). Some of the risk factors towards patient falls include visual impairments, balance and gait disorders, use of strong medications, cognitive problems, and muscle weaknesses due to aging, among others (Chu, 2017). Opioids are among the most common drugs used by older adults for pain management, as they are frequently affected by conditions like kidney disease, cancers, osteoarthritis, and bone fractures that cause extreme pain (Dolati et al., 2020). It is important to investigate whether these medications affect older adults' risk of falls.

My investigation was guided by a PICO question titled, "In aged care residents over the age of 65, does opioid use as pain management contribute to falls increase when compared to non-opioid use for pain management". The research is aimed at determining whether the use of opioids in pain management among older adults results in increased falls incidences compared to not using these medications at all. Dolati et al. (2020) state that opioids are used as the standard pain management regimen in the clinical setting for patients affected by different health conditions, including kidney disease, musculoskeletal pain, neuropathic pain, inflammatory arthritis, hypertension, polycystic kidney disease, and renal osteodystrophy among others. This means that older adults are likely to use opioids as these diseases mostly affect them. I reviewed quantitative studies with experimental and systematic review designs to get the findings. P - Opioid use in aged care residents

I Pain medication

C Alternative medications

O Increased falls in aged care

There is sufficient evidence from research studies to affirm that using opioids in treating chronic pain among older adults elevates their propensity to falls, may not provide long-term benefits in easing suffering and can worsen some conditions. A case-control study by Machado-Duque et al. (2018) that investigated the link between opioid use and fall risk among older adults showed that there was a statistically significant danger of falls with hip fractures (OR:4.49; 95%CI:2.727.42) among the 287 patients who took part in the study. In another study by Yoshikawa et al. (2020), the researchers conducted a systematic review to determine the link between opioid use among older adults and the risk of adverse health outcomes. The results of the research showed that there was a significant relationship between opioid use and fall incidences, fractures, and injuries, with large effect sizes of 0.15-0.71 (Yoshikawa et al., 2020). The same findings were identified by Daoust et al. (2018) and Santosa et al. (2020), who showed that patients who refilled their opioid medications had an increased risk of falls and injuries.

Daoust et al. (2018), who investigated the link between the recent use of opioids and the dangers of falls among patients aged 65 years and above, found out that when such patients refiled these medications within two weeks, their risk of falls increased by 2.4 times. Additionally, falls-related injuries among patients who used opioids significantly increased their danger of in-hospital death (Daoust et al. 2018). Opioids were found to cause adverse side effects such as nausea, orthostatic hypotension, poor appetite, impaired cognition, fatigue, constipation, and depression among users (Dolati et al., 2020). Such outcomes show that it may not be prudent to prescribe opioids for pain management among older adults. There is a need for proper monitoring of the use of these medications among patients aged 65 years and above in residential care due to their propensity to cause falls with injuries. Clinicians can decide to use alternative pain medications to address patients' health conditions.

References

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