A PICOT starts with a designated patient population in a particular clinical area and identifies clinical problems or issues that arise from clinical care. The intervention should be an independent, specified nursing change intervention. The intervention cannot require a provider prescription. Include a comparison to a patient population not currently receiving the intervention, and specify the timeframe needed to implement the change process.
Formulate a PICOT statement using the PICOT format provided in the assigned readings.

The PICOT statement will provide a framework for your capstone project.
In a paper of 500-750 words, clearly identify the clinical problem and how it can result in a positive patient outcome.
Make sure to address the following on the PICOT statement:
1.Evidence-Based Solution
2.Nursing Intervention
3.Patient Care
4.Health Care Agency
5.Nursing Practice
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
You are required to submit this assignment to LopesWrite. Please refer to the directions in the Student Success Center.

Due to its capstone project, I need to build from the previous paper.
Last time you did it for me my PICOT I will attach to you the capstone approval paper
This is the PICOT
For adult patients in a telemetry floor (P), does increase staffing and optimizing scheduling (I) increase their future (T) safety (O) compared to maintaining the current level of staffing and scheduling (C)?
P: Adult patients on a telemetry floor
I: Increasing staffing and optimizing scheduling
C: Maintaining the current level of staffing and scheduling
O: Increased patient safety
T: Future safety

PICOT Question Guide

 

The following contains PICOT question guides/templates to use to help write questions using all of the PICOT elements.  Each template contains a guide that you can use to write a complete PICOT question, examples of PICOT elements, and illustrations[1].  Review some tips and hints below to think about for each of the PICOT elements that can help create a sound clinical nursing PICOT question:

 

P=Population of patients:     Think about a group of patients you are interested in studying—identify the group by age ranges, diagnosis/disease of interest, history or length of time with the diagnosis/disease of interest, location, unit, or setting, gender type (if applicable), race (if applicable), or other identifiable characteristics such as Medicare, Medicaid, immobile, ventilated, inpatient, outpatient, etc.

I=Intervention:                     Consider the nursing action or intervention you are thinking that would make a difference?  From your search for evidence, what is the evidence indicating that nurses can do to help improve the problem or issue you have chosen?

C=Comparison:                     Think about comparing to the intervention of interest or the alternative such as routine/standard care.  If no comparison, state not implementing the intervention or no comparison group.

O=Outcome:                           Reflect upon what would be the measurable, relatable indicator that would demonstrate the intervention is making a difference or not?  What would be the needed outcome that you could observe/check/measure? For example, “the pain is okay” would not be a measurable outcome.  Rates pain level less than 3 on pain scale would be measurable.

T=Timeframe:                       For this element, reflect on how long it would take to implement your study by collecting data or the time needed to observe to see if any changes occurred or will occur. Think about 1 month, 3 months, 6 months etc… Use a timeframe that is realistic.

Template A

 

Among/In _________________________ (P), does______________________ (I) (**decrease/increase/impact/influence/affect/reduce/improve**) _____________________ (O) compared to ______________________________ (C) over ______________________________(T)?

(**choose one term**)

Example:

Among 65+ and older diabetic immobile adults in long-term care (P), does a bedside oral care kit and checklist protocol (I) compared to routine oral care without a bedside oral care kit (C) affect the number of times oral care is completed (O) over 3 months (T)?

P=Population of patients:  65+ and older diabetic immobile adults in long-term care

I=Intervention:   bedside oral care kit and a checklist protocol

C=Comparison:  routine oral care without a bedside oral care kit

O=Outcome:  number of times (frequency) oral care is completed

T=Timeframe:  3 months

Template B

Among/In _________________________ (P), would______________________(I) (**decrease/increase/impact/influence /affect/reduce/improve **)_____________________ (O) compared to ______________________________ (C) over ______________________________(T)?

(**choose one term**)

Example:

In male ICU patients who are 65+ and older diagnosed with COPD (P), would the confusion assessment screening tool (CAST) (I) impact the number of early identification of delirium (O) compared to no screening tool (C) over 6 months (T)?

P=Population of patients:  Inpatient male ICU patients 65+ and older diagnosed with COPD

I=Intervention:   confusion assessment screening tool (CAST)

C=Comparison:  routine care/no screening tool

O=Outcome:  number of early identification of delirium

T=Timeframe:  6 months

Template C

Among/In _________________________ (P), will ______________________ (I) (**decrease/increase/impact/influence/affect/reduce/improve **)_____________________ (O) compared to ______________________________ (C) over ______________________________ (T)?

(**choose one term**)

Example:

Among Hispanic pregnant women between 36-40 weeks (P), will completing a lactation course (I) increase the number of breastfeeding initiations by or within 6 hours of delivery (O) compared to no lactation course (C) over 6 months?

P=Population of patients:  Hispanic pregnant women between 36-40 weeks

I=Intervention:   lactation course completed

C=Comparison:  no lactation course

O=Outcome:  number of breastfeeding initiations within 6 hours of delivery

T=Timeframe:  6 months

 

Template D

 

Among/In _________________________ (P), what is the effect of ______________________ (I) on ____________________ (O) compared to ___________________________ (C) over ______________ (T)?

Example:

In pediatric non-Hispanic Black males ages 8-18 years old with a 5 year history of type 1 diabetes (P), what is the effect of the Glucose Buddy Diabetes Tracker app (I) on maintaining HbA1C levels <7% (O) compared to the mySugar Diabetes Tracker Log app (C) over 6 months (T)?

 

P=Population of patients:  pediatric non-Hispanic Black males ages 8-18 years old with 5 year history of type 1 diabetes

I=Intervention:   Glucose Buddy Diabetes Tracker app

C=Comparison:  mySugar Diabetes Tracker Log app

O=Outcome:  HbA1C levels <7%

T=Timeframe:  6 months

[1] Adapted from Houser (2018) and the American Academy of Ambulatory Care Nursing (AAACN). (2018). AAACN research toolkit:  Template for asking PICOT questions.

 

Based on identification of a problem affecting nurses at your site (vertical conflict in the
workplace/incivility in the workplace), the student will create a proposal for change using
evidence-based practice.
Proposal will include the following:
• Problem Statement (and PICOT question)
• Two goals (must be SMART goals)

• Three behavioral objectives: Using Bloom’s Taxonomy: psycho-motor, cognitive and affective
• Action Plan/Evaluation tool methods
• Implication for Nursing Practice
• 4-6 Evidence Based References
Goals must be related to the course objectives and the area of your practicum experience. (For
reference the following are course objectives)
1. *Communicate effectively using listening, speaking, reading and writing skills.
2. Use quantitative and analytical skills to evaluate and process numerical data.
3. *Solve problems using critical thinking and scientific reasoning.
4. Formulate strategies to locate, evaluate, and apply information.
5. Demonstrate knowledge of diverse cultures, including global and historical perspectives.
6. *Create strategies that can be used to fulfill personal, civic and social responsibilities.
7. Demonstrate knowledge of ethical thinking and its application to issues in society.
8. *Use computer and emerging technologies effectively.
9. Demonstrate an appreciation for aesthetics and creative activities.
10. Describe how natural systems function and recognize the impact of humans on the
environment.
The objectives should be specific and measurable. The plan of action should include step-bystep process to meet the objectives. The implications for nursing practice should be evidence-based.

References should be in Vancouver Style**
Scenario: You are the pharmacist in the RA clinic and the following two patients are candidates
for initiation of biologics therapy.
Patient A: 44-year old woman, with a PMH of multiple sclerosis and COPD. Relevant results
include: blood pressure 120/70 mmHg, Erythrocyte Sedimentation Rate (ESR) >30 mm per hour,
rheumatoid factor (RF) 40 IU/mL, Anticyclic Citrullinated Peptide (anti-CCP) 35 IU/mL, C-reactive
protein (CRP) 14.0 mg/L.

Patient B: 65-year old male, with a PMH of myocardial infarction. Relevant results include: blood
pressure 170/110 mmHg, Erythrocyte Sedimentation Rate (ESR) >40 mm per hour, rheumatoid
factor (RF) 60 IU/mL, Anticyclic Citrullinated Peptide (anti-CCP) 45 IU/mL, C-reactive protein
(CRP) 20.0 mg/L.
Part 1 – With reference to the literature, discuss the appropriateness of infliximab or rituximab for
each of your patients. Your answer should include pharmacology, clinical and laboratory markers,
co-morbidities, patient demographics and cost-effectiveness.
(500 words)
Part 2 – Recent evidence has shown that rituximab can also be administered as a subcutaneous
injection instead of only as an intravenous infusion. With reference to the literature, discuss the
rationale for this and discuss the key steps for administering subcutaneous rituximab. (250
words)
Part 3 – As the pharmacist in the RA clinic, discuss your contribution to this patient’s management. (250 words)