NURS FPX 4025 Assessment 3 Applying the PICO (T) Process

Reduced quality of life, cardiac cachexia, arrhythmia, sudden cardiovascular mortality, higher hospitalization rates, and thrombosis are among the detrimental effects of heart failure (HF) (Malik & Chhabra, 2023). Additionally, despite the fact that the illness is not new and that the medical community is quite interested in it, HF patients continue to die at a high rate. According to some estimations, the current five-year survival rates of patients with newly diagnosed HF can reach about 50% (Roger & Clinic, 2021), a statistic that can be investigated using the PICO model for research. These complications and consequences may be even more severe when it comes to historically marginalized groups, and the majority of the time, these groups do not have access to adequate healthcare, which negatively impacts their general well-being. This is a concern that can be addressed through nursing research PICO questions. The most common population affected by HF is the Black population, which is followed by the Hispanic population (Bozkurt et al., 20%). According to NURS FPX 4025 Assessment 3, Black and Hispanic individuals are more likely to experience the mentioned healthcare disadvantages, which increase their likelihood of acquiring heart failure problems and distressing outcomes overall.

PICOT Question

Patients with heart failure frequently experience readmission. Within 30 days of any procedure, about one in four HF patients who were released from the hospital were readmitted (Oskouie et al., 2024). As noted in NURS FPX 4025 Assessment 3, hospitalizations of HF patients have a detrimental effect on their quality of life and increase the strain on the healthcare system, costing the US economy over 11 billion dollars a year (Bozkurt et al., 2023). A PICO(T) question was developed using an evidence-based practice PICO example to assist HF patients who are increasingly being readmitted. What effect does telehealth visitation integration have on

the readmission rate among HF patients over a one-year period compared to standard care? The question’s target group includes those with heart failure. The PICO model for research will be used to compare the implementation of telehealth visits after hospital discharge to no intervention. The result is the readmission rates of HF patients who received the intervention. Last but not least is the one-year duration for which the data will be collected.

Research Process

Numerous databases and search terms were utilized in the process of reviewing the evidence to address the mentioned PICO(T) question. The databases that were used were PubMed Central, Proquest Nursing Databases, and CINAHL Complete. As the search progressed, filters were applied to ensure that only peer-reviewed, English-language results from the previous five years were considered. The terms “heart failure,” “readmissions,” and “telehealth” were utilized. In order to further refine the results, the terms “e-health” and “telemedicine” were also included as keywords during the search. In order to choose the best evidence to use in PICO(T) in clinical decision making, the type of study was also taken into account. The study’s primary focus was on meta-analyses and systematic reviews. As discussed in NURS FPX 4025 Assessment 3, the reliability and applicability of each evidence source to lowering readmission rates for HF patients were assessed. As an evidence-based practice PICO example, one of the sources taken into consideration was a systematic review of randomized controlled trials (RCTs) that looked at the implementation of remote monitoring as a way to reduce readmission incidences in cases of heart failure and/or chronic obstructive pulmonary disease (Stergiopoulos et al., 2024). Blood pressure, oxygen saturation, weight, and heart rate were all remotely measured as part of the telemonitoring procedures (Stergiopoulos et al., 2024). Frontiers in Digital Health is a peer-reviewed, interdisciplinary journal that published the article

in 2024 on PubMed Central. Because they work as doctors at Johns Hopkins or the Mayo Clinic, they are reputable writers. The reduction of readmission rates of HF patients with telemedicine as an intervention is the focus of this systematic review, which shares the same patient population, outcome, and intervention as the proposed PICO(T) question. This topic was also highlighted in NURS FPX 4025 Assessment 3.

The additional evidence selected was a meta-analysis and systematic review study that aimed to determine how mobile health apps affected the outcomes of HF patients (Ni et al., 2024). This study can be used in PICO(T) clinical decision-making. In this review, we examined a number of outcomes, including hospitalization rates. According to Ni et al. (2024), the mobile application included telehealth visits, social support access, educational materials, recorded reporting of symptoms and vital signs, reminders, and patient-based suggestions. The study’s findings, which demonstrate the application of the PICO model for research, show that the use of mobile apps can enhance patient-provider interaction and self-management of the disease, lead to a reduction in hospitalizations, and ultimately improve the quality of life of patients with HF (Ni et al., 2024). In 2024, the paper appeared in the peer-reviewed academic journal of Nursing Management. The CINAHL Complete database has information on it. Ni and the writers are affiliated with the West China Hospital’s Cardiology department. Ramtin and colleagues’ review, meta-analysis, and systematic analysis from 2023 served as an evidence-based practice PICO example, evaluating and synthesizing data to determine whether the use of distance education was linked to the readmission of patients with heart failure (HF). As discussed in NURS FPX 4025 Assessment 3, remote education in this work refers to instruction via phone calls or video calls, text messages, telemonitoring with an individual education plan, mobile applications, and print booklets with physical copies (Ramtin et al., 2023). Through this

systematic review and meta-analysis, the authors concluded that telehealth and other remote learning techniques and systems probably reduce readmissions among patients with heart failure (Ramtin et al., 2023). This study was located using the ProQuest Nursing Databases. John Wiley & Sons, Inc., a well-known publisher of academic publications, initially published the article in Nursing Open, an open-access, peer-reviewed magazine. Furthermore, the 2023 study only looks at the readmission rates of heart failure patients; as a result, it may be pertinent to the diagnosis and issue being examined, which can be used in PICO(T) clinical decision-making.

The following is how the aforementioned evidence helps to address the PICO(T) question: How do telehealth visits affect hospital readmission rates for HF patients over a 12-month period when compared to standard care? The telehealth logic of telemonitoring was not statistically significant when used to lower the rehospitalization rate in patients with heart failure (Stergiopoulos et al., 2024), which can be investigated using the PICO(T) framework in nursing. This is one of the sources of evidence. NURS FPX 4025 Assessment 3 noted that while telemonitoring was found to be insignificant in lowering readmission rates, other telehealth interventions might have comparable effects. According to a systematic review and meta-analysis by Ni and colleagues (2024), hospitalization rates for heart failure patients generally decreased after the introduction of a mobile health application that allows patients to track their symptoms, report vital signs, schedule telehealth visits with providers, and access educational materials.

The other systematic review and meta-analysis by Ramtin and other authors in 2023 demonstrated the applicability of the PICO model for research and found that distance learning had a positive effect on the readmission rates of HF patients. Both studies, conducted by Ramtin and colleagues (2023) and Ni and colleagues (2024) revealed that phone calls and video visits

with the use of telehealth, and the use of medical applications resulted in decreased rehospitalization in HF patients. The study presented implies that telemedicine, which is addressed in NURS FPX 4025 Assessment 3, can reduce hospital readmissions when compared to situations when telehealth solutions are not used. In most aspects, telemonitoring did not matter (Stergiopoulos et al., 2024). Nevertheless, the overall hospitalization readmission rate of individuals with HF can be decreased when remote learning tools and mobile health apps are used (Ni et al., 2024; Ramtin et al., 2023).

References

American Heart Association (AHA). (2023, March). What is heart failure? heart.org. Retrieved March 20, 2025, from https://www.heart.org/en/health-topics/heart-failure/what-is-heart- failure

Bozkurt, B., Ahmad, T., Alexander, K. M., Baker, W. L., Bosak, K., Breathett, K., Fonarow, G. C., Heidenreich, P., Ho, J. E., Hsich, E., Ibrahim, N. E., Jones, L. M., Khan, S. S., Khazanie, P., Koelling, T., Krumholz, H. M., Khush, K. K., Lee, C., Morris, A. A., Page, R. L., 2nd, … Writing Committee Members (2023). Heart failure epidemiology and outcomes statistics: A report of the heart failure society of America. Journal of cardiac failure, 29(10), 1412–1451.

            https://doi-org.library.capella.edu/10.1016/j.cardfail.2023.07.006

Malik A, Chhabra L. (2023). Congestive heart failure. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan. https://www.ncbi.nlm.nih.gov/books/NBK430873/

Ni, Y.-X., Liu, X.-H., He, L., Wen, Y., You, G.-Y., & Igarashi, Y. (2024). Mobile application‐ based interventions for people with heart failure: A systematic review and meta‐ analysis. Journal of Nursing Management, 2024, 1–14. https://doiorg.library.capella.edu/10.1155/2024/6859795

Ramtin, S., Yazdani, Z., Tanha, K., & Negarandeh, R. (2023). The impact of distance education on readmission of patients with heart failure: A systematic review and meta-analysis. Nursing Open, 10(7), 4205-4215. https://doi.org/10.1002/nop2.1698

Roger, V. L., & Clinic, M. (2021). Epidemiology of heart failure. Circulation Research, 128(10), 1421. https://10.1161/circresaha.121.318172

Stergiopoulos, G. M., Elayadi, A. N., Chen, E. S., & Galiatsatos, P. (2024). The effect of telemedicine employing telemonitoring instruments on readmissions of patients with heart failure and/or COPD: A systematic review. Frontiers in digital health, 6, 1441334. https://doi-org.library.capella.edu/10.3389/fdgth.2024.1441334