NURS FPX 4025 Assessment 3 Applying the PICO(T) Process

Applying the PICO(T) Process

The neuropsychiatric symptoms of Systemic Lupus Erythematosus (SLE) are distressing for patients and their families and present challenges for the healthcare system. Patients with SLE can experience complex cognitive and mood disorders, headaches, seizures, psychosis, etc. These symptoms, and several others, may be easily confused with other disorders or syndromes, and this poses a challenge for clinicians as well and may lead to suboptimal outcomes for affected patients. Evidence shows that a delay or a miss in diagnosing the neuropsychiatric component of SLE can lead to an increased burden of disease and a deterioration in the affected person’s quality of life (Khan et al., 2023). The PICO(T) Model aids the clinician in framing possible interventions for the recognition and diagnosis of neuropsychiatric symptoms. It guides the clinician to address a specific clinical issue and, as a result, to design and implement the most appropriate methods of assessment that will ultimately facilitate improvement in clinical outcomes.

Delayed Recognition and Diagnosis of Neuropsychiatric Symptoms in SLE

Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disease that results in inflammation and damage in multiple systems. Describing the neuropsychiatric symptoms of SLE is among the most complex and challenging. There may be involvement of the peripheral and central nervous systems at any point in the course of SLE. The negative effects of a delayed diagnosis in SLE patients impact every person with SLE; However, the most pronounced effects are on patients who are in the lowest socioeconomic classes and are the most remote. This is due to a lack of access to specialty services (Mitchell, 2024). The need for specialized services increases with the delay in provision and results in greater loss of function and chronic disability for the patient. Given this, the management of the neuropsychiatric symptoms of SLE is a key aspect of the holistic approach to the treatment of patients with SLE.

Research indicates that the identification of neuropsychiatric symptoms in SLE patients is improved when a structured checklist is used. To accomplish better identification, earlier, standardized, and more collaborative multidisciplinary screening with some regularity has been suggested. Schlencker et al. (2022) proposed that, by incorporating some structure to the steps of assessment, an earlier and more appropriate clinical assessment would result in a referral of significantly greater relevance. There is some general agreement with the principles being proposed; however, significant variability in the assessment and screening techniques remains evident. The clinical consequences of these techniques for patients with SLE should be the focus of further study.

Developing a PICOT Question

Due to the complexity of some of the neuropsychiatric symptoms, SLE patients go long periods of time without a diagnosis of SLE. This leads to a large number of SLE patients going without treatment that they desperately need. Because many of the symptoms seen in SLE patients are shared with other psychiatric and neurologic conditions, it can confuse the clinician as to whether the symptoms are due to SLE. Some of the proposed methods to help decrease the diagnostic and treatment gaps include the use of standardized screening and assessments of neuropsychiatric symptoms. According to Yusof and Vital et al. (2021), utilization of a more structured approach to assessment may help recognize symptoms sooner and help initiate treatment sooner. Therefore, the research on routine assessment and how it leads to treatment is a vital part of evidence-based practice.

PICOT-Formatted Research Question

For adult systemic lupus erythematosus patients (P) who have the potential to experience neuropsychiatric symptoms, how does (I) the implementation of routinely used, standardized neuropsychiatric screenings and assessments, (C) compared to the current model of clinical assessments that do not involve standardized screenings, affect (O) the potential for early diagnosis and recognition of neuropsychiatric symptoms (T) within 1 year?

Population (P): Adults diagnosed with systemic lupus erythematosus who have the potential to experience neuropsychiatric symptoms
Intervention (I): Use of routinely employed, standardized neuropsychiatric screenings and assessments
Comparison (C): Current model of clinical assessments that do not involve standardized screenings
Outcome (O): Potential for early diagnosis and recognition of neuropsychiatric symptoms
Time (T): Within 1 year

Impact of the PICOT Approach on Managing SLE

The PICO(T) model provides a standardized structure for analyzing a clinical issue and developing evidence-based solutions to address the nature of the concerns of a specific patient population. Specifying the population, intervention, comparison, outcome, and timeframe allows clinicians to narrow their literature search to solutions that foster the development of diagnostic and clinical outcome improvements. Xu et al. (2026) pointed out that well-formed clinical questions lead to the development of assessment strategies, screening and interdisciplinary care methods, and service delivery models that are easier to evaluate. This framework also supports the incorporation of research evidence within the discipline of nursing and the provision of care that is most relevant and beneficial to the patient. The PICO(T) model aids recognition and diagnosis of neuropsychiatric manifestations in SLE patients and strengthens the capacity and range of timely and appropriate health care services.

Search of the Literature: Noting Search Engines, Key Words, and Credibility Factors

Four chosen healthcare databases, PubMed, CINAHL, MEDLINE, and Cochrane Library, were used to obtain literature on the delayed identification and diagnosis of the neuropsychiatric symptoms of systemic lupus erythematosus. Access to peer-reviewed literature related to the PICO(T) questions was provided by the databases. The literature search was made on the following terms: systemic lupus erythematosus, neuropsychiatric lupus, neuropsychiatric symptoms, delayed diagnosis, early recognition and methods for screening and assessment, and tools for multidisciplinary diagnosis and evaluation. Search strategies were developed using Boolean operators. The last five years were focused on clinical studies, clinical guidelines, and systematic reviews. Evidence-based practices and guidelines were reviewed from the professional associations related to rheumatology and neurology.

Credibility of Articles

Evaluating the quality and credibility of literature is essential to assess how they contribute to the clinical question. Here, the Currency, Relevance, Authority, Accuracy, and Purpose (CRAAP) test was applied. Based on Sarwar et al. (2021), the currency of the evidence relates to the understanding of the neuropsychiatric manifestations as well as the diagnostic frameworks and methods of SLE. The relevance was determined by how much the source elaborated on early recognition and the screening, diagnostic, and causation delay methods. Authority was given to the article for being published in a reputable, peer-reviewed journal and being authored by researchers in the fields of rheumatology and neurology and the treatment of autoimmune disorders. Accuracy was given for the design of the study and for the procedures and reporting of the data. Purpose was given for the objective and for the evidence-based study supporting clinical decision pathways.

This evaluation method described above was integral for identifying the considerable evidence needed to refine clinical evaluations and the practice of neuropsychiatric lupus. It reviewed evidence from studies and research that were methodologically sound. This enables professionals and practitioners to render clinically pertinent decisions regarding the SLE management framework. It paves the way for an SLE management framework where diagnostic barriers are removed and where a consistent practice is instituted that aims to enhance the quality of life for SLE patients.

Findings from Relevant Sources on COPD (Chronic obstructive pulmonary disease)

Jayasinghe et al. (2025) discussed the delayed diagnosis of neuropsychiatric systemic lupus erythematosus (NPSLE), which is difficult to recognize in the clinic because of the overlap of psychiatric and neurological symptoms and the heterogeneous nature of SLE. This results in confusion and delays in proper treatment and is a growing burden. An example is Sloan et al. (2024), who developed concepts for the frameworks of neuropsychiatric assessments. Sloan stated that the presence of structure in assessments can aid the assessor in identifying expressions that would otherwise remain hidden. This implies that the use of assessments and diagnostic tools would be commonly and routinely practiced to a greater extent to enable the early treatment of symptoms of the disease.

Estiasari et al. (2024) proposed a number of frameworks developed from the assessment and management of neuropsychiatric lupus. The evidence indicated that working with a rheumatologist, neurologist, and psychiatrist would contribute to a higher-quality assessment in a timely manner. In summary, the evidence indicated that the screening of SLE patients for neuropsychiatric symptoms would benefit from working together and would be improved by ongoing symptom observation.

Credible Sources

The studies on neuropsychiatric manifestations of SLE have highlighted the need for formal assessments and timely identification. These studies have also been strengthened by Estiasari et al. (2024), who have highlighted the need for a comprehensive approach in practice to neuropsychiatric lupus. The study pointed out that comprehensive practice in neuropsychiatric lupus facilitates timely communication and referrals to other practitioners, thus providing greater certainty. The studies are scholarly and peer-reviewed, and therefore, they provide an evidence-based approach to practice for the nurse in the area of neuropsychiatric lupus.

Relevance of Findings to PICO(T)

The findings in this subsection connect evidence directly to the PICO(T) question, including potential methods to improve the identification and diagnosis of SLE neuropsychiatric manifestations. These findings relate to the intervention of the PICO(T) question and thus are relevant to the expected result of the evaluation process.

Furthermore, Estiasari et al. (2024) showed that the use of expanded screening can be used to detect neuropsychiatric symptoms. Together, this evidence supports the need for formal evaluation methodologies to identify and treat neuropsychiatric manifestations in SLE patients.

Conclusion

The PICO(T) framework can identify various aspects of healthcare related to methods and practices that reduce the time lag to formal diagnosis of neuropsychiatric symptoms in patients with SLE. Evidence indicates that routine screening and the use of a comprehensive assessment strategy and a multidisciplinary approach enhance the early identification and intervention process. Incorporating these practices and strategies into day-to-day workplace activities is likely to improve the patient experience, reduce adverse effects from delays in diagnosing and treating neuropsychiatric lupus, and address inequities in access to specialist services.

References

Estiasari, R., Banu, S., Widhani, A., Octaviana, F., Maharani, K., Aninditha, T., Islami, M. H., Imran, D., & Lastri, D. N. (2024). Multidisciplinary re-evaluation of neuropsychiatric events to confirm the neuropsychiatric lupus diagnosis at a tertiary hospital. Lupus Science & Medicine, 11(1), 1163–1173. https://doi.org/10.1136/lupus-2024-001163

Jayasinghe, M., Rashidi, F., Gadelmawla, A. F., Rissardo, J. P., Rashidi, M., Elendu, C. C., Leticia, A., Khalil, I., Hmedat, K. I., Atef, M., Moharam, H., & Prathiraja, O. (2025). Neurological manifestations of systemic lupus erythematosus: A comprehensive review. Cureus, 17(2), 569. https://doi.org/10.7759/cureus.79569

Khan, M. I., Qureshi, H., Akhtar, S., Bae, S. J., & Hassan, F. (2023). Prevalence of neuropsychiatric disorders in patients with systemic lupus erythematosus: A systematic review and meta-analysis. Frontiers in Psychiatry, 14(1), 987. https://doi.org/10.3389/fpsyt.2023.1098734

Mitchell, J. L. (2024). Understanding the impact of delayed diagnosis and misdiagnosis of systemic lupus erythematosus (SLE). Journal of Family Medicine and Primary Care, 13(11), 4819–4823. https://doi.org/10.4103/jfmpc.jfmpc_1177_24