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Nursing PICOT Essay

Nursing PICOT Essay

For this Nursing PICOT Essay assignment, you will create a PICO(T) question based on the scenario presented in the discussion board. Your paper should be in APA 7th edition format, including title page and reference page. Address the following:

  • PARAGRAPH 1: Begin your paper with an introduction to your PICOT topic. This can be any clinical (medical) issue you choose -EXCEPT COVID-19.
    • Indicate what you will address in the rest of your paper (introductory statement)
    • Describe your topic
    • Describe its significance (this may include statistics on the problem, complications, etc.)
    • Essentially, explain WHY your problem needs to be addressed
  • PARAGRAPH 2, FIRST SENTENCE -Determine an appropriate PICO(T) question for addressing. Write your PICO(T) in correct question format. INTERVENTION PICO(T) only. Do not use other types of PICO(T)s.
  • PARAGRAPH 2, In your text,
    • describe your population/patient (consider age, disease/condition, gender or biological sex, etc.)
    • describe the main intervention (the drug or other treatment you propose) AND the comparison (the main alternative to your drug/treatment intervention -the alternative could be NO treatment)
    • describe what your outcome (reduced complication – be specific; improved memory; reduced anxiety, etc.) – Whatever the outcome may be, but it must be specific and measurable. You cannot measure “improvement” or “reduced complications”. Be SPECIFIC.
  • PARAGRAPH 3: Identify and explain 2 facilitators and 2 barriers to implementing the practice you propose in your PICO(T) (What helps/what hinders?)
  • PARAGRAPH 4: Conclusion: Summarize your paper

Objectives

Develop a clinical question using proper PICO(T) format

Explain the components of a PICO(T) question

Identify facilitators and barriers to implementing a specific EBP practice

References

Minimum of three (3) total references: one (1) reference from required course materials and two (2) peer-reviewed references. All references must be no older than five years (unless making a specific point using a seminal piece of information).

References should support the reasoning behind the PICOT, the problem or the intervention.

Peer-reviewed references include references from professional data bases such as PubMed or CINHAL applicable to population and practice area, along with evidence based clinical practice guidelines.

**Examples of unacceptable references are Wikipedia, UpToDate, Epocrates, Medscape, WebMD, hospital organizations, insurance recommendations, & secondary clinical databases.

PICOT Research Proposal Sample Paper

Population Description

The intensive care unit (ICU) is a specialized clinical area concerned with offering care to critically ill patients while monitoring the progress of the patient. Patients admitted in ICU have a critical illness that is possibly reversible. Life-threatening conditions that require ICU support include sepsis, stroke, traumatic brain injury, heart failure, and ruptured brain aneurysm (Anesi et al., 2017), among others. Services including blood pressure monitoring, medication administration, ventilation, and close monitoring are offered to patients by trained critical nurses. The main purpose of admission of the patient to ICU is the stabilization of the patient.

The presence of an unfavorable ICU environment, reduced immunity of ICU patients, and the lifesaving procedures including central line insertion and ventilation support predispose patients in ICU to life-threatening infections. The common infections include ventilator-associated pneumonia (VAP), central line-associated bloodstream infection (CLABSI), surgical site infection, and catheter-associated urinary tract infections (CAUTI). The presence of such infections increases hospital stay, cost of care, morbidity, and risk of death. Additionally, research shows that elderly persons are more likely to be admitted to ICU. The presence of comorbidities in this population and advanced age increases the risk of infection hence resulting in poor prognosis.

Description of Intervention

The chlorohexidine solution is an antimicrobial with bactericidal properties. It is the most effective gram-positive bacteria intervention. It is widely used against microbial as a mouth wash and also reduces skin colonization by antimicrobials. It has a fast onset of action and a prolonged duration hence widely used to reduce colonization. Reduced skin colonization around the catheter leads to the reduced introduction of microbial into the bloodstream hence prevention of CLABSI (Arunga et al., 2021). ICU patients without CLABSI are likely to recover quickly hence reducing the cost of care with improved patient outcomes. As such, it is imperative that nurses offer equitable care to all patients in the ICU using chlorohexidine to prevent the condition.

Comparison of Intervention to Previous Research

Bathing of areas around the central line with chlorohexidine to prevent CLABSI has been widely leveraged and is acceptable by most healthcare providers. Several kinds of research support the use of chlorohexidine in ICU patients including that of Frost et al. (2018). I have used chlorohexidine in the management of my patients in the ICU and the results are immense. Daily bathing and appropriate procedure are useful in reducing the risk of infection.

 In a study by Frost et al. (2018) that sought to study the effectiveness of chlorhexidine in elderly ICU patients, a systemic literature search was done that aimed at identifying the effectiveness of chlorhexidine in reducing CLABSI, CAUTI, multi-drug resistant organism (MDRO), and VAP. The study found out that the use of chlorohexidine lead to a reduction of CLABSI by 29%, reduction of MDRO by 18% while no change in the rate of VAP (Frost et al., 2018). However, the study also found out that daily bathing using chlorohexidine was not achieved.

In another randomized control trial study by Zamir et al. (2020), on the effectiveness of chlorohexidine lock devices in ICU patients, a total of 100 patients were used. 50 were exposed to normal care of the central line while the other 50 used the device. The study revealed a reduced rate of CLABSI from 6.6 to 4.8 in patients who used the chlorohexidine lock device. The study further revealed that immobilizing the catheter helps in reducing the rate of CLABSI.

More evidence from a study by Urbancic et al. (2018) confirmed a reduced rate of CLABSI attributable to chlorhexidine use. The observational study was done in 12 months and pre and post-intervention results were compared. The infection rate reduced from 1.69 per 1000 catheter days to 1.33. The evidence from all these researches conquers my PICOT question.

Expected Outcome

The expected outcome from this study should not differ from the previous studies regarding CLABSI prevention. I expect to find a reduced rate of CLABSI in patients using chlorhexidine to bath central lines. Reduced CLABSI will lead to a reduced hospital stay, cost of care, and risk of death. Hence patients will be discharged from ICU early enough to enable them to recover. Compared to the use of normal saline in flushing central lines, chlorohexidine offers an additional advantage.

Implementation of Intervention and Evaluating Outcome

Chlorohexidine will be used in bathing patients with the central line. Daily bathing will be done using the right procedure. Continuous assessment of the site and the patient will be done daily and routinely. Monitoring of patients for any signs of infection such as fever, malaise, swelling, and pus accumulation will be done. Blood cultures will be carried out routinely to identify causative organisms in case of infection. Period of hospital stay, general condition of the patient, and incidences of new infections will be used in evaluating the effectiveness of the intervention.

Application of Nursing Science, Social Determinants of Health, Genome, and Genetics in ICU Patients

Nursing science is used by critical care nurses to offer quality care to ICU patients. Nursing expertise and advanced knowledge are required by any nurse who offers care to patients. Additionally, nurses assess the risks and benefits of a particular intervention of patients. Ideally, patients in ICU require support from their relatives as well. Support can be emotionally or financially to enable them to receive care. All social determinants of health are applicable in ICU patients to help in recovery and to reduce readmissions to ICU (Maslove et al., 2017).

Genetics is related to heredity while genomes deal with the interaction of genes within an individual. Genome knowledge is required in the monitoring of patients. Monitoring includes infection identification, evaluating prognosis, and tracking response to intervention. Additionally, practitioners often use novel physiology markers in monitoring, identifying endotypes of infection, and response tracking. Finally, understanding the genetic history of a patient in the ICU is important in tracing the origin of certain conditions and therefore will guide the course of treatment to be offered.

References

Anesi, G. L., Wagner, J., & Halpern, S. D. (2017). Intensive Care Medicine in 2050: toward an intensive care unit without waste. Intensive Care Medicine, 43(4), 554–556. https://doi.org/10.1007/s00134-016-4641-8

Arunga, S., Mbarak, T., Ebong, A., Mwesigye, J., Kuguminkiriza, D., Mohamed-Ahmed, A. H. A., Hoffman, J. J., Leck, A., Hu, V., & Burton, M. (2021). Chlorhexidine gluconate 0.2% as a treatment for recalcitrant fungal keratitis in Uganda: a pilot study. BMJ Open Ophthalmology, 6(1), e000698. https://doi.org/10.1136/bmjophth-2020-000698

Frost, S. A., Hou, Y. C., Lombardo, L., Metcalfe, L., Lynch, J. M., Hunt, L., Alexandrou, E., Brennan, K., Sanchez, D., Aneman, A., & Christensen, M. (2018). Evidence for the effectiveness of chlorhexidine bathing and healthcare-associated infections among adult intensive care patients: a trial sequential meta-analysis. BMC Infectious Diseases, 18(1), 679. https://doi.org/10.1186/s12879-018-3521-y

Maslove, D. M., Lamontagne, F., Marshall, J. C., & Heyland, D. K. (2017). A path to precision in the ICU. Critical Care (London, England), 21(1). https://doi.org/10.1186/s13054-017-1653-x

Urbancic, K. F., Mårtensson, J., Glassford, N., Eyeington, C., Robbins, R., Ward, P. B., Williams, D., Johnson, P. D., & Bellomo, R. (2018). Impact of unit-wide chlorhexidine bathing in intensive care on bloodstream infection and drug-resistant organism acquisition. Critical Care and Resuscitation: Journal of the Australasian Academy of Critical Care Medicine, 20(2), 109–116. https://pubmed.ncbi.nlm.nih.gov/29852849/

Zamir, N., Pook, M., McDonald, E., & Fox-Robichaud, A. E. (2020). Chlorhexidine locking device for central line infection prevention in ICU patients: protocol for an open-label pilot and feasibility randomized controlled trial. Pilot and Feasibility Studies, 6(1), 26. https://doi.org/10.1186/s40814-020-0564-9

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