PICOT Statement Paper
Review the Topic Materials and the work completed in NRS-433V to formulate a PICOT statement for your capstone project.
A PICOT starts with a designated patient population in a particular clinical area and identifies clinical problems or issues that arise from clinical care. The intervention should be an independent, specified nursing change intervention. The intervention cannot require a provider prescription. Include a comparison to a patient population not currently receiving the intervention, and specify the timeframe needed to implement the change process.
Formulate a PICOT statement using the PICOT format provided in the assigned readings. The PICOT statement will provide a framework for your capstone project.
In a paper of 500-750 words, clearly identify the clinical problem and how it can result in a positive patient outcome.
Make sure to address the following on the PICOT statement:
- Evidence-Based Solution
- Nursing Intervention
- Patient Care
- Health Care Agency
- Nursing Practice
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
You are required to submit this assignment to LopesWrite. Please refer to the directions in the Student Success Center.
BURNOUT AMONG NURSING PROFESSIONALS 1
Burnout among Nursing Professionals
Student’s Name
Institutional Affiliation
Burnout among Nursing Professionals
Background
Nurses often encounter problems such as increased burnout during their practice. Nurse burnout is one of the main factors associated with job stress. It leads to nurses, especially those with insufficient emotional energy, having challenges coping with work situations and communicating with patients. Burnout among nurses is a global workplace challenge caused by multifaceted organizational settings. It pertains to work-related anxiety that manifests as unfriendly attitudes toward work. Burnout often affects the job satisfaction of nurses working together in challenging situations. Burnout among nurses is a relevant area of study since it leads to nurses leaving work due to dissatisfaction and thus contributes to increased shortage of nurses globally.
Burnout is also linked to the dissatisfaction of the patient as it reduces the quality of care nurses offer. Further, it affects motivation, leading to decreased workplace productivity, which is linked to deterioration of the quality of care. Organizational, personal, and interpersonal stressors are some of the causes of burnout. These stressors include age, insecurity, adverse work experience, and insufficient coping mechanisms. Work overload, poor health and safety services, and staff shortage can also cause burnout.
Using the steps of evidence-based practice, the research identified burnout as a problem among nurses that needs to be addressed. The PICOT question for the research was: Do nurses who attend team-building events experience lower levels of burnout six months after the event compared to those who do not attend?
P: Population – nurses
I: Intervention – team-building events
C: Comparison – nurses who do not attend team-building events
O: outcome – reduced burnout
T: Six months
The study involved conducting a literature search pertaining to the PICOT question to select applicable peer-reviewed articles. Six journal articles, which were selected, are summarized in the evaluation table below.
Running head: BURNOUT AMONG NURSING PROFESSIONALS 1
BURNOUT AMONG NURSING PROFESSIONALS 2
Literature Evaluation Table
Criteria
Article 2
Article 2
Article 3
Article 4
Article 5
Article 6
Author (publication year)
Hayward, Bungay, Wolff, & MacDonald, (2016)
Lahana, Papadopoulou, Roumeliotou, Tsounis, Sarafis, & Niakas, (2017)
Moghaddasi, Mehralian, Aslani, Masoodi, & Amiri,(2013)
Rushton, Batcheller, Schroeder, & Donohue, (2015).
Adib-Hajbaghery, Khamechian & Alavi (2012).
Álvarez Verdugo, & Prieto Bocanegra, (2013).
Article Title
A qualitative study of experienced nurses’ voluntary turnover: Learning from their perspectives.
Burnout among nurses working in social welfare centers for the disabled
Burnout among nurses working in medical and educational centers in Shahrekord, Iran
Burnout and resilience among nurses practicing in high-intensity settings
Nurses’ perception of occupational stress and its influencing factors: A qualitative study
Prevalence of burnout syndrome in nursing staff of a third level hospital Boyacá, Colombia
Purpose/ Aim of the study and/or research question
To critically examine the factors that contribute to the turnover of experienced nurses.
Investigates decision-making processes by experienced nurses and examines personal and external factors that affect these decisions.
To examine burnout and factors associated with the syndrome among nurses working will mentally ill patients
To evaluate burnout among nurses working in educational and medical centers in Shahrekord
To support the creation of a healthy work environment as well as design a 2-phase project to promote nurses’ resilience.
To investigate nurses’ experiences and perceptions of job-related stress
To investigate the levels of burnout among nurses in a tertiary hospital in Tunja
Research design
A qualitative, interpretive descriptive design
cross-sectional survey
Descriptive study
a cross-sectional survey
A qualitative study
A cross-sectional study
Sample/setting
12 registered nurses, averaging 16 years in practice.
18 nurses working in public health centers for the disabled
340 nurses working in medical and education centers in Shahrekord.
Random sampling
114 nurses in 6 high-intensity units
19 nurses working in hospitals
22 professionals
Data collection methods; instruments
Interviews
self-administered questionnaire
Questionnaire
the Maslach Burnout Inventory-Human Services
A moral distress scale
A perceived stress scale
A resilience scale
A meaning scale
The State Hope Scale
Interviews
Questionnaire
Key Findings
Nurses decisions to leave practice were mainly influenced by factors related to work environment and personality traits, such as workload and relationship with colleagues
Burnout dimensions of emotional exhaustion and depersonalization recorders high levels, whereas personal accomplishment was low.
Burnout was sizable among nurses
A strong link between burnout and resilience
Key findigns were that there are many stressors in the nursing profession, such as adverse authorities, shortage of nurses, and poor social status
Factors determining burnout included working years, hours of night work, rest per month, and type of employment contract
Explanation of how the article supports EBP
It illustrates the affective consequences of authentic project-based learning
Nurses working for persons with disabilities in Greece showed increased burnout levels
Disproportionate relationship between the workload, income, and number of nurses influenced nursing burnout
Three common aspects of burnout, which were all predicted using moral distress
Organizations need to intervene to reduce workload, whereas supervisors should clearly outline boundaries and expectations of the nursing role.
Nursing professionals may suffer from depersonalization due to emotional exhaustion for working for 10 years as well as night work schedules.
BURNOUT AMONG NURSING PROFESSIONALS 1
References
Adib-Hajbaghery, M., Khamechian, M., & Alavi, N. M. (2012). Nurses’ perception of occupational stress and its influencing factors: A qualitative study. Iranian Journal of Nursing and Midwifery Research, 17(5), 352–359.
Álvarez Verdugo, L. P., & Prieto Bocanegra, B. M. (2013). Prevalence of burnout syndrome in nursing staff of a third level hospital Boyacá, Colombia. Enferm Glob, 12(29), 73-88.
Hayward, D., Bungay, V., Wolff, A. C., & MacDonald, V. (2016). A qualitative study of experienced nurses’ voluntary turnover: Learning from their perspectives. Journal of Clinical Nursing, 25(9-10), 1336-1345.
Lahana, E., Papadopoulou, K., Roumeliotou, O., Tsounis, A., Sarafis, P., & Niakas, D. (2017). Burnout among nurses working in social welfare centers for the disabled. BMC Nursing, 16(1), 1-10.
Moghaddasi, J., Mehralian, H., Aslani, Y., Masoodi, R., & Amiri, M. (2013). Burnout among nurses working in medical and educational centers in Shahrekord, Iran. Iranian Journal of Nursing and Midwifery Research, 18(4), 294–297.
Rushton, C. H., Batcheller, J., Schroeder, K., & Donohue, P. (2015). Burnout and resilience among nurses practicing in high-intensity settings. American Journal of Critical Care, 24(5), 412-420.
Alt PDF
The Journal of the Canadian
Chiropractic Association
The Canadian Chiropractic Association
What is your research question?
An introduction to the PICOT
format for clinicians
John J. Riva, BA, DC, Keshena M.P. Malik, BSc,
DC, […], and Jason W. Busse, DC, PhD
Additional article information
Introduction
Clinicians often witness impressive treatment
results in practice and may wish to pursue
research to formally explore their anecdotal
experiences. The potential to further new
knowledge both within the profession and to the
greater healthcare system is compelling. An
obvious next step for a practitioner considering
research is to connect with experienced
researchers to convey their idea for a study, who
may in turn ask, “What is your research
question?” With limited understanding of how to
respond, this interaction may result in the first
and last experience these clinicians will have with
the research community.
It has been estimated that between 1% and 7% of
the chiropractic profession in Canada is engaged
in research. Arguably, this low engagement
could be the result of practitioners’ perceived
importance of research and levels of research
literacy and capacity. However, increasing
demands for evidence-based approaches across
the health system puts pressure on all clinicians to
base their decisions on the best available
scientific evidence. Lack of clinician
representation in research has the probable effect
of limiting growth and new developments for the
profession. Furthermore, lack of clinician
involvement in research complicates the transfer
of study findings into practical settings.
The Canadian Institutes of Health Research
describes integrated knowledge translation as a
process that involves collaboration between
researchers and knowledge users at all stages of a
research project. This necessitates involvement
of clinicians to help in forming a research
question, interpreting the results, and moving
research findings into practice. This shared effort
between clinicians and researchers increases the
likelihood that research initiatives will be relevant
to practice. Conversely, it has been reported that
there is a growing communication gap between
clinicians and academics in chiropractic.
Clinicians have important practice-related
questions to ask, but many may lack the ability to
map out their research strategy, specifically in
communicating their question in a manner
required to develop a research protocol.
David L. Sackett, Officer of the Order of Canada
and the founding Chair of Canada’s first
Department of Clinical Epidemiology &
Biostatistics at McMaster University, highlights
the importance of mapping one’s research
strategy in exploration of the research question:
“one-third of a trial’s time between the germ of
your idea and its publication in the New England
Journal of Medicine should be spent fighting
about the research question.” (personal
communication, November 30, 2011) We
describe a randomized controlled trial (RCT)
example to highlight how clinicians may use
existing literature and the PICOT format to
formulate a research question on treatment
efficacy.
PICOT Defined
The PICOT format is a helpful approach for
summarizing research questions that explore the
effect of therapy:
(P) – Population refers to the sample of
subjects you wish to recruit for your
study.
There may be a fine balance between
defining a sample that is most likely to
respond to your intervention (e.g. no co-
morbidity) and one that can be generalized
to patients that are likely to be seen in actual
practice.
(I) – Intervention refers to the treatment that
will be provided to subjects enrolled in your
study.
(C) – Comparison identifies what you plan
on using as a reference group to compare
with your treatment intervention. Many
study designs refer to this as the control
group. If an existing treatment is considered
the ‘gold standard’, then this should be the
comparison group.
(O) – Outcome represents what result you
plan on measuring to examine the
effectiveness of your intervention. Familiar
and validated outcome measurement tools
relevant to common chiropractic patient
populations may include the Neck Disability
Index or Roland-Morris Questionnaire.
There are, typically, a multitude of outcome
tools available for different clinical
populations, each having strengths and
weaknesses.
(T) – Time describes the duration for your
data collection.
RCT Design Example Using PICOT
Dosage effects of spinal manipulative
therapy for chronic neck pain
Neck pain is second in frequency only to low
back pain among musculoskeletal complaints
reported in the general population and among
those presenting to manual therapy providers.
Chronic neck pain (i.e. neck pain lasting longer
than 90 days) is a common reason for presenting
to a chiropractor’s office, and such patients often
receive spinal manipulation or mobilization.
Recent systematic reviews of RCTs and prior
observational studies have shown increases in
cervical range of motion, and decreases in
self-rated neck pain following cervical spine
manipulation. In 2010, the Cochrane systematic
review concluded, “Optimal technique and dose
need to be determined.”
Despite evidence of benefit, there is a limited
understanding of the optimal dose for neck
manipulation; as such, frequency and duration of
this treatment varies greatly between clinicians.
Although patient characteristics and clinicians’
beliefs likely account for some of this variation, it
seems likely that many cases of mechanical neck
pain will require a minimal number of spinal
manipulative therapy (SMT) treatments to derive
benefit and that no further benefit will result after
a certain upper threshold is reached. To properly
examine the dose effects of manipulation for neck
pain, it is necessary to consider three treatment
factors:
1. frequency
2. intensity
3. total number of manipulations
A factorial design RCT allows investigators to
consider more than one treatment factor at a time
and examine possible interactions between them.
This trial design allows for determination of, not
only, the effects of frequency and duration, but
also whether it is more effective to provide a
certain number of manipulations over shorter or
longer durations (i.e. an interaction between the
two factors). Considering a 3×4 factorial design,
patients would attend 1, 2, or 3 sessions per week
(i.e. the first ’factor’ of frequency) with
manipulation provided over a duration of 2
weeks, 4 weeks, 6 weeks, or not at all (i.e. the
second ‘factor’ of duration). To improve
generalizability of findings, neck manipulation
could be performed using standard rotary or
lateral break diversified technique, which is the
most common manually applied neck
manipulation in chiropractic practice. Pain relief
is a common concern among patients presenting
with neck pain and detection of a resulting
difference of 13 mm on the 100mm Visual
Analog Scale (VAS) line is considered a clinically
important change in intensity for patients with
chronic pain.
Research Question: In adults with chronic neck
pain, what is the minimum dose of manipulation
necessary to produce a clinically important
improvement in neck pain compared to
supervised exercise at 6 weeks?
(P) – Population: Adults 18 to 60 years of
age, with a clinical diagnosis of chronic
mechanical neck pain who have not received
cervical SMT in the past year. Patients with
non-mechanical neck pain or
contraindications to cervical manipulation
will be excluded.
(I) – Intervention: Subjects randomized to
have manipulation would receive standard
rotary or lateral break diversified technique
once, twice, or three times per week over a
period of 2, 4, or 6 weeks (see Table 1).
These subjects would also receive the same
exercise regimen given to the control group
to eliminate exercise as a second variable
affecting outcomes.
Table 1
Frequency and Duration of
SMT
(C) – Comparison: A standardized supervised
exercise regimen would be used as an active
control group. All subjects, regardless of
group assignment, would perform a
standardized exercise regime at each session
over a period of 6 weeks. Using this
strategy, we will be able to minimize the
non-specific effects due to attending a clinic.
(O) – Outcome: Changes in neck pain,
measured using the 100mm VAS for pain.
(T) – Time: The outcome would be measured
weekly for 6 weeks.
Clinician input, assuming expertise in the ‘gold
standard’ standard rotary or lateral break
diversified technique and an ability to teach it,
would be helpful during the planning of patient
recruitment. Specifically, in leading training
initiatives to calibrate each treating chiropractor
to deliver his/her manipulation in a similar way
(i.e. load, force, angle) and to assist in
normalizing communication with study subjects.
This standardization, through structured training
sessions for those rendering treatment, will help
ensure no additional interventions were
inadvertently applied (i.e. education, extra
advice).
Other Study Designs Amenable to
PICOT
The PICOT format example described above
represents a factorial RCT methodology that has
been informed by the existing literature. While a
well-conducted RCT is appropriate for answering
many questions on treatment efficacy, they are
typically costly, time-consuming and challenging
to conduct. Not all research questions that
clinicians wish answered are feasible using this
research methodology and the use of a PICOT
format is also applicable to other study designs.
The clinical research question being asked ideally
determines the best research design for a study. A
prospective or retrospective cohort design may be
an easier methodology to administer in
comparison to a RCT; but study results can by
affected by confounding due to the comparison of
non-randomized groups. Another methodology,
used to look for associations between respondent
characteristics and outcomes of interest, is a
cross-sectional survey. This methodology is faster
and less expensive to do in comparison to a RCT
since it considers one time-point of individuals in
various spectrums of the variables of interest.
However, this design can also can be prone to
recall problems by respondents who self-report
information if investigators ask about events in
the past. A case-control study is most appropriate
when attempting to identify associations between
patient characteristics and outcomes that take a
long time to occur or are very rare. For example,
the study by Cassidy et al. (2008) looking at risk
of vertibrobasilar artery stroke following
chiropractic care, whilst more complex in the
design approach, used aspects of a case-control
methodology.
While these study designs are common in clinical
research today, they are not exhaustive of all
designs available. Systematic reviews will be
familiar to most as a study design aimed at
summarizing bodies of studies; but other less
familiar individual patient focus designs, such as
N-of-1 RCT, also exist which are amenable to
the PICOT format depending on the research
question that is being posed.
Discussion
Many considerations need to be contemplated in
the PICOT formulation: How detailed should the
literature search be in breadth and quality level?
What study design best fits the research question?
Should the patient population include very similar
types of patients or will there be more of a real-
world wide variety of participants? Will the
intervention be very specific and rendered by a
clinical expert or will there be a combination of
tailored interventions rendered by a non-clinician
with a more general skill set? Will the
comparison be against usual care (i.e. ‘gold
standard’) or a sham placebo procedure? Will the
outcomes measured be from validated
instruments on a form or more from direct patient
verbal communication and will these results be
presented in a way most important to clinicians,
patients or policy-makers? And if so, what
amount of difference and how many patients
would be required to both statistically and
clinically conclude the intervention was
effective? Will measurement of outcomes occur at
multiple times or once at 5 days, 6 months or
10
years?
While these considerations are clearly complex
and not inclusive of the entire process, to develop
a strong research question framed in the PICOT
format, it is an important basis to understand both
the clinical area of investigation and the current
literature that exists. As highlighted by the
example above, it is necessary to review the type
and quality of research that has already been
performed in the area of interest to guide
development of a question. When initially
synthesizing the literature, some key entry
questions to examine include:
what are the important research questions in
the field?
what has been found?
what areas need further exploration?
would the proposed study fill a gap and
better an understanding?
In our example design, the literature search
identified existing knowledge in the respective
area. A recent high-quality Cochrane review
reported on previously completed RCTs in the
area, strengths and weaknesses of these
studies
and offered direction as to gaps in current
understanding that would benefit from further
research exploration. As research is a time
consuming and often costly endeavour, building
on the best available existing knowledge rather
than “re-inventing the wheel” is favourable.
Only after a thorough literature synthesis and
investigation into these answers should a research
question be formulated – in some instances a
systematic review methodology may actually
align best with the PICOT framework for your
research question. Turning an idea into a good
research question requires it to be feasible,
interesting, novel, ethical and relevant. This
feasibility refers to, not only, resources (time and
money), but also to whether there is agreement on
the meaning of the research question and to
whether everything that needs to be measured can
be measured by the study design. The
question
should be of interest to many in the clinical area
to drive both team momentum for the project and
dissemination of the results. Generating new
knowledge in large existing gaps of healthcare
provides the opportunity to help large volumes of
patients who previously may have had poorer
clinical outcomes. Practically, ethical
considerations have to be accounted for in related
study designs to ensure subjects are not harmed
by the study. Finally, reflection is required on
how well the study design will apply to the real
world.
A strong research question should always pass the
‘so what?’ test. Who will the research help? What
is the benefit? There should be a definitive and
strong rationale for the purpose of the research. A
well-thought-out focused research question leads
directly into hypotheses; the predictions about the
nature and direction of the relationship between
the variables under study. Hence, the question
acts as the foundation of the study.
The importance of moving from studies to
empirically supported treatments to evidence-
based practices may very well rest on whether or
not a clinician views the research as relevant to
their daily practice. It is common for clinicians to
express frustration that researchers are not asking
questions that are of most relevance to practice.
Similarly, researchers often find that clinicians
have difficulty distilling the important concepts
they would like investigated in a way that can be
feasibly researched.
To support both clinical and academic interests,
an important clinical research question should
therefore be one that is developed in conjunction
with a diverse team. This expertise should align
with the best research methodology available and
propose a project feasible to complete through
study that will adequately answer the research
question asked. In Canada, the Canadian
Chiropractic Research Foundation has reported
that there are currently 12 university-based
research chairs, 15 PhD candidates and 1
4
Masters students. An opportunity exists to
engage these researchers, as well as those from
chiropractic schools, in helping to formulate
important clinical research questions.
Conclusion
Clinicians interested in research pursuits, related
to patient care, should consider the use of a
literature search and the PICOT format when
engaging clinical researchers. This approach will
provide clinicians and researchers an initial basis
for mutual understanding, communication and
direction to help answer clinical study questions
of most relevance.
Key Points
Clinicians should frame practice-based
research questions in the PICOT format
Look to existing literature for guidance
in the formulation of a research
question
Clinicians have an important role in
contributing to the integrated
knowledge translation of research
studies
Framing of a research question offers a
common language between clinician
and researcher discourse
Footnotes
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