PICO and Evidence Appraisal Worksheets

Purpose: To identify a problem or concern that nursing can change and develop a PICO question to guide the change project. Directions: Use the form below to complete the PICO assignment in Milestone #1. This includes filling in the table with information about your research question and your PICO elements. Step 1: Select the key PICO terms for searching the evidence. Clearly define your PICO question. List each element P (problem, population, or problem), I (intervention), C (Comparison with other treatment/current practice), and O (Desired outcome). Is the potential solution something for which you (as nurse or student) can find a solution through evidence research? Look in your book for guidelines to developing your PICO question. Step 2: Identify the problem. What have you noticed in your work or school environment that isn’t achieving the desired patient or learning outcomes? What needs to change in nursing, what can you change with the support of evidence in the literature? Describe the problem or practice issue that you want to research.

What is your practice area; clinical, education, or administration? (This is NOT where you will list your PICO question) Step 3: How was the practice issues identified? How did you come to know this was a problem in your clinical practice? Review the listed concerns and check all that apply. Step 4: What evidence must be gathered? Everyone should have a literature search. However, what other sources of reliable information will be helpful for your particular question? Step 5: What terms will you use in order to make sure that your search is wide enough to obtain required information but narrow enough to keep it focused? What databases will you search? How will you narrow your search if needed?

PICO Worksheet
What is the PICO question? Does the adult patient age 65 years or older, at risk for developing delirium and its complications have better outcomes with frequent nursing assessment and intervention for early signs of delirium than no screening and intervention when symptoms obvious? Define each element of the question below:

P- (Patient, population, or problem): Adult patients age 65 years or older in acute care settings. I- (Intervention): Early identification and intervention of delirium. Nurses will screen for signs of delirium using evidence based screening tool upon admission and daily, intervening when tool indicates delirium present or developing C- (Comparison with other treatment/current practice): No Screening tools used and intervention when obvious signs of delirium present. O- (Desired outcome): With early identification and intervention of delirium patients will experience fewer complications from delirium during their hospitalization. What is the practice issue/problem?

As much as 24% of patients in acute care setting outside the ICU develops delirium and can experience long-term complications. With early identification of symptoms, clinical staff can put into effect EBP protocols to help reduce the risk of patients developing these complications. What is the practice area?

Search terms: delirium, acute care settings, brain failure, dementia, sun downing, adult inpatient, best practice, older people, prevention, interventions, effectiveness, patient care outcomes, cognitive impairment.

Databases to search: Google Scholar, PubMed, Proquest, CINAHL, Joanna Briggs Institute, National Guidelines Institute, Proquest, Medical Library at both facilities I work for. Search Strategies: I used specific terms as described above, I also used the Boolean operators AND and OR – I have not used NOT. Some of the article I came across was from UK even though I used American spelling the databases provided the articles with alternative spelling. The medical librarians were helpful and provided a lot of guidance, I preferred information I had gathered myself. I used limits when I used CINAHL and Proquest and did get more succinct information with the limits.

Evidence Appraisal Worksheet
Your Name:
Date: May 14, 2015
Your Instructor’s Name:
Purpose: To find evidence to support an intervention that will change the outcomes. Directions: Type your search question below. Find AT LEAST FOUR sources to support the need for change and the potential intervention you have selected to solve the problem. At least three of your sources must be peer-reviewed articles. The forth source could be another peer-reviewed article or a reliable, credible source. Look in your text for ideas of other sources that can be used. Using the table below, insert and describe your four chosen resources. Step 1: APA Reference for the article. You will need to list the reference for the source in APA format. Be careful when using built-in APA formats and library citations. They may not be in APA format. Refer to Chapter 7 of your APA manual. Step 2: Type of Source. If your source is a research article, you will need to ensure that it is a peer review article.

You need at least three peer-reviewed articles for your project. If your article is a non–research source, then you will need to list what type of source it is; systematic review, clinical practice guidelines, organizational experience, or individual expert opinion/case study/literature review. You may only use ONE non-research source. Step 3: Strength of Research. Refer to page 238-240 for research evidence and page 242-244 for non-research evidence. While you do not need to assign a level for each study, you will assign a quality of evidence (high, good, or low/major flaw) and should discuss the study using some of the elements that are discussed in the appraisal forms.

For example, Research evidence: was the sample size adequate? Was there a controlled group? Was it a randomized study? Were results clearly stated? Was the conclusion based on the results? Were study limitations discussed? Not all of these elements need to be discussed, but you should discuss this information to determine if the strength of the evidence is HIGH, GOOD, or LOW/MAJOR FLAW. Step 4: Brief Description of the Research. In this section, you will summarize the source in your own words. How does this information apply to your project? What are the results of the source? What are their recommendations?