NR 730 Week 3 The PICOT Question

Student Name

Chamberlain University

NR-730: DNP Project

Prof. Name

Date

NR 730 Week 3 Discussion

Discussion

PICOT Question

In adult patients with uncontrolled hypertension in a primary care setting (P), does motivational interviewing for lifestyle modification (I), compared to usual care (C), improve medication adherence (O) over 10 weeks (T)?

This PICOT question serves as the foundation for a Doctor of Nursing Practice (DNP) practice change project. It focuses on addressing a major public health concern—uncontrolled hypertension—through a patient-centered and evidence-based approach using motivational interviewing (MI).

Purpose

The purpose of this discussion is to evaluate and refine a PICOT question that will guide a DNP practice change project. This process ensures alignment with evidence-based practice principles and the achievement of measurable clinical outcomes.

1. State Your Proposed DNP Practice Change Project PICOT Question

My proposed PICOT question is:

In adult patients with uncontrolled hypertension in a primary care setting (P), does motivational interviewing focused on lifestyle change (I), compared to usual care (C), improve medication adherence (O) over a 10-week period (T)?

This question emphasizes the importance of patient engagement and aims to address the persistent issue of poor adherence to antihypertensive therapy, which remains a major barrier to achieving optimal blood pressure control.

2. Examine How Your PICOT Question Addresses the Identified Practice Problem

Uncontrolled hypertension continues to be a critical issue in primary care, given its strong association with stroke, cardiovascular disease, and renal complications. A leading contributor to this issue is nonadherence to prescribed antihypertensive medications.

The PICOT question addresses this problem through the following elements:

PICOT Element	Description	Purpose
Population (P)	Adult patients with uncontrolled hypertension	Focuses on individuals at high risk for preventable complications
Intervention (I)	Motivational interviewing	Enhances patient engagement, self-awareness, and adherence through behavioral change techniques
Comparison (C)	Usual care	Benchmarks results against standard care, which may not adequately address behavioral barriers
Outcome (O)	Medication adherence	A key determinant in achieving blood pressure control and preventing long-term complications
Time (T)	10 weeks	Allows sufficient duration to observe measurable behavioral and adherence improvements

This PICOT structure directly targets the behavioral root cause of uncontrolled hypertension by integrating an evidence-based and patient-centered intervention.

3. Evaluate How the Outcome Identified in Your PICOT Question Aligns with the Evidence-Based Intervention

The expected outcome—improved medication adherence—is strongly aligned with the intervention of motivational interviewing. MI is grounded in behavioral change theory and encourages patients to explore their ambivalence, build intrinsic motivation, and commit to sustained health behaviors.

Element	Relevance to PICOT Question
Outcome (Medication Adherence)	Essential for achieving optimal blood pressure control and reducing long-term cardiovascular risks
Evidence-Based Intervention (Motivational Interviewing)	Proven to enhance adherence across various chronic conditions, including hypertension
Alignment	MI directly targets behavioral modification, promoting adherence and better overall health outcomes

Research supports that motivational interviewing can significantly enhance adherence and improve outcomes in chronic disease management. According to O’Halloran et al. (2020), MI has demonstrated effectiveness in improving physical activity and adherence behaviors across populations with chronic conditions. Therefore, the outcome identified in this PICOT question is both realistic and evidence-driven.

Program Competencies

This discussion supports the following program outcomes (POs):

Competency Area	Description	Program Outcome(s)
Integration of Scientific Knowledge	Applies scientific evidence in clinical practice to design and implement effective interventions	POs 3, 5
Organizational and System Leadership	Demonstrates leadership to drive systemic change and enhance patient outcomes	PO 6
Evidence Translation	Critically appraises and translates research into evidence-based innovations	POs 3, 5
Technology Application	Utilizes technology to support efficient, data-driven healthcare delivery	POs 6, 7
Policy Advocacy	Evaluates and advocates for policies addressing equitable healthcare and social determinants of health	POs 2, 9
Culture of Collaboration	Promotes interdisciplinary teamwork to enhance population health	PO 8
Professional Leadership	Leads with integrity, clinical judgment, and accountability in implementing and evaluating care initiatives	POs 1, 4

Course Outcomes

This discussion also supports the following course outcomes (COs):

Course Outcome	Description	Program Competencies (PCs)	Program Outcomes (POs)
Clinical Scholarship in Practice	Designs, implements, and evaluates evidence-based improvements across healthcare systems	PCs 1, 3, 5	POs 3, 5, 9
Evidence Synthesis	Critically appraises and integrates high-quality evidence to improve outcomes, quality, and cost-effectiveness	PCs 1, 2, 3, 4, 6, 8	POs 4, 5, 6, 8

References

Melnyk, B. M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Wolters Kluwer.

O’Halloran, P. D., Blackstock, F., Shields, N., Holland, A., Iles, R., Kingsley, M., … & Taylor, N. F. (2020). Motivational interviewing to increase physical activity in people with chronic health conditions: A systematic review and meta-analysis. Clinical Rehabilitation, 34(2), 190–201. https://doi.org/10.1177/0269215519886015

NR 730 Week 3 The PICOT Question

Williams, B., Shaw, A., & Duggleby, W. (2018). Patient adherence and the role of motivational interviewing in hypertension management. Journal of Clinical Nursing, 27(3–4), 573–582. https://doi.org/10.1111/jocn.1405