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NURS FPX 4030 Assessment 3 PICO(T) Questions and an Evidence-Based Approach CM

Using a PICO(T) Framework and Evidence to Develop Care Practices

NURS FPX 4030 Assessment 3 PICO(T) Questions and an Evidence-Based Approach CM

PICO(T) is an acronym that can guide health care professionals in their quest for evidence based research. Expanded, PICO(T) is Population/Problem, Intervention, Comparison (of the interventions), Outcomes and Timeframe and can be used to develop a person centered plan that will ensure the patients’ needs and wants are addressed. In this paper we will discuss a practice issue dealing specifically with end of life patients that are planning to die at home, applying to PICO(T) process, we will identify evidence based sources that can provide answers to our research question, explain key findings from the research and explain the relevance of those key findings from the chosen articles.

Use of the PICO(T) Approach when Caring for End of Life Care at Home

The problem issue identified here is care with compassion to meet the personal needs of patients at end of life in the home setting as well as meeting the needs of their loved ones. Our goal is to develop a personalized plan of care that will meet the psychosocial needs as well as the physical needs of our patients. The question being asked here is: Are we meeting the needs of end of life patients using the medical model or person centered care model by being non-judgmental and helping them die knowing their wishes and needs were met?

NURS FPX 4030 Assessment 3 PICO(T) Questions and an Evidence-Based Approach CM

The intervention approach we have identified is a person-centered care approach. The person-centered approach promotes an enhanced emphasis on what the patient wants and needs, it encourages a relationship between the patient, family and health care provider to develop and plan of care that put the person’s wishes as priority (Diepen et al., 2021). For example: if the patients states they want everything possible done to prolong their life then the health care provider does exactly that, whereas, when the patient states they was to go home and spend as much time as they have left with family and friends and be as comfortable as possible then that too is what we make happen. The population being studied are the patients that have chosen to go home and be as comfortable as possible though out the end of their lives. 

Identification of Sources of Evidence

Gothenburg Model

The Gothenburg model was established in 2010 by the University of Gothenburg Center for Person-Centered Care, as an advocate for person centered care and to promote a partnership between the patient and the provider to better achieve the patients goals. This model proposed three routines: to initiate, integrate and safeguard. The first being to initiate a partnership between the patient and the healthcare team. The second being integrate meaning to shear decision making between the patient and the healthcare team and the third to safeguard the partnership. This model discouraged using the term patient in the person centered model but strongly focused on the person or patient being the center of the decision making, although not diminishing the healthcare providers input but focusing on a mutual agreement (Britten et al., 2017).

6S Dialogue Model

The 6S concept was developed as a tool to use when implementing person or patient centered care, to provide nurses with knowledge about their patients to enable them to meet the patients’ needs and wants. The 6S’s are as follows, self-image, symptom relief, self-determination, social relationships, synthesis and strategies. This model was developed to enable patients to co-create, along with healthcare professionals and family, a meaningful palliative plan of care that meets their needs and beliefs promoting the possibility of an appropriate and meaningful death (Henoch et al, 2019).

Structural Equation Model

The structural Equation Model focuses on helping the patient achieve their goals though holistic methods, taking into consideration their individual preferences and needs rather than just that of the disease process. Using this model we can lessen the stress and anxiety of the dying patient thus promoting a peaceful and personal end of life experience. This method also promotes increased compassion and satisfaction for nurses providing holistic care (Ji-Yeong et al., 2021). 

Findings from Articles

As Person Centered-Care promotes the enhancement of patient-family/healthcare professional relationships that are based on the informed wished of the patient. Person centered care is care that has moved from focusing on the medical model of care or the disease process to focusing on the wishes and the needs of the patient and family. Using patient centered care it is imperative that the healthcare professional takes time to know and understand the patient while considering their background and culture as well as where they are in their disease process. Research proves that using this approach ensures that the patient is treated not just the disease (Kennedy, 2017).  The articles that were chosen for this paper backs the fact person centered care will enhance the patients as well as the health care providers experience during end of life.

NURS FPX 4030 Assessment 3 PICO(T) Questions and an Evidence-Based Approach CM

Relevance of Findings from Articles

The study by Britten et al (2017) was chosen because if provides a comprehensive explanation of the Gothenburg Model of patient centered care. Which focuses on promoting a plan of care that is based on a mutual agreement between the provider and the patient.

The rationale behind choosing the study by Henoch et al (2019) was that it uses the 6S model to develop and enable the patient along with their family and the healthcare provider to build a meaningful palliative plan that meets their wants and needs during end of life.

The studies of Ji-Yeong (2021) focuses on helping the patient and the healthcare provider to lessen the stress and anxiety during the dying process and promote a holistic approach to the care they receive.

Conclusion

There is need to develop end of life care practices that are centered on the person and their desires for end of life. The PICO(T) framework was applied to determine if the intervention approach of person centered care is effective in helping the patient during the end of life to live out their life the way they choose to, rather than focusing on treating the disease. The articles that were chosen for this paper reinforce the idea of treating the person not the problem.

References

Britten, N., Moore, L., Lydahl, D. Elam, M., Wolf, A., (2017) Elaboration of The Gothenburg Model of Person Centered Care. International Journal of Public Participation in Health Care, 20(3) 407-418. https://doi.org/10.1111/hex.124668

Diepen, C., Wolf, A., (2021). Care Is Not Care If It Isn’t Person-Centered. International Journal of Public Participation in Health Care, 24(2), 548-555 https://doi.org/10.1111/hex.13199  

Henoch, I., Osterlind, J., (2019). Development of the 6S Dialogue Tool to Facilitate Person-Centered Palliative Care. Journal of Advanced Nursing, 75 (11) 3138-3146.  https://doi.org/10.1111/jan.14115

Ji-Yeong Y., Cho, I., (2021). Structural Equation Model for Developing Person-Centered Care. International Journal of Environmental Research and Public Health, 18(19), 10421. http://dx.doi.org/10.3390/ijerph181910421

Kennedy, C., (2017). What is Person Centered-Care and Can It Be Achieved in Emergency Departments? Emergence Nurse, 25(2)19. https://dx.doi.org library.capella.edu/capella.edu/10.7748/en.2017.e1699 

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