Practice change simulation

Running Head: IDENTIFYING A CLINICAL QUESTION 1

IDENTIFYING A CLINICAL QUESTION 2

Introduction

Nursing is an essential profession in our communities as it directly supports and promotes human life. Due to this critical role nurses executes, it becomes exclusively important that every procedure and practice they undertake is adequately backed up by evidence. This evidence is obtained through research, which must be not only verifiable but also timely and relevant. All questions associated with any clinical practice must be answered to facilitate effectiveness in care delivery. Nursing research has become synonymous with today's care, with many institutions and departments set up to carry out healthcare research and development. The PICOT method exactly does the same by assisting in the creation of researchable and answerable questions. When properly formulated, these questions facilitate direct, faster, and easier evaluation and understanding of the health or associated clinical question giving way for quality healthcare delivery. In the PICOT, P represents the target population, I is the intervention or treatment to be implemented, C is the comparison of the treatment intervention with a reference group, O is the outcome of the intervention, and T is the time through which data is collected Melnyk & Fineout-Overholt, 2015).

PICOT Question

Most patients, moreso children, find the perioperative period as the most challenging and stressful moment. About three out of four children undergoing surgery records unsummounted anxiety and pain, which can result in adverse behavioral sequelae and cognitive problems that can go even into postoperative. This anxiety and anguish get relief by the presence of children's parents who offers the needed comfort and support, among other pre, intra, and postoperative measures. Whilst the parent's presence may facilitate fast and speedy recovery and prevent postoperative complications, there comes a time when the child-parent separation is necessary, and this is a hard decision that a physician is faced with. In our case scenario, the pediatric operation amounted to some complications that necessitated the extension of the child length of hospital stay from two days to a fortnight. The pediatrician is faced with a hard choice to ask the pediatric patient's mother to leave the patient alone at night as the mother had been staying with the child all along the admission period. The other clinical entourage is against the surgeon's idea yielding a clinical decision scenario. It is important for the surgeon to stay away from the subjective decision but welcome an evidence-based decision to inform the idea. A well-formulated PICOT question would thus be as follows: For a pediatric patient who has developed a postoperative complication, resulting in an extended length of hospital stay, how does the extended presence of the parent into the night time compare with limited daytime stay with regard to pediatric patients recovery and present and future child's cognitive functioning for the first two weeks of hospital stay.

P-hospitalized pediatric patient

I-extended length of parent stay into the night.

C- Parents limited daytime stay

O-pediatric patient recovery and cognitive functioning

T-first two weeks of hospital stay

Related Literature

The paper utilized five existing literature work as described below to seek evidence of the above PICOT question.

According to Thomas et al., 2019, the traditional practice of medicine in the mid-20th Century created miserable healthcare centers for pediatric patients. The general belief was that the extended length of stay of pediatric patient's parents allegedly hampered effective medical attention that their children could receive. This made the parents visits to be restricted to only daytime. Evenings were hard times for the children as they could not easily relinquish and substitute the comfort of their parents with that of their fellow pediatric patients. The belief system necessitated Thomas et al., 2019, to conduct this study comparing the recuperation progress of those patients receiving parental visits vs. those who did not. The researchers concluded that pediatric patients lacking frequent and adequate parental visits reported intense psychological trauma and adverse cognitive changes, unlike their other counterparts.

Another study by Sahiner & Bal, 2016 supported the findings of Thomas et al., 2019, by concluding that the child-parent separation negatively affected the child perioperative experiences, thus prolonging the recovery period. It also affected the children's cognitive functioning that went beyond the recovery period into adulthood. Also, Raiskila et al., 2016 conducted a study and found that the extended child-parent stay played a crucial role in the child's cognitive and behavioral functioning and development. It relieved the child of the heightened fear, anxiety, and pains related to their conditions and subsequent operation, which is important in the healing and recovery process. The trio are even worse at night, and overnight stay is a good if not the best therapy.

Franck et al., 2015, also dug into the child-parent issue and concluded that the overnight stay is not only best for the recuperating patient but also for their parents. Though the parents can be able to cope with related stress, either decision may take a toll on them, affecting their physical, psychological, and mental wellbeing. This prompts the implementation of a program to support the parents. The children are the hardest hit by the operation, both physically and mentally, and thus need parental care. Franck et al., 2015, concludes that the involvement of the family in nursing care cannot be underestimated. The support and comfort have become synonymous with the modern-day practice that seeks a holistic approach to patient care. The children are in their development phase may not be strong enough to find meanings in their suffering, and the torture can very detrimental to their physical and cognitive development. Caregivers must therefore try to offer the best and home like environment to assist pediatric patients to cope with the perioperative experience. However, Doupnik et al., 2017 study found that limited visits are important for the wellbeing of both the child and the parent. The child is able to have enough time to rest, and so the parents. Sleep is important for the psychological and cognitive well being of the parents and patients, with the researchers emphasizing the importance of the rest therapy.

Conclusion

With this bunch of evidence, the physician can rationally make the decision. Though much evidence supports the idea of the mother staying into the night, there is also some aspect of the rest that the doctor must consider in deciding whether and under which terms to allow the mother. I consider the Franck et al., 2015 ideas as the most progressive as it looks at the two sides of the pie, parents, and pediatric patients. All of them need support and care to facilitate better and holistic care.

References

Doupnik, S. K., Hill, D., Palakshappa, D., Worsley, D., Bae, H., Shaik, A., Qiu, M. (., Marsac, M., & Feudtner, C. (2017). Parent coping support interventions during acute pediatric hospitalizations: A meta-analysis. Pediatrics, 140(3), e20164171. https://doi.org/10.1542/peds.2016-4171

Franck, L. S., Ferguson, D., Fryda, S., & Rubin, N. (2015). undefined. Medical Care Research and Review, 72(4), 419-437. https://doi.org/10.1177/1077558715579667

Melnyk, B. M., & Fineout-Overholt, E. (2015). Evidence-based practice in nursing and healthcare: A guide to best practice. Low.

Raiskila, S., Lehtonen, L., Tandberg, B. S., Normann, E., Ewald, U., Caballero, S., Varendi, H., Toome, L., Nordhøv, M., Hallberg, B., Westrup, B., Montirosso, R., & Axelin, A. (2016). Parent and nurse perceptions of the quality of family-centered care in 11 European NICUs. Australian Critical Care, 29(4), 201-209. https://doi.org/10.1016/j.aucc.2016.09.003

Sahiner, N. C., & Bal, M. D. (2016). The effects of three different distraction methods on pain and anxiety in children. Journal of Child Health Care, 20(3), 277-285. https://doi.org/10.1177/1367493515587062

Thomas, A., Sprague, S., Braga, L. H., & Voineskos, S. H. (2019). The steps of practicing evidence-based surgery (EBS). Evidence-Based Surgery, 9-15. https://doi.org/10.1007/978-3-030-05120-4_2