Essay on Nursing Research and Evidence-Based Practice

During the height of the COVID-19 pandemic in Intensive Care Units (ICUs) around the county, there were many theories on treatments based on previous research done in Acute Respiratory Distress Syndrome (ARDS). One of the many theories was using prone positioning and inhaled Nitric Oxide (iNO) to improve oxygenation in mechanically ventilated patients with ARDS. The purpose of this paper is to show the connection between nursing research and evidence-based practice, to show how clinical questions are developed using the PICOT model, and to discuss the components of the PICOT model within the article "Early effects of ventilatory rescue therapies on systemic and cerebral oxygenation in mechanically ventilated COVID-19 patients with acute respiratory distress syndrome: a prospective observational study."

Heading A, Connection between research and evidence-based practice

"Evidence-based practice is now widely recognized as the key to improving healthcare quality and patient outcomes" (Chien, 2019). Although Chien's statement shows the importance of utilizing evidence-based practice in the clinical setting of nursing, to get the best evidence-based practice, we must first consult research to answer the questions of what is the best practice to use in different medical situations. The goal of nursing research is to discover new information or corroborate current information based on a hypothesis. However, evidence-based practice is not concerned with the discovery of new information but with utilizing the information discovered through research, interpreting, and administering the information into making the best clinical decisions. 

How PICOT is used to develop focused clinical questions

Formidable results from treatments that are observed by medical staff are found, and the staff wants to develop the experience into a new treatment method. From observation into formal research and evidence-based practice, the development of this new treatment starts by finding out what exactly the research question is. "Clinicians have improtant practice-related questions to ask, but many lack the ability to map out their research strategy, specifically in communicating their question in a manner required to develop a research protocol" (Riva, 2012). In order to develop this, a clinician or research must use the PICOT model to frame the problem into a valid research question. "The PICOT method is a helpful approach fro summarizing research questions that explore the effect of therapy" (Riva, 2012). PICOT is a mnemonic to frame a clinical question: P is for the population of the study; I is for intervention meaning what therapy is used for the population; C is for comparison, meaning what will be used to compare the research to like a control group in the study or the results of another study that has been done previously; O is for the outcome, what are the results of the study, using measurement tools to validate the outcomes; and T is for time or duration of the study. Using the PICOT model makes it easier for clinicians and researchers to develop a clinical question to make it easier to search for an answer. 

Heading C My Article

In the article, "Early effects of ventilatory rescue therapies on systemic and cerebral oxygenation in mechanically ventilated COVID-19 patients with acute respiratory distress syndrome: a prospective observational study", researchers attempt to determine whether different interventions have any effect on systemic and cerebral oxygenation. They have combined all results to show the combined effect of all interventions and broken down each intervention individually to show each intervention's effectiveness independently. The elements of the PICOT model used were as follows: 

(P) Adult COVID-19 patients who demonstrated acute ARDS determined using the Berlin criteria and underwent noninvasive cerebral monitoring for cerebral oxygenation using multiple methods. 

(I) Interventions included Lung Recruitment Methods, Prone Positioning, inhaled Nitric Oxide, and ECCO2R/ECMO. 

(C) Comparison was made using the same parameters to measure systemic and cerebral oxygenation pre- and post-treatment. 

(O) The outcomes varied when comparing the results as a whole and comparing each treatment on an independent basis. The study's outcome showed that SpO2 (88% vs. 91%), PaO2 (66 vs. 71 mmHg), and nICP (17 vs. 21 mmHg) were all increased compared to the pre-treatment data for the study's total population with all interventions. On an individual basis, Prone Positioning and inhaled Nitric Oxide were shown to be the best methods to increase systemic and cerebral oxygenation. Prone Positioning showed increases in PaO (62 vs. 81.5 mmHg), rSO2 (53% vs. 59.5%), with a slight increase in nICP (16 vs. 18 mmHg), MAP (72.5 vs. 78.5 mmHg), and nCPP (55.5 vs. 60.5 mmHg). Inhaled Nitric Oxide showed increases in PaO2 (65 vs. 72 mmHG) and rSO2 (53% vs. 57%) with no effect on MAP and nCPP, with a slight reduction in nICP (18 vs. 17 mmHg).

(T) The time between measurements pre-treatment and post-treatment was varied based on the intervention used. From 5 minutes after Lung Recruitment Maneuvers to 1 hour after administration of inhaled Nitric Oxide. 

A focused clinical question based on the PICOT model for this article is, In COVID-19 patients with acute onset of ARDS, how effective are different methods used to attempt to increase oxygenation compared to pre-treatment data?

In conclusion, the connection between research and evidence-based practice is to have better healthcare outcomes by utilizing current research to model clinical practice.