Using PICO(T) Questions and an Evidence-Based Approach for Care Practice

Using PICO(T) Questions and an Evidence-Based Approach for Care Practice

In order for nurses to fully utilize evidence-based practice, it is important to possess a spirit of inquiry as well as a culture that supports it. Finding evidence to enhance the outcomes of patients and support change of practice is dependent on the manner in which a question is framed. PICOT, an acronym for patient population, issue of interest or intervention, comparison, outcome, and the time taken for the intervention to attain the outcome, is a consistent and systematic manner that can be used to identify the components of a clinical problem. With a well-built PICOT question, the best evidence to inform practice can be identified quickly. This paper will focus on patients suffering from depression and make use of the PICOT approach to explore the issue, identify the sources of evidence that could help in answering the PICOT question, explain findings from the articles, and explain the articles’ relevance in making decisions linked to the PICOT question.

The issue of interest in this paper is the management of depression using non-pharmacological approaches. The question that needs to be answered is: Is the use of complementary and alternative medicine therapies like exercise more effective in the reduction of depressive symptoms as opposed to the use of antidepressants alone in the treatment of patients with major depressive disorders within a period of 6 months? In this case, patients suffering from major depressive disorders is the population (P), the use of exercise is the intervention of interest (I), antidepressants’ use is the comparison intervention (C), reduced depressive symptoms is the outcome of interest (O) and 6 months is the time-frame (T).

Sources of Evidence

The sources of evidence used are journals. The article by Al-Qhatani, Shaikh and Shaikh (2018) reveals that exercise is a potential alternative treatment for depression management given the efficacy linked to it. This article was chosen because it can help answer the PICO(T) question, particularly the question on the intervention of depression treatment. The article by Netz (2017) is another source of evidence employed in answering the PICO(T) question. Netz (2017) makes a comparison between antidepressants and depression on the basis of their effectiveness in the treatment of depression. In the article, she claims that there is reluctance by some scholars on the use of exercise as a stand-alone treatment for depression, but it can be used as an add-on to enhance the efficacy of treatment. This source is important in making evidence-based decisions about whether exercise can be an alternative to antidepressants in depression treatment.

Self-Regulatory Model

The self-regulatory model by Leventhal has been utilized successfully in enabling a better understanding of the behavior of patients suffering from chronic medical disorders. This model has 5 components, namely: identify (the label used to describe the illness as well as the symptoms viewed by the patient as being part of the disorder); cause (individual ideas regarding the cause of the disease), timeline (whether the patient believes the disease is cyclic, chronic or acute), consequences (expected outcome and effects of the illness) and perceived controllability (the reaction to the illness or symptom to professional or self-intervention) (Magaard et al., 2018). Illness beliefs impact illness-related behaviors as well as treatment outcomes such as quality of life and psychological health. Illness beliefs tend to have an impact on depression treatment outcomes in various ways. For instance, a significant number of patients suffering from depression believe that the use of antidepressants could result in addiction, which may explain why many patients fail to adhere to medication (Magaard et al., 2018). Furthermore, beliefs that psychotherapy and physical exercise are beneficial in controlling depression predict improved depression scores.

Findings from Articles

Patients suffering from depression tend to experience impairments in various aspects of their lives, leading to reduced quality of life as compared to the general population. Research shows that over 50 percent of patients with depression experience recurrent depressive episodes following treatment after about 16 weeks (Kolovos et al., 2017). Various antidepressants have been associated with certain side effects, such as fatigue, nausea, constipation, weight gain, and increased appetite. Rodriguez (2019) reveals that about 50 percent of patients with depression who make use of antidepressants tend to discontinue their use after about 6 months. This is backed by Al-Qahtani, Shaikh, and Shaikh (2018), who claim that patients with depression tend to discontinue the use of antidepressants and discontinue the use of drugs, and about a third of the patients fail to attain remission.

Research shows that physical exercise plays the role of augmentative therapy and a stand-alone treatment in reducing depressive symptoms (Al-Qahtani, Shaikh & Shaikh., 2018; Schuch & Stubbs, 2019). The greatest improvement is observed among patients performing exercise under the supervision of exercise physiologists, physiotherapists, and physical educators (Al-Qahtani, Shaikh & Shaikh, 2018). However, exercise is linked to a heightened risk of musculoskeletal injury, but with enough doses of exercise that are individualized for every patient, the efficacy is improved since the benefits of exercise far offset the risks. Furthermore, Magaard et al. (2018) identify that patients believe that the use of antidepressants results in addiction and has other negative effects and hence discontinue their use and instead engage in physical exercise and/or psychotherapy, which are related to increased efficacy.

The effectiveness of exercise as an alternative to antidepressants has been questioned by some scholars, but the majority agree that exercise, together with small doses of antidepressants, can help reduce depressive symptoms (Al-Qhatani, Shaikh & Shaikh., 2018; Imboden et al., 2020; Netz, 2017). Exercise releases endorphins and other brain chemicals that enhance mood and improve one’s sense of well-being, and it also has a major impact on the working memory, which according to Imboden et al. (2020), is of major clinical significance given that only a few other treatment options can have such effects. A period of 6 months in which patients with depression engage in different workout regimes is reasonable enough to assess the efficacy of the intervention in reducing depressive symptoms among the patients.

Relevance of Findings

Magaard et al. (2018) article was among the most useful articles in the research. The authors employ  common sense or a self-regulatory model to explain the behavior of patients with depression. In the article, the authors emphasize the importance of understanding the illness beliefs of the patients in order to find an effective way of treatment. If a majority of the patients believe that antidepressants cause more harm to them than good and discontinue their use, why not employ alternative treatments? An alternative treatment identified in the study is physical exercise. Therefore, if most patients believe in the efficacy of exercise in lessening depressive symptoms, why not encourage its use?

Imboden et al. (2020) have outlined the relevance of employing stretching and aerobic exercise as add-ons to the treatment of depression. The article has been useful in identifying the efficacy of exercise, and the authors claim that exercise alone can be effective in the treatment of depression, but it is important to incorporate antidepressants in small dosages. This has been supported by (Netz (2017), who claims that exercise needs to be used as a viable alternative to or, where necessary, in combination with drug therapy in depression treatment.

Schuch and Stubbs (2019) emphasize the role of exercise in the treatment of depression by claiming that dropping out from exercise interventions is similar to dropping out from other depression treatments and hence the need to find strategies that can increase adherence and promote better health. Lastly, Al- Qahtani, Shaikh, and Shaikh’s (2018) article has been useful in giving insight into the amount of exercise that needs to be performed to enhance efficacy in the treatment of depression. The authors emphasize the need for short durations of exercise and the need for exercise professionals to supervise the patients since supervision is linked to reduced dropout rates. Finding exercises that are suitable for individual patients is important.

Conclusion

Drug therapy, like antidepressants, has, over time, been identified with adverse effects on patients suffering from major depressive disorders. Using the PICOT approach to identify alternative treatments, the use of exercise as a complementary and alternative medicine was identified as the best alternative to offset the effects of antidepressants. Various articles have been used to find evidence of the efficacy of exercise. Most scholars support its use, claiming that exercise can act as a stand-alone treatment for depression. Still, most of the scholars suggest accompanying exercise with small doses of antidepressants. 6 months has been identified as a reasonable time frame for observing the effectiveness of exercise in reducing depressive symptoms.

References

Al-Qahtani, A. M., Shaikh, M. A. K., & Shaikh, I. A. (2018). Exercise as a treatment modality for depression: A narrative review. Alexandria journal of medicine, 54(4), 429-435.

Imboden, C., Gerber, M., Beck, J., Holsboer-Trachsler, E., Pühse, U., & Hatzinger, M. (2020). Aerobic exercise or stretching as add-on to inpatient treatment of depression: Similar antidepressant effects on depressive symptoms and larger effects on working memory for aerobic exercise alone. Journal of Affective Disorders, 276, 866-876.

Kolovos, S., Bosmans, J. E., Riper, H., Chevreul, K., Coupé, V. M., & van Tulder, M. W. (2017). Model-based economic evaluation of treatments for depression: a systematic literature review. PharmacoEconomics-open, 1(3), 149-165.

Magaard, J. L., Löwe, B., Brütt, A. L., & Kohlmann, S. (2018). Illness beliefs about depression among patients seeking depression care and patients seeking cardiac care: an exploratory analysis using a mixed method design. BMC psychiatry, 18(1), 1-9.

Netz, Y. (2017). Is the comparison between exercise and pharmacologic treatment of depression in the clinical practice guideline of the American college of physicians evidence-based?. Frontiers in pharmacology, 8, 257.

Rodriguez, T. (March 1, 2019). Patient-Centered Medical Management for Depression. Psychiatry Advisor. Retrieved from https://www.psychiatryadvisor.com/home/depression-advisor/patient-centered-medical-management-for-depression/

Schuch, F. B., & Stubbs, B. (2019). The role of exercise in preventing and treating depression. Current sports medicine reports, 18(8), 299-304.

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Using PICO(T) Questions and an Evidence-Based Approach for Care Practice

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 the 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.

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 judgment
skills. When reliable and relevant evidence-based findings are utilized, patients, healthcare 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 and 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 as 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:
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