NUR 550 Evidence-Based Practice Project Proposal PICOT
Management of teenage depression can be done using non-medication interventions. Teen depression results in long-term psychosocial impairment and continued depressive episodes in adulthood. This project aims to establish if exercise therapy can be used to manage teenage depression. The paper outlines teen depression, its epidemiology, clinical presentation, complications, and diagnosis. The paper also explores literature by developing a PICOT question that is used to search relevant articles from various databases. A synthesis of the literature is then executed and implementation plan stipulated. The implementation plan entails the use of exercise therapy among teenagers as a way of validating that it is effective in managing depression to remission. An evaluation plan is also then outlined explaining how data will be collected and analyzed, measures to take if the project fails and implication of the project to practice. The paper then presents a dissemination plan where various measures like journals, one-on-one meetings, seminars are selected.
Untreated depression in teenagers may result in suicide. A report by Kroning and Kroning (2016) outline that approximately 5% of teens and children have depression at any given time. Depression result in problems like school difficulties, reduced enjoyment of life and difficulty in handling relationships. It has been ranked as one of the leading causes of death among teens in the United States. This paper aims at defining teen depression, outline its epidemiology, clinical presentations, complications, and diagnosis. The paper will also offer a PICOT question.
Defining Teen Depression
Defining depression among teens can only be done by examining the various forms it takes. In teenagers, depression occurs in four different forms. The first one is adjustment disorder with depressed mood which occurs as a response to a life event (Zuckerbrot et al., 2018). A reaction to a school transfer or death of someone dear triggers the adjustment disorder. The symptoms begin a few months after the event and last for six months. The disease interferes with sleep, schoolwork and social functioning. The second form is dysthymia which lasts for more than a year. It presents as irritability, low energy, low self-esteem and a feeling of hopelessness. Four out of every 100 teens qualify for dysthymia and it interferes with learning, socialization and overall function (Zuckerbrot et al., 2018). The third form is a bipolar disorder that presents as episodes of depression followed by periods of mania. The disease increases the likelihood of engaging in risky behavior and it causes mood problems that impair daily functioning, education, and friendships. The last form is severe major depression. Statistics reveal that 8 percent of teens meet the criteria for the disease (Zuckerbrot et al., 2018). Affected teens have persistent sadness and irritability, suicidal ideation and lack of interest in previously enjoyed activities.
Depression among children is below 1% but it rises substantially throughout adolescence. The increased level of depression after puberty is linked to pronounced biological and social changes. According to Breslau et al., (2018), the contributor to depression among teens are puberty and brain and cognitive maturation. The teens face an increased social understanding and self-awareness, increased reported stress levels, and changes in brain circuits dealing with danger and reward responses. The rate of depression increases from 5% to 20% as the teens approach late adolescence (Breslau et al., 2018). Although not consistent, research indicates that depression levels may be slightly higher in low-income and middle-income countries. A unique feature in teen depression is a strong female preponderance. The females face hormonal changes which suggest that depression in puberty can be associated with hormone-brain relations. The estrogen in girls increases the stress levels which in turn sensitize the brain to the harmful effects of stress.
Most depressed teens are sad, primarily irritated and unstable and have emotional outbursts and anger. Research outlines that 80% of depressed teenagers have irritable mood, reduced energy, apathy, psychomotor retardation, marked lack of interest, sleep disorders like oversleeping, feelings of guilt and hopelessness, changes in appetite and weight, difficulty concentrating and isolation (Kroning & Kroning, 2016). Additionally, depression among teens results in poor school performance, suicidal ideation and attempts, low-self-esteem and serious behavioral problems like drug use and abusive alcohol. Generally, the most prevalent symptoms among this group are depressed mood, difficulties in thinking and sleep disorders whereas the most stable symptoms are anhedonia and depressed mood.
Complications arise when depression among teenagers is not managed. The most prevalent risk is the potential for suicide. Research outlines that depression is linked to 90% of complete suicide that results due to a psychiatric illness (Kroning & Kroning, 2016). Those who do not contemplate suicide do not fulfill developmental tasks like learning in school, establishing independence, dating, finding a first job or thinking about long term plans. Depression is associated with lack of motivation, decreased concentration, and low energy and thus teenagers suffering from depression perform dismally in school (Garber et al., 2018). Lastly, teenagers may experiment with alcohol or drugs to handle the miserable feeling brought by depression. They may also adopt destructive behaviors like self-injury, binge eating, and purging.
Re: Topic 2 DQ 2
Population health is determined by ecological, global, and social determinants and factors such as nutrition, genetics, lifestyle, environment, and socioeconomic factors. However, the two key determinants of population health are nutrition and lifestyle (Olshansky, 2017). As a crucial determinant of health, nutrition is perceived in three dimensions: person, family, and community. In rural settings, nutrition is a significant challenge that affects population health as people have limited access to healthy foods. As a result, they are likely to experience calorie deficiency, protein malnutrition, premature deaths, low birth weights, and other issues. Although people have access to healthy foods in the urban regions, they face lifestyle challenges such as less physical activity and obesity due to junk foods (Olshansky, 2017). Environmental pollution influences population health, although the impact is more intensified in rural communities. People in rural regions are more exposed to hygiene, agrochemicals, and insecticides, while those in urban areas are more vulnerable to air and water pollution but are less affected. Health disparity resulting from inequality in household income, gender, and education is another socioeconomic determinant that affects population health (Olshansky, 2017).
The principle of genetics and genomics has also affected population health. For instance, genetic risks can influence the rate of morbidity of a particular disease, such as cancer. Available literature shows that diseases like cancer, Alzheimer’s disease, leukemia, and many others have been associated with genetic risks (Baird, 2017). To properly understand how ecological and global issues, social determinants of health, principles of genetics, and genomes affect population health, the application of translational research is necessary. The reason is that translational research involves four steps in which an issue can be researched, possible interventions examined, and the impact of these recommendations on population health assessed.
Baird, P. A. (2017). The role of genetics in population health. In R. G. Evans, M. L. Barer, & T. R. Marmor (Eds.), Why are some people healthy and others not? (pp. 133-160). Routledge.
Olshansky, E. F. (2017). Social determinants of health: The role of nursing. AJN The American Journal of Nursing, 117(12), 11.
To diagnose teen depression, one must look for five or more symptoms that must last for at least two weeks (Zuckerbrot et al., 2018). The first one is a change in mood or loss of interest in usual activities. Secondly, the symptoms should cause significant distress or impairment in emotional, academic and social functioning. Emotionally teens may cry excessively or become irritable, socially they may withdraw from family and friends or shift in their social network while academically they may perform poorly in school or take longer before completing their school word.
Exploring the Literature
Before initiating research, several considerations are put in place, background questions are considered, like how detailed should the literature search be in breadth and quality level? What study design best fits the research question? Should the patient population include very similar types of patients, or will there be more of a wide real-world variety of participants? Will the intervention be and rendered by a clinical expert, or will there be a combination of tailored interventions provided by a non-clinician with a more comprehensive skill set? (Riva, Malik, Burnie, Endicott, & Busse, 2012). Strategies also are recommended for refining searches by using a controlled vocabulary, truncation, Boolean operators, PICOT (Population/Patient Problem, Intervention, Comparison, Outcome, Time) searching, and search limits. Suggestions for methods of managing resources also are identified (Robb & Shellenbarger, 2014). Using these approaches will assist in more effective literature searches and may help evidence-based practice decisions (Robb & Shellenbarger, 2014)
Among depressed teens (P) in the urban area, is the use of exercise therapy (I) in comparison to bibliotherapy (C) result in better disease remission (O) within six months (T)?
Based on most of the searches, PICOT clinical question could not be fully defined. This was due to complexities in search results that had limited evidence. However, each of the databases contained abundant information that addressed depression management approaches for teenagers diagnosed with mental disorders (Radovic, Gordon & Melvin, 2017). Findings from each of the two articles failed to address the comparison between physical activity and bibliotherapy practices in the management of depression among adolescents. Guided by this argument, search heading was changed to efficacy and acceptability of exercise as a treatment option for adolescent depression when compared to bibliotherapy to identify articles relevant for the topic (Bailey et al., 2018). Conversely, SU Library Search, PubMed, and TRIP databases had numerous published and easily accessible published articles compared to another database. On the other hand, Cochrane, CINHAL and Dynamed libraries were limited on the number of published articles regarding the study topic. It meant that each of the databases could not be used independently to guide evidence on the implementation.
From the findings of the search materials, it is evident that physical activity improves remission in addressing depression among adolescents when compared to bibliotherapy. The magnitude of depression decreases when teenagers engage in group exercise when compared to participating in individual physical activity. This is supported by the premise that group physical activity improves socialization and during these engagements, the teenagers are likely to forget memories that predispose them to depression. However, future search materials need to incorporate studies on different types of physical activities that yield maximum outcomes in the management of depression among the youth.
Selected Study Review
Reasons for the Study
Depression and anxiety are singled out as the most common mental health disorders that readily affects children and adolescents. Different approaches, including pharmacotherapy and non-pharmacotherapy options, exist to manage mental illnesses for the different age groups. The study in the selected article identified the use of bibliotherapy in the treatment of depression among teenagers and how the therapy option result in disease remission (Yuan et al.,2018). Bibliotherapy is a form of psychological therapy which aims at encouraging patients to change unhelpful thoughts and behaviors that causes depression. Bibliotherapy results in improved self-management and reduces the impact of the stigma associated with depression. This study is relevant to the PICOT clinical question as it analyzes bibliotherapy option of care to help in developing a comparison with exercise therapy to guide the decision on implementation of the best approach of care for teenagers with depression.
The article was based on a selection of eight studies which comprised of 979 participants. The participants were children or adolescents (aged 6 to 18 years), and these were enrolled in the primary study (Yuan et al., 2018). The selected group had a diagnosis of anxiety or depression and must have exceeded a predefined threshold as per the author’s definition of anxiety or depressive symptoms. The sample group was randomly selected, and a comparison of the bibliotherapy was made against a control group with no treatment. However, studies were excluded if bibliotherapy was not implemented for the treatment of depression or anxiety. Nonetheless, study articles met the inclusion criteria if they included adolescent patients with comorbid mental health disorders in addition to depression or anxiety. The retrieved articles were relevant to the PICOT clinical question as they resolved divergences related to the non-pharmacotherapy of depression in teenagers.
Clarity and Reliability of the Instruments of the Study
Instruments of the variable used in the research were clearly defined and were reliable to address the PICOT clinical question. The researcher independently identified the parameters for depression and anxiety among the target population. Data were extracted using the PRISMA guidelines whereby five relevant databases were used to predict the patterns of the study outcomes (Yuan et al., 2018). These databases included Embase, Web of Science, PubMed, PsycINFO, and Cochrane. Ideally, the issue related to the use of bibliotherapy in managing depression for teenagers was clearly defined. This mainly focused on treating depression or anxiety and the prevention of relapse after therapy. The outcomes from the databases mentioned above varied based on the settings or clinical condition of the patients, and this reflected the impact of bibliotherapy in addressing patients diagnosed with depression.
Analysis of Data
Data from different databases were analyzed using the DerSimonian and Laird random-effects model for the interpretation of meta-analysis. Using this framework, the heterogeneity of the outcomes was evaluated using the Q statistic and I2 statistic to estimate the variation in side effects. However, risk ratios (RRs) was used in the analysis of dichotomous measure outcomes for the treatment of the teenagers in the intervention that incorporated bibliotherapy (Yuan et al., 2018). Nonetheless, the publication bias of the selected articles was examined using the funnel plot method as well as the Egger regression asymmetry test.
Unusual Events during the Study
No unusual event was noted considering that the research involved the analysis of peer-reviewed literature materials. Due to this, no consequences will be identified in case the researcher intends to replicate the study. In other words, the variables of the study will remain unchanged, and the expected outcomes of behavior change guide the implementation process for the replicated study (Yuan et al., 2018). However, the setting for the replication of the study is likely to change, considering that the approach may apply to different population group or gender in a bid to address depression.
How results fit in with previous research in the area of study
The outcomes fit in previous research as it focuses on the intention to treat population under study. The results build on findings from other reviews about the non-pharmacotherapy options in providing care to patients diagnosed with psychiatric problems. Since the analysis incorporated findings from bibliotherapy studies, it was possible to predict the positive treatment outcome using the approach (Yuan et al., 2018). The experiences of the target population were also consistent with findings presented by other researchers to affirm the benefits of using bibliotherapy for depression or anxiety in adolescent patients.
Implications of the research for Clinical Practice
Findings revealed bibliotherapy as an effective psychotherapy option in managing depression among adolescents. However, the long-term effects of the therapy are unjustifiable, implying that the approach cannot be used as a standalone method in addressing anxiety or depression among teenagers. Besides, the level of support of bibliotherapy for clinical practice is challenged by the premise related to treatment adherence (Yuan et al., 2018). In other words, patients are likely to forget self-help interventions administered through bibliotherapy, considering that individuals rely on written materials and other electronic media to practice behavior change. This can lead to a delay in help-seeking behavior of patients.
Depression is one of the leading mental disorders affecting teens. The burden of this mental disorder has led to considerable concern, and hence finding the best intervention for the management of depression is very crucial. As such, I have decided to conduct a study analyzing the effectiveness of exercise therapy and bibliotherapy in managing diabetes. A study by Das et al. (2016) on the review of mental health interventions reported that exercise therapy was the most effective intervention in reducing depression and improving self-esteem among adolescents. Moreover, another study conducted by Arat and Wong (2017) on the relationship between physical activity and mental health found out that adolescents who engaged in physical activity had a low prevalence of mental health problems such as depression. Some of the activities assessed in the study included exercise for 60 minutes, walking and riding a bicycle at least once a week.
On the contrary, based on my research question, a study carried out by Jacob and De (2016) reported that taking in the properly based bibliography intervention among adults is effective in reducing the symptoms of depression. The study was, however, limiting as it only analyzed the response among female adolescents. Generally, very few studies have compared the effectiveness of physical exercise to bibliotherapy in the management of teen depression.
Factors which relate to the safety of the patient, quality of care provided, and evidence-based practice are driving changes to the healthcare. The current nursing profession concerned majorly in moving good evidence into practice to optimize the patient’s outcomes. In my research, most evidence recommends the use of exercise therapy in better disease remission among teenagers suffering from depressive symptoms. As such, I will utilize multiple models of implementing my evidence into practice. My implementation plan will be made up of 8 steps incorporating the Stetler model as follows (Cheron et al., 2019):
Step 1: Preparation- purpose, context, and research sources of evidence.
This step identifies the purpose of the research. My research question is meant to solve a significant healthcare concern based on the recent finding of showing the increased burden in managing depression among adolescents.
Step 2: Identification of stakeholders who will be involved in the implementation process.
This step is crucial as it gives an insight of those who need to be prepared for the change and enhance its outcome. Both external and internal stakeholders will be involved in the implementation of my project into practice (Cheron et al., 2019). The internal stakeholders will include physicians, pharmacists, psychiatrists, physiotherapists, and nurses, who serve as primary caregivers. On the other hand, external stakeholders include mainly the patient who will give feedback on the effectiveness of the intervention.
Step 3: Identification of the practice change that has proven to be the most effective through research.
Given that depressive symptom among teenagers has become a global concern, most healthcare providers have proposed the use of CBT. However, recent studies have reported that the most effective intervention in managing depression among teenagers is through exercise therapy (Arat, & Wong, 2017). Studies show that teenagers who exercise frequently have a low prevalence of depression, among other mental disorders (Das et al., 2016).
Step 4: Identification of potential barriers and how to deal with them.
This is an important step, especially in shaping the practice outcome. The most significant challenge in implementing exercise therapy is a lack of adequate knowledge on the specific exercises for different mental conditions (Das et al., 2016). As such, patients suffering from depression need to be educated on the type, extent, and duration of the exercise they need to engage themselves in for effective outcome.
Step 5: Effective dissemination of information.
Effective communication of the practice, including its benefits over the existing ones, and how to make it even more productive is very crucial in both the preparation and adoption of the practice change.
Step 6: Implementation of the practice.
Once stakeholders are fully aware of the practice, I will immediately implement the use of the intervention, starting by a small group of teenagers, recommending it as the most effective way of managing depression.
Step 7: Evaluation of the impact of the practice.
It is essential to clarify the expected outcome based on actual evidence of the success of the practice in the past. Consequently, I will consider the cost benefits of the intervention over the commonly used in managing depression. Most importantly, the best way to evaluate the change will be through feedback from the patients through filling out questionnaires.
Step 8: Identification of ways of sustaining the change in practice.
The practice will be sustained better by continues mass education on how to use exercise therapy and its benefits. Once the healthcare system has realized the positive outcome of the practice, it will automatically be accepted widely.
With all the implementation steps in order, I believe that the practice will be effectively introduced into practice with a positive outcome.
After the implementation of an intervention program, it is ideal to have a process evaluation plan to help in documenting the intervention characteristics and elicit information pertaining the barriers and facilitators of intervention components (Harvey & Kitson, 2015). The project aims at implementing an exercise-based therapy among adolescents to help them cope with depression. The evaluation plan will determine whether the project has achieved its objectives which is getting a full remission from depressed adolescents. The first step will be comparing data of depressed adolescents seen before implementation and six months after the project implementation. The figure obtained will indicate whether the number of depressed adolescents has reduced. Data will also be assessed on the number of adolescents who have achieved full remission before and after the project implementation. The data will be analyzed using an excel sheet because it is easy to update for the project stakeholders collecting the data (Hopkins, 2017). Additionally, results from an excel sheet are easy to synthesize and categorize enhancing the ability of the researcher to offer concrete quantitative data to the stakeholders.
Secondly, the patients will fill out questionnaires and provide feedback on the project impact. The questionnaire will assess the satisfaction level with the new program, the challenges faced when adopting the exercise routines and opinions on how to improve the program (Royse, Thyer & Padgett, 2015). The evaluation will also look at the stakeholder’s commitment and availability of resources will indicate the commitment of the hospital management. In terms of reliability, the program should achieve its set objective which is increasing remission among depressed adolescents through exercise therapy. The project should also cut down the cost compared to other previously used interventions. The validity, on the other hand, will be outlined by accurate and consistent results similar to those established by other researchers (Royse, Thyer & Padgett, 2015). Applicability of the project will be indicated by the increased use of exercise therapy in handling teenage depression.
In an event that the project will not meet its objectives, the root causes of the poor results will be established and an assessment of available resource done to set the way forward (Creasy, 2017). The project stakeholders and mental health nurses will work together to find out the reasons behind the negative impact. An evaluation will be executed to establish if the project was implemented with quality as well as if the employed technique was appropriate for managing depression among adolescents. Lastly, to ensure that the evaluation report is not biased, the evaluation measures and strategies will be reviewed to ensure that they are valid and appropriate.
Once the project results are positive, exercise therapy will be set as an option for managing depression among teenagers. A policy will also be drafted to help the mental health nurses in implementing exercise therapy and using it in their daily practice. In terms of practice implication, the project to practice is to empower mental health nurses with guidance on how to promote exercise among depressed adolescents (Harvey & Kitson, 2015). Positive results will help in making exercise therapy a first-line treatment for mild or moderate depression in primary care. The exercise regime used will be sustained beyond the period of treatment to prevent relapse and deliver considerable physical health benefits.
PICOT (Population/Problem, Intervention, Comparison, Outcome, and Time to achieve the outcome) is a method that helps clarify the qualities needed to create a good question out of a practice issue or problem affecting a population of focus.
The goal of this assignment is to finish your PICOT for your chosen nursing practice problem. To complete this assignment, refer to your “Evidence-Based Practice Project Proposal: Identification of Nursing Practice Problem” assignment from Topic 1. Include revisions to your nursing practice problem or PICOT in this assignment if necessary. The final PICOT you create for this assignment will serve as the foundation for your evidence-based practice project proposal. To complete this assignment, use the “PICOT-Final” template.
Recognizing an ethical standard that respects community autonomy is critical for public health. This standard can be met by requiring community collaboration (for example, by establishing a community advisory board) to protect vulnerable populations, ensure fair terms of cooperation, confirm that the interventions to be tested are acceptable to community members, and reduce potential misunderstandings about the research. Such community advisory boards should determine whether the research objectives are valuable to local residents and whether the methods are acceptable before approving the research (Buchanan & Miller, 2006).
Social injustice is a critical ethical concern in this era of translational research. The issue of social injustice and disparity arises when resource-rich countries conduct translational medical research in resource-poor countries. One example is research on rare diseases, where the resulting intervention/product is prohibitively expensive to implement in developing countries (Mandal et al., 2017).
For an overview of the evidence-based practice project proposal assignments, see the “Evidence-Based Practice Project Proposal – Assignment Overview” document.
You are required to cite at least four peer-reviewed sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and nursing content.
While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
You are not required to submit this assignment to LopesWrite.
Also Check Out: NUR 590 Strategies For Disseminating EBP Project
Topic 3 DQ 1
Discuss the ethical guidelines that would need to be implemented when conducting translational research. What are the ethical and legal considerations related to translating research into practice? Discuss what steps you would take as a member of a translational research team in order to establish ethical guidelines for conducting translational research.
Topic 3 DQ 2
Discuss the role of the Institutional Review Board. Discuss ethical research considerations specific to population health. How are respect for the persons, potential benefits and burdens of the research, and justice kept in balance? Provide an example.
Topic 3 Participation
Topic 3: Translational Research Framework and Legal and Ethical Considerations
- Discuss ethical guidelines for conducting translational research.
2. Examine ethical considerations related to translating research into practice .
3. Examine legal considerations related to translating research into practice.
4. Discuss ethical research considerations specific to population health.
Advanced Practice Nursing: Essential Knowledge for the Profession
Read Chapter 26 in Advanced Practice Nursing: Essential Knowledge for the Profession.
Population Health: Creating a Culture of Wellness
Read Chapter 10 in Population Health: Creating a Culture of Wellness.
A Few Ethical Issues in Translation Research for Gene and Cell Therapy
Read “A Few Ethical Issues in Translation Research for Gene and Cell Therapy,” by Riva and Petrini, from Journal of Translational Medicine (2019).
The Underappreciated and Misunderstood PICOT Question: A Critical Step in EBP Process
Read “The Underappreciated and Misunderstood PICOT Question: A Critical Step in EBP Process,” by Gallagher-Ford and Melnyk, from Worldviews on Evidence-Based Nursing (2019).
Life After PICOT: Taking the Next Step in a Clinical Inquiry Project
Read “Life After PICOT: Taking the Next Step in a Clinical Inquiry Project,” by Granger, from AACN Advanced Critical Care (2020).
The Belmont Report
Read “The Belmont Report,” by The National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, located on the U.S. Department of Health and Human Services website (1979).
PICO: A Model for Evidence-Based Research
View “PICO: A Model for Evidence-Based Research,” by Binghamton University Libraries, located on YouTube (2017).
What is Evidence-Based Practice?
View “What is Evidence-Based Practice?” by Lippincott NursingCenter.com, located on YouTube (2016).
Course Code Class Code Assignment Title Total Points
NUR-550 NUR-550-O503 Evidence-Based Practice Project Proposal: PICOT 75.0
Criteria Percentage Unsatisfactory (0.00%) Less Than Satisfactory (80.00%) Satisfactory (88.00%) Blank (92.00%) Blank (100.00%)
Population (Revision) 7.0% The population is not described, or the required revisions were not made for the population description. NA Revisions were made accordingly for the population description, but some information or detail is needed for accuracy or clarity. NA The population is thoroughly and accurately described. No revision was needed.
Intervention (Revision) 8.0% The proposed intervention is not described, or the required revisions were not made for the described intervention. NA Revisions were made accordingly for the proposed intervention, but some information or detail is needed for accuracy or clarity. NA The proposed intervention is clearly described and relevant to the nursing practice problem and population. No revision was needed.
Comparison 10.0% A description of the comparison information is not included. A description of the comparison information is incomplete or incorrect. A description of the comparison information is included but lacks evidence and measurable outcomes. A description of the comparison information is complete and includes sufficient evidence and measurable outcomes. A description of the comparison information is extremely thorough with substantial evidence and measurable outcomes.
Outcome 10.0% A description of the outcome is not included. A description of the outcome is not included. A description of the outcome is included but lacks evidence. A description of the outcome is complete and includes sufficient evidence. A description of the outcome is extremely thorough with substantial evidence
Timeline 10.0% A description of the timeline is not included. A description of the timeline is incomplete or incorrect. A description of the timeline is included but lacks evidence. A description of the timelines is complete and includes sufficient evidence. A description of the timeline is extremely thorough with substantial evidence.
PICOT 20.0% The PICOT statement is omitted. The PICOT statement is incomplete. The PICOT statement is presented but there some inaccuracies. The PICOT statement is presented. Some detail is needed. The PICOT statement concisely and accurately describes the problem.
Problem Statement 20.0% A problem statement is not included. The problem statement is incomplete. The problem statement is generally presented. There are some inaccuracies. More support is needed to justify or rationalize the problem. The problem statement is presented. Adequate support is provided to justify or rationalize the problem. The problem statement concisely describes the issue using strong support to rationalize and justify the problem.
Required Sources 5.0% Sources are not included. Number of required sources is only partially met. Number of required sources is met, but sources are outdated or inappropriate. Number of required sources is met. Sources are current, but not all sources are appropriate for the assignment criteria and nursing content. Number of required resources is met. Sources are current and appropriate for the assignment criteria and nursing content.
Documentation of Sources (citations, footnotes, references, bibliography, etc., as appropriate to assignment and style) 5.0% Sources are not documented. Documentation of sources is inconsistent or incorrect, as appropriate to assignment and style, with numerous formatting errors. Sources are documented, as appropriate to assignment and style, although some formatting errors may be present. Sources are documented, as appropriate to assignment and style, and format is mostly correct. Sources are completely and correctly documented, as appropriate to assignment and style, and format is free of error.