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researchable_topic.docxRunning head: ICU QUIET TIME 1
ICU QUIET TIME 5
Researchable Topic: ICU Quiet Time
Ese Nosakhare
Nurs-6052N Essentials of Evidence-Based Practice
June 13, 2015
The identification of the research problem is the first and foremost step that every researcher has to undertake. The hardest thing for a nurse in evidence-based practice (EBP) is coming up with a clinical question that can be answered with research-based evidence (Polit and Beck, 2012). Knowing this, a clinical question that is focused on patients and significant to nursing can help obtain the knowledge needed to address the needs of certain patient populations (Thibane, Thomas & 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 for research. Doing so will allow the best evidence to achieve 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 focused on the key features to help complete evidence-based practice. Therefore, this discussion is aimed at deriving the correct clinical question to assist in research. The study is primarily concerned with how to reduce incidences of disorientation in ICU patients using the PICO format.
Developing a research problem is a creative process (Polit and Beck, 2012, p. 76). Neurotrauma 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, the regular intrusion of staff and visitors, and patient care activities. Current evidence suggests that a relationship exists between sleep, delirium, and mortality (Gardner & Henderson, 2009). Delirium is commonly linked to higher medical costs, increased risk of death and extended hospital stays. There has not been a direct between lack of sleep and restlessness. Current knowledge that sleep deprivation affects cognitive function point to a very direct connection between the two.
Extended hospital stays, increased medical costs and high risk for mortality have been directly associated with fever (Weinhouse & Watson, 2009). Nurses can assist with decreasing the incident delirium in ICU patients by implementing simple methods and hence help improve health outcomes. Some of these methods include turning off lights or even dimming them, reducing noise levels, reducing the number of visits/intrusions, proper positioning of patients and adequate pain control, etc. All these interventions aim at helping patients have some quiet time (Gardner & Henderson, 2009).
According to Thabane in his book, “Exploring patient, visitor and staff views on open visiting.” He states that the practicality of carrying out any study venture is based on the study question and should be well thought-out early in the procedure in order to steer clear of waste of useful power and intellectual vigor (Thabane, Thomas and Paul, 2006). Once one has identified a topic of interest, you can ask wide-range questions that can lead you to a researchable problem (Polit & Beck, 2012). These questions can assist one place emphasis on the research problem and give the focus better clarity. The questions to add to the background are listed below:
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 the doctors, RN’s and administration?
3. What should be the specific information to improve delirium guidelines based on the answers to the first questions?
4. What are other alternative methods to cope with the current problem in Neuro-trauma ICU?
5. What is the expected outcome of applied interventions?
6. What time frame is required? (If applicable).
These PICOT questions will enable asking of well structured, clear, focused and answerable questions. Key concepts and words derived from the question are then used in medical literature and nursing research for the most excellent evidence today.
The principle for generating an answerable query is followed the PICO format; Population at risk, Intervention, Comparison, Outcome. PICO is a systematic and consistent method used to identify the components of a clinical matter. The use of the PICO format to formulate a clinical question aids in the clarification of certain aspects of the clinical subject. This clarification will help guide the study of the evidence. When a PICO question is properly defined, the probability of finding the best evidence to guide clinical practice in a quick and efficient manner increases. In this case the PICO question would be; In the ICU patients, does reducing intrusion and noise result in proper sleep and reduced delirium?
A literature search was conducted using Pub MED, CINAHL and EBSCOhost databases. The keywords used for the searches were; ICU, delirium, quiet time, enforced visitations, rest periods, patient outcomes and sleep. The inclusion criteria were only articles from the past decades, inpatient, adult critical-care patients. The initial search yielded 70 articles. Using these terms in database search engines mentioned above will help find research evidence to answer this specific PICO question.
Conclusion
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 a vital role to play in executing and leading change to improve patient’s sleep. Prevention and adequate management of sleep deprivation in ICU patients may help reduce the incidence of delirium and its 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.
