Purposeful Identification Of The Problem Or Opportunity

Purposeclear Identification Of The Problem Or Opportunity Is The First

Purpose clear identification of the problem or opportunity is the first step in evidence-based nursing. In a previous course, you identified a practice problem of interest and developed a PICOT question. This assignment is a review of PICOT with the opportunity to revise or refine it. You will post your PICOT in the Week 1 Discussion for your classmates to review and provide feedback.

Students are given the opportunity to request an extension on assignments for emergent situations. Supporting documentation must be submitted to the assigned faculty. If the student's request is not approved, the assignment is graded and a late penalty is applied as follows: Monday = 10% of total possible point reduction, Tuesday = 20%, Wednesday = 30%. If the student's request is approved, the student will be informed of the revised due date. Should the student fail to meet the revised due date, the assignment is graded and a late penalty is applied as follows: Monday = 10%, Tuesday = 20%, Wednesday = 30%.

This assignment enables the student to meet the following Course Outcome (CO): CO 2: Using current knowledge, standards of practice, and research from evidence-based literature, synthesize a foundation for the nurse executive role. (PO 3,4)

Total Points Possible: 50

Paper For Above instruction

The process of developing a PICOT question is fundamental in evidence-based nursing practice, as it guides the search for relevant evidence to address specific clinical issues. In this paper, I will present my refined PICOT question, describe the problem it addresses, and discuss how the practice problem was identified. I will also explain the search strategy used to gather evidence and demonstrate how this evidence can support a practice change aimed at improving patient outcomes.

Development and Refinement of the PICOT Question

My original PICOT question focused on improving medication adherence among elderly patients with hypertension. Over the course of my studies and practice, I refined this question to better align with current practice and available evidence. The refined PICOT question is: "In adults aged 60 and above with hypertension (P), does the implementation of a structured patient education program (I), compared to standard care (C), improve medication adherence (O) over six months (T)?"

This revision was motivated by the recognition that patient education is a modifiable factor with substantial evidence supporting its role in medication adherence. It also aligns with my clinical environment, where patients often struggle with understanding their medication regimens, leading to poor adherence and adverse outcomes.

Definition of PICOT Elements

1. P (Patient/Problem): Adults aged 60 and above diagnosed with hypertension.
2. I (Intervention): Implementation of a structured patient education program focusing on hypertension management.
3. C (Comparison): Standard care without the additional structured education program.
4. O (Outcome): Improvement in medication adherence, measured through pharmacy refill rates and self-report adherence scales.
5. T (Timeframe): Six months from implementation.

Issue or Problem Focused on Evidence-Based Practice Change

In my clinical practice setting, I observed that despite prescribing antihypertensive medications, many elderly patients showed poor adherence, leading to uncontrolled blood pressure and increased risk for cardiovascular events. The concern was whether patient education could be a simple yet effective intervention to improve adherence. Literature indicates that tailored education increases adherence rates among hypertensive patients (Kroenke et al., 2016; Ogedegbe & Schoenthaler, 2017). The problem was identified through clinical audits, patient feedback, and reviewing blood pressure control rates, which failed to meet desired standards.

Practice Issue Identification Process

The issue was identified through routine clinical audits and patient interviews. I noticed a pattern where patients lacked understanding of their medication regimens and perceived barriers to adherence. Concerns such as forgetfulness, misconceptions about medications, and side effect fears surfaced repeatedly. A review of patient records confirmed the trend of uncontrolled blood pressures, indicating a systemic issue requiring intervention. This evidence prompted the consideration of an educational program as a potential strategy to improve outcomes.

Search Terms and Strategy

For the evidence search, I used terms like "hypertension," "medication adherence," "patient education," and "elderly." To narrow the search, I applied filters such as publication date within the last five years, peer-reviewed journals, and studies involving adult or elderly populations. If results were too broad or lacked relevance, I narrowed the focus using specific intervention terms like "structured education" or "behavioral interventions." Combining Boolean operators (AND, OR) helped refine the search, ensuring a focused, manageable body of evidence to inform practice.

In conclusion, the development of this PICOT question and associated evidence allows for a targeted approach to improve medication adherence among hypertensive elderly patients. By integrating evidence-based strategies into practice, nurses can positively influence patient outcomes, ultimately contributing to reduced cardiovascular risk and enhanced quality of life.

References

• Gomez, K. S., & Hamilton, D. K. (2015). Evidence-based approaches to improving medication adherence in hypertensive patients. Journal of Advanced Nursing, 71(3), 516-529.
• Kroenke, K., et al. (2016). Effectiveness of patient education on medication adherence in hypertension: A systematic review. BMC Cardiovascular Disorders, 16, 124.
• Ogedegbe, G., & Schoenthaler, A. (2017). A review of interventions to improve medication adherence in hypertensive patients. Current Hypertension Reports, 19(11), 88.
• Paasche-Orlow, M. K., & Wolf, M. S. (2015). Evidence-based interventions to improve medication adherence. The Journal of Clinical Hypertension, 17(8), 569-573.
• Kim, S., et al. (2018). Impact of educational interventions on hypertension management: A meta-analysis. Nursing Research, 67(4), 271-278.
• Centers for Disease Control and Prevention. (2020). Hypertension management in the elderly: Best practices. CDC Publications.
• Santos, M. J., & Carvalho, J. (2019). Strategies to enhance medication adherence in older adults. Clinical Nursing Research, 28(8), 1003-1015.
• Sharma, N., & Saini, N. (2019). Role of patient education in hypertension control. Journal of Community Health Nursing, 36(2), 75-81.
• Wilkinson, J. R., et al. (2017). Evaluating the impact of nurse-led educational programs on hypertension management. Nursing Clinics of North America, 52(4), 481-493.
• World Health Organization. (2019). Hypertension: Integrated management guidelines. WHO Publications.