Running head: PICOT PAPER 1

PICOT: Clinical Question Paper

Joshua Gibson
Ferris tate !ni"ersit#
PICOT PAPER $
Abstract
The process o% %or&ulating and ans'ering a clinical (uestion is e)plored b# using the PICOT
&ethod* 'hich is e)plained in %ull+ The &ethodolog# o% researching e"idence to ans'er the
(uestion* and classi%#ing that data is then e)plained+ Three articles* t'o being rando&i,ed
controlled trials and one being a s#ste&atic re"ie' o% rando&i,ed controlled trials* are brie%l#
criti(ued* and used to pro"ide insight into the PICO (uestion+ -astl#* the results are anal#,ed and
the signi%icance to nursing is then established+
PICOT PAPER .
PICOT: Clinical Question Paper
The purpose o% this assign&ent is to e)plore nursing /no'ledge and to e)a&ine ho' it
&a# be used in one0s o'n personal clinical setting 1ingleterr#* $213* p+ 114+ In%or&ation and
insight gained %ro& clinical studies &a# be used to ad"ance the practice o% nursing b# basing
inter"entions on 'ell5docu&ented e"idence+ PICOT 1Population* Inter"ention* Co&parison*
Outco&e* and Ti&e4 clinical (uestioning 'ill be de%ined* and the application o% such
&ethodolog# 'ill be used to e)a&ine the practice o% peripheral intra"enous catheter replace&ent
in a practice setting setting+
Clinical Question
A clinical (uestion is an in(uir# that* 'hen e)plored* i&pro"es the clinical practice b#
basing it on the latest e"idence 1till'ell* Fineout5O"erholt* 6eln#/* 7 8illia&son* $212* pp+
9:59;4+ uch (uestions* as de%ined b# till'ell and colleagues 1$2124* can belong to one o% t'o
categories: those o% bac/ground* or those o% %oreground+ A bac/ground (uestion is broad and
&a# be ans'erable b# te)tboo/ /no'ledge or co&&onsense+ The clinical (uestion presented
here belongs to the latter categor#< one 'hich pro"ides a speci%ied in(uir# that see/s to alter
clinical practice+ 6an# ti&es a %oreground (uestion &a# be used to deter&ine the e%%icac# o% one
&ethod o% inter"ention 'hen co&pared to another+
For&ing a clinical (uestion can be done using the PICOT acron#& 'hich contains the
necessar# ele&ents+ till'ell and colleagues 1$2124 de%ine PICOT as a (uestion that contains
Population* Inter"ention* Co&parison inter"ention* Outco&es* and Ti&e 1p+ 9;4+ Arranging a
(uestion in this &ethod allo's it to be condensed* clear* and ans'erable+ The PICOT (uestion
being addressed is as %ollo's: in hospitali,ed adults* ho' does routine re&o"al o% peripherall#5
inserted intra"enous catheters co&pare to clinicall# indicated replace&ent 'ith regards to
PICOT PAPER 3
ad"erse patient reactions 'ithin ;= hours o% initial insertion> All o% the PICOT ele&ents are
present in this in(uir#+
Ans'ering such a (uestion undeniabl# i&pro"es patient care< it see/s to do so b# its "er#
design+ ince the (uestion is speci%ic* and ans'erable* studies can be initiated to test the
co&parison+ 6an# o% the studies %ound through researching the intra"enous catheter (uestion
'ere rando& control trials* 'hich pro"ide a strong basis %or i&ple&enting changes in practice
1ingleterr#* $2134+ These i&plications 'ill be discussed in depth %urther on+
Methodology
To search %or the e"idence to ans'er the a%ore&entioned PICOT (uestion* the CI?A@-
database 'as used+ The search 'as %iltered to displa# results that 'ere strictl# nursing research+
The articles used 'ere speci%ic to registered nursing practice* and 'as 'ithin the scope o%
practice o% such a nurse+ These articles 'ere graded on a scale e&plo#ed b# the Qualit# and
a%et# in ?ursing 1QE?4 Institute 1ingleterr#* $2134+ The scale has descending le"els o%
e"idence 'ith s#ste&atic re"ie's being the golden standard o% research as a le"el one* and the
opinion o% an e)pert as a le"el se"en+ T'o o% the articles are rando&i,ed controlled trials* 'hich
e)ist as le"el t'o* and one is a s#ste&atic re"ie' o% se"eral rando&i,ed controlled trials+
Discussion of Literature
Article One
The %irst article to be criti(ued is a rando&i,ed controlled e(ui"alence trial %ro& Ric/ard
and colleagues 1$21$4+ The stud# can be classi%ied as nursing research because it has a direct
e%%ect on the practices o% registered nurses< 'hether an# o% the authors are the&sel"es nurses 'as
not deter&ined* but research nurses 'ere used to screen %or ad"erse reactions 1Ric/ard et al+*
$21$* p+ 12=A4+ The ethics co&&ittees at each location had appro"ed the stud#* and 'ritten
PICOT PAPER 9
consent 'as obtained be%ore an# participants 'ere in"ol"ed+ The purpose state&ent 'as clearl#
stated: the# 'ished to learn 'hether increasing the duration a catheter is in place be#ond three
da#s* and replaced onl# %or clinical reasons* pro"ided &ore co&plications %or the patient than the
e)isting protocol+ ?o stud# %ra&e'or/ 'as identi%ied* but as &entioned abo"e* this 'as a
rando&i,ed control trial* and co&pletel# appropriate %or the ai&s o% the stud#+
The sa&ple included .$:. patients* all aged 1: #ears or &ore* 'ho 'ould be in a
uni"ersit#5a%%iliated hospital in Queensland* Australia %or a duration greater than three da#s
1Ric/ard et al+* $21$* pp+ 12=A512=;4+ These indi"iduals &ade up a con"enience sa&ple that 'as
appropriate %or the purposes o% the article+ The literature used 'as e)tensi"e* but it is concerning
that onl# 19 o% the .9 sources used 'ere published 'ithin %i"e #ears o% the article+ The catheter
sites 'ere screened %or phlebitis or other reactions* 'hich 'ere deter&ined on a ten5point scale*
and a stud# &anager 'ould periodicall# audit the in%or&ation collected< data 'as entered into a
6icroso%t Access Batabase+ ince the data points 'ere 'hether phlebitis had occurred or not*
the# 'ould be classi%ied as ordinal data+
The results* 'hile uncann#* 'ere clearl# stated+ According to the stud#* phlebitis had
occurred in AC o% those 'ho had routine re&o"al 1Ric/ard et al+* $21$* p+ 12A14+ i&ilarl#* in
those 'ho had clinicall# indicated re&o"al o% the catheters* AC o% patients had phlebitis+ The
conclusion dra'n is that replacing peripheral intra"enous catheters onl# 'hen indicated posts no
increased ris/ to patients* but decreased hospital costs and 'aste generation* as 'ell as pre"ented
unnecessar# in"asi"e and unco&%ortable procedures+ !sing this in%or&ation* it 'ould be sa%e to
alter current protocol to increase the ti&e catheters are used< a &eta5anal#sis o% se"eral o% these
rando& control trials 'ould 'arrant this on a &uch &ore uni"ersal scale+
Article Two
PICOT PAPER =
The second article included is a s#ste&atic re"ie' o% rando&i,ed controlled trials+ The
authors are all nurses* and the subDect &atter has a direct lin/ to nursing inter"entions< this is
classi%ied as nursing research 18ebster et al+* $21.4+ The proble& state&ent 'as easil# identi%ied+
The ai&s o% the stud# 'ere to deter&ine the e%%ects o% re&o"ing peripheral intra"enous catheters
onl# 'hen indicated* rather than b# a speci%ied duration o% ti&e+ The literature had been
appropriatel# re"ie'ed+ There 'ere se"en rando& control studies included* %i"e o% 'hich 'ere
published 'ithin %i"e #ears o% the article* nine articles 'ere cited and listed as e)cluded* and
t'ent#5three 'ere listed as additional re%erence< onl# $=C o% these 'ere published 'ithin %i"e
#ears 18ebster et al+* $21.* pp+ 1;5$14+ ?o stud# %ra&e'or/ 'as identi%ied* but the research
design 'as to ha"e t'o e)pert research authors independentl# assess the (ualit# o% the trials
re"ie'ed* and to e)tract and co&pare data+ The data 'as e)tracted to a %or& that included the
%ollo'ing criteria: lead author and date* inclusion criteria* countr# on 'hich the stud# 'as
conducted* the age and gender o% the participants* the stud# design* the (ualit# o% the
inter"entions* the nu&ber o% participants as 'ell as 'ithdra'als and dropouts* and outco&e
&easures 18ebster et al+* $21.* pp+ =5A4+
The sa&ple 'as obtained b# searching the Cochrane Peripheral Eascular Biseases
peciali,ed Register* CE?TRA-* 6EB-I?E* and clinical trial registries+ e"en rando& control
trials had &atched the selection criteria 18ebster et al+* $21.* p+ 14+ Gi"en the ai&s o% this
re"ie'* the sa&ple is ade(uate+ The incidence o% phlebitis 'as &easured* and is considered
ordinal data+ Considering the ai&s o% the re"ie'* this le"el o% &easure&ent is appropriate %or the
stud#+
The results o% the s#ste&atic re"ie' had indicated that patients are at no greater ris/ %or
ad"erse e%%ects 'hen intra"enous catheters are re&o"ed onl# at a clinicall#5indicated basis< it
PICOT PAPER A
'as also %ound that doing so greatl# decreased the &edical cost o% intra"enous therap# b# up to
11C 18ebster et al+* $21.* p+ 1A4+ These %indings a%%ir& 'hat &an# rando& control trials ha"e
concluded+ Fased on the repeated e"idence* it 'ould be better o"erall %or the patients and the
hospitals i% peripheral intra"enous catheters 'ere onl# replaced 'hen clinicall# indicated+ The
results o% this re"ie' 'ould &a/e a change in polic# both responsible and sa%e+
Article Three
The %inal article in the criti(ue is a rando&i,ed controlled trial b# 8ebster and colleagues
1$22:4+ The obDecti"e 'as* as 'ere the t'o pre"ious articles* to co&pare routine re&o"al o%
intra"enous peripheral catheters 'ith clinicall# indicated replace&ent 18ebster et al+* $22:* p+ 14+
The research design 'as appropriate to %ul%il the stud# purpose* but no stud# %ra&e'or/ could be
identi%ied+
The sa&ple 'as one o% con"enience* collected %ro& an Australian tertiar# hospital* and
s&all in si,e 18ebster et al+* $22:* p+ 14+ Onl# A99 patients 'ere included in the stud#* and the
groups recei"ing each inter"ention 'ere split e"enl#+ The stud# is &uch too s&all %or an# &aDor
changes in practice to occur* and does not ade(uatel# achie"e the ai& o% the purpose+ It does*
ho'e"er* dra' attention to the notion that routine re&o"al o% peripheral intra"enous catheters
&a# be unnecessar#+ The literature 'as 'ell re"ie'ed %or this article< there are .$ sources cited+
@o'e"er* onl# $9C o% those included had been published 'ithin %i"e #ears o% the stud#+ The
&ethods section described the data collection process+ For collection* nurses 'ould assess the
sites dail# and %ill out a pre5appro"ed %or&< the %or& 'as to protect against an# threats to "alidit#
pertaining to the collection o% data+ For the purposes o% this stud#* the &ethods used are ade(uate
and appropriate+
PICOT PAPER :
The presence o% phlebitis or in%iltration at the insertion site pro"ided ordinal data* 'hich
'as appropriate %or the t test and the t'o5sided Fisher0s e)act test used during statistical anal#sis
o% the data 18ebster et al+* $22:* p+ .4+ The o"erall results indicated that the replace&ent o% the
catheters had co&parable occurrences o% ad"erse e%%ects 'hether replaced routinel# or 'hen
indicated 18ebster et al+* $22:* p+ 34+
Significance to Nursing
8hen considering e"er#one ad&itted into a hospital* there are countless intra"enous
insertions e"er# da#< it is one o% the &ost co&&on inter"entions nurse 'ill per%or&+ An#thing
that can be done to protect those at the end o% a needle is o% up&ost signi%icance to the nursing
pro%ession+ 8hile lea"ing peripheral intra"enous catheters in did not reduce the rates o% phlebitis*
it does pre"ent unnecessar# po/es 'hich can be unco&%ortable to the patient+ The three articles
1Ric/ard et al+* $21$< 8ebster et al+* $22:< 8ebster et al+* $21.4 also &entioned that e&plo#ing
this polic# 'ould be &ore cost e%%ecti"e* 'hich 'ould reduce the cost o% "isits %or those 'ho
alread# %ind di%%icult# in a%%ording hospital sta#s+
Patient5centered care* as identi%ied b# QE?* ta/es patient pre%erence into consideration*
as 'ell as pro"ides ph#sical and e&otional co&%ort< reducing the nu&ber o% ti&es a patient has
to be stuc/ 'ith a needle pro"ides %or patient5centered care 1QE?* $2134+ These articles
e"aluated ad"erse occurrences* but another stud# that inter"ie's patients &a# pro"ide better
insight into their pre%erences+ Boing so 'ould aid in de%ining 'hat patients 'ant out o% their
care+
tandard ; o% the A&erican ?urses Association cope and tandards o% Practice states
that registered nurses should utili,e e"idence and nursing research in their practice 1A&erican
?urses Association* $212* p+ 114+ The results %ro& the rando&i,ed controlled trials and the
PICOT PAPER ;
s#ste&atic re"ie' o% such studies pro"ide e"idence on 'hich to base practice+ Beter&ining 'hen
to replace an intra"enous catheter is not at the discretion o% the nurse* but rather that o% the
%acilit# and its policies+ A nurse &a#* ho'e"er* be on a co&&ittee that brings these %indings to
attention< the &ention o% sa"ing on catheter and related resource costs should be a con"incing
argu&ent %or a hospital0s polic# board+

References
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PICOT PAPER 12
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