Nursing Practice Problem and PICOT Question


Stroke remains a leading cause of death across the US for many years, and such a tendency presents the need for intervention in terms of patient education, as it becomes evident that patients with a predisposition for stroke are not well aware of the risks associated with the disease (Centers for Disease Control and Prevention [CDC], 2021). While the issues of age and ethnic affiliation of the patient remain the most prevalent in terms of preventive care, there are other factors such as nutrition and licit drug use that contribute significantly to stroke prevention. Hence, the nursing practice problem emphasized in the present research is the absence of tangible framework nurses could follow to educate older patients on the matter of the correlation between proper nutrition and stroke prevention.

To find a solution to the aforementioned nursing practice problem, it is necessary to conduct a nutrition education intervention and measure the results of the study. Hence, in terms of the PICOT framework, the (p)population of the research will include healthy patients aged 55 and older. The (i)intervention will address the introduction of nutrition education among patients. The (c)control aspect of the research will include the group of individuals receiving no nutrition education. The expected (o) outcome of the study is a reduced stroke risk among the patients in the intervention group. The (t)time required to receive reliable results should have at least a five-year window to measure the stroke cases both within comparison and intervention groups. Hence, the PICOT question itself may be defined as follows: does nutrition education decrease the risk of stroke in older adults?


The major problem tackled in the research conducted by Pase et al. (2017) was the correlation between the intake of sugar-sweetened and artificially sweetened beverages and the risk of incident stroke and dementia among people 45 and older. The significance of nursing relates to the fact that the intake of sugary beverages among the population is a growing concern for preventive health care. The objective of the study was to measure the recent and cumulative consumption of sugary- and artificially sweetened beverages in a community-based cohort and the respondents’ stroke incident rates ten years after the last contact with the participant, making the purpose of the study to estimate the correlation between stroke risk and beverage intake. The research question of the study was: does consumption of sugary- and artificially beverages affect the risk of stroke among people older than 45 years?

In the study conducted by Chiu et al. (2020), the problem was the correlation between adherence to a vegetarian diet and the risk of ischemic stroke among the Taiwanese population. The significance of nursing is characterized by the nurses’ ability to reconsider their attitude toward the promotion of a vegetarian diet among patients. The purpose of the study was to analyze whether adherence to a vegetarian diet affected the risk for ischemic stroke among the healthy population with the help of the objective to measure how the adherence to a vegetarian diet contributed to the reduction of stroke incidence compared to the control group. The research question was: does a vegetarian diet impact one’s risk of having ischemic stroke among a healthy population?

The problem addressed by El-Hajj et al. (2021) was the correlation between adherence to the Mediterranean diet (MeD) and stroke risk. The purpose of reducing the stroke prevalence among the Lebanese population in the long term was realized through the objective to assess the adherence to MeD and stroke predisposition among the population. The study is significant to nursing due to its ability to disclose relevant information on the interrelation between MeD adherence and stroke risk mitigation. The research question was: how does adherence to MeD affect the risk of stroke among the Lebanese population?

The last study conducted by Wekesah et al. (2019) tackled the problem the stroke risk factors perception among the Nairobi population. The significance of the study may be characterized by its in-depth assessment of people’s subjective perception of stroke risk, leading to potential reconsideration and educational practices. The purpose of increasing the Nairobi population’s awareness of stroke risk factors was manifested by exploring the current perception of cardiovascular disease risk among the population. The research question was: how does awareness of risk factors among the Nairobi population affect the prevention and development of cardiovascular diseases?

As far as the article by Pase et al. (2017) is concerned, it will be of paramount importance to take into account how beverage intake contributes to the incidence of stroke before developing a nutrition education intervention for the research. The study by Chiu et al. (2020) demonstrates the presence of a correlation between nutrition and stroke incidence among the healthy population, so it will be used to justify the relevance of the PICOT question. The study conducted by El-Hajj et al. (2021) will be used in terms of the PICOT question outlined to justify the relevance of the intervention, as the study demonstrates that there is a significant difference between stroke and non-stroke patients in terms of adherence to MeD (p. 4). As far as the study by Wekesah et al. (2019) is concerned, the research will be used as a blueprint for gathering phenomenological data.

The studies by Chiu et al. (2020) and El-Hajj et al. (2021) are the closest to the groups identified in the PICOT question, as the former obtains both intervention and control groups, whereas the latter builds a case based on binary opposition. The study by Wekesah et al. (2019) includes solely focus groups with no control group as such, and the research conducted by Pase et al. (2017) also did not include a comparison group, focusing on the two age-related cohorts.

Method of Study

The studies conducted by Pase et al. (2017) and Chiu et al. (2020) were both cohort studies, but the primary difference between them was the fact that the former did not include a comparison group. The study by El-Hajj et al. (2021) was distinct because it was a mixed-methods study that addressed both qualitative (interviews) and quantitative (surveys) approaches to data collection and analysis. Finally, the focus group study by Wekesah et al. (2019) was different due to its purely qualitative approach to collecting information.

The primary benefit of the cohort study is the ability to analyze the subject from a long-term perspective and collect exhaustive evidence throughout the examination cycles. However, the fact that it is expensive and time-consuming may serve as a severe limitation to the research. The benefit of the mixed-methods study is the researchers’ opportunity to operate both measurable and subjective data to generate more precise predictions. However, the inability to develop an exhaustive framework of variables creates an obstacle in terms of applying statistical analysis to the study. As far as focus group methodology is concerned, the primary advantage is conducting in-depth interviews and looking into the issue from the patients’ perspective. However, it is extremely challenging to analyze such data objectively.

Results of Study

All the studies discussed presented the findings in favor of the correlation between stroke risk and adherence to a healthy diet. Thus, the primary conclusion of the study by El-Hajj et al. (2021) stated that “the higher the adherence to MeD, the lower the risk of stroke” (p.4). The study by Wekesah et al. (2019), for its part, demonstrated that there was a demand for increasing the population’s awareness about the CVD risk factors, especially when people with lower socioeconomic status were concerned. Pase et al. (2017) concluded that the intake of artificially sweetened beverages was associated with stroke risk, whereas Chiu et al. (2020) implied the correlation between adherence to a vegetarian diet and lower stroke risks. Hence, there is a need for nutrition education intervention based on the aforementioned findings, such as promoting MeD and lower sweetened beverage intake.

All four studies have a similar implication for the nursing practice, which stands for the reconsideration of the current patterns of nutrition education in the context of stroke prevention. Indeed, all the studies indicate that the current knowledge of the diet’s significance among the general population is insufficient and requires immediate intervention.

Ethical Considerations

The two primary ethical considerations in conducting research are consent and impartiality. The first consideration concerns agreement and awareness when sharing sensitive data with the authors of the research. The second consideration addresses the objectivity of data processing, as frequently, authors willing to justify a certain hypothesis alter the primary data to achieve desired outcomes.

All studies in question successfully met the criteria for consent and impartiality, as all the participants were asked to provide informed consent (written except for the study by El-Hajj et al., (2020)) to share the data. None of the articles were funded by organizations that might provoke a conflict of interest or biases, and all the procedures were approved by the institutional boards (Pase et al., 2017; Wekesah et al., 2019; Chiu et al., 2020). No information on institutional board approval was mentioned in the study by El-Hajj et al. (2021).

Outcomes Comparison

The anticipated outcomes of the PICOT question include the demonstration of quantitative evidence regarding the success of nutrition education in the context of stroke prevention. The primary hypothesis of the PICOT question is the fact that nutrition education would be extremely beneficial for the prevention of stroke among older adults.

The outcomes of all the studies indicate a high level of correlation between nutrition and one’s predisposition to stroke. The study by Wekesah et al. (2019) also addressed the need for increasing people’s awareness about stroke risk factors, as their perception and knowledge were insufficient in terms of mitigating the risk. Hence, the outcomes of the studies are similar to the PICOT question anticipated outcomes.

Proposed Evidence-Based Practice Change

The link between the articles defined and the PICOT question is the evaluation of the diet’s significance in the context of stroke prevention. All the aforementioned articles show a positive correlation between adherence to diet and stroke risks. Hence, the nursing practice problem of the absence of a working nutrition education framework is justified by the evidence provided in the articles. The PICOT question will define the scope of relevance of this issue among the older population that is already at higher risk of stroke.

An evidence-based practice change would be the introduction of a nutrition education program and its implementation in the counseling plan for older patients. In such a way, growing awareness of the diet’s significance may result in lower stroke incidence rates in the long run.


Centers for Disease Control and Prevention. (2021). Stroke. Web.

Chiu, T. H., Chang, H. R., Wang, L. Y., Chang, C. C., Lin, M. N., & Lin, C. L. (2020). Vegetarian diet and incidence of total, ischemic, and hemorrhagic stroke in 2 cohorts in Taiwan. Neurology, 94(11), e1112-e1121. Web.

El-Hajj, M., Salameh, P., Rachidi, S., Al-Hajje, A., & Hosseini, H. (2021). Adherence to the Mediterranean diet decreases the risk of stroke in the Lebanese population: A case-control study. Pharmacy Practice (Granada), 19(1), 1-7. Web.

Pase, M. P., Himali, J. J., Beiser, A. S., Aparicio, H. J., Satizabal, C. L., Vasan, R. S., Seshadri, S., & Jacques, P. F. (2017). Sugar-and artificially sweetened beverages and the risks of incident stroke and dementia: A prospective cohort study. Stroke, 48(5), 1139-1146. Web.

Wekesah, F. M., Kyobutungi, C., Grobbee, D. E., & Klipstein-Grobusch, K. (2019). Understanding of and perceptions towards cardiovascular diseases and their risk factors: A qualitative study among residents of urban informal settings in Nairobi. BMJ Open, 9(6), 1-9. Web.

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