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Problem Statement (PICOT)

The research question, based on the chosen category of the NURS FPX 6030 Assessment 2 PICOT, covers the following topic: palliative care intervention in elderly patients with terminal illnesses. The assessment will cover a broader scope in terms of intervention directed to the psychological aspect of terminally ill patients, the study of psychological intervention Vs usual …concerning results and duration of time taken. The PICOT question will be addressed as follows: The PICOT question will be addressed as follows:

Elderly patients suffering from terminal diseases constitute the ‘Patient’ symbolized by the letter ‘P.’

I – Intervention (Palliative care based mainly on the psychological approach)

C—Comparison (This study will compare the results of using palliative care with the results of using regular care procedures).

O – Outcomes (Reduction in the degree of pain)

T – Time, which is six months.

NURS FPX 6030 Assessment 2 Problem Statement

Need Statement

The concept of the project relates to the necessity of applying psychological interventions in subjects with terminal conditions. This need should be met because, first of all, patients with palliative needs are those in the terminal phase of the disease, which requires emotional, physical, and moral support to help overcome pain and make the last days as comfortable, happy, and stress-free as possible. It enables the patient to share the psychological and spiritual aspects of his or her life. They conducted a survey, and the research findings revealed that terminally ill patients cannot make their own decisions, and they largely depend on others. Hence, they suffer from burden, depression, and frustration.

For this reason, care provision assists patients in managing pain symptoms effectively, thus meeting the objective of providing psychological care. Reflecting on the patient’s history, the moments they would like to live again or again and again, the thing a patient is proud of, and a thing a patient has a fear. These questions will assist the patient in thinking about their lives and will make them feel accomplished and emotionally and psychologically relieved, as posted by Johns et al. (2019).

The current study conducted by Wisesrith (2021) shows that patients diagnosed with terminal cancer with stages III and IV seriously suffer from psychological stress and seem to need spiritual help and psychological support. According to this study, psychological care assisted patients with terminal cancer in controlling their pain, having a sense of achievement in his/her lives, and surmising their upcoming death (Wisesrith et al., 2021).

Population and Setting

The focus population of the current project will be comprised of ACS patients in their elderly age and in the terminal stages of cancer. NURS FPX 6030 Assessment 2 rationale for addressing or providing psychological palliative care to the selected elderly terminal patients is that they are psychologically depressed because of their ill health and are about to die; in addition, they are in a lot of pain arising from cancer treatment, which reduces the quality of life they have.

Intervention Overview

For managing and alleviating the pain from cancers and cancer treatments among patients with terminal illness, the following psychological techniques were recommended: [1] musical therapy [2] required a method of taking part in art such as drawing, painting, clay sculpting [3] relaxation through breathing exercises [4] group consisting of expressive-supportive sessions for discussion and moral support (Warth et al., 2020).

This intervention can aptly be applied to the selected elderly clients. The proposed interferences are easy to incorporate into the elderly populations as none of them involves much physical activity or energy consumption. Therefore, such activities can be easily enjoyed by the elderly, especially inally ill patients who use beds or wheelchairs.

All the interventions proposed are appropriate and suitable for the context that has been identified as the intervention area. The patients within the facility include elderly terminal illness patients, and they had the necessary resources within their reach (art material, instruments) to put up the interventions. Regarding the group therapy requisites and the resting exercises, wheelchairs were available at the hospital. NURS FPX 6030 Assessment 2 elderly patients were taken outside to the garden (if the weather was conducive), and the sessions were conducted there. These interventions helped to cater to the needs of the patients by supporting them psychologically, morally, emotionally, and spiritually to endure the pains they suffered in exchange for cancer treatment (Wisesrith et al.,2021).

Comparison of Approaches

The outcomes of the interventions mentioned above, such as music therapy, breathing exercises, and discussion group therapy, will enhance the ability of the patient to manage the pain experienced; besides, the patient will have a better psychological, spiritual, moral, and emotional status. As a result, this will enhance the patient’s conformity to therapy and will improve the subsequent follow-up sessions. Patients will be more likely to follow the treatment and happier with the inclusion of psychological pain management interventions than pharmacotherapy (Ruano et al., 2022).

Initial Outcomes Draft

The reduction of psychological pain in patients who are terminally ill is the expected outcome that I will be implementing through the intervention. The result of my intervention serves the intention of increasing the patient’s acceptance of the interventions as well as positive psychological, moral, emotional, and spiritual modes by mitigating pain. NURS FPX 6030 Assessment 2 Pain management leads to the patient having an optimistic view of life, and the rest of their life years will indeed be more positive. The patients will be able to proceed with cancer therapy, which will, in one way or the other, enhance the quality of their lives, not to mention the improved quality of care to be accorded to them. Therefore, it will help the patient to have psychological treatment for the final life with good quality, comfort, and painlessness (Ruano et al., 2022).

Time Estimate

The approximate time estimated for developing the intervention is two months, which is feasible. Challenges likely to impact the duration of the time frame include the unavailability of the resource, relationship, and consensus as to the chosen intervention. These are the timelines for carrying out the estimations, and any hitches may lead to an extension of the approximate timeline of six months for implementing the intervention. This period is reasonable for demonstrating the efficiency of the palliative interventions that have been undertaken. Challenges that may prolong the time frame include the resistance of the hospital management regarding the use of these interventions and patients.

Literature Review

NURS FPX 6030 Assessment 2 concern that was discovered in the study was that elderly cancer patients, especially in the last stage of the illness, suffered from severe pain arising from cancer treatment. They got to a point where they were not able to manage and continue with the therapy and declined to accept treatment. However, since pain was an issue that needed to be minimized, measures implemented included the following: relaxing techniques (breathing exercises, mild yoga, or artwork) had been adopted (Saracino et al., 2019). The study concluded that the patients who obtained positive touch and other complementary therapies, including massage, aromatherapy, and acupuncture for the purpose of minimizing the body pain as the main line of the intervention therapy had a better effect in the decrease of pain as compared to those who did not obtain any such technique of treatment (Henson et al., 2020).

Consequently, the patients declined the required treatment (Johns et al., 2019). As a result, interventions were developed with the aim of reducing pain in cancer patients and enhancing quality and safety in the care of cancer patients. Various preventive measures targeting physical suffering were described alongside the conventional prescription of opioids for pain relief (Scarborough & Smith, 2019). Such interventions entailed cognitive therapies to alter the way the patient perceived the pain (Curseen et al., 2020).

Thus, a study observed that psychological therapies used in combination with pharmacologic therapy were found to be more effective in controlling pain symptoms in end-stage cancer patients. The interaction of the combined treatment had an amplified influence on the pain symptoms. Hence, the cancer patients had decreased levels of depression and lower levels of pain symptoms (Bovero and colleagues, 2022).

NURS FPX 6030 Assessment 2 CRAAP Analysis

This process was supplemented by the CRAAP analysis in order to estimate the relevance, currency, sufficiency, and trustworthiness of the obtained evidence. According to insight derived from the CRAAP (currency, relevance, authority, accuracy, and purpose) analysis, the above-gathered data was relevant to the respective topic since the keywords mirrored the topic. The search terms employed herein were ‘terminally ill patient,’ ‘End-of-Life’ patients, ‘palliative care,’ ‘adjuvant therapies,’ ‘psychological care,’ ‘hospice care,’ and ‘Psychotherapy. ’ These strategies ensured that the studies found were relevant to the PICOT question and have been used to select articles accurately. In addition, the chosen articles fall within the present five years up to 2023, the intended year for the accomplishment of the goals. This gave evidence that the data collected was up-to-date information.

Moreover, the credibility of the articles was deemed by the qualification of the healthcare providers in which 5 of those authors have PhD, 17 of them were MD doctors, 15 of them belong to the field of medicine, and 3 of them are researchers. To support this accuracy, the authors did not have any copy write strikes on the work that was published. The same source also offered assurance that such information was reliable and could be used in this evaluation. NURS FPX 6030 Assessment 2 To a certain extent, the article’s purpose was justified when the information found in the articles was used to align with the requirements of PALLIATIVE CARE of TERMINALLY ILL and end-of-life patients. Since all the criteria for CRAAP analysis were evident from the articles used, the current evidence used herein was considerably relevant, current, sufficient, and credible to be used in this study.

Aims established by the WHO for cancer care healthcare policies aimed at enhancing quality in the management of cancer pains. Working through WHO has highlighted the desirability of promoting interventions inclined to reduce pain in terminal illnesses employing spiritual and psychological approaches. These interventions will facilitate adequate conn relief in patients and assist in enhancing their psychological, religious, ethical, and physiological disdispositionsHO, 2019).

Healthcare Policy that Impacts the Approach to Address an Identified Need

Healthcare Policies

Some of the general healthcare policies of the WHO that have been laid down to enhance the quality of care for cancer patients are those regarding pain management. WHO has spelled out directions for developing interventions to reduce pain, especially in the terminal stages of the disease, through spirituality and psychological support. NURS FPX 6030 Assessment 2 interventions will contribute to managing the pain in the patients, which will enhance their psychological, spiritual, moral, and emotional aspects (WHO, 2019).

The policy coverage Medicare offered for a terminal illness and its pains entailed behavioral health integration, physical therapy services, and acupuncture treatment. Also, Medicare policy perceives pain as real and tangible symptoms that should be alleviated by offering to pay for the use of opioid analgesics. Some of these medicines include morphine, codeine, hydrocodone, etc, for the management of pain, and some practices involve psychological treatments (Medicare, 2020).

Healthcare Technologies

Such technologies allow caring for the patient and can significantly enhance his quality of life. This means NURS FPX 6030 Assessment 2 technologies offer them psychological treatment and enhance their religious and mental health status. Such technologies are as follows: wearable devices that stimulate electrical signals in the body to improve and delete the status of a patient psychologically. It is smooth and does not hurt or start an agony in terminal patients. However, it is supposed to enhance life satisfaction by raising mental status (Gibson et al., 2019). In addition to this, a patient can use gadgets like tablets to take part in art therapy or music therapy. This has been made possible by the use of online applications that enable the patient to make music and create digital art. In the process, the patient will be engaged and help them dwell little on physical pain, sadness, or loneliness, therefore contributing to enhancing their quality of life (Zhang et al., 2022).

Reference

Pain Management, 12(8), 895–906. https://doi.org/10.2217/pmt-2022-0015

Curseen, K. A., Taj, J., & Grant, Q. (2020). Pain management in patients with serious illness.

Complementary Therapies in Clinical Practice, 34, 280–287. https://doi.org/10.1016/j.ctcp.2018.12.014

Hanna, J. R., McConnell, T., Harrison, C., Patynowska, K. A., Finucane, A. M., Hudson, B., Paradine, S., McCullagh, A., & Reid, J. (2022). Palliative Medicine, 36(10), 1483–1492. https://doi.org/10.1177/02692163221122269

Henson, L. A., Maddocks, M., Evans, C., Davidson, M., Hicks, S., & Higginson, I. J. (2020).

The role of social work. Rural and Remote Health, 19(3), 5285. https://doi.org/10.22605/RRH5285

Medicare. (2020). Pain management insurance coverage. Medicare.gov.

Ruano, A., García-Torres, F., Gálvez-Lara, M., & Moriana, J. A. (2022). Journal of Pain and Symptom Management, 63(5), e505–e520. https://doi.org/10.1016/j.jpainsymman.2021.12.021

Saracino, R. M., Rosenfeld, B., Breitbart, W., & Chochinov, H. M. (2019). Psychotherapy at the end of life. The American Journal of Bioethics: AJOB, 19(12), 19–28. https://doi.org/10.1080/15265161.2019.1674552

Scarborough, B. M., & Smith, C. B. (2019).

Zheng, R., Guo, Q., Chen, Z., & Zeng, Y. (2021). Dignity therapy, psycho-spiritual well-being and quality of life in the terminally ill: Systematic review and meta-analysis. BMJ Supportive & Palliative Care, bmjspcare-2021-003180. Advanced online publication. https://doi.org/10.1136/bmjspcare-2021-003180