Reply to 2 peers and provide them each with a potential or actual study using  a mixed method design to address their practice challenge.  Be sure to provide citations.

For week 2, you will add the following content to your formal literature synthesis based on the practice challenge you described last week.

1. Define problem statement, hypothesis, and PICOT statement. Cite resources

A problem statement is developed by the researcher and identifies a potential problem that is relevant to practice. A hypothesis is a fundamental explanation based on limited data and observation that serves as a foundational starting point with which to proceed with further investigation. PICOT stands for Population (P), Intervention (I), Comparison (C), Outcome (O) and Time-frame (T) of intervention. A PICOT statement is a reliable “formula” for producing answerable, researchable questions (Polit & Beck, 2017).

2. Develop a problem statement, potential hypothesis, and potential PICOT statement based on your practice challenge.

Nursing staff shortages impact patient care as well as the nurses who provide the patient care. Nurse staffing needs vary depending on acuity, day or night shift, procedures, and any number of unforeseen events. Short staffing jeopardizes not only the patients but the license and health of the nurses as well. A potential hypothesis regarding this topic may be that if nursing staffing was improved, the occurrence error related patient incidences. The population affected in this PICOT statement is the patients. The intervention in this PICOT statement is that the nursing staffing levels can be increased to alleviate the shortages. The comparison will be a hospital that remains at lower staffing levels. The outcome will be the number of nurse retention compared in both hospitals. The comparison time will be one year.

3. Identify potential (ones you make up) or actual studies using 2 different methodologies (qualitative and quantitative). Be sure to provide citations. 

A qualitative study that evaluates the patient effects of nurse short staffing is study performed by Clark, P. A., Leddy, K., Drain, M., & Kaldenberg, D. “state nursing shortages and patient satisfaction: more RNs—better patient experiences” (2007). In this study, the do a qualitative analysis on the quality of patients care and the correlation between adequate nursing staffing.

A quantitative study that evaluates the patient effects of nurse short staffing is “nurse staffing and patient outcomes: a longitudinal study on trend and seasonality by He, J., Staggs, V. S., Bergquist-Beringer, S., & Dunton, N. (2016). In this study He performed a longitudinal study based off quarterly unit-level nursing data in 2004–2012 were extracted from the National Database of Nursing Quality Indicators (NDNQI).

Second Post

The opioid misuse and abuse has become an epidemic nationwide. There has been a 30 percent increase in overdoses in the U.S. from July 2016 through September 2017. (Centers for Disease Control and Prevention, 2018) To be able develop a solution for this epidemic, the problem must be identified. To identify the issue, a problem statement and hypothesis needs to be created. This will better identify the problem and study the cause behind the issue.

“A problem statement presents the idea, issue, or situation that the researcher intends to examine in the study” (Trice & Bloom, 2015 p. 128). The problems statement sets the foundation for the researcher. To further describe the problem statement, the PICOT format is used to clarify “more fully the population of the study as well as the intervention/comparison of interest, the outcome desired, and the time framed involved” (Trice & Bloom, 2015 p. 130). PICOT format stands for P) population of the subjects in the study I) treatment that will be provided in the study C) comparison of the control group to the one in the study O) outcome that is being measure to test the effectiveness of the intervention T) time; the duration of the data collection. (Riva, Malik, Burnie, Endicott, & Busse, 2012) Along with a problem statement, a hypothesis is needed to put a “question into a form that can be tested” (Trice & Bloom, p. 134). A hypothesis will allow the researcher to make a proposition regarding the issue pertaining to the problem statement chosen.

Problem statement: The opioid epidemic is costing thousands of American lives annually.

Hypothesis: If a person is started on narcotics at an earlier age than 21 years, they are more likely to be addicted to narcotics than those not started after 21 years of age.

PICOT:

P) Population: addicts; those addicted to narcotics

I) Intervention: safe prescribing (not prescribing narcotics under the age of 21)

C) The difference between addicts who received narcotics before the age of 21 vs the addicts who were given narcotics after age 21.

O) fewer addicts and overdoses

T) time of my data collection

The Centers for Disease Control and Prevention(CDC) analyses data using the National Vital Statistics System (NVSS). The CDC “combined the natural, semi-synthetic, and synthetic opioid categories (including methadone) when reporting deaths involving opioid analgesics, also referred to as prescription opioids” (Centers for Disease Control and Prevention, 2017). In 2016, there has been 32,445 reports deaths involving opioids, averaging 89 deaths per day. From 2015, reported deaths have increased by 9,847 annually. A large amount of these deaths are not correlated with prescription opioids but to illegally-made fentanyl. The NVSS data does not differentiate between prescription drugs and illegally-made.

“Every ‘Never’ I Ever Said Came True”: Transitions from opioid pills to heroin injecting is a qualitative study “documents the pathways to injecting heroin by users in Philadelphia and San Francisco before and during a pharmaceutical opioid pill epidemic” (Mars, Bourgois, Karandinos, Montero, & Ciccarone, 2014). Data was collected by interviewing the drug dealers and observing the addicts behavior. The study include Philadelphia and San Francisco due to the “contrasting political economies, immigration patterns and source type of heroin” (Mars, Bourgois, Karandinos, Montero, & Ciccarone, 2014). It was determined in this study that heroin users in both cities began using heroin after they became addicted to prescription pills. They switches to heroin due to the availability being more accessible.

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