High Risk Patients

PICO QUESTION

High risk patients in hospital who are at risk for pressure ulcers (p), what is the best practice for prevention of pressure ulcers (i) compared with standard of care (turning every two hours) (c), decrease the occurrence of pressure ulcers (o) during hospitalization (t)
Population: bedrest patients
High risk patients (10-12 in Braden scale)
PICO question and database search assignment Week 5

Guidelines and Grading Rubric: PICOT Question and Database Search Assignment (50 points)

This assignment is a scholarly paper providing students an opportunity to:
1. write a significance of the clinical problem that leads to the PICO(T) question
2. formulate an answerable and searchable PICO(T) question,
3. demonstrate ability to conduct appropriate database searches,
4. identify and select (without bias) clinically relevant best evidence based on established selection (inclusion and exclusion) criteria, and
5. correctly identify type and level of evidence as described by Melnyk and Fineout-Overholt (2019).
This assignment is a part of the final EBP paper in week 13. Students are expected to use the faculty feedback and suggestions from this assignment to write section 1 and 2 of the final EBP for Week 13.
The PICOT question and Database Search Assignment paper is worth 50 points and due on week 5, Sunday midnight. Students must follow the guidelines and instructions below to receive the maximum points.

Criteria/Outline Scores
1. Background/Introduction (5 points)
Write a specific clinical problem that leads to a PICOT question. Provide clear and succinct significance of the problem and problem statement using criteria in Polit & Beck (2021), p. 73. Use at least 3 credible citations following the APA 7th edition. (1-2 paragraphs, limit to 400 words)
• Write a clear background by describing the nature of the clinical problem that lead to PICOT question
• Articulate the significance of the clinical problem by addressing the following areas (see P&B, p. 68-73):
o Use of evidence to establish the prevalence/incidence of a specific clinical problem/situation
o Use of evidence to establish the risks associated with a specific clinical problem/situation
o Use of evidence to establish the potential impact of a specific clinical problem/situation on clients’ quality of life
• Offer solution or practice change to the clinical question and set the stage for the subsequent EBP inquiry
• Address how this problem is of great significance to nursing with a clear link to the clinical practice
• Introduction must contain at least 3 citations from credible sources
2. PICO(T) question (5 points)
Develop a PICOT question related to the clinical problem described in section I using the format provided by Melnyk and Fineout-Overholt (2019), Box 2.2, page 44. A clinical question must be written clearly in a PICOT format with all five components identified, patient/population, intervention, comparison (if applicable), outcome, and time
3. Database Search Process (10 points) (1 paragraph)
• Describe the process you used to accomplish a comprehensive review of the relevant literature that focused on your PICO(T) question. State the specific inclusion and exclusion criteria you used for selection of “best evidence” for this paper.

• What database(s) did you search? Include details, such as the databases/evidence sources searched and include the timeframe that YOU did your search. (Example: “Cumulative Index for Nursing and Allied Health Literature (CINAHL) searched from Sep 1, 2020 through Sep 10, 2020. PubMed searched simultaneously).
• What type of research designs and level of evidence did you target to best address your PICO(T) question? Provide rationales.
• What keywords/search terms did you use? What specific MeSH terms did you use?
• What limiters did you apply to your search and explain how each limiter affected the total number of articles found?
• Provide rationale for your final selection of the studies included as the best evidence.

4. Search results (5 points) (1 paragraph)
Describe details of search results including number of articles found from each database. Too narrow search may give few results and need to adjust the search terms used. Too broad search may give too many results and need to use appropriate limiters.

Your description must provide sufficient detail to enable replication of your search results.
State your rationale for exclusion of results from each article that matched all selection criteria but were not selected. (Example: The study by Brown, White, and Green (2016) were RCT’s included in the Systematic Review by Orange and White (2018) and therefore excluded as best evidence because the data overlapped with the study by Orange et al.)

5. Evidence Matrix (Appendix A) (25 points)
Directions for completing the table below:
Identify and describe the components from each study selected as best evidence by writing an accurately paraphrased and cited description of the components in the correct cells of the table. Do not use quotes. The precise number of columns needed will vary in accordance with the number of articles selected across EBP inquiries. Typically, 4-6 relevant articles are adequate. If you have more or less articles than is typical discuss this directly with course faculty prior to submitting the articles for this assignment.
NOTES:
• Your article must be an original study and not an integrative review of research, a narrative review of articles, a clinical protocol, or a quality improvement article. The selected evidence based article must be a research article, i.e., Systematic review, meta-analysis, RCT, cohort study, etc. (See M & F, Table 5.7, p. 171).
• Studies not matching ALL your selection criteria should not be chosen as best evidence.
• Do not include overlapping studies (same population sample, same studies reviewed).
• Select the highest-level studies for inclusion.

Grading of the evidence matrix will be based on the following:
• Information listed about each individual study must be accurate and relevant to the PICO question (4 points)
• Correctly identify population in the article (4 points)
• Correctly identify independent and dependent variables (4 points)
• Correctly identify outcome measures (4 points)
• Correctly identify level of evidence and type of study design (4 points)
• Appropriately report results with statistics that directly answer the main outcome in the PICO question (4 points)
• Submit selected articles in pdf files with appropriate label of the first author’s last name. (1 point)
Note: Based on this assignment, your PICO question and the selected articles will be approved by the course faculty before you can proceed with writing your EBP paper for week 13. If PICO question needs a revision and articles do not match well with the PICO elements, you must resubmit for a final approval. Your paper will be given one of the following conditions:
______ Your PICO question is approved as is, with the supporting evidence you submitted. You may proceed to the next stage of writing your EBP paper. You may want to start your writing for the EBP paper by critiquing your articles, using the critiquing templates in the EBP rubric.
_____ Your PICO question and/or support articles require a minor modification. You may proceed with the revision based on my comments in this assignment. Resubmit your PICO and/or support articles to me for consideration for final approval. If you need assistance with this, contact me by way of the private communication to faculty through the D2L platform or schedule a time to talk with me on the telephone.
______ Your PICO question and/or your selected articles require a major modification. Schedule a time to talk with me on the telephone within the next 7 days to discuss a plan to progress. In the meantime, read my comments and initiate revising your PICO and selecting new support articles based on my comments in this assignment.

Appendix A.
State your PICO(T) here: ________________________________________________

**Selected articles must represent best evidence to answer the PICO Question. Study variables must match all PICO elements.

*Note that the measured outcome refers to study main outcomes such as stress, pain, anxiety, or other measures for your dependent variable.
Instructions Study#1 Study#2 Study#3
Authors, year:
Title of the article:
Type of Evidence (e.g. Systematic Review, RCT):

Hierarchical Evidence Rating Level:

What population was studied?

Identify the independent variable(s) (IV) for each study.
Include both the intervention and control variables.

What were the DVs?
Identify the specific outcome measured.

What was the primary finding from this study related to your PICO(T) question?

Instructions Study#4 Study#5 Study#6
All Authors:
Title of the article:
Type of Evidence (e.g. Systematic Review, RCT:
Hierarchical Evidence Rating
What population was studied?
Identify the independent variable(s) (IV) for each study. Include both the intervention and control variables.
What were the DVs?
Identify the specific outcome measured.

What was the primary finding from this study related to your PICO(T) question?