PICO(T) Questions and an Evidence-Based Approach

PICO(T) Questions and an Evidence-Based Approach

The utility of PICO(T) questions is important in nursing practice. It enables the identification of the patient, the intervention, a comparison group, the desired outcome, and the timeframe. This framework helps to facilitate research because it identifies key aspects to be considered during research. This paper evaluates a clinical issue of interest and applies the PICO(T) framework to formulate a research question.

Practice Issue to be Explored Via a PICO(T) Approach

The healthcare issue of interest is the nursing shortage in the medical-surgical ward. The nursing shortage is a problem facing many healthcare facilities globally (Saikia, 2018). It has impeded workflow and lowered patient quality-of-service delivery (Tamata et al., 2021). Consequently, this will likely increase morbidity rates and prolong patients’ recovery times (Saikia, 2018). The PICO(T) research question to be explored is: Among the patients receiving postoperative care in the medical-surgical ward, do optimized nurse-to-patient ratios, compared to high nurse-to-patient ratios, improve recovery rates over seven months?

The patients in the medical-surgical ward population are patients receiving postoperative care. The intervention is optimized for nurse-to-patient ratios, implying that more nurses are available and each nurse serves a significantly low number of patients (Drennan & Ross, 2019). A high nurse-to-patient ratio signifies a nursing shortage, and nurses serve a relatively higher number of patients (Drennan & Ross, 2019). The outcome is improved recovery rates for postoperative patients. The timeframe is seven months.

Sources of Evidence

Various sources of evidence can be useful in answering the PICO(T) question. Medical research databases can be stellar sources of information for this PICO(T) question. These research databases include PubMed, Google Scholar, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (Pei & Wu, 2019). These databases contain numerous peer-reviewed health-related journals that provide adequate information on nursing shortages (Pei & Wu, 2019). The peer-reviewed journals are published by qualified healthcare professionals whose credentials can be easily accessed (Pei & Wu, 2019).

Furthermore, the journals in these databases can be evaluated for credibility using the CRAAP model. By so doing, the research selects desirable journals based on their timeliness, relevance, accuracy, authority, and purpose (Esparrago-Kalidas, 2021). The CRAAP criteria ensure that the journals and publications are credible and adequately address the PICO(T) question (Esparrago-Kalidas, 2021). The databases contain customized navigation features that allow the researcher to access the most recent information about the PICO(T) question. Furthermore, information from these databases can be compared to develop the best evidence-based practice.

Findings from Articles

According to Saikia (2018), the nursing shortage is a global problem. It increases the workload to be completed by nursing staff. Nurses are forced to work long-hour shifts and reduce their day-offs (Tamata et al., 2021). Consequently, this results in elevated stress and burnout among nurses. Besides, their morale is lowered, affecting the quality of service delivery (Tamata et al., 2021). Reduced quality of service delivery is likely to prolong patients’ recovery rates. This can be attributed to increased incidences of medication errors, such as wrong medications, underdosing, and overdoses (Tamata et al., 2021). Medication errors increase morbidity rates and minimize recovery rates (Gouda et al., 2019). Recurrent medication errors can increase mortality rates for patients requiring critical care, such as postoperative patients (Gouda et al., 2019). Examples of postoperative services include adequate pain control, assessing surgical sites, appropriate administration of medications, and assessing the stability of patients (Gouda et al., 2019).

Findings reveal that various countries have set the optimized nurse-to-patient ratios for different departments. In the United States of America, the acceptable nurse-to-patient ratio in the medical-surgical ward is about 1:5 (Saikia, 2018). The optimized nurse-to-patient ratios are 1:4 and 1:2 for the emergency department and the critical care unit, respectively (Saikia, 2018). In this context, the PICO(T) question focuses on postoperative patients in the medical-surgical ward. Therefore, the optimized ratio used as the intervention is a nurse-to-patient ratio of 1:5. The comparison entails any ratios above the optimized ratio. Optimized nurse-to-patient ratios will improve workflow and promote job satisfaction (Gouda et al., 2019). Accordingly, this will increase the quality of healthcare services and promote patient-centered care for postoperative patients (Gouda et al., 2019). Patient-centered care promotes patient recovery, reduces hospital stays, and improves the patient’s quality of life (Gouda et al., 2019).

Relevance of Findings from Articles

The findings identified the impacts of the nursing shortage on the quality of healthcare services. The nursing shortage manifested by the high nurse-to-patient ratios lowers the quality of nursing services by increasing the risk of medication errors and lowering staff morale, diminishing productivity (Tamata et al., 2021). Medication errors are likely to increase the morbidity and mortality rates of patients. This implies that unoptimized nursing-to-patient ratios will prolong hospitalizations due to delayed recovery rates (Saikia, 2018; Tamata et al., 2021). Findings also reveal that the optimized ratio of nurses to patients in the medical-surgical unit should be 1:5 (Saikia, 2018). This optimized ratio ensures adequate delivery of postoperative services, including adequate pain control, assessing surgical sites, appropriate administration of medications, and assessing the stability of patients. Notably, this is associated with improved patient recovery rates and reduced hospitalization time.

These findings are relevant to the PICO(T) question because they help identify the intervention’s impact on the outcome: optimized nurse-to-patient ratios and patient recovery rates. Furthermore, the findings help identify the impact of the comparison action on the outcome: high nurse-to-patient ratios and patient recovery rates. In addition, the findings help to identify optimized nurse-to-patient ratios that should be applied in the medical-surgical ward: 1:5. Therefore, the findings will guide the decision-making process regarding the PICO(T) question. The articles’ results also reveal that optimized nurse-to-patient ratios will increase recovery rates among postoperative care patients. Saikia (2018) reported the most relevant findings identifying the acceptable ideal nurse-to-patient ratios in the medical-surgical unit. This will be used as the intervention in the PICO(T) question.

Conclusion

The nursing shortage is a problem facing many healthcare facilities globally. It has impeded workflow and lowered the quality of service delivery to patients. Optimized nurse-to-patient ratios will enhance workflow, increase the quality-of-service delivery, and improve patient outcomes. The PICO(T) question was developed to determine if optimized nursing staff ratios improve patient recovery rates. The most relevant findings are those by Saikia (2018), which identified the optimized staff ratio in the medical-surgical ward to be 1:5.

References

Drennan, V. M., & Ross, F. (2019). Global nurse shortages – The Facts, the Impact and Action for Change. British Medical Bulletin, 130(1), 25–37. https://doi.org/10.1093/bmb/ldz014

Esparrago-Kalidas, A. J. (2021). The Effectiveness of CRAAP Test in Evaluating Credibility of Sources. International Journal of TESOL & Education, 1(2), 1–14.

Gouda, A. H., Mohammed, E., & Ameen, D. A. (2019). Factors Affecting Postoperative Nursing Performance in The Surgical Units. Egyptian Journal of Health Care, 2019EJHC Vol.10 No.1.

Pei, L., & Wu, H. (2019). Does Online Learning Work Better than Offline Learning in Undergraduate Medical Education? A Systematic Review and Meta-Analysis. Medical Education Online, 24(1). https://doi.org/10.1080/10872981.2019.1666538

Saikia, D. (2018). Nursing Shortages in the Rural Public Health Sector of India. Journal of Population and Social Studies, 26(2), 101–118. https://doi.org/10.25133/JPSSv26n2.008

Tamata, A. T., Mohammadnezhad, M., & Tamani, L. (2021). Registered nurses’ perceptions on the factors affecting nursing shortage in the Republic of Vanuatu Hospitals: A qualitative study. PLoS ONE, 16(5 May), 1–17. https://doi.org/10.1371/journal.pone.0251890

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Create a 3-5 page submission in which you develop a PICO(T) question for a specific care issue and evaluate the evidence you locate, which could help to answer the question.

Introduction

PICO(T) is an acronym that helps researchers and practitioners define aspects of a potential study or investigation.

It stands for:

P – Patient/population/problem.
I – Intervention.
C – Comparison (of potential interventions, typically).
O – Outcome(s).
T – Time frame (if time frame is relevant).
The end goal of applying PICO(T) is to develop a question that can help guide the search for evidence (Boswell & Cannon, 2015). From this perspective, a PICO(T) question can be a valuable starting point for nurses who are starting to apply an evidence-based model or EBPs. By taking the time to precisely define the areas in which the nurse will be looking for evidence, searches become more efficient and effective. Essentially, by precisely defining the types of evidence within specific areas, the nurse will be more likely to discover relevant and useful evidence during their search. When applying the PICO(T) approach, the nurse can isolate the interventions of interest and compare to other existing interventions for the evidenced impact on the outcome of the concern.

You are encouraged to complete the Vila Health PICO(T) Process activity before you develop the plan proposal. This activity offers an opportunity to practice working through creating a PICO(T) question within the context of an issue at a Vila Health facility. These skills will be necessary to complete Assessment 3 successfully. This is for your own practice and self-assessment and demonstrates your engagement in the course.

Reference
Boswell, C., & Cannon, S. (2015). Introduction to nursing research. Jones & Bartlett Learning.

Professional Context

As a baccalaureate-prepared nurse, you will be responsible for locating and identifying credible and scholarly resources to incorporate the best available evidence for the purposes of enhancing clinical reasoning and judgement skills. When reliable and relevant evidence-based findings are utilized, patients, health care systems, and nursing practice outcomes are positively impacted.

PICO(T) is a framework that can help you structure your definition of the issue, potential approach that you are going to use, and your predictions related to the issue. Word choice is important in the PICO(T) process because different word choices for similar concepts will lead you toward different existing evidence and research studies that would help inform the development of your initial question. When writing a PICO(T)-formatted research question, you want to focus on the impact of the intervention and the comparison on the outcome you desire.

Scenario

For this assessment, please use a health care issue of interest from your current or past nursing practice.

If you do not have an issue of interest from your personal nursing practice, then review the optional Case Studies presented in the resources and select one of those as the basis for your assessment.

Instructions

For this assessment, select a health care issue of interest and apply the PICO(T) process to develop the research question and research it.

Your initial goal is to define the population, intervention, comparison, and outcome. In some cases, a time frame is relevant and you should include that as well, when writing a question you can research related to your issue of interest. After you define your question, research it, and organize your initial findings, select the two sources of evidence that seem the most relevant to your question and analyze them in more depth. Specifically, interpret each source’s specific findings and best practices related to your issues, as well explain how the evidence would help you plan and make decisions related to your question.

If you need some structure to organize your initial thoughts and research, the PICOT Question and Research Template document (accessible from the “Create PICO(T) Questions” page in the Capella library’s Evidence Based Practice guide) might be helpful.

In your submission, make sure you address the following grading criteria:

Define a practice issue to be explored via a PICO(T) approach. Create a PICO(T)-formatted research question
Identify sources of evidence that could be potentially effective in answering a PICO(T) question (databases, journals, websites, etc.).
Explain the findings from articles or other sources of evidence as it relates to the identified health care issue.
Explain the relevance of the findings from chosen sources of evidence to making decision related to a PICO(T) question.
Communicate using writing that is clear, logical, and professional with correct grammar and spelling using the current APA style.
Example Assessment: You may use the following to give you an idea of what a Proficient or higher rating on the scoring guide would look like:

Assessment 3 Example [PDF].
Additional Requirements
Your assessment should meet the following requirements:

Length of submission: Create a 3-5-page submission focused on defining a research question and interpreting evidence relevant to answering it.
Number of references: Cite a minimum of four sources of scholarly or professional evidence that support your findings and considerations. Resources should be no more than 5 years old.
APA formatting: Format references and citations according to the current APA style.
Portfolio Prompt: Remember to save the final assessment to your ePortfolio so that you may refer to it as you complete the final capstone course.

Competencies Measured

By successfully completing this assessment, you will demonstrate your proficiency in the course competencies through the following assessment scoring guide criteria:

Competency 1: Interpret findings from scholarly quantitative, qualitative, and outcomes research articles and studies.
Explain the findings from articles or other sources of evidence that are relevant to the health care issue.
Competency 2: Analyze the relevance and potential effectiveness of evidence when making a decision.
Identify sources of evidence that could be potentially effective in answering a PICO(T) question.
Explain the relevance of the findings from chosen sources of evidence to making decision related to a PICO(T) question.
Competency 3: Apply an evidence-based practice model to address a practice issue.
Define a practice issue to be explored via a PICO(T) approach and develop a PICO(T)-formatted research question.
Competency 5: Apply professional, scholarly communication strategies to lead practice changes based on evidence.
Organize content so ideas flow logically with smooth transitions; contains few errors in grammar/punctuation, word choice, and spelling.
Apply APA formatting to in-text citations and references exhibiting nearly flawless adherence to APA format.