NUR 670

Reply to Abel Casanova

The Purpose of the PICO Question for the PMHNP

A PICO question is useful because it helps turn a broad clinical concern into a clear and focused question that can guide evidence-based practice. For psychiatric mental health nurse practitioners, this is especially important because mental health problems are often complex and connected to many different factors, such as access to care, safety, family support, diagnosis, treatment options, and social barriers. The PICO format helps organize the question by identifying the patient or population, the intervention, the comparison, and the expected outcome. This allows the provider to search for the best available evidence and apply it in a way that is meaningful for the patient population being treated.

For psychiatric mental health nurse practitioners (PMHNPs), using a PICO question goes beyond research; it’s a useful tool for improving clinical decisions and patient care. Since psychiatric providers often work with vulnerable patients in crisis, a clear PICO question helps focus on what needs improvement and what interventions might yield better outcomes. It also allows advanced practice nurses to advocate for better resources and create patient-centered interventions.

My selected PICO question is: In rural youth experiencing an acute mental health crisis and presenting to the emergency department, does a PMHNP-led telepsychiatry and mobile crisis response model, compared with standard emergency department boarding and traditional referral processes, reduce psychiatric boarding time and improve successful transition to follow-up mental health care?

The purpose of this PICO question is to explore whether nurse-led telepsychiatry and mobile crisis response can help reduce delays in psychiatric care for rural youth. This topic is important because many children and adolescents in rural areas do not have quick access to psychiatric services. When there are no available psychiatric beds or local mental health providers, youth may remain in the emergency

department for long periods of time while waiting for placement or follow-up care. This process, known as psychiatric boarding, can increase stress for the patient and family and may delay the treatment the patient needs. Herrera et al. (2023) found that youth evaluated by mobile crisis teams were affected by psychiatric boarding, especially during the COVID-19 pandemic, showing how serious this issue can be for young people in crisis.

This PICO question is also important because rural communities often have fewer mental health professionals, fewer inpatient psychiatric resources, and longer distances to travel for care. Telepsychiatry may help reduce some of these barriers by allowing patients to receive psychiatric evaluation and support without waiting for an in-person specialist to become available. Shalev et al. (2024) explained that telepsychiatry has been used in emergency settings to assist with psychiatric assessments, treatment planning, and patient disposition. In addition, Watanabe et al. (2023) found that telemental health can improve access to mental health services for people living in rural areas.

Mobile crisis teams play a crucial role in psychiatric emergencies by providing assessment, de-escalation, safety planning, family support, and referral coordination, allowing for more active and supportive care. Burns et al. (2024) and Peters et al. (2025) highlight the increasing importance of crisis care models in enhancing behavioral health access and reducing unnecessary emergency department visits.

This PICO question is meaningful for advanced practice psychiatric nurses because it highlights the leadership role PMHNPs can have in improving mental health systems. PMHNPs are trained to assess psychiatric symptoms, evaluate risk, provide treatment, educate patients and families, and coordinate care. Cai et al. (2022) noted that psychiatric mental health nurse practitioners have an important role in meeting the demand for mental health services, including virtual care. Therefore, the purpose of this PICO question is not only to reduce emergency department boarding time but also to improve access, continuity of care, and outcomes for rural youth experiencing mental health crises.

Overall, the PICO question gives the research and clinical work a clear focus. It helps take a real problem seen in practice and connect it to an evidence-based approach that may improve care. For PMHNPs, using a PICO question can support better clinical decisions, stronger patient advocacy, and more personalized care, especially for patients and communities that may not always receive the support they need.

Reply to Geslande Dessalines, BSN, RN

One of the most important purposes of developing a PICO question in psychiatric mental health nursing is to create a focused, evidence- based clinical question that guides research, clinical decision-making, and patient-centered care. The PICO framework helps advanced practice psychiatric nurses identify a specific population, intervention, comparison, and outcome in order to evaluate whether a clinical approach is effective (Tusaie & Fitzpatrick, 2022). In psychiatric practice, where treatment outcomes are often influenced by biological, psychological, social, cultural, and spiritual factors, having a clearly structured clinical question is essential for improving patient engagement and treatment success. PICO questions also help PMHNPs bridge the gap between clinical observations and evidence-based interventions by organizing problems into searchable and measurable concepts (Eriksen & Frandsen, 2021). In my original post, I focused on the cultural and religious apprehension many individuals experience when seeking psychiatric treatment. My PICO question asks: In adults from culturally and religiously diverse populations who are hesitant to seek psychiatric care, does culturally and spiritually sensitive psychiatric education and engagement by PMHNPs, compared to standard psychiatric education and treatment approaches, improve willingness to initiate therapy and psychotropic medication treatment? This question is highly relevant because many patients never reach the point of treatment adherence or symptom improvement if they are unwilling to engage in care from the beginning.

The purpose of this PICO question is to examine whether culturally and spiritually responsive communication from PMHNPs can reduce fear, stigma, and mistrust associated with psychiatric treatment. This issue is especially important within minority and faith-based communities where mental illness may be interpreted through spiritual or cultural beliefs rather than through a medical lens. Research demonstrates that religiosity significantly influences mental health- seeking behaviors among adults in the United States, especially among ethnic minority populations (Boateng et al., 2023). Many individuals first seek help through spiritual leaders, prayer, or family support before considering psychiatric treatment. When providers dismiss these beliefs or fail to acknowledge their importance, patients may feel misunderstood and disengage from care entirely.

This PICO question is also important because it directly supports the role of the PMHNP as a holistic and culturally competent provider. According to Wheeler (2020), therapeutic alliance and trust are foundational components of successful psychiatric treatment. Patients are more likely to participate in therapy and medication management when they feel respected, heard, and culturally understood. Similarly, Tusaie and Fitzpatrick (2022) emphasize that advanced practice psychiatric nurses must assess spiritual beliefs, cultural values, and social influences when developing treatment plans. Addressing these factors is not separate from psychiatric care; it is part of delivering effective patient-centered treatment. Another reason this PICO question matters is because culturally responsive care has been shown to improve engagement and satisfaction with mental health services. Lam et al. (2023) discuss how the DSM-5 Cultural Formulation Interview helps clinicians better understand patients’ beliefs regarding illness, suffering, and healing. This approach allows providers to frame treatment recommendations in ways that align with the patient’s worldview instead of unintentionally creating resistance. For example, explaining that therapy and medication can work alongside faith rather than against it may reduce apprehension among religious patients. Stanford et al. (2023) similarly found that integrating spirituality into psychiatric care can strengthen rapport, increase openness to treatment, and improve

overall therapeutic outcomes. Additionally, mental health professionals increasingly recognize that religion and spirituality are clinically relevant aspects of psychiatric care rather than topics to avoid. Vieten et al. (2023) found that many mental health clinicians believe spiritual discussions are appropriate and beneficial when addressing patient concerns and treatment planning. This is especially important for PMHNPs working in culturally diverse settings where spirituality often shapes health behaviors and coping strategies.

Ultimately, the purpose of my PICO question is to identify evidence-based strategies that help culturally and religiously diverse patients feel safer and more comfortable initiating psychiatric care. As future PMHNPs, we must understand that effective treatment begins long before prescribing medication. It begins with trust, cultural humility, and the ability to meet patients where they are without dismissing their beliefs or experiences. When PMHNPs integrate cultural sensitivity and spiritual awareness into practice, they can reduce stigma, strengthen therapeutic relationships, and improve access to mental health treatment for vulnerable populations.