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Foundations of Professional Nursing NUR3846

Los Angeles Valley College

Description

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.

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 the diagnosis you worked with in the first two assessments.

INTRUCTIONS

After reviewing the materials you created to research a specific diagnosis in the first two assessments, apply the PICO(T) process to develop a 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 chosen diagnosis, and 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:

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.

COMPETENSIES MEASURED

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1 Using a PICO(T) Framework and Evidence to Develop Care Practices Learner’s Name Capella University NURS-FPX4030: Making Evidence-Based Decisions Instructor Name August, 2020 Copyright ©2019 Capella University. Copy and distribution of this document are prohibited. 2 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 Copyright ©2019 Capella University. Copy and distribution of this document are prohibited. 3 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 Copyright ©2019 Capella University. Copy and distribution of this document are prohibited. 4 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 Copyright ©2019 Capella University. Copy and distribution of this document are prohibited. 5 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. Copyright ©2019 Capella University. Copy and distribution of this document are prohibited. 6 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 shortterm 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. Copyright ©2019 Capella University. Copy and distribution of this document are prohibited. 7 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-proquestcom.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/ Copyright ©2019 Capella University. Copy and distribution of this document are prohibited. 1 Determining the Credibility of Evidence Kristina Apoyan Capella University NURS FPX-4030 April 12th, 2024 Determining the Credibility of Evidence 2 Diabetes mellitus (DM) is one of the diagnoses that can benefit from the evidence-based approach. This is a chronic condition that occurs as a result of increased blood sugar in the body. Diabetes interferes with the ability of the pancreas to produce enough insulin to convert blood sugar into energy (CDC, 2023). This leads to excess glucose in the bloodstream, increasing the risk of kidney and heart diseases and vision loss. Significantly, since diabetes is a long-lasting condition, a comprehensive approach to treating and managing it is required. As such, incorporating evidence-based practice in diabetes management will ensure better outcomes due to enhanced clinical judgment and reasoning skills. Criteria for Determining Credibility of Resources Determining the credibility of a source, such as a website or journal article, depends on different factors. For instance, the CRAAP test criteria indicate the credibility of a resourcebased currency, relevance, authority, accuracy, and purpose of the source (UW, 2024). The currency criteria show the timelessness of the resources regarding their publication date. Usually, articles that were published within the last five years are considered credible because they contain current and up-to-date information. Similarly, the source's relevance indicates its importance and alignment with the diagnosis (UW, 2024). In this case, a relevant resource provides information about effective treatment and management of diabetes. The next criteria involve considering the authors' expertise and authority and the source's reputation. In addition, the credibility of the resource is determined by the purpose and existence of the source. For instance, peer-reviewed and objective articles are deemed credible resources because they present accurate and reliable information. Analysis of the Credibility and Relevance of Evidence and Resources 3 There are various resources for locating evidence-based information about the treatment and management of diabetes. These include PubMed, the National Library of Medicine, the Cochrane Library, the Journal of Diabetes Nursing, and Diabetes Care. For instance, the peerreviewed article by Adu et al. (2019) is a credible resource because it is current and published at PubMed Central (PMC), a reputable source. Similarly, this article is relevant to diabetes management since it focuses on barriers and enablers of diabetes self-management. The Consensus Report by Davies et al. (2022) also provides credible and relevant information about the effective management of hyperglycemia in type 2 diabetes. This is because the article was published within the past five years, is peer-reviewed, and obtained from Diabetes Care, a reputable source. In addition, the narrative review by Aloke et al. (2022) offers evidencebased and credible information about diabetes. It helps in understanding the prevalence of diabetes mellitus, risk factors, and advanced management strategies. Evidence-Based Practice Model and Its Importance Evidence-based practice models play a crucial role in gathering evidence and applying it in healthcare settings to address a practice challenge. For instance, the Iowa model facilitates the implementation of practice decisions based on the available research and evidence (Christenberry, 2017). This approach follows six important steps: identifying the trigger, determining its priority in the organization, involving stakeholders, and evaluating available evidence. The next step consists of checking whether the evidence is credible and reliable and appraising the level of success (Christenberry, 2017). The significance of incorporating the Iowa model in diabetes management is that it helps nurses evaluate and apply evidence and ensure complete implementation effectively. It also optimizes the use of resources and time in the organization. 4 References Adu, M. D., Malabu, U. H., Malau-Aduli, A. E. O., & Malau-Aduli, B. S. (2019). Enablers and barriers to effective diabetes self-management: A multi-national investigation. PloS one, 14(6), e0217771. https://doi.org/10.1371/journal.pone.0217771 Aloke, C., Egwu, C. O., Aja, P. M., Obasi, N. A., Chukwu, J., Akumadu, B. O., Ogbu, P. N., & Achilonu, I. (2022). Current Advances in the Management of Diabetes Mellitus. Biomedicines, 10(10). https://doi.org/10.3390/biomedicines10102436 Centers for Disease Control and Prevention. (2023). What is Diabetes? https://www.cdc.gov/diabetes/basics/diabetes.html Christenbery, T. L. (2017). Appendix: Evidence-Based Practice Models. In Evidence-based practice in nursing: Foundations, skills, and roles. Springer Publishing, https://connect.springerpub.com/content/book/978-0-8261-2759-4/back-matter/bmatter1 Davies, M. J., Aroda, V. R., Collins, B. S., Gabbay, R. A., Green, J., Maruthur, N. M., ... & Buse, J. B. (2022). Management of hyperglycemia in type 2 diabetes, 2022. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes care, 45(11), 2753-2786. https://doi.org/10.2337/dci220034 University of Washington. (2024). FAQ: How do I know if my sources are credible/reliable? https://guides.lib.uw.edu/research/faq/reliable 1 Locating Credible Databases and Research Kristina Apoyan Capella University NURS-FPX4030 April 12th, 2024 Locating Credible Databases and Research 2 Introduction Evidence-based practice (EBP) is crucial to achieving optimal patient outcomes. Nurses, especially newly recruited ones, may face numerous challenges as they strive to locate evidencebased information concerning patient care. That is because there are many resources available for research, but not all of them are useful and credible. For instance, treating and managing patients with diabetes mellitus (DM) requires highly specialized care, which is only achievable if nurses embrace evidence-based practice. For example, management of DM involves interventions such as lifestyle changes such as increased physical activity, dietary modifications, etc. (Borse et al., 2021). A nurse is required to apply evidence-based data to know the best intervention for the patient. In the context of handling a patient with diabetes mellitus, this paper offers guidelines on how a newly recruited nurse, unfamiliar with diabetes management, can access evidence-based information on the same. The analysis focuses on the communication techniques the senior nurse can use to educate the new nurse on evidence-based practice, and ways to locate and evaluate credible sources. The Communication Strategies for Newly Trained Nurses As a supervisor, it is crucial to create and promote a supportive and friendly learning environment for newly trained nurses. A supervisor nurse can promote a learning environment by embracing open communication with the nurses, which is the first step to learning (Asiedu & Doe, 2023). The supervisor nurse should actively listen to their concerns and acknowledge their willingness to learn. For instance, in the case of the new nurse handling a patient with diabetes, the supervisor nurse should embrace the new nurse and commend her willingness to learn. She should not use language that embarrasses the new nurse for her lack of familiarity with the diagnosis as such would discourage her from seeking clarifications in the future (Asiedu & Doe, 3 2023). The senior nurse should also facilitate research by guiding the new nurse on where and how to access credible resources within the hospital's online library. There should be an emphasis on the importance of relying on reputable and credible data sources for evidence-based interventions in diabetes management. Best Places to Undertake Research Not all online sources are reliable for research. The new nurse has to understand how to identify credible and relevant sources for the situation at hand. This is achieved by applying the CRAAP test, which stands for currency, relevance, authority, accuracy, and purpose. In this case, the best places to look for credible materials include hospital and university libraries, online databases and journals, hospital policy manuals, and professional organizations. Identified Sources for Evidence-Based Management of Diabetes Mellitus The following five platforms have been identified as the most appropriate sources of evidence-based information on diabetes management. The information sources have been in the order of importance to this particular case. They include: The PubMed website, managed by the National Library of Medicine, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Cochrane Library, the Journal of Diabetes Nursing (https://diabetesonthenet.com/journals/), and the Hospital Policies and Guidelines on diabetes management. Why the Sources Offer the Best Evidence The PubMed website would be the most useful for the nurse handling the DB case. This website is recognized for its extensive collection of biomedical research, including DM management. It was the first choice since it has a user-friendly interface and also offers tools for 4 advanced research, making it ideal for a newly trained nurse (National Library of Medicine, n.d.). The CINAHL platform offers a specialized database focusing on nursing and related health topics. It has vast materials such as evidence-based journals and systematic reviews on DM management. The Cochrane database and the Journal of Nursing Diabetes offer evidence-based practical insights into managing patients with DM. The Hospital Policy and Guidelines would help nurses align their care practices with the hospital's evidence-based practices. Conclusion To effectively navigate the various platforms and find evidence-based knowledge on DM management requires guidance and research. Through effective communication and guidance on how to find credible sources of information, nurses can offer patient-centered and evidencebased care. The above materials would help the new nurse gather adequate information to manage the patient. References 5 Asiedu, M.A. & Doe, J.K. (2023). Role of Openness in Communication in the Absorptive Capacity and Innovation Generation Link in Higher Education Institutions. Education Journal. https://doi.org/10.11648/j.edu.20231201.12 Borse, S.P. et al. (2021). Management of type 2 diabetes: Current strategies, unfocussed aspects, challenges, and alternatives. Med Princ Pract, 30(2), 109-121. https://pubmed.ncbi.nlm.nih.gov/32818934/ Connor, L. et al. (2023). Evidence-based practice improves patient outcomes and healthcare system return on investment: Findings from a scoping review. World Views on EvidenceBased Nursing, 20(1), 6-15. https://sigmapubs.onlinelibrary.wiley.com/doi/10.1111/wvn.12621#:~:text=Evidence%2 Dbased%20practice%20and%20decision,isolated%20reports%20throughout%20the%20l iterature. National Library of Medicine. (n.d.). PubMed database. https://pubmed.ncbi.nlm.nih.gov/?term=diabetes+mellitus
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Explanation & Answer

Attached.

1


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

o The PICOT research framework is a fundamental approach for identifying and
evaluating evidence-based interventions for caring for patients with different
conditions, including diabetes mellitus (DM).
o This research technique involves defining the patient population (P) of interest,
intervention (I), comparison (C), desired outcome (O), and the timeframe (T)
(Boswell & Cannon, 2015).
o Use of PICO(T) Approach When Caring for Patients with Diabetes Mellitus
o In this case, the PICOT question is: In patients diagnosed with diabetes mellitus
(P), does a combination therapy (I) compared to metformin monotherapy (C)
result in improved glycemic control and reduced diabetic complications (O) for
six months (T)?


Identification of Sources of Evidence

o The evidence for answering the proposed PICOT question was obtained from
different sources, including databases, websites, and journals.
o PubMed provides essential biomedical literature about diabetes and evidencebased interventions.
o Similarly, peer-reviewed journals and websites such as Diabetes Care and the
American Diabetes Association (ADA) were used as evidence for investigating
and answering the PICOT research question.


Findings from the Articles

o AlDuwayhis et al. (2022) define diabetes as a metabolic disorder resulting in
insulin secretion deficiency.

2
o The results of a comprehensive review indicate that a combined therapy approach
can be used to improve glycemic control and reduce complications associated
with diabetes mellitus.
o Xie et al. (2023) argue that combination therapy has more clinical benefits than
monotherapy.
o Hung et al. (2022) show that the initial use of combined therapy in patients with
untreated type 2 diabetes leads to better glycemic control than metformin
monotherapy.
o Relevance of Findings from the Articles
o The findings from the chosen articles provide relevant evidence for addressing the
PICOT question.
o For instance, the study by AlDuwayhis et al. (2022) helps to understand the
prevalence of diabetes and the importance of attaining standard glycemic goals.
o Similarly, the study by Xie et al. (2023) outlin...


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