Capstone Project Milestone #1: PICO and Evidence Appraisal Worksheets
Order Instructions:
See the attached files.
SAMPLE ANSWER
Capstone Project Milestone #1:
PICO and Evidence Appraisal Worksheets
Purpose: To identify a problem or concern that nursing can change and develop a PICO question to guide the change project.
Directions: Use the form below to complete the PICO assignment in Milestone #1. This includes filling in the table with information about your research question and your PICO elements.
Step 1: Identify the problem. What have you noticed in your work or school environment that isn’t achieving the desired patient or learning outcomes? What needs to change in nursing, what can you change with the support of evidence in the literature? Describe the problem or practice issue that you want to research. What is your practice area; clinical, education, or administration? (This is NOT where you will list your PICO question)
Step 2: How was the practice issues identified? How did you come to know this was a problem in your clinical practice? Review the listed concerns and check all that apply.
Step 3: What is the scope of the problem? Does this problem affect an individual, population, or an entire institution?
Step 4: Select the key PICO terms for searching the evidence. Clearly define your PICO question. List each element P (problem, population, or problem), I (intervention), C (Comparison with other treatment/current practice), and O (Desired outcome). Is the potential solution something for which you (as nurse or student) can find a solution through evidence research? Look in your book for guidelines to developing your PICO question.
Step 5: What evidence must be gathered? Everyone should have a literature search. However, what other sources of reliable information will be helpful for your particular question?
Step 6: What terms will you use in order to make sure that your search is wide enough to obtain required information but narrow enough to keep it focused? How will you narrow your search if needed? What databases will you search?
| PICO Worksheet | |||
| What is the practice issue/problem?
The focus is on the effects of nursing care management coupled with telehealth technology on CHF patients. Telehealth is one of the new trends in nursing. It is attractive and very feasible solution which has been associated with high patient outcomes in healthcare facilities which have integrated the policy. It has been associated with reduced workloads leading to effective quality care service delivery. However, the acceptance of the technology has hindered the implementation of the facility in the health care. The concerns include the autonomy and the interference with nurse-patient relationship. This calls for a tailor-made solution to improve the acceptance. This is challenging because the current approaches seems to be generic. In this context, implementation strategy includes promotion of telehealth system to CHF will involve collaborative involvement including training and support could improve the CHF patient care. |
|||
| What is the practice area?
__X_ Clinical ___ Education |
___ Administration ___ Other |
||
| How was the practice issue identified? (check all that apply)
_X__ Safety/risk management concerns _X__ Unsatisfactory patient outcomes ___ Wide variations in practice __X_ Significant financial concerns |
___ Difference between hospital and community practice __X_ Clinical practice issue is a concern ___ Procedure or process is a time waster ___ Clinical practice issue has no scientific base ___ Other: |
||
| What is the scope of the problem?
___ Individual __X_ Population _X__ Institution/system |
|||
| What is the PICO question? What nursing care interventions coupled with telehealth technology are the most effective in improving Congestive Heart Failure Patient’s quality of life.
Define each element of the question below: P– (Patient, population, or problem): The presenting issue is care management by Nurses on CHF Patients. CHF is associated with increased re-hospitalization, ER visits and mortality. Additionally, nurses are overwhelmed by the workload presented by these incidences. The overall cost of care and management is alarmingly high and deserves considerable attention. I– (Intervention): The intervention being considered is the integration Telehealth technology in nursing care on CHF patients. The aim is to improve the patient’s quality of life and simultaneously providing workload relief to the nurses; thereby reducing the CHF cost of care to considerable charges. C– (Comparison with other treatment/current practice): This intervention will be compared with the standard nursing care. Some health care providers have not yet accepted telehealth technology citing autonomy and nurse-patient relations. There is need to compare the Telehealth integrative care for CHF patients with other conventional standard care. O– (Desired outcome): The outcome expected is reduced re-hospitalization, Emergency room visits and other costs of care associated with CHF. The reduction of nurse workloads and improvement on the quality of life for CHF patients are also considered. |
|||
| What evidence must be gathered? (check all that apply) | |||
| __X_ Literature search
___ Guidelines ___ Expert Opinion _X__ Patient Preferences |
___ Clinical Expertise
_X__ Financial Analysis _X__ Standards (Regulatory, professional, community) ___ Other |
||
| List possible search terms, databases to search, and search strategies:
There are various databases provided by CNN library; however, only few databases adequately address CHF care management using telehealth technology. These databases include; CANAL, DYNAMIC, Nursing reference center and Medline. The research question heading “What nursing care interventions coupled with telehealth technology are the most effective in improving Congestive Heart Failure Patient’s quality of life” was used to search for relevant articles “was used to run the search in the databases. If the search results are not satisfactorily, it is important for the researcher to think of brainstorming key word. The key word are then put together and used in the search. Use of key word to search the topic adequately expands the focus of search. Secondly, the researcher may consider using more than one search engine; this will provide further search results. The researcher is also advised to look beyond the first search page results. In this context, the key words used for search includes: CHF, Telemonitoring technology, Role of nurses in CHF management, recent trends in CHF care, Benefits of Telehealth, hazards associated with telehealth in CHF care, improving CHF patient’s quality of life and CHF patient centered care. These key words were used in CIHANL, MEDLINE, PROQUEST and EBSCOHOST search engines which generated to a total of 1520 articles. To refine the number of articles generated from the search of CHF management using Telehealth, advanced search subject headings in the relevant data base such as EBSCOHOST were used. Additionally, Boolean limiters were used to refine the results. The articles regenerated were refined to 100 articles. After skimming through the articles, 46 articles were relevant to the research study. Using limiters such as peer reviewed articles, year of publication; a total of eighteen articles matched the requirements for the research topic. Five of the articles were from nursing magazines excerpts, eight were on Telehealth and CHF management, and six articles were on CHF management but did not include the integration of the modern technology aspect. From the research, out of ten, only four of the articles that matched the research topic will be analyzed. The articles chosen are limited between 2010 and 2015 to ensure that only up to date information has been used. However, earlier articles were briefly read to identify relevant previous health information is not omitted. |
|||
Evidence Appraisal Worksheet
Your Name:
Date:
Your Instructor’s Name:
Purpose: To find evidence to support an intervention that will change the outcomes.
Directions: Type your search question below. Find AT LEAST FOUR sources to support the need for change and the potential intervention you have selected to solve the problem. At least three of your sources must be peer-reviewed articles. The forth source could be another peer-reviewed article or a reliable, credible source. Look in your text for ideas of other sources that can be used. Using the table below, insert and describe your four chosen resources.
Step 1: APA Reference for the article. You will need to list the reference for the source in APA format. Be careful when using built-in APA formats and library citations. They may not be in APA format. Refer to Chapter 7 of your APA manual.
Step 2: Type of Source. If your source is a research article, you will need to ensure that it is a peer review article. You need at least three peer-reviewed articles for your project. If your article is a non–research source, then you will need to list what type of source it is; systematic review, clinical practice guidelines, organizational experience, or individual expert opinion/case study/literature review. You may only use ONE non-research source.
Step 3: Strength of Research. Refer to page 238-240 for research evidence and page 242-244 for non-research evidence. While you do not need to assign a level for each study, you will assign a quality of evidence (high, good, or low/major flaw) and should discuss the study using some of the elements that are discussed in the appraisal forms. For example, Research evidence: was the sample size adequate? Was there a controlled group? Was it a randomized study? Were results clearly stated? Was the conclusion based on the results? Were study limitations discussed? Not all of these elements need to be discussed, but you should discuss this information to determine if the strength of the evidence is HIGH, GOOD, or LOW/MAJOR FLAW.
Step 4: Brief Description of the Research. In this section, you will summarize the source in your own words. How does this information apply to your project? What are the results of the source? What are their recommendations?
| Evidence Appraisal Worksheet | ||||
| PICO Question:
|
||||
| APA Reference for Article
Give the APA-formatted reference for the article. |
Type of Source
*Research: Peer-reviewed article *Non-research systematic review, clinical practice guidelines, organizational experience, or expert opinion/case study/literature review |
Strength of Research
Discuss the strength of the sources. Report if evidence is High, Good, or Low/Major Flaw. Use the tools on page 238-244 of your text and discuss the reasons why you have assigned a particular level of quality. |
Brief Description of Research
Address the questions. *How does the information in the article apply to the project problem or proposed intervention? *Summarize in your own words. * Include results of the study and how these results are applicable to your project. * What is the recommendation of the source for clinical practice? |
|
|
1 |
Lawton, G. (2010). Telehealth Delivers many benefits, but concerns linger. PTin motion journal. |
CIHANL Non-research |
The article is a systematic review research method. It summarizes previous works conducted by the researchers, and thus, it makes it easy to identify knowledge gap.
Study limitations identified were time and financial constraints. For these reasons, report evidence is ratings are Good. |
The article addresses the benefits associated with telehealth technology. It also highlights the barriers which are impeding successful integration of the technology in the health care sector.
There are no results in this paper because it is a peer reviewed. Study recommends integration of telehealth in healthcare system. The research tool applicable in research topic is its literature review. Conclusions are deductive |
|
2 |
Paul, YT. , Gregory, Pecina, J., Stroebel, R., Chaudhry, R., Shah, N.D., & Naessens, JM. (2010). A randomized controlled trial of telemonitoring in older adults with multiple chronic conditions: the Tele-ERA study. BMC Health Services Research 10: 255
|
Proquest Peer reviewed |
The article applied the randomized controlled trial research system. T. This reduces introduction of potential bias in the study.
Additionally, the study population of two hundred patients was adequate to divide the group to intervention and control group. The main limitation is that the study lacked inherent blind group; which could have resulted to Hawthorne error and introduction to error. The study ratings are High.
|
The article analyzes the impact of home based telemonitoring on adults diagnosed with multiple cardiovascular pathologies. The article evaluates the effectiveness of the strategy in reducing disease management costs such as hospitalization, Emergency visits among the elderly >60 years.
Study results indicated a 27.1% reduction in re-hospitalization rate and 38.2% Emergency visit as compared to standard care The study concluded by indicating that use of telemonitoring technology in cardiovascular patients improves the quality of life for the patient. However, the study pinpointed cost effectiveness as the main challenge of adopting the technology. Recommendations on further research for cost justification and analysis was suggested. |
|
3 |
Baker, LC. Macaulay, DS., Sort, A., Diner, M., Johnson, G., Birnbaum, G. (2012). Effects of Care Management and Telehealth: A Longitudinal Analysis Using Medicare Data. Journal of the American Geriatrics Society1:1560–1567
|
Ebscohost Peer reviewed |
The study evaluates the impact of telehealth, and integrative care management in reduction of CHF mortality. The study also evaluates barriers to effective management of telehealth, and its impact on the patient healthcare outcome.
The study population was adequate and consisted of 1,767. Sensitive analysis was conducted using Cox proportional hazard model. The study limitation was financial and time constraints were the major limitation. Additionally, the nurses failed to record all the paper work, making some information such as number of emergency visits poorly recorded. The ratings for this article is High |
The study evaluates the impact of telehealth, and integrative care management in reduction of CHF mortality. The study also evaluates barriers to effective management of telehealth, and its impact on the patient healthcare outcome.
After 2 years, 15% reduction mortality, the number of emergency visits reduced by 18%. The results and conclusion obtained can be generalized. The study concluded that integrative care management on CHF patients, coupled with telehealth technology improves the outcomes of the patient. The research recommends on further research cost effectiveness and reduction of healthcare professional’s workload. |
|
4 |
Brewster, L., Gail M., Wessels, B., Kelly, C., & Hawley, M.(2013) Factors affecting frontline staff acceptance of telehealth technologies: a mixed-method systematic review. Journal of Advanced Nursing
|
Medline Peer reviewed |
The study research method deployed is mixed systematic research method. The data source reviewed was 2000-2012. The decade range was sufficient to capture the effective and relevant information. The review entailed a thematic analysis including a narrative synthesis. The conclusions are based on the analysis and the rating of the article is High |
The article highlights on the factors which impede the integration of telehealth technologies in managing CHF patients. The article provides a clear outline on the role of healthcare staff in the acceptance of new technology trends in nursing.
The paper reviews 14 studies; 2 quantitative studies, 2 mixed methods and 10 qualitative studies. This approach is relevant to minimize bias and to compare study results. Study conclusion suggested that lack of acceptance by healthcare staff as the key barrier to the integration of CHF telehealth technology. Future research should look into work load reduction and cost effectiveness. |
We can write this or a similar paper for you! Simply fill the order form!
