Prepare this assignment as a 1,500-1,750 word paper using the instructor feedback from
the previous course assignments and the guidelines below.
Revise the PICOT question you wrote in the Topic 1 assignment using the feedback you
received from your instructor.
The final PICOT question will provide a framework for your capstone project (the project
students must complete during their final course in the RN-BSN program of study).
In the Topic 2 and Topic 3 assignments, you completed a qualitative and quantitative
research critique on two articles for each type of study (4 articles total). Use the feedback
you received from your instructor on these assignments to finalize the critical analysis of
each study by making appropriate revisions.
The completed analysis should connect to your identified practice problem of interest that
is the basis for your PICOT question.
Refer to “Research Critiques and PICOT Guidelines – Final Draft.” Questions under each
heading should be addressed as a narrative in the structure of a formal paper.
Proposed Evidence-Based Practice Change
Discuss the link between the PICOT question, the research articles, and the nursing
practice problem you identified. Include relevant details and supporting explanation and
use that information to propose evidence-based practice changes.
Critiques and PICOT Final Draft
Among adults with a genetic history or predisposition to obesity (BMI> 30), how effective is the
adoption of interventions aimed at preventing obesity incidences within healthcare systems
compared to the implementation of treatment plans that focus on patient involvement in safety-
CRITIQUES AND PICOT FINAL DRAFT 2
related programs such as dietary carbohydrate in the maintenance of a healthy weight (BMI<25)
for 12 weeks?
Nursing Practice Problem
Due to the significant increase in obesity incidences across the world, the condition has
rapidly become a leading cause of preventable mortalities related to numerous comorbid
conditions, including type 2 diabetes, hypertension, and nonalcoholic fatty liver disease,
hypercholesterolemia, and hypertriglyceridemia, among others. Consequently, these
comorbidities, coupled with poor diet and overweight individuals, have intensified the risk
factors for disease burden in the United States. For instance, Wang et al. (2018) stipulate that the
increased population of obese and overweight adults has substantially overwhelmed Australia’s
health system. The occurrence of such events is primarily based on the continued consumption of
unhealthy food, which has, in turn, driven the obesity epidemic and further influenced the
availability, prices, and promotion of ultra-processed foods.
More precisely, the increase in mortality rates among obese individuals is based on
comorbid conditions, which exacerbates the underlying challenges and complicates the processes
carried out within healthcare facilities. Although various recommendations and proposals have
been suggested by different governments to address obesity and overweight issues, little progress
has been made due to the failure to implement them comprehensively or sustainably that
guarantees effectiveness. For instance, Wang et al. (2018) point out that the continued
government investment in the acute care system has contributed to the addition of healthcare
professionals’ roles and nursing practices.
CRITIQUES AND PICOT FINAL DRAFT 3
The underlying health conditions associated with obesity or overweight tend to
overwhelm the healthcare workers’ responsibilities as they strive to deliver quality care services
to the ailing directly as physicians and nurses or indirectly as assistants, technicians, and aides,
among others. As a result, the adoption of interventions aimed at preventing obesity incidences
within healthcare systems has been associated with the loss of sight of the physicians and nurses’
health and well-being as they confront the stresses of increased workload, rapidly increased
knowledge bases, and an increase in government regulations. These factors are followed closely
by malpractice suits and the determination of suitable ways to balance the personal and
professional lives among health workers (Macpherson- Sánchez, 2015).
Background of the Studies
Wang et al. (2018) highlight that patients and healthcare professionals alike have a
fundamental role to play in the improvement of desired health outcomes. Similarly, in their
study, Skagerström et al. 2017 applied a qualitative approach that focused on assessing nurses’
experiences and their perceptions of involving recuperating patients in safety-related treatment
plans. As a result, the researchers determined that patients and healthcare workers have a
collective responsibility to improve health outcomes. These findings were grounded on the
notion that the increment of patient-involvement in safety-related programs could significantly
enhance healthcare and nursing practices, in general. Conversely, Sun et al. (2020) postulate that
the COVID-19 pandemic has brought unprecedented challenges and intense pressure on
healthcare workers and nurses. The authors sought to assess healthcare workers’ psychological
status at the forefront of providing the necessary care services to individuals diagnosed with
COVID-19. Most fundamentally, the authors realized that, due to the intense pressure from the
CRITIQUES AND PICOT FINAL DRAFT 4
heavy workload brought along by the numerous patients and their distinct health conditions,
healthcare workers feel disregarded and left out (Sun et al. 2020).
Contrastingly, Hall et al. (2016) highlight that the well-being of healthcare workers
(physicians and nurses alike) plays a pivotal role in the quality of patient-centered care delivered
and the reduction of medical errors. These findings are followed closely by the stipulation that
impoverished well-being and the escalation of burnout among healthcare professionals translate
into poor patient safety based on medical errors. As such, the study’s objectives entailed
assessing the link between burn among healthcare professionals and the well-being, as well as
the safety of patients. On the other hand, Giacchero Vedana et al. (2017) conducted a study to
determine nursing practitioners’ attitudes towards suicidal behavior and other related factors. As
such, the authors noted that the nurses’ attitudes in the emergency department towards suicidal
thoughts primarily impact their ability to provide the necessary care services that guarantee
patient safety. Therefore, they sought to assess the attitudes that lead to suicidal behavior and
thoughts among nurses working in emergency environments.
The Link between the PICOT Question, the Research Articles, and the Nursing Practice
As mentioned herein, obesity and being overweight among adults predisposes them to
numerous health conditions, which adversely impact their well-being and safety in general. The
occurrence and prevalence of these health conditions call for quality, timely, and competent care
CRITIQUES AND PICOT FINAL DRAFT 5
provided by healthcare professionals across different settings. Since healthcare nurses
(physicians and nurses) are tasked with fostering patient safety by delivering patient-centered
care, the increase in health conditions among obese and overweight adults intensifies their
workload. It contributes to the deterioration of the care providers (Hall et al. 2016). Moreover,
most of the healthcare and nursing practices applied across the facilities within a nation align
with the health systems put in place by different regulatory entities based on their effectiveness
and efficiency in addressing specific issues that affect the welfare of the people. Specifically,
when faced with a particular health issue, the governmental entities within a country work
alongside intergovernmental agencies to develop suitable approaches that would guarantee
solutions, as well as the mitigation of such occurrences in the future (Macpherson-Sánchez,
Subsequently, these approaches are rolled out to the various health systems with specific
guidelines, conditions, and recommendations on their applicability. In this case, the research
articles have depicted that rolling out these approaches in a generalized healthcare system is
associated with adverse eventualities that include heavy workload on healthcare workers. The
increase of the physicians’ and nurses’ workload culminates in the deterioration of their well-
being, further hindering the delivery of quality and patient-centered care (Macpherson-Sánchez,
2015). Therefore, the PICOT question seeks to determine the effectiveness of the approaches
rolled out into the general health system by comparing them with the adoption and
implementation of treatment plans that focus on patient involvement in safety-related programs.
More precisely, the two interventions are compared in terms of their effectiveness in maintaining
healthy weight among obese and overweight adults.
CRITIQUES AND PICOT FINAL DRAFT 6
Method of Study, their Benefits and Limitations
The study conducted by Skagerström et al. 2017 follows an explorative approach in
which data from the respondents was obtained through open-ended interviews. Besides, a content
analysis technique was applied in the evaluation of the data collected. On the other hand, the
study carried out by Sun et al. (2020) focused on the incorporation of Colaizzi’s technique in the
qualitative assessment of the psychological experiences of nurses while delivering healthcare
services to patients diagnosed with the COVID-19 condition. This technique utilizes a
phenomenological approach that epitomizes the respondents’ feelings and experiences to
determine a common trend instead of individual attributes in the study subjects. The use of the
two distinct, yet similar, descriptive approaches are associated with benefits that include the
accentuation of the fundamental structure of the phenomena in any given study. For instance,
Colaizzi’s phenomenological technique facilitates the application of a seven-phase procedure that
delves into the rigorous scrutiny of the various steps used in collecting and analyzing the data.
Ultimately, the results obtained from the approach are concise and outline all the descriptions of
the event under study (Sun et al. 2020). Nevertheless, the limitation of applying this approach
includes grounds for researchers’ biases, which substantially impede the successful adoption of
the technique as it is primarily dependent on the ability to interpret the data.
On the other hand, the article by Hall et al. (2016) employed a systematic review design
focused on the assessment, identification, and synthesis of all peer-reviewed and published
resources related to a specific research question or objective. Contrastingly, the study carried out
by Giacchero Vedana et al. (2017) utilized a cross-sectional approach that describes a design that
follows a similar pattern to a systematic review except that it focuses on the identification as the
CRITIQUES AND PICOT FINAL DRAFT 7
inclusion of other works of research. The two approaches are associated with benefits that
include the provision of a broad review of all the relevant studies related to clinical or health-
related issues. Most fundamentally, the systematic review approach occurs as a result of
reviewing and integrating information from published and unpublished studies, and subsequently
developing informed and logical outcomes. Thus, it serves as an exhaustive assessment that
focuses on current literature and data from different sources, facilitating the attainment of
accuracy and reliability.
Nonetheless, the cross-sectional approach involves observational research that
incorporates an in-depth analysis of the data obtained from a particular populace. The benefits of
this approach include obtaining data from different participants with unique characteristics and
demographics. Moreover, the data collected can be replicated across different types of studies.
Nevertheless, since it captures one event at a specific point in time, the cross-sectional approach
is characterized by shortcomings that include a lack of applicability in phenomena for extended
periods (Macpherson-Sánchez, 2015).
Results of the Study
Based on the qualitative and quantitative studies, the authors determined that healthcare
workers who look after and deliver care services to COVID-19 patients are predisposed to
adverse effects that can be categorized into four levels. The first level entails the onset of
negative emotions, including discomfort, helplessness, and fatigue, that emanate from anxiety,
fear, and a heavy workload. Moreover, the second stage entails coping techniques that include
altruistic, life-modification, and team support activities that play a pivotal role in the
maintenance of the healthcare workers’ psychological well-being (Sun et al. 2020). The third
CRITIQUES AND PICOT FINAL DRAFT 8
stage entails thriving under pressure, which comprises a high level of affection and gratitude, the
enhancement of professional responsibility, and self-reflection. The last level entails the co-
occurrence and co-existence of positive and negative emotions.
Similarly, the assessment of the patients’ involvement in fostering safety-related
programs facilitated the realization that they, alongside healthcare workers, have a shared
responsibility towards the enhancement of healthcare practices and the attainment of desired
health outcomes. As stipulated by the authors in the different articles, healthcare workers tend to
focus on their roles and the policies applied within a facility instead of adopting initiatives aimed
at accomplishing patient-engagement in the improvement of patient safety (Hall et al. 2016). The
latter approach has been associated with crucial benefits that include the commencement of
dialogue between the patient and the care provider and the creation of an enabling platform to
ask the relevant questions.
Most fundamentally, the research articles’ findings indicate that burnout among nurses
and other healthcare workers has substantially contributed to medical errors. These have been
coupled with identifying the correlation between burnout, medical errors, the overall diminishing
well-being, and the safety of the patients. The correlation between these factors exemplified that
the safety of patients depends on the well-being of the healthcare workers and the policies or
practices applied within a healthcare facility (Macpherson-Sánchez, 2015).
Implications of the Studies
Most fundamentally, the studies played a pivotal role in depicting that the reliance on the
interventions within health systems, those rolled out through government investment in specific
CRITIQUES AND PICOT FINAL DRAFT 9
policies and procedures, predisposes healthcare workers to harsh working conditions and poor
physical and mental health status. For instance, they all concur that an increase in health
conditions due to risk factors such as obesity and overweight among adults, coupled with the
policies and practices applied within the health system, increase the workload for nurses and
physicians (Hall et al. 2016). Additionally, these aspects lead to the development of suicidal
thoughts for healthcare professionals working in the emergency department due to low morale
and judgmental attitudes. However, the authors advocate for the development of patient-centered
care through the involvement of the patients in the development of safety-related programs that
include dietary interventions and procedures that would facilitate the prevention of other health
conditions (Skagerström et al. 2017).
When conducting research, especially in the nursing and healthcare field, the two
fundamental ethical considerations that should be taken into account include informed consent
and respect for intellectual property and the rights of the participants. In the researcher studies
used in this case, these ethical considerations were taken into account as the determination of the
healthcare workers’ experiences necessitated the acquisition of their informed consent and
respect for their various rights. More precisely, the researchers obtained informed consent from
the respondents and participants before involving them. Similarly, they respected the
participants’ rights by withholding their identities and ensuring originality in their work
(Skagerström et al. 2017).
Outcome Comparison and Proposed Evidence-Based Practice Change
CRITIQUES AND PICOT FINAL DRAFT 10
Based on the factors identified from the various research studies, it is apparent that the
PICOT question’s anticipated outcomes include the improvement of patients’ well-being
following the implementation of treatment plans that focus on patient involvement in safety-
related programs. More precisely, the involvement of patients in the development of safety-
related programs that include carbohydrate diets for obese and overweight adults is likely to
maintain a healthy weight (Skagerström et al. 2017). The implementation of these interventions
is likely to result in more benefits for obese individuals than the adoption of interventions rolled
out by the government and international agencies to prevent obesity incidences (Macpherson-
These outcomes have been postulated by the findings obtained from the various articles
used in determining the correlation between healthcare workers’ well-being and the achievement
of patient-safety across the health systems applied in different contexts. The two points of view
have facilitated the identification of the need to change or restructure the policies and practices
applied within health systems to incorporate the opinions of healthcare workers and their ability
to develop strategies based on patient involvement in safety-related programs (Skagerström et al.
Indeed, obesity and overweight among adults is a risk factor for numerous health
conditions that may adversely impact their well-being and lead to mortality. The occurrence of
these underlying health conditions translates into a heavy workload for healthcare workers
(physicians and nurses). They are required to provide the necessary medical conditions that
safeguard the welfare of the people. Nevertheless, the health system applied within most
CRITIQUES AND PICOT FINAL DRAFT 11
facilities comprises prevention strategies. Interventions are rolled out or facilitated by
government bodies and international agencies based on their efficacy in different settings.
Although these practices are based on evidence, they bring adverse effects on the healthcare
workers in terms of heavy workloads and the predisposition to unsafe work environments and
situations. However, the patients’ involvement in the development of safety-related programs
that would enhance healthcare in various ways has been associated with substantial benefits to
both the healthcare workers and the patients. Therefore, such approaches should be adopted
alongside the policies and practices applied within healthcare facilities.
Giacchero Vedana, K. G., Magrini, D. F., Zanetti, A. C., Miasso, A. I., Borges, T. L., & Dos
Santos, M. A. (2017). Attitudes towards suicidal behaviour and associated factors among
nursing professionals: A quantitative study. Journal of Psychiatric and Mental Health
Nursing, 24(9-10), 651-659.
CRITIQUES AND PICOT FINAL DRAFT 12
Hall, L. H., Johnson, J., Watt, I., Tsipa, A., & O’Connor, D. B. (2016). Healthcare staff
wellbeing, burnout, and patient safety: A systematic review. PLOS ONE, 11(7),
Macpherson-Sánchez, A. E. (2015). Integrating fundamental concepts of obesity and eating
disorders: Implications for the obesity epidemic. American Journal of Public
Health, 105(4), e71-e85.
Skagerström, J., Ericsson, C., Nilsen, P., Ekstedt, M., & Schildmeijer, K. (2017). Patient
involvement for improved patient safety: A qualitative study of nurses’ perceptions and
experiences. Nursing Open, 4(4), 230-239.