Compare an ambulatory resident versus non-ambulatory resident.

Paper Order or Assignment Requirements

I have chosen a PICO Question on maintaining Skin integrity. Because I work in a Long -term facility maintaining skin integrity is a BIG issue. Because some of our residents are non-ambulatory diseases such as DMCHF and CVA compromise their skin integrity
P- The population that is mostly affected are residents that are non-ambulatory and it does matter if they are male or female. Age and weight may play a factor in maintaining skin integrity. The older the patient the less elastic the skin. This can cause great problems to the skin. Weight plays a factor because of the fiction that may develop.
I- The intervention for most residents is re-positioning every 2 hours. Skin breakdown occurs when re-positioning isnt enough?
C- Compare an ambulatory resident versus non-ambulatory resident.
O- Outcome is to improve the skin integrity and minimize pressure ulcers.
PICO and Evidence Appraisal Worksheets
PICO Worksheet
Your Name:
Your Instructors Name:
Purpose: To identify a problem or concern that nursing can change and develop a PICO question to guide the change project.
Directions: Use the form below to complete the PICO assignment in Milestone #1. This includes filling in the table with information about your research question and your PICO elements.
Step 1: Identify the problem. What have you noticed in your work or school environment that isnt achieving the desired patient or learning outcomes? What needs to change in nursing what can you change with the support of evidence in the literature? Briefly describe the problem or practice issue that you want to research. What is your practice area; clinical education or administration?
Step 2: How was the practice issues identified? How did you come to know this was a problem in your clinical practice? Review the listed concerns and check all that apply.
Step 3: What is the scope of the problem? Does this problem affect an individual population or an entire institution?
Step 4: Select the key PICO terms for searching the evidence. Clearly define your PICO question. List each element P (problem population or problem) I (intervention) C (Comparison with other treatment/current practice) and O (Desired outcome). Is the potential solution something for which you (as nurse or student) can find a solution through evidence research? Look in your book for guidelines to developing your PICO question.
Step 5: What evidence must be gathered? Everyone should have a literature search. However what other sources of reliable information will be helpful for your particular question?
Step 6: State the search question in narrow manageable terms. What terms will you use in order to make sure that your search is wide enough to obtain required information but narrow enough to keep it focused? How will you narrow your search if needed?

PICO WorksheetWhat is the practice issue/problem?
What is the practice area?
___ Clinical
___ Education

___ Administration
___ OtherHow was the practice issue identified? (check all that apply)
___ Safety/risk management concerns
___ Unsatisfactory patient outcomes
___ Wide variations in practice
___ Significant financial concerns

___ Difference between hospital and community practice
___ Clinical practice issue is a concern
___ Procedure or process is a time waster
___ Clinical practice issue has no scientific base
___ OtherWhat is the scope of the problem?
___ Individual
___ Population
___ Institution/systemWhat is the PICO question?
___ P (Patient population or problem):
___ I (Intervention):
___ C (Comparison with other treatment/current practice):
___ O (Desired outcome):What evidence must be gathered? (check all that apply)___ Literature search
___ Guidelines
___ Expert Opinion
___ Patient Preferences
___ Clinical Expertise
___ Financial Analysis
___ Standards (Regulatory professional community)
___ OtherState the search question in narrow manageable terms:
Evidence Appraisal Worksheet
Your Name:
Your Instructors Name:
Purpose: To find evidence to support an intervention that will change the outcomes.
Directions: Type your search question below. Find AT LEAST FOUR sources to support the need for change and the potential intervention you have selected to solve the problem. At least three of your sources must be peer-reviewed articles. The forth source could be another peer-reviewed article or a reliable credible source. Look in your text for ideas of other sources that can be used. Using the table below insert and describe your four chosen resources.
Step 1: APA Reference for the article. You will need to list the reference for the source in APA format. Be careful when using built-in APA formats and library citations. They may not be in APA format. Refer to Chapter 7 of your APA manual.
Step 2: Type of Source. If your source is a research article you will need to ensure that it is a peer review article. You need at least three peer-reviewed articles for your project. If your article is a nonresearch source then you will need to list what type of source it is; systematic review clinical practice guidelines organizational experience or individual expert opinion/case study/literature review. You may only use ONE non-research source.
Step 3: Strength of Research. Refer to page 238-240 for research evidence and page 242-244 for non-research evidence. While you do not need to assign a level for each study you will assign a quality of evidence (high good or low/major flaw) and should discuss the study using some of the elements that are discussed in the appraisal forms. For example Research evidence: was the sample size adequate? Was there a controlled group? Was it a randomized study? Were results clearly stated? Was the conclusion based on the results? Were study limitations discussed? Not all of these elements need to be discussed but you should discuss this information to determine if the strength of the evidence is HIGH GOOD or LOW/MAJOR FLAW.
Step 4: Brief Description of the Research. In this section you will summarize the source in your own words. How does this information apply to your project? What are the results of the source? What are their recommendations?

Evidence Appraisal WorksheetPICO Question:

APA Reference for Article
Give the APA-formatted reference for the article.
Type of Source
*Research: Peer-reviewed article
*Non-research systematic review clinical practice guidelines organizational experience or expert opinion/case study/literature review
Strength of Research
Discuss the strength of the sources.
Report if evidence is High Good or Low/Major Flaw. Use the tools on page 238-244 of your text and discuss the reasons why you have assigned a particular level of quality.
Brief Description of Research
Address the questions.
*How does the information in the article apply to the project problem or proposed intervention?
*Summarize in your own words.
* Include results of the study and how these results are applicable to your project.
* What is the recommendation of the source for clinical practice?1





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