Description
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.
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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.
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:
PICOT Question and Search Strategy Template
Use with the library guide: Evidence Based Practice in Nursing & Health Sciences
1. Define your question using PICOT (review the “Create PICOT Questions” page as needed):
Population:
__________________________________________________________________
Intervention: __________________________________________________________________
Comparison: __________________________________________________________________
Outcome:
__________________________________________________________________
Time (optional): __________________________________________________________________
2. Write out your question: ______________________________________________________
________________________________________________________________________________
3. Write down the most important words from your question in the gray boxes. For each top
term, add synonyms or related terms in the boxes below it. All these are your search terms.
4. Review the “Best Bets” in the Nursing Databases list. Check the databases you will search:
__ CINAHL Complete (*Recommended)
__ Health & Medical Collection
__ Nursing & Allied Health
__ OVID Nursing Full Text Plus
__ Public Health Database
__ PubMed Central
5. Write in your first search below. Follow the instructions on the “Find EBP Articles…” page.
AND
OR
AND
OR
Scholarly/peer reviewed
Limit publication date:
6. Type of studies you want to include in your search:
__ Systematic Review or Meta-Analysis
__ Individual Research Studies
__ Clinical Practice Guidelines
__ Critically Appraised Research Studies
7. What information did you find to help answer your question?
__________________________________________________________________________________
__________________________________________________________________________________
______________________________________________________________________
This form is adapted from: Syrene A. Miller, PICO Worksheet and Search Strategy, National Center for Dental Hygiene Research
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Using a PICO(T) Framework and Evidence to Develop Care Practices
Learner’s Name
Capella University
NURS-FPX4030: Making Evidence-Based Decisions
Instructor Name
August, 2020
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2
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
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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
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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
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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.
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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.
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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-proquestcom.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/
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