NR 505 Discussion PICOT/PICo and Practice Questions

Quantitative Approach

Initially, I thought that the qualitative approach would be a better approach for my evidence-based project proposal. After further review, I now am convinced that the quantitative approach is a better approach for my evidence-based Practice (EBP) project proposal. Evidence-based practice is aimed at hardwiring current knowledge into common care decisions to improve care processes and patient outcomes (Stevens, 2013). Evidence-based practice also unifies research evidence with clinical expertise and encourages through individualization of care through inclusion of patient preferences (Stevens, 2013).

Why the Quantitative Approach is best for rural populations’ unplanned healthcare (Area of Interest)

Because of my clinical experience with my area of interest in the rural population, this approach will allow a collection of opinions, facts, attitudes, and behaviors to be analyzed. The quantitative approach will also allow results to be generalized from a larger population such as the rural population. With the use of the quantitative approach, this population will have the opportunity to reveal their needs and causes of lack of healthcare. This research approach will be beneficial in order to decrease the incidence of unplanned healthcare, which is one of the biggest healthcare challenges that this population continues to face. With the use of the quantitative research method, data can be collected from various forms such as: online surveys, paper surveys, telephone interviews, and face to face interviews. The collection of this data will allow comparison of opinions and further investigation toward a resolution. As exploration of the chosen population occurs with the combination of clinical experiences, an advancement of the proposed EBP will promote the intended outcome of better healthcare strategies.

PICO Quantitative Question

In the rural population (P) does health education, early diagnosis, and healthcare programs (I) compared to deploying health resources geographically (C) reduce the incidence of unplanned healthcare (O).

Quantitative Practice Question

Is there a link between the lack of healthcare education, early diagnosis, healthcare programs and unplanned healthcare?

Reference Stevens, K.R. (2013). The Impact of Evidence-based Practice in Nursing and the Next big Ideas. Online Journal Issues in Nursing, 18(2), 1. doi: 10.3912/OJIN18No02MAN04

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I believe both quantitative and qualitative approaches could be beneficial for this specific topic, but I plan to focus on the qualitative approach. In qualitative research the focus is on the collection and analysis of data. The researcher has to remain fluid and flexible during the research process. Their direction may need to change slightly in order to get closer to their goal. Qualitative research main purpose is to explore and describe a participant’s experience. The approach starts out with a broad question, but process oriented and context bound (Malagon-Maldonado, 2014). The focus for quantitative research is usually narrow and product related.

My PICo question is: in a hospital setting where nurses conduct bedside shift report opposed to station-based report, is patient satisfaction higher? I picked this question to help guide the nurses to understand the value bedside shift report has for the patients and their families as well as the nurses. We have set this practice as a standard in our hospital and many units do very well. We see staff struggling on the units that have larger number of patients. While using the qualitative approach I will start broad in my question but hope to identify some research specific to the patient satisfaction in the emergency department. As the nursing operations manager of the emergency department, we strive to improve our communication with our patients concerning their plan of care. This research will hopefully identify some of the barriers and how successful organizations supported their staff to overcome those barriers (Taylor, 2015).

Malagon-Maldonado, G. (2014). Qualitative Research in Health Design. Health Environments Research & Design Journal (HERD) (Vendome Group LLC), 7(4), 120-134. Retrieved from http://www.herdjournal.com.chamberlainuniversity.idm.oclc.org/ME2/Default.asp Taylor, J. S. (2015). Improving patient safety and satisfaction with standardized bedside handoff and walking rounds. Clinical Journal of Oncology Nursing, 19(4), 414-416. Retrieved from https://cjon.ons.org

When gathering your data are you going to use the nurses in the ER as a point of reference? I work in the ER and we don’t do bedside report but the rest of the hospital does. I do think that giving bedside report would be good so that way if there are any issues with the patient or condition that they are in it can addressed promptly. One really bad scenario is we had a nurse go into to check on her patients after taking report and found that one of her patients was bradycardia and having breathing difficulties. She was not hooked up to the cardiac monitor or the continuous monitoring of oxygen saturation level. Had this been the case someone would have been aware of this patients condition declining instead of the oncoming nurse finding it after receiving report. Bedside report is crucial for oncoming and outgoing
nurses, for it ensures and sustains the continuity of patient care (Sadule-Rios, 2017).

Sadule-Rios, N. (2017). Off to a Good Start: Bedside Report. MEDSURG Nursing, 26(5), 343-345. Retrieved from https://eds-a-ebscohost-com.chamberlainuniversity.idm.oclc.org/eds/pdfviewer/pdfviewer?vid=2&sid=af15de18-fc5e-4850-97a0-4f51189be927%40sessionmgr4007Links to an external site.

This is an interesting topic and one that my facility has made changes with recently. In an effort to increase our patient satisfaction scores as well as improve our nurse to nurse communication, we have implemented new ideas to how and where we give our reports. In the past, we would just give nurse to nurse reports in the ER at the nurses station or via the telephone. This was the standard for many years. We recently made changes to how this is to be done and it has shown to improve our patient satisfaction scores thus far. When a patient is up for admission, the accepting floor will come to the bedside in our ER for a bedside report. Oftentimes, the provider is also present which is extremely helpful and has really had a positive impact with our patients. With all members of the staff present at the bedside, there is rarely questions to what was done for the patient and why it was done. We found that bedside report also seems to better help the patient understand what care was given and why it was ordered. We encourage the providers to be present during report if they have the opportunity to do so but it is not always possible due to other patient care needs. During our call-back surveys and written surveys, this new measure has received great praise by our patients and their families. We like this type of report and continue to use it daily in our facility.

For my evidenced based practice proposal project, I chose to go with a qualitative approach for research on veterans’ risk for suicide post deployment. For this project, I wanted to better understand the motivation and thought process of the veteran post deployment and if there were extenuating circumstances that accelerated their decision towards self-harm and thus qualitative research was the best approach. Ramchand (2016), discusses the need for qualitative approach as a way to better understand where veterans are coming from when they experience suicidal ideation and what is driving them to a place of crisis. There are so many different research trajectories on the subject of post war veterans and their risk for suicide such as the integration of females in combat zones and pre-existing mental illness in the combat veteran that I was not sure how to narrow down the issue to formulate a question. I chose to keep the subject matter broad and my research question is: Are post war veterans at a greater risk for suicide as they reintegrate into society?

Population (P): Post war veterans

Interest (I): Risk for suicide

Context (Co): Reintegration into society

The qualitative research design I chose to use is the phenomenology because it looks at the lived experiences of the individual. This research design seeks to understand the individual and the experiences they have lived by asking in-depth questions about their life and circumstances surrounding their existence. Polit &Beck (2017), discuss how individuals create truth about their own reality through their lived experiences. In depth questioning from the researcher helps to draw out these truths and better understand the circumstances that molded their beliefs. Interpretive phenomenology allows the researcher to enter the world of the participant without pre-conceived notions or ideas to better understand the individual (Polit, 2017). I have chosen to research the post war veterans risk for suicide through the interpretive aspect of the phenomenological design because I want to understand their thought process on the subject and not come with my own agenda or pre-conceived ideas.

Polit, D. & Beck, C. (2017). Essentials of nursing research: Appraising evidence for nursing practice (9^th ed.). Philadelphia, PA: Wolters Kluwer.

Ramchand, R., Ayer, L., Kotzias, V., Engel, C., Predmore, Z., Ebener, P., & Haas, G. (2016). Suicide risk among women veterans in distress: Perspectives of responders on the veterans’ crisis line. Women’s Health Issues: Official Publication of The Jacobs Institute of Women’s Health, 26(6), 667-673. doi:10.1016/j.whi.2016.07.005

Thank you for your kind words. I have been looking at the different aspects of qualitative research and how data is interpreted and analyzed. Since the researcher is mostly dealing with the emotions and experiences of individuals, remaining supportive and un-biased is imperative in order to allow the participant freedom to express themselves without reproach. Clark &Veale (2018), discussed the importance of qualitative researches disclosing their own personal opinions and beliefs in a personal statement within their research so as not to compromise the data or results. Qualitative research looks at a different aspect of the human experience and is more subjective in nature with the participants verbalizing feelings and the emotional aspect of a lived experience. Clark (2018), references the aspect of coding which is labeling a similar concept among participants with a single word. For instance, in interviewing post war veterans, I may encounter similar themes as individuals discuss feelings and emotions during combat and I can utilize a single word throughout my findings depicting that specific emotional response. The research I have done on the qualitative approach has been very interesting and provided a more in depth on the interview process for research participants.

Clark, K. R., & Vealé, B. L. (2018). Strategies to enhance data collection and analysis in qualitative research. Radiologic Technology, 89(5), 482CT-485CT.

I think I will be using quantitative approach for my approach at my EBP project proposal. The reason I have chose to use quantitative is because I feel as though this will give me better control over study conditions and population size that is involved and then I could late increase the study to include larger numbers. This approach will work best for my area of study with postpartum depression as I can research smaller groups to see if it will work such as a group of women from the doctors office.

I have had to modify my PICOT question as to not make it so broad. I have decided to form it like this; In women whom are diagnosed with PPD is exercise a more effective way of treatment than medication or no intervention for decreasing their depression? This would be my quantitative question.

Forming my qualitative question I would frame it like this; What are the experiences of women diagnosed with PPD and exercising instead of taking medication for their depression? I know from my own personal experience with PPD when I had my first child I didn’t know what was going on with me and had I known or had someone educated about it, I would not of had to suffer through that time of my life. A study has shown that women who took two yoga classes a week for eight weeks had improved symptoms of depression and anxiety (Ashford, 2017). My experience with my last son that was born a year and a half ago I had started to have feelings of PPD and five weeks after my c-section and I was cleared by my doctor,I started back to CrossFit and noticed a change within a week of how I was feeling. I was more energized and just felt better.

The more research I do the more I have become interested and passionate about this topic as it often times goes un-diagnosed by so many healthcare providers.Depression its self affects one in ten women ages 18-44 each year (CDC, 2017). This is an alarming number and those that have depression prior to giving birth are more likely to develop PPD. It is our job as FNP’s to educate our patients to be able to pick up on signs and symptoms PPD and recommending the right treatment for the patient.

Ashford, K. (2017). THE MOTHER LOAD. Delicious Living, 33(5), 25-29.Retrieved from https://eds-b-ebscohost-com.chamberlainuniversity.idm.oclc.org/eds/pdfviewer/pdfviewer?vid=2&sid=ed8878e1-c4a4-498a-8b66-6bd9daa506dd%40sessionmgr104Links to an external site. Centers for Disease Control and Prevention. (2017). Depression among women. Retrieved from https://www.cdc.gov/reproductivehealth/depression/index.htmLinks to an external site.

NR 505 Discussion PICOT/PICo and Practice Questions