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RESEARCH:QUIET TIME IN NEURO ICU 5

Running Head: RESEARCH: ICU QUIET TIME 1

Researchable Topic: ICU Quiet time

Ese Nosakhare

Nurs-6052N Essentials of Evidence-Based Practice

June 13, 2015

Researchable Topic: ICU Quiet time DS Dr. Sullivan Title needed when you begin on page two. This title should be the same as the title page, centered and not bolded

The identification of research problem is the first and foremost step that every researcher has to undertake. What is hard for a nurse to do in evidence-based practice (EBP) is coming up with a clinical question that can be answered with research evidence (Polit & Beck, 2012). Knowing this, a clinical question that is patient focuseds and important significant to nursing can help obtain the knowledge needed to addressing the needs of certain patient populations (Thibane, Thomas & and Ye, 2009). A nurse making a clinical question that can be answered requires a game plan that can identify pertinent nursing issues. Furthermore, the nurse must put that nursing issue into an easy format to research. Doing so will endure allow the best evidence to realize EBP (Richardson, 2009). Analyzing present issues in nursing connected to evidence based practices for ICU delirium, a nurse should have the capability to identify certain steps in making a well-rounded clinical question that is structured and focusesd on the key features to help complete evidence based practice DS Dr. Sullivan Your introductory paragraph is good but you could make it better by including one sentence that clearly defines the purpose of the paper. This is usually the last sentence in the introductory paragraph.

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Developing a research problem is a creative process (Polit and Beck, 2012, p.76). Neuro-trauma ICU patients typically have an increased need for sleep. However, the ICU setting predisposes ICU patients to sleep deprivation due to exposure to bright lights, high noise levels, regular intrusion of staff and visitors, and patient care activities. Current evidence suggests that a relationship exists among sleep, delirium, and mortality DS Dr. Sullivan Use of resources or references would have added credibility to your discussion

. Delirium is commonly linked to higher medical costs, increased risk for death and extended stays DS Dr. Sullivan Need a citation . There has not been a direct link between lack of sleep and delirium has yet to be proven. Current knowledge that sleep deprivation affects cognitive function, points to a very direct connection between the two. Extended hospital stays, increased medical costs, and high risk for mortality have been associated with delirium DS Dr. Sullivan Need a citation . Nurses can assist with decreasing the incidence delirium in ICU patients by using simple methods and hence help improve health outcomes. Some of these methods include turning off lights or dimming them, reducing noise levels, reducing the number of visits/intrusions, proper positioning of patients and adequate pain control etc. all help the patient have some quiet time DS Dr. Sullivan Need a citation .

Thabane, et. al DS Dr. Sullivan Be careful with your punctuation here. To cite with et al., use this method: (Jones et al., 2009). For more on using et al., see http://writingcenter.waldenu.edu/34.htm . (2009), states that the practicality of doing any research project is “based on the research question and should be considered early in the process in order to avoid waste of resources and intellectual energy DS Dr. Sullivan Please correct quotation(s). See APA book p. 91, 170, 172. ”. Once an identified a topic of interest, you can ask wide-range questions that can lead you to a problem that is researchable (Polit and Beck, 2012, p.76 DS Dr. Sullivan If this is a direct quote then please use quotation marks. See APA book p. 170-173. ). These questions can help one place emphasis on the research problem and give the focus better clarity. The questions to add to the background are: 1)What are the current practices regarding delirium management in the neuro ICU? 2)What are the main influencing factors for the implementation of the ICU delirium guidelines in the neuro ICU as reported by doctors, RN’s and administration? 3)What should be the specific information to improve delirium guidelines based on the answers to the first two questions DS Dr. Sullivan You needed 5 questions DS Dr. Sullivan You could have added to this discussion by explaining how you used these questions to develop your PICOT. Another way would be to explain why these questions were not used (not feasible).

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The formula to creating an answerable question is following PICO format; Population, Intervention, Comparison, Outcome. PICO is a systematic and consistent method used to identify the components of a clinical issue. The use of the PICO format to formulate a clinical question aids in the clarification certain aspects of the clinical issue. This clarification will help guide the research for the evidence. When a PICO question is well-definedwell defined, the probability of finding the best evidence to guide clinical practice in a quickly and efficient manner increases DS Dr. Sullivan What is your PICO question? .

A literature search was conducted using CINAHL, EBSCOhost and PubMed databases. The keywords used for the searches were: ICU, delirium, quiet time, delirium and sleep, enforced visitation, rest periods, patient outcomes. The inclusion criteria was only articles that were from the last 105 years, inpatient, adult critical-care patients. The initial search yielded 70 articles. Using these terms in databases search engines mentioned above will help find research evidence to answer this specific PICO question DS Dr. Sullivan It would have added to your discussion in this section if you would have correlated the key terms with the variables. For example: For the intervention variable of Catheter cleaning with CHG, the key words CHG, “catheter care,” “perineal care,” “antimicrobial cleanser,”and so on.

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The objective of this research is to investigate if strict enforcement of scheduled hours of rest time would decrease the multiple incidences of delirium in adult critical-care patients in the ICU. ICU patients have a very high risk for lack of sleep which leads to a source of concern for multi-disciplinary teams in health care. Nurses have vital role to play in executing and leading changes to improve patient’s sleep. Prevention and adequate management of sleep deprivation in ICU patients may help reduce the incidence of delirium in ICU patients and its attendant negative effects. Studies have correlated sleep deprivation with incidences of delirium in ICU patients, which lead to impaired cognitive function and longer hospital stays. With this specific topic and PICO question, I fully commit to answering my background questions and sharing the findings.

 References

Gardner, G., Collins, C., Osborne, S., Henderson, A., & Eastwood, M. (2009). Creating a therapeutic environment: A non-randomised controlled trial of a quiet time intervention for patients in acute care. International Journal of Nursing Studies, 778-786.

 

Richardson, A., Thompson, A., Coghill, E., Chambers, I., & Turnock, C. (2009) Development and implementation of a noise reduction intervention program: A pre- and post-audit of three hospital wards. Journal of Clinical Nursing, 3316-3324.

 

Thabane L, Thomas T, Ye C, Paul J (2006).. Posing the research question: Not so simple.     Exploring patient, visitor and              staff views on open visiting. Nursing Times.

 

Weinhouse, G. L., Schwab, R. J., Watson, P. L., Patil, N., Vaccaro, B. & Ely, E. W (2009). Bench-to-bedside review: Delirium in ICU patients - importance of sleep deprivation. Critical Care, 234-241.

Walden University M.S. in Nursing

Formative Evaluation Criteria for Applications and Formal Papers

Categories and Criteria

Possible Points

Points

QUALITY OF WORK SUBMITTED - 35 Possible Points

1. The extent to which work meets the assigned criteria and work reflects graduate level critical and analytic thinking (0-30 Points)

Assignment exceeds expectations. All topics are addressed with a minimum of 75% containing exceptional breadth and depth about each of the assignment topics.

25-30

20

Assignment meets expectations. All topics are addressed with a minimum of 50% containing good breadth and depth about each of the assignment topics.

20-24

Assignment meets most of the expectations. One required topic is either not addressed or inadequately addressed.

16-19

Assignment superficially meets some of the expectations. Two or more required topics are either not addressed or inadequately addressed.

 

2. Purpose of the paper is clear (0-5 Points)

A clear and comprehensive purpose statement is provided which delineates all required criteria.

5

3

Purpose of the assignment is stated, yet is brief and not descriptive.

4

Purpose of the assignment is vague.

3

No purpose statement was provided.

0

ASSIMILATION AND SYNTHESIS OF IDEAS - 50 Possible Points

 

 

The extent to which the work reflects the student’s ability to-

1. Understand and interpret the assignment’s key concepts (0-10 Points)

Demonstrates the ability to critically appraise and intellectually explore key concepts.

10

8

Demonstrates a clear understanding of key concepts.

8

Shows some degree of understanding of key concepts.

7

Shows a lack of understanding of key concepts, deviates from topics.

0-4

2. Apply and integrate material in course resources (i.e. video, required readings, and textbook) and credible outside resources (0-20 Points)

Demonstrates and applies exceptional support of major points and integrates 2 or more credible outside sources, in addition to 3-4 course resources to support point of view.

15-20

6

Integrates specific information from 1 credible outside resource and 3 to 4 course resources to support major points and point of view.

10-14

Minimally includes and integrates specific information from 2-3 resources to support major points and point of view.

3-9

Includes and integrates specific information from 0 to 1 resource to support major points and point of view.

0-2

3. Synthesize (combines various components or different ideas into a new whole) material in course resources (i.e. video, required readings, and textbook) by comparing different points of view and highlighting similarities, differences, and connections.  (0-20 Points)

Synthesizes and justifies (defends, explains, validates, confirms) information gleaned from sources to support major points presented. Applies meaning to the field of advanced nursing practice.

18-20

17

Summarizes information gleaned from sources to support major points, but does not synthesize.

16-17

Identifies but does not interpret or apply concepts, and/or strategies correctly; ideas unclear and/or underdeveloped.

14-15

Rarely or does not interpret, apply, and synthesize concepts, and/or strategies.

0-13

WRITTEN EXPRESSION AND FORMATTING - 15 Possible Points

1. Paragraph and Sentence Structure: Paragraphs make clear points that support well developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are clearly structured and carefully focused--neither long and rambling nor short and lacking substance. (0-5 Points)

Paragraphs and sentences follow writing standards.

5

4

Paragraphs and sentences follow writing standards 80% of the time.

4

Paragraphs and sentences follow writing standards 70% of the time.

3

Paragraphs and sentences follow writing standards < 70% of the time.

0-2

2. English writing standards: Correct grammar, mechanics, and proper punctuation (0-5 Points)

 

Uses correct grammar, spelling, and punctuation with no errors.

5

3

Contains a few (1-2) grammar, spelling, and punctuation errors.

4

Contains several (3-4) grammar, spelling, and punctuation errors.

3

Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.

0-2

3. The paper follows correct APA format for title page, headings, font, spacing,   margins, indentations, page numbers, running head, parenthetical/in-text citations, and reference list (0-5 Points)

Uses correct APA format with no errors.

5

2

Contains a few (1-2) APA format errors.

4

Contains several (3-4) APA format errors.

3

Contains many (≥ 5) APA format errors.

0-2

Total Points for Assignment:

63

Guidance for Application Assignments :

Application Assignments require a title page, introduction, body of the paper, conclusion, and reference page. The title page needs to follows APA style and includes a title, student name, course number and section, and date. An abstract is not required. APA style headings are to be used appropriately to separate and organize sections of the paper. The use of direct quotes is discouraged and should only be used when the source material uses language that is particularly striking or notable. The introduction should provide an overview of the topic, the purpose of the paper, and topics that will be addressed. The body of the paper needs to address all required topics. The conclusion ought to provide closure for the reader, synthesize the content, and tie everything together to help clarify the main points of the paper. The reference page should include all references cited in the assignment in correct APA format.. Some course assignments may require the use of more than 2 credible outside resources. In these cases, the minimum outside sources specified in the instructions for the assignment will be applied in the grading of these course assignments. Credible sources include scholarly peer-reviewed journal articles, evidence based resources, and professional (.org), educational (.edu), and government websites (.gov). Commercial websites (.com) are not considered credible sources. Please note: When selecting articles for course assignments, you are advised (unless you are referencing seminal information) to focus on work published within the past five years.

Late Policies :

Assignments submitted late without prior agreement of the Instructor, outside of an emergency absence, or in violation of agreements for late submission, will receive a grade reduction for the Assignment amounting to a 20% point loss. After 5 days, the Assignment will not be graded. Students should be aware that late Assignments may not receive the same level of written feedback as do Assignments submitted on time.

Notes:

 

 

 

You have done nice work of summarizing your area of interet, developing your PICOT question and identifying your search terms. This should be an interesting project as we progress. Excellent work!

Week 2 Assignment Expectations:

 

 

 

 

 

 

1) Summary of area of interest, identify problem, explanation of significance in nursing

 

 

 

2) 5 questions with how analyzed them for feasibility, chose one for PICOT and give rationale.

 

 

 

3) Preliminary PICOT, delineate variables, and description of each variable

 

 

 

4) 10 possible keywords