PICOT Format Evidence-Based Practices & Nursing

PICOT Format Evidence-Based Practices & Nursing

Course Project: Part 1—Identifying a Researchable Problem

PICOT format Evidence-Based Practices & Nursing

Introduction      Normally, PICOT format is helpful in formulation of questions in an evidenced based clinical practice. PICOT generated questions generally fall under for main categories of clinical practices. These include; therapy, prevention, diagnosis, etiology as well as Prognosis. The essential elements in PICOT questions. The PICOT format is valuable in addressing research questions comprehensively. Five elements are normally addressed including; population, intervention, comparison, outcome and time as well (Riva, Malik, Burnie, Endicott, & Busse, 2012).

Summary of Case Study

         The ever increasingly high incidence of breast cancer conditions has posed serious challenges in the nursing profession. Provision of appropriate healthcare to the cancer patients has been lacking leading to adverse effects of the proliferation of cancerous cells which further worsen the conditions of the patients. As primary care, clinicians have the responsibility to stressing providing healthcare services within healthcare facilities as well as monitoring treatment in home based facilities to help manage cancer condition. Most cancer patient need clinicians who practice evidence-based clinical practices (Riva, Malik, Burnie, Endicott, & Busse, 2012).

Research Question

   In cancer patients receiving chemotherapy, will they have better white blood cell count monitoring with a follow-up at home versus follow-up at a health care facility during their treatment?

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PICOT Format

1) P-Population: Patients aged 18-60 years-old, breast cancer who have not received chemotherapy in the past six months are subjected to the treatment. Patients with other serious health conditions such as heart diseases were excluded in the study. 30 patients, with 15patients stationed at the healthcare facility while the other 15 patients receiving home-based care, are expected to take part in the study.

2)   I -Intervention: The patients will receive dosage based on the age, sex and health general body health as well as the stage of cancer cells proliferation in the body. The patients are required take the prescribed drugs at regular intervals. The subjects will be subjected to treatment under the same during the research study.

3)     C-Comparison: All the subject regardless of variations in their level of dose requirement will be subjected to the same treatment for the same duration, 3months. Standardized treatment will be given to subjects with no extreme variations in their level of dose requirement and would be used as an active control group. Using this strategy, it will be possible to minimize the non-specific effects due to a group of the patient receiving treatment within the healthcare.

4)   O-Outcome: The response in chemotherapy treatments will be check by examining the numbers of defective cancerous cells in the body tissues. The patients will report to the theatre in order to be examined by an oncologist. The results will be recorded in terms of improved seen in each patient and in the two categories, that those that received home-based care as well as those who received chemotherapy treatment within the healthcare facility (Stevens, 2001).

5)   T-Time: The outcome would be measured after 2 weeks for 3months. The results will be recorded at an interval of two weeks from the onset of the study throughout the 3months

In evidenced-based clinical practice, it is imperative to standardize treatments in order to avoid skewing expected treatment outcomes. Teaching the subjects, the importance of chemotherapy treatment should be part and parcel of the planning process of the patient recruitment into the research study. More importantly, standardizing instruction to study subjects is also important in ensuring no additional interventions are inadvertently introduced during the study period. Additional intervention can be by way of extra pieces of advice to the study subjects (Stevens, 2001).

Evidence-based clinical practices, clinicians are encouraged to not only provide available cancer care choices but also undertake to provide information on quality care. In addressing challenges and complication associated with breast cancer, clinicians should provide timely, accurate information (Morley, 2009).

Keywords in Literature Review

The keywords to look for in literature review include; breast net weight, breast biopsies related history, hyperplasia prior to biopsy, radiation of the chest, breastfeeding, obesity, excessive use of alcohol, sedentary lifestyles, and chemotherapy as well as exogenous hormones. These items show the mode of progression of cancerous cells and influence the type of healthcare to be provided to patients in evidence-based clinical practices (Stevens, 2001).

Reference

Morley, P. T. (2009). Evidence evaluation worksheets: the systematic reviews for the evidence evaluation process for the 2010 International Consensus on Resuscitation Science. Resuscitation, 80(7), 719-721.

Riva, J. J., Malik, K. M., Burnie, S. J., Endicott, A. R., & Busse, J. W. (2012). What is your research question? An introduction to the PICOT format for clinicians. The Journal of the Canadian Chiropractic Association, 56(3), 167.

Stevens, K. R. (2001). Systematic reviews: The heart of evidence-based practice. AACN Clinical Issues, 12(4), 529–538.

Week 4:

Course Project: Part 2—Literature Review

Application: Using the Data/Information/Knowledge/Wisdom Continuum

Introduction

Nursing informatics is a field that integrates the nursing science with the process of managing data, collecting information, applying information as well as applying the knowledge to make decisions. The healthcare field requires the making of intelligent decisions that are founded on a proper analysis of data, information and knowing how best to apply this information to make the decisions. It is imperative to note that there are terabytes of soft copy data and information as well as tons of hard copy of the same and thus making the role of nursing informatics to narrow down to the most relevant information. Science cannot account and satisfy all the decisions that can be made by healthcare practitioners, some decisions require ethical, social and economic considerations. This is where nursing informatics chips in to provide relevant data, information, and knowledge that when used in the appropriate way can be embraced as wisdom (Makar, 2012).

Pediatric nursing is no exception in the above-discussed phenomena and this is why pediatrics have to be complemented by informatics techniques in their day to day encounters. Today the world is faced with a major dilemma regarding the use of vaccines. Is vaccination a solution to health hazards or does it expose children to more risks? The same research question has been elevated to include adults and it has been on the debate for so long since the olden days of vaccination. It all starts with the small pox vaccine that is faced with a lot of controversies when the diseased matter is introduced into a healthy body for the purposes of preparing the body by manipulating the immune system to get ready for a similar instance. Jenner’s methods to introduce cowpox infected fluid work pretty well in the process of conferring the immune system but his methods later set fear in the community (Maldonado, 2002).

The above-discussed research question spans across many nursing principles as the healthcare is ethically and professionally challenged to determine the safety and legitimacy of vaccines and inoculation programs. The Walden Library offers researchers and nursing practitioners with the resources and databases for the probing of the inoculation concern. The library has a number of databases some of which are business, computing and general knowledge oriented. It is imperative to choose a relevant database source as well that harbors most healthcare related articles as well as other research by scholar-practitioners too. After going through the databases, the Cochrane library database repository makes one of the finest databases relevant to the subject of concern. The search terms used include, “Does vaccine and inoculation programs prevent health hazards in children?” (“Databases by Name – Academic Guides at Walden University,” n.d.).

On the other hand, a similar search follows but with a converse statement to the prevention and protection against diseases. It follows in the structure, “Does vaccine and inoculation programs increase health risks in children?” The database throws up hundreds of articles, e-books and newspaper articles published by medical and critics revolving around the inoculation concern. A process to select the relevant articles is necessary thanks to the database search criteria that takes care of the necessity. There are a number of ways that one can narrow down his/her search to the most relevant and up to date articles that provide data and information about the research question. A good article is one which is peer reviewed and has references as well as having its full publication in the repository. Peer reviewed articles have already been compared to existing knowledge against a topic of concern and thus very vital when it comes identifying a relevant and satisfactory source (Gassert, 2000).

After finding the relevant articles from the repository, an informatics nursing practitioner needs to extract relevant information from the numerous sources selected. It is important to note that not every single word contributes to the main topic of study or rather the research question under consideration. Thus this makes it a necessity to employ keyword search criteria by the use of assistive software that can scan through electronic documents and highlight all the keywords or phrases of consideration. Information is obtained following a structure that guides a researcher in staying and keeping in the research goal and objective frame (Gassert, 2000).

More important after extracting relevant data and information is the process of structuring the information and process the data into information too. Information can be organized into cells that are object specific and data mining techniques are employed to identify patterns and trends that are unseen without organizing information. The process of data mining and data analytics is the process of gaining knowledge as the information is subjected to real life phenomena to give insights on what the healthcare field is missing. The information is synthesized to speak more about itself in relevance to the research question under consideration and this gives way for knowledge in the health care field (Makar, 2012).

Conclusion

It is worth noting that once knowledge is gained, another process of making rational and intelligent decisions commences and this is what concludes the process of nursing informatics. The application of knowledge to make calculated decisions that are in most cases right and effective is termed as wisdom. In this discussion, Wisdom can be gained from the process of informatics as contributed by the role of making effective decisions by application of knowledge gained. However, gaining wisdom takes time and experience as practitioners apply knowledge in diverse fields (Makar, 2012).

References

Databases by Name – Academic Guides at Walden University. (n.d.). Retrieved from http://academicguides.waldenu.edu/az.php

Gassert, C. A. (2000). Academic Preparation in Nursing Informatics. Health Informatics, 15-32. doi:10.1007/978-1-4757-3252-8_2

Makar, E. V. (2012). The Alliance for Nursing Informatics Emerging Leaders Program. CIN: Computers, Informatics, Nursing, 30(4), 179-182. doi:10.1097/nxn.0b013e318255c114

Maldonado, Y. A. (2002). Current Controversies in Vaccination. JAMA, 288(24), 3155. doi:10.1001/jama.288.24.3155

Prymula, R. (2013). Controversies in Vaccination. European Review, 21(S1), S56-S61. doi:10.1017/s1062798713000227

Course Project: Part 3—Translating Evidence Into Practice

Translating Evidence into Practice

The PICOT question arising from this research is: When do cancer patients on chemotherapy, receive better white blood cell count monitoring; with a follow-up at home or with follow-up at a health care facility during their treatment? Answering this question has a lot of significance in the nursing practice. First, chemotherapy is among the cancer treatments that cause damage to the white blood cells, the cells responsible for fighting infections in our bodies. As such, when chemotherapy damages some of the white blood cells, it leads to neutropenia, a condition that increases the risks of getting infected (“Blood Cell Counts | Breastcancer.org,” 2017). For people with any cancer, and who may be undergoing chemotherapy, such infections are very severe and usually require treatment with antibiotics. Hence, nurses need to closely monitor the white blood cells count in their patients for effective prediction of potential severe neutropenia, ahead of time. The PICOT question, therefore, regarding the best setting to follow-up white blood cells count, is important towards assisting patients with breast cancer (“Low White Blood Cell Count: A Side Effect of Treatment,” 2017).

In my literature review, I deduced that besides breast cancer is the main challenge in healthcare; there are inadequate treatments for patients suffering from this type of cancer. According to Polit, & Beck, (2017), people living with breast cancer experience the worst of health conditions, yet their number is increasing at an alarming rate. Among the most surprising factors attributed to breast cancer is that screening for the condition using the modern technology may lead to acquiring cancer itself. Hence, the number of patients with the breast cancer is expected to continue rising. Lifestyle changes are among the major attributes of the rise in breast cancer cases. For instance, as women seek leisure activities, the engage in alcohol consumption, which is a major contributor to breast cancer. As well, consumption of fast foods is attributed to excessive weight, another risk factor for breast cancer.

Hoffman et al., (2014), attributes hormone replacement therapy (HRT) as another risk factor for breast cancer. Recent research by Hoffman et al, (2014), has proven that the more a woman uses HRT, the more she is predisposed to breast cancer. As well, studies have found that women who give birth in their late ages of life are at higher risks of acquiring breast cancer as compared to their counterparts who sire children at early ages. Then research explains why women in developing countries tend to have higher risks of getting breast cancer as compared to those in developing countries.

Further, LoBiondo-Wood, & Haber, (2017) point out that the real causes of cancer have caused a lot of contradictions as well as inconsistencies. For instance, the real cause of breast cancer has not been identified, but there exist several predisposing factors that increase the risks of women acquiring breast cancer. Some scientists have attributed breast cancer to genetic inheritance, environmental pollution, infection, and oral contraceptives, but epidemiological research has disapproved all of these claims, showing that the causes of breast cancer are sporadic. However, although breast implants were dismissed as leading to the common type of breast cancer, they have been connected with increasing the risks of lymphoma, a rare form of breast cancer. LoBiondo-Wood, & Haber, (2017) profess that although dietary fats are not the only predisposing factors for breast cancer, they play a significant role towards the development of the condition.

This literature review reveals that treatment of breast cancer needs increased health strategies. On the other hand, health practitioners should come up with mechanisms that prevent breast cancer patients from getting exposed to radiation on a regular basis. In conclusion, the review is proof that there are no adequate measures put in place to prevent the prevalence of breast cancer. Hence such measures need to be formulated so that the increase in breast cancer cases can be halted.

The evidence-based nursing practice in this context involves standardization of treatments to avoid twisting the expected treatment outcomes. For example, Polit, & Beck, (2017), have associated screening as a predisposing factor for breast cancer due to exposure to radiation. Therefore, breast screening is not a standardized strategy for approaching breast cancer. Instead, nurses should result to chemotherapy, which should be done alongside regular monitoring of white blood cells count. If the evidence-based practice is not applied, the patient could experience additional complications such as increased risks of being infected. As well, other treatment strategies may worsen the situation by facilitating the spread of cancer cells, for instance, exposure to radiation.

More importantly, standardizing instruction to study subjects is critical as well in ensuring no additional interventions are inadvertently introduced during the study period. The strategy management skill that I would use is educating staff on skills and principles about breast cancer. The education program would be aimed at all my colleagues, including those in pre-service training as well as those in in-service training (Stevens, 2001).

Through the use of manuals as well as user-friendly guidelines, I would educate staff members on the newly acquired knowledge. The manuals would incorporate recent research-based data, which would foster the development of innovative practices. For the implementation of the evidence-based practice, I would use the current research-based data to come up with strategies for handling the involved problem. (McCormack et al., 2017) The evidence-based practice would assist towards better decision-making process as we decide on the best setting to carry out the monitoring process. Additional intervention can be by way of extra pieces of advice to the study subject (“Implementing the Evidence-Based Practice (EBP) Competencies in Healthcare: A Practical Guide for Improving Quality, Safety, and Outcomes,” 2017).

References

Blood Cell Counts | Breastcancer.org. (2017). Breastcancer.org. Retrieved 9 October 2017, from http://www.breastcancer.org/symptoms/testing/types/blood_counts

Hoffman, A. J., Robinson, C. B., & Weisbrod, B. L. (2014). Putting evidence into practice: an update of evidence-based interventions for cancer-related fatigue during and following treatment. Clinical journal of oncology nursing, 18(6), 38.

Implementing the Evidence-Based Practice (EBP) Competencies in Healthcare: A Practical Guide for Improving Quality, Safety, and Outcomes. (2017). Nursingknowledge.org. Retrieved 9 October 2017, from https://www.nursingknowledge.org/implementing-the-evidence-based-practice-ebp-competencies-in-healthcare-a-practical-guide-for-improving-quality-safety-and-outcomes.html

LoBiondo-Wood, G., & Haber, J. (2017). Nursing Research-E-Book: Methods and Critical Appraisal for Evidence-Based Practice. Elsevier Health Sciences.

Low White Blood Cell Count: A Side Effect of Treatment. (2017). Breastcancer.org. Retrieved 9 October 2017, from http://www.breastcancer.org/treatment/side_effects/low_white_blood_cell

McCormack, L., Sheridan, S., Lewis, M., Boudewyns, V., Melvin, C., & Kistler, C. et al. (2017). Communication and Dissemination Strategies to Facilitate the Use of Health-Related Evidence. Ncbi.nlm.nih.gov. Retrieved 9 October 2017, from https://www.ncbi.nlm.nih.gov/books/NBK179104/

Polit, D. F., & Beck, C. T. (2017). Nursing research: Generating and assessing evidence for nursing practice (10th ed.). Philadelphia, PA: Wolters Kluwer. Chapter 8, “Planning a Nursing Study”This chapter focuses on the necessary steps for planning a research study. It describes different research designs and their key features and discusses how to plan for data collection.

Stevens, K. R. (2001). Systematic reviews: The heart of evidence-based practice. AACN Clinical Issues, 12(4), 529–538.