NUR 550 PICOT Assignment

Evidence-Based Practice Project Proposal: PICOT

PICOT (Population/Problem, Intervention, Comparison, Outcome, and Time to achieve the outcome) is a method that helps clarify the qualities needed to create a good question out of a practice issue or problem affecting a population of focus. NUR 550 PICOT Assignment

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The purpose of this assignment is to complete your PICOT for your selected nursing practice problem. Refer to your “Evidence-Based Practice Project Proposal: Identification of Nursing Practice Problem” assignment from Topic 1 to complete this assignment. If your nursing practice problem or PICOT required revision, include those revisions in this assignment. The final PICOT you develop in this assignment will provide the framework for developing your evidence-based practice project proposal. Use the “PICOT-Final” template to complete this assignment.

Refer to the “Evidence-Based Practice Project Proposal – Assignment Overview” document for an overview of the evidence-based practice project proposal assignments.

You are required to cite at least four peer-reviewed sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and nursing content.

While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are not required to submit this assignment to LopesWrite.

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PICOT Draft – NUR 550 PICOT Assignment

Name:

Part 1: Propose a relevant nursing practice problem for an evidence-based practice project. Explain why you selected this topic and how it is relevant to advance nursing practice. Include one research article that demonstrates support for the nursing practice problem.

In mechanically ventilated ICU patients, does positioning the patient in semi-fowlers result in a lower incidence of nosocomial pneumonia when compared to the supine position?

Is there really one posture that can help prevent developing pneumonia while being intubated, similar to how research has revealed what is the most suitable position for specific individuals and their illnesses. I selected this subject because it will teach me a lot about hospital acquired illnesses and how to avoid them. This, I think, will be useful for me as an urgent care nurse practitioner.

The article below gives a great explanation of both methods and their trial run on both positions with intubated patient, as well as the results that they discovered after trialing 878 participants.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7016937/

Part II: In the table below, describe the population and the intervention. (You will continue drafting the PICOT, completing the shaded areas in Topic 3.)

PICOT Question
P	Population	Intubated patients in the ICU.
I	Intervention	Semi-fowlers and supine position while intubated on a ventilator.
C	Comparison
O	Outcome
T	Timeframe
PICOT
Problem Statement

PICOT Final Example

Name_____________________________________

Complete your PICOT using your approved proposed nursing practice problem. If they were approved, you may use the population and intervention developed in your Topic 1 assignment. Include any necessary revisions in this submission. Refer to the “Example PICOT” below as needed for guidance on how to complete the PICOT.

PICOT Question
P	Population
I	Intervention
C	Comparison
O	Outcome
T	Timeframe
PICOT Create a complete PICOT statement.
Problem Statement Create a problem statement for your PICOT. You will use this problem statement throughout your final written paper.

References

Example PICOT: Delete this example page prior to submitting your PICOT.

EXAMPLE PICOT
PICOT Question
P	Population	Adult patients with hypertension, Spanish primary language
I	Intervention	Written education in Spanish
C	Comparison	Teaching using an interpreter
O	Outcome	Improved BP control
T	Timeframe	6 months
PICOT	In adult patients with hypertension, for whom Spanish is their primary language (P), does providing written education in Spanish (I) when compared to using an interpreter (C) lead to improved blood pressure control (O) over the course of 6 months (T)? NUR 550 PICOT Assignment
Problem Statement The problem statement is a scholarly statement that justifies or rationalizes that this is problem. A problem statement must include literature for support and justification.	Hispanics are more likely to have uncontrolled, untreated, or even undiagnosed hypertension when compared to other ethnic groups (Rodriguez et.al., 2015). Incidences of misinformation can occur when patients and providers do not share a common language. There is a lack of understanding or the inability to ask questions on the patient’s part. In addition, many Spanish-speaking patients find that the translation services, when available, are not adequate. These patients often do not trust the information received from providers, which can lead to unintentional noncompliance (Rodriguez et.al., 2015).

References

Rodriguez, C. J., Allison, M., Daviglus, M. L., Isasi, C. R., Keller, C., Leira, E. C., Palaniappan, L., Piña, I. L., Ramirez, S. M., Rodriguez, B., & Sims, M. (2014). Status of cardiovascular disease and stroke in Hispanics/Latinos in the United States: a science advisory from the American Heart Association. Circulation, 130(7), 593–625. doi:10.1161/CIR.0000000000000071

Translational Research Graphic Organizer

PICOT Question – In mechanically ventilated ICU patients, does positioning the patient in semi-fowlers result in a lower incidence of nosocomial pneumonia when compared to the supine position?

Nursing Practice Problem: Ventilated-Associated Pneumonia is a common disease that has increased due to inappropriate positioning of mechanically ventilated patients in ICU. The problem can be prevented by implementing effective positioning which increases safety and quality of care to ICU patients and recommendations aimed to compare semi-fowler or semi-recumbent positioning against supine positioning.

Comparison 1: Translational Research vs. Qualitative Research

Criteria	Effects of 60° Semi-recumbent Position on Preventing Ventilator-associated Pneumonia: A Single-blind Prospective Randomized Clinical Trial http://dspace.tbzmed.ac.ir:8080/xmlui/handle/123456789/45001 Traditional Research Type: Qualitative research	Semi‐recumbent position versus supine position for the prevention of ventilator‐associated pneumonia in adults requiring mechanical ventilation https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7016937/ Translational Research Type: Translational research	Observations (Similarities/Differences)
Methodology	Randomized clinical trial of using 25 patients recruited in surgical ICU units for ventilation mechanical surgery (Hassankhani et al., 2017). The patients were designated to be positioned differently over a year of intensive care with the aim of providing insights about the risks associated with positioning and VAP.	Search for evidence from online libraries and randomized controlled trials (Wang et al., 2016). The evidence obtained from online libraries such as CENTRAL, MEDLINE, EMBASE, CINAHL, and CBM comparing the impacts of semi-recumbent positioning and supine positioning to prevent ventilated-associated pneumonia (VAP).	Head-of-bed-elevation (HOBE) was effective to lower pulmonary infiltration of chests for patients. Both methods were effective to prevent VAP. Semi-recumbent position helped reduce the risks of VAP. Both used randomized clinical trials over a period of time. Both methods did not provide information about the change of positioning by slight change of degrees of elevation.
Goals	To help assess and present insights of the benefits and effectiveness of Head-of-bed-elevation (HOBE) on 60 degrees in the prevention of VAP. Compare HOBE of 60 degrees against 45 degrees for patients in ICU and the prevention of VAP (Hassankhani et al., 2017). To measure how HOBE 60 degrees helps improve gas circulation and air circulation	To evaluate the safety of patients receiving intensive care during mechanical intubation. To assess the effectiveness of semi-recumbent position in reducing the risks of VAP (Wang et al., 2016). To help patients in ICU avoid complications that would interfere with their recovery process.	Both have similar goals and objectives as they dictate the impacts of semi-recumbent positioning and head-of-bed-elevation in preventing cases of VAP infections (Bassi et al., 2017). Both methods are effective and are prevents the issues associated with VAP to patients receiving mechanical ventilation intubation.
Data Collection	Data was obtained from a single-blind prospective randomized clinical trial which involved 25 patients. Each group (HOBE 60^0 and HOBE ^45) were recruited and results obtained for a year (Hassankhani et al., 2017). Data on progress was recorded in each morning and evening by nurses which included age, weight, underlying disorders, etiology of hospitalization, history of medication, and drug sensitivity. NUR 550 PICOT Assignment	Quality of evidence was utilized as it involved the evaluation of data from peer-reviewed articles (Wang et al., 2016). Authors screened titles, abstracts, and full-texts containing information about the comparison of semi-recumbent positioning versus supine position for patients in ICU and the prevention of VAP. 10 Trials were involved but only eight were successful due to loss of track of records.	Data collection was different as one involved perusal of evidence from peer-reviewed clinical articles and the other one used clinical trials. The exclusion criterion was used by qualitative data collection while the translational data collection involved the evaluation of evidence obtained from various peer-reviewed literatures.

Comparison 2: Translational Research vs. Quantitative Research

Criteria

Supine versus semi-Fowler’s positions for tracheal extubation in abdominal surgery-a randomized clinical trial

https://bmcanesthesiol.biomedcentral.com/articles/10.1186/s12871-020-01108-5

Translational Research Type: Quantitative

Semi‐recumbent position versus supine position for the prevention of ventilator‐associated pneumonia in adults requiring mechanical ventilation

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7016937/

Translational Research Type: Translational research

Observations (Similarities/Differences)

Methodology

Randomized clinical trials were used with 141 participants where two groups of supine and semi-fowlers positioning were utilized.

The participants were grouped depending on the supine and semi-fowlers positioning whereby, 70 patients after surgery were positioned in supine while the other 71 were positioned in semi-fowlers position (Zhu et al., 2020).

Evidence was obtained from records of changes and vital signs such as coughs, comfort, pain, and comfort-scores before and after surgery.

Search for evidence from online libraries and randomized controlled trials. The evidence obtained from online libraries such as CENTRAL, MEDLINE, EMBASE, CINAHL, and CBM comparing the impacts of semi-recumbent positioning and supine positioning to prevent ventilated-associated pneumonia (VAP) (Wang et al., 2016).

Both utilized the randomized clinical trials

The traditional method used online peer-review methods while the quantitative method used participants to obtain data at the end of the trial

Evidence was obtained from changes of patients’ healing process for both medical positions but the traditional research utilized evidence from reviewed articles on insights of the discussed positioning methods (Bassi et al., 2017).

Goals

To ascertain that semi-fowlers position is considered effective and more comfortable after mechanical ventilation surgery and prevents VAP (Zhu et al., 2020).

To improve the quality of care offered in ICUs and prevent prolonged hospice stay and reduce the risks of infections that might prolong the recovery process of patients.

To evaluate the safety of patients receiving intensive care during mechanical intubation.

To assess the effectiveness of semi-recumbent position in reducing the risks of VAP (Wang et al., 2016).

To help patients in ICU avoid complications that would interfere with their recovery process.

Both methods aimed to provide insights on the effective positioning after mechanical intubation surgery for patients in ICU

Both methods ascertained that semi-fowler or semi-recumbent methods were deemed effective to prevent VAP.

Data Collection

Demographic data was obtained before surgery

After surgery, data obtained included heartbeat rates, mean arterial pressure, peripheral capillary oxygen saturation, temperature, and respiratory rate (Zhu et al., 2020).

Monitoring of recovery process for both groups were implemented and changes recorded by nurses.

Quality of evidence was utilized as it involved the evaluation of data from peer-reviewed articles. Authors screened titles, abstracts, and full-texts containing information about the comparison of semi-recumbent positioning versus supine position for patients in ICU and the prevention of VAP. 10 Trials were involved but only eight were successful due to loss of track of records (Wang et al., 2016).

The traditional research methods collected data from peer reviewed articles and abstracts concerning the difference of supine and semi-fowler positioning in preventing VAP.

The quantitative method obtained data from clinical operations and real-time patients in a hospital and the evidence offered insights on the benefits of semi-fowler when compared to supine positioning in preventing VAP.

References

Bassi, G. L., Xiol, E. A., Pagliara, F., Hua, Y., & Torres, A. (2017, June). Body position and ventilator-associated pneumonia prevention. In Seminars in respiratory and critical care medicine (Vol. 38, No. 03, pp. 371-380). Thieme Medical Publishers.
Hassankhani, H., Akbarzadeh, S., Lakdizaji, S., Najafi, A., & Mamaghani, E. A. (2017). Effects of 60 degrees Semi-recumbent Position on Preventing Ventilator-associated Pneumonia: A Single-blind Prospective Randomised Clinical Trial. JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH, 11(12), OC36-OC39.
Wang, L., Li, X., Yang, Z., Tang, X., Yuan, Q., Deng, L., & Sun, X. (2016). Semi‐recumbent position versus supine position for the prevention of ventilator‐associated pneumonia in adults requiring mechanical ventilation. Cochrane Database of Systematic Reviews, (1).
Zhu, Q., Huang, Z., Ma, Q., Wu, Z., Kang, Y., Zhang, M., … & Huang, F. (2020). Supine versus semi-Fowler’s positions for tracheal extubation in abdominal surgery-a randomized clinical trial. BMC anesthesiology, 20(1), 1-9. NUR 550 PICOT Assignment