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.

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Exploration of Practice Issue

The epidemiological profile of stroke in the United States has evolved over time. Although it is currently the fifth leading cause of death, stroke still accounts for over 140,000 deaths annually. The financial burden is substantial, with healthcare costs reaching $34 billion each year (Khan et al., 2021). Stroke remains the primary cause of long-term physical disability among adults. Hypertension is the most critical modifiable risk factor for stroke, with its impact varying depending on the stroke subtype (Murphy & Werring, 2020).

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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 a 12-month period (T)?

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Population (P)

Individuals who have experienced an ischemic stroke.

Intervention (I)

Administration of antihypertensive medications.

Comparison (C)

Patients who do not use antihypertensive medications.

Outcome (O)

A decrease in the incidence of recurrent stroke.

Time (T)

12 months.

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Benefits of the PICO(T) Approach

The PICO(T) framework is widely embraced in nursing and healthcare research due to its effectiveness in structuring clinical questions and enhancing the efficiency of evidence searches (Schiavenato & Chu, 2021). It plays a critical role in developing standardized hypertension management protocols, which are essential for stroke prevention. By clearly defining each component of the clinical question, the PICO(T) model strengthens the quality and reliability of evidence (Kloda et al., 2020). According to Jørgensen et al. (2022), patients diagnosed with hypertension and treated with antihypertensive medications at the time of stroke exhibited a reduced risk of recurrence.

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Sources of Evidence

Assessing the PICO(T) question requires reliable and valid evidence from peer-reviewed journals and databases. Trusted institutions and hospitals also offer valuable data (Kattie, 2021). A significant rise in blood pressure is the most prevalent clinical indicator of Acute Ischemic Stroke (AIS). Randomized controlled trials (RCTs) comparing antihypertensive therapy to non-treatment provide critical data on treatment efficacy over specific timeframes (Whelton et al., 2018). Dawson et al. (2022) support prescribing antihypertensive drugs for secondary stroke prevention. Data synthesis from diverse, credible sources offers insight into the treatment’s impact on brain function (García-Rudolph et al., 2019).

Clinical guidelines, such as those provided by the American Heart Association (AHA), compile the most current evidence-based strategies to reduce stroke risk. These guidelines assist a broad audience, including clinicians, hospital administrators, and allied health professionals, in managing patients with acute arterial ischemic stroke (Powers et al., 2019).

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Rationale

Blood pressure significantly influences ischemic stroke risk. Studies indicate that maintaining BP below 150/90 mmHg reduces stroke occurrence. In hypertensive emergencies, managing BP is directly linked to minimizing brain injury, such as acute ischemic stroke (Wajngarten & Silva, 2019). As both cardiac arrest and stroke are major contributors to morbidity and mortality, the PICO(T) framework allows for evaluating the short- and long-term impacts of interventions on stroke outcomes.

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Findings from Sources of Evidence

Hypertension is one of the main risk factors for stroke. A disproportionately high systolic-to-diastolic BP ratio elevates stroke risk (Wajngarten & Silva, 2019). Antihypertensive therapy significantly reduces recurrence rates. The GRADE system (Grading of Recommendations, Assessment, Development, and Evaluation) is commonly used to formulate treatment guidelines for stroke prevention.

Wajngarten and Silva (2019) conducted a comprehensive systematic review and meta-analysis that advocated primordial prevention—reducing sodium intake, promoting healthy diets, restricting tobacco use, and fostering supportive environments—as a way to decrease cardiovascular disease burden. Achieving this requires coordinated efforts from healthcare professionals, institutions, and government bodies. Sedentary lifestyles and poor diets are directly correlated with increased stroke risk and hypertension (Kuriakose & Xiao, 2020).

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Credibility of Resources

Using the CRAAP (Currency, Relevance, Authority, Accuracy, Purpose) test, the referenced sources are highly credible in addressing hypertension in stroke management. Around 9% to 15% of individuals experience a recurrent stroke within a year. Dawson et al. (2022) advocate antihypertensive use to lower recurrence risk. These results are instrumental in forming evidence-based protocols for managing hypertension in stroke patients (Bulto et al., 2023). Sources like PubMed, Google Scholar, and the American Stroke Foundation provide trusted, scholarly resources.

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Relevance of these Findings

Current medical guidelines recommend vigilant monitoring of cardiovascular and neurological conditions during stroke treatment, often involving induced hypertension within clinical trials. Effective BP control remains a major challenge in stroke care. Before thrombolytic therapy, blood pressure must typically be lowered to below 185/110 mmHg (Bath et al., 2022).

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Relevant findings lead to Positive Outcomes

The Florida Stroke Registry shows that antihypertensive therapy during acute stroke events presents opportunities for improving care quality (Gillian Gordon Perue et al., 2023). Clinical guidelines suggest maintaining BP below 130/80 mmHg. For patients at high risk of recurrence, even lower levels (<140/90 mmHg) are optimal. Those at high risk of hemorrhagic stroke may benefit from levels below 120/80 mmHg. Selecting antihypertensive therapy should be based on individual risk profiles for both ischemic and hemorrhagic stroke (Hemphill et al., 2015).

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

Gillian Gordon Perue, Ying, H., Bustillo, A. J., Zhou, L., Gutierrez, C. M., Wang, K., Gardener, H., krigman, judith, Jameson, A., Foster, D., Dong, C., Tatjana Rundek, Rose, D. Z., Romano, J. G., Ayham Alkhachroum, Sacco, R., Negar Asdaghi, & Koch, S. (2023). A 10-year review of antihypertensive prescribing practices after stroke and the associated disparities from the Florida Stroke Registry. https://doi.org/10.1101/2023.02.15.23286003

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

J., Brown, M., Demaerschalk, B. M., Hoh, B., Jauch, E. C., Kidwell, C. S., Leslie-Mazwi, T. M., Ovbiagele, B., Scott, P. A., Sheth, K. N., Southerland, A. M., Summers, D. V., & Tirschwell, D. L. (2019). Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 50(12). https://doi.org/10.1161/str.0000000000000211

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