course materials

1. Develop Care Practices Discussion
Develop Care Practices Discussion ON Develop Care Practices DiscussionCreate a 3-5-page
submission in which you develop a PICO(T) question for aspecific care issue and evaluate
the evidence you locate, which could help toanswer the question.1 Using a PICO(T)
Framework and Evidence to Develop Care Practices Learner’s Name Capella University
NURS-FPX4030: Making Evidence-Based Decisions Instructor Name August, 2020 Copyright
©2019 Capella University. Copy and distribution of this document are prohibited. 2 Using a
PICO(T) Framework and Evidence to Develop Care Practices When developing care
practices for patients, the PICO(T) research framework, which expands to
Population/Patient, Intervention, Comparison, Outcome, and Time, can be used to create an
effective care plan and ensure that patients’ needs are met. Relying on secondary research,
the author of this paper will define a practice issue surrounding patients with dementia,
apply the PICO(T) process, identify sources of evidence that may provide answers to the
research question, explain key findings from articles, and explain the relevance of those key
findings. Use of the PICO(T) Approach when Caring for Patients with Dementia The practice
issue identified for resolution is the need to develop care practices that effectively manage
agitation in patients with dementia in nursing homes that are outside of pharmacological
approaches. The question being explored is: Is the non-pharmacological approach,
specifically an intervention approach, more effective than the pharmacological approach in
managing behavioral symptoms (such as agitation) in patients with dementia? The
intervention approach identified is person-centered care or patient-centered care (PCC), an
approach that emphasizes more on an individual’s experiences and the communication of
his or her needs than on the pure implementation of a health care provider’s expertise
(Desai, et al., 2017). Develop Care Practices DiscussionThe population being studied are
patients with dementia with agitative behavioral symptoms in nursing homes. As the
objective is to explore care practices that address this issue, only factors related to care in
nursing homes are considered. The study does not take into consideration cultural, political,
and social factors (Kim & Park, 2017). Identification of Sources of Evidence DICE Model
Copyright ©2019 Capella University. Copy and distribution of this document are prohibited.
3 The DICE (Describe, Investigate, Create, and Evaluate) model is a notable PCC intervention
model that identifies optimal treatment options for patients with dementia with
neuropsychiatric symptoms. Developed by a panel of interdisciplinary experts at the
University of Michigan Program for Positive Aging, the model is constitutive of a four-step
approach. The first step of the approach is the accurate description of the patient’s

2. behavior, the second is the identification of possible underlying causes, the third is the
creation and implementation of treatment plans, and the fourth is the assessment of the
strategies developed (Desai et al., 2017; Kales et al., 2014). The model’s essential
recommendations for facilitating improvement in neuropsychiatric symptoms among
patients with dementia are educating the caregiver; forging better communication between
the patient and the caregiver; assisting the caregiver in organizing meaningful activities
such as cooking, painting, or reading depending on the patient’s interests; and training the
caregiver on simplifying his or her work routines (Desai et al., 2017; Kales et al., 2014).
Develop Care Practices DiscussionIndividualized Intervention Model The individualized
intervention model is a model in which intervention activities are carried out based on the
history, needs, abilities, and preferences of patients with dementia. In this model, PCC-based
activities are directly carried out by trained health care staff with expertise in social work,
recreational therapy, geriatric psychiatry, and psychology (Kim & Park, 2017). Care Staff-
Directed Model In the care staff–directed model, PCC activities are based on the staff’s
education and training on empathy and person-centeredness. The model also makes a
provision for offering Copyright ©2019 Capella University. Copy and distribution of this
document are prohibited. 4 staff regular feedback for their work. The intervention period in
such a model ranges from 3 months to 2 years (Kim & Park, 2017). Findings from Articles
As PCC is a major nonpharmacological approach to treating agitation in patients with
dementia, its effectiveness is studied by making a comparative analysis to the
pharmacological approach to manage behavioral symptoms in patients with dementia.
Pharmacological treatment in general refers to the use of psychotropic medication to
manage agitation or neuropsychotic symptoms (NPS) in patients with dementia
(Madhusoodanan & Ting, 2014; Kales et al., 2014). Some of the common pharmacological
interventions include the use of antipsychotropics, antidepressants such as sertraline and
citalopram, and sedative-hypnotics through the use of benzodiazepines to control acute
agitation (Madhusoodanan & Ting, 2014). The use of psychotropic medication poses high
risks of mortality and harmful side effects (Kales et al., 2014). Develop Care Practices
DiscussionPsychotropic medication is also expensive and is restricted by regulatory bodies.
However, the use of pharmacological intervention is justified when the benefits outweigh
the risks or in situations wherein nonpharmacological interventions have proven
unsuccessful (Madhusoodanan & Ting, 2014). The PCC approach has proven effective in
addressing the etiology of aggressive outbursts. Unlike the pharmacological approach,
which is based on treating symptoms, the PCC approach contributes to the resolution of
underlying causes (Desai et al., 2017). The study by Kales et al. (2014) finds reasonable
evidence of the DICE program’s contribution toward better clinical practices and
improvement in aggressive behavior, and it observes that the approach results in fewer
hospitalizations and readmissions. In their systematic review and meta-analysis of 19
primary studies, Kim and Park (2017) found 15 studies that measure the impact of PCC on
Copyright ©2019 Capella University. Copy and distribution of this document are prohibited.
5 agitation using the Cohen-Mansfield Agitation Inventory (an agitation mapping
instrument) and the Brief Agitation Rating Scale. They found that 8 of the 15 studies show
positive effects on agitation with individualized interventions (with a significant mean

3. difference of -0.513), showing better effects than with care staff–directed interventions
(with a significant mean difference of -0.160). As this paper relies on secondary research on
the PCC intervention to manage agitative behavior in patients with dementia in nursing
homes, there are multiple time frames for the various intervention studies reviewed.While
some studies had a long intervention period ranging from 9 months to 2 years, others had
shorter intervention periods of just a few weeks. From the above exploration of the
research problem based on the PICO(T) framework, it is clear that this framework has
contributed to the delineation of precise intervention practices and has brought conceptual
clarity on the issue of agitative behavior in patients with dementia. Relevance of Findings
from Articles The study by Kales et al. (2014) was chosen as it provides a comprehensive
explanation of the PCC-based DICE intervention program and its potential outcomes and
draws an objective comparison of the program with pharmacological intervention. The
study observed that the DICE model was developed by a panel of experts with years of
clinical and research expertise in managing NPS in patients with dementia. The strategies
formulated in the DICE approach were found to carry a strong evidence base. As it is
evidence-informed, the DICE approach could be helpful for clinicians across diverse
settings. Develop Care Practices DiscussionKales et al. (2014) conclude their study with a
discussion on the potential of the DICE approach in enhancing clinical practices and
ensuring the treatment of agitative behavior in patients with dementia. Copyright ©2019
Capella University. Copy and distribution of this document are prohibited. 6 The rationale
for selecting the study by Kim and Park (2017) was that it presents a systematic review and
meta-analysis of 19 primary intervention studies, of which 17 studies are from long-term
care facilities. In their systematic review and meta-analysis of these studies, Kim and Park
(2017) found that PCC has a significant impact on reducing NPS in patients with dementia.
Kim and Park’s (2017) review found the increased engagement between care providers and
patients and the magnitude of the program’s intensity to be the reasons for shortterm PCC
intervention having greater benefits in comparison to long-term intervention. The findings
are relevant because they are based on 17 long-term, clinical PCC intervention studies
comprising both controlled and non-controlled cluster-randomized trials conducted over
the past 10 years (Kim & Park, 2017). Kim & Park’s findings prove to be the most credible.
In their systematic review and meta-analysis of primary studies, Kim and Park’s findings
(2017) adhere to the guidelines of the Preferred Reporting Items for Systematic Reviews
and Meta-Analyses. They also utilize analysis tools such as the Cochrane Collaboration’s risk
of bias and the risk of bias assessment tool to ensure quality screening of the studies.
Conclusion There is a need to develop care practices that are outside of pharmacological
approaches for managing agitation in patients with dementia. The PICO(T) framework was
applied to determine if the intervention approach of person-centered care or patient-
centered care (PCC) was more effective than the pharmacological approach by identifying
sources of evidence, explaining the findings and proving the relevance of those findings. The
articles by Kales et al. (2014) and Kim and Park (2017), provide precise, reliable, and
relevant information to adequately explore the effectiveness of the PCC approach. Copyright
©2019 Capella University. Copy and distribution of this document are prohibited.7
References Desai, A., Wharton, T., Struble, L., & Blazek, M. (2017). Person-centered primary

4. care strategies for assessment of and intervention for aggressive behaviors in dementia.
Journal of Gerontological Nursing, 43(2), 9–17. https://search-
proquestcom.library.capella.edu/docview/1862119355?pq-origsite=summon Kales, H. C.,
Gitlin, L. N., & Lyketsos, C. G. (2014). Management of neuropsychiatric symptoms of
dementia in clinical settings: Recommendations from a multidisciplinary expert panel.
Journal of the American Geriatrics Society, 62(4), 762–769.
https://ncbi.nlm.nih.gov/pmc/articles/PMC4146407/# Kim, S. K. & Park, M. (2017).
Effectiveness of person-centered care on people with dementia: A systematic review and
meta-analysis. Clinical Interventions in Aging, 12, 381–397.
https://doaj.org/article/400107a4cbaa44e6b7c0e3531bb4abac Madhusoodanan, S., &
Ting, M. B. (2014). Pharmacological management of behavioral symptoms associated with
dementia. World Journal of Psychiatry, 4(4), 72–79.
https://ncbi.nlm.nih.gov/pmc/articles/PMC4274589/ Copyright ©2019 Capella
University.Copy and distribution of this document are prohibited. PICO(T) Questions and an
Evidence-Based Approach Create a 3-5-page submission in which you develop a PICO(T)
question for a specific care issue and evaluate the evidence you locate, which could help to
answer the question. PICO(T) is an acronym that helps researchers and practitioners define
aspects of a potential study or investigation. It stands for: • • • • • P –
Patient/population/problem. I – Intervention. C – Comparison (of potential interventions,
typically). O – Outcome(s). T – Time frame (if time frame is relevant). The end goal of
applying PICO(T) is to develop a question that can help guide the search for evidence
(Boswell Cannon, 2015). From this perspective, a PICO(T) question can be a valuable
starting point for nurses who are starting to apply an evidence-based model or EBPs. By
taking the time to precisely define the areas in which the nurse will be looking for evidence,
searches become more efficient and effective. Essentially, by precisely defining the types of
evidence within specific areas, the nurse will be more likely to discover relevant and useful
evidence during their search. You are encouraged to complete the Vila Health PCI(T)
Process activity before you develop the plan proposal. This activity offers an opportunity to
practice working through creating a PICO(T) question within the context of an issue at a
Vila Health facility.These skills will be necessary to complete Assessment 3 successfully.
This is for your own practice and self-assessment and demonstrates your engagement in the
course. Demonstration of Proficiency By successfully completing this assessment, you will
demonstrate your proficiency in the course competencies through the following assessment
scoring guide criteria: • • • • • • • • • Competency 1: Interpret findings from scholarly
quantitative, qualitative, and outcomes research articles and studies. Explain the findings
from articles or other sources of evidence. Competency 2: Analyze the relevance and
potential effectiveness of evidence when making a decision. Identify sources of evidence
that could be potentially effective in answering a PICO(T) question. Explain the relevance of
the findings from chosen sources of evidence to making decision related to a PICO(T)
question. Competency 3: Apply an evidence-based practice model to address a practice
issue. Define a practice issue to be explored via a PICO(T) approach. Competency 5: Apply
professional, scholarly communication strategies to lead practice changes based on
evidence. Communicate using writing that is clear, logical, and professional with correct

5. grammar and spelling using current APA style. Reference Boswell, C., Cannon, S. (2015).
Introduction to nursing research. Burlington, MA: Jones Bartlett Learning. Develop Care
Practices DiscussionProfessional Context As a baccalaureate-prepared nurse, you will be
responsible for locating and identifying credible and scholarly resources to incorporate the
best available evidence for the purposes of enhancing clinical reasoning and judgement
skills. When reliable and relevant evidence-based findings are utilized, patients, health care
systems, and nursing practice outcomes are positively impacted. PICO(T) is a framework
that can help you structure your definition of the issue, potential approach that you are
going to use, and your predictions related to the issue. Word choice is important in the
PICO(T) process because different word choices for similar concepts will lead you toward
different existing evidence and research studies that would help inform the development of
your initial question. Scenario For this assessment, please use an issue of interest from your
current or past nursing practice. If you do not have an issue of interest from your personal
nursing practice, then review the optional Case Studies presented in the resources and
select one of those as the basis for your assessment. Instructions For this assessment, select
an issue of interest an apply the PICO(T) process to define the question and research it.
Your initial goal is to define the population, intervention, comparison, and outcome. In some
cases, a time frame is relevant and you should include that as well, when writing a question
you can research related to your issue of interest. After you define your question, research
it, and organize your initial findings, select the two sources of evidence that seem the most
relevant to your question and analyze them in more depth. Specifically, interpret each
source’s specific findings and best practices related to your issues, as well explain how the
evidence would help you plan and make decisions related to your question. If you need
some structure to organize your initial thoughts and research, the PICOT Question and
Research Template document (accessible from the “Create PICO(T) Questions” page in the
Capella library’s Evidence Based Practice guide) might be helpful. In your submission, make
sure you address the following grading criteria: • • • • • • Define a practice issue to be
explored via a PICO(T) approach. Identify sources of evidence that could be potentially
effective in answering a PICO(T) question. Explain the findings from articles or other
sources of evidence. Explain the relevance of the findings from chosen sources of evidence
to making decision related to a PICO(T) question. Communicate using writing that is clear,
logical, and professional with correct grammar and spelling using the current APA style.
Example Assessment: You may use the following to give you an idea of what a Proficient or
higher rating on the scoring guide would look like: Assessment 3 Example [PDF]. Additional
Requirements Your assessment should meet the following requirements: • Length of
submission: Create a 3–5-page submission focused on defining a research question and
interpreting evidence relevant to answering it. • • Number of references: Cite a minimum of
four sources of scholarly or professional evidence that support your findings and
considerations. Resources should be no more than 5 years old. APA formatting: Format
references and citations according to the current APA style. Portfolio Prompt: Remember to
save the final assessment to your ePortfolio so that you may refer to it as you complete the
final capstone course. PICOT Question and Search Strategy Template Use with the library
guide: Evidence Based Practice in Nursing & Health Sciences 1. Define your question using

6. PICOT (review the “Create PICOT Questions” page as needed): Population:
__________________________________________________________________ Intervention:
__________________________________________________________________ Comparison:
__________________________________________________________________ Outcome:
__________________________________________________________________ Time (optional):
__________________________________________________________________ 2. Write out your question:
______________________________________________________
________________________________________________________________________________ 3. Write down the
most important words from your question in the gray boxes. For each top term, add
synonyms or related terms in the boxes below it. All these are your search terms. 4. Review
the “Best Bets” in the Nursing Databases list. Check the databases you will search: __
CINAHL Complete (*Recommended) __ Health & Medical Collection __ Nursing & Allied
Health __ OVID Nursing Full Text Plus __ Public Health Database __ PubMed Central 5. Write
in your first search below. Follow the instructions on the “Find EBP Articles…” page. AND
OR AND OR ? Scholarly/peer reviewed ? Limit publication date: 6. Type of studies you want
to include in your search: __ Systematic Review or Meta-Analysis __ Individual Research
Studies __ Clinical Practice Guidelines __ Critically Appraised Research Studies 7. What
information did you find to help answer your question?
__________________________________________________________________________________
__________________________________________________________________________________
______________________________________________________________________ This form is adapted from:
Syrene A. Miller, PICO Worksheet and Search Strategy, National Center for Dental Hygiene
Research …Purchase answer to see full attachment