Sample Nursing Research Paper on Evidence-Based Practice Project: PICOT and Theoretical Framework

Sep 8, 2021
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A nursing research paper is a type of project student nurses are required to write as part of their nursing curriculum. It is a general project, which means it can be about various topics. This sample nursing paper details a proposed PICOT question, which is a simple study designed to generate evidence that will be used for evidence-based practice. 

Evidence-based practice is one of the cornerstones of nursing. The generation of evidence by way of research provides nurses, patients, and the healthcare system numerous benefits. More than streamlining the process by which nurses deliver care to patients and lowering costs for healthcare facilities, evidence-based practice improves patient outcomes (Chien, 2019). Evidence-based practice, of course, will not be possible without research. The ability to perform experiments, synthesize data, and translate findings into practical use is at the center of evidence-based practice. Indeed, the importance of research cannot be understated, seeing how 55% of all nursing practice is based on research findings (Chrisman et al., 2014). As the Institute of Medicine (2011) noted in their landmark work The Future of Nursing: Leading Change, Advancing Health, nurses play a crucial role in improving practice through continuous research. Over the past few decades, the PICOT project has become a useful tool for developing research skills among nurses (Murrock, 2020), thus making it an invaluable part of the nursing curriculum. In line with the goals of evidence-based practice, this nursing paper presents a PICOT question and the theoretical framework that underpins the project.

PICOT Question and Topic Background

The PICOT is: Among patients recently diagnosed with coronary artery disease (P), does an exercise routine for cardiac patients that combines aerobic exercise and yoga (I) lead to better lipid levels (O) than just aerobic exercise (C) within a three-month period (T)?

I have chosen APN (advanced practice nurse) as my MSN specialty track. Even as an APN student, I am already aware of the burden heart disease poses upon individuals, families, and communities. The Centers for Disease Control and Prevention [CDC] (2020) reports that around a quarter of deaths in the United States is due to cardiac conditions. In 2020, more than 655,000 died from heart disease (Virani et al., 2020). Coronary artery disease or CAD is the most common type of heart disease, affecting 18.2 million adults in the United States (CDC, 2020). It is characterized by the accumulation of a waxy substance called plaque along the lining of coronary arteries, thus causing narrowing or partial blocking of these blood vessels and, subsequently, failure to deliver adequate blood supply to the cardiac muscle (National Heart, Lung, and Blood Institute [NHLBI], n.d).

Risk factors for CAD include family history of heart disease, smoking, lack of physical activity, poor diet, obesity, and stress among others. CAD is associated not only with decreased life expectancy but also with reduced quality of life. On the national level, CAD costs Americans billions of dollars in healthcare expenditure and lost productivity. Given the multitude of factors that influence the development of the disease and prognosis, treatment is often comprehensive, integrating multimodal approaches that may include medications, lifestyle modification, cardiac rehabilitation, and psychological counseling among others (Houston, 2018).

As lifestyle modification that involves regular exercise and cholesterol levels are variables of coronary heart disease, this PICOT seeks to determine the interplay between these factors. Studies have shown that regular physical exercise helps lower lipid levels and thus has a positive effect on risk for complications (Wang and Xu, 2017). Aerobic exercise in particular has been identified as an ideal approach to reaping the benefits of maintaining physical fitness. Defined as the rhythmic movement of large muscles for a sustained duration, aerobic exercise helps build up tolerance to physical activity. This allows patients with CAD to become more adept at carrying out daily activities, thus increasing their mobility, independence, and autonomy. Moreover, aerobic exercise also lowers the risk of CAD complications as well as events like myocardial infarction and stroke. Finally, studies also show that aerobic exercise helps lessen visceral fat and lowers low-density lipoprotein (LDL) and triglyceride levels (Wang et al., 2020).  

Meanwhile, yoga has emerged as a new addition to the treatment approaches to CAD. It has been shown to lower risk of events like stroke and heart attack as well as improve patient outcomes (Chhajer et al., 2018). A study by Nagaranthna et al. (2021) determined that yoga improves the blood lipid levels of prediabetic and diabetic patients by lowering bad cholesterol and raising good cholesterol. The findings by Nagarathna et al. are in line with the findings of Azami et al. (2019), whose study shows that yoga lowered total cholesterol and decreased LDL considerably.

In line with these new developments, this PICOT project seeks to determine if combining aerobic exercise and yoga will have a more positive effect on lipid levels compared to aerobic exercise alone.

Key Stakeholders

Any PICOT project involves a number of stakeholders, which refer to individuals or groups who have a stake in the project. In the case of this PICOT, the stakeholders include the following:

  1. Cardiac Patients: Cardiac patients, particularly patients diagnosed with CAD, comprise the main stakeholders of this project, as they are the ones who will benefit from the results of this project.
  2. Healthcare Workers: Healthcare workers including physicians and APNs are also main stakeholders as they are principal care providers to patients. Results of this PICOT project can potentially change how cardiac patients are treated, which means that nurses may eventually be in a position to implement a practice change.
  3. Yoga Instructors: While the PICOT project is yet to determine if yoga improves lipid levels better than aerobic exercise, there is no question that yoga has a positive effect on cardiac patients’ health in general. This in turn indicates the need for greater coordination between healthcare workers and yoga instructions in order to optimize the potential of yoga as a treatment modality. For this reason, they can be considered as key stakeholders.
  4. Aerobic Exercise Instructors: Similar to yoga instructors, aerobic exercise instructors are also key stakeholders. Aerobic exercise has been identified as a beneficial form of physical activity. Involving aerobic exercise instructors in the project will help optimize its potential to improve the health status of patients.

These three groups represent the main stakeholders of this PICOT project. Note, however, that there are other minor stakeholders in this project such as family members who share the responsibility of effecting lifestyle modifications for patients.

Theoretical Framework

The theoretical framework for this PICOT project adopts the Adaptation Model of Nursing, which was developed by Sister Callista Roy. First published in the 1970s, the Adaptation Model aims to define the nature of the individual and delineate the role of the nurse as a provider of care. The model features four main concepts: person, health, environment, and nursing. According to this model, the person is composed of interrelated systems all working together to achieve balance. The individual is constantly interacting with the environment, and this interaction, in turn, influences the health of the person. The role of the nurse in this model is to facilitate the person’s adaptation that results in positive outcomes (Roy and Andrews, 1999). Applying this model, this project regards the cardiac patient as a person whose holistic health is in need of adaptation. In this regard, the nurse facilitates adaptation by way of conducting the PICOT project. The project will determine if supplementing aerobic exercise with yoga will have a better effect on lipid profile. The results will help refine practice, thus enhancing adaptation techniques specific to addressing coronary artery disease.

Data Collection Methods

Data will be collected from patients who will consent to the PICOT project. As this project involves human subjects, the study including data collection during clinical lab experience will only commence once the ethical committee of the university and its hospital grants permission.

The project hopes to gather data from at least 60 patients. Inclusion criteria will include a recent diagnosis of CAD, eligibility to yoga and aerobic classes as advised by a physician, and a history of elevated lipid levels. The patients will be divided into two groups. The first group (experiment group) will be enrolled in a class that provides alternating sessions of aerobic exercise and yoga. The second group (control group) will be enrolled in a class that provides only aerobic exercise. Three separate readings of lipid levels will be conducted with two-week intervals. This will serve as the baseline data. The classes will be held four days a week and the program will last for a total of 12 weeks. Lipid tests will be conducted at the 4th, 8th, and 12th week of the program, while three more separate readings will be conducted two weeks after the program with two-week intervals (i.e., 2, 4, and 6 weeks post-program).

The lipid levels of the two groups will be compared to determine if there is a correlation between the type of exercise the patient performed and their lipid levels. To control for factors such as diet and medication, inclusion criteria will also include known history of adherence to existing treatment regimen as prescribed by the patients’ physicians.

Conclusion

As one of the most common heart conditions, CAD poses massive challenges to patients, their families and communities, and the healthcare system in general. Adequate physical activity has always been one of the most important aspects of treating coronary heart disease. As more types of physical exercise are identified as viable routines for cardiac patients, it is necessary to determine those that offer the most benefit. As such, this PICOT project seeks to explore the potential of yoga as a strategy for lowering lipid levels. The results from this study are expected to provide an opportunity for learning more about yoga’s role in addressing CAD and therefore improve outcomes and general quality of life for cardiac patients.

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References

Azami, M., Ahmadi, M. R. H., YektaKooshali, M. H., and Qavam, S. (2019). Effect of yoga on lipid profile and c-reactive protein in women. International Journal of Preventive Medicine, 10, 81. doi: 10.4103/ijpvm.IJPVM_487_17

Centers for Disease Control and Prevention (2020, September 8). Heart disease facts. CDC. https://www.cdc.gov/heartdisease/facts.htm

Chhajer, B., Singh, V., Kumari, G., and Lohmor, M. (2018). Effect of yoga based lifestyle intervention on coronary artery disease patients. Biomedical and Pharmacology Journal, 11(3). DOI : https://dx.doi.org/10.13005/bpj/1489

Chien, L. Y. (2019). Evidence-based practice and nursing research. The Journal of Nursing Research, 27(4), e29. doi: 10.1097/jnr.0000000000000346

Chrisman, J., Jordan, R., Davis, C., and Williams, W. (2014). Exploring evidence-based research practice. Nursing Made Incredibly Easy, 12(4), 8-12. doi: 10.1097/01.NME.0000450295.93626.e7

Houston, M. (2018). The role of noninvasive cardiovascular testing, applied clinical nutrition and nutritional supplements in the prevention and treatment of coronary heart disease. Therapeutic Advances in Cardiovascular Disease, 12(3), 85-108. https://doi.org/10.1177/1753944717743920

Institute of Medicine (US) Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the Institute of Medicine. (2011). The Future of Nursing: Leading Change, Advancing Health. National Academies Press (US). https://pubmed.ncbi.nlm.nih.gov/24983041/

Murrock, C. (2020). Building scholarship for evidence-based practice in undergraduate nursing students. Nursing Education Perspectives, 41(5), E45-46. doi: 10.1097/01.NEP.0000000000000612

Nagarathna, R., Kumar, S., Anand, A., Acharya, I. N., Singh, A. K., Patil, S. S., Latha, R. H., Datey, P., and Nagendra, H. R. (2021). Effectiveness of yoga lifestyle on lipid metabolism in a vulnerable population—A community based multicenter randomized controlled trial. Medicines, 8(7), 37-52. https://doi.org/10.3390/medicines8070037

Roy, C. and Andrews, H. A. (1999). The Roy Adaptation Model (2nd ed.). Appleton and Lange.

The National Heart, Lung, and Blood Institute. (n.d.). Coronary heart disease. NHLBI. https://www.nhlbi.nih.gov/health-topics/coronary-heart-disease

Virani, S. S., Alonso, A., Benjamin, E. J., Bittencourt, M. S., Callaway, C. W., Carson, A. P., Chamberlain, A. M., Chang, A. R., Cheng, S., Delling, F. N., Djousse, L., Elkind, M. S., Ferguson, J. F., Fornage, M., Khan, S. S., Kissela, B. M., Knutson, K. L., Kwan, T. W., Lackland, D. T....Tsao, C. W. (2020). Heart disease and stroke statistics—2020 update: a report from the American Heart Association. Circulation, 141(9), e139–e596. https://doi.org/10.1161/CIR.0000000000000757

Wang, L., Ai, D., and Zhang, N. (2017). Exercise benefits coronary heart disease. In J. Xiao (Ed.), Exercise for cardiovascular disease prevention and treatment. Advances in experimental medicine and biology, vol. 1000. Springer. https://doi.org/10.1007/978-981-10-4304-8_1

Wang, Y. and Xu, D. (2017). Effects of aerobic exercise on lipids and lipoproteins. Lipids in Health and Disease, 16(132). https://doi.org/10.1186/s12944-017-0515-5

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