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NURS FPX 4030 Assessment 3: PICO (T) Questions and an Evidence-Based Approach

Capella 4030 Assessment 3

NURSFPX 4030 Assessment 3: PICO (T) Questions and an Evidence-Based Approach

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Capella University

NURS FPX 4030 Assessment 3

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PICO (T) Questions and an Evidence-Based Approach

In the PICO(T) research framework, PICO(T) is an acronym that stands for patient, intervention, comparison, outcome, and time in a clinical research problem. The PICOT procedure starts with a case situation and a question designed to elicit a response. This research study will describe a practice problem involving patients with depression and anxiety, and the implementation of the PICO(T) procedure. In this work, the identification of evidence sources, the role of key findings from research articles, and the importance of relevant findings will help to answer the research question.

Use of PICO (T) Approach When Caring for Patients with Depression

The practice issue is depression or anxiety, described as persistent despair or loss of interest in activities. It can also interfere with sleep and appetite. The symptoms also include tiredness and lack of attention. It has affected the more than 4 percent of the worldwide population which includes young and old persons. More then 200 million people have been affected by depression. It is not like ordinary emotional responses or mood swings in ordinary conditions. The frequent and intense depressions can cause severe health complications. Due to this affected person suffers and is not able to perform his/her best at work or in the family. In some severe cases, it also leads to death. More than half  a million leave this world thorugh suicide. Among individuals ranging from 14 to 30, suicide is one of the most highest cause of mortality deaths (Khubchandani et al., 2021).

NURSFPX 4030 Assessment 3: PICO (T) Questions and an Evidence-Based Approach

Nurses must have the skills and professional abilities to properly manage patients with depression issues. They also carry out interventions and activities to effectively treat obese patients.  Due to this the practice question that arises is: In patients with the problem of depression or anxiety (P), the use of integrated therapies (CBT along with drugs) (I) is more effective than utilizing a single intervention (C) for depression reduction (O) within 3 months (T). The identified intervention strategy is patient-centered care (PCC) which focuses more on the individual experience and understanding of his/her needs rather than the pure adoption of healthcare providers’ skills (Cardel et al., 2022). In this case, the first step is the identification and assessment of the patient’s information, demographics, daily activities, and nutrition. The intervention covers numerous therapies and treatments employed in the healthcare system by healthcare practitioners and nurses. 

Identification of Sources of Evidence

The Iowa Model Revised is an evidence-based practice to promote quality in healthcare was selected for solving the PICO(T) question. A team of nurses from the University of Iowa Hospital and Clinics and College of Nursing created this research model in 1994.

The first step is to identify the plausible reasons for change, the model identifies the possibilities for advancing excellence in healthcare through the use of an evidence-based approach. The purpose is clearly stated in the second step. To establish clear goals and assist the user stay focused, it is suggested that the question or purpose be articulated in a Population, Intervention, Comparison, Outcome (PICO) structure. The next step is to determine whether the problem is a high priority for the individuals affected. This may be perceived by the patients served or the organization involved. So if the problem is urgent, the user proceeds to the next step. The next step entails building a team. The team includes all the stakeholders who are involved in the practice change. The next step is to gather, evaluate, and synthesize the evidence. This step entails creating a protocol, implementing the plan, preparation of clinicians, and advocating adoption. If the change is suitable, it must be sustained by including stakeholders, linking the change into the workflow, and reevaluating as needed. Finally, the findings should be assessed and used to help others execute comparable practice changes within other institutions (Cullen et al., 2022).

NURSFPX 4030 Assessment 3: PICO (T) Questions and an Evidence-Based Approach

For relevant evidence, the databases that were used included, Google Scholar, CINAHL, Pubmed, the American Journal of Psychology, the Journal of Anxiety and Depression, and the European Journal of Depression. All the databases searched had a date limitation of articles published during the last five years. There were various rationales why the Iowa Model was chosen for advice in solving the PICO(T) question. The model is well known because it is simple and used for a wide range of project issues. The linear process with intermittent feedback was also compelling. This model was also picked since it was created by nurses, so most suited to use by nurses.

Findings from Articles

The nurses use Cognitive behavioral therapy intervention in this regard. CBT and enhanced mindfulness-based stress reduction (MBSR) have been discovered to help people with depression. Additionally, pharmaceutical treatments have also been demonstrated to be useful in treating anxiety and depression. However, in recent years, researchers have shown that both psychotherapies and pharmaceutical drugs are useful in treating depression. There are various versions of CBT because it is among the most effective treatments. Individual CBT and group CBT are the two forms of CBT (Karyotaki et al., 2021). CBT sessions are held between therapists and clients. Therapists attempt to focus on the client’s problems and assist the client in properly managing depression. A CBT session typically lasts 6 to 20 minutes (Reavell et al., 2018).

Capella 4030 Assessment 3

The Cuijpers et al. (2020) followed the randomized trials comparing psychotherapy and pharmacotherapy for the immediate or long-term treatment of depression. This research is related to the comparison of the combination of psychotherapy and pharmacotherapy to either one alone. They analyzed 101 trials totaling 11,910 patients. Treatment response (50% improvement between baseline and endpoint) was the primary outcome. Chronic and treatment-resistant depression, as well as baseline depression severity, were investigated as potential modifiers. In the network meta-analysis, combination treatment outperformed psychotherapy and pharmacotherapy alone in terms of obtaining a response at the end of treatment. There was no significant difference between counseling and medication alone. The findings were comparable for treatment-resistant depression and a combination of psychotherapy and medication appears to be the best option (Cuijpers et al., 2020).

There were 58 studies totaling 9,301 patients conducted by Cuijpers et al. (2021). They infer that when compared to care as usual (CAU), medication and psychotherapy seem to be equally helpful for treating depression. The results of the combination of psychotherapy and medication prove superior to using them alone. Primary care treatments must be structured in such a way that any of these therapies can be provided in response to patients’ choices and priorities (Cuijpers et al., 2021).

A total of 81 relevant studies (13,722 patients) were conducted by Furukawa et al. (2021). The vast network oof psychotherapies and treatments have been assessed by them to treat the issue of depression. The findings reveal that acute-phase psychotherapies outperformed protocolized pharmacotherapies, standard treatment, and pill placebo, even when not accompanied by maintenance psychotherapies (Furukawa et al., 2021).

Capella 4030 Assessment 3

A meta-analysis of Placebo-controlled and head-to-head trials of 16 antidepressants, seven psychotherapies, and five antidepressant and psychotherapy combinations was conducted by  Zhou et al. (2020). These studies were used for the serious treatment of children and adolescents having anxiety or depression problems by the utilization of standard criteria. Many treatments are available to treat the individuals with severe symptoms of depressions. However, research has found fluoxetine as good option for the treatment of depression symptoms. 

A meta-analysis of 93 studies was examined by Guidi & Fava, (2020). They assessed the pharmacotherapy responses with the help of antidepressant medications. The sequential strategy’s preventative value is based on the reduction of residual symptoms or a rise in psychological well-being. According to the findings of this revised systematic review and meta-analysis, successive provision of psychotherapy after the acute-phase medication, in combination with anti-depressant medication (ADM), was related to a lower risk of relapse and recurring in major depressive disorder (MDD) (Guidi & Fava, 2020).

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Relevance of Findings from Articles

Combining the approaches had proven to be more effective than employing them alone. The Cuijpers et al. (2020) was chosen as in the network meta-analysis, combination treatment outperformed psychotherapy and pharmacotherapy alone in terms of obtaining a response at the end of treatment. They successfully recommend counseling and medicine alone had no great difference on depression issues. A combo of psychotherapy and medicine acted to be the best option for individuals having depression problems.

The comparison of medication and psychotherapy with standard treatment was the reason to choose the study of Cuijpers et al. (2021) because it appear to be more effective in treating depression. The combined effects of psychotherapy and medication outperform their individual effects.

Similarly, the examination of a well-connected network of pharmacotherapies, psychotherapies, and their combinations for treating depressive issues was the reason behind selecting Furukawa et al. (2021). Their data showed that even when no maintenance psychotherapies were used, acute-phase psychotherapies outperformed protocolized pharmacotherapies, standard treatment, and pill placebo. Guidi & Fava, (2020) study was selected as it examined how people responded to acute-phase pharmacotherapy alone or in combination with antidepressant medication. The preventive value of the sequential strategy is based on the elimination of residual symptoms or an increase in psychological well-being.

The rationale for choosing  Zhou et al. (2020) is that they utilized established criteria to treat children and adolescents with anxiety or depression. They stated that many treatments are available to treat the individuals with severe symptoms of depressions. However, research has found fluoxetine as good option for the treatment of depression symptoms.  This study is the most credible and reliable source among all studies as this meta-analysis gives a detailed review of all treatments. 


For the management of patients with depression or anxiety problems, it is necessary to establish care techniques including CBT and pharmacotherapy approaches. By identifying sources of evidence, outlining the results, and demonstrating the relevance of those results, the PICO(T) framework was used to assess whether the CBT strategy and pharmacotherapy were more effective than using them alone.


Cuijpers, P., Noma, H., Karyotaki, E., Vinkers, C. H., Cipriani, A., & Furukawa, T. A. (2020). A network meta‐analysis of the effects of psychotherapies, pharmacotherapies, and their combination in the treatment of adult depression. World Psychiatry, 19(1), 92–107.

Cuijpers, P., Oud, M., Karyotaki, E., Noma, H., Quero, S., Cipriani, A., Arroll, B., & Furukawa, T. A. (2021). Psychologic treatment of depression compared with pharmacotherapy and combined treatment in primary care: A network meta-analysis. The Annals of Family Medicine, 19(3), 262–270.

Furukawa, T. A., Shinohara, K., Sahker, E., Karyotaki, E., Miguel, C., Ciharova, M., Bockting, C. L. H., Breedvelt, Josefien J. F., Tajika, A., Imai, H., Ostinelli, E. G., Sakata, M., Toyomoto, R., Kishimoto, S., Ito, M., Furukawa, Y., Cipriani, A., Hollon, S. D., & Cuijpers, P. (2021). Initial treatment choices to achieve sustained response in major depression: A systematic review and network meta‐analysis. World Psychiatry, 20(3), 387–396.

Guidi, J., & Fava, G. A. (2020). Sequential combination of pharmacotherapy and psychotherapy in major depressive disorder. Journal of the American Medical Association (JAMA) Psychiatry.

Karyotaki, E., Efthimiou, O., Miguel, C., Bermpohl, F. M. genannt, Furukawa, T. A., Cuijpers, P., & individual patient data meta-analyses for depression (IPDMA-DE) collaboration. (2021). Internet-based cognitive behavioral therapy for depression: A systematic review and individual patient data network meta-analysis. Journal of the American Medical Association (JAMA )Psychiatry.

Khubchandani, J., Sharma, S., Webb, F. J., Wiblishauser, M. J., & Bowman, S. L. (2021). Post-lockdown depression and anxiety in the USA during the COVID-19 pandemic. Journal of Public Health.

Reavell, J., Hopkinson, M., Clarkesmith, D., & Lane, D. A. (2018). Effectiveness of cognitive behavioral therapy for depression and anxiety in patients with cardiovascular disease. Psychosomatic Medicine, 80(8), 742–753.

Zhou, X., Teng, T., Zhang, Y., Del Giovane, C., Furukawa, T. A., Weisz, J. R., Li, X., Cuijpers, P., Coghill, D., Xiang, Y., Hetrick, S. E., Leucht, S., Qin, M., Barth, J., Ravindran, A. V., Yang, L., Curry, J., Fan, L., Silva, S. G., & Cipriani, A. (2020). Comparative efficacy and acceptability of antidepressants, psychotherapies, and their combination for acute treatment of children and adolescents with depressive disorder: a systematic review and network meta-analysis. The Lancet Psychiatry, 7(7), 581–601.

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