Capella FPX 4025 Assessment 4

Name

Capella University

NURS-FPX4025 Research and Evidence-Based Decision Making

Prof. Name

Date

Presenting Your PICO(T) Process Findings to Your Professional Peers

Urinary tract infections (UTIs) are a prevalent health concern causing significant discomfort and healthcare visits among women. Common symptoms involve urinary urgency, frequency, painful urination, and suprapubic pain. In the United States, it is estimated that approximately 41% of women will experience a UTI in their lifetime, with around 10% encountering one each year (Bono et al., 2025). Recurring infections not only impair quality of life but also increase healthcare demands. This discussion centers on the application of evidence-based prophylactic antibiotic therapy to manage recurrent UTIs in women of reproductive age, examining updated findings on strategies designed to enhance clinical outcomes.

Diagnosis: Prognosis, Potential Risks, and Associated Complications

In adult women, UTIs present a persistent health issue, often challenging the immune system’s ability to ward off repeat infections. Consequences can escalate to complications such as kidney damage or sepsis. Symptoms typically include urgency, painful urination, and occasionally fever or flank pain in severe episodes (Bono et al., 2025). Frequent hospital readmissions are a notable risk for those suffering from recurrent UTIs, often linked to delayed recovery and complications like fluid retention.

The recurrence rate remains high, with nearly half of affected women developing another UTI within a year, especially among those aged 16 to 35 (Bono et al., 2025). UTIs contribute notably to healthcare burdens, accounting for 10 million outpatient appointments and 2 million emergency visits annually in the U.S., with an estimated expenditure of \$1.6 billion (Wang & LaSala, 2021).

Additionally, comorbid conditions such as diabetes, chronic kidney disease (CKD), and neurological impairments increase the likelihood of recurrent UTIs. A Kaplan-Meier analysis identified that patients with diabetes, CKD, or frailty indicators per the FRAIL scale were significantly more susceptible to developing UTIs (p < 0.001). A Cox regression model revealed that individuals exhibiting one, two, or three or more FRAIL elements had progressively higher risks — 19%, 24%, and 43% respectively — compared to those without frailty, with risk increasing by 11% for each additional FRAIL factor (Chao et al., 2021).

Additional risk factors include postmenopausal hormonal shifts, incomplete bladder emptying, and urinary incontinence, with prevalence rates of 4.5% for those aged 16–50, 15% for ages 51–70, and 22% in individuals over 70. Patients with type 2 diabetes face heightened UTI risks due to increased bacterial susceptibility within the urinary tract. The anticipated incidence rate for T2D stands at 6,058 per 10,000 individuals, emphasizing its clinical relevance (Bodke et al., 2023). Clinicians should remain vigilant for atypical presentations of UTIs in diabetic patients, promoting timely diagnosis and intervention. Psychosocial challenges, including cognitive decline, depression, and limited healthcare access, also increase vulnerability to unmanaged infections. Chronic outcomes of recurrent UTIs may involve pyelonephritis, antimicrobial resistance, and frequent hospital admissions (Bodke et al., 2023). Early recognition, patient education, and preventive interventions, including prophylactic antibiotics, are fundamental for minimizing complications (Alghoraibi et al., 2023).

Formulating the Research Question

To address recurrent UTIs in adult women, the following PICO(T) question was crafted: In adult females with recurrent urinary tract infections (P), how does daily prophylactic antibiotic therapy (I) compared to no prophylaxis or standard care without preventive measures (C) affect recurrence rates and patient outcomes (O) over a 12-month period (T)?

The PICO(T) components are as follows:

• Population (P): Adult women experiencing recurrent UTIs.
• Intervention (I): Daily administration of prophylactic antibiotics.
• Comparison (C): No preventive antibiotics or standard symptomatic care.
• Outcome (O): Decreased recurrence rates and improved health outcomes.
• Timeframe (T): 12 months.

This question is structured to assess how preventive antibiotics might reduce infection recurrence and improve overall patient well-being, rather than solely managing episodes reactively (Luchristt et al., 2024).

Summary of Evidence from Peer-Reviewed Sources

An extensive literature review was performed using databases such as PubMed, CINAHL, the Cochrane Library, and Google Scholar, with articles evaluated through the CRAAP test to ensure quality and relevance (Kalidas, 2021). Four peer-reviewed articles were chosen to assess prophylactic antibiotic use for recurrent UTIs.

A systematic review by Luchristt et al. (2024) found that a one-month course of antibiotics was more effective in reducing UTI recurrence over 12 months than longer, lower-dose regimens. Published in Urology, the study confirms the value of proactive, short-term antibiotic therapy for recurrent UTI management.

Alghoraibi et al. (2023) conducted a study involving 477 adults, of whom 227 experienced recurrent infections. Continuous prophylaxis, primarily using Nitrofurantoin, Bactrim, or amoxicillin-clavulanic acid, was prescribed to 55% of participants. Bactrim was favored for younger or post-transplant patients, while Nitrofurantoin was common for those with neurogenic bladder or limited mobility. Their results demonstrated significant reductions in infection recurrence, emergency visits, and hospital admissions (P < 0.001).

The American Urological Association (AUA, 2025) guidelines also advocate prophylactic antibiotic use for women with frequent UTIs, reinforcing its position in evidence-based urological care.

Additionally, Liu et al. (2020) reviewed eight randomized controlled trials, concluding that prophylactic antibiotics following urinary catheter removal (within 14 days) lowered infection risks, with a pooled risk ratio of 0.47. The greatest benefits were noted in older patients, those with extended catheter use, and individuals treated with trimethoprim/sulfamethoxazole. This meta-analysis, published in American Journal of Infection Control, underscores the cautious but strategic use of antibiotics in high-risk populations.

Evidence-Based Response to the PICO(T) Question

Collectively, these studies support the proposed PICO(T) inquiry, revealing that prophylactic antibiotics yield superior outcomes compared to no preventive treatment in women with recurrent UTIs. Persistent infections lead to chronic symptoms and frequent healthcare engagements, while preventive strategies like daily antibiotics reduce recurrence and emergency care requirements (Luchristt et al., 2024). Liu et al. (2020) similarly confirmed the protective effect of continuous antibiotic use. Future investigations should address patient adherence, healthcare access, mental health variables, and individualized care models to optimize management for recurrent UTI cases.

Essential Care Steps Guided by Evidence-Based Recommendations

Evidence-informed strategies play a crucial role in managing recurrent UTIs. Care begins with comprehensive clinical assessments to determine infection patterns and severity. This facilitates personalized treatment planning, including the initiation of prophylactic antibiotics for suitable candidates, effectively reducing infection frequency (Alghoraibi et al., 2023).

The next priority involves applying proven interventions such as low-dose, daily antibiotic regimens, shown to minimize recurrence rates and decrease emergency healthcare utilization. Concurrently, educating patients on self-care behaviors—including adequate hydration, symptom monitoring, and medication adherence—empowers them to manage their health proactively (AUA, 2025). These combined efforts not only reduce infection rates but also enhance quality of life and reduce hospital dependency.

Conclusion

This review emphasizes the importance of applying evidence-based prophylactic antibiotic therapies for adult women with recurrent UTIs. Current research validates the effectiveness of preventive antibiotics in lowering infection recurrence rates, reducing healthcare costs, and improving patient experiences. Adopting these measures allows healthcare professionals to minimize infection episodes, reduce hospital visits, and elevate patients’ quality of life.

References

Alghoraibi, Asidan, A., Aljawaied, Almukhayzim, Alsaydan, Alamer, Baharoon, Masuadi, Shukairi, Layqah, L., & Baharoon. (2023). Recurrent urinary tract infection in adult patients, risk factors, and efficacy of low dose prophylactic antibiotics therapy. Journal of Epidemiology and Global Health, 13(2), 200–211. https://doi.org/10.1007/s44197-023-00105-4

American Urological Association. (2025). Recurrent Uncomplicated Urinary Tract Infections in Women: AUA/CUA/SUFU Guideline (2022) – American Urological Association. Www.auanet.org. https://www.auanet.org/guidelines-and-quality/guidelines/recurrent-uti

Capella FPX 4025 Assessment 4

Bodke, H., Wagh, V., & Kakar, G. (2023). Diabetes mellitus and prevalence of other comorbid conditions: A systematic review. Cureus, 15(11), e49374. https://doi.org/10.7759/cureus.49374

Bono, M. J., Reygaert, W. C., & Leslie, S. W. (2025). Uncomplicated urinary tract infections. National Library of Medicine; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK470195/

Chao, C.-T., Lee, S.-Y., Wang, J., Chien, K.-L., & Huang, J.-W. (2021). Frailty increases the risk for developing urinary tract infection among 79,887 patients with diabetic mellitus and chronic kidney disease. BMC Geriatrics, 21(1), 1–12. https://doi.org/10.1186/s12877-021-02299-3

Kalidas, E. A. J. (2021). The effectiveness of CRAAP test in evaluating credibility of sources. International Journal of TESOL & Education, 1(2), 1-14. https://www.i-jte.org/index.php/journal/article/view/25

Liu, L., Jian, Z., Li, H., & Wang, K. (2020). Antibiotic prophylaxis after extraction of urinary catheter prevents urinary tract infections: A systematic review and meta-analysis. American Journal of Infection Control, 49(2), 247–254. https://doi.org/10.1016/j.ajic.2020.07.034

Capella FPX 4025 Assessment 4

Luchristt, D., Siddiqui, N. Y., Bruton, Y., & Visco, A. G. (2024). Extended treatment-dose antibiotic therapy versus low-dose prophylaxis for the management of recurrent uncomplicated urinary tract infections in peri- and postmenopausal women. Urology, 198, 29–35. https://doi.org/10.1016/j.urology.2024.12.029

Wang, R., & LaSala, C. (2021). Role of antibiotic resistance in urinary tract infection management: A cost-effectiveness analysis. American Journal of Obstetrics and Gynecology, 225(5), 550.e1–550.e10. https://doi.org/10.1016/j.ajog.2021.08.014

Capella FPX 4025 Assessment 3

Name

Capella University

NURS-FPX4025 Research and Evidence-Based Decision Making

Prof. Name

Date

Applying the PICO(T) Process

Acute Heart Failure (AHF) continues to be a major cause of death globally. Its impact steadily increases in developed nations like the United States. Around one million new HF patients are identified annually across the country (Heidenreich et al., 2022). Optimal management of AHF is vital for improving patient prognosis and reducing costs. This paper examines diuretic resistance and investigates evidence-based fluid management interventions in AHF patients. It draws on current research findings to evaluate their relevance and potential benefits in clinical settings.

Explaining a Diagnosis

AHF is a life-threatening condition that impacts patients’ quality of life. Common indicators such as limited physical strength, tiredness, breathlessness and fluid deposit contribute to recurrent hospital visits and diminished quality of life. Key risks tied to AHF include excessive fluid retention, pulmonary congestion and irregular heart rhythms. It can develop into acute decompensated heart failure (ADHF). It is a critical state requiring intensive monitoring and specialized cardiovascular support. AHF is a leading contributor to mortality in the United States. It accounts for over 380,000 deaths annually (Savarese et al., 2022).

Vulnerable populations like older adults are at increased risk from age-related diseases, multiple medications and decreased physical resistance. Health inequities are more distinct among racial and ethnic minorities. African Americans have higher hospitalization and mortality rates due to AHF. It is linked to healthcare access barriers, poverty and variability in care strategies (Mwansa et al., 2021). Financial uncertainty makes outcomes more problematic. Low-income people are more likely to face diagnostic delays and limited services. These biases amplify the burden of AHF. It underlines the need for equitable care plans prioritizing access to vital health resources.

PICO(T) Research Question

The PICO(T) research question developed for AHF management is: In patients with acute heart failure (AHF) who experience diuretic resistance (P), how does the use of evidence-based fluid management interventions (I) compared to standard diuretic therapy (C) affect fluid retention and patient outcomes (O) over 12 weeks (T)? 

This query meets the PICO(T) standards as follows:

• • P (Population/Problem): The population in this research question is patients with AHF. This group faces challenges such as diuretic resistance. It makes it difficult to prevent decompensation and rehospitalization.

• I (Intervention): The intervention being explored involves using evidence-based fluid management strategies. This approach focuses on the patient’s clinical status rather than a one-size-fits-all diuretic regimen.

• C (Comparison): This question compares standard diuretic therapy with the standard management approach for preventing fluid overload and improving AHF outcomes.
• O (Outcome): The measured outcomes are fluid retention and patient outcomes. These indicators of AHF management success reflect clinical outcomes and patient well-being.
• T (Time): The time frame for this query is over 12 weeks, sufficient to evaluate the effects of evidence-based fluid management interventions on patient outcomes.

This PICO(T) query helps focus the research on assessing the efficiency of use of evidence-based fluid management interventions compared to standard diuretic therapy in improving outcomes for patients with AHF who experience diuretic resistance.

Literature Search

A systematic literature review was done to obtain information regarding adopting evidence-based fluid management techniques in AHF patients. Some peer-reviewed scholarly databases such as PubMed, CINAHL, the Cochrane Library and Google Scholar were searched to determine access to most peer-reviewed and credible sources. The initial search strategy involved the utilization of targeted search words such as “acute heart failure,” “management of fluid overload,” “diuretic resistance,” “routine diuretic therapy,” “evidence-based fluid therapy,” and “chronic heart failure management.” Boolean terms (AND, OR) were used to enhance the specificity of search outcomes. This strategy was to identify studies comparing traditional diuretic treatment with fluid management strategies in AHF patients who exhibit resistance to conventional diuretic treatment.

The legitimacy of the evidence gathered was determined through the CRAAP approach. It examines Currency, Relevance, Authority, Accuracy and Purpose to assess the validity of sources. Peer-reviewed journal articles, reviews and meta-analyses from the last five years were prioritized to guarantee incorporating the most recent evidence. Data from well-established administrations like the American Heart Association (AHA) was emphasized for clinical significance (AHA, 2021). Filters were applied to limit the search to full-text articles, English-language journals and adult patient studies with AHF. The literature search initially included general AHF management. Integrating more specific terms such as “evidence-based fluid management” and “effect of fluid control on AHF outcomes. The search was narrowed to obtain the most relevant studies to answer the research question. This focused strategy protected the application of the most pertinent and applicable evidence to guide best practices in fluid regulation in AHF.

Relevant Articles

During the search for suggestions on evidence-based fluid therapy in AHF, various quality sources were consulted to address the intricacies of fluid management interventions and their impact on patient outcomes in diuretic-resistant scenarios. Among the sources of interest was a systematic review by Rahman et al. (2020). It was published in a quality journal. In the review, mechanical fluid removal methods were addressed. The study emphasized evidence-based fluid management interventions. Peritoneal dialysis and paracentesis are included as potential fluid management measures in AHF.

It was considered highly credible due to the thorough literature review in a prestigious cardiology journal. Wobbe et al.’s (2020) meta-analysis was another source, where ultrafiltration (UF) therapy was evaluated in patients with AHF. The review stressed the efficacy of UF in maximizing fluid removal. It improves weight loss and reduces rehospitalization. UF treatment was compared to standard diuretic therapy through randomized controlled trials. This trial applies to the research question. It discussed the effect of fluid management on patient quality of life and compliance with standard diuretic therapy. Its credibility was supported by publication in Heart Failure Reviews and the authors’ credibility in cardiology.

The third source is a clinical guideline by the European Society of Cardiology (ESC). It issued evidence-based endorsements for sodium and fluid therapy in AHF (ESC, 2021). ESC guidelines are generally accepted as the pillars of heart failure treatment. It gives credibility and relevance to this source in determining current clinical practice. A systematic review by Stachteas et al. (2024) assessed sodium-glucose co-transporter-2 (SGLT-2) inhibitors as a potential therapy for diuretic resistance in AHF. The review examined medical evidence regarding the effects of SGLT-2 inhibitors on managing fluid levels, alleviating symptoms and enhancing health outcomes. The authors evaluated their safety profile and adverse effects in AHF. This review of observational studies was highly credible due to its rigorous methodology in a respected journal. These sources offered a broad and current understanding of fluid management in AHF. 

Analyzing Evidence

The data for the PICO(T) query is that fluid management strategies have improved prognosis versus a restrictive fluid strategy in patients with diuretic resistance. Rahman et al. (2020) studied that restrictive fluid therapy in AHF patients leads to malnutrition, dehydration and worsening quality of life. They highlight the importance of evidence-based mechanical fluid removal methods such as peritoneal dialysis and paracentesis in managing fluid overload in AHF. Wobbe et al. (2020) confirmed that UF therapy enhances fluid removal and reduces rehospitalization compared to standard diuretic therapy.

ESC (2021) strategies adopt this practice by encouraging adaptable sodium and fluid management in AHF. Stachteas et al. (2024) discoursed the therapeutic potential of SGLT-2 inhibitors over diuretic resistance in AHF. It summarizes their effects on fluid balance, clinical outcomes, and safety issues. These sources indicate more modified approaches. The review states that mechanical fluid removal and UF therapy are integrated into daily clinical practice across healthcare settings. The assumption is that proper training and facilities are available for healthcare professionals to implement these evidence-based therapies. It safeguards effective implementation and compliance in AHF patient care.

Conclusion

The evidence favoring the employment of evidence-based fluid management strategies over conventional diuretic therapy in AHF and diuretic-resistant patients is strong. Research shows that tailored fluid management techniques. It includes ultrafiltration, mechanical fluid removal techniques and SGLT-2 inhibitor use, benefiting patient outcomes, decreasing rehospitalization rates and improving quality of life. These strategies concur with existing clinical guidelines and the value of individualized interventions to control fluid overload appropriately. Utilizing these approaches, in conjunction with necessary training and resources for healthcare providers has significant potential to maximize treatment and alleviate AHF burdens.

References

AHA. (2021). Heart failure. Www.heart.org. https://www.heart.org/en/health-topics/heart-failure 

ESC. (2021, August 25). 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Escardio.org. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Acute-and-Chronic-Heart-Failure 

Heidenreich, P. A., Fonarow, G. C., Opsha, Y., Sandhu, A. T., Sweitzer, N. K., & Warraich, H. J. (2022). Economic issues in heart failure in the United States. Journal of Cardiac Failure, 0(0), 453–466. https://doi.org/10.1016/j.cardfail.2021.12.017

Mwansa, H., Lewsey, S., Mazimba, S., & Breathett, K. (2021). Racial/ethnic and gender disparities in heart failure with reduced ejection fraction. Current Heart Failure Reports, 18(2), 41–51. https://doi.org/10.1007/s11897-021-00502-5

Capella FPX 4025 Assessment 3

Rahman, R., Paz, P., Elmassry, M., Mantilla, B., Dobbe, L., Shurmur, S., & Nugent, K. (2020). Diuretic resistance in heart failure. Cardiology in Review, Publish Ahead of Print(2), 73–81. https://doi.org/10.1097/crd.0000000000000310

Savarese, G., Becher, P. M., Lund, L. H., Seferovic, P., Rosano, G. M. C., & Coats, A. J. S. (2022). Global burden of heart failure: A comprehensive and updated review of epidemiology. Cardiovascular Research, 118(17). https://doi.org/10.1093/cvr/cvac013  

Stachteas, Nasoufidou, Patoulias, Karakasis, Karagiannidis, Mourtzos, & Samaras, A. (2024). The role of Sodium-Glucose Co-Transporter-2 inhibitors on diuretic resistance in heart failure. International Journal of Molecular Sciences, 25(6), 3122–3122. https://doi.org/10.3390/ijms25063122

Wobbe, B., Wagner, J., Szabó, Rostás, Farkas, N., Garami, Balaskó, Hartmann, P., Solymár, M., Tenk, Ottóffy, Nagy, A., Habon, T., Hegyi, P., & Czopf. (2020). Ultrafiltration is better than diuretic therapy for volume-overloaded acute heart failure patients: A meta-analysis. Heart Failure Reviews, 26(3), 577–585. https://doi.org/10.1007/s10741-020-10057-7

Capella FPX 4025 Assessment 2

Name

Capella University

NURS-FPX4025 Research and Evidence-Based Decision Making

Prof. Name

Date

Applying an EBP Model

Chronic Obstructive Pulmonary Disease (COPD) is a long-lasting illness that narrows the airways. It can cause long-term complications, including shortness of breath. The patient suffers from a chronic cough and frequent respiratory exacerbations. The World Health Organization (WHO) reports that COPD is a worldwide health problem. Statistics project it as a leading cause of illness and mortality (WHO, 2024).

This article examines how an Evidence-Based Practice (EBP) approach can address a critical aspect of COPD treatment. It highlights its role in enhancing patient outcomes through evidence-based clinical decision-making. This EBP project is intended for an inpatient pulmonary rehabilitation unit where patients with recurrent or severe COPD exacerbations undergo intensive therapy. The interventions primarily focus on prescribers. They determine the inhaler treatments and optimize treatment regimens. Nursing professionals are responsible for providing patient education and monitoring adherence.

Issue Associated with the Diagnosis

COPD is the main reason of demise globally. It resulted in 3.6 million deaths in 2021, accounting for almost 5% of all worldwide mortality. A majority of those aged under 70 who die with COPD are from low- and middle-income countries (LMICs). More than 70% of COPD deaths in developed countries are due to smoking (WHO, 2024). A comparative analysis evaluated the efficacy and safety of Breztri Aerosphere (budesonide-glycopyrrolate-formoterol), a twice-daily metered-dose inhaler, and Trelegy Ellipta (fluticasone-umeclidinium-vilanterol), a once-daily dry-powder inhaler, in patients with COPD treated in routine clinical practice. The research highlights the dilemma of selecting an effective inhaler for patients with COPD.

Breztri Aerosphere raises exacerbation rates. Both inhalers pose an equal threat of pneumonia. It is an important safety factor for patients with COPD. Integrating an EBP framework safeguards that treatment decisions reflect the latest research. It optimizes safety and outcomes while minimizing risks. Feldman et al. (2024) compared the efficacy and safety of Breztri with Trelegy Ellipta in patients with COPD. Breztri was linked with a greater risk of COPD complications but showed no difference in pneumonia risk. It is given a higher risk of exacerbation and environmental impact. Trelegy Ellipta is beneficial as it reduces the risk of COPD exacerbations without increasing the risk of pneumonia. An EBP ensures they receive a safer inhaler, reducing COPD exacerbations. Real-world data analysis enables the personalization of treatment decisions. It is leading to improved outcomes (Feldman et al., 2025).

EBP Model and Its Steps

The Iowa Model of EBP offers a systematic approach to managing recurrent COPD exacerbations. The framework empowers staff with a process for identifying clinical problems. It chooses interventions based on solid research and evaluates their effectiveness (Dusin et al., 2023). By integrating research findings with organizational priorities and patient care, the Iowa Model safeguards that clinical choices align with current evidence. It is well-suited to address the increased risk of exacerbation associated with Breztri. It creates change by identifying a particular issue. The model encourages building a team. It involves gathering and analyzing relevant data, piloting practice changes and evaluating the outcomes of those changes. With the complex nature of COPD care, the Iowa Model serves as a guide for addressing clinical issues and driving long-term practice advancement. Its stepwise nature allows for the integration of EBP. It enables sustained improvement in patient care.

The link between frequent COPD exacerbations and budesonide-glycopyrrolate-formoterol was identified through clinical assessment and patient data analysis. Findings revealed that Breztri was associated with a higher rate of flare-ups without offering any advantages over Trelegy. To resolve this dilemma, an interdisciplinary team comprising pulmonologists, respiratory therapists, pharmacists, and nurse practitioners was formed to explore alternative therapeutic modalities. It is designed to support patient education and institute evidence-based interventions to facilitate better management of COPD.

Literature highlights the effectiveness of working teams in minimizing exacerbations, enhancing medication compliance, and developing individualized therapy plans based on current clinical recommendations (Tandan et al., 2024). A comprehensive critical assessment of peer-reviewed literature was done. It addresses comparative effectiveness of inhaler therapy, strategies to prevent COPD exacerbations and ways to improve patient adherence. The most important interventions were chosen, and these are individualized inhaler instruction, tracking of adherence and tailored pharmacologic therapy.

A real-world, quantitative study employing a new-user cohort design was initiated in patients with COPD to assess the effect of switching from Breztri to Trelegy Ellipta on the rate of exacerbations, symptom improvement, and drug persistence. Patient outcomes were monitored through exacerbation rates, hospitalization due to pneumonia during treatment and treatment adherence to determine real-world efficacy between Breztri Aerosphere and Trelegy Ellipta. Since the cohort study yielded positive results, the new care strategy was incorporated into routine clinical practice, accompanied by monitoring and provider education to ensure its ongoing success. The Iowa Model was an ideal framework for this endeavor. It provides a structured approach to managing COPD exacerbations, fostering interdisciplinary collaboration and optimizing care strategies.

Application of the Model to Evidence Search

The Iowa Model outline was utilized to investigate the relative efficacy of Breztri Aerosphere and Trelegy Ellipta in minimizing COPD exacerbations. It enhances symptom management and improves patient adherence. The issue-driven trigger emerged through an analysis of clinical outcomes in a new-user cohort investigation leveraging longitudinal commercial US claims data. This evaluation showed that Breztri Aerosphere and Trelegy Ellipta were associated with an increased risk of COPD exacerbations, without demonstrating greater efficacy than Trelegy Ellipta.

It indicates the need for EBP prescribing practices. In response to this issue, a multidisciplinary team was convened to assess intervention strategies. The PICOT (Patient, Intervention, Comparison, Outcome) format was utilized to create a defined research question. In patients with COPD (P), how does Breztri Aerosphere (I), compared to Trelegy Ellipta (C), affect COPD exacerbation frequency (O) over six months (T)? The mnemonic device facilitates the modification of targeted research questions and guides systematic evidence searches by identifying key components (Howe et al., 2024). 

A literature examination was conducted using records such as PubMed, CINAHL, and the Cochrane Library. The exploration strategy integrated specific expressions. It includes “COPD,” “Single Inhaler Triple Therapy (SITT),” “Budesonide-Glycopyrrolate-Formoterol,” “Fluticasone-Umeclidinium-Vilanterol,” “COPD Exacerbation,” and “pneumonia risk.” This methodical approach led to the identification of quality clinical practice guidelines and systematic reviews. However, several challenges emerged during the search process. Two primary obstacles involved establishing rigorous quality control criteria for study selection and ensuring that the retrieved evidence applied to COPD patient populations. 

Credibility and Relevance of Resources

Three key resources were identified to support evidence-based decision-making: peer-reviewed comparative studies on Breztri Aerosphere and Trelegy Ellipta as well as clinical guidelines for managing COPD. Duan et al. (2023) explore and compare the efficacy of Breztri Aerosphere with triple therapy using Trelegy Ellipta in the treatment of COPD. The FULFIL trial found that triple therapy reduces moderate to severe exacerbations, delays lung function decline and improves symptoms of COPD compared to Breztri Aerosphere therapy. Trelegy Ellipta provides better clinical outcomes than Breztri Aerosphere. The second study, by Feldman et al. (2024), compared the efficacy and safety of Breztri with those of Trelegy Ellipta in patients with COPD.

Breztri was linked with a greater hazard of COPD complications but showed no difference in pneumonia risk, given its higher risk of exacerbation. The study’s credibility is strengthened, as it is published in the British Medical Journal (BMJ), a peer-reviewed, high-impact journal. Its use of real-world clinical data enhances generalizability. It makes it highly applicable to everyday practice. The last study by Wang and Lin (2024), examine Breztri Aerosphere and Trelegy Ellipta in triple therapy for COPD, focusing on exacerbation reduction, pneumonia risk, and clinical outcomes. Budesonide is associated with a lower risk of pneumonia, while fluticasone provides slightly better symptom control.

Budesonide can be safer in terms of pneumonia risk, whereas fluticasone offers better symptom relief. Each resource was critically assessed using the CRAAP criteria (Currency, Relevance, Authority, Accuracy, and Purpose) to guarantee validity. All studies were recent, peer-reviewed and published by authoritative sources. It enhances their reliability. Their direct focus on COPD exacerbation care made them superior to lower-tier evidence. It reinforces the team’s role in guiding clinical decision-making.

Conclusion

The Iowa Model of EBP provides a framework for addressing COPD exacerbations by integrating research findings into clinical decision-making. This paper highlights the importance of selecting appropriate inhaler therapy based on evidence. It demonstrates that Trelegy Ellipta offers superior outcomes compared to Breztri Aerosphere in reducing the frequency of exacerbations. It improves symptom control and enhances patient adherence.

References

Duan, R., Li, B., & Yang, T. (2023). Pharmacological therapy for stable chronic obstructive pulmonary disease. Chronic Diseases and Translational Medicine, 9(2). https://doi.org/10.1002/cdt3.65

Dusin, J., Melanson, A., & Mische-Lawson, L. (2023). Evidence-based practice models and frameworks in the healthcare setting: A scoping review. British Medical Journal Open, 13(5). https://doi.org/10.1136/bmjopen-2022-071188

Feldman, W. B., Suissa, S., Kesselheim, A. S., Avorn, J., Russo, M., Schneeweiss, S., & Wang, S. V. (2024). Comparative effectiveness and safety of single inhaler triple therapies for chronic obstructive pulmonary disease: New user cohort study. British Medical Journal, 387. https://doi.org/10.1136/bmj-2024-080409 

Feldman, W. B., Wang, S. V., & Kesselheim, A. S. (2025). Real-world evidence is a vital tool for informing treatment strategies in chronic obstructive pulmonary disease. BMJ, r427–r427. https://doi.org/10.1136/bmj.r427

Capella FPX 4025 Assessment 2

Howe, R. (2024). LibGuides: Respiratory Care: Evidence-Based Practice: PICO. Libguides.uthscsa.edu. https://libguides.uthscsa.edu/c.php?g=625986&p=4364976

Tandan, M., Dunlea, S., Cullen, W., & Bury, G. (2024). Teamwork and its impact on chronic disease clinical outcomes in primary care: A systematic review and meta-analysis. Public Health, 229, 88–115. https://doi.org/10.1016/j.puhe.2024.01.019

Wang, M.-T., & Lin, C. W. (2024). Environmentally friendly inhaler regimens for COPD. BMJ, q2825. https://doi.org/10.1136/bmj.q2825

WHO (2024, November 6). Chronic Obstructive Pulmonary Disease (COPD). World Health Organisation. https://www.who.int/news-room/fact-sheets/detail/chronic-obstructive-pulmonary-disease-(copd)

Capella FPX 4025 Assessment 1

Name

Capella University

NURS-FPX4025 Research and Evidence-Based Decision Making

Prof. Name

Date

Analyzing a Research Paper

DOI: https://doi.org/10.1186/s12913-023-10234-y  

Article Review

Sentinel U Patient Case Study

Patient Name: Beulah Roush

Diagnosis of Medical Issue: UTI (urinary tract infection) secondary to dehydration

Current Treatment: Currently taking ciprofloxacin (antibiotic for UTI), receiving IV fluids (for dehydration)

Care Plan: While cystitis (UTI) is not life-threatening, untreated cases can lead to pyelonephritis (kidney infection) or sepsis.

Summary of Findings

The article of Costa et al. (2023) shows that by a substantial increase in daily water intake by 1.5L, the incidences of recurrent urinary tract infections (rUTIs) in women, especially the premenopausal and the postmenopausal women who suffer from frequent UTIs, can be reduced. The evidence suggests that increasing daily water intake by 1.5 liters can reduce rUTI recurrence by nearly 50%. Building on previous clinical trial information and real-world epidemiology numbers, the economic model predicts significant decreases in the number of UTI-related health care encounters, antibiotic use, and related costs for seven high-income countries (the United States, the United Kingdom, France, Germany, Italy, Spain, and Sweden).

The analysis shows that a simple behavioral change, increasing hydration, delivers both clinical and cost savings with the potential savings for healthcare worldwide annually in the hundreds of thousands to millions of dollars on a country-by-country basis. The findings uphold the use of hydration as a cost relationship, low-risk metric to prevent UTI recurrence and lessen the burden on health systems globally.

Relevance and Potential Effectiveness of Evidence

This article by Costa et al. (2023) is of extreme relevance to rUTI management and prevention, specifically in older adults or people at risk from dehydration, a patient case such as Beulah Roush. The evidence, from economic modeling of previously validated clinical trials, implies that evidence-based intervention that increases water intake is a simple, non-pharmacological intervention with measurable efficacy in rUTI reduction. Crossing seven countries, the intervention led to a projected cost savings of up to $4,429,882 annually in the U.S. alone. Antibiotic use was also significantly reduced, by 36%, lowering the risk of resistance. Not itself a randomized controlled trial, the article rests on high-level evidence and offers a convincing, cost-effective strategy to pair with existing treatment guidelines and achieve better patient results in inpatient and outpatient contexts.

Article Link

https://doi.org/10.1186/s12913-023-10234-y  

References

Costa, J., Iroz, A., Vecchio, M., Roze, S., & Lotan, Y. (2023). Water intake and recurrent urinary tract infections prevention: Economic impact analysis in seven countries. BioMed Central Health Services Research, 23(1). https://doi.org/10.1186/s12913-023-10234-y 

Capella FPX 4025 Assessment 1

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NURS FPX 4025 Assessment 4

Name

Capella University

NURS-FPX4025 Research and Evidence-Based Decision Making

Prof. Name

Date

NURS FPX 4025 Assessment 3

Name

Capella University

NURS-FPX4025 Research and Evidence-Based Decision Making

Prof. Name

Date

DEI and Ethics in COPD Smoking Cessation Programs

Understanding COPD and Smoking Cessation

Chronic Obstructive Pulmonary Disease (COPD) is a progressive lung disease that significantly impairs breathing, primarily due to long-term smoking. Despite the known health risks, quitting smoking remains a significant challenge for many individuals. COPD is a leading cause of mortality in the United States, affecting approximately 16 million adults (Centers for Disease Control and Prevention [CDC], 2024). Smoking cessation is crucial in slowing disease progression, yet many barriers—such as nicotine addiction, stress, and lack of social support—impede individuals from successfully quitting. Addressing these barriers requires implementing effective interventions tailored to diverse populations. This assessment evaluates the impact of structured smoking cessation programs compared to standard counseling in COPD patients over six months, considering the role of diversity, equity, and inclusion (DEI) and ethical considerations in improving patient outcomes.

Diversity, Equity, and Inclusion (DEI) in COPD Care

Disparities in healthcare access significantly affect COPD management, particularly in smoking cessation efforts. Marginalized populations—including low-income individuals, racial and ethnic minorities, and those in rural communities—often face barriers to receiving adequate smoking cessation support (Alupo et al., 2024). Limited healthcare access, financial constraints, and lower health literacy levels contribute to poor disease management. Older adults with COPD may also experience difficulties due to mobility challenges, medication costs, and limited healthcare provider availability. Ensuring equitable access to smoking cessation programs requires culturally competent care, tailored educational materials, and community outreach efforts that address specific needs. Nurses play a vital role in advocating for inclusive healthcare practices by facilitating access to smoking cessation resources and supporting diverse patient populations in their journey toward quitting smoking.

Ethical Considerations in Smoking Cessation Programs

Providing smoking cessation support for COPD patients involves ethical considerations, particularly in patient autonomy, beneficence, and justice. While healthcare providers must encourage smoking cessation, they must also respect patient autonomy and decision-making. Some individuals may struggle with nicotine dependence despite understanding the health risks. Therefore, it is essential to adopt a patient-centered approach that offers guidance without coercion. Beneficence, or the duty to promote patient well-being, is upheld by offering evidence-based smoking cessation programs, including behavioral counseling and pharmacotherapy (Wang et al., 2024). Ethical care also demands justice, ensuring all patients—regardless of socioeconomic status—receive access to high-quality smoking cessation interventions. Addressing disparities in care and advocating for policy changes can help create equitable access to effective COPD management strategies.

Table: DEI and Ethical Considerations in COPD Smoking Cessation Programs

Conclusion

Implementing structured smoking cessation programs within COPD management is crucial in slowing disease progression and improving patient outcomes. However, healthcare providers must consider DEI principles and ethical responsibilities to ensure equitable access to effective interventions. Addressing healthcare disparities, promoting culturally sensitive care, and respecting patient autonomy can enhance the success rates of smoking cessation programs. By integrating evidence-based approaches and ethical considerations, nurses and healthcare professionals can support diverse COPD populations in achieving smoking cessation and improving their overall quality of life.

References

Alupo, P., Baluku, J., Bongomin, F., Siddharthan, T., Katagira, W., Ddungu, A., Hurst, J. R., Boven, van, Worodria, W., & Kirenga, B. J. (2024). Overcoming challenges of managing chronic obstructive pulmonary disease in low- and middle-income countries. Expert Review of Respiratory Medicine. https://doi.org/10.1080/17476348.2024.2398639

American Lung Association (ALA). (2024). Learn about COPD. American Lung Association. https://www.lung.org/lung-health-diseases/lung-disease-lookup/copd/learn-about-copd

Centers for Disease Control and Prevention (CDC). (2024). COPD. Chronic Disease Indicators. https://www.cdc.gov/cdi/indicator-definitions/chronic-obstructive-pulmonary-disease.html

NURS FPX 4025 Assessment 3

Fu, Y., Chapman, E. J., Boland, A. C., & Bennett, M. I. (2022). Evidence-based management approaches for patients with severe chronic obstructive pulmonary disease (COPD): A practice review. Palliative Medicine, 36(5), 770–782. https://doi.org/10.1177/02692163221079697

Han, M. K., Fu, Y., Ji, Q., Duan, X., & Fang, X. (2023). The effectiveness of theory-based smoking cessation interventions in patients with chronic obstructive pulmonary disease: A meta-analysis. BMC Public Health, 23(1). https://doi.org/10.1186/s12889-023-16441-w

Wang, Z., Qiu, Y., Ji, X., & Dong, L. (2024). Effects of smoking cessation on individuals with COPD: A systematic review and meta-analysis. Frontiers in Public Health, 12. https://doi.org/10.3389/fpubh.2024.1433269

NURS FPX 4025 Assessment 2 Applying an EBP Model

Name

Capella University

NURS-FPX4025 Research and Evidence-Based Decision Making

Prof. Name

Date

Applying an Evidence-Based Practice (EBP) Model

Evidence-based practice (EBP) is fundamental in nursing, ensuring that clinical decisions are guided by the best available research. One major health challenge is chronic obstructive pulmonary disease (COPD), a progressive lung disease primarily linked to smoking. The management of COPD is complicated by patients’ difficulty in quitting smoking, which exacerbates disease progression. Research has shown that smoking cessation significantly improves COPD outcomes; however, many patients struggle due to nicotine addiction, emotional dependence, and inadequate support systems (Principe et al., 2024). By using the Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) model, healthcare professionals can systematically implement effective interventions to assist COPD patients in quitting smoking. This paper discusses the key issues surrounding COPD and smoking cessation, explores the JHNEBP model’s steps, and examines evidence-based interventions to enhance patient outcomes.

Issue Associated with COPD and Smoking Cessation

COPD is a major health issue characterized by chronic airflow limitation, persistent cough, and shortness of breath, significantly impacting patients’ quality of life. The leading cause of COPD is smoking, which contributes to airway inflammation and lung function decline. Principe et al. (2024) found that smokers are 4.01 times more likely to develop COPD compared to non-smokers. While smoking cessation provides substantial health benefits, many patients struggle due to physiological and psychological nicotine dependence.

Integrating EBP in COPD management ensures that care strategies are guided by scientific research, clinical expertise, and patient preferences. Han et al. (2023) emphasize that structured programs combining behavioral counseling, pharmacotherapy, and pulmonary rehabilitation are more effective than simply advising patients to quit. Nicotine replacement therapy (NRT) and cognitive-behavioral interventions have been found to increase smoking cessation success rates. The JHNEBP model provides a structured approach for evaluating and applying evidence-based interventions, ultimately improving patient adherence, reducing hospitalizations, and enhancing quality of life (Jiang et al., 2024).

Application of the JHNEBP Model

The JHNEBP model provides a structured framework for incorporating research into nursing practice, making it particularly effective in guiding smoking cessation interventions for COPD patients. This model comprises three steps: Practice Question, Evidence Translation, and Implementation (Brunt & Morris, 2023).

1. Practice Question:
   The first step involves formulating a clear clinical question using the PICO (Population, Intervention, Comparison, Outcome) framework. In this case, the focus is on identifying effective smoking cessation interventions for COPD patients.

2. Evidence Translation:
   This step entails conducting a comprehensive literature review to identify high-quality research, clinical guidelines, and expert recommendations on smoking cessation. Evaluating the credibility and relevance of studies ensures that only strong, evidence-based interventions influence clinical decision-making (Coleman et al., 2022).

3. Implementation:
   The final step involves applying evidence-based interventions into clinical practice. This includes integrating behavioral therapy, pharmacotherapy, and pulmonary rehabilitation into smoking cessation programs. Addressing barriers such as patient motivation and resource availability is crucial for achieving successful outcomes. Additionally, nurses play a key role in educating patients and providing ongoing support to enhance adherence to cessation strategies (Jiang et al., 2024). The JHNEBP model ensures a structured and patient-centered approach, leading to improved COPD management.

Evidence Search and Evaluation

The JHNEBP model’s PET (Practice Question, Evidence Translation, Implementation) framework was used to conduct an evidence-based search for smoking cessation interventions. Searches were performed in PubMed, CINAHL, and Cochrane Library, using keywords such as COPD, smoking cessation, nicotine replacement therapy, behavioral counseling, and pulmonary rehabilitation. Each study was critically analyzed for credibility, relevance, and applicability.

To assess the credibility of sources, the CRAAP (Currency, Relevance, Authority, Accuracy, and Purpose) test was applied. Studies such as those by Principe et al. (2024) and Han et al. (2023) provided strong evidence supporting structured smoking cessation interventions, making them relevant to EBP. The research by Jiang et al. (2024) reinforced the importance of nurses in implementing cessation strategies, further validating the application of the JHNEBP model in clinical settings.

Conclusion

Applying the JHNEBP model to smoking cessation interventions ensures that nursing practices are grounded in reliable research and tailored to patient needs. By implementing structured programs that combine behavioral therapy, pharmacotherapy, and pulmonary rehabilitation, healthcare providers can significantly enhance smoking cessation rates, slow COPD progression, and improve patient outcomes. Integrating EBP into clinical practice promotes patient-centered care, ultimately leading to better long-term COPD management.

Table: JHNEBP Model and Its Application

References

Brunt, B. A., & Morris, M. M. (2023). Nursing professional development evidence-based practice. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK589676/

Coleman, S. R. M., Menson, K. E., Kaminsky, D. A., & Gaalema, D. E. (2022). Smoking cessation interventions for patients with chronic obstructive pulmonary disease: A narrative review with implications for pulmonary rehabilitation. Journal of Cardiopulmonary Rehabilitation and Prevention, 43(4). https://doi.org/10.1097/HCR.0000000000000764

Han, M. K., Fu, Y., Ji, Q., Duan, X., & Fang, X. (2023). The effectiveness of theory-based smoking cessation interventions in patients with chronic obstructive pulmonary disease: A meta-analysis. BioMed Central Public Health, 23(1), 1510. https://doi.org/10.1186/s12889-023-16441-w

NURS FPX 4025 Assessment 2 Applying an EBP Model

Jiang, Y., Zhao, Y., Tang, P., Wang, X., Guo, Y., & Tang, L. (2024). The role of nurses in smoking cessation interventions for patients: A scoping review. BioMed Central Nursing, 23(1), 803. https://doi.org/10.1186/s12912-024-02470-2

Principe, R., Zagà, V., Martucci, P., Michele, L., Barbetta, C., Serafini, A., Cattaruzza, M., & Giacomozzi, C. (2024). Smoking cessation in the management of chronic obstructive pulmonary disease (COPD): Narrative review and recommendations. Ann Ist Super Sanità, 60(1), 14–28. https://doi.org/10.4415/ANN_24_01_04

Williams, P. J., Philip, K. E. J., Gill, N. K., Flannery, D., Buttery, S., Bartlett, E. C., et al. (2022). Immediate, remote smoking cessation intervention in participants undergoing a targeted lung health check: Quit smoking lung health intervention trial,

NURS FPX 4025 Assessment 1

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Capella University

NURS-FPX4025 Research and Evidence-Based Decision Making

Prof. Name

Date

Evaluation of the Article

The study by Assaf et al. (2022) is a quantitative, cross-sectional analysis that examines the quality of life (QoL) in patients with chronic obstructive pulmonary disease (COPD). This research design effectively identifies correlations between variables at a single point in time, though it does not establish causality. While the study offers moderate-level evidence regarding factors affecting QoL in COPD patients, additional research, such as randomized controlled trials (RCTs), would be necessary to determine causal relationships.

The credibility of this article is reinforced by its publication in F1000Research, a peer-reviewed journal with an open-review process that promotes transparency. The authors are affiliated with respected academic and healthcare institutions and adhere to ethical research standards while using validated assessment tools. Additionally, references to authoritative organizations, such as the World Health Organization (WHO) and the American Thoracic Society (ATS), further enhance the article’s reliability and academic rigor.

The study identifies smoking, dyspnea, and psychological distress as key factors that negatively affect COPD patients’ QoL. It highlights the significance of pulmonary rehabilitation, smoking cessation, and adherence to prescribed medications in improving patient outcomes. These findings are particularly relevant in healthcare settings where smoking rates are high. The study’s conclusions align with the case of Mr. James Carter in the Sentinel U simulation, as his chronic symptoms—such as dyspnea and persistent cough—are worsened by his long-term smoking habits and lack of adherence to treatment. Implementing evidence-based interventions based on the study’s insights can significantly improve his quality of life.

Table: Article Evaluation

Summary and Credibility of the Article

The study conducted by Assaf et al. (2022) explores various determinants affecting the QoL of COPD patients, focusing on dyspnea, chronic cough, smoking, and psychological distress. It highlights the importance of pulmonary rehabilitation, smoking cessation programs, and adherence to prescribed treatments as essential strategies for effective COPD management. These findings are directly relevant to Mr. James Carter’s case in the Sentinel U simulation, as his symptoms and behaviors mirror those identified in the study. The research provides a strong foundation for implementing targeted interventions to enhance patient care.

This article is published in F1000Research, a peer-reviewed journal with an open-review process that strengthens its credibility. The authors are affiliated with leading academic and healthcare institutions specializing in pulmonary care, and the study references well-established organizations such as WHO and ATS. The use of structured questionnaires and statistical analyses further enhances the study’s reliability.

Although the study’s cross-sectional design prevents causal conclusions, it offers valuable insights for healthcare professionals managing COPD patients. In clinical practice, integrating recommendations from this study—such as pulmonary rehabilitation and smoking cessation programs—can significantly improve patient outcomes, particularly for individuals like Mr. Carter, who require structured interventions to enhance their quality of life.

References

Assaf, E. A., Badarneh, A., Saifan, A., & Al-Yateem, N. (2022). Chronic obstructive pulmonary disease patients’ quality of life and its related factors: A cross-sectional study of the Jordanian population. F1000Research, 11, 581. https://doi.org/10.12688/f1000research.121783.1

Centers for Disease Control and Prevention (CDC). (2023). Chronic obstructive pulmonary disease (COPD): Causes, symptoms, and treatment. Centers for Disease Control and Prevention. https://www.cdc.gov/copd/

NURS FPX 4025 Assessment 1

World Health Organization (WHO). (2023). Chronic respiratory diseases: COPD. World Health Organization. https://www.who.int/health-topics/chronic-respiratory-diseases#tab=tab_1