Assignment Requirements: A (one page) annotated bibliography will be submitted to the assignment section on Canvas within a week of doing your article presentation to receive points, this includes a summary and/or evaluation of one article, using APA format. Each student will submit a one page annotated bibliography on the article from your discussion. Your annotation may do one or more of the following.
Teaching EBP Column
The PICO Game: An Innovative Strategy for Teaching Step 1 in Evidence-Based Practice Kerry A. Milner, RN, DNSc • Sheryl Cosme, RN-BC, DNP
This column shares the best evidence-based strategies and innovative ideas on how to fa- cilitate the learning and implementation of EBP principles and processes by clinicians as well as nursing and interprofessional students. Guidelines for submission are available at https://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1741-6787
BACKGROUND Nurses use the evidence-based practice (EBP) process in or- der to produce safe, high quality, effective care. EBP compe- tencies have been created by Quality and Safety Education for Nurses (n.d.) and nurse leaders (Melnyk, Gallagher-Ford, Long, & Fineout-Overholt, 2014) to improve the standardization of EBP in practice. Within health systems, nurses are leading the charge for evidence-based policies and practices (Makic, VonRueden, Rauen, & Chadwick, 2011). In order to find rele- vant evidence in databases, nurses must have the knowledge and skill to frame practice questions in a searchable format. The PICO process is a consistent, systematic way to identify com- ponents of a practice issue, and a well-designed PICO question increases the probability of finding relevant evidence to inform practice (Stillwell, Fineout-Overholt, Melnyk, & Williamson, 2010).
TEACHING STRATEGY Games are a teaching strategy used by educators to engage stu- dents in learning, promote self-confidence, foster group coop- eration, and interaction (Bensinger, 2015). Games are effective for developing critical appraisal skills and statistical literacy for EBP (Mick, 2016; Wonder & Otte, 2015). Games should have clear goals, an uncertain outcome so the learner is motivated, and enhance the learner’s self-esteem by including opportuni- ties for success (Sealover & Henderson, 2005).
The PICO Game C© was developed for identifying the pop- ulation (P), intervention (I), comparison intervention (C), and outcome (O) from clinical scenarios that focus on interventions or therapies. Before playing the game, educators should review the templates and definitions for building a PICO question (Melnyk & Fineout-Overholt, 2014).
THE PICO GAME C© DIRECTIONS The object of the game is to be the first player to complete three PICO questions correctly. There are 20 scenario cards with different practice issues focusing on comparing an intervention
to usual or standard of care. Eighty cards have a P, I, C, or O word to match a scenario. Table 1 displays a sampling of scenarios and matching P, I, C, O. Players select three scenario cards and do not show other players. The dealer gives each player five cards. The rest of the cards are placed faced down in one pile that all players can reach. The top card of the pile is placed face up. When it is your turn, you must either draw the top card from the stockpile or put it into your hand without showing anyone, or you can take one card from the discard pile. The discard pile is fanned out and you may draw from the entire pile, not just the face up card, but if you take a card you must replace that card with the same type of card (e.g., P card for P card). If you draw from the stockpile you can discard any type of card. Players yell “PICO” when they think they have a completed question, and the dealer checks it against the PICO answer key card; if correct, it is placed in front of that player and the game continues. Variations of the game include playing in teams and the team to complete three PICO questions first wins, or the number of completed PICO questions to win may be increased.
RESULTS Eighteen Doctor of Nursing Practice students completed an evaluation of the game. Most students believed the game was an exciting and fun way to build and strengthen skills to frame practice questions in a searchable format. Students believed their understanding of how to use the PICO process to identify components of a practice question increased and that the pro- cess increases their chances of finding best evidence to inform practice.
The method for teaching how to build PICO questions is the same regardless of participant education level or years of practice. The game can be used as an active learning strat- egy with undergraduate students or nurses in practice. The game may be expanded to include scenarios and templates for formulating etiology, diagnosis, prognosis, or meaning PICO questions. WVN
514 Worldviews on Evidence-Based Nursing, 2017; 14:6, 514–516. C© 2017 Sigma Theta Tau International
Teaching EBP Column Table 1. Scenario Examples and PICO
Sample of scenarios P I C O
The labor and delivery unit has seen a 3-month spike in postpartum hemorrhage after changing the oxytocin infusion dosage from 80 mg/500 mL to 10 mg/500 mL.
Postpartum women Oxytocin 10 mg dose
Oxytocin 80 mg dose Postpartum hemorrhage
As a school nurse, you have a hunch that traditional handwashing is better than antibacterial gels for preventing the spread of germs among school-aged children.
Antibacterial gel Spread of germs
There was an editorial in the latest nursing practice journal challenging the use of isolation precautions claiming they create more harm to the adult patient’s mental health. The authors propose the use of standard precautions to prevent the spread of bacteria-resistant microorganisms.
Adult patient Isolation precaution Standard precaution Bacteria-resistant microorganisms
Clinical practice guidelines from national cancer organizations recommend screening for psychological distress. Both the Distress Thermometer and the Impact Thermometer have been suggested as valid tools for screening for distress, however, the administration is requesting an evidence review and synthesis on both tools before selecting one for implementation.
Cancer patients Distress Thermometer
Impact Thermometer Psychological distress
There is a sacred cow contest going on in your long-term care setting where nursing leaders are asking for evidence on best practices for shift-to-shift handoffs. Several acute care hospitals within the same health system have made the change from verbal or written handoffs to a standardized electronic handoff but internal data on patient safety are not available.
Long-term care Standardized electronic handoff
Verbal or written handoff
Worldviews on Evidence-Based Nursing, 2017; 14:6, 514–516. 515 C© 2017 Sigma Theta Tau International
The PICO Game
LINKING EVIDENCE TO ACTION
� The PICO process is a consistent, systematic way to identify components of a practice issue.
� Nurses must have the knowledge and skill to build focused PICO questions to find relevant evidence to inform practice.
� The PICO game may provide a helpful tool for use in both academic and clinical settings to help stu- dents and nurses identify the P, I, C, O in practice scenarios.
Kerry A. Milner, Associate Professor, College of Nursing, Sa- cred Heart University, Fairfield, CT, USA; Sheryl Cosme, Sh- eryl Cosme, Sr. Operations Manager, Accreditation Program, Practice Transitions Accreditation Program and Nursing Skills Competency Program, American Nurses Credentialing Center, Silver Spring, MD, USA
Address correspondence to Dr. Kerry A. Milner, College of Nursing, Sacred Heart University, 5151 Park Avenue, Fairfield, CT 06825, USA; [email protected]
Accepted 20 May 2017 Copyright C© 2017, Sigma Theta Tau International
References Bensinger, H. (2015). Critical-thinking challenge games and
teaching outside of the box. Nurse Educator, 40(2), 57–58. https://doi.org/10.1097/NNE.0000000000000099
Makic, M. B. F., VonRueden, K. T., Rauen, C. A., & Chad- wick, J. (2011). Evidence-based practice habits: Putting more sacred cows out to pasture. Critical Care Nurse, 31(2), 38–62. https://doi.org/10.4037/ccn2011908
Melnyk, B. M., & Fineout-Overholt, E. (2014). Evidence-based prac- tice in nursing & healthcare (3rd ed.). New York, NY: Wolters Kluwer Health.
Melnyk, B. M., Gallagher-Ford, L., Long, L. E., & Fineout- Overholt, E. (2014). The establishment of evidence-based practice competencies for practicing registered nurses and advanced practice nurses in real-world clinical settings: Profi- ciencies to improve healthcare quality, reliability, patient out- comes, and costs. Worldviews on Evidence-Based Nursing, 11(1), 5–15. https://doi.org/10.1111/wvn.12021
Mick, J. (2016). The appraising evidence game. Worldviews on Evidence-Based Nursing, 13(2), 176–179. https://doi.org/10.1111/ wvn.12139
Quality and Safety Education for Nurses. (n.d.). QSEN competencies. Retrieved from https://qsen.org/competencies/pre-licensure- ksas/
Sealover, P., & Henderson, D. (2005). Scoring rewards in nursing education with games. Nurse Educator, 30(6), 247– 250.
Stillwell, S. B., Fineout-Overholt, E., Melnyk, B. M., & Williamson, K. M. (2010). Evidence-based practice, step by step: Asking the clinical question. American Journal of Nursing, 110(3), 58–61. https://doi.org/10.1097/01.NAJ.0000368959.11129.79
Wonder, A. H., & Otte, J. L. (2015). Active learning strate- gies to teach undergraduate nursing statistics: Connecting class and clinical to prepare students for evidence-based prac- tice. Worldviews on Evidence-Based Nursing, 12(2), 126–127. https://doi.org/10.1111/wvn.12075
doi 10.1111/wvn.12255 WVN 2017;14:514–516
516 Worldviews on Evidence-Based Nursing, 2017; 14:6, 514–516. C© 2017 Sigma Theta Tau International
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