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Evidence-Based Practice using PICO
The question posed for this search activity will be, "Does early referral of terminally ill patients into a hospice program results in better patient outcomes, in particular, with regard to pain management?" The patient group in this question is terminally ill patients. The intervention is terminally ill disease. The comparison is time entered into hospice care. The outcome is reduced pain. The primary search terms for this search are hospice and pain management. Synonyms for the search are in-home care, bereavement care, critical condition, deathbed, palliative, and anesthesia. The MeSh terms are Hospices, Terminal Care, Pain management and Chronic Disease.
Based on the located synonyms, the better phrasing of the question may be, "Do early admitted hospice patience have a better outcome regarding pain management?" The reason for shaving the question slightly is that only terminally ill patients can be admitted into hospices. So, the term does not necessarily need to be part of the actual question.
The first search that I ran was using CINAHL. I initially tried using the primary research terms placed separately in quotations. This brought up very vague searches with no helpful articles. The total amount of papers was 2,330. I next removed the term "terminally ill" and left the other two and the search titles became very useful articles but the total amount of articles increased. In total, there were 14,200 articles that came up with the search. This search brought up the following helpful articles on the first search page:
Berry, Patricia...
Barriers to pain management in hospice: A study of family caregivers. Hospice Journal. Vol 10(4), 19-33.
Fothergill-Bourbonnaise, Frances; Wilson, Jennifer (2006). A comparative study of intensive therapy unit and hospice nurses' knowledge on pain management. Journal of Advanced Nursing. Volume 17(3), 362-372.
Gloth, F. Pain Management in Older Adults: Prevention and Treatment. Journal of the American Geriatrics Society. Vol 49(2), 188-199.
Miller, Susan; Et al. (2002). Does Receipt of Hospice Care in Nursing Homes Improve the Management of Pain at the End of Life? Journal of the American Geriatrics Society. Vol 50(3), 507-515.
Miller, Susan; et al. (2003). Hospice enrollment and pain assessment and management in nursing homes. Journal of Pain and Symptom Management. Vol 24(3), 791-799.
I then decided to try using some of the synonyms for the search terms to see if I could narrow the total any further. I first tried using the terms early terminal care, placed in quotations. This brought up only three articles none of which were useful. For the next try, I used the terms early entry and hospice. Early entry was placed into quotations and hospice was left out of quotations. This resulted in 75 studies some of which were very helpful including the following:
Chow, E.; et al. (2000). How Accurate are Physicians' Clinical Predictions of Survival and the Available Prognostic Tools in Estimating Survival Times in Terminally III Cancer Patients? A Systematic Review. Clinical Oncology. Vol 13(3), 209-218.
Kinzbrunner,…
Shepperd, Wee; et al. (2012). Home-based end of life care.
This search engine did not seem very helpful at all. Perhaps it is meant more for basic definitions as opposed to research-based questions.
The most helpful article that I found during my searching was the Miller article "Does receipt of hospice care in nursing homes improve the management of pain at end of life." I think this article will be helpful as it implies using hospice care sooner and integrating it with the care of physicians and nurses at nursing homes.
A study conducted by Leep Hunderfund et al. tested the effectiveness of a follow-up assessment and risk factor specific intervention measures in reducing falls in an inpatient setting (2011). The study suggested that the Hendrich Risk Fall Model works as an effective primary screening tool and, when used in combination with further physician assessment, reduces the number of patient falls dramatically. Ang, Mordiffi and Wong corroborated these results in
Mobility Evidence-based Practice Progressive Mobility Protocol This paper is a project based on PICO. The clinical question that serves as the foundation for this data-based design is; for immobile critical care patients, does the use of a nurse driven progressive mobility protocol reduce ICU LOS compared to every hour of repositioning? In this paper, the adult patients admitted to an ICU represent the population (P) of interest. The nurse driven progressive mobility
Still, the concept of guided imagery tends to stray far from traditional methods of pain management. Pharmaceuticals have long been a major method of treatment for pain, but have resulted in major backlashes in regards to patients becoming addicted, especially in long-term and chronic cases of pain. If guided imagery could be a successful method, it may reduce pain or increase pain tolerance, without the threat of chemical dependence. There
Qualitative, meetings and seminars, then questions to ascertain efficacy. Smallish, 65 in one hospital. Survey and qualitative observation. Clear and effective communication goals were met using positive educational interventions. Longitudinal and sample size. Good basic, lacks lengthy literature review. Data may be extrapolated, but further work needs to be done using larger, more diverse sample. Melnyk, B., et.al. Evidence-based Practice: Step-by-Step Igniting a Spirit of Inquiry. 2009 What is the effectiveness of an evidence-based practice format on collaborative inquiry. Meta-Analysis
Meta- Analysis and Evidence-Based Research on Children Feeding Disorders The eating disorders are among pediatric clinical problems in the United States that can cause distress to clinicians and parents. Typically, eating disorders are affecting more than 40% of children of pre-school and school ages, and the associated psychology and health problems of the eating disorders include a mental retardation, behavioral problems, growth retardation, and poor academic records in schools. This study
Evidence-Based Medicine Working Group. (1992). Evidence-Based medicine: A new approach to teaching the practice of medicine. JAMA, 268 (17), 2420-2425. Evidence-based medicine is a new paradigm that places emphasis on new skills for physicians that include: performing efficient in performing literature searches and applying formal rules of evidence in examining clinical literature (critical appraisal exercise, which applies when authority is not trusted, the answer unknown, or there are divergent opinions). This