PICOT Questions An Evidence Based Approach

NURSING

Nursing: PICO(T) Questions and An Evidence-Based Approach

The importance of the PICOT question cannot be underestimated since it is a standard mechanism to determine the specific terms that form a question, for which answers are obtained through evidence-based research. The search strategy has to be systematic to gain effective results, and the results would be transformed into positive patient outcomes afterward. This paper examines a certain PICOT question and the pertinent evidence for applying an evidence-based model to improve the outcomes.

PICOT Elements and Question

Patient/population/problem (P): Adult hospitalized patients

Intervention (I): Low nurse-patient ratio

Comparison (C): High nurse-patient ratios

Outcomes (O): Patient outcomes and satisfaction scores

Time frame (T): Not relevant

Hence the PICO(T) question becomes:

Among adult hospitalized patients, what is the impact of a low nurse-patient ratio compared to a high nurse-patient ratio for impacting patient outcomes and satisfaction scores? 

Evidence to Support the PICOT Question

Nurse-patient ratio leads to improved or deteriorated patient conditions, which could be attributed to nurse-sensitive outcomes (NSOs) (Kuoatly et al., 2018). With a nurse shortage, it is witnessed that NSOs are adverse, especially in terms of higher mortality rates, low rescue attempts, infections, and re-hospitalization rates. Latest research suggested that with a low nurse-patient ratio that came out from low nurse staffing, it was evident that a high ratio of falls and hospital-acquired infections (HAIs) along with catheter-associated urinary tract infections (CAUTI) were observed (Kuoatly et al., 2018). 

Rationing nursing care (RONC) is valuable in delegating accurate tasks to certain nurses and particular skills administered by specially assigned nurses only (Zhu et al., 2019). If patients cannot get medications and obtain the outcomes of nursing tasks, which could be due to nurse burnout as staffing is low, the patients would suffer in terms of satisfaction. Studies had indicated that bloodstream infections were reported at higher rates when the qualified nurse was unavailable. For example, the task had to be fulfilled by the one that might be under training or not specialized in injecting drips (Zhu et al., 2019). The gap in patient outcomes results from a shortage of nurse care, which could be the consequence of failure or delay of the services coming from the nurses’ side.

Further, the patient satisfaction results could be subjected to self-reported measures that patients use for evaluating their health outcomes. It could be due to their perceptions of the nurse’s work. However, interrelationships have been investigated widely among nurses’ workload, nurse staffing, nurse availability, nurse-patient ratio, and patient safety (Zhu et al., 2019). 

Nurse-patient ratios and their calculation methodologies have an impact on patient outcomes. It is said that numerous methods have been introduced to explore which one has maximum positive patient satisfaction throughout the national hospitals (Twigg et al., 2021). For instance, in California, it was first introduced that for every three patients, one nurse should be appointed; hence, declaring the nurse-patient ratio as 1:3 was later included in the law by 1999 (Twigg et al., 2021). Similarly, in Australia, the nurse-patent ratio was formulated to address the requirements of certain wards and departments. The patients with minor problems were assigned fewer nurses and those suffering from chronic diseases were given a high priority with a higher number of nurses. In addition, another useful method was initiated in 2002 named The Nursing Hours per Patient Day (NHPPD) (Twigg et al., 2021). In Australia, it has become common to use this method as it utilizes a bottom-up approach after discerning the patient complexities and urgency.

Furthermore, a tool was developed to assess how many nurses should be hired in a certain ward. That patient accuracy could be gained with the appropriate allocation of nurses. It is known as Safer Nursing Care Tool, formulated in England; however, it was not advocated for use in hospitals all over the country (Twigg et al., 2021). 

As mentioned earlier, nurse workload also determines how many nurses are available to attend to the patients daily. Insufficient staffing poses health risks not only for the patients but also for the nurses. Nurse burnout is inevitable, which massively hinders the available nurse from performing well. They fail to rescue the patients due to work overload and cannot focus clearly on patient-related tasks and not on time (Fagerstrom et al., 2018). A particular skill mix is essential to certify patient outcomes leading to higher ratios of patient satisfaction as well as hospital repute. For this purpose, Finland created the RAFAELA classification system in which nurses address patient care needs daily because of suitable nurse allocation and shrewd decision-making of hospital resources (Fagerstrom et al., 2018). The system’s measures enabled the hospital to measure precisely the nurse workload (NWL) so that favorable working conditions are identified for meeting patients’ needs (Fagerstrom et al., 2018). The daily need assessment, need fulfillment, and registration of new nurses are recorded in the classification system to measure sensitivity levels for optimal nurse staffing. The study revealed net benefits to be higher with this strategy concerning safety occurrences and mortality rates (Fagerstrom et al., 2018).