Write a 1000-1500 word essay addressing each of the following points/questions. Be sure to completely answer all the questions for each bullet point. There should be three main sections, one for each bullet below. Separate each section in your paper with a clear heading that allows your professor to know which bullet you are addressing in that section of your paper. Support your ideas with at least five (5) sources using citations in your essay. Make sure to cite using the APA writing style for the essay. The cover page and reference page in correct APA do not count towards the minimum word amount. Review the rubric criteria for this assignment.
Identify a clinical question related to your work environment, write the question in PICOT format and perform a literature search on the identified topic.
To enable the student to identify a clinical question related to a specified area of practice and use medical and nursing databases to find research articles that will provide evidence to validate nursing interventions regarding a specific area of nursing practice.
Review the Application Case Study for Chapter 3: Finding Relevant Evidence to Answer Clinical Questions as a guide for your literature search.
- Identify a clinical question related to your area of clinical practice and write the clinical foreground question in PICOT format utilizing the worksheet tool provided as a guide.
- Describe why this is a clinical problem or an opportunity for improving health outcomes in your area of clinical practice. Perform a literature search and select five research articles on your topic utilizing the databases highlighted in Chapter 3 of the textbook (Melnyk and Finout-Overholt, 2015).
- Identify the article that best supports nursing interventions for your topic. Explain why this article best supports your topic as you compare the article to the other four found in the literature search.
Expert Answer and Explanation
In the United States (U.S.), hospitals embrace evidence-based practice (EBP) to ease decision-making and develop the protocol for care delivery. Research is the hallmark of EBP because it produces findings that clinicians rely on to make clinical decisions. For a nurse, taking part in an EBP program begins with recognizing the domain of the clinical question. To establish the question, the nurse follows specific procedures, including identifying the patient issue, intervention, and duration of treatment. A background and a foreground question are the major types of clinical questions, and the two differ in the sense that the former is general while the latter is specific. To generate a particular question, a nurse uses the PICOT framework. It is crucial to examine how this framework can help with research that compares asthma treatment using salbutamol and salmeterol.
The reason why the issue is considered a Clinical Problem or an Opportunity for Improvement
The most effective asthma treatment is a clinical problem for several reasons. Asthma may lead to the patient’s hospitalization, mainly if a patient receives an ineffective intervention. Ineffective therapy, in this case, means administering a different medication other than the required treatment. Hospitalization and increased length of hospital stay can lead to the accumulation of costs of treatment or even cause the use of more medical resources (Nwaru et al., 2020). Being hospitalized for a long exposes a person to various nosocomial infections, including Urinary Tract Infections (UTIs). The issue is also a clinical problem because it may adversely affect the quality of the patient’s life. Asthma limits the activities that one can perform because it hinders a patient to the level where they cannot work or enjoy certain hobbies. Therefore, the treatment that is effective between salbutamol and salmeterol needs a suitable response to help prevent adverse asthma complications.
The literature search strategy used involves using various terminologies to identify sources from Google database and Cochrane. The keywords used are highlighted in table 1.0.
Layout of the Relevant Terminologies
|Concepts||Keywords||Google Terms||Cochrane Terms|
Adults with asthma
|Adult, middle-aged, women||Middle-aged, 40-50 years.||Middle aged adults: adults living with asthma|
Salbutamol, a short-acting asthma medication.
|Salbutamol (Albuterol); short-acting||Asthmatic patients.||Short-acting asthma medication.|
Salmeterol, a long-acting medication
|Short-acting: salmeterol (fluticasone)||Prevention of asthma symptoms.||Long-acting asthma treatment.|
Affect asthma symptoms
|Quick relief; Reduced emergency room visits; Improvement in lung functioning; Reduce frequency of asthma attacks;||Quick relief for asthma||Prevention of asthma attacks; improved respiratory outcomes.|
The articles were sourced from Google and Cochrane with each database yielding different number of articles.
|Set #||Query||Limiters/Expanders||Results (Google)||Results (for Cochrane)|
|S1 (Keyword that represents population)||Middle-aged||Boolean/Phrase||17,000||12,000|
|S2||Women with asthma||Boolean/Phrase||6,000||4,000|
|S3 (Combine to represent population)||(S1 and S2)||Boolean/Phrase||276||202|
|S4 (Limiting to English)||(S1 and S2)||Boolean/Phrase||56||43|
|S5 (use keyword to represent intervention).||Salbutamol||Boolean/Phrase||8,900||5600|
|S6 (use keyword to represent intervention)||Salmeterol||Boolean/Phrase||7,200||320|
|S7 (Combine the keywords for the intervention and population )||S1 and S2 and S5||Boolean/Phrase||120||23|
The Article that best supports Nursing Interventions for the chosen Topic
The search for the literature yielded five main articles, with one of these articles being more relevant than the other four. The article that seems to answer the question is the article authored by Baggot and colleagues (2020). According to these authors, overreliance on the Short-Acting Beta Agonists (SABAs) is associated with severe health events, including the risk of experiencing frequent attacks. What, however, makes the article more relevant to the question is that it provides the survey results of the views of a majority of adult woman subjects concerning the various treatments for asthma. Therefore, it meets most of the criteria defined in the PICOT question. The study revealed that most of the participants preferred interventions that would get rid of their asthma instead of the SABAs they are used to.
Comparing the Article to the Other Four found in Literature Search.
What sets apart the study by Baggot et al. (2020) from that of Muneswarao and colleagues (2019) is that the former focuses on a specific adult population while the latter explores the use of the different treatments across various groups, including children. Therefore, Muneswarao et al.’(2019) study do not adequately respond to the research question.
The overuse of the SABA is mainly seen among patients with asthma, which often comes at a cost because it can lead to a rise in the risk of death. Canonica et al.(2021) explore the concerns surrounding the use of the SABA, and they explore the evidence that supports new guidelines established to support asthma treatment.
The difference between Baggot et al. (2020) and Nwaru et al.(2020) is noticeable in the two studies’ population groups. The latter involves a study in which subjects included individuals aged 12-45 years old.
SABA is popular among people with asthma, and while Kaplan and colleagues (2020) recognize the importance of this intervention, they maintain that overreliance on this treatment can lead to adverse clinical events. Their study is different from Baggot et al. (2020) because they explore strategies for reducing asthma exacerbations in children and adults.
Baggott, C., Chan, A., Hurford, S., Fingleton, J., Beasley, R. Hardwood, M…….& Magnus Levack, W.M. (2020). Patient Preferences for Asthma Management: A Qualitative Study. Respiratory Medicine Original Research, 10 (8). Doi: http://dx.doi.org/10.1136/bmjopen-2020-037491.
Canonica, G. W., Paggiaro, P., Blasi, F., Musarra, A., Richeldi, L., Rossi, A., & Papi, A. (2021). Manifesto on the overuse of SABA in the management of asthma: new approaches and new strategies. Therapeutic advances in respiratory disease, 15, 17534666211042534. https://doi.org/10.1177/17534666211042534.
Kaplan, A., Mitchell, P. D., Cave, A. J., Gagnon, R., Foran, V., & Ellis, A. K. (2020). Effective Asthma Management: Is It Time to Let the AIR out of SABA?. Journal of clinical medicine, 9(4), 921. https://doi.org/10.3390/jcm9040921.
Muneswarao, J., Hassali, M. A., Ibrahim, B., Saini, B., Ali, I., & Verma, A. K. (2019). It is time to change the way we manage mild asthma: an update in GINA 2019. Respiratory research, 20(1), 183. https://doi.org/10.1186/s12931-019-1159-y.
Nwaru, B. I., Ekström, M., Hasvold, P., Wiklund, F., Telg, G., & Janson, C. (2020). Overuse of short-acting β2-agonists in asthma is associated with increased risk of exacerbation and mortality: a nationwide cohort study of the global SABINA programme. The European respiratory journal, 55(4), 1901872. https://doi.org/10.1183/13993003.01872-2019.
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