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Assignment Description:

Identifying A Clinical Question

Write a 1200-1500 word essay addressing each of the following points/questions. Be sure to completely answer all the questions for each bullet point. There should be three main sections, one for each bullet below. Separate each section in your paper with a clear heading that allows your professor to know which bullet you are addressing in that section of your paper. Support your ideas with at least five (5) sources using citations in your essay. Make sure to cite using the APA writing style for the essay. The cover page and reference page in correct APA do not count towards the minimum word amount.

Identify a clinical question related to your work environment, write the question in PICOT format and perform a literature search on the identified topic.


Purpose

To enable the student to identify a clinical question related to a specified area of practice and use medical and nursing databases to find research articles that will provide evidence to validate nursing interventions regarding a specific area of nursing practice.


Guidelines

1. Identify a clinical question related to your area of clinical practice and write the clinical foreground question in PICOT format utilizing the worksheet tool provided as a guide.

2. Describe why this is a clinical problem or an opportunity for improving health outcomes in your area of clinical practice. Perform a literature search and select five research articles on your topic utilizing the databases highlighted in Chapter 3 of the textbook (Melnyk and Finout-Overholt, 2015).

3. Identify the article that best supports nursing interventions for your topic. Explain why this article best supports your topic as you compare the article to the other four found in the literature search. All five articles should be discussed.

The following specifications are required for this assignment:

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Length: 1200-1500 words – answers must thoroughly address the questions in a clear, concise manner.

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Must include introduction and conclusion paragraphs.

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Structure: Include a title page and reference page in APA 7th edition format. These do not count towards the minimal word amount for this assignment.  Your essay must include an introduction and a conclusion.

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References: Use the appropriate APA style in-text citations and references for all resources utilized to answer the questions. A minimum of five (5) scholarly sources are required for this assignment.

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In-text citation should be included as reference list.

Link to some resources

Question Templates for Asking PICOT Questions

INTERVENTION

In ____________________(P), how does ____________________ (I) compared to ____________________(C) affect _____________________(O) within ___________(T)?

ETIOLOGY

Are____________________ (P), who have ____________________ (I) compared with those without ____________________(C) at ____________ risk for/of ____________________(O) over ________________(T)?

DIAGNOSIS OR DIAGNOSTIC TEST

In ___________________(P) are/is ____________________(I) compared with _______________________(C) more accurate in diagnosing _________________(O)?

PROGNOSIS/PREDICTION

In ______________ (P), how does ___________________ (I) compared to _____________(C) influence __________________ (O) over _______________ (T)?

MEANING

How do _______________________ (P) with _______________________ (I) perceive _______________________ (O) during ________________(T)?



Short Definitions of Different Types of Questions:

Intervention: Questions addressing the treatment of an illness or disability.

Etiology: Questions addressing the causes or origin of disease, the factors which produce or predispose toward a certain disease or disorder.

Diagnosis: Questions addressing the act or process of identifying or determining the nature and cause of a disease or injury through evaluation.

Prognosis/Prediction: Questions addressing the prediction of the course of a disease.

Meaning: Questions addressing how one experiences a phenomenon.

Sample Questions:

Intervention: In African-American female adolescents with hepatitis B (P), how does acetaminophen (I) compared to ibuprofen (C) affect liver function (O)?

Etiology: Are 30- to 50-year-old women (P) who have high blood pressure (I) compared with those without high blood pressure (C) at increased risk for an acute myocardial infarction (O) during the first year after hysterectomy (T)?

Diagnosis: In middle-aged males with suspected myocardial infarction (P), are serial 12-lead ECGs (I) compared to one initial 12-lead ECG (C) more accurate in diagnosing an acute myocardial infarction (O)?

Prognosis/Prediction: 1) For patients 65 years and older (P), how does the use of an influenza vaccine (I) compared to not receiving the vaccine (C) influence the risk of developing pneumonia (O) during flu season (T)?

2) In patients who have experienced an acute myocardial infarction (P), how does being a sm


Application Case Study, Chapter 3, Finding Relevant Evidence to Answer Clinical Questions

SCENARIO

A child having a routine pediatric appendectomy develops multiple complications, and instead of the usual 2 days spent in the hospital, the child is now in the second week of hospitalization. The surgeon is insisting that the mother go home and get a good night’s sleep as she has been staying with the child 24/7. Other staff members are commenting on how wonderful it is to have a parent remain overnight. As a nurse, you are concerned about both the patient and the mother. You wonder what is best for the mother and the child in regard to having the mother continue to stay overnight for the rest of the child’s hospitalization.

BACKGROUND INFORMATION

You think about background information you might need. You know your hospital has recently changed their visitation policy from limited hours with no overnight stays to that of open visitation to allow patients to have their family members and friends with them 24/7.

You e-mail the chair of the visitation committee to ask for the evidence they used to develop the policy. This was easy, as the committee used a citation manager, RefWorks. He shared his RefWorks records with you. As you look through the evidence they used, you quickly realize they focused on adult patients, not pediatric patients. While this evidence may be relevant, you wonder if there may be evidence that speaks specifically to pediatric visitation. This information helps you formulate the following PICOT question:

PICOT QUESTION

In parents of hospitalized children, how does remaining overnight with the child compared with limited day visits affect parental level of anxiety?

And transfer the concepts to a PICOT table:

Population

Parents of hospitalized children

Intervention

Parent remains overnight

Comparison

Limited day visits

Outcome

Anxiety level

Time

During hospitalization

You contact your healthcare librarian to discuss your PICOT question and search strategy. You both agree that the best search strategy approach begins with three different methods: (1) using keywords; (2) using subject headings; and (3) looking for specific keywords in the title if your search produces too many articles. The librarian asks if you would like her to do the search. You thank her pol

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Chapter 1

Making the Case for Evidence-Based Practice and Cultivating a Spirit of Inquiry

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The Three Components of EBP

A lifelong problem-solving approach to clinical practice that integrates

  • Critical appraisal and synthesis of the most relevant and best research (external evidence)
  • One’s own clinical expertise, which includes internal evidence generated from outcomes management or quality improvement projects, patient assessment, and evaluation
  • Patient preferences and values

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Types of Evidence Used in EBP

External evidence

  • Evidence generated through rigorous research (e.g., RCTs and cohort studies) that is intended to be generalized to and used in other settings

Internal evidence

  • Evidence typically generated through practice initiatives such as outcomes management or quality improvement projects that are not intended to be generalized to other clinical settings

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The Components of EBP and Types of Evidence Used

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Question

Is the following statement true or false?

Finding a quasi-experimental study in a peer-reviewed nursing journal article that tests a protocol for the frequency of turning for immobile patients is an example of external evidence.

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Answer

True

Rationale: External evidence includes peer-reviewed publications that present the findings of research and are intended to be generalized to other clinical settings.

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The Origins of Evidence-Based Practice

  • Concept began when Dr. Archie Cochrane published a report in 1972 for the Nuffield Provincial Hospitals Trust that demonstrated how slow the medical profession was in using published evidence to change practice
  • Cochrane died in 1988, and the Cochrane Center Collaboration was established in 1992

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    Chapter 2

    Asking Compelling Clinical Questions

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    Barriers to Finding the Right Information at the Right Time

    • Lack of proficiency in using computers
    • Lack of computer access at point of care
    • Low comfort level/lack of skill using search techniques
    • Lack of access to appropriate electronic databases
    • Lack of time to search for the best evidence

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    Types of Questions to Develop Prior to Beginning a Literature Search

    Background questions

    • Asks for general information about a clinical issue
    • Usually has two components:
    • 1. The starting place of the question (e.g., what, where, when, why, and how)
    • 2. The outcome of interest
    • Broader in scope than a foreground (PICOT) question

    Example: “How does the drug acetaminophen work to affect fever?”

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    Types of Questions to Develop Prior to Beginning a Literature Search—(cont.)

    Foreground questions (PICOT format)

    • Asks for specific scientific evidence about diagnosing, treating, or educating patients
    • The focus is on specific knowledge
    • Use of PICOT format is recommended for a focused literature search

    Example: “In children aged 3 to 8 years, how does acetaminophen compare with ibuprofen in lowering a fever?”

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    Question

    Is the following statement true or false?

    Foreground questions can often be answered by consulting an up-to-date nursing or science textbook.

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    Answer

    False

    Rationale: Foreground questions are clinical questions that can only be answered by specific scientific evidence that is usually found in original studies or systematic reviews of original studies (e.g., RCTs). This type of evidence is not available in textbooks, which are more appropriate for answering background questions.

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    Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

    Chapter 3

    Finding Relevant Evidence to Answer Clinical Questions

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    Answering Clinical Questions

    • Searching for evidence that has already been appraised for validity and reliability decreases the amount of time needed to determine whether the information is reliable
    • Pre-appraised literature can include:
    • Systematic reviews and meta-analyses
    • Meta-syntheses
    • Integrative reviews
    • Synopses/critiques of single studies

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    Hierarchy of Information Resources

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    Databases Useful for Finding Individual Research Reports

    • MEDLINE®
    • CINAHL
    • PsycINFO®

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    Databases Useful for Finding

    Pre-Appraised Evidence

    • Cochrane Database of Systematic Reviews
    • BMJ Clinical Evidence
    • Database of Reviews of Effects (DARE)
    • National Guideline Clearinghouse (NGC)
    • Physician’s Information and Education Resources (PIER)
    • American College of Physicians Journal Club (ACP)

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    Question

    Which of the following sources of evidence would be the best evidence to use to suggest a clinical practice change?

    • A well-designed randomized controlled trial (RCT)
    • A systematic review that encompasses multiple studies
    • Expert opinion of experienced and educated nurses
    • A case study that addresses a similar clinical situation

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    Answer

    b. A systematic review that encompasses multiple studies

    Rationale: Systematic reviews are pre-appraised evidence, which are considered to be higher on the hierarchy of evidence than expert opinion, individual RCTs, or case studies.

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