Inquiry into Evidence-Based Practice Paper I

Evidence-based practice (EBP) is inherent in the nursing profession, guiding how nurses can provide care in a meaningful way to their patients. EBP integrates the best available research evidence, clinical expertise, and patient values to help bridge the gap between scientific knowledge and its application in the clinical setting to ensure that the best available knowledge informs healthcare interventions. One of the key elements in EBP is the use of the PICOT format, which helps nurses formulate clinical questions answering specific patient needs and conditions: Inquiry into Evidence-Based Practice Paper I.

This paper reviews the research article “Safety and Feasibility of Regional Citrate Anticoagulation for Continuous Renal Replacement Therapy with Calcium-Containing Solutions: A Randomized Controlled Trial” by Huang et al. (2024). The present study was designed to assess the safety and feasibility of calcium-containing solutions instead of calcium-free solutions in RCA for CRRT. The paper will, based on the PICOT framework, discuss the development of focused clinical questions, review the alignment of the study to PICOT components, and address ethical considerations of EBP and research. Finally, this discussion will outline how research findings must be brought into practice to enhance the quality of patient outcomes.

Compare and Contrast Research and Evidence-Based Practice

Although complementary, research and evidence-based practice are two different concepts in their objectives and processes. Research is a systematic process where new knowledge is developed, or existing theory is verified, as explained by Capili (2020). It answers focused scientific questions via hypothesis testing, experimentation, and tight analysis. The findings from research studies lay the basis for medical advancements and inform the creation of new treatments, protocols, and interventions.

Notably, while EBP applies existing research findings to clinical decision-making, the converse is untrue. According to Cardoso (2021), the best available evidence is integrated with clinical expertise and patient preferences in EBP, therefore ensuring decisions on care are based on data and that each case is directed towards individualized needs. Unlike research studies, which aim at the discovery of new information, EBP emphasizes the translation of knowledge into practice to improve healthcare quality and patients’ results.

Huang et al. (2024) point out the relationship between research and EBP. This study examined the safety and feasibility of calcium-containing solutions in RCA and, as such, presented evidence that can directly inform EBP in managing CRRT. For example, if a calcium-free solution is not available or is impracticable, nurses, informed by such findings, would have no problem adopting effective and safe alternatives without compromising their patients’ safety. This interplay between research and EBP underlines the importance of both evidence generation and application in improving patient care.

Development of Focused Clinical Questions

Focused clinical questions are an important basis for ensuring that evidence-based practices inform the professionals in identifying, finding, and applying evidence relevant to patient needs. The question should be worded with care and made specific, as this would make the search process both effective and concise in presenting findings to solve the clinical problem. The PICOT framework provides a systematic approach to formulating these questions by breaking them into five key elements: population (P), intervention (I), comparison (C), outcome (O), and time (T). Each element adds specificity to the question, facilitating the identification of targeted evidence (McClinton, 2022).

This structured approach ensures that clinical inquiries are comprehensive, researchable, and directly applicable to patient care. Health professionals emphasize specific elements in the clinical scenario, which thus simplifies the process of gathering evidence to make informed decisions that will help improve patient outcomes and solve some of the complex medical issues.

Key Components of the PICOT Model

The PICOT model is a core strategy of EBP in which a systematic approach is taken in structuring clinical inquiries. Individual component accounts for a specific part of the research question in terms of taking charge of the focus and providing action.

• P (Population): This is the group or condition to which the population belongs. This study comprises critically ill patients on CRRT in a cardiac intensive care unit (CICU).
• I (Intervention): Specifies the treatment or strategy under consideration. The study examines the use of calcium-containing solutions for RCA.
• C (Comparison): Identifies the alternative intervention. Calcium-free solutions are used as the comparison in this research.
• O (Outcome): It describes effects either observed in the observed system or as desired in the controlled system. Safety, feasibility and incidence of metabolic complications such as citrate accumulation and metabolic alkalosis are evaluated in the study.
• T (Time): Defines the timeframe for observation or intervention. The study assesses outcomes during the CRRT process, typically lasting 12–24 hours.

The PICOT model, thus, employs breaking down a clinical question into its components, creating and putting into practice the evidence-based interventions for the needs of the patient and the clinical context are more feasible.

Analysis of the Chosen Article Using PICOT

Identification and Discussion of PICOT Components in the Article

Huang et al. (2024) have done a good job of applying the PICOT framework to answer a critical question in CRRT management:

• P (Population): Patients critically ill in a CICU needing CRRT.
• I (Intervention): Use of RCA with calcium-containing solutions.
• C (Comparison): Utilization of RCA using calcium-free solutions.
• O (Outcome): Safety and feasibility of the intervention, metabolic complications, and intervention treatment termination rates leading to.
• T (Time): Period of the CRRT treatment, commonly between 12 and 24 hours.

The study used a randomized controlled trial design and then collected robust data, which they analyzed. The use of calcium-containing solutions for the treatment of CRRT-associated RCA was shown to be a safe and effective alternative to calcium-free solutions with no significant difference between groups in metabolic complication or premature termination rate.

Example of a Focused Clinical Question

Grounded on the study, the ensuing clinical question can be framed using the PICOT framework:

• “In critically ill patients undergoing CRRT (P), how does the use of calcium-containing solutions (I) compare to calcium-free solutions (C) in reducing metabolic complications and ensuring treatment feasibility (O) over a 24-hour treatment period (T)?”

The main question of the study is an important aspect of it providing a good basis for clinical investigations and evidence-based decision-making.

Conclusion

Ethical Considerations in Evidence-Based Practice and Research

Research and EBP are both ethical and central to research and EBP in that patient rights, patient safety, and patient dignity are maintained. The standards, according to Barrow et al. (2022) in the research are informed consent, confidentiality of participants, and protection from harm. According to Huang et al. (2024), their work followed these principles; it was approved by the Ethics Committee of Xiamen Cardiovascular Hospital, and consent was obtained from all participants.

Besides, ethical practice in EBP involves the need to balance evidence-based intervention with the patient’s autonomy and preference. It will be important for clinicians to involve the patient in shared decision-making by explaining options for treatment and incorporating the patient’s values into the care plan. For example, if nurses apply findings from the Huang et al. (2024) study regarding the safety and feasibility of calcium-containing solutions to patients and their families, care decisions are supposed to be made to align with their needs and circumstances.

Importance of Evidence-Based Practice and the PICOT Model

EBP advances the practice of improving patient outcomes and ensuring quality care. PICOT enhances EBP by giving a systematic method of formulating and addressing clinical questions. The study by Huang et al. (2024) illustrates how research that is aligned with PICOT can result in evidence that will inform practice and provide safety and effectiveness for alternatives to RCA in CRRT.

References

Barrow, J. M., Khandhar, P. B., & Brannan, G. D. (2022, September 18). Research Ethics. National Library of Medicine; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK459281/

Capili, B. (2020). How Does Research Start? AJN, American Journal of Nursing, 120(10), 41–44. https://doi.org/10.1097/01.naj.0000718644.96765.b3

Cardoso, D. (2021). The effectiveness of an evidence-based practice (EBP) educational program on undergraduate nursing students’ EBP knowledge and skills: A cluster randomized control trial. International Journal of Environmental Research and Public Health, 18(1), 293. https://doi.org/10.3390/ijerph18010293

Huang, S., Sun, G., Wu, P., Wu, L., Jiang, H., Wang, X., Li, L., Gao, L., & Meng, F. (2024). Safety and Feasibility of Regional Citrate Anticoagulation for Continuous Renal Replacement Therapy With Calcium‐Containing Solutions: A Randomized Controlled Trial. Seminars in Dialysis, 37(3), 249–258. https://doi.org/10.1111/sdi.13200

McClinton, T. D. (2022). A guided search: Formulating a PICOT from assigned areas of inquiry. Worldviews on Evidence-Based Nursing, 19(5), 426–427. https://doi.org/10.1111/wvn.12598

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Format:

• Write a minimum of (3) but not more than (5) pages that fully discuss the concepts listed in the grading rubric. Note: Your title and reference pages will not be considered as part of the 3-5 pages. The body of your paper must be a minimum of three pages.
• Follow the APA (7th ed.) manual to guide formatting.
• Use 1″ margins, double-spaced, and 12-point Times New Roman font.
• List at least (3) references. Note: Do not use your textbook or the APA (7th ed.) manual as a reference. Excluding in-text citations and/or a reference page will result in a failing grade for the paper. (If Schmidt & Brown is used as a reference, your paper will be returned to you and must be re-written.)

Instructions:

• Choose a research article that contains the elements of PICOT.
• Identify and discuss the elements of PICOT based on the article.
• Provide an example of a focused clinical question (based on the chosen article) formulated using the elements of PICOT.
  

  Inquiry into Evidence-Based Practice Paper I

PICOT is a mnemonic for a framework used to structure clinical research questions. It stands for:

• P: Patient or problem
• I: Intervention
• C: Comparison
• O: Outcome
• T: Time (optional)

I want:

• 1 title page (1st page)
• The body includes 4 pages (pages 2-5)
• 1 References page that includes 3 to 5 references (page 6)

Please read the attached grading Rubric

• The total pages for this should be 6 (including the title page and reference page)