NURS FPX 4030 PICOT Framework for Medication Errors Paper

NURS FPX 4030 PICOT Framework for Medication Errors Paper

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

Learner’s Name Capella University

NURS-FPX4030: Making Evidence-Based Decisions Instructor Name

August, 2023

 

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

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 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

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.

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.

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/

 

NURS FPX 4030 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.

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:

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.

VIEW SCORING GUIDE

Resources: PICO(T) Process

      • This article presents a study that examined the use of PICO(T) questions to locate evidence related to specific types of resources and research.
    • Ho, G. J., Liew, S. M., Ng, C., Shunmugam, R., & Glasziou, P. (2016). Development of a search strategy for an evidence based retrieval service. PLoS One, 11(12), 1–14. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0167170
      • This article presents a study comparing the use of PICO(T) questions in a literature search to other search strategies.

This first two chapters in the following text, of which the Capella library has limited copies, could be helpful in expanding your knowledge regarding the PICO(T) process.

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

Resources: Communicating Research

      • This article provides preliminary evidence of the effectiveness of interventions used to train nursing students in patient-centered communication. Although all the interventions obtained significant results in communication skills, it has not yet been determined which methodology is more effective.

Resources: Case Studies

ADDITIONAL INSTRUCTIONS FOR THE CLASS

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  • Discussion Questions (DQ)

Initial responses to the DQ should address all components of the questions asked, including a minimum of one scholarly source, and be at least 250 words. Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source. One or two-sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words. I encourage you to incorporate the readings from the week (as applicable) into your responses.

  • Weekly Participation

Your initial responses to the mandatory DQ do not count toward participation and are graded separately. In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies. Participation posts do not require a scholarly source/citation (unless you cite someone else’s work). Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week.

  • APA Format and Writing Quality

Familiarize yourself with the APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in Loud-cloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required). Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation. I highly recommend using the APA Publication Manual, 6th edition.

  • Use of Direct Quotes

I discourage over-utilization of direct quotes in DQs and assignments at the Master’s level and deduct points accordingly. As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content. It is best to paraphrase content and cite your source.

  • LopesWrite Policy

For assignments that need to be submitted to Lopes Write, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me. Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes. Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own? Visit the Writing Center in the Student Success Center, under the Resources tab in Loud-cloud for tips on improving your paper and SI score.

  • Late Policy

The university’s policy on late assignments is a 10% penalty PER DAY LATE. This also applies to late DQ replies. Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances. If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect. I do not accept assignments that are two or more weeks late unless we have worked out an extension. As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.

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Communication is so very important. There are multiple ways to communicate with me: Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class. Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours. NURS FPX 4030 PICOT Framework for Medication Errors

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