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.