Health in Vanuatu

Create a 3-5-page submission in which you develop a PICO(T) question for a specific care issue and evaluate the evidence you locate, which could help to answer the question. PICO(T) is an acronym that helps researchers and practitioners define aspects of a potential study or investigation.  It stands for: P – Patient/population/problem. I – Intervention. C – Comparison (of potential interventions, typically). O – Outcome(s). T – Time frame (if time frame is relevant). The end goal of applying PICO(T) is to develop a question that can help guide the search for evidence (Boswell Cannon, 2015). From this perspective, a PICO(T) question can be a valuable starting point for nurses who are starting to apply an evidence-based model or EBPs. By taking the time to precisely define the areas in which the nurse will be looking for evidence, searches become more efficient and effective. Essentially, by precisely defining the types of evidence within specific areas, the nurse will be more likely to discover relevant and useful evidence during their search. You are encouraged to complete the Vila Health PCI(T) Process activity before you develop the plan proposal. This activity offers an opportunity to practice working through creating a PICO(T) question within the context of an issue at a Vila Health facility. These skills will be necessary to complete Assessment 3 successfully. This is for your own practice and self-assessment and demonstrates your engagement in the course. Demonstration of Proficiency By successfully completing this assessment, you will demonstrate your proficiency in the course competencies through the following assessment scoring guide criteria: Competency 1: Interpret findings from scholarly quantitative, qualitative, and outcomes research articles and studies. Explain the findings from articles or other sources of evidence. Competency 2: Analyze the relevance and potential effectiveness of evidence when making a decision. Identify sources of evidence that could be potentially effective in answering a PICO(T) question. Explain the relevance of the findings from chosen sources of evidence to making decision related to a PICO(T) question. Competency 3: Apply an evidence-based practice model to address a practice issue. Define a practice issue to be explored via a PICO(T) approach. Competency 5: Apply professional, scholarly communication strategies to lead practice changes based on evidence. Communicate using writing that is clear, logical, and professional with correct grammar and spelling using current APA style. Reference Boswell, C., Cannon, S. (2015). Introduction to nursing research. Burlington, MA: Jones Bartlett Learning. Professional Context As a baccalaureate-prepared nurse, you will be responsible for locating and identifying credible and scholarly resources to incorporate the best available evidence for the purposes of enhancing clinical reasoning and judgement skills. When reliable and relevant evidence-based findings are utilized, patients, health care systems, and nursing practice outcomes are positively impacted. PICO(T) is a framework that can help you structure your definition of the issue, potential approach that you are going to use, and your predictions related to the issue. Word choice is important in the PICO(T) process because different word choices for similar concepts will lead you toward different existing evidence and research studies that would help inform the development of your initial question. Scenario For this assessment, please use an issue of interest from your current or past nursing practice. If you do not have an issue of interest from your personal nursing practice, then review the optional Case Studies presented in the resources and select one of those as the basis for your assessment. Instructions For this assessment, select an issue of interest an apply the PICO(T) process to define the question and research it. Your initial goal is to define the population, intervention, comparison, and outcome. In some cases, a time frame is relevant and you should include that as well, when writing a question you can research related to your issue of interest. After you define your question, research it, and organize your initial findings, select the two sources of evidence that seem the most relevant to your question and analyze them in more depth. Specifically, interpret each source’s specific findings and best practices related to your issues, as well explain how the evidence would help you plan and make decisions related to your question. If you need some structure to organize your initial thoughts and research, the PICOT Question and Research Template document is at the bottom of instructions. In your submission, make sure you address the following grading criteria: Define a practice issue to be explored via a PICO(T) approach. Identify sources of evidence that could be potentially effective in answering a PICO(T) question. Explain the findings from articles or other sources of evidence. Explain the relevance of the findings from chosen sources of evidence to making decision related to a PICO(T) question. Communicate using writing that is clear, logical, and professional with correct grammar and spelling using the current APA style. Example Assessment: You may use the following to give you an idea of what a Proficient or higher rating on the scoring guide would look like: Assessment 3 Example [PDF]. Additional Requirements Your assessment should meet the following requirements: Length of submission: Create a 3–5-page submission focused on defining a research question and interpreting evidence relevant to answering it. Number of references: Cite a minimum of four sources of scholarly or professional evidence that support your findings and considerations. Resources should be no more than 5 years old. APA formatting: Format references and citations according to the current APA style. Portfolio Prompt: Remember to save the final assessment to your ePortfolio so that you may refer to it as you complete the final capstone course. Example of PICO papers. Using a PICO(T) Framework and Evidence to Develop Care PracticesWhen developing care practices for patients, the PICO(T) research framework, which expands to Population/Patient, Intervention, Comparison, Outcome, and Time, can be used to create an effective care plan and ensure that patients’ needs are met. Relying on secondary research, the author of this paper will definea practice issue surrounding patients with dementia, apply the PICO(T) process, identify sources of evidence that may provide answers to the research question, explain key findings from articles, and explain the relevance of those key findings.Use of the PICO(T) Approach when Caring for Patients with DementiaThe practice issue identified for resolution is the need to develop care practices that effectively manage agitation in patients with dementiain nursing homesthat are outside of pharmacological approaches. The question being explored is: Is the non-pharmacological approach, specifically an intervention approach, more effective than the pharmacological approachin managing behavioral symptoms(such as agitation)in patients with dementia? The intervention approach identified is person-centeredcareor patient-centered care(PCC), an approach that emphasizes more on an individual’s experiences and the communication of his or her needs than on the pure implementation of a health care provider’s expertise (Desai, et al., 2017). The population being studiedare patients with dementiawith agitativebehavioral symptoms in nursing homes. As the objective is to explore care practices that address thisissue,only factors related to care in nursing homes are considered. The study does not take into considerationcultural, political, and social factors(Kim & Park, 2017).Identification of Sources of EvidenceDICE Model3 The DICE (Describe, Investigate, Create, and Evaluate) modelis a notable PCC interventionmodel thatidentifiesoptimal treatment options for patients with dementiawith neuropsychiatric symptoms.Developed by a panel of interdisciplinary experts at the University of Michigan Program for Positive Aging,the model is constitutive of afour-step approach.The first stepof the approachisthe accurate description of the patient’s behavior, the second is the identification ofpossible underlying causes, thethird is thecreation and implementation of treatment plans, and the fourthisthe assessment of the strategiesdeveloped(Desai et al., 2017; Kaleset al., 2014).The model’s essential recommendationsfor facilitating improvement in neuropsychiatric symptoms among patients with dementiaare educatingthe caregiver;forging better communication between the patient and the caregiver;assistingthe caregiver in organizingmeaningful activitiessuch as cooking, painting, or reading depending on the patient’s interests;and training the caregiver on simplifyinghis or herworkroutines (Desai et al., 2017; Kaleset al.,2014). Individualized Intervention ModelThe individualized intervention modelis a model in which intervention activities are carried out based onthe history, needs, abilities, and preferences of patients with dementia. In this model, PCC-based activities are directly carried out by trained health care staff with expertise in social work, recreational therapy, geriatric psychiatry, and psychology (Kim & Park, 2017). Care Staff-Directed ModelIn the carestaff–directed model, PCC activities are based onthestaff’seducationandtraining on empathy and person-centeredness. The intervention period in such a model rangesfrom 3 months to 2 years(Kim & Park, 2017).Findings from ArticlesAs PCC is a major nonpharmacological approach to treatingagitation in patients with dementia, its effectiveness is studied by makingacomparative analysis to thepharmacological approach to manage behavioralsymptoms in patients with dementia. Pharmacological treatment in general refers to the use of psychotropic medication to manage agitation or neuropsychotic symptoms(NPS)in patients with dementia(Madhusoodanan & Ting, 2014; Kales et al., 2014). Some of the common pharmacological interventions include the use of antipsychotropics, antidepressants such as sertralineand citalopram,andsedative-hypnotics through the use of benzodiazepinesto control acute agitation (Madhusoodanan & Ting, 2014). The use of psychotropic medication poses high risks of mortality andharmfulside effects (Kales et al., 2014).Psychotropic medicationisalsoexpensive andisrestrictedby regulatory bodies. However, the use of pharmacological intervention isjustified when the benefits outweighthe risks or in situations whereinnonpharmacological interventions have provenunsuccessful(Madhusoodanan & Ting, 2014). The PCC approach hasproveneffectiveinaddressingthe etiologyof aggressive outbursts. Unlike the pharmacological approach, whichis based on treating symptoms, the PCC approach contributes to the resolution of underlying causes (Desai et al., 2017). The study by Kales et al. (2014) finds reasonable evidence of the DICE program’scontribution toward better clinical practicesandimprovement in aggressive behavior, and it observes that theapproach resultsin fewer hospitalizationsand readmissions.In their systematic review and meta-analysis of 19 primary studies,Kim and Park (2017) found 15 studies that measure the impact of PCC on agitation using the Cohen-Mansfield Agitation Inventory (an agitation mapping instrument)and the Brief Agitation Rating Scale. They found that 8 of the 15 studies show positive effects on agitation with individualized interventions (with a significant mean difference of -0.513),showing better effectsthan with carestaff–directed interventions (with a significant mean difference of -0.160). As this paper relies onsecondary research on the PCC intervention to manage agitative behaviorinpatients with dementiain nursing homes, there are multipletime frames for the various intervention studies reviewed. While some studies had a long intervention period ranging from 9 months to 2 years, othershad shorterintervention periods of just a few weeks. From the above exploration of the research problem based on the PICO(T) framework, it is clear that thisframeworkhas contributed to the delineation of precise intervention practices and has broughtconceptual clarity on the issueof agitativebehavior in patients with dementia. Relevance of Findings from ArticlesThe study by Kales et al. (2014) waschosen as it provides a comprehensive explanation of the PCC-based DICE intervention programandits potential outcomes and draws an objective comparison of the program with pharmacological intervention. The study observedthat the DICE model was developed by a panel of experts with years of clinical and research expertise in managing NPS in patients with dementia. The strategies formulated in the DICE approach were found to carryastrong evidence base. As it is evidence-informed, the DICEapproach could be helpful for clinicians across diverse settings.Kales et al. (2014)conclude their studywith a discussion onthe potential of the DICE approach in enhancing clinical practices and ensuringthetreatment of agitativebehavior in patients with dementia. The rationalefor selecting the study by Kim and Park (2017) was that it presents a systematic review and meta-analysis of 19 primary intervention studies,of which 17 studies are from long-term care facilities. In their systematic review and meta-analysis of thesestudies, Kim and Park (2017)found that PCC has asignificant impact on reducing NPS in patients with dementia. Kim and Park’s(2017)review foundtheincreased engagement between care providers and patients and the magnitude of the program’s intensityto be the reasons for short-term PCC intervention having greater benefits in comparison to long-term intervention.The findings are relevant becausethey are based on 17 long-term, clinical PCC intervention studies comprising both controlled and non-controlled cluster-randomized trials conducted over the past 10 years (Kim & Park, 2017). Kim & Park’s findings prove to be the most credible. In their systematic review and meta-analysis of primary studies, Kim and Park’s findings (2017) adhere to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. They also utilize analysis tools such as the Cochrane Collaboration’s risk of biasand the risk of bias assessment toolto ensure quality screening of the studies. ConclusionThere is a need to develop care practices that are outside of pharmacological approaches for managing agitation in patients with dementia. The PICO(T) frameworkwas applied to determine if the intervention approach of person-centeredcareor patient-centered care(PCC)was more effective than the pharmacological approach by identifying sources of evidence, explaining the findings and proving the relevance of those findings. The articles by Kales et al. (2014)and Kim and Park (2017), provide precise, reliable,and relevant informationtoadequately explore the effectiveness of the PCC approach. References Desai, A., Wharton, T., Struble, L., & Blazek, M. (2017). Person-centered primary care strategies for assessment of and intervention for aggressive behaviors in dementia. Journal of Gerontological Nursing, 43(2), 9–17. https://search-proquest-com.library.docview/1862119355?pq-origsite=summonKales, H. C., Gitlin, L. N., & Lyketsos, C. G. (2014). Management of neuropsychiatric symptoms of dementia in clinical settings: Recommendations from a multidisciplinary expert panel. Journal oftheAmerican GeriatricsSociety, 62(4), 762–769. https://ncbi.nlm.nih.gov/pmc/articles/PMC4146407/#Kim, S. K.&Park, M. (2017). Effectiveness of person-centered care on people with dementia: A systematic review and meta-analysis. Clinical Interventions in Aging, 12, 381–397. https://doaj.org/article/400107a4cbaa44e6b7c0e3531bb4abacMadhusoodanan, S., & Ting, M. B. (2014). Pharmacological management of behavioral symptoms associated with dementia. World Journal of Psychiatry, 4(4), 72–79. https://ncbi.nlm.nih.gov/pmc/articles/PMC427458