1
Q
what are the 2 steps of asking compelling clinical questions
A
- ASK the burning clinical question in PCIOT format
2. SEARCH for relevant best evidence
2
Q
how do we want to ask the clinical question? (2)
A
- in a way that maximizes the info obtained with least amount of time
- want to be able to retrieve the most relevant and best evidence in a economical way
3
Q
how can we capture clinical questions, that require best available evidence, on the spot? (5)
A
- EBP posters to stimulate enquiry in clinical settings
- place post-it notes at bedside or in conference room
- place PICOT boxes in clinical settings
- hope EBP rounds w staff
- focus groups to brainstorm at clinical practice meetings
4
Q
see slides for an example of an EIP project flow sheet
A
- very detailed and long, assuming we don’t have to memorize
5
Q
what is step 1 of “ask the burning clinical question”
A
- triage & prioritize your questions
6
Q
how do we prioritize a clinical question? (3)
A
consider whether the clinical issue is:
- high volume
- high risk
- high cost
7
Q
describe what is meant by a a “high volume”
A
- affects many of the same types of pts being for in an organization
8
Q
describe what is meant by “high risk” clinical issue (2)
A
- identifying that the current practice might actually be putting pts at risk
- or something more can be done to avert or lessen risk of harm to the pt
9
Q
to level rationate to engage in the EBP, what else can we check to prioritize a clinical question?
A
organizational priorities
- mission statement
- annual reports
- focus of quality improvement data
- recently funded projects in the organization
10
Q
in step 1 of “ask”, you need to triage your questions into four groups. what are the 4 groups?
A
- staff development questions (ex. how do i interpret an elevated pCO2 in COPD)
- clinical care questions (ex. do BG values using using point of care testing correlate w central lab values?)
- standard care process & questions (ex. are the urethral catheters left in according to guidelines?)
- questions for admin/clinical leadership (ex. do nurses provide better care if they are allowed a nap on night shift?)
11
Q
once a priority clinical question is identified, you can move on to _____
A
- developing a PICOT qyestions
12
Q
when you are developing a PICOT question, it is important to differentiate between 2 types of clinical questions you might ask. what are they?
A
- background questions
- foreground questions
13
Q
what are background questions? (4)
A
- broad in scope
- posed to ask general questions about a clinical issue
- asks what, where, when, why, and how followed by the “the outcome” of interest
- questions easily answered in textbook
14
Q
the relative proportion of background questions _____ as clinical experience increases
A
- decreases
15
Q
what are 3 examples of background questions
A
- does or how does exercise strengthen the heart?
- when do complications of whopping cough usually occur and in what age groups?
- how well do creatinine or irone supplements work as a substitute for food sources of these nutrients?
16
Q
background questions can lead to…
A
- foreground questions
17
Q
what are foreground questions (2)
A
- questions posed using PICOT
- can be answered from scientific knowledge about diagnosis, intervention/therapy, eitology, and prognosis/prediction, meaning
18
Q
what are 2 examples of PICOT questions
A
- in older adults, does walking versus jogging better strengthen heart function?
- in women aged 20-35 years, does creatinine versus iron work better as a substitute for food sources of these nutrients
19
Q
are these questions background or foreground:
- what causes migraines?
- when do complications of appendicitis usually occur?
- what are the effects of prolonged bed rest on pts with severe scolios after lumbar surgery?
A
all background
20
Q
what does PICOT stand for
A
- Patient, population, or disease of interest
- Intervention/range of interventions
- Comparison intervention
- Outcome of interest
- Time involved to demonstrate an outcome
21
Q
what may be included in the “P” element of PICOT (4)
A
- age
- gender
- ethnicity
- primary diagnosis of disorder
22
Q
what are some examples for the “P” element of a PICOT question (2)
A
- in adult pts with total hip replacements….
- bariatric adolescents considering or undergoing gastric bypass surgery
23
Q
what may included in the “I” element of a PICOT question (4)
A
- therapy
- exposure to disease
- prognostic factor
- risk behavior
24
Q
what are some examples of the “I” aspect of a PICOT question (2)
A
- the nurse’s role as a primary member of the multipldisciplinary team regarding perioperative care of the bariatric adolescent pt
- PCA pain medication
25
what may be included in the "C" element of a PICOT question (4)
- alternative therapy, placebo, or no intervention
- no disease
- prognostic factor
- absence of risk factor
26
what is an examples of the "C" element of a PICOT question
- compared to "prn IM pain medication"
27
what may be included in the "O" element of a PICOT question (4)
- outcome expected from therapy
- risk of disease
- accuracy of diagnosis
- rate of occurrence of adverse outcome
28
what are some examples of the "O" element of a PICOT question
- controlling post-op pain
29
what may be included in the "T" element of a PICOT question (2)
- time it takes for intervention to demonstrate an outcome
| - time over which populations are observed for the outcome to occur given a certain condition
30
what is an example of the "T" element of a PICOT question
- during the perioperative and recovery time
31
```
what element(s) are missing in this question:
Is chlorhexidine more effective in preventing infections than povidone-iodine?
```
- population or patient
32
an example of a prognosis/prediction PICOT question:
- In urban African American with HTN how does tele-monitoring blood pressure improve blood pressure control within the six months of initiation of the medication?
are any elements missing?
- control group is missing
33
what type of foreground questions are there (5)
- intervention
- prognosis/prediction
- diagnosis
- etiology
- meaning
34
an example of an intervention PICOT question:
- in middle aged Caucasian obese females (BMI>30kg/m2) (P), how do lifestyle interventions (healthy diet, exercise, and stress reduction) (I) compared with daily admin of ACE inhibitors (C) affect BP (O) over 6 months (T)
are any elements missing?
- none missing
35
what is an example of an etiology PICOT question:
- are kids who have obese adoptive parents compared with kids without obese adoptive parents at increased risk for obesity during the ages of 5 and 18?
are any elements missing?
- no missing elements
36
an example of a diagnostic/diagnosis PICOT question:
In infants, is a PKU test done at 2 weeks of age, compared to a PKU test done at 24 hours of age, more accurate in diagnosis inborn error in metabolism?
are any elements missing?
- no elements missing (time is implied in 24 hours)
37
what is the template for intervention PICOT questions
what is the effectiveness of [insert intervention] versus [insert comparison] in patients with [insert population/enviro] on [health outcome]
38
evidence based healthcare recognized that, beyond simply considering what intervention is most effective, patient preferences and values are also important to decision making. what is used to ask questions of meaningfulness?
PICo questions
39
what does PICo stand for
- Population
- phenomenom of Interest
- Context
40
describe the "P" element of a PICo question
- similar to PICO(T) format
41
describe the "I" element of a PICo question
- this is the experiences related to someone's health or illness
- refers to how people perceive an aspect of their health or their health care
42
what are examples of phenomenoms of interest (3)
- symptoms
- receiving a diagnosis
- participating in the care of someone
43
describe the "Co" element of a PICo question
- what are the surroundings of the phenomenon or person?
44
what are examples of what may be included in the "Co" element of a PICo question
- environment
- particular cultural factors
- the community
- setting or health problem shaping how the person experiences a phenomnenon
45
what is an example of a PICo question (2)
- what is the experience of elderly patients (P) being unable to move independently (I) in one's home (Co)?
- what is the experience of young parents (P) attending antenatal education (I) at a hospital (Co)?
46
example of a meaning PICOT question:
- how do pregnant women (P) newly diagnosed with diabetes perceive reporting their blood sugar levels (O) to their HCP during their pregnancy and six weeks postpartum (T)?
Are any elements missing?
- C is missing
- however it is not required as there is no comparison to the "I" issue of interest in regard to being newly diagnosed with diabetes
- the emphasis is on pregnant women experience reporting BG lvls to their HCP over time
47
what is a PICOT question NOT? (difference between a PICOT question and research question) (4)
- not a best/better question (what is the best treatment, is X better than Y?)
- not answered by yes/no/number (will population P who get X see an improvement in outcome? in population P, what % will treatment X improve the outcome?)
- not a prediction or thesis statement (i will prove that ____)
- not an open question (what are barrier to the outcome, in population P what is the effect of X compared with Y)
48
for a meaning-based clinical question, what type of primary research will you use? synthesized?
- primary = QL studies
| - synthesized = systematic reviews
49
for what a prognosis based clinical question, what type of primary research will you look for? synthesized?
- primary = cohort or descriptive
| - synthesized = systematic
50
for a causation-based clinical question, what type of primary research will be used (5)? synthesized?
- primary = cohort, case control, descriptive, QL
| - synthesized = systematic review
51
for a diagnosis/assessment based clinical question, what kind or primary research will be used?
- instrument development research
52
for a prevention-based clinical question, what kind of primary research will be used? synthesized? other?
- primary = RCT, controlled trials
- synthesized = systematic
- other = clinical practice guidelines
53
for a therapy-based clinical question, what kind of primary research will be used? synthesized? other?
- primary = RCT, controlled
- synthesized = systematic
- other = clinical practice guidelines
NURS 3550 - Research
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