● Theoretical framework : The theoretical rationale for the hypothesis. It serves as the structure that supports the theory of a research investigation. ● Theory : An idea or set of interrelated concepts and propositions intended to explain and make predictions regarding phenomena. ● Variable : An intervention or action that is being studied to observe its effect on the research group. Developing the clinical (research) question Scenario 4 Mai works in the stroke rehabilitation unit of a large teaching hospital. She has recently been promoted to Clinical Nurse II and she is very proud of her achievements. As part of her new role, Mai has been appointed to serve as a member of the hospital’s Nursing Research Council. Mai and her colleagues are concerned about an increase in the incidence of delirium among their patients. They believe that sleep deprivation is increasing this incidence. The standard on the unit is that patients are awakened for vital signs at 6 a.m. They are also bathed before 9:30 a.m. before physical and occupational therapy sessions begin. The nurses are proposing to delay taking vital signs and to bathe patients on a timetable that coincides with their habits at home before the stroke, including helping patients to bathe in the evening rather than early morning. They want to decrease sleep interruptions and promote adequate rest. They have found that patients who suffer from episodes of delirium have longer lengths of stay and poorer patient outcomes. Mai and her colleagues wonder what interventions can prevent delirium and ultimately lead to better patient outcomes. Their initial proposed changes in clinical interventions will require changes in staffing routines and the cooperation of the interdisciplinary team. Mai’s colleagues urge her to consult the members of the Nursing Research Council for help in determining if these changes are in alignment with available evidence and if a research study might help identify and implement practice changes. They also need help in formulating the clinical research question. With the help of experts on the Nursing Research Council, an initial plan is developed: ● Develop a focused clinical question to help focus on the relevant issues. ● Perform a literature search. ● Critically appraise relevant research articles. ● Identify other sources of evidence. ● Gather non-research data from the rehabilitation unit, including the incidence of delirium, characteristics of the affected population, and the effect of delirium on patient outcomes. In Scenario 4, Mai and her colleagues have some genuine concerns and ideas about improving practice. However, they need to define what they want to investigate. This means that it is necessary to develop a focused and structured question that will serve as a basis for the literature review and the identification of relevant external evidence. The PICO format Many nurses rely on the PICO format to formulate EBP research questions. The question itself will serve as a guide for literature review and the gathering of evidence (Polit & Beck, 2022). ● “P” Stands for Population What patient population/patient problem is being investigated? In this case, Mai’s patient population consists of adult (18 years of age and older) stroke patients who suffer from delirium in the intensive care unit. However, the nurses also need to evaluate the need for further population specifications. For example, do clinical findings show
Self-Assessment Quiz Question #5 A study in which neither the researchers nor the participants know the specific details of the experiment is a/an:
a. Double-blind study. b. Experimental study. c. Control group study. d. Random selection study.
that delirium occurs primarily in patients within a specific age range in their clinical setting? If so, that is the age range on which they will focus. For another example, is it necessary to eliminate patients from the study population who have received a diagnosis of dementia, which can be mistaken for delirium? Does the severity of stroke seem to predispose patients to delirium? Should they concentrate on a population with a certain degree of impairment caused by stroke? Findings from the literature, quality improvement data, and input from nurses who have clinical expertise in stroke rehabilitation will be used as evidence. Defining a particular population is a critical initial step that must be considered carefully. ● “I” Stands for Intervention What is going to be done for or to the identified patient population? What potential interventions should be considered to increase the amount of rest and sleep the patients receive? Mai and her colleagues propose changing the time vital signs are taken and when activities such as bathing are performed. They also want to show that ultimately getting more rest and potentially decreasing delirium will positively impact patient outcomes. Mai and her colleagues need to refine their focus. They may be looking at two issues: Does adequate sleep and rest decrease the incidence of delirium in stroke rehabilitation patients? Does a decrease in delirium lead to an increase in the achievement of desired patient outcomes? Can the two issues be combined into one literature review or research study? Mai and her colleagues have some work to do before choosing the interventions. Interventions depend on the research question, and the question must be carefully developed. ● “C” stands for Comparison What is the alternative to the planned intervention? Mai and her colleagues are thinking of using a control group of patients who continue to have vital signs taken and will be assisted to bathe at the current times. This will provide a comparison to those patients whose sleep will not be interrupted for vital signs and bathing. However, if the question focuses on decreasing the incidence of delirium and improving patient outcomes, there needs to be a more evident determination of what the interventions will be, as well as who will comprise the control group. ● “O” Stands for Outcome What are the desired outcomes? Outcomes require that nurses clearly state what they are hoping to achieve. The preceding questions should help Mai and her colleagues to determine what they want to investigate. As they work with nurse researcher colleagues, they will refine and identify their clinical research question. Nursing consideration: Developing and refining a clinical research question is not an easy task. Consulting nurses with research expertise will help to accomplish this task and conduct a successful critical appraisal of relevant literature.
Review of the literature and critical appraisal of EBP research articles After the research question is refined and clarified, a literature review is necessary. A literature review (or critical appraisal) is an
organized, systematic process for evaluating research studies in a given field. The reviewer uses a set of standardized criteria
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