Using A PICO(T) Framework And Evidence To Develop Care Pract

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.

Paper For Above instruction

Developing effective, evidence-based care practices is fundamental in nursing, particularly when addressing complex conditions such as dementia, which presents with various neuropsychiatric symptoms, including agitation. The use of the PICO(T) framework provides a systematic approach to framing clinical questions that guide evidence retrieval and decision-making. In this paper, I apply the PICO(T) framework to investigate whether non-pharmacological interventions, specifically person-centered care (PCC), are more effective than pharmacological approaches in managing agitation among dementia patients in nursing homes. This approach not only aligns with the goal of reducing neuropsychiatric symptoms with minimal adverse effects but also supports the shift towards holistic, individualized care models in gerontology nursing practice.

Identification of the Practice Issue and PICO(T) Formulation

The practice issue selected is the management of agitation in patients with dementia residing in nursing homes. Agitation poses significant challenges, including risk of injury, increased caregiver burden, and diminished quality of life for patients. Traditionally, pharmacological interventions—such as antipsychotics and sedatives—have been used to control agitation. However, evidence suggests these medications carry high risks, such as increased mortality and adverse side effects. Therefore, exploring alternative approaches, specifically non-pharmacological methods like PCC, is essential. The formulated PICO(T) question is: "In nursing home patients with dementia exhibiting agitation, is person-centered care more effective than pharmacological treatment in reducing agitation over a 6-month period?"

Sources of Evidence and their Relevance

To answer this question, credible sources from academic databases such as CINAHL, PubMed, and PsycINFO were identified. Two particularly pertinent sources are Kales, Gitlin, and Lyketsos (2014), who developed guidelines based on multidisciplinary expert consensus on managing neuropsychiatric symptoms, and Kim and Park’s (2017) systematic review and meta-analysis evaluating the effectiveness of PCC interventions. These sources provide both theoretical frameworks and empirical evidence to guide clinical practice.

The study by Kales et al. (2014) emphasizes the importance of individualized, non-pharmacological interventions, including caregiver education, communication strategies, and meaningful activity engagement. It highlights that such approaches not only lessen agitation but also reduce the use of psychotropic medications, thereby minimizing related risks. Their comprehensive approach underscores that PCC tailored to individual needs addresses the underlying causes of agitation, which pharmacological treatments often overlook.

Kim and Park’s (2017) meta-analysis synthesized data from 19 studies, revealing that PCC interventions produce significant reductions in agitation, with effect sizes greater than those of traditional care approaches. Their analysis also demonstrates that interventions with higher intensity and increased engagement between care providers and patients yield better outcomes, even within short timeframes like 6-9 months. The robustness of their systematic review—guided by PRISMA standards and bias assessment tools—confers high credibility and applicability to clinical settings.

Findings’ Interpretation and Clinical Relevance

The findings from these studies reinforce the potential of PCC as a safer, more effective alternative for managing agitation in dementia. Kales et al. (2014) provide evidence that individualized care plans, developed through models like DICE (Describe, Investigate, Create, and Evaluate), can reduce neuropsychiatric symptoms by addressing personal preferences and underlying causes, rather than merely suppressing symptoms pharmacologically. This approach aligns with current recommendations advocating for minimizing psychotropic medications due to their risks.

Kim and Park (2017) expand on these findings by demonstrating through meta-analytic evidence that personalized, engagement-driven interventions yield statistically significant improvements in agitation scores. These findings are particularly relevant to nursing practice, emphasizing the importance of staff training, patient engagement, and the customization of activities, which collectively promote better behavioral outcomes and quality of life.

Implementing PCC based on these evidence sources can lead to meaningful shifts in clinical practice. For example, adopting models like DICE allows healthcare providers to systematically assess behaviors, identify causes, and develop tailored interventions. The evidence suggests that such strategies not only improve patient outcomes but also reduce medication reliance and adverse events, leading to safer, more ethical care in long-term settings. Moreover, training staff to deliver such care enhances their skills, promotes teamwork, and fosters a culture centered on holistic, patient-driven care.

In practice, integrating these evidence-based strategies would involve staff education programs focused on PCC principles, ongoing behavioral assessments, and family involvement in care planning. The emphasis on non-pharmacological interventions aligns with the principles of the Institute for Healthcare Improvement and other organizations advocating for safer dementia care practices. Consequently, the adoption of PCC can fulfill quality improvement goals, enhance patient-centeredness, and ultimately improve the well-being of patients and their caregivers.

Conclusion

The application of the PICO(T) framework has facilitated a focused approach to exploring the superiority of person-centered care over pharmacological treatments for agitation in dementia patients within nursing homes. The evidence from Kales et al. (2014) and Kim and Park (2017) underscores the effectiveness of individualized, non-pharmacological interventions in managing neuropsychiatric symptoms while mitigating risks associated with medications. Integrating these findings into clinical practice can help shift toward safer, more humane, and effective care strategies that uphold patients’ dignity and quality of life.

References

  • 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.
  • 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.
  • 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.
  • Madhusoodanan, S., & Ting, M. B. (2014). Pharmacological management of behavioral symptoms associated with dementia. World Journal of Psychiatry, 4(4), 72–79.
  • Jones, C., & Cannon, S. (2015). Introduction to nursing research. Jones & Bartlett Learning.
  • Desai, A., et al. (2017). Person-centered primary care strategies for assessment of and intervention for aggressive behaviors in dementia. Journal of Gerontological Nursing, 43(2), 9–17.
  • 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.
  • Kales, H. C., et al. (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.
  • Madhusoodanan, S., & Ting, M. B. (2014). Pharmacological management of behavioral symptoms associated with dementia. World Journal of Psychiatry, 4(4), 72–79.
  • Boswell, C., & Cannon, S. (2015). Introduction to nursing research. Jones & Bartlett Learning.

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