Professional blog

Topic Search Strategy: Uncontrolled Asthma in Children

Clinical Question

A PICOT question in nursing aids on the formulation of a clinical question and thus guide the search for evidence. Notably, according to Bethany (2019), PICOT is an acronym for the population (P), intervention (I), comparison (C), outcome (O), and time (T). The members in my team were focused on the identification and evaluation of various pieces of evidence guided by the PICOT on the issue of children with hospital admissions for uncontrolled asthma. Notably, the problem of uncontrolled asthma is a profound one, especially for neonates as well as the other children and teens. According to the Centers for Disease Control and Prevention (CDC) (2019), pediatric asthma affects 4-12 percent of women, especially those in their childbearing years. Additionally, asthma in children and adolescents who are aged between 5 and 17 years is responsible for a total loss of 10 million school days each year (CDC, 2019). Moreover, the costs of caretakers for pediatric asthma is $726.1 million per year due to work absence (Engelkes et al., 2015). For children, asthma is not only detrimental to the health and wellbeing of children but can also lead to fatalities.

My PICOT question in support of the group topic is: in children and teens aged between 0-17 years (Population/patient) what is the impact of asthma education (Intervention) to expectant mothers compared to medications (Comparison) on the prevention of hospital admissions for uncontrolled asthma (Outcomes) over a one-year period (Time). As such, the purpose of the paper is to investigate the impact of asthma education and self-management strategies to the application of medications in the prevention of hospital admissions for uncontrolled asthma among neonates and teens. The comparison of the two interventions helps in the determination of the most effective one and hence lead to evidence nursing practice. Additionally, it will help in the discovery of new ways in which uncontrolled asthma can be managed, especially in children and teens.

Levels of Evidence

The level of evidence required for addressing the question enables a researcher to search for the most appropriate and quality evidence. The type of question I am asking is which intervention is more effective between the provision of asthma education and self-management interventions to the pregnant mothers and the provision of asthma medications to children in the prevention of hospital admissions arising from the condition. As such, I am seeking to compare the two therapies and determine which one should be used. The best type of evidence which can be used to answer the question is the randomized controlled trial (RCT). RCT falls under level 1 of the level of evidence (LOE), which provides studies of good quality (Dang & Dearholt, 2017). Notably, a RCT is a comparative, prospective experiment that is conducted under controlled conditions (Bhide, Shah, & Acharya, 2018). The allocation of the interventions is done in a random approach to the comparison groups. Additionally, a RCT is effective in evaluating the relationship between an intervention and outcome. A RCT is a quantitative design which we used will tell whether the use of education outweighs the adoption of pharmacological therapies in the prevention of hospital admissions from uncontrolled asthma in newborns and teens.

Search Strategy

The search for the different articles and resources which I used to respond to the clinical question was done in different databases via the use of key terms and phrases. In specific, I used search terms such as “education in the management of neonate asthma,” “self-management interventions for pediatric asthma,” “pharmacological interventions of asthma in newborns,” “effectiveness of education of expectant women in the prevention of asthma in newborns,” “education versus medications in the prevention of asthma in children and teens.”  One of the key databases that I used is the Agency for Healthcare Research & Quality (AHRQ). In specific, the AHRQ database uses various quality indicators in the determination of the standards of quality healthcare and whether healthcare facilities meet those standards. Additionally, Google Scholar was used in exploring the numerous studies which have been published on the subject matter of preventing hospital admissions from uncontrolled asthma in children and teens. The AHRQ will provide the provider-level indicators which should be monitored to ensure that avoidable hospitalizations are prevented.

I made various decisions in refinement to get the required articles down to a reasonable number for review. One of those was the inclusion and exclusion criteria. In specific, the studies had to deploy randomized controlled trials. Additionally, they had to be published less than ten years ago. Furthermore, they had to be relevant to the clinical issue. Using such limits ensured that the articles were filtered with the most relevant and recently published ones being used. Using the limits ensured that the only articles which came up were those that were of high quality and could provide relevant information about the clinical issue. In my next paper and the group’s work, two articles will provide guidance. One of those is Rice et al. (2015)’s “LEAP: A randomized–controlled trial of a lay-educator inpatient asthma education program.” The other article is “Management based on exhaled nitric oxide levels adjusted for atopy reduces asthma exacerbations in children: a dual centre randomized controlled trial” by Petsky et al. (2015). The choice of these two articles is based on their ability to conduct RCTs in evaluating whether education and medications are effective in the prevention of unavoidable hospitalizations of newborns with uncontrolled asthma.

Conclusion

Evidence-based practice allows for the use of interventions which have been proven and found effective in addressing various conditions. My team focused on the identification of the interventions which could be used to prevent avoidable hospitalizations of children and teens with uncontrolled asthma. I conducted a literature search of research studies which addressed my clinical questions, which is on addressing uncontrolled asthma. The articles which could help in the clinical question were RCTs, which fall under the level I of evidence. Using such a level of evidence helped in getting quality and relevant articles. The search used key terms/phrases and was done on the AHRQ and Google Scholar databases. Two articles were chosen, which were relevant and those which provided appropriate information for the clinical issue. The proposed study will provide evidence-based practice interventions for the prevention of avoidable hospitalizations of neonates and teens with uncontrolled asthma.