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

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

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.
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 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 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 1 [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. A title page is not required but you must include a reference list.
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 current APA style.

this is an example given by professor:
Introduction
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 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

this is the villa health activity mentioned:
Vila Health: PICO(T) Process
Introduction
Prevention and Infection Control Nurse Introduction
Interviews
Email
Email 2
Conclusion
Introduction
In health care and public health, evidence-based practice is quickly becoming the cornerstone of what determines high quality. Whether it’s performance, quality, or public policy improvement, evidence-based practice allows health care and public health professionals to identify trends in practice, system or process problems, or other problems, and interventions to correct or improve them.

But without a good, well-thought-out PICO(T) question to guide the evidence search, you can often miss the mark. In this activity, you will experience the PICO(T) process firsthand.

After completing this activity, you will be able to:

Understand the basic elements of the PICO(T) process.
Understand the increasingly interprofessional nature of health care and public health.
Experience the elements of the PICO(T) process (the population or problem, intervention, comparison, outcome, and time).
Prevention and Infection Control Nurse Introduction
St. Anthony Medical Center
You are a nurse at St. Anthony Medical Center, a major hospital in a metropolitan area with 500 patient care assistants (PCAs) and thousands of other professional staff members. You’re going to be tasked with an important quality improvement project. To hear more about it, you have a meeting set up with the hospital’s Prevention and Infection Control nurse.

Ellen French
Prevention and Infection Control Nurse

Hi! It’s good to see you. I think you’re going to do some great work for us. In fact, I know you are, because there’s a QI project that’s suddenly gotten very important.

So here’s the background on the project. Last week, the hospital’s board met, and they talked about a problem they want solved: flu vaccinations for our PCAs, or patient care assistants. They’re not happy about the rate of compliance last year, and they want us to get that rate up in time for this year’s flu season. Obviously, no hospital wants to be known as the one where you pick up the flu from a staff member!

It’s a clinical problem, a potential public health issue, and a possible PR nightmare. And as you’ll see from the numbers, our compliance rates last year were pretty sad. So we need an intervention, and we want you to help design it for us. That’s going to mean starting with a solid PICO(T) question, so let’s start there.

Let’s review what the PICO(T) process is, so that we’re on the same page. The PICO(T) process helps you design a question that guides your research. The acronym PICO(T) includes the question’s five components. The P stands for Population or Problem, and it’s basically the “who” or “what” part of the question. You’re describing the specific population or problem that you want to research. Is it people with diabetes? People with diabetes in a given county? Middle-aged men and women who use opiates more than twice a week? Or is it a problem with low flu vaccination rates among PCAs? You get the idea.

The I stands for Intervention. What are you going to do? Are you going to test out a particular therapy or evidence-based model? Try specific tests or medications? Conduct a survey?

Without a Comparison, you won’t know whether your intervention worked. So, for instance, the C might be to compare one part of the population (the part that hears a presentation on condom use, let’s say) to another part that didn‘t hear the presentation. You can compare what happens with either different treatment or no treatment. Depending on your question, there may not be a true comparison. In that case, you’ll compare the current state with the desired state.

The O stands for outcome. What do you hope to accomplish? Diminished symptoms might be the goal of a particular medical intervention, whereas increased behaviors might be a public health goal.

Finally, there’s the Time frame. How long do you have to complete the intervention?

Now, I’ve set up some interviews with a few other people, both inside and outside the hospital. I’m hoping that — with their input and the evidence-based research you’re able to do — you can design a performance improvement intervention to get our compliance rates up.

Once you’ve completed your interviews, check back with me, and we’ll go over what you’ve got so far. We’ll have to get your project approved by your course facilitator.

St. Anthony Medical Center
Interviews
Peggy Truman
Director of public health for Hennsey County
Question: The St. Anthony Medical Center board is not happy about their patient care assistants’ flu vaccination rates. They want those rates to improve by the time flu season comes around again. I’ve been assigned to design an intervention to improve those rates. As a public health official, what would you suggest I start with?

Peggy: Interesting project! Well, I’m very familiar with the evidence on what prevents people in the general population from getting their flu vaccination. Their reasons for getting — or not getting — their flu shots are probably not that different from those of your PCAs. So I’d start by thinking about the many reasons why the general population doesn’t get their flu shots.

Ordinarily, we think about barriers to access, but that doesn’t seem to apply in a hospital! I assume that any PCA who wants a flu shot can get one pretty easily and at no cost. So it’s a reasonable starting place to focus on what discourages or encourages someone to get a flu shot, and which of those factors apply to PCAs more than the general population.

Still, there may be factors that apply specifically to PCAs. What makes a PCA decide to get a flu shot? Is it knowing the risks of failing to get one? Is it feeling that they ought to, in order to protect their patients? Do they want to set a good example for patients? Or do you think it’s all of the above?

You’ll probably need to talk to some of your PCAs to get a better feel for this. But you’ll also want to do some preliminary research. If I were doing this project, I’d get to the library and find some articles on successful vaccine intervention programs in institutional settings like hospitals. That will give you some ideas for interventions that might improve your compliance rates.

Question: Have you done campaigns to encourage flu vaccination in the past? What interventions did you use that were successful? Were any unsuccessful?

Peggy: We certainly have, and I’d say they were mixed. We might do an intervention one year, and see that more people get vaccinated. But then we do the same intervention the next year, and different people get vaccinated. Some do it one year and don’t bother the next, or vice versa. The thing to keep in mind is that the flu affects different demographics differently. So you need to appeal to them differently. A 25-year-old is not going to respond to information about the risk of flu the same way as a 55-year-old.

For older people, the information about risk is much more compelling and more likely to prompt a decision to vaccinate. To younger people, flu just sounds like a cold that they probably won’t get anyway. We’ve tried information campaigns in mailers, humorous campaigns on social media, and using social service agencies as ambassadors to talk up the flu shot outside of the doctor’s office.

Question: What kind of results did you get from them?

Peggy: Well, for the older demographic, we used presentations about influenza that educated people about the associated risks. Not everyone knows the complications that can arise from the flu. But once they do — at least this is what happened in our last county-wide campaign — they see the reason for the flu shot. We got a good response in that demographic. So you might do well with informative presentations to your PCAs about the flu — you know, what it can do to them, what it could do to their younger children or older relatives, information of that nature.

It might be smart to address PCAs’ fears about vaccination, too. They probably know more than the average person about what can go wrong with a flu shot. If you give some statistical information about how likely — or unlikely — adverse events really are, it might help to allay those fears and get them out of the way.

Mary Mills
Nurse Manager of the Medical/Surgical Unit
Question: What do the PCAs you manage think about flu shots?

Mary: It really depends on the person! The older ones just get them, or at least that’s the impression I get. They think they should, so they do it and they don’t make a big deal of it. There are a few who are actually opposed to them on principle, and you can get into an argument about whether or not vaccines cause autism if you’re not careful.

And frankly, the CNAs of color sometimes aren’t big fans of it, but not for the reason you might think. People of color have been the victims of some pretty appalling medical malpractice disguised as research, so they’re not always thrilled to roll up their sleeves for the latest thing. Why should they trust that the flu shot is what they’re told it is? As a person of color myself, I understand that perspective, even if I don’t share it. I don’t mean that all of them say that, but I have heard those opinions here and there.

Question: How do you think it’s best to try and communicate with PCAs about flu shots? Emails? Calls? Other tactics?

Mary: PCAs are on the move a lot. I don’t think calls would be a good idea. It’s just one more thing for them to have to deal with on top of charting and rounds and everything else! I check my email every day, but I don’t know if they do, so that might not be a good method. What about a popup message in the EHR when they log in?

Question: What kind of appeals do you think PCAs are most likely to respond to?

Mary: Well, they’ve heard over and over that the shot’s effective, that it prevents infection, that it’s good for your patients, blah blah blah. I know that’s true, and so does everyone else. But when we’ve heard it all before, I’m not sure it’s really going to help to hear it again. And when the data comes out that the shots for one year are only 50 percent effective for a particular strain of flu, that doesn’t help make the case either.

Instead, if you can come at them with a more novel argument, it’s probably going to disrupt their habitual responses.

Question: What do you think about the idea of using presentations to convey information about the value of the flu vaccine?

Mary: I don’t know. I mean, PCAs are inundated with information 24/7 around here. And if you pit a PowerPoint against an opinion, the opinion usually wins. I think it makes more sense to dodge the rational part altogether, and think of a way to motivate people that doesn’t relate to the flu shot itself.

For example, why not set it up as a friendly competition between our PCAs and our nurses and physicians? Nurses and physicians are pretty good about getting their vaccine, from what I’ve heard. So base all of your communications on the idea that the PCAs are trying to have a better compliance rate this year than the doctors! If you do that, you might see compliant PCAs bugging the noncompliant ones to just get it done, so they can show up the doctors.

And I think stressing the obligations they have to their patients and even their families might be effective.

Jackie Sandoval
Chief Nursing Officer
Question: What data do you have on flu vaccine compliance rates for patient care assistants at this hospital?

Jackie: That’s a good question, and you’ve come to the right person! Part of my job is to manage infection control at the hospital, so I’m in charge of our vaccination efforts. Here’s what we know. The CDC recommends annual vaccination, so we start our drive to get the PCAs in for their shots before early flu season — roughly late September or early October.

Last year, 73 percent of our PCAs got the flu vaccine by October 15, which is good compared to PCAs nationally (about 64 percent). But it’s not good according to the board, and I agree with them. We’d like to see 85 to 90 percent compliance this year. We know we’d probably get higher rates if we made it mandatory, but the board has been reluctant to do that.

Still, we want to do as much as we can to encourage it. We’d like to see 100 percent compliance, although we’re realistic about the odds of that!

Question: Do you have any suggestions for possible tactics that might make the project more successful?

Jackie: Well, I’m not sure how hard to push this. But it could be useful to frame it as an ethical obligation — that it’s their duty as part of the health care team to do it, even if they have personal or political beliefs about it. It seems reasonable to expect that even PCAs who don’t like the idea will be more willing if we can associate their patients with it.

Another idea is to give them some idea of what the flu does to their patients when they get it. So maybe some statistics, specific to your hospital, about patient morbidity and mortality related to the flu?

One thing I would try to hit hard: a lot of PCAs just don’t see the point. They’ll talk about how the shot doesn’t even necessarily have the right flu strain in it, or that it isn’t always effective — and they’re not entirely wrong about those things. So you probably won’t have a lot of success if you don’t address those issues. You can’t convince them that it’s 100 percent effective, because of course that isn’t true.

That’s where tying it back to an ethical obligation might be helpful – you know, “It may not be 100 percent effective if you get the shot, but it will be 0 percent effective for your patient if you don’t get it.” Something like that.

One other possibility: You might want to frame it in terms of what they want, instead of what they’ll avoid. PCAs need and love their PTO, so maybe suggest that they’re less likely to be out sick if they get the shot!

Email
Read your email from Ellen French. Send your PICO(T) question to Ellen. She’ll respond with her changes.

Conclusion
As you’ve seen in this simulation, the data and perspectives to create a good PICO(T) question can come from multiple sources