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 Evidence-Based Approach

PICO (T) is a renowned tool for Evidence-Based Practice (EBP). It signifies population, intervention, comparison, outcome, and time. Analyzing a research question into these components styles identification and evaluation of appropriate EBP (Kloda et al., 2020). A stroke is defined as an acute, focal neurological disorder that is triggered by a vascular injury that can cause either central nervous system bleeding or infarction. It is not a single medical condition. It can be caused by various risk factors, conditions, and disease processes (Murphy & Werring, 2020). This assessment will concentrate on a PICO(T) question related to the issue of stroke.

Exploration of Practice Issue

The epidemiological landscape of stroke in the US has changed. With more than 140,000 fatalities a year, it is still the fifth top cause of death. Stroke has a significant financial effect on the healthcare system, with annual costs in the US achieving $34 billion (Khan et al., 2021). It is the leading cause of permanent physical impairment in adults. The most essential variable risk indicator for stroke is hypertension, and its effect depends on the subtypes of stroke (Murphy & Werring, 2020).

PICO(T) Question

Ischaemic stroke individuals (P) use antihypertensive medications(I), compared to patients not taking antihypertensive medicines(C), reduce the rate of recurrent stroke (O), over 12 month period (T)?  

Population (P)

Ischaemic stroke individuals

Intervention (I)

Antihypertensive medications

Comparison (C)

Patient not using antihypertensive medicines

Outcome (O)

Reduce incidence of recurrent stroke

Time (T)

12-month 

Benefits of the PICO(T) Approach

The PICO(T) approach is widely popular in the scientific nursing and healthcare sciences. Substantial evidence supports its effectiveness in establishing guidelines and boosting search efficiency (Schiavenato & Chu, 2021). Standard guidelines based on hypertension management are essential in the prevention of stroke. It aids in distinguishing and evaluating evidence-based research for stroke patients. The PICO(T) approach improves the overall caliber of research by boosting the credibility and strength of the evidence collected (Kloda et al. (2020). In the research findings of Jørgensen et al., (2022), many people with stroke had visited and diagnosed with hypertension. People using antihypertensive medicines at the time of the stroke showed a reduction in the risk of stroke.

Sources of Evidence

It is essential to consider sources’ quality, validity, and applicability when assessing the PICO(T) question. PICO(T) must be solved effectively by consulting various sources, such as databases and peer-reviewed publications. Reputable hospitals may contribute to comprehensive scrutiny of the research question (Kattie, 2021). A substantial rise in blood pressure is the most public clinical symbol of Acute Ischaemic Stroke (AIS).To offer helpful evidence, RCTs compare antihypertensive medications with no-lowering BP medicines in stroke patients. These findings can evaluate the effect of treatment on stroke individuals over a stated period (Whelton et al., 2018). People with previous ischaemic strokes are advised to take antihypertensive medicines to reduce recurrent stroke (Dawson et al., 2022). These studies can include data from multiple sources to assess the broad outcome on the brain (García-Rudolph et al., 2019).

Evidence-based proposals for treating stroke can be found by studying reputable clinical practice guidelines. The American Heart Association’s (AHA) suggestions for decreasing stroke risks frequently integrate the most recent research. These guidelines provide a current set of suggestions in one document for clinicians caring for adult patients who have experienced an acute arterial ischemic stroke. Hospital administrators, doctors, allied health professionals, and prehospital care providers are among the target audience members (Powers set al., 2019).

Rationale

The risk of ischemic stroke is significantly affected by blood pressure (BP), and it has been shown that decreasing blood pressure to less than 150/90 mmHg lowers the rate of stroke. It is the top factor to know that controlling blood pressure in hypertensive emergencies is directly linked to brain damage, such as acute ischemic stroke (Wajngarten & Silva, 2019). Significant cardiovascular health difficulties that can cause morbidity and mortality include cardiac arrest and stroke. The PICO(T) question allows the assessment of interventions for short-term and long-term effects on stroke patients. 

Findings from Sources of Evidence

One of the main risks of stroke is high blood pressure. When systolic blood pressure rises doubles than diastolic, it increases the risk of stroke (Wajngarten & Silva, 2019). Antihypertensive medication lowered the number of recurrent stroke episodes. These guidelines were created using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) methodology to help medical professionals decide on pharmaceutical interventions to prevent recurrent stroke.

  Wajngarten and Silva et al. (2019) led a critical systematic journal and meta-analysis that elaborated on preventing the onset of stroke risk factors with primordial prevention strategies. The burden of cardiovascular diseases can be reduced by taking steps like reducing the amount of salt intake, applying dietary interventions, enforcing tobacco control, and encouraging the creation of a healthy environment. A determined effort involving close collaboration between healthcare professionals, institutions, and governments is necessary to achieve this goal. An unhealthy diet and unsatisfactory physical activity are linked to an increased risk of stroke, high blood pressure, and obesity. A sedentary lifestyle increases the risk of stroke (Kuriakose & Xiao, 2020).

Credibility of Resources

Relating the CRAAP test to the cited sources, it is evident that they show high credibility in providing evidence for hypertension management in stroke patients. Recurrent stroke disturbs 9% to 15% of people in a year. People with previous ischaemic strokes are advised to take antihypertensive medications to reduce the risk of recurrent stroke (Dawson et al., 2022). These findings provide unfailing evidence for healthcare professionals to address hypertension and develop effective treatment strategies to prevent recurrent stroke (Bulto et al., 2023). American Stroke Foundation, Pub-Med, and Google Scholar are credible resources that provide valuable antihypertensive management to reduce the recurrent incidence of stroke.

Relevance of these Findings

The current guidelines promote the use of carefully tracked neurological and cardiac conditions in conjunction with induced hypertension, ideally in clinical trials. One of the most significant obstacles in stroke care is effectively controlled BP during stroke. Guidelines recommend depressing elevated blood pressure before thrombolysis, significantly greater than 185/110 mmHg (Bath et al., 2022).

Relevant findings lead to Positive Outcomes

In the extensive Florida Stroke Registry, the use of antihypertensive medicines during acute stroke cases shows a chance for quality improvement (Gillian Gordon Perue et al., 2023). Clinical practice guidelines target blood pressure of less than 130/80 mmHg. Low blood pressure (usually levels <140/90 mmHg) is ideal for patients with a high risk of recurrent ischemic stroke. Individuals highly susceptible to intracranial hemorrhage benefit from lowering blood pressure (to <120/80 mmHg). Distinguished risk profiles for recurrent ischemic and hemorrhagic strokes should guide the selection of BP treatments (Hemphill et al., 2015).

Conclusion

To sum up, evidence-based practice for stroke care benefits from the PICO(T) approach. The effect of high BP on the risk of stroke highlights the importance of efficient interventions. Many sources highlight customized blood pressure control, which leads to good outcomes. To optimize the care of stroke patients, each person’s risk profile must be carefully considered.

References

Bath, P. M., Song, L., Silva, G. S., Mistry, E., Petersen, N., Tsivgoulis, G., Mazighi, M., Bang, O. Y., & Sandset, E. C. (2022). Blood Pressure Management for Ischemic Stroke in the First 24 Hours. Stroke, 53(4), 1074–1084. https://doi.org/10.1161/strokeaha.121.036143

Bulto, L. N., Roseleur, J., Noonan, S., Pinero de Plaza, M. A., Champion, S., Dafny, H. A., Pearson, V., Nesbitt, K., Gebre

michael, L. G., Beleigoli, A., Schultz, T., Hines, S., Clark, R. A., & Hendriks, J. M. (2023). Effectiveness of nurse-led interventions versus usual care to manage hypertension

And lifestyle behavior: a systematic review and meta-analysis. European Journal of Cardiovascular Nursing. https://doi.org/10.1093/eurjcn/zvad040

Dawson, J., Béjot, Y., Christensen, L. M., De Marchis, G. M., Dichgans, M., Hagberg, G., Heldner, M. R., Milionis, H., Li, L., Pezzella, F. R., Taylor Rowan, M., Tiu, C., & Webb, A. (2022).European Stroke Organisation (ESO) guideline on pharmacological interventions for long-term secondary prevention after ischaemic stroke or transient ischaemic attack. European Stroke Journal, 239698732211000. https://doi.org/10.1177/23969873221100032

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

García-Rudolph, A., Sánchez-Pinsach, D., Salleras, E. O., & Tormos, J. M. (2019). Subacute stroke physical rehabilitation evidence in activities of daily living outcomes. Medicine, 98(8), e14501. https://doi.org/10.1097/md.0000000000014501

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Hemphill, J. C., Greenberg, S. M., Anderson, C. S., Becker, K., Bendok, B. R., Cushman, M., Fung, G. L., Goldstein, J. N., Macdonald, R. L., Mitchell, P. H., Scott, P. A., Selim, M. H., & Woo, D. (2015). Guidelines for the Management of Spontaneous Intracerebral Hemorrhage. Stroke, 46(7), 2032–2060. https://doi.org/10.1161/str.0000000000000069

Jørgensen, J. M. A., Christensen, D. L., Nielsen, K. K., Sadiq, H. S., Khan, M. Y., Jusabani, A. M., & Walker, R. (2022). Incidence and characteristics of stroke in Zanzibar–a hospital-based prospective study in a low-income island population. Frontiers in Neurology, 13. https://doi.org/10.3389/fneur.2022.931915

Khan, S. U., Khan, M. Z., Khan, M. U., Khan, M. S., Mamas, M. A., Rashid, M., Blankstein, R., Virani, S. S., Johansen, M. C., Shapiro, M. D., Blaha, M. J., Cainzos-Achirica, M., Vahidy, F. S., & Nasir, K. (2021). Clinical and Economic Burden of Stroke Among Young, Midlife, and Older Adults in the United States, 2002-2017. Mayo Clinic Proceedings: Innovations, Quality & Outcomes, 5(2), 431–441. https://doi.org/10.1016/j.mayocpiqo.2021.01.015

Kloda, L. A., Boruff, J. T., & Soares Cavalcante, A. (2020). A comparison of patient, intervention, comparison, outcome (PICO) to a new, alternative clinical question framework for search skills, search results, and self-efficacy: a randomized controlled trial. Journal of the Medical Library Association, 108(2). https://doi.org/10.5195/jmla.2020.739

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

Kuriakose, D., & Xiao, Z. (2020). Pathophysiology and treatment of stroke: Present status and future perspectives. International Journal of Molecular Sciences, 21(20), 7609. https://doi.org/10.3390/ijms21207609

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Murphy, S. JX., & Werring, D. J. (2020). Stroke: Causes and Clinical Features. Medicine, 48(9), 561–566. https://doi.org/10.1016/j.mpmed.2020.06.002

Powers, W. J., Rabinstein, A. A., Ackerson, T., Adeoye, O. M., Bambakidis, N. C., Becker, K., Biller

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

Wajngarten, M., & Silva, G. S. (2019). Hypertension and Stroke: Update on Treatment. European Cardiology Review, 14(2), 111–115. https://doi.org/10.15420/ecr.2019.11.1

Whelton, P. K., Carey, R. M., Aronow, W. S., Casey, D. E., Collins, K. J., Dennison Himmelfarb, C., DePalma, S. M., Gidding, S., Jamerson, K. A., Jones, D. W., MacLaughlin, E. J., Muntner, P., Ovbiagele, B., Smith, S. C., Spencer, C. C., Stafford, R. S., Taler, S. J., Thomas, R. J., Williams, K. A., & Williamson, J. D. (2018). 2017

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

 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension, 71(6). https://doi.org/10.1161/hyp.0000000000000065