Name
Chamberlain University
NR-730: DNP Project
Prof. Name
Date
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 is designed to guide the development of a Doctor of Nursing Practice (DNP) practice change project. It emphasizes a patient-centered approach by targeting a major public health issue—uncontrolled hypertension—while incorporating an evidence-based strategy such as motivational interviewing (MI).
The goal of this assignment is to evaluate and refine a PICOT question that can serve as the foundation for a DNP practice change project. By doing so, it helps ensure alignment with evidence-based practice and measurable clinical outcomes.
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 highlights the significance of patient engagement and aims to address the ongoing challenge of poor adherence to prescribed antihypertensive therapies.
Uncontrolled hypertension remains a critical issue in primary care due to its strong association with stroke, cardiovascular disease, and renal complications. A primary cause of uncontrolled hypertension is nonadherence to prescribed medications.
The PICOT question addresses this problem by:
Population (P): Focusing on adult patients with uncontrolled hypertension, a group at risk for preventable complications.
Intervention (I): Using motivational interviewing, a behavioral technique shown to enhance patient engagement, foster self-awareness, and encourage sustainable lifestyle and treatment adherence.
Comparison (C): Benchmarking outcomes against the standard or usual care, which often includes routine education and follow-up but may not fully address behavioral barriers.
Outcome (O): Measuring improvement in medication adherence, a direct factor in controlling blood pressure and improving long-term outcomes.
Time (T): Assessing the effect over 10 weeks, allowing sufficient time to observe measurable behavioral changes.
Thus, the PICOT question directly targets the root cause of poor hypertension management while proposing a practical, evidence-based intervention.
The expected outcome—improved medication adherence—aligns with motivational interviewing because MI is rooted in behavioral change theory. It allows providers to engage patients in meaningful conversations that uncover ambivalence, build intrinsic motivation, and encourage commitment to healthier behaviors.
| Element | Relevance to PICOT Question |
|---|---|
| Outcome (Medication Adherence) | Critical for achieving blood pressure control and reducing long-term complications. |
| Evidence-Based Intervention (Motivational Interviewing) | Proven effective in improving adherence across chronic conditions, including hypertension. |
| Alignment | MI targets behavioral change, directly supporting adherence improvements and, consequently, better health outcomes. |
Research supports that motivational interviewing can significantly enhance adherence and improve clinical outcomes in chronic disease management (O’Halloran et al., 2020). Therefore, the outcome in the PICOT question is not only realistic but also evidence-driven.
This discussion helps meet the following program outcomes:
Integration of Scientific Knowledge: Applies scientific underpinnings in daily clinical practice to promote evidence-based solutions (POs 3, 5).
Organizational and System Leadership: Demonstrates leadership to influence systemic change and foster continuous improvements in patient outcomes (PO 6).
Evidence Translation: Uses analytic approaches to critically appraise and translate research into practice innovations (POs 3, 5).
Technology Application: Evaluates information systems and technology to enhance healthcare delivery (POs 6, 7).
Policy Advocacy: Analyzes policies to advocate for equitable healthcare and address social determinants of health (POs 2, 9).
Culture of Collaboration: Builds supportive cultures that enable interdisciplinary collaboration to promote population health (PO 8).
Professional Leadership: Leads with clinical judgment, resilience, and accountability in implementing and evaluating care (POs 1, 4).
This discussion supports the following course outcomes:
Clinical Scholarship in Practice: Applies methodologies to design, implement, and evaluate evidence-based improvements at micro, meso, and macro levels (PCs 1, 3, 5; POs 3, 5, 9).
Evidence Synthesis: Critically appraises and synthesizes high-quality evidence to improve quality, cost-effectiveness, and outcomes across diverse populations (PCs 1, 2, 3, 4, 6, 8; POs 4, 5, 6, 8).
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
Melnyk, B. M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Wolters Kluwer.
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
