N2780: Week 4

PICO(T) question would be: example 2

"P" ICU patients "I" restricted visiting hours "C" unrestricted visiting hours "O" patient recovery times "T" -not needed PICO(T) Question: In ICU patients (P), how does restricted visiting hours (I), compared (past tense-evidence that is already there) (research question more than EBP question) to unrestricted visiting hours (C), affect patient recovery times (O)? (No "T" needed since this is my search strategy and would limit the number of articles I would retrieve in my search).

and the PICO(T) question would be

"P" hospitalized patients "I" physician catheter removal orders "C" nurse-driven catheter removal protocol "O" CAUTI rates "T" during hospitalization PICOT Question: In hospitalized patients (P), how do physician catheter removal orders (I) compared to a nurse-driven catheter removal protocol (C), affect CAUTI rates (O) during hospitalization (T)? ("T" is used in this case as CAUTI rates are tracked during hospitalization and in the period immediately after hospitalization and impact hospital reimbursement so "during hospitalization" is important in this case!!

the steps of the EBP process

-Cultivating a spirit of inquiry -Asking clinical questions -Searching for the best evidence -Critically appraising the evidence *Integrating the evidence with clinical expertise, client preferences, and values* -Evaluating the outcomes of the practice decisions or changes based on evidence -Disseminating EBP results

critical roles of clinicans

-clinical inquiry at the point of care -clinical experience/expertise -patient connections -knowledge of unit culture and context -knowledge of organizational culture and context

with clinical inquiry

-clinical questions answered!

review the PICO(T) pearls

-don't use any local terms (soda and pop) -no directional terms (increase, decrease, improve) -don't go for the low hanging fruit Population and outcome need to intertwine EBP is like a treasure hunt and your PICO(T) question is like the first part of your treasure map! Use your PICO(T) question to get into the databases and HAVE FUN discovering the answers to YOUR VERY OWN EBP "TREASURE HUNT"!!

clinical inquiry

An ongoing curiosity about the best practice, the best evidence to guide clinical decision making.

clinical inquiry description 2

Clinicians are accountable for asking questions that reflect: -needs of patients (values) -interaction of environment (physical too) -health (organization, system, etc.) -patient characteristics (what unique traits they have impact our practice)

first experience with EBP

Don't address an issue that is so big and widespread that addressing it will take years! Start with simpler issues that are easier to fix. Also, be aware of the workplace politics surrounding the issue. Who "owns" the idea? Don't pick something for your initial project that's going make someone in a position of power mad (like the Chief of Surgery).

important to note about EBP

EBP is not JUST about patient care...but about what's best for everybody in all realms of healthcare!!

When clinicians are encouraged to be inquisitive and supported in exploration of best practice, the following outcomes can be expected:

Engage Thinking Bring Important Issues Forward Participate in Problem Solving Generate Effective Solutions Utilize Evidence in Practice

evidence-based practice EBP

Evidence-based practice (EBP) is a problem solving approach to clinical practice that integrates the conscientious use of best evidence in combination with a clinician's expertise as well as patient preferences and values to make decisions. -not just problem solving but any problem can use this (Melnyk & Fineout-Overholt, 2015

Aunt Sue: 56 , 5-4 in and 250 lbs; presents to her primary care provider (PCP) complaining of feeling tired all the time and with pressure in her head. EXAM: BP 170/94. Her PCP suggested BP meds but Sue said she wanted to try diet and exercise for six months before going on meds; she had experience with several family members that had side effects from the meds. PCP steps away to do a little homework to be able to continue the conversation in a more meaningful way. What would the PICOT question be?

In middle aged women, how does the use of meds compared to diet and exercise affect BP readings?

different types of questions depending on what you're curious about

Intervention: whats the best thing to do Prognosis or prediction: how does a diagnosis of colon cancer compared to rectal cancer Etiology: where does something come from Diagnosis: how does using this test compare to this other test Meaning (this one doesn't have a comparison): how does It feel or your experience as a sibling who diagnosed with cancer

without inquiry

News of clinical advances often diffuses slowly through the literature Only a small percentage of clinicians access and use the information in a timely fashion -no flow into clinical practice -too much info and not enough clinical advances or research Research to clinical practice (17 years) (Melnyk & Fineout-Overholt, 2011)

clinical inquiry example

On our med-surg unit, we have a lot of elderly patients who are admitted from nursing homes that have foley catheters. We also have a large number of surgical patients that come to us from the OR with a new foley catheters. Although we work hard to try to get foleys out as soon as possible, our catheter-acquired urinary tract infection rates are higher than they should be, especially in patients with a foley. One of the challenges is there is often a delay in getting an order to remove the foley from the physicians. We're wondering if there is a way to remove foleys more efficiently by using a nurse-driven standardized catheter removal protocol and see if we can improve our CAUTI rates

parts of PICO(T)

P Patient population/disease (patients diagnosed with cystic fibrosis etc.) I Intervention or issue of interest(how does one intervention compared to C affect an outcome) C Comparison intervention O Outcome (T) Time-NOTE: not all PICO(T) questions need a designated time!! (time is optional) Since EBP can be used anywhere a decision needs to be made, PICO(T) questions arise from anything as well!

PICO(T)

PICO(T) questions rise out of clinical inquiry Your PICO(T) question is NOT your project---it's a search strategy

clinical inquiry description

The ongoing process of questioning and evaluating practice, providing informed practice, and innovating through research and experiential learning. Clinical inquiry is when the clinician identifies a question that must be answered to increase professional understanding of a patient care, administrative, personnel, organization or system level issue. -allows you to ask questions

step 0:

cultivate a spirit of inquiry and an EBP culture

what clinical inquiry looks like

is the story of what you're curious about It can be written out as a paragraph or shared verbally with others