Discussion: PICOT Question

Over the course of the next eight weeks, we will be examining concepts related to nursing research and the translation of evidence to practice. To help you better understand the process, you will be identifying a practice issue for nurse practitioners.
 You will develop a PICOT question associated with the issue, find evidence to support a change in practice, and present your recommendations for change to your peers. This week, we will work on helping you refine your area of interest so that you will be able to develop a concise question for next week’s assignment. You are encouraged to use the area of interest you chose for the project in NR500NP and/or NR501NP; however, you may choose a different area if you wish.

Select an issue in nurse practitioner (NP) practice that is of interest to you and in which you would like to see a practice change occur. Conduct a review of literature to see what is currently known about the topic. In 1-2 paragraphs, describe the scope and relevance of the issue and your recommended change. Provide reference support from at least two outside scholarly sources to support your ideas. 
Please pick something you can do as a NP in your practice that is patient focused. Your intervention needs to relate to a measurable patient health outcome. Please avoid anything that would require a policy or law change, such as full-practice authority. Burnout and satisfaction surveys also are not appropriate topics as they are not patient centered. 

Review this 4-minute video to gain a better understanding of the requirements of a PICOT question. The PICOT question is not a research question, but a quality improvement issue that requires a practice change. 

Hello, my name is Dr. Lynch. Hey, I'm an assistant professor a Chamberlain University College of Nursing. Today we're gonna talk about pico questions and best practices in formulating these questions. There are five parts to a pico question. Patient intervention, comparison, outcome in time. The slides subsequently we will discuss each part of this question. The first ingredient for cooking up a pico question is population. Pick a broad topic, drill down, focus down so that then your population is very specific. Type two diabetic female patients age 30 to 40 who consume over 400 g of carbohydrates per day. A bunch more specific population then patients with diabetes intervention. What intervention do you think will make a difference? Is that supported by the scholarly literature? What is being done in clinical practice today? Are there better alternatives? You must use an intervention based on scholarly literature? Remember the definition of scholarly literature is a US based peer reviewed journal article geared for clinicians published in the past five years, or the latest clinical practice guideline. Comparison. So what is the standard of care currently? Patients without the intervention, patients without a condition, patients without risk factor. This part defines another population who will be used as a comparison against the group receiving the intervention. What is your desired outcome? The outcome should relate directly to the intervention and outcomes should be measurable. Time. This is a specific timeframe to demonstrate the outcome. In quality improvement efforts, the timeframe has to be realistic and manageable. Not over years, may not be even over months, but it could be. But it is usually a short timeframe to make an improvement effort. Many students ask what the differences between pico research and quality improvement questions. This chart will help you understand the difference. The pico question used here is in postoperative kidney transplant adults aged 65 to 75, how does a health coach compared with no health coaching affect hospital readmission rates within 90 days of discharge? This is a perfect pico question compared to the research question or QI question that also could be asked about this matter. Here's an example. In real life, you're a nurse practitioner working in a skilled nursing facility, the rate of false as unacceptable. And your care team has come together to discuss what should be done about this. Your pico question is, in elderly patients between age 65.75 residing in a sniff, how do fall prevention programs with risk assessment compared to fall prevention programs without risk assessment effect fall rates within 90 days after the intervention. So you can see how this question will guide how you view the literature on this topic. You will be looking for fall prevention with risk assessment in the scholarly literature to see what has worked in other places. What are the crucial ingredients in an outpatient fall prevention program? The literature holds the key, holds the answer to these questions. If you need further assistance, please contact your instructor directly. You can also contact the librarians at the Chamberlain library who can be accessed through many means, email, chat on real time. This material comes from Malbec and find out overhauled book evidence-based practice in nursing and health care, a guide to best practice, which is a great addition to your library.

Case for the Ongoing Development and Use of Nursing Grand Theories         

Case for the Obsolescence of Nursing Grand Theories

Introduction

The implementation and success of a strategic plan depends on the support of key stakeholders. This in turn depends on your ability to communicate clearly and persuasively with decision makers and to sell your vision of the future. You must also be able to lead the initiative and sustain strategic direction. This assessment provides you with an opportunity to showcase your strategic thinking and exercise the communication skills necessary to move your strategic plan forward toward implementation.

Note: In this assessment, you will develop a presentation to stakeholders for the strategic plan you developed in Assessment 2.

Preparation

Your strategic plan has been reviewed, and you have been asked to present your plan—including operational recommendations and strategic control mechanisms—at a strategic visioning session with key stakeholders (senior leaders if your plan is organization-wide, community leaders if your plan is for a community health project, or the nurse manager of a specific department or team). This session is the next step in moving your plan toward implementation.

Your deliverable for this assessment is a slide deck of 10-20 slides to supplement your presentation and facilitate discussion of your plan. You may use Microsoft PowerPoint or any other suitable presentation software. Please use the notes section of each slide to develop your talking points and reference your sources, as appropriate.

As you prepare to complete this assessment, you may want to think about other related issues to deepen your understanding or broaden your viewpoint. You are encouraged to consider the questions below and discuss them with a fellow learner, a work associate, an interested friend, or a member of your professional community. Note that these questions are for your own development and exploration and do not need to be completed or submitted as part of your assessment.

Reflect on the current cultural climate in your care setting.

• What aspects of the current cultural climate would aid in achieving one or more specific goals contained in your strategic plan?
• What aspects of the current cultural climate would present a challenge in achieving one or more specific goals contained in your strategic plan?
• What leadership theories, models, or strategies could help you turn this challenge into an opportunity?

Effectively communicating with internal and external stakeholders and constituencies can help in achieving strategic initiatives.

• How would you communicate the essential aspects of the strategic plan you developed in Assessment 2 to stakeholders or groups, both internal and external to your care setting?

Presentation

• Summarize your plan for achieving 2-3 main goals. Include corresponding metrics, targets, and initiatives to help achieve the desired quality or safety improvements in the care setting.

Note: It may be useful to think about what you hoped to achieve in addressing your care setting’s positive core or specific area of concern in Assessment 1. For example:

• Progress toward achieving the Triple Aim.
• Better patient safety outcomes.
• Lower readmission rates.
• Higher volume of patients and care.
• Increased financial gain.
• Minimizing staff burnout.
• Improved relationship and trust with the community or a specific population.

In addition, remember to consult the literature, research studies, and resources from professional and governmental organizations when developing metrics, targets, and initiatives.

• Explain how you will communicate your plan to those stakeholders and constituencies who are essential to implementing your plan and sustaining strategic direction.
  • Identify the key individuals or groups with whom you must communicate.
  • Identify the cultural or ethical factors, if any, that are relevant to the design of your communication plan, including how key individuals or groups typically prefer to be contacted.
• Describe the actions you will take to align your care setting’s structure, systems, shared values, management style, staff, and skills with your strategic goals.
  • Describe the changes that are needed to achieve your goals.
  • Describe the goals and processes for on-boarding relevant individuals or groups.
• Explain how you will evaluate the success of your strategic plan.
  • Define successful implementation.
  • Describe the successful outcomes for this project.
  • Explain how you will compare outcomes to current performance benchmarks.
  • Explain how you will collect data to evaluate whether you have achieved specific goals and outcomes.
  • Identify your priorities, assuming you cannot accomplish everything.
• Explain how relevant cultural, ethical, and regulatory considerations influenced the design of your strategic plan and strategies for its implementation.
• Explain your role, as a nurse leader, in successfully implementing your proposed plan and sustaining strategic direction.
  • Explain how leadership and health care theories support your role.
• Explain why your leadership qualities and skills will enable you to successfully implement your plan and sustain strategic direction.
  • Explain why you should be the one to lead this initiative.
  • Explain how you have demonstrated some or all of these qualities in past work.

 What aspects of the topic readings do you find the most interesting? What is your view of the analysis of disease and healing in the readings? Explain.