Medical team

Formulating a question that targets the goal of your research is a challenging but essential task. The question plays a crucial role in all other aspects of the research, including the determination of the research design and theoretical perspective to be applied, which data will be collected, and which tools will be used for analysis. It is therefore essential to take the time to ensure that the research question addresses what you actually want to study. Doing so will increase your likelihood of obtaining meaningful results.

In this first component of the Course Project, you formulate questions to address a particular nursing issue or problem. You use the PICO modelpatient/population, intervention/issue, comparison, and outcomeoutlined in the Learning Resources to design your questions.

To prepare:

Review the article, Formulating the Evidence Based Practice Question: A Review of the Frameworks, found in the Learning Resources for this week. Focus on the PICO model for guiding the development of research questions.

Review the section beginning on page 75 of the course text, titled, Developing and Refining Research Problems in the course text, which focuses on analyzing the feasibility of a research problem.

Reflect on an issue or problem that you have noticed in your nursing practice. Consider the significance of this issue or problem.

Generate at least five questions that relate to the issue which you have identified. Use the criteria in your course text to select one question that would be most appropriate in terms of significance, feasibility, and interest. Be prepared to explain your rationale.

Formulate a preliminary PICO questionone that is answerablebased on your analysis. What are the PICO variables (patient/population, intervention/issue, comparison, and outcome) for this question?

Note: Not all of these variables may be appropriate to every question. Be sure to analyze which are and are not relevant to your specific question.

Using the PICO variables that you determined for your question, develop a list of at least 10 keywords that could be used when conducting a literature search to investigate current research pertaining to the question.

To complete:

Write a 3- to 4-page paper that includes the following:

A summary of your area of interest, an identification of the problem that you have selected, and an explanation of the significance of this problem for nursing practice

The 5 questions you have generated and a description of how you analyzed them for feasibility

Your preliminary PICO question and a description of each PICO variable relevant to your question

At least 10 possible keywords that could be used when conducting a literature search for your PICO question and a rationale for your selections

Please use all scholarly research articles and 5 references total

Reference:

Davies, K. S. (2011). Formulating the evidence based practice question: A review of the frameworks. Evidence Based Library and Information Practice, 6(2), 75�80.

CASE OF INTEREST:

During a monthly feedback session by the medical team in a hospital’s Palliative and Home Based department, it was observed that chronic wounds of patients on  vacuum assisted closure (VAC) generally took a shorter time to heal than those on other interventions. This drew the interest of the team, who decided to conduct an informal interview with patients who either had had wound care done, or were on wound care at home. 30 patients were interviewed over the next 5 weeks, 15 of whom had received VAC  care either immediately before (up to 1 month prior) or during that period. True to the initial observation, most of those who had received VAC reported quicker healing (less than 4 weeks) than their counterparts. They further expressed more satisfaction with the quality of wound care unlike those on traditional wound care. Coincidentally, of those expressing satisfaction with VAC, 5 of them had had diabetic related wounds. Jay, a member of the team, is interested to find out why VAC is more efficient than the other traditional wound healing approaches in diabetic wounds.

My interest is picked from the above scenario. Mine is to find out the reason for faster healing and better outcome due to VAC in the context of helping the team understand the reason for the results that they found.

Home care for the sick has been viewed as a very important role in patient care (Nightingale, 1874). Wound formation example bedsores, is one of the challenges faced by home based patients, especially so due to limited mobility. Vacuum assisted wound closure (VAC), a method utilizing negative pressure created by a pump (Fogg, 2009), has been gaining popularity as a remedy over the earlier methods. Though in need for more evidence according to a 2010 review, (Plumb, Lyratzopoulos, Gallo, & Campbell, 2010) it has been shown to be effective in managing diabetic foot (Xie, McGregor & Dendukuri, 2010) , and chronic wounds  (Fogg, 2009).

This will enable the nurses and other members of the team to understand the rationale behind VAC utilization based on latest evidence and reason for preference over the traditional techniques, in chronic wound care.

PICO is an approach that is used to facilitate easy search for research questions in the medical field. The mnemonic PICO stands for P= Patient or population; the person or group of people with the medical condition of interest. I= Issue/ intervention; the key intervention to be considered. C= Comparison; the key comparison variable. O= Outcome, the expected result (Richardson, Wilson, Nishikawa, & Hayward, 1995). We will use it to analyze the possible topic of interest.

Possible questions for study, and their analysis:

  1. How does VAC compare with other wound management methods in the long term care for the home- based care patients in terms of time and quality of chronic wound healing?

P=home- based care patients with chronic wound. I= VAC. C= wound management methods other than VAC. O= time taken for healing & quality of healing

  • In chronic wound patients receiving home health care, how does the use of wound VAC therapy improve and decrease healing time of a wound over traditional wound care methods?

P=home- health care patients with chronic wound. I=VAC. C= Traditional wound care. O= how healing is improved & time for healing reduced

  • Why is VAC more effective compared to traditional methods of chronic wound care in home based care?

P=home based care patients with chronic wounds. I=VAC. C=traditional wound care methods. O= Reason for better effectivity

  •  In diabetic wound patients receiving home health care, how does the use of wound VAC therapy improve and decrease healing time of a wound over traditional wound care methods?

P=diabetic wound patients on home based care I= VAC. C= Traditional wound care. O= improved healing, shorter time for healing

  • What is the relationship between satisfaction with quality/ time of wound healing and VAC technique, compared against traditional wound care methods among home- based care patients?

P=home based wounded patients; I =VAC; C=VAC and traditional wound care techniques; O=patient satisfaction

Preferred PICO question is the second: In chronic wound patients receiving home health care, how does the use of wound VAC therapy improve and decrease healing time of a wound over traditional wound care methods?

The dependent variables are: ‘improved wound healing’ and ‘decreased healing time.’ These are the expected outcomes- the main interest of the study.

The independent variables are: ‘VAC therapy’ and ‘traditional wound care methods.’ These will be manipulated in order to observe their effect on the subjects

Keywords: VAC; wound; healing; home- based; clinical; negative pressure; chronic; surgical; PICO; treatment.

REFERENCE

Fogg, E.2009. Best treatment of non-healing and problematic wounds. Journal of the American  Aca Fogg demy of Physician Assistants. 22 (8): 46, 48.

Nightingale, F. (1874) Suggestions for Improving the Nursing Service o f Hospitals and

On Methods o f Training Nurses for the Sick Poor

Plumb J., Lyratzopoulos, G., Gallo, H. & Campbell, B. 2010. Comparison of the assessment of

five new interventional procedures in different countries. International Journal of Technology Assessment in Health Care, 26:1 (2010), 102–109. Cambridge University Press.

Richardson,W., Wilson, M.,Nishikawa, J., & Hayward, R. 1995. The well-built clinical question: A key to evidence-based decisions. ACP Journal Club, 123, A12-13. Pg 75-80

Xie, X. McGregor, M. & Dendukuri, N. 2010. The Clinical effectiveness of negative pressure wound therapy: a systematic review. Journal of Wound Care 19 (11):490-495.

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