PICO(T) Questions and an Evidence-Based Approach-Urinary Retention
The PICO(T) framework helps BSN-prepared nurses define a practice issue and search for, analyze, and apply evidence in practice settings. This article defines urinary retention as a practice issue experienced in nursing that can be explored via the PICO(T) approach. Then, it creates a PICO(T)-formatted research question related to the practice issue. It also identifies potential sources of evidence to help effectively answer the PICO(T) question, discusses the findings of articles and other sources regarding urinary retention, and discusses how the results from specific sources of data are relevant to addressing the PICO(T) issue.
Practice Issue to Be Explored and Development of a PICO(T)-Formatted Research Question
The healthcare issue of interest in my current nursing practice is urinary retention in elderly patients in my current long-term care facility. Urinary retention is a condition that makes the patient unable to satisfactorily empty the contents of their bladder when full (National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), 2019). The NIDDK (2019) also notes that urinary retention is more of a condition than a disease related to other health problems, such as prostate issues in older men and cystoceles in women. It is an issue of concern in elderly patients as it is a risk factor for other conditions that complicate care, such as kidney damage, bladder stones, and urinary tract infections (UTIs) (Martin et al., 2023). Due to the risk of complications and associated poor quality of life among institutionalized older adults, it is essential to develop an evidence-based approach to prevent and reduce the occurrence of urinary retention. In this case, the issue of urinary retention among elderly patients in long-term care facilities will be explored using the PICO(T) framework—two by comparing non-pharmacological methods. The main intervention is the use of pelvic floor exercises, and the comparison intervention is the standard care for elderly patients.
The PICO(T) formatted research question is:
Among elderly patients in long-term care facilities (P), do pelvic floor exercises (I) compared to standard care (C) reduce the incidence of urinary retention (O) within a six-month period (T)?
Sources of Evidence to Help Answer PICO(T) Question
The major sources of credible evidence to help answer the PICO(T) question developed to address the issue of urinary retention among elderly patients include medical databases, peer-reviewed journals, and practice guidelines provided for in related organizational websites. The databases used include PubMed, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and the Cochrane Library. PubMed provides a database for peer-reviewed medical and health-related journals, while the CINAHL and the Cochrane Library provide articles that are specific to nursing and a database for systematic reviews and meta-analyses, respectively. Websites such as the American Urological Association (AUA) website and the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) provide guidelines and information to guide the delivery of evidence-based urologic care. These sources have the potential to answer the PICO(T) question as the sources provide a search for peer-reviewed articles specific to the management of urinary retention.
Findings from Selected Articles on Urinary Retention
A literature search was conducted in PubMed using a combination of keywords such as “urinary retention, elderly patients, pelvic floor exercises, standard urinary retention care, and non-pharmacological urinary retention care.” Several search results were returned. Out of the several articles, two were selected. The first article by Zong et al. (2022) found that Kegel pelvic floor muscle training, in conjunction with clean intermittent catheterization (IC), successfully manages urine retention, especially in women who have undergone hysterectomy due to cervical cancer. Notably, the study found that pelvic floor muscle strengthening applied with clean intermittent self-catheterization improved bladder function and reduced the risk for associated infections such as UTI while improving patient comfort. This article is credible as it is peer-reviewed and current, and the researchers have authority on the subject.
The second article is a systematic evaluation of exercise therapies targeting the strength of the pelvic floor muscles in the management of urine incontinence in older women. The systematic review results demonstrated that supervised pelvic floor muscle-targeting exercise programs significantly increased pelvic floor muscle strength, reduced symptoms of urine incontinence, and enhanced patients’ quality of life (Fricke et al., 2021). This article is credible as it is published in a peer-reviewed journal focused on women’s health, is recent, and provides details of the inclusion criteria for all reviewed articles.
Relevance of the Findings from Chosen Sources of Evidence
The study by Zong et al. (2022) provides relevant evidence that can help answer the PICO(T) question as it provides details on why urinary retention is an issue of concern in women’s health, hence the need to address the condition. Importantly, it provides empirical evidence on how effectively improving the pelvic muscles’ strength is in improving urinary function. Based on this evidence, it is possible to explore various ways to incorporate pelvic floor muscle training exercises with other care practices to improve health outcomes in elderly patients with urinary retention. The findings by Fricke et al. (2021), although not directly focused on urinary retention but rather urinary incontinence, are relevant to answering the developed PICO(T) question. This is because the findings also elaborate on how improving the strength of core muscles as well as pelvic floor muscles improves overall bladder muscle strength and control of bladder function. The findings also show how professional-guided exercises can improve pelvic floor muscle strength more effectively.
Conclusion
Urinary retention is a potentially harmful condition in older patients, with a risk of leading to other health complications as well as reducing the quality of life of the patient. As older patients bear a risk for polypharmacy and medication errors, it is important for a BSN-prepared nurse to explore non-pharmacological interventions to manage urinary retention in older patients and improve health and patient outcomes. A PICOT framework can be useful in comparing various interventions and developing evidence to guide implementation for the most effective intervention.
References
Fricke, A., Lark, S. D., Fink, P. W., Mundel, T., & Shultz, S. P. (2021). Exercise interventions to improve pelvic floor muscle function in older women with urinary incontinence: A systematic review. Journal of Women’s Health Physical Therapy, 45(3), 115–125. https://doi.org/10.1097/JWH.0000000000000202
Martin, J., Chandler, W., & Speakman, M. (2023). Chronic urinary retention in the elderly. The BMJ, 366. https://doi.org/10.1136/BMJ.L4590
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). (2019, December). Definition & facts of urinary retention. https://www.niddk.nih.gov/health-information/urologic-diseases/urinary-retention/definition-facts
Zong, J., You, M., & Li, C. (2022). Effect of Kegel pelvic floor muscle exercise combined with clean intermittent self-catheterization on urinary retention after radical hysterectomy for cervical cancer. Pakistan Journal of Medical Sciences, 38(3Part-I), 462. https://doi.org/10.12669/
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Question 
Create a 3-5 page submission in which you develop a PICO(T) question for the diagnosis you worked with in the first two assessments and evaluate the evidence you locate, which could help to answer the question.
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.
PICO(T) Questions and an Evidence-Based Approach-Urinary Retention
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 they relate to the identified healthcare issue.
Explain the relevance of the findings from chosen sources of evidence to making a 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.