Chamberlain College of Nursing NR439 PPEWorksheet

Problem/PICOT/EvidenceSearch (PPE)Worksheet

Name:
Date:
Criteria Clinical nursing problems are always encountered on a day to day
Clinical Nursing
Practice Problem
experience in the nursing practice. Patient care which involves trauma
Select and identify
ONLYone quality or prevention, promotion of recovery, screening of health, coordination of
safety clinical priority
area from the health care, and assessment of patients are processes that pose challenges
assignment guidelines
practice scenario.
Summarize why to the nursing team. In this essay, the personal clinical nursing problem is
youbelieve the nursing
practice problem/issue is chosen which includes factors like competence to the problem, interest in
the most important.
Summarize your
the scenario, time, energy, personnel, space, and the equipment to carry
rationale (why) for
choosing the problem.
out the study. The essay is mostly inclined to find out how nurses can

enhance patient care in ICU and prevent ICU-acquired delirium. Delirium

is the brain organ dysfunction that can affect critically ill patients who

mostly rely on mechanical ventilation. According to previous research

data, most ICU patients have died due to the effects of delirium. This is a

clinical nursing problem that is a major problem that must be given much

attention because patients who end up in a coma and have to be put on life

support machines will always be present in hospitals (Elliot, 2014). It is

thus important for the nursing department to come up with a long term

solution that will help patients on mechanical ventilators have a full

recovery without brain function failure. This nursing problem is worth

researching because critical patients will mostly end up in ventilators and

they may end up dying due to delirium. To reduce the high mortality rates

in ICU patients then a set of evidence-based practice guidelines must be

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implemented to prevent delirium. Moreover, through increasing the

awareness of delirium among ICU patients, nurses can implement new

guidelines that prevent the onset of delirium thus reducing the cost of

treatment, days of recovery, and also reduce the mortality rate of ICU

patients as a result of delirium.  

Clinical Nursing What practices can be implemented by ICU nurses to decrease the
PICOT Question

Using the NR439 Guide

prevalence and incidences of delirium in critically ill patients who require
for Writing PICOT
Questions and mechanical ventilators?
Exampleslocated in the
assignment For critical patients (P) who require treatment from ICU nurses
guidelines,write out
your PICOT
question.Include the (P) does the use of given set guidelines (I)b reduce the future risk of
PICOTletters in your
question. contracting delirium (O) over there treatment time (T) in the ventilator?

Define PICOT Population/Patient.

Elements

Defineeach of the
Acute care nurses who have the expertise to treat critical patients
PICOT elements from
your question above. who require mechanical ventilators in treatment. Patients of interest are

critical patients who require mechanical intervention in breathing. Age,

gender or any other characteristics of the patient may be considered.

Intervention

Implementation of a program for ICU delirium education to

current staff and new nurses in the hospital

Comparison: N/A

Outcome: the expected outcomes are reduced incidences of

delirium in ICU patients, better awareness of ICU delirium, decreased

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length of stay, and costs thus reduced number of deaths.

Evidence According to Munroe et al. (2017), the journal was done as a

RetrievalProcess and
Summary
result of high mortality rates due to delirium. Non-pharmacologic
Using only the
Chamberlain College of methods of preventing delirium were experimented to research on proper
Nursing library:
(1)Locateevidencethat is guidelines to prevent delirium. Patients in the test included moderate to
relevant to your chosen
nursing practice
problem. Explain how high risk for delirium and those from ICU units. According to the
you believe the evidence
is relevant to your findings, it was evident that certain pharmacological strategies in selected
chosen nursing practice
problem.
(2)Explain why you
surgical settings were useful. It was a challenge to pinpoint the specific
chose the evidence
(3)Provides a complete components that led to reduced delirium among patients. But according to
APA reference to the
evidence(must include the author, staff education on delirium was an effective strategy.
authors, year, title of
the evidence, title of
the resource) Moreover, music therapy which was less researched on was also found to
(4) Evidence must be
published within the last be an effective strategy in reducing delirium incidences among patients.
10 years
(5) Providesthe
Moreover, from the research, it was difficult to draw a fine line on the
permalink

true extent of harms between using pharmacologic and non-

pharmacologic interventions.

According to Bounds (2016), he carried out research based on

electronic medical records to sought and quantify the prevalence of

occurrence and duration of patients with delirium in the ICU before and

after the implementation of the ABCDE bundle. The ABCDE bundle

includes awakening, breathing, coordination, choice of medication,

Delirium identification, prevention and management, and lastly early

physical mobility. From the research, it was evident that from the

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implementation of the ABCDE bundle, there was a reduction in the cases

of delirium cases and the duration of delirium in ICU patients. From the

evidence, it can be concluded that the application of the ABCDE bundle

on ICU patients is a successful guideline set that nurses can use to reduce

the prevalence of delirium thus improving patient healthcare quality.

According to Yang et al. (2017), they researched random

experimental study in the West China Hospital. The research expounded

on patient demographics including gender, body mass index, age, health

conditions, drug substance use status, and other medical histories. The

research used the CAM-ICU scale every four hours daily in a span of

twenty-eight days or until ICU discharge. According to the research, it

was concluded that the older age of fifty one and above, regular smokers

were at a higher risk of delirium. Moreover, it was evident that

administering sedation with dexmedetomidine was a protective

pharmacologic method in preventing delirium.

According to Hannon (2015), he stated that delirium in ICU

patients was greatly undetected and thus it was less treated. According to

the author, he sought to understand how such an outcome of delirium can

be earlier detected and treated to improve outcomes in patients. For the

research, the author concluded that alcohol and substance abusers,

mentally ill, and hypertension patients were at a higher risk of contracting

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Chamberlain College of Nursing NR439 PPEWorksheet

delirium. Administering of minimal sedation medication and other non-

pharmacological strategies are important aspects in preventing delirium.

Reorienting the patient, proper pain management, noise control, and early

prosthesis of the patient’s hearing and visuals are important in preventing

delirium among patients.

Implications of the The above evidence-based researches provide a deep

Evidence
Summarize what you
learned from the
understanding of how delirium affects the patients. The journals have
evidence.Summarize
why you believe the detailed information on the onset of delirium that acute nurses can utilize
nursing evidence-based
practice committee in treating critical patients in the ICU. Moreover, the above journals
should focus their next
research project on the
nursing practice provide detailed findings on how to prevent delirium and how to prevent
problem.
it. The journals also provide information on which kind of patients are

mostly affected by delirium giving nurses clear information that they can

use in patient care in ICU.

Evidence Search Critically ill

Terms
Identify 4 (or more)
relevant searchable
Nursing intervention
terms you used for your
search for evidence. Prevention

Delirium

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References

Bounds, M (2016). Effect of ABCDE bundle implementation on prevalence of delirium in

intensive care unit patients. American Journal of Critical Care, 25(6), 535-544.

Elliott, S. R. (2014). ICU delirium: A survey into nursing and medical staff knowledge of

current practices and perceived barriers towards ICU delirium in the intensive care unit.

Intensive & Critical Care Nursing, 30(6), 333-338. doi:10.1016/j.iccn.2014.06.004

Hannon, S. (2015). ICU delirium: Impacts & interventions. Alaska Nurse, 66(5), 6-7. Retrieved

from: http://www.aknurse.org

Munro, C. L., Cairns, P., Ji, M., Calero, K., Anderson, W. M., & Liang, Z. (2017). Delirium

prevention in critically ill adults through an automated reorientation intervention: A pilot

randomized controlled trial. Heart & Lung: The Journal of Critical Care, 46(4), 234-238.

doi:10.1016/j.hrtlng.2017.05.002

Yang, J., Zhou, Y., Kang, Y., Xu, B., Wang, P., Lv, Y., & Wang, Z. (2017). Risk factors of

delirium in sequential sedation patients in intensive care units. Biomed Research

International, 1-9. doi:10.1155/2017/3539872

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