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: 30%
• Length: 2 x 500 words discussion posts
• Due date: Week 8, Sunday 10th September 2023, 23:59:00 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
esearch 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
eakdown 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
XXXXXXXXXXwords)
[2] Develops an appropriate research question using the PICO or PICo framework and
explains which model was selected and why XXXXXXXXXXwords)
[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 XXXXXXXXXX
words)
Instructions for responding to one peer's post [post 2]:
[1] Choose one peer's post and
iefly 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 XXXXXXXXXXwords)
[3] Provides suggestions and recommendations XXXXXXXXXXwords)
Please note:
For the both two posts, please
[1] Submit directly to the discussion board (no attachments please)
[2] References (APA 7th reference) should be within last 10 years should be included, from
2013 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 Ru
ic
Please access the marking ru
ic to ensure that you are maximising your marks in your
submission.
NUR256 Assessment 2 examples
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
esearch. Four key references were drawn upon for analysis with conclusive data determining the
ecommended 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 XXXXXXXXXXsignifies that
the use of pharmacological approaches, namely, anti-psychotics medications, often are em
aced 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 XXXXXXXXXXreinforces 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 XXXXXXXXXXconstructed 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 distu
ance as precipitants for behavioural change and apply relevant FABI
(Douglas et al., XXXXXXXXXXThe 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 XXXXXXXXXXresearched 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 confe
ed 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 XXXXXXXXXXalso 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 XXXXXXXXXXrevealed
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 em
ace interventions that produce the least harm. Given the frequent emergence
of evidence supporting steering away from pharmacological interventions, only specific situations
should wa
ant 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
ased 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, XXXXXXXXXXThe 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, XXXXXXXXXXThese 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., XXXXXXXXXXPharmacological 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 occu
ence 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, XXXXXXXXXXAbout 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, XXXXXXXXXXSome 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, XXXXXXXXXXOpioids are among the most
common drugs used by older adults for pain management, as they are frequently affected
y conditions like kidney disease, cancers, osteoarthritis, and bone fractures that cause
extreme pain (Dolati et al., XXXXXXXXXXIt 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 XXXXXXXXXXstate 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
enal 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
y Machado-Duque et al XXXXXXXXXXthat 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
etween opioid use and fall incidences, fractures, and injuries, with large effect sizes of
XXXXXXXXXXYoshikawa et al., XXXXXXXXXXThe same findings were identified by Daoust et al. (2018)
and Santosa et al. (2020), who showed that patients