PICOT and Research Critique

PICOT and Research Critique

This PICOT and Research Critique  assignment is a revision of previous assignments. It includes revising highlighted areas done by my professor.  Documents to be revised PICOT , quantitative, and qualitative research critiques(each document attached separately). After revision to be placed in one attachment. Will be submitted to turnitin. Rubric, and assignment requirements attached.

ASSIGNMENT REQUIREMENTS

Details:
Prepare this PICOT and Research Critique assignment as a 1,500-1,750 word paper using the instructor feedback from the Topic 1, 2, and 3 assignments and the guidelines below.

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PICOT Statement 

Revise the PICOT statement you wrote in the Topic 1 assignment.

The final PICOT statement will provide a framework for your capstone project (the project students must complete during their final course in the RN-BSN program of study).

Research Critiques

In the Topic 2 and Topic 3 assignments you completed a qualitative and quantitative research critique. Use the feedback you received from your instructor on these assignments to finalize the critical analysis of the study by making appropriate revisions.

The completed analysis should connect to your identified practice problem of interest that is the basis for your PICOT statement.

Refer to “Research Critique Guidelines.” Questions under each heading should be addressed as a narrative in the structure of a formal paper.

Proposed Evidence-Based Practice Change

Discuss the link between the PICOT statement, the research articles, and the nursing practice problem you identified. Include relevant details and supporting explanation and use that information to propose evidence-based practice changes.

Prepare this PICOT and Research Critique  assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This PICOT and Research Critique  assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this PICOT and Research Critique  assignment to Turnitin. Please refer to the directions in the Student Success Center.

Sample Essay

PICOT Question

In a hospital-based setting with patients, how does a rapid response team or code blue team compare to not having a team at all affect the number of deaths during three months?

Research Critique

Qualitative Research Critique

In both studies, the researchers described the background of their studies and the purpose of research. Benin et al. (2012) highlighted how multidisciplinary rounds decrease codes and mortalities that take place beyond the ICU. Despite this positive outcome, they highlight how healthcare providers and researchers still question the impact of RRTs and are cautious about implementing RRTs without strong literature that supports improved outcomes. Similarly, Leach & Mayo (2013) acknowledge how RRTs help to prevent avoidable deaths during crises but cite the lack of adequate data that supports the real effectiveness of RRTs.

Method of Study

Both Benin et al. (2012) and Leach & Mayo (2013) identified the designs used in their studies. They both used a qualitative research design to determine participants’ feelings, perceptions, and views about RRTs. However, Benin et al. (2012) used purposeful sampling in collecting data through open-ended interviews. An investigator interviewed 49 participants using standard open questionnaires and findings were analyzed using common qualitative data coding techniques and comparative methods (Atlas-TI, GmbH, Germany) qualitative software coding program.

In contrast, Leach & Mayo (2013) used both convenience sampling and purposeful sampling. Convenience sampling was used to observe nine RRT events. On the other hand, interviews with 17 participants were conducted through purposeful sampling. To determine possible theories that could emerge from observational data and interviews, the researchers used the method of grounded theory. The findings were analyzed through concepts indicator models. A key benefit of qualitative descriptive study design is that it provides a more in-depth and comprehensive view of participants’ feelings, attitudes, and perceptions about RRTs and encourages openness by participants expanding their responses which results in new themes that were not initially incorporated by the researcher. However, its limitation is the likelihood of bias on participant responses due to the researcher’s presence.

Results of Study

The results in both studies were detailed and very conclusive. Besides, the researchers proposed a number of recommendations. In the study by Benin et al. (2012), there were four major themes found namely: patient care, hospital administration, workload, education, and morale. In each theme, several subthemes with negative and positive implications emerged. For instance, Benin et al. (2012) found that RRTs empowered nurses and physicians since they promoted the availability of skilled support during crises and provided some sense of security. The researchers also noted that RRTs were a learning tool, promoted workload redistribution, escalated the care of patients, and ensured a central mechanism for triaging patients. On the contrary, some of the negative implications of RRTs that were noted are increased conflicts between physicians and nurses, inadequate exposure of physician-learners to decision-making processes, additional work burden to members of the RRT and that the lack of continuity contributed to delays and errors (Benin et al., 2012).

Leach & Mayo (2013) found five key categories that can be used to determine and describe the effectiveness of RRTs. These categories are as follows: teamwork, expertise, communication, team structure, and organizational culture. The structure of a highly effective RRT incorporates the functions of an RRT, design, and roles descriptions of every team member.  The participants defined an RRT as a mobile team that rapidly responds to requests by bedside nurses for help with a patient whose clinical status could be gradually deteriorating.

The expertise involved highly skilled staff who use a proactive approach to make rounds and determine patients who are at risk early, to identify clinical problems and respond rapidly within five minutes. The researchers also discussed the significance of communication in regards to the effectiveness of RRTs (Leach & Mayo, 2013). They found that poor communication slowed the team’s effectiveness to make prompt decisions and vice versa.  The researchers observed teamwork as a form of collaboration between team members, working towards a common goal of addressing a patient’s immediate needs, understanding the reasons, and the primary purpose of an RRT and training (Leach & Mayo, 2013).

Ethical Considerations

Researchers in both studies discussed various ethical considerations that they observed before, during, and after conducting their studies. Benin et al. (2012) mentioned that they obtained written consent from all 49 participants. They further highlight that they obtained ethical approval of their study from the Yale School of Medicine Human Investigation Committee.  To maintain transparency and honesty, Benin et al. (2012) acknowledged relevant organizations, funders, and participants who contributed to their study positively.

Leach & Mayo (2013) acknowledge funding of their study by the school of nursing, University of California, Los Angeles, and Gordon and Betty Moore Foundation. They mention obtaining ethical approval to conduct their study from the University of California. Besides, they embraced voluntary participation, and participants mandatorily signed written informed consent.

Quantitative Research Critique

Background of Study

Both Al-Omari et al., (2019) and Dias e al. (2015) conducted quantitative studies that centered on the impact of RRTs in inpatient settings. The study by Al-Omari et al., (2019) was influenced by the background knowledge of increased incidences of cardiopulmonary arrest in hospitals that have significant mortality and morbidity. Since RRTs have proven to be highly effective in providing appropriate care to prevent further deterioration of patients’ health status in hospital settings, they hypothesized that the implementation of an RRT can help to address emergent situations due to cardiopulmonary arrests.

The study by Dias e al. (2015) explored the opinions of nurses on the value of RRTs in a hospital setting. The researchers agree that although RRTs have demonstrated to be potential as evidenced by epidemiological data, it is vital to evaluate nurses’ opinions on every team since nurses are crucial in the provision of care and are well-positioned to share unique perspectives on RRTs.

Method of Study

The researchers in both studies used a quantitative research design to collect data and obtain outcomes. Al-Omari et al., (2019) utilized a quasi-experimental method that used a pre-trial and post-trial strategy to compare the epidemiological performance of an RRT before and after implementation. The study included 154,869 patients and outcomes were presented in the form of percentages and counts of epidemiological performance before and after implementing the intervention (Al-Omari et al., 2019). A major benefit of a quasi-experimental method is that it allows the transfer and generalizability of outcomes to large populations. This means that the performance of the RRT as reported in their study can match the performance of RRT teams reported in other hospital settings under the same conditions. However, its limitation is that the population sampled may not be a representation of all samples. Besides, since the study took place in Saudi Arabia, cultural influence may invalidate the outcomes in other geographical regions.

In comparison, Dias e al. (2015) used a descriptive method that utilized an explorative descriptive method to recruit 22 nurses who worked in an inpatient healthcare setting to obtain their opinions on RRTs using questionnaires. The nurses shared their views about the structures, processes, and outcomes of RRTs. They also recommended ways on how to improve performance (Dias e al., 2015). A potential benefit of the descriptive methodological approach is that it provides an in-depth analysis of nurses’ experiences and views on RRTs as it bases on individual accounts. Its limitation is the likelihood of response bias. The participants were aware that they were being observed and may have responded based on thoughts as to what the researcher was seeking rather than providing individual honest opinions.

Results of Study

Based on the findings by Al-Omari et al. (2019), nurses activate RRTs more and the commonest triggers are cardiovascular and respiratory abnormalities. RRTs influenced a significant drop in mortality rates from 0.78% to 0.28%. Besides, there was also a significant drop in incidences of cardiopulmonary arrests from 1.053% to 0.258%. Al-Omari et al. (2019) further noted that RRTs teams were very practical in implanting and facilitating dialogue about patient care to incorporate discussions on end-of-life care. Generally, RRTs were very effective in reducing mortality, occupancy, and total admissions.

The findings by Dias et al. (2015) revealed that RRTs are yet to reach their potential in terms of structure (45.96%), processes (56.54%), and outcomes (74.99%).  Nurses who took part in the study highlighted that RRTs decreased the risks associated with a deteriorating clinical status among hospitalized patients (Dias e al., 2015). They further mentioned that the performance of RRTs can be improved through leveraging interpersonal relationships and adequate team composition.  RRTs’ team performance can also be improved through a continuous supply of materials, education actions. Technical support and statistical data on target areas that need improvement (Dias e al., 2015).

Proposed Evidence-Based Practice Change

The findings from both qualitative and quantitative studies indicate that RRTs are a valuable tool to improve clinical nursing practice and patient outcomes. RRTs are however more relevant in inpatient hospital settings where they can focus on emergencies for early identification and prompt intervention. Therefore, the adopted EBP change is the formation and implementation of an RRT in the inpatient setting to handle emergent clinical situations.

References

Benin, A. L., Borgstrom, C. P., Jenq, G. Y., Roumanis, S. A., & Horwitz, L. I. (2012). Republished: Defining impact of a rapid response team: a qualitative study with nurses, physicians, and hospital administrators. The postgraduate medical journal, 88(1044), 575–582. https://doi.org/10.1136/postgradmedj-2012-000390rep

Leach, L. S., & Mayo, A. M. (2013). Rapid response teams: a qualitative analysis of their effectiveness. American Journal of Critical Care, 22(3), 198-210. http://dx.doi.org/10.4037/ajcc2013990

Al-Omari, A., Al Mutair, A., & Aljamaan, F. (2019). Outcomes of rapid response team implementation in tertiary private hospitals: a prospective cohort study. International Journal of Emergency Journal, 12, 31. DOI: 10.1186/s12245-019-0248-5

Dias, A. O., Grion, C. M., & Martins, E. A. (2015). Quality analysis of the rapid response team in a university hospital: nurses’ opinions. Cienc Cuid Saude, 14(1), 917-923. DOI: 10.4025/cienccuidsaude.v14i1.22919