Nurses are usually at the frontline of healthcare and have the maximum one on one contact with patients. It is therefore important that the foundation of their practice be based on reliable evidence (Stone, 2000). This paper will discuss the relationship between evidence based practice (EBP) and research, the process of developing focused clinical questions using the PICOT model and an analysis of the application of the PICOT model in of the identified articles for the purposes of this assignment. The application of evidence based research refers to incorporating an individual’s clinical expertise with the best available external evidence from external sources (Stone, 2000). It is vital that nurses gain knowledge on the current findings from research in the nursing field so that they are in a position to access and chose the best evidence to implement. Evidence based research comprise of expertise in clinical practice, research and experience with the patient.
Research is the method of investigating an identified issue with the aim of soliciting new information on a specific topic in order to ad on the existing knowledge. In the field of nursing, the aim of research is to give clients, their care givers and families the best care in every step and area of their treatment in order to ensure wellbeing. In addition, it is important that nurses consider the issue of which research findings can be implemented in their clinical practice to enable them offer the best care to their patients.
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A nurse who is assigned care for a child, elderly, male or female and adult patients should bring to the nursing practice more than just the latest information (Tycross, 2011). The information gathered should be one that is already tested and confirmed to be applicable and producing improved patient care outcomes. In most cases health care practitioners offer care for the reasons that it is the common and known process or it is the one ordered instead of giving the care that is founded on evidence found in their profession. According to Twycross, nursing staff feel that finding and applying evidence based research is an esoteric process that is not within their roles (Twycross, 2011). However, all the aspects of the information gathered for the nursing care should be critically and systematically analyzed, identify its sources, and its strength. Where does the information come from? Is it from general use or is it generated from research? Upon determining the foundation of the care to be offered, the relevance and application of the information to the specific client situation is considered.
One of the first steps in Evidence Based Research involves the formulation of a question that is based on issues identified with patients or a specific disease and looking for evidence to answer the clinical question. A good clinical question comes from clinical practice. A clinical question should be patient centered. It should also focus on outcomes. A clinical question ought to be directly related to the patient or the issue at hand and put in a way that will enable the search for an answer (Stone, 2000). PICO helps in this process. PICO is a mnemonic for vital aspects of a well formulated clinical question. It also assists in developing the research strategy by determining the major concepts that ought to be in the article that can give answers to the question.
Regarding the PICO model, the question can be more focused when an individual is more specific for each element. The first element in the research question is the patient or problem description. This element requires an individual to be as specific as possible. There are several factors that might require consideration in this first element. They include the disease of interest, sex, age and setting. The second element of this tool is intervention. In most cases, an intervention is usually as treatment. However, it can also be a prognostic or a diagnostic component. The third component is comparison. Comparison refers to the other available options that can be offered to the patient. One can compare two more groups. One group is often referred to as the control group while the other one is the treatment group. Moreover, the other group can be the current practice. The last element of PICO is outcomes as a result of the intervention. For example, will the intervention upon implementation lead to less complication and reduced morbidity? Under this element, outcomes that are of first priority should be identified. They include survival, life quality and disease.
This sections of focused on the article; “Dementia-related agitation: a review of non-pharmacological interventions and analysis of risks and benefits of pharmacotherapy”, which is analyzed using the PICOT model. The PICO elements in this study are as stated below. Respectively, the PICO question states; In dementia patients displaying challenging dementia-related agitation, do non-pharmacological approaches when compared to psychotropic medications, reduce the frequency and severity of challenging dementia-related agitation where P is represented patients with dementia related agitation, I represents non-pharmacological interventions, C represents pharmacotherapy and O represents reduced frequency and severity related to dementia-related agitation
Problem
Dementia related agitation
Due to increased life span, the number of individuals diagnosed with dementia is increasing. In 2015, approximately 9.9 million people were diagnosed with dementia throughout the world (Ijaopo, 2017). This represents one person out of every three people. According to the United States Alzheimer’s Association, approximately 5 million Americans suffer from dementia. It is estimated that by 2050, the number will have risen to 16 million cases. During the course of the illness, more than 90% of the patients suffering from dementia develop psychiatric problems which are commonly known as neuropsychiatric symptoms (Ijaopo, 2017). These symptoms include agitation, anxiety, aggression, apathy etc. Agitation is the most common widespread symptom in dementia patients. Agitation can be described as restless behavior, or improper physical and verbal actions that may cause trouble for family members, caregivers and other service users (Ijaopo, 2017). In most cases, agitation is related to care giver burden which cause bourn outs for most care givers. In the same way, agitation can cause agitation in other people too.
Intervention
The methods for treating agitation and other related symptoms has been a major challenge. For many years, there has been no specific proven pharmacotherapy in treating agitation in dementia patients. The recommended way of treating agitation in dementia patients incorporates non-pharmacological and pharmacotherapy interventions (Ijaopo, 2017). The increasing concerns on the efficiency and possible side effects of pharmacotherapy has led to the increased use of non-pharmacological interventions as the first option in treatment of agitation.
The American and Canadian Association for Geriatric Psychiatry, NICE UK, and the European Association of Geriatric Psychiatry advocate for the first treatment for individuals suffering from agitation in all types and severity in dementia to be the non-pharmacological treatments (Ijaopo, 2017). The non-pharmacological interventions include multisensory stimulation, aromatherapy, music therapy, cognitive behavioral therapy, animal-assisted therapy, electroconvulsive therapy (ECT) and physical exercises (Ijaopo, 2017). These engagement and activity interventions are increasingly being accepted worldwide as the important aspects of the comprehensive dementia related agitation because of their reduced risks and effectiveness as compared to the drugs treatment.
Comparison
In most cases, doctors use pharmacotherapy methods in the treatment of dementia related agitation. Some of the drugs used include neuroleptics, anti-depressants, sedatives/hypnotics and anxiolytics among others are frequently used (Ijaopo, 2017). Despite their use, the FDA has not approved any of them as a treatment for agitation in dementia. In fact, the FDA has given several warnings on the increased probability of stroke and mortality related to consumption of some of the drugs in the elderly population suffering from dementia.
There is research evidence on the probability of an increase of major cerebrovascular issues related to the use of antipsychotics. Other most common negative effects of observed in the use of antipsychotics include an increase in the frequency of falls, injuries related to falls such as hip fractures etc. (Ijaopo, 2017). In most instances, these increased risks develop after the start of psychotic drugs use despite the fact that chronic therapy is also believed to be a contributing factor too.
Outcomes
The intermediate outcomes include; caregiver behavior change and reduced use of antipsychotics. The final health outcomes include; reduced severity of agitated behaviors, decreased mortality associated with antipsychotics use, decreased rates of falls and injuries and improved patient health. The secondary outcomes include reduced burden and stress for caregivers and the nursing staff.
In conclusion, evidence based practice and the use of the PICOT model are important tools in clinical practice. EBP is important because it helps focus in offering the most effective and efficient care with the goal of achieving improved patient outcomes. In addition, the approach encourages an inquiry attitude among health care practitioners which ensures that the practice is guided by the very best evidence. The PICOT model is helpful and important too in that it assist in organizing and focusing the foreground query into a searchable one. Furthermore, categorizing the PICO elements assists in determining the search words to be used in literature review.
References
Ijaopo, E. O. (2017). Dementia-related agitation: A review of non-pharmacological interventions and analysis of risks and benefits of pharmacotherapy. Translational Psychiatry,7 (10). doi:10.1038/tp.2017.199
Stone, P. W. (2002). Popping the (PICO) question in research and evidence-based practice. Applied Nursing Research,15 (3), 197-198. doi:10.1053/apnr.2002.34181
Twycross, A. (2011). Leadership is key to ensuring evidence is used in practice. Evidence-Based Nursing,14 (2), 31-31. doi:10.1136/ebn1149
