Recommending an Evidence-Based Practice Change

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Advanced Levels of Clinical Inquiry and Systematic Reviews

Leslie Hill

Walden University

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Introduction

  • Clinical issues. Various clinical issues exist and this leads to a situation where an individual may identify and describe a chosen clinical concern of interest (Davies, 2011).
  • Addressing the clinical issue. While addressing this clinical issue, a PICO(T) question may be of great significance and importance as it aids in addressing the identified clinical issue (Davies, 2011).
  • Developing the PICO(T) question. Despite that the PICO(T) question plays a significant role in addressing the identified clinical issue, there is a need for developing this question effectively so that it may be of great help in addressing the clinical issue (Davies, 2011).
  • Selection of the clinical issue. The selected clinical issue also needs to be highly relevant and the one that may be addressed while using an appropriate PICO(T) question (Davies, 2011).

Selected Clinical Issue of Interest

  • Selected clinical issue. The appropriate or selected clinical issue to address in this assignment entails the examination of the effect of preventive dressings on decreasing or preventing pressure ulcers as opposed to leaving such areas open to air.
  • The PICO(T) question. As far as this assignment is concerned, the selected clinical issue of interest is as follows; In the bedbound patient, what is the effect of preventive/prophylactic dressings on the decrease/prevention of pressure ulcers as compared to leaving areas open to air.
  • Description of the clinical issue. Pressure ulcers are injuries to skin as well as underlying tissues that result from prolonged pressure on skin, (Park et al., 2016). They can be reduced by preventive dressings instead of leaving the area open to air as they limit the ability of a patient to change positions.

  • PICO(T). Developed by Davies in 2011, is a mnemonic of developing a question and breaking down the search question and includes the Problem/Patient, Intervention, Comparison, Outcome and Time for undertaking this practice.
  • Patient. The population to focus on was the bedbound patients, (Barakat, Lai, Wand, & White, 2019).
  • Intervention. The intervention was the preventive/prophylactic dressings.
  • Comparison. Comparison is made to leaving such areas open to air.
  • Outcome. The outcome is that further breakdown will be prevented and healing will be promoted.
  • Time. The appropriate time that this would be carried out is during stage one or two skin ulcers.

Description of PICO(T) Question

Research Articles from Databases

  • Research databases. Various research databases exists that may be used while conducting a search for the peer-reviewed articles.
  • Choice of appropriate databases. The choice of appropriate databases is important so that the appropriate articles may be obtained.
  • CINAHL database. It was one of the appropriate database that was used and is the largest and most in-depth nursing researching database.
  • Medline database. It involves bibliographic information of articles from academic journals.
  • PubMed database. Offers articles covering life sciences as well as biomedical topics.
  • Embase database. A biomedical and pharmacological bibliographic database of published literature.
  • Barakat-Johnson, M., Lai, M., Wand, T., & White, K. (2019). A qualitative study of the thoughts and experiences of hospital nurses providing pressure injury prevention and management. Collegian, 26(1), 95–102.
  • Park, S. H., Lee, Y. S., and Kwon, Y. M. (2016). Predictive validity of pressure ulcer risk assessment tools for the elderly: A meta-analysis. Western Journal of Nursing Research, 38(4), 459-483.
  • Roberts S., Mclness E., Wallis M., Bucknall T., Banks M., & Chaboyer W. (2016). Nurses’ perception of a pressure ulcer prevention care bundle: a qualitative descriptive study. BMC Nursing, 15, 64.
  • Boyko T., Longaker M. T., and Yang G. (February 1, 2018). Review of the current management of Pressure Ulcers. Journal of Advances in Wound Care, vol. 7, issue No. 2. pages 57-67.

Selected Articles

Levels of Evidence

  • Level 1 evidence. The article by Roberts, S. et al. (2016), provided level one evidence as it was evidence from systematic review of all relevant and randomized controlled trials.
  • Level 2 evidence. The article by Park, Lee, & Kwon (2016) provided level 2 evidence as it was information from meta-analysis of all the relevant and randomized controlled trials, (Burns, 2011).
  • Level 4 evidence. The article by Barakat-Johnson, Lai, Wand, & White (2019) provided level 4 evidence as it was summaries of individual thoughts and experiences.
  • Level 5 evidence. The article by Boyko, Longaker, & Yang (2018) provided level 5 evidence as it was evidence from an effectively designed and randomized controlled trials regarding pressure ulcers.
  • Strengths of using systematic reviews. Offers a summary of findings from several studies and reduces biases.

References

Barakat-Johnson, M., Lai, M., Wand, T., & White, K. (2019). A qualitative study of the thoughts and experiences of hospital nurses providing pressure injury prevention and management. Collegian, 26(1), 95–102.

Boyko, T., Longaker, M., and Yang, G., (February 1, 2018). Review of the current management of Pressure Ulcers. Journal of Advances in Wound Care, vol. 7, issue No. 2. pages 57-67.

Burns, P. B., Rohrich, R. J., & Chung, K. C. (2011). The levels of evidence and their role in evidence-based medicine. Plastic and reconstructive surgery, 128(1), 305–310. https://doi.org/10.1097/PRS.0b013e318219c171.

Davies, K. S. (2011). Formulating the Evidence Based Practice Question: A Review of the Frameworks. Evidence Based Library and Information Practice, 6(2), 75-80. https ://doi.org/10.18438/ B8WS5N

References Continued

Park, S. H., Leek, Y. S., & Kwon, Y. M. (2016). Predictive validity of pressure ulcer risk assessment tools for the elderly: A meta- analysis. Western Journal of Nursing Research, 38(4), 459-483.

Roberts, S., Mclness, E., Wallis, M., Bucknall, T., Banks, M., & Chaboyer, W. (2016). Nurses’ perception of a pressure ulcer prevention care bundle: a qualitative descriptive study. BMC Nursing, 15, 64.