[Sharon]

Part 1: Develop a research question using PICO that focused on a clinical problem you have experienced. Post your research question in the discussion area below and share why you chose this research question (Maximum 250 words)

Part 2: Comment on one of your peer’s research questions. (Maximum 250 words) • Ask a clarifying question • Offer a different perspective • Share your reflections or your experience related to the research question.

[Attila]

Pain management in long-term care homes is sometimes neglected or not taken as seriously as it should be. Pain is a very personal experience, and – as I have witnessed it numerous times – nurses and care staff downplay the residents’ pain experience or simply do not recognize the cues that people exhibit when they cannot express it verbally, like people living with dementia. My research question would look into the possible ways to improve the pain management of residents living with dementia and non-verbal residents.

For the PICO framework, the population is people living with dementia who cannot express their discomfort verbally. Possible interventions would be training programs or tools for nurses to improve awareness and assessment skills of pain in non-verbal patients or patients living with dementia. I could compare the intervention results to those of a control group, where we use standard care without specialized training programs or tools. The outcome would be improved pain management and increased patient comfort for the intervention group members.

Framing the research question using the PICO framework can be the following: “In people living with dementia or people who cannot express their discomfort verbally (P), does the implementation of specialized training programs or tools for nurses (I) compared to standard care (C) lead to improved pain management and patient comfort (O)?”

[Jennifer]

Hi Attila,

You bring forward an important issue of pain management in LTC. For the PICO framework it is helpful to be as concise as possible. For Example:
P= People with dementia who communicate non-verbally.
I = Specialized Nursing Education
C = Traditional Nursing Education
O= Improved pain management outcomes

Thinking about your PICO framework – what is your specific research question? You will revisit this question in future modules and discussions.

Jen C.

[Attila]

Jen,
The specific research question could be the following:

“In people with dementia, do specialized nurse training programs compared to standard care improve pain management?”

Attila

[Jennifer]

Population Long Term Care residents

During My time as a dedicated wound care nurse for 5 floors of LTC residents, the resident has refused full appropriate dressing changes since she returned from acute care hospital 2 weeks ago. She will allow the outer layer of the dressing to be changed but not a therapeutic dressing change.
Therefore it has been 2 weeks since the full dressing change.
She was transported to acute care hospital and they sedated her in order to do the dressing change.

Intervention Called for an ethics meeting as wounds are progressively getting worse and resident is not allowing care to be provided. Utilized PRN pain medications for wound treatments and not effective for residents pain/anxiousness, Ethics suggested capacity assessment, and stated if she is deemed to have capacity for treatment decisions, specifically understanding the relevant facts and appreciating the consequences of her decision for her situation.
Comparison
Outcome
Since she has capacity, she’s allowed to make the decision and that’s how we respect her autonomy.
There is a concern that she might be intentionally wanting her wounds to get worse, and then the amputations will happen. I don’t discount this concern.
This is a classic example of Respect for Autonomy (her decision) being in conflict with the combined Beneficence (wanting to do good for our residents), and Non-Maleficence (do no harm) or trying to avoid the amputations.
This resident had a previous ethics consult a few years ago, and that she has history of trauma in her past. There is increasing attention in health care to Trauma-Informed Care (TIC). Going to acute care yesterday was likely traumatic for this resident.
Another Meeting with ethics sooner than later.

How can we as health care staff ensure our residents receive the proper care and still respect residents to body autonomy?

[Jennifer]

Hi Jennifer,

Thank you for your response. It can certainly be a challenge when evidence-informed nursing practice does not align with belief, values or wants of the resident/client/patient. This is a practice challenge that many nurses experience and an important area to explore using research. It is helpful to keep the area of research inquiry narrowed for what is feasible for the project timeline and resources available. This way the research can address the question.

Example:
P – Residents in LTC with Worsening Wounds
I – Therapeutic communication
C – Pain assessments
O- Residents demonstrate a greater understanding of treatment
RQ: What nursing intervention promotes acceptance of wound care treatments for residents in long-term care.

Based on the example provided how would you create a more concise PICO statement and research question?

Jen C.

[Jennifer]

Hi Jen,

I’m not sure how to narrow down a question for this example I gave in regards to worsening wounds.
P – Residents in LTC with Worsening Wounds
I – Therapeutic communication
C – Pain assessments
O- Residents demonstrate a greater understanding of treatment
RQ: What nursing intervention promotes acceptance of wound care treatments for residents in long-term care.

Based on the example provided how would you create a more concise PICO statement and research question?

Maybe I need to redo this, I cannot think of a question that would be narrow in regards to health teaching a non compliant resident.

[Jennifer]

Hi Jennifer,

Thank you for your post. I am happy to help where I can. I’ve responded to your email. You have a described a very important case study that many nurses experience in practice. I’ve offered you a couple of articles as food for thought that may be helpful to break down the case study into a specific research question that you will explore throughout this course. The outcomes may help you during your fellowship, in your nursing practice and beyond.

If you would like – you can send your ideas by email to help narrow down your area of inquiry before posting your PICO statement using your own words. Let me know if you have further questions. You are on the right track !

Jen C

[Jennifer]

P – Residents in LTC with Chronic Wound
I – Health Teaching
C – Patients understanding
O- Residents more accepting of wound care
RQ: How can we effectively partner with Residents to ensure proper wound management?
RQ: How can we ensure our residents understand the importance of proper wound management?

[Oghenefegor]

Hello Jennifer,
Reading your post is very enlightening. Indeed, it can be quite challenging when two or more ethical principles conflict. Sometimes, as healthcare providers, we might have differing perspectives from those of our patients. This leaves me sometimes wondering. What if we could explore why some patients decline therapeutic treatment even in the event of imminent bodily harm?

[Attila]

I agree with the points raised in this posting. While it is not always easy, and sometimes it feels counterproductive, it is important to respect the autonomy of residents, especially when they have the capacity to make informed decisions about their own care. There is a delicate balance between respecting a resident’s autonomy and ensuring their well-being. Despite the worsening condition of her wounds, the resident’s refusal of full dressing changes underscores the importance of involving ethics consultations and capacity assessments. By confirming her decision-making capacity, we uphold her right to autonomy, even when her choices may lead to adverse outcomes. This approach aligns with the principles of beneficence and non-maleficence as we strive to do good and avoid harm while respecting her decisions.

In my daily practice, I often find this difficult to adhere to. I always want the best for my residents; however, in situations like this, I need to step back and re-assess the circumstances to try to understand the underlying motivators.

[Jennifer]

To all course participants:

Once you have completed the TCPSII certificate, please send a copy to me at jcalver@werpn.com
If you completed the most recent certificate prior to this course, you do not have to redo the course and can send the certificate you have completed.

Thank you

Jen

[Oghenefegor]

Test

[Oghenefegor]

How can Short Periods of Compassion-based Responsive Behaviors help Prevent Depression in Older Adults?

As a bedside nurse, I have come to notice an increasing number of older adults with a diagnosis of depression. This is the prompting for my research question.

Older adulthood can be a very vulnerable and challenging time. This is especially due to the various physical changes, cognitive changes, psychological changes, social changes, and all changes that come about at this stage of life. According to Erik Erikson’s theory of psychosocial development, for some individuals, older adulthood might be a life stage of integrity, but for others, it might be a period of despair. On one hand, Erik Erikson describes manifestations of integrity in older adulthood as feeling a sense of accomplishment, fulfillment, peace, success and wholeness. On another hand, Erik Erikson describes characteristics of despair as feelings of depression, bitterness, regret, hopelessness and so on.

Whether or not an individual lives a life of integrity, despair, or even a combination of both in older adulthood is a dimensionally multipronged conceptualization. This is especially due to factors such as one’s physical health, one’s financial life, and many other factors that could influence one’s older adulthood experience.

—–asserts that the quality of an older adult’s relationship with their caregivers has a significant impact on their mental health and their feelings of fulfillment in older adulthood.

—-shows that older adults who have meaningful and rich relationships with their caregivers are less likely to experience feelings of depression. Sadly, due to various reasons, family members may experience challenges in building meaningful relationships with their older adult relatives. —- attributes this as a contributing factor to the feelings of depression amongst older adults. Although one must take into consideration the challenges that may be faced by family members including but not limited to time constraints brought about by multiple responsibilities vying for one’s attention. However, looking beyond the horizon is a ray of hope. A slight wisp of relief that comes from getting to know that a compassion-filled meaningful connection with someone can be established in just about — seconds, be it with a family member, a loved one, a friend, or even someone on the street. But, in this case, an older adult family member.

Hence my research question, “How can short periods of compassion-based responsive behaviors by caregivers help mitigate depression rates among older adults?

[Oghenefegor]

Hello everyone,
Please, disregard my discussion post above. It was my rough draft. Kindly refer to my discussion post attached as a Word document.

Thanks.
Oghenefegor U.

Attachments:

You must be logged in to view attached files.

[Jennifer]

Hi Oghenefegor,

Thank you for your post. Depression in older adults is certainly an area that needs further exploration. Please provide your PICO statement and research question in your post related to the topic you have selected. This will help you to complete activities in subsequent modules.

Let me know if you have any questions

Jen

[Jennifer]

Depression in older adults can be difficult to notice sometimes, are they just having a withdrawn day, are they constant with Apathy, do they have a diagnosis’s and hx of depression and use of medications

I’m a firm believer of laughter is the best medicine, and am constantly telling my team that two minutes of your time, seems like a lifetime to some of them since they do not get full human connections as they previously did, with their family and friends.

Human connection is needed and necessary.

[Oghenefegor]

Hello Jen,
Thank you. Please, see below:
P – Older adults
I – Short periods of compassion-based responsive behaviors by caregivers
C – ——
O- Mitigation of depression rates among older adults.
RQ: How can short periods of compassion-based responsive behaviors by caregivers help mitigate depression rates among older adults?

[Jennifer]

Hi Fegor,

This is a clear and concise PICO statement and research question. This will help you as you move forward in this course and future research activities.

Jen C.

[Author]

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