Problem/PICOT/Evidence Search Worksheet

QUESTION

Purpose

Collaborative identification and interpretation of practice problems is a requirement of professional practice (AACN, 2008). Locating and summarizing findings using credible online databases is necessary for evidence-based nursing (AACN, 2008; QSEN, 2020). This assignment provides a learning activity for students to experience a practice-based scenario and apply a process worksheet designed to assist in the identification of an independent nursing problem or concern, develop a PICOT clinical question, and search for evidence using credible online databases/sources.

Course Outcomes

This assignment enables the student to meet the following Course Outcomes.

CO 1: Examine the sources of evidence that contribute to professional nursing practice. (PO 7)

CO 2: Apply research principles to the interpretation of the content of published research studies. (POs 4 & 8)

CO 4: Evaluate published nursing research for credibility and significance related to evidence-based practice. (POs 4 & 8)

CO 5: Recognize the role of research findings in evidence-based practice. (POs 7 & 8)

Directions

Read over each of the following directions.
You must read the Assignment Practice Scenario below before completing the PPE Worksheet.
Download and use the required PPE WorksheetLinks to an external site..
Review the information provided in our library of how to search for journal articles hereLinks to an external site..
Review the information provided in our library of how to locate and copy a journal permalinkLinks to an external site..
You are required to complete the worksheet using the productivity tools required by Chamberlain University, which is Microsoft Office Word 2013 (or later version), or Windows and Office 2011 (or later version) for MAC. You must save the file in the “.docx” format. Do NOT save as Word Pad. A later version of the productivity tool includes Office 365, which is available to Chamberlain students for FREE by downloading from the student portal at http://my.chamberlain.eduLinks to an external site.. Click on the envelope at the top of the page.
Complete each section of the Problem/PICOT/Evidence (PPE) Worksheet. For the Clinical PICOT Question,use the NR439 Guide for writing PICOT Questions and ExamplesLinks to an external site.. Use one of the templates/guides to write your Clinical PICOT Question using all of the PICOT elements. Be sure to include the PICOT letters in your question.
Be sure to use the rubric to make certain you are meeting all grading criteria of the PPE Worksheet.
Submit the completed PPE Worksheet on the Week 3 Assignment page.
Students, A short tutorial with tips for completing the Week 3 Problem/PICOT/Evidence Search (PPE) worksheet assignment may be viewed here.

Assignment Practice Scenario

Your Chief Nurse Executive (CNE) recognizes you are pursuing your BSN and has asked you to be a member of the nursing evidence-based practice (NEBP) committee. She has advised the members that the purpose is to conduct nursing research studies involving clinical practice problems. Increasing nurses’ awareness of quality and safety concerns will help develop an attitude of inquiry and asking questions (Sherwood & Barnsteiner, 2017). Baccalaureate nurses “collaborate in problem identification, participate in the process of search, retrieval, and documentation of evidence, and integrate evidence using credible databases and internet resources” (AACN, 2008, pp. 16-17).

The CNE has advised all members of the following areas of quality and safety clinical practice that each committee member needs to consider and choose only one as a priority area for conducting a research study. Sources of research problems come from nursing clinical practice (Houser, 2018):

Quality	Safety
Patient satisfaction Patient education	Falls
Non-pharmacological pain management	Errors. Examples include: Medication Patient identification Communication
Readmissions Length of stay Costs	Healthcare Associated Infections (HAIs). Examples include: Central Line Associated Blood Stream Infections (CLABSI) Catheter Associated Urinary Tract Infections (CAUTI) Ventilator Associated Pneumonia (VAP) Surgical Site Infections (SSI) Sepsis (Screening or Prevention)
Discharge Teaching/Coaching Transitions of Care/Level of Care	Pressure Ulcers Skin Integrity

Your CNE has requested that you select ONLYone topic areaand complete the PPE Worksheet using only one topic area. The committee will collaborate and decide as a team which nursing clinical problem area will be the priority focus of their next research study. Thank you for your valuable contributions to this important NEBP committee.

Best Practices

For questions about this assignment, please contact your instructor.
Spell check for spelling and grammar errors prior to final submission.
Please see the grading criteria and rubrics on this page.
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Scholarly Sources and Citations

Use APA format in citations and references.

References

American Association of Colleges of Nurses. (2008). Executive summary: The essentials of baccalaureate education for professional nursing practice. http://www.aacnnursing.org/Education-Resources/AACN-Essentials

Houser, J. (2018). Nursing research: Reading, using, and creating evidence (4th ed.). Jones and Bartlett.

Sherwood, G., & Barnsteiner, J. (2017). Quality and safety in nursing: A competency approach to improving outcomes (2nd ed.). Wiley-Blackwell.

Quality and Safety Education for Nurses. (2018). QSEN knowledge, skills, and attitude competencies. http://qsen.org/competencies/pre-licensure-ksas/

ANSWER

Student Name:

Due Date:

Problem/PICOT/Evidence Search (PPE) Worksheet

Criteria

There has been a spike in CLABSI cases in the hospital over the past few months. This issue is the most important because the incident cases keep rising. In the ICU, CLABSI cases have increased from eight to fourteen within two months. Six other cases have been reported among non-ICU patients within the same timeframe. Overall, within the last six months, 32 cases have been reported.

Failure to prioritize this issue will result in adverse effects. CLABSI is costly, contributes to approximately 30 000 deaths annually, and typically lengthens hospital stays by 19-21 days (Hugo et al., 2022). These infections also cost between $55,000 and $69,000 per case (Hugo et al., 2022). CMS administers a 1% payment reduction to hospitals that perform poorly in HAI scores (AHRQ, 2014). Given these outcomes, the hospital must prioritize this issue and undertake appropriate measures to reduce CLABSI rates at the facility.

Clinical Nursing Practice Problem

Healthcare Associated Infections (HAIs): Central Line Associated Blood Stream Infections (CLABSI)

Clinical Nursing

PICOT Question

Using the NR439 Guide for Writing PICOT Questions and Examples located in the assignment guidelines, write out your PICOT question. Include the PICOT letters in your question.

In adult inpatients with a central venous catheter (P), would a CLABSI prevention care bundle (I) reduce the CLABSI incidence rates (O) compared to routine care without the prevention bundle (C) within ten weeks (T)?

Define PICOT Elements

Define each of the PICOT elements from your question above.

P– The target population is adult inpatients with central venous catheters (CVCs). These patients can have CVCs in place for hours, weeks, or even longer. Various practitioners must access the CVC to administer drugs and fluids or collect samples. Each entry into the CVC’s access points presents opportunities for introducing micro-organisms, putting these patients at multiple infection risks.

I– (Intervention): Care bundles refer to a set of evidence-based interventions collectively administered to enhance patient outcomes. CLABSI care bundles entail hand hygiene, maximal insertion site selection, optimal sterile barriers for line insertion, and daily monitoring of device necessity with immediate removal of unneeded lines. These five measures are evidence-based and must be implemented together to improve care quality.

C– (Comparison): The comparison intervention involves implementing standard care without using these care bundles.

O– (Measurable outcome): The expected intervention outcome is reducing the number of CLABSI cases in the organization or reducing the CLABSI incidence rates at the organization.

T– (Time frame in months): The timeframe for implementing this intervention is two months. Within this timeframe, the project managers will plan for implementation, conduct meetings, and prepare the organization for change. During the project’s first phase, they will develop the data collection tools, assemble & prepare the care bundle package, and conduct training sessions for nurses. The second phase involves implementing the care bundle under the supervision of an expert. The third phase entails project evaluation, providing improvement feedback to practitioners, refining the intervention, and making necessary changes.

Evidence Retrieval Process and Summary

Using only the Chamberlain College of Nursing library:

(1) Locate evidence that is relevant to your chosen nursing practice problem. Explain how you believe the evidence is relevant to your chosen nursing practice problem.

(2) Explain why you chose the evidence

(3) Provides a complete APA reference to the evidence (must include authors, year, title of the evidence, title of the resource)

(4) Evidence must be published within the last 10 years

(5) Provides the permalink

I believe the evidence is relevant because it directly answers the PICOT question. The study examined the impact of the central venous catheter care bundle on the outcomes of patients critically ill with CLABSI. The study compares clinical outcomes before and after the implementation of the care bundle to ascertain the intervention’s impact. Its results directly answer our PICOT question, which seeks to determine the care bundle’s impact on CLABSI incidences compared to the lack thereof.

I selected the evidence because:

It is primary research, peer-reviewed, and published within the last ten years.
The study participants have similar characteristics as our target population: all the 250 study subjects were adults treated with a central venous access device (CVAD).
The study has both clinical and statistical relevance.

Reference

Atia, G. A. (2020). Effect of Central Venous Catheter Care Bundle Implementation on Outcomes of Critically Ill Patients. Evidence-Based Nursing Research journal, 2(1), 28–39. https://www.ajol.info/index.php/ebnr/article/view/219588/207217

Title of the evidence: Quasi-experimental research (pre/post-test design).

Implications of the Evidence

Summarize what you learned from the evidence. Summarize why you believe the nursing evidence-based practice committee should focus their next research project on the nursing practice problem.

The conclusion drawn from this study is that adherence to the CVC care bundle significantly improves clinical outcomes by decreasing CLABSI incidences. The care bundle reduced CLABSI rates among adult patients admitted to the intensive care unit by 68% (Atia, 2020). The incidence reduction occurred due to nurses’ improved knowledge of caring for patients with CVCs and compliance with CVC insertion and removal practices and CVC maintenance care.

The committee should consider supporting this project because it will create significant value for the organization. Apart from helping eliminate the existing problem, the care bundle intervention also impacts nurses’ compliance and knowledge levels of practice guidelines. The nurses can then apply these skills in other practice areas, potentially leading to reforms in other HAI-related areas. The intervention might also help the organization establish a safety culture, considering that process and outcome surveillance and training are integrated into the intervention bundle. Oversight/continuous monitoring and improved knowledge and attitude can help improve the organization’s safety culture.

Evidence Search Terms

Identify 4 (or more) relevant searchable terms you used for your search for evidence.

· ‘CLABSI prevention’

· ‘CLABSI prevention’ and ‘care bundles’

· ‘Care bundles’

· ‘Central line-associated bloodstream infections’

· ‘CLABSI’ and ‘quality improvement’

Evidence Search

Strategies

Select 4 (or more) relevant search strategies you used to narrow/limit your search for

evidence.

____ Boolean Operators/Phrase

____ Selected publication dates within last 10 years

____ Academic or scholarly (Peer Reviewed) journals

____ Quotation marks for key words

____ Selected key terms from PICOT question

References

AHRQ. (2014). Quality Indicators Toolkit Selected Best Practices and Suggestions for Improvement PSI 7: Central Venous Catheter (CVC)-Related Bloodstream Infections (BSIs) Why Focus on Central Line-Related Bloodstream Infections (CLABSIs)? https://www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/qitoolkit/d4a-crbsi-bestpractice.pdf

Hugo, M. C., Rzucidlo, R. R., Weisert, L. M., Parakati, I., & Schroeder, S. K. (2022). A Quality Improvement Initiative to Increase Central Line Maintenance Bundle Compliance through Nursing-led Rounds. Pediatric Quality & Safety, 7(1), e515. https://doi.org/10.1097/pq9.0000000000000515

Problem/PICOT/Evidence Search Worksheet

QUESTION

Purpose

Course Outcomes

Directions

Assignment Practice Scenario

Best Practices

Scholarly Sources and Citations

References

ANSWER

References

Problem PICOT Evidence Search Worksheet Download

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