Improving Health And Nursing Assessment Answer

Part 2: Critical Appraisal of Strength of Evidence Apply a recognised model to critically appraise the level of evidence underpinning each theme and the overall strength of the research evidence
Part 3: Synthesise All Evidence Forms Demonstrate how you sourced and included clinical expertise evidence and patient preferences/values evidence

Part 4: Transforming Evidence into Practice Answer the clinical question by drawing on the full evidence base. Make at least one evidence informed statement about best practice related to your original topic. Outline how you would go about transforming the evidence into practice.

EVIDENCE BASED PRACTICES 

Introduction:

The elderly people (more than 65 years old) account for a significant portion of the contemporary societies and the number of such population is increasing at a rapid rate. The nature of pain changes along with age (Wilkinson, 2018). As the patients become more elderly, managing the pain becomes more complex due to physical issues and lack of knowledge among the patients (Blake, 2018). Therefore, the nurses need to follow a comprehensive process including thorough assessment of the medical history of the patients, obtaining their physical information, analysis of the laboratory results and incorporation of the evidence based practices. The role of nurses is important in case of the pain management among the elderly patients as it requires extensive examination and effective decision making. Use of evidence based practices helps the nurses to search and assess the latest evidence based practices to implement the best decisions. So, it is necessary to define the role of nurses clearly for managing the pain among elderly patients. 

The current research deals with analysis on the role of nurses for the implementation of the evidence based practice in pain management process among the elderly patients. In this research the role of nurses in implementation of the evidence based practices (EBP) on pain management of elderly patients are explored in several steps. At first, the unique nature of pain among the elderly patients and the importance on understanding the pain for effective management are analyzed (Scot et al.2018). In the second stage, the importance of implementing EBP for managing pain among such patients and what are the roles of the nurses to implement the pain management techniques. Scope of the study is limited to assessing role of the nurses to implement EBP among the elderly patients only. It provides an idea on the overall pain management process and does not discuss in detail whether the role of nurses changes in case of chronic and acute pain. Finally , this study argues that the nurses play a crucial role to implement the evidence based practices for managing pain among the elderly patients.

Research question:

What is the role of nurses in implementation of the evidence based practices for pain management among elderly patients? 

Rationale of the study:

At older age, many cases of pain remains unreported as often the elderly people starts considering that this is a natural incidence. However, the pain becomes chronic if it stays more than 3 months and result in several other issues including the impaired activities for daily living, immobility, physical strain and stress (Eaton et al.2015). The evidence based practices is especially important for the pain management among the elderly people because of improving the quality of care (Blytt et al.2018). However, to manage the pain among elderly patients to optimum level, understanding the unique nature of their pain is necessary. 
Importance of understanding the nature of pain among elderly adults: The pain is considered as a multidimensional experience (Mann, and Carr, 2018; Platts-Mills et al.2018). It does not cause the physical sensation only, but also influences the emotional responses as well. It clearly indicates uniqueness of the pain experienced by an individual as the physical sensation can cause different types of emotional responses. Therefore, the effects of pain can vary among the individuals on basis of their unique emotional responses and physical features (Unneby et al.2017). So, in order to manage the pain, it is essential to understand how the problem is affecting the individual in order to manage it in the right way.

The effects of pain become more complex if the pain is not managed in the right way (Kaasalainen et al.2018; Hunnicutt et al.2018). In many cases, the elderly patients show a tendency of not reporting their problems. The role of detection is also important in case of pain management. If the pain remains undetected, treating and managing them is not possible. A study indicates that almost half of the patients in the geriatric nursing homes had undetected chronic pain.

Role of evidence based practice in decision making for the pain management among elderly patients: 

Taking the right decision is crucial in case of every pain management process. However, each elderly person is affected differently due to pain and so, the issues faced by each such individual needs to be managed in unique ways (Ladeira et al. 2017). Taking the right decisions is crucial for getting the optimum outcomes from the pain management efforts. The evidence based practices are effective to guide the professionals for taking the right decisions on basis of the current best evidences and assessment of the patients.

The evidence based approach works in several stages. The application of evidence based practices (EBP) starts from the process of asking questions to the patients. By asking questions to the patients, the healthcare professionals become able to know extent of the issue in depth. In the second stage, the professionals give importance on obtaining detailed information from the patients on their issues for answering the questions. Execution of the step helps the professionals to get a deeper insight of their problems and assess the issues effectively. In the third stage, the professionals select the right resources and start searching for the evidences. Use of evidences is effective for the healthcare professionals to understand what provides the best outcome for the patient and take actions accordingly. In the fourth step, after all the evidences are collected, the health care professionals assess the collected evidences on basis of their effectiveness and identify the most effective ones. The fifth or the last stage deals with application of the selected practice and assessing its outcome.

In case of elderly adults, the evidence based practice is highly effective (Chou et al.2015). The elderly patients may not report their issues to the health care professionals. So, for their cases, asking the questions help the professionals to gather data about their experience with the pain. Every individual responds differently to the pain. So, the EBP also helps the professionals to assess which strategy can provide the individuals with the best possible outcomes. Finally, the EBP also facilitates the professionals to assess the impact of pain management techniques on health of the patients.

Role of nurses in application of evidence based practices:

 The nurses play a key role in implementation of the evidence based practices for managing pain among the elderly patients. Analysis on the use of evidence based practices in pain management indicates that the process needs huge collaboration of the patients. Successful implementation of the entire process depends upon how effectively, the information on the issue faced by the patient is being collected, evidences are searched and the obtained evidences are assessed (Kim et al.2017). The collection of information becomes more crucial in case of the elderly patient as in many cases they do not report it to the health care professionals. In addition, the effects of pain are different among different individuals. It indicates that the professionals need to tailor the existing practices on basis of the particular needs of the patient.

 The above discussion indicates that implementation of the evidence based practice in pain management is not possible unless the professionals have in depth knowledge and the hands on experience on the physical issues faced by the patients.

The nurses, in an organization get adequate chance to communicate with the patients and knowing their issues. Additionally, the nurses also get the chance to gather hands on experience on the problems encountered by the patients as part of their duties. (Merolli et al.2016) Therefore, it is easier for the nurses to identify whether an organizational practice is suitable for the patients or if there is any need to modify it. The EBP can be considered as the integration between the clinical expertise as well as the patient values to deliver the health services. As the nurses deal with the patients on regular basis , they have clear understanding on values and preferences of the patients . So, the nurses can incorporate such concepts in better way.

Developing the clinical question using a recognized formula:

Developing the clinical questions is one of the most important activities for implementation of the EBP approach in pain management. The clinical questions enable the nursing professionals to identify the issues of the patient. Such questions also help the healthcare professionals to identify the factors that are triggering the issues among the patients. So, before implementation of the EBP method, it is necessary to have the well-defined clinical questions (Reed,2017). The clinical questions can be developed using specific frameworks. PICO is one such question formulation framework that helps the healthcare professionals to create clinical questions for both background and foreground information collection for the patient. 

Analyzing the issue using PICO format:

The P in PICO stands for the patient, problem and population. In other words, the first stage of PICO deals with collecting the background information for the patients. The questions for collecting information from the aged pain patients can be -- 
•    How old are you?
•    What is your weight?
•    Where do you feel the pain?
•    When do you feel the pain the most?
•    What gives you comfort from pain?
•    What other physical issues you do have?
I denote the types of interventions, the prognostic factors and the exposures. These questions help the nursing professionals to analyze problems associated with the patient.
•    What are the root causes of pain?
•    Is medication needed?
•    Is any exercise needed?

The C reflects comparison between the alternatives identified by the nursing professional. In this case, professionals may try to find answer of the following question–

•    The medication or exercise? Which one is more effective for the patients? Or the patient needs a combination of both of them?
 The final stage of PICO question formulation framework deals with a assessment of the outcomes. In this case, the professional may as the following question:

•     Is the pain management strategy providing with desired outcome?
Searching for the right evidences to implement an evidence based practice approach becomes easier when the right framework is used. Development of the right framework for searching the evidences depends on a number of factors. Development of the searching framework can be conducted in several steps. 
 Selecting type of the evidences to be searched: The evidences are of two types -- primary evidence and the secondary evidence. The primary evidence is obtained from the practical experiences whereas the secondary evidence is obtained from the past researches.

Choosing the resource: The background and the foreground questions , the books, systematic reviews and the online data bases can be considered as the useful resources for the professionals. The nursing professionals may need to focus on using the right resources to get answers of the clinical questions.
 Selection of the right searching method: The searching methods include the techniques like the keyword based strategy or the Boolean technique.
In the current case, the nurses can use their own experience and background information of the patients to get the primary evidences. For the secondary evidences , the nurses can use the books or online databases.

Conclusion:

Analysis on the evidence based practices in the current research indicates that such practices enable the nurses to enhance quality of the care through application of evidences. In case of pain management among the patients, it is especially important for nurses to play the leading role for implementation of the evidence based practices as such patients do not put stress on reporting their pain. However effectiveness of such practices depends on the use of right evidences and the nursing professionals need to identify those in a systematic way. Finally, development of the right clinical questions also play a critical role for implementation of the evidence based practices .

References

Blake, N. (2018). Yes, nurses do research, and it’s improving patient care. [online] Elsevier Connect. Available at: https://www.elsevier.com/connect/yes-nurses-do-research-and-it-is-improving-patient-care [Accessed 16 Apr. 2018]. 
Blytt, K. M., Bjorvatn, B., Husebo, B., & Flo, E. (2018). Effects of pain treatment on sleep in nursing home patients with dementia and depression: A multicenter placebo?controlled randomized clinical trial. International journal of geriatric psychiatry, 33(4), 663-670.
Chou, R., Hashimoto, R., Friedly, J., Fu, R., Dana, T., Sullivan, S., Bougatsos, C. and Jarvik, J., 2015. Pain management injection therapies for low back pain.
Eaton, L.H., Meins, A.R., Mitchell, P.H., Voss, J. and Doorenbos, A.Z., 2015, March. Evidence-based practice beliefs and behaviors of nurses providing cancer pain management: a mixed-methods approach. In Oncology nursing forum (Vol. 42, No. 2, p. 165). NIH Public Access.
Hunnicutt, J. N., Tjia, J., & Lapane, K. L. (2017). Hospice use and pain management in elderly nursing home residents with cancer. Journal of pain and symptom management, 53(3), 561-570.
Kaasalainen, S., Zacharias, R., Hill, C., Wickson-Griffiths, A., Hadjistavropoulos, T., & Herr, K. (2017). Advancing the pain management in older adults agenda forward through the development of key research and education priorities: A Canadian perspective. Canadian Journal of Pain, 1(1), 171-182.
Kim, S., Brathwaite, R., & Kim, O. (2017). Evidence-based practice standard care for acute pain management in adults with sickle cell disease in an urgent care center. Quality management in health care, 26(2), 108.
Ladeira, C.E., Cheng, M.S. and da Silva, R.A., 2017. Clinical Specialization and Adherence to Evidence-Based Practice Guidelines for Low Back Pain Management: A Survey of US Physical Therapists. journal of orthopaedic & sports physical therapy, 47(5), pp.347-358.
Mann, E. and Carr, E., 2018. Pain management. Foundation Studies for Caring: Using Student-Centred Learning, p.259.
Merolli, M., Gray, K. and Martín-Sánchez, F., 2016. Patient Participation in Chronic Pain Management Through Social Media: A Clinical Study. In Nursing Informatics (pp. 577-581).
Platts-Mills, T. F., Hollowell, A. G., Burke, G. F., Zimmerman, S., Dayaa, J. A., Quigley, B. R., ... & Weaver, M. A. (2018). Randomized controlled pilot study of an educational video plus telecare for the early outpatient management of musculoskeletal pain among older emergency department patients. Trials, 19(1), 
Reed, S.L., 2017. Evidence based practice recommendation: non-pharmacological pain management interventions during labor.
Scott, J., Kaye, A. and Baluch, A. (2018). Pain Management in the Elderly Population: A Review. [online] PubMed Central (PMC). Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3096211/ [Accessed 16 Apr. 2018].
Unneby, A., Svensson, O., Gustafson, Y., & Olofsson, B. (2017). Femoral nerve block in a representative sample of elderly people with hip fracture: A randomised controlled trial. Injury, 48(7), 1542-1549.
Wilkinson JE, e. (2018). An exploration of the roles of nurse managers in evidence-based practice implementation. - PubMed - NCBI. [online] Ncbi.nlm.nih.gov. Available at: https://www.ncbi.nlm.nih.gov/pubmed/21668735 [Accessed 16 Apr. 2018].