PICOT

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NR 439 PICOT Question Guide

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 olderdiagnosed with COPD (P), wouldthe 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%

T=Timeframe: 6 months

 
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Reserved For Prof. Speedstar

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You are a family nurse practitioner (FNP) employed as a contract (1099 independent contractor) in a busy primary care practice for 2 years. The providers in the group include one physician, who is also the owner of the practice, and two other nurse practitioners, who are staff employees (W2 employees). The owner of the practice recently made comments about the need to produce more revenue. You relate with his concerns and feel that you have several strategies that could be helpful. Your contract is up for renewal in 3 months. You are highly satisfied with your job and want to stay with the group. You see 20 patients per day on average and take call every third weekend.

Discussion Question:

What negotiation strategies should you use to propose a contract renewal? How does your role as a 1099 contractor benefit the practice over the W2 employees? What evidence will you present to the practice to reinforce your value in the practice both in terms of revenue and patient satisfaction? Consider any additional services you may be willing to provide under your contract. Use logical reasoning, and provide evidence-based rationales for your decisions.

Keep in mind that your negotiation terms and conditions must be within the legal scope of practice for an ANP.

 
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description of what you believe to be the consequences of a healthcare organization not involving nurses in each stage of the SDLC when purchasing and implementing a new health information technology system

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a nurse has an important role in the Systems Development Life Cycle (SDLC). With a focus on patient care and outcomes, nurses may not always see themselves as contributors to the development of new systems. However, as you may have observed in your own experience, exclusion of nurse contributions when implementing systems can have dire consequences.

Description of what you believe to be the consequences of a healthcare organization not involving nurses in each stage of the SDLC when purchasing and implementing a new health information technology system. Provide specific examples of potential issues at each stage of the SDLC and explain how the inclusion of nurses may help address these issues. Then, explain whether you had any input in the selection and planning of new health information technology systems in your nursing practice or healthcare organization and explain potential impacts of being included or not in the decision-making process. Be specific and provide examples.

https://healthit.ahrq.gov/health-it-tools-and-resources/evaluation-resources/workflow-assessment-health-it-toolkit

Software Development Life Cycle [SDLC] https://www.youtube.com/watch?v=xtpyjPrpyX8

 
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Every Nurse Is A Leader

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#1 Identify the educational preparation and role(s) of the clinical nurse leader (CNL) designation. Give an example of how the CNL influences direct patient care whether in a hospital or out in the community.

#2 Identify advocacy strategies that you can use to create change in your current workplace (med-surge setting).

Please include in-text citations, and cite all factual information. References must be within the last 5 – 7 years.

 
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What is the cardinal sign of Lyme disease?

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Report Issue

Lyme Disease Case Study

A 38-year-old male had a 3-week history of fatigue and lethargy with intermittent complaintsof headache, fever, chills, myalgia, and arthralgia. According to the history, the patient’ssymptoms began shortly after a camping vacation. He recalled a bug bite and rash on his thigh immediately after the trip. The following studies were ordered:

Studies

Results

Lyme disease test,

Elevated IgM antibody titers against Borrelia burgdorferi(normal: low)

page1image15987072

Erythrocyte sedimentation rate (ESR),

30 mm/hour (normal: ≤15 mm/hour)

Aspartate aminotransferase (AST),

32 units/L (normal: 8-20 units/L)

Hemoglobin (Hgb),

12 g/dL (normal: 14-18 g/dL)

Hematocrit (Hct),

36% (normal: 42%-52%)

Rheumatoid factor (RF),

Negative (normal: negative)

Antinuclear antibodies (ANA),

Negative (normal: negative)

Diagnostic Analysis

Based on the patient’s history of camping in the woods and an insect bite and rash on the thigh, Lyme disease was suspected. Early in the course of this disease, testing for specific immunoglobulin (Ig) M antibodies against B. burgdorferi is the most helpful in diagnosing Lyme disease. An elevated ESR, increased AST levels, and mild anemia are frequently seen early in this disease. RF and ANA abnormalities are usually absent.

Critical Thinking Questions

  1. What is the cardinal sign of Lyme disease? (always on the boards)
  2. At what stages of Lyme disease are the IgG and IgM antibodies elevated?
  3. Why was the ESR elevated?
  4. What is the Therapeutic goal for Lyme Disease and what is the recommended treatment.
 
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A 52-year-old man complained of pain and cramping in his right calf caused by walking two blocks. The pain was relieved with cessation of activity. The pain had been increasing in frequency and intensity. Physical examination findings were essentially normal except for decreased hair on the right leg. The patient’s popliteal, dorsalis pedis, and posterior tibial pulses were markedly decreased compared with those of his left leg.

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Peripheral Vascular Disease

Case Studies

A 52-year-old man complained of pain and cramping in his right calf caused by walking two

blocks. The pain was relieved with cessation of activity. The pain had been increasing in

frequency and intensity. Physical examination findings were essentially normal except for

decreased hair on the right leg. The patient’s popliteal, dorsalis pedis, and posterior tibial

pulses were markedly decreased compared with those of his left leg.

Studies Results

Routine laboratory work Within normal limits (WNL)

Doppler ultrasound systolic pressures Femoral: 130 mm Hg; popliteal: 90 mm Hg;

posterior tibial: 88 mm Hg; dorsalis pedis: 88

mm Hg (normal: same as brachial systolic

blood pressure)

Arterial plethysmography Decreased amplitude of distal femoral, popliteal,

dorsalis pedis, and posterior tibial pulse waves

Femoral arteriography of right leg Obstruction of the femoral artery at the midthigh

level

Arterial duplex scan Apparent arterial obstruction in the superficial

femoral artery

Diagnostic Analysis

With the clinical picture of classic intermittent claudication, the noninvasive Doppler and

plethysmographic arterial vascular study merely documented the presence and location of the

arterial occlusion in the proximal femoral artery. Most vascular surgeons prefer arteriography

to document the location of the vascular occlusion. The patient underwent a bypass from the

proximal femoral artery to the popliteal artery. After surgery he was asymptomatic.

Critical Thinking Questions

1. What was the cause of this patient’s pain and cramping? 2. Why was there decreased hair on the patient’s right leg? 3. What would be the strategic physical assessments after surgery to determine the

adequacy of the patient’s circulation?

4. What would be the treatment of intermittent Claudication for non-occlusion?

 
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What is the cardinal sign of Lyme disease?

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Lyme Disease

Case Study

A 38-year-old male had a 3-week history of fatigue and lethargy with intermittent complaints

of headache, fever, chills, myalgia, and arthralgia. According to the history, the patient’s

symptoms began shortly after a camping vacation. He recalled a bug bite and rash on his

thigh immediately after the trip. The following studies were ordered:

Studies Results

Lyme disease test, Elevated IgM antibody titers against Borrelia burgdorferi

(normal: low)

Erythrocyte sedimentation rate

(ESR),

30 mm/hour (normal: ≤15 mm/hour)

Aspartate aminotransferase

(AST),

32 units/L (normal: 8-20 units/L)

Hemoglobin (Hgb), 12 g/dL (normal: 14-18 g/dL)

Hematocrit (Hct), 36% (normal: 42%-52%)

Rheumatoid factor (RF), Negative (normal: negative)

Antinuclear antibodies (ANA), Negative (normal: negative)

Diagnostic Analysis

Based on the patient’s history of camping in the woods and an insect bite and rash on the

thigh, Lyme disease was suspected. Early in the course of this disease, testing for specific

immunoglobulin (Ig) M antibodies against B. burgdorferi is the most helpful in diagnosing

Lyme disease. An elevated ESR, increased AST levels, and mild anemia are frequently seen

early in this disease. RF and ANA abnormalities are usually absent.

Critical Thinking Questions

1. What is the cardinal sign of Lyme disease? (always on the boards) 2. At what stages of Lyme disease are the IgG and IgM antibodies elevated? 3. Why was the ESR elevated? 4. What is the Therapeutic goal for Lyme Disease and what is the recommended treatment.

 
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Psychiatric Assessment Of The Adult And Older Adult

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Week 1: Psychiatric Assessment of the Adult and Older Adult

Many assessment principles are the same for children and adults; however, with adults/older adults, consent for participation in the assessment comes from the actual client and not parents or guardians. The exception to this is adults/older adults who have been determined incapacitated by a court of competent jurisdiction. Some adults may be easier to assess than children/adolescents as they are more psychologically minded. That is, they have better insights into themselves and their motivations than children/adolescents (although this is not universally true).

Older adults present some of their own unique assessment challenges in that they may have higher levels of stigma associated with seeking psychiatric care. Additionally, there are higher rates of neurocognitive disorders superimposed on other clinical conditions such as depression or anxiety, which creates additional diagnostic challenges.

This week, you will develop your own personal format for initial interviews of mental health clients. You also will explore the restrictions and limitations for practice as a PMHNP in your home state and create a plan for passing the national certification exam.

Photo Credit: KatarzynaBialasiewicz / iStock / Getty Images Plus

Discussion: Interview Format

Despite what you may believe (or may have been told), there is no such thing as one “right” way to do an interview. In fact, there are numerous books written about the various ways of conducting the clinical interview. In actual clinical practice, you will find the format that “works” best for you and addresses your unique strengths and the needs of the client.

In this Discussion, you will practice finding the interview format that works for you and share those ideas with your colleagues for feedback.

Learning Objectives

Students will:

· Develop formats for initial interviews of mental health clients

To prepare for this Discussion:

· Review the Learning Resources.

· Develop an interview format you would use for an initial interview of a client.

Post:

Attach the interview format document you would use for an initial interview of a client.

Describe what interview format your preceptor uses for the initial interview of a client.

Describe which element of your interview format is most helpful in your practice.

References

American Nurses Association. (2014). Psychiatric-mental health nursing: Scope and standards of practice (2nd ed.). Washington, DC: Author.

· Standard 5C “Consultation” (page 57)

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer.

· Section 5.1, “Psychiatric Interview, Mental Status Examination” (pp. 192–211)

· Section 5.2, “The Psychiatric Report and Medical Record” (pp. 211–217)

· Section 5.3, “Psychiatric Rating Scales” (pp. 217–236)

· Section 5.5, “Personality Assessment: Adults and Children” (pp. 246–257)

· Section 5.7, “Medical Assessment and Laboratory Testing in Psychiatry” (pp. 266–275)

· Chapter 6, “Classification in Psychiatry” (pp. 290–308)

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

· “Cautionary Statement for Forensic Use of DSM-5”

· “Assessment Measures”

· “Cultural Formulation”

· “Glossary of Technical Terms”

· “Glossary of Cultural Concepts of Distress”

Barton Associates. (2017). Nurse practitioner scope of practice laws. Retrieved from https://www.bartonassociates.com/locum-tenens-resources/nurse-practitioner-scope-of-practice-laws/

American Psychiatric Association. (2016). Practice guidelines for the psychiatric evaluation of adults. Retrieved from http://psychiatryonline.org/doi/pdf/10.1176/appi.books.9780890426760

Laureate Education (Producer). (2017b). Working with Adults and Older Adults” [Video file]. Baltimore, MD: Author.

Note: The approximate length of this media piece 3 minutes.

Hagen, B. (Producer). (n.d.-a). Conducting a mental status exam [Video file]. Mill Valley, CA: Psychotherapy.net.

Note: The approximate length of this media piece is 25 minutes.

American Psychological Association. (2008). Assessment of older adults with diminished capacity. Retrieved from https://www.apa.org/pi/aging/programs/assessment/capacity-psychologist-handbook.pdf

Rosen, S. L., & Reuben, D. B. (2011). Geriatric assessment tools. Mount Sinai Journal of Medicine, 78(4), 489–497. doi:10.1002/msj.20277

Substance Abuse and Mental Health Services Administration (SAMHSA). (2015). TIP 59: Improving cultural competence. Retrieved from http://store.samhsa.gov/product/TIP-59-Improving-Cultural-Competence/SMA15-4849

 
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The Holistic Patient Assessment

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Assignment Description

Signature Assignment Title: The Holistic Patient Assessment

Part 1: Choose an adult (over the age of 18) friend or relative and perform a holistic health assessment. Clearly document your holistic health assessment data

Your assessment should include the following parts:

  • Health History
  • Physiological Assessment
  • Psychological Assessment
  • Social Assessment
  • Cultural Assessment
  • Developmental Assessment
  • Spiritual Assessment

Part 2: Interpret the findings in your holistic health assessment data according to pathophysiologic disease states.  

  • Choose one physiologic abnormality and discuss possible pathophysiologic reasons for the abnormality.  
  • Look at the abnormality on a holistic basis.  
  • How does this abnormality impact the other areas of the patient’s life, especially those areas discussed in this course?
  • Discuss the client’s stress and coping mechanisms.  
  • Are they healthy?  
  • What improvements could be made?

Part 3: Create a teaching plan that addresses the client holistically by applying the assessment data you have analyzed.  

  • Describe at least one client goal for each of the categories (physical, psychological, social, cultural, developmental, and spiritual).
  • How will you teach the client about the goal?  
  • How will you evaluate your teaching?  

Part 4: Prepare a PowerPoint presentation for your patient teaching.  

  • You should have at least six slides (one for each type of goal – physical, psychological, social, cultural, developmental, and spiritual), in addition to the title slide, objective slide, and references slide.  
  • Please be sure to have at least one scholarly source in the PPT.

Assignment Expectations:

  • Length: Essay of 1500 words; PP of 12 content slides (and include a title, objective, and reference slides – these do not count towards the required content slides)
  • Structure: PP as noted above. Essay: Include a title page and reference page in APA format. These do not count towards the minimum word count for the essay part of the assignment. Your essay must include an introduction and a conclusion. 
  • References: Use appropriate APA style in-text citations and references for all resources utilized to answer the questions. A minimum of three scholarly sources plus the textbook are required.


Total Point Value of Assignment: 500 points

 
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mental Health Depression

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                                         Agenda Comparison Grids,  APA citation, 3 references (200-250 words)

Topic Mental Health Depression

Regardless of political affiliation, every citizen has a stake in healthcare policy decisions. Hence, it is little wonder why healthcare items become such high-profile components of presidential agendas. It is also little wonder why they become such hotly debated agenda items.

In Part 1 of this module’s Assignment, you were asked to begin work on an Agenda Comparison Grid to compare the impact of the current/sitting U.S. president and the two previous presidents’ agendas on the healthcare item you selected for study. In this Discussion, you will share your first draft with your colleagues to receive feedback to be applied to your final version.

To Prepare:

  • Review the Resources and reflect on the importance of agenda setting.
  • Consider how federal agendas promote healthcare issues and how these healthcare issues become agenda priorities.
  • Review Part 1 of the Module 1 Assignment and complete the requirements for this Discussion.
 
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