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.
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.
    You are encouraged to complete the Vila Health PCI(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.
    Demonstration of Proficiency
    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.
  • 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.
  • Competency 5: Apply professional, scholarly communication strategies to lead practice changes based on evidence.
    • Communicate using writing that is clear, logical, and professional with correct grammar and spelling using current APA style.
  • Reference
    Boswell, C., Cannon, S. (2015). Introduction to nursing research. Burlington, MA: 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.
    Scenario
    For this assessment, please use an 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 an issue of interest an apply the PICO(T) process to define the 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.
  • Identify sources of evidence that could be potentially effective in answering a PICO(T) question.
  • Explain the findings from articles or other sources of evidence.
  • 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].
  • 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.
  • Scoring Guide
    Use the scoring guide to understand how your assessment will be evaluated

Running head: USING A PICO(T) FRAMEWORK 1

Copyright ©2019 Capella University. Copy and distribution of this document are prohibited.

 

 

 

 

 

 

 

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

Learner’s Name

Capella University

Making Evidence-Based Decisions

PICO(T) Questions and an Evidence-Based Approach

January, 2019

 

 

 

 

 

 

 

 

 

 

 

 

USING A PICO(T) FRAMEWORK 2

Copyright ©2019 Capella University. Copy and distribution of this document are prohibited.

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,

Wharton, Struble, & Blazek, 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

 

 

USING A PICO(T) FRAMEWORK 3

Copyright ©2019 Capella University. Copy and distribution of this document are prohibited.

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, Gitlin, & Lyketsos, 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,

Gitlin, & Lyketsos, 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

 

 

USING A PICO(T) FRAMEWORK 4

Copyright ©2019 Capella University. Copy and distribution of this document are prohibited.

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

 

 

USING A PICO(T) FRAMEWORK 5

Copyright ©2019 Capella University. Copy and distribution of this document are prohibited.

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.

 

 

USING A PICO(T) FRAMEWORK 6

Copyright ©2019 Capella University. Copy and distribution of this document are prohibited.

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.

 

 

USING A PICO(T) FRAMEWORK 7

Copyright ©2019 Capella University. Copy and distribution of this document are prohibited.

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. Retrieved from 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. Retrieved from

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.

Retrieved from 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. Retrieved

from https://ncbi.nlm.nih.gov/pmc/articles/PMC4274589/

Place your order
(550 words)

Approximate price: $22

Calculate the price of your order

550 words
We'll send you the first draft for approval by September 11, 2018 at 10:52 AM
Total price:
$26
The price is based on these factors:
Academic level
Number of pages
Urgency
Basic features
  • Free title page and bibliography
  • Unlimited revisions
  • Plagiarism-free guarantee
  • Money-back guarantee
  • 24/7 support
On-demand options
  • Writer’s samples
  • Part-by-part delivery
  • Overnight delivery
  • Copies of used sources
  • Expert Proofreading
Paper format
  • 275 words per page
  • 12 pt Arial/Times New Roman
  • Double line spacing
  • Any citation style (APA, MLA, Chicago/Turabian, Harvard)

Our guarantees

Delivering a high-quality product at a reasonable price is not enough anymore.
That’s why we have developed 5 beneficial guarantees that will make your experience with our service enjoyable, easy, and safe.

Money-back guarantee

You have to be 100% sure of the quality of your product to give a money-back guarantee. This describes us perfectly. Make sure that this guarantee is totally transparent.

Read more

Zero-plagiarism guarantee

Each paper is composed from scratch, according to your instructions. It is then checked by our plagiarism-detection software. There is no gap where plagiarism could squeeze in.

Read more

Free-revision policy

Thanks to our free revisions, there is no way for you to be unsatisfied. We will work on your paper until you are completely happy with the result.

Read more

Privacy policy

Your email is safe, as we store it according to international data protection rules. Your bank details are secure, as we use only reliable payment systems.

Read more

Fair-cooperation guarantee

By sending us your money, you buy the service we provide. Check out our terms and conditions if you prefer business talks to be laid out in official language.

Read more

Order your paper today and save 30% with the discount code HAPPY

X
Open chat
1
You can contact our live agent via WhatsApp! Via + 1 323 412 5597

Feel free to ask questions, clarifications, or discounts available when placing an order.

Order your essay today and save 30% with the discount code HAPPY