NR 500 Week 5 PICOT Paper

NR 500 Week 5 PICOT Paper

NR 500 Week 5 PICOT Paper

NR 500 Week 5 Discussion: PICO (T) (graded)

The PICO (T) format is a way to develop a clinical question that lends itself to searching for evidence. Select a common nursing practice (e.g., wound care management) in your clinical setting and formulate a PICO question. Once you have formulated your question, conduct a library search and locate one scholarly article that addresses the topic you have selected. Post your clinical question in the TD, explain the PICO (T) elements, and provide a full reference of the article you selected.

Sample PICO (T) Paper

Week 5 DQ: The PICO (T) format is a way to develop a clinical question that lends itself to searching for evidence. Select a common nursing practice (e.g., wound care management) in your clinical setting and formulate a PICO question. Once you have formulated your question, conduct a library search and locate one scholarly article that addresses the topic you have selected. Post your clinical question in the TD, explain the PICO(T) elements, and provide a full reference of the article you selected.

There are tutorials in the Chamberlain Library specific to PICO and performing a literature search.

A clearly stated research question outlines where the study will be conducted, defines the population of interest, and determines the types of interventions that may be tested (Hastings, & Fisher, 2014, p. 9). When acquiring about a problem, it is important to identify the parts of the clinical question. PICO (T) is an acronym that stands for patient or population, intervention or best practice to be assessed, comparison group, outcome, and timeframe (Hastings & Fisher, 2014, p. 9). These are all elements of a sound quantitative question. The important task for a nurse researching an evidence-based problem is to ask the question using correct terminology so that key words can then be used to create a literature search with suitable solutions (Hastings & Fisher, 2014, p. 9 NR 500 Week 5 PICOT Paper).

The PICO (T) question that I developed regarding the emergency department involves initiating skin care bundle treatments on non-ambulatory patients in the emergency department to reduce the risk of hospital acquired pressure ulcers (HAPUs) in-hospital admissions. Denby & Rowlands reinforce that patients staying in the ED for greater than 2 hours are at higher risk for developing HAPUs (2010, p. 35). I selected the pressure ulcer related question because I’m the designated unit-based skin care resource nurse at the main campus ESI.

The issue of pressure ulcer prevention in the ED is an evidence-based question I can continue to research on later, perform my own research, and hopefully initiate pressure ulcer prevention methods in the department. For this discussion thread, I utilized the EBSCOhost/CINAHL database to locate journal articles relevant to my PICO (T) question.

Pressure Ulcer Prevention (PUP) in the ED

The first article that sparked my interest was from the Journal of Wound, Ostomy and Continence Nursing. This article is over the recommended 5 years old for a scholarly source, but this article is considered the gold standard for pressure ulcer prevention strategies in the ED. This article is referred to in more recent PUP research articles to validate results. The purpose of the article was to determine if implementing pressure ulcer interventions in the emergency department was possible.

The research was conducted in a small 176-bed nonprofit community hospital and used data analysis to examine the relationship of the ED visit and the hospital- acquired pressure ulcers of patients who were directly admitted to the hospital from the ED (Denby & Rowlands, p. 35 NR 500 Week 5 PICOT Paper). The study looked at 32,664 patients in 2006 that was seen in the ED and that 24,498 patients were admitted to the hospital. One hundred twenty-five of those patients developed hospital acquired pressure ulcers and 99.2% of those patients had an ED length of stay longer than 2 hours (Denby & Rowlands, p. 35). The results show that pressure ulcer interventions should be implemented in during the ED length of stay.

The second article was from Wounds UK and this author did reference the previously mentioned article. Pressure ulcer risk assessment is the first step of pressure ulcer prevention. The purpose of this article was to implement a pressure ulcer risk assessment tool called the Exeter Pressure Risk Assessment Tool (EPRAT) to prevent tissue damage during a patient’s stay in ED. The goal was to have 100% of the ED staff completing the assessment tool on every patient that presented to the ED to identify high-risk patients for developing pressure ulcers and ensure that every patient has the pressure-relieving equipment they require during their ED stay.

(Faulkner, Dowse, Pope, & Kingdon-Wells, 2015, p. 22 NR 500 Week 5 PICOT Paper). The initiative was implemented over an 18-month period. Staff nurses were taught individually how to use the EPRAT tool effectively utilizing PowerPoint slides on how to grade pressure ulcers, look at pictures of pressure ulcers on a computer, and have nurses correctly grade pressure ulcers in different patient scenarios (Faulkner et al., 2015, p. 22).

The EPRAT was designed to be easy and quick to complete by the triage nurse and ED staff nurses. If a patient has a check in either one of the following risk factor boxes: Unable/Unlikely to reposition independently; PVD/Diabetes/Peripheral Sensory Impairment; Terminal Illness/Acutely Unwell or in two or more checks in any of the risk factors, then the patient is at risk of developing a pressure ulcer (Faulkner et al., 2015, p. 22).

After the completion of the EPRAT, the correct pressure-redistributing equipment is implemented and documented (Faulkner et al., 2015, p. 22). Since implementing the EPRAT, there was a 99% compliance of the correct completion and documentation of the implementation of pressure relieving equipment (Faulkner et al., 2015, p. 24). The initiative improved the patient experience by providing increased, preventing pressure ulcer formation and educating the patient to reposition regularly to prevent skin damage (Faulkner et al., 2015, p. 25 NR 500 Week 5 PICOT Paper).

PICO (T): Pressure Ulcer Prevention in the ED

The purpose of my PICO (T) question is to determine if implementing pressure ulcer interventions such as turning and position every 2 hours, keeping skin clean and dry from bodily fluids, and reducing friction and shearing will relieve the patients chance of developing HAPUs. P = Adult non-ambulatory patients in the emergency department

I = Initiating pressure ulcer prevention treatments (keeping skin clean and dry from bodily fluids, reducing friction and shearing during transfers, providing adequate hydration and nutrition, and positioning for proper body alignment) upon arrival to the emergency department.

C = Not using pressure ulcer prevention

O = Decrease in-patient hospital-acquired pressure ulcers that could’ve been prevented at the start of the emergency room visit

T = not applicable

Researchable question: Do adult non-ambulatory patients who are admitted to the ER have fewer pressure ulcers if early prevention measures (keeping skin clean and dry from bodily fluids, reducing friction and shearing during transfers, providing adequate hydration and nutrition, and positioning for proper body alignment) are implemented during the ER visit versus after in-patient admission?

Keywords: Emergency Service, Non-Ambulatory Patients, Pressure Ulcer Prevention, Risk Assessment

NR 500 Week 5 PICOT Paper References

Denby, A., Rowlands, A. (2010). Stop them at the door: Should a pressure ulcer prevention protocol be implemented in the emergency department? Journal of Wound, Ostomy and Continence Nursing, 37 (1), 35-38. 

Faulkner, S., Dowse, C., Pope, H., & Kingdon-Wells, C. (2015). The emergency department’s response to pressure ulcer crisis. Wounds UK, 11(2), 20-25.

Hastings, C., & Fisher, C. A. (2014). Searching for proof: Creating and using an actionable PICO question. Nursing Management, 45(8), 9-12.

NR 500 Week 6 Discussion Clinical Significance

Explore these issues on the Internet and through other resources. Share what you find out on these topics:

Confidence Intervals: Why are they useful in helping to determine clinical significance?

There are many controversies surrounding the issue of clinical significance vs. statistical significance. Identify one of them and summarize it. Finish with your opinion about the controversy.

NR 500 Week 7  Creating a Professional Presentation (graded)

Think about good and not-so-good professional presentations that you have attended in the past. Give an example of what made an effective presentation. Give another example of what detracted from their ability to deliver a message to the audience.

NR 500 Week 8 What Did You Learn (graded)

Reflecting on this course, consider and answer the following questions: How do you envision using the AACN essentials learned in this course in your future graduate course work? How do you envision using the concepts learned in this course in your future nursing practice?