Using a PICO(T) Framework and Evidence to Develop Care Practices

The PICO(T) evaluation criteria are a structured guide that allows the creation of care strategies that are science-based and human-focused. Our paper is devoted to analyzing the use of NURS FPX 4030 Assessment 3 PICO (T) Questions and an Evidence-Based Approach methodology in managing chronic kidney disease (CKD). NURS FPX 4030 Assessment 3: We are going to address the urgent need for developing a practice issue relevant to CKD, and therefore, crafting a PICO(T) format inquiry will help us to establish sources of evidence by critical scrutiny of available findings in numerous articles on the subject for substantiation of care plan in case CKD patients.

Use of the PICO(T) Approach When Caring for Patients with Dementia

NURS FPX 4030 Assessment 3: Practice Issue:

CKD is one of the chronic diseases that have continuously distorted the health of the American population for years.

PICO(T)-Formatted Research Question:

• P (Patient/Population/Problem): Lifestyle changes must be made by adult patients diagnosed with Chronic Kidney Disease (CKD) Stage 3.
• I (Intervention): Implementing a program that provides structure to your exercise.
• C (Comparison): This intervention will consist of a comparison of physical activity and standard care.
• O (Outcome): Several physical aspects of one’s body develop during this time, such as cardiorespiratory endurance, muscle strength, functional movement, flexibility, and balance.
• T (Time Frame): In the time frame of six months.

Exploration of Practice Issue:

A key practice problem here is the development of a treatment regime for CKD patients, focusing on the psychosocial component to maximize physical function and the quality of life (QoL) through systematic exercise plans (Rao et al., 2021). Through the PICO(T) method, we can put the target population (CKD cases), intervention (the structured exercise program), comparison (traditional physical activity or standard care), outcome (improvement of physical functioning and quality of life), and timeframe (over six months) more precisely than ever before. 

NURS FPX 4030 Assessment 3: This approach generates a research question that shows evidence-based practice, enabling nurses to identify pertinent information and inform decision-making regarding the parameters of the exercise regime for CKD patients. Investigating this theme through the PICO(T) approach increases the performance and improvement of evidence-based prevention and treatments for CKD management.

Identification of Sources of Evidence

Peer-Reviewed Journals: 

Scholarly journals like “The Journal of Renal Nutrition” and “The American Journal of Kidney Disease” are resources endorsed for their quality in publications of research work related to CKD management and intervention (Smith, 2023). Studies from the journals are subjected to elaborate peer-reviewing processes, thus assuring the strength and truthfulness of the presented facts.

Clinical Practice Guidelines: 

For example, the National Kidney Foundation and KDIGO organizations have approved the guidelines based on research to provide evidence for CKD management (Chen et al., 2019). These guidelines are developed in a structured way through sequential analysis of scientific publications and consideration of expert opinion; as such, they are considered pillars of EBP.

Randomized Controlled Trials (RCTs): 

Using RCTs, we can find out if structured exercise programs improve CKD patients’ lives (Hellberg et al., 2019). We will have the necessary data to answer our PICO(T) question. Randomly dividing participants between the intervention and control groups helps establish a definitive conclusion about the role of exercise interventions on fundamental functioning and improved quality of life measures.

Meta-Analyses and Systematic Reviews: 

Meta-analyses and systematic reviews that accumulate data from multiple studies provide a better picture of how exercise intervention helps class 5 patients (Hu et al., 2020). They lead to pooled effect sizes across studies and identify possible sources of variation, thereby meeting the goal of understanding the overall impact of exercise among those with CKD.

Clinical Trials Registries: 

Looking up clinical trial registries like ClinicalTrials.gov can help one ascertain an ongoing or forthcoming trial that is clinically investigating exercise strategies in proteinuria kidney patients (Cheung et al., 2021). Even though these resources do not necessarily directly address the TQ, they can provide a glimpse into the latest updates in research and prospects on the topic being focused on.

Findings from Articles

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American Journal of Kidney Diseases:

The American Journal of Kidney Diseases published a paper by Pasko and Kirby (2021), which presents revised competencies and expectations for medical dietitian nutritionists in nephrology. The study highlighted the importance of making personalized dietetic plans as part of the CKD management process, remembering that nutritional value is vital in minimizing disease progression and improving overall health outcomes (Kim & Jung, 2020). This strong evidence has high credibility; interestingly, a journal is respected for peer-reviewing nephrology studies.

Journal of Renal Nutrition:

Statements from another established authority, the Journal of Renal Nutrition, which reports the study by Pace and Kirk (2021) on the advantages of diets in CKD management, are also credible. The study demonstrates the outcomes of renal function and the general health of patients with chronic kidney disease (CKD) under dietary modifications. From this research, strategies for improving health outcomes through evidence-based nutrition are formulated, and the evidential results are added to the credibility of the evidence.

National Kidney Foundation Guidelines:

The National Kidney Foundation stipulates various guidelines, supported by scientific evidence, for managing patients with Chronic Kidney Disease. These recommendations suggest saving people’s lives and enabling healthy living conditions through early diagnosis, preventing lifestyle and drug implications at later stages (AbdulRaheem, 2023). This is partly made meaningful by advisory strategies conducted as a part of systematic literature reviews coupled with expert consensus, which enhances the credibility of the evidence presented.

Meta-Analyses and Systematic Reviews:

A meta-analysis and a systematic review identifying commonalities and differences in various interventions are essential in comprehensively examining the effectiveness of the different treatments in CKD management (Chu et al., 2021). 

NURS FPX 4030 Assessment 3 These analyses allow cumulative effect sizes and identify the sources of heterogeneity. They elevate the level of public health knowledge and understanding of the effect of the programs on CKD outcomes. Although independent studies have the critical power that causes the same evidence, the meta-analysts and systematic reviewers have higher proof levels because of their broad and thorough approach to data synthesis.

Relevance of Findings from Articles

Impact on Intervention Selection:

The perfect results obtained from the chosen ascertained ideas are meaningful when deciding interventions for CKD management. For instance, the CKD progression, as well as the patient outcomes, can be improved by following a diet plan. Several issues related to CKD progression and patient outcomes are highlighted in the American Journal of Kidney Diseases and the Journal of Renal Nutrition (Liu et al., 2021). These outcomes emphasize the necessity of having a customized dietary plan in the intervention plan that can signify an improvement in the function of the kidney and the lowering of the risk of complications.

Guideline Adherence:

The information presented in the evidence-based National Kidney Foundation guidelines is a source of up-to-date knowledge concerning the best care practices for patients with chronic kidney disease. Strictly following these policies lies between the finger-leading on the tip of the intervention’s thumb based on the best practices supported by substantial evidence and expert consensus (Peters et al., 2021). Supplying healthcare professionals with the required guidelines that will assist them in making the right decisions is imperative. This will promote applying appropriate interventions, resulting in better patient outcomes.

Informed Treatment Planning:

Meta-analyses and systematic reviews represent the ones opting for multi-scope research so that sports practitioners make rational treatment planning decisions based on these findings (Liu et al., 2021). From the theoretical analysis, the quarries detail the efficacy of intense interventions and those most likely to produce positive results. Issuing from a synthesis of data from several studies, a meta-analysis gives a strong evidence base for decisions and policy making and, consequently, steers interventions that are more closely associated with success in CKD management.

Identifying High-Impact Strategies:

A noteworthy and encouraging finding is that the studies focusing on the effectiveness of dietary interventions and compliance with nutritional guidelines are of special importance to the makers. This further shows that CKD management schemes should first and foremost consider dietary modifications and adhering to the guidelines, as these are probably to bring a range of positive outcomes, including improvement of renal function, reduction of disease progression, and ultimately corollary health of patients (Rao et al., 2021). For this reason, healthcare providers should primarily target functionally appropriate actions based on these studies’ findings when developing treatment plans for CKD patients.

Conclusion

The PICO(T) framework is an essential planning instrument for creating individual therapy concepts for patients suffering from CKD. By systematically delineating the population, intervention, comparison, outcome, and time frame, nurses can arrive at focused research questions that guide them to appropriate evidence for the nursing decision-making process. 

The findings from trustworthy sources, such as peer-reviewed journals, clinical practice guidelines, and meta-analytic studies, are significant sources of knowledge regarding what strategies and interventions best manage these conditions and improve patient outcomes. Developing integrated, evidence-based practices drawn up through the PICOT strategy can lead to more precise and individualized care for CKD patients, allowing them to gain more pleasure from their lives and better health.

References

AbdulRaheem, Y. (2023). Unveiling the significance and challenges of integrating prevention levels in healthcare practice. Unveiling the Significance and Challenges of Integrating Prevention Levels in Healthcare Practice, 14(3), 1–6. https://doi.org/10.1177/21501319231186500

Chen, T. K., Knicely, D. H., & Grams, M. E. (2019). Chronic kidney disease diagnosis and management. JAMA, 322(13), 1294. https://doi.org/10.1001/jama.2019.14745

Cheung, A. K., Chang, T. I., Cushman, W. C., Furth, S. L., Hou, F. F., Ix, J. H., Knoll, G. A., Muntner, P., Pecoits-Filho, R., Sarnak, M. J., Tobe, S. W., Tomson, C. R. V., & Mann, J. F. E. (2021). KDIGO 2021 clinical practice guideline for managing blood pressure in chronic kidney disease. Kidney International, 99(3), S1–S87. https://doi.org/10.1016/j.kint.2020.11.003

Chu, C. D., Chen, M. H., McCulloch, C. E., Powe, N. R., Estrella, M. M., Shlipak, M. G., & Tuot, D. S. (2021). Patient awareness of CKD: A systematic review and meta-analysis of patient-oriented questions and study setting. Kidney Medicine, 3(4), 576-585.e1. https://doi.org/10.1016/j.xkme.2021.03.014

Hellberg, M., Höglund, P., Svensson, P., & Clyne, N. (2019). Randomized controlled trial of exercise in CKD—The RENEXC study. Kidney International Reports, 4(7), 963–976. https://doi.org/10.1016/j.ekir.2019.04.001

Hu, M. X., Turner, D., Generaal, E., Bos, D., Ikram, M. K., Ikram, M. A., Cuijpers, P., & Penninx, B. W. J. H. (2020). Exercise interventions for the prevention of depression: A systematic review of meta-analyses. BMC Public Health, 20(1). https://doi.org/10.1186/s12889-020-09323-y

Kim, S. M., & Jung, J. Y. (2020). Nutritional management in patients with chronic kidney disease. The Korean Journal of Internal Medicine, 35(6), 1279–1290. https://doi.org/10.3904/kjim.2020.408

Liu, P., Quinn, R. R., Lam, N. N., Al-Wahsh, H., Sood, M. M., Tangri, N., Tonelli, M., & Ravani, P. (2021). Progression and regression of chronic kidney disease by age among adults in a population-based cohort in Alberta, Canada. JAMA Network Open, 4(6). https://doi.org/10.1001/jamanetworkopen.2021.12828

Peters, S. E., Jha, B., & Ross, M. (2021). Rehabilitation following surgery for flexor tendon injuries of the hand. Cochrane Database of Systematic Reviews, 1(1). https://doi.org/10.1002/14651858.cd012479.pub2

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