NR 505 Week 2: PICOT Question Worksheet
Please read the assignment guidelines and rubric. Provide answers to the following:
1) Identify and describe one practice-related issue or concern. You may choose to build on the practice issue you identified in NR500NP/NR501NP. Provide support for the issue from scholarly nursing sources current within the last 5 years.
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The identified practice-related issue is impaired executive functioning in children 4-12 years with Attention Deficit/Hyperactivity Disorder (ADHD). ADHD is a developmental disorder often diagnosed in children in PMHNP practice. The hallmark characteristics of ADHD are problems with executive functions. Children diagnosed with ADHD exhibit difficulties in the ability to pay attention, inhibit impulses, restrain movements, and regulate behavior. This affects their communication, daily living, and socialization. These difficulties are usually secondary to deficits in executive functioning (Miklós et al., 2019). The major elements associated with executive function are anticipation, goal selection, planning, initiation, self-regulation, attention, mental flexibility, and using feedback. These processes typically develop throughout childhood and adolescence and are valuable to an individual’s cognitive, emotional, behavioral, and social functioning (Veloso et al., 2020). Thus, impairment in executive functioning results in various difficulties for an individual.
2) Explain why the issue/concern is important to nurse practitioner practice and the issue’s impact on health outcomes. Provide support for the importance of the issue from scholarly nursing sources current within the last 5 years.
The issue of impaired executive functioning in children with ADHD is essential to NP practice since NPs often assess, diagnose, and develop treatment plans for children with ADHD. NPs need to understand that the difficulties faced by children with ADHD are caused by impaired executive functioning. Thus, the NP must address this aspect of ADHD first to improve a child’s cognitive, emotional, behavioral, and social functioning (Miklós et al., 2019). Furthermore, NPs are usually limited in the treatment options for children with ADHD since they are few and usually entail prescribing psychostimulants as a first-line treatment. Thus, there is a need to explore other interventions that can improve children’s executive functioning in addition to medication therapy.
3) Define each element of your PICOT question in one or two sentences.
- P-Population and problem (What is the nursing practice concern or problem and whom does it affect?)
The focus of the PICOT is children with ADHD aged 4-12 years. This is the target age group to prevent ADHD from persisting over an individual’s lifespan.
- I–Intervention (What evidence-based solution for the problem would you like to apply?)
The proposed intervention is to incorporate cognitive training for executive function in the management of 4-12 year-olds with ADHD. The intervention was selected because it is linked with reducing ADHD symptoms and improving interpersonal, educational, and occupational outcomes in children and adolescents (Veloso et al., 2020).
- C–Comparison (What is another solution for the problem? Note that this is typically the current practice, no intervention at all, or alternative solutions.)
The proposed intervention will be compared to the usual practice of providing medication therapy alone.
- O–Outcome (Very specifically, how will you know that the intervention worked? How you will measure the outcome?)
The expected outcome is a reduction of ADHD symptoms by 50%.
- T–Timeframe (Timeframe involved for the EBP initiative/target date of completion.)
The success of the proposed intervention will be determined after 12 months.
Construct your PICOT question in the standard PICOT question format (narrative) and define each letter separately, such as:
- P = Children 4-12 years with ADHD
- I = Incorporating cognitive training
- C = Medication therapy alone
- O = Reduce ADHD symptoms by 50%
- T = 12 months.
- PICOT Question written in full: In children, 4-12 years with ADHD (P), does incorporating cognitive training (I) compared to medication therapy alone (C) reduce ADHD symptoms by 50% (O) within 12 months (T)?
Miklós, M., Futó, J., Komáromy, D., & Balázs, J. (2019). Executive Function and Attention Performance in Children with ADHD: Effects of Medication and Comparison with Typically Developing Children. International journal of environmental research and public health, 16(20), 3822. https://doi.org/10.3390/ijerph16203822
Veloso, A., Vicente, S. G., & Filipe, M. G. (2020). Effectiveness of cognitive training for school-aged children and adolescents with attention-deficit/hyperactivity disorder: a systematic review. Frontiers in Psychology, 10, 2983. https://doi.org/10.3389/fpsyg.2019.02983
Great question. It is common knowledge that the prescription of medication for children with ADHD has become rampant and alarming. These concerns have led clinicians to research suitable alternatives to reduce the medication given to the patient population. Behavioral therapy is a form of psychotherapy that can help an individual with ADHD cultivate and enhance various skills to manage behavioral challenges. However, there is no evidence that shows that behavioral therapy can manage the core symptoms of ADHD as effectivelyas medication. Hence, I am really looking forward to what your study uncovers. The only information available shows that ADHD can teach children the skills they need to control the symptoms by staying organized and focused. Behavioral therapy focuses on several skills known as executive functions. These functions include time management, planning tasks, and organization (Van Dis et al., 2020). Children with ADHD are weak at executive functions because they do not have adequate self-regulation skills. During behavioral therapy, kids with problematic behaviors are likely to do well because they have ample support from their parents and other professionals, such as nurses, educators, and therapists. Therapists and educators will create routines and tools to get tasks completed successfully with minimal conflict. They can develop checklists, time limits, planners, and reward charts. Some studies indicate that behavioral therapy is more effective for children than teenagers due to the intensity of behavioral problems during adolescence(Caye et al., 2019). The basis for behavioral therapy and any other form therapy is time. Hence, it is important to carry out a study over an extended period. If possible, you can create follow-ups one or two years after the study is completed to continue measuring the effectiveness of the intervention. The findings will verify whether behavioral therapy focused on reinforcing positive long-term habits and reducing impulsivity can replace the current high doses of stimulant medication given to children and young adults with ADHD.
Caye, A., Swanson, J. M., Coghill, D., & Rohde, L. A. (2019). Treatment strategies for ADHD: an evidence-based guide to select optimal treatment. Molecular psychiatry, 24(3), 390-408. https://doi.org/10.1038/s41380-018-0116-3
Van Dis, E. A., Van Veen, S. C., Hagenaars, M. A., Batelaan, N. M., Bockting, C. L., Van Den Heuvel, R. M., … & Engelhard, I. M. (2020). Long-term outcomes of cognitive behavioral therapy for anxiety-related disorders: a systematic review and meta-analysis. JAMA psychiatry, 77(3), 265-273. doi:10.1001/jamapsychiatry.2019.3986
In week 1 discussion as area of interest I identified improvement of vaccination with HPV vaccine among children 11-12 years old in family practice that can be implemented by NP. This question brought my attention because HPV vaccine administration is highly effective in preventing HPV-related cancers (CDC, 2023), however, the vaccination rates are low due to vaccine refusal by parents (Davis et al., 2022) and low rates of vaccine approach from health care providers (Walling et al., 2019). It is highlighted by Szilagui (2020) that it is associated with lack of information about vaccine, and it is correlated to low rates of providers’ recommending vaccine and providing information about its effectiveness (Walling et al., 2019). Since family practice NP is a primary care provider, therefore compliance with HPV vaccine immunization is a practice question I chose to work on. PICOT elements for my area of interest are following :
P = 11-12 years old children in family practice
I = implementation of HPV vaccine recommendation, education about vaccine, and appointment reminder system
C = no recommendation, education about vaccine, and appointment reminder system
O = compliance with HPV vaccine by age of 13 years old
T = Short-term (within 6 month to a year)
My PICOT question is :
In 11-12 years old children (Population) what is the effect of HPV vaccine recommendation, education, and appointment reminder system (Intervention) in comparison to in comparison to no recommendation, education about vaccine, and appointment reminder system (Comparison) on compliance with HPV vaccine by age of 13 years old (Outcome) to be completed within 6 months to a year (Time).
CDC. (2023). Human Papillomavirus. Centers for Disease control and Prevention. https://www.cdc.gov/hpv/parents/about-Links to an external site. hpv.html
Davis, K.R., Norman, S. L., Olson, B. G., Demirel, S., & Taha, A. A. (2022). A Clinical
Educational Intervention to Increase HPV Vaccination Rates Among Pediatric Patients Through Enhanced Recommendations. Journal of Pediatric Health Care, 36(6), 589–597. https://doi.org/10.1016/j.pedhc.2022.07.003Links to an external site.
Szilagyi, P.G., Albertin, C. S., Gurfinkel, D., Saville, A. W., Vangala, S., Rice, J. D., Helmkamp,
L., Zimet, G. D., Valderrama, R., Breck, A., Rand, C. M., Humiston, S. G., & Kempe, A. (2020). Prevalence and characteristics of HPV vaccine hesitancy among parents of adolescents across the US. Vaccine, 38(38), 6027–6037. https://doi.org/10.1016/j.vaccine.2020.06.074
Walling, E.B., Dodd, S., Bobenhouse, N., Reis, E. C., Sterkel, R., & Garbutt, J. (2019).
Implementation of strategies to improve human papillomavirus vaccine coverage: A provider survey. American Journal of Preventive Medicine, 56(1), 74–83. https://doi.org/10.1016/j.amepre.2018.07.038
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