NURS FPX 4025 Assessment 3: Heart Failure and the PICO(T) Process
PICO(T) is a form of research method that produces concrete and pertinent evidence-based responses to clinical questions. It helps clinicians to incorporate the evidence-based practice (EBP) in their practice. In the case of PICO(T), P denotes patients, population or problem, I denote intervention, C refers to comparison or control, O denotes outcome and T denotes time, though not every case is applicable. Applying the PICO(T) process gives a guide to refine the search results in reducing the choice of evidence to be used in clinical cases. NURS FPX 4025 Assessment 3 will employ the PICO(T) methodology to formulate a research question about the issue of heart failure and apply the research to answer the question.
Heart Failure
Heart failure is a long-acting illness that is experienced by numerous individuals in the world, a condition that can be explored using PICO(T) in clinical decision making. HF is linked with low-quality of life, high rates of hospitalization, and unfavorable mortality, in general. Approximately 6 million Americans have HF currently, just in the United States (Roger & Clinic, 2021). HF occurs amid severe illness where the cardiac output is unable to satisfy the body functional requirements. The American Heart Association (AHA) reports that factors that increase the risk of acquiring HF are previous tobacco consumption, high blood pressure, obesity, raised cholesterol, and an absence of exercises (AHA, 2025), which can be analyzed using the PICO(T) framework in nursing. Although all these are risk factors thought to be modifiable, the risk factors may also be genetic such as history of a previous myocardial infarction, birth defects, and cardiomyopathy (AHA, 2025), which is addressed in NURS FPX 4025 Assessment 3.
The harmful potential of HF consists of the reduction of quality of life, cardiac cachexia, arrhythmia, sudden cardiovascular death, increased frequency of hospitalization, and thrombosis (Malik & Chhabra, 2023). Also, although the disease is not new and it attracts significant interest of the medical society, HF patients still have a high mortality, even today. There is an estimation that the current five-year survival rates of patients with newly diagnosed HF can reach approximately 50 per cent (Roger & Clinic, 2021), a statistic that can be explored using the PICO model for research. Such complications and consequences may be even more severe concerning historically marginalized groups. More often than not, such populations fail to access adequate healthcare, which takes a toll on their general well-being, a concern that can be addressed through nursing research PICO questions. The most prevalent population affected with HF is the black population, coming after Hispanic population (Bozkurt et al., 2023). Such populations are more vulnerable to cardiac risk factors of HF in relation to white people and may be connected to the presence of systemic racism and inequalities of social determinants of health (Bozkurt et al., 2023). Black and Hispanic citizens face a higher risk of developing complications of HF and concerning outcomes in general due to the aforementioned healthcare disadvantages, an issue highlighted in NURS FPX 4025 Assessment 3.
PICOT Question
Readmission is a common event in a patient with HF. Approximately one in four patients with HF who has been discharged following hospitalization readmitted within 30 days of any process (Oskouie et al., 2024). Hospitalizations of HF patients negatively impact their quality of life and add to the burden on the healthcare system, incurring approximately 11 billion U.S. dollars annually in the United States (Bozkurt et al., 2023), an issue highlighted in NURS FPX 4025 Assessment 3. To help HF patients who are increasingly being re-admitted, a PICO(T)
question was formulated using an evidence-based practice PICO example. In HF patients, what is the impact of the integration of telehealth visitations on the rate of readmission when contrasted with usual care in a period of one year? The population that is addressed in this question has HF patients. The intervention will be the introduction of telehealth visits post-discharge in the hospital, and this intervention will be compared to no intervention, following the PICO model for research. The outcome is the Readmission rates of HF patients who have had the intervention. And the last is the timeframe within which the data collection will be done, a period of a year.
Research Process
During the process of investigating the evidence to answer the above PICO(T) question, various databases and key words were applied. The databases used were CINAHL complete, proquest nursing databases and Pub-med central. As the search proceeded, filters were used so that only results within the last five years, peer-reviewed, and the English language could be used. Keywords used were, “heart failure,” “readmissions,” and “telehealth.” During the search, the words e-health and telemedicine were also included as keywords so that further refinement of the results could be done. The nature of the study conducted was also taken into consideration, to find the best evidence to be applied in PICO(T) in clinical decision making. The study focused on systematic reviews and meta-analyses. All evidence sources were evaluated for credibility and relevance to improve HF patient readmission rates, a topic addressed in NURS FPX 4025 Assessment 3. One of the sources that was considered is a systematic review of randomized controlled trials (RCTs) that examined the introduction of remote monitoring as a means to decrease readmission incidences in cases of HF and/or chronic obstructive pulmonary disease (Stergiopoulos et al., 2024), serving as an evidence-based practice PICO example. The
telemonitoring strategies comprised the remote measurements of blood pressure, oxygen saturation, weight, and heart rate (Stergiopoulos et al., 2024). Of the reviewed studies by Stergiopoulos and colleagues, it was identified that 67% of the RCTs of patient with HF indicated that telemonitoring had no significant effect on readmission rate (Stergiopoulos et al., 2024). The article, published in PubMed Central in 2024, was in a peer-reviewed, cross-disciplinary journal called Frontiers in Digital Health. They are credible authors since they are medical doctors either in the Mayo Clinic or Johns Hopkins. This systematic review focuses on the same patient population, outcome, and intervention as the proposed PICO(T) question: the reduction of readmission rates of HF patients using telemedicine as an intervention, a topic highlighted in NURS FPX 4025 Assessment 3.
The other evidence chosen was a systematic review and a meta-analysis research study that sought to identify the effects of mobile health applications on the outcomes of patients with HF (Ni et al., 2024), which can be applied in PICO(T) in clinical decision making. Hospitalization rates were one of the outcomes that we discussed in this review. The mobile application contained reminders, recorded reporting of symptoms and vital signs, educational information, recommendations based on the patient, telehealth visits and access to social support (Ni et al., 2024). Results of the study carried out indicate that the application of mobile apps can improve patient-provider interaction and self-management of the disease and result in a decrease in the number of hospitalizations and a subsequent increase in the quality of life of patients with HF (Ni et al., 2024), illustrating the use of the PICO model for research. The article was published in the Journal of Nursing Management, which is a peer-reviewed scholarly journal in 2024. It was identified on the CINAHL Complete database. Ni and authors belong to the department of the West China Hospital-Cardiology. The review, a meta-analysis and a systematic
analysis done by Ramtin and colleagues (2023), were conducted to assess and synthesize data to conclude whether the implementation of distance education was connected to the readmission of patients with heart failure (HF), serving as an evidence-based practice PICO example. The distance education in this work means education through telephone conversations or video calls, text messages, telemonitoring with an individual education plan, mobile application, and print booklets with hard copies (Ramtin et al., 2023), which is addressed in NURS FPX 4025 Assessment 3. The authors established through this systematic review and meta-analysis that telehealth, as well as other distance education systems and practices, likely decrease readmission in HF patients (Ramtin et al., 2023). ProQuest ion Nursing Databases were used to locate this study. The article was first published in Nursing Open, a peer-reviewed and open-access journal by John Wiley & Sons, Inc., a popular publisher of scholarly works. Along with this, the study published in 2023 is solely focused on readmission rates of HF patients, and therefore, it could be considered relevant to the diagnosis and problem under review, which can be applied in PICO(T) in clinical decision making.
The evidence above is useful in answering the posed PICO(T) question as follows: In HF patients, what is the impact of the implementation of telehealth visits on hospital readmission rates compared to usual care over 12 months? As one of the sources of evidence, it is possible to note that the telehealth logic of telemonitoring was not statistically significant when used to reduce the rehospitalization rate in patients with HF (Stergiopoulos et al., 2024), a finding that can be examined using the PICO(T) framework in nursing. Although telemonitoring was shown to be insignificant in reducing readmission rates, other forms of telehealth interventions may achieve similar results, an issue highlighted in NURS FPX 4025 Assessment 3. In a systematic review and meta-analysis conducted by Ni and colleagues (2024), it was found that
upon the implementation of a mobile health application wherein patients can monitor their symptoms, report their vital signs, schedule telehealth visits with providers, and have the ability to access educational resources, there was a general reduction in hospitalization of HF patients. The other systematic review and meta-analysis conducted by Ramtin and colleagues (2023) revealed the positive effect of distance education on the reduction of readmissions of HF patients, demonstrating the application of the PICO model for research. The article by Ni and colleagues (2024) corroborates the study by Ramtin and colleagues (2023) because they both concluded that distance education, such as the use of mobile applications and access to the telehealth phone calls and video visits, decreased rehospitalization in patients with HF. Based on the presented evidence, telehealth appears capable of reducing hospital readmissions compared to not using telehealth modalities, a topic explored in NURS FPX 4025 Assessment 3.Telemonitoring proved to be insignificant to a great extent (Stergiopoulos et al., 2024). Nonetheless, mobile health apps and remote learning tools may help improve the overall hospitalization readmission in people with HF (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
Oskouie, S., Pandey, A., Sauer, A. J., Greene, S. J., Mullens, W., Khan, M. S., Quinn, K. L., Ho, J. E., Albert, N. M., & Van Spall, H. G. (2024). From hospital to home: Evidence-based care for worsening heart failure. JACC. Advances, 3(9), 101131. https://doiorg.library.capella.edu/10.1016/j.jacadv.2024.101131
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
