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The Patient/Population, Intervention, Comparison, Outcome, and Time PICO(T) framework provides a used tool that can inform the design, development, and implementation of effective, patient-centered care plans. According to Boswell and Cannon (2018), the intended goal of using the PICO(T) framework is to create a robust question that can provide clear guidance to the search for evidence. Consistent with this perspective, a well-formulated PICO(T) question can provide a strong foundation for nursing students and practitioners who are starting to integrate evidence-based models into practice. In this paper, I draw on existing literature and the PICO(T) framework to define a practice issue facing patients with posttraumatic stress disorder (PTSD). The paper also presents sources of evidence for answering the research question and provides a brief explanation of the findings and their relevance.
Applying PICO(T) Framework in Caring for Patients with Stress and Depression
The practice issue of focus in this paper is to design and implement patient-centered care practices for effectively managing mental health problems such as stress, anxiety, and depression among PTSD patients admitted in nursing homes that are outside of conventional pharmacological interventions. The PICO(T) question is: Is Mindfulness-based stress reduction (MBSR) intervention more effective than pharmacological therapies in managing symptoms such as stress, depression, and anxiety in patients with PSTD?
The intervention approach identified in this paper is the mindfulness-based cognitive therapy, a meditation technique that emphasizes training people or patients to focus their attention on mental processes and aspects such as thoughts, perceptions, feelings, emotions, and other sensations as they appear (Davis et al., 2019). The population under investigation includes patients with PTSD symptoms such as anxiety, depression, and stress in outpatient settings. The research process will focus on only factors related to care in outpatient settings without accounting for the sociocultural, political, and economic status.
Identifying Sources of Evidence
Reviewing previous research and existing literature can help identify relevant evidence that could be potentially effective in answering a PICO(T) question. MBSR is a non-pharmacological intervention for a range of mental health problems. This treatment approach aims at promoting relaxation and achieving a higher level of sense of wellbeing by integrating mindfulness meditation and yoga (Bishop et al., 2018). Numerous studies have examined the efficacy of mindfulness-based programs in managing psychiatric conditions in different settings. In this section, I explore three primary research studies reporting on the efficacy of MBSR on PSTD.
Davis et al. (2019) undertook a multisite randomized controlled trial (RCT) to examine the effectiveness of MBST in treating PTSD among veterans. An RCT conducted by Bremner et al. (2017) examined 17 veterans to establish how MBST impacts PSTD symptoms among veterans. In a related mixed-method feasibility study, Müller-Engelmann et a. (2017) examined the efficacy of MBSR) as a Standalone treatment therapy for PTSD after exposure to mixed traumatic experiences. A synthesis of these credible and peer-reviewed scholarly resources can help generate reliable evidence that can be leveraged to enhance clinical practice.
Review of Research Findings
The three studies reviewed in this paper revealed that MBSR is an increasingly promising approach for improving PTSD symptoms among patients in varied settings. In the pilot study by Bremner et al. (2017), PSTD patients who received mindfulness-based treatment reported improved PTSD symptoms compared to those in present-centered group therapy after a six-month intervention period. The mixed-methods feasibility study by Müller-Engelmann et a. (2017) reported similar results indicating that MBSR is effective in reducing PTSD symptoms. Nine patients who completed the mindfulness program exhibited large improvements in PTSD symptoms. The findings of these two investigations are confirmed by the results of the multisite RCT by Davis et al. (2019), which showed that the MBSR approach has beneficial benefits in PTSD treatment among veterans. Participants in the MBSR group exhibited statistically significant improvements in PTSD symptoms compared to their peers in the present-centered group therapy. All three studies indicate that mindfulness-based cognitive therapies are effective in alleviating signs of anxiety disorders attributable to experience traumatic events.
Overall, these three empirical studies present empirical evidence demonstrating that MBSR intervention programs have a high potential in helping to ameliorate PTSD symptoms. Across the three investigations reviewed in this section, patients who were treated using the MBSR approach exhibited significant improvements in PTSD symptoms. Therefore, mindfulness-based therapies are safe and effective treatment interventions for patients with PTSD symptoms such as stress, depression, and anxiety.
Relevance of Research Findings
The findings of the three research studies provide nuanced insights that can help in formulating and defining the basic elements of the PICO(T) question, including the target population, intervention, comparison, and likely outcomes. Besides that, the investigations illuminate a potentially appropriate research design that can be used to answer the clinical question. The multisite RCT by Davis et al. (2019) is the most relevant because of its strength. In addition to being more current, this investigation has used a “large sample size, multisite design, active control group, single-blind outcome ratings, fidelity monitoring, large minority representation, and randomized approach” (Davis et al., 2019, p. 39). These factors enhanced the overall validity and reliability of the study.
The rationale for selecting the mixed-method feasibility study is its research design, particularly the assessment of patients’ PTSD symptoms before and after treatment. Similarly, the pilot study involved measurement of PTSD symptoms before and after treatment and a six-month follow-up. The pre-and post-test tests and one-month follow-up coupled with the in-depth interviews provided a more comprehensive and nuanced insight into the effects of the intervention. However, these two investigations were limited by smaller sample sizes.
References
Bishop, J. R., Lee, A. M., Mills, L. J., Thuras, P. D., Eum, S., Clancy, Erbes, C., R., Polusny, M., A., Gregory J. Lamberty, G., J., & Lim, K. O. (2018). Methylation of FKBP5 and SLC6A4 in relation to treatment response to mindfulness based stress reduction for posttraumatic stress disorder.Frontiers in Psychiatry, 9, 418. Web.
Boswell, C., & Cannon, S. (2018). Introduction to nursing research. Jones & Bartlett Learning.
Bremner, J. D., Mishra, S., Campanella, C., Shah, M., Kasher, N., Evans, S., Fani, N., Shah, A., J., Reiff, C., Davis, L., L., Vaccarino, V., & Carmody, J. (2017). A pilot study of the effects of mindfulness-based stress reduction on posttraumatic stress disorder symptoms and brain response to traumatic reminders of combat in Operation Enduring Freedom/Operation Iraqi Freedom combat veterans with posttraumatic stress disorder.Frontiers in psychiatry, 8, 157. Web.
Davis, L. L., Whetsell, C., Hamner, M. B., Carmody, J., Rothbaum, B. O., Allen, R. S.,… & Bremner, J. D. (2019). A multisite randomized controlled trial of mindfulness-based stress reduction in the treatment of posttraumatic stress disorder. Psychiatric Research and Clinical Practice, 1(2), 39-48. Web.
Müller-Engelmann, M., Wünsch, S., Volk, M., & Steil, R. (2017). Mindfulness-based stress reduction (MBSR) as a standalone intervention for posttraumatic stress disorder after mixed traumatic events: a mixed-methods feasibility study.Frontiers in Psychology, 8, 1407. Web.
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