#1774817 Topic: PICO(T) Evidence Review 2

#1774817 Topic: PICO(T) Evidence Review 2

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Type of document: Dissertation Chapter – Literature Review

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Category:   Nursing


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PICOT 2 Table Guidelines

1. Grading the Evidence – Assign a “Quality Rating” for each individual study (Dearholt and Dang, 2012, A, B, or C). Quality Rating using the scheme below (Newhouse) or the one from Dearholt and Dang (2012)

a. Quality Rating Scheme from Newhouse, R.P. (2006). Examining the support for evidence-based nursing practice. Journal of Nursing Administration, 36(7-8), 337-40.

A: High – consistent results with sufficient sample, adequate control, and definitive conclusions; consistent recommendations based on extensive literature review that includes thoughtful reference to scientific literature

B: Good – reasonably consistent results; sufficient sample, some control, with fairly definitive conclusions; reasonably consistent recommendations based on fairly comprehensive literature review that includes some reference to scientific evidence

PICO(T) Evidence Review 2
PICO(T) Evidence Review 2

C: Low/major flaw – Little evidence with inconsistent results; insufficient sample size; conclusions cannot be drawn.

2. Create a Strengths and Weaknesses Table for each study in your review. Using the table, discuss the strengths and weaknesses of the evidence. Include threats to internal and external validity for each article. To critique/identify strengths and weaknesses of each article, you may use the Rapid Critical Appraisal Forms (Melnyk & Fineout-Overholt, 2014), or the Quantitative Article Critique Tool, although you will not include these forms tools in your paper.

Strengths and Weaknesses Table

Evidence Based Practice Question (PICO(T)):
Source (Authors, year)StrengthsWeaknessesLevel of Quality Rating

3. Overall Evidence Synthesis: Using the Evidence Review table from PICOT 1, discuss the similarities and differences between the studies. Discuss agreement about the results among studies. Discuss strengths and weaknesses of the studies in the table and how these compare to one another.

Summative Evidence Rating Table:

Evidence Based Practice Question (PICO):
Level of EvidenceNumber ofStudiesSummary of FindingsOverall Quality

4. Gaps – Identify what is not known as a result of the evidence synthesis. Inconsistencies in study populations, interventions, comparison, and outcomes were discussed as gaps in the evidence. Make recommendations for future research to address identified gaps. Were studies difficult to compare because the intervention and/or outcomes of differed from one study to another?

5. Recommendation for practice

a. Discuss considerations when deciding to apply or not apply the evidence to practice (practice context, patient preferences, strength of the evidence).

b. Identify potential barriers to implementation of the evidence (feasibility, ethical concerns, resources, risk/benefit to patient/organization).

c. Make a recommendation for practice for a specific population/setting based on the evidence, with USPSTF Grade Rating.

i. This recommendation is based on weighing the rating you gave to each studies evidence, similarities and differences between studies, major validity threats, feasibility of the decision, resources needed, ethical issues, potential risks and benefits at the patient, nursing, and organizational levels, and patients’ or health care professionals’ differences that may limit the full implementation of the evidence.

Running Head: PICOT Review 1

PICOT Review 17

PICOT Evidence Review

University of Maryland Baltimore School of Nursing

Andi Wise

PICOT Evidence Review 1 Evidence Search

Nursing practice strives and demands improvement in quality care and enhance patient safety outcomes. The Joint Commission predicts that two – thirds of sentinel adverse errors are associated with miscommunication between the caregivers during hand-off among the patients (The Joint Commission, 2018). The implication of the handoff is the transfer and acceptance of the responsibility for the care of the critical ill or injured adult. Effective communication enhances this transfer (Halms, 2013). In most cases, crucial information about the care of the patient is lost during changes in shifts (Jukkala, 2012). Thus, we need strategies to enhance the safety and quality of the hand-off process.

Most hospitals lack information standardization that is essential during handoff in intensive care units that translates to inaccuracy in information exchange (Halms, 2013). The situation leads to inconsistent patient care with a high degree of dissatisfaction among the patients as well as the patient safety associated with medical errors. The family members of the patients can also be affected and it can be catastrophic to the patients. Confirming that hand-off occurs at the bedside with patient participation and not at the nurses’ station is an opportunity to promote patient gratification and safety by involving patients and family members to be participants where they can clarify and correct inaccuracies (McMurray, 2011). Therefore, The Joint Commissions and the National Patient Safety Goals suggests the need for improvements in communication effectiveness among the caregivers (The Joint Commission, 2018).

Among the adults in the critical care unit (P), does the handoff among the clinician that incorporate the patients with the family members (I), relative to the handoff that involves the clinician only (C), improve patient safety (O) during the length of stay in the ICU (T).

In the above PICO(T) question, the population, P includes the adult patients in the ICU. The intervention, I is the clinician handoff at the end of the shift that involves the patient and the family members. The standard practice –comparison is the clinician handoff report. The outcomes, O entails the patient safety. Time, T is the length of stay in the ICU.

Description of Search

I have utilized Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases and PubMed at the Health Sciences and Human Services Library of the University of Maryland, to complete the advanced search. The search terms “acute care” or “inpatient” AND “hand-off” or “shift report” AND “patient safety” or “patient satisfaction” were applied during the research. The original search resulted in 229 articles. The result then was limited by peer review and narrowed to the article year range from 2011to 2018 with English language only, which left 107 articles for review. Tile and abstract was reviewed in the 107 articles. A total of 85 articles were excluded due to various reasons cited in PRISMA diagram. The full-text review applied to the remaining 22 articles, there were 17 articles eliminated due to various reasons but not limited to: lack of controlled trial, insufficient result and irrelevant experiment towards PICO question. Conclusively, five articles were eligible and included in the evidence review process.

The current research focuses on particular departments and institutions with much of their emphasis on the convenience use of designs, samples as well as outcome measures. The starting point in the future research in handoff must be the development of the conceptual framework that places the PICOT questions within the theoretical framework on the basis of the previous evidence search. It is also suitable to isolate the articles identified through evidence search that are not particular to the items of the PICOT questions. Only the articles that address all issues as suggested in the PICOT questions can be considered for use in the research.


Ford, Y., Heyman, A., & Chapman, Y. (2014). Patients’ perceptions of bedside handoff: The need for a culture of always. Journal of Nursing Care Quality, 29(4), 371-378.

Halms, M. A. (2013): Nursing handoffs: Ensuring safe passage for patients. American Journal of Critical Care, 22(2), 158-161

Jukkala, A., James, D., Autrey, P., & Azuero, A. (2012). Developing a standardized tool to

improve nurse communication during shift report. Journal of Nursing Care Quality,

27(3), 240-246.

McMurray, A., Chaboyer, W., Wallis, M., Johnson, J., & Gehrke, T. (2011). Patients’

perspectives of bedside nursing handover. Collegian, 18, 19-26.

The Joint Commission. (2018): The National Patient Safety Goals. Retrieved February 06, 2018 from http://www.jointcommission.org/standards_information/npsgs.aspx

Sand, K., & Sherman, J. (2014). A quantitative assessment of patient and nurse outcomes of

nursing bedside report implementation. Journal of Clinical Nursing, 23, 2854-2863.

Appendix I

PRISMA Search Flow Diagram

Appendix IIEvidence Appraisal Table Template
Study citation:Ford, Y., Heyman, A., & Chapman, Y. (2014). Patients’ perceptions of bedside handoff: The need for a culture of always.Journal of Nursing Care Quality, 29(4), 371-378.
Study objective/intervention or exposures comparedDesignSample (N)InterventionOutcomes studied (how measured)ResultsLevel
This study identifies patient’s perceptions of the bedside handoff through direct and quantitative measurement. To emphasize bedside handoff with patient engagement not only meets the Joint Commission standards but also contributes to improve patient safetyQuantitative, descriptive studyBorgess medical center in Michigan Inpatient n=103Inclusion criteria:At least 18 years of age, fluent in spoken and written English, no Dx of dementia or confusionHad to spend entire stay on study unit and have experienced at least 3 handoffsSurvey catalogued into 4 variable-Understanding-Participation-Safety-SatisfactionPatient’s perceptions of safety, understanding, and satisfaction8 items using 4 point likert type scale plus 1 open ended comment boxinstrument reviewed by nurse experts including CNS, Nurse Managers, Clinical Educators, a PHD nurse researcherSignificant associations between frequency of bedside handoff with safety, understanding of care and satisfaction.Patient associations of always having bedside report and each survey item ranged from 0.242 to 0.541, p=0.017Patient associations between rarely having bedside handoff and each item was negative, r=0.4882
Study Citation:Halms, M. A. (2013). Nursing handoffs: Ensuring safe passage for patients. American Journal of Critical Care, 22(2), 158-161
To address PICO question: “what effect do standardized nursing handoffs have on patients’, clinicians’ and financial outcomesClinical Evidence review7 research and QI studies from 2007- 2012· 4 quality improvement· 1 prospective observational· 1 interventional study1 systematic review· Face to face, 2 way communication· Structured written forms, templates, or checklist· “captures intention” share problems and hypothesis with a predictive diagnosis of the patient’s clinical situationPatient’s outcome· Advanced along clinical pathway (structured face to face)· Reduced complications-falls (standardized interdepartmental tool· Reduced adverse event (structured face to face)Patient’s satisfaction· Higher satisfaction (walking rounds)· improved understanding of health conditions (patient participation)According to author this current review is further validation of previous positive finding regarding standardization of nursing handoff.3
Study citation:Jukkala, A., James, D., Autrey, P., & Azuero, A. (2012). Developing a standardized tool toimprove nurse communication during shift report. Journal of Nursing Care Quality, 27(3), 240-246.
Study objective/intervention or exposures comparedDesignSample (N)InterventionOutcomes studied (how measured)ResultsLevel
To develop and pilot test a standardized tool to improve communication among nurses during shift reportQuantitative Descriptive studyQuasi-experimental; one group pre/post test; Quality improvement project. A communication scale- MICU shift report scale was developed to collect data on nurses perceptions of communication during handover report. Baseline data collected; scale repeated post completion of 3 12hr shifts that utilized report tool developed by QI team43 RNs participated in the study Inclusion criteria: RN in the MICU and work 2 shifts or more during the 2 week PDSA (Plan-Do-Study-Act) cycle (n=70)Exclusion criteria: float pool RN or not working for 2 scheduled shifts during the PDSA periodPre test completed by 43 (61.4%) nurses from a 25 bed MICU in large in a large academic health center (n=77). Posttest completed by 34 nurses (48.5%)The MICU Shift Report Communication Scale (MSR) collects data on the nurse’s perception of handoff communication during shift reportThree Domains in MSR:Communication openness, quality of information and shift reportParticipates studied via minihuddles or one-on-one interactionsParticipants in post-survey shift report scale showed lower scores indicates a more favourable overall perception of the quality and quantity of communication among nurses in the MICU. Following implementation of the new report tool (18.75 vs 17.72; t=2.23; P=0.03) indicating improvement in the perception of communication during handoff.The intervention group was not statistically different on age (mean=32.7, SD=9.48) or length of work experienceThe MICU shift report communication scale may be useful to provide information to support health care organizations and nurse leaders in the evaluation of nurse communication during shift report· MICU MSR scores ranged from 12-27 (mean=18.78, SD=3.28)· Scale reliability (Cronbach’s alpha=0.79)2
Study citation:McMurray, A., Chaboyer, W., Wallis, M., Johnson, J., & Gehrke, T. (2011). Patients’ perspectives of bedside nursing handover. Collegian, 18, 19-26.
Study objective/intervention or exposures comparedDesignSample (N)InterventionOutcomes studied (how measured)ResultsLevel
This study examined patients’ perspectives of participation in shift to shift bedside nursing handover.Qualitative descriptive case study10 patients in one Queensland hospital.6 female4 malesAge (52-74)Median 68Inclusion criteria: English speakers, in hospital overnight, able to tolerate 30-60min interviewExclusion: critically ill or infectious, unable to consentFace to face interview with 9 questionnaires interview questions or surveys done in addition to the interview about ¾ to 1 hour length of interview regarding bedside handoff including its limitations, patient’s existing and potential role in handoff, the role of family members, and issues related to confidentiality-tape recorded, transcribed, and evaluated using thematic content analysis.Participants were asked their views about bedside handover during their hospitalizationDependent variables Participants’s view about bedside handover including its benefits and limitationsTheir existing and potential role in hand-offFamily members’ role and issues related to confidentialityThis study was not significantly different on gender, race, age, or length of hospital stay.This analysis indicated the bedside nursing handover is an ideal practice for implementing a partnership model of care.· Patient appreciation for participate during handoff· Bedside handoff enhance accuracy in the information being communicatedPatient preference of Increase nurse- patient interaction during handoff3
Study citation:Sand, K., & Sherman, J. (2014). A quantitative assessment of patient and nurse outcomes of nursing bedside report implementation. Journal of Clinical Nursing, 23, 2854-2863.
Study objective/intervention or exposures comparedDesignSample (N)InterventionOutcomes studied (how measured)ResultsLevel
To quantify quantitative outcomes of a practice change to a blended form of a bedside nursing reportQuasi-experimental pre-and post implementation designAll patients and RN’s in large university hospital Patients: n= 233 baseline n= 157, 3 months n= 154, 13 months Nurses: n= 148 baseline n= 98, 3 months n= 54, 13 monthsIndependent variables:Implementing bedside nursing report at shift changeDependent variables:Improved communication, patient safety (falls) and satisfaction5 point Likert type format17 open ended questions provided to patients about perception of bedside report after implementation17 online survey provided to nurses about efficiency, effectiveness, patient safety, teamwork, and demographic dataStatistically significant improvement post implementation in patient safetyReduced falls from 20 @ baseline to 4 at 13 monthsNurses introductions (p=0.012), encouraging involvement in care (p=0.05), exchanging important information at shift change (p=0.027), and engaging a shift report discussion (p=0.042) effectiveness of communication (p=0.000), promoting patient involvement (p=0.000), and promoting patient safety(p=0.001).2

Full-text articles assessed for eligibility �(n = 22)





See narrative description for keywords and subjects

229 results generated via

search from CINAHL

Inclusion and exclusion criteria applied

�(n = )

122 articles removed by the database software after application inclusion and exclusion criteria

Articles remained for review

Titles and abstracts

�(n = 107)

85 articles excluded:

Lack of relevance to the PICO(T) question (58)

Unavaliable access to full text (27)

17 articles excluded:

Lack of controlled trial (8)

Comparison between unit orientation (not bedside report)(2)

Insufficient results (not patient saftety) (3)

Trials in units or floor other than intensive care (5)

5 final studies included

Recommendation based on the methodology used by the U.S. Preventative Services Task Force (USPSTF):
GradeDefinitionSuggestions for Practice
AThe USPSTF recommends the service. There is high certainty that the net benefit is substantial.Offer/provide this service.
BThe USPSTF recommends the service. There is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial.Offer/provide this service.
CNote: The following statement is undergoing revision. Clinicians may provide this service to selected patients depending on individual circumstances. However, for most individuals without signs or symptoms there is likely to be only a small benefit from this service.Offer/provide only if other considerations support the offering or providing of the service in an individual patient.
DThe USPSTF recommends against the service. There is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits.Disourage the use of this service.
IThe USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of the service. Evidence is lacking, of poor quality, or conflicting, and the balance of benefits and harms cannot be determined. Read the clinical considerations section of USPSTF Recommendation Statement.If offered, patients should understand the uncertainty about the balance of benefits and harms.
Source: U.S. Preventive Services Task Force Ratings. U.S. Preventive Services Task Force. December 2013. http://www.uspreventiveservicestaskforce.org/Page/Name/us-preventive-services-task-force-ratings

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