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NURS FPX 4030 Assessment 3 PICO(T) Questions And An Evidence Based Approach

Student Name

Capella University

NURS4030 Making Evidence-Based Decisions

Prof. Name

Date

PICO(T) Questions and an Evidence-Based Approach

Nurses utilize the PICO(T) question strategy to find evidence for a healthcare problem. The PICO(T) stands for Patient/Population/Problem, Intervention, Comparison of Potential Interventions, Outcomes, and Time frame. With the help of this strategy, nurses can conduct research and gather evidence on a particular problem related to patients to serve them with the best evidence-based care. For this purpose, a healthcare issue is selected, followed by choosing a potential intervention and comparing it with another possible strategy. Lastly, the outcomes are evaluated based on the current evidence, which directs nurses to deliver evidence-based care treatments. 

Healthcare Issue to be Explored by PICO(T) Strategy

The PICO(T) question to be explored in this assessment is as follows:

Do hypertensive patients (P) have better-regulated blood pressure levels (O) through medication therapy (I) or lifestyle modifications (C)?

Hypertension is a chronic healthcare issue often encountered by elderly people. According to the World Health Organization, a patient is hypertensive if the blood pressure exceeds 140/90 mmHg. The patients do not experience significant symptoms, requiring regular blood pressure check-ups to diagnose hypertension (World Health Organization, 2023). Timely management of hypertension helps prevent conditions such as angina, heart attack, heart failure, and sudden death. The existing treatment strategies include pharmacological therapy of ACE inhibitors, ARB blockers, Calcium channel blockers, and diuretics. 

NURS FPX 4030 Assessment 3 PICO(T) Questions And An Evidence Based Approach

Furthermore, lifestyle changes and healthy eating also regulate blood pressure. Many healthcare providers deem pharmacological therapy more effective than lifestyle modification. In contrast, others consider that pharmacological treatment should not be prioritized and a healthier lifestyle can regulate patients’ blood pressure levels. Therefore, nurses need to treat patients with a more practical approach. The PICO(T) strategy can evaluate this, and nurses can deliver evidence-based interventions that are more suitable for patients. With this strategy, nurses can resolve existing conflicts in hypertension management and draw conclusions based on substantial data.

Evidence-Based Sources to Answer PICO(T) Question

 The sources of evidence that can be potentially effective in solving a PICO(T) question include several databases, relevant journals, and websites on hypertension. The databases available for searching evidence on the above PICO question are PubMed, CINAHL, Google Scholar, Capella University Library, MEDLINE, BioMed Central, and Cochrane Library. The journals that can be sought to obtain evidence-based data on hypertension are the Journal of Hypertension, Hypertension Research, International Journal of Hypertension, and American Journal of Hypertension.

Moreover, the American Heart Association, Centers for Disease Control and Prevention, World Health Organization, and Preventive Cardiovascular Nurses Association are websites that highlight hypertension and treatment strategies. These sources are chosen because they align with the CRAAP criteria, ensuring their credibility and relevance when answering PICO questions on hypertension.

NURS FPX 4030 Assessment 3 PICO(T) Questions And An Evidence Based Approach

CRAAP stands for Currency, Relevance, Authority, Accuracy, and Purpose. All the referred sources are credible and relevant to hypertension and can provide valuable insights into hypertension management as they are up to date. Nurses can integrate these two approaches, i.e., the CRAAP test and PICO question, to obtain meaningful and authentic information on hypertension that can improve patient health outcomes. 

Findings From the Relevant Sources

  1. According to Al-Makki et al. (2021), hypertensive patients who have already undergone lifestyle modification counseling should receive medication therapy. The patients must have a confirmed diagnosis of hypertension with BP exceeding 140/90 mmHg. Moreover, the first line of drugs should be from any class of thiazide, angiotensin enzyme inhibitor or angiotensin receptor block, and long-acting dihydropyridine calcium channel blocker. This resource is the most credible as it is relevant to hypertension and authorized by WHO and AHA journals. Moreover, the study was published in 2021 within the last five years publications.
  2. Another study supports the non-pharmacological treatment of hypertension and prehypertension through a Dietary Approach to Stop Hypertension (DASH), physical exercise, interventions to lose weight, and stress management strategies. Integrating lifestyle modifications with less salt intake, eating fruits and vegetables, increased physical activities such as walking and running, and reducing weight can lead to balanced blood pressure (Fu et al., 2020). This source is also credible as it is recently published, supported by the AHA journal, and relevant to hypertension. 
  3. According to Oliveros and colleagues (2019), a hypertension management strategy must consider multiple factors, such as complex medical comorbidities, degree of frailty, and psychosocial factors. Non-pharmacological interventions should be encouraged to prevent hypertension and as an adjuvant therapy to mitigate antihypertensive needs. Moreover, pharmacological interventions are necessary for older patients with hypertension who show a negligible decrease in blood pressure levels with lifestyle modification alone.

Decision-Making on PICO Question Using Findings

Considering the findings from evidence-based research data, the decision derived is that prehypertensive patients should first be guided towards non-pharmacological interventions, such as the DASH diet and lifestyle modifications, before considering pharmacological therapy. However, hypertensive patients with BP exceeding 140/90mmHg or with comorbidities are advised to follow physicians’ initial antihypertensive medication. Hypertension can be well regulated by adjuvant therapy of lifestyle modifications and antihypertensive drugs. Nurses must provide patient-centered care tailored to the health needs of hypertensive patients based on the frailty degree, comorbidities, and relevant psychosocial factors. 

Conclusion

As a chronic health issue, hypertension requires intricate management and long-term care. To implement the best evidence-based care strategy, nurses must look for credible data on hypertension. For this purpose, nurses can use the PICO(T) approach to make the right decisions. Here, the PICO question is whether hypertensive patients have regulated blood pressure via pharmacological therapy or lifestyle modifications. The right decision was based on relevant findings, including lifestyle modification for pre-hypertensives and pharmacological or adjuvant therapy for older people with hypertension and comorbidities.  All the findings are based on CRAAP criteria and offer credible solutions.

References 

Al-Makki, A., DiPette, D., Whelton, P. K., Murad, M. H., Mustafa, R. A., Acharya, S., Beheiry, H. M., Champagne, B., Connell, K., Cooney, M. T., Ezeigwe, N., Gaziano, T. A., Gidio, A., Lopez-Jaramillo, P., Khan, U. I., Kumarapeli, V., Moran, A. E., Silwimba, M. M., Rayner, B., & Sukonthasan, A. (2021).

Hypertension pharmacological treatment in adults: A world health organization guideline executive summary. Hypertension, 79(1). https://doi.org/10.1161/hypertensionaha.121.18192 

Fu, J., Liu, Y., Zhang, L., Zhou, L., Li, D., Quan, H., Zhu, L., Hu, F., Li, X., Meng, S., Yan, R., Zhao, S., Onwuka, J. U., Yang, B., Sun, D., & Zhao, Y. (2020). Nonpharmacologic interventions for reducing blood pressure in adults with prehypertension to established hypertension. Journal of the American Heart Association, 9(19). https://doi.org/10.1161/jaha.120.016804 

NURS FPX 4030 Assessment 3 PICO(T) Questions And An Evidence Based Approach

Oliveros, E., Patel, H., Kyung, S., Fugar, S., Goldberg, A., Madan, N., & Williams, K. A. (2019). Hypertension in older adults: Assessment, management, and challenges. Clinical Cardiology, 43(2), 99–107. https://doi.org/10.1002/clc.23303 

Portillo, I. A., Johnson, C. V., & Johnson, S. Y. (2021). Quality evaluation of consumer health information websites found on google using DISCERN, CRAAP, and honcode. Medical Reference Services Quarterly, 40(4), 396–407. https://doi.org/10.1080/02763869.2021.1987799 

World Health Organization. (2023). Hypertension. https://www.who.int/news-room/fact-sheets/detail/hypertension#:~:text=Hypertension%20(high%20blood%20pressure)%20is