NRS 433 Topic 1 DQ 1 Describe the difference between a nursing practice problem and a medical practice problem
NRS 433 Topic 1 DQ 1 Describe the difference between a nursing practice problem and a medical practice problem
Topic 1 DQ 1
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.
Describe the difference between a nursing practice problem and a medical practice problem. Provide one example of each. Discuss why is it important to ensure your PICOT is based on a nursing practice problem.
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:
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/
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
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.
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
Check Out Also: Benchmark -Evidence-Based Practice Project Literature Review Paper
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
Your post was very clear,
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).
References:
Richard I. G. Holt, Katharine Barnard-Kelly, Giorgos Dritsakis, Kerensa I. Thorne, Lauren Cohen, Elizabeth Dixon, Mayank Patel, Philip Newland-Jones, Helen Partridge, Suvitesh Luthra, Sunil Ohri, Kareem Salhiyyah, Jo Picot, John Niven, Andrew Cook, & on behalf of the OCTOPuS study group. (2021). Developing an intervention to optimize the outcome of cardiac surgery in people with diabetes: the OCTOPuS pilot study. Pilot and Feasibility Studies, 7(1), 1–12. https://doi-org.lopes.idm.oclc.org/10.1186/s40814-021-00887-z
Wikan Purwihantoro Sudarmaji, Sholihin Sholihin, Roby Aji Permana, Agustina Soares, & Yanuar
Aga Nugraha. (2020). A Clinical Decision Support System as a Tool to Improve the Accuracy of Nursing Diagnoses. Jurnal Ners, 14(3), 388–392. https://doi-org.lopes.idm.oclc.org/10.20473/jn.v14i3.17171
Hi Tamara thank you for your informative post
The PICOT question format is a standardized “formula” for creating researchable and answered questions. When you create a good one, the rest of the process of gathering and analyzing evidence becomes much easier.
Question for PICOT:
Population: Bariatric teens who are contemplating or have had gastric bypass surgery.
Intervention: The nurse’s position as a major component of the multidisciplinary team for bariatric adolescent perioperative care.
Comparison: The nurse’s function as a secondary member of the multidisciplinary team is limited to perioperative care of the bariatric adolescent patient and requires no specific training.
Outcome: The bariatric adolescent patient has greater continuity of treatment when the nurse is included as one of the major members of the multidisciplinary team approach.
Time frame: perioperative to 6 weeks post-surgery.
PICOT Question: When the nurse is a primary member of the multidisciplinary team, does the bariatric adolescent patient undergoing gastric bypass have better perioperative and postoperative care than when the nurse is a secondary member whose only role is to provide perioperative care and has no specialized training?
Reference:
Nursing : Picot questions. Library Research Guides. (n.d.). Retrieved April 8, 2022, from https://libguides.ggc.edu/NURS/PICOT
In To make your case, start with a PICOT question, the author describes two comparing questions when considering research. I thought it was interesting and very important, so I put it in my notes for future reference. Comparing questions can be viewed as backward and forward thinking. The backward question is the generalization of a topic, common knowledge, or information we might find in a nursing manual. The author explains this common knowledge is a “foundation for the forward question that will provide evidence for clinical decision making, the PICOT” (Echevarria, 2014). I thought this was worth considering because some of us students haven’t been in nursing school for several years, and the “common knowledge” may have changed over time with new EBP. I haven’t been in nursing school for almost two decades. I think it’s important that I review backward questions before I create a PICOT. Current knowledge on the backward question is important in the “outcome” of the PICOT format because the expectation may have changed. Respectfully, Jana
Echevarria, I. M., & Walker, S. (2014). To make your case, start with a PICOT question. Nursing, 44(2), 18–19. https://doi.org/10.1097/01.NURSE.0000442594.00242.f9
Thank you Tamara for your post! Yes, when establishing a quality improvement project or leading to EBP, the PICOT approach is used. It is divided into five sections: Patients/Problem, Intervention, Comparison, Outcome, and Time, each of which is used to formulate a question to hypothesize improvements that might be made in nursing or medical practice to enhance patient outcomes. To avoid practicing medicine outside of the scope of nursing by undertaking a clinical research study rather than an evidence-based practice project, make sure the PICOT is based on a nursing practice concern. Evidence-based practice (EBP) has been shown in research to produce greater treatment quality, better patient outcomes, lower costs, and more nurse satisfaction than traditional care practices. Nurses have an important role in detecting patient concerns, whether they are at the bedside or taking care of patients in an outpatient setting. Nurses have an important role in preventing and minimizing patient falls in the inpatient setting. In the hospital where I work, and I’m sure in every hospital, there are safety and fall precautions, such as having x3 side rails up on the patient bed, having the bed locked and in the lowest position, and having the call light in reach so the patient can receive help instead of getting out of bed. Nurses do have a great responsibility in ensuring the safety of the patient.
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. Retrieved from https://lc.gcumedia.com/nrs433v/nursing-research-understanding-methods-for-best-practice/v1.1/#/chapter/1
Good example and clear explanation of the PICOT. Nurses use EBP to provide patients with safe, quality care and to improve outcomes by first developing a PICOT statement that can be associated with either a quality improvement project or lead to EBP (Helbig, 2018). The researcher must gather information through PICOT (problem, intervention, comparison, outcome, and time) to prove why the study should be performed. The nursing practice problem deals with the person’s response to real health problems that the patient is exhibiting or a potential health problem that may arise from the medical diagnosis. While medical problem only gives information about the disease pathology, the nursing problem expresses the impact of the diseases on the patients’ wellbeing and the family. Basing on nursing practice problem ensures that the PICOT includes the best evidence available from previous studies on patient care, and values from experts in the field.
Reference:
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
A well-constructed PICOT question is essential for research queries in the nursing field. Advanced studies or nurses in professional settings rely on the PICOT framework in the development of some of their studies. PICOT is a mnemonic for a clinical question that looks at the aspect of patient, intervention, comparison, outcome and time. The PICOT process begins with the identification of a problem or a case scenario, and the question is formulated to elicit an answer (Fnadino, 2019). PICOT process in the medical aspect might not be similar in the scope of the nursing field. The difference between medical practice problems and medical practice problems is that medical practice problems deal with the diagnosis of disease and their treatment while nursing practice problems are concerned with issues that surround nursing practice, and this involves aspects such as patient’s response to a health problem or patient-related assessment. Nursing practice problems can take the scope of evaluation and intervention aspects. Medical practice problem revolves around a medical condition where prognosis, causes and treatment of the condition are a big aspect of medical practice. Nursing practice problems deal with modalities such as comfort, health screening, trauma prevention and promotion of recovery, which are not dealt with in the medical practice scope. The development of a competent PICOT question help to ensure that the necessary outside sources such as peer-reviewed journals can be used in the assessment of the problem and intervention.
An example of a nursing practice problem is the patient level of satisfaction. Patient-level of satisfaction does not revolve around the condition but the ability of the care plan to achieve the desired health outcomes and adhere to patient beliefs and values. Nursing practice problems can take the shape of low levels of patient satisfaction in nurses treating immigrant populations (Zhang et al., 2021). Medical practice problems revolve around treatment options or prognosis of conditions. An example of medical practice issues is the use of pain medication such as tramadol, morphine and oxycodone for post-operative patients. Nursing practice problems will involve the evaluation of medication errors and complications after treatment. It is important that the PICOT is based on the nursing practice problem because it helps to make it easier to discuss the scope of the issue and identify relevant materials that can help in the evaluation of the interventions. PICOT questions that revolve around nursing practice problems will make it easier for me to understand the issue and intervention hence better ability to comprehend the content in the peer-reviewed articles.
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
Topic 1 DQ 1
Nursing practice problems and medical practice problems are related as they are utilized for effective care interventions and focused on alleviation of patient’s pain and suffering. However, these two are different. At the core of a nursing problem is the assessment and evaluation of a patient. This implies that a nursing practice problem emanated from the nursing practice, especially during the assessment of a patient in relation to their responses to a health issue that they are experiencing. Nursing practice problems can range from the care needs of a patient from the moment they present in healthcare facilities, during their diagnosis and evaluation or assessment of their need.
A nursing practice problem needs a comprehensive gathering of data on a patient to make the right diagnosis and associate the inherent features with a known healthcare issue (Camargo et al., 2018). For instance, carrying out an in-depth physical exam to examine the problem and diagnosing it leads to better interventions by a healthcare provider. The implication is that nursing care entails the entire individual, family or community. Nursing practice problems deal with a host of patient modalities that include support, comfort, promotion of recovery, health education and care coordination among others. For instance, a patient presenting to the facility with signs and symptoms of fever and headache may implore a triage nurse to identify the conditions as nursing practice problems after their assessment.
On its part, a medical practice problem is about the medical condition or a disease suffered by an individual. Medical practice problems identify conditions, seeks for their causes, creates a prognosis and prescribes the treatment interventions (Ellis, 2019). Furthermore, the identification of medical and nursing problems has different goals where nursing issue judges the existence of a possibility of improving self-care while medical diagnosis identifies a variation from the expected functioning of the body. Addressing a condition that requires a pathology assessment is an example of a medical practice problem.
The PICOT is the initial step in improving evidence-based practice with the aim of solving patient problems. Nurses deploy EBP to offer patients safe, quality, and accessible care with better outcomes. A PICOT should be based on a nursing practice problem since it is designed to offer solutions with the aim of improving patient care (Rutberg & Bouikidis, 2018). A nursing practice problem will allow providers to address care need of patients based on a host of considerations to improve their care. Nursing practice problems allow nurses to collect relevant information and make inferences on potential conditions affecting the patient.
References
Camargo, F. C., Iwamoto, H. H., Galvão, C. M., Pereira, G. D. A., Andrade, R. B., & Masso, G.
- (2018). Competences and Barriers for the Evidence-Based Practice in Nursing: an integrative review. Revista brasileira de enfermagem, 71, 2030-2038.
DOI: 10.1590/0034-7167-2016-0617.
Ellis, P. (2019). Evidence-based practice in nursing. Learning Matters.
Rutberg, S., & Bouikidis, C. D. (2018). Focusing on the fundamentals: A simplistic
differentiation between qualitative and quantitative research. Nephrology Nursing Journal, 45(2), 209-213.