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Assessment task 2: Discussion board assessment Assessment description: For this unit, you will be completing one discussion board assessment. In this assessment, you will be creating an original post and a reply post to your peers based on a healthcare topic that interests you. · Weight: 50% · Length: 2 x 500 words discussion posts · Due date: 6th August 2023, 23:30:00 ACST · Learning Outcomes: 1, 2, 3, 4 *Please note that you will not be able to view other students’ submissions (and therefore peer review their work) until you have submitted your discussion board post. Assessment instructions Using what you have learned in modules 1, 2 & 3. create an original post explaining a research question you have developed on a healthcare challenge in your own area. The original post should explain: (1) what the healthcare challenge is and (2) include a breakdown of the PICO or PICo that you have used to create your research question. Instructions for original post [post 1] (500 words): 1. Clearly and succinctly summarize the research topic in your own healthcare area that you want to address and justify why research is useful for addressing the clinical problem (100-150 words) 2. Develops an appropriate research question using the PICO or PICo framework and explains which model was selected and why (100-150 words) 3. Discuss the most suitable forms of evidence (e.g., evidence from qualitative study, evidence from randomized control trials, or evidence from systematic reviews) to answer the research question you proposed and justify why with references support (200- 300 words) Instructions for responding to one peer's post [post 2]: (500 words) 1. Choose one peer's post and briefly clarify why you choose this health issue to respond to. (Around 100 words) 2. Provides feedback/comments on the peer's post such as the peer's topic and methods used for developing the research question, with references support. (150-200 words) 3. Provides suggestions and recommendations. (150-200 words) Please note: For both two posts, please 1. Submit directly to the discussion board (no attachments please) 2. References (APA 7th reference) should be within last 5 years should be included, from 2018 and onward. 3. Your reference list is not included in the word count. 4. 1st person is acceptable in the discussion board assessment. 5. Please reference all your claims – including in the evaluation section, if necessary. If you are including information from a journal article/textbook etc. then you must reference it. 6. You will only be able to review and respond to your peer’s posts once you have submitted your own. Marking Rubric Please access the marking rubric to ensure that you are maximising your marks in your submission. NUR256 Assessment 2 examples Only Example 1 (part A – original post): In order to establish a clinical research question, I employed the PICO framework. The aim was to examine appropriate goals of care for patients living with dementia established through quantitative research. Four key references were drawn upon for analysis with conclusive data determining the recommended outcome. Having exposure within acute medical nursing, I often witness pharmacological intervention utilised as first-line behavioural and psychological symptoms of dementia (BPSD) reduction tool. The aforementioned question provides opportunity to delve deeper and gain insight regarding short-term and long-term outcomes with such actions. Research from Douglas et al. (2018) signifies that the use of pharmacological approaches, namely, anti-psychotics medications, often are embraced as first-line interventions, despite the wealth of evidence demonstrating adverse repercussions that ensue. P = Patients living with dementia I = Pharmacological intervention C = Non-pharmacological intervention O = Effective behaviour management Research question: In patients living with dementia, is pharmacological intervention compared to non-pharmacological intervention more effective in behaviour management? To generalize dementia, the gradual decrease in cognitive function resulting in widespread multifactorial dysregulation of the physiological and health related quality of life (HRQL). Dyer et al. (2017) reinforces that resultant of a deterioration in one’s ability to communicate, unmet needs may be reflected in changed behaviours, or increased BPSD. Kongpakwattana et al. (2018) extends on this with postulating that eighty percent of dementia-affected persons exhibit BPSD. Dyer et al. (2017) constructed a systematic review of randomised controlled trials (RCT) on pharmacological and non-pharmacological BPSD interventions. The information conveyed fifteen systematic reviews, listed eighteen different interventions and had a standardized mean surveying dementia-affected adults through avenues such as musical therapy, analgesic therapies, antipsychotics, and cholinesterase inhibitors. The report revealed that the effect size for most interventions was considered small, whereas pharmacological interventions yielded a larger result. Non-pharmacological and functional analysis-based interventions (FABI, interventions modelled on expectant reasons behaviours are elicited) demonstrated significant improvement in regards to BPSD with fewer adverse risks involved. Healthcare providers should consider examining physical illness including infections, dehydration, constipation and sleep disturbance as precipitants for behavioural change and apply relevant FABI (Douglas et al., 2018). The authors further discuss incident of inappropriate prescribing amounting to forty percent of dementia-affected persons not requiring anti-psychotic drugs. Through RCT meta-analysis, Ballard et al. (2016) researched sixteen care homes, including three hundred participants over a nine month period to determine if a reduction in anti-psychotic use improved HRQL. To summarise, the review conferred a significant fifty percent reduction in anti-psychotics contributed to nil significant increase in BPSD. There was also a thirty percent reduction in adverse effects for those receiving both anti-psychotics and social interaction. In this study, Ballard et al. (2016) also alarmingly discovered that anti-psychotic medication worsened HRQL by a factor of 4.54 points. A significant secondary finding demonstrated non-pharmacological interventions improved HRQL by 6.04 points. Examining the benefits of engaging in non-pharmacological and FABI, Douglas et al. (2018) revealed that both have similar effects with a higher degree of HRQL for patients than pharmacological intervention whilst providing a lower risk of adverse events. Therefore, policy and standards of practice should embrace interventions that produce the least harm. Given the frequent emergence of evidence supporting steering away from pharmacological interventions, only specific situations should warrant such interventions such as immediate risk of harm and severe distress (Kongpakwattana et al. 2018). Example 1 (part B – Peer Feedback): In response to the research question by XXX, “In Patients living with Dementia, is pharmacological intervention compared to non-pharmacological intervention more effective in behaviour management?” I have completed my own further research as I have an interest in this particular topic due to working in the health profession, I see a lot of these challenges throughout my workplace and reach to understand this in more detail. There have been times where patients that have Dementia are suffering from delusions and have become agitated along with behavioural changes. Treatment for this has usually been based on the Biomedical model through prescribing medications in order to manage Behavioural and Psychological symptoms of Dementia (BPSD) (Emblad & Mukaetova-Ladinska, 2021). The first article that I have chosen to investigate is based on Non-Pharmacological interventions for BPSD. A systematic approach was conducted between January 2015 to June 2020 with over seventeen studies completed being 2 of them as qualitative and the other 15 studies as quantitative. There was a total of 853 participants each with their own carer. The study focuses on four main aspects: wellbeing, quality of life (QOL), cognitive function and behavioural and psychological symptoms of dementia (BPSD) (Emblad & Mukaetova-Ladinska, 2021). The results showed significant outcomes with increased QOL, where the other two results for BPSD and wellbeing had minimal changes. Other outcomes noted in this research had shown that with non-pharmacological interventions, there had also been reduced side-effects along with minimal clinical symptoms (Emblad & Mukaetova-Ladinska, 2021). There were two main forms which non-pharmacological interventions focus on being the first: Structured forms in which the patient is guided with daily activities by the carer and the second, was unstructured forms where the patient leads the activities. This was dependant on the severity of the patient with Dementia. It allows the patient to be in control and focus on what they would like to do which reduces agitation and behavioural concerns (Emblad & Mukaetova-Ladinska, 2021). These structures allowed expansion of communication between the carer and the person with dementia. When investigating the pharmacological interventions, a research article by (Dyer et al., 2017), conducted a systematic overview during 2015 to 2020 for an age group between 70-85 years old in a Random Controlled Trial (RCT) where 15 systematic reviews and 7 of them were pharmacological interventions. These particular medications that were applied were for the treatment of Behavioural and psychological symptoms of dementia (BPSD). In particular, the medication used during these studies were anti-depressants, Melatonin, anti-psychotics and Cholinesterase inhibitors (Dyer et al., 2017). These medications had significant results however, adverse effects were almost always present when administered. Analgesia was also given as part of the treatment for severe dementia with a step-up approach (Dyer et al., 2017). Pharmacological treatment is applied when a person with dementia has suffered acute symptoms. It is used as a second line treatment to non-pharmacological interventions however is used when all other treatments fail and the person is at risk to themselves or others. When both Pharmacological and non-pharmacological interventions are applied, they work well together. Results do show that therapy-based treatment tends to work better with less adverse effects. References XXXXXXX Example 2 (part A – original post): Opioids in Pain Management Among Older Adults Patient falls are a common occurrence among older adults and can greatly affect their health and wellbeing. Patient falls affect 29% of older adults resulting in 0.67 falls per individual annually and can cause 21-39% of such people to develop the fear of falls (Ganz & Latham, 2020). About 10% of individuals who experience falls suffer from injuries such as fractures, sprains, joint dislocations, and concussions, which results in 2.8 million visits to the emergency department and $49.5 billion used to treat such patients in the U.S. annually (Ganz & Latham, 2020). Some of the risk factors towards patient falls include visual impairments, balance and gait disorders, use of strong medications, cognitive problems, and muscle weaknesses due to aging, among others (Chu, 2017). Opioids are among the most common drugs used by older adults for pain management, as they are frequently affected by conditions like kidney disease, cancers, osteoarthritis, and bone fractures that cause extreme pain (Dolati et al., 2020). It is important to investigate whether these medications affect older adults' risk of falls. My investigation was guided by a PICO question titled, "In aged care residents over the age of 65, does opioid use as pain management contribute to falls increase when compared to non-opioid use for pain management". The research is aimed at determining whether the use of opioids in pain management among older adult’s results in increased falls incidences compared to not using these medications at all. Dolati et al. (2020) state that opioids are used as the standard pain management regimen in the clinical setting for patients affected by different health conditions, including kidney disease, musculoskeletal pain, neuropathic pain, inflammatory arthritis, hypertension, polycystic kidney disease, and renal osteodystrophy among others. This means that older adults are likely to use opioids as these diseases mostly affect them. I reviewed quantitative studies with experimental and systematic review designs to get the findings. P - Opioid use in aged care residents I – Pain medication C – Alternative medications O – Increased falls in aged care There is sufficient evidence from research studies to affirm that using opioids in treating chronic pain among older adults elevates their propensity to falls, may not provide long-term benefits in easing suffering and can worsen some conditions. A case-control study by Machado-Duque et al. (2018) that investigated the link between opioid use and fall risk among older adults showed that there was a statistically significant danger of falls with hip fractures (OR:4.49; 95%CI:2.72–7.42) among the 287 patients who took part in the study. In another study by Yoshikawa et al. (2020), the researchers conducted a systematic review to determine the link between opioid use among older adults and the risk of adverse health outcomes. The results of the research showed that there was a significant relationship between opioid use and fall incidences, fractures, and injuries, with large effect sizes of 0.15-0.71 (Yoshikawa et al., 2020). The same findings were identified by Daoust et al. (2018) and Santosa et al. (2020), who showed that patients who refilled their opioid medications had an increased risk of falls and injuries. Daoust et al. (2018), who investigated the link between the recent use of opioids and the dangers of falls among patients aged 65 years and above, found out that when such patients refiled these medications within two weeks, their risk of falls increased by 2.4 times. Additionally, falls-related injuries among patients who used opioids significantly increased their danger of in-hospital death (Daoust et al. 2018). Opioids were found to cause adverse side effects such as nausea, orthostatic hypotension, poor appetite, impaired cognition, fatigue, constipation, and depression among users (Dolati et al., 2020). Such outcomes show that it may not be prudent to prescribe opioids for pain management among older adults. There is a need for proper monitoring of the use of these medications among patients aged 65 years and above in residential care due to their propensity to cause falls with injuries. Clinicians can decide to use alternative pain medications to address patients' health conditions. References xxxxxxx Example 2 (part B – Peer feedback post): I’ve chosen XXX’s article to peer review as I feel it coincides closely with my own. Having exposure within medical nursing I see first-hand the prevalence