Picot Question and References 1 Picot statement
Olabisi Babalola
Grand Canyon University NRS-433V Introduction to Nursing Research
July 30th, 2017 Introduction
Despite the amount of documentation done on patient education, working in a
medical/surgical unit, patient still seem unaware of why they are in the hospital, unaware of their
medication and of their disease process
How can we ensure effective, measurable patient education of patients in the acute care setting.
Picot Question
Population: Adult patients on the medical/surgical floor Picot Question and References 2 Intervention: Develop a questionnaire with open ended questions on what patients have learnt
about their present diagnoses and medication before discharge.
Outcome: Data collected on questionnaire will give insight into the effectiveness of present
method of patient education and if not effective, developing new or improve the present method
of patient education.
Time: Questionaire given to patients day before discharge.
PICOT Question: Disparity between nursing documentation and patient knowledge: How
effective is the present patient education in acute care settings.
References and Abstract
Breimaier, H. E., Heckemann, B., Halfens, R. G., & Lohrmann, C. (2015). The Consolidated Framework for
Implementation Research (CFIR): a useful theoretical framework for guiding and evaluating a guideline
implementation process in a hospital-based nursing practice. BMC Nursing, 14(1), 1-9.
doi:10.1186/s12912-015-0088-4
Background: Implementing clinical practice guidelines (CPGs) in healthcare settings is a complex
intervention involving both independent and interdependent components. Although the Consolidated
Framework for Implementation Research (CFIR) has never been evaluated in a practical context, it
appeared to be a suitable theoretical framework to guide an implementation process. The aim of this
study was to evaluate the comprehensiveness, applicability and usefulness of the CFIR in the
implementation of a fall-prevention CPG in nursing practice to improve patient care in an Austrian
university teaching hospital setting. Methods: The evaluation of the CFIR was based on (1) team-meeting
minutes, (2) the main investigator's research diary, containing a record of a before-and-after, mixedmethods study design embedded in a participatory action research (PAR) approach for guideline Picot Question and References 3 implementation, and (3) an analysis of qualitative and quantitative data collected from graduate and
assistant nurses in two Austrian university teaching hospital departments. The CFIR was used to organise
data per and across time point(s) and assess their influence on the implementation process, resulting in
implementation and service outcomes. Results: Overall, the CFIR could be demonstrated to be a
comprehensive framework for the implementation of a guideline into a hospital-based nursing practice.
However, the CFIR did not account for some crucial factors during the planning phase of an
implementation process, such as consideration of stakeholder aims and wishes/needs when
implementing an innovation, pre-established measures related to the intended innovation and preestablished strategies for implementing an innovation. For the CFIR constructs reflecting & evaluating
and engaging, a more specific definition is recommended. The framework and its supplements could
easily be used by researchers, and their scope was appropriate for the complexity of a prospective CPGimplementation project. The CFIR facilitated qualitative data analysis and provided a structure that
allowed project results to be organised and viewed in a broader context to explain the main findings.
Conclusions: The CFIR was a valuable and helpful framework for (1) the assessment of the baseline,
process and final state of the implementation process and influential factors, (2) the content analysis of
qualitative data collected throughout the implementation process, and (3) explaining the main findings. Neville, C. E., McCourt, H. J., McKinley, M. C., Lowis, C., Barrett, S. L., McGuinness, B., & ... Woodside, J. V.
(2013). Encouraging lifestyle behaviour change in mild cognitive impairment patients: development of
appropriate educational material. Aging & Mental Health, 17(3), 276-286.
doi:10.1080/13607863.2013.768210 Abstract:
Objectives:A healthy lifestyle may help maintain cognitive function and reduce the risk
of developing dementia. This study employed a focus group approach in order to gain
insight into opinions of mild cognitive impairment (MCI) patients, caregivers (CG) and Picot Question and References 4 health professionals (HP) regarding lifestyle and its relationship with cognition. The
qualitative data were used to design, develop and pilot test educational material (EM) to
help encourage lifestyle behaviour change.Method:Data gathering phase: structured
interviews were conducted with HP (n= 10), and focus groups with MCI patients (n= 24)
and CG (n= 12). EM was developed and pilot tested with a new group of MCI patients
(n= 21) and CG (n= 6).Results:HP alluded to the lack of clinical trial evidence for a
lifestyle and MCI risk link. Although they felt that lifestyle modifications should be
recommended to MCI patients, they appeared hesitant in communicating this
information and discussions were often patient-driven. MCI patients lacked awareness
of the lifestyle cognition link. Participants preferred EM to be concise, eye-catching and
in written format, with personal delivery of information favoured. Most pilot testers
approved of the EM but were heterogeneous in terms of lifestyle, willingness to change
and support needed to change.Conclusion:MCI patients need to be made more aware of
the importance of lifestyle for cognition. EM such as those developed here, which are
specifically tailored for this population would be valuable for HP who, currently, appear
reticent in initiating lifestyle-related discussions. Following further evaluation, the EM
could be used in health promotion activities targeting MCI patients.
Haspeslagh, A., De Bondt, K., Kuypers, D., Naesens, M., Breunig, C., & Dobbels, F. (2013).
Completeness and satisfaction with the education and information received by patients
immediately after kidney transplant: a mixed-models study. Progress In Transplantation, 23(1),
12-22. doi:10.7182/pit2013249
Context-Self-management is important in ensuring good clinical results in kidney transplant
recipients. It was unclear whether the current education program at a single kidney transplant
center sufficiently prepares recent transplant recipients for the many complex self-management
tasks required. Objective-To evaluate the completeness of and the satisfaction with the current
inpatient kidney transplant education program and to determine recipients' needs for
information in the first months after discharge. Methods-We used a concurrent mixed-methods
design, including 31 kidney transplant recipients who were assessed via a semistructured
interview (qualitative part) and a questionnaire specifically designed for this study, consisting of
30 Likert-type and open-ended questions (quantitative part). Results-Kidney transplant patients
reported having received extensive information about medication use after transplant surgery
(antirejection medication, 93.5%). Information about healthy lifestyle (physical activity and
rehabilitation, 54.8%), return to work (54.8%), and emotional coping (25.8%) was considered
suboptimal, although most patients expressed a need for such information. Patients indicated a
need for more concrete and practical information, not only during their hospital stay, but also in
the long term after transplant. Conclusions-This is the first mixed-models approach showing that
our education program immediately after transplant focuses on the transfer of factual
knowledge, which seems to insufficiently train patients in developing self-management skills.
Updates of our program are warranted to overcome the gaps in the information provided, to
provide more practical tips, and to repeat education in the long-term after the transplant
surgery, tailored to the patients' needs Picot Question and References
Roy, D. (2015). HEALTH PROFESSIONAL AND FAMILY PERCEPTIONS OF POST-STROKE INFORMATION.
Nursing Praxis In New Zealand, 31(2), 7-24. Abstract
The global burden of stroke is increasing. Many stroke survivors live with significant
impairment; the care and support they
and their families require is complex. Literature indicates some evidence to support
the routine provision of information
to stroke survivors and their families, but the best way to provide information is
unclear. We undertook a mixed methods
descriptive survey to ascertain information needs of stroke families through
identifying current practice and resources,
the appropriateness, accessibility, timeliness and information gaps. The survey,
which is embedded in a longitudinal
research programme titled ‘Stroke Families Whānau Programme’, was used to gain
an understanding of family members’
(n=19) and practitioners’ (n=23) opinions on information provision post-stroke.
Qualitative and quantitative data were
collected via face-to-face interviews. Descriptive statistics were used to analyse
quantitative data; content analysis was
used for qualitative data. We found that for families, access to information was
variable, both in quality and timeliness.
Most described being overwhelmed initially with information they could not absorb;
then later floundering as they
had to find their own way through the maze. Few could recall information that
focused specifically on them as family
members. Health professionals described a range of resources and practices used
to provide information. They identified
barriers to effective provision of information, including language and other
communication barriers, time constraints
and workload issues. Most did not assess health literacy levels or consider family
needs to be separate to or different
from the stroke survivor’s. We concluded that access to appropriate information
post-stroke was problematic for most
families and was compounded by the nature of the experience; shock following the
sudden onset and adjusting to
changed family dynamics. Health professionals recognised the limitations of
resources, time, and funding alongside the
need for timely, quality education for families post-stroke, however, a gap was
identified between health professionals’
theoretical understanding of best practice in information provision and their actual
practice. 5 Picot Question and References 6 Sánchez González, J. C., Martínez Martínez, C., Bethencourt Fernández, D., & Pablos López, M. (2015).
The assessment of knowledge about treatment in haemodialysis patients. Enfermería Nefrológica, 18(1),
23-30.
Introduction: The increase in the number of patients with chronic kidney disease (CKD) who require
renal replacement therapy is a fact in our healthcare environment. Hemodialysis (HD) is one of the
alternative treatments of choice for these patients. The patients often have doubts and behaviours that
suggest a lack of knowledge on hemodialysis and aspects around it such as forgetting medication and
ignorance of dietary rules among others. The lack of such knowledge can lead to treatment no
adherence what establish a important health problem. The aim of our study was to analyze the
information and knowledge grade in hemodialyzated patients about the HD, diet, medication and their
vascular access (VA). Material and methods: We did a cross-sectional study in which, with a inquiry, we
studied the knowledge grade about hemodialysis treatment in patients with CKD who received
hemodialysis at the 'Fundación Jiménez Díaz Hospital'. 32 patients were evaluated, for statistical analysis
the mean and standard deviation for quantitative variables, and frequency table and contingency tables
for qualitative variables was used. For hypothesis testing the test of Chi-square test was used. Results:
The successes rate was 14.44 ± 2.75, a total of 18 questions. Our patients generally have mid / high
knowledge, dependent on age, occupation and if they cook their own food. Conclusions: According to
others studies we believe to keep a continuous education throughout treatment is essential, in addition
to periodic reviews to indicate the knowledge grade. Tobiano, G., Marshall, A., Bucknall, T., & Chaboyer, W. (2015). Patient participation in nursing care on
medical wards: An integrative review. International Journal Of Nursing Studies, 52(6), 1107-1120.
doi:10.1016/j.ijnurstu.2015.02.010 Picot Question and References 7 Abstract:
Background: Patient participation is a way for patients to engage in their nursing care.
In view of the possible link between patient participation and safety, there is a need for
an updated review to assess patient participation in nursing care. Objectives: To
investigate patients' and nurses' perceptions of and behaviours towards patient
participation in nursing care in the context of hospital medical wards. Design: Integrative
review. Data sources: Three search strategies were employed in August 2013; a
computerised database search of Cumulative Index of Nursing and Allied Health
Literature, Cochrane Library, Medline and PsychINFO; reference lists were handsearched; and forward citation searching was executed. Review methods: After reviewing
the studies, extracting study data and completing summary tables the methodological
quality was assessed using the Mixed-Methods Assessment Tool by two reviewers.
Reviewers met then to discuss discrepancies as well as the overall strengths and
limitations of the studies. Discrepancies were overcome through consensus or a third
reviewer adjudicated the issue. Within and across study analysis and synthesis of the
findings sections was undertaken using thematic synthesis. Results: Eight studies met
inclusion criteria. Four themes were identified - enacting participation, challenges to
participation, promoting participation and types of participation. Most studies included
were conducted in Europe. The majority of studies used qualitative methodologies, with
all studies sampling patients; nurses were included in three studies. Data were largely
collected using self-reported perceptions; two studies included observational data.
Methodological issues included a lack of reflexivity, unvalidated data collection tools,
sampling issues and low response rates. Conclusions: On medical wards, patients and
nurses desire, perceive or enact patient participation passively. Challenging factors for
patient participation include patients' willingness, nurses' approach and confusion
around expectations and roles. Information-sharing was identified as an activity that
promotes patient participation, suggesting nurses encourage active communication with
patients in practice. Involving patients in assessment and care planning may also
enhance patient participation. For education, enhancing nurses' understanding of the
attributes of patient participation, as well as patient-centred care approaches may be
beneficial for medical ward nurses. From here, researchers need to examine ways to
overcome the barriers to patient participation; further nurse participants and
observational data is required on medical wards.

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