NURS FPX 4030 Assessment 3 Picot Questions and an Evidence Based Approach

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Capella university

NURS-FPX 4030 Making Evidence-Based Decisions

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PICO (T) Questions and an Evidence-Based Approach

As developed understanding from previous assessments, Chronic Obstructive Pulmonary Disease (COPD) is a prevalent, progressive lung condition characterized by persistent respiratory symptoms due to airway obstruction. It significantly impacts patients’ quality of life and poses substantial healthcare burdens. Thus, utilizing the PICOT framework (Population, Intervention, Comparison, Outcome, Time) helps in systematically addressing practice inquiries to improve COPD management. By integrating evidence-based information, this paper aims to address a similar research question established for nurses to explore the diagnoses and deliver effective clinical care to the affected patients.

Practice Issue to be Explored and PICO(T) Question

COPD, being a significant health issue, results in increased hospital readmissions and declined patients’ quality of life due to frequent exacerbations and associated morbidities (Saleh et al., 2023). Despite various treatment modalities, achieving optimal management and reducing readmission rates remain a substantial practice issue in these patients. Therefore, an evidence-based approach is necessary to identify and implement the most effective interventions, emphasizing the need for structured frameworks like PICO(T) to guide research and clinical practice improvements.

PICO(T) – formatted Research Inquiry

In adults with COPD (population), does pulmonary rehabilitation (intervention) compared to standard care without rehabilitation (comparison) reduce hospital readmissions (outcome) within six months (time)?

Benefit of Using the PICO(T) Framework

Exploring the practice issue using a PICO(T) approach offers a systematic method to identify and evaluate the most effective interventions for COPD management. This framework facilitates focused research that directly addresses clinical questions relevant to patient care, leading to informed clinical decisions that enhance patient outcomes (Schiavenato & Chu, 2021). In the context of COPD, utilizing PICO(T) can help determine the efficacy of pulmonary rehabilitation, providing robust evidence to support its implementation in routine clinical practice, ultimately improving the quality of life and reducing readmission rates for COPD patients.

Sources of Evidence and Criteria

The eligibility criteria to identify credible and relevant sources of evidence is developed in the mnemonic of the CRAAP test, which stands for currency, relevance, authority, accuracy, and purpose (Esparrago-Kalidas, 2021). While currency ensures the information is up-to-date, crucial for incorporating the latest research findings and clinical guidelines into practice, the relevance assesses whether the source directly addresses the PICO(T) components, ensuring its applicability. Moreover, authority considers the credibility of the authors and the publication journal or website, preferring sources with established expertise in respiratory medicine and peer-reviewed publications. Accuracy examines the reliability of the information, prioritizing sources that are peer-reviewed and have unbiased information. Lastly, purpose evaluates the intent behind the information, ensuring it aligns with the interests of researchers and healthcare providers.

The below-mentioned sources are selected by applying these criteria to ensure the identification of high-quality evidence that is pertinent for answering the PICO(T) question on pulmonary rehabilitation in COPD management:

Databases: Literature recommends the utilization of critical databases, such as PubMed, CINAHL, and the Cochrane Library, which provide access to a vast array of peer-reviewed journals and systematic reviews. MEDLINE using PubMed port is highly recommended for searching systematic reviews (Goossen et al., 2020).
Journals: Specific journals such as the Chronic Obstructive Pulmonary Disease: Journal of COPD Foundation and the American Journal of Respiratory and Critical Care Medicine (AJRCCM) are employed as they offer relevant and peer-reviewed studies on COPD and pulmonary rehabilitation.
Reputable Websites: Websites like the Global Initiative for Chronic Obstructive Lung Disease (GOLD) and the American Thoracic Society (ATS) provide clinical guidelines and evidence-based recommendations pertinent to COPD management, effectively addressing our PICOT question.

Findings from the Selected Sources of Evidence

Several literature studies address our PICOT question, elaborating on the effectiveness of pulmonary rehabilitation in reducing readmission rates and improving quality of life. A few studies are presented here:

Myers et al. (2021), published in a reputable journal by the COPD Foundation, investigated the role of pulmonary rehabilitation in reducing readmission risk for Medicare receivers. The study concluded that both interventions reduce 30-day readmission chances but increase the risk of annual all-cause re-hospitalizations, partially favoring our PICO(T) question. This inverse relation to annual readmission rates is due to patients’ non-adherence to rehabilitation sessions.
Another article by Alison (2020), available in the PubMed database, addresses the PICO(T) question through a clinical trial that shows a positive relation between pulmonary rehabilitation and readmission rates. It presents that increased intervention use can reduce the risk of readmission among COPD patients; however, heterogeneity may result due to a lack of participants’ compliance, ongoing support, and self-management.
Lastly, the study published in the ATS Journal—AJRCCM and available in the PubMed database shows that pulmonary rehabilitation started within 90 days of discharge reduces all-cause re-hospitalization in COPD patients yearly, demonstrating the post-intervention rate at 56.4%, as compared to the pre-intervention rate (64.6%) (Nici, 2021). Supporting our PICOT question, this article also comments on the underutilization of pulmonary rehabilitation due to a lack of providers’ knowledge, health disparities, and poor institutional support.

Among the sources mentioned, the study by Myers et al. (2021) published by the COPD Foundation and the article by Nici (2021) in AJRCCM are the most credible. Both are published in reputable journals that focus on respiratory diseases, and their findings are supported by substantial research. The article by Alison (2020), while relevant and available in the PubMed database, appears to have some limitations due to heterogeneous results, affecting the strength of its conclusions.

Decision-Making on PICOT Question

The findings from the chosen sources of evidence are highly relevant to making decisions related to the PICO(T) question, which examines whether pulmonary rehabilitation reduces hospital readmissions in COPD patients. Myers et al. (2021) highlight that while pulmonary rehabilitation reduces 30-day readmission rates, it also indicates an increased risk of annual re-hospitalizations due to non-adherence. This underscores the importance of personalized care plans to improve patient adherence, which includes patient education and ongoing support. Nici (2021) study provides strong evidence that pulmonary rehabilitation, when initiated within 90 days post-discharge, significantly reduces all-cause annual re-hospitalizations.

This finding directly supports the PICO(T) question, demonstrating the potential of timely rehabilitation to improve patient outcomes. However, the study recommends adequate utilization of the intervention by promoting providers’ education and organizational support. Alison (2020) also supports the PICO(T) question by showing a positive relationship between pulmonary rehabilitation and reduced readmission rates. Yet, the impact of patient compliance and support systems is noted as a critical factor. Thus, the literature supports our PICO(T) inquiry, giving a favorable decision with advanced recommendations.

Among these, findings from Nici (2021) are the most relevant as they offer a clear and actionable outcome, such as initiating pulmonary rehabilitation soon after discharge, which is likely to lead to positive outcomes. This approach not only addresses the critical post-discharge period, where patients are most vulnerable to complications but also underscores the value of early and proactive care. By beginning rehabilitation early, patients can benefit from improved lung function, better disease management, and enhanced overall well-being, which collectively reduce the likelihood of re-hospitalization (Nici, 2021). This evidence reinforces the importance of timely intervention and supports the adoption of pulmonary rehabilitation as a standard post-discharge practice for COPD patients.

Conclusion

In conclusion, COPD requires a structured and evidence-based approach to improve patient outcomes. Thus, the PICO(T) framework is used to address a practice issue of increased readmission rates among these patients by recommending pulmonary rehabilitation. Our assessment explored the effectiveness of pulmonary rehabilitation in managing COPD readmission through evidence-based literature from credible sources. These sources highlight the significant benefits of initiating pulmonary rehabilitation shortly after discharge, emphasizing the importance of patient adherence, providers’ knowledge, and organizational commitment to enhance care quality and reduce the healthcare burden associated with COPD.

References

Alison, J. (2020). Reducing hospital readmissions for COPD exacerbations: The role of exercise and ongoing support. Respirology, 26(1). https://doi.org/10.1111/resp.13918

Esparrago-Kalidas, A. J. (2021). The effectiveness of CRAAP test in evaluating credibility of sources. International Journal of TESOL & Education, 1(2), 1–14. https://i-jte.org/index.php/journal/article/view/25

Goossen, K., Hess, S., Lunny, C., & Pieper, D. (2020). Database combinations to retrieve systematic reviews in overviews of reviews: A methodological study. BMC Medical Research Methodology, 20(1). https://doi.org/10.1186/s12874-020-00983-3

Myers, L. C., Faridi, M. K., Hasegawa, K., & Camargo Jr, C. A. (2021). Pulmonary rehabilitation and readmission rates for Medicare beneficiaries with acute exacerbation of chronic obstructive pulmonary disease. Chronic Obstructive Pulmonary Diseases: Journal of the COPD Foundation, 8(4). https://doi.org/10.15326/jcopdf.2020.0193

Nici, L. (2021). Pulmonary rehabilitation after a COPD exacerbation: Impact on readmission risk in a real-world setting. American Journal of Respiratory and Critical Care Medicine, 204(9). https://doi.org/10.1164/rccm.202107-1768ed

Saleh, S., Skeie, S., & Grundt, H. (2023). Re-admission and quality of life among patients with chronic obstructive pulmonary disease after telemedicine video nursing consultation – A randomized study. Multidisciplinary Respiratory Medicine, 18(1). https://doi.org/10.4081/mrm.2023.918

Schiavenato, M., & Chu, F. (2021). PICO: What it is and what it is not. Nurse Education in Practice, 56(1). https://doi.org/10.1016/j.nepr.2021.103194