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Students will submit a PICO question to guide scholarly inquiry to answer an intervention or assessment issue in their area of practice. The question should be well written in PICO format, researchable, and address an identified practice issue. Note that the "C" can be usual or standard care (lack of the intervention) rather than another intervention. 

Please first write out each component (P, I, C, and O) and then write it as a question suitable for investigation.

Write a short paragraph explaining which AACN DNP Essential(s) your PICO relates to, and why. 

Optional: students may add a short reference list of studies related to the chosen topic for review by faculty (this portion is ungraded). These could be studies used for the critical appraisals. Each study must be match the population, intervention, and outcome specified in the PICO (assuming the C is usual care or standard practice). 


The Effectiveness of Pharmacological vs. Non-Pharmacological in Managing Chronic Pain among Alzheimer's Patients Residing in Long Term Care Facility

Background                                                                                                                    

Cognitive health impairments, especially among the elderly patients above 65 suffering from Alzheimer's disease (AD), are of significant health concern for all healthcare providers due to the associated chronic pain. Chronic pain is the persistent and recurrent pain perceived over a predefined duration, often 3 to 6 months after onset or, according to a wider definition incorporating no arbitrarily fixed duration, pain that extends beyond the expected healing period (Cravello et al., 2019). There are about 35 million persons across the globe with dementia, of whom 50 percent experience chronic pain (Cravello et al., 2019). Additionally, older patients above 65 years old without Alzheimer's disease have other cognitive impairments that cause chronic pain. Besides, the presence of chronic pain in the elderly individuals with cognitive decline is often neglected, under-reported, underestimated, misdiagnosed, and sometimes not properly treated, with consequences that have a considerable impact on the health status, independence in activities of daily living, and the quality of life (Zucchella et al., 2018). Therefore, determining the most appropriately chronic pain management strategy is essential to reduce the adverse consequences associated with chronic pain among the AD patients. This paper will focus on pharmacological and pharmacological chronic pain management strategies.

Treatment of chronic pain in elderly patients with cognitive decline or AD is often based on non-pharmacological and pharmacological strategies. Research indicates that pharmacological treatment of chronic pain considers physiological changes, high comorbidity, and drug interactions that often occur frequently among the elderly with cognitive impairments (Zucchella et al., 2018). On the other hand, non-pharmacological treatment involves physical therapy or alternative therapies. Therefore, this paper aims to develop a PICO question to help determine the effectiveness of pharmacological chronic pain management strategy compared to non-pharmacological treatment strategies to treat chronic pain among the elderly AD patients living in long-term care nursing homes.

PICO Question

The PICO question elements are as follows:       

P (Population/Patient) - AD patients of 65 years old and above experiencing chronic pain in a long-term care facility.

I (Intervention)-Pharmacological treatment strategies

C (Comparison)-Non-pharmacological treatment strategies

O (Outcome)-Reduced chronic pain

PICO Question: In AD patients of 65 years old and above experiencing chronic pain in a long-term care facility, what is the effectiveness of the pharmacological intervention as compared to non-pharmacological intervention in reducing chronic pain?

How the PICO Relates to AACN DNP Essentials

The PICO question relates to various AACN DNP Essentials. As a DNP, it is important to note that one of the focuses is on practice that is innovative and evidence-based, revealing the application of credible research findings. The PICO question relates to "Essential I: Scientific Underpinnings for Practice." The scientific underpinnings of the PICO question reflect the more complex clinical practice is at the doctoral level and the rich legacy that is the conceptualized foundation of nursing (Christiansen & Champion, 2018). By answering the PICO question, a DNP will have to focus on the nursing actions or processes by which positive transformations in the health status of the population under investigation are affected. Besides, the interventions used in the PICO must take into consideration the patterning of human behaviors in interaction with the environment in ordinary life events and crucial life circumstances. The PICO also relates to "Essential VI: Inter-professional collaboration for improving patient and population health outcomes" (Christiansen & Champion, 2018). In this essential, the implementation of the intervention requires a multi-tiered health care environment that depends on the contributions of highly skilled and knowledgeable individuals from multiple professions. Nurses must work in collaboration with other inter-professional teams to implement the intervention and ensure its success.




References

Christiansen, B., & Champion, J. D. (2018). Examining Doctor of Nursing Practice clinical competency. The Journal for Nurse Practitioners14(5), 93-100.

Cravello, L., Di Santo, S., Varrassi, G., Benincasa, D., Marchettini, P., de Tommaso, M., & Paladini, A. (2019). Chronic pain in the elderly with cognitive decline: A narrative review. Pain and Therapy, 1-13.

Zucchella, C., Sinforiani, E., Tamburin, S., Federico, A., Mantovani, E., Bernini, S., Casale, R., & Bartolo, M. (2018). The multidisciplinary approach to Alzheimer's disease and dementia. A narrative review of non-pharmacological treatment. Frontiers in Neurology9, 1058. https://doi.org/10.3389/fneur.2018.01058

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