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DQ 1 Describe the difference between a nursing practice problem and a medical practice problem

DQ 1 Describe the difference between a nursing practice problem and a medical practice problem

Topic 1 DQ 1
Apr 4-6, 2022
PICOT is utilized by the health care community to identify and study a nursing or medical practice
problem. Consequently, PICOT examples that may provide insight into the use of the PICOT process,
may not be relevant to nursing practice as they are based on a medical practice problem.
Describe the difference between a nursing practice problem and a medical practice problem. Provide
one example of each. Discuss why is it important to ensure your PICOT is based on a nursing practice
problem.
Gale Storm-Bryant
Posted Date
Apr 13, 2022, 7:44 PM
Re-Post
Nurses practice revolves around the nursing process (Toney—Butler, Thayer, 2021). Nurses practice
revolves around the improvement of the patient and the care process. It resembles the PICOT in many
ways like the intervention/would be the planning process, the comparison/would be the
implementation and the outcome /would be the evaluation. PICOT is used to develop the question
needed to be researched and answered with evidence (Helbig, 2018) and the nursing process steps
provide answers in the evaluation phase. The difference between a nursing or medical practice problem,
nurses practice works to improve patient care and medical provides the cause or pathology of the
patient. Nurses must practice within their scope of practice (OP, 2010). It is important for nurses to
ensure their PICOT is based on nursing care and not a diagnosis. Nursing diagnosis is different from
diagnosing a patient's health issue for treatment as doctors do. Nurses must remain within their scope
of practice.
PICOT question is the first step in evidence-based practice, and many times the question is written

DQ 1 Describe the difference between a nursing practice problem and a medical practice problem

DQ 1 Describe the difference between a nursing practice problem and a medical practice problem

poorly. It should not be written in past tense, its used to help search for the best evidence to answer the
question (Gallagher Ford, 2019). It has been noted that there is difficulty in finding quality information
and at times we lack the skills to evaluate the literature. There is a evidence-based research tool (EBR)
which improved the ability of nursing students to find and review articles and correctly apply the PICOT
(Long, et al., 2016).

An example of a nursing PICOT:
P: Patient – Adults 65 and over with constipation
I: Intervention – Encourage to exercise 45 min per day
C: Comparison – Patients who do not exercise
O: Outcome – Increased bowel movements in a week

T: Time Frame – 1 month

An example of a medical PICOT:
P: Patient – 65-year-old complaining of knee pain
I: Intervention – MRI
C: Comparison – MRI of normal knee
O: Outcome – Diagnosis of Arthritis
T: Time Frame – 2 weeks

References:

Gallagher Ford, L., & Melnyk, B. M. (2019). The Underappreciated and Misunderstood PICOT Question:
A
Critical Step in the EBP Process. Worldviews on Evidence-Based Nursing, 16(6), 422–423. https://doi-
org.lopes.idm.oclc.org/10.1111/wvn.12408

Helbig, J. (2018). History and Process of Nursing Research, Evidence-Based Nursing Practice, and
Quantitative
and Qualitative Research Process. Grand Canyon University (Eds.), Nursing Research:
Understanding Methods for Best Practices. https://lc.gcumedia.com/nrs433v/nursing-research-
understanding-methods-for-best-practice/v1.1/#/chapter/1

Long, J. D., Gannaway, P., Ford, C., Doumit, R., Zeeni, N., Sukkarieh, H. O., Milane, A., Byers, B., Harrison,
L., Hatch, D., Brown, J., Proper, S., White, P., & Song, H. (2016). Effectiveness of a technology‐based
intervention to teach evidence‐based practice: The EBR tool. Worldviews on Evidence-Based Nursing,
13(1), 59–65. https://doi-org.lopes.idm.oclc.org/10.1111/wvn.12132

Office of Professions (OP), (2010, June 18th). Education Law. Article 139, Nursing
http://www.op.nysed.gov/prof/nurse/article139.htm#sect6902

Toney-Butler TJ, Thayer JM. [Updated 2021 Jul 9]. Nursing Process. StatPearls [Internet].
https://www.ncbi.nlm.nih.gov/books/NBK499937/

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Wanda Felder
Posted Date
Apr 10, 2022, 6:59 PM

Remember to complete your PICOT, by including each of the elements listed in the image below.

https://i.pinimg.com/originals/de/67/6d/de676d6fbfc11dfa2e1cacebdb29ae5b.png
Tamara Houston
Posted Date
Apr 7, 2022, 6:19 AM
Replies to Gale Storm-Bryant
PICOT is a method used when developing a quality improvement project or lead to EBP (Helbig, 2018).  It
breaks down to five parts Patients/problem, Intervention, Comparison, Outcome, and Time which is
used to develop a question to hypothesize changes that can be made in nursing or medical practice for
patient improvement. Nursing practice problems are problems that occur during routine nursing
practice as it relates to the patient’s condition. A medical practice problem is one that occurs with the
disease process of a patient involving the medical condition or disease.
An example of a nursing practice problem would be
P: Hospital Staff
I: Hand Sanitizer
C: Handwashing using soap and water
O: Minimize the spread of hospital acquired infection
T:  3 consecutive months

An example of a medical practice problem would be:
P: Post op patient

I: Prophylactic Antibiotic Therapy
C: Pre-Op & Post Op Antibiotic therapy
O: Reduction of Surgical Site infection
T: Three consecutive months

It is important to ensure a PICOT is based on a nursing practice problem to prevent practicing in the
scope of medicine by way of conducting a clinical research study versus an evidence-based practice
project. Research questions are posed with the intention of generating new knowledge or verifying that
published findings are reproducible (Zuzelo, 2018). Nurses use evidence-based practice to provide
patients with safe, quality care and to improve outcomes (Helbig, 2018). The goal is to improve nursing
processes that produce safe patient outcomes during nursing care.

Helbig, J. (2018). History and process of nursing research, evidence-based nursing practice, and
quantitative and qualitative research process. Nursing research: Understanding methods for best
practice. https://lc.gcumedia.com/nrs433v/nursing-research-understanding-methods-for-best-
practice/v1.1/#/chapter/1

Zuzelo, Patti Rager (2018) Evidence-based practice methodology. Holistic Nursing Practice: Volume 32
(6)- p 340-342 doi: 10.1097/HNP.0000000000000297. Retrieved
from https://journals.lww.com/hnpjournal/Citation/2018/11000/Evidence_Based_Practice_Methodolog
y__Use_the.9.aspx

Gale Storm-Bryant
replied toTamara Houston
Apr 7, 2022, 11:35 PM
 Replies to Tamara Houston
Tamara,
Your post was very clear,
Research produces positive and negative outcomes. It does not always produce what the researcher is
looking for. When looking at different processes that can be used for research a pilot came to mind, an
experiment before going live. One issue that will cause research to have a negative outcome would be
inconsistence when not using all parts on all participants (Holt, et al. 2021). You can have positive
outcomes as well but how accurate will your research be. Research in healthcare is to improve patient
outcomes, provide quality care and patient satisfaction, if our evidence is not consistent, we could cause
harm to our patients. Accurate research takes many years and patient consent to participate, time may

not always be on our side depending on what the research may be trying to prove or provide
information about. A perfect example is the COVID19 vaccine, who did they get to agree to test the
vaccine before approving it? (not trying to be controversial – just an example). Research needs an
adequate number of participants (Holt, et al. 2021) articles to be substantial. PICOT structure and the
nursing process for patients’ outcomes working together may provide the framework for a shorter time
for review of results (Wikan, et al. 2020).
References:

Richard I. G. Holt, Katharine Barnard-Kelly, Giorgos Dritsakis, Kerensa I. Thorne, Lauren Cohen, Elizabeth
Dixon, Mayank Patel, Philip Newland-Jones, Helen Partridge, Suvitesh Luthra, Sunil Ohri, Kareem
Salhiyyah, Jo Picot, John Niven, Andrew Cook, & on behalf of the OCTOPuS study group. (2021).
Developing an intervention to optimize the outcome of cardiac surgery in people with diabetes: the
OCTOPuS pilot study. Pilot and Feasibility Studies, 7(1), 1–12. https://doi-
org.lopes.idm.oclc.org/10.1186/s40814-021-00887-z

Wikan Purwihantoro Sudarmaji, Sholihin Sholihin, Roby Aji Permana, Agustina Soares, & Yanuar
Aga Nugraha. (2020). A Clinical Decision Support System as a Tool to Improve the Accuracy of Nursing
Diagnoses. Jurnal Ners, 14(3), 388–392. https://doi-org.lopes.idm.oclc.org/10.20473/jn.v14i3.17171

 Natalee Burrell
replied toTamara Houston
Apr 8, 2022, 12:33 PM(edited)
 Replies to Tamara Houston
Hi Tamara thank you for your informative post
The PICOT question format is a standardized "formula" for creating researchable and answered
questions. When you create a good one, the rest of the process of gathering and analyzing evidence
becomes much easier.
Question for PICOT:
Population: Bariatric teens who are contemplating or have had gastric bypass surgery.

Intervention: The nurse's position as a major component of the multidisciplinary team for bariatric
adolescent perioperative care.

Comparison: The nurse's function as a secondary member of the multidisciplinary team is limited to
perioperative care of the bariatric adolescent patient and requires no specific training.

Outcome: The bariatric adolescent patient has greater continuity of treatment when the nurse is
included as one of the major members of the multidisciplinary team approach.

Time frame: perioperative to 6 weeks post-surgery.
PICOT Question: When the nurse is a primary member of the multidisciplinary team, does the bariatric
adolescent patient undergoing gastric bypass have better perioperative and postoperative care than
when the nurse is a secondary member whose only role is to provide perioperative care and has no
specialized training?

Reference:
Nursing : Picot questions. Library Research Guides. (n.d.). Retrieved April 8, 2022, from
https://libguides.ggc.edu/NURS/PICOT
 Jana Garcia
replied toTamara Houston
Apr 8, 2022, 6:12 PM
 Replies to Tamara Houston
HI Tamara,
In To make your case, start with a PICOT question, the author describes two comparing questions when
considering research. I thought it was interesting and very important, so I put it in my notes for future
reference. Comparing questions can be viewed as backward and forward thinking. The backward
question is the generalization of a topic, common knowledge, or information we might find in a nursing
manual. The author explains this common knowledge is a “foundation for the forward question that will
provide evidence for clinical decision making, the PICOT” (Echevarria, 2014). I thought this was worth
considering because some of us students haven’t been in nursing school for several years, and the
"common knowledge” may have changed over time with new EBP. I haven’t been in nursing school for
almost two decades. I think it's important that I review backward questions before I create a
PICOT. Current knowledge on the backward question is important in the "outcome" of the PICOT format
because the expectation may have changed. Respectfully, Jana
Echevarria, I. M., & Walker, S. (2014). To make your case, start with a PICOT question. Nursing, 44(2),
18–19. https://doi.org/10.1097/01.NURSE.0000442594.00242.f9
 Kerri Zepeda
replied toTamara Houston

Apr 9, 2022, 5:12 PM
 Replies to Tamara Houston
Thank you Tamara for your post! Yes, when establishing a quality improvement project or leading to
EBP, the PICOT approach is used. It is divided into five sections: Patients/Problem, Intervention,
Comparison, Outcome, and Time, each of which is used to formulate a question to hypothesize
improvements that might be made in nursing or medical practice to enhance patient outcomes. To avoid
practicing medicine outside of the scope of nursing by undertaking a clinical research study rather than
an evidence-based practice project, make sure the PICOT is based on a nursing practice concern.
Evidence-based practice (EBP) has been shown in research to produce greater treatment quality, better
patient outcomes, lower costs, and more nurse satisfaction than traditional care practices. Nurses have
an important role in detecting patient concerns, whether they are at the bedside or taking care of
patients in an outpatient setting. Nurses have an important role in preventing and minimizing patient
falls in the inpatient setting. In the hospital where I work, and I'm sure in every hospital, there are safety
and fall precautions, such as having x3 side rails up on the patient bed, having the bed locked and in the
lowest position, and having the call light in reach so the patient can receive help instead of getting out of
bed. Nurses do have a great responsibility in ensuring the safety of the patient.
Helbig, J. (2018). History and Process of Nursing Research, Evidence-Based Nursing Practice, and
Quantitative and Qualitative Research Process. Nursing research: Understanding methods for best
practice. Retrieved from https://lc.gcumedia.com/nrs433v/nursing-research-understanding-methods-
for-best-practice/v1.1/#/chapter/1
 Dan Zheng
replied toTamara Houston
Apr 10, 2022, 12:55 PM
 Replies to Tamara Houston
Hi, Tamara,
Good example and clear explanation of the PICOT. Nurses use EBP to provide patients with safe, quality
care and to improve outcomes by first developing a PICOT statement that can be associated with either
a quality improvement project or lead to EBP (Helbig, 2018). The researcher must gather information
through PICOT (problem, intervention, comparison, outcome, and time) to prove why the study should
be performed. The nursing practice problem deals with the person's response to real health problems
that the patient is exhibiting or a potential health problem that may arise from the medical diagnosis.
While medical problem only gives information about the disease pathology, the nursing problem
expresses the impact of the diseases on the patients’ wellbeing and the family. Basing on nursing
practice problem ensures that the PICOT includes the best evidence available from previous studies on
patient care, and values from experts in the field.
Reference:
Helbig, J. (2018). History and process of nursing research, evidence-based nursing practice, and
quantitative and qualitative research process. Nursing research: Understanding methods for best

practice. https://lc.gcumedia.com/nrs433v/nursing-research-understanding-methods-for-best-
practice/v1.1/#/chapter/1
Kelechi Mbalewe
Posted Date
Apr 7, 2022, 12:36 AM
Replies to Gale Storm-Bryant
Hello Class,
A well-constructed PICOT question is essential for research queries in the nursing field. Advanced
studies or nurses in professional settings rely on the PICOT framework in the development of some of
their studies. PICOT is a mnemonic for a clinical question that looks at the aspect of patient,
intervention, comparison, outcome and time. The PICOT process begins with the identification of a
problem or a case scenario, and the question is formulated to elicit an answer (Fnadino, 2019). PICOT
process in the medical aspect might not be similar in the scope of the nursing field. The difference
between medical practice problems and medical practice problems is that medical practice problems
deal with the diagnosis of disease and their treatment while nursing practice problems are concerned
with issues that surround nursing practice, and this involves aspects such as patient’s response to a
health problem or patient-related assessment. Nursing practice problems can take the scope of
evaluation and intervention aspects. Medical practice problem revolves around a medical condition
where prognosis, causes and treatment of the condition are a big aspect of medical practice. Nursing
practice problems deal with modalities such as comfort, health screening, trauma prevention and
promotion of recovery, which are not dealt with in the medical practice scope. The development of a
competent PICOT question help to ensure that the necessary outside sources such as peer-reviewed
journals can be used in the assessment of the problem and intervention.
An example of a nursing practice problem is the patient level of satisfaction. Patient-level of
satisfaction does not revolve around the condition but the ability of the care plan to achieve the desired
health outcomes and adhere to patient beliefs and values. Nursing practice problems can take the shape
of low levels of patient satisfaction in nurses treating immigrant populations (Zhang et al., 2021).
Medical practice problems revolve around treatment options or prognosis of conditions. An example of
medical practice issues is the use of pain medication such as tramadol, morphine and oxycodone for
post-operative patients. Nursing practice problems will involve the evaluation of medication errors and
complications after treatment. It is important that the PICOT is based on the nursing practice problem
because it helps to make it easier to discuss the scope of the issue and identify relevant materials that
can help in the evaluation of the interventions. PICOT questions that revolve around nursing practice
problems will make it easier for me to understand the issue and intervention hence better ability to
comprehend the content in the peer-reviewed articles.
Reference
Fandino, W. (2019). Formulating a good research question: Pearls and pitfalls. Indian journal of
anaesthesia, 63(8), 611.

Zhang, T., Wu, X., Peng, G., Zhang, Q., Chen, L., Cai, Z., & Ou, H. (2021). Effectiveness of standardized
nursing terminologies for nursing practice and healthcare outcomes: A systematic review. International
Journal of Nursing Knowledge, 32(4), 220-228.

Claire Haws
replied toKelechi Mbalewe
Apr 8, 2022, 7:09 AM(edited)
 Replies to Kelechi Mbalewe
Hi Kelechi,
It is important to add the idea that PICOT questions need to be researchable and challengeable. In Aslam
& Emmanuel's journal article, they explain that successful PICOT questions can be researchable by
making a foreground for the question. This means putting thought into the population or problem to
understand demographics, the intervention or treatment being considered, having a comparator or
control, and really evaluating the outcome. The outcome need to be a quantitative factor, easy to
calculate, specific, and reproducible. They explain that separating the question into these parts makes it
researchable so that the answer to the question can be evidence based (Aslam & Emmanuel, 2010). The
best place to go for evidence-based research include medical journals, especially those that are peer
reviewed. These journals pull information and new ideas from patient studies and clinical scenarios,
promoting the idea that research needs to be current and up to date, constantly changing and improving
the quality of patient care (Helbig, 2018).
References
Aslam, S., & Emmanuel, P. (2010). Formulating a researchable question: A critical step for facilitating
Good Clinical Research. Indian Journal of Sexually Transmitted Diseases and AIDS, 31(1), 47.
https://doi.org/10.4103/0253-7184.69003
Helbig, J. (2018). History and Process of Nursing Research, Evidence-Based Nursing Practice, and
Quantitative and Qualitative Research Process. Nursing research: Understanding methods for best
practice. Retrieved April 6, 2022, from https://lc.gcumedia.com/nrs433v/nursing-research-
understanding-methods-for-best-practice/v1.1/#/chapter/1
 Farida Rajwani
replied toKelechi Mbalewe
Apr 7, 2022, 10:25 PM
 Replies to Kelechi Mbalewe
Hello Kalechi,
great post just want to add, Evidence-based practice (EBP) models help address clinical problems;
translate relevant research to practice; and improve care, outcomes, and systems quality. Based on
Melnyk and Fineout-EBP Overholt's model, this article offers a model for nursing evidence-informed

health policy (EIHP). To inform and motivate discussion toward the best possible health policy agenda
and advances, the EIHP approach integrates the application of the strength of the evidence and issue
understanding with stakeholder values and ethics. The PICOT question has two purposes in this model:
to clarify the policy question that drove the evidence search and to objectively reinterpret and analyze
existing or proposed policies.
Practical issues are discussed, as well as the model's significance for nursing education and regulation.
Improve care, results, and system quality by putting relevant research into practice. These clinical
problem-solving models can be applied to address health policy issues in nursing education and
regulation.
Reference; Jacqueline M. Loveridge, An Evidence-Informed Health Policy Model: Adapting Evidence-
Based Practice for Nursing Education and Regulation, Journal of Nursing Regulation, Volume 7, Issue
2,2016,Pages 27-33,ISSN 2155-8256,
https://doi.org/10.1016/S2155-8256(16)31075-4.
 Natalee Burrell
replied toKelechi Mbalewe
Apr 8, 2022, 1:41 PM
 Replies to Kelechi Mbalewe
Hi Kelechi
I enjoyed reading your post.
Evidence-based practice (EBP) has been shown in studies to result in better quality treatment, improved
patient outcomes, lower costs, and more nurse satisfaction than conventional methods to care. 1-5
Despite these encouraging results, many nurses continue to apply evidence-based treatment in an
inconsistent manner. Furthermore, some nurses who received their education before EBP was included
in the nursing curriculum lack the computer and Internet search abilities required to adopt these
practices. As a consequence, misunderstandings regarding EBP persist, such as that it is excessively
complicated or time-consuming.
addressing the types of questions that establish the framework for EBP, such as: how does supine
posture compare to raising the head of the bed 30 degrees influence intracranial pressure in patients
with head injuries? How does giving the beta-blocker metoprolol (Lopressor, Toprol-XL) vs giving no
treatment influence the frequency of tachycardic episodes in individuals with supraventricular
tachycardia? The following phases in the EBP process are unlikely to occur without this spirit of inquiry.
References:
Bernadette Mazurek Melnyk is dean and distinguished foundation professor of nursing at Arizona State
University in Phoenix. (n.d.). Evidence-based practice: Step by step: The seven steps of… : Ajn the
American Journal of Nursing. LWW. Retrieved April 8, 2022, from
https://journals.lww.com/ajnonline/Fulltext/2010/01000/Evidence_Based_Practice__Step_by_Step__T
he_Seven.30.aspx?WT.mc_id=HPxADx20100319xMP

 Tracy Shoop
replied toKelechi Mbalewe
Apr 8, 2022, 1:55 PM
 Replies to Kelechi Mbalewe
Hello Kelechi,
I agree with your post and can add that if hospitals should be concerned with their scores related to
patient satisfaction. These scores have been shown to correlate directly to staffing ratios. With national
attention focusing on nurses leaving the bedside, attention should be focused on staffing ratios. It
makes sense that patient mortality and morbidity suffers when nurses are too busy to frequently round
on or respond to life threatening emergencies (Kyung & Sung-Hyen, 2021). Legislation is important to
help assist the profession in moving forward with mandated staffing ratios. Such parameters exist in
other professions such as the airline industry. Why are we constantly putting health care workers at risk
of their own health? Skipping breaks, working many days in a row and not respecting a work-life balance
are becoming the norm. Would you want a nurse caring for your family member if she was working 7
days in a row? What about 16 hour shifts? As nurses we need to work together to make the profession
stronger. Without the proper research to fall back on we do not have a leg to stand on.

Kyung, J. H., & Sung-Hyun, C. (2021). Associations between Nurse Staffing Levels, Patient Experience,
and Hospital Rating. Healthcare, 9(4), 387. http://dx.doi.org/10.3390/healthcare9040387
 Dan Zheng
replied toKelechi Mbalewe
Apr 10, 2022, 1:18 PM
 Replies to Kelechi Mbalewe
Hi, Kelechi,
PICOT question is essential, useful and challengeable in today's nursing research. In nursing research,
PICOT is used to select and investigate health care problems. Nursing problem gives a holistic and
individualistic approach to the care of patients acknowledging the physiological and psychological
response of the patient to the diseases. When beginning nursing research and selecting a PICOT
question, it is important to ensure your PICOT questions based on a nursing practice problem to ensure
the most relevant intervention and outcome for the delivery of care and solving nursing problem. It’s
important to consider the use of a literature search and the PICOT format when engaging clinical
researchers. This approach will provide researchers an initial basis for mutual understanding,
communication and direction to help answer clinical study questions of most relevance (Riva et al.,
2012). But there are a lot of considerations need to be contemplated in the PICOT formulation.

Therefore, it’s critical to develop a strong research question framed in the PICOT format which is an
important basis to understand both the clinical area of investigation and the current literature that
exists.
Reference:
Riva, J. J., Malik, K. M., Burnie, S. J., Endicott, A. R., & Busse, J. W. (2012). What is your research
question? An introduction to the PICOT format for clinicians. The Journal of the Canadian Chiropractic
Association, 56(3), 167–171.
Wanda Felder
Posted Date
Apr 6, 2022, 10:39 PM
Replies to Gale Storm-Bryant
When developing a nursing practice problem, research from evidence-based practice (EBP) is essential.
Lehane et al. (2018) state that the goal of the Institute of Medicine is to have 90% of clinical decisions
supported by EBP by 2020. To meet this goal, it will require a commitment by healthcare training
programs and healthcare facilities. These healthcare programs and institutions must focus on EBP at all
levels: undergraduate, graduate, and continuing education. EBP is what is needed to soundly support
the PICOT. Nonetheless, the nursing practice problem will be the focus.
Eriksen and Frandsen (2018) assert that the most commonly used research model is PICOT. Therefore,
utilizing PICOT when developing the nursing practice problem is an appropriate and effective tool. PICOT
can help direct the focus of the nursing practice problem for the researcher. There is structure gained
when using PICOT, and it also supports a literature search (Eriksen &Fradsen, 2018).

Do you find more structure in your research when utilizing PICOT?
Eriksen, M. B. & Frandsen, T. F. (2018). The impact of patient, intervention, comparison, outcome (PICO)
as a search strategy tool on literature search quality: A systematic review. Journal of the Medical Library
Association, 106(4), 420–431. Retrieved from https://jmla.pitt.edu/ojs/jmla/article/view/345/726

Lehane, E., Leahy-Warren, P., O’Riordan, C., Savage, E., Drennan, J., O’Tuathaigh, & C., Hegarty, J.
(2018). Evidence-based practice education for healthcare professions: An expert view. BMJ Evidence-
Based Medicine, 24(3), 103–108. https://doi.org/10.1136/bmjebm-2018-111019

Gale Storm-Bryant
replied toWanda Felder
Apr 7, 2022, 10:41 PM

 Replies to Wanda Felder
Dr. Felder,
Thank you for your question.
After learning about PICOT, I do believe it is very structured for research but also for the nursing
process. When reviewing the information for my DQ1 reply my mind continued to go back to the nursing
process. When I put them together it helped me define the use of both. As stated, nurses must remain
within their scope of practice and when I was creating my PICOT example, I referred back to the nursing
process. The PICOT provided clarity in assisting me to formulate my nursing diagnosis and plan, it was
simple (Wikan, et al. 2020). This is my first time learning about PICOT I was not aware that the
medical/physician had a tool similar to the nursing process to assist them in how they prepare for the
patient. For research purposes you mentioned a literature search, the way PICOT is structured it allows
you to use all the words within different sections of the question to be researched. I can look for
intervention information, outcome information, because built into articles can be answers on many
levels.

Reference:

Wikan Purwihantoro Sudarmaji, Sholihin Sholihin, Roby Aji Permana, Agustina Soares, & Yanuar
Aga Nugraha. (2020). A Clinical Decision Support System as a Tool to Improve the Accuracy of Nursing
Diagnoses. Jurnal Ners, 14(3), 388–392. https://doi-org.lopes.idm.oclc.org/10.20473/jn.v14i3.17171

 Kerri Zepeda
replied toWanda Felder
Apr 9, 2022, 5:25 PM
 Replies to Wanda Felder
Thank you Wanda for your post! Evidence-based practice (EBP) research is critical when developing a
nursing practice problem. As stated, "the Institute of Medicine is to have 90% of clinical decisions
supported by EBP by 2020." I agree that in order to meet this goal, there has to be a commitment from
all health care professionals. Education is extremely important, especially in the healthcare field, and
evidence-based practice is essential. To achieve the best outcomes, nurses must learn how to apply
evidence-based practices (EBP) to give patients safe, high-quality, and conveniently accessible
treatment. The development of PICOT questions is the initial stage in EBP. Learning about PICOT
questions is a useful method for condensing research questions about the effects of therapy and caring
for the patient. Because PICOT can incorporate nurse-driven interventions to answer patients' concerns
and give safe and efficient nursing care, it's critical that it's founded on a nursing practice problem. It's

critical that your PICOT is founded on a nursing practice issue. Nurses use EBP to provide patients with
therapy that is safe, high-quality, and conveniently accessible, resulting in better outcomes. When this
technology is deployed, nursing errors and negative patient outcomes are reduced.
Helbig, J. (2018). Nursing research: Understanding methods for best practice. Grand Canyon University
(Ed). Retrieved from https://lc.gcumedia.com/nrs433v/nursing-research-understanding-methods-for-
best-practice/v1.1/#/chapter/1
Wanda Felder
Posted Date
Apr 6, 2022, 10:38 PM
Replies to Gale Storm-Bryant
Nurses are significant in their role of identifying patient problems as they are at the patients' bedside or
triaging patients in the outpatient setting. In the inpatient setting, nurses play a critical role in reducing
and eliminating patient falls. Interestingly enough, it seems that the role of reducing and preventing
patient falls is placed solely on the nurse (King et al., 2018). As a healthcare provider, and knowing that
there is an interprofessional team caring for patients, nurses holding so much of the responsibility
seems inappropriate. Ideally, patient admissions are reduced because research has shown that
extended admissions are correlated with a higher incidence of patient falls (Chu, 2017). The grounded
dimensional analysis (GDA) study by King et al. (2018) discussed the impact of nursing care when caring
for patients who are fall risks.
In practice have you identified when patients have benefited from a nursing intervention to prevent a
nursing problem?

Chu, R. Z. (2017). Preventing in-patient falls. Nursing, 47(3), 24–30.
https://doi.org/10.1097/01.nurse.0000512872.83762.69
‌ King, B., Pecanac, K., Krupp, A., Liebzeit, D., & Mahoney, J. (2018). Impact of fall prevention on nurses
and care of fall risk patients. The Gerontologist, 58(2), 331–340.
https://doi.org/10.1093/geront/gnw156


Alicia Field
replied toWanda Felder
Apr 7, 2022, 6:31 PM
 Replies to Wanda Felder
Hello Dr. Felder,

The use of foley catheters in the laboring patients has been the subject of much debate. When a patient
is having a cesarean section and requires a foley catheter, removing that catheter immediately after the
procedure decreases the risk of urinary tract infections and encourages early ambulation (El-Mazny et
al., 2014). It has also shown to decrease length of hospital stay (El-Mazny et al., 2014). Early ambulation
helps get the gastrointestinal tract moving again and gives the patient a sense of independence. Patients
are better able to care for themselves and their infant.
The facility that I currently work at removes foley catheters 12 hours post op. We have seen a decrease
in urinary tract infections and earlier ambulatory times. When I first started in the maternal newborn
unit, the foley remained in place for 24 hours. As new evidence-based research becomes available
protocols change. We as nurses must be willing to embrace those changes.
Reference:

El-Mazny, A., El-Sharkawy, M., & Hassan, A. (2014). A prospective randomized clinical trial comparing
immediate versus delayed removal of urinary catheter following elective cesarean section. European
Journal of Obstetrics & Gynecology and Reproductive Biology, 181,
111–114. https://doi.org/10.1016/j.ejogrb.2014.07.034

 Marise Guillaume Charles
replied toWanda Felder
Apr 9, 2022, 11:18 PM
Replies to Wanda Felder
Hi Dr. Wanda Felder,
It is true that the impact of medication errors is a puzzle resulting to negative patient outcomes hence
the need for intervention. The point of medical administration is the key area of error occurrences
hence the need for critical scrutiny (Mulac et al., 2021). Barcode technology comes as a solution to the
adverse events related to this menace. Nurses often fail to follow the guidelines offered at the point of
medical intervention hence the likelihood of error occurrence (Küng et al., 2021). The relation of
medication errors and comorbidity and mortality may be reduced through the use of barcodes in the
nursing practice when administering medication.
Reference
Küng, K., Aeschbacher, K., Rütsche, A., Goette, J., Zürcher, S., Schmidli, J., & Schwendimann, R. (2021).
Effect of barcode technology on medication preparation safety: a quasi-experimental
study. International journal for quality in health care : journal of the International Society for Quality in
Health Care, 33(1), mzab043. https://doi.org/10.1093/intqhc/mzab043

Mulac, A., Mathiesen, L., Taxis, K., & Gerd Granås, A. (2021). Barcode medication administration
technology use in hospital practice: a mixed-methods observational study of policy deviations. BMJ
quality & safety, 30(12), 1021–1030. https://doi.org/10.1136/bmjqs-2021-013223
Wanda Felder
Posted Date
Apr 6, 2022, 10:38 PM
~~~Please read this article so that you understand the role of EBP and the utilization of EBP research
articles in your DQ posts and your papers.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5622465/
these are only additional resources for you to expand your knowledge on this topic
Dan Zheng
Posted Date
Apr 6, 2022, 10:11 PM(edited)
Replies to Gale Storm-Bryant
Medical problems focus on the pathology, cause and treatment of disease, while nursing problems
center on the risk and potential problem of a disease, prevention of a diseases or its effect on the
general wellbeing of an individual. A nursing practice problem also looks at the nursing judgment about
an individual patient, a family, or a community and how they respond to actual or potential health
problems that they are exposed to. For example, the medical problem for patients with diabetes
mellitus may be eye disease, heart disease, kidney disease, foot and nerve problems, etc. But nurses
may give nursing problems like risk of Infection, instability of blood glucose levels, risk of decreased
cardiac output, risk of electrolyte Imbalance, risk of fall (Sudarmali et al., 2020).
Nurses must understand how to implement evidence-based practices (EBP) to provide patients with
safe, high-quality, and easily accessible treatment to ensure best outcomes. The first step of EBP is to
develop PICOT questions (Helbig, 2018). The PICOT format is a helpful approach for summarizing
research questions that explore the effect of therapy and caring, including Population, Intervention,
Comparison, Outcome, Time (Riva et al., 2012). It’s important to ensure PICOT is based on a nursing
practice problem because it can involve nurse-driven interventions to solve patients’ concerns, and
deliver safe and efficient nursing care.
References:
Helbig, J. (2018). Nursing research: Understanding methods for best practice. Grand Canyon University
(Ed). https://lc.gcumedia.com/nrs433v/nursing-research-understanding-methods-for-best-
practice/v1.1/#/chapter/1

Riva, J. J., Malik, K. M., Burnie, S. J., Endicott, A. R., & Busse, J. W. (2012). What is your research
question? An introduction to the PICOT format for clinicians. The Journal of the Canadian Chiropractic
Association, 56(3), 167–171.
Sudarmali W.P., Nursalam, N., & Wulandari, S. (2020). Identification of Nursing Problems in Hospitalized
Patients with Diabetes Mellitus. Jurnal Ners,15(2), 480-485. https://doi.org/10.20473/jn.v15i2.20516

Claire Haws
replied toDan Zheng
Apr 8, 2022, 7:09 AM(edited)
 Replies to Dan Zheng
Hi Dan,
The use of a PICOT question is also beneficial for constructing different types of research questions.
Santos et. al explain that some of these kinds of research questions include symptom and assessment,
clinical practice, and human/material resource management questions. It is important when developing
the PICOT question to focus the subject. This will save time and make research streamlined (2007). In
nursing, time is everything, so saving it will promote patient safety and success in the clinical
environment. Santos et. al also explain that because there are so many scientific journals and sources
for information available, using the PICOT strategic helps in research because it will define what areas to
research and look into more specifically (2007). Helbig explains that using nursing research is crucial to
quality of patient care because it can prevent disease and disability, help regulate and limit symptoms,
and improve end of life care because it provides the opportunity for the best information to be used
(2018).
References
Helbig, J. (2018). History and Process of Nursing Research, Evidence-Based Nursing Practice, and
Quantitative and Qualitative Research Process. Nursing research: Understanding methods for best
practice. Retrieved April 6, 2022, from https://lc.gcumedia.com/nrs433v/nursing-research-
understanding-methods-for-best-practice/v1.1/#/chapter/1
Santos, C. M., Pimenta, C. A., & Nobre, M. R. (2007). The pico strategy for the Research Question
Construction and Evidence Search. Revista Latino-Americana De Enfermagem, 15(3), 508–511.
https://doi.org/10.1590/s0104-11692007000300023
Farida Rajwani
Posted Date
Apr 6, 2022, 9:37 PM
Replies to Gale Storm-Bryant
"Nursing science has to incorporate every sort of research, from discovery to translation, from bench to
bedside, from mechanistic to holistic," says Professor Rita Pickler (Pickler, 2018). Evidence-based

practice is now universally acknowledged as a critical component of enhancing healthcare quality and
patient outcomes. Even though the goals of nursing research (generating new knowledge) and evidence-
based nursing practice.
Patients/problem What is the problem and/or patient population under investigation?
I.  Intervention  Will you be given a new medication? Is there going to be a change in a technique or a
treatment?
C. Comparison  Will it is compared to a commonly prescribed medication, therapy, or procedure?
O. Outcome What is it that has to be done? What are you hoping to achieve?
T . Time How long will the information be collected?
Example of a PICOT;   Nursing example;

P. Perioperative cardiac surgery patient
I.  Chlorhexidine bath wipes, the comparison intervention
C. Used for soap and water.
O. No post-operative wound infection on surgical site.
T. Post-operative time for example (2wks).

The research backs up the claim that cardiac surgery patients who were showered with chlorhexidine
wipes had a lower incidence of sternal wound infection than those who were simply, treated with soap
and water.
Medical example;
P. Patient with cardiac failure.
I. Digoxin usage
C. Education on digoxin toxicity weekly/monthly session
O. Patient awareness of signs of digoxin toxicity
T. Weekly or monthly. evaluation based.

Reference;  Echevarria, Ilia M. MS, MSN, RN, CCRN, CHES, NEA-BC; Walker, Susan DrNP, RN-BC Start with
a PICOT question to make your case, Nursing Critical Care: May 2015 – Volume 10 – Issue 3 – p 14-16 DOI:
10.1097/01.CCN.0000464307.39978.1a
Helbig, J. (2018). History and Process of Nursing Research, Evidence-Based Nursing Practice, and
Quantitative and Qualitative Research Process. Nursing Research: Understanding Methods for Best

Practices.https://lc.gcumedia.com/nrs433v/nursing-research-understanding-methods-for-best-
practice/v1.1/#/chapter/1
, CHIEN, Li-Yin Evidence-Based Practice, and Nursing Research, Journal of Nursing Research: August 2019
– Volume 27 – Issue 4 – p e29 DOI: 10.1097/Jnr.0000000000000346


Jana Garcia
replied toFarida Rajwani
Apr 10, 2022, 2:38 PM
 Replies to Farida Rajwani
Hello Fraida,
Thank you for you post. When understanding PICOT, I keep in mind that I have to formulate a word
search in a data bank to find research studies. A well written question includes (P) population
(I)intervention(C)comparison(O)outcome and (time frame), should be short and to the point without
added language, descriptions, or directions. Consider this advice I found in the Editorial, The
Underappreciated and Misunderstood PICOT Question: A critical Step in EBP Process, "words placed into
the search data base are the exact words the computer is going to scan in the literature, so the more
words, the less you will find" (Gallager, 2019). This is good to know because we will save ourselves time
concentrating on the basic word in our search, this starts with a well written question. Consider this
advice I found on well written PICOT question in Nursing & Health Sciences Research Journal, "Good
research questions are complex involving critical thinking and are relevant, focused, and feasible"
(Bermudez, 2021). Bermudez explains some questions are not reasonable, focused or feasible. She
states, “What will happen if this research is not done – does it really matter?” (Bermudez, 2021). In
other words, if our PICOT question isn't going to benefit anyone, it's not reasonable, focused, or
feasible. When researching studies, we can pay close attention to the "limitations" section of the
studies. If there are several limitations, it may not be a feasible question. Bermudez states, "potential
limitations determine the degree to which these limitations will significantly impact the study". If we are
looking for answers to an irrelevant, unfocused, unfeasible question, we may not find any answers.
Respectfully, Jana

Gallagher Ford, L., & Melnyk, B. M. (2019). The Underappreciated and Misunderstood PICOT Question: A
Critical Step in the EBP Process. Worldviews on evidence-based nursing, 16(6), 422–423.
https://doi.org/10.1111/wvn.12408

Bermudez, N. (2021). Formulating Well-Written Clinical Practice Questions and Research
Questions. Nursing & Health Sciences Research Journal, 4(1), 70–82.

Gale Storm-Bryant
Posted Date
Apr 6, 2022, 8:51 PM
Nurses practice revolves around the nursing process (Toney—Butler, Thayer, 2021). Nurses practice
revolves around the improvement of the patient and the care process. It resembles the PICOT in many
ways like the intervention/would be the planning process, the comparison/would be the
implementation and the outcome /would be the evaluation. PICOT is used to develop the question
needed to be researched and answered with evidence (Helbig, 2018) and the nursing process steps
provide answers in the evaluation phase. The difference between a nursing or medical practice problem,
nurses practice works to improve patient care and medical provides the cause or pathology of the
patient. Nurses must practice within their scope of practice (OP, 2010).
An example of a nursing PICOT:
P: Patient – Adults 65 and over with constipation
I: Intervention – Encourage to exercise 45 min per day
C: Comparison – Patients who do not exercise
O: Outcome – Increased bowel movements in a week
T: Time Frame – 1 month

An example of a medical PICOT:
P: Patient – 65-year-old complaining of knee pain
I: Intervention – MRI
C: Comparison – MRI of normal knee
O: Outcome – Diagnosis of Arthritis
T: Time Frame – 2 weeks

It is important for nurses to ensure their PICOT is based on nursing care of physical and psychological
and not a pathological diagnosis (OP, 2010). Nursing diagnosis is different from diagnosing a patient's
health issue for treatment as doctors do. Nurses must remain within their scope of practice.

References:

Helbig, J. (2018). History and Process of Nursing Research, Evidence-Based Nursing Practice, and
Quantitative and Qualitative Research Process. Nursing Research: Understanding Methods for Best
Practices.
https://lc.gcumedia.com/nrs433v/nursing-research-understanding-methods-for-best-
practice/v1.1/#/chapter/1

Office of Professions (OP), (2010, June 18th). Education Law. Article 139, Nursing
http://www.op.nysed.gov/prof/nurse/article139.htm#sect6902

Toney-Butler TJ, Thayer JM. [Updated 2021 Jul 9]. Nursing Process. StatPearls [Internet].
https://www.ncbi.nlm.nih.gov/books/NBK499937/

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