Introduction 

Registered nurses begin their professional journey with research queries using an evidence-based framework to enhance patient outcomes. PICOT question formulation is an essential function that is used by nurses to create effective patient care plans and practices to meet their specific needs. PICOT stands for population/patient, intervention, comparison, outcome, and time (Seppi, 2019). The PICOT process often starts with analyzing a case study in a clinical practice and formulates a research question that helps to answer a problem or find solution to an issue. This means using PICOT, researchers can create a comprehensive question by searching evidence from the literature (only credible sources) to support their original question. Patient refers to who is the patient or population of patients in a particular hospital or clinical setting; intervention refers to actions or treatment applied to that population; comparison means what other interventions are available; outcomes refers to the desired outcome, and time frame defines how much time taken to reach the desired outcome (Schramm, 2019). 

This report addresses the evaluation of credible resources online to help nurses find the best treatment or diagnosis of anxiety and depression in patients. Several scholarly databases and online journals were researched while looking up for the relevant search terms and synonyms to arrive at the best resources. Moreover, the research has been narrowed down by limiting the work to the pertinent content such as peer-reviewed articles or other websites. The purpose of PICOT process is to find the research results that meet the standards of quality. After careful consideration of research results, the best available evidence is searched to construct the PICOT question (Kappelmann, 2020). Therefore, depending on secondary research mythology, the author of this report defines a practice issue in the hospital settings surrounding patients with depression and anxiety. The key findings from the resources are explained to apply PICOT process and the relevance of those key findings is explained. 

Using the PICOT Approach on Depression Patients

In healthcare settings where a majority of adult patients with depression are brought more often than in the past, patients need effective treatments and strategies to have long-term benefits. There are currently 10 patients in the psychiatry ward who suffer from depression and chronic anxiety. Nurses need to have knowledge and research skills to effectively prevent depressive symptoms in patients put under their care; they need to apply interventions and take actions to treat depression patients with positive outcomes. Moreover, they need to compare their effectiveness with other methods and also need to measure the time taken to research, implement, and apply these techniques successfully. Normally, this intervention period is six to eight weeks depending on the severity of the patient’s condition or mental health (Hofmann, 2017). Therefore, the question being explored in this research is: Is psychotherapy approach is more comprehensive and effective compared to medication in managing behavior of patients with depressive symptoms? 

NURS FPX 4030 Assessment 3 PICOT Questions and an Evidence-Based Approach JJ

Models for Interventions

The Individualized Intervention Model is a framework that considers of patients’ needs, history, abilities, and preferences in finding the best intervention strategies to eradicate depression (Feller, 2018). In this framework, the patient care tasks and strategies are applied directly by senior nurses and junior subordinates who are responsible for treating ten patients of depression in the current healthcare settings. These nurses have experience in psychotherapy, psychological treatment, and medication approach to reduce and cure depression in patients. Moreover, Care Staff Directed Model is also useful that is different from the Individualized Intervention Model. For instance, in the Care Staff Directed Model, patient care activities are mostly based on staff’s education and training to prove empathetic services to depression patients (Guidi, 2021). This model allows nurses to get proper feedback from their staff to improve their practices. 

Findings from Scholarly Resources

While choosing between psychotherapy or medication treatment, psychologists and nurses should consider a few things. Two kinds of psychotherapies are popular to treat depression such as cognitive behavioral therapy and interpersonal therapy. Some practitioners prefer medication treatments to be more helpful than psychotherapy. However, there are several evidences that show using a combination of psychotherapy and medication yields the best outcomes in terms of patient care (Dzevlan, 2019). 

NURS FPX 4030 Assessment 3 PICOT Questions and an Evidence-Based Approach JJ

The evidence-based research is performed to help nurses identify the best scholarly resources to improve their patient care outcomes. The first article chosen published in the Cambridge University Press is “The efficacy of psychotherapy, pharmacotherapy and their combination on functioning and quality of life in depression: a meta-analysis” that discusses and compares the effectiveness of psychotherapy and other intervention diseases in treating depression patients (Kamenov, 2017). The researchers focus on Quality of Life (QoL) outcomes in the treatment of depressive symptoms and findings suggest that psychotherapy and pharmacotherapy yielded small to moderate effect sizes in terms of QoL. The results of the study show that the combined treatment of medicines and psychotherapy is more effective than using a single technique. A similar research is selected as the second research articles named “Cognitive Therapy vs. Medications in the Treatment of Moderate to Severe Depression” is explored that addresses the usage of anti-depressive medicines to treat moderate to severe depression patients (DeRubeis, 2005). There is little data on this topic with cognitive therapy; the researchers tested 120 patients with 16 days or medication in the clinical settings of the University of Pennsylvania, Philadelphia. The dosage given was 50mg daily. After 8 weeks, response rates in medications were 50% and in cognitive therapy were 25%. The results of the research show that both cognitive and medication therapies can be equally effective in the initial treatment of patients of moderate to severe depression symptoms. The degree of effectiveness depends on the training and experience level of nurses or therapists (Kamenov, 2016). 

Other research by Hollen (2014) states that for anxiety disorders, all methods such as anit-anxiety medications, anti-depressant medicines, and psychotherapy all have been effective in the recent years. However, more researches show that psychotherapy is generally more effective compared to medicines for depression patients. This shows that only treating patients with medicines does not prove to be always beneficial. In case of schizophrenia or bipolar disorder, mood patients receive treatment using mood-changing medications (Djulbegovic, 2017). Therefore, it is vital for medical healthcare professionals to stabilize and personalize their treatment preferences based on patients’ needs and histories and apply evidence-based research to answer their questions to address a particular patient issue. Similarly, another study named “Cognitive therapy vs. medications for depression: Treatment outcomes and neural mechanisms” states that studies show the effectiveness of cognitive therapy as beneficial as medications at treating depressive symptoms. The research states that psychotherapy also helps to reduce the relapse risk; while medications and cognitive therapy results in similar neural mechanisms that are distinctive to each (Marwood, 2018). 

Relevance of Findings

The research by Kamenov (2016) was chosen because it compressively discusses how pharmacotherapy can be as effective as psychotherapy in depression patients. The research also discusses with solid evidence how a combination of these two researches can be the best for patients.  The study is it the most relevant for helping nurses make the best decisions based on evidence. The study observed and concluded that combined treatment can be superior for improving function and QoL outcomes. Moreover, the study by Robert and Hollen (2014) also compares the efficacy of anti-depressant medication in depressive patients and apply interventions such as desipramine hydrochloride in addition to cognitive therapy. This research provides comprehensive results to show that cognitive therapy is as effective as medication therapy for treating moderate to severe depression. However, this research states that nurses’ level of skill can also determine the rate of their success using these strategies. This research also proves to be the most authentic and relevant resource because it offers a systematic review of primary data and uses statistical tools to arrive at conclusions. Another relevant research by Nils and Martin (2020) also compares psychotherapy against medication for depressive patients using individual symptom meta-analysis. This research shows that meta-analytic strategy does not reveal any differences in the efficacy of psychotherapy and medication process. The rationale for selecting this research that is provides a systematic review of meta-analysis of many intervention studies and provides findings that help to answer the PICOT question. 

NURS FPX 4030 Assessment 3 PICOT Questions and an Evidence-Based Approach JJ

Conclusion

There is a great need for developing evidence-based practices in nursing to help form PICOT questions that aim to find the best treatments related to depression in patients. The PICOT method is applied to see if the interventions nurses are using are effective compared to other methods of treatment. The sources of evidence reveal that both psychotherapy and medication play an equally important role in treating depressive patients; however, their combination can yield even stronger outcomes. 

References

Djulbegovic, B., & Guyatt, G. H. (2017). Progress in evidence-based medicine: a quarter century on. The Lancet, 390(10092), 415-423.

Dzevlan, A., Redzepagic, R., Hadzisalihovic, M., Curevac, A., Masic, E., Alisahovic-Gelo, E., & Hadzimuratovic, A. (2019). Quality of life assessment in antidepressant treatment of patients with depression and/or anxiety disorder. Materia socio-medica, 31(1), 14.

Feller, M., Snel, M., Moutzouri, E., Bauer, D. C., de Montmollin, M., Aujesky, D., … & Dekkers, O. M. (2018). Association of thyroid hormone therapy with quality of life and thyroid-related symptoms in patients with subclinical hypothyroidism: a systematic review and meta-analysis. Jama, 320(13), 1349-1359.

Guidi, J., & Fava, G. A. (2021). Sequential combination of pharmacotherapy and psychotherapy in major depressive disorder: a systematic review and meta-analysis. JAMA psychiatry.

Hofmann, S. G., Curtiss, J., Carpenter, J. K., & Kind, S. (2017). Effect of treatments for depression on quality of life: a meta-analysis. Cognitive behaviour therapy, 46(4), 265-286.

Kamenov, K., Twomey, C., Cabello, M., Prina, A. M., & Ayuso-Mateos, J. L. (2017). The efficacy of psychotherapy, pharmacotherapy and their combination on functioning and quality of life in depression: a meta-analysis. Psychological medicine, 47(3), 414-425.

NURS FPX 4030 Assessment 3 PICOT Questions and an Evidence-Based Approach JJ

Kappelmann, N., Rein, M., Fietz, J., Mayberg, H. S., Craighead, W. E., Dunlop, B. W., … & Kopf-Beck, J. (2020). Psychotherapy or medication for depression? Using individual symptom meta-analyses to derive a Symptom-Oriented Therapy (SOrT) metric for a personalised psychiatry. BMC medicine, 18, 1-18.

Schramm, E., Kriston, L., Elsaesser, M., Fangmeier, T., Meister, R., Bausch, P., … & Härter, M. (2019). Two-year follow-up after treatment with the cognitive behavioral analysis system of psychotherapy versus supportive psychotherapy for early-onset chronic depression. Psychotherapy and psychosomatics, 88(3), 154-164.

Seppi, K., Ray Chaudhuri, K., Coelho, M., Fox, S. H., Katzenschlager, R., Perez Lloret, S., … & Djamshidian‐Tehrani, A. (2019). Update on treatments for nonmotor symptoms of Parkinson’s disease—an evidence‐based medicine review. Movement Disorders, 34(2), 180-198.

NURS FPX 4030 Assessment 3 PICOT Questions and an Evidence-Based Approach JJ

DeRubeis, R. J., Hollon, S. D., Amsterdam, J. D., Shelton, R. C., Young, P. R., Salomon, R. M., … & Gallop, R. (2005). Cognitive therapy vs medications in the treatment of moderate to severe depression. Archives of general psychiatry, 62(4), 409-416.

Marwood, L., Wise, T., Perkins, A. M., & Cleare, A. J. (2018). Meta-analyses of the neural mechanisms and predictors of response to psychotherapy in depression and anxiety. Neuroscience & Biobehavioral Reviews, 95, 61-72.