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

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

The PICO(T) framework supports evidence-based practice by guiding research and improving outcomes. For chronic obstructive pulmonary disease (COPD), a condition marked by frequent exacerbations and economic burden, interventions like pulmonary rehabilitation with bronchodilator therapy are essential. This essay explores these interventions, formulates a research question, and analyzes credible evidence to demonstrate how evidence-based decisions optimize COPD care: Using a PICO(T) Framework and Evidence to Develop Care Practices.

Utilizing the PICO(T) Framework to Define a Practice Issue and Research Question

Practice Issue

COPD is a disease of the respiratory system, which deteriorates over time and causes chronic bronchial asthma and chronic obstructive pulmonary disease, hospitalization, and a reduced quality of life. New pharmacological therapies have been developed to treat patients, but variation in the care process results in uncoordinated and perhaps unwarranted deterioration as well as readmission to hospitals (Vogelmeier et al., 2020).

As such, pulmonary rehabilitation integrated with bronchodilator treatment has great potential to solve all these lacks. Despite this, there is still variable adoption of the same across different clinical practices. To effectively reduce the burden and impact of COPD, as well as enhance patient outcomes it is important to determine the comparative efficacy of this intervention to standard care.

PICO(T) Question

The PICO(T) framework provides a systematic way to frame the research question:

Research Question

Among patients with COPD (P), what is the effectiveness of pulmonary rehabilitation together with bronchodilator therapy (I) as compared to standard management (C) on hospital admissions and quality of life (O) within 12 months (T)? This question is focused on getting quantifiable results and allows for have efficient search of research data for supporting clinical processes. In that regard, the PICO(T) question has the advantage of not deviating from real-world practice because of the alignment of the intervention with patient-centered outcomes.

Identifying Credible Evidence Sources for PICO(T) Research

Several reliable sources of evidence can support research on COPD management and interventions. A bibliographic database useful for the subject of the present paper is CINAHL (Cumulative Index to Nursing and Allied Health Literature), which provides access to peer-reviewed articles, codes of references, and evidence-based guidelines regarding nursing and allied health, including pulmonary rehabilitation. PubMed is a medical literature database that offers trial and about clinical trials, systematic reviews, and meta-analyses on COPD.

The Cochrane Library is among the most outstanding for its top-quality systematic reviews and evidence syntheses mainly implemented for controlling the effectiveness of some types of interventions, such as pulmonary rehabilitation. The CDC provides adequate epidemiology data, COPD clinical reference information, and COPD patient information. Finally, the recommendations of the ATS Guidelines for pulmonary rehabilitation and other pulmonary interventions are used to maintain the compliance of the solutions provided. Altogether, these resources offer good support to conduct an evidence-based practice to improve client and organizational outcomes (Cross et al., 2022).

These sources are well-suited for answering the PICO(T) question due to their rigorous peer-review processes and focus on clinical applicability. For example, systematic reviews from the Cochrane Library and clinical trials from PubMed provide robust evidence, while guidelines from ATS ensure the research aligns with established best practices.

Findings from Evidence Relevant to COPD Management

Source 1: Cochrane Library – Systematic Review on Pulmonary Rehabilitation

A systematic review from the Cochrane Library evaluated the impact of pulmonary rehabilitation on COPD outcomes. The review also included data from other RCTs to show that pulmonary rehabilitation decreased readmissions by 28%, in addition to improving the patient’s quality of life with validated instruments such as the SGRQ. Perceived benefits of exercise training were increased fatigue quality, less breathlessness, and improved psychological state. Tonga and Oliver (2023) concluded that PR (pulmonary rehabilitation) should be recognized as an integral part of COPD, particularly when taking pharmacological approaches.

Source 2: PubMed – Randomized Controlled Trial on Combined Therapy

A PubMed-RCT was conducted to assess pulmonary rehabilitation with bronchodilator therapy for 12 months; this revealed a 35% reduction in exacerbations and a 20% improvement in functional status compared to the current standard care (Meneses-Echávez et al., 2023). Another critical factor concerns patient compliance which had a great contribution to improving the results. These findings provide robust evidence supporting the integration of pulmonary rehabilitation with bronchodilator therapy in COPD care. Both sources highlight measurable benefits, including reduced hospitalizations, improved symptom management, and enhanced quality of life.

Relevance of Evidence Findings to Clinical Decision-Making

The findings from the selected articles are directly relevant to the PICO(T) question and offer valuable insights for clinical decision-making.

Clinical Outcomes

The outcomes in both studies are consistent with the goals in the PICO(T) question: improvements in quality-of-life ratings and decreases in rates of readmission to the hospital. These evidences make solid grounds for adopting pulmonary rehabilitation in the management of patients with COPD.

Consistency in Care

The evidence shows the possibility of applying pulmonary rehabilitation as a traditional practice in COPD and, therefore, creating unity in management procedures. This may minimize inconsistencies in the care being provided to patients and simultaneously maximize the utilization of research-validated practices by all patients (Shenoy & Paul, 2023).

Policy and Program Development

These results provide evidence for designing policies to promote increased implementation of pulmonary rehabilitation programs in healthcare facilities. In line with these interventions, there is improved identification of resources through which costs related to COPD exacerbations and hospitalizations can be covered.

Patient-Centered Care

The increased focus on the enhancement of quality of life and the decrease of symptom distress is patient-oriented. The application of these findings guarantees that implemented interventions are relevant to and desired by the patients.

Economic Implications

Reducing hospital readmissions through pulmonary rehabilitation and bronchodilator therapy has significant economic benefits. By decreasing healthcare utilization, these interventions contribute to cost-effective care delivery.

By integrating these findings into practice, healthcare professionals can enhance patient outcomes, promote cost-efficiency, and align care with evidence-based guidelines.

Conclusion

The PICO(T) framework can be applied for COPD management, providing a link between pulmonary rehabilitation and bronchodilator therapy, low hospital readmission rates, and better quality of life. Several types of research from Cochrane Library and PubMed support the findings, as they are consistent with the patient-centered results. This approach improves clinical care, thus supporting the principle of improving the delivery of care through evidence-based practice.

References

Cross, A. J., Liang, J., Thomas, D., Zairina, E., Abramson, M. J., & George, J. (2022). Educational interventions for health professionals managing chronic obstructive pulmonary disease in primary care. Cochrane Database of Systematic Reviews, 2022(5). https://doi.org/10.1002/14651858.cd012652.pub2

Meneses-Echavez, J. F., Guapo, N. C., Loaiza-Betancur, A. F., Machado, A., & Bidonde, J. (2023). Pulmonary rehabilitation for acute exacerbations of COPD: A systematic review. Respiratory Medicine, 219, 107425. https://doi.org/10.1016/j.rmed.2023.107425

Shenoy, M. A., & Paul, V. (2023, July 25). Pulmonary rehabilitation. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK563166/

Tonga, K. O., & Oliver, B. G. (2023). Effectiveness of pulmonary rehabilitation for chronic obstructive pulmonary disease therapy: Focusing on traditional medical practices. Journal of Clinical Medicine, 12(14), 4815. https://doi.org/10.3390/jcm12144815

Vogelmeier, C. F., Román-Rodríguez, M., Singh, D., Han, M. K., Rodríguez-Roisin, R., & Ferguson, G. T. (2020). Goals of COPD treatment: Focus on symptoms and exacerbations. Respiratory Medicine, 166(1), 105938. https://doi.org/10.1016/j.rmed.2020.105938

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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.

Introduction
PICO(T) is an acronym that helps researchers and practitioners define aspects of a potential study or investigation.

It stands for:

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

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

Instructions
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.

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

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

In your submission, make sure you address the following grading criteria:

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:

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.

Competencies Measured
By successfully completing this assessment, you will demonstrate your proficiency in the course competencies through the following assessment scoring guide criteria:

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