PICO Paper - Kelly J. Berthoud

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PICO Paper
Kelly Lockhart, RN
Ferris State University
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Abstract
To meet the Requirements of the Nursing Research course, the author worked throughout the
semester to complete a population, intervention, comparison, outcome (PICO) project. Once the
PICO question was formulated, the author collaborated with a classmate to find applicable
nursing research. To complete the process, this PICO paper looks at the relevant evidence and
evaluates the research that could be adapted into nursing practice. The author gives suggestions
for the specified unit pertaining to the stated PICO question for future use.
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PICO Paper
Nursing research is planned with goals to promote evidence based practice, ensure the
credibility of the profession, provide accountability for practice, and document cost effectiveness
(Nieswiadomy, 2012, p. 5-6). It is necessary that professional nurses understand these purposes
and incorporate up to date nursing research into practice. “Nurses prepared at the baccalaureate
level should be able to understand and apply research findings from nursing and other disciplines
in their clinical practice. They should be able to work with others to identify potential research
problems” (Nieswiadomy, 2012, p. 7).
Personally, the professional nurse can utilize research to develop their specialized body
of knowledge. Professionally, the research should be used to implement new, evidence based
initiatives to improve quality and safety within health care. The author has taken the issue of
implementing bedside handoffs and increasing staff compliance. The PICO question formulated
looked for reasons that the bedside handoffs improved patient outcomes. This paper will discuss
the findings from the PICO project and discuss how this information is applicable and may be
integrated into nursing practice. The information will be specifically evaluated for the author’s
area of nursing on a general medical surgical unit.
PICO Question
Does RN bedside report improve patient outcomes compared to traditional report outside of the
room in hospitalized patients?
The author formulated this PICO question following the observation of noncompliance
by nurses on one medical surgical unit one year after implementing mandatory bedside reporting
at change of shift. Would communication of the benefits and evidence behind implementing
bedside report improve compliance for bedside reporting? The literature was searched for key
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outcomes improved by implementing bedside report. Once data is obtained from the nursing
research, the next key piece is communication. How will nurse leaders be able to convey the
literature in a way understandable to staff? If the staff understands the rationale behind bedside
report, will they be compliant?
Research Findings
Outcome 3
Assess current nursing research findings for applicability to a variety of clinical practice
environments and populations. (Generalist Nursing Practice)
Bedside reporting is fairly innovative and fresh in the nursing profession. The most
recent nursing research found for bedside reporting was from 2013 and oldest from 2009. The
author completed a literature search to find information surrounding the PICO question. The
literature search revealed that most frequently, the outcome linked to initiating bedside report
was increased patient satisfaction. There was initially difficulty finding further information on
improving other patient outcomes with bedside report.
Through collaboration with others, the author was able to more clearly define the PICO
question and more easily search for research. The three articles that the author focused on were
from 2012 and 2013, they all three agreed that “bedside nursing report may lead to
improvements in patient outcomes as well as patient and nursing satisfaction” (Sherman, SandJecklin & Johnson, 2012).
When looking at the evidence, the population was taken into account. The articles
obtained all focused on inpatient units in acute care settings. The first article referenced was a
meta-analysis (level II data) focusing on nursing research dated back to 1975. This article was
helpful mostly because of the broad range of supporting information (from 42 articles). The
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article mentioned that there were benefits of an increase in nurse satisfaction and communication
both between nurses, and also nurse-patient communication. It gave quantitative data for
improvement in patient outcomes. One downside given in this article was some patients felt
confidentiality was a problem (Sherman, Sand-Jecklin & Johnson, 2012).
The other 2 articles obtained were at a level IV data. These articles were both nursing
research published in 2013. The first article, Transforming Care at the Bedside (TCAB):
Enhancing Direct Care and Value-added Care (Dearmon, et. al, 2013), gave more specific
details of how bedside reporting improved outcomes. Dearmon et.al (2013) supported with their
research that call lights and pain medication needs decreased. Nurse to nurse communication
and information flow increased. Nurses indicated positive implementation of bedside report
which led to increased time at the bedside. Fall rates decreased with implementation. This study
provided quantitative data supporting improved outcomes.
Next article reviewed was Improving Patient Satisfaction with Nursing Communication
Using Bedside Shift Report (Radtke, 2013). This article studied a medical surgical unit
implementing bedside report over a three month period. The data in this study showed an
increase in patient satisfaction from 75% to 87.6% (Radtke, 2013). Following the research,
bedside reporting was initiated organization wide and it discusses improved results. Patient
satisfaction reached the 90% target throughout the organization. Radtke explains the theory
behind the change relating to Peplau and Lewin, and also gives good supporting evidence of the
patient’s perspective of bedside report.
Recommendations to Improve Quality and Safety
Outcome 6
Integrate credible evidence for application to personal practice, which articulates and
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incorporates professional values, relevant healthcare policy, and availability of resources.
(Professionalism)
With the available data, it is evident that there are benefits to performing bedside report at
change of shift. As with any new process, it is sometimes difficult to get staff buy-in. With the
implementation in the author’s specified unit, the supporting evidence surrounding the
implementation of bedside report was not clear in the beginning. Staff had negative connotations
surrounding the initiative, and did not feel that there was any benefit to the updated process. As
professionals, nurses have a duty to serve their patients, to advocate for them and to advance the
profession. To continually advance nursing and its professionals, there needs to be a continued
focus on quality and safety. Bedside reporting is one way of increasing the quality of care as
evidenced by an increase in patient satisfaction (Radtke, 2013), and also improving safety
(Dearmon et. al, 2013).
Outcome 1
Examine the professional nurse’s application of communication and collaboration in the use of
nursing research. (Collaborative Leadership)
For this PICO project, the author had collaborated with a fellow classmate to create the
PICO question and to review the literature. This process proved to be very valuable throughout
the PICO project. When trying to formulate an appropriate question, and searching for relevant
research, the classmate provided suggestions. Being paired with the classmate also gave the
author the opportunity to do the same. Proofing another’s PICO question helped the author see
flaws in her own work. Communication throughout the process increased the author’s
understanding on the subject matter.
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Once data is gathered, it must be communicated prior to being usable by staff. In this
scenario, the supporting evidence previously discussed needs to be communicated to the targeted
unit in a meaningful manner. Since bedside reporting has already been implemented on this unit,
the author suggests looking for congruent results from the unit’s own data. If the supporting data
can demonstrate improvement on the unit, will the nursing staff understand the benefits of
bedside reporting?
Conclusion
The nursing research utilized in this paper would be beneficial to share with the specified
unit from the stated PICO question. However, to increase nurse’s compliance with bedside
reporting, nurse leaders should gather data specific to their unit to share with staff. This
information would benefit staff and help to draw a correlation between the research and the
evidence based practice change. It is crucial in this scenario that leadership continues to followup with the nursing staff and review the importance of bedside reporting.
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References
Dearmon, V., Roussel, L., Buckner, E., Mulekar, M., Pomrenke, B., Salas, S., … Brown, A.
(2013). Transforming care at the bedside (TCAB): Enhancing direct care and valueadded care. Journal of Nursing Management. 21. 668-678.
Nieswiadomy, R. (2012). Foundations of nursing research. Upper Saddle River, NJ: Pearson
Education.
Radke, K. (2013). Improving patient satisfaction with nursing communication using bedside
shift report. Clinical Nurse Specialist. Retrieved from: www.cns-journal.com.
Sherman, J., Sand-Jecklin, K., & Johnson, J. (2013). Investigating bedside nursing report: a
synthesis of the literature. Medsurg Nursing. 22(5) 308-318.
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