Running head: CLINICAL QUESTION PAPER Clinical Question Paper William Winowiecki Jr. Ferris State University 1 CLINICAL QUESTION PAPER 2 Clinical Question Paper As a registered nurse there are many situations in which one may have to make an imperative decision within their scope of practice. Nurses often refer to findings from research and partake in the usage of evidence-based practice to help in backing nursing decisions. The purpose of this paper is to portray how a nurse uses applied knowledge, research and evidence based practice to interpret and portray their findings amongst peers and the patient population. Clinical Question Within the nursing practice there are many individuals whom come into the emergency room and other areas clinically that experience flu like symptoms. As a registered nurse whom works in the Emergency Department and has witnessed multiple scenarios in which individuals present with flu like symptoms, with and without vaccination against influenza. It has lead me to develop a research question in which I determined if receiving the influenza vaccination is way more beneficial than not receiving the vaccination. Within this semester we were asked to develop a clinical question and develop a research proposal using the PICOT format. Within the PICOT format, there are five parts starting with, P (patient population of interest), I (intervention or area of interest), C (comparison intervention of group), O (outcome) and T (time) (Nieswiadomy, 2012). With that being said, the question that I decided to use for my research was, “Does receiving the influenza vaccine reduce prevalence of influenza when compared to, individuals whom do not vaccinate in the patient population?.” By answering the PICOT question I would like to show the evidence supported that receiving the influenza vaccination is beneficial to all patient populations. When vaccinating against influenza it will help in lowering the prevalence of influenza within the patient population. By portraying the benefits of receiving the influenza I think it could help influence CLINICAL QUESTION PAPER 3 the patient population. In order to educate individuals on the benefits of receiving the influenza vaccination one must take the time to understand the patient population and the barriers that may inhibit their beliefs on the benefits of receiving the influenza vaccination. Some of the research articles depicted within this document will discuss how various populations have certain barriers in which they choose not vaccinate. Methodology With the influenza affecting individuals of all ages, I took the time to search for articles regarding the influenza and all populations. The articles that were searched for were studies that were completed by individuals whom worked with the medical field, along with individuals whom have obtained their doctorate degree within their profession. With that provision set in place it had allowed for nursing research to occur while deferring from advanced nursing practice to be a source of relevant research for PICOT question. When searching for answers to help facilitate the findings for my question, I used nursing research to help answer my question. Within the research process we me must evaluate where to find the best sources of information when researching. I used scholarly journals to help facilitate my findings. I often used referred journals as a source of information within the nursing research process. Referred journals are when experts in certain subjects are asked to evaluate the nursing sources. In addition, peer reviewed journals are an excellent source in that they provide reviewed manuscripts by professional colleagues who are content or methodological within the process. (Nieswiadomy,2012). Within nursing research there are seven levels of evidence that can be used in the evaluation process of whether or not an article is suited for usage in the research process. The first level is when there is a systematic review and meta-analysis of random and controlled trials. CLINICAL QUESTION PAPER 4 Level two is when there are one or more randomized controlled trials, whereas, level 3 is a controlled trial with no randomization. Level 4 is a case control or cohort study. Level 5 includes a systematic review of descriptive and qualitative studies. Level 6 is a single descriptive or qualitative study. Lastly, level 7 is varying expert opinions (Ferris, 2014). With the ability to interpret various research findings and data within the article it made finding relevant articles an easy task for my research PICOT question. Discussion of Literature Of the research delineated towards the PICOT question, I had chosen three different articles in which I thought would be useful in conducting research in answering my PICOT question. Article 1 In the article, “Incompletely Matched Influenza Vaccine Still Provides Protection in Frail Elderly”, it talks about the prevalence of disease within populations whom had been vaccinated and the various strains of influenza. The findings from this article indicate that vaccinated residents within a nursing home environment were least likely to have laboratory-confirmed influenza, or experience pneumonia-related or influenza-related hospitalizations than residents whom hadn’t vaccinated (Anna et al., 2010). I found this to be a very useful article in that it showed that indicated that individuals whom were vaccinated with the influenza vaccination were less likely to develop influenza then individuals whom hadn’t been vaccinated. This article will help in stressing the importance that vaccination amongst the patient population is important in reducing the prevalence of the virus. With the elderly population being such a fragile population it is important to vaccinate against the flu virus, as it may lead to other illnesses. CLINICAL QUESTION PAPER 5 Article 2 The second article, “Improved immunogenicity with high-dose seasonal influenza vaccine in HIV-infected persons: a single-center, parallel, randomized trial,”is a study on how high dosage of influenza vaccination is more effective the standard dosages in immunocompromised individuals. The findings from this article indicate that higher dosage of influenza vaccine was effective with individuals whom have HIV (McKittrick, 2013). The findings from this article were again useful in that it helped depict how the influenza vaccination was effective in preventing illness in immunocompromised patients. The cons to this article includes that it is only a limited population that is researched. By stating that individuals whom have HIV it was effective only indicates that influenza vaccination was effective with this select population. Thus it does not state the importance of how this vaccination is important to all the populations. Article 3 The third article that was useful towards my PICOT question was, “Health Disparities and Prevention: Racial/Ethnic Barriers to Flu Vaccinations,” is based on a phone survey given to various races to see the prevalence of influenza vaccinations amongst this population. According to the authors, Chen, Fox, and Cantrell (2007) “Whites and African Americans who were very concerned about getting the flu were significantly more likely to be vaccinated (96% and 91%, respectively), compared with those who were not concerned (45% and 33%). However, vaccination rates among Latinos who were very concerned about getting the flu (54%), although significantly higher than Latinos who were not concerned (34%).” CLINICAL QUESTION PAPER 6 I found this article to be very useful in that it helped depict that, racial barriers may influence if an individual had chosen to vaccinate against the flu. These findings leave questions to whether or not it is an educational barrier or financial barrier within this population. I think that the findings of this article are important in that you must understand your patient population before you can advance upon your thesis within the research process. All in all the findings from this article indicates that there is a definite racial barrier with the Latino population, in deciding whether or not vaccination is a necessity. Significance to Nursing Within the nursing practice it is important that you follow select standards when practicing within the profession and educating professionals amongst the nursing profession. The American Nurses Association has a set of standards in place to help registered nurses practice ethically. The standards that the ANA has set for research amongst medical professionals includes communication, collaboration and evidence based practice. The ANA defines evidence based practice as when the nurse integrates research and evidence into their daily practice (ANA, 2010). Communication can be defined as using various techniques to communicate in every aspect of the nursing practice (ANA,2010). Communication is very important within the nursing profession in that various techniques must be used to present a statement. Within the PICOT question communicating the importance of the influenza vaccination may influence whom choses to vaccinate. The next standard ANA defines as importance to nursing research is collaboration. Collaboration is when the registered nurse collaborates with family, healthcare consumers, amongst medical professions to reach a common goal (ANA,2010). Collaboration is very important within the research question delineated in this presentation in that when research CLINICAL QUESTION PAPER 7 and results are found the professionals can help in collaborating amongst each other to solve the agenda in why select individuals are not vaccinating against influenza. Lastly the most important area that ANA defines as an area of importance within the nursing profession is evidence based practice. Evidence based nursing practice is important because it allows for nurses to provide the best possible care to patients with the most up to date research within the nursing profession (Nieswiadomy, 2012). Within evidence based practice and research I will be able to illustrate findings through various case scenarios in that receiving the influenza vaccination is important. The various levels of evidence described earlier also help in determining what kind of evidence an individual has found within the research. Many of the articles that I had researched for answering this question were randomized trials and case controlled studies in which a specific population has been studied. All in all through the research process and understanding the importance of evidence based practice, amongst other ANA standards such as communication and collaboration. The registered nurse should be able to communicate their findings to help back decisions. Within the PICO format I was able to develop a question and research various studies in which I can back my decision in which receiving the influenza vaccination is imperative. CLINICAL QUESTION PAPER 8 References ANA. (2010). Nursing Scope: Standards of Practice (2nd ed.). Maryland: . Anna S. Dean, Cameron R.M. Moffatt, Alexander Rosewell, Dominic E. Dwyer, Richard I. Lindley, Robert Booy, C. Raina MacIntyre, (2010) Incompletely matched influenza vaccine still provides protection in frail elderly. Vaccine, Volume 28, Issue 3, 8 Retrieved from: http://0-www.sciencedirect.com.libcat.ferris.edu/science/article/ pii/S0264410X09004307) Chen, J. Y., Fox, S. A., & Cantrell, C. H. (2007). Health Disparities and Prevention: Racial/Ethnic Barriers to Flu Vaccinations. Journal Of Community Health, 32(1), 5-20. Critical anaylsis worksheet. (2014). P. Ursuy (Comp.), Big Rapids, MI: Ferris State University. McKittrick, N., Frank, I., Jacobson, J., White, C., Kim, D., Kappes, R., & ... Tebas, P. (2013). Improved immunogenicity with high-dose seasonal influenza vaccine in HIV-infected persons: a single-center, parallel, randomized trial. Annals Of Internal Medicine, 158(1), 19-26. doi:10.7326/0003-4819-158-1-201301010-00005 Nieswiadomy, R. M. (2012). Foundations of nursing research (6th ed.). Boston: Pearson.