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Evidence Based Practice PICOT
- Consider a recent clinical experience in which you were providing care for a patient.
- Determine the extent to which the care that you provided was based on evidence and research findings or supported only by your organization’s standard procedures. How do you know if the tasks were based on research?
- What questions have you thought about in a particular area of care such as a procedure or policy?
- Review Chapter 2, pages 31–34 on “Asking Well worded Clinical Questions” in Polit & Beck and consult the resource from the Walden Student Center for Success: Clinical Question Anatomy & examples of PICOT questions (found in this week’s Learning Resources). Formulate your background questions and PICOT question.
- Reflect on the barriers that might inhibit the implementation of evidence-based practice in your clinical environment.
- Review the article “Adopting Evidence-Based Practice in Clinical Decision Making” in this week’s Learning Resources. Select one of the barriers described that is evident in your organization and formulate a plan for overcoming this barrier.
By Day 3
Post an evaluation of the use, or lack thereof, of EBP in a recent clinical experience. Identify which aspects of the care delivered, if any, were based on evidence and provide your rationale. List your background questions and PICOT question about this nursing topic. Critique how the policies, procedures, and culture in your organization may hinder or support the adoption of evidence-based practices. Identify the barrier you selected from the article and explain how this barrier could be overcome within your organization.
Course Project: Part 1—Identifying a Researchable Problem
One of the most challenging aspects of EBP is to actually identify the answerable question.
—Karen Sue Davies
Formulating a question that targets the goal of your research is a challenging but essential task. The question plays a crucial role in all other aspects of the research, including the determination of the research design and theoretical perspective to be applied, which data will be collected, and which tools will be used for analysis. It is therefore essential to take the time to ensure that the research question addresses what you actually want to study. Doing so will increase your likelihood of obtaining meaningful results.
In this first component of the Course Project, you formulate questions to address a particular nursing issue or problem. You use the PICOT model—patient/population, intervention/issue, comparison, and outcome—outlined in the Learning Resources to design your questions.
- Review the article, “Formulating the Evidence Based Practice Question: A Review of the Frameworks,” found in the Learning Resources for this week. Focus on the PICOT model for guiding the development of research questions.
- Review the section beginning on page 75 of the course text, titled, “Developing and Refining Research Problems” in the course text, which focuses on analyzing the feasibility of a research problem.
- Reflect on an issue or problem that you have noticed in your nursing practice. Consider the significance of this issue or problem.
- Generate at least five questions that relate to the issue which you have identified. Use the criteria in your course text to select one question that would be most appropriate in terms of significance, feasibility, and interest. Be prepared to explain your rationale.
- Formulate a preliminary PICO question—one that is answerable—based on your analysis. What are the PICO variables (patient/population, intervention/issue, comparison, and outcome) for this question?
Note: Not all of these variables may be appropriate to every question. Be sure to analyze which are and are not relevant to your specific question.
- Using the PICOT variables that you determined for your question, develop a list of at least 10 keywords that could be used when conducting a literature search to investigate current research pertaining to the question.
Write a 3- to 4-page paper that includes the following:
- A summary of your area of interest, an identification of the problem that you have selected, and an explanation of the significance of this problem for nursing practice
- The 5 questions you have generated and a description of how you analyzed them for feasibility
- Your preliminary PICOT question and a description of each PICOT variable relevant to your question
- At least 10 possible keywords that could be used when conducting a literature search for your PICOT question and a rationale for your selections
By Day 7
Submit your Project. It will also be a component of your Portfolio Assignment for this course, which is due by Day 7 of Week 10
Course Project: Part 2—Literature Review
This is a continuation of the Course Project presented in Week 2. Before you begin, review the Course Project Overview document located in the Week 2 Resources area.
The literature review is a critical piece in the research process because it helps a researcher determine what is currently known about a topic and identify gaps or further questions. Conducting a thorough literature review can be a time-consuming process, but the effort helps establish the foundation for everything that will follow. For this part of your Course Project, you will conduct a brief literature review to find information on the question you developed in Week 2. This will provide you with experience in searching databases and identifying applicable resources.
- Review the information in Chapter 5 of the course text, focusing on the steps for conducting a literature review and for compiling your findings.
- Using the question you selected in your Week 2 Project (Part 1 of the Course Project), locate 5 or more full-text research articles that are relevant to your PICOT question. Include at least 1 systematic review and 1 integrative review if possible. Use the search tools and techniques mentioned in your readings this week to enhance the comprehensiveness and objectivity of your review. You may gather these articles from any appropriate source, but make sure at least 3 of these articles are available as full-text versions through Walden Library’s databases.
- Read through the articles carefully. Eliminate studies that are not appropriate and add others to your list as needed. Although you may include more, you are expected to include a minimum of five articles. Complete a literature review summary table using the Literature Review Summary Table Template located in this week’s Learning Resources.
- Prepare to summarize and synthesize the literature using the information on writing a literature review found in Chapter 5 of the course text.
Write a 3- to 4-page literature review that includes the following:
- A synthesis of what the studies reveal about the current state of knowledge on the question that you developed
- Point out inconsistencies and contradictions in the literature and offer possible explanations for inconsistencies.
- Preliminary conclusions on whether the evidence provides strong support for a change in practice or whether further research is needed to adequately address your inquiry
- Your literature review summary table with all references formatted in correct APA style
PICOT Question Examples
Before giving PICOT Question Examples, first is to define what is a PICOT question. PICOT is an acronym to help you formulate a clinical question and guide your search for evidence. Using this format can help you find the best evidence available in a quicker, more efficient manner. The PICOT question format is a consistent “formula” for developing answerable, researchable questions. When you write a good one, it makes the rest of the process of finding and evaluating evidence much more straightforward.
- P: Population/patient – age, gender, ethnicity, individuals with a certain disorder
- I: Intervention/indicator (Variable of Interest) – exposure to a disease, risk behavior, prognostic factor
- C: Comparison/control – could be a placebo or “business as usual” as in no disease, absence of risk factor, Prognostic factor B
- O: Outcome – risk of disease, accuracy of a diagnosis, rate of occurrence of adverse outcome
- T: Time – the time it takes for the intervention to achieve an outcome or how long participants are observed
Note: Not every question will have an intervention (as in a meaning question) or time (when it is implied in another part of the question) component.
Evidence-Based PICOT Questions Examples
Population: Bariatric adolescents considering or undergoing gastric bypass surgery.
Intervention: The nurse’s role as a primary member of the multidisciplinary team regarding perioperative care of the bariatric adolescent patient.
Comparison: The nurse’s role as a secondary member of the multidisciplinary team without any specialized training and is only involved in perioperative care of the bariatric adolescent patient.
Outcome: When the nurse is involved as one of the primary members in the multidisciplinary team approach, the bariatric adolescent patient has better continuity of care.
Time: peri-operative including the 6 weeks post recovery.
PICOT Question: Does the bariatric adolescent patient undergoing gastric bypass have better continuity of care perio-peratively and post-operatively when the nurse is a primary member of the multidisciplinary team versus when the nurse is a secondary member whose only role is in providing peri-operative care and has no specialized training?
Intervention PICOT Question Examples, an Intervention example:
In adult patients with total hip replacements (Patient population) how effective is PCA pain medication (Intervention of interest) compared to prn IM pain medication (Comparison intervention) in controlling post operative pain (Outcome) during the perioperative and recovery time? Note: The IM pain medication would be called the control group. It would be unethical to have a control group that received NO pain medication. Many times the control group means they get “business as usual!” or the current standard of care.
Therapy PICOT Question Examples, a non-intervention example:
What is the duration of recovery (O) for patients with total hip replacement (P) who developed a post-operative infection (I) as opposed to those who did not (C) within the first six weeks of recovery (T)?
Etiology PICOT Question Examples:
Are kids (P) who have obese adoptive parents (I) at Increased risk for obesity (O) compared with kids (P) without obese adoptive parents (C) during the ages of five and 18 (T)?
Diagnostic PICOT Question Examples:
Is a PKU test (I) done on two week old infants (P) more accurate in diagnosis inborn errors in metabolism (O) compared with PKU tests done at 24 hours of age (C)? Time is implied in two weeks and 24 hours old.
Prevention PICOT Question Examples:
In OR nurses doing a five minute scrub (P) what are the differences in the presence and types of microbes (O) found on natural polished nails and nail beds (I) and artificial nails (C) at the time of surgery (T)?
Prognosis/Prediction PICOT Question Examples:
Does telemonitoring blood pressure (I) in urban African Americans with hypertension (P) improve blood pressure control (O) within the six months of initiation of the medication (T)?
Meaning PICOT Question Examples:
How do pregnant women (P) newly diagnosed with diabetes (I) perceive reporting their blood sugar levels (O) to their healthcare providers during their pregnancy and six weeks postpartum (T)?