Assessment 3 Instructions: PICO(T) Questions and an Evidence-Based Approach

 

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.

Introduction

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. When applying the PICO(T) approach, the nurse can isolate the interventions of interest and compare to other existing interventions for the evidenced impact on the outcome of the concern.

You are encouraged to complete the Vila Health PICO(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.

 

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Reference

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

Professional Context

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 to 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. When writing a PICO(T)-formatted research question, you want to focus on the impact of the intervention and the comparison on the outcome you desire.

Scenario

For this assessment, please use a health care 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 this assessment, select a health care issue of interest and apply the PICO(T) process to develop the research 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. Create a PICO(T)-formatted research question
    • Identify sources of evidence that could be potentially effective in answering a PICO(T) question (databases, journals, websites, etc.).
    • Explain the findings from articles or other sources of evidence as it relates to the identified health care issue.
    • 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 the 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:

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.
    • 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 the current APA style.

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.

Competencies Measured

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 that are relevant to the health care issue.
    • 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 and develop a PICO(T)-formatted research question.
    • Competency 5: Apply professional, scholarly communication strategies to lead practice changes based on evidence.
      • Organize content so ideas flow logically with smooth transitions; contains few errors in grammar/punctuation, word choice, and spelling.
      • Apply APA formatting to in-text citations and references exhibiting nearly flawless adherence to APA format.
  • SCORING GUIDE

Use the scoring guide to understand how your assessment will be evaluated.

VIEW SCORING GUIDE

 

PICO(T) Questions and an Evidence-Based Approach Scoring Guide

CRITERIA NON-PERFORMANCE BASIC PROFICIENT DISTINGUISHED
Define a practice issue to be explored via a PICO(T) approach and develop a PICO(T)-formatted research question. Does not define a practice issue to be explored via a PICO(T) approach. Identifies a practice issue, but does not frame it within the context of a PICO(T) question or approach. Defines a practice issue to be explored via a PICO(T) approach. Develops a PICO(T)-formatted research question. Defines a practice issue to be explored via a PICO(T) approach. Develops a PICO(T)-formatted research question. Notes how the exploration of the practice issue will benefit from a PICO(T) approach.
Identify sources of evidence that could be potentially effective in answering a PICO(T) question. Does not identify sources of evidence that could be potentially effective in answering a PICO(T) question. Attempts to identify sources of evidence, but does not connect them to the PICO(T) question, or the connection is unclear. Identifies sources of evidence that could potentially be effective in answering a PICO(T) question. Identifies sources of evidence that could be potentially effective in answering a PICO(T) question. Presents criteria or rational used to determine potential to answer the PICO(T) question.
Explain the findings from articles or other sources of evidence that are relevant to the health care issue. Does not explain the findings from articles or other sources of evidence that are relevant to the health care issue Lists the findings from articles or other sources of evidence, but does not offer a full explanation. Explains the findings from articles or other sources of evidence that are relevant to the health care issue. Explains the findings from articles or other sources of evidence that are relevant to the health care issue. Notes which sources are the most credible.
Explain the relevance of the findings from chosen sources of evidence to making decision related to a PICO(T) question. Does not explain the relevance of the findings from chosen sources of evidence. Identifies the relevance of the findings from chosen sources of evidence, but does not offer a full explanation of how it relates to the PICO(T) question. Explains the relevance of the findings from chosen sources of evidence to making decision related to a PICO(T) question. Explains the relevance of the findings from chosen sources of evidence to making decision related to a PICO(T) question. Notes which findings are the most relevant or likely to lead to positive outcomes.
Organize content so ideas flow logically with smooth transitions; contains few errors in grammar/punctuation, word choice, and spelling. Does not organize content so ideas flow logically with smooth transitions. Contains errors in grammar/punctuation, word choice, and spelling. Attempts to organize content with some logical flow and smooth transitions. Contains several errors in grammar/punctuation, word choice, and spelling. Organizes content so ideas flow logically with smooth transitions; contains few errors in grammar/punctuation, word choice, and spelling. Organizes content with a clear purpose. Content flows logically with smooth transitions using coherent paragraphs, correct grammar/punctuation, word choice, and free of spelling errors.
Apply APA formatting to in-text citations and references exhibiting nearly flawless adherence to APA format. Does not apply APA formatting to headings, intext citations, and references. Does not use quotes or paraphrase correctly. Applies APA formatting to in-text citations, headings and references incorrectly and/or inconsistently, detracting noticeably from the content. Inconsistently uses headings, quotes and/or paraphrasing. Applies APA formatting to in-text citations and references exhibiting nearly flawless adherence to APA format. Exhibits strict and flawless adherence to APA formatting of headings, intext citations, and references. Quotes and paraphrases correctly.

 

 

Assessment 3: PICO(T) Questions and an Evidence-Based Approach Resources

 

Resources: PICO(T) Process

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

 

Resources: Communicating Research

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      • This article presents the approach to communication in clinical situations and also discusses the barriers related to nurses sharing and communicating.
      • 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.

 

Resources: Case Studies

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  • If you choose not to use a problem from your practice experience as the basis of this assessment, consider reviewing the following case studies:

 

Activity: Vila Health: PICO(T) Process

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Click the linked Vila Health: PICO(T) Process title above to complete this formative activity, which 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.

 

 

Resources: Program Resources and Library Resources

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  • Writing Resources

A variety of writing resources are available in the NHS Learner Support Lab, linked in the courseroom navigation menu. Access these resources to help you better understand and improve your writing.

APA Style and Format

Capella University follows the style and formatting guidelines in the Publication Manual of the American Psychological Association, known informally as the APA manual. Refer to the Writing Center’s APA Module for tips on proper use of APA style and format.

Library Resources

Access the following library resources:

      • The library research guide will be useful in guiding you through the Capella library, offering tips for searching the literature and other references for your assessments.
      • This is a list of the library databases that are relevant to nursing and health sciences.
      • Library guide to EBP-related topics with a focus on nursing and health sciences.
      • Guide to help you more efficiently locate scholarly and peer-reviewed resources.
      • This guide offers a five-step approach to improving your research search effectiveness.

 

 

 

PICOT Question and Search Strategy Template

Use with the library guide: Evidence Based Practice in Nursing & Health Sciences

 

  1. Define your question using PICOT (review the “Create PICOT Questions” page as needed):

Population:         __________________________________________________________________

Intervention:     __________________________________________________________________

Comparison:       __________________________________________________________________

Outcome:            __________________________________________________________________

Time (optional): __________________________________________________________________

 

  1. Write out your question: ______________________________________________________

________________________________________________________________________________

 

  1. Write down the most important words from your question in the gray boxes. For each top term, add synonyms or related terms in the boxes below it.  All these are your search terms.

 

  1. Review the “Best Bets” in the Nursing Databases list. Check the databases you will search:
__ CINAHL Complete (*Recommended)

__ Nursing & Allied Health

__ Public Health Database

 __ Health & Medical Collection

__ OVID Nursing Full Text Plus

­__ PubMed Central

 
  1. Write in your first search below. Follow the instructions on the “Find EBP Articles…” page.

 

 

 

OR
AND

                                                                                 

  • Scholarly/peer reviewed Œ  Limit publication date:

 

  1. Type of studies you want to include in your search:
__ Systematic Review or Meta-Analysis

__ Clinical Practice Guidelines

 __ Individual Research Studies

__ Critically Appraised Research Studies

 

  1. What information did you find to help answer your question?

__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

 

This form is adapted from: Syrene A. Miller, PICO Worksheet and Search Strategy, National Center for Dental Hygiene Research

 

 

 

Example: Using a PICO(T) Framework and Evidence to Develop Care Practices

NURS-FPX4030: Making Evidence-Based Decisions

 

Using a PICO(T) Framework and Evidence to Develop Care Practices

Evidence-based approaches can be used to effectively address a number of healthcare-related issues. When applying evidence-based practice, the primary goal is to

ensure patient safety and provide the best possible health outcome. One way to achieve this is by formulating a PICO(T) question when conducting research. By utilizing a PICO(T) framework, the researcher will address the population, interventions, comparison or control, outcome, and timeframe. For the purpose of this paper, the PICO(T) question we will explore is: “With adults in the hospital setting, does hourly rounding compared to no hourly rounding affect patient fall outcomes?”

Use of the PICO(T) Approach When Caring for Patients at Risk for Falls

The most frequent adverse events documented in hospitals are patient falls. It is estimated that hospitals in the United States experience between 700,000 and 1 million patient falls annually, which causes up to 250,000 injuries and 11,000 fatalities (LeLaurin & Shorr, 2019). To break this down even further, about 2% of hospitalized patients fall at least once, during their stay. Approximately one in four falls result in injury, with about 10% resulting in serious injury. Falls and the standard of nursing care provided in a hospital setting have been directly correlated. In this scenario, the PICO(T) approach will be applied to determine the effect hourly patient rounding has on inpatient falls. Patient rounding is the procedure of regularly checking on patients to assess safety and anticipate their needs. The practice issue of concern is the occurrence of patient falls in the acute hospital setting. The population is hospitalized, adults. The intervention is hourly rounding. The comparison is not performing hourly rounding. The desired outcome is determined by the results on if hourly rounding was effective or not in fall prevention.

Identification of Sources of Evidence

To gather reliable research on medical issues, sources must be carefully selected. Due to the severity of inpatient falls, this topic is heavily researched. Capella University Library databases offer a plethora of journal articles pertaining to this subject matter. In preparation for this paper, I reviewed several journal articles on CINAHL Complete. An example of one useful source found in this database was the article “Preventing Falls in Hospitalized Patients: State of the Science.” This is a scholarly, peer-reviewed article that provides research findings based on both clinical controlled and quality improvement studies. The article discusses the benefits of hourly rounding on patient falls as evidenced by the study findings. Two additional articles found on CINAHL utilized for this assessment (LeLaurin & Shorr, 2019) and (Najafpour et. al, 2019) were also beneficial. The selected articles were all credible, as they were relevant, written within the last 5 years, and peer-reviewed.

Another reliable article utilized for this assignment was found on Google Scholar. The peer-reviewed article by Amanda Savage goes into detail on reducing patient falls through purposeful hourly rounding. The author reviewed 360 scholarly articles on inpatient hospital falls in preparation for writing this piece and referenced several of those articles within her own. The article also provides several graphs and charts throughout to show evidence of the impact of purposeful rounding on falls. The intention of the writing was to determine if patient falls were decreased as a direct result of meeting patients’ needs when performing hourly rounding, thus, making the rounding purposeful.

Findings from Articles

Falls were classified as “never events” by the Centers for Medicare and Medicaid Service (CMS), meaning they should never happen while a patient is being treated in the hospital setting (Savage, 2020). Many factors place patients at risk for falls including impaired mobility, comorbidities, vision impairment, medication effects, orthostatic hypertension and confusion. Some ways to decrease falls include use of vision aids, assistive devices, regular toileting schedule, and medication modifications (Najafpour et. al, 2019). But one of the most crucial things nurses can do to enhance patient safety and cut down on falls in hospitals is hourly rounding. Patient care needs are addressed in hourly rounding and include safety concerns, pain, toileting, repositioning, and ensuring belongings of the patient are within reach. By meeting these needs during rounding, falls could be decreased by 50% (Smith, 2020).

Relevance of the Article Findings

            The articles researched for this assignment provided relevant findings related to hourly rounding and the correlation of inpatient falls. According to Smith, when the 4 P’s (pain, potty, position and personal belongings) are addressed during rounding, the occurrence of falls will be reduced. Smith also states for best practice, rounds should occur hourly during the day and every two hours at night. Najafpour et. al concluded that when modifiable risks are identified and resolved during rounds, falls are less likely to occur. Savage proved, based on study findings, implementing an hourly rounding log for staff leads to less falls. Finally LeLaurin & Shorr determined that although the overall fall rate in hospitals in the United States has dropped over time, there is still significant potential for improvement in the standard of nursing care for fall prevention.

Conclusion

According to the referenced articles, and with the application of the PICO(T) framework, the question if hourly rounding affects patient fall outcomes, can be confidently answered. A number of factors contribute to patient falls, some of which are modifiable. Adjusting these factors is imperative for best outcomes. Based off of credible evidence-based research, we can safely conclude that hourly rounding decrease patient falls in the hospital setting.

 

 

References

LeLaurin, J. H., & Shorr, R. I. (2019). Preventing Falls in Hospitalized Patients: State of the Science. Clinics in geriatric medicine, 35(2), 273. https://doi.org/10.1016/j.cger.2019.01.007

Najafpour, Z., Godarzi, Z., Arab, M., & Yaseri, M. (2019). Risk Factors for Falls in Hospital In-Patients: A Prospective Nested Case Control Study. International Journal of Health Policy and Management, 8(5), 300-306. https://doi.org/10.15171/ijhpm.2019.11

Savage. (2020, November 30). Reducing Patient Falls Through Purposeful Hourly Rounding. University of St Augustine for Health Sciences. https://doi.org/10.46409/sr.UOZB3951

Smith. (2020, December 6). Impact of Hourly Rounding on Fall Rates: A Benchmark Paper. ScholarWorks at UT Tyler. https://scholarworks.uttyler.edu/nursing_msn/95/