Effective Reduction of Depression
PICOT: In adults of 35 years and above with depression but with no other underlying health conditions (P), how does a monitored exercise program (I), compared to the use of antidepressants (C), effective in reducing depression (O) in 4 months? (T).
Evidence-based practice is only useful if clinicians are implementing it in practice. There are 18 points to an evidence-based implementation scale that can be used to evaluate evidence-based practice used in educational or clinical settings (Melnyk & Fineout-Overholt, 2023, p. 858). Throughout this course, I have discovered daily CHG bathing reduces gram positive central line-associated bloodstream infections (CLABIs) but has no impact on gram negative CLABSIs (Denkel at al., 2023). The evidence-based practice implementation scale relates to a lot of the things I have done through this course related to my PICOT question.
The first question asks if the evidence was used for clinical decision making. I have not had the opportunity to use the evidence in my clinical decision making as CHG bathing was already implemented in my hospital. The second question asks if evidence was critically appraised from a research study. I have appraised evidence from several levels of evidence through this course from case studies to randomized controlled trials. The third question asks if I have generated a PICOT question which I did to use for my search for evidence. PICOT questions are foundational to the evidence-based practice process, and quality improvement projects (McClinton, 2022).
Questions 4, 6, 8, 9, 10, 11, and 16 relate to sharing the evidence reviewed from the data collection to the outcomes. I have done this throughout the course in the form of discussion boards and papers, but I have also shared the information I have learned with my coworkers when I have discussed the data related to CHG bathing. The fifth question asks if I collected data of a clinical issue in simulation which I have not, but I have reviewed the data from several studies related to my PICOT question. Question seven is about evaluating the outcomes of the PICOT question. I have reviewed studies that implemented CHG bathing and wrote a paper evaluating the outcomes of the study.
Question twelve asks if I have accessed the Cochrane database of systematic reviews which I have to look for reviews regarding my PICOT question. Questions thirteen and fourteen are about accessing an evidence-based guideline and using it as a basis for a clinical decision. This would be my next step if I were to implement my intervention by using Medscape guidelines regarding CLABSI prevention. Question 15 asks if I have evaluated a care initiative by collecting patient outcome data. I have not personally collected patient data, but I have reviewed a lot of the data through the research articles I have appraised. Question 17 is about making a clinical decision for patient care based on patient outcome data. CHG bathing was already implemented in my hospital, but I have continued support for the intervention because of the data that shows CHG bathing precents gram positive CLABSIs. The last question asks if I have promoted EBP to my clinical colleagues. The answer to this question is yes as I have discussed with my colleagues the results of my research and have promoted researching their own questions online when they are trying to make clinical decisions and encouraged implementing them in practice.
References
Denkel, L. A., Schwab, F., Clausmeyer, J., Behnke, M., Golembus, J., Wolke, S., Gastmeier, P., & Geffers, C. (2023). Central-line associated bloodstream infections in intensive care units before and after implementation of daily antiseptic bathing with chlorhexidine or octenidine: A post-hoc analysis of a cluster-randomised controlled trial. Antimicrobial Resistance and Infection Control, 12(1), p. 1-14. https://doi.org/10.1186/
McClinton, T. D. (2022). A guided search: Formulating a PICOT from assigned areas of inquiry. Worldviews on Evidence-Based Nursing, 19(5), p. 426-427. https://doi.org/10.
Melnyk, B. M., & Fineout-Overholt, E. (2023). Evidence-based practice in nursing & healthcare: A guide to best practice (5th ed.). Wolters Kluwer.