Assessment 3 Instructions: PICO(T) Questions and an Evidence-Based Approach Create a 3-5 page submission in which you develop a PICO(T) question for a specific care issue and evaluate the evidence you locate, which could help to answer the question.
PICO(T) Framework and Development of Evidence-Based Care Practices
Identifying the right question is central to any research undertaking that seeks to be effective (Salcido, 2017). The research question dictates the trajectory of the activity, from planning, implementation, analysis, evaluation, and finally, reporting. The PICO(T) acronym is critical in the toolkit for the implementation of evidence-based medicine. PICO(T) describes the specific area for key knowledge areas: Population or patient (P), Intervention (I), Control or comparison (C), and Outcome (O). The timeframe format includes the Time (T) aspect and sets out to consider the time when comparing the effectiveness of interventions over specified periods. Therefore, the PICO question will be: In hospitalized spinal injury patients with diminished mobility (P), how does adoption of the standard pressure injury prevention protocols (I), compared to repositioning patients only (C), resulting in reduced development of pressure ulcers, in 21 days (T)? The PICO(T) approach will help to interrogate and critically appraise the existing literature in an orderly and systematic process to arrive at new knowledge and best practices in managing impaired skin integrity for these patient populations. The standardized pressure injury prevention protocol consists of six components: patient repositioning, protective dressings, surface modification using mattresses, nutritional support, patient assessment, and staff education (Cruz, 2020).
Evidence Answering the PICO(T) Question
Identifying sources of evidence was conducted to identify evidence to answer the PICO(T) question for this task. The search was conducted on four different databases. These include PubMed, CINALH, Google Scholar, and the Cochair Library. The whole subheading of “risk of impaired skin integrity in immobilized spinal injury patients” and specific key search words were used. Key terms in the search strategy were “pressure ulcers,” “pressure sores,” “impaired skin integrity,” and “spinal injury.” Literature sources included in the study were only those published in English, published within five years, and the full text was accessible. Identified articles were included in this review.
Findings From Articles
Nursing practice that complies with international guidelines for best practice effectively reduces Hospital Acquired Pressure Injuries (HAPI) that result in impaired skin integrity (Padula & Black, 2019). The guidelines specify different nursing care practices ranging from skin review and risk assessment, skin care, nutritional support, pressure-relieving techniques, and reduction in shear and friction.
The U.S. Agency for Healthcare Research and Quality introduced practice protocols for managing pressure ulcer prevention (Padula & Black, 2019)). These protocols are updated every three to five years by the National Pressure Ulcer Advisory Panel. Hospitals adopt these guidelines into their daily routine. This quality improvement concept supports using new technologies such as prophylactic dressings, repositioning, and nutrition to prevent pressure ulcers. These interventions were found to reduce the cumulative incidence of pressure ulcers (Tayyib et al., 2021; Lavallée et al., 2019). The article gives evidence of both the financial and immediate quality improvements of adopting these care protocols.
Findings by Raynaldo (2020) revealed that evidence-based preventive measures against pressure sores effectively reduced their severity. A literature review of seven articles by the author determined that the pressure injury preventive bundle adopted and strategically implemented resulted in a reduction of pressure ulcer severity from stage two to one. The article made recommendations supporting continuous medical education and training for staff toward the application of bundle interventions supported by evidence. As a result, this will ensure a positive outcome in reducing the severity and incidence of HAPI. Cruz (2020) reported a 7.37% reduction in pressure ulcer incidence after 30 days of the pressure bundle implementation program. These findings show a clinically significant improvement in impaired skin integrity outcomes by adopting standardized, evidence-based protocols to prevent HAPI.
Analysis of Relevance of the Identified Sources
The findings and conclusions from the reviewed articles are relevant to the PICO(T) question as they provide evidence of the efficacy of the pressure prevention protocols. Pressure injuries are predictable and can be prevented and remain disproportionately frequent in ICU immobilized patients, such as spinal injury patients. The initial step to avoiding pressure injuries is accurate and timely risk assessment (Cruz, 2020)