As a psychiatric nurse practitioner, I am involved in providing patients with consultations; the interventions that I usually prescribe include pharmacotherapy and psychotherapy. This information defines the field of practice that I am interested in advancing. The patients that I typically work with are middle-aged adults, which defines the population of interest. Also, I often work with patients with mild-to-severe depression, which is a relatively prevalent and significant health concern. These factors define the condition of interest and further specify the population of the proposed researchable PICO questions (Schardt, Adams, Owens, Keitz, & Fontelo, 2007). The offered questions focus on the opportunities for advancing the care at my workplace, but they can also generate evidence and contribute to the investigation of their respective topics.
In middle-aged people diagnosed with depression, what effects does SC have on the symptoms of depression as compared to CAU?
- Population: middle-aged people diagnosed with depression.
- Intervention: stepped care (SC).
- Comparison: care as usual (CAU).
- Outcome: changes in symptoms.
SC suggests that the least intensive and resource-consuming interventions should be used before more resource-consuming ones. This approach is less likely to result in ineffective mental care (under-treated and excessively-treated patients) when compared to CAU, and there is consistent evidence of SC resulting in better patient outcomes in depression management (Straten, Hill, Richards, & Cuijpers, 2015). The employment of this approach at my workplace can lead to practice advancement.
In middle-aged people diagnosed with depression, what effects does the use of SC have on the cost-effectiveness of care as compared to CAU?
- Population: middle-aged people diagnosed with depression.
- Intervention: SC.
- Comparison: CAU.
- Outcome: cost-effectiveness of care.
The ability of SC to improve the cost-effectiveness of care is less well-established than its effects on patient outcomes, but there is some evidence suggesting that cost-efficiency may be one of the outcomes of the approach (Ho, Yeung, Ng, & Chan, 2016; Straten et al., 2015). The improvement of the cost-effectiveness of care is important for the healthcare industry, which means that the introduction of SC at my workplace can be viewed as practice advancement from this perspective as well.
In middle-aged people diagnosed with moderate to severe depression, does the combination of medications and high-intensity psychological interventions result in different patient outcomes as compared to the prescription of only medications?
- Population: middle-aged people diagnosed with moderate to severe depression.
- Intervention: the prescription of the combination of medications and high-intensity psychological interventions.
- Comparison: the prescription of medications alone.
- Outcome: patient outcomes.
It is relatively well-established that the combination of pharmacotherapy and high-intensity psychological interventions is more effective in moderate-to-severe depression management than the use of only medications (National Institute for Health and Care Excellence, 2016). Therefore, the routinization of this practice at my workplace would be considered an advancement.
In the care providers who work with patients with depression, how does a cultural awareness training affect actual and perceived depression care quality as compared to the pre-intervention performance and measured two months after the intervention?
- Population: care providers working with middle-aged patients with depression.
- Intervention: cultural awareness training.
- Comparison: pre-training actual and perceived quality of care.
- Outcome: post-training actual and perceived quality of care.
- Time: two months.
Culturally appropriate care is important for mental care, but the problem of insufficient cultural awareness in nurses is still acute (Kohn-Wood & Hooper, 2014). Thus, the proposed intervention can advance the practice at my workplace.
In patients diagnosed with depression, how does shared decision-making affect clinical outcomes, and patient satisfaction as compared to its absence?
- Population: middle-aged patients diagnosed with depression.
- Intervention: shared decision-making (patient involvement in decision-making).
- Comparison: the absence of shared decision-making.
- Outcome: changes in clinical outcomes and patient satisfaction.
Taking patients’ preferences into account is important for the quality of care as shown by modest improvements in clinical outcomes and notable increases in patient satisfaction (Lindhiem, Bennett, Trentacosta, & McLear, 2014; Winter & Barber, 2013). Shared decision-making is supported by evidence, which means that its routinization can improve the quality of care at my workplace.
Ho, F., Yeung, W., Ng, T., & Chan, C. (2016). The efficacy and cost-effectiveness of stepped care prevention and treatment for depressive and/or anxiety disorders: A systematic review and meta-analysis. Scientific Reports, 6(1), 1-10. Web.
Kohn-Wood, L., & Hooper, L. (2014). Cultural competency, culturally tailored care, and the primary care setting: Possible solutions to reduce racial/ethnic disparities in mental health care. Journal of Mental Health Counseling, 36(2), 173-188. Web.
Lindhiem, O., Bennett, C., Trentacosta, C., & McLear, C. (2014). Client preferences affect treatment satisfaction, completion, and clinical outcome: A meta-analysis. Clinical Psychology Review, 34(6), 506-517. Web.
National Institute for Health and Care Excellence. (2016). Depression in adults: Recognition and management. Web.
Schardt, C., Adams, M. B., Owens, T., Keitz, S., & Fontelo, P. (2007). Utilization of the PICO framework to improve searching PubMed for clinical questions. BMC Medical Informatics and Decision Making, 7(1), 1-6. Web.
Straten, A., Hill, J., Richards, D. A., & Cuijpers, P. (2015). Stepped care treatment delivery for depression: A systematic review and meta-analysis. Psychological Medicine, 45(2), 231-246. Web.
Winter, S., & Barber, J. (2013). Should treatment for depression be based more on patient preference? Patient Preference and Adherence, 7, 1047-1057. Web.