#1774817 Topic: PICO(T) Evidence Review 2

#1774817 Topic: PICO(T) Evidence Review 2

Number of sources: 1

Writing Style: APA

Type of document: Dissertation Chapter – Literature Review

Academic Level:Master

Number of Pages: 12 (Double Spaced)

Category:   Nursing

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PICOT_2_Table_Guidelines__2_.docx

PICO_Evidence_Review.doc

Appendix__Table_sample.docx

NRSG_790_PICOT_2_Guidelines__2_.docx

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

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

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:

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.

Reference

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

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

Included

Eligibility

Screening

Identification

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