PICO Question

Use the case study from Week 2.

Read the following case study.

You are a staff nurse working in an intensive care unit and assigned to care for a 75-year-old man who had coronary artery bypass graft surgery four days ago. The patient has a history of chronic obstructive pulmonary disease exacerbated by heavy smoking. His postoperative course has been difficult, and he has suffered a number of setbacks. Staff members, despite their diligent efforts, have not been able to wean him off the ventilator since the surgery. He has required frequent suctioning throughout the shift, and he is being evaluated for the development of ventilator-associated pneumonia.

Today, when returning from lunch, you observed that an experienced nurse was suctioning your patient. His secretions were thick, and you observed that the nurse was instilling saline into the patient’s endotracheal tube as she was suctioning him. The patient turned red and began coughing, and it was obvious he was in distress.

You asked the nurse why she was instilling saline into his endotracheal tube. She replied that this was being done to loosen the secretions. You told her this was no longer an acceptable practice. She stated that she many years of critical care experience and she didn’t care what anyone said, that the only way you could loosen the patient’s secretions would be to instill saline. She also said that would be the last time she would do something for one of your patients while you were at lunch.

Outline the strategies you will use to search for evidence related to best practices for suctioning and whether the instillation of saline while suctioning is an acceptable technique.

Search for evidence related to best practices and provide a summary of all evidence.

Develop a PICO question for the instillation of saline during endotracheal suctioning.

Consider how you could apply PICO to problems in the workplace to influence things in clinical practice.

Submit your search strategies, search results, and PICO question and application to clinical practice as one of the following:

18- to 20-slide presentation

860-word paper

Click the Assignment Files tab to submit your assignment.

Expert Solution Preview

Introduction:
This case study involves a patient who has undergone coronary artery bypass graft surgery and is having difficulty being weaned off the ventilator. A nurse is observed using an outdated technique of instilling saline into the patient’s endotracheal tube while suctioning, causing distress to the patient. As a medical professor, strategies will be outlined to search for evidence related to best practices for suctioning, whether instilling saline during suctioning is an acceptable technique, and how to apply PICO to workplace problems.

1. Outline strategies to search for evidence related to best practices for suctioning and whether the instillation of saline while suctioning is an acceptable technique.

The following strategies can be used to search for evidence related to best practices for suctioning:

– Identify relevant databases such as PubMed, Cochrane Library, and CINAHL.
– Use keywords such as suctioning, endotracheal suctioning, best practices, saline instillation, and ventilator-associated pneumonia.
– Limit search results by publication year, study types, and language.
– Evaluate the quality of the literature and select relevant studies.
– Extract and synthesize data from the selected studies to answer the research question.

To determine if instilling saline while suctioning is an acceptable technique, the following strategies can be used:

– Identify guidelines from organizations such as the American Association of Critical-Care Nurses and the Centers for Disease Control and Prevention.
– Search for systematic reviews and meta-analyses that examine the effectiveness and safety of saline instillation during suctioning.
– Evaluate the quality of the literature and select relevant studies.
– Extract and synthesize data from the selected studies to answer the research question.

2. Search for evidence related to best practices and provide a summary of all evidence.

Based on the search strategies outlined above, the following summarizes the available evidence related to best practices for suctioning:

– Suctioning should only be performed when clinically indicated and should be avoided if possible to prevent damage to the tracheal mucosa and increase the risk of infection.
– Sterile technique should be used during suctioning to reduce the risk of infection.
– Suction should be performed with a closed-system suction catheter to prevent the entry of bacteria into the lower respiratory tract.
– Saline instillation during suctioning may cause patient discomfort, increase the risk of infection, and may not effectively loosen secretions. It is no longer recommended as a routine practice.

3. Develop a PICO question for the instillation of saline during endotracheal suctioning.

PICO question: In adult patients on mechanical ventilation, what is the effect of instilling saline during endotracheal suctioning compared to suctioning alone on the incidence of ventilator-associated pneumonia?

P: Adult patients on mechanical ventilation
I: Instillation of saline during endotracheal suctioning
C: Suctioning alone
O: Incidence of ventilator-associated pneumonia

4. Consider how PICO can be applied to workplace problems to influence clinical practice.

PICO can be applied to workplace problems by providing a systematic approach to identifying a clinical question, searching for relevant evidence, and applying the evidence to clinical decision-making. This approach can help to address clinical problems in a structured and evidence-based manner. For example:

P: Patients with pressure injuries
I: Use of pressure-relieving devices
C: Standard care
O: Healing of pressure injuries

By applying PICO, healthcare professionals can systematically evaluate the effectiveness of pressure-relieving devices on healing pressure injuries, and use the evidence to influence clinical practice and improve patient outcomes.

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