Using A PICO(T) Framework And Evidence To Develop Car 980427

Using a PICO(T) Framework and Evidence to Develop Care Practices Learner’s Name Capella University Making Evidence-Based Decisions PICO(T) Questions and an Evidence-Based Approach January, 2019

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

In the dynamic field of geriatric care, developing effective, evidence-based practices to manage behavioral symptoms in patients with dementia is paramount. Among these symptoms, agitation poses significant challenges to both caregivers and patients, often impacting quality of life and healthcare outcomes. This paper explores the application of the PICO(T) framework to address the question: "Is a non-pharmacological, person-centered approach more effective than pharmacological interventions in managing agitation in patients with dementia in nursing homes?" through a comprehensive review of secondary research, including systematic reviews and clinical studies.

Defining the Practice Issue and Applying the PICO(T) Framework

Care for patients with dementia, especially in institutional settings like nursing homes, demands methods that prioritize patient safety, dignity, and quality of life. The practice issue addressed here is the management of agitation—a common and disruptive neuropsychiatric symptom—using approaches beyond pharmacology, which often carries significant risk profiles.

The PICO(T) components are as follows:

  • Population/Patient: Patients with dementia exhibiting agitation in nursing home settings.
  • Intervention: Person-centered care (PCC), a non-pharmacological approach emphasizing individualized activities and communication.
  • Comparison: Pharmacological treatments using psychotropic medications such as antipsychotics or sedatives.
  • Outcome: Reduction in agitation and overall behavioral symptoms, improved patient well-being, reduced hospitalizations, and fewer adverse effects.
  • Time: Varying across studies, ranging from a few weeks to two years, depending on the intervention design.

Evidence Sources and Key Findings

The primary evidence sources identified for this review include the DICE model (Describe, Investigate, Create, Evaluate) developed by Desai et al. (2017) and a systematic review and meta-analysis conducted by Kim and Park (2017). The DICE model provides a structured, interdisciplinary approach emphasizing personalized intervention strategies, caregiver education, and ongoing assessment. Its core principles include understanding individual behaviors, underlying causes, creating tailored interventions, and evaluating outcomes—aligned with the principles of person-centered care.

Kim and Park’s (2017) systematic review analyzed 19 primary studies focusing on the efficacy of person-centered care interventions. The meta-analysis revealed that individualized interventions significantly reduced agitation, outperforming care staff–directed approaches. Specifically, studies indicated that tailored activities, engagement, and caregiver training resulted in a mean reduction in agitation scores of -0.513, compared to -0.160 for staff-directed interventions. These findings suggest that personalized, non-pharmacological approaches can effectively mitigate agitation in dementia patients, with better outcomes associated with increased engagement and intervention intensity.

Relevance of the Evidence

The relevance of these findings is underlined by their implications for clinical practice in nursing homes. The study by Kales et al. (2014) highlights the adverse effects of pharmacological treatments, including increased mortality, side effects, and regulatory restrictions, emphasizing the need for alternative strategies. The evidence from Kim and Park (2017) supports implementing person-centered care models as effective, safe, and desirable solutions to manage agitation. Importantly, both studies endorse interventions rooted in individualized understanding and caregiver involvement, aligning with ethical standards and quality-of-life considerations for dementia patients.

Furthermore, the integration of tools like the DICE model facilitates systematic assessment and personalized intervention planning, promoting a shift away from medication reliance. These approaches are particularly relevant given increasing emphasis on reducing polypharmacy and enhancing nonpharmacological strategies in dementia care, aligning with contemporary clinical guidelines for managing behavioral symptoms.

Implications for Practice and Future Directions

Adopting a person-centered, evidence-based approach guided by the PICO(T) framework offers a viable pathway to improve behavioral management in dementia. The evidence suggests that individualized interventions can lead to meaningful reductions in agitation, enhance patient quality of life, and decrease adverse health outcomes. It is essential for clinical practitioners to incorporate caregiver training, behavioral assessments, and tailored activity programs into care plans.

Future research should focus on standardizing intervention protocols, optimizing intervention duration, and evaluating long-term outcomes. Large-scale randomized controlled trials could further elucidate the comparative effectiveness of various non-pharmacological strategies, facilitating policy development and clinical guideline refinement.

Conclusion

The application of the PICO(T) framework to investigate care practices for agitation in dementia patients underscores the potential of non-pharmacological, person-centered interventions. Evidence from systematic reviews and clinical models affirms that personalized approaches enhance behavioral outcomes more effectively and safely than pharmacological treatments. Emphasizing individualized assessments, caregiver education, and continuous evaluation can lead to improved clinical practice, better patient experiences, and reduced medication-related risks. Continued research and implementation efforts are vital to establishing these practices as standard care in nursing homes and other care facilities.

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.
  • 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.
  • 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.
  • Madhusoodanan, S., & Ting, M. B. (2014). Pharmacological management of behavioral symptoms associated with dementia. World Journal of Psychiatry, 4(4), 72–79.
  • Kales, H. C., et al. (2014). Clinical management of neuropsychiatric symptoms in dementia. Geriatric Psychiatry, 78(4), 453–462.
  • Desai, A., et al. (2017). Strategies for managing agitation in dementia. International Journal of Geriatric Psychiatry, 32(6), 727–736.
  • Thomas, R. Q., & Pollack, M. (2018). Evidence-based interventions for agitation and aggression in dementia. Alzheimer’s & Dementia, 14(7), 935–944.
  • Sloane, P. D., & Zimmerman, S. (2017). Nonpharmacological approaches to agitation in dementia. The Gerontologist, 57(Suppl 2), S98–S105.
  • Livingston, G., et al. (2014). Non-pharmacological management of behavioural and psychological symptoms of dementia. The Lancet, 383(9920), 9–20.
  • Liperoti, R., et al. (2019). Impact of person-centered care on agitation in dementia: A systematic review. International Journal of Geriatric Psychiatry, 34(9), 1383–1392.

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