Week 3 The Clinical Issue and Research Questions Developed Using PICOT7/3/23, 5:40 PM
Week 3 The Clinical Issue and Research Questions Developed Using PICOT
Start Assignment
Due Jul 2 by 11:59pm
Points 150
File Types doc, docx, and pdf
Submitting a file upload
PICOT is an acronym used to help develop clinical research questions and guide you in your search
for evidence. Finding the right answers requires the right questions. The PICOT format will help you
construct questions that will likely lead to effective searches, the best available evidence of
interventions, and the meaningfulness of patient experiences.
P = Patient population
I = Intervention or issue of interest
C = Comparison of interventions or comparison of interests
O = Outcome
https://canvas.westcoastuniversity.edu/courses/33594/assignments/852723
Page 1 of 5
Week 3 The Clinical Issue and Research Questions Developed Using PICOT
7/3/23, 5:40 PM
T = Time frame (this element is not always included)*
For example, you may wish to research the effects of interrupted sleep on cognition of ICU patients
65 or older.
Using this PICOT model,
In __________(P), how does __________ (I) compared to _________ (C) influence _________
(O) over ________ (T)?
In ICU patients who are 65 or older, how does interrupted sleep (awakened one time or more in four
hours) as compared to uninterrupted sleep influence the patient’s cognitive ability over 5 days?
Questions of meaningfulness and effectiveness relate to how people experience an intervention or
phenomenon.
What is the effectiveness of using a turn schedule (I) versus an audible public address reminder (C)
on the incidence of pressure ulcers (O) in elderly patients in LTAC who require turning (P)?
*Not all studies will have a time frame. This is optional to include as part of your PICOT.
Assignment Directions
Begin by selecting a topic in nursing
(https://canvas.westcoastuniversity.edu/courses/33594/pages/picot-topic-list)
(https://canvas.westcoastuniversity.edu/courses/33594/files/13092989?wrap=1) that is of interest to you.
Next, use PICOT to format a possible research question about that topic. Provide 1 possible PICOT
research question. Find 1 quantitative or qualitative peer-reviewed research article related to your
nursing topic that was published within the last 5 years. Reminder: All peer-reviewed research articles
have methods, discussion, and results sections. Upload the article with your paper in PDF or Word
format. This source can be used again in the Week 4 article assignment if it meets the criteria.
See PICOT Formatting Guide (https://canvas.westcoastuniversity.edu/courses/33594/files/13093180?
wrap=1)
(https://canvas.westcoastuniversity.edu/courses/33594/files/13093180/download?
download_frd=1) or pages 249-257 in your book for additional help with formatting your PICOT.
Include the following:
Title page
Provide a brief description of the topic and background information (see page 37 of your
https://canvas.westcoastuniversity.edu/courses/33594/assignments/852723
Page 2 of 5
Week 3 The Clinical Issue and Research Questions Developed Using PICOT
7/3/23, 5:40 PM
textbook). You can use your text, your peer-reviewed journal source, or the EBP care sheets
(https://canvas.westcoastuniversity.edu/courses/33594/pages/evidence-based-practice-care-sheets) in
CINAHL or Nursing Reference Center Database.
Explain the significance of the topic to nursing practice (see chart on page 37 of your textbook).
Background information can be found in journal articles in the introduction section. Results and
conclusions will speak to significance of the topic. The EBP care sheets may have sources for you
to choose from.
Provide 1 clearly-stated PICOT question.
Include 1 peer-reviewed journal source related to your topic.
The chosen topic and PICOT will be used for your Week 9 poster assignment. It will also guide
your article searches in Week 4 on which you will complete appraisals in Week 6.
Your paper should:
Be 2–3 pages (not including the title page and reference page)
Use current APA format to style your paper and to cite your source.
There will be a 5 point deduction if peer-reviewed research journal article is not used and a 5 point
deduction if the article is not included with your submission.
Review the rubric for further information on how your assignment will be graded.
Clinical Issue and Research Questions Developed Using PICOT Rubric
Criteria
Topic
Topic/
Relevance
to Nursing
Ratings
50 to >43.0 pts
Meets or
Exceeds
43 to >35.0 pts
Mostly Meets
Expectations
Expectations
A description of the
A description of the
topic is presented but
A clear and
succinct
description of the
topic is
presented.
topic is presented but
may be ambiguous or
confusing. Some
background
information is
is ambiguous or
confusing. Some
background
information is
provided, but more is
An unclear
description of
the topic is
presented or
is missing. No
Background
information is
relevant and
specific to the
provided, but more is
needed for a full
explanation. The
significance of the
needed for a full
explanation. The
significance of the
topic to nursing
background
information is
provided. The
significance
https://canvas.westcoastuniversity.edu/courses/33594/assignments/852723
35 to >27.0 pts
Below Expectations
Pts
27 to >0 pts
Does Not
Meet
Expectations
50 pts
Page 3 of 5
Week 3 The Clinical Issue and Research Questions Developed Using PICOT
7/3/23, 5:40 PM
topic. The
significance of the
topic to nursing
practice is somewhat
practice is somewhat
explained but is not
of the topic to
nursing
topic to nursing
explained and may not
supported with
practice is not
practice is
explained clearly
be supported with
examples.
examples.
explained.
and is supported
with examples.
PICOT
Research
85 to >73.1 pts
Meets or Exceeds
73.1 to >59.5 pts
Mostly Meets
59.5 to >45.9 pts
Below
45.9 to >0 pts
Does Not
Questions
Expectations
Expectations
Expectations
Meet
This
All research
Only some research
Few questions are
Expectations
criterion is
linked to a
questions are
accurately framed
questions are framed
as PICOT questions,
framed as PICOT
questions, or are
Research
questions are
Learning
Outcome
as complete PICOT
questions. PICOT
or some PICOT
questions are
incomplete.
PICOT questions
missing or are
not framed as
PICOT
questions provide a
incomplete. PICOT
provide a vague or
PICOT
Research
Questions
clear and specific
focus for research
questions provide a
vague or unclear focus
unclear focus for
research that is
questions.
Peer-reviewed
within the topic. One
peer-reviewed
for research that may
not be within the topic.
not within the
topic. One journal
journal source
is not
journal source
One peer-reviewed
source is included
included.
related to the topic
is included with
journal source is
included but not
but it is not peerreviewed.
assignment
related to the topic.
85 pts
submission.
APA and
15 to >12.9 pts
12.9 to >10.5 pts
10.5 to >8.1 pts
8.1 to >0 pts
Mechanics
Meets or
Exceeds
Mostly Meets
Expectations
Below
Expectations
Does Not Meet
Expectations
Expectations
Follows length
Follows few
Follows few
Follows all the
requirements
requirement and most
of the requirements
requirements
related to format,
requirements
related to format,
related to
related to format,
source citations,
source citations,
format, length,
source
source citations, and
layout. Writing is
and layout.
Writing may be
and layout.
Writing may be
citations, and
layout. Written
generally clear and
organized but is not
unclear or
informal in
unclear or
informal in
https://canvas.westcoastuniversity.edu/courses/33594/assignments/852723
Page 4 of 5
Week 3 The Clinical Issue and Research Questions Developed Using PICOT
7/3/23, 5:40 PM
in a clear,
concise or formal in
language. Multiple
language. Multiple
concise, formal,
and organized
language. Multiple
errors exist in spelling
errors exist in
spelling and
errors exist in
spelling and
manner.
and grammar with
grammar,
grammar,
Responses are
mostly error
minor interference with
readability or
interfering with
readability or
interfering with
readability or
free.
Information
comprehension. Most
information from
comprehension.
Some information
comprehension.
Some information
from sources is
sources is paraphrased
from sources is
from sources is
paraphrased
appropriately
and cited correctly.
paraphrased and
cited correctly.
paraphrased and
cited correctly.
15 pts
and accurately
cited.
Total Points: 150
https://canvas.westcoastuniversity.edu/courses/33594/assignments/852723
Page 5 of 5
EVIDENCEBASED CARE
SHEET
Pressure Injuries: Prevention Strategies
What We Know
› Pressure injuries (PIs ; Figure 1 )—referred to as “pressure ulcers” until the change in
terminology by the National Pressure Ulcer Advisory Panel (NPUAP; 2016) and also
referred to as decubitus ulcers, pressure sores, or bedsores—are localized, oftentimes
painful, areas of damaged skin and/or underlying soft tissue resulting from prolonged or
intense pressure or a combination of pressure and shear. The skin at the site of a PI can be
intact or the injury can appear as an open ulcer. PIs usually occur over bony prominences
or in areas where medical or other devices or surfaces exert prolonged pressure against
the skin. Factors that can potentiate the injurious effects of pressure and shear include
prolonged skin moisture, poor nutrition, and poor perfusion.(11) (For details, see Quick
Lesson About … Pressure Injuries: an Overview )
ICD-9
707.0
ICD-10
L89
Authors
Tanja Schub, BS
Cinahl Information Systems, Glendale, CA
Eliza Schub, RN, BSN
Cinahl Information Systems, Glendale, CA
Reviewers
Eva Beliveau, RN, MSN, CNE
Professor of Nursing, Northern Essex
Community College
Gina DeVesty, BSN, MLS
Cinahl Information Systems, Glendale, CA
Nursing Executive Practice Council
Glendale Adventist Medical Center,
Glendale, CA
Editor
Diane Hanson, MM, BSN, RN, FNAP
Figure 1: Graphic illustrating four of the eight pressure injury classifications
established by the National Pressure Ulcer Advisory Panel (NPUAP).
Additional categories include Unstageable, Deep Tissue, Medical
Device Related, and Mucosal Membrane Pressure Injury. Copyright©
Nanoxyde, 2008. Licensed under Creative Commons Attribution-Share
Alike 3.0 Unported, 2.5 Generic, 2.0 Generic and 1.0 Generic License
• Of note, the majority of current literature does not yet reflect the NPUAP’s recent
change in terminology; it is expected that the termpressure injury will gradually replace
pressure ulcer anduse of Arabic numerals to identify PIs stagesinstead of Roman
numeral,as acknowledgement of the change becomes widespread(1)
–The European Pressure Ulcer Advisory Panel (EPUAP) continues to support the
guidelines issued in 2014 and has not yet adopted the new terminology and pressure
ulcer classification system propounded by NPUAP in April 2016(8)
• PI risk factors include older age, impaired mobility, physical inactivity, being subject
to friction and shear, moisture, low body mass index (BMI) and/or poor nutritional
status (especially low protein intake), dehydration, incontinence, sensory loss, cognitive
impairment, certain medical conditions (e.g., diabetes mellitus, [DM] peripheral vascular
August 13, 2021
Published by Cinahl Information Systems, a division of EBSCO Information Services. Copyright©2021, Cinahl Information Systems. All rights
reserved. No part of this may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, or by
any information storage and retrieval system, without permission in writing from the publisher. Cinahl Information Systems accepts no liability for advice
or information given herein or errors/omissions in the text. It is merely intended as a general informational overview of the subject for the healthcare
professional. Cinahl Information Systems, 1509 Wilson Terrace, Glendale, CA 91206
disease [PVD], stroke, and spinal cord injury [SCI]), drugs that affect wound healing
(e.g., corticosteroids), hip fracture, smoking, and need for assisted ventilation(4,5,6,10,14)
• PIs are associated with a decrease in quality of life and a 1-yearmortality rate that approaches40%(14)
• Up to 95% of PIs are thought to be preventable(15)
–As of 2008, the Centers for Medicare & Medicaid Services (CMS) in the United States no longer reimburses facilities for
treatment of facility-acquired Stage 3 and 4 PIs(2)
› Standard prevention strategies include risk assessment using standardized PI risk assessment tools (e.g., Braden scale), skin
care, frequently redistributing pressure (particularly over bony prominences) by frequent repositioning, maintaining good
hygiene, minimizing moisture (especially that caused by incontinence), management of incontinence by scheduled toileting
plans, use of mattresses and/or cushions to reduce/relieve pressure, preventing skin damage through use of topical agents
(e.g., creams, ointments) or dressings, avoiding over-sedation, and optimizing nutrition(4,5,6,9,10,14,15)
• PI risk assessment scales have low to modest predictive ability and Cochrane reviewers found no reliable evidence
demonstrating that the use of structured risk assessment tools reduces the incidence of PIs(13)
• Although the value of regular patient repositioning in reducing the risk of developing PIs has been confirmed, and clinical
practice guidelines commonly recommend patient repositioning every 2 hours, the optimal frequency for repositioning has
not been established in clinical trials(6)
• Cochrane reviewers analyzed 59 randomized trials and found evidence that(9)
–constant low-pressure support surfaces reduce the incidence of PIs compared to standard foam mattresses
–sheepskin mattress overlays reduce the incidence of PIs
–pressure-relieving overlays on the operating table reduce the incidence of PIs
–alternating pressure mattresses reduce the incidence of PIs compared to standard foam mattresses
–alternating pressure mattresses and constant low-pressuresupport surfaces have similar efficacy for reduction of PIs
–alternating pressure mattresses and alternating pressure overlays have similar efficacy for reduction of PIs
–addition of a Jay Gel cushion to foam wheelchair cushions reduces PI risk
• Cochrane reviewers of256 recent studies for the prevention and treatment of PI report the focus on repositioning, nutrition,
and support surfaces continue to be major recommendations(13)
• Although malnutrition is associated with increased PI risk, there is insufficient evidence to support the routine use of
vitamin C and zinc supplementation to reduce PI risk(6)
• Authors of a recent systematic review found no evidence supporting the use of any behavioral or educational interventions
for PI prevention in adults with SCI(3)
–Researchers in South Korea randomized 47 patients with SCI to a self-efficacy enhancement program or a control group.
Patients in the intervention group had greater improvements in self-care knowledge, self-efficacy, and self-carebehaviors
for PI prevention. However, there was no significant difference in incidence of PIs between the groups(7)
› The prevalence of PIs in U.S. facilities has declined over the last decade(12)
• Researchers who conducted the International Pressure Ulcer Prevalence Survey, a 10-year study of 918,621 inpatients
in the U.S., observed that the overall prevalence of PIs declined from 13.5% in 2006 to 9.3% in 2015. The prevalence of
facility-acquired PIs declined from 6.2% in 2006 to 3.1–3.4% in 2013–2015(12)
What We Can Do
› Learn more about PI prevention so you can accurately assess your patients’ personal characteristics and health education
needs; share this knowledge with your colleagues(5)
› Collaborate with an interdisciplinary healthcare team at your facility to develop a PI prevention plan to reduce the risk for PI
development
› Assess PI risk and skin condition(6,14)
• On admission, assess for skin compromise, especially at bony prominences; signs of recent trauma; effects of friction or
shear; immobility and/or functional incapacity; factors that influence healing (e.g., nutritional status); and incontinence.
Ask about medical history (including previous treatments or surgeries); and measure body weight(6)
• Reassess risk daily in acute care settings, at each home care visit, and weekly in long-term care settings
–Use a valid risk assessment scale (e.g., Braden Scale for Predicting PI Risk; the most widely used risk assessment tool
according to facility protocol(6,14)
– Risk assessment tools permit routine organized assessment of the skin and factors related to skin integrity
› Optimize nutrition and hydration(6)
• Request referral to a registered dietitian for patient evaluation and recommendation of specific amounts of proteins,
calories, fluids, electrolytes, and micronutrients
–Provide liquid nutritional supplements, enteral nutrition, or total parenteral nutrition, as prescribed
• Perform ongoing nutritional assessment
–Use of a standardized nutrition assessment tool, such as the Mini Nutritional Assessment (MNA), can assist in
determining the extent of malnutrition
• Assess body composition (height and weight), and for alteration in laboratory values (e.g., serum albumin, prealbumin, and
Hgb), which can indicate malnutrition
› Manage moisture and maintain skin integrity—cleanse and dry skin after each incontinent event; use noncytotoxic cleansers
to avoid drying or irritating skin; do not rub the skin(14)
• For incontinent patients, use special supplies (e.g., topical skin barriers, a pouching system, or indwelling catheters) and
frequently inspect skin
• For patients with dry skin, use moisturizer frequently because dry skin is more susceptible to breakdown
› Minimize pressure, friction, and shear(6,14)
• Use heel protective devices (Figure 2) for patients at high-risk for PIs
• Provide a pressure-redistributing support surface instead of a standard mattress, per clinician orders or facility protocol
(Figure 3)
Figure 2: The convoluted foam of the heel protector increases cushioning, promotes air circulation, and
dissipates heat for protection against skin breakdown. Copyright ©2015, EBSCO Information Services
Figure 3: Example of continuous pressure air-suspension mattress overlay that is utilized to
reduce the risk for pressure injury development. Copyright© 2014, EBSCO Information Services
• Use lift sheets, overhead trapeze bars, and hoists; do not drag or pull the patient
• Reposition the patient frequently
–Turn the patient every 1–2 hours using a hoist, trapeze, or lift sheet
–Use pressure-redistributing devices (e.g., pillows, wedges) to reduce pressure on bony prominences; frequently evaluate
their effectiveness
– Avoid use of donut-type ring cushions as support devices because they can increase the size of the PI by causing further
ischemia rather than reducing risk for PI development
–Do not massage bony prominences (6)
› Educate patient and family about PI etiology, risk factors, and prevention strategies (e.g., good nutrition, regular inspection
of skin, frequent repositioning), and when to seek medical attention
Coding Matrix
References are rated using the following codes, listed in order of strength:
M Published meta-analysis
RV Published review of the literature
SR Published systematic or integrative literature review
RU Published research utilization report
X Practice exemplars, stories, opinions
RCT Published research (randomized controlled trial)
QI Published quality improvement report
GI General or background information/texts/reports
L Legislation
R Published research (not randomized controlled trial)
PP Policies, procedures, protocols
C Case histories, case studies
PGR Published government report
U Unpublished research, reviews, poster presentations or
other such materials
G Published guidelines
PFR Published funded report
CP Conference proceedings, abstracts, presentation
References
1. Black, J.M., Goldberg, M., McNichol, L., & Moore, L. (2016). Revised national pressure ulcer advisory panel pressure injury staging system: Revised pressure injury staging
system. Journal of wound, ostomy, and continence nursing, 43(6), 585-597. doi:10.1097/WON.0000000000000281 (G)
2. Centers for Medicare & Medicaid Services. (2020, February 11). Hospital-acquired conditions. Retrieved June 15, 2020, from
https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalAcqCond/Hospital-Acquired_Conditions.html (GI)
3. Cogan, A. M., Blanchard, J., Garber, S. L., Vigen, C., Carlson, M., & Clark, F. A. (2017). Systematic review of behavioral and educational interventions to prevent pressure
ulcers in adults with spinal cord injury. Clinical Rehabilitation, 31(7), 871-880. doi:10.1177/0269215516660855 (SR)
4. Doh, G., & Heo, C.Y. (2021). Pathogenesis and prevention of pressure ulcer. Journal of the Korean Medical Association, 64(1), 16-25. doi:10.5124/jkma.2021.64.1.16 (RV)
5. Dunk, A. M., & Carville, K. (2016). The international clinical practice guidelines for prevention and treatment of pressure ulcers/injuries. Journal of Advanced Nursing, 72(2),
243-244. doi:10.1111/jan.12614 (G)
6. European Pressure Ulcer Advisory Panel, National Pressure Ulcer Advisory Panel, & Pan Pacific Pressure Injury
Alliance. (2016). Prevention and treatment of pressure ulcers: Quick reference guide. Retrieved June 15, 2021, from
http://www.npuap.org/wp-content/uploads/2014/08/Updated-10-16-14-Quick-Reference-Guide-DIGITAL-NPUAP-EPUAP-PPPIA-16Oct2014.pdf (G)
7. Kim, J. Y., & Cho, E. (2017). Evaluation of a self-efficacy enhancement program to prevent pressure ulcers in patients with a spinal cord injury. Japan Journal of Nursing
Science, 14(1), 76-86. doi:10.1111/jjns.12136 (RCT)
8. Markova, A. (2019). Pressure ulcer terminology. European Pressure Ulcer Advisory Panel. Retrieved June 15, 2021, from
http://www.epuap.org/news/pressure-ulcer-terminology/ (GI)
9. McInnes, E., Jammali-Blasi, A., Bell-Syer, S. E., Dumville, J. C., Middleton, V., & Cullum, N. (2015). Support surfaces for pressure ulcer prevention. Cochrane Database of
Systematic Reviews, Issue 9. Art. No.: CD001735. doi:10.1002/14651858.CD001735.pub5 (M)
10. National Institute for Health and Care Excellence (NICE). (2015). Pressure ulcers. Retrieved June 25, 2021, from
https://www.nice.org.uk/guidance/qs89/resources/pressure-ulcers-pdf-2098916972485 (G)
11. National Pressure Ulcer Advisory Panel. (2016, April 13). National Pressure Ulcer Advisory Panel (NPUAP) announces a change
in terminology from pressure ulcer to pressure injury and updates the stages of pressure injury. Retrieved June 15, 2021, from
http://www.npuap.org/national-pressure-ulcer-advisory-panel-npuap-announces-a-change-in-terminology-from-pressure-ulcer-to-pressure-injury-and-updates-the-stages-of-pressure-inju
(G)
12. VanGilder, C., Lachenbruch, C., Algrim-Boyle, C., & Meyer, S. (2017). The International Pressure Ulcer Prevalence™ Survey: 2006-2015: A 10-year pressure injury prevalence
and demographic trend analysis by care setting. Journal of Wound, Ostomy, and Continence Nursing, 44(1), 20-28. doi:10.1097/WON.0000000000000292 (R)
13. Walker, R.M., Gillespie, B.M., Mcinnes, E., Moore, Z., Eskes, A.M., Patton, D., & Chaboyer, W. (2020). Prevention and treatment of pressure injuries: A meta-sythesis of
Cochrane Reviews. Journal of Tissue Viability, 29(4), 227-243. doi:10.1016/j.jtv.2020.05.004 (M)
14. Welesko, M.-B., & Javier, N. M. (2018). Pressure injury. In F. F. Ferri (Ed.), 2018 Ferri’s clinical advisor: 5 books in 1 (pp. 1056-1058). Philadelphia, PA: Elsevier. (GI)
15. Zack, A. M. (2018). Pressure ulcer. In F. J. Domino (Ed.), The 5-minute clinical consult 2018 (26th ed., pp. 808-809). Philadelphia, PA: Wolters Kluwer. (GI)
Order an Essay Now & Get These Features For Free:
Turnitin Report
Formatting
Title Page
Citation
Outline
