picot question regarding IVH prevention for neonates

After reviewing the guidelines for Paper 1 (See Assignments) and reading Ch. 11, post:

Guidelines for preventing IVh is the main topic

The trigger for your question, indicate if it is a knowledge or problem based issue.
Your clinical question in narrative format, and
A reference for a systematic review that supports the proposed intervention.

Your initial post should be around 300- 350 words

How to Develop a PICOT Question (Text only)

1. This lecture is intended to help you begin writing your PICOTS question.

2. PICOTS is an acronym representing words to help you build a question for exploration. P for patient population, I for intervention or issue that will be explored, C for comparison intervention, O for outcomes, T for timing, and S for setting. You learned about PICOTS in research, but you will write PICOTS questions in the evidence-based practice course. PICOTS help to focus on the specific issues of interest. That is why writing a PICOTS question for evidence-based practice helps to determine how to search the literature. It teases out the search terms that you need to use in your literature search.

3. The way to process starts is with a trigger. Remember, knowledge-based triggers are those that come from reading something or going to a conference and learning something during one of the sessions that was visited. Problem-based triggers are those that come from practice. This is part of the Iowa Model that we are following. What is the trigger that causes you to have a question about your practice that needs to be changed?

4. A problem-focused example is one in which you might say \”I wonder what I can do to stop patients from falling so much while in the E.D.?\” You have noticed that on the manager’s Dashboard that the falls are quite high. This is an example of a problem-focused trigger. It is a good question, but may need some refinement to create an efficient search for related evidence to answer the question.

5. The P in PICOTS starts with population, so it is the population or the person or the environment. For our question that we have posed, it is the patients in the emergency department. We start by focusing on the population, the person, or the environment in the medi-paradigm. Population is defined as the group of people of concern. This group may be related to a disease process, a health condition, a risk factor, a specific environment, an age group, or any combination. In other words, it helps to focus the search for literature to a specific population. In the question already posed, the populations would be patients in the E.D.

6. I is for intervention or issue. Issue is also a nursing action or intervention or a nursing treatment. The issue could be that patients fall while in the E.D. and there is no tool that seems to help prevent the falls like the tools that may be used in other parts of the hospital. The focus is on nursing intervention and nursing action, not any other discipline, just nursing. If there is no tool, which there is not for specific emergency department patients, then the nurses notice that it doesn\’t work and that is why it is a problem trigger. The underlying question may be more about the environment, since we know the tool does not work, that may be currently used in the E.D., and we have not found in the literature any specific tools that are created for just emergency department patients to prevent falling, then we have to go beyond that, and we have to look at the environment. What changes could be made in the environment to prevent patients in the E.D. from falling?
7. C is for comparison. You compare one nursing intervention against the other nursing intervention, or you compare the nursing intervention against the usual nursing care, or it is the effectiveness of one nursing intervention and maybe no comparison is even needed if it is the effectiveness of one specific nursing intervention that is explored. We are going to compare to the usual care for our question.

8. O is for outcome. You specify the outcome that you want to see. You specify the effect of the intervention. We are going to use prevention of falls in the E.D. The outcome is that health portion of the medi-paradigm in which we are looking. It is the specific effect of what matters to the nurse and the patient. The patient\’s safety is an issue that needs to be considered by our nurses for the patient population in the emergency department. Our outcome is the prevention of falls in the E.D. environment.

9. T is for timing. The duration. The frequency of treatment. The length of follow up. The duration for our group is going to be a quarterly duration that we are going to follow the patients.

10. S is for setting. Where is it going to happen? Well, ours is in the E.D. environment.

11. We can now plug in the PICOTS pieces into the blanks. What is the effectiveness of-whatever the intervention is-and the timing, versus the comparison if there is one, in patients with a particular population on whatever that outcome is in the setting. Our statement what is the effectiveness of changing the environment versus the usual environment to prevent emergency department patients from falling in the emergency department?

Another example is What is the effectiveness of a transfer sling versus a transfer belt in elderly patients while in long-term acute care, with impaired mobility, on patient comfort and incidence of nurse back injury?

A third example is What is the effectiveness of using a turn schedule versus an audible public address reminder on the incidence of pressure ulcers in elderly patients while in long-term acute care that require turning?

12. Deconstruct the question to identify key words and search terms, use synonyms, and then after you have done all that, and have searched using the terms identified as key words. Consider contacting the librarian about what your search terms were, what you have already used, where you have searched to get some help if that is what you need. Deconstructing the question is to identify the key terms and think about the synonyms.

For example, using the previous question built, emergency department may also be emergency room in the literature. You may have to try both search terms. Elderly patients may also be geriatric patients that may need to be considered and used as a search term. Pressure ulcer may also be decubitus. The process of creating search terms and doing before beginning the search process. The result is maybe two or three different terms, and then when you look at the literature, you may look at the key terms on a good article that you have found, to see what those search terms are, or those key terms are, within that article to then use for future and additional searching. When contacting a librarian do the work first as he/she will want to know the search strategy you have already employed in order to best help you.

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