PICOT Question and Evidence-based Approach

PICOT Question and Evidence-based Approach

PICOT Question and Evidence-based Approach

Questions and Evidence-based Approach

Urinary pretension and incontinence are some of the major indications for catheterization in hospitalized patients and outpatients. Urinary catheterization can be done through the urethra or the suprapubic routes. The urethral route is more commonly sued because it is less invasive and takes a shorter time. The principles and goals for catheterization remain the same for men and women.

PICOT Question and Evidence-based Approach

The centers for disease control and prevention (CDC) estimates that about 75% of hospital-acquired nosocomial urinary tract infections are associated with indwelling catheterization and at least 15% of patients receive indwelling urinary catheterization during their hospitalization (CDC, 2019). Catheter-associated UTIs (CAUTI) present significant mortality and morbidity in the efforts to provide safe health care.

The revised guidelines on the prevention of CAUTI in 2019 by the centers for disease control and prevention (CDC) reported women, the elderly, and immunocompromised are at increased risk of developing CAUTI. In the recommendations (Lachance & Grobelna, 2019 PICOT Question and Evidence-based Approach). This paper describes an evidence-based project that aims at comparing the suprapubic catheter. PICOT Question and Evidence-based Approach

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Formulation of Research Question and Literature Search Strategy

The immediate subsequent evidence-based practice step after topic identification is to formulate the research question. The research question helps in guiding the search for evidence. This project adopted the PICOT format. It stated: “For women requiring long-term urinary catheterization (P), does doing suprapubic catheterization (I) reduce the incidence of catheter-associated UTIs (O) than urethral catheterization (C)?” In this PICO question, the population is the women requiring long-term catheterization. In this project long-term catheterization means indwelling catheter staying in situ for more than 10 days. PICOT Question and Evidence-based Approach

The need to provide care requires that the care is safe for the patient. however, this ideal scenario is not found in the hospitals. Catheter-associated UTI presents a different health challenge in promoting care quality. Suprapubic catheterization is less used in addressing major indications for catheterization. The data presented in annual reports and periodical findings generalize the CAUTIs to all types of catheterizations (Podkovik et al., 2019 PICOT Question and Evidence-based Approach).

Addressing the safety of the two types of catheterizations in highly at-risk populations such as females, the elderly, and immunocompromised are expected to present a different dimension to care. Using the PICOT format to address will allow for a comparison of the two techniques of catheterization.

The process of searching evidence started with the definition of keywords and Boolean operators. Search filters were applied to the search results to ensure that the more recent evidence is accumulated for application into practice. Evidence databases were identified and results were compared for their relevance to the topic. Priority was given to research articles of the highest available evidence levels such as randomized control trials and systematic reviews. PICOT Question and Evidence-based Approach

Evidence Source #1

Gibson and colleagues (2019) set out to compare indwelling suprapubic and transurethral catheterization concerning CAUTI. In their research study, 418 participants in a nursing resident home requiring long-term use of indwelling catheters were enrolled. There were no criteria to assign the participants into the ureteral and suprapubic groups because the use of these techniques was simply informed by clinical decisions in the nursing home.

Eighty-three percent (173 participants had urethral catheters while 17% (35) of the participants had suprapubic catheters. Assessments were done at baseline, two weeks, one month, and one year. The study found after covariate adjustments that the suprapubic group had a lower incidence of CAUTIs than the urethral group 6.6/1000 vs 8.8/1000 cases (Gibson et al., 2019). The suprapubic group also had lower hospitalization rates and the use of antibiotics. However, the study also found out that the rate of multidrug-resistant organisms was higher in the suprapubic group. PICOT Question and Evidence-based Approach

Evidence Source #2

Jian et al.’s (2018) study aimed at comparing the suprapubic tube (ST) and urethral catheterization (UC) in patients who underwent robot-assisted radical prostatectomy (RARP). This study was a systematic review with metanalyses that involved randomized control trials and other studies. Seven articles that included three randomized control trials were included in this review.

The authors found no significant differences in shirt term outcomes between the two urinary drainage techniques. However, the suprapubic tube was associated with sleep and discomfort more than the urethral tube (Jian et al., 2018 PICOT Question and Evidence-based Approach). The incidence of CAUTIs was inferred by the rate of emergency visits and retention that were low in both groups and had no significant differences. This study noted that the suprapubic group had other major concerns such as malfunction and clot retention. PICOT Question and Evidence-based Approach

Evidence Source #3

The third source of evidence was also a systematic review with metanalyses. A study was done by Li et al. (2019) also aimed at comparing suprapubic and transurethral catheters following RARP. It was also a systematic review that included nine studies, three RCTs, and six non-RCTs. Short-term and long-term outcomes were assessed at baseline and periodically. The study found that a suprapubic catheter causes less postoperative pain as compared with the transurethral catheter (Li et al., 2019). However, there were no significant differences in catheter-associated complications such as infection and retention. PICOT Question and Evidence-based Approach

Relevance of the Above Research Findings

Urethral also known as transurethral catheterization is usually the first-choice technique in many practice settings whenever there is a need to drain the urinary bladder (English, 2017). The above findings have confirmed this fact but have also acknowledged the use of suprapubic catheterization. The first source of evidence presented a slightly significant decrease in the incidence of CAUTIs with suprapubic catheterization.

However, the subsequent sources have refuted this finding citing that the difference has been insignificant taking into account various other complications associated with suprapubic catheterization. These studies did not deny the benefits of suprapubic catheterization. These findings are relevant in answering the PICO question. Both the comparison and intervention variables have been extensively addressed. It can be safely be reported that suprapubic catheterization does not reduce the incidence of CAUTIs as compared with urethral catheterization in any population. This relevance also applies to practice in that the use of suprapubic catheterization will best be applied only where it is indicated and cannot be adopted to population interventions to reduce infections. PICOT Question and Evidence-based Approach

Conclusion

Suprapubic and urethral catheterization aim at similar outcomes but do not differ significantly in complications. This evidence-based practice project has confirmed this hypothesis through analysis of findings from three high evidence level sources. The sources included two sustentation reviews with metanalyses and one control trial. These sources would be summarized that suprapubic catheterization is bets where it is indicated, that is, where urethral catheterization is contraindicated. It does not confer any superiority in the reduction of the incidence of CAUTIs in all patient populations. This conclusion is useful in answering the PICO question and application to practice. Other interventions should be sought to reduce the CAUTI incidence.

PICOT Question and Evidence-based Approach References

CDC. (2019, October 1). Catheter-associated urinary tract infections (CAUTI). Cdc.Gov. https://www.cdc.gov/hai/ca_uti/uti.html

English, S. F. (2017). Update on voiding dysfunction managed with suprapubic catheterization. Translational Andrology and Urology, 6(Suppl 2), S180–S185. https://doi.org/10.21037/tau.2017.04.16

Gibson, K. E., Neill, S., Tuma, E., Meddings, J., & Mody, L. (2019). Indwelling urethral versus suprapubic catheters in nursing home residents: determining the safest option for long-term use. The Journal of Hospital Infection, 102(2), 219–225. https://doi.org/10.1016/j.jhin.2018.07.027

Jian, Z., Feng, S., Chen, Y., Wei, X., Luo, D., Li, H., & Wang, K. (2018). Suprapubic tube versus urethral catheter drainage after robot-assisted radical prostatectomy: a systematic review and meta-analysis. BMC Urology, 18(1), 1. https://doi.org/10.1186/s12894-017-0312-5

Lachance, C. C., & Grobelna, A. (2019). Management of patients with long-term indwelling urinary catheters: A review of guidelines. Canadian Agency for Drugs and Technologies in Health. https://www.ncbi.nlm.nih.gov/books/NBK545495/

Li, Z., Li, K., Wu, W., Wang, Q., Ma, X., Lin, C., Peng, S., Lai, Y., Wang, F., & Huang, H. (2019). The comparison of transurethral versus suprapubic catheter after robot-assisted radical prostatectomy: a systematic review and meta-analysis. Translational Andrology and Urology, 8(5), 476–488. https://doi.org/10.21037/tau.2019.08.25

Podkovik, S., Toor, H., Gattupalli, M., Kashyap, S., Brazdzionis, J., Patchana, T., Bonda, S., Wong, S., Kang, C., Mo, K., Wacker, M. R., Miulli, D. E., & Wang, S. (2019). Prevalence of catheter-associated urinary tract infections in neurosurgical intensive care patients – the overdiagnosis of urinary tract infections. Cureus, 11(8), e5494. https://doi.org/10.7759/cureus.5494

PICOT Question and Evidence-based Approach Instructions

Create a 3-5-page submission in which you develop a PICO(T) question for a specific care issue and evaluate the evidence you locate, which could help to answer the question. PICOT Question and Evidence-based Approach

Introduction

PICO(T) is an acronym that helps researchers and practitioners define aspects of a potential study or investigation.

It stands for:

P – Patient/population/problem.
I – Intervention.
C – Comparison (of potential interventions, typically).
O – Outcome(s).
T – Time frame (if time frame is relevant).

The end goal of applying PICO(T) is to develop a question that can help guide the search for evidence (Boswell & Cannon, 2015). From this perspective, a PICO(T) question can be a valuable starting point for nurses who are starting to apply an evidence-based model or EBPs. By taking the time to precisely define the areas in which the nurse will be looking for evidence, searches become more efficient and effective. Essentially, by precisely defining the types of evidence within specific areas, the nurse will be more likely to discover relevant and useful evidence during their search. PICOT Question and Evidence-based Approach

You are encouraged to complete the Vila Health PCI(T) Process activity before you develop the plan proposal. This activity offers an opportunity to practice working through creating a PICO(T) question within the context of an issue at a Vila Health facility. These skills will be necessary to complete Assessment 3 successfully. This is for your own practice and self-assessment and demonstrates your engagement in the course. PICOT Question and Evidence-based Approach

Reference
Boswell, C., & Cannon, S. (2015). Introduction to nursing research. Jones & Bartlett Learning.

Professional Context

As a baccalaureate-prepared nurse, you will be responsible for locating and identifying credible and scholarly resources to incorporate the best available evidence for the purposes of enhancing clinical reasoning and judgement skills. When reliable and relevant evidence-based findings are utilized, patients, health care systems, and nursing practice outcomes are positively impacted. PICOT Question and Evidence-based Approach

PICO(T) is a framework that can help you structure your definition of the issue, potential approach that you are going to use, and your predictions related to the issue. Word choice is important in the PICO(T) process because different word choices for similar concepts will lead you toward different existing evidence and research studies that would help inform the development of your initial question.

Scenario

For this assessment, please use an issue of interest from your current or past nursing practice.

If you do not have an issue of interest from your personal nursing practice, then review the optional Case Studies presented in the resources and select one of those as the basis for your assessment. PICOT Question and Evidence-based Approach

Instructions – PICOT Question and Evidence-based Approach

For this assessment, select an issue of interest an apply the PICO(T) process to define the question and research it.

Your initial goal is to define the population, intervention, comparison, and outcome. In some cases, a time frame is relevant and you should include that as well, when writing a question you can research related to your issue of interest. After you define your question, research it, and organize your initial findings, select the two sources of evidence that seem the most relevant to your question and analyze them in more depth. Specifically, interpret each source\’s specific findings and best practices related to your issues, as well explain how the evidence would help you plan and make decisions related to your question. PICOT Question and Evidence-based Approach

If you need some structure to organize your initial thoughts and research, the PICOT Question and Research Template document (accessible from the \”Create PICO(T) Questions\” page in the Capella library\’s Evidence Based Practice guide) might be helpful.

In your submission, make sure you address the following grading criteria:

Define a practice issue to be explored via a PICO(T) approach.
Identify sources of evidence that could be potentially effective in answering a PICO(T) question.
Explain the findings from articles or other sources of evidence.
Explain the relevance of the findings from chosen sources of evidence to making decision related to a PICO(T) question. PICOT Question and Evidence-based Approach

Communicate using writing that is clear, logical, and professional with correct grammar and spelling using the current APA style.
Example Assessment: You may use the following to give you an idea of what a Proficient or higher rating on the scoring guide would look like:

Assessment 3 Example [PDF].
Additional Requirements
Your assessment should meet the following requirements:

Length of submission: Create a 3–5-page submission focused on defining a research question and interpreting evidence relevant to answering it.

Number of references: Cite a minimum of four sources of scholarly or professional evidence that support your findings and considerations. Resources should be no more than 5 years old.

APA formatting: Format references and citations according to the current APA style.

Portfolio Prompt: Remember to save the final assessment to your ePortfolio so that you may refer to it as you complete the final capstone course. PICOT Question and Evidence-based Approach

Competencies Measured

By successfully completing this assessment, you will demonstrate your proficiency in the course competencies through the following assessment scoring guide criteria:

Competency 1: Interpret findings from scholarly quantitative, qualitative, and outcomes research articles and studies.

Explain the findings from articles or other sources of evidence.

Competency 2: Analyze the relevance and potential effectiveness of evidence when making a decision.
Identify sources of evidence that could be potentially effective in answering a PICO(T) question.

Explain the relevance of the findings from chosen sources of evidence to making decision related to a PICO(T) question.

Competency 3: Apply an evidence-based practice model to address a practice issue.
Define a practice issue to be explored via a PICO(T) approach.

Competency 5: Apply professional, scholarly communication strategies to lead practice changes based on evidence.

Organize content so ideas flow logically with smooth transitions; contains few errors in grammar/punctuation, word choice, and spelling.

Apply APA formatting to in-text citations and references exhibiting nearly flawless adherence to APA format. PICOT Question and Evidence-based Approach

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