Identifying A Clinical Question

The current demands for quality and convenient care prompt healthcare professionals to embrace research as a tool for promoting care quality. More essentially, registered nurses have an ethical and professional responsibility to provide research-based knowledge and translate evidence-based findings to clinical practice. The need to incorporate the best available evidence anchors the concept of evidence-based practice (EBP).

Identifying A Clinical Question

Melnyk & Fineout-Overholt (2019) defines the evidence-based practice as “the conscientious use of current best evidence in making decisions about patient care” (p. 36). Based on this definition, it is valid to contend that EBP entails systematically searching for and critically appraising external evidence, using one’s clinical expertise, leveraging internal evidence to achieve positive patient outcomes, and respecting patient/family preferences and values (Melnyk & Fineout-Overholt, 2019).

Although healthcare professionals use evidence-based practice to promote care and solve contextual challenges, it does not happen in a vacuum. In this sense, the essential requirement for incorporating evidence-based practice into clinical operations is developing a culture of inquiry by setting clinical questions to guide the selection and appraisal of external evidence sources. Therefore, this paper uses the PICO(T) format to identify clinical questions and explain resources that support the nursing interventions for the topic.

A PICOT Format for Formulating a Clinical Foreground Question

Creating a spirit of inquiry entails questioning the current practices, strengthening the role of evidence-based mentors to provide guidance and expertise on EBP, and providing infrastructure and tools for leveraging internal and external evidence, including computer systems, library repositories, databases, and EBP training sessions, and adopting administrative and leadership styles that validate the rationale for evidence-based practice (Melnyk & Fineout-Overholt, 2019, p. 46).

Since the first step of cultivating a culture of inquiry is questioning the current healthcare practices, it is essential to use a comprehensive format that enables researchers to identify patient populations or problems, define interventions, compared alternatives, stipulate the desired outcomes, and set time for evaluating the impacts of the specified intervention (s).

The PICOT format enables researchers to structure clinical research questions and connect them with evidence syntheses. According to Eriksen & Frandsen (2018), the PICO format encompasses four articulated parts: the problem or patient population (P), exposure to the problem or the intervention (I), a comparison of exposure or interventions (C), and the outcomes of interest (O).

Often, researchers perceive the need to set timeframes for assessing the identified interventions’ effectiveness in addressing clinical or population health issues. As a result, it is possible to add time (T) as the fifth component of the PICO(T) framework for asking clinical foreground questions.

Besides enabling researchers to develop clinical foreground questions, the PICOT framework provides ideal opportunities for identifying, selecting, and reviewing evidence sources. According to Melnyk & Fineout-Overholt (2019), a PICOT statement/question is a crucial source of keywords, subtitles, and subject headings that allow researchers to filter search options and select evidence sources consistent with the topics of exploration.

Without developing concise PICOT statements, researchers would encounter ambiguities and constraints when identifying and selecting evidence sources that provide suggestions and solutions to clinical problems.

PICO(T) Question

The clinical question for this assessment adheres to the PICO(T) format: In inpatient chronic schizophrenia patients (P), do social skills group training sessions (I), compared to standard care (C), increase conversational skills (O)? Hence;

P: Inpatient chronic schizophrenia patients

I: Social skills group training sessions

C: Standard care

O: Increased conversational skills

Description of the Clinical Problem

Schizophrenia is a degenerative cognitive disorder that impacts an individual’s thinking patterns, perceptions, memory, activities, and emotional expression. Ganguly et al. (2018) contend that this disorder manifests through multiple symptoms, including disorganized speech, diminished emotional expression, delusions, and hallucinations.

The modifiable and non-modifiable risk factors for schizophrenia include age, gender, past unresolved trauma, and substance abuse. According to Ganguly et al. (2018), past traumatic and stressful events can be ideal antecedents for schizophrenia by triggering anxiety, irritability, and concentration proems. Equally, abusing substances like cannabis, cocaine, and methamphetamine can trigger psychotic states in people with chronic schizophrenia.

Based on the clinical manifestation of schizophrenia and its symptoms, it is valid to contend that patients with this disorder encounter adverse consequences, including compromised quality of life, poor social skills, stigmatization, disorganized behaviors, a lack of sense of security, and suicidality.

As a result, pharmacologic and non-pharmacologic interventions intercept schizophrenia progression and reduce complications. Ganguly et al. (2018) argue that the administration of antipsychotic medications is the initial schizophrenia treatment that blocks dopamine receptors to reduce the disease’s symptoms. However, antipsychotic drugs can only reduce positive symptoms of schizophrenia and are deficient in improving the social well-being of individuals with chronic schizophrenia.

Amidst the need to improve patients’ cognitive and social well-being, non-pharmacologic interventions, including therapies, emerge as the most sought-after approaches. Examples of treatment and non-pharmacologic support options for patients with chronic schizophrenia include cognitive behavior therapy (CBT), yoga, and social skills group training sessions.

According to Browne et al. (2020), social skills training (SST) emphasizes five principles: modeling, reinforcement of social skills, shaping skills and desired behaviors, over-learning, and generalization. These components address social cognitive deficits by facilitating contextual, nonverbal, and paralinguistic aspects of social interactions and interpersonal relationships.

Selecting Research Articles by Utilizing Different Databases

After developing a foreground question and describing the problem or topic of exploration, researchers can select external evidence sources from reputable databases. Melnyk & Fineout-Overholt (2019) recommend Cochrane, BMJ, EMBASE, PsycInfo, MEDLINE, CINAHL, and Google Scholar as authoritative databases that contain systematic reviews, research summaries, clinical guidelines, bibliographic databases, and clinical trials. Other evidence sources available in these databases are cohort studies, descriptive studies, expert opinions, and evidence-based clinical practice guidelines.

When selecting research articles for the PICO(T) question about the appropriateness and effectiveness of social skills group training sessions in improving the conversational skills of schizophrenia patients, I used various keywords and subject headings, including social skills training (SST), SST, and conversational skills, social skills for schizophrenia patients, group training sessions for schizophrenia patients, and SST therapy. These keywords and subtitles enabled by to select five scholarly articles and filter my search to identify current evidence sources (published within the last five years).

The identified studies include a pre-post intervention study by Aruldass et al. (2022), a randomized cluster study by Schutt et al. (2022), a systematic review of randomized controlled trials (RCTs) by Turner et al. (2017), a clinical trial by Takaloo et al. (2020), and a book chapter by Browne et al. (2020).

The five articles provide insights into the importance and applicability of social skills training in improving the social well-being of schizophrenia patients. They focus on various themes, including social skills training for persons with schizophrenia (Browne et al., 2020), short-term social skills training in schizophrenia spectrum disorder (Takaloo et al., 2020), the efficacy of SST (Turner et al., 2017), cognitive enhancement therapy vs. social skills training in schizophrenia (Schutt et al., 2022), and the effectiveness of SST among people with severe mental disorders/illness (Aruldass et al., 2022).

The Article that Best Supports the Nursing Intervention

Although the five articles explore and discuss the effectiveness of social skills training (SST) in improving conversational skills for schizophrenia patients, I perceive that a quantitative study by Aruldass et al. (2022) best supports social skills training (SST) as a nursing intervention. According to Aruldass et al. (2022), SST employs behavioral and social learning principles, such as behavioral goal setting, positive reinforcement, modeling, shaping, and combined interventions.

Further, the findings from this study reveal that group-based SST interventions promote peer support and enable trainers to obtain feedback from patients. While social skills training is a crucial aspect of the psychological rehabilitation of people with chronic schizophrenia, contextualizing training sessions and involving family members can improve the generalization of social skills.

Conclusion

Setting foreground questions is a prerequisite for evidence-based practice because it enables researchers to select and appraise evidence sources that are consistent with clinical issues and topics of exploration. When developing clinical questions, it is essential to use the PICOT format that emphasizes patient problem (P), intervention (I), comparison of exposure or interventions (C), desired outcomes (O), and time (T).

Notably, this framework allows me to identify five articles that answer the PICO statement: in inpatient chronic schizophrenia patients, do social skills group training sessions (I), compared to standard care (C), increase conversational skills (O)?

References

  • Aruldass, P., Sekar, T. S., Saravanan, S., Samuel, R., & Jacob, K. S. (2021). Effectiveness of social skills training groups in persons with severe mental illness: A pre–post-intervention study. Indian Journal of Psychological Medicine, 44(2), 114–119. https://doi.org/10.1177/02537176211024146
  • Browne, J., Meuser, K. T., & Pratt, S. I. (2020). Social skills training for persons with schizophrenia. Social Skills across the Life Span, 329–342. https://doi.org/10.1016/b978-0-12-817752-5.00017-2
  • Eriksen, M. B., & Frandsen, T. F. (2018). The impact of patient, intervention, comparison, outcome (PICO) as a search strategy tool on literature search quality: A systematic review. Journal of the Medical Library Association, 106(4), 420–431. https://doi.org/10.5195/jmla.2018.345
  • Ganguly, P., Soliman, A., & Mustafa, A. A. (2018). Holistic management of schizophrenia symptoms using pharmacological and non-pharmacological treatment. Frontiers in Public Health, 6(166). https://doi.org/10.3389/fpubh.2018.00166
  • Melnyk, B., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Wolters Kluwer.
  • Schutt, R. K., Xie, H., Mueser, K. T., Killam, M. A., Delman, J., Eack, S. M., Mesholam-Gately, R., Pratt, S. I., Sandoval, L., Santos, M. M., Golden, L. R., & Keshavan, M. S. (2022). Cognitive enhancement therapy vs. social skills training in schizophrenia: A cluster randomized comparative effectiveness evaluation. BMC Psychiatry, 22(1). https://doi.org/10.1186/s12888-022-04149-x
  • Takaloo, S., Mirsepassi, Z., Sharifi, V., Farsham, A., Farhadbeigi, P., & Karbalae Nouri, A. (2020). Short-term social skills training in schizophrenia spectrum disorders: A clinical trial in an outpatient setting. Iranian Journal of Psychiatry and Behavioral Sciences, 14(4), e99462. https://doi.org/10.5812/ijpbs.99462
  • Turner, D. T., McGlanaghy, E., Cuijpers, P., van der Gaag, M., Karyotaki, E., & MacBeth, A. (2017). A meta-analysis of social skills training and related interventions for psychosis. Schizophrenia Bulletin, 44(3), 475–491. https://doi.org/10.1093/schbul/sbx146

Assignment Description: Identifying A Clinical Question

Write a 1000-1500 word essay addressing each of the following points/questions. Be sure to completely answer all the questions for each bullet point. There should be three main sections, one for each bullet below. Separate each section in your paper with a clear heading that allows your professor to know which bullet you are addressing in that section of your paper.

Support your ideas with at least five (5) sources using citations in your essay. Make sure to cite using the APA writing style for the essay. The cover page and reference page in correct APA do not count towards the minimum word amount. Review the rubric criteria for this assignment.

Identify a clinical question related to your work environment (i work in mental health), write the question in PICOT format and perform a literature search on the identified topic.

Purpose

To enable the student to identify a clinical question related to a specified area of practice and use medical and nursing databases to find research articles that will provide evidence to validate nursing interventions regarding a specific area of nursing practice.

Review the Application Case Study for Chapter 3: Finding Relevant Evidence to Answer Clinical Questions as a guide for your literature search.

Guidelines

Identify a clinical question related to your area of clinical practice and write the clinical foreground question in PICOT format utilizing the worksheet tool provided as a guide.

Describe why this is a clinical problem or an opportunity for improving health outcomes in your area of clinical practice. Perform a literature search and select five research articles on your topic utilizing the databases highlighted in Chapter 3 of the textbook (Melnyk and Finout-Overholt, 2015).

Identify the article that best supports nursing interventions for your topic. Explain why this article best supports your topic as you compare the article to the other four found in the literature search.

M1 Assignment UMBO – 3, 4
M1 Assignment PLG – 1, 2
M1 Assignment CLO – 2, 3

Assignment Instructions and Specifications

Submitting Your Work

Assignment Rubric

Start by reading and following these instructions:

Study the required chapter(s) of the textbook and any additional recommended resources. Some answers may require you to do additional research on the Internet or in other reference sources. Choose your sources carefully.

Consider the discussion and the any insights you gained from it.

Review the Assignment Rubric and the specifications below to ensure that your response aligns with all assignment expectations.

Create your Assignment submission and be sure to cite your sources, use APA style as required, check your spelling, and review the rubric.

The following specifications are required for this assignment:

Length: 1000 – 1500 words; answer must thoroughly address questions in a clear, concise manner
Structure: Include a title page and reference page in APA format. These do not count towards the minimum word count for this assignment. Your essay must include an introduction and a conclusion.
References: Use appropriate APA style in-text citations and references for all resources utilized to answer the questions. A minimum of five (5) scholarly sources are required for this assignment to support the topic.

Format: Save your assignment as a Microsoft Word document (.doc or .docx)

Filename: Name your saved file according to your first initial, last name, and the assignment number (for example “RHall Assignment 1.docx”)

After completing the assignment above, select the link below to access the next module overview.