Feb 23, 2024 NRS 433 PICOT Question and Literature Search
NRS 433 PICOT Question and Literature Search
NRS 433 PICOT Question and Literature Search
NRS 433 PICOT Question and Literature Search
Clinical Problem-Shortage of nurses in the ICU
The increase in the number of patients in need of healthcare has caused crisis in healthcare systems in U.S and the world in general, especially the shortage of nurse workers in the ICU. This challenge is witnessed in many forms. For instance, most healthcare organizations requires that nurses to be assigned four patients to care for at once. However, high acuity may become a problem because it adds burden to the available nurses. The circumstance leads to the shortage of staff; therefore, the charge nurse could face a difficult task. If one nurse calls off from the ICU, the charge nurse is compelled to point someone to cover the shift during their day off. Therefore, she may be forced to give the nurse a total of more than four patients due to the absence of one nurse worker. When this happens, the available nurse becomes overburdened. The nurse workload increases due to the excessive patient care
demands placed on the assigned nurse, which compromises patient care. Nonetheless, the situation raises the occurrence of medical errors. The increasing volume of medical needs among the patients poses different challenges to the nurses including developing back injuries. In addition, due to severe workloads, nurses are frequently obliged to hold urination for extended periods of time, which can lead to urinary tract infections. Furthermore, the nurse workers experience significant stress and emotional damage. When faced with challenges caused by a heavy workload, having adequate nursing staff in the intensive care unit and other departments in a facility is the best solution. It significantly improves the well-being of nurses at work by increasing their job satisfaction and it prevents instances of poor health such as sickness and mortality rates.
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PICOT Question
In the ICU departments, does sufficient nurse workers (I) prevent the occurrence of medical errors, infections and stress among patients and nurses themselves (O) within one year (T) compared to inadequate nurse workers (C)?
Population (P) – The target population is the patients in the ICU.
Intervention (I) – Sufficient nurse workers
Comparison (C) – Inadequate nurse workers.
Outcome (O) -Prevents infections, stress, and medical errors among the patients and nurses
Time (T) – The duration is one year.
Literature Evaluation Table
Criteria
Article 1
Article 2
Article 3
APA-Formatted Article Citation with Permalink
Fagerstrom, L., Kinnunen, M., & Saarela, J. (2018). Nursing workload, patient safety incidents, and mortality: An observational study from Finland. BMJ Open, 8(4), e016367 https://www.researchgate.net/publication/324739031_Nursing_workload_patient_safety_incidents_and_mortality_An_observational_study_from_Finland
Nogueira, T. D. A., Menegueti, M. G., Perdoná, G. D. S. C., Auxiliadora-Martins, M., Fugulin, F. M. T., & Laus, A. M. (2017). Effect of nursing care hours on the outcomes of Intensive Care assistance. PloS one, 12(11), e0188241. https://journals.plos.org/plosone/article/file?type=printable&id=10.1371/journal.pone.0188241
Haegdorens, F., Van Bogaert, P., De Meester, K., & Monsieurs, K. G. (2019). The impact of nurse staffing levels and nurse’s education on patient mortality in medical and surgical wards: an observational multicentre study. BMC health services research, 19(1), 1-9. https://pubmed.ncbi.nlm.nih.gov/31752859/
How Does the Article Relate to the PICOT Question?
The article identifies how nurses’ daily workloads relate to patients’ safety. It reveals that the nurses’ workload increases the health risks among patients. However, a reduced workload reduces the health risks.
It examines the ratio of nurse care hours delivered to patient needs.
It investigates the relationship between inpatient mortality and nursing staff ratios in the surgical and medical wards.
Quantitative or Qualitative (How do you know?)
The study is quantitative since the investigators employed an observational study as a research method to collect quantitative data.
This study is quantitative based on the nature of the research’s data.
The research is quantitative because it uses actual data from the selected hospital’s admission
Purpose Statement
The study seeks to determine if every nurse’s workload relates to patient safety issues and death.
To compare nursing care indicators with the typical number of nursing hours spent caring for patients in intensive care units (ICUs).
To ascertain how staffing numbers in surgical and medical wards affect patient mortality.
Research Question
Do patient safety incidents and mortality connect with individual nurses’ daily workload?
What is the relationship between patient care indicators and the amount of time spent on them during nursing care?
Is in-hospital mortality affected by the mean nursing hours per patient?
Outcome
A medical error and mortality likelihood was almost 25% lower if OPC/nurse was below the limit. Compared to the traditional patient-to-nurse measure, a workforce measure based on daily measurements of individual patient care needs and the required NWL (OPC/nurse) was marginally better at forecasting incidents and fatality rates.
Nursing care hours impact the health outcomes among patients.
The investigation determined that a higher nurse staffing level determines the low levels of patient mortality
Setting
The study included 36 units from four hospitals in Finland, one of which was a tertiary acute care hospital while the other three were secondary acute care hospitals.
An ICU in one of the private hospitals in Sao Paulo, Brazil
The study was conducted in seven Belgian Hospitals’ Medical and Surgical wards
Sample
36 units
The selected hospital’s ICU patients between January 1, 2011, and December 31, 2013
The research involved 34,267 patients admitted to both medical and surgical wards
Method
The researchers employed the studying of safety incidents through observation. Also, they are based on collecting information from the reporting system in healthcare institutions.
The researchers based on the daily schedule of the nursing staff and the electronic records system, which provided them with information on the number of nurses working in the surveyed ICU daily and monthly. The investigators then utilized the Generalized Linear Models to analyze it
The research included all admitted patients, excluding children under seven and pregnant women. The researchers employed a randomized controlled trial and conducted an observational study to collect data from the medical and surgical wards.
Key Findings of the Study
The increased workload of hospital nurses increases the danger of patient fatalities and safety problems.
According to the study, giving patients additional hours per day decreased the incidences of pneumonia and phlebitis, which are related to using a ventilator.
Understaffing among nurses results in higher patient mortality. The researchers reached this conclusion since there were negative outcomes concerning the nurses’ proportion of hours per patient and mortality rate.
Recommendations of the Researcher
Investigators, in this case, recommended that future researchers confirm the study’s findings. It showed a link between the daily workload for each nurse and patient safety issues and mortality.
Health care providers should focus on assessing the hazards which result from inadequate nurse staffing in the ICU because patient safety is impacted massively by the number of nursing care hours. They achieve this goal by including indicators to monitor healthcare services. In essence, there is a need to negotiate nurse staffing and promote patient safety using various indicators that monitor healthcare services.
According to the inquiry, creating a method for calculating the ideal nurse staffing level to provide care for each patient during the proper daily hours is crucial.
Criteria
Article 4
Article 5
Article 6
APA-Formatted Article Citation with Permalink
Pazokian, M., & Borhani, F. (2017). Nurses’ perspectives on factors affecting patient safety: A qualitative study. Evidence Based Care, 7(3), 76-81. https://ebcj.mums.ac.ir/article_9382.html
Banda, Z., Simbota, M., & Mula, C. (2022). A qualitative study of nurses’ perceptions of the effects of high nursing workload on patient care in an intensive care unit of a referral hospital in Malawi. BMC nursing, 21(1), 1-7. https://pubmed.ncbi.nlm.nih.gov/35650646/
Bridges, J., Griffiths, P., Oliver, E., & Pickering, R. M. (2019). Hospital nurse staffing and staff–patient interactions: an observational study. BMJ quality & safety, 28(9), 706-713. https://pubmed.ncbi.nlm.nih.gov/30918050/
How Does the Article Relate to the PICOT Question?
The article identifies how different elements, for instance, nurse staffing, affect patient safety.
The study investigates nurses’ perspectives on the issue of heavy workloads in the ICU.
The authors successfully carried out an observational study to comprehend how patients feel about their satisfaction with the care they receive, both when it is high and when it is low.
Quantitative or Qualitative (How do you know?)
It is a qualitative study because it used structured interviews during the data collection process
Since interviews are conducted as part of the data collection procedure, the research is qualitative.
The research is qualitative because analyzing the patients’ provided feedback is involved.
Purpose Statement
The research seeks to determine nurses’ perspectives on the elements that influence patient safety
To investigate and describe how Malawian nurses perceive the effects of a heavy nursing burden in the ICU.
The study aims to look into how patients engage with nursing and staffing in terms of both quality and quantity.
Research Question
What elements, according to nurses, affect patient safety?
What impact do heavy workloads have in ICU nursing?
Is there a link between patient outcomes and high nurse staff?
Outcome
Improving nurses’ skills, ensuring adequate staffing, and improving nursing equipment and facilities are key to better health care services.
Because of their heavy workloads, nurses provided patients with subpar treatment, endangering their safety. High workloads also jeopardized the safety of the nurses.
Negative relationships occasionally prevented satisfaction
Setting(Where did the study take place?)
Five educational healthcare facilities in Tehran
Queen Elizabeth Central Hospital, Blantyre, Malawi.
England, NHS HospitalTrust
Sample
The study involved 32 nurses from different units: critical care, intensive care, emergency, gastroenterology, and nephrology.
12 nurses
The research involved 270 patients and 13800 staff members
Method
The research involved a qualitative study design involving semi-structured interviews of between 30 and 45 minutes. Before the interviews, the researchers obtained consent from the nurses who participated in the research.
The researchers conducted a purposive sampling to choose research volunteers depending on how long they had previously worked at the hospital. After that, they gave their informed consent. To gather the research data, the researchers then conducted ten in-depth interviews. They used Braun & Clarke’s thematic analysis technique to assess the data after the data collection phase.
The investigators observed the patient outcomes based on varied staff ratios for one year. Then they used regression analysis to analyze the gathered data about the quality of care for patients.
Key Findings of the Study
The outcomes for patient safety are enhanced when nurses’ skills are increased, staffing levels are met, and facilities and equipment are upgraded. These actions encourage motivation and job satisfaction.
The excessive nurse workload impacts critically ill patients and ICU nurses. It compromises patient safety and prevents effective care. It also hurts the health of nurses.
From the study, the nurses with at least eight patients displayed poor interaction with them compared to those who handled a lower number.
Recommendations of the Researcher
Adequate staffing should be implemented in nursing to prevent stress among them and promote better patient outcomes
Nurse managers and policymakers should concentrate on increasing the number of ICU nurses and implementing various measures to solve the problem of high workloads and the impacts it causes on patient care.
The authors advise looking into why there is a poor relationship between nurses and patients when there is a low staffing ratio.
References
Banda, Z., Simbota, M., & Mula, C. (2022). Nurses’ perceptions on the effects of high nursing workload on patient care in an intensive care unit of a referral hospital in Malawi: a qualitative study. BMC nursing, 21(1), 1-7. doi: 10.1186/s12912-022-00918-x.
Bridges, J., Griffiths, P., Oliver, E., & Pickering, R. M. (2019). Hospital nurse staffing and staff–patient interactions: an observational study. BMJ quality & safety, 28(9), 706-713. DOI: 10.1136/bmjqs-2018-008948
Fagerstrom, L., Kinnunen, M., & Saarela, J. (2018). Nursing workload, patient safety incidents, and mortality: An observational study from Finland. BMJ Open, 8(4), e016367 DOI: 10.1136/bmjopen-2017-016367
Haegdorens, F., Van Bogaert, P., De Meester, K., & Monsieurs, K. G. (2019). The impact of nurse staffing levels and nurse’s education on patient mortality in medical and surgical wards: an observational multicentre study. BMC health services research, 19(1), 1-9. DOI: 10.1186/s12913-019-4688-7
Nogueira, T. D. A., Menegueti, M. G., Perdoná, G. D. S. C., Auxiliadora-Martins, M., Fugulin, F. M. T., & Laus, A. M. (2017). Effect of nursing care hours on the outcomes of Intensive Care assistance. PloS one, 12(11), e0188241. doi.org/10.1371/journal.pone.0188241
Pazokian, M., & Borhani, F. (2017). Nurses’ perspectives on factors affecting patient safety: A qualitative study. Evidence Based Care, 7(3), 76-81. DOI:10.22038/EBCJ.2017.24174.1520
For this project, you will develop a PICOT question, which is a type of clinical guiding question. The PICOT question must be related to a problem in nursing practice. Identify six peer-reviewed research articles to support your PICOT question, as shown below. The PICOT question you choose, as well as six peer-reviewed research articles, will be used in later tasks.
The first step of the evidence-based practice process is to evaluate a nursing practice environment to identify a nursing problem in the clinical area. When a nursing problem is discovered, the nurse researcher develops a clinical guiding question to address that nursing practice problem.
Use the “Literature Evaluation Table” to complete this assignment.
Select a nursing practice problem of interest to use as the focus of your research. Start with the patient population and identify a clinical problem or issue that arises from the patient population. In 200–250 words, provide a summary of the clinical issue.
Literature Evaluation Table
Student Name:
Nursing Practice Problem (200-250 words):
Patient falls occurring in healthcare facilities, especially in inpatient settings, are a major patient safety concern because of their adverse effects on patient care and quality outcomes. Patient falls lead to increased cost of care, longer stays in hospitals and affect the overall quality outcomes. As a core part of healthcare providers’ team, nurses should develop and use evidence-based practice (EBP) interventions to reduce their occurrence through empowering patients, especially by raising awareness of their susceptibility to falls. The Centers for Disease Control and Prevention (CDC) asserts that falls constitute a serious patient safety risk and lowers the ability of the affected patients, especially older patients in inpatient settings, to attain autonomy and conduct self-care as proposed by Orem’s self-care deficit theory. For instance, statistics by CDC asserts that an estimated 36,000 deaths occur each year associated with falls among elderly patients. Yet another 3 million visit emergency departments due to experiencing falls. Because they are preventable, the Centers for Medicare and Medicaid Services, based on its value-based purchase model, does not consider falls as events that require reimbursement since they are not only preventable but also manageable using evidence-based practice (EBP) strategies like patient-centered education and awareness (Vincenzo et al., 2022). As part of tailoring interventions for patient safety (TIPS) patient education helps providers and patients to reduce the prevalence and susceptibility of falls and falling (Dykes et al., 2023). The purpose of this paper is to evaluate existing literature that supports the proposed EBP project on reducing falls in inpatient settings through patient education and awareness. The paper reviews qualitative and quantitative articles and demonstrates their significance to the PICOT question or framework.
Following the PICOT format, write a PICOT question in your selected nursing practice problem area of interest. The PICOT question should be applicable to your proposed capstone project (the project students must complete during their final course in the RN-BSN program of study).
The PICOT question will provide a framework for your capstone project.
Conduct a literature search to locate six research articles focused on your selected nursing practice problem of interest. This literature search should include three quantitative and three qualitative peer-reviewed research articles to support your nursing practice problem.
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Nursing Research PICOT
Catheter-associated urinary tract infection (CAUTI) is a common problem encountered by nurses in my current healthcare organization, a Post-Acute care and Geriatrics long term care center. CAUTI has been a major concern considering that most patients are catheterized at some point in hospitalization. Besides, geriatric patients with urinary problems and bedridden patients are usually catheterized. As a result, the facility experiences many cases of CAUTIs, which question the quality of nursing care provided to patients. A high CAUTI rate equates to poor quality of nursing care, and nurses have been forced to find solutions to lower the rate and improve patients’ outcomes.
CAUTIs account for approximately 20% of all hospital-acquired infections in the facility. Furthermore, in the past three years, the rate of CAUTIs in the facility has increased from 2.8 to 6.9 infections per 1000 catheter days. CAUTIs are associated with increased hospitalization, reduced quality of life, increased health care costs, and mortality rates (Menegueti et al., 2019). The CAUTI-related mortality rate in the facility was 3.5%., which necessitates urgent interventions to lower the incidence.
Research is a systematic study that involves developing, measuring, and evaluating. It is a scientific inquiry that aims to answer a research question. Research is applied to assess and establish the impact of a specific intervention in attaining the desired outcome (Mulkey, 2021). It employs scientific methodologies to determine the reliability and validity of study results. Nursing research can generate new knowledge on approaches to prevent CAUTIs in hospitalized patients, which can be applied to improve clinical practices and patient outcomes. Besides, it can be used to assess and establish the effect of an intervention aimed at preventing CAUTIs. Nursing research can also measure and compare the impact of two or more interventions in achieving the desired outcome (Mulkey, 2021). The knowledge generated from the study results can then guide nursing practice and improve the current practices to reduce the CAUTI rates.
References
Menegueti, M. G., Ciol, M. A., Bellissimo-Rodrigues, F., Auxiliadora-Martins, M., Gaspar, G. G., Canini, S., Basile-Filho, A., &Laus, A. M. (2019). Long-term prevention of catheter-associated urinary tract infections among critically ill patients through the implementation of an educational program and a daily checklist for maintenance of indwelling urinary catheters: A quasi-experimental study. Medicine, 98(8), e14417. https://doi.org/10.1097/MD.0000000000014417
Mulkey, M. A. (2021). Engaging Bedside Nurse in Research and Quality Improvement. Journal for nurses in professional development, 37(3), 138–142. https://doi.org/10.1097/NND.0000000000000732
Nursing Research PICOT
Catheter-associated urinary tract infection (CAUTI) is a common problem encountered by nurses in my current healthcare organization, a Post-Acute care and Geriatrics long term care center. CAUTI has been a major concern considering that most patients are catheterized at some point in hospitalization. Besides, geriatric patients with urinary problems and bedridden patients are usually catheterized. As a result, the facility experiences many cases of CAUTIs, which question the quality of nursing care provided to patients. A high CAUTI rate equates to poor quality of nursing care, and nurses have been forced to find solutions to lower the rate and improve patients’ outcomes.
CAUTIs account for approximately 20% of all hospital-acquired infections in the facility. Furthermore, in the past three years, the rate of CAUTIs in the facility has increased from 2.8 to 6.9 infections per 1000 catheter days. CAUTIs are associated with increased hospitalization, reduced quality of life, increased health care costs, and mortality rates (Menegueti et al., 2019). The CAUTI-related mortality rate in the facility was 3.5%., which necessitates urgent interventions to lower the incidence.
Research is a systematic study that involves developing, measuring, and evaluating. It is a scientific inquiry that aims to answer a research question. Research is applied to assess and establish the impact of a specific intervention in attaining the desired outcome (Mulkey, 2021). It employs scientific methodologies to determine the reliability and validity of study results. Nursing research can generate new knowledge on approaches to prevent CAUTIs in hospitalized patients, which can be applied to improve clinical practices and patient outcomes. Besides, it can be used to assess and establish the effect of an intervention aimed at preventing CAUTIs. Nursing research can also measure and compare the impact of two or more interventions in achieving the desired outcome (Mulkey, 2021). The knowledge generated from the study results can then guide nursing practice and improve the current practices to reduce the CAUTI rates.
References
Menegueti, M. G., Ciol, M. A., Bellissimo-Rodrigues, F., Auxiliadora-Martins, M., Gaspar, G. G., Canini, S., Basile-Filho, A., &Laus, A. M. (2019). Long-term prevention of catheter-associated urinary tract infections among critically ill patients through the implementation of an educational program and a daily checklist for maintenance of indwelling urinary catheters: A quasi-experimental study. Medicine, 98(8), e14417.
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