Nursing Pico Picot Essay

M2: Lesson 4 – Discussion
Create an original posting with a minimum of 250-300 words.
Back up your arguments with reliable evidence.Nursing Pico Picot Essay

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Asking the Relevant Clinical Questions
Evidence-based nursing is a process founded on the collection, interpretation, appraisal, and integration of valid, clinically significant, and applicable research. It is not about developing new knowledge or validating existing knowledge, but rather translating existing evidence so that it can be applied to clinical decision making. This process starts with formulating a sound PICO question. PICO is a format for developing a good clinical research question prior to starting a review or research. It is a mnemonic used to describe the four elements of a sound clinical foreground question.Nursing Pico Picot Essay
Scenarios:

#1 A nurse in the PACU is interested in ways to decrease the use of pain medication in post-op patients. She’s wondering if classical music or guided imagery might be efficacious.

#2 A 17-year-old African American woman, just diagnosed with hepatitis B, has been taking acetaminophen for headaches. Her mother has heard that acetaminophen can cause liver problems, and she asks you if her daughter should continue taking the drug for her headaches, considering her hep-b diagnosis.

#3 You are on a hospital committee exploring best practices in inpatient oncology nursing. The first question to come before the committee is, “how can we improve patients’ sleep quality and quantity without resorting to sleep medication?” The committee decides to explore relaxation techniques (e.g., massage; music), noise reduction, bed/pillow comfort, and ambient temperature changes. Your assignment is to find the best practices to reduce noise levels on the unit.Nursing Pico Picot Essay

#4 A 53-year-old woman with rheumatoid arthritis wants to possibly change her medication to short-term low-dose corticosteroids instead of NSAIDS, which are upsetting her stomach. Will the corticosteroids be as effective?

#5 Jeff, a smoker of more than 30 years, has tried to quit unsuccessfully in the past. A friend of his recently quit with acupuncture. He wonders if he should try it.

Instructions:

Choose one (1) clinical scenario above, and answer the following questions:
What is evidence-based nursing practice and why is it important?
What is the PICO process?Nursing Pico Picot Essay
Formulate a well defined clinical question that will yield the most relevant and best evidence.
Describe the background of the question
Present the question using PICOT format
Indicate what will be the best study to answer the clinical question.

This essay is going to examine the importance of evidence-based practise within a health care setting. It will then discuss the link between evidence based practise and qualitative research. A qualitative research article will then be reviewed on how the research for that study was carried out, and how reliable the evidence is in the article, by using the Thorax Hierarchy of Evidence (Thorax, 2004) Other pieces of evidence will then be discussed contradicting the article. The evidence will be found, by a clinical question being formulated through the PICO process (Pico, 2010).This question will then be entered into a nursing/ medical database that will bring up articles of research relating to keywords within the question.

Evidence based practise is the process, of which the improvents of medical procedures are carried out. Key points of the procedure are highlighted and adjustments are made with supporting evidence from research, and clinical expertise to back up the adjustments, in order to improve the standard of patient care.Nursing Pico Picot Essay

Evidence based practise allows nurses to ensure that the care, that they are delivering is effective due to it being based on thorough research and clinical information. This allows the patient to have a better overall outcome of health, and a shorter period of treatment. Evidence based practise is also a good way of keeping nurses informed about the current care standards and procedures that may have changed.

Some of the ways evidence based practise can be used are:

Researching information about patient’s diagnostic if it is unfamiliar. This is so that nurses are able to explain to the patient about their condition if they ask any questions.

Creating a care plan, this could be because the nurse may not be totally sure about the care that the individual should be receiving in their circumstances, due to everyone being different.

Obtaining information on drugs, as they may be unfamiliar or the nurse is unsure why they have been prescribed for that patient. (en.bmj)Nursing Pico Picot Essay

Increasingly more of the research that is being done for evidence based practise, finds the qualitative research method most appropriate and recognises the benefits that come of it (Fampra).

The article, “The role of peer communication in the socialization of adolescents’ pain experiences: a qualitative investigation” (Jill E Hatchette, Patrick J Mcgrath, Michael Murray and G Allen Finley [11/01/08]) investigates how teenagers express pain when being influenced verbally and non-verbally by peers. The article is going to be reviewed by using qualitative research, Screening Questions (Public Health Resource unit, 2006).

The research for the article was carried out by using the, focus groups qualitative research method. This is when researchers set out with a question, that they have not predicted the answer to yet, and examine groups of people from the same area, looking at their social norms and behaviour (FHI, 2010).Nursing Pico Picot Essay

The qualitative research method is appropriate for this study, due to an advantage of this method being that it is able to provide detailed descriptions, of how people perceive and experience an issue, for example pain (FHI, 2010). It is also believed that social conditions can affect other types of research due to people’s consciousness in a social situation (book ref, an analysis of thinking and research about qualitative methods, potter, 1996). The article discusses other reasons for choosing the qualitative research method over others. For instance, the article suggests that there was no other research on the topic done at the time, therefore making it hard for a hypothesis to be created. Secondly the research done in the article is part of a bigger study on adolescences and pain, therefore the results can be correlated with other research done on the study.Nursing Pico Picot Essay

The sampling done in the research article took place in a high school in Halifax, Nova Scotia, Canada, using 7th, 8th and 9th grade students. This was so that the study was able to get a range of adolescent aged people. A criteria was set for the people that could participate within the study, this was: All participants were to be able to speak and read fluent English, as well as not having any development disabilities. This was so that people who met the criteria could be selected randomly, therefore allowing the study to be generalised amongst the population (Fampra). They then sent 350 letters out to people who met the criteria, however only 24 responded and participated in the study.Nursing Pico Picot Essay

With qualitative research, the studies should be carried out in a neutral place, so that the researcher is able to watch the participant’s behaviour and reactions closer. Therefore allowing the researcher to get the most accurate results (bmj.com). In the articles case the data collection took place in facilities in the local mall or the participant’s school. The participants were then separated up into same sex focus groups. The researcher decided to do same sex focus groups so that people who were participating in the study were not discriminated against as well as focus groups being more likely to encourage quieter people to speak out about their opinions (bmj.com/content/311/7000/299.extract). The article also refers to this as the “Peacock effect ( tendency for males to speak more frequent and authoritatively than females.” (ref) The article suggests that, the peacock affect is also another reason why the researchers choose to use the qualitative research method. The research that was found was recorded in questionnaire and tape recording form, this was so that the data could be reflected back on as well as to be transcribed.Nursing Pico Picot Essay

As part of the study the researcher should ensure the participants fully understand about the research and any risks they may take (ocw.jhsph.ed). The researcher for the article did this by repeating several times throughout the study, by saying that there were no wrong answers, there was to be confidentially within the group and if the person was to feel slight pain this was to be expected. Before the research was able to go ahead, the researcher had to receive written and informed consent (fhi.org). This was to show that the participants fully understand what was going to happen and they gave their permission for it to happen, as well their parents of guardian being aware due to them still being minors. Also before the study go ahead, by law the research has to be approved, in the articles case the research was approved by the board of Memorial University Newfoundland.

The article talks about how the research was analysed by using a constant comparative method. According to (Glaser & Strauss, 1985) this is when key events are compared for instance when similar reactions are given towards pain. Some of the common categories that occurred in the study were; pain experience, attitudes towards pain and opinion. In order to reduce bias, the research results were analysed by the researcher themselves as well as an independent co-investigator. This was so that the researcher could not project any of his views on the study.Nursing Pico Picot Essay

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From the findings of the study, there is evidence shown to prove and contradict the researchers point. For instance the article talks about the attitudes adolescents have towards OTC analgesics, it highlights some of the key negative and positive points that were brought up when the participants were being interviewed, for instance people over medicating themselves. The researcher then discussed the points and referred them back to the original question for example; males are less likely to show pain that they have accidently caused themselves. The researcher then talks about the findings that can be related to modern health care, by saying; now that the influence of peers and pain has been researched providing a better knowledge on the subject, this enables better supportive facilities to be put into place for instance, development of web based intervention. However the researcher goes on to say at the end that due to there being only a small sample of people to participate within the study, it could not be generalised due to it being disproportionate of the area and not a full representation of people’s characteristic.Nursing Pico Picot Essay

The essay is now going to discuss what a hierarchy of evidence is and how reliable the article above is, by placing it on the Thorax hierarchy of evidence (Thorax, 2004).

The Hierarchy of evidence is to prioritise research studies by accessing the validity and quality of the research (nice.org). A hierarchy of evidence is often used in a medical setting, due to research needing to be as up to date and reliable as possible (ebnp). For instance an opinion from someone with respected authority and clinical expertise will be lower on the hierarchy of evidence, than evidence from a randomised control trial.Nursing Pico Picot Essay

The article The role of peer communication in the socialization of adolescents’ pain experiences: a qualitative investigation”, sits on the level |b on the Thorax hierarchy of evidence (Thorax, 2004). This is because the study is classed as a randomised control trail, due to participants being picked at random when being assigned into the focus groups. The article would not be categorised on the level above due to there being no other data or evidence for systematic reviews (medicine.ox.ac.uk), also the article states that there was no other research done on the topic therefore a combination of studies could not be gathered creating a meta analysis.Nursing Pico Picot Essay

By using the four step guide to Pico, which is population, intervention, comparison and outcome, a clinical question was able to be formulated. This was ‘Do adolescents minimise pain they feel?’ From the question that was formulated, keywords were picked out in order to put into an electronic database these were; adolescents, pain and minimise. This was so that the most appropriate articles and other pieces of research relating to the keywords would be brought up (Bournemouth.ac.uk). If there were to be no articles relating to the keywords other synonyms can be used in their place. However over 1000 articles were brought up relating to the keywords. Therefore the limitations were changed so that only articles written after 2006 were able to be shown, as well as the full articles having to be online, and in the context of a journal, article, book or EBook. This was so that the research and information within the articles was most up to date and reliable (support.mircosoft.com)Nursing Pico Picot Essay

The article “Correlation and consistency of pain severity rating by teenagers using different pain scales” was most appropriate to answer the Pico question. On the other hand, the article contradicts the first article that was looked at. This is because the first article suggests pain complaints are often ignored, however in the second article says that pain is often over estimated. Although after looking at the Thorax hierarchy of evidence the first article would be more reliable due to it being placed higher in the hierarchy. Whereas the second article would be placed on the ||a, this is because other studies have been done similar, however the study done in the article did not include a randomised control trial (Thorax, 2004).Nursing Pico Picot Essay