NR 451RN Capstone Course

Capstone Project Milestone #1:

PICO and Evidence Appraisal Worksheets

PICO Worksheet

Your Name:  

Date:  May 13, 2023

Your Instructor’s Name:

Purpose: To identify a problem or concern that nursing can change and develop a PICO question to guide the change project.

Directions:Use the form below to complete the PICO assignment in Milestone #1. This includes filling in the table with information about your research question and your PICO elements.

Step 1: Select the key PICO terms for searching the evidence. Clearly define your PICO question. List each element P (problem, population, or problem), I (intervention), C (Comparison with other treatment/current practice), and O (Desired outcome). Is the potential solution something for which you (as nurse or student) can find a solution through evidence research? Look in your book for guidelines to developyour PICO question.

Step 2: Identify the problem.What have you noticed in your work or school environment that isn’t achieving the desired patient or learning outcomes? What needs to change in nursing, what can you change with the support of evidence in the literature? Describe the problem or practice issue that you want to research. What is your practice area; clinical, education, or administration? (This is NOT where you will list your PICO question)

Step 3: How was the practice issues identified?How did you come to know this was a problem in your clinical practice? Review the listed concerns and check all that apply.

Step 4: What evidence must be gathered? Everyone should have a literature search. However, what other sources of reliable information will be helpful for your particular question?

Step 5: What terms will you use in order to make sure that your search is wide enough to obtain required information but narrow enough to keep it focused? What databases will you search? How will you narrow your search if needed?

PICO Worksheet
What is the PICO question? In adult patients hospitalized in an intensive care unit, how does the use of a nurse-driven protocol for evaluating the appropriateness of short-term urethral catheter continuation or removal, compared with no protocol, affect the number of catheter days and CAUTI rates over a six month period?_________________________________________________________ Define each element of the question below: P– (Patient, population, or problem): adult patients hospitalized in an intensive care unit. I– (Intervention): nurse-driven protocol for evaluating the appropriateness of short-term urethral catheter continuation or removal. C– (Comparison with other treatment/current practice): compared with no protocol O– (Desired outcome): the number of catheter days and CAUTI rates.
What is the practice issue/problem?A significant nursing clinical issue in my nursing practice that I selected is Catheter Associated Urinary Tract Infections. Urinary tract infections (UTIs) are the most common nosocomial infection, accounting for up to 40% of infections reported by acute care hospitals. Up to 80% of UTIs are associated with the presence of an indwelling urinary catheter. A catheter-associated urinary infection (CAUTI) increases hospital cost and is associated with increased morbidity and mortality. RNs can play a major role in reducing CAUTI rates to save lives and prevent harm. It is important that the overuse of urinary catheters is reduced, and should be removed per nurse-driven evidence-based protocols. The evidence-based tool incorporates an algorithm to determine if a urinary catheter is appropriate based on nursing screening and assessments; as well as alternatives for retentions and incontinence; timely removal; and a checklist on catheter insertion.
What is the practice area? _X_ Clinical ___ Education			___ Administration ___ Other
How was the practice issue identified? (check all that apply) _X__ Safety/risk management concerns ___ Unsatisfactory patient outcomes _X__ Wide variations in practice ___ Significant financial concerns		___ Difference between hospital and community practice _X__ Clinical practice issue is a concern ___ Procedure or process is a time waster ___ Clinical practice issue has no scientific base ___ Other:
What evidence must be gathered? (check all that apply)
__X_  Literature search __X_ Guidelines ___ Expert Opinion ___ Patient Preferences	___ Clinical Expertise ___ Financial Analysis __X_ Standards (Regulatory, professional, community) ___ Other
Search terms: Catheter Associated Urinary Tract Infections (CAUTI), Urinary tract infections (UTIs)
Databases to search: Agency for Healthcare Research and Quality (AHRQ); Centers for Disease Control and Prevention (CDC); American Nurses Association; Association for Professionals in Infection Control and Epidemiology (APIC); CINAHL Plus with Full Text; and The Joint Commission.
Search Strategies: Identifying search terms; Searching with keywords; and Searching with subject headings.

Evidence Appraisal Worksheet

YourName:Lisa Green

Date:  May 13, 2016

Your Instructor’s Name:  Dr. Deborah Ellison

Purpose: To find evidence to support an intervention that will change the outcomes.

Directions: Type your search question below. Find AT LEAST FOUR sources to support the need for change and the potential intervention you have selected to solve the problem. At least three of your sources must be peer-reviewed articles. The fourth source could be another peer-reviewed article or a reliable, credible source. Look in your text for ideas of other sources that can be used. Using the table below, insert and describe your four chosen resources.

Step 1: APA Reference for the article. You will need to list the reference for the source in APA format. Be careful when using built-in APA formats and library citations. They may not be in APA format. Refer to Chapter 7 of your APA manual.

Step 2: Type of Source. If your source is a research article, you will need to ensure that it is a peer review article. You need at least three peer-reviewed articles for your project. If your article is a non–research source, then you will need to list what type of source it is; systematic review, clinical practice guidelines, organizational experience, or individual expert opinion/case study/literature review. You may only use ONE non-research source.

Step 3: Strength of Research. Refer to page 238-240 for research evidence and page 242-244 for non-research evidence. While you do not need to assign a level for each study, you will assign a quality of evidence (high, good, or low/major flaw) and should discuss the study using some of the elements that are discussed in the appraisal forms. For example, Research evidence: was the sample size adequate? Was there a controlled group? Was it a randomized study? Were results clearly stated? Was the conclusion based on the results? Were study limitations discussed? Not all of these elements need to be discussed, but you should discuss this information to determine if the strength of the evidence is HIGH, GOOD, or LOW/MAJOR FLAW.

Step 4: Brief Description of the Research. In this section, you will summarize the source in your own words. How does this information apply to your project? What are the results of the source? What are their recommendations?

Evidence Appraisal Worksheet
PICO Question:  In adult patients hospitalized in an intensive care unit, how does the use of a nurse-driven protocol for evaluating the appropriateness of short-term urethral catheter continuation or removal, compared with no protocol, affect the number of catheter days and CAUTI rates over a six month period?
	APA Reference for Article Give the APA-formatted reference for the article.	Type of Source *Research: Peer-reviewed article *Non-research systematic review, clinical practice guidelines, organizational experience, or expert opinion/case study/literature review	Strength of Research Discuss the strength of the sources. Report if evidence is High, Good, or Low/Major Flaw. Use the tools on page 238-244 of your text and discuss the reasons why you have assigned a particular level of quality.	Brief Description of Research Address the questions. *How does the information in the article apply to the project problem or proposed intervention?  *Summarize in your own words. * Include results of the study and how these results are applicable to your project. * What is the recommendation of the source for clinical practice?
1	Panchisin, T.L. (2016). Improving outcomes with the ANA CAUTI Prevention Tool. Nursing, 46(3), 55-59.	Research: Peer-Reviewed Article	Good quality: reasonable consistent results; reasonable consistent recommendations based on fairly comprehensive literature review.	The ANA CAUTI Prevention Tool is a step-by-step process in checklist form that provides the rationale for inserting an indwelling urinary catheter and guides the inserter in using sterile technique. The tool also contains key practice strategies to reduce CAUTIs, decrease catheter usage, and ensure proper insertion, maintenance, timely removal, and post removal care. This article discusses key components of this tool.
2	Marvin, C., & Mills, G. (2015). Using quality improvement methods to prevent catheter-associated UTI. British Journal of Nursing, 24, 522-528.	Research: Peer- Reviewed Article	High Quality: consistent; adequate control; definitive conclusions and consistent recommendations	Catheter-associated urinary tract infection (CAUTI) is considered to be reasonably preventable and there is an abundance of published guidance, all of which details similar CAUTI-prevention strategies. Many strategies and methods have been applied to reduce CAUTI, this article describes a quality improvement approach to the implementation of CAUTI prevention strategies, which can provide better patient experience and outcomes for patients.
3	Underwood, L. (2015). The Effect of Implementing a Comprehensive Unit-Based Safety Program on Urinary Catheter Use. Urologic Nursing, 35(6), 271-279.	Research: Peer-Reviewed Article	High Quality: consistent; adequate control; definitive conclusions and consistent recommendations	The goal of this performance improvement study was to evaluate the effect of a targeted intervention to decrease catheter-associated urinary tract infections (CAUTIs) and urinary catheter utilization by implementing quality improvement initiatives.
4	Welden, L.M. (2013). Electronic Health Record: Driving Evidence-Based Catheter-Associated Urinary Tract Infections (CAUTI) Care Practices. Online Journal of Issues in Nursing, 18(3).	Research: Peer-Reviewed Article	High Quality: consistent; generalized results; adequate control; definitive conclusions; consistent recommendations based on comprehensive literature review that includes thorough reference to scientific evidence.	In this article, the literature is reviewed and the method employed is described in the quality improvement project using the electronic health record to assist in driving evidence-based care. This QI project demonstrated a significant decrease in positive urine cultures, improved catheter care practices, and documentation of evidence-based criterion for catheter utilization.