NRS490 Grand Canyon WK1 PICOT Statement for Patient Population Paper

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Review the Topic Materials and the work completed in NRS-433V to formulate a PICOT statement for your capstone project.

A PICOT starts with a designated patient population in a particular clinical area and identifies clinical problems or issues that arise from clinical care. The intervention should be an independent, specified nursing change intervention. The intervention cannot require a provider prescription. Include a comparison to a patient population not currently receiving the intervention, and specify the timeframe needed to implement the change process.

Formulate a PICOT statement using the PICOT format provided in the assigned readings. The PICOT statement will provide a framework for your capstone project.

In a paper of 500-750 words, clearly identify the clinical problem and how it can result in a positive patient outcome.

Make sure to address the following on the PICOT statement:

  1. Evidence-Based Solution
  2. Nursing Intervention
  3. Patient Care
  4. Health Care Agency
  5. Nursing Practice

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. Please refer to the directions in the Student Success Center.

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1 Running head: PICOT STATEMENT AND LITERATURE SEARCH PICOT STATEMENT AND LITERATURE SEARCH Jessica Mock NRS-433V Grand Canyon University 2 PICOT & LITERATURE Can children with mental disabilities have better health outcomes in adulthood if they are managed upon early detection vs later detection? Does early intervention truly impact health or does mental disability have the same outcome despite the starting point of interventional therapies? P- Population, patient, problem Children that have mental disabilities such as autism, delayed speech or functions, ADHD, or any type of dysfunction found in these children in which some may be diagnosed early and receive treatment where some may not be diagnosed until late childhood or into school age stages. Is there a difference in health in adulthood if both are receiving care but at different points? I – Intervention Interventions will depend on diagnosis, stage, level of health disparity. Educational interventions, therapies, medications, treatments, programs C – Comparison Children who receive early diagnosis and intervention vs children that go longer with no diagnosis or delayed diagnosis and delayed interventions O – Outcome Is there a difference or what is the impact in health behaviors in adulthood based on timing of diagnosis and interventions between children? T - Time These are impacts that can be seen later in adolescence into early adulthood 3 PICOT & LITERATURE Rutherford, M., McKenzie, K., Forsyth, K., McCartney, D., O, H. A., McClure, I., & Irvine, L. (2016). Why are they waiting? Exploring professional perspectives and developing solutions to delayed diagnosis of autism spectrum disorder in adults and children. Research in Autism Spectrum Disorders, 31, 53–65. https://doi-org.lopes.idm.oclc.org/10.1016/j.rasd.2016.06.004 Abstract This mixed method study enhances knowledge of the reason’s professionals give for delay in diagnostic assessment of autism spectrum disorders.•The study translates research evidence into practical application through action plans for ASD services.•The paper presents an Action Plan for child diagnostic teams to improve efficiency and quality of the diagnostic assessment process.•The paper presents an Action Plan for adult diagnostic teams to improve efficiency and quality of the diagnostic assessment process. Background This paper reports on the development of child and adult Action Plans for Autism Spectrum Disorder to address the problem of delayed diagnosis and lengthy waiting times. Evidence used in the development of action plans was gathered from a sequential mixed methods study to further understand the reasons for the long waiting time and potential solutions. This is the first published investigation, from the perspective of diagnosing professional teams, of the reasons for delays, which also generates solutions. Methods Ninety- five clinicians from 8 child and 8 adult services attended 16 focus groups to explore clinicians’ views on a) reducing the wait for diagnosis and b) providing a good quality diagnostic process with good adherence to clinical guidelines. During focus groups, quantitative data were fed back, used to frame discussions and facilitate 4 PICOT & LITERATURE solution focused action planning with each service. Sixteen local action plans were synthesized to create an ASD Action Plan for children and an ASD Action Plan for adults. Results Key solutions are proposed to support the reduction of the wait for diagnostic assessment, through reducing non-attendance rates, reducing inappropriate referrals, developing efficient working and communication and improving the effectiveness of care pathways. These are presented in actions plans for use by clinical teams. Conclusion The first step in addressing the clinical challenge of increased wait for diagnostic assessment of ASD is understanding the complex and multi-factorial reasons for delays. The action plans developed here through systematic enquiry and synthesis may provide clinical diagnostic teams with evidence -based guidance on common challenges and solutions to guide future quality improvement programs. Future research to evaluate whether using Action Plans leads to a reduction in waiting times would be of value. 5 PICOT & LITERATURE Zheng, Y., Maude, S. P., Brotherson, M. J., & Merritts, A. (2016). Early Childhood Intervention in China from the Families’ Perspective. International Journal of Disability, Development & Education, 63(4), 431–449. https://doi-org.lopes.idm.oclc.org/10.1080/1034912X.2015.1124988 Abstract Research highlights the importance of early childhood intervention (ECI) for children with disabilities, and there is an increasing interest in China with respect to research on ECI. However, little research exists exploring the experience of families of young children with disabilities receiving ECI services and supports in China. The purpose of this study was to understand the ECI experiences of families of such children. A qualitative research design was used, and data were collected through interviews with six families in southwest China. This study indicated that, although China has made some progress in ECI for young children with disabilities, progress in this area is still at an early stage of development. Many issues still need to be addressed, including knowledge about typical and atypical development, early identification, professional development, increased government investment, and better implementation of existing laws. [ABSTRACT FROM AUTHOR] 6 PICOT & LITERATURE Richards, M., & Vostanis, P. (2004). Interprofessional perspectives on transitional mental health services for young people aged 16 - 19 years. Journal of Interprofessional Care, 18(2), 115–128. https://doi-org.lopes.idm.oclc.org/10.1080/13561820410001686882 Abstract This qualitative study investigated the need for transitional mental health services for young people aged 16 - 19 years in a health district, as perceived by professionals from mental health, social, education and non-statutory services. Semi-structured interviews with 39 managers and practitioners who planned or provided services for this age range, from a wide range of agencies, explored issues related to older adolescents' needs, service communication, transfer arrangements, current gaps, and recommendations. Interviews were transcribed verbatim and themes emerged according to grounded theory. The four identified themes, with 21 categories, were: (i) older adolescents have multi-faceted needs, (ii) statutory mental health services are not geared towards this age group, (iii) communication between services is variable, and (iv) there are no formal transfer arrangements from child to adult services. The findings support the need for specialist transitional services, and the adoption of an interprofessional service model incorporating education, social services and nonstatutory agencies. [ABSTRACT FROM AUTHOR] 7 PICOT & LITERATURE Chakraborty, S., Sagar Kommu, J. V., Srinath, S., Seshadri, S. P., & Girimaji, S. C. (2014). A Comparative Study of Pathways to Care for Children with Specific Learning Disability and Mental Retardation. Indian Journal of Psychological Medicine, 36(1), 27. Retrieved from https://lopes.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=edb &AN=94741876&site=eds-live&scope=site Abstract Context: Early intervention in specific learning disability (SpLD) results in better outcome and prevents comorbidity. Understanding the pathways is therefore important. Aims: To study and compare the pathways to care for children with SpLD and mental retardation (MR) before reaching a tertiary care center. Settings and Design, Material and Methods: A cross-sectional study was conducted for pathways to care of two groups: SpLD and MR with 50 children in each group from 8 to 16 years. MINI-KID for comorbidity and Goldberg's pathway to care instrument was used. The groups were divided into early contact (up to three carers) and late contact (more than three carers) and compared. Statistical Analysis: Data were analyzed using Statistical Packages for Social Sciences (SPSS) version 10.0 software. Results: Majority (n = 24 or 48%) of SpLD children visited "others" (teachers, neighbors, relatives, and guardians of fellow classmates) as first carer. Allopathic practitioners were the first choice for MR children (n = 31 or 62%). Six children (12%) in SpLD group and 10 of MR (20%) group have seen either traditional practitioner or healer as first carer. Maximum referral to the tertiary center in both groups was done by others (62% in SpLD and 56% in MR group). Early contacts in SpLD group belonged to younger age group (P = 0.01). While comparing both groups on the basis of early and late contact, mother's education was found to be significant in early contact group (P = 0.036) and having comorbidity was significant among late contacts (P = 0.038). Conclusions: 8 PICOT & LITERATURE The pathways to care for SpLD children are more or less similar to MR children whose parents recognize MR late. Both the groups visit multiple carers including traditional healers substantiating the strong belief for supernatural causation of developmental disorders in India. [ABSTRACT FROM AUTHOR] 9 PICOT & LITERATURE Baglama, B., & Demirok, M. S. (2016). Determination of Preservice Special Education Teachers’ Views on Early Childhood Intervention. Cypriot Journal of Educational Sciences, 11(4), 213–222. Retrieved from https://lopes.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=eric &AN=EJ1140744&site=eds-live&scope=site Abstract Experiences in early childhood have a great influence on a child's physical and mental development. Early childhood interventions are widely accepted as an effective way to prevent learning difficulties and to promote healthy development for children with special needs. For this reason, it is important for teachers who will work with children with special needs or children who are at risk to have sufficient knowledge about early childhood intervention and be competent in this area. Therefore, the present study aims to determine the views of preservice special education teachers about early childhood intervention. This study used quantitative research method and a questionnaire form was used to collect the data. The results are discussed in detail with reference to relevant literature. Implications and recommendations for further research are also provided in order to improve the quality of education policies, programs and practices related with early childhood intervention and increase awareness and knowledge related with early childhood interventions among teacher candidates. 10 PICOT & LITERATURE Frey, G. C., Temple, V. A., & Stanish, H. I. (2017). Interventions to promote physical activity for youth with intellectual disabilities. Salud Pública de México, 59(4), 437. Retrieved from https://lopes.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=edb &AN=124408973&site=eds-live&scope=site Abstract Objective. To describe interventions designed to promote physical activity for youth with intellectual disabilities. Materials and methods. A systematic review of nine databases until January 31, 2015 identified 213 citations. The inclusion criteria were: a) the study sample consisted of youth with intellectual disabilities, b) the study implemented an intervention to initiate, increase, or maintain physical activity, and c) quantitative or qualitative data were used to report the effectiveness of the intervention. Eleven articles from the 213 citations met this criterion. Results. Nine studies reported significant increases in physical activity behavior. Conclusions. Conclusions cannot be made regarding intervention components that impacted outcome variables, if the observed effects were specifically due to the intervention or if interventions could be maintained long-term. To advance the knowledge base in this area, a concerted effort should be made to increase rigor in study conceptualization and research design. [ABSTRACT FROM AUTHOR] 11 PICOT & LITERATURE Temple, V. A., Frey, G. C., & Stanish, H. I. (2017). Interventions to promote physical activity for adults with intellectual disabilities. Salud Pública de México, 59(4), 446. Retrieved from https://lopes.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=edb &AN=124408974&site=eds-live&scope=site Abstract Objective. To describe interventions designed to promote physical activity for adults with intellectual disabilities and the effects on overall physical activity levels and on health outcomes. Materials and methods. A systematic review of eight databases until January 31, 2015 identified 383 citations. The inclusion criteria were: a) the study sample consisted of adults with intellectual disabilities, b) the study implemented an intervention to initiate, increase, or maintain physical activity, and c) quantitative or qualitative data were used to report the effectiveness of the intervention. Six articles from the 383 citations met this criterion. Results. Three studies resulted in significant increases in physical activity behavior; however wellcontrolled trials designed to improve weight status by increasing physical activity did not produce significant effects. Conclusion. Overall, the results indicate that interventions to increase physical activity should simultaneously target the individual with intellectual disability as well as their proximal environment over a sustained period of time. [ABSTRACT FROM AUTHOR] Running head: PICOT STATEMENT AND RESEARCH CRITIQUES PICOT Statement and Research Critiques Jessica Mock Grand Canyon University- 433V February 3, 2018 1 PICOT STATEMENT AND RESEARCH CRITIQUES 2 Research Critiques and PICOT Statement Each health care system has a primary objective, which is to enhance the patients’ quality of life. Patients expect the best quality of life when they visit health care centers, which make them contented with the offered services. In the present day, the health care confronts various challenges that include delayed diagnosis and long waiting times, delayed speech, ADHD, or any dysfunction found in children. The content aims to give evidence-based change in the nursing practice and review the PICOT statement and article critique. Interaction is between the research articles, nursing practice problem, and PICOT question. PICOT Statement Problem The principal aim of the research was to conduct an analysis and evaluation of the growth of child and adult Actions plans for Autism Spectrum Disorder to deal with the issue of delayed diagnosis and long waiting times, delayed speech, ADHD, or any dysfunction found in children. Mental disabilities may be diagnosed early and receive treatment or may not be diagnosed until late childhood or into school age stages. The purpose of the research was to understand the difference in health in adulthood if both are receiving care but at different points. The study also gave reasons as to why there is a lengthy waiting time as well as possible solutions. Intervention For the early intervention in specific learning disability (SpLD), the study performed a cross-sectional investigation for pathways to care of 2-groups. The groups are MR and SpLD with 50 children in every group in the age range of 8-16 years. The study utilized Goldberg’s pathways and MINI-KID for comorbidity to care instrument (Rutherford et al., 2016). The PICOT STATEMENT AND RESEARCH CRITIQUES 3 researchers divided the groups into early contact and late contact. Later on, the statistical analysis of data occurred using SPSS. To determine the views of preservice special education, the research utilized a questionnaire to gather the data. Intervention’s description to enhance physical activity for youth with intellectual disabilities used a systematic review of 9-databased. The sample studied included youth with intellectual disabilities and the implementation of interventions to increase, initiate, or keep physical activity occurred. The study states the necessity of early childhood intervention (ECT) for children with disabilities. Comparison Based on the intervention mentioned above, a comparison of Children who receive early diagnosis and intervention and children who take long with no diagnosis or delayed diagnosis and delayed interventions will be made. The study states the necessity of early childhood intervention (ECT) for children with disabilities. Besides, less research exists showing the experiences of families young children with disabilities getting services of ECI and support in China. However, the investigation revealed the skills of ECI of families with such children. Outcome and time The transitional mental health services for young individual results involve the need for professional transitional services as well as the adoption of a service model of inter-professional integrating social services, education, and non-statutory agencies. A good outcome will be attainable through enhancing the decrease of the wait for diagnostic evaluation, via decreasing unworthy referrals, rates of non-attendance, creating effective communication and working as well as the efficacy of care pathways. These are impacts that can be seen later in adolescence into early adulthood. PICOT STATEMENT AND RESEARCH CRITIQUES 4 PICOT question: Can children with mental disabilities have better health outcomes in adulthood if they are managed upon early detection vs. later detection? Does early intervention truly impact health or does mental disability have the same result despite the starting point of interventional therapies later in adolescence to early adulthood? Rutherford, M., McKenzie, K., Forsyth, K., McCartney, D., O’Hare, A., McClure, I., & Irvine, L. (2016). Why are they waiting? Exploring professional perspectives and developing solutions to delayed diagnosis of autism spectrum disorder in adults and children. Research in Autism Spectrum Disorders, 31, 53-65. Background of the study The principal aim of the research was to conduct an analysis and evaluation of the growth of child and adult Actions plans for Autism Spectrum Disorder to deal with the issue of delayed diagnosis and long waiting times, delayed speech, ADHD, or any dysfunction found in children. Mental disabilities may be diagnosed early and receive treatment or may not be diagnosed until late childhood or into school age stages. The purpose of the research was to understand the difference in health in adulthood if both are receiving care but at different points. The study also gave reasons as to why there is a lengthy waiting time as well as possible solutions. The survey gathered the evidence utilized in the growth of action plans from a following combined method. The investigation was the first publication concerning the reasons for delays from diagnosis professional teams, which provided solutions. The research topic is crucial to the nursing, where the mixed method investigation provides knowledge as to why professionals provide a delay in diagnostic evaluation for disorders of the autism spectrum. Besides, it gives grounds to the practical application via action PICOT STATEMENT AND RESEARCH CRITIQUES 5 plans for Autism Spectrum Disorder services. It also produced a plan of action for child and adult diagnostic teams to promote the efficacy and quality of the diagnostic evaluation process. The study states the necessity of early childhood intervention (ECT) for children with disabilities. Method of Study In this research, the authors did not explicitly address various risks and benefits of participation. They conducted a systematic review and narrative synthesis of quantitative analysis on the difference in health behaviors in adulthood based on the timing of diagnosis and interventions. The authors used 95 clinicians from eight child services and eight adult services who attended sixteen focus groups to research the views of clinicians on decreasing the waiting time for diagnosis and giving a better quality process of diagnosis (Rutherford et al., 2016). However, the researchers fed back the quantitative data during the focus groups, used to facilitate solution and frame discussions focusing on action planning with every service provided. Synthesis of 16 local locations occurred to build an ASD Action Plan for adults and children. Moreover, the researchers conducted a quantitative study to investigate the requirement for transitional mental health services for young individuals with age of 16-19 years. The young people are in health district based on mental health professionals, non-statutory services, education, and social services. The investigators used semi-structured interviews with practitioners and 39 managers who gave out the facilities for the young people. Results of the study The interpretation of the findings is that the transitional mental health services for young individual results involve the need for professional transitional services as well as the adoption of a service model of inter-professional integrating social services, education, and non-statutory PICOT STATEMENT AND RESEARCH CRITIQUES 6 agencies. However, these findings reflect the validity/accuracy of the reality, and thus I have confidence in them. The study found that the primary results are suggested to enhance the decrease of the wait for diagnostic evaluation, via decreasing unworthy referrals, rates of nonattendance, creating effective communication and working as well as the efficacy of care pathways. The clinical team presents this in actions plans. SpLD results in good finding and protects comorbidity (Rutherford et al., 2016). The results show that the majority of children with SpLD visited others as their first carer (48%). The first choice for MR children is allopathic practitioners (68%). In SpLD group, 6-children (12%) and (20%) of 10 MR have visited healer or traditional practitioner as the first carer. Suggestions made for further results are an evaluation of whether utilizing Action Plans to a decrease in the waiting period would be of value. Ethical Considerations Based on the research conducted, there is no approval of the study by an Institutional Review Board. The analysis was carried out based on the primary and secondary source materials in electronic databases form. However, there was no direct participation any participant in the process of investigation. The study also lacks ethical considerations concerning the treatment of mental disability and other issues. Proposed Evidence-Based Practice Change The study has proposals that the transitional mental health services for young individual outcomes involve the need for professional transitional services as well as the adoption of a service model of inter-professional integrating social services, education, and non-statutory agencies. Once this is considered, there will be an enhancement in the decrease of the wait for diagnostic evaluation, via decreasing unworthy referrals, rates of non-attendance, creating effective communication and working as well as the efficacy of care pathways. The clinical team PICOT STATEMENT AND RESEARCH CRITIQUES 7 presented this in actions plans. Suggestions made for further results are an evaluation of whether utilizing Action Plans to a decrease in the waiting period would be of value. The Affiliation between PICOT Question, Nursing Practice Problem, and Research Articles The chief nursing issue addressed in the study is delayed diagnosis and long waiting times, delayed speech, ADHD, or any dysfunction found in children. Practice issue has an affiliation to the PICOT question, whereby from the latter, the purpose of the research was to understand the difference in health in adulthood if both are receiving care but at different points. The study also gave reasons as to why there is a lengthy waiting time as well as possible solutions. However, the PICOT question seeks to find a resolution to the basic practice glitches. Also, the article by Rutherford et al. (2016) determined the affiliation between the long waiting and the difference in health in adulthood receiving care at different points. The results obtained from the article indicates that the transitional mental health services for young individual results involve the need for professional transitional services as well as the adoption of a service model of inter-professional integrating social services, education, and non-statutory agencies. This way, there is an affiliation between the nursing problem and the PICOT question. Conclusion The findings of the study are significant to nursing practice as nurses who are practicing can get knowledge from the survey concerning the clinical challenge of the high level of wait for the diagnostic evaluation of ASD. The nurses also understand the multi-factorial and complex reasons for delays. The clinical diagnostic teams benefit from the action plans formed via systematic inquiry and synthesis providing them with guidance, which is evidence based on similar problems and solutions to for guiding them in future quality enhancements of programs. PICOT STATEMENT AND RESEARCH CRITIQUES 8 The SpLD children pathways care tend to be identical to MR children whose parents notice MR late. Based on interventions components, one cannot make conclusions that affected outcome variables if interventions could be maintained long-term or if the seen effects resulted from intervention. References Rutherford, M., McKenzie, K., Forsyth, K., McCartney, D., O’Hare, A., McClure, I., & Irvine, L. (2016). Why are they waiting? Exploring professional perspectives and developing solutions to delayed diagnosis of autism spectrum disorder in adults and children. Research in Autism Spectrum Disorders, 31, 53-65. Retrieved from: https://doiorg.lopes.idm.oclc.org/10.1016/j.rasd.2016.06.004 PICOT STATEMENT AND RESEARCH CRITIQUES 9
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Running head: PICOT STATEMENT

1

PICOT Statement
Student’s Name
Institutional Affiliation

PICOT STATEMENT

2
Identification of Clinical Problem

Every health care system involves a primary objective, which is to promote the quality of
life of patients. Every patient expects the best quality of life whenever they go to the hospitals,
which satisfies them with the services offered. However, various issues confront health care
currently, which include long waiting times and delayed diagnosis, ADHD, or any other
dysfunction found in children. The main objective of the investigation was to carry out an
evaluation and analysis of the child and adult growth Actions plans for Autism Spectrum
Disorder to deal with the problem of long waiting times and delayed diagnosis, ADHD or any
other dysfunction.
Evidence-Based Solution
Rutherford et al. (2016) explain as to why professionals offer delayed assessment of
diagnosis of autism spectrum disorders. The investigation translates the evidence into the
practical application via actions plans for services of ASD. The authors presented an action plan
for child and adult diagnostic group to enhance the quality and efficacy of the process of
diagnostic evaluation. Zheng et al. (2016) point out that various problems need to be covered like
early identification, atypical and typical development, increased government investment,
professional development, and enhanced execution of available regulations. According to
Richards and Vostanis (2004), it is crucial for transitional mental health services for individuals
with 16 years to 19-years in health district, as perceived by specialists from social, mental health,
non-statutory services, and education. Besides, Chakroborty et al. (2014) support the idea that
early intervention in certain learning disability (SpLD) leads to the enhanced outcome and
controls comorbidity. This way, the authors give a comparison of pathways to care for children
with mental retardation and SpLD before reaching a tertiary care center (Temper et al., 2017).

PICOT STATEMENT

3

Nursing Intervention, Patient Care, Health Care Agency, & Nursing Practice
For early intervention in specific learning disability (SpLD), Rutherford et al. (2016)
claim that it is crucial to utilize Goldberg’s pathways and MINI-KID for comorbidity to care
instrument. It is necessary to enhance physical exercise for youth with intellectual disabilities, as
it is one of the intervention’s description. Frey et al. (2017) executed an intervention for
initiating, increasing, or maintaining physical activity as well as reporting the efficacy of the
intervention. However, nurses will describe to the patients how to perform various exercises for
individuals with intellectual disabilities. Thro...


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