Nursing Research by Evidence-Based Practice Guidelines
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, write the question in PICOT format and perform a literature search on the identified topic.
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.
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.
Here are the resources:
Melnyk, B. M. & Fineout-Overholt, E. (2015). Evidence-based practice in nursing & healthcare: A guide to best practice (3rd ed.). Wolters Kluwer Health. ISBN: 978-1-4511-9094-6 Chapters 1, 2, 3
Worksheet: Question Templates for Asking PICOT Questions
Application Case Study: Chapter 3: Finding Relevant Evidence to Answer Clinical Questions
Agency for Healthcare Research and Quality (AHRQ). (n.d.).
The Cochrane Collaboration. (n.d.).
American Association of Colleges of Nursing (AACN). (2018).
American Association of Colleges of Nursing (AACN). (2006, March 13). AACN Position Statement on Nursing Research.
Institute for Healthcare Improvement. (2018). The IHI Triple Aim.
U.S. Preventive Services Task Force. (2018, September).
Patient Centered Outcomes Research Institute. (2018).
American Nurses Credentialing Center (ANCC). ANCC Magnet Recognition Program.
Nursing Research by Evidence-Based Practice Guidelines
Evidence-based practices enable the nurses and other healthcare professionals to evaluate the research to understand the risks of the effectiveness of a particular diagnostic test and treatment. Evidence-based nursing practice helps nurses build a body of knowledge, standardize nursing practice, reduce the gap between nursing education and theory, and practice and improve patient outcomes. The discussion of the paper will focus on a PICOT question related to the area of practice, articles on the topic, and identification of an article that bests support the nursing intervention for the topic selected.
The Clinical Question Related to The Area of Practice
Sepsis is a serious and potentially life-threatening health condition and is caused by the body’s response to an infection. Bacterial infections are the most common causes of sepsis. The standard gold treatment by the health professionals is the completion of six bundles one hour after the presentation of the condition. Research shows that timely administration of care and treatment improves patient outcomes and reduces mortality. Sepsis has become a national priority with supported by various initiatives such as National Institute for Health and Care Excellence through guidelines for sepsis and the recommendations by the National Confidential, Enquiry into Patient Outcome and Death. Other efforts include the introduction of financial incentives designed to promote the delivery of antibiotics with an hour of patient presentation with the disease and accuracy (Tarrant et al., 2016). The move towards a 1-h bundle has been associated with low mortality. The PICOT question for the clinical areas is in adult patients diagnosed with sepsis, how is a 1-h sepsis bundle compared to a 3-h sepsis bundle help in reducing mortality rates within three months.
Why The Topic Is a Clinical Problem or An Opportunity for Improving Health Outcomes in Your Area of Clinical Practice
Severe sepsis is a major healthcare concern in the country, with an estimated number of 100 000 cases every year (Pinnington et al. 2016). The mortality rate is between 28% to 50%, while 65 000 people suffer long-term complications (Pinnington et al, 2016). The national campaign on the topic has focused on timely delivery of treatment. Still, the national audits show a deficiency in care delivery, creating an immediate requirement for an improvement in the delivery of care. For example, it has proven challenging to deliver treatment within the first four to eight hours after a patient’s presentation to the hospital. It is recommended that patients be treated through the “sepsis six” care bundle to be implemented within an hour (Tarrant et al., 2016). Best practice in the treatment of sepsis involves timely administration of antibiotics one hour after the presentation of the symptom and diagnosis.
The literature search was conducted using various databases, including CINHAL, PUBMED, and Google Scholar. The search was conducted using key phrases such as 1-h bundle, 3-h bundle, mortality, in-hospital mortality, and sepsis care. Inclusion criteria for the articles include relevancy to the topic, articles published within the last five years, and articles published in English. The five most relevant articles were selected.
The first article identified sought to evaluate the impact of 1-h and 3-h sepsis bundles on patient outcomes and antimicrobial use. The two bundles were implemented using the Breakthrough Series Collaboration in a total of 14 hospitals (Venkatesh et al., 2022). The baseline and post-intervention studies evaluated the impact of the one and 3-h bundles on outcomes and antimicrobial prescriptions. The results of the study indicated a significant reduction in the number of patients requiring ICU admission. No significant difference in ICU median or the length of hospital stay in the overall cohort in the two phases. Timely administration of antibiotics was associated with a decrease in the hospital stay. The 1-hour bundle is part of the timely administration of antibiotics (Venkatesh et al., 2022).
The second study focused on specifying when the delays of the 3-h bundle of SSC guideline recommendations if applied to severe sepsis, become harmful and impact morality. The article is a retrospective cohort study involving 5 072 patients. 27.8% of the patients died, and many of them had a 3-h bundle (Pruinelli et al., 2018). Patients in the study were set to receive various recommendations, including broad-spectrum antibiotics, blood culture, and crystalloids. Any patient that did not receive any of the recommended actions suffered death. Any amount of delay in minutes led to increased mortality risks. The finding of the study is that the mortality rate increases with delay in the administration of antibiotics (Pruinelli et al., 2018).
The third article identified sought to address the impact of implementing a one-hour bundle achievement in septic shock. Ko et al. (2021) compared in-hospital mortality based on the achievement of a 1-h bundle while utilizing multivariable logistic regression. The patients were categorized into three including groups one (1 h), the second group (1-3 h), and the third group (3-6 h). The results of the study did not indicate a significant difference in the in-hospital mortality in comparison with the group that failed to achieve a 1-h bundle based on the multivariable logistic regression analysis. The three and 6-h groups, however, had lower odds ratios in in-hospital mortality. The study did not establish a link between the attainment of the 1-h bundle with improved outcomes. The data obtained suggested further investigation on the clinical effects of achieving the 1-h bundle in patients diagnosed with sepsis (Ko et al., 2021).
The fourth article identified aimed at evaluating the impact of 1-h bundle completion in clinical outcomes. The article was a multicentre prospective and observational study, which was conducted in 17intensive care units. 89 participants out of 178 had access to bundle-adherent care. Non-adherence to certain recommendations such as the administering broad-spectrum of antibiotics and obtaining of blood culture are associated with in-hospital mortality. From the results of the study, the completion of a 1-h bundle was associated with a reduction of lower in-hospital mortality. Contributing components include administration of antibiotics within an hour after diagnosis has been made and obtaining brush cultures.
The fifth and last article was an ethnographic study that conducted a 300-h non-participant observation in medical and surgical wards, acute medical units, and the emergency departments. The study involved the implementation of six care bundles in sepsis care. The study implemented various strategies that include education, prompting for behaviour, engagement, staff motivation, and providing prompts for behaviour. The results of the study indicated that completion of the 1-h bundle was not straightforward. To facilitate the implementation of the six bundles can be facilitated by viewing the sepsis six as a complex trajectory where reliability requires a significant level of attention to be given to the coordination workflow (Tarrant et al., 2016).