1. Outcome Introduction and Thesis Statement
1. Introduce the topic/purpose of the paper.

2. Conclude the introductory paragraph with a direct thesis statement that informs the reader of the purpose, or the primary objective of this paper.
This criterion is linked to a Learning Outcome Attitude of Inquiry
1. Briefly describe the nursing meta-paradigm. Describe the relationship of each PICO element to the meta-paradigm element. Provided support with at least one reference other than textbook.

2. What is a phenomenon of interest (POI)? Identified the POI being investigated. PICOT Question on Palliative Care Essay

4. Using the selected phenomenon of interest, write a PICO question. Identify the P, I, C, and O
This criterion is linked to a Learning Outcome Searching the Evidence
1. Using your PICO, perform a literature search. What types of studies did you find interesting? Describe the types of evidence you found and what you learned performing the search.
2.Identify the key words and phrases from the PICO you created which can be used to search the evidence.
3. Describe at least two bibliographic databases that were used in the search (name, brief history, and what makes it unique).
4. Describe any tools or filters that were used to broaden/narrow your search.
This criterion is linked to a Learning Outcome Article Synopsis
1. Provide at least two (2) examples of current articles related to your PICO. For each article, describe/explain the type of research used (qualitative, quantitative, design) and support with reference(s).
2. Provide a brief synopsis of each article (minimum of 3-5 sentences) and cite appropriately.
This criterion is linked to a Learning OutcomeBest Sources of Evidence
1.What are clinical practice guidelines and how are they used by the healthcare team?
2. Search for a clinical practice guideline (CPG) related to your topic.
3. Provide the following information on the guideline:
Describe how and where you found the CPG.
Describe the guideline, include the organization, title, year, purpose, etc. (be sure to cite/reference appropriately).
Describe how the CPG relates/applies to your PICO.
This criterion is linked to a Learning Outcome Conclusion
1. Summarize the major points of the paper in one (1) paragraph.

2. No new information or references should be included in this section.
This criterion is linked to a Learning Outcome Appendix: Topic Search Table
1. Search a topic using 2 different databases. Complete and insert the table as an appendix with the following information: databases used, search terms (from your PICO), results, what MeSH and/or Boolean operators, filters or limits you used (table).
This criterion is linked to a Learning Outcome Scholarship
1. Formal, scholarly writing with no first person language.

2. Writing should be clear and concise.

3. Organize work by headings.

4. Writing should be free of APA errors.

5. Full paper submitted to Turnitin and reviewed with minimal similarity.

6. CON approved title page.

7. References in addition to textbook (preferably peer-reviewed, within last 5-7 years).

8. Citations and references follow APA 7th edition format.

9. Writing should be free of grammatical and spelling errors.

10. Paper not to exceed six (6) pages (excluding title page, reference page, and any appendices).

11. Follow assignment instructions.

12. Demonstrate good overall writing skills.

13. Additional deductions may apply for late submissions, plagiarism, or lack of scholarship and professionalism

PICOT Question on Palliative Care

Palliative care is loving care provided by healthcare workers and other caretakers to people suffering from irreversible life-threatening illnesses in order to improve their quality of life and allow them to die peacefully and in tranquillity. It is end-of-life care provided to patients who have reached the end of their medical options. These patients have conditions such as incurable metastasized cancer. Palliative care is holistic, and the nurse must be sympathetic, kind, and loving while providing care. The nurse, in her various roles, is an extremely important person in the provision of palliative care. To begin with, caregivers spend the most time with terminally ill patients. This allows them to provide the finest tailored palliative care to terminally ill persons (Collins & Small, 2019). Three holistic care disciplines take primacy over the others in palliative care. There are three of them: the physical, psychological, and spiritual domains (Lu et al., 2018). Terminally ill individuals are usually cancer patients, although other serious diseases also qualify as incurable when there is no way to clearly stop their progression by curing them. Palliative care encompasses a wide range of services and is not identical with hospices. Hospice, on the other hand, is a type of end of life care that is only provided at the terminal phase (Lu et al., 2018). Nonetheless, the two phrases are frequently used interchangeably and indiscriminately in healthcare and nursing writings and discourse. The purpose of this paper is to lay out the process of clinical inquiry using a PICOT question identifying available evidence on the biggest challenge in palliative care between pain management and spiritual care.

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The Nursing Metaparadigm

According to Wayne (2021), four concepts normally called the metaparadigm concepts of nursing apply to any nursing theory whether it is middle range, practical, or grand theory. The four concepts are nursing, environment, person, and health. In this paper, the metaparadigm of concern is nursing. Each of the PICOT elements relates to the nursing metaparadigm. To begin with, the population (P) of terminally ill patients is dependent on the nurses (nursing) as these are the caregivers. Without the input of nurses there would be no palliative care. They offer holistic care including physical (such as pain relief), spiritual, psychological, and emotional care.

The intervention (I) is delivered by the nurses through the nursing metaparadigm. Without the nursing knowledge applied by nurses to deliver interventions such as spiritual care or pain management, there would be no palliative care (Abu-Odah et al., 2020). The comparison (C) is also an intervention but that is contrasted with the previous intervention as mentioned in the PICOT question. It is therefore also delivered by nurses through the knowledge of nursing. The outcome (O) is the intended consequence of the actions of the nurses and is therefore also related to nursing as the metaparadigm. Lastly, the timeframe (T) is a component that relates to nursing as a metaparadigm because nursing uses goals in care panning that are smart. This means that these goals are always time-honored or time-bound.

The Phenomenon of Interest and the PICOT Question

The phenomenon of interest is the challenge of pain relief and spiritual care in relation to the quality of life of the terminally ill patient. Chronic pain is a significant issue in palliative care. The majority of this discomfort is caused by cancer that has spread to other places of the body. When nerve roots become crushed, as when tissues grow out of control, the pain is frequently terrible and only partially responsive to traditional pain treatment measures. This is why, in the case of chronic pain in the terminally sick, pain management must adhere to therapeutic recommendations guided by evidence from efficacy research (Melnyk & Fineout-Overholt, 2019). Likewise, because the terminally ill patient knows that they will soon die, the concept of spiritual care usually carries a lot of weight too. But the provision of these two interventions competes with each other in the care planning spectrum. Often, the question may be posed as to whether pain relief of the provision of spiritual care is the most challenging in palliative care. What is certain though is that the patient needs both so that their quality of life may be improved during their last days. The ICOT question thus draws from the above phenomenon of interest. PICOT Question on Palliative Care Essay

The PICOT Question

The PICOT question that has been formulated drawing from the above phenomenon of interest on pain management and spiritual care is as follows:

In terminally ill patients on palliative care (P), is pain management the biggest challenge (I) compared to spiritual care (C) in improving the quality of life of the patients (O) within three months? (T)

Table

PICOT elements

The Literature Search Criteria

To arrive at the current scholarly evidence that supports the elements of the PCOT question, a literature search was conducted in reputable research databases. On this topic, I searched research databases for literature and proof. CINAHL, PubMed, Cochrane, and ProQuest were the databases used. This search was conducted using key terms, which were entered into the search engines of the individual databases. The main terms in this case were “palliative care,” “pain treatment,” “spiritual care,” and “challenges.” To achieve successful outcomes, these crucial phrases were merged using the Boolean operator “AND.” Following the initial hit of 1,215 articles, more filtering was performed using year of publication, full article status, and methodology, among other criteria. This technique resulted in only 18 extremely precise papers that addressed the search topic of the problem in improving palliative care quality of life.

Two Articles

Two of the specific articles chosen among the eighteen are those by Abu-Odah et al (2020) and Gofton et al. (2018). The former is a qualitative analysis while the latter is a systematic review. Systematic reviews provide the highest level of evidence compared to all other methodologies (Creswell & Creswell, 2018). In Abu-Odah et al. (2020), the researchers aimed at looking at the challenges that face patients in palliative care. However, they concentrated their research on those patients from low income backgrounds t see what challenges they face most. The challenges they found facing patients from these population demographics were mostly related to socioeconomic status as a social determinant of health (Powell, 2016). In Gofton et al. (2018), the researchers also concentrated on challenges facing patients in palliative care. However, they chose to concentrate on those with neurological etiologies such as space-occupying lesions. Theirs was a qualitative analysis of the possible challenges.

Palliative neurology is focused with providing treatment to terminally ill patients suffering from disorders affecting the nervous system, most commonly the brain. A good example is a space-occupying lesion, or SOL, which continues to grow and affects the patient’s cognitive functions. According to Gofton et al. (2018) communication or impaired language, activities of daily living or ADLs, and emotional anguish for the patient since they can no longer accomplish the things they used to do readily are among the problems. PICOT Question on Palliative Care Essay

Clinical Guidelines

This is why pain management in the cases of chronic pain must follow laid down clinical guidelines that are informed by evidence from research on efficacy (AAPM, 2022; Melnyk & Fineout-Overholt, 2019).  American Academy of Pain Medicine (AAPM, 2022) provides the clinical guidelines for pain management in palliative and other care. The correct decision to manage the chronic pain of terminal cancer in this case that is appropriate is the prescription of an opioid analgesic such as Percodan or oxycodone. Percodan is a combination of an opioid and a non-opioid analgesic. The CPG relates to the PICOT in that the main intervention in the PIOT question is pain management.

Conclusion

The clinical inquiry method is used to identify evidence that supports interventions in clinical practice. What is used is the PICOT framework. In this paper, palliative care has been looked at in terms of challenges facing the patients. In particular, pain management and the provision of spiritual care have been compared. 

References

Abu-Odah, H., Molassiotis, A., & Liu, J. (2020). Challenges on the provision of palliative care for patients with cancer in low- and middle-income countries: A systematic review of reviews. BMC Palliative Care, 19(55), 1-16. https://doi.org/10.1186/s12904-020-00558-5

Collins, C. M., & Small, S. P. (2019). The nurse practitioner role is ideally suited for palliative care practice: A qualitative descriptive study. Canadian Oncology Nursing Journal, 29(1), 4–9. https://doi.org/10.5737/2368807629149

Creswell, J.W., & Creswell, J.D. (2018). Research design: Qualitative, quantitative, and mixed methods approaches, 5^th ed. Sage Publications, Inc.

Gofton, T.E., Chum, M., Schulz, V., Gofton, B. T., Sarpal, A., & Watling, C. (2018). Challenges facing palliative neurology practice: A qualitative analysis. Journal of the Neurological Sciences, 385, 225–231. https://doi.org/10.1016/j.jns.2017.12.008

Lu, Y., Gu, Y., & Yu, W. (2018). Hospice and palliative care in China: Development and challenges. Asia-Pacific Journal of Oncology Nursing, 5(1), 26-32. https://doi.org/10.4103/apjon.apjon_72_17

Melnyk, B.M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing & healthcare: A guide to best practice, 4^th ed. Wolters Kluwer.

Powell, D.L. (2016). Social determinants of health: Cultural competence is not enough. Creative Nursing, 24(1), 5-10. http://dx.doi.org/10.1891/1078-4535.22.1.5

Wayne, G. (2021). Nursing theories and theorists. https://nurseslabs.com/nursing-theories/

PICOT Question on Palliative Care Essay