You are a student nurse on placement in an Emergency Department (ED). An elderly lady, Perla Daniel, is brought into the emergency department by her daughter. The daughter explains that her 81-year-old mother has been feeling faint, having difficulty standing and has been losing her balance over the last five days. As part of the assessment process the RN undertakes a medication review and finds Perla has two boxes of blood pressure medication with her. The RN determines that both boxes contain the same medication and the same dose of medication, but are different brands with one box being blue, while the other is a green colour with white writing. The nurse asks the Perla which medication she has been taking. Perla tells the RN she has been taking both medications and that the medication in the green box was given to her by the local pharmacy last week. She further adds that she was going to visit the doctor next week as she is nearly out of the medication in the blue box.

The RN tells you that they have seen this situation many times before. The RN adds that many elderly people do not have adequate knowledge of their medication and this can result in increased hospital admissions, poor health outcomes and in some cases, death.

Word count – 1000 words (leeway 10% either side of the 1000 words)

Instructions

You are to search the library databases to determine whether there is evidence to support what the RN has told you.

The learning for this assignment will take place in Weeks 1 to 5. During the first four weeks of the unit, you will learn about PICO, how to create it, why we use it, and how it helps to find credible research relevant to the clinical world. In this assessment, you will provide evidence of your learning by using the PICO template to build a systematic literature search. To assist you in this task a blank PICO template is provided on the Unit Moodle site along with an example of a completed PICO template. Please ensure your assignment is double spaced and you use 12-point Times New Roman font.

IMPORTANT – You are required to use the PICO template available on the NURS11158 Moodle site under the assessment tab when completing the tasks for this assessment. Please note: Evidence sources should be no older than 5 years.

Task 1: Development of PICO - Total word count: 50 words

Firstly, complete the PICO (population/patient, intervention/issue, control/comparison, and outcomes) framework. Be sure to use the PICO template provided on the NURS11158 Moodle site.

Secondly, develop a research question to help search the topic.

Thirdly, document the databases accessed and identify the search terms used. Databases for finding academic resources include MEDLINE, CINAHL, Cochrane, JBI etc. You are to search at least four databases and find the ‘best’ five academic resources including journal articles and evidence summaries.

Task 2: Justification for including academic resources in assignment - Total word count: 950 words (approximately 190 words for each academic resource included in the assignment. Word count includes reference, type of study, ethical approval, and justification).

Select five of the ‘best’ academic resources from your research. Use the PICO template to provide:

(i) Reference (APA). Provide an APA reference for each academic resource. APA references use a hanging indentation; and the first line of the justification paragraph should be indented; see the example PICO and the 6th edition of the APA referencing guide.

(ii) Type of Study. Indicate the type of study for each article/resource e.g. Systematic Review.

(iii) Ethical Approval. State whether the article/resource required ethical approval? Yes/No - if yes, was it clearly stated in the article/resources? If no, why not?  

(iv) Write a justification paragraph using the five components of academic credibility (ARCOC - Authority, Relevance, Coverage, Objectivity and Currency) for each academic resource. Write a justification for EACH of the academic resources included in your assignment. Be sure to state why the selected resource is academically credible. The justification paragraph MUST include the five components of academic credibility (Authority, Relevance, Coverage, Objectivity and Currency-ARCOC). These exact words MUST be included in the justification. Slight variations of the root word are acceptable e.g. Authority, authoritative.

This is an open book assessment. You have two hours to complete the quiz. You are allowed two attempts at the quiz. The second attempt must be completed before the closing date.

The quiz consists of 10 questions. Each question has 2 parts. Both sections of the question should be attempted. Each question is worth 2 marks.

The highest score from the two attempts will be recorded as your grade for this assessment.

Please be sure to study the 6th edition of the APA referencing guide intently prior to attempting this assessment. The 6th APA referencing guide can be accessed via the link on the NURS11158 Moodle site. 

Your answers to the quiz will be marked at the completion of the quiz. At the completion of the quiz you will be provided with feedback as to the correct answer for each question, along with your result for the quiz. 

This assignment has a focus on evaluating and referencing clinical practice guidelines, evaluating and referencing reputable websites, and analysing ethical considerations in evidence-based nursing practice. You will also need to access the National Safety and Quality Health Service Standards and information on the quality use of medicines.

Setting the Scene for your assignment: You are a nursing student on clinical placement in an Emergency Department. Your RN has shared with you their observation about the number of elderly people coming into the hospital with medication related conditions. The RN is concerned that many elderly people admitted to the Emergency Department do not have adequate knowledge of their medication and this is resulting in increased hospital admissions, poor health outcomes and in some cases death. The RN further adds that the department does not have clinical practice guidelines based on the best available evidence to be used by staff to guide the management of elderly people who are presenting with medication related health issues, or what information the nurse should provide the person. As a result, the RN states that they have seen inconsistent information regarding medication safety provided to elderly people when they are discharged from the Emergency Department. The RN asks you to search and review the current evidence to assist the department to develop policies and procedures with regards to safe medication practice for elderly people.

Word count: 1200 words (leeway 10% either side of the 1200 words)

Instructions

Following on from your searches in Assessment 1, you are to write recommendations for the Emergency Department staff to assist them in ensuring their practice aligns with the best available evidence. You also need to explore the ethical considerations around medication safety and elderly people.

What sources of evidence you must use: You MUST use relevant clinical practice guidelines, reputable websites, credible journal articles, the National Safety and Quality Health Service Standards and information on the Quality Use of Medicines. You may also use relevant articles from your first assessment.

What do you need to do next: First, appraise the evidence presented in clinical practice guidelines, websites and academic materials including journal articles, secondly, explore the ethical considerations, and finally, provide evidence-based recommendations that can be incorporated into the Emergency Department's policies and into clinical nursing practice.

Please ensure your assignment is double spaced and you use 12-point Times New Roman font.

To summarise how to set out your assessment:

Task 1. Summary of evidence and recommendations. Locate at least one relevant clinical practice guideline, reputable websites and a selection of credible journal articles. Summarise the current evidence and recommendations for this situation. Relate these findings to the National Safety and Quality Health Service Standards and quality use of medicines.

Task 2. Ethical considerations. Describe the ethical considerations in relation to medication safety for elderly people as per scenario above. Limit your discussion points to the four ethical principles (autonomy, beneficence, non-maleficence, and justice). These exact words MUST be included in the discussion.

Task 3. Provide evidence-based recommendations for the Emergency Department. These recommendations must be cited in-text. Provide 2-4 clear evidence-based recommendations able to be incorporated into the Emergency Department's policies and into clinical nursing practice. Justify your recommendations. Be sure to include in-text citations for your recommendations.

Please note: Evidence sources should be no older than 5 years.

The format of your assignment should be as follow:

• A title page. Please see Assessment 3 exemplar for title page requirements.
• Body (consisting of 3 paragraphs with headings as per the tasks).
• References in the 6th edition of the APA style. The is available via a link on the NURS11158 Moodle site. 

Formatting: i) APA reference list items use a hanging indentation; and ii) the first line of each paragraph should be indented; see the exemplar and the 6th edition of the Abridged APA Referencing Guide on the Moodle site for guidance.