NURS-FPX4030 Assessment #3 Instructions PICO(T) Questions and an Evidence-Based Approach

NURS-FPX4030 Assessment #3 Instructions PICO(T) Questions and an Evidence-Based Approach

Assessment 3 Instructions: PICO(T) Questions and an Evidence-Based Approach

Create a 3-5 page submission in which you develop a PICO(T) question for a specific care issue and evaluate the evidence you locate, which could help to answer the question.

Introduction

PICO(T) is an acronym that helps researchers and practitioners define aspects of a potential study or investigation.

It stands for:

P – Patient/population/problem.

I – Intervention.

C – Comparison (of potential interventions, typically).

O – Outcome(s).

T – Time frame (if time frame is relevant).

The end goal of applying PICO(T) is to develop a question that can help guide the search for evidence (Boswell & Cannon, 2015). From this perspective, a PICO(T) question can be a valuable starting point for nurses who are starting to apply an evidence-based model or EBPs.

By taking the time to precisely define the areas in which the nurse will be looking for evidence, searches become more efficient and effective. Essentially, by precisely defining the types of evidence within specific areas, the nurse will be more likely to discover relevant and useful evidence during their search.

When applying the PICO(T) approach, the nurse can isolate the interventions of interest and compare to other existing interventions for the evidenced impact on the outcome of the concern.

You are encouraged to complete the Vila Health PICO(T) Process activity before you develop the plan proposal. This activity offers an opportunity to practice working through creating a PICO(T) question within the context of an issue at a Vila Health facility. These skills will be necessary to complete Assessment 3 successfully. This is for your own practice and self-assessment and demonstrates your engagement in the course.

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Reference

Boswell, C., & Cannon, S. (2015). Introduction to nursing research. Jones & Bartlett Learning.

Professional Context

As a baccalaureate-prepared nurse, you will be responsible for locating and identifying credible and scholarly resources to incorporate the best available evidence for the purposes of enhancing clinical reasoning and judgement skills. When reliable and relevant evidence-based findings are utilized, patients, health care systems, and nursing practice outcomes are positively impacted.

PICO(T) is a framework that can help you structure your definition of the issue, potential approach that you are going to use, and your predictions related to the issue. Word choice is important in the PICO(T) process because different word choices for similar concepts will lead you toward different existing evidence and research studies that would help inform the development of your initial question. When writing a PICO(T)-formatted research question, you want to focus on the impact of the intervention and the comparison on the outcome you desire.

Scenario

For this assessment, please use a health care issue of interest from your current or past nursing practice.

If you do not have an issue of interest from your personal nursing practice, then review the optional Case Studies presented in the resources and select one of those as the basis for your assessment.

Instructions

For this assessment, select a health care issue of interest and apply the PICO(T) process to develop the research question and research it.

Your initial goal is to define the population, intervention, comparison, and outcome. In some cases, a time frame is relevant and you should include that as well, when writing a question you can research related to your issue of interest. After you define your question, research it, and organize your initial findings, select the two sources of evidence that seem the most relevant to your question and analyze them in more depth. Specifically, interpret each source’s specific findings and best practices related to your issues, as well explain how the evidence would help you plan and make decisions related to your question.

If you need some structure to organize your initial thoughts and research, the PICOT Question and Research Template document (accessible from the “Create PICO(T) Questions” page in the Capella library’s Evidence Based Practice guide) might be helpful.

In your submission, make sure you address the following grading criteria:

Define a practice issue to be explored via a PICO(T) approach. Create a PICO(T)-formatted research question

Identify sources of evidence that could be potentially effective in answering a PICO(T) question (databases, journals, websites, etc.).

Explain the findings from articles or other sources of evidence as it relates to the identified health care issue.

Explain the relevance of the findings from chosen sources of evidence to making decision related to a PICO(T) question.

Communicate using writing that is clear, logical, and professional with correct grammar and spelling using the current APA style.

Example Assessment: You may use the following to give you an idea of what a Proficient or higher rating on the scoring guide would look like:

Assessment 3 Example [PDF].

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

When developing care practices for patients, the PICO(T) research framework, which expands to Population/Patient, Intervention, Comparison, Outcome, and Time, can be used to create an effective care plan and ensure that patients’ needs are met. Relying on secondary research, the author of this paper will define a practice issue surrounding patients with dementia, apply the PICO(T) process, identify sources of evidence that may provide answers to the research question, explain key findings from articles, and explain the relevance of those key findings.

Use of the PICO(T) Approach when Caring for Patients with Dementia

The practice issue identified for resolution is the need to develop care practices that effectively manage agitation in patients with dementia in nursing homes that are outside of pharmacological approaches. The question being explored is: Is the non-pharmacological approach, specifically an intervention approach, more effective than the pharmacological approach in managing behavioral symptoms (such as agitation) in patients with dementia?

The intervention approach identified is person-centered care or patient-centered care (PCC), an approach that emphasizes more on an individual’s experiences and the communication of his or her needs than on the pure implementation of a health care provider’s expertise (Desai, et al., 2017).

The population being studied are patients with dementia with agitative behavioral symptoms in nursing homes. As the objective is to explore care practices that address this issue, only factors related to care in nursing homes are considered. The study does not take into consideration cultural, political, and social factors (Kim & Park, 2017).

Identification of Sources of Evidence

DICE Model

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The DICE (Describe, Investigate, Create, and Evaluate) model is a notable PCC intervention model that identifies optimal treatment options for patients with dementia with neuropsychiatric symptoms. Developed by a panel of interdisciplinary experts at the University of Michigan Program for Positive Aging, the model is constitutive of a four-step approach.

The first step of the approach is the accurate description of the patient’s behavior, the second is the identification of possible underlying causes, the third is the creation and implementation of treatment plans, and the fourth is the assessment of the strategies developed (Desai et al., 2017; Kales et al., 2014).

The model’s essential recommendations for facilitating improvement in neuropsychiatric symptoms among patients with dementia are educating the caregiver; forging better communication between the patient and the caregiver; assisting the caregiver in organizing meaningful activities such as cooking, painting, or reading depending on the patient’s interests; and training the caregiver on simplifying his or her work routines (Desai et al., 2017; Kales et al., 2014).

Individualized Intervention Model

The individualized intervention model is a model in which intervention activities are carried out based on the history, needs, abilities, and preferences of patients with dementia. In this model, PCC-based activities are directly carried out by trained health care staff with expertise in social work, recreational therapy, geriatric psychiatry, and psychology (Kim & Park, 2017). Care Staff-Directed Model

In the care staff–directed model, PCC activities are based on the staff’s education and training on empathy and person-centeredness. The model also makes a provision for offering

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staff regular feedback for their work. The intervention period in such a model ranges from 3 months to 2 years (Kim & Park, 2017).

Findings from Articles

As PCC is a major nonpharmacological approach to treating agitation in patients with dementia, its effectiveness is studied by making a comparative analysis to the pharmacological approach to manage behavioral symptoms in patients with dementia.

Pharmacological treatment in general refers to the use of psychotropic medication to manage agitation or neuropsychotic symptoms (NPS) in patients with dementia (Madhusoodanan & Ting, 2014; Kales et al., 2014). Some of the common pharmacological interventions include the use of antipsychotropics, antidepressants such as sertraline and citalopram, and sedative-hypnotics through the use of benzodiazepines to control acute agitation (Madhusoodanan & Ting, 2014).

The use of psychotropic medication poses high risks of mortality and harmful side effects (Kales et al., 2014). Psychotropic medication is also expensive and is restricted by regulatory bodies. However, the use of pharmacological intervention is justified when the benefits outweigh the risks or in situations wherein nonpharmacological interventions have proven unsuccessful (Madhusoodanan & Ting, 2014).

The PCC approach has proven effective in addressing the etiology of aggressive outbursts. Unlike the pharmacological approach, which is based on treating symptoms, the PCC approach contributes to the resolution of underlying causes (Desai et al., 2017).

The study by Kales et al. (2014) finds reasonable evidence of the DICE program’s contribution toward better clinical practices and improvement in aggressive behavior, and it observes that the approach results in fewer hospitalizations and readmissions. In their systematic review and meta-analysis of 19 primary studies, Kim and Park (2017) found 15 studies that measure the impact of PCC on

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agitation using the Cohen-Mansfield Agitation Inventory (an agitation mapping instrument) and the Brief Agitation Rating Scale. They found that 8 of the 15 studies show positive effects on agitation with individualized interventions (with a significant mean difference of -0.513), showing better effects than with care staff–directed interventions (with a significant mean difference of -0.160).

As this paper relies on secondary research on the PCC intervention to manage agitative behavior in patients with dementia in nursing homes, there are multiple time frames for the various intervention studies reviewed. While some studies had a long intervention period ranging from 9 months to 2 years, others had shorter intervention periods of just a few weeks. From the above exploration of the research problem based on the PICO(T) framework, it is clear that this framework has contributed to the delineation of precise intervention practices and has brought conceptual clarity on the issue of agitative behavior in patients with dementia.

Relevance of Findings from Articles

The study by Kales et al. (2014) was chosen as it provides a comprehensive explanation of the PCC-based DICE intervention program and its potential outcomes and draws an objective comparison of the program with pharmacological intervention. The study observed that the DICE model was developed by a panel of experts with years of clinical and research expertise in managing NPS in patients with dementia.

The strategies formulated in the DICE approach were found to carry a strong evidence base. As it is evidence-informed, the DICE approach could be helpful for clinicians across diverse settings. Kales et al. (2014) conclude their study with a discussion on the potential of the DICE approach in enhancing clinical practices and ensuring the treatment of agitative behavior in patients with dementia.

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The rationale for selecting the study by Kim and Park (2017) was that it presents a systematic review and meta-analysis of 19 primary intervention studies, of which 17 studies are from long-term care facilities.

In their systematic review and meta-analysis of these studies, Kim and Park (2017) found that PCC has a significant impact on reducing NPS in patients with dementia. Kim and Park’s (2017) review found the increased engagement between care providers and patients and the magnitude of the program’s intensity to be the reasons for short- term PCC intervention having greater benefits in comparison to long-term intervention.

The findings are relevant because they are based on 17 long-term, clinical PCC intervention studies comprising both controlled and non-controlled cluster-randomized trials conducted over the past 10 years (Kim & Park, 2017).

Kim & Park’s findings prove to be the most credible. In their systematic review and meta-analysis of primary studies, Kim and Park’s findings (2017) adhere to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. They also utilize analysis tools such as the Cochrane Collaboration’s risk of bias and the risk of bias assessment tool to ensure quality screening of the studies.

Conclusion

There is a need to develop care practices that are outside of pharmacological approaches for managing agitation in patients with dementia. The PICO(T) framework was applied to determine if the intervention approach of person-centered care or patient-centered care (PCC) was more effective than the pharmacological approach by identifying sources of evidence, explaining the findings and proving the relevance of those findings. The articles by Kales et al. (2014) and Kim and Park (2017), provide precise, reliable, and relevant information to adequately explore the effectiveness of the PCC approach.

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References

Desai, A., Wharton, T., Struble, L., & Blazek, M. (2017). Person-centered primary care strategies for assessment of and intervention for aggressive behaviors in dementia. Journal of Gerontological Nursing, 43(2), 9–17. https://search-proquest- com.library.capella.edu/docview/1862119355?pq-origsite=summon

Kales, H. C., Gitlin, L. N., & Lyketsos, C. G. (2014). Management of neuropsychiatric symptoms of dementia in clinical settings: Recommendations from a multidisciplinary expert panel. Journal of the American Geriatrics Society, 62(4), 762–769. https://ncbi.nlm.nih.gov/pmc/articles/PMC4146407/#

Kim, S. K. & Park, M. (2017). Effectiveness of person-centered care on people with dementia: A systematic review and meta-analysis. Clinical Interventions in Aging, 12, 381–397. https://doaj.org/article/400107a4cbaa44e6b7c0e3531bb4abac

Madhusoodanan, S., & Ting, M. B. (2014). Pharmacological management of behavioral symptoms associated with dementia. World Journal of Psychiatry, 4(4), 72–79. https://ncbi.nlm.nih.gov/pmc/articles/PMC4274589/

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Additional Requirements

Your assessment should meet the following requirements:

Length of submission: Create a 3-5-page submission focused on defining a research question and interpreting evidence relevant to answering it.

Number of references: Cite a minimum of four sources of scholarly or professional evidence that support your findings and considerations. Resources should be no more than 5 years old.

APA formatting: Format references and citations according to the current APA style.

Portfolio Prompt: Remember to save the final assessment to your ePortfolio so that you may refer to it as you complete the final capstone course.

Competencies Measured

By successfully completing this assessment, you will demonstrate your proficiency in the course competencies through the following assessment scoring guide criteria:

Competency 1: Interpret findings from scholarly quantitative, qualitative, and outcomes research articles and studies.

Explain the findings from articles or other sources of evidence that are relevant to the health care issue.

Competency 2: Analyze the relevance and potential effectiveness of evidence when making a decision.

Identify sources of evidence that could be potentially effective in answering a PICO(T) question.

Explain the relevance of the findings from chosen sources of evidence to making decision related to a PICO(T) question.

Competency 3: Apply an evidence-based practice model to address a practice issue.

Define a practice issue to be explored via a PICO(T) approach and develop a PICO(T)-formatted research question.

Competency 5: Apply professional, scholarly communication strategies to lead practice changes based on evidence.

Organize content so ideas flow logically with smooth transitions; contains few errors in grammar/punctuation, word choice, and spelling.

Apply APA formatting to in-text citations and references exhibiting nearly flawless adherence to APA format.

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PICOT QUESTION PROCESS

Creating a question using the PICOT elements will provide a framework for the research you need to conduct an evidence-based study or to make an evidence-based decision.

PICOT Elements:

(P) – Population, Patients or Problem: The sample of subjects used in a study, or the problem being addressed.

(I) – Intervention:  The treatment that will be provided to subjects enrolled in your study.

(C) – Comparison or Control:  Identifies an alternative intervention or treatment to compare. Many study designs refer to this as the control group. If an existing treatment is considered the ‘gold standard’, then it should be the comparison group. A control group is not required for every type of study.

(O) – Outcome: The clinical outcome that measures the effectiveness of the intervention.

(T) – Time: Duration of the data collection.  Some versions don’t include this element, and time may not be specified in cases where the question is focused on prediction or diagnoses.

PICOT Question Format Examples:

Please be sure to check your assignment, as it may direct you to use a different format.

• Intervention: In _______ (P), how does _______ (I) compared to  _______  (C) affect _______  (O) within _______ (T)?
• Prognosis/Prediction:  In _______ (P), how does _______ (I) compared to _______ (C) influence/predict _______ (O) over _______ (T)?
• Diagnosis or Diagnostic test:  In _______   (P) are/is _______   (I) compared to _______ (C) more accurate in diagnosing _______ (O)?
• Etiology:  Are _______ (P), who have _______ (I) compared to those without _______ (C) at _______ risk for/of _______ (O) over _______ (T)?
• Meaning:  How do_______ (P) with _______ (I) perceive _______ (O) during _______ (T)?

 

Example PICOT Questions:

• For residents of long-term care facilities (P), how does implementation of a hydration assessment tool (I) compared to current practice (C) affect the number of hospital admissions with the diagnosis of dehydration (O) during a three-month period (T)?
• In acute care hospitals (P), how does having a rapid response team (I) compared with not having a response team (C) affect the number of cardiac arrests (O) during a three-month period (T)?
• In women with gestational diabetes (P), how does a monitored diet and exercise program over the course of pregnancy (I &T), compare to the use of metformin only (C) reduce the incidence of high birth weight babies(O)?
• In patients admitted for acute myocardial infarction (P), how well does the hospital’s new data model created from EMR data (I) compared to current practices (C) predict readmission rates (O) within 30 days after initial discharge (T)?
• For patients of a rural health clinic (P), does the use of text message reminders (I), compared with telephone calls (C) reduce the number of missed appointments (O) over a six month period (T)?

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