Discuss the impact of a clinical practice problem on the patient or patients and the organization it affects. 1. ?Identify each of the following PICO comp

C361 Task 1 1

Kayla Brooks

Evidence Based Practice and Applied Nursing Research

Western Governer’s University

Task 1

12/11/21

Tabitha Mauldin

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C361 Task 1 1

A. Discuss the impact of a clinical practice problem on the patient(s) and the organization it affects.

For patients experiencing anxiety the impact can be both physical and emotional. On the emotional side increased anxiety can cause depression, irritability, exhaustion, and even suicidal ideation. Increased and prolonged anxiety can also cause physical symptoms including; increased heart rate, palpitation, sweating, insomnia, muscle aches and pains, and shortness of breath.

For organizational effects, anxiety can cause a number of other issues for patients and staff. Untreated anxiety can lead to increased irritability in patients. When patients are more irritable, they are more apt to have pressured speech, become verbally aggressive or even physically aggressive. This can cause a disruption to the unit that they patient is on, possibly leading to the need for physical restraints to keep the patient and staff safe. The disruption to the unit can actually have a domino effect and cause other patients to experience anxiety or even fear. Another impact of increased anxiety in patients for the organization could be a decrease in patient satisfaction scores due to not feeling as if they were treated adequately for their problems.

1. Identify the following PICO components of the clinical practice problem:

• patient/population/problem (P): Patients experiencing anxiety

• intervention (I): Aromatherapy/essential oils

• comparison (C) N/A

• outcome (O) Decreased anxiety

2. Develop an evidence-based practice (EBP) question based on the clinical practice problem discussed in part A and the PICO components identified in part A1.

For patient’s experiencing with anxiety will the use of aromatherapy result in decreased anxiety?

B. Select a research-based article that answers your EBP question from part A2 to conduct an evidence appraisal.

1. Discuss the background or introduction (i.e., the purpose) of the research article.

2. Describe the research methodology.

3. Identify the level of evidence using the Johns Hopkins Nursing Evidence- Based Practice (JHNEBP) model.

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C361 Task 1 1

4. Summarize how the researcher analyzed the data in the article.

5. Summarize the ethical consideration(s) of the research-based article. If none are present, explain why.

6. Identify the quality rating of the research-based article according to the JHNEBP model.

Note: Refer to “Appendix E: Research Evidence Appraisal Tool” for information on how to establish the quality rating.

7. Analyze the results or conclusions of the research-based article and explain how the article helps answer your EBP question.

Utilizing the article “Effects of essential oils on central nervous system: Focus on Mental Health” published in Phytotherapy Research Journal. According to the author, Lorena R. Lizarrage-Valderrama, essential oils have been used to treat many illnesses with evidence showing use as long as 2,000 years ago. This article discusses the recent studies that have been conducted to test the possibility of utilizing essential oils to treat central nervous system issues including; anxiety, depression, seizures and possibly using essential oils as a sedative. Essential oils are a complex mixture of odor compounds derived from plant compounds rather than using synthetic pharmaceuticals, which can have many different side effects to their use. Essential oils can be used by inhalation, skin absorption, or ingestion. This article discusses studies that suggest essential oils with the major compounds of linalool, limonene and pinene to significantly contribute to anxiolytic and antidepressant effects. This article reviews and summarizes studies to evaluate the potential use of essential oils to treat anxiety and depression. (Lizarrage-Valderrama, L.R, 2020)

The research methodology for this article was to analyze preclinical studies and clinical trials conducted between 2004 and 2019. These studies were collated from multiple scientific databases. The author utilized the scientific names of plants, sage essential oil, nervous system, animal testing, clinical trials, neuropharmacology, molecular pathways, anxiolytic and antidepressant effects as search words to find these articles. (Lizarrage-Valderrama, L.R, 2020)

According to the John Hopkins Nursing Evidence-Based practice model the level of evidence for this article would be Level One. This article is written based off of research of quantitative and qualitative evidence from multiple sources or research. Per the article there were multiple experimental studies that collected quantitative and qualitative evidence concurrently by collecting how many people were affected by the essential oils and what symptom or brain function was affected. The quality rating according to JHNEBP for this article is good, the article contains multiple studies each with decent sample sizes, the evidence also shows consistent results with good evidence that essential oils do help with anxiety and depression symptoms. (D. Dang, & S. Dearholt, 2018)

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C361 Task 1 1

The researcher analyzed the data by collecting the numbers and outcomes from each of the experimental studies and compiling them into two table graphs. These graphs contain the name of the essential oil or its plant source, how the outcome was assessed, the number and type of test subject, route of administration, dosage and actual mode of administration, the outcome, the effect and a reference to which experimental study article it was obtained from.

For the research studies that were analyzed the ethical consideration of using human participants and needing informed consent for these patients while also maintaining patient confidentiality. Some of these research studies also utilized mice or rats so the ethical consideration of potential animal cruelty would need to be addressed.

As for the results of this study it does show that there are significant neurological benefits in animals as evidenced by the interactions with CNS receptors and physiological changes to brain scans. Clinical trials have also shown evidence that essential oils can change psychological responses by triggering neural pathways and helping to decrease anxiety in human trial participants. The article does state that due to the complexity of essential oil compounds that more research should be done to further conclude the benefits of essential oils on anxiety.

C. Select a non-research article from a peer-reviewed journal that helps to answer your EBP question from part A2 to conduct an evidence appraisal.

1. Discuss the background or introduction (i.e., the purpose) of the non- research article.

2. Describe the type of evidence (e.g., case study, quality improvement project, clinical practice guideline).

3. Identify the level of evidence using the JHNEBP model.

Note: The article you select should not be more than five years old. Note: Refer to “Appendix F: Non-Research Evidence Appraisal Tool” for information on how to level the non-research-based article.

4. Identify the quality rating of the non-research-based article according to the JHNEBP model.

5. Discuss how the author’s recommendation(s) in the article helps to answer your EBP question.

D. Recommend a practice change that addresses your EBP question using both the research and non-research articles you selected for Part B and Part C.

Anxiety is a common occurrence on the Mental health unit. Many of our patients utilize medications to assist with decreasing anxiety. Often times these medications do not get utilized until anxiety is at a higher rate. When assessing the effectiveness of these anti- anxiety medications patients do see a decrease in anxiety but still have residual anxiety. It is

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my personal opinion that implementing the use of essential oils to assist with decreasing anxiety before it becomes too high or in conjunction with pharmaceutical medications would be of benefit to our patients. In order to implement the use of essential oils into our daily practice I feel that staff should start offering the use of essential oils and/or medication when patients report anxiety.

1. Explain how you would involve three key stakeholders in supporting the practice change recommendation.

The mental health providers would be collaborated with on when to utilize these essential oils and how much can or should be used and to evaluate which oils can be used with certain medications and which ones may have an adverse effect if utilized together.

The nursing staff are a key stakeholder in this due to being directly involved with patients. Decreasing patients' anxiety can help decrease the potential of outbursts or agitation on the unit and can help with patient/staff relationship.

Our patients are the third key stakeholder in this due to being directly affected by the usage of essential oils. Hopefully utilizing these essential oils will help decrease anxiety, make their stay more comfortable and also provide them with another option to assist with anxiety when discharged from the hospital.

2. Discuss one specific barrier you may encounter when implementing the practice change recommendation.

3. Identify one strategy that could be used to overcome the barrier discussed in part D2.

One barrier that may be encountered when attempting to implement essential oils into our nursing practice would be resistance to change. Not only would we need to overcome providers and nursing staff being resistant to change but also our patients. It is a well-known fact that most people do not like to deviate from their daily normal routine. There is also the opposition to using herbal remedies and some seeing them as not effective or just having the placebo effect. One strategy to overcome this would be to educate staff on the beneficial effects of these essential oils by offering the information obtained from the studies. Another way to overcome this is to allow staff to sample and utilize these oils to see if they have any beneficial effect for them as well.

4. Identify one outcome (the O component in PICO) from your EBP question to measure the recommended practice change.

An indicator to measure the outcome of using essential oils is to evaluate patients after use. Currently on the unit patients are evaluated 4 times a day, if they receive any as needed medications and then one hour after using medications. I feel like this process would also be good to evaluate the effectiveness of essential oils with treating anxiety. Accessing patients on their level of anxiety on a 0-10 scale like with pain, documenting that level and then

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utilizing essential oils to help relieve this anxiety, after waiting 15-30 minutes reassessing the patient's level of anxiety on that 0-10 scale again and documenting this new level.

Resources:

Debora Dang, & Sandra L. Dearholt. (2018). Johns Hopkins Nursing Evidence-Based Practice Third Edition: Model and Guidelines: Vol. Third edition. Sigma Theta Tau International.

Lizarraga‐Valderrama, L. R. (2020). Effects of essential oils on central nervous system: Focus on

mental health. Phytotherapy Research, 35(2), 657–679. https://doi.org/10.1002/ptr.6854

Effect of aromatherapy on preoperative anxiety in adult patients: A meta-an…: Sage Search for

Western Governors University (ebscohost.com)

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NON research options

Integrative reviews

Quality improvement, clinical practice guildlines

Protocol, pilot and feasibility can NOT use

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 Get pdf of both articles

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Running head: PICO ASSIGNMENT 1

Dianah Opondo

WGU

5/18/2021

PICOT ASSIGNMENT 2

PICOT Assignment

A. Discuss the impact of a clinical practice problem on the patient(s) and the organization

it affects.

Nurse to patient ration is a clinical practice problem that affects most hospitals around the

world. According to Joaquin (2019), a nurse that is overwhelmed with additional workload is

less likely to provide excellent care to patients, which is against the oath by healthcare

providers of putting patient’s needs before self. Poor nurse to patient ratio, therefore, affects

patient in terms of the quality of care, healthcare providers in the area of work related fatigue,

and the hospital or medical facility involved, through poor treatment outcomes. The nursing

ratio has adverse effects on patients in Intensive Care Units (ICU) who require close attention.

The PICO components in this problem are intensive care patients (P), additional nurses to

reduce the ratio (I), an evaluation of patient treatment outcomes for patients in ICU and those in

the general recovery ward (C) and higher recovery by patients in healthcare facilities that have

the desires nurse to patient rations (O). Using PICO to evaluate nurse to patient ratio helps in

finding practical holistic problems that address matters touching on healthcare providers,

employer institutions, patients, and the overall healthcare industry.

Evidence based practice (EBP) PICO question: For patients in Intensive Care Units

(ICUs), does a low nurse to patient ration lead to faster recovery periods compared to those

in normal recovery wards? For this question, the PICO components are as follows: Patients in

ICU (P), low nurse to patient ratio (I), faster recovery relative to those in ordinary wards (C)

and general recovery period (O). Developing an EBP question using PICO is critical in helping

nurses understand the risks involved in handling many patients within ICU so that they can take

PICOT ASSIGNMENT 3

a proactive role in voicing their concerns to hospitals and sharing suggestions on what would

be the ideal scenario on nursing ratios for improved patient recovery periods. As frontline

caregivers, nurses have primary data on patient recovery, which is crucial in making managerial

decisions in the hiring of additional departmental personnel.

B. Select a research-based article that answers your EBP question from part A2 to

conduct an evidence appraisal.

The article selected in “The effect of nurse-to-patient ratios on nurse-sensitive patient

outcomes in acute specialist units: a systematic review and meta-analysis” by Driscoll eta al.

published in the European journal of Cardiovascular Nursing, volume seven issue 1 of 2018.

Background and introduction

Because of the elusive nature of the optimal dosage of nurses caring for patients, an

updated review of the effect of nurse staffing on patient outcomes necessitated this study. The

study is founded on events over the past decade where across countries, hospitals, have

implemented different approaches of managing nursing personnel. The study reviews staffing

levels in Victoria, Australia and California USA against The UK and Ireland where mandatory

staffing levels have been in inexistence and where the law does not mandate that, respectively.

The situation in Wales is similar to that of California and Victoria because of the introduction of

Nurse staffing levels act of 2016 but with a twist because it guides staffing levels but does not

explicitly set the proper numbers. The chosen article appreciates in its introduction, the

controversy that surrounds nurse-staffing levels because every geographic region and hospital

has unique sets challenges and there is no uniform formula, which meets all the unique

requirements on this subject. The study examines the board domain on this subject that is,

structural factors, process of care and outcomes. Structural factors include people, place, and

PICOT ASSIGNMENT 4

the outlook of healthcare delivery systems while processes are how care is undertaken through

interaction with nursing professional and outcomes are simply the results of healthcare services

in an organizational context. Article introduction defines the topical scope by mapping out

some of the crucial elements that are patient factors, ward factors and nursing factors to

establish a systematic outcome of how they have cumulatively affect patient outcomes over the

last decade. A review of recently published studies that investigate the correlation between

nurse staffing levels in acute specialist units is an introductory phrase that sets the tone for what

this study seeks to achieve.

Research methodology

The researchers developed a systematic review protocol based on the PRISMA

statement to identify studies that were undertaken in acute specialist units to review the

relationship between nurse staffing levels as patient outcomes. The study involved defining

nurse to patient ratio (NPR) and nurse-sensitive patient outcomes (NSPO) so that a clear

correlation can be established. In the context of this study, NPR is the number of nurses

working per shift or within a 24-hour period divided by number of patients occupying beds

within that period also referred to as nursing hours per patient bed days (NHPPD). Nurse

sensitive patient outcomes on the other hand are defined as cardiac arrest, respiratory failure,

and hospital acquired pneumonia and heart failure among others. The methodology involved

conducting a search strategy within these defined parameters on electronic databases like,

“(Medline (OvidSP), Medline in Process (OvidSP), CINAHL (Cumulative Index to Nursing and

Allied Health Literature) (EBSCO), PsycInfo (OvidSP), Embase (OvidSP), and HMIC (Health

Management Information Consortium) (OvidSP)”. Systematic reviews of literature and past

findings from these databases formed the bases that included the identified terms like critical

PICOT ASSIGNMENT 5

care, intensive care, cardiac ward and intensive treatment ensured that only the relevant

information was collected. A tailor made tool was employed in screening questions to ensure

that sampled papers met the inclusion criteria for a comprehensive study outcome.

Level of evidence using the Johns Hopkins Nursing Evidence-Based Practice (JHNEBP)

model

JHNEB model is useful as a problem solving approach to decisions that are crucial to

clinical processes in a three-step methodology called PET (Practice question, evidence, and

translation). The objectives on this model are to ensure that the latest findings from research

are incorporated in patient care for better outcomes (Ryan et al., 2017). The image below is a

pictorial presentation of processes within the model.

PICOT ASSIGNMENT 6

PICOT ASSIGNMENT 7

From the model, devising practice question is crucial is collecting subsequent evidence

for translation under PET. In this regard, the researchers met all the three elements by using the

right question to undertake a cross-sectional study with adjusted measures. Literature from past

studies was carefully, gathered using identified terms, and the study listed multiple peer-

reviewed articles from 2006 to 2016 that provide answers to the PICO question. Relevant ratios

that include Odd ratios, risk ratios and inverse ratio were applied to explain the phenomenon of

nurse to patient ratio and its outcome. Translation of evidence, therefore, was done in

accordance with the JHNEPB model to reveal best practices that would improve operations in

the hospital environment. For studies that where meta-analysis was not performed, a narrative

analysis was done where clinical homogeneity was assessed in study cohorts, hospital units,

and diagnosis to ensure statistical heterogeneity. Doing so ensured the validity of study output

and compliance to the JHNEPB model.

Summary of how the researcher analyzed the data in the article.

The researchers listed past studies, identified study design, sample population and

setting and proceeded to review the measure of nurse to patient ratio. There was the additional

component of outcome measures and key findings from these publications. From this

analytical outlook, it was possible to understand the number of patients in a particular setting,

say ICU, against the number of nurses in a 24-hour period to establish the outcomes using

unvariate statistical analysis. Based on the identified variables, it was easy to identify the

correlation between higher levels of nurse staffing and a drop in hospital mortality. It was also

established that no recommendations could be made on the optimal ration because of the

heterogeneity between the studies but all outcomes from the publications revealed that higher

levels of nurses reduced in-hospital mortality despite all of them being cross-sectional making

PICOT ASSIGNMENT 8

it difficult to determine the causal relationship between variables. From the analysis, it

emerged that there were previous scholarly works that established a correlation between lower

nurse ratio and low ICU mortality, “(OR 0.91, 95% CI 0.86-0.96) surgical wards (OR 0.84,

95% CI 0.8–0.89) and medical wards (OR 0.94, 95% CI 0.94–0.95) per additional FTE nurse

per patient day.” The analysis made further revelations that for every decrease in one patient

load, there is a drop in risk of in-hospital mortality of 14% and this came from the available

meta-data. The research, therefore, applied meta-data and ratio analysis to validate findings.

Summary of the ethical consideration(s) of the research-based article and if none are

present, an explanation why

The research-based article has no section for ethical considerations. The reason for not

including this section is the open nature of the study that acknowledges intellectual property

and ensured that publications were reviewed with integrity. Ethical consideration in research

is important in guiding objectivity, honesty, and integrity among others. It is particularly

important when dealing with human subjects. This study was based on a review of past

articles on the PICO question and since it was conducted with openness and integrity, it was

not necessary to outline ethical considerations. The samples studies, however, had ethical

consideration sections because they involved collection of primary data from human

participants. Data for this specific study was from secondary sources which had upheld ethical

standards and that created a line of ethical buffer for the research making it not as important

as it would had they been from primary sources.

PICOT ASSIGNMENT 9

Identify the quality rating of the research-based article according to the JHNEBP model.

Evidence level and rating Article Title:

The effect of nurse-to-patient ratios on nurse-

sensitive patient outcomes in acute specialist

units: a systematic review and meta-analysis.

Number:

N/A

Author(s):

Driscoll, Grant, Carroll, Dalton, Deaton, Jones,

and Astin.

Publication Date:

2018

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