Type: Research Paper 

Subject: PICOT Question and Search Strategies

Subject area: Nursing

Education Level: PhD Program

Length: 5 pages

Referencing style: APA

Preferred English: US English

School: Chamberlain University 

Spacing Option: Double

Name ________________ Partner’s Name__________________

PICO (T) and Literature Search Worksheet

PICO (T)

1.  Is your clinical problem a foreground questions (specific and relevant to the clinical issue) or a background question (broader and answer more general questions) (Stillwell et al, 2010, pg. 59)?  Remember a well written PICO needs to be written as a Foreground question.  Select one.

Foreground ___

Among the children population of asthmatic patients admitted in the Norton children hospital, what interventions will be developed to improve the comprehension of information in regard to continued treatment and care when being transitioned to Norton Adult hospital? 

2. Define your question using PICO by identifying:  Problem, Intervention, Comparison Group Outcomes and Time (not always used) (Schmidt & Brown, 2019, pg. 85-86).

Your question should be used to help establish your search strategy.

Patient/Problem:  Most pediatric patients with asthma among other chronic conditions continue to face barriers especially when they transition from pediatric to adult care. It is important to use evidence based practice to help in the identification of gaps related to the transition literature so as to determine the best target for future interventions. 

 

Intervention:  The intervention is going to be in regard to care transition from the the Norton children hospital to a Norton Adult hospital (Hergenroeder & Wiemann, 2018).  For example this will entail any single or various component intervention which will address the various elements in regard to healthcare transition like patient care documentation, educational material and other processes (Hergenroeder & Wiemann, 2018).  However, it is also important to note that the interventions are going to also vary widely with the structure, components and the process of transition, for this reason, not intervention will be singled out. 

Comparison: There will no single based comparator, however, a comparison will be based on evidence-based practice on the management and treatment of asthma (Kroll, 2020).

Outcome:  Outcomes will look at improved quality of life, reduced mortality, improved treatment and care. 

Time: 3 Months

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Change in your question terms will most likely require an additional literature search.  

 Write out your PICO:   Among the children population of asthmatic patients admitted in the Norton children hospital, what interventions will be developed to improve the comprehension of information in regard to continued treatment and care when being transitioned to Norton Adult hospital? 

3.  Identify type of question/problem (Stillwell et al, 2010, pg. 60)

Intervention or therapy: Interventions are going to be related to the Pediatric unit manager transitioning patients from pediatric to adult medical care.  This will include any single and multi-facet interventions that look at the six main element related to healthcare transition like patient care documents, educational materials and processes.  Intervention will also look at the transition structure and process. 

Etiology: Asthma is a chronic condition that is characterized by obstruction of airflow leading to a tight chest, coughing, wheezing and shortness of breath.  In the United States asthma is among the leading chronic condition among children. Children admitted in the pediatric ward are bound to experience frequent spells of coughing that  are going to occur when the children is out playing, laughing  or when they are sleep and after they wake up (Forno & Saglani, 2019).  The coughing may only be symptomatic, however this will drain them off their energy. There will be cases of rapid breathing, the child will constantly complain of tightness in the chest. He or she will exhibit a whistling or wheezing sound especial when the child is breathing in or out.  There will be retractions in the chest due to difficulty in breathing including loss of breath, tightened chest and neck muscles and feelings of tiredness. 

Diagnosis or diagnostic test: Diagnosis of the condition and need to transition to adult care will look at the patient’s medical challenges like wheezing, shortness of breath, coughing and tightness of the chest.  It will also be important to collect patient data with allergies or eczema which usually increase the chances of the condition getting worse. Also the family history of a person with asthma can increase the chances of finding the condition worse.  Also in regard to physical exam, it will be important to look at the function of the eyes, ears, throat, nose, skin, lungs and chest.  Also a lung test can be done to pediatrics, though it is usually difficult since children suffer from many condition that exhibit asthma like symptom (Institute for Healthcare Improvement, 2020).  However since they are transitioning to adult care, then a lung test will be important in measure the patient’s breathing. Often lung tests will be done before and after taking a bronchodilator, which is meant to open the patient’s airways.  If the breathing improves after using a bronchodilator it means that they should continue with adult care. 

Prognosis or prediction: The severity of asthma is not usually that of a death risk. This is because, when the patient is educated and empowered more about asthma and management, it will be important that the nurse ensures they are able to stick to the management plan (Turner & Upham, 2020).  Also the nurse will be required to work closely with the patient and other care team to ensure that they are provided with the right attention and services even as they transition to adult care.  The patient will also be educated on how to use an inhaler, take mediation and changes of lifestyle. 

Meaning:  Transitioning the patient from pediatric to adult care, is about educating the patient to become self-independent when it comes to the treatment and management of the condition. 

4. Type of study (research type) to include in the search (Schmidt & Brown, 2019, pg. 8).  Check all that apply.

Meta-Analysis ___ Systematic Review ___ Randomized Controlled Trial ___

Quasi-experimental ___ Cohort/Case ___ Qualitative ___

Other ___ (specify) _______________________________________________ 

5.  PICOs reviewed with partner.  List the combined or chosen PICO.  Note what type of PICO – intervention, etiology, diagnosis, prognosis/prediction, meaning.

Among the population of asthmatic patients admitted in the pediatric ward, what interventions will be developed to improve the comprehension of information in regard to continued treatment and care when being transitioned to adult care ward? 

Literature Search 

1.  List key concepts (see question 2) and alternate spellings and synonyms for your PICO question that can be used for your search.   Remember not all databases use the same key terms for searches for subject headings.  You will need to determine what key words are used for specific databases to be successful in your search (see Gerberi & Mariana, 2017, pg. 196-197 for examples).  These become your key search terms. 

Current PICO Alternative key words

Patient/Problem: Asthma, pediatric care, adult care, bronchitis

Intervention: Education, therapy, counseling

Comparison: analysis, relationship

Outcome: Results

2.  List any inclusion criteria – gender, age, year of publication, language

Gender, age, year of publication

3.  List any exclusion criteria.

           Study type
List where you plan to search:

EBSCOHost (host platform) 

Data bases - CINAHL ___ Medline ___   other ________________

Specific data base subheading for your key concepts

Subject, title, author and abstract

ProQuest (host platform)

Data bases - Medical ____ Research Library ____ other ________

            Specific data base subheading for your key concepts

Institution, title, author, date of publication

Go to lib guides and click on NURS 312 that takes you to the following two systematic review databases and one additional database.

Cochrane Library – goes straight to website

Joanna Briggs Institute – takes us to OVID

Google Scholar – takes to website

5.  Identify the database subject headings for your PICO (T) key terms. (see Gerberi & Marienau, 2017, pg. 201 for examples)       

Asthma Difficulty in breathing tight chest

6.  Search using truncation and terms (see Gerberi & Marienau, 2017, pg. 196-197 for examples) (Schmidt & Brown, 2019, pg. 112)

                 

Asthma* Pediatric care*

7.  Boolean Logic (OR/AND) -(see Gerberi & Marienau, 2017, pg. 201-202 for examples)

       

8.  Consulted a librarian either through email, Ask a Librarian, cell phone or in the library – Info found at - https://libguides.bellarmine.edu/c.php?g=836628&p=7606610

Indicate the name of the librarian – John Boyd, Marth Lundergren, Kevin Peer, John Steemer, Dan Bays  

                 __________________John Boyd

                Identify what assistance was gained from that consultation.

                Using the internet Library

9.  Relevant articles (identify additional articles from relevant article reference lists).  Note any article greater than five years and reason for including – landmark article, noted numerous studies etc.)

Forno, E., & Saglani, S. (2019). Severe asthma in children and adolescents: Mechanisms and management. Springer Nature. 

Hergenroeder, A. C., & Wiemann, C. M. (2018). Health care transition: Building a program for adolescents and young adults with chronic illness and disability. Springer. 

Kroll, K. (2020). Pediatric psychology in clinical practice: Empirically supported interventions. Cambridge University Press. 

Turner, S., & Upham, J. W. (2020). Asthma in children and adults – What are the differences and what can they tell us about asthma? Frontiers Media SA. 

10. Identify key secondary sources (textbooks, practice guidelines indexed by the National Guideline Clearinghouse (https://health.gov/node/160), professional society websites, and other government websites, and the Institute for Health Care Improvement - http://www.ihi.org/?gclid=EAIaIQobChMIoO66jZWx6gIVkYbACh3wCwdrEAAYASAAEgIHivD_BwE

Institute for Healthcare Improvement. (2020). Asthma action plan ("Stoplight" Tool) | IHI - Institute for healthcare improvement. Improving Health and Health Care Worldwide | IHI - Institute for Healthcare Improvement. https://www.ihi.org/resources/Pages/Tools/AsthmaActionPlanStoplightTool.aspx

Maine Medical Center. (n.d.). Reducing asthma hospitalizations and emergency department visits | IHI - Institute for healthcare improvement. Improving Health and Health Care Worldwide | IHI - Institute for Healthcare Improvement. https://www.ihi.org/resources/Pages/ImprovementStories/ReducingAsthmaHospitalizationsandEmergencyDepartmentVisits.aspx

References

Gerberi, D., & Marienau, M. S. (2017). Literature Searching for Practice Research. AANA 

     Journal, 85(3), 195–204.

Schmidt, N.A., Brown, J.M. (2011). Evidence-based practice in nursing & healthcare: A guide 

     to best practice. Wolters Kluwer/Lippincott Williams & Wilkins

Stillwell S.B., Fineout-Overholt E., Melnyk B.M., & Williamson K.M. (2010). Asking the 

     clinical question: a key step in evidence-based practice. AJN American Journal of 

     Nursing, 110(3), 58– 61.  https://doi->

     org.libproxy.bellarmine.edu/10.1097/01.NAJ.0000368959.11129.79