NURSING (NR)504 COMPLETE WEEK DISCUSSIONS PACKAGE LATEST.

Week 2 Forming the PICO Question (graded) Form a PICO question that you will use for your change project. Include each element of the PICO question. How did you develop this question? Why is it important to your clinical practice? Respond This section lists options that can be used to view responses. Collapse All Print View Show Options Responses Responses are listed below in the following order: response, author and the date and time the response is posted. Sort by Read/Unread Sort by Response Sorted Ascending, click to sort descending Sort by Author Sort by Date/Time* (an instructor response) Collapse Mark as Read Introductory Post Instructor Card Email this Author 4/22/2015 11:11:53 AM Please share a PICO question related to nursing in your specific job setting that you plan to use for your course project in this class. Discuss the following: How did you come up with this question? What internal and external data can be identified that are relevant to this problem? Again, please remember, this should be a PICO question/statement that goes with the problem you will be addressing in your Change Project for this course, so be sure to read the Course Project Guidelines under the Course Project Files in Doc Sharing for more information regarding the assignments for it when identifying your question. Respond Collapse Mark as Read RE: Introductory Post Lisa Hunt Email this Author 5/13/2015 8:42:10 PM Hello all I work on a medicine/stroke unit and this population is at high risk for falls. Many of the cva patients suffer right side brain injury affects their understanding. Many of the patients may state they understand to call before getting up and will forget to call for help when they need to go to the bathroom. Many of the falls on the unit are due to the patient trying to get up and go to the bathroom. On my unit we have had 27 falls and are working diligently to decrease this number through re educating the staff on fall preventive equipment, assessing patient for high risk factors and doing purposeful hourly rounding. My hospital instituted purposeful hourly rounding in the orientation process and should include toileting the patient, and checking the patient to ensure safety measures are in place and to reduce falls with injury. The question raised is, are all staff members really doing purposeful hourly rounding to ensure patient safety and satisfaction. Hourly rounding is an EBP and has shown to increase patient satisfaction. My question is does purposeful hourly rounding help decrease falls if done purposefuly P: population/stroke patients I: purposeful hourly rounding C: not doing purposeful hourly rounding O: prevent/decrease the number of falls Reference: Lisa Respond (an instructor response) Collapse Mark as Read RE: Introductory Post Instructor Card Email this Author 5/16/2015 1:20:23 PM This is a very good question to address for stroke patient safety Lisa - you have put it into PICO format well. Respond Collapse Mark as Read RE: Introductory Post Saynetta George Email this Author 5/13/2015 10:49:41 PM Hello Professor Card and class, I am in a recent change of dynamics to a telephonic case manager for a managed care organization from a float nurse at a hospital. I have realized the bedside is becoming more and more difficult for me. My PICO includes the rationale I have for leaving the bedside which is working the unit with less nurses, or in nurse slang "working short" Internal data includes the hospital increasing our pay and providing bonuses to the nurses who stay in spite of the shortage and burnout they experience. The external data can be that nurses are leaving the bedside due to impossible demands and early burnout related to constantly being asked to work short and when errors occur we are suspended or written up. Patient safety and satisfaction surveys are low because client's feel as if they are being ignored. P= Problem Not enough nursing staff to accommodate the client load I= Intervention Add more nursing staff to add coverage that increases client safety C= Comparison As we look at other hospitals in other cities what is their nurse-client ratio and how can we implement the manner in which we can have safer client ratios O= Outcome How are our client's improved by overworked nurses and is burnout a possibility and how can hospitals prevent understaffing T- How long should nurses be made to work in these dangerous conditions before law makers implement changes and create new laws to prevent this from occurring. Will client's be seriously hurt or even die because of a nursing staff shortage? Renee American Nurses Association. (2010). Nursing: Scope and standards of practice (2nd ed.). Silver Spring. MD: Author Dearholt, S. L., & Dang, D. (2012). Johns Hopkins nursing-evidence-based practice: Model and guidelines (2nd ed.). Indianapolis, IN: Sigma Theta Tau International Respond (an instructor response) Collapse Mark as Read RE: Introductory Post Instructor Card Email this Author 5/16/2015 1:25:33 PM Good discussion of this question Saynetta - in addition to looking at how other hospitals staff, you should be comparing how increased staffing (your intervention) with the current practice of staffing now to see if there would be improved patient outcome. Respond Collapse Mark as Read RE: Introductory Post Saynetta George Email this Author 5/16/2015 10:31:19 PM Hi Professor Card, Thank you for your suggestion. I will include these interventions also. The results will be amazing to view. I am excited to complete the research to this. Renee Respond Collapse Mark as Read RE: Introductory Post Jessica Quinn Email this Author 5/16/2015 5:28:31 PM Saynetta, excellent topic! Adequate staffing leads to improved patient outcomes and care. I am working as a float Nurse for all of the Med-Surg/Tele Areas and it is tough when we are working short! Our unit supervisors staff the units based on patient census rather than patient acuity which is unfair and unsafe. A nurse might have 6 patients with 5 complete cares or 4 unstable patients. In order to provide optimal patient care and patient education, we must have help and a reasonable nurse to patient ratio. Also, there has been increased incidences of falls throughout the hospital, two with injury, and some patients who are high fall risk require 1:1 observation which pulls one of our CNAs off the floor. I am sure there is a ton of research proving better staffing = better patient outcomes and overall satisfaction. Respond Collapse Mark as Read RE: Introductory Post Shellie Cartwright Email this Author 5/17/2015 12:14:28 AM Instructor Card and classmates, I currently work for an organization that has had a large increase in census within the ER and overall admissions to the hospital as a whole. The hospital I work for is Magnet certified and is constantly evaluating ways in which to provide high-quality, evidence-based, patient-centered care with an effective and efficient process. An efficient process considers the flow of throughput, or flow of patients from beginning to end of their hospital stay, be it outpatient or inpatient. Aligning with Magnet, the organization collaborates with nursing through the shared-governance committees. The committees continually listen to new ideas backed with evidence and research to bring positive change to the patients and/or staff. "Organizations are in a unique position to become pioneers of the future and to demonstrate solutions to numerous problems inherent in today's healthcare systems. Beyond the "What" and "How", organizations must ask themselves what difference these efforts have made" (ANA, pg. 6). Working in the ER it is always a race against the clock, while providing high-quality, safe care to patients. Patients present to the ER and want to be evaluated, treated and have a disposition quickly. Each patient has a different perception or expectation of how much time this process should take. Often it is necessary to explain to patients they are not taken back in order of arrival, but rather in order of priority. There are different reasons that delay patients through the ER process. One area of contention noted is that of lengthy turn around times for simple diagnostic procedures, such as, urine dip test, rapid strep tests, cardiac markers, and urine pregnancy tests. Above all, I can say that at my facility the delay in treatment, and testing is significantly delayed awaiting urine pregnancy tests. Woman wait for certain medications, such as pain medications, and specific diagnostic tests, such as CT scans, awaiting urine pregnancy results. If the ER had point of care testing, the urine pregnancy results could be obtained much more quickly, versus waiting for the lab to result the data. This issue has been identified by the staff and ER physicians as a cause of delay for patients. According to Dearholt and Dang, "problem-focused triggers are those identified by staff during routine monitoring of quality, risk, adverse event, financial, or benchmarking data" (2012, pg. 59). Forming a PICO format to address the issue of point of care testing, specifically urine pregnancy tests, is critical to clearly identifying the problem which evidence-based research will be framed. P- patient, population, or problem - Women of childbearing ages which present to the ER for treatment and/or testing, requiring a urine pregnancy test. I-intervention - Performing point of care urine pregnancy tests within the ER, by competent, trained staff. C-comparison with other intervention - Urine pregnancy tests being performed outside of the ER, within the laboratory, by laboratory staff. O-outcomes that are measurable - Improvement in turn around time of urine pregnancy tests within the ER, improving patient quality care and patient satisfaction. According to ED Management (na., 2010), after a patient had been seen by a nurse or physician, point of care testing along with a rapid triage process was initiated. Improved evaluation and treatment time for patients, as well as enhanced patient flow in the ED, was the result of the new process. This process of bedside triage, point of care testing, and good communication with other departments, made the plan successful (ED Mangement, 2010). Shellie References American Nurses Association. (2010). Nursing: Scope and standards of practice (2nd ed.). Silver Spring, MD: Author. Dearholt, S.L., & Dang, D. (2012). Johns Hopkins nursing evidence-based practice: Model and guidelines (2nd ed.). Indianapolis, IN: Sigma Theta Tau International. Emergency department decreases 4-hour wait times to 9 minutes. (2010, January). ED Management, 1-3. Respond Collapse Mark as Read Forming the PICO question Olivia Dewalt Email this Author 5/10/2015 7:00:43 AM I have seen first hand the effects of dietary habits on cognitive function. My grandfather is a Pennsylvania Dutch type 2 diabetic who has eaten a high carb diet for his entire life. He has been instructed by healthcare professionals that his diet should be low in fat to protect his heart. My husband's grandfather, also a type 2 diabetic, was told the same. Neither of them has ever maintained control of their diet, simply eating sugars and carbs freely. While my grandfather is just now exhibiting occasional signs of dementia, Nate's grandfather's cognitive function and memory have declined rapidly in the last few years and he no longer recognizes family members. I would like to research the link between high carb diets with uncontrolled diabetes and dementia in elderly patients. With approximately 5.2 million Americans having Alzheimer's disease (, 2015) and approximately 29.1 million having type 2 diabetes (, 2012), these are obviously widespread issues, and both have become increasingly prevalent in the recent decades. In addition, according to a study by the NIH in which 937 elderly people were surveyed every 15 months for several years, "A dietary pattern with relatively high caloric intake from carbohydrates and low caloric intake from fat and proteins may increase the risk of MCI or dementia in elderly persons" (2015). I believe there is a gap in knowledge in that many healthcare professionals educate their patients to avoid fats while controlling their sugar intake, but do not place enough stress on the importance of carb control. Type 2 diabetes and dementia are tragic, preventable diseases and as educators, nurses have the opportunity to aid in this prevention. But first we must recognize the severity of the link between carbs and poor body and brain function and the many benefits of fats and proteins in the diet. My PICO question could be worded as follows: Do diabetics who maintain a high fat and low carb/gluten diet rather than a low fat, high carb/gluten diet have an decreased risk of developing some form of dementia? Population: Diabetic patients Intervention: Education about importance of high fat and protein versus high carb and gluten diet Comparison: Low fat, high carb and gluten diet Outcome: Increased risk of dementia References: Rosebud, O.R. (2013). Relative Intake of Macronutrients Impacts Risk of Mild Cognitive Impairment or dementia. J Alzheimers Dis. 2012 Jan 1; 32(2): 329–339. doi: 10.3233/JAD-2012-. Retrieved from: Respond (an instructor response) Collapse Mark as Read RE: Forming the PICO question Instructor Card Email this Author 5/11/2015 6:48:29 PM This sounds like an excellent question that can have important ramifications for patient education Olivia - you have put it into PICO format well. Respond Collapse Mark as Read Forming the PICO Question Courtney Gregware Email this Author 5/11/2015 12:18:19 PM Dear Professor and Class, As a professional nurse it is important to have a good understanding of how to form questions to help our patients and improve outcomes for them. Houser(2015) outlines PICO as population, intervention, comparison and outcome. For my PICO question I would like to address the topic of effective pain management for patients after surgery. In our practice we often use pain as the fifth vital sign, but unfortunately there is a lot of work that needs to be done to fully address patients pain. Hersh (2015) states that, “Our efforts need to be refocused on how to better address patient’s pain; a holistic approach is needed which goes beyond just medications and which includes other treatment approaches such as exercise, psychological support, imagery techniques, behavioral modifications, mediation, diet, acupuncture, manipulation techniques and many other techniques.” Pain affects peoples’ quality of life and is big reason why patients seek out healthcare professionals in the first place. This is a very serious issue and affects many people. My PICO question is: P: My focus for the purposes of this will be to focus on better educating nurses on adequately treating patients pain. Armed with better knowledge, nurses can work with patient to better treat their pain and help them get moving faster post-operatively. I: The interventions would be nurse education that would start with presentations at staff meetings, pain tips in daily huddles and one on one coaching by helping nurses at the bedside. Using charge nurses as at the elbow support will be a very timely intervention that will help nurses use all tools to adequately control patients pain. C: Comparison is a very important component of developing an effective program to teach nurses and by extension patients how to adequately control pain. Using HCAHP scores before during and after the interventions will be a good way to measure how helpful the interventions will be. O: The best outcomes in this scenario is that patients are able to heal faster and get out of the hospital in a timely manner as their pain is adequately controlled. Ultimately if patients perceive that their pain is better controlled and it is then the HCAHP scores should reflect this. Courtney References: Chamberlain College of Nursing, (2015). NR451 RN Capstone Course: Week 2 lesson. Dearholt, S. L., & Dang, D. (2012). Johns Hopkins nursing evidence-based practice: Model and guidelines (2nd ed.). Indianapolis, IN: Sigma Theta Tau International. Houser, J. (2015). Nursing research: Reading, using, and creating evidence (3rd ed.). Sudbury, MA: Jones and Bartlett.