Professional nurses rely on research findings to inform practice decisions; they use critical thinking to apply research directly to specific patient care situations.

Think about an independent nursing practice problem you care passionately about and would be interested in searching for evidence.

The below problems should not be used:

*medical/doctor/physician problems such as medications, or medications administration or effects, diagnostics such as EKGs, labs, cardiac catheterizations.

*staffing, nurse-to-patient ratios, workforce issues are organizational/system /political/administrative/multi-stakeholder problems that nursing cannot solve independently.

  • Describe a significant nursing clinical issue, topic of interest, or practice problem that is important to you. Describe why you chose the problem/topic.
  • Write your clinical question in the PICO(T) format for your nursing practice problem.
  • *To write your clinical question in the PICO(T) format, use the NR439_Guide for writing PICOT Questions and Examples found in your required reading or access the following link:

NR439_Guide for writing PICOT Questions and Examples (Links to an external site.)

  • List each of your PICOT elements.

Share why you care about this nursing practice problem and why you believe the problem would benefit from finding the best evidence.

The topic that is most concerning to me in my field and most relevant is that of compliance in the hospice patient.  Compliance with medication and interventions really does help manage symptoms and usually low live discharge rate occurs.  Live discharge occurs when they either want off service, go to the hospital, move out of area or are placed in the care of someone else  I am a hospice nurse of one year and see a terrible compliance issue with these patients.  Yes, they are at the “end of lifeâ€� in most cases but they should not have other issues/complication then their primary diagnosis. I believe a little back ground will be needed to describe my true setting.  Medicare (or insurance office that handle their money) will refer my company to take a look at them for admission (with great pressure to admit) to keep patients from coming back to the hospitals.  A trip to the ER, admission, treatment etc is big bucks that these insurance companies must pay out.  If they are placed on hospice, they pay a set amount monthly driving the cost down.  It is our job to keep the patients away from the hospital by managing their symptoms adequately and efficiently day or night. 

So they reason why I choose this because I believe we can do a better job with helping our patients with comfort measures at end life.  (they could work with regular hospital d/c as well). 

 

Write your clinical question in the PICO(T) format for your nursing practice problem

Population-(our LCD guidelines set by medicare) the non-compliant hospice patient, a patient with a terminal illness usually over the age of 65.  They can either be at home, in a facility, homeless, in the hospital etc. 

Intervention-The things that I believe would make a difference is simple things like pill box, writing what the medication is used for on each medication, setting timers on phone or alarm clock for medication administration, daily (or several times a day) wellness checks, speed dial set up on phones to reach nurses quickly, having medication and equipment needs anticipated and having a second nurse assess at least one time to have a second eye/opinion on patient needs.  I am full of ideas today 😊, I am modifying my list and coming up contracting or staffing paramedics that live in areas close to patients.  They are cheaper and can be trained to do what we do in case of a change of condition in the middle of the night or day while everyone is busy (only if billable by medicare).  Also setting up a tablet on a tripod where the patients medication usually is or where the patient using sits/lays would be a cheap and effective way to help with efficiency and compliance.  Also purchasing a b/p cuff, pulse ox, stethoscope and thermometer would greatly help each patient.  Yes some of these techniques may be invasive this is only for patients that are willing.  This can also be for the primary caregivers and they can be trained how to

The topic that is most concerning to me in my field and most relevant is that of compliance in the hospice patient.  Compliance with medication and interventions really does help manage symptoms and usually low live discharge rate occurs.  Live discharge occurs when they either want off service, go to the hospital, move out of area or are placed in the care of someone else  I am a hospice nurse of one year and see a terrible compliance issue with these patients.  Yes, they are at the “end of lifeâ€� in most cases but they should not have other issues/complication then their primary diagnosis. I believe a little back ground will be needed to describe my true setting.  Medicare (or insurance office that handle their money) will refer my company to take a look at them for admission (with great pressure to admit) to keep patients from coming back to the hospitals.  A trip to the ER, admission, treatment etc is big bucks that these insurance companies must pay out.  If they are placed on hospice, they pay a set amount monthly driving the cost down.  It is our job to keep the patients away from the hospital by managing their symptoms adequately and efficiently day or night. 

So they reason why I choose this because I believe we can do a better job with helping our patients with comfort measures at end life.  (they could work with regular hospital d/c as well). 

 

Write your clinical question in the PICO(T) format for your nursing practice problem

Population-(our LCD guidelines set by medicare) the non-compliant hospice patient, a patient with a terminal illness usually over the age of 65.  They can either be at home, in a facility, homeless, in the hospital etc. 

Intervention-The things that I believe would make a difference is simple things like pill box, writing what the medication is used for on each medication, setting timers on phone or alarm clock for medication administration, daily (or several times a day) wellness checks, speed dial set up on phones to reach nurses quickly, having medication and equipment needs anticipated and having a second nurse assess at least one time to have a second eye/opinion on patient needs.  I am full of ideas today 😊, I am modifying my list and coming up contracting or staffing paramedics that live in areas close to patients.  They are cheaper and can be trained to do what we do in case of a change of condition in the middle of the night or day while everyone is busy (only if billable by medicare).  Also setting up a tablet on a tripod where the patients medication usually is or where the patient using sits/lays would be a cheap and effective way to help with efficiency and compliance.  Also purchasing a b/p cuff, pulse ox, stethoscope and thermometer would greatly help each patient.  Yes some of these techniques may be invasive this is only for patients that are willing.  This can also be for the primary caregivers and they can be trained how to