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Picot statement

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Picot statement

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The first step of the EBP process is to develop a question from the nursing practice problem of interest.

Select a practice problem of interest to use as the focus of your research.

Start with the patient and identify the clinical problems or issues that arise from clinical care.

Following the PICOT format, write a PICOT statement in your selected practice problem area of interest, which is applicable to your proposed capstone project.

The PICOT statement will provide a framework for your capstone project (the project students must complete during their final course in the RN-BSN program of study).

Conduct a literature search to locate research articles focused on your selected practice problem of interest. This literature search should include both quantitative and qualitative peer-reviewed research articles to support your practice problem.

Select six peer-reviewed research articles which will be utilized through the next 5 weeks as reference sources. Be sure that some of the articles use qualitative research and that some use quantitative research. Create a reference list in which the six articles are listed. Beneath each reference include the article’s abstract. The completed assignment should have a title page and a reference list with abstracts.

Suggestions for locating qualitative and quantitative research articles from credible sources:

  1. Use a library database such as CINAHL Complete for your search.
  2. Using the advanced search page check the box beside “Research Article” in the “Limit Your Results” section.
  3. When setting up the search you can type your topic in the top box, then add quantitative or qualitative as a search term in one of the lower boxes. Research articles often are described as qualitative or quantitative.

To narrow/broaden your search, remove the words qualitative and quantitative and include words that narrow or broaden your main topic. For example: Diabetes and pediatric and dialysis. To determine what research design was used, review the abstract and the methods section of the article. The author will provide a description of data collection using qualitative or quantitative methods.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

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.

This is my practice problem: The risk of developing end-stage renal disease in patients with type 2 diabetes and or nephropathy.

PICOT Statement

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PICOT Statement

The practice problem this student wishes to focus on is nursing turn-over in the psychiatric field. This leads to unsafe care to patients and a lack of continuity of care. In the psychiatric field, this especially takes a toll on the patients due to lack of trust and repore. The patients tend to pull back and not engage with nursing staff because the patients don’t trust that the nurse will be there for the duration of their treatment.

P-Population- The population is the group of psychiatric nurses. – please specify what setting this would be in, outpatient or inpatient?

Nurses working in psychiatric settings have high rates of turnover because of unfavorable organizational factors. The problem arises due to low psychiatric nurse-to-patient staffing ratios, heavy workloads, and time constraints among others resulting in burnout and low job satisfaction (Hanrahan, Aiken, McClaine, & Hanlon, 2010).

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I-Intervention-The intervention is minimizing burnout among the psychiatric nurses. – be specific as to what intervention you will implement – minimizing burnout is complicated and often multi-faceted PICOT Statement

It is necessary to minimize burnout by improving organizational factors in psychiatric healthcare settings (Lukose, & Azeez, 2015). The psychiatric nurses become physically and emotionally exhausted since they deal with mentally ill patients.

C-Comparison-The reference (comparison) would consist of psychiatric nurses who do not experience minimized burnout. What may have been meant here is that the comparison group would be the group who will not receive the intervention you will implement – make sure to clarify that intervention too.

Therefore, the effectiveness of using the intervention of minimizing burnout among the psychiatric nurses would be measured by comparing with the reference group.

O –Outcome-The outcome is the lowered turnover among psychiatric nurses. Reducing burnout should decrease the emotional and physical fatigue that psychiatric nurses experience (Chakraborty, Chatterjee, & Chaudhury, 2012). Consequently, their attitudes towards work would be positive and they would continue working in the psychiatric field thus reducing the staff turnover. PICOT Statement

T- Time-The outcome would be assessed for 2 months. – Please specify if two months is the time frame for measuring outcomes or will two months include the implementation of the intervention you are proposing?

Where is your PICOT statement/question?

References

Chakraborty, R., Chatterjee, A., & Chaudhury, S. (2012). Internal predictors of burnout in psychiatric nurses: An Indian study. Industrial Psychiatry Journal, 21(2), 119-124. doi:http://dx.doi.org/10.4103/0972-6748.119604

The study examined the psychological factors that could predict burnout among Indian psychiatric nurses. The study comprised of 101 psychiatric nurses from two hospitals. They gave their informed consent and provided socio-demographic data. The research then used the Pearson’s r (Spearman’s rho) method to determine the correlation existing between socio-demographic and clinical variables and burnout. The multiple linear regression analysis was useful in entering the dependent and independent variables. The findings indicated that various socio-demographic and clinical variables affected burnout. The study concluded that lower burnout was predicted by past military training, internal locus, emotional maturity, sense of general physical well-being and adjustability. PICOT Statement

Hanrahan, N. P., Aiken, L. H., McClaine, L., & Hanlon, A. L. (2010). Relationship between Psychiatric Nurse Work Environments and Nurse Burnout in Acute Care General Hospitals. Issues in Mental Health Nursing, 31(3), 198–207.

The abstract of this journal mentions that research was conducted to evaluate how organizational factors lead to burnout among psychiatric nurses. The research used robust clustered regression analysis to determine the relationship of the two variables (organizational factors and levels of burnout). A total of 353 psychiatric nurses from 67 hospitals were evaluated. The study also measured organizational factors using an instrument from the National Quality Forum. According to the research results, high quality psychiatric environments reduced the level of burnout faced by psychiatric nurses.

Holmberg, C., Caro, J., & Sobis, I. (2017). Job satisfaction among Swedish mental health nursing personnel: Revisiting the two-factor theory. International Journal of Mental Health Nursing, complete the publication information here 1-12. doi: 10.1111/inm.12339

The study explored the Herzberg’s theory and its relationship to job satisfaction among mental health staff offering inpatient psychiatric care in Sweden. The study was qualitative and it used semi-structured interviews among 25 mental health nurses. They described their perception of responsibilities, interactions with colleagues and management, as well as professional experiences in psychiatric nursing. The study concluded that the mental health nurses had lower job satisfaction because of inadequate monetary incentives and professional development opportunities. PICOT Statement

Lukose, S., & Azeez, A. E. P. (2015). Occupational stress, mental health and attitude towards mental illness of nursing staff working in general and psychiatric hospital: A comparative study. Journal of Organization and Human Behavior, 4(4) Retrieved from https://search.proquest.com/docview/1765137272?accountid=45049

The research was conducted to determine the occupational stress faced by psychiatric nursing staff. Therefore, the study was cross-sectional hospital-based in four centers. The participants included 50 female nurses working in psychiatric hospitals and 50 in general hospitals. Additionally, judgmental sampling method was utilized to collect 100 samples. The stress level, mental health, and the nurses’ attitudes towards mental conditions were evaluated using General Health Questionnaire and socio-demographic data sheet. The research revealed that compared to general nurses, the psychiatric nurses experience increased occupational stress and workload. They also faced more work conflict, ambiguity and political pressure. PICOT Statement

Tuvesson, H., Eklund, M., & Wann-Hansson, C. (2012). Stress of Conscience among psychiatric nursing staff in relation to environmental and individual factors. Nursing Ethics, 19(2), 208–219.

The research investigated how various factors (individual and environmental) affect the stress of conscience among nurses providing psychiatric healthcare services. The study was conducted in Sweden among 93 psychiatric nurses working in 12 psychiatric wards. They answered a questionnaire that had different instruments evaluating various factors. SPSS 17.0 was used to conduct statistical analyses. The logistic regression models involved using the Mann-Whitney U-test and Spearman rank correlations. Moreover, according to the study conclusions, the psychiatric nurses experienced high stress of conscience when they faced aggressive and angry behavior as well as a sense of moral burden. However, protective factors included mastery and control at work. PICOT Statement

Yanchus, N., Periard, D., Moore, S., Carle, A., & Osatuke, K. (2015). Predictors of Job Satisfaction and Turnover Intention in VHA Mental Health Employees: A Comparison between Psychiatrists, Psychologists, Social Workers, and Mental Health Nurses. Human Service Organizations: Management, Leadership & Governance, 39(3), 219-244.

The study explored job satisfaction and turnover intention among various healthcare professionals working in the Veterans Health Administration. The professionals included mental health nurses, psychiatrists, social workers as well as psychologists. Psychological safety, civility, autonomy and procedural justice were the predictors. Moreover, a total of 11, 726 VHA mental health staff participated in the study. The results of the study indicated that turnover intention among the mental health employees was predicted by autonomy, civility and procedural justice PICOT Statement

PICOT STATEMENT

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PICOT STATEMENT

A PICOT starts with a designated patient population in a particular clinical area and identifies clinical problems or issues that arise from clinical care. The intervention should be an independent, specified nursing change intervention. The intervention cannot require a provider prescription. Include a comparison to a patient population not currently receiving the intervention, and specify the timeframe needed to implement the change process.

Formulate a PICOT statement using the PICOT format provided in the assigned readings. The PICOT statement will provide a framework for your capstone project.

In a paper of 500-750 words, clearly identify the clinical problem and how it can result in a positive patient outcome.

Make sure to address the following on the PICOT statement:

Evidence-Based Solution

Nursing Intervention

Patient Care

Health Care Agency

Nursing Practice

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

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 required to submit this assignment to Turnitin. Please refer to the directions in the Student Success Center

Picot Statement and Literature Search

Your Name: Idalmis Espinosa

Institution: Grand Canyon University

Course: NRS-433V Introduction to Nursing Research PICOT STATEMENT

Date: 05/03/17

Literature Search

Practice Problem/Issue and PICOT Question

Hypertension contributes to the death of many people throughout the world, yet there is still poor management of the condition. Establishing effective control measures could significantly help to control the number of deaths worldwide. To control and management hypertension effectively, it is important to identify and manage the lifestyle risk factors associated with the condition as that helps to lower blood pressure. In addition, it is vital to perform regular screening, communicating effectively with patients, monitoring patients on a regular basis, and adhering to treatment. In particular, it is possible to prevent and control the condition quite effectively through lifestyle changes (diet and regularly engaging in exercise) as these help to significantly regulate blood pressure.

PICOT Question

For male adults between the ages of 40 and 70 with hypertension, and with multiple co-morbidities (P), will the change in lifestyle (engaging regularly in exercise and eating healthier and balanced meals) (I), compared to patients who use medication to treat/manage their hypertension (C), help to regulate their blood pressure and reduce the risk of developing cardiovascular diseases (O) in their recovery period within 6 months (T).

References

Dua, S., Bhuker, M., Sharma, P., Dhall, M., & Kapoor, S. (2014). Body Mass Index Relates to Blood Pressure Among Adults. North American Journal of Medical Sciences, 6(2), 89–95. http://doi.org/10.4103/1947-2714.127751 PICOT STATEMENT

Background: The blood pressure and anthropometric measurements are important for evaluating the health of children, adolescents as well as adults.

Aim: The aim is to study the blood pressure and body dimensions and to find out the prevalence of overweight/obesity and hypertension among adults.

Materials and Methods: A cross-sectional study was conducted of all the people belonging to the Punjabi community, residing in Roshanara area and Jaina building in Delhi, for the past 20 years and aged 18-50 years. The men were engaged in transport business and women were mainly housewives.

Results: Mean values of all the measurements, that is, height, weight, upper arm circumference, pulse rate, systolic blood pressure (SBP), and diastolic blood pressure (DBP) were higher among males as compared with females, except skinfold thicknesses. Body mass index (BMI) and fat percentage was found to be higher among females as compared with males. There was a significant positive correlation between BMI, fat percentage, and blood pressure both SBP as well as DBP. Odds ratio showed that overweight/obese subjects were more likely to have hypertension than those with normal BMI.

Conclusion: Prevalence of prehypertension among overweight/obese suggested an early clinical detection of prehypertension and intervention including life style modification, particularly weight management.

Howes, F., Warnecke, E., &Nelson, M. (2013). Barriers to lifestyle risk factor assessment and management in hypertension: A qualitative study of Australian general practitioners. Journal of Human Hypertension, 27, 474-478 doi:10.1038/jhh.2013.9

Hypertension is a leading cause of mortality and disease burden worldwide, yet its management remains suboptimal. Identification and management of lifestyle risk factors should be a clinical priority in all patients because of the beneficial effects of lifestyle intervention on blood pressure. The objective of this qualitative focus group study was to identify barriers to lifestyle management in hypertension in Australian general practice. Purposeful sampling was used to select large group practices. Six focus groups (n=30) were audio recorded and transcribed. An iterative thematic analysis was conducted. Overall participants felt they had the required knowledge to provide broad lifestyle advice. However, cynicism dominated due to an overwhelming lack of success in practice. Patient reluctance and ambivalence were identified as major barriers but participants were willing to share the responsibility. Other barriers included time, reduced access to allied health and broader determinants of health. General practitioners need to be empowered to allow continuation of valuable lifestyle advice and counselling. The results emphasise the importance of ongoing lifestyle assessment and tailoring of management to the complex interplay of factors that impact on a patient’s ability to adopt and maintain lifestyle change. System issues need to be addressed to provide better streamlined care.

Legido-Quigley H, Camacho Lopez PA, Balabanova D, Perel P, Lopez-Jaramillo P, Nieuwlaat R, et al. (2015) Patients’ knowledge, attitudes, behaviour and health care experiences on the prevention, detection, management and control of hypertension in Colombia: A qualitative study. PLoS ONE 10(4): e0122112. https://doi.org/10.1371/journal.pone.0122112 PICOT STATEMENT

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Abstract

Hypertension is a leading cause of premature death worldwide and the most important modifiable risk factor for cardiovascular disease. Effective screening programs, communication with patients, regular monitoring, and adherence to treatment are essential to successful management but may be challenging in health systems facing resource constraints. This qualitative study explored patients’ knowledge, attitudes, behaviour and health care seeking experiences in relation to detection, treatment and control of hypertension in Colombia. We conducted in-depth interviews and focus group discussions with 26 individuals with hypertension and 4 family members in two regions. Few participants were aware of ways to prevent high blood pressure. Once diagnosed, most reported taking medication but had little information about their condition and had a poor understanding of their treatment regime. The desire for good communication and a trusting relationship with the doctor emerged as key themes in promoting adherence to medication and regular attendance at medical appointments. Barriers to accessing treatment included co-payments for medication; costs of transport to health care facilities; unavailability of drugs; and poor access to specialist care. Some patients overcame these barriers with support from social networks, family members and neighbours. However, those who lacked such support, experienced loneliness and struggled to access health care services. The health insurance scheme was frequently described as administratively confusing and those accessing the state subsidized system believed that the treatment was inferior to that provided under the compulsory contributory system. Measures that should be addressed to improve hypertension management in Colombia include better communication between health care professionals and patients, measures to improve understanding of the importance of adherence to treatment, reduction of co-payments and transport costs, and easier access to care, especially in rural areas.

Rao, C. R., Kamath, V. G., Shetty, A., & Kamath, A. (2013). High blood pressure prevalence and significant correlates: A quantitative analysis from Coastal Karnataka, India. ISRN Preventive Medicine, doi:10.5402/2013/574973

Abstract

Hypertension is a premier risk factor for cardiovascular disease which can be recognized if sought and treated effectively. Effective management of high blood pressure is possible when the magnitude of the problem is identified. So, a cross-sectional community based survey among 1,239 respondents aged ≥30 years was designed to estimate the prevalence and the sociodemographic correlates of hypertension among adults aged ≥30 years. Data was collected by personal interviews, followed by anthropometric and blood pressure measurements. Analysis was done using Statistical Package for the Social Sciences (SPSS) version 11.5. The prevalence of hypertension was 43.3%, with the prevalence being more among males (51.6%) as compared to females (38.9%). Of the total prevalence 23.1% (287) were known cases, and 20.2% (250) were newly detected cases. Based on the seventh report of the Joint National Committee (JNC VII) on high blood pressure, prehypertension was noted among 38.7%. Advancing age, male gender, current diabetic status, central obesity, overweight and obesity as defined by body mass index, and family history of hypertension were identified as significant correlates for hypertension by multivariate logistic regression.

Shima, R., Farizah, M. H., & Majid, H. A. (2014). A qualitative study on hypertensive care behavior in primary health care settings in Malaysia. Patient Preference and Adherence, 8, 1597–1609. http://doi.org/10.2147/PPA.S69680

Abstract

Purpose: The aim of this study was to explore patients’ experiences with their illnesses and the reasons which influenced them in not following hypertensive care recommendations (antihypertensive medication intake, physical activity, and diet changes) in primary health clinic settings.

Patients and methods: A qualitative methodology was applied. The data were gathered from in-depth interviews with 25 hypertensive patients attending follow-up in nine government primary health clinics in two districts (Hulu Langat and Klang) in the state of Selangor, Malaysia. The transcribed data were analyzed using thematic analysis.

Results: There was evidence of lack of patient self-empowerment and community support in Malaysian society. Most of the participants did not take their antihypertensive medication or change their physical activity and diet after diagnosis. There was an agreement between the patients and the health care professionals before starting the treatment recommendation, but there lacked further counseling and monitoring. Most of the reasons given for not taking antihypertensive medication, not doing physical activity and not following diet recommendations were due to side effects or fear of the side effects of antihypertensive medication, patients’ attitudes, lack of information from health care professionals and insufficient social support from their surrounding environment. We also observed the differences on these reasons for nonadherence among the three ethnic groups.

Conclusion: Health care professionals should move toward supporting adherence in the management of hypertensive patients by maintaining a dialogue. Patients need to be given time to enable them to overcome their inhibition of asking questions and to accept the recommendations. A self-management approach must be responsive to the needs of individuals, ethnicities, and communities.

Tong, X., Taylor, A. W., Giles, L., Wittert, G. A., Shi, Z. (2014). Tea consumption is inversely related to 5-year blood pressure change among adults in Jiangsu, China: A cross-sectional study. Nutrition Journal, 13(98). doi: 10.1186/1475-2891-13-98. PICOT STATEMENT

Abstract

Background: Data relating to the association between tea consumption and blood pressure change are inconsistent. The aim of this analysis was to investigate the association between tea consumption and the change in blood pressure (BP) in Chinese adults over a 5-year period.

Methods: Data from 1109 Chinese men (N= 472) and women (N= 637) who participated in the Jiangsu Nutrition Study (JIN) were analysed. BP was measured in 2002 and 2007. Tea (green, black and total tea) consumption was quantitatively assessed at the follow-up survey in 2007.

Results: Total tea and green tea consumption were inversely associated with 5-year diastolic BP (DBP) but not systolic BP (SBP) change. In the multivariable analysis, compared with no consumption of tea, those with daily total tea/green tea consumption of at least10 g had 2.41 mmHg and 3.68 mmHg smaller increase of DBP respectively. There was a significant interaction between smoking and total tea/green tea consumption and DBP change. The inverse association between total tea/green tea consumption and DBP change was significant only in non-smokers. Green tea consumption was inversely associated with SBP change only in non-smokers and those without central obesity.

Conclusion: The consumption of green tea is inversely associated with 5-year BP change among Chinese adults, an effect abrogated by smoking PICOT STATEMENT