PICO question help

[rose2012]

Hi,

I want to know if there is some fast way to come up with a PICO question and find one or more meta-analysis articles on it to discuss in a 5-minute presentation in my skills class.

Every time I try to find articles on an area that truly interests me, I find nothing specific. I have so much left to study and prepare for before the end of the semester, and this short PICO presentation won't even be graded, as will my other assignements.

I'm interested in ways to reduce hospital waste, which seems massive to me. (The number of gowns and gloves and masks I go through for my patients on contact precautions is astounding, and every time I throw this stuff away I think of what this waste is going to do to the environment.) But even doing a search on "hospital waste" and "infection rates," let alone using a formulated PICO question, I get nothing pertinent.

Another interest I have is that I'm saddened about the way people die in ICUs, often in misery because the family is too afraid to make their loved ones DNR and therefore the hospital requires things like NG tube feedings that may be very unpleasant or not allowing even a sip of water to a thirsty patient due to NPO status. But alas, I must admit I don't even have a specific research question in mind that could help.

If there's any advice anyone can give me about doing this without a great expediture of time, I would really appreciate it. I realize that evidenced-based practice is highly important in nursing practice, but right now I think the teacher mainly wants us to get a basic sense of how to do it, and I'm stuck.

Thank you,

Rose

[pmabraham, BSN, RN]

Good day, Rose:

Introduction to Evidence-Based Practice help may help; not sure.

The structure of the PICO might look like this:[TABLE=width: 0]

[TR]

[TD=width: 33%]Patient / Problem

[/TD]

[TD=width: 66%]heart failure, ejection fraction 40%, elderly

[/TD]

[/TR]

[TR]

[TD=width: 33%]Intervention

[/TD]

[TD=width: 66%]irbesartan or avapro

[/TD]

[/TR]

[TR]

[TD=width: 33%]Comparison, if any

[/TD]

[TD=width: 66%]none, placebo, standard care

[/TD]

[/TR]

[TR]

[TD=width: 33%]Outcome

[/TD]

[TD=width: 66%]primary: reduce need for hospitalization;

secondary: reduce mortality

[/TD]

[/TR]

[/TABLE]

So take out the right side answers in the example above, and the problem you want to solve like "hospital waste" along with your anticipated interventions, et al.

On DNR, it is not always fear. It may be based on their belief system; and as family members, their wishes should be respected... not forced (my opinion only).

Thank you.

[Esme12, ASN, BSN, RN]

Question Templates for Asking PICOT Questions:

P: Population/disease ( i.e. age, gender, ethnicity, with a certain disorder)

I: Intervention or Variable of Interest (exposure to a disease, risk behavior, prognostic factor)

C: Comparison: (could be a placebo or "business as usual" as in no disease, absence of risk factor, Prognostic factor B )

O: Outcome: (risk of disease, accuracy of a diagnosis, rate of occurrence of adverse outcome)

T: Time: The time it takes to demonstrate an outcome (e.g. the time it takes for the intervention to achieve an outcome or how long participants are observed).

Note: Not every question will have an intervention (as in a meaning question) or time (when it is implied in another part of the question) component.

For an intervention/therapy:

In _______(P), what is the effect of _______(I) on ______(O) compared with _______© within ________ (T)?

For etiology:

Are ____ (P) who have _______ (I) at ___ (Increased/decreased) risk for/of_______ (O) compared with ______ (P) with/without ______ © over _____ (T)?

Diagnosis or diagnostic test:

Are (is) _________ (I) more accurate in diagnosing ________ (P) compared with ______ © for _______ (O)?

Prevention:

For ________ (P) does the use of ______ (I) reduce the future risk of ________ (O) compared with _________ ©?

Prognosis/Predictions

Does __________ (I) influence ________ (O) in patients who have _______ (P) over ______ (T)?

Meaning

How do ________ (P) diagnosed with _______ (I) perceive ______ (O) during _____ (T)?

PICO

Some good evidence based information/studies from the AHRQ (Agency for Healthcare Research and Quality) EPC Evidence-based Reports | Agency for Healthcare Research & Quality (AHRQ)

I hope this helps:)

[Double-Helix, BSN, RN]

I can see why you're having trouble with the topics that you chose. Hospital waste isn't really a nursing or medical field issue (more of a hospital management issue) so it will be very hard to find research in that area- particularly evidence-based research, double-blind, peer reviewed studies, etc.

It's very difficult to evaluate quality of death, as it's very subjective and many actively dying patients are not able to answer questions. Not to mention, there are many variables that might affect their responses to questions, as well as an issue of time (the surveyor would need to be notified of the impending death, get to that hospital, meet with the patient/family, etc.

Since your assignment isn't grade, don't make this difficult on yourself. Choose something that is heavily researched. What have you heard a lot about lately in regard to medical innovations/controversy? Baby-friendly hospitals, adequate pain management, fall-prevention programs, smoking cessation, pressure ulcer treatment/prevention, breast feeding vs formula feeding, central line associated blood stream infections (CLABSI), catheter associated UTI's (CAUTI). Those are all heavily researched areas that should make it easy for you to find a meta-analysis and create a short presentation.