Capstone Project Milestone #1: PICO and Evidence Appraisal Guidelines Purpose Clear identification of the problem or opportunity is the first step in evidence-based nursing. This first milestone offers two tools to assist in the identification and gathering of evidence to link the problem, proposed intervention, and desired outcomes. Completion of the milestone will include identification of the problem or concern using the PICO format and an evidence appraisal to find evidence to support an intervention that will change the outcomes. Course Outcomes This assignment enables the student to meet the following Course Outcomes. CO4: Develops and outlines a scientific, systematic decision-making process to integrate critical thinking with clinical judgment to assure safe and effective outcomes. (PO #4) CO8: Selects evidence for best practice when planning professional nursing care for individuals, families, aggregates, and communities. (PO #8) Due Date Milestone #1 consists of the completion of one worksheet that contains two parts (i.e., the PICO worksheet and the evidence appraisal worksheet). Submit the file with the two worksheets completed to the Dropbox by Sunday, 11:59 p.m. MT at the end of Week 2. Points Milestone #1 is worth 175 points (75 points for the PICO worksheet and 100 points for the evidence appraisal worksheet). Directions 1. Read this document including the grading rubrics below. 2. Download the PICO/Evidence Appraisal worksheets form from Doc Sharing. Consider what is the nursing problem or issue that you have uncovered. Make sure it is related to nursing, i.e., one that a nurse can solve independently. Do not select a medical problem that is dependent upon a medical professional to resolve. Completion of PICO worksheet will offer a tool for your literature search. 3. For the evidence appraisal worksheet, find AT LEAST FOURsources to support the need for change and the potential intervention you have selected to solve the problem. Three of these sources must be peer-reviewed articles while one can be a reliable professional source. 4. Submit the completed PICO/Evidence Appraisal worksheet to the Week 2 Dropbox. Grading Criteria: PICO Category Points % Description PICO question and components 40 53% Question or nursing problem is identified and is an independent nursing decision. PICO elements are correctly identified. Outcomes are measurable. Practice issue and scope of the problem 20 27% Practice issue/problem is thoroughly described. The need for change is evident.Practice area is identified. Identification of the practice issue is clear. Scope of the problem is identified. Evidence and search terms 15 20% Appropriately identifies the types of evidences that should be gathered (must include literature search). Uses manageable search terms and ways in which the search can be narrowed if discussed. Total 75 points 100% Grading Rubric: PICO Assignment Criteria Outstanding or Highest Level of Performance A (92–100%) Very Good or High Level of Performance B (84–91%) Competent or Satisfactory Level of Performance C (76–83%) Poor or Failing or Unsatisfactory Level of Performance F (0–75%) Total PICO question and components 40 points Question or nursing problem is identified and is an independent nursing decision. PICO elements are correctly identified. Outcomes are measurable. 37–40 points Question or nursing problem is identified and is an independent nursing decision. PICO elements are correctly identified. Outcomes but are not measurable. 34–36 points Question or nursing problem is identified and is an independent nursing decision. One PICO element is not correctly identified. Outcomes but are not measurable. 30–33 points Question or nursing problem is identified but is not an independent nursing decision. Several PICO elements are not correctly identified. Outcomes are not measurable or may not be present. 0–29 points /40 Practice issue and scope of the problem 20 points *Practice issue/problem is thoroughly described. The need for change is evident.*Practice area is identified. *Identification of the practice issue is clear. *Scope of the problem is identified. 19–20 points *Practice issue/problem is vaguely described. The need for change is evident. *Practice area is identified. *Identification of the practice issue is clear. *Scope of the problem is identified. 17–18 points *Practice issue/problem is vaguely described. The need for change is not obvious. *Practice area is identified. *Identification of the practice issue is clear. *Scope of the problem is identified. 15–16 points *Practice issue/problem is vaguely described. Need for change is not obvious. *Practice issues or scope of the problem are not addressed and/or not accurate. 0–14 points /20 Evidence and search terms. 15 points Appropriately identifies the types of evidences that should be gathered (must include literature search). Uses manageable search terms and ways in which the search can be narrowed if discussed. 14–15 points Appropriately identifies the types of evidences that should be gathered (must include literature search). Uses manageable search terms. Ways in which the search can be narrowed is not included. 13 points Appropriately identifies the types of evidences that should be gathered (must include literature search). Search terms are not measurable. Ways in which the search can be narrowed is not included. 11–12 points Types of evidence that should be gathered is not noted or not correct, literature search not identified. Search terms are not measurable or absent. Ways in which the search can be narrowed is not included. 0–10 points /15 Total Points /75 Grading Criteria: Evidence Appraisal Category Points % Description Article Selection 30 30% Four articles used. At least three articles are peer-reviewed research. Other source is scholarly and appropriate for the change project. Type of source is properly identified. References are listed in APA format. Strength of Research 20 20% Strength of the research is listed as High, Good, or Low/Major Flaw. Reasons why the rating was given is clearly discussed and logical. Description of Research 50 50% Description of the research is thorough and detailed. Summary was given in own words. Results of the study were summarized with the application to the project noted. Recommendations for clinical practice were discussed. Total 100 points 100% Grading Rubric: Evidence Appraisal Assignment Criteria Outstanding or Highest Level of Performance A (92–100%) Very Good or High Level of Performance B (84–91%) Competent or Satisfactory Level of Performance C (76–83%) Poor or Failing or Unsatisfactory Level of Performance F (0–75%) Total Article Selection 30 points Four articles used. At least three articles are peer-reviewed research. Other source is scholarly and appropriate for the change project. Type of source is properly identified. References are listed in APA format. 28–30 points Four articles used. At least three articles are peer-reviewed research. Other source is scholarly and appropriate for the change project. Type of source is not properly identified. References are listed in APA format. 25–27 points Four articles used. At least three articles are peer-reviewed research. Other source is scholarly and appropriate for the change project. Type of source is not properly identified. References some errors in APA format. 23–24 points Less than three articles are peer-reviewed research. Other source is not scholarly or appropriate for the change project. Type of source is not properly identified. References have multiple errors in APA format. 0–22 points /30 Strength of Research 20 points Strength of the research is listed as High, Good, or Low/Major Flaw. Reasons why the rating was given is clearly discussed and logical. 19–20 points Strength of the research is listed as High, Good, or Low/Major Flaw. Reason why the rating was given is documented but is not logical. 17–18 points Strength of the research is listed as High, Good, or Low/Major Flaw. Reason why the rating was given is vague or absent. 15–16 points Strength of the research is not listed as High, Good, or Low/Major Flaw. Reason why the rating was given is vague or absent. 0–14 points /20 Description of Research 50 points Description of the research is thorough and detailed. Summary was given in own words. Results of the study were summarized with the application to the project noted. Recommendations for clinical practice were discussed. 46–50 points Description of the research is thorough and detailed. Summary was given in own words. Results of the study were listed but no application or summary of results were given. Recommendations for clinical practice were discussed. 42–45 points Description of the research is vague. Summary was given in own words. Results of the study were listed but no application or summary of results were given. Recommendations for clinical practice were not discussed. 38–41 points Description of the research is vague. Summary was not in own words but rather quotes from the source. Results of the study may not be listed. Recommendations for clinical practice were not discussed. 0–37 points /50 Total Points /100 Capstone Project Milestone #1: PICO and Evidence Appraisal Worksheets PICO Worksheet Your Name: Date: Your Instructor’s Name: Purpose: To identify a problem or concern that nursing can change and develop a PICO question to guide the change project. Directions: Use the form below to complete the PICO assignment in Milestone #1. This includes filling in the table with information about your research question and your PICO elements. Step 1: Select the key PICO terms for searching the evidence. Clearly define your PICO question. List each element P (problem, population, or problem), I (intervention), C (Comparison with other treatment/current practice), and O (Desired outcome). Is the potential solution something for which you (as nurse or student) can find a solution through evidence research? Look in your book for guidelines to developing your PICO question. Step 2: Identify the problem. What have you noticed in your work or school environment that isn’t achieving the desired patient or learning outcomes? What needs to change in nursing, what can you change with the support of evidence in the literature? Describe the problem or practice issue that you want to research. What is your practice area; clinical, education, or administration? (This is NOT where you will list your PICO question) Step 3: How was the practice issues identified? How did you come to know this was a problem in your clinical practice? Review the listed concerns and check all that apply. Step 4: What evidence must be gathered? Everyone should have a literature search. However, what other sources of reliable information will be helpful for your particular question? Step 5: What terms will you use in order to make sure that your search is wide enough to obtain required information but narrow enough to keep it focused? What databases will you search? How will you narrow your search if needed? PICO Worksheet What is the PICO question?____________________________________________________________ Define each element of the question below: P- (Patient, population, or problem): I- (Intervention): C- (Comparison with other treatment/current practice): O- (Desired outcome): What is the practice issue/problem? What is the practice area? ___ Clinical ___ Education ___ Administration ___ Other How was the practice issue identified? (check all that apply) ___ Safety/risk management concerns ___ Unsatisfactory patient outcomes ___ Wide variations in practice ___ Significant financial concerns ___ Difference between hospital and community practice ___ Clinical practice issue is a concern ___ Procedure or process is a time waster ___ Clinical practice issue has no scientific base ___ Other: What evidence must be gathered? (check all that apply) ___ Literature search ___ Guidelines ___ Expert Opinion ___ Patient Preferences ___ Clinical Expertise ___ Financial Analysis ___ Standards (Regulatory, professional, community) ___ Other Search terms: Databases to search: Search Strategies: Evidence Appraisal Worksheet Your Name: Date: Your Instructor’s Name: Purpose: To find evidence to support an intervention that will change the outcomes. Directions: Type your search question below. Find AT LEAST FOUR sources to support the need for change and the potential intervention you have selected to solve the problem. At least three of your sources must be peer-reviewed articles. The forth source could be another peer-reviewed article or a reliable, credible source. Look in your text for ideas of other sources that can be used. Using the table below, insert and describe your four chosen resources. Step 1: APA Reference for the article. You will need to list the reference for the source in APA format. Be careful when using built-in APA formats and library citations. They may not be in APA format. Refer to Chapter 7 of your APA manual. Step 2: Type of Source. If your source is a research article, you will need to ensure that it is a peer review article. You need at least three peer-reviewed articles for your project. If your article is a non–research source, then you will need to list what type of source it is; systematic review, clinical practice guidelines, organizational experience, or individual expert opinion/case study/literature review. You may only use ONE non-research source. Step 3: Strength of Research. Refer to page 238-240 for research evidence and page 242-244 for non-research evidence. While you do not need to assign a level for each study, you will assign a quality of evidence (high, good, or low/major flaw) and should discuss the study using some of the elements that are discussed in the appraisal forms. For example, Research evidence: was the sample size adequate? Was there a controlled group? Was it a randomized study? Were results clearly stated? Was the conclusion based on the results? Were study limitations discussed? Not all of these elements need to be discussed, but you should discuss this information to determine if the strength of the evidence is HIGH, GOOD, or LOW/MAJOR FLAW. Step 4: Brief Description of the Research. In this section, you will summarize the source in your own words. How does this information apply to your project? What are the results of the source? What are their recommendations? Evidence Appraisal Worksheet PICO Question: APA Reference for Article Give the APA-formatted reference for the article. Type of Source *Research: Peer-reviewed article *Non-research systematic review, clinical practice guidelines, organizational experience, or expert opinion/case study/literature review Strength of Research Discuss the strength of the sources. Report if evidence is High, Good, or Low/Major Flaw. Use the tools on page 238-244 of your text and discuss the reasons why you have assigned a particular level of quality. Brief Description of Research Address the questions. *How does the information in the article apply to the project problem or proposed intervention? *Summarize in your own words. * Include results of the study and how these results are applicable to your project. * What is the recommendation of the source for clinical practice?
