DQ: Describe the difference between a nursing practice problem and a medical practice problem
NRS 433 Topic 1 DQ 1
PICOT is utilized by the health care community to identify and study a nursing or medical practice problem. Consequently, PICOT examples that may provide insight into the use of the PICOT process, may not be relevant to nursing practice as they are based on a medical practice problem.
There are many differences between nursing and medical practice problem as both health care disciplines has different approach towards looking at a patient problem. The goal of medical diagnosis process is to formulate a clinical judgment for the following reason: to identify or rule out a disease, to explain the findings and their likely causes to the patient, predict the disease’s course and modify its predicted course (Chiffi,D., Zanotto.R.2015). Medical providers rely on many diagnostic tests and procedures along with their assessments and clinical reasoning to develop the diagnosis. For example, the patient who presented with abdominal pain, nausea vomiting goes through the medical work up including blood work and diagnostic studies such as CAT scan towards the medical diagnosis of acute pancreatitis &alcohol withdrawal symptom. While the medical problems focus on patient’s clinical outcome, nursing diagnosis on this situation might be focused on patient as a whole. In this case, patient’s goal of care is based on nursing problem. Some of the problem /nursing diagnosis might be Intolerance to pain due to the pancreatitis or ineffective coping due to the loss of loved one. Nursing problem will guide nurses to approach clinical conditions of patients more holistically and provide support to not just the individual but the community.
Nurses practice revolves around the nursing process (Toney—Butler, Thayer, 2021). Nurses practice revolves around the improvement of the patient and the care process. It resembles the PICOT in many ways like the intervention/would be the planning process, the comparison/would be the implementation and the outcome /would be the evaluation. PICOT is used to develop the question needed to be researched and answered with evidence (Helbig, 2018) and the nursing process steps provide answers in the evaluation phase. The difference between a nursing or medical practice problem, nurses practice works to improve patient care and medical provides the cause or pathology of the patient. Nurses must practice within their scope of practice (OP, 2010). It is important for nurses to ensure their PICOT is based on nursing care and not a diagnosis. Nursing diagnosis is different from diagnosing a patient’s health issue for treatment as doctors do. Nurses must remain within their scope of practice.
PICOT question is the first step in evidence-based practice, and many times the question is written poorly. It should not be written in past tense, its used to help search for the best evidence to answer the question (Gallagher Ford, 2019). It has been noted that there is difficulty in finding quality information and at times we lack the skills to evaluate the literature. There is a evidence-based research tool (EBR) which improved the ability of nursing students to find and review articles and correctly apply the PICOT (Long, et al., 2016).
An example of a nursing PICOT:
P: Patient – Adults 65 and over with constipation
I: Intervention – Encourage to exercise 45 min per day
C: Comparison – Patients who do not exercise
O: Outcome – Increased bowel movements in a week
T: Time Frame – 1 month
An example of a medical PICOT:
P: Patient – 65-year-old complaining of knee pain
I: Intervention – MRI
C: Comparison – MRI of normal knee
O: Outcome – Diagnosis of Arthritis
T: Time Frame – 2 weeks
References:
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Gallagher Ford, L., & Melnyk, B. M. (2019). The Underappreciated and Misunderstood PICOT Question: A
Critical Step in the EBP Process. Worldviews on Evidence-Based Nursing, 16(6), 422–423. https://doi-
org.lopes.idm.oclc.org/10.1111/wvn.12408
Helbig, J. (2018). History and Process of Nursing Research, Evidence-Based Nursing Practice, and Quantitative
and Qualitative Research Process. Grand Canyon University (Eds.), Nursing Research:
Understanding Methods for Best Practices. https://lc.gcumedia.com/nrs433v/nursing-research-
understanding-methods-for-best-practice/v1.1/#/chapter/1
Long, J. D., Gannaway, P., Ford, C., Doumit, R., Zeeni, N., Sukkarieh, H. O., Milane, A., Byers, B., Harrison,
L., Hatch, D., Brown, J., Proper, S., White, P., & Song, H. (2016). Effectiveness of a technology‐based
intervention to teach evidence‐based practice: The EBR tool. Worldviews on Evidence-Based Nursing,
13(1), 59–65. https://doi-org.lopes.idm.oclc.org/10.1111/wvn.12132
Office of Professions (OP), (2010, June 18th). Education Law. Article 139, Nursing
http://www.op.nysed.gov/prof/nurse/article139.htm#sect6902
Toney-Butler TJ, Thayer JM. [Updated 2021 Jul 9]. Nursing Process. StatPearls [Internet].
https://www.ncbi.nlm.nih.gov/books/NBK499937/
Wanda Felder
Posted Date
Apr 10, 2022, 6:59 PM
Remember to complete your PICOT, by including each of the elements listed in the image below.
https://i.pinimg.com/originals/de/67/6d/de676d6fbfc11dfa2e1cacebdb29ae5b.png
Replies to Gale Storm-Bryant
PICOT is a method used when developing a quality improvement project or lead to EBP (Helbig, 2018). It breaks down to five parts Patients/problem, Intervention, Comparison, Outcome, and Time which is used to develop a question to hypothesize changes that can be made in nursing or medical practice for patient improvement. Nursing practice problems are problems that occur during routine nursing practice as it relates to the patient’s condition. A medical practice problem is one that occurs with the disease process of a patient involving the medical condition or disease.
DQ: Describe the difference between a nursing practice problem and a medical practice problem
An example of a nursing practice problem would be
P: Hospital Staff
I: Hand Sanitizer
C: Handwashing using soap and water
O: Minimize the spread of hospital acquired infection
T: 3 consecutive months
An example of a medical practice problem would be:
P: Post op patient
I: Prophylactic Antibiotic Therapy
C: Pre-Op & Post Op Antibiotic therapy
O: Reduction of Surgical Site infection
T: Three consecutive months
It is important to ensure a PICOT is based on a nursing practice problem to prevent practicing in the scope of medicine by way of conducting a clinical research study versus an evidence-based practice project. Research questions are posed with the intention of generating new knowledge or verifying that published findings are reproducible (Zuzelo, 2018). Nurses use evidence-based practice to provide patients with safe, quality care and to improve outcomes (Helbig, 2018). The goal is to improve nursing processes that produce safe patient outcomes during nursing care.
Helbig, J. (2018). History and process of nursing research, evidence-based nursing practice, and quantitative and qualitative research process. Nursing research: Understanding methods for best practice. https://lc.gcumedia.com/nrs433v/nursing-research-understanding-methods-for-best-practice/v1.1/#/chapter/1
Zuzelo, Patti Rager (2018) Evidence-based practice methodology. Holistic Nursing Practice: Volume 32 (6)- p 340-342 doi: 10.1097/HNP.0000000000000297. Retrieved from https://journals.lww.com/hnpjournal/Citation/2018/11000/Evidence_Based_Practice_Methodology__Use_the.9.aspx
Research produces positive and negative outcomes. It does not always produce what the researcher is looking for. When looking at different processes that can be used for research a pilot came to mind, an experiment before going live. One issue that will cause research to have a negative outcome would be inconsistence when not using all parts on all participants (Holt, et al. 2021). You can have positive outcomes as well but how accurate will your research be. Research in healthcare is to improve patient outcomes, provide quality care and patient satisfaction, if our evidence is not consistent, we could cause harm to our patients. Accurate research takes many years and patient consent to participate, time may not always be on our side depending on what the research may be trying to prove or provide information about. A perfect example is the COVID19 vaccine, who did they get to agree to test the vaccine before approving it? (not trying to be controversial – just an example). Research needs an adequate number of participants (Holt, et al. 2021) articles to be substantial. PICOT structure and the nursing process for patients’ outcomes working together may provide the framework for a shorter time for review of results (Wikan, et al. 2020).
A problem-solving approach to clinical practice, evidence-based practice (EBP) integrates evidence, patient preferences, values, and clinical expertise to make informed decisions. (Helbig, 2022). Medical practice problems and nursing practice problems share the characteristic of being used in medicine, but they are different in many other ways. An issue encountered during nursing practice is one that is related to a patient’s response to a health problem they are experiencing, such as during a patient assessment. Nursing practice problems involve numerous considerations. From symptoms of an illness to difficulties completing activities of daily living due to a fractured extremity for example, this can vary from patient to patient. A nurse’s care involves the entire individual, their family, or their community. Nursing practice problems involve support, comfort, prevention of trauma, promotion of recovery, health screening, appraisal, and/or assessment, and health education. ). A nursing model deals with human response to actual or potential health problems and life processes.
A medical practice problem involves a medical condition or disease. It identifies a condition, searches for causes, establishes a prognosis, and prescribes a treatment for it . Medical diagnoses identify a deviation from a norm, while nursing diagnoses assess self-care potential. (Chiffi and Zanotti 2015). Take the example of a patient who has fractured his wrist. Medications for pain will be prescribed by the physician after the fracture has been set. The nurse will discuss the patient’s aftercare and medication instructions with him or her. In addition to reviewing splint care, the nurse may arrange for a visiting nurse to assist with daily living activities.
The PICOT question is the first step in establishing or improving evidence-based practice with the goal of solving problems with patients. “Nurses use EBP to provide patients with safe, quality care and to improve outcomes” (Helbig, 2018) It looks at the clinical judgment about an individual patient, a family ,or a community and how they respond to actual or potential health problems that they are exposed to .
Refence.
Chiffi. D, Zanotti. R (2015). Medical and nursing diagnoses: a critical comparison. https://pubmed.ncbi.nlm.nih.gov/24819249/
Helbig, J. (2022). History and process of nursing research, evidence-based nursing practice, and quantitative and qualitative research process. In Grand Canyon University (Eds.), Nursing Research: Understanding Methods for Best Practice. https://bibliu.com/app/#/view/books/1000000000588/epub/Chapter1.html#page_7
Evidence-Based Practice (EBP) is the clinical application of research or utilization of it. It is an approach to the delivery of health care that is problem solving and brings in the top evidence from studies and data from patient care with expertise of clinicians and patient values and preferences. EBP is used by nurses to give patients safe, high-quality care and to better their outcomes. When EBP is being developed, that individual is viewing research that was already investigated. A PICOT statement must first be created. This can be related to a quality improvement project, or it can lead to EBP (Helbig, 2018).
A nursing practice problem is the first part of the PICOT question. It is associated with a problem with a patient that is something a nurse can resolve or work on. A medical practice problem would cover a medical issue that a nurse would not be able to resolve and would be out of the nurse’s scope of practice. It would be deferred to a clinician. One example of a nursing practice problem is in elderly patients, is rounding every hour or every two hours affect the incidence of falls in a twelve-hour period (Echevarria and Walker, 2015). An example of a medical practice question is in woman of childbearing age, does birth control use or no birth control use increase the risk of breast cancer in a 20-year period.
References:
Echevarria, Ilia M., and Susan Walker. “Start with a PICOT Question to Make Your Case.” Nursing Critical Care, vol. 10, no. 3, May 2015, pp. 14–16, https://doi.org/10.1097/01.ccn.0000464307.39978.1a.
Helbig, June. Grand Canyon University (Ed). (2018). Nursing research: Understanding methods for best practice. Retrieved from https://lc.gcumedia.com/nrs433v/nursing-research-understanding-methods-for-best-practice/v1.1/chapter 1/