[Sharon]

Part 1: Develop a research question using PICO that focused on a clinical problem you have experienced. Post your research question in the discussion area below and share why you chose this research question (Maximum 250 words)

Part 2: Comment on one of your peer’s research questions. (Maximum 250 words) • Ask a clarifying question • Offer a different perspective • Share your reflections or your experience related to the research question.

[Paula]

Using the PICO strategy, I formulated the following:

Population: clients enrolled in an opioid addition treatment program (Scenario: I work with clients dependent on opioids to prevent dope sickness or experiencing crippling physiological symptoms of withdrawal).

Intervention: motivational interviewing (found in a search through the scholarly literature).

Comparison: cognitive behaviour therapy (long-established evidence of support for best practices in mental health treatment of addiction)

Outcome: sobriety, improved retention in the program

My research question aims to explore which therapeutic intervention is more closely aligned with achieving or maintaining sobriety and improved treatment retention. The research findings advocate for a combination of both therapies as effective for the desired outcome.

Additionally, it’s noteworthy that the course material’s definition of meta-analysis as “A systematic review that uses quantitative methods to synthesize & summarize results” lacks inclusion of qualitative methods, which significantly contributes to mental health research (7 steps- pg 7). There are instances where quantitative research is ethically questionable. For instance, in my area of interest, adverse childhood experiences (ACE) and subsequent maladaptive opioid use, an experimental (quantitative) design is inappropriate due to the unethical nature of exposing individuals to ACE. I am keen to discover if there are other nurses working in the field of mental health in this course.

7 Steps To The Perfect Pico Search: Evidence-based nursing practice. Retrieved from https://www.ebsco.com/sites/g/files/nabnos191/files/acquiadam-assets/7-Steps-to-the-Perfect-PICO-Search-White-Paper.pdf

[Jennifer]

Hi Paula,

Your post has provided excellent examples of the elements in the PICO framework. Can you develop a research question using the elements you have identified?

Jen

[Paula]

TEST

This seems to be working for me now 🙂

Research question, how does ACEs influence subsequent opioid misuse?

[Victoria]

Hi Paula,

Thank you for your post! I appreciate your interest in this unique population of patients and your consideration of motivational interviewing and CBT therapy as potential combined interventions. These are certainly interventions that can be well explored through research. I appreciate your ethical stance on the inappropriateness of experimental designs in studying adverse childhood experiences and opioid use. This is so important and underscores your commitment to responsible research practices. I do not have experience working in the area of mental health, but I really admire the nurses who work in mental health and would be interested to learn more about this unique patient population. I would love to hear more about your experience in the field!

Thank you again,

Victoria

[Victoria]

Population: Operating Room (OR) Patients

Intervention: A Preoperative Checklist for nurses working in same day surgery (SDS) units and nurses working on surgical units who are admitting and sending patients to the OR for surgery.

Outcome: Patients receive their preoperative prophylactic antibiotics on time within recommended guidelines for prophylactic administration (30-120 minutes as per current literature), ultimately reducing the risk of surgical site infection (SSI) postoperatively.

Research Question: Does a Preoperative Admission Checklist for nursing improve the number of operating room patients receiving preoperative prophylactic antibiotics on time?

Using PICO, I developed the research question above. In surgery, we often experience issues with patients receiving their preoperative prophylactic antibiotic dose on time within the recommended guidelines. Current literature suggests that preoperative prophylactic antibiotics should be given 30-120 minutes (exact timing is dependent on antibiotic type) prior to surgical incision for optimal effect (Cradar & Varacallo, 2023). If we implemented a standardized preoperative checklist for nursing staff working in SDS and surgical units who admit and send patients to the OR for surgery, this has the potential to improve the timely administration of preoperative antibiotics to surgical patients, ultimately improving surgical outcomes. From my experience, this question arises from the critical importance of timely antibiotic administration in preventing surgical site infections (SSIs) and associated complications. Through research, we can aim to assess whether a standardized protocol can streamline nursing processes, reduce potential delays, and ultimately improve adherence to established guidelines for preoperative prophylactic antibiotic administration.

References

Crader MF, & Varacallo M. (2023). Preoperative Antibiotic Prophylaxis. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK442032/

[Jennifer]

Hello Victoria, your research question brings up a similar question I would receive routinely in the Primary Care setting. Although outside of the hospital setting, my experience would be phone calls from clients with a history of THR for example and their dental office directing them to their family doctor to inquire if prophylactic antibiotics are required prior to major dental procedures and if so a prescription and direction would be required from their family doctor, which may require an extra medical visit to acquire this. Additionally, in the Primary Care setting we would often be seeing the patients post surgery with infection needing ongoing treatment and follow up, which in turn poses the question of the benefit in gathering detailed information on what their instruction was regarding preoperative prophylactic antibiotics and if that was adhered to as directed.

I would like to clarify my understanding of preoperative prophylactic antibiotics, is the routine administration of preoperative prophylactic antibiotics standard for all surgeries or indicated for extensive surgeries ie. Hip/knee replacement surgeries or bone graft procedures for example?

[Victoria]

Hi Jennifer,

Thank you for your response and questions! Yes it is very common for any patients who have undergone joint surgery, or any surgery involving a prosthetic implant, to see their family doctors about prophylactic antibiotics prior to receiving major dental work. I have similar experience to you when discharging heart surgery patients after valve replacement surgery. We’d send them home with strict instructions to see their family doctor for a prescription of prophylactic antibiotics before any major dental work. There is tons of literature out there supporting this, and dives into more specific details (such as prophylaxis for dental treatment after prosthetic joint replacement). A quick google scholar search will lead you to many studies out there that explore this topic.

As per your question about the standard of routine administration of preoperative prophylactic antibiotics, only speaking from my experience here with both adult and pediatric patients in the operating room, it is fairly standardized, however some limitations do exist. I do believe these standards can fluctuate by hospital/organization. Yes, from my experience majority of patients undergoing extensive surgeries receive routine prophylactic preoperative antibiotics. Some even continue to receive them postoperatively (our open heart surgery patients would receive a dose of Ancef preoperatively, followed by 2 doses of Ancef postoperatively as well, which was a standardized order in the hospital I was working in for every heart surgery patient). However, in my experience with pediatrics there are some limitations, specifically for infants and neonates. Additionally, if a patient is already receiving IV antibiotics routinely for treatment of an infection preoperatively, in my experience some surgeons and anesthesiologists may chose to withhold prophylactic treatment as the patient is already being treated with antibiotics. Though literature supports prophylactic administration of antibiotics for most surgical procedures, it can become very patient and surgery specific, and is ultimately the decision of the surgeon and anesthesiologist if the patient is to receive them or not. In any case, the timely administration of these antibiotics is so important to ensure prevention of SSI postoperatively.

I hope this makes sense and answers your question. Thanks again for your response!

[Jennifer]

Hi Victoria,

Excellent research question and nurse innovator idea!

Jen (course facilitator)

[Jennifer]

Population: Parents with vaccine hesitancy for their children’s primary immunizations.

Intervention: Face to Face communication and education, supported with Vaccine Information Statements.

Outcome: Increased vaccination uptake and adherence for the childhood primary immunization series.

Research Question: How can Primary Care Providers reduce parental vaccine hesitancy and improve childhood primary immunization rates?

I developed this research question using the PICO method. I chose this question because Parental hesitancy for their children’s primary immunization series is a common concern within Primary Care and requires additional health teaching on behalf of the health care provider. Often after further communication, education and resources are discussed to answer any questions they may have, the results show that the hesitancy was not a refusal of vaccines but often a lack of understanding of the benefits and potential side effects that may or may not arise. After counsel many concerns are addressed and any fears that were preconceived are alleviated.

[Paula]

Hello Jennifer, I did respond to your post (per Part 2 instructions in this discussion), but I failed to tag your original post, and I can’t seem to delete mine. But, I believe my response should appear below this post. Oh, the joys of learning how to navigate an unfamiliar online forum 🙂

[Jennifer]

Hi Jennifer,

The elements of PICO you have described bring a very important topic to light. A hint when identifying keywords for a research question is to make it as concise as you can. This will be help to strengthen the quality of your research. For example: P= Vaccine Hesitant Parents; I = Health Teaching by Nurses.

Great work this week!

Jen (course facilitator)

[Sasha]

This is awesome! I think this is a very much needed intervention. Education plays a pivotal role in address vaccine hesitancy. Particularly within minority communities among people of colour and indigenous members of the population who given their historical relationships with the health care system may not feel at ease. Mistrust and skepticism towards medical interventions can be alleviated through building trust in these communities and empowering them with accurate information.

Sasha

[Paula]

Hello Jennifer, your posted PICO research question demonstrates a constructive patient-centred approach to addressing the common concern you described in primary care. By focusing on education, communication, and understanding, your research question can improve individual immunization rates while also contributing to the community’s overall health. Another perspective on your scenario could be considering the broader socioeconomic impact and public health implications of reducing vaccine hesitancy. The focus could shift from the individual level (parents and children) to the community and population level. How might a community-based intervention involving not only primary care providers but also community leaders, schools, and local organizations reduce parental vaccine hesitancy and contribute to increased childhood primary immunization rates at the population level? This perspective emphasizes the interconnectedness of individuals within a community and the shared responsibility for public health. It advocates a more holistic approach that considers the broader social and environmental factors influencing vaccine hesitancy and immunization rates.

During the COVID-19 shutdown, my experience with vaccine hesitancy was just that. Our health teams’ approach at the individual level for our clients morphed into community partners’ engagement and collaboration. Given that our patients are from a marginalized population (opioid-dependent individuals), our goal was to shape vaccination attitudes towards increasing vaccination rates, protecting vulnerable individuals who may not be able to receive vaccines, and, ultimately, preventing the further spread of COVID-19. I am very happy that those times are in our rearview mirror 😊

[Jennifer]

Hi Paula, thank you for your perspective on the community as a whole and the benefits of how an improved understanding on that level would trickle down to the individuals within the community. I agree a holistic approach on a broader scale is required as well. I can only imagine the barriers faced during that COVID-19 era regarding vaccination uptake within the many different populations and the unique challenges they posed. I agree that I too am happy those times are behind us as well 😉

[Sasha]

Question: For nurses who self report experiencing psychological distress and burnout, does participation in a peer support program lead to a reduction in self reported symptoms over a period of 6 months?
Population: Nurses experiencing distress
Intervention: participation in peer support program
Comparison: current resources/ no peer support program
Outcome: expected reduction of symptoms

This question is relevant as it discusses the current issue of psychological distress in nursing which is a longstanding issue recently exacerbated by the Covid 19 pandemic. Research has seen peer support as a unique resource in a variety of other settings including among other first responders i.e firefighters and police and in mental health and addictions for example something like and alcoholics anonymous.

[Author]

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