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PICO PaperBrianna RichFerris State UniversityPICO PaperNurses as well as other health care professionals not only care for their patients, but they continually are seeking ways to improve their patient’s safety. To do this many nurses research different topics of issue and try to find the best evidence to change or improve different procedure, increasing the safety of their patients. The purpose of this paper is to “interpret research findings and use evidence-based research to support nursing decisions” (Ferris State University, 2014). So, in this paper we will research a specific clinical question, and a few research article will be discussed answering this question. This paper will provide information about what is the best way to prevent deep vein thrombosis’s (DVT’s) and pulmonary embolism’s (PE’s) post-surgery. Then after reviewing the articles we will determine through evidence-based practice which intervention provides our patients with the safest results.Clinical QuestionBefore the research can start there needs to be a specific type of question asked. This specific question is called a PICO question. PICO is an acronym that help researchers formulate a question that can be easily answered with the right evidence based research. P stands for population. When the question is written out there needs to be a targeted population, so it helps break down the searching process. If there was not a specific population targeted then you would may have many different kinds of interventions come up to help fix the problem, and this can get overwhelming. This is why it needs to be narrowed down to a certain population to come up with the best interventions leading to the best outcomes. Next, the I stands for intervention. This would be a certain intervention that is of interest to the targeted population. The question would be trying to determine if this intervention will work or is currently working for this population. Then there is the C, which stand for comparison. Within the PICO question researchers are trying to compare the intervention of interest to another intervention that may also be used at this time. The idea of this is to try and figure out which intervention is safer for this specific population. Then the O represents outcomes. What are we trying to get out of these intervention? What outcome are we trying to pursue for this population? So, this section is looking for if the interventions worked in helping improve our patient’s safety. After putting all of these parts together we come up with a research question that will help narrow down the results to get the best information.Clinical ProblemThis paper will discuss one specific clinical problem. The problem addressed in this paper is the amount of post-surgical patients that developed a DVT or PE. A DVT “is a blood clot that forms in a vein deep in the body” (National Heart, Lung and Blood Institute, 2011). These clots can be dangerous because they can break off and travel to other parts of the body. According to the National Heart, Lung and Blood Institute (2011), a blood clot can travel to the lungs, which is called a pulmonary embolism and block blood flow which is very dangerous and may causes death. So, since these DVT’s and PE’s can be so dangerous and life threatening research needs to be done to help limit the amount of people developing them. So, the PICO question for this paper is, does the combinations of pharmacological and mechanical interventions reduced the risk of DVT’s and PE’s compared to pharmacological or mechanical interventions used alone in post op surgical patients? This question addresses a specific population, which is post op surgical patients. It also have an intervention of interest which is the combination of both pharmacological interventions and mechanical interventions to prevent DVT’s and PE’s. It has an intervention to compare the intervention of interest with and this is pharmacological or mechanical interventions alone. Then lastly the outcome that we want is to reduce the number of post op surgical patients that develop DVT’s and PE’s. So, this question meets the PICO recommendation making it easy to find specific research. The reason that this question is so important is because these post op surgical patients can die as a result of developing DVT’s or PE’s, so to maintain the optimal patient safety research need to be done to find the best intervention. Once the best intervention is identified it can start to be a standard protocol for post op surgical patients to help reduce the risk of developing DVT’s or PE’s. This will make for safe, quality care for the patients. Methodology When researching any topic researchers need to be aware of the sources and information that they are reading. To find the highest quality research they need to know exactly what they are looking for when it comes to the different sources. The sources need to be reliable and credible, and the research needs to be done by a health care professional. Ideally as a nurse nursing research is the best, but sometimes high quality nursing research is hard to find. Nursing research is research or studies that were performed by nurses. This is so important to nurses because as a nurse we may view things differently than a doctor would. So, having nursing research the results and information throughout the study are from a nurse’s perspective. This is great because nurse do the same jobs and have the same outlook on different situation compared to what a doctor may think about a certain problem. So, nursing research is great if you can find the right information that is credible and reliable. Another thing to look at when researching a certain topic is making sure that it is specific to your PICO question. You don’t want research or evidence that has a different population or a different intervention because it will not help support your question. An additional thing to help guide the search for quality research is to us online databases or libraries like MEDLINE, PubMed and CINAHL. These databases have search engines that the results can be limited to either nursing research specifically or you can have it find results that are peer reviewed. Using this search engine will help to eliminate unwanted articles that may not pertain to the PICO question. One other thing to look for when searching different article and studies is the level of evidence. There are seven different levels of evidence. The levels range from level 1 being the best level of evidence and consisting of “systematic review & meta-analysis of randomized controlled trials” to level seven which is “expert opinion” (Melnyk & Fineout-Overholt, 2011). Finding articles that have level one evidence is the best evidence, but even if you have a level 7 evidence this is still quality and will be beneficial to your research. All of these things listed above can assist researchers in finding the right research with great quality to answer the PICO question.Discussion of LiteratureAfter researching different articles and using many different databases three quality articles were found to answer the PICO question, does the combinations of pharmacological and mechanical interventions reduced the risk of DVT’s and PE’s compared to pharmacological or mechanical interventions used alone in post op surgical patients? Article OneThe first article that was found is called, Venous thromboembolism prophylaxis in surgical patients: Identifying a patient group to maximize performance improvement. Before actually using the article it is important to critic the article, so that we know if it credible and good to use. One reason that this is a great article is because it is nursing research. This means that the authors involved with this study are nurses. Just like mentioned earlier this kind of article is ideal for a great perspective on this issue. Another thing to look at is the purpose of the article. The purpose of this article is clearly defined. They are trying to figure out if DVT occur to surgical patients even if patients are receiving prophylaxis measures. They stick to this problem and perform a study to try and come up with beneficial results. It is also important to see if the population that was used in the sample was appropriate for the question they are trying to address. In this article the sample was appropriate because they did a study of 2,474 surgical patients in a hospital over a year’s period (Weigelt, Lal, & Riska, 2011). Next, the level of measurement should be easily determined as well as if and how the data was collected. This articles used a quantitative research design, the level of measurement is nominal and they do collect the data obtained from the study. They keep a documentation of what intervention or interventions each patient used. They also kept documentation if the patients developed or did not develop DVT’s or PE’s. Also, this article is level one evidence because it is a systemic review. Overall, after performing an article critic this article has great quality. All of the areas that needed to be reviewed to make sure that it is a quality study were addresses. So, this article is a great especially if it benefits the specific PICO question.The results of the article are very useful for this PICO question. After the study was concluded the results were finalized. Even though DVT’s and PE’s still can occur if prophylaxis is used correctly, they found that “heparin is the preferred drug—used alone, or for the patients at highest risk—combined with leg compression devices (mechanical prophylaxis)” (Weigelt, Lal, & Riska, 2011). This shows that using a combination is the best method to prevent DVT’s and PE’s in post-surgical patients. Yes, heparin can be used alone and be beneficial, but for those patients that are at high risk a combination of both pharmacological interventions and mechanical interventions is the best intervention. This shows that a combination is the best even over heparin alone because it is recommended for those patients that are in need of a great intervention to prevent DVT’s. So, according to this article the use of both interventions in combination is the best method.Article TwoPortable compression device and low-molecular-weight heparin compared with low-molecular-weight heparin for thromboprophylaxis after total joint arthroplasty is the next article to be reviewed. This article is not nursing research but is written and the study is performed by doctors. Not as ideal as nursing research but it is performed by healthcare professionals so it will still be valuable in addressing the PICO question. The purpose of this article also is clearly defined and this article was performed to determine the rate of DVT when using mechanical and pharmacological intervention or pharmacological interventions alone in post op surgical patients. The sample used for this study again was appropriate for the study. This study involved 277 post op surgical patients and these participants were randomized (Edwards et al., 2008). This study also used a quantitative research method as well as nominal level of measurement. In this study the method of data collection is the documentation of the interventions used for each patient. They also documented the results of the interventions and if they ended up being useful or not. Just like the first article the level of evidence used is level one because it is a meta-analysis of a randomized trial. So, again this article is a great article to use when researching interventions for DVT prevention.The results of this article help to answer the PICO question addressed in this paper. “This preliminary study demonstrated significant reduction in rate of DVT after TKA when the continuous enhanced circulation therapy (CECT) device was combined with LMWH” (Edwards et al., 2008). This statement illustrates that continuous enhanced circulation therapy (CECT) device which is a mechanical intervention is best used in combination with LMWH, a pharmacological intervention in the reduction of DVT’s post-surgery. So, again there is another article that concludes the combination of both measures is the best intervention, better than using one intervention alone. Article ThreeThen last the article, Heparins and mechanical methods for thromboprophylaxis in colorectal surgery, also addresses DVT prevention. This article is not nursing research because nurses do not write it but doctors wrote it, so it is still helpful to this medical question about DVT prevention. While critiquing this article it was easy to find the purpose of this study. They were working to compare what methods were better in preventing DVT’s post colorectal surgery. They compared heparin, mechanical methods or a combination of the two. Again, the sample used was suitable for the study because they used about 2,000 surgical patients (Jorgensen, Rasmussen, Andersen, & Borly, 2004). This article was quantitative based and they used nominal level of measurement. This article again used documentation to collect the data of which intervention was used from heparin alone, heparin and mechanical intervention, mechanical intervention alone and placebos. They then documented the results of the interventions used. Again, the level of evidence used in this study was level 1. It is level 1 because it was meta-analysis and it was randomized. Another good article to response to the question about what intervention is the best method to prevent post op DVT’s.The results of this article again complement this PICO question. After collecting all the data and analyzing the results they came to the conclusion that, “the combination of graded compression stockings and LDH is better than LDH alone in preventing DVT and/or PE” (Jorgensen, Rasmussen, Andersen, & Borly, 2004). Again, according to this article the combination method is the best method to help decrease the incidence of DVT’s and PE’s from occurring post op. Significance to NursingThe results from these three articles all support that the combination of both pharmacological and mechanical interventions is best when used together to prevent DVT’s and PE’s. Knowing and practicing this can improve the safety of post op surgical patients. The combination of these interventions should be integrated into post op surgical facilities because after much research this is the best method to decrease DVT’s and PE’s. Knowing that DVT’s and PE’s can be so harmful and deadly it is important to perform the best preventative measure to keep these patients as safe as possible. Nurses are taught be do their best to provide the safest and quality care that is possible. According to the QSEN Institute (2014), they work to prepare nurses “with the knowledge, skills, and attitudes (KSAs) necessary to continuously improve the quality and safety of the healthcare systems in which they work”. So, like mentioned before nurses not only care for their patients, but are always seeking ways to improve their patient’s safety. In this situation making sure that the post op surgical patients are receiving the appropriate measures to assist in reducing the incidence of DVT’s is very important because this would improve their safety. Overall, any measure it better than none in preventing DVT’s, but the top intervention is to use a combination of both pharmacological and mechanical interventions. As nurses it is our job to protect and provide safe care to our patients, and doing our best to help post op surgical patients avoid DVT’s and PE’s is essential for safe and quality care.ReferencesEdwards, J. Z., Pulido, P. A., Ezzet, K. A., Copp, S. N., Walker, R. H., & Colwell, C. W. Jr. (2008). Portable compression device and low-molecular-weight heparin compared with low-molecular-weight heparin for thromboprophylaxis after total joint arthroplasty. Journal of Arthroplasty, 23(8), 1122–1127. DOI: 10.1016/j.arth.2007.11.006Ferris State University. (2014). NURS 350 research in nursing course syllabus. Retrieved from , P. W., Rasmussen, M. S., Andersen, B. R., & Borly, L. (2004). Heparins and mechanical methods for thromboprophylaxis in colorectal surgery. Cochrane Database for Systemic Review. DOI:10.1002/14651858.CD001217Melnyk, B.M. & Fineout-Overholt, E. (2011). Evidence-based practice in nursing and healthcare: A guide to best practice. Philadelphia: Lippincott, Williams & WilkinsNational Heart, Lung and Blood Institute. (2011). What is deep vein thrombosis. In National Heart, Lung and Blood Institute. Retrieved from Institute. (2014). The evolution of the quality and safety education for nurses (QSEN) initiative. In QSEN Institute. Retrieved from , J. A., Lal, A., & Riska, R. (2011). Venous thromboembolism prophylaxis in surgical patients: Identifying a patient group to maximize performance improvement. Joint Commission Journal on Quality and Patient Safety, 37(4), 178-183. Retrieved from CINAHL ................
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