To identify a problem or concern that nursing can change and develop a PICO question to
guide the change project.
Step 2: 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 3: What is the scope of the problem? Does this problem affect an individual, population, or an
entire institution?
PICO Worksheet
What is the practice issue/problem?
The focus is on the effects of nursing care management coupled with telehealth technology on CHF
patients. Telehealth is one of the new trends in nursing. It is attractive and very feasible solution which
has been associated with high patient outcomes in healthcare facilities which have integrated the
policy. It has been associated with reduced workloads leading to effective quality care service delivery.
However, the acceptance of the technology has hindered the implementation of the facility in the
health care. The concerns include the autonomy and the interference with nurse-patient relationship.
This calls for a tailor-made solution to improve the acceptance. This is challenging because the current
approaches seems to be generic. In this context, implementation strategy includes promotion of
telehealth system to CHF will involve collaborative involvement including training and support could
improve the CHF patient care.
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
X_ Unsatisfactory patient outcomes
_ Wide variations in practice
_X 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 is the scope of the problem?
_ Individual _X Population X Institution/system
What is the PICO question? What nursing care interventions coupled with telehealth technology are
the most effective in improving Congestive Heart Failure Patient’s quality of life.
Define each element of the question below:
P- (Patient, population, or problem): The presenting issue is care management by Nurses on CHF
Patients.
CHF is associated with increased re-hospitalization, ER visits and mortality. Additionally, nurses are
overwhelmed by the workload presented by these incidences. The overall cost of care and management
is alarmingly high and deserves considerable attention.
I- (Intervention): The intervention being considered is the integration Telehealth technology in nursing
care on CHF patients.
The aim is to improve the patient’s quality of life and simultaneously providing workload relief to the
nurses; thereby reducing the CHF cost of care to considerable charges.
C- (Comparison with other treatment/current practice): This intervention will be compared with the
standard nursing care.
Some health care providers have not yet accepted telehealth technology citing autonomy and nurse-
patient relations. There is need to compare the Telehealth integrative care for CHF patients with other
conventional standard care.
O- (Desired outcome): The outcome expected is reduced re-hospitalization, Emergency room visits and
other costs of care associated with CHF. The reduction of nurse workloads and improvement on the
quality of life for CHF patients are also considered.
What evidence must be gathered? (check all that apply)
X Literature search Guidelines
Expert Opinion _X Patient Preferences
_ Clinical Expertise X Financial Analysis
_X_ Standards (Regulatory, professional, community)
_ Other
List possible search terms, databases to search, and search strategies:
There are various databases provided by CNN library; however, only few databases adequately address CHF care
management using telehealth technology. These databases include; CANAL, DYNAMIC, Nursing reference center
and Medline.
The research question heading “What nursing care interventions coupled with telehealth technology are the most
effective in improving Congestive Heart Failure Patient’s quality of life” was used to search for relevant articles
“was used to run the search in the databases.
If the search results are not satisfactorily, it is important for the researcher to think of brainstorming key word.
The key word are then put together and used in the search. Use of key word to search the topic adequately
expands the focus of search. Secondly, the researcher may consider using more than one search engine; this will
provide further search results. The researcher is also advised to look beyond the first search page results.
In this context, the key words used for search includes: CHF, Telemonitoring technology, Role of nurses in CHF
management, recent trends in CHF care, Benefits of Telehealth, hazards associated with telehealth in CHF care,
improving CHF patient’s quality of life and CHF patient centered care. These key words were used in CIHANL,
MEDLINE, PROQUEST and EBSCOHOST search engines which generated to a total of 1520 articles. To refine the
number of articles generated from the search of CHF management using Telehealth, advanced search subject
headings in the relevant data base such as EBSCOHOST were used. Additionally, Boolean limiters were used to
refine the results. The articles regenerated were refined to 100 articles.
After skimming through the articles, 46 articles were relevant to the research study. Using limiters such as peer
reviewed articles, year of publication; a total of eighteen articles matched the requirements for the research
topic. Five of the articles were from nursing magazines excerpts, eight were on Telehealth and CHF management,
and six articles were on CHF management but did not include the integration of the modern technology aspect.
From the research, out of ten, only four of the articles that matched the research topic will be analyzed. The
articles chosen are limited between 2010 and 2015 to ensure that only up to date information has been used.
However, earlier articles were briefly read to identify relevant previous health information is not omitted.
Chamberlain College of Nursing NR 451 RN Capstone Course
NR451 Milestone1 PICO Evidence Appraisal Worksheets.docx 11/17/14 mk 2
EVIDENCE APPRAISAL WORKSHEET
Your Name:
Date:
Your Instructor’s Name:
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 forth 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?
Chamberlain College of Nursing NR 451 RN Capstone Course
NR451 Milestone1 PICO Evidence Appraisal Worksheets.docx 11/17/14 mk 3
Evidence Appraisal Worksheet
PICO Question:
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 Lawton, G. (2010). Telehealth
Delivers many benefits, but
concerns linger. PTin motion
journal.
CIHANL
Non-research
The article is a systematic
review research method. It
summarizes previous works
conducted by the researchers,
and thus, it makes it easy to
identify knowledge gap.
Study limitations identified
were time and financial
constraints.
For these reasons, report
evidence is ratings are Good.
The article addresses the
benefits associated with
telehealth technology. It also
highlights the barriers which
are impeding successful
integration of the technology
in the health care sector.
There are no results in this
paper because it is a peer
reviewed.
Study recommends integration
of telehealth in healthcare
system. The research tool
applicable in research topic is
its literature review.
Conclusions are deductive
2 Paul, YT. , Gregory, Pecina, J.,
Stroebel, R., Chaudhry, R.,
Shah, N.D., & Naessens, JM.
(2010). A randomized
controlled trial of
telemonitoring in older adults
with multiple chronic
conditions: the Tele-ERA study.
BMC Health Services Research
10: 255
Proquest
Peer reviewed
The article applied the
randomized controlled trial
research system. T. This
reduces introduction of
potential bias in the study.
Additionally, the study
population of two hundred
patients was adequate to
divide the group to
intervention and control
group. The main limitation is
that the study lacked inherent
blind group; which could have
resulted to Hawthorne error
and introduction to error. The
study ratings are High.
The article analyzes the impact
of home based telemonitoring
on adults diagnosed with
multiple cardiovascular
pathologies. The article
evaluates the effectiveness of
the strategy in reducing
disease management costs
such as hospitalization,
Emergency visits among the
elderly >60 years.
Study results indicated a 27.1%
reduction in re-hospitalization
rate and 38.2% Emergency
visit as compared to standard
care
The study concluded by
indicating that use of
telemonitoring technology in
cardiovascular patients
improves the quality of life for
the patient. However, the
study pinpointed cost
effectiveness as the main
challenge of adopting the
technology. Recommendations
on further research for cost