NURS-FPX4030 PICO(T) Questions and an Evidence-Based Approach Scoring Guide

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PICO(T) Questions and an Evidence-Based Approach

Samantha Alderman Capella University NURS-FPX4030: Making Evidence-Based Decisions Amanda Zemmer February 6, 2022

PICO(T) Questions and an Evidence-Based Approach When using the PICO(T) method to formulate an effective plan of care for patients, Population/Patient, Intervention, Comparison, Outcome, and Time can be used to efficiently answer a clinical question. The care practice being focused on will be Coronary Artery Bypass Graft (CABG) patients and the anxiety they may have prior to surgery. Discussion will include utilizing the PICO(T) method, identifying sources of evidence that could be effective in answering PICO(T) questions, explaining significant findings from credible sources, and clarifying the importance of those significant findings. Use of the PICO(T) Approach when Caring for CABG patients The practice issue being explored is the amount of stress and anxiety that patients who are on a waiting list for CABG surgery endure prior to their procedure and determining if it can be reduced. The question under investigation is: For patients who are on a Coronary Artery Bypass Graft wait lists, does a program comprising of presurgical in-home visits and follow- through telephone calls from a nurse who specializes in coronary patients, lead to reduced patient apprehension and anxiety? There are several benefits that can come from providing presurgical in-home visits or telephone calls to patients who are undergoing a CABG. Exploring the options available to these patients, such as caring conversation according to Fredriksson, will help to alleviate apprehension and anxiety that patients may endure which could be very beneficial in consideration to their overall heart health (Bullingtion et al., 2019, p. 139). Health care workers need to focus on patient-centered care and the overall wellbeing of whomever they are attentive to. Considering PICO(T) options that would be beneficial for CABG patients is fundamental for providing a solid foundation for their welfare.

knowledgeable to identify and respond to the need for assistance. According to Peplau, therapeutic communication has a positive impact on reducing anxiety that patients may experience. Complex heart surgeries accompanied by lengthy hospitalizations can be very stressful to patients which has a likelihood of leading to depression. Peplau states that focusing on the patient and their emotional needs leading up to a CABG has been shown to have a positive impact on the overall general condition of the patient’s heart as well because stress and anxiety can raise blood pressure, resulting in stress to the heart muscle (Zarea et al., 2018, p. 160). Findings from Articles Patient who are on a waiting list for a CABG have obvious stress on their hearts as they are already waiting for a surgical treatment. It has been shown that stress and anxiety can have a profound effect on deterioration of the coronary system within the human body. Acute stressors such as worry, or excessive anticipation can even lead to a myocardial infarction or unexpected death. Emotional stress can provoke coronary blood flow inequalities which can also lead to a heart attack (Vaccarino & Bremner, 2017, p. 7). Having a coronary care team specialist, such as a nurse who will works together with the providers who perform CABG’s, would significantly reduce stress and anxiety in patients awaiting surgery and reduce the risk of further deterioration to the already weakened heart. Anything that a health care provider can do to help their patient should be at the forefront of delivering care. It is appropriate and expected. The coronary care nurse would significantly help by making scheduled phone calls or even making in-home visits to the patient leading up to their surgery to offer advice, answer questions, provide reassurance and provide well-rounded care to their patient.

The COMFORT Model as discussed by Goldsmith et al. (2020) delivers a well-supported set of evidence-based findings to help reduce patient anxiety. This article is less than two years old and serves as a well-versed and comprehensive guideline for health care workers to use in reducing the anxiety and apprehension that patients may experience. It uses seven different outlets to aid in providing reassurance to not only the patient but the family and postsurgical out- of-network caregivers. The article is written by the Journal of Hospice and Palliative Nursing, which is a licensed, peer-reviewed journal for nurses to concentrate on scientific, scholastic and investigation facets of delivering patient-centered care. This model is an excellent tool to help answer the PICO(T) question posed. It is evident that the credibility of this model is foundational for setting a solid foundation and building a credible framework for providing PICO(T) question delivery. Relevance of Findings from Articles The clinical study done by Zarea et al. (2018) discussing Peplau’s Therapeutic Communication Model was chosen since it specifically focuses on the anxiety that patient’s experience leading up to their CABG procedure and ways to reduce it. Data was collected using evidence-based practice using the Hospital Anxiety and Depression Scale and showed that two to four months post-surgery, that patients who had a coronary specialist involved with them directly had a significant reduction in anxiety and depression prior to and subsequent operation and hospitalization (Zarea et al., 2018, p. 161). This evidence-based article highlights a patient-centered, clinical and scientific study that delivers evidence of their findings. Using simple therapeutic communication with patients prior to their surgery is a highly effective, non-medicinal solution to help ease the patient into their surgical procedure. Anxiety and despair are one of the most important preemptive considerations

References Bullingtion, J., Soderlund, M., Bos Sparen, E., Kneck, A., Omerov, P., & Cronqvist, A. (2019). Communication skills in nursing: A phenomenologically-based communication training approach. Nurse Education in Practice , 39 (1), 136–141. https://www-sciencedirect- com.library.capella/science/article/pii/S1471595318303901?via%3Dihub Goldsmith, J., Wittenberg, E., & Parnell, T. (2020). The COMFORT communication model. Journal of Hospice & Palliative Nursing , 22 (3), 223–237. doi/10.1097/NJH.0000000000000647. Vaccarino, V., & Bremner, J. D. (2017). Behavioral, emotional and neurobiological determinants of coronary heart disease risk in women. Neuroscience & Biobehavioral Reviews , 74 , 1– 29. doi/10.1016/j.neubiorev.2016.04. Zarea, K., Maghsoudi, S., Dashtebozorgi, B., Hghighizadeh, M., & Javadi, M. (2018). The impact of peplau’s therapeutic communication model of anxiety and depression in patients candidate for coronary artery bypass. Clinical Practice and Epidemiology in Mental Health , 10 , 159–165. doi/10.2174/
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PICO(T) Questions and an Evidence-Based Approach
When using the PICO(T) method to formulate an effective plan of care for patients,
Population/Patient, Intervention, Comparison, Outcome, and Time can be used to efficiently
answer a clinical question. The care practice being focused on will be Coronary Artery Bypass
Graft (CABG) patients and the anxiety they may have prior to surgery. Discussion will include
utilizing the PICO(T) method, identifying sources of evidence that could be effective in
answering PICO(T) questions, explaining significant findings from credible sources, and
clarifying the importance of those significant findings.
Use of the PICO(T) Approach when Caring for CABG patients
The practice issue being explored is the amount of stress and anxiety that patients who
are on a waiting list for CABG surgery endure prior to their procedure and determining if it can
be reduced. The question under investigation is: For patients who are on a Coronary Artery
Bypass Graft wait lists, does a program comprising of presurgical in-home visits and follow-
through telephone calls from a nurse who specializes in coronary patients, lead to reduced patient
apprehension and anxiety?
There are several benefits that can come from providing presurgical in-home visits or
telephone calls to patients who are undergoing a CABG. Exploring the options available to these
patients, such as caring conversation according to Fredriksson, will help to alleviate
apprehension and anxiety that patients may endure which could be very beneficial in
consideration to their overall heart health (Bullingtion et al., 2019, p. 139). Health care workers
need to focus on patient-centered care and the overall wellbeing of whomever they are attentive
to. Considering PICO(T) options that would be beneficial for CABG patients is fundamental for
providing a solid foundation for their welfare.
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