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Running head: PICO PAPER 1

Pico Paper
Lindsey Koch
Ferris State University


Pico Paper
The purpose of this assignment is to examine how nursing knowledge is used to make
differences for people. Nursing knowledge is extremely important for the healthcare field and
while it may be effective there, it can also be effective in individuals’ lives. While research is
very important, there has to be a link that brings it into the practice and that is where nurses come
in. The research helps guides nurses to make appropriate decisions, not only in their lives, but
also for their patients.
Clinical Question
The acronym PICOT stands for patient/population, intervention/interest area, comparison
intervention/current practice, outcome(s) desired, and time to achieve outcome, which is optional
(Nieswiadomy, 2012, p. 282). It is also sometimes referred to as PICO. PICO is a way to
correctly write a clinical problem. It can also make it an easy way to set up a clinical question to
determine the needs of a population. Once the needs of the population are met, patient quality
and safety can be improved.
The PICO question that I chose was: are children with anxiety disorders at a higher risk
for truancy issues than children without anxiety disorders between the ages of five and ten? I
personally chose this question because I deal with students daily that have anxiety issues, and I
also deal with students with truancy issues. I wanted to check to see how these issues overlapped.
I figured that if I could determine that they do overlap, I could work on the children’s anxiety to
improve truancy issues. By doing this, I would not only improve the children’s health, but I
would improve the children’s education as well.

By the school nurse using professional communication and working with the school, this
PICO question could improve the life of many students. For example, psychologists can work
with these children to help them deal with their anxiety and stay in school (Plante, 2007). This
will help the children with their psychosocial and health issues while helping them stay in
school. With the school nurses additional input, the child can be on their way to a healthy
The method that I used to search for evidence was using key words that fit my PICO
question. I searched nursing, anxiety, and truancy. These terms helped find my three sources on
how anxiety influences truancy and how nursing is applied to it.
My scope of practice in nursing is nursing as a registered nurse and as a school nurse. It
wouldn’t be helpful to my paper or PICO question if I used advanced practice nursing. I used the
scope of practice that would be most helpful to the PICO question I was asking. It wouldn’t be
useful to utilize research that didn’t have to do with my scope of practice.
The level of evidence I used throughout the PICO question was a level six, a level three,
and a level four study. Even though these are not the best level of evidence studies, I found them
quite relevant to my PICO question. For example, School refusal and anxiety in adolescence:
Non-randomized trial of a developmentally sensitive cognitive behavioral therapy was a level
three controlled trial because it was significant to nursing because children need to be screened
for their health needs to keep them in school. This is a fairly good level of evidence to use for a
paper. Nursing research findings are used to help select an appropriate environment for your

Discussion of Literature
Article One
The first article that I use was called Truancy, School Refusal and Anxiety in the School
Psychology International journal. It was regarding children with anxiety and the issues that it
causes them at school versus children without anxiety. It was a level six level of evidence.
Through this study, they found that the relationship between types of school refusal and some
types of anxiety is confirmed.
This article gained statistics through gathering observations and interviewing students.
This article explains that refusal to go to school has to do with the individual, the school, and the
type of anxiety present (Brandibas, 2004, p. 119). This can lead to issues with truancy is the
individual does not attend school for a certain number of days. After much research, the
relationship between anxiety and going to school/truancy is confirmed (Brandibas, 2004, p. 124).
With this information, help can be given to these students to better their anxiety and truancy
Article Two
The second article that I used was School Refusal and Anxiety in adolescence: Non-
randomized trial of a developmentally sensitive cognitive behavioral therapy. This article is
regarding twenty students who were refusing to go to school who also had an anxiety disorder
(Heyne, 2011). This was a level three controlled trial with no randomization. It was significant to
my question because children need to be screened for their health needs to stay healthy and
attend school.

This article gained information as a non-randomized trial of twenty adolescents.
Information was gained through telephone screening. While the variables used were school
attendance, school-related fear, and anxiety. The school attendance was recorded twice daily to
have accurate information for the trial. These individuals used cognitive behavioral therapy for
their anxiety and attendance increased significantly when anxiety decreased (Heyne, 2011).
Anxiety and school refusal was confirmed in this study.
Article Three
The third article that I chose was Anxiety, somatic symptoms and school refusal in
children and adolescents. This was a level four evidence cased study about a boy with anxiety
and his refusal to attend school. This was a level four case study because it is a single case study.
Information was gained through observation.
While this child was missing school due to anxiety, this is a common occurrence among
children. About twelve percent of students experience an anxiety disorder that affects their
schooling (Plante, 2007). With a known cause of anxiety, nurses and other school officials can
help reduce truancy issues by addressing the anxiety before it becomes a major issue.
Significance to Nursing
The evidence of anxiety and school refusal or truancy issues can be concluded after all
three of these articles. Through this conclusion, school nurses can improve the quality and safety
of the student population. Through the nurse’s help and evidence based practice, the students will
have less truancy issues when their anxiety is addressed. This is where the nurse becomes
involved in the care and improves the quality and safety of the students.

The quality and safety of individuals is one of the most important parts of nursing. The
Quality and Safety Education for Nurses (QSEN) major focus is to make sure all nurses have the
appropriate knowledge, skills, and attitudes to keep improving the quality and safety in their
environment (Dolansky, 2013). Using QSEN, school nurses can improve the environment of the
individuals by decreasing anxiety and increasing school attendance by providing care through
evidence-based practice.
Evidence-based practice and research is one of the American Nursing Association’s
(ANA) scopes of practice where a registered nurse uses evidence and research, such as PICO
questions, into their practice (Ferris State University, 2010). ANA incorporates itself into PICO
by helping the evidence to be of the quality needed to be useful. With the situation being anxiety
and school refusal, this issue will not need many resources. The resources used will be a
psychologist that will provide a therapy program, the nurse, the parents and the children working
The link between anxiety and school refusal has been confirmed. While other children
have issues to miss school, those with anxiety miss more school than the other children. This was
confirmed in over three studies. With this new knowledge, nurses can help these children reach
the resources that they need to stay in school without issues. Using evidence based practice; this
PICO question can improve these children’s lives.


Brandibas, G., Jeunier, B., Clanet, C., & Fouraste, R. (2004, February). Truancy, School Refusal
and Anxiety. School Psychology International, 25(1), 117-126.
Dolansky, M. A., & Moore, S. M. (2013, September 30). Quality and Safety Education for
Nurses (QSEN): The Key is Systems Thinking. OJIN: The Online Journal of Issues in
Nursing, 18(3). doi:10.3912/OJIN.Vol18No03Man01
Ferris State University. (2010). Standards of Professional Nursing Practice. Retrieved from
Heyne, D., Sauter, F. M., Van Widenfelt, B. M., Vermeiren, R., & Westenberg, M. P. (2011).
School refusal and anxiety in adolescence: Non-randomized trial of a developmentally
sensitive cognitive behavioral therapy. Journal of Anxiety Disorders, 25(7), 870-878.
Nieswiadomy, R. M. (2012). Foundations of nursing research (6th ed.). Boston: Pearson.
Plante, W. A. (2007, December). Anxiety, somatic symptoms and school refusal in children and
adolescents. The Brown University Child and Adolescent Behavior Letter, 23(12), 1-4.