PICO(T) Questions and an Evidence-Based Approach

In the United States, cardiovascular illnesses and cancers of all kinds are the leading causes of mortality, followed by stroke as the third leading cause of death (Xu et al., 2022). Additionally, it is a prominent contributor to significant and enduring disability in the United States. There is a lack of awareness among the general public and healthcare professionals regarding the nature of stroke, its signs and symptoms, and appropriate actions to take in the event of a stroke. Prompt treatment is essential for optimizing the efficacy of stroke intervention. This paper will utilize the PICO(T) process to formulate a research question on stroke management and conduct a comprehensive investigation.

Practice Issue

The abrupt onset of a localized neurological impairment characterizes stroke. It can be caused by either a blockage in an artery due to a blood clot or plaque buildup (ischemic stroke) or by the rupture of an artery in the brain or the subarachnoid space (hemorrhagic stroke). Ischemic strokes make up the bulk of cases, accounting for roughly 87 percent of all strokes, as stated by Xu et al. (2022). Other types of strokes include around 10 percent of cases of intracerebral hemorrhage and 3 percent of cases of subarachnoid hemorrhage. A stroke that has just begun is a severe medical emergency. There is a higher risk of irreversible brain injury the longer blood supply to the brain is cut off. Brain cells undergo rapid cell death within a short period. During a stroke, the death of over two million brain cells per minute occurs, which significantly elevates the likelihood of enduring irreversible damage to the brain, disability, or mortality.

Stroke is a significant contributor to long-term disability and death in the United States. It is a complex chronic disease often accompanied by other health conditions, leading to increased healthcare expenses and rates of hospital readmission. Regrettably, stroke patients frequently arrive at acute care facilities with stroke events that occurred after their initial diagnosis. Sharrief et al. (2023) found that readmission rates for stroke patients can reach 13%, with a significant proportion of these readmissions being unplanned and potentially preventable. According to Wong et al. (2023), approximately 6.6 million adults in the United States have experienced a stroke, with an annual occurrence of around 795,000 new or recurrent strokes. Telehealth, as a post-discharge intervention, can effectively decrease readmission rates in stroke patients. A PICOT question was formulated to facilitate additional research supporting this evidence-based practice.

PICO(T) Question

The PICOT question to be addressed is: Among adult patients above the age of 18 years who have been newly diagnosed with stroke (P), how does the use of telehealth appointments with an NP immediately after discharge (I), as compared to traditional in-person clinic appointment (C), affect the rate of 30-day readmissions rates (O), within three months (T)?

PICOT Questions and an Evidence-Based Approach

Health care professionals work hard to address patient needs as situations necessitate. Despite their commitment to delivering quality and patient-centered care, health care professionals face many challenges that hinder them from achieving the desired outcomes. Such challenges need to be analyzed in-depth and suitable interventions adopted to address and prevent them in the future. The outcomes depend on the approaches used to address a care issue. The purpose of this paper is to develop a PICOT question for a specific care issue and evaluate the evidence that could be used to answer the question.

Practice Issue to Explore via a PICOT Approach

Nurses play an instrumental role in health care delivery as primary care providers. They are involved in most processes regarding patient care, implying that patient outcomes always depend on how effectively nurses deliver their work. As a result, they should be mentally and physically healthy to execute their roles as professionally and ethically expected. To ensure continuity of care, new graduate nurses join the practice at different times. They are expected to get maximum support from their colleagues to execute their mandate confidently. However, they are typical targets of workplace incivility, with many experiencing bullying at some point during the transition from education to practice (Anusiewicz et al., 2019). Such nurses should be prepared to cope with practice challenges to adapt comfortably.

The impacts of workplace incivility cannot be overlooked at any point of care. Shi et al. (2018) found that graduate nurses transitioning to practice are highly vulnerable to workplace incivility due to inexperience and confidence problems. If not assisted, workplace incivility further affects their ability to provide patient care. For instance, workplace incivility has been found to cause distraction and emotional upset that put patients at risk (Khan et al., 2021). Bullied or intimidated nurses feel like they do not get the support needed, losing interest in their work. Such problems increase their vulnerability to medication administration malpractices, common among new graduate nurses (Armstrong, 2018). Patients should be protected from adverse outcomes by addressing workplace incivility effectively.

PICOT Question: In graduate nurses (P), can cognitive rehearsal training (I) compared to no intervention (C) empower graduate nurses to cope with workplace incivility (O) within six months?

The PICOT approach identifies the Problem/Population, potential Interventions, Comparison, Outcomes, and Timeline. It guides evidence search since the practice issue is known and proposed interventions identified. The process that follows primarily involves searching and appraising evidence on the proposed interventions to help address the practice issue.

Sources of Evidence to Answer the PICOT Question

The internet has a lot of information on workplace incivility and how to control it in health care settings. Information on the practicality of cognitive rehearsal is also extensive in websites, blogs, books, dissertations, and journal articles, among other sources. Reliable websites from government, health, and learning institutions can provide tips on workplace incivility control and help new nurses adapt to new climates. Books are also authoritative to a significant extent. However, journal articles are the most effective in answering the PICOT question among these sources.

When answering a PICOT question, nurses use the evidence-based approach to address a practice issue. They search for the best evidence from current, authoritative, accurate, and relevant sources. Accurate sources seek information from research studies. They are also peer-reviewed by experts in the same field. As a result, journal articles will be used to answer the PICOT question since they meet these criteria.

Findings from Articles

Health care research has explored the effectiveness of cognitive rehearsal in addressing workplace incivility, and findings vary depending on the studied population, the scope of research, and the objectives of the researchers. Armstrong (2018) recommended combining educational training about the workplace and effective responses to enable nurses to deal with uncivil behaviors. Cognitive rehearsal was proposed as part of the educational training to enable nurses to identify and report uncivil behaviors. Increased knowledge on identifying incivility issues ensures that nurses are not easily distracted.

Two more articles provide valuable information on the importance of cognitive rehearsal training as an empowerment method for new nurses. Kim et al. (2020) advised health care administrators to be committed to identifying incivility toward junior nursing students and develop targeted programs to reduce clinical incivility. Cognitive rehearsal training is among the targeted programs that can work effectively for nurses when learning and during practice. Zhang and Xiong (2019) found cognitive rehearsal an effective method for improving environments in which care is provided. Besides empowering nurses to identify, resist, and report incivility, it improves interpersonal relationships and decreases turnover intention. Overall, these articles meet the credibility criterion and can answer the PICOT question authoritatively. They share similar characteristics for nursing research evidence, including authority, relevance, currency, and reliability. Although their study designs vary, they are extensive and conclusive on how cognitive rehearsal can help new nurses cope with workplace incivility.

Relevance of the Findings

Research relevant to a PICOT question should help health care providers address a practice issue comprehensively. Armstrong (2018) conducted a systematic review specifically on applying workplace training techniques to enable nurses to deal with incivility. It is detailed on when, how, and why the training is essential. Kim et al. (2020) explained the importance of targeted programs in improving nurses’ well-being. The study illustrates the expected outcomes when cognitive rehearsal and other methods are used for addressing incivility. However, the article focuses primarily on junior nursing students. Zhang and Xiong (2019) provide evidence on cognitive rehearsal as a coping strategy. However, the study reviews the effectiveness of the approach among many other methods. It is right to deduce that all the articles are relevant as far as addressing workplace incivility is concerned.

Cognitive rehearsal is a psychological intervention. It ensures that nurses are prepared to face a problem and can identify and respond to it confidently. Among the findings, Kim et al.’s (2020) article recommendations are the most likely to lead to positive outcomes. Kim et al. (2020) explained the outcomes achieved through cognitive rehearsal, including behavior change, adjustment, and improving the work environment. The article also explains how cognitive rehearsal can be combined with other methods for better outcomes.

Conclusion

A healthy workplace is crucial for nurses to deliver comprehensive patient care. Such a workplace is characterized by high collaboration, support, and protecting nurses from abuse and intimidation. As an issue hampering patient safety and health care quality, workplace incivility among new graduate nurses can be addressed via a PICOT approach. The population of concern would be the graduate nurses experiencing incivility, the proposed intervention would be cognitive rehearsal, and the outcome is improving coping ability. Research should be sourced from current, authoritative, and credible resources. The selected articles address workplace incivility from multiple dimensions, but cognitive rehearsal dominates the proposed interventions.

References

Anusiewicz, C. V., Shirey, M. R., & Patrician, P. A. (2019). Workplace bullying and newly licensed registered nurses: an evolutionary concept analysis. Workplace Health & Safety, 67(5), 250-261. https://doi.org/10.1177%2F2165079919827046

Armstrong, N. (2018). Management of nursing workplace incivility in the health care settings: A systematic review. Workplace Health & Safety, 66(8), 403-410. https://doi.org/10.1177%2F2165079918771106

Khan, M. S., Elahi, N. S., & Abid, G. (2021). Workplace incivility and job satisfaction: Mediation of subjective well-being and moderation of forgiveness climate in health care sector. European Journal Of Investigation in Health, Psychology and Education, 11(4), 1107–1119. https://doi.org/10.3390/ejihpe11040082

Kim, S. A., Hong, E., Kang, G. Y., Brandt, C., & Kim, Y. (2020). Effect of Korean nursing students’ experience of incivility in clinical settings on critical thinking. Heliyon, 6(7), e04367. https://doi.org/10.1016/j.heliyon.2020.e04367

Shi, Y., Guo, H., Zhang, S., Xie, F., Wang, J., Sun, Z., … & Fan, L. (2018). Impact of workplace incivility against new nurses on job burn-out: A cross-sectional study in China. BMJ Open, 8(4), e020461. http://dx.doi.org/10.1136/bmjopen-2017-020461

Zhang, X., & Xiong, L. (2019). Impact of nurse horizontal violence and coping strategies: A review. Yangtze Medicine, 3(4), 289-300. https://doi.org/10.4236/ym.2019.34028

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.

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 a health care 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 a health care issue of interest and apply the PICO(T) process to develop the 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 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. 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:

• Assessment 3 Example [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.
• 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.

Competencies Measured

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 that are relevant to the health care issue.
• 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 and develop a PICO(T)-formatted research question.
• Competency 5: Apply professional, scholarly communication strategies to lead practice changes based on evidence.
  • Organize content so ideas flow logically with smooth transitions; contains few errors in grammar/punctuation, word choice, and spelling.
  • Apply APA formatting to in-text citations and references exhibiting nearly flawless adherence to APA format.