What is a practice problem in nursing

Professional nurses rely on research findings to inform practice decisions; they use critical thinking to apply research directly to specific patient care situations.

Think about an independent nursing practice problem you care passionately about and would be interested in searching for evidence. The below problems should not be used:

*medical/doctor/physician problems such as medications, or medications administration or effects, diagnostics such as EKGs, labs, cardiac catherizations.

*staffing, nurse-to-patient ratios, workforce issues are organizational/system /political/administrative/multi-stakeholder problems which nursing cannot solve independently.

Describe a significant nursing clinical issue, topic of interest, or practice problem that is important to you. Describe why you chose the problem/topic.

Write your clinical question in the PICO(T) format for your nursing practice problem. *To write your clinical question in the PICO(T) format, use the NR439_Guide for writing PICOT Questions and Examples found in your required reading or access the following link: ****see attached***

List each of your PICOT elements.

Share why you care about this nursing practice problem and why you believe the problem would benefit from finding the best evidence.

The following contains PICOT question guides/templates to use to help write questions using all of the PICOT elements. Each template contains a guide that you can use to write a complete PICOT question, examples of PICOT elements, and illustrations. Review some tips and hints below to think about for each of the PICOT elements that can help create a sound clinical nursing PICOT question:

P=Population of patients: Think about a group of patients you are interested in studying—identify the group by age ranges, diagnosis/disease of interest, history or length of time with the diagnosis/disease of interest, location, unit, or setting, gender type (if applicable), race (if applicable), or other identifiable characteristics such as Medicare, Medicaid, immobile, ventilated, inpatient, outpatient, etc.

I=Intervention: Consider the nursing action or intervention you are thinking that would make a difference? From your search for evidence, what is the evidence indicating that nurses can do to help improve the problem or issue you have chosen?

C=Comparison: Think about comparing to the intervention of interest or the alternative such as routine/standard care. If no comparison, state not implementing the intervention or no comparison group.

O=Outcome: Reflect upon what would be the measurable, relatable indicator that would demonstrate the intervention is making a difference or not? What would be the needed outcome that you could observe/check/measure? For example, “the pain is okay” would not be a measurable outcome. Rates pain level less than 3 on pain scale would be measurable.

T=Timeframe: For this element, reflect on how long it would take to implement your study by collecting data or the time needed to observe to see if any changes occurred or will occur. Think about 1 month, 3 months, 6 months etc... Use a timeframe that is realistic.

Template A

Among/In _________________________ (P), does______________________ (I) (**decrease/increase/impact/influence/affect/reduce/improve**) _____________________ (O) compared to ______________________________ (C) over ______________________________(T)?

(**choose one term**)

Example:

Among 65+ and older diabetic immobile adults in long-term care (P), does a bedside oral care kit and checklist protocol (I) compared to routine oral care without a bedside oral care kit (C) affect the number of times oral care is completed (O) over 3 months (T)?

P=Population of patients: 65+ and older diabetic immobile adults in long-term care

I=Intervention: bedside oral care kit and a checklist protocol

C=Comparison: routine oral care without a bedside oral care kit

O=Outcome: number of times (frequency) oral care is completed

T=Timeframe: 3 months

Template B

Among/In _________________________ (P), would______________________(I) (**decrease/increase/impact/influence /affect/reduce/improve **)_____________________ (O) compared to ______________________________ (C) over ______________________________(T)?

(**choose one term**)

Example:

In male ICU patients who are 65+ and older diagnosed with COPD (P), would the confusion assessment screening tool (CAST) (I) impact the number of early identification of delirium (O) compared to no screening tool (C) over 6 months (T)?

P=Population of patients: Inpatient male ICU patients 65+ and older diagnosed with COPD

I=Intervention: confusion assessment screening tool (CAST)

C=Comparison: routine care/no screening tool

O=Outcome: number of early identification of delirium

T=Timeframe: 6 months

Template C

Among/In _________________________ (P), will ______________________ (I) (**decrease/increase/impact/influence/affect/reduce/improve **)_____________________ (O) compared to ______________________________ (C) over ______________________________ (T)?

(**choose one term**)

Example:

Among Hispanic pregnant women between 36-40 weeks (P), will completing a lactation course (I) increase the number of breastfeeding initiations by or within 6 hours of delivery (O) compared to no lactation course (C) over 6 months?

P=Population of patients: Hispanic pregnant women between 36-40 weeks

I=Intervention: lactation course completed

C=Comparison: no lactation course

O=Outcome: number of breastfeeding initiations within 6 hours of delivery

T=Timeframe: 6 months

Template D

Among/In _________________________ (P), what is the effect of ______________________ (I) on ____________________ (O) compared to ___________________________ (C) over ______________ (T)?

Example:

In pediatric non-Hispanic Black males ages 8-18 years old with a 5 year history of type 1 diabetes (P), what is the effect of the Glucose Buddy Diabetes Tracker app (I) on maintaining HbA1C levels <7% (O) compared to the mySugar Diabetes Tracker Log app (C) over 6 months (T)?

P=Population of patients: pediatric non-Hispanic Black males ages 8-18 years old with 5 year history of type 1 diabetes

I=Intervention: Glucose Buddy Diabetes Tracker app

C=Comparison: mySugar Diabetes Tracker Log app

O=Outcome: HbA1C levels <7%