NURS-FPX4030 Assessment 3 PICOT Questions and an Evidence-Based Approach ExamplePreventive nursing f

NURS-FPX4030 Assessment 3 PICOT Questions and an Evidence-Based Approach Example

Preventive nursing focuses on the early detection of an illness and implementing interventions to stop the illness from occurring or progressing. In a hypothetical case scenario, a nurse had a hard time diagnosing surgical site infection using the warning signs of infection NURS-FPX4030 Assessment 3 PICOT Questions and an Evidence-Based Approach. The patient only had erythema and swelling at the incision site without fever, discharge, or pain.

His desire to prevent surgical site infection from occurring in his patient led to his doubt that the signs were not adequate to say for sure that his patient started to have a surgical site infection (SSI). SSIs are a major cause of long patient hospital stays, mortality, morbidity, and increased cost of treatment (Iskandar et al., 2019). Annually, there are more than 100000 cases of surgical site infections (National Healthcare Safety Network, 2022).

SSIs surveillance and prevention have been some of the strategies used to intervene to prevent the outcome of SSIs. This paper aims to formulate a clinical question, identify potential sources, and explain their findings to answer the clinical question NURS-FPX4030 Assessment 3 PICOT Questions and an Evidence-Based Approach.

Definition of Practice Issue

The scenario above involves a situation where the nurses need clinical or scientific evidence to make informed decisions about the patient. To ensure proper patient surveillance, he will need to identify and prevent SSI early in this patient.

An alternative way to diagnose SSI is through laboratory investigations. Like other infections, SSIs can cause inflammation that can be detected through blood testing. C-reactive protein (CRP) assays have been a good marker for inflammation in the body NURS-FPX4030 Assessment 3 PICOT Questions and an Evidence-Based Approach.

Its assay can suggest inflammation in the body in the setting of SSIs. However, surgery is also an iatrogenic process that can cause inflammation (Chijioke, 2019). As such, the use of CRP in SSI surveillance requires clinical evidence. The benefits of using this protein marker in surgical site infection can be ascertained through evidence-based practice.

Clinical Question

Having defined the clinical issue, the second phase of the John Hopkins EBP model is to research for evidence. This started with the formulation of a practice question. The practice question was formulated in a PICOT format NURS-FPX4030 Assessment 3 PICOT Questions and an Evidence-Based Approach.

The PICO question stated: “In postoperative adult patients (P), is C-Reactive Protein assay (I) compared with the use of clinical signs (C) more accurate in early diagnosis of surgical site infections (O)? In this PICO question, the population includes adult patients who have had significant surgeries during their inpatient stay in the hospital. The intervention is laboratory testing that measures the serum amount of CRP during this period after the surgery.

The comparison intervention will use clinical signs of inflammation, such as tenderness, discharge, swelling, redness, and hotness. The time element will not be included in this clinical practice question NURS-FPX4030 Assessment 3 PICOT Questions and an Evidence-Based Approach.

PICO approach will benefit the exploration of the clinical issue by providing the search terms and phrases. Using the PICO question will improve the specificity of the literature search, thus improving its relevance and credibility (Eriksen & Frandsen, 2018).

The conceptual clarity before the search will also improve through PICO as all elements, including comparisons, are declared before literature acquisition. The population, problem, and interventions are defined, thus making the framework of the literature search clearer. Therefore, the returned search results will be high-quality, high-level evidence (Eldawlatly et al., 2018). Finally, using PICO questions will reduce the time required to complete the search.

Evidence-based Sources

A literature search was performed from the Cochrane Library, Cumulated Index to Nursing and Allied Health Literature (CINAHL), and PubMed databases. These sources are authoritative and contain peer-reviewed resources, including but not limited to journal articles and books.

After the literature search, articles were manually selected, and three sources were presented to attempt to answer the PICO question. The four resources selected were articles by Kim et al. (2021), Malheiro et al. (2020), Okui et al. (2022), and Shetty et al NURS-FPX4030 Assessment 3 PICOT Questions and an Evidence-Based Approach. (2022). These resources were credible because they were current, relevant, authoritative, accurate, and objective research articles (Kurpiel, 2022).

Their credibility made them fit to be used to answer the PCIO question. The credibility assessment was performed using the criteria from the CRAAP test. This test assesses the currency, relevance, authority, accuracy, and purpose of an evidence-based source. NURS-FPX4030 Assessment 3 PICOT Questions and an Evidence-Based Approach

Findings from the Articles

The article by Shetty et al. (2022) was from a prospective cohort study involving 51 orthopedic patients. This study found that fifteen patients developed surgical site infections and that CRP rose in all patients after surgery. However, the rise levels differed in both groups after the third post-op day (POD). The rise was gradual, and the difference between the two groups was statistically significant. Therefore, CRP is a good marker of SSI but only after the second day of the postoperative period.

Kim et al. (2021) excluded patients with comorbidities from their study that involved post-operative patients who underwent posterior lumbar fusion or decompression. Their observational study found a rise in all patients who had these surgeries. However, by POD7, CRP levels had been decreasing in some patients, of which 43% did not develop SSIs, and increasing in some patients who eventually developed SSIs. The serial CRP level change rate had a sensitivity of 90.9% and a specificity of 68.1% in SSI detection. Therefore, additional clinical patient monitoring is also important.

Okui et al. (2022) found that, on average, patients were being diagnosed with SSI between POD5 and POD9. Patients with poorer outcomes, such as SSI diagnosis, longer hospital stays, and low survival rates, had higher CRP levels by the 14th postoperative day. Early diagnosis with SSI was associated with severe SSI and outcomes. Therefore, early SSI detection is essential for patient care outcomes, and CRP levels can be good markers

Malheiro et al. (2020) compared various factors that would be used to predict the risk of infection, such as post-surgical antibiotic use, positive culture test,  CRP values, body temperature, leukocyte count, surgical re-intervention, admission to the emergency room, and hospital readmission among patients who had undergone colorectal surgeries and cholecystectomies.

The study found that antibiotic use and CRP values had the highest sensitivities for SSI risk. These two factors are, therefore, sensitive to the prediction of SSIs and thus good SSI surveillance markers NURS-FPX4030 Assessment 3 PICOT Questions and an Evidence-Based Approach.

The sources by Malheiro et al. (2020) and Kim et al. (2021) were the most credible because they additionally addressed other confounders, thus suitable for inference making. Additionally, they had the highest sample sizes making their findings more powerful due to increased accuracy. The other sources were also credible, nevertheless.

Relevance of the Findings

The four sources presented more or less related findings and addressed one common intervention, the CRP value use. Each source addressed the various elements of the PICO but only partially. The most addressed element was population and intervention. Only one source (Kim et al., 2021) addressed the comparison intervention.

The findings presented by Kim et al. (2021), Okui et al. (2022), and Shetty et al. (2022) are useful in addressing the appropriateness of the intervention from the PICO. Their findings explain to the clinician when to do CRP values and which patients. The other source by Malheiro et al. (2020) is too general for the PICO question despite using the largest sample size in their study. The source by Kim et al. (20210 remains the most credible in solving the clinical practice issue.

Conclusion

The clinical issue involved a scenario where the use of clinical signs in the early detection of surgical site infection was unreliable. Therefore, using CRP values to screen for SSIs early in the postop period was a new intervention that would require evidence-based answers. This activity adopted the John Hopkins EBP model to seek evidence-based answers to the clinical issue.

A PICO question was used to improve search accuracy and provide conceptual clarity to the search. The four sources selected based on their credibility answered the PICO question in parts. Of the four sources, one source was outstanding because it was the most credible in that it additionally addressed the comparison intervention.

Therefore, the use of the PICO question is a valuable intervention in the EBP process as literature search and drawing a conceptual framework for literature acquisition depend on it.

NURS-FPX4030 Assessment 3 PICOT Questions and an Evidence-Based Approach References

Chijioke, A. C. (2019). Evaluation of Serial C-Reactive Protein as a Predictor of Surgical Site Infection Following Emergency Laparotomy in Children in Ile-Ife, Nigeria. World Journal of Surgery and Surgical  Research, 2, 1138.

Eldawlatly, A., Alshehri, H., Alqahtani, A., Ahmad, A., Al-Dammas, F., & Marzouk, A. (2018). The appearance of Population, Intervention, Comparison, and Outcome as a research question in the title of articles of three different anesthesia journals: A pilot study. Saudi Journal of Anaesthesia, 12(2), 283. https://doi.org/10.4103/sja.sja_767_17

Eriksen, M. B., & Frandsen, T. F. (2018). The impact of patient, intervention, comparison, outcome (PICO) as a search strategy tool on literature search quality: a systematic review. Journal of the Medical Library Association: JMLA, 106(4), 420–431. https://doi.org/10.5195/jmla.2018.345

Iskandar, K., Sartelli, M., Tabbal, M., Ansaloni, L., Baiocchi, G. L., Catena, F., Coccolini, F., Haque, M., Labricciosa, F. M., Moghabghab, A., Pagani, L., Hanna, P. A., Roques, C., Salameh, P., & Molinier, L. (2019). Highlighting the gaps in quantifying the economic burden of surgical site infections associated with antimicrobial-resistant bacteria. World Journal of Emergency Surgery, 14(1). https://doi.org/10.1186/s13017-019-0266-x

Kim, M. H., Park, J.-H., & Kim, J. T. (2021). A reliable diagnostic method of surgical site infection after posterior lumbar surgery based on serial C-reactive protein. International Journal of Surgery: Global Health, 4(5), e61–e61. https://doi.org/10.1097/gh9.0000000000000061

Kurpiel, S. (2022, April 13). Research guides: Evaluating sources: The CRAAP test. https://researchguides.ben.edu/c.php?g=261612&p=2441794

Malheiro, R., Rocha-Pereira, N., Duro, R., Pereira, C., Alves, C. L., & Correia, S. (2020). Validation of a semi-automated surveillance system for surgical site infections: Improving exhaustiveness, representativeness, and efficiency. International Journal of Infectious Diseases: IJID: Official Publication of the International Society for Infectious Diseases, 99, 355–361. https://doi.org/10.1016/j.ijid.2020.07.035

National Healthcare Safety Network. (2022, January). Surgical Site Infection Event (SSI). Cdc.gov. https://www.cdc.gov/nhsn/pdfs/pscmanual/9pscssicurrent.pdf

Okui, J., Obara, H., Shimane, G., Sato, Y., Kawakubo, H., Kitago, M., Okabayashi, K., & Kitagawa, Y. (2022). The severity of early diagnosed organ/space surgical site infection in elective gastrointestinal and hepatopancreatobiliary surgery. Annals of Gastroenterological Surgery, 6(3), 445–453. https://doi.org/10.1002/ags3.12539

Shetty, S., Ethiraj, P., & Shanthappa, A. H. (2022). C-reactive protein is a diagnostic tool for postoperative infection in orthopedics. Cureus, 14(2), e22270. https://doi.org/10.7759/cureus.22270

NURS-FPX4030 Assessment 3 PICOT Questions and an Evidence-Based Approach Instructions

Create a 3-5-page submission in which you develop a PICO(T) question for a specific care issue and evaluate the evidence you locate, which could help to answer the question. PICO(T) is an acronym that helps researchers and practitioners define aspects of a potential study or investigation. It stands for:

• P – Patient/population/problem.
• I – Intervention.
• C – Comparison (of potential interventions, typically).
• O – Outcome(s).
• T – Time frame (if time frame is relevant).

The end goal of applying PICO(T) is to develop a question that can help guide the search for evidence (Boswell & Cannon, 2015). From this perspective, a PICO(T) question can be a valuable starting point for nurses who are starting to apply an evidence-based model or EBPs.

By taking the time to precisely define the areas in which the nurse will be looking for evidence, searches become more efficient and effective. Essentially, by precisely defining the types of evidence within specific areas, the nurse will be more likely to discover relevant and useful evidence during their search.

You are encouraged to complete the Vila Health PCI(T) Process activity before you develop the plan proposal. This activity offers an opportunity to practice working through creating a PICO(T) question within the context of an issue at a Vila Health facility. These skills will be necessary to complete Assessment 3 successfully. This is for your own practice and self-assessment and demonstrates your engagement in the course.

DEMONSTRATION OF PROFICIENCY

By successfully completing this assessment, you will demonstrate your proficiency in the course competencies through the following assessment scoring guide criteria:

• Competency 1: Interpret findings from scholarly quantitative, qualitative, and outcomes research articles and studies.
  • Explain the findings from articles or other sources of evidence.
• Competency 2: Analyze the relevance and potential effectiveness of evidence when making a decision.
  • Identify sources of evidence that could be potentially effective in answering a PICO(T) question.
  • Explain the relevance of the findings from chosen sources of evidence to making decision related to a PICO(T) question.
• Competency 3: Apply an evidence-based practice model to address a practice issue.
  • Define a practice issue to be explored via a PICO(T) approach.
• Competency 5: Apply professional, scholarly communication strategies to lead practice changes based on evidence.
  • Communicate using writing that is clear, logical, and professional with correct grammar and spelling using current APA style. Assessment #3 Instructions: PICO(T) Questions and an Evidence- Based Approach.

NURS-FPX4030 Assessment 3 PICOT Questions and an Evidence-Based Approach Reference

Boswell, C., & Cannon, S. (2015). Introduction to nursing research. Burlington, MA: Jones & Bartlett Learning.

PROFESSIONAL CONTEXT for NURS-FPX4030 Assessment 3 PICOT Questions and an Evidence-Based Approach

As a baccalaureate-prepared nurse, you will be responsible for locating and identifying credible and scholarly resources to incorporate the best available evidence for the purposes of enhancing clinical reasoning and judgement skills. When reliable and relevant evidence-based findings are utilized, patients, health care systems, and nursing practice outcomes are positively impacted.

PICO(T) is a framework that can help you structure your definition of the issue, potential approach that you are going to use, and your predictions related the issue. Word choice is important in the PICO(T) process because different word choices for similar concepts will lead you toward different existing evidence and research studies that would help inform the development of your initial question.

SCENARIO

For this assessment, please use an issue of interest from your current or past nursing practice. If you do not have an issue of interest from your personal nursing practice, then review the optional Case Studies presented in the resources and select one of those as the basis for your assessment.

Instructions for Completing NURS-FPX4030 Assessment 3 PICOT Questions and an Evidence-Based Approach

For this assessment, select an issue of interest an apply the PICO(T) process to define the question and research it. Your initial goal is to define the population, intervention, comparison, and outcome. In some cases, a time frame is relevant and you should include that as well, when writing a question you can research related to your issue of interest.

After you define your question, research it, and organize your initial findings, select the two sources of evidence that seem the most relevant to your question and analyze them in more depth. Specifically, interpret each source’s specific findings and best practices related to your issues, as well explain how the evidence would help you plan and make decisions related to your question.

If you need some structure to organize your initial thoughts and research, the PICOT Question and Research Template document (accessible from the “Create PICO(T) Questions” page in the Capella library’s Evidence Based Practice guide) might be helpful. In your submission, make sure you address the following grading criteria:

• Define a practice issue to be explored via a PICO(T) approach.
• Identify sources of evidence that could be potentially effective in answering a PICO(T) question.
• Explain the findings from articles or other sources of evidence.
• Explain the relevance of the findings from chosen sources of evidence to making decision related to a PICO(T) question.
• Communicate using writing that is clear, logical, and professional with correct grammar and spelling using current APA style.

Example Assessment: You may use the following to give you an idea of what a Proficient or higher rating on the scoring guide would look like:

• Assessment 3 Example 1 [PDF].

ADDITIONAL REQUIREMENTS

Your assessment should meet the following requirements:

• Length of submission: Create a 3–5-page submission focused on defining a research question and interpreting evidence relevant to answering it. A title page is not required but you must include a reference list.
• Number of references: Cite a minimum of four sources of scholarly or professional evidence that support your findings and considerations. Resources should be no more than 5 years old.
• APA formatting: Format references and citations according to current APA style.
• NURS-FPX4030 Assessment 3 PICOT Questions and an Evidence-Based Approach

Portfolio Prompt: Remember to save the final assessment to your ePortfolio so that you may refer to it as you complete the final capstone course.

Resources: PICO(T) Process

• The resources below explore the PICO(T) process:
  • Abbade, L. P. F., Wang, M., Sriganesh, K., Jin, Y., Mbuagbaw, L., & Thabane, L. (2017). The framing of research questions using the PICOT format in randomized controlled trials of venous ulcer disease is suboptimal: A systematic survey. Wound Repair & Regeneration, 25(5), 892-900.

• • • This article presents a study that examined the use of PICO(T) questions to locate evidence related to specific types of resources and research.

• • Ho, G. J., Liew, S. M., Ng, C., Shunmugam, R., & Glasziou, P. (2016). Development of a search strategy for an evidence based retrieval service. PLoS One, 11(12), 1-14. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0167170

• • • This article presents a study comparing the use of PICO(T) questions in a literature search to other search strategies.

This first two chapters in the following text, of which the Capella library has limited copies, could be helpful in expanding your knowledge regarding the PICO(T) process.

• • Boswell, C., & Cannon, S. (2020). Introduction to nursing research. Jones & Bartlett Learning.

Resources: Communicating Research

• The resources below explore communicating research:
  • Bullington, J., Söderlund, M., Elisabeth Bos Sparén, Kneck, Å., Omérov, P., & Cronqvist, A. (2019). Communication skills in nursing: A phenomenologically-based communication training approach. Nurse Education in Practice, 39, 136-141.
    • This article presents the approach to communication in clinical situations and also discusses the barriers related to nurses sharing and communicating.

• • Gutiérrez-Puertas, L., Márquez-Hernández, V.,V., Gutiérrez-Puertas, V., Granados-Gámez, G., & Aguilera-Manrique, G. (2020). Educational interventions for nursing students to develop communication skills with patients: A systematic review. International Journal of Environmental Research and Public Health, 17(7), 2241.

• • • This article provides preliminary evidence of the effectiveness of interventions used to train nursing students in patient-centered communication. Although all the interventions obtained significant results in communication skills, it has not yet been determined which methodology is more effective.

PICOT QUESTION PROCESS

Creating a question using the PICOT elements will provide a framework for the research you need to conduct an evidence-based study or to make an evidence-based decision.

PICOT Elements:

(P) – Population, Patients or Problem: The sample of subjects used in a study, or the problem being addressed.

(I) – Intervention:  The treatment that will be provided to subjects enrolled in your study.

(C) – Comparison or Control:  Identifies an alternative intervention or treatment to compare. Many study designs refer to this as the control group. If an existing treatment is considered the ‘gold standard’, then it should be the comparison group. A control group is not required for every type of study.

(O) – Outcome: The clinical outcome that measures the effectiveness of the intervention.

(T) – Time: Duration of the data collection.  Some versions don’t include this element, and time may not be specified in cases where the question is focused on prediction or diagnoses.

PICOT Question Formats:

• Intervention: In _______ (P), how does _______ (I) compared to _______  (C) affect _______  (O) within _______ (T)?
• Prognosis/Prediction:  In _______ (P), how does _______ (I) compared to _______ (C) influence/predict _______ (O) over _______ (T)?
• Diagnosis or Diagnostic test:  In _______   (P) are/is _______   (I) compared to _______ (C) more accurate in diagnosing _______ (O)?
• Etiology:  Are _______ (P), who have _______ (I) compared to those without _______ (C) at _______ risk for/of _______ (O) over _______ (T)?
• Meaning:  How do_______ (P) with _______ (I) perceive _______ (O) during _______ (T)?

Example PICOT Questions:

• In acute care hospitals (P), how does having a rapid response team (I) compared with not having a response team (C) affect the number of cardiac arrests (O) during a three-month period (T)?
• In women with gestational diabetes (P), how does a monitored diet and exercise program over the course of pregnancy (I &T), compared to the use of metformin only (C) reduce the incidence of high birth weight babies(O)?
• In patients admitted for acute myocardial infarction (P), how well does the hospital’s new data model created from EMR data (I) compared to current practices (C) predict readmission rates (O) within 30 days after initial discharge (T)?
• For patients of a rural health clinic (P), does the use of text message reminders (I), compared with telephone calls (C) reduce the number of missed appointments (O) over a six month period (T)?

References:

• Melnyk, B.M., Fineout-Overholt, E., Stillwell, S. & Williamson, K. M. (2010). Evidence-Based Practice: Step by Step: The Seven Steps of Evidence-Based Practice. AJN, American Journal of Nursing, 110, 51-53.
• Posing the research question: Not so simple
• To make your case, start with a PICOT question
• What is your research question? An introduction to the PICOT format for clinicians.
• Melnyk, B. M., & Fineout-Overholt, E. (2015). Evidence-based practice in nursing & healthcare: A guide to best practice. (Not in library)

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