17 Jun WHAT EVIDENCE MUST BE GATHERED?
Capstone Project Milestone #1:
PICO and Evidence Appraisal Worksheets
PICO WORKSHEET
Your Name:
Date: 07/16/2016
Your Instructor’s Name:
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: 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 2: 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 3: 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 4: 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 5: 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? What databases will you search? How will you narrow your search if needed?
PICO Worksheet
What is the PICO question? Can post management of an MI reduce readmissions for further complications and reoccurrences?
Define each element of the question below:
P- (Patient, population, or problem): Target population is over the age of 25, male or female.
I- (Intervention): Implement diet programs, safe exercise routines and educational material along with prevention resources.
C- (Comparison with other treatment/current practice):
Hospitals to continue current management and continued increase in hospital costs, readmissions and increased surgeries vs. implementing early prevention programs and post management.
O- (Desired outcome): Desired outcome will be to see a decrease in patients being re-hospitalized for myocardial infarctions and a decrease in surgeries.
What is the practice issue/problem?
My topic of interest is pre and post myocardial infarction management. I would like to research about educating patients who are at risk for myocardial infarction about proper exercise and diet, healthy living and preventative measures to take to avoid myocardial infarction. Additionally, I would like to research how patients who have already had a myocardial infarction can reduce the risk of re-occurance, and educate on signs and symptoms of myocardial infarction. The problem I have identified is that many patients with a history of MI are unaware of post management such as adequate diet, safe exercise routines, smoking cessation and medication regimen.
What is the practice area?
__X_ Clinical
_X__ Education
___ Administration
___ Other
How was the practice issue identified? (check all that apply)
_X__ Safety/risk management concerns
___ Unsatisfactory patient outcomes
___ Wide variations in practice
___ Significant financial concerns
___ Difference between hospital and community practice
___ Clinical practice issue is a concern
___ Procedure or process is a time waster
___ Clinical practice issue has no scientific base
___ Other:
What evidence must be gathered? (check all that apply)
_X__ Literature search
_X__ Guidelines
_X _ Expert Opinion
___ Patient Preferences ___ Clinical Expertise
___ Financial Analysis
___ Standards (Regulatory, professional, community)
___ Other
Search terms: Myocardial Infraction, Heart healthy diet, Safe exercise routines for cardiac patients, signs and symptoms of a heart attack, how to take nitroglycerin, monitoring blood pressure, importance of following up with a Cardiologist, MI post management.
Databases to search: National Guideline Clearinghouse, HCAHPS Consumer Assessment of Healthcare Providers and Systems, The National Library of Medicine.
Search Strategies: Accuracy, authority, objectivity, and currency are key criteria to judge websites. Also, using a public resource for evidence-based clinical practice guidelines, and identifying my own assumptions to create skepticism in which is crucial for critiquing and evaluating.
EVIDENCE APPRAISAL WORKSHEET
Your Name: Joyce Ramil
Date: 07/16/2016
Your Instructor’s Name: Professor Linda Fly.
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 fourth 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:
Article #1
APA Reference for Article:
Cite the APA-formatted reference for the article. Malik, R., Begum, S., & Afridi, M. N. (2016). ACUTE MYOCARDIAL INFARCTION; FREQUENCY OF MODIFIABLE RISK FACTORS. Professional Medical Journal, 23(3), 293-297. doi:10.17957/TPMJ/16.3223
Type of Source:
Is it Research (peer-reviewed article) or Non-research systematic review, clinical practice guidelines, organizational experience, or expert opinion/case study/literature review. Research (peer- reviewed article)
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. The strength of the source is good. The sample size of the research was adequate. The results were clearly stated providing details of the results. Limitations were discussed and provided.
Brief Description of Research:
Address the questions in your summary:
*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?
The research conducted consisted of 224 patients. Patients were asked about their demographics and hypertension and diabetes status. Information was also obtained regarding smoking and history ischemic heart disease. The study researched the most common risk factor for AMI and was abkle to determine that the highest risk and most common risk is hypertension and the lowest being dyslipidemia. The information in the article applies to the proposed intervention because it provides information as to which factor are putting patients at a higher risk for MI. By knowing the most common risk factor of an MI we can work on preventing those specific risk factor and narrow down the specific kind of care needed to prevent any hospitalization. 55.4 % of the patients showed a risk factor of hypertension, 43.8% shows a risk factor of smoking, 27.2 % showed a risk factor of Diabetes Mellitus, and 23.2 showed a risk factor od dyslipidemia.
Article #2
APA Reference for Article: Di Cecco, R., Patel, U., & Upshur, R. G. (2002). Is there a clinically significant gender bias in post-myocardial infarction pharmacological management in the older (>60) population of a primary care practice?. BMC Family Practice, 38.
Type of Source:
Is it Research (peer-reviewed article) or Non-research systematic review, clinical practice guidelines, organizational experience, or expert opinion/case study/literature review. Research (peer-reviewed article)
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. The strength of the source is good. The sample size of the research was also a good amount and the results were clearly stated providing details of the results. Limitations were discussed and provided. The article clearly stated the investigation discussed and included supporting details.
Brief Description of Research:
Address the questions in your summary:
*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?
This article applies to my proposed intervention because it talks about post MI pharmacological management. The study was conducted to determine the difference of lipid lowering agents between males and females post myocardial infraction. A comprehensive chart audit was conducted of 142 men and 81 women in an academic primary care practice. Variables were extracted on demographic variables, cardiovascular risk factors, medical and non-medical management of myocardial infraction. The results showed that women were older than men. A statistically significant difference was found between men and women for the prescription of lipid lowering medications. About 23% more men than women had undergone angiography, and about 14% more men than woman had undergone coronary artery bypass graft surgery.
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