Class 504.comment 1.unit 1

Purpose: Comment the Discussion (Class 504 Unit 1 Comment 1

Thing to Remember:

Answer this discussion with opinions/ideas creatively and clearly. Supports post using several outside, peer-reviewed sources.

1 References, find resources that are 5 years or less

No errors with APA format 6 Edition

To Comment

    My name is Kristina Donnellan. I started my nursing career on a medical-surgical unit in a small critical access hospital in Maine about six years ago. I realized quickly that med-surg nursing was not for me so I began to apply for ICU jobs across the state of Maine about one year into my nursing career. I was fortunate to have been offered a position at a large tertiary care center here in Maine in their Cardiac Intensive Care Unit.  Although the thought of becoming a Cardiac ICU nurse seemed terrifying at the time, it was the best decision I have made in my career yet this far.  I have truly found a passion for cardiology as well as caring for critically ill patients. Not long after finishing my BSN I went back to college and obtained my AAS in paramedicine to continue working in the field of EMS (I obtained by EMT-Basic license about ten years prior). as it was something that I am very passionate about. In my free time, I work as a Paramedic for a Fire Department in my hometown and I am an instructor for the Paramedicine program at a local college.

Case Study

            The case study found on page 108 of MeInyk and Fineout-Overholt’s Evidence Based Practice in Nursing and Healthcare: A guide to best practice (2015) talks about a case involving an infant who is in a pediatric intensive care unit, four days post cardiac surgery with a pulmonary artery catheter in place. The case study goes on to explain that the patient has an abnormal clotting profile and when the pulmonary artery catheter is removed the patient has a continuous ooze from the site and a marked deterioration in their condition; ultimately found to have a cardiac tamponade that required surgical intervention (MeInyk & Fineout-Overholt, 2015). At the end of the shift the nurse wonders how rare of a complication this is and wants to learn more about it. This nurse’s thought process is also known as inquiry; described as an ongoing curiosity about the best evidence to guide clinical decision making ( MeInyk, Fineout-Overholt, Stillwell & Williamson, 2009). Inquiry is the first step to utilizing evidence-based practice to learn more about a particular topic and implement it in day-to-day practice.

            In the medical field there are many sources of information that can be helpful when trying to answer a question or even simply learn more about a particular topic and the sheer amount of information can be overwhelming. The best method to obtain information based upon inquiry is to search the current literature.  Riva, Malik, Burnie, Endicott & Busse suggest that the PICOT format is a helpful approach for summarizing research questions (2012). This method allows you to utilize the acronym PICOT (the patient population, intervention or issue of interest, comparison intervention or group, outcome and time frame) to ask a clinical question and yield the most relevant and best evidence (MeInyk & Fineout-Overholt, p. 10, 2015). The PICOT method allows for a clear approach utilizing concise and easy to use terms and if properly structured will help to guide and ease the process of research (Debono, Zhang, Ye, Paul, Arya,  Hurlburt, .Thabane, 2013). Once I formatted my question into the PICOT format I would likely utilize an online, reputable database such as CINAHL to start my research. In this particular case study the components of the PICOT would be:  the population which is pediatrics and more specifically pediatric patients who are post cardiac surgery with an abnormal clotting profile, the intervention which is the removal of the pulmonary artery catheter, in compared to not removing the catheter, while the outcome is cardiac tamponade and the timeframe is immediate.      

          In the medical field, I believe that it is also important to remember to reach out to your colleagues and engage in discussions, as this is also a great way to learn new information. Different people have different experiences and backgrounds with vast assortments of knowledge and can be a great resource when you feel the need to inquire about a specific topic. I, however, when utilizing my colleagues would be aware that they may not have the most up to date information or may practice more based on experience than evidence and would still do a search of the literature to ensure that I am providing the best, patient-centered care possible.

References

 Debono, V., Zhang, S., Ye, C., Paul, J., Arya, A., Hurlburt, L. & Thabane, L. (2013).

            A look at the potential association between picot framing of a research question

            and the quality of reporting of analgesia rcts. BMC Anesthesiology, 13(1), 44-