Nursing Clinical Issue Discussion Paper

According to Houser (2018), defining the research problem and question are essential steps in the research process. Nurses should identify nursing practice problems, gaps in knowledge, or practices that would be addressed by evidence. This paper discusses a practice problem and clinical question in PICOT format that would be addressed by evidence.

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Nurses spend most of the hospitalized patients delivering care using the nursing process for different case presentations. However, unexpected patient deteriorations are common in the wards, requiring an interdisciplinary approach to promote patient safety, reduce in-ward cardiac arrest, and prevent death (Vincent et al., 2018)Nursing Clinical Issue Discussion Paper. Due to high patient acuity in some of the inpatient wards, nurses may not prevent all patient deterioration. The availability of physicians in the units is ineffective in initiating and implementing effective resuscitation that promptly improves patients’ survival. Also, nurses working in the wards may lack adequate knowledge to implement effective rapid responses to prevent impending disability, complication, or death. Therefore, there is a dire need for trained rapid response teams (RRTs) of professionals who can promptly and effectively prevent more deterioration.

The PICOT question is – Among patients admitted to the hospital (P), would rapid response teams with continuous telemetry monitoring (I) decrease patient deterioration and mortality (O) compared to no response teams (C) over three months (T)?Nursing Clinical Issue Discussion Paper

The increased failure to rescue in the inpatient wards of patients admitted with all kinds of medical or surgical problems sparked the need for this PICOT. According to Rocha et al. (2018), rapid response teams can use clinical deterioration identification systems to facilitate early diagnosis. Therefore, the support provided by continuous telemetry monitoring will help the rapid response teams intervene early and offer emergency care, preventing cardiac arrest and hospital mortality. Continuous telemetry monitoring provides timely surveillance of patients’ HR, RR, pulse oximetry, and capnography (Lyons et al., 2018). According to Dukes et al. (2019), a dedicated team of nurses and other care professionals without other responsibilities is essential to ensure effective RRTs. In cases of rapid response calls, RRT would prevent the need for team members to leave other duties to attend to the emergency.

In summary, the practice problems of unexpected cardiac arrest and hospital mortality would be reduced by instituting rapid response teams. The project manager expects that using continuous telemetry monitoring that detects early deterioration will facilitate the success of RRTs in improving patient survival Nursing Clinical Issue Discussion Paper.

References

Dukes, K., Bunch, J. L., Chan, P. S., Guetterman, T. C., Lehrich, J. L., Trumpower, B., … & Girotra, S. (2019). Assessment of rapid response teams at top-performing hospitals for in-hospital cardiac arrest. JAMA internal medicine, 179(10), 1398-1405. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2739059

Houser, J. (2018). Nursing Research: Reading, Using and Creating Evidence: Reading, Using and Creating Evidence (4th ed.). Jones & Bartlett Learning.

Lyons, P. G., Edelson, D. P., & Churpek, M. M. (2018). Rapid response systems. Resuscitation, 128, 191–197. https://doi.org/10.1016/j.resuscitation.2018.05.013

Rocha, H. A. L., Alcântara, A. C. D. C., Rocha, S. G. M. O., & Toscano, C. M. (2018). Effectiveness of rapid response teams in reducing intrahospital cardiac arrests and deaths: a systematic review and meta-analysis. Revista Brasileira de terapia intensiva, 30, 366-375. https://doi.org/10.5935/0103-507X.20180049

Vincent, J. L., Einav, S., Pearse, R., Jaber, S., Kranke, P., Overdyk, F. J., Whitaker, D. K., Gordo, F., Dahan, A., & Hoeft, A. (2018). Improving detection of patient deterioration in the general hospital ward environment. European journal of anaesthesiology, 35(5), 325–333. https://doi.org/10.1097/EJA.0000000000000798

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NR 439 PICOT Question Guide

The following contains PICOT question guides/templates to use to help write questions using all of the PICOT elements.  Each template contains a guide that you can use to write a complete PICOT question, examples of PICOT elements, and illustrations[1].  Review some tips and hints below to think about for each of the PICOT elements that can help create a sound clinical nursing PICOT question: Nursing Clinical Issue Discussion Paper

 

P=Population of patients:     Think about a group of patients you are interested in studying—identify the group by age ranges, diagnosis/disease of interest, history or length of time with the diagnosis/disease of interest, location, unit, or setting, gender type (if applicable), race (if applicable), or other identifiable characteristics such as Medicare, Medicaid, immobile, ventilated, inpatient, outpatient, etc.

I=Intervention:                     Consider the nursing action or intervention you are thinking that would make a difference?  From your search for evidence, what is the evidence indicating that nurses can do to help improve the problem or issue you have chosen?

C=Comparison:                     Think about comparing to the intervention of interest or the alternative such as routine/standard care.  If no comparison, state not implementing the intervention or no comparison group.

O=Outcome:                           Reflect upon what would be the measurable, relatable indicator that would demonstrate the intervention is making a difference or not?  What would be the needed outcome that you could observe/check/measure? For example, “the pain is okay” would not be a measurable outcome.  Rates pain level less than 3 on pain scale would be measurable.

T=Timeframe:                       For this element, reflect on how long it would take to implement your study by collecting data or the time needed to observe to see if any changes occurred or will occur. Think about 1 month, 3 months, 6 months etc… Use a timeframe that is realistic Nursing Clinical Issue Discussion Paper.

Template A

 

Among/In _________________________ (P), does______________________ (I) (**decrease/increase/impact/influence/affect/reduce/improve**) _____________________ (O) compared to ______________________________ (C) over ______________________________(T)?

(**choose one term**)

Example:

Among 65+ and older diabetic immobile adults in long-term care (P), does a bedside oral care kit and checklist protocol (I) compared to routine oral care without a bedside oral care kit (C) affect the number of times oral care is completed (O) over 3 months (T)?

P=Population of patients:  65+ and older diabetic immobile adults in long-term care

I=Intervention:   bedside oral care kit and a checklist protocol

C=Comparison:  routine oral care without a bedside oral care kit

O=Outcome:  number of times (frequency) oral care is completed

T=Timeframe:  3 months

Template B

Among/In _________________________ (P), would______________________(I) (**decrease/increase/impact/influence /affect/reduce/improve **)_____________________ (O) compared to ______________________________ (C) over ______________________________(T)?

(**choose one term**)

Example: Nursing Clinical Issue Discussion Paper

 

In male ICU patients who are 65+ and older diagnosed with COPD (P), would the confusion assessment screening tool (CAST) (I) impact the number of early identification of delirium (O) compared to no screening tool (C) over 6 months (T)?

P=Population of patients:  Inpatient male ICU patients 65+ and older diagnosed with COPD

I=Intervention:   confusion assessment screening tool (CAST)

C=Comparison:  routine care/no screening tool

O=Outcome:  number of early identification of delirium

T=Timeframe:  6 months

Template C

 Among/In _________________________ (P), will ______________________ (I) (**decrease/increase/impact/influence/affect/reduce/improve **)_____________________ (O) compared to ______________________________ (C) over ______________________________ (T)?

(**choose one term**)

 

Example:

Among Hispanic pregnant women between 36-40 weeks (P), will completing a lactation course (I) increase the number of breastfeeding initiations by or within 6 hours of delivery (O) compared to no lactation course (C) over 6 months?

P=Population of patients:  Hispanic pregnant women between 36-40 weeks

I=Intervention:   lactation course completed

C=Comparison:  no lactation course

O=Outcome:  number of breastfeeding initiations within 6 hours of delivery

T=Timeframe:  6 months

Template D

 

Among/In _________________________ (P), what is the effect of ______________________ (I) on ____________________ (O) compared to ___________________________ (C) over ______________ (T)?

Example:

In pediatric non-Hispanic Black males ages 8-18 years old with a 5 year history of type 1 diabetes (P), what is the effect of the Glucose Buddy Diabetes Tracker app (I) on maintaining HbA1C levels <7% (O) compared to the mySugar Diabetes Tracker Log app (C) over 6 months (T)?

 

P=Population of patients:  pediatric non-Hispanic Black males ages 8-18 years old with 5 year history of type 1 diabetes

I=Intervention:   Glucose Buddy Diabetes Tracker app

C=Comparison:  mySugar Diabetes Tracker Log app

O=Outcome:  HbA1C levels <7%

T=Timeframe:  6 months

[1] Adapted from Houser (2018) and the American Academy of Ambulatory Care Nursing (AAACN). (2018). AAACN research toolkit:  Template for asking PICOT questions Nursing Clinical Issue Discussion Paper.

Discussion Questions
Professional nurses rely on research findings to inform practice decisions; they use critical thinking to apply research directly to specific patient care situations.
Think about an independent nursing practice problem you care passionately about and would be interested in searching for evidence.
The below problems should not be used:
*medical/doctor/physician problems such as medications, or medications administration or effects, diagnostics such as EKGs, labs, cardiac catherizations.
*staffing, nurse-to-patient ratios, workforce issues are organizational/system /political/administrative/multi-stakeholder problems which nursing cannot solve independently.
• Describe a significant nursing clinical issue, topic of interest, or practice problem that is important to you. Describe why you chose the problem/topic.
• Write your clinical question in the PICO(T) format for your nursing practice problem.
• *To write your clinical question in the PICO(T) format, use the NR439_Guide for writing PICOT Questions and Examples found in your required reading or access the following link:
NR439_Guide for writing PICOT Questions and Examples (Links to an external site.)
• List each of your PICOT elements.
Share why you care about this nursing practice problem and why you believe the problem would benefit from finding the best evidence Nursing Clinical Issue Discussion Paper.

Week 2: Assigned Readings

Required
Houser, J. (2018). Nursing research: Reading, using, and creating evidence (4th ed.). Jones and Bartlett.
• Chapter 2: The Research Process and Ways of Knowing (WO 1)
• Chapter 4: Finding Problems and Writing Questions (WOs 2, 3, 4, 5, 6)
Optional
Riva, J. J., Malik, K. M., Burnie, S. J., Endicott, A. R., & Busse, J. W. (2012). What is your research question? An introduction to the PICOT format for clinicians (Links to an external site.). Journal of the Canadian Chiropractic Association, 56(3), 167-171. (WOs 1, 2, 3, 4)
Stillwell, S. B., Fineout-Overholt, E., Melnyk, B. M., & Williamson, K. M. (2010). Asking the clinical question: A key step in evidence-based practice (Links to an external site.). American Journal of Nursing, 110(3), 58-61. 10.1097/01.NAJ.0000368959.11129.79 (WOs 2, 3, 4)

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Must use and cite the reading from the book and outside scholarly.

Discussion Questions

Professional nurses rely on research findings to inform practice decisions; they use critical thinking to apply research directly to specific patient care situations.

Think about an independent nursing practice problem you care passionately about and would be interested in searching for evidence Nursing Clinical Issue Discussion Paper.

The below problems should not be used:

*medical/doctor/physician problems such as medications, or medications administration or effects, diagnostics such as EKGs, labs, cardiac catherizations.

*staffing, nurse-to-patient ratios, workforce issues are organizational/system /political/administrative/multi-stakeholder problems which nursing cannot solve independently.

• Describe a significant nursing clinical issue, topic of interest, or practice problem that is important to you. Describe why you chose the problem/topic.
• Write your clinical question in the PICO(T) format for your nursing practice problem.
• *To write your clinical question in the PICO(T) format, use the NR439_Guide for writing PICOT Questions and Examples found in your required reading or access the following link:

NR439_Guide for writing PICOT Questions and Examples (Links to an external site.)Nursing Clinical Issue Discussion Paper

• List each of your PICOT elements.

Share why you care about this nursing practice problem and why you believe the problem would benefit from finding the best evidence.

Week 2: Assigned Readings

Required

Houser, J. (2018). Nursing research: Reading, using, and creating evidence (4th ed.). Jones and Bartlett.

• Chapter 2: The Research Process and Ways of Knowing (WO 1)
• Chapter 4: Finding Problems and Writing Questions (WOs 2, 3, 4, 5, 6)Nursing Clinical Issue Discussion Paper

Optional

Riva, J. J., Malik, K. M., Burnie, S. J., Endicott, A. R., & Busse, J. W. (2012). What is your research question? An introduction to the PICOT format for clinicians (Links to an external site.). Journal of the Canadian Chiropractic Association, 56(3), 167-171. (WOs 1, 2, 3, 4)

Stillwell, S. B., Fineout-Overholt, E., Melnyk, B. M., & Williamson, K. M. (2010). Asking the clinical question: A key step in evidence-based practice (Links to an external site.). American Journal of Nursing, 110(3), 58-61. 10.1097/01.NAJ.0000368959.11129.79 (WOs 2, 3, 4)

Must use and cite the reading from the book and outside scholarly Nursing Clinical Issue Discussion Paper