PICOT Question Analysis

PICOT Question Analysis

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PICOT Question Analysis

Nursing Practice Problem and PICOT Question

People with end stage renal disease (ESRD) are likely to benefit from renal replacement therapy (RRP), which is offered through various approaches, including peritoneal dialysis, kidney transplant, and hemodialysis. Patients undergoing hemodialysis usually attend three sessions of dialysis weekly, where medical practitioners attach them to various machines, including dialysis machines for at least four hours for every session. Patients also receive guidelines to restrict their phosphorus, sodium, and potassium intake. Patients who follow all treatment plans increase their chances of getting better. Patients can live for more than 20 years with strict adherence to medication plans. Nevertheless, many patients fail to follow stipulated medication plans due to different factors, including clinical reasons such as being reactive to certain medication and economic constraints (Ishaq, & Rafique, 2021). Medical practitioners, therefore, should remind patients to adhere to medical plans to recover effectively from the disturbing condition.

PICOT Question

Does attending education of ESRD patients twice weekly of patients who do not follow treatment plan enhance compliance with treatment contrasted with non-complying patients who do not get counselling and education from nursing practitioners upon assessment over 12 week duration?

P: The populace refers to people who suffer from ESRD and undergo hemodialysis at a dialysis facility or hospital.

I: The involvement or pointer refers to risk actions such as missing medication, nonconformity with treatments, and noncompliance with dietary recommendations.

C: The contrast refers to patients who obey medication plans, prescriptions, and nutritional plans.

O: The result refers to hostile outcomes of nonconformity such as accident, poor quality of life, and illness.

T: The period for reviewing the suggested intercession is four to six months.

Background

The issue of noncompliance by patients attract the attention of various scholars who try to understand the issue and possibly offer suitable recommendations. Antony et al. (2020), examine the problem of noncompliance to medication plans among ESRD patients undergoing hemodialysis. The problem challenges nursing practitioners to identify effective ways for encouraging ESRD patients to stick to medication plans. Nurses gain valuable information from the assessment by various scholars to formulate strategies for enhancing compliance with medication among the target population. However, failing to embrace suitable measures to improve adherence to medication plans could affect any attempts to improve the health and well-being of ESRD patients.

How Articles Support the Nurse Practice Issue

Various articles show the importance encouraging adherence on the part of the nurse to ensure ESRD patients make significant progress in their health. Antony et al. (2020), for example, argue that finding effective solutions to personal factors that deter patients from following recommended plan may help to improve compliance. According to Antony et al. (2020) nurses should have the capacity to suggest possible remedies because they are well conversant with what the practice and illness entails. They are in a better place to suggest ways that patients can view treatment plans as being beneficial to their health rather than being stressful. On the same aspect, Shahdadi and Rahnama (2018) who examine the roles of nurses and their experience when offering hemodialysis care argue that a suitable way to increase adherence is for nurses to improve their quality of care. Shahdadi and Rahnama (2018) argue that nurses should identify and eradicate any obstacle that could derail how they attend to ESRD patients because inability to provide the desired care may deter the patient’s desire to proceed with the medication plan.

Method of Study

Antony et al. (2020) and Shahdadi and Rahnama (2018) use quantitative method and qualitative research, respectively. On the other hand, Ishaq and Rafique (2021) and Kustimah et al. (2019) both use qualitative research design in their study. The scholars in both scenarios administer open-ended questionnaire to collect data. The main difference between qualitative and quantitative research design is that the former entails gathering, analyzing, and interpreting data that is not numerical in nature. Qualitative research is more useful in knowing how a single entity in a research perceives a particular matter. Quantitative research, on the other hand, entails gathering and assessing numerical data. The primary benefit of using the qualitative research is that the researcher gets an opportunity to understand the participants’ attitudes. Quantitative research, on the other hand, is beneficial because it is possible to get reliable, precise, and consistent results if the data are generated in the correct manner and from reliable sources.

Results of Study

The findings by Antony et al. (2020), Shahdadi and Rahnama (2018), Ishaq and Rafique (2021) and Kustimah et al. (2019) are all informative. Antony et al. (2020) find in their article that discovered a momentous connection between medical observance levels and hospital biomarkers of those receiving treatment. This aided clarify why some clients exhibited low medication and session devotion. They also established that patient psychotherapy enriched observance significantly. Shahdadi and Rahnama (2018), on their part, found that administrative intrusions could aid diminish the suppressors and endorse the enablers, which in turn, could help interveners offer improved quality care to patients receiving hemodialysis. Ishaq and Rafique (2021) find from their research that cost-related consequences of non-adherence such as mortality and morbidity led clients to follow treatment plans. Kustimah et al. (2019) find from their study that categorized factors that prompt nonconformity into patient and medication-related elements. All these findings provide valuable insight into the nursing practice.

The identified articles have significant impact on nursing practice. Findings from the studies encourage nurse practitioners to be innovative and inclusive in the way they relate with ESRD patients. Nurses learn that such patients rely on them to get stable guidance on how to deal with the challenges that come with adhering to medication plan. Nurses also learn the need to include patients in their medication plans by explaining what they need to understand or difficult concepts that may contribute towards the patient withdrawing from medication. More fundamentally, findings from the articles remind nurses the importance of evaluating all care processes to ensure that patients adhere to the entire medication plan.

Outcomes Comparison

The possible outcome of the PICOT question is that those receiving education and do not follow treatment plans is likely to increase their adherence compared to ESRD patients who do not receive education and do not follow medication plans. The PICOT question is likely to show that ESDR patients who adhere to dietary plans, prescriptions, and treatment have a better chance for getting better as opposed to patients who do not follow these guidelines. Furthermore, a possible outcome of the PICOT question is that nonadherence to medical plans may have severe implications, including morbidity, poor quality of life, and injuries. The outcomes of the four articles compare to the anticipated PICOT outcomes in the way all of them advocate for adherence to medication plans to get over the health problem. However, whereas outcomes from the articles emphasize on nurses’ involvement in helping patients adhere to medication plans, findings from the PICOT questions emphasize on adhering to medication plans. Overall, the outcomes from the PICOT question and research articles show that the most effective way for ESRD patients to recover from the condition is to adhere to medication plans. Consequently, practitioners and patients should get valuable information from the findings to enhance their service delivery and adherence to medication, respectively.

Proposed Evidence-Based Practice Change

Significant connection exist between the PICOT question, the research articles, and the nursing practice problem I identified. An evident similarity in all the features is that they identify nonconformity to medication as a major challenge for ESRD patients. The PICOT question identifies laxity to adhere to medication plans as a significant constraint to ESDR patients. The research articles identify noncompliance to medication as a serious concern and encourage nurses to take measures that help patients (Antony et al., 2020; Flythe et al., 2016). The identified nursing problem also finds laxity to follow medication plan to be a major concern. Another similarity in the PICOT question, the research articles, and the nursing practice problem is that they acknowledge that it is possible to achieve tremendous improvement by following medication plans. An evidence-based practice change for clinical settings helping ESRD patients is for nurses to gain adequate insight into what is required to improve adherence to medication plans. However, nurses may have to undergo adequate training that equip them with relevant skills needed to enhance adherence. Nurses, for example, may learn how to use enticing methods to enhance adherence to treatment plan.  

References

Antony, E., James, M., Roy, A., & George, S. (2020). Assessment of treatment adherence and its predictors in maintenance hemodialysis patients. Asian Journal of Research in Nephrology, 3(3), 22-29. https://www.journalajrn.com/index.php/AJRN/article/download/30107/56490

Flythe, J. E., Katsanos, S. L., Hu, Y., Kshirsagar, A. V., Falk, R. J., & Moore, C. R. (2016). Predictors of 30-day hospital readmission among maintenance hemodialysis patients: A hospital’s perspective. Clinical Journal of the American Society of    Nephrology, 11(6), 1005-1014. doi: 10.2215/CJN.11611115

Ishaq, G., & Rafique, R. (2021). Cost and benefits analysis of treatment adherence in end-stage renal disease patients. Journal of Behavioral Sciences, 31(2), 258-276.

Kustimah, K., Siswadi, A. G. P., Djunaidi, A., & Iskandarsyah, A. (2019). Factors affecting non-adherence to treatment in End Stage Renal Disease (ESRD) patients undergoing hemodialysis in Indonesia. The Open Psychology Journal, 12(1), 141-146. doi: 10.2174/1874350101912010141

Shahdadi, H., & Rahnama, M. (2018). Experience of nurses in hemodialysis care: a phenomenological study. Journal of Clinical Medicine, 7(2), 30-38. doi: 10.3390/jcm7020030