PICOT and Evidenced-Based Practice Sample Paper

PICOT and Evidenced-Based Practice Sample Paper

PICOT and Evidenced-Based Practice  Sample Paper

What is a Picot question in nursing?

The word PICOT is a mnemonic forming the elements of a clinical research question. The PICOT process begins with the provision of a case scenario and a case question that is designed to elicit an answer.

What does PICOT Question Entail? or What does Picot Stand for in Nursing?

PICOT questions entail (P) patient, population or problem, (I) intervention which means the intervention or treatment being reviewed for consideration, (C) comparison or control which means other interventions that should be deliberated, (O) outcome or objective is the outcome desired or expected and (T) time frame which refers to the period that would be taken to achieve the desired outcome (reference).

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Examples of a PICOT Process – Example of a PICOT question

The PICOT process entails seven steps:

1. Formulating the PICOT question– this is the first step of the PICOT process where the researcher comes up with a research question based on the topic of interest.

Among intensive care patients (Population), how does frequent repositioning (Intervention) compared with the use of support surfaces (Comparison) lower the prevalence of pressure ulcers’ development (Outcome) within 30 days (Time)?PICOT and Evidenced-Based Practice Sample Paper
2. The second step is the identification of the keywords for the PICOT question.

P- Intensive care patients

I- Repositioning

C- support-surfaces

O- lowers the prevalence of pressure ulcers

How to Formulate a PICOT Research Question

  • P (Problem of a patient): Who is the patient? What are the issues of him/her?
  • I (Exposure’s intervention): What is the plan to treat them? How would we do this?
  • C (Compassion): How do we compare the intervention? What will be the comparison of it?
  • O (Outcome): What would we get in the end? Will there be any positive results/output?

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3. The third stage is planning the evidence search strategy

This step entails looking into various databases and other reliable and credible sites that can provide information and answers to the formulated research question. One can utilize a database search strategy known as the “query” which is available in databases like PubMed. This database provides two options for narrowing down search results which are health services queries and clinical queries (reference). One can also narrow down the search strategy by customizing the search on preferred language, year of publication, type of publication, peer review, and full text. Limiting the search results improves the effectiveness and the rigor of the search results narrowing them down to the most relevant data sources.

4. Execute a search
This fourth step entails searching the PICOT elements individually. The search can be achieved through the use of keywords. For example, based on the PICOT statement some of the keywords that can be used include pressure ulcers, repositioning, and sleeping. During the search, one should alternate the use of the words ‘and’ and ‘or’. One can also use synonyms for the keywords used.

5. Refining the results

The fifth step entails refining results. During this step, the researcher limits the number of articles searched. This can be achieved by using different strategies like the search of peer-reviewed journals or research documents. One can also set the limit of years of publication which would narrow down the search results.

6. Reviewing the content

The sixth step of reviewing the content entails reviewing the research results to check whether the necessary information is available in the searched articles to answer the designed research question. This step is important because if the articles derived do not answer the deigned question, one would be required to carry out another search until they get the most relevant articles.

7. Determining if the research results meet the set standards
This is the last step which requires the researcher to check whether the research results provide the best available evidence. It is vital to acknowledge that it would be best to use high-quality evidence as it would be adopted in the clinical settings to improve the patient’s well-being.

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PICOT and Evidenced-Based Practice Nursing Writing Help

How to write a PICOT Question for Nursing

How to Come Up with a Perfect PICOT Question

Six Types of PICOT Questions – What are the Types of PICOT Questions?

1. Therapy questions

Therapy questions are designed to query the effectiveness of interventions as designed to improve the patient’s health outcomes. Some of the interventions offered include surgical procedures, lifestyle changes, medications, and counseling.

2. Prevention questions

Prevention questions are questions regarding the efficacy of interventions in preventing diseases and mortality. It is equally important to assess both harms and benefits of interventions.

3. Diagnosis questions

Diagnosis questions query the ability of procedures or tests to differentiate between those with medical conditions and those without.

4. Prognosis questions

Prognosis questions query the probable causes of patients’ disease or the likelihood that they will develop a certain illness.

5. Etiology questions

Etiology questions query the cause of harm brought about by an intervention or exposure to an agent.

6. Meaning questions

Meaning questions query patients’ experiences and concerns to ascertain whether the intervention can be generalized to a population with similar characteristics.

So, How do you Answer a PICO/PICOT Question? How do you develop/ formulate a PICO/PICOT question?

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            PICOT question and evidence-based practice are of paramount importance as they help the researchers to come up with valid research questions which not only influence clinical practice but also which would facilitate the advancement of research. Extensive research could be used to answer clinical queries and promote the adoption of improved clinical practice.

References

List of references follows.

What is an example of a Picot question?

NRS 433V RS-Research Critique Guidelines:  Benchmark – Research Critiques and PICOT Statement Final Draft Sample question;

Prepare this assignment as a 1,500-1,750 word paper using the instructor feedback from the Topic 1, 2, and 3 assignments and the guidelines below.

PICOT Statement

Revise the PICOT statement you wrote in the Topic 1 assignment.

The final PICOT statement will provide a framework for your capstone project (the project students must complete during their final course in the RN-BSN program of study).

Research Critiques

In the Topic 2 and Topic 3 assignments you completed a qualitative and quantitative research critique. Use the feedback you received from your instructor on these assignments to finalize the critical analysis of the study by making appropriate revisions.

The completed analysis should connect to your identified practice problem of interest that is the basis for your PICOT statement.

Refer to \”Research Critique Guidelines.\” Questions under each heading should be addressed as a narrative in the structure of a formal paper.

Proposed Evidence-Based Practice Change

Discuss the link between the PICOT statement, the research articles, and the nursing practice problem you identified. Include relevant details and supporting explanation and use that information to propose evidence-based practice changes.

Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. Please refer to the directions in the Student Success Center.

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Introduction

The decisions and actions of today’s nurses should be based on evidence obtained from clinical research. Patients need quality and safe care that will help them to recover from their health problems. They select hospitals based on the quality of care that they are able to provide. Additionally, medical insurance organizations use quality of care as the basis for reimbursement. Therefore, contemporary healthcare organizations strive to maintain a good public image by providing quality and safe patient care. They ensure that the practice standards that nurses use as guidance during healthcare delivery are evidence-based (Burns, 2011). The purpose of this capstone project is to identify an evidence-based practice approach that can be used to address the problem of nurse shortage in healthcare settings. The development of an evidence-based practice process begins with the identification of a clinical practice problem. PICOT and Evidenced-Based Practice Sample Paper

Clinical Practice Problem

Healthcare systems often face problems associated with the shortage of qualified nurses. Nurses are charged with the responsibility of ensuring that patients receive quality and safe care (Rochefort, Buckeridge & Abrahamowicz, 2015). The authors further assert that in the past years, the healthcare industry has experienced an increased need for more registered nurses caused by a longer length of stay in the hospital and increased patient acuity. An inadequate number of staff nurses is associated with negative patient outcomes. High cases of adverse events are usually reported in medical facilities where the available registered nurses cannot adequately provide healthcare services to patients (D’Lima, Murray, & Brett, 2018). It is important to develop a PICOT statement that will act as guidance when locating relevant articles that have exhaustively explored the nursing practice under discussion.

PICOT Statement

The PICOT statement that will act as a framework for the capstone project has been developed by considering five major elements. The elements include the Patient/Population (P), Intervention (I), Comparison (C), Outcome (O), and Time (T). The PICOT statement reads that;

“For patients who are receiving care in healthcare settings (P), does hiring an adequate number of nurses (I) reduce incidences of adverse events or improve patient safety outcomes (O) as compared to an inadequate number of nurses (C) within a period of 3 months (T).

Literature Search

A comprehensive literature search has been conducted to locate articles in which the authors have explored the nursing practice problem in detail. The nursing databases that have been searched include Cochrane, CIHAHL, Google Scholar, and PubMed. A number of search terms have been used when exploring the databases. The key search terms that have been used to locate the articles include “poor nurse staffing” and “the impacts of inadequate nurse staffing on patient outcomes.” A total of six articles that address the research problem have been located and reviewed. Some of them are qualitative studies while others are quantitative.

PICOT and Evidenced-Based Practice Sample Paper

Research Critique and Literature Review

Research critique of the articles has been conducted in order to gather information that the researchers have published in relation to the research problem. The researchers have explored how patient outcomes are affected by nurse staffing in different types of healthcare settings. The research critique of both qualitative and quantitative studies have focused on the background of the study, method of the study, research findings, ethical considerations, and conclusions. The qualitative methods were appropriate to answer the research questions, while the quantitative approaches were effective for addressing research hypotheses. Furthermore, the researchers of all the reviewed studies have interpreted findings in a manner that can easily be understood by the reader. Moreover, the authors have made appropriate ethical considerations when using human subjects as study participants. In all the studies, the conclusions are congruent to the thesis statements as they clearly highlight how the studies have addressed respective research problems.

An inadequate number of nurses is associated with increased nursing workload, patient mortality, and patient safety incidents. Fagerstrom, Kinnunen, and Saarela (2017) conducted an observational study to determine the effects of nursing workload on patient mortality rates and patient safety. They discovered that patient outcomes are determined the amount of workload allocated to each nurse in the healthcare settings. Enough nurse staffing levels are linked to less workload and more time to observe and care for each of their patients. This reduces the risk of occurrence of adverse events hence reducing patient safety incidents. Moreover, when nurses give patients the required attention, their health condition is likely to improve, and this leads to better outcomes.

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In another study, He, Staggs, Bergquist-Beringer, and Dunton (2016) obtained similar results with those of Fagerstrom, Kinnunen, and Saarela (2017). He et al. conducted a study to investigate the effect of nursing shortages on patient outcomes such as inpatient falls and hospital-acquired infections. The staffing variables used in the study included the percentage of nursing hours that registered nurses provided and the total nursing hours per patient day. He et al. discovered that nursing shortages were associated with negative patient outcomes. During winter, the nurse staffing levels tend to be lower in comparison to other seasons. However, the total staffing hours for nurses during winter is higher because more patients visit the hospital during the season. This implies that the percentage of nursing hours for registered nurses increases and this results in work overload and burnouts among nursing staff. This results in poor health outcomes as many patients develop pressure ulcers because they are not closely monitored by the nurses.

Nurse-to-patient ratios determine the readmission rates for patients. Tubbs-Cooley, Cimiotti, Silber, Sloane, and Aiken (2013) researched the effect of nurse staffing ratios on readmission rates for children admitted to pediatric care. The authors explained that the support provided by bed-side nurses influences readmission rates, especially if the nurses do not monitor the discharged patients properly. Nurses play a crucial role in transitioning from in-patient to out-patient care because they are aware of the patient’s condition and what the patient needs to know in disease management. The researchers discovered that hospital nurse-to-patient staffing ratios are linked to the likelihood of readmission 15 to 30 days after the patient has been discharged from the hospital. Pediatric hospitals which met a pediatric staffing benchmark had lower readmission rates. Tubbs-Cooley et al. further explained that increased workloads among nursing staff implied that nurses had less time to prepare their patients for discharge and to educate them about disease management. This has a negative impact on patient outcomes. PICOT and Evidenced-Based Practice Sample Paper help

When there is a shortage of nurses, more adverse events are likely to affect hospitalized patients. Moreover, the qualifications and skills that nurses have also influence the occurrence of adverse events. Rochefort, Buckeridge, and Abrahamowicz (2015) conducted a cohort study in the intensive care unit of an academic healthcare center. The research aimed at assessing the frequency of adverse events in association with nurse staffing levels. The events selected included hospital-acquired infections such as pneumonia and in-hospital falls. These events have common characteristics such as high mortality and morbidity rates. The study also aimed at determining the optimal nurse staffing levels that were needed to minimize the occurrence of adverse events. From the study, the researchers discovered that the primary attributes of nurse staffing that influenced the occurrence of adverse events include nurse staffing intensity, the skill mix (proportion of the total number of working hours as reported by registered nurses), and overtime use. Other nurse staffing attributes include education levels and nursing experience. The study found out that the number of skilled and experienced nurses available in healthcare settings determines the rates of adverse events alongside the intensity and duration of exposure to nurse staffing. Moreover, they found that nursing shortages contributed to nursing workload which is associated with negative patient outcomes.

Although nurses are usually aware of insufficient nurse staffing levels and their associated impacts, they rarely talk about it. Van Oostveen, Mathijssen & Vermeulen (2015) conducted a qualitative research study to gain insight into the nurses’ perceptions of nurse staffing levels in their hospitals. They discovered that nurses face a significant workload but shy away from requesting their organizations to hire additional practitioners due to the lack of autonomy and authority. D’Lima, Murray & Brett (2018), in their qualitative study, investigated factors that are related to nursing staffing in the Intensive Care Unit.  They pointed out that encouraging teamwork between nurses and other healthcare professionals and increasing staffing levels may solve the problem of poor patient outcomes associated with staffing shortages.

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Proposed Evidence-Based Practice Change

The evidence contained in the reviewed literature can be used to improve healthcare delivery and patient outcomes. Based on the information obtained from the reviewed articles, the proposed evidence-based practice change is to hire an adequate number of nurses in order to address the problem of nursing shortages and to improve patient outcomes. Generally, published literature supports the idea that hiring an adequate number of nurses reduces incidences of adverse events or improves patient safety outcomes as compared to working with an inadequate number of nurses. To embrace evidence-based practice, healthcare organizations should ensure that they hire adequate nurses who can closely monitor patients to protect them from adverse events.

References

Burns, N., & Grove, S. (2011). Understanding nursing research (5th ed.). St. Louis, MO: Elsevier.

D’Lima, D., Murray, E., & Brett, S. (2018). Perceptions of Risk and Safety in the ICU. Critical Care Medicine46(1), 60-70. doi: 10.1097/ccm.00000

—–More references follows

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