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Purpose: To identify a problem or concern that nursing can change and develop a PICO question to guide the change project.

Directions: Use the form below to complete the PICO assignment in Milestone #1. This includes filling in the table with information about your research question and your PICO elements.

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Step 1: Select the key PICO terms for searching the evidence. Clearly define your PICO question. List each element P (problem, population, or problem), I (intervention), C (Comparison with other treatment/current practice), and O (Desired outcome). Is the potential solution something for which you (as a nurse or student) can find a solution through evidence research? Look in your book for guidelines for developing your PICO question.

Step 2: Identify the problem. What have you noticed in your work or school environment that isn’t achieving the desired patient or learning outcomes? What needs to change in nursing, what can you change with the support of evidence in the literature? Describe the problem or practice issue that you want to research. What is your practice area; clinical, education, or administration? (This is NOT where you will list your PICO question)

Step 3: How were the practice issues identified? How did you come to know this was a problem in your clinical practice? Review the listed concerns and check all that apply.

Step 4: What evidence must be gathered? Everyone should have a literature search. However, what other sources of reliable information will be helpful for your particular question?

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Step 5: What terms will you use in order to make sure that your search is wide enough to obtain required information but narrow enough to keep it focused? What databases will you search? How will you narrow your search if needed?

PICO Worksheet
What is the PICO question? _ Is routine catheter care along with the use of antimicrobial solutions alone enough to prevent catheter-associated urinary tract infections in patients 60 years old and above during hospital stay?

Yes. This is because catheter-related urinary tract infections are mainly caused by the change of the indwelling catheter tube from patient to patient making them prone to infection. This is the best way to prevent related infections. _______________________________________________________

Define each element of the question below:

P– (Patient, population, or problem): Patients aged 60 years and above who are admitted to stay in the hospital for some time

I– (Intervention): Catheter-associated urinary tract infection

C– (Comparison with other treatment/current practice): There are no comparison groups. The question is about the issue of interest

O– (Desired outcome): Accurate assessment plan of care and catheter utilization

What is the practice issue/problem?

The problem is how to prevent catheter relater urinary tract infection among patients aged 60 years and above.

What is the practice area?

_x__ Clinical

___ Education

___ Administration

___ Other

How was the practice issue identified? (check all that apply)

_x__ Safety/risk management concerns

_x__ Unsatisfactory patient outcomes

___ Wide variations in practice

___ Significant financial concerns

__x_ Difference between hospital and community practice

___ Clinical practice issue is a concern

___ Procedure or process is a time waster

___ Clinical practice issue has no scientific base

___ Other:

What evidence must be gathered? (check all that apply)
__x_ Literature search

_X__ Guidelines

__x_ Expert Opinion

__x_ Patient Preferences

__x_ Clinical Expertise

___ Financial Analysis

___ Standards (Regulatory, professional, community)

___ Other

Search terms:

Catheter, Urinary Tract Infection,>60 years, patients, prevention

Databases to search: Cochrane, Clinical Evidence, Evidence-Based journals, PubMed Clinical Queries and CINAHL.
Search Strategies: Systematic review, Clinical Practice Guidelines and Electronic Textbooks and Individual research studies.

Purpose: To find evidence to support an intervention that will change the outcomes.

Directions: Type your search question below. Find AT LEAST FOUR sources to support the need for change and the potential intervention you have selected to solve the problem. At least three of your sources must be peer-reviewed articles. The fourth source could be another peer-reviewed article or a reliable, credible source. Look in your text for ideas of other sources that can be used. Using the table below, insert and describe your four chosen resources.

Step 1: APA Reference for the article. You will need to list the reference for the source in APA format. Be careful when using built-in APA formats and library citations. They may not be in APA format. Refer to Chapter 7 of your APA manual.

Step 2: Type of Source. If your source is a research article, you will need to ensure that it is a peer review article. You need at least three peer-reviewed articles for your project. If your article is a non–research source, then you will need to list what type of source it is; systematic review, clinical practice guidelines, organizational experience, or individual expert opinion/case study/literature review. You may only use ONE non-research source.

Step 3: Strength of Research. Refer to page 238-240 for research evidence and page 242-244 for non-research evidence. While you do not need to assign a level for each study, you will assign a quality of evidence (high, good, or low/major flaw) and should discuss the study using some of the elements that are discussed in the appraisal forms. For example, Research evidence: was the sample size adequate? Was there a controlled group? Was it a randomized study? Were results clearly stated? Was the conclusion based on the results? Were study limitations discussed? Not all of these elements need to be discussed, but you should discuss this information to determine if the strength of the evidence is HIGH, GOOD, or LOW/MAJOR FLAW.

Step 4: Brief Description of the Research. In this section, you will summarize the source in your own words. How does this information apply to your project? What are the results of the source? What are their recommendations?

Evidence Appraisal Worksheet
PICO Question:


APA Reference for Article

Give the APA-formatted reference for the article.

Type of Source

*Research: Peer-reviewed article

*Non-research systematic review, clinical practice guidelines, organizational experience, or expert opinion/case study/literature review

Strength of Research

Discuss the strength of the sources.

Report if evidence is High, Good, or Low/Major Flaw. Use the tools on page 238-244 of your text and discuss the reasons why you have assigned a particular level of quality.

Brief Description of Research

Address the questions.

*How does the information in the article apply to the project problem or proposed intervention?

*Summarize in your own words.

* Include results of the study and how these results are applicable to your project.

* What is the recommendation of the source for clinical practice?

1 Henneberg, S. (2015). Urinary tract infections. New York, NY: Rosen Young Adult Clinical Practice Guidelines. This research study is clearly organized defining its objective The results and conclusion in the study are also presented in a well-defined way. However, the limitation of this research is that the study had a relatively small sample size. Nevertheless, the strength of the evidence is moderately high Healthcare practitioners should resort to conciliations to prevent unnecessary catheter placement (such as catheter placement restrictions) to spearhead withdrawal of unnecessary catheters through the use of reminders and stop orders.
2 Ovid Technologies, Inc., & Cochrane Collaboration. (1990). Cochrane database of systematic reviews. (Evidence based medicine reviews.) New York, N.Y.: Ovid Technologies, Inc.


Evidence-Based Guidelines The strength of the evidence is good since the sample size was adequate and relevant to the objective of the research. Despite the fact that the results were clearly stated, the conclusion was not definitive enough because the group was controlled and the study limitations was high.


These evidence-based guidelines have focused on the prevention methods and provided recommendations for implementation of prevention strategies. Key advices included the use of aseptic insertion of urinary catheters by qualified personnel, use of aseptic technique and sterile equipment, as well as proper urinary catheter maintenance with a sterile closed drainage system permitting unobstructed urine flow.
3 Murrell, K. E. (Ed.). (2014). Urinary tract infections: Epidemiology, pathogenesis and prevention. New York, NY: Nova Science Publishers. Electronic text book The sample size of this study was adequate for this kind of research although it was not a controlled group. The results are clearly stated and figure presented in an understanding manner. The conclusion is very precise and in line with the study results. The evidence strength is high because very few limitations were encountered during the study.


Simply disseminating findings and scientific evidence brings little results to change clinical practice. It is important to implement the findings in practice at the same time promoting high-quality services and patient care. Implementation strategies should be carefully chosen. Unfortunately, the appropriate use of prevention bundles to lower the rate of infection is not paid much attention to. Consequently, more effective strategies should be developed to implement effective practices of patient safety in the medical field.
4 Simel, D. L., Rennie, D., & Keitz, S. A. (2009). The rational clinical examination: Evidence-based clinical diagnosis. New York: McGraw-Hill Medical. Individual research studies The research study is for a randomized group. This might have been the cause for a limited sample size. Whereas the results are not clearly illustrated, the conclusion is clearly stated and self-explanatory. It concurred with the study results adequately enough. The strength of the evidence is low. Interventions aimed on formulating strategies used to reduce unnecessary catheter use; this is done by avoiding unnecessary placement and prompting removal have been successful. Also, the strategies focused on decreasing CAUTI rates by controlling infections through proper hand hygiene, aseptic insertion and obtaining surveillance and feedback have shown positive results.

PICO stands for:

* Population/ Patient Problem: Who is your patient? (Disease or Health status, age, race, sex)

*Intervention: What do you plan to do for the patient? (Specific tests, therapies, medications)

*Comparison: What is the alternative to your plan? (I.e. No treatment, different type of treatment, etc.)

Outcome: What outcome do you seek? (Less symptoms, no symptoms, full health)

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