NUR 590 Topic 1 DQ 1: BASED ON YHE PICOT YOU DEVELOPED FOR NUR-550, SUMMARIZE THE INTERVENTION YOU ARE PROPOSING
NUR 590 Topic 1 DQ 1: BASED ON YHE PICOT YOU DEVELOPED FOR NUR-550, SUMMARIZE THE INTERVENTION YOU ARE PROPOSING
NUR 590 Topic 1 DQ 1: BASED ON YHE PICOT YOU DEVELOPED FOR NUR-550, SUMMARIZE THE INTERVENTION YOU ARE PROPOSING
Based on the PICOT you developed for NUR-550, summarize the intervention you are proposing. How does this support the population of focus, your setting, and role? Justify how the problem you selected to investigate is amenable to a research-based intervention using the PICOT format. Include your PICOT statement with your response.
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Science teaches us to explore and question. In medicine, it the same. There is always something to explore in medicine, whether its to improve upon interventions or to learn complex diseases. Throughout my career as a nurse and nursing student, it was always expressed to me that in order for me to become a successful nurse I would need to engage in continuing education for the life of my career. In life, we should always strive for continuing education for personal development and growth. The future of nursing will require nurses to question, explore and take initiative making decisions on patient care, interventions, in leadership and public health.
“Explain the importance of a spirit of inquiry in an evidence-based culture and what you can do as an advanced registered nurse to encourage this within your practice or organization. In response to your peers, compare the role and implementation of EBP in your specialty area with another advanced registered nurse specialty” (National League of Nursing, 2014, para. 1). The COVID-19 pandemic was a wake up call in that we as a nation need to focus on improving our nursing practice. Nurses will need to be encourage and pushed into leadership roles, executive positions and in the areas a research and development. Many nurses took the lead in saving their patients and hospitals as the pandemic ravaged hospitals throughout the country.
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There was also a spike in people researching how to get into the field of medicine (particularly in nursing and nursing research). There became a fascination into epidemiology, public health and medical research as people and nurses became curious about vaccine development and how outbreaks of disease and virus happen. As a advanced registered I would encourage evidence based culture by being an example of someone who uses EBP and work in collaboration with other staffers to implement EBP research into the real world. During the heigh of the pandemic, EBP research was used to help patients as other interventions and methods failed.
Implementing EBP
In the field of advanced nursing practice, there are various ways advanced nurses implement EBPs. Nurse practitioners implement and EBP “when she/he prescribes a treatment for a patient that is substantiated by scientific research; Often, nurse practitioners look for an experimental study that compares the efficacy of a treatment with an untreated control group” (Nurse Practitioner Schools, 2021).
Certified mid-wifery
For nursing midwives, EBP is are used to enhance the lives of the mother, child and community. Mothers are the backbone of communities and the health and safety of woman determines the health and safety of their respective communities. Areas of challenges are identified and EBP are used to improve the lives of women in order to safely carry, deliver and raise children.
NUR 590 Topic 1 DQ 1: BASED ON YHE PICOT YOU DEVELOPED FOR NUR-550, SUMMARIZE THE INTERVENTION YOU ARE PROPOSING References:
National League of Nursing. (2014). Practical/Vocational Nursing Program Outcome: Spirit of Inquiry. https://www.nln.org/docs/default-source/default-document-library/spirit-of-inquiry-final.pdf?sfvrsn=0
Nurse Practitioner Schools. (2021). Guide to Evidence-Based Nursing Practice for NPs. Retrieved from https://www.nursepractitionerschools.com/resources/guide-to-evidence-based-nursing-practice/
A spirit of inquiry could be rephrased as curiosity and desire for increased knowledge by on current best practices as defined by research. Currently it can take many years for new information to be put into practice to achieve the quadruple aim of EBP: improvement of healthcare quality, improved patient outcomes, reduced costs, and empowered clinicians (Melnyk & Fineout-Overholt, 2019). Some ways to evaluate EPB includes quality improvement projects as well as outcome management (Melnyk & Fineout-Overholt, 2019).
Nursing informatics is the study and integration of nursing with information technology, like EHRs and statistics, to support all care team members in decision making. Advanced practice nurses can encourage EBP and inquiry by identifying and solving problems. Therefore, nursing informatics (NI) can use help improve processes and the floor nurses’ experiences with EHR. One way my organization is doing this currently is re-educating nurses on the EHR system, Meditech. Nurses have been showing each other “one thing I learned.” Therefore, while in class the nurse may heave learned one thing, by sharing that learning, nurses have reinforced their learning while picking up other time saving tips.
Melnyk, B.M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing and healthcare: A guide to best practice (4th ed.). Wolters Kluwer. ISBN-13:9781496384539
An evidence-based culture in a healthcare organization is an easy thing to aspire to, yet a challenging and rigorous process to truly pursue and achieve. It is essential that a “spirit of inquiry” be fostered in order to truly achieve the ultimate goal of evidence-based practice that comes from a culture that supports clinical care that is validated by substantial research and data.
According to Wyant (2018), it is critical that a culture of evidence-based practice begin with asking the right questions, and pursuing the correct information to support practice change in order to achieve better patient care results and outcomes. But even before the right questions can be asked, a spirit of inquiry must exist in order to stimulate the curiosity and wonder of what could be, and how things could be better.
Known as “step 0” of the evidence-base practice process, a spirit of inquiry, or wonder, is often triggered when a registered nurse reads an article with an interesting approach to a patient care issue, an individual comes up with an idea as to better improve a care practice, or the question is simply asked, “what else is out there, and is there a proven way to do this best?”. All of these initial questions support a spirit of inquiry, which triggers the beginning of an amazing journey known as evidence-based practice, translational research, literature review and practice implementation and observation/improvement (Wyant, 2018).
As a registered nurse, and specifically as a nurse leader, it is one’s duty to promote, celebrate and praise those who ask the hard questions of why and how patient care could be improved. It is essential that these individuals with a deep wonder of the “what if’s” be supported and encouraged to speak up, in order to create a culture of evidence-base practice that begins with the genuine spirit of inquiry and curiosity (Wyant, 2018). As a current nurse leader, and one who coaches others in leadership practices and improvement projects, this is a great reminder to me to speak truth into these individuals that when an engaged caregivers asks how we could do better, it is not necessarily a critique on the current – but instead, a genuine curiosity, and wonder of what could be.
NUR 590 Topic 1 DQ 1: BASED ON YHE PICOT YOU DEVELOPED FOR NUR-550, SUMMARIZE THE INTERVENTION YOU ARE PROPOSING References
Wyant, T. (2018). A Spirit of Inquiry Leads to Evidence-Based Answers to Practice Questions.
ONS Voice,
33(1), 43
A spirit of inquiry by nurses that goes through a systematic process for raising clinical questions is a core factor in EBP journey (Wyant, 2020). This occurs when a nurse thinks of a question in relation to an existing clinical practice and seeks ways to improve that particular practice. One way to encourage this within the organization as an advanced practice nurse is to lead by example. For example, while working in the unit we see multiple elderly patients having difficulty sleeping in the hospital, our thinking minds as clinicians will ask ourselves how we can improve their sleep patterns. This process is called the spirit of inquiry, where the “questioning” begins to exist. Motivating staff to share their experiences and thoughts should be encouraged. Their curiosity could potentially lead to improving patient’s health.
The role of EBP in my specialty area of practice with emphasis in healthcare quality and patient safety is significant in improving clinical practice and addressing patient safety concerns. Because EBP involves a problem-solving approach that integrates research evidence, it can improve health outcomes and quality of service (Songur et al., 2018). In comparison to other specialty practice, such as nurse anesthetists, EBP can help them determine which interventions can assist in guiding their practice. For example, if there are high rates of atelectasis, they can come up with EBPs that focus on the role of breathing exercises to be used pre and post procedures to determine if such interventions can help in decreasing incidence rates of atelectasis in patients.
NUR 590 Topic 1 DQ 1: BASED ON YHE PICOT YOU DEVELOPED FOR NUR-550, SUMMARIZE THE INTERVENTION YOU ARE PROPOSING References
Sonğur, C., Özer, Ö., Gün, Ç. (2018). Patient safety culture, evidence-based practice and performance in nursing. Syst Pract Action Res, 31, 359–374. ttps://doi.org/10.1007/s11213-017-9430-y
The PICOT question that I am proposing is: For infants < 30wks gestation (P), Can feeding infants with their own mother’s breastmilk (OMM) (I), compared with feeding with infant formula (C), reduce the incidence of necrotizing enterocolitis (NEC) (O), over a 1-year period of time (T).
Infants born before 37 weeks of gestational age are classified as premature. Premature infants are a unique population of patients that must ward off illnesses and diseases while being challenged with growing and developing in a challenging fashion. One such illness that poses a life-threatening illness for premature infants is necrotizing enterocolitis (NEC). According to Masi et al., (2021), NEC is a detrimental disease of the intestine that mainly impacts preterm infants. NEC is a condition that affects around 5% of NICU admissions whereby prematurity, low birth weight, and antibiotic therapy increase its prevalence (Knowles et al., 2021).
The intestinal tract of preterm infants is very significant to their growth and development. Premature infants become stronger as they gain weight and grow. Therefore, nutrition is a key factor in a premature infant’s growth and development, in preventing NEC, and in their overall survival.
Sim et al., (2023) discussed that an infant’s gut microbiota is composed of a diverse number of bacterial organisms that live within the gut and contain both beneficial and harmful mechanisms that impact the development of their immune response. The microbiota also determines how capable infants are at fighting off illnesses (Sim et al., 2023). Thus, compared to the term infant, preterm infants have significantly altered gut microbiota that is impacted by clinical factors such as prematurity and delivery methods (Sim et al., 2023).
Nolan et al., (2020) found that own mother’s milk (OMM) contains human milk oligosaccharides (HMOs) and microbiome properties that serve as a protective force against NEC. Thus, the intervention that I am proposing is to observe the impact of OMM versus infant formula feedings in preventing incidents of NEC, while creating a specialized program to encourage lactating mothers to provide sufficient supplies of OMM that will sustain the growth and development of premature infants.
Investigating feeding methods in relation to NEC prevention is amendable to a research-based intervention because the solution includes natural forces such as breast milk that is readily available to lactating mothers.
As a NICU nurse working in the NICU, I have first-hand knowledge and experience of the devastation that NEC places on premature infants. Therefore, creating a specialized program to encourage lactating mothers in providing OMM to the premature infant population could positively impact their survival rates and improve their overall outcomes. This proposed intervention will support premature infants who are admitted to the neonatal intensive care unit (NICU) over a 6 month to one-year period of time.
NUR 590 Topic 1 DQ 1: BASED ON YHE PICOT YOU DEVELOPED FOR NUR-550, SUMMARIZE THE INTERVENTION YOU ARE PROPOSING References
Knowles, T. A., Hosfield, B. D., Pecoraro, A. R., Li, H., Shelley, W. C., & Markel, T. A. (2021). It’s all in the milk: chondroitin sulfate as a potential preventative therapy for necrotizing enterocolitis. Pediatric Research, 89(6), 1373-1379. https://10.1038/s41390-020-01125-7
Masi, A. C., Embleton, N. D., Lamb, C. A., Young, G., Granger, C. L., Najera, J., Smith, D. P., Hoffman, K. L., Petrosino, J. F., Bode, L., Berrington, J. E., & Stewart, C. J. (2021). Human milk oligosaccharide DSLNT and gut microbiome in preterm infants predict necrotizing enterocolitis. Gut, 70(12), 2273-2282. https://10.1136/gutjnl-2020-322771
Nolan, L. S., Rimer, J. M., & Good, M. (2020). The Role of Human Milk Oligosaccharides and Probiotics on the Neonatal Microbiome and Risk of Necrotizing Enterocolitis: A Narrative Review. Nutrients, 12(3052), 3052. https://10.3390/nu12103052
Sim, K., Powell, E., Cornwell, E., Simon Kroll, J., & Shaw, A. G. (2023). Development of the gut microbiota during early life in premature and term infants. Gut Pathogens, 15(1), 1-16. https://10.1186/s13099-022-00529-6
RESPOND HERE
It is true that premature infants become stronger as they gain weight and grow. Premature infants are at risk of various health complication in case of wrong nutritional choices. Therefore, nutrition is a primary determinant of this population’s growth and development. Most healthcare institutions have premature infant services to help parents. These infants are born before 37 weeks of gestational age (Masoudian et al., 2019). As a result, premature infants have weak immune system. Weak immune system exposes premature babies to different health complications.
Therefore, premature infants require special healthcare attention. Necrotizing enterocolitis (NEC) is among life-threatening illnesses for premature infants (Jin et al., 2019). Unfortunately, some infants succumb to these life-threatening health complications. A good rapport between parents and healthcare workers ensures that premature infants are protected against wrong healthcare choices. Parents with limited information about parenting premature infants are prone to making wrong decisions. Therefore, healthcare professionals play an important role in helping parents to take care of premature infants.
NUR 590 Topic 1 DQ 1: BASED ON YHE PICOT YOU DEVELOPED FOR NUR-550, SUMMARIZE THE INTERVENTION YOU ARE PROPOSING References
Jin, Y. T., Duan, Y., Deng, X. K., & Lin, J. (2019). Prevention of necrotizing enterocolitis in premature infants–an updated review. World journal of clinical pediatrics, 8(2), 23. doi: 10.5409/wjcp.v8.i2.23
Masoudian, P., Sullivan, K. J., Mohamed, H., & Nasr, A. (2019). Optimal timing for inguinal hernia repair in premature infants: a systematic review and meta-analysis. Journal of Pediatric Surgery, 54(8), 1539-1545. https://doi.org/10.1016/j.jpedsurg.2018.11.002
Central line-associated infections are critical and provide fatal outcomes for patients. It increases the morbidity, mortality, health care cost, and duration of hospital stay. The use prevention bundle in central venous access patients reduces the infections related to the central line to a certain level. However, the rate of CLABSI (Central Line-Associated Bloodstream Infection) remains a significant healthcare concern in hospitals after adopting the prevention bundle. My PICOT: “Central line-associated bloodstream infections (CLABSI) in hospitalized adult patients(P) with prevention bundle(C) will decrease (O)by early removal of central line and implementation of Vascular access team(I) in 6 months(T)”?
The proposed intervention is to have an efficient vascular access team in the acute care setting to avoid unnecessary central line placement in patients. The novel vascular team will significantly decrease CLABSI by providing proper access according to the patient’s specific needs and educating the staff regarding care and maintenance of the peripheral line. The vascular access team is cost-effective and decreases the use of central lines in the hospital setting(Martillo et al., 2020).
NUR 590 Topic 1 DQ 1: BASED ON YHE PICOT YOU DEVELOPED FOR NUR-550, SUMMARIZE THE INTERVENTION YOU ARE PROPOSING References
Martillo, M., Zarbiv, S., Gupta, R., Brito, A., Shittu, A., & Kohli-Seth, R. (2020). A comprehensive vascular access service can reduce catheter-associated bloodstream infections and promote the appropriate use of vascular access devices. American Journal
of Infection Control, 48(4), 460–464. https://doi.org/10.1016/j.ajic.2019.08.019