Studies of association between exposure and outcome

Abbade et al. (2016), states that the PICOT format is generally applicable to comparative studies or studies of association between exposure and outcome.  In breaking down this week’s assignment we will first look at the elements of each provided PICOT question.  The first question:

  • P: Children 5-19 years old
  • I: Use of motivation interviews during well-child visits to influence BMI, quality of life, and daily physical activity
  • C: Practice as usual compared to motivational interviews during well-child visits
  • O: The use of motivation interviews to influence BMI improvement, quality of life, and daily physical activity
  • T: 8-10-week period

In identifying key search terms for the first PICOT question, I would focus on motivational interviews, well-child visits, BMI, quality of life, physical activity, and an 8-10-week timeframe.

In further investigating the first PICOT question, a research-based intervention that was being addressed was the use of motivational interviews.  Borrello et al. (2015), describe motivational interviewing as a collaborative, goal-oriented style of communication with particular attention to the language of change. It is designed to strengthen personal motivation for and commitment to a specific goal by eliciting and exploring the person’s own reasons for change within an atmosphere of acceptance and compassion.  The quantifiable outcomes were that those patients who received motivational interviews at their visit showed to have decreased BMI, improved/increased physical activity, and overall improved quality of life. This group of researchers used a meta-synthesis to quantify the research findings with the inclusion of six articles.  The use of anthropometric measures, the Motivational Interviewing Treatment Integrity (MITI) scale, and pre-and post-measurement data.  In the review of the research, I do not feel as though an eight to ten-week timeframe is long enough to measure true raw data of implementing the suggested intervention because maintained BMI decrease, improved physical activity, and quality of life need more time to be assessed. Eight to ten weeks does not allow time for life factors, such as finance, access, patient contact, and measurable outcomes.  One positive attribute is that there were pre and post interaction but follow-up and additional conversations/interviews need to be had at the 12-week mark, six-month mark and annual mark need to be addressed, to truly elicit valid outcomes. One of the biggest factors regarding weight is “relapse” or falling back into old patterns or habits and the value of the initial motivational interview could be lost.

In the review of a secondary study that utilized randomized controlled trials, the timeframe of eight to ten weeks was not enough time to truly evaluate the effects of motivational interviews to improve BMI, physical activity and quality of life.  Three months was the time frame that this group utilized.  Luque et al. (2018), found that positive effects of a motivational interview on BMI and other obesity-related behavior outcomes.

In the second PICOT question:

  • P: Adult critical care patients
  • I: Implementing research-based skincare integrity bundle
  • C: Implementing research-based skincare integrity bundle compared to standard care practice influencing hospital-acquired pressure injuries
  • O: Affect on the incidence of hospital-acquired pressure injures
  • T:8-10-week period

In identifying key search terms for the second PICOT question, I would focus on research-based skincare integrity bundle, adult critical care patients, current incidence with current standard care practice, and 8-10-week timeframe.

In further investigation of PICOT question two, the research-based evidence was to evaluate the use of a multifaceted approach aimed at improving equipment, digital documentation and education on risk assessment, prevention, and treatment strategies regarding pressure injuries.  Goodman et al. (2018), reports a pressure injury as a localized injury and/or underlying tissue, usually over a bony prominence, resulting from sustained pressure (including pressure associated with shear).   The quantifiable outcome that this research group identified was that in-spite of all research applied they found despite multiple quality improvement initiatives, suggesting critically ill patients represent a unique challenge for reducing hospital-acquired pressure injuries (HAPI) for these patients at our institution (Goodman et al., 2018).  This group of researchers implemented a quality improvement initiative.  In this initiative, they sought to assess, available equipment, education, and digital documentation and utilized project champions to promote changes and evoke support.  Data was collected through the use of the International Pressure Ulcer/Injury Prevalence (IPUP) Survey and a Plan-Do-Study-Act (PDSA) methodology.  Although I do feel as though eight to ten weeks would be a quantifiably adequate amount of time to assess this patient group, this group of researchers evaluated the data over a year’s time. The biggest contingency, that would have an effect is the patient length of stay (LOS) in the critical care setting.  In today’s time, patients’ LOS is a measure that is taken into heavy consideration, and therefore evaluating the use of the addressed measures in the PICOT question could potentially yield short-term results but on the long-term scale, results show variability.  In considering implementing the research there are several things to be considered to allow this intervention to effective, these include, LOS, staffing ratios, patient condition, quality of care, intervention adjuncts, patient age, availability of funding to support this continued initiative.  Although patient benefit should be at the forefront of positive outcomes, sometimes budget is the key indicator in hindrance to yield effective outcomes.

Overall, the use of the PICOT question can frame effective and quantifiable research outcomes, when seeking to elicit specific results.  As a DNP scholar effectively implementing a practice change, utilization of a quality PICOT question can potentially yield results that will evoke a positive change in healthcare changes, that will overall improve the healthcare paradigm as a whole.

Abbade, L. P., Wang, M., Sriganesh, K., Mbuagbaw, L., & Thabane, L. (2016). Framing of research question using the PICOT format in randomised controlled trials of venous ulcer disease: A protocol for a systematic survey of the literature. BMJ Open6(11), e013175. (Links to an external site.)

Borrello, M., Pietrabissa, G., Ceccarini, M., Manzoni, G. M., & Castelnuovo, G. (2015). Motivational interviewing in childhood obesity treatment. Frontiers in Psychology6 (Links to an external site.)

Goodman, L., Khemani, E., Cacao, F., Yoon, J., Burkoski, V., Jarrett, S., Collins, B., & Hall, T. N. T. (2018). A comparison of hospital-acquired pressure injuries in intensive care and non-intensive care units: a multifaceted quality improvement initiative. BMJ Open Quality7(4), e000425. (Links to an external site.)

Luque, V., Feliu, A., Escribano, J., Ferré, N., Flores, G., Monné, R., Gutiérrez-Marín, D., Guillen, N., Muñoz-Hernando, J., Zaragoza-Jordana, M., Gispert-Llauradó, M., Rubio-Torrents, C., Núñez-Roig, M., Alcázar, M., Ferré, R., Basora, J., Hsu, P., Alegret-Basora, C., Arasa, F., Venables, M., Singh, P., Closa-Monasterolo, R. (2019). The Obemat2.0 Study: A Clinical Trial of a Motivational Intervention for Childhood Obesity Treatment. Nutrients11(2), 419.

I need a comment for this discussion board and use 3 sources no later than 5 years and at least 2 paragraphs. 

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