Research Proposal and combination of 2 previous papers

Running Head: CLINICAL EVIDENCE BASED PRACTICE 1

CLINICAL EVIDENCE BASED PRACTICE 5

Narcolepsy with Cataplexy

Nicole Stallworth

Herzing University

Clinical Evidence Based Practice.

  Narcolepsy with cataplexy is a sleep disorder that affects about 0.02% of adults in the world. The disorder is characterized by sleepiness during the daytime, with loss of muscle tone. Narcolepsy on its own is a sleep disorder in which there is excessive sleepiness and hallucinations. The disorder occurs in men with an equal chance of occurrence in women. Symptoms of the disease appear in childhood or during adolescence. Most people who have the symptoms of the disorder go for years without getting an appropriate diagnosis. People with the disorder have an urge to sleep even during normal activities. Sleep characteristics can even occur while a person is awake. In cataplexy, there is muscle paralysis of the Rapid Eye Movement (REM) phase of the sleep cycle, which occurs during waking hours. It results in loss of muscle tone, leading to weakness of the trunk, arms and legs. The main cause of narcolepsy with cataplexy is deficiency of hypocretin, a hormone from the brain. The hormone alerts systems in the brain, regulating sleep wake cycles. In the condition, the cells that produce hypocretin, which are located in the hypothalamus, are destroyed. There is no cure for the condition at the moment. However, behavioural treatments and some medications can help improve symptoms in patients. When well managed, patients lead normal lives (Dauvilliers et al, 2007). The topic is important in nursing care due to the several cases of misdiagnosis of the condition taking place. Notably, the condition can be diagnosed through physical examinations, medical history taking and conducting sleep studies on patients. Based on the nature of diagnosing the condition, nurses are best suited to diagnose the problem, as they care for the patient (Rios et al, 2010).

For a nurse to obtain relevant yet sensitive information from a patient, which can guide them to diagnosing a problem such as narcolepsy with cataplexy, there is need for a model to guide in assessing the patient. The PICOT question format is a formula for developing researchable and answerable questions, which clinicians can use to ease the evaluation process. Notably, most nurses fail to understand the real cause of conditions facing a patient apart from the disease itself, due to lack of the skills necessary in assessment. They also do not understand that in clinical care, there is need to focus on a multi-sectorial approach in order to understand what really intensifies the conditions patients face. What is more, nurses need to understand the importance of using an integrated approach to patient care, which is preventive and promotive oriented, rather than just a curative and rehabilitative one. The PICO(T) format therefore is necessary in evaluating a patient to diagnose the underlying factors, which may have led to the problem, away from the clinical setting (Indicators, 2003).

P: A 21-year-old AA female diagnosed with narcolepsy with cataplexy without a family history of narcolepsy.

I: Adding altered eating patterns reduction of daily stress and daily naps.

C: Methylphenidate alone.

O: Reduction of daytime sleepiness and cataplexy.

In A 21 year-old AA female diagnosed with narcolepsy with cataplexy without a family history of narcolepsy will Adding altered eating patterns, reduction in daily stress and daily naps versus Methylphenidate alone lead to a Reduction of daytime sleepiness and cataplexy?

A good question that the nurse should frame to the patient should be simple to understand, answerable and realistic. In the model, “P” stands for population or patient, whereby the question the nurse should ask should focus mainly on the ethnicity, gender and age of the patient with the disorder in question. The “I” in the format stands for intervention or indicator, whereby the question of interest should be geared towards discovering the exposure to the disease, the prognostic factor and the risk behaviour that may have led to the disorder. The “C” in the model stands for comparison or control, whereby the nurse should frame the question to inquire the state of the patient while normal. It could be a placebo or business as usual question, in the absence of symptoms in the patient. The “O” in the model stands for the outcome, whereby the nurse should focus the question on understanding the rate of occurrence of the condition and the risk of the disease. It is in this stage that the nurse should also make an accurate diagnosis of the condition. Finally, the “T” in the model stands for time, whereby the clinician should focus on understanding the duration of time the clinical procedure on the patient, geared towards intervention may take, as well as the period of time to observe the patient. Essentially, every question should have an intervention (Riva et al, 2012).

The PICO(T) framework not only helps the clinician make an accurate diagnosis to a condition, but also helps in carrying out the right intervention on patients. Quality of care is dependent on the ability to formulate a good action plan with proven efficacy. Besides, the clinician should understand that self-care for patients while way from the hospital setting is important in preventing recurrence of conditions. To achieve this, there is need to understand the background information concerning a patient, so that the clinician can give appropriate advice to the patient after the clinical procedure. The advice will guide the patient in developing primary healthcare goals for themselves, while away from the clinic, which will reduce revisits to the clinic. Most patients however find some questions that clinicians ask a bit personal. They may end up giving wrong answers to avoid disclosing information they may deem embarrassing. The feedback obtained may therefore be subjective, which may lead to wrong decision-making by the clinician. In order to receive objective responses from patients, the clinician needs a model to guide them in asking clear questions and also help in receiving answers easily. The PICO(T) format is essential in this scope, as its efficacy is research based and proven to be essential to clinical care.

References

Indicators, A. Q. (2003). Guide to patient safety indicators. Rockville, MD: Agency for Healthcare Research and Quality.

Riva, J. J., Malik, K. M., Burnie, S. J., Endicott, A. R., & Busse, J. W. (2012). What is your research question? An introduction to the PICOT format for clinicians. The Journal of the Canadian Chiropractic Association, 56(3), 167.

Rios, L. P., Ye, C., & Thabane, L. (2010). Association between framing of the research question using the PICOT format and reporting quality of randomized controlled trials. BMC medical research methodology, 10(1), 11.

Dauvilliers, Y., Arnulf, I., & Mignot, E. (2007). Narcolepsy with cataplexy. The Lancet, 369(9560), 499-511.