PIOCO and Nursing Evidence Based Practice

Question: Create a Design for Change proposal inclusive of your PICO and evidence appraisal information from your Capstone Project. Answer: Introduction: In an approach to address the key requirements of this particular assignment an initiative shall be shortly undertaken wherein a John Hopkins Nursing Evidence-based Practice model shall be applied to analyse a formulated PICO question. The example of a hospital of Royal Adelaide Hospital, Australia have been cited wherein the administrative and the medical team has emphasized on gathering relevant information associated with the pain management of the terminally ill adult population. Focus was also given to understand whether morphine in comparison to other narcotics is more effective in pain management wherein an increased dose of morphine can produce a positive outcome. Hence the information assimilated was inclusive of database, journals that was further followed by assessment at an organizational level. The Practice question: Following an extensive information assimilation and assessment the medical team and the administrative units of the concerned hospital forwarded a practice question that has been designed in alignment with the PICO answerable framework. The practice question is as follows: PICO question is as follows: In elderly adults with a terminal illness are narcotics of Morphine more likely to increase their tolerance and then result in the need for increase doses of morphine? Elderly Adults with terminal illness Different pain control method such as Methadone Liquid Morphine (Roxanol) Less need for increased doses of Morphine Evidence: The EBP team members were found to perform an extensive literature search with the help of various online search databases namely Pub Med, Science Direct and Cochrane using the keywords like morphine, Liquid morphine or Roxanol, Methadone and pain management in terminally ill adults. The information that was found to bear relevancy with the topic of assessment were further conveyed to the concerned hospitals. Moreover onsite training was also conducted in the concerned hospital by the EBPO team to improve the nursing interventions skills of the nurses associated with pain management of the terminally ill adult patients. Therefore referring to the information gathered through extensive literature search positive outcomes of methadone application in comparison to efficacy of liquid morphine or Roxanol is evident as a better pain management tool for the terminally ill patient. Hence in accordance to the evidences gathered some recommendations are mentioned below can deliver positive health outcome for the concerned patient: Methadone can be a prescribed as a drug for reducing the pain intensity in the terminal adult patients as this drug being highly lipophilic in nature is absorbed rapidly The application of methadone is recommended because compared to morphine this drug is devoid of any active metabolites and hence do not have any significant impact on hepatic metabolism process. As methadone has as N-methyl-D Aspartate (NMDA) receptor antagonist this particular property is found to be significant with reduced propensity to develop opioid tolerance compared to morphine the drug is highly recommended for the patients with neuropathic pain. Application of methadone is also recommended to patients with non-malignant pain syndromes. Also to bedridden patients and also in patients with allodynia and are not capable of oral intake of medicines compared to transdermal application of morphine methadone is suggested. As methadone is found to produce long effect of action if applied through rectal administration, the nurses should learn the effective application skills in this respect. It is also recommended that the nurses should acquire proper training and understand the significance of dose for methadone application. Translation: In compliance with the John Hopkins Nursing Evidence Based Practice Model the concerned health care team and the nursing professionals of the cited hospital has further considered in development of a pain assessment tool wherein certain nursing interventions has been incorporated as guidelines. The pain assessment scales considered in this case are 0-10 Numeric Pain Rating Scale, Visual Analog Scale, Verbal Pain Intensity Scale, Neuropathy Pain Scale and Descriptor Differential Scale. Additionally a pilot study was also decided to be conducted for the fiscal year 2016 including 50 terminally ill adult patients admitted in the hospital for the study. Therefore both the evidences gathered and the pilot study affirmed better outcome of application of methadone compared to that of liquid morphine that was effective for reducing the intensity of pain in the terminally ill patients. Conclusion: The study and literature review was found to successfully address the requirements of the PICO question developed and significant involvement and enthusiasm was evident among the nursing professionals of the concerned hospital. Hence the associated staffs of the Royal Adelaide Hospital realised the operational efficacy and practical feasibility of the John Hopkins Nursing Evidence based Practice Model. References: American Nurses Association. (2015). Nursing: Scope and standards of practice (3rd ed.). Silver Spring, MD. Author Chamberlain College of Nursing. (2016) NR-451 Week 2: The clinical question. [Online lesson]. Downers Grove, IL: DeVry Education Group. Dearholt, S. L., Dang, D. (2014). Johns Hopkins Nursing Evidence-Based Practice: Model and Guidelines (2nd ed.). Indianapolis, IN: Sigma Theta Tau International Gardiner, C., Gott, M., Ingleton, C., Hughes, P., Winslow, M., Bennett, M. (2012). Attitudes of Health Care Professionals to Opioid Prescribing in End-of-Life Care: A Qualitative Focus Group Study.Journal Of Pain And Symptom Management,44(2), 206-214. https://dx.doi.org/10.1016/j.jpainsymman.2011.09.008 Love, R. Bourgeois, K. (2014). Topical Methadone: An Alternative for Pain Control in End-of-Life Management.Journal Of Palliative Medicine,17(2), 128-128. https://dx.doi.org/10.1089/jpm.2013.0517 Manfredonia, J. (2005). Prescribing Methadone for Pain Management in End-of-Life Care.The Journal Of The American Osteopathic Association,105(3_suppl), 18S-21S. Retrieved from https://jaoa.org/article.aspx?articleid=2093089 Porteous, A., Robson, P., Lee, M. (2013). End-of-Life Management of Patients Who Have Been Established on Oral Methadone for Pain Control.Journal Of Palliative Medicine,16(8), 820-820. https://dx.doi.org/10.1089/jpm.2013.0048