PICOT Framework & Evidence to Develop Patient Centered Care Discussion

Assessment 3 Instructions: LB cf_Exemplar NURS-FPX X S SOLUTION: NURS-FPX4030 + capella.edu/bbcswebdav/institution/NURS-FPX/NURS-FPX4030/210400/Course_Files/cf_Exemplar_NURS-FPX4030_Assessment_3.pdf 1 Using a PICO(T) Framework and Evidence to Develop Care Practices Learner’s Name Capella University NURS-FPX4030: Making Evidence-Based Decisions Instructor Name August, 2020 hop Home | Capella University Assessment 3 Instructio X Els cf_Exemplar NURS-FPX4030 S SOLUTION: NURS-FPX4030 + O B courserooma.capella.edu/webapps/blackboard/content/listContent.jsp?course_id=_317072_1&.content_id=_9877574_1 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 (accessible from the “Create PICO(T) Questions” page in the Capella library’s Evidence Based Practice guide) might be helpful. 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: Type here to search DO hip ho Assessment 3 Instructions: F BB cf_Exemplar_NURS-FPX. X S SOLUTION: NURS-FPX4030 + V apella.edu/bbcswebdav/institution/NURS-FPX/NURS-FPX4030/210400/Course_Files/cf_Exemplar_NURS-FPX4030_Assessment_3.pdf 2 Using a PICO(T) Framework and Evidence to Develop Care Practices When 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. NURS 4030 PICOT Framework & Evidence to Develop Patient Centered Care Discussion

Relying on secondary research, the author of this paper will define a 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 Dementia ਦੇ The practice issue identified for resolution is the need to develop care practices that effectively manage agitation in patients with dementia in nursing homes that are outside of pharmacological approaches. The question being explored is: Is the non-pharmacological approach. Specifically an intervention approach, more effective than the pharmacological approach in managing behavioral symptoms (such as agitation) in patients with dementia? The intervention approach identified is person-centered care or patient-centered care (PCC). an approach that emphasizes more on an individual’s experiences and the communication E Bb Assessment 3 Instructions: F Bb cf_Exemplar_NURS-FPX X S S SOLUTION: NURS-FPX4030 + V poma.capella.edu/bbcswebdav/institution/NURS-FPX/NURS-FPX4030/210400/Course_Files/cf_Exemplar_NURS-FPX4030_Assessment_3.pdf (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 studied are patients with dementia with agitative behavioral symptoms in nursing homes. As the objective is to explore care practices that address this issue, only factors related to care in nursing homes are considered. The study does not take into consideration cultural, political, and social factors (Kim & Park, 2017). Identification of Sources of Evidence DICE Model Copyright © 2019 Capella University. Copy and distribution of this document are prohibited. 3 The DICE (Describe. Investigate. Create, and Evaluate) model is a notable PCC intervention model that identifies optimal treatment options for patients with dementia with neuropsychiatric symptoms. Developed by a panel of interdisciplinary experts at the University ambalbican Domozom to za model dann S. – S. ho Hh Assessment 3 Instructions: 1 Bb cf_Exemplar_NURS-FPX X S SOLUTION: NURS-FPX4030 + a.capella.edu/bbcswebdav/institution/NURS-FPX/NURS-FPX4030/210400/Course_Files/cf_Exemplar_NURS-FPX4030_Assessment_3.pdf neuropsychiatric symptoms. Developed by a panel of interdisciplinary experts at the University of Michigan Program for Positive Aging, the model is constitutive of a four-step approach. The first step of the approach is the accurate description of the patient’s behavior, the second is the identification of possible underlying causes, the third is the creation and implementation of treatment plans, and the fourth is the assessment of the strategies developed (Desai et al., 2017; Kales et al., 2014). NURS 4030 PICOT Framework & Evidence to Develop Patient Centered Care Discussion

The model’s essential recommendations for facilitating improvement in neuropsychiatric symptoms among patients with dementia are educating the caregiver, forging better communication between the patient and the caregiver, assisting the caregiver in organizing meaningful activities such as cooking, painting, or reading depending on the patient’s interests: and training the caregiver on simplifying his or her work routines (Desai et al., 2017: Kales et al., 2014). Individualized Intervention Model The individualized intervention model is a model in which intervention activities are carried ਈ out based on the 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). Bb Assessment 3 Instructions: F Bb of_Exemplar_NURS-FPX X S SOLUTION: NURS-FPX4030 + a.capella.edu/bbcswebdav/institution/NURS-FPX/NURS-FPX4030/210400/Course_Files/cf_Exemplar_NURS-FPX4030_Assessment_3.pdf WENGI approach to manage behavioral symptoms 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 sertraline and citalopram, and sedative-hypnotics through the use of benzodiazepines to control acute agitation (Madhusoodanan & Ting, 2014). The use of psychotropic medication poses high risks of mortality and harmful side effects (Kales et al., 2014). Psychotropic medication is also expensive and is restricted by regulatory bodies However, the use of pharmacological intervention is justified when the benefits outweigh the risks or in situations wherein nonpharmacological interventions have proven unsuccessful (Madhusoodanan & Ting, 2014). The PCC approach has proven effective in addressing the etiology of aggressive outbursts. Unlike the pharmacological approach, which is 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’s contribution toward better clinical practices and improvement in aggressive behavior, and it observes that the approach results in fewer hospitalizations and readmissions. In their systematic review and meta-analysis . Bb Assessment 3 Instructions: Bb cf_Exemplar_NURS-FPX. X S SOLUTION: NURS-FPX4030 + oma.capella.edu/bbcswebdav/institution/NURS-FPX/NURS-FPX4030/210400/Course_Files/cf_Exemplar_NURS-FPX4030_Assessment_3.pdf results in fewer hospitalizations and 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 Copyright ©2019 Capella University. Copy and distribution of this document are prohibited. 5 agitation using the Cohen-Mansfield Agitation Inventory (an agitation mapping instrument) and the Brief Agitation Rating Scale. NURS 4030 PICOT Framework & Evidence to Develop Patient Centered Care Discussion

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 effects than with care staff-directed interventions (with a significant mean difference of -0.160). As this paper relies on secondary research on the PCC intervention to manage agitative behavior in patients with dementia in nursing homes, there are multiple time frames for the various intervention studies reviewed. While some studies had a long intervention period ranging from 9 months to 2 years, others had shorter intervention periods of just a few weeks. From the above exploration of the research problem based on the PICOT framework, it is clear that this Assessment 3 Instructions: Bb cf_Exemplar_NURS-FPX X S SOLUTION: NURS-FPX4030 11 + apella.edu/bbcswebdav/institution/NURS-FPX/NURS-FPX4030/210400/Course_Files/cf_Exemplar_NURS-FPX4030_Assessment_3.pdf Van IQUS HIIEI VETITIONI SCULES IEVIEWEU. WME Some Studies mag a long wEVETILION Pel100 Igung wa B . from 9 months to 2 years, others had shorter intervention periods of just a few weeks. From the above exploration of the research problem based on the PICO(T) framework, it is clear that this framework has contributed to the delineation of precise intervention practices and has brought conceptual clarity on the issue of agitative behavior in patients with dementia. ER Relevance of Findings from Articles PERE The study by Kales et al. (2014) was chosen as it provides a comprehensive explanation of the PCC-based DICE intervention program and its potential outcomes and draws an objective comparison of the program with pharmacological intervention. The study observed that the DICE model was developed by a panel of experts with years of clinical and research expertise it managing NPS in patients with dementia. The strategies formulated in the DICE approach were found to carry a strong evidence base. As it is evidence-informed the DICE approach could be helpful for clinicians across diverse settings. Kales et al. (2014) conclude their study with a discussion on the potential of the DICE approach in enhancing clinical practices and ensuring the treatment of agitative behavior in patients with dementia. Copyright ©2019 Capella University. Copy and distribution of this document are prohibited. . Assessment 3 Instructions: F Bb cf_Exemplar_NURS-FPX X S SOLUTION: NURS-FPX4030 + apella.edu/bbcswebdav/institution/NURS-FPX/NURS-FPX4030/210400/Course_Files/cf_Exemplar_NURS-FPX4030_Assessment_3.pdf ਆ The rationale for 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 these studies, Kim and Park (2017) found that PCC has a significant impact on reducing NPS in patients with dementia. Kim and Park’s (2017) review found the increased engagement between care providers and patients and the magnitude of the program’s intensity to be the reasons for short- term PCC intervention having greater benefits in comparison to long-term intervention. The findings are relevant because they 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). NURS 4030 PICOT Framework & Evidence to Develop Patient Centered Care Discussion

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 bias and the risk of bias assessment tool to ensure quality screening of the studies. Conclusion Bb Assessment 3 Instructions: Bb cf_Exemplar_NURS-FPX X S SOLUTION: NURS-FPX4030 + V 3.capella.edu/bbcswebdav/institution/NURS-FPX/NURS-FPX4030/210400/Course_Files/cf_Exemplar_NURS-FPX4030_Assessment_3.pdf 7 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.capella.edu/docview/1862119355?pq-origsite=summorf Kales. 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 of the American Geriatrics Society, 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/400107a4cbaa14e6b7c0e3531bb4abac Madhusoodanan, S., & Ting. M. B. (2014). Pharmacological management of behavioral symptoms associated with dementia. T’orld Journal of Psychiatry, 4(4), 72-79. கதான் ਦੀ DET ER PARA TODOS httpsncbi.nlm.nih.gov/pmc/articles PMC4274589 ਵਿਚ ਹੀ