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Problem Statement

Healthcare systems across the globe continue to grapple with issues that compromise patient safety and long-term wellness, three of which are hand hygiene compliance in hospital settings, rising childhood obesity linked to screen time, and inadequate glycemic control among adults with T2DM. Hand hygiene is essential to infection prevention in healthcare, yet professionals seldom follow it. Inconsistency increases healthcare-associated infections (HAIs), which raise patient morbidity, death, and healthcare expenses. Although prevalent, traditional observational audits are hampered by the Hawthorne effect, where healthcare professionals momentarily increase performance while monitored. Bruchez et al. (2020) found that electronic hand hygiene monitoring systems eliminate observer bias and give real-time feedback to improve compliance rates.

Childhood obesity is a growing public health concern, and excessive screen time has emerged as a significant contributing factor. Screen usage increases obesity risk due to sedentary activity, inconsistent sleep cycles, and bad eating habits. A comprehensive study by Haghjoo et al. (2022) identified a dose-response connection between screen time and childhood and teenage obesity. Children who spend more time on digital gadgets are more likely to acquire obesity-related diseases, including T2DM and cardiovascular disease.

In adults with T2DM, suboptimal glycemic control remains a critical issue despite advancements in pharmacotherapy. Diet, exercise, and behavioural support are commonly advised but seldom done in conventional treatment. Goyal Mehra et al. (2022) demonstrated that organized lifestyle regimens can lower HbA1c levels by 2% compared to medicine alone. The American Diabetes Association (2022) stresses that long-term glycemic management prevents neuropathy, nephropathy, and cardiovascular disease.

Improved PICOT Questions and Supporting Evidence

Intervention PICOT Question

In hospitalized adult patients (P), how does the use of electronic hand hygiene monitoring systems (I) compared to traditional observational audits (C) affect hand hygiene compliance rates (O) within 6 months (T)?

Population of Interest: The population includes hospitalized adult patients in acute care settings at increased risk for healthcare-associated infections (HAIs). Healthcare workers' hand cleanliness, which prevents infections, indirectly affects these patients.

The intervention of Interest: The intervention involves implementing electronic hand hygiene monitoring systems. Sensors in these systems detect hand hygiene incidents in real-time and notify healthcare practitioners. They aim to promote accountability and consistent hand hygiene behaviour without the limitations of direct observation.

Evidence: Evidence substantiates the efficacy of electronic monitoring devices in enhancing hand hygiene compliance. A research by Bruchez et al. (2020) examined the Hawthorne effect in an intensive care unit (ICU) and found that observer presence in standard observation methods increases compliance rates. Electronic monitoring offered objective and continuous data, leading to more accurate and lasting hand hygiene improvements. The study found that observational audits alone might mislead and fail to modify behaviour.

Comparison of Interest: The comparison involves traditional observational audits, where trained personnel manually record hand hygiene practices. These audits are widespread yet biased and lack electronic system uniformity.

Outcome of Interest: The desired result is improved hand hygiene compliance rates, which are measurable using system-generated electronic reports. Tracking and comparing quantitative data is possible with these reports. Bruchez et al. (2020) found that electronic monitoring systems accurately recorded hand hygiene incidents.

Timeframe: The electronic monitoring system will be implemented and assessed over six months. This timeframe provides for training, clinical workflow integration, and post-intervention data gathering.

Etiology PICOT Question

Are school-aged children (P) who have high screen time exposure (I) compared to those without excessive screen time (C) at increased risk for obesity (O) over a 12-month period (T)?

Population of Interest: In a vital developmental stage, school-aged children between 6 and 12 years old are vulnerable to environmental and behavioural impacts on weight and health.

Intervention of Interest: The intervention relates to non-educational screen use of more than two hours each day (TV, tablets, cellphones, and video games). Screen time promotes sedentary lifestyles and poor diets.

Evidence: Haghjoo et al. (2022) conducted a systematic review and dose-response meta-analysis, concluding that increased screen time significantly raises the risk of overweight and obesity in adolescents. Screen duration was positively correlated with BMI, confirming that children with more excellent screen time are more likely to develop obesity-related health issues. The results emphasize the need for screen limits as a preventative measure.

Comparison of Interest: The comparison group includes youngsters who watch less than one hour of TV every day. These kids are more active and have regular sleep and eating habits, which help them stay healthy.

Outcome of Interest: The main effect is increased obesity risk, which may be objectively quantified using age-adjusted BMI percentiles, as suggested by the CDC. Childhood obesity risk assessment using BMI is reliable and commonly used.

Timeframe: Screen use and obesity development are tracked for 12 months to observe screen-induced weight and behaviour changes.

Prognosis/Prediction PICOT Question:

For adult patients with type 2 diabetes (P), how does participation in a structured lifestyle modification program (I) compared to standard care alone (C) influence long-term glycemic control (HbA1c levels) (O) over 12 months (T)

P opulation of Interest: The population includes adult patients diagnosed T2DM, typically aged 30–65 years. These patients need long-term glycemic treatment to avoid cardiovascular disease, neuropathy, and nephropathy.

The intervention of Interest: The lifestyle change approach includes individualized nutrition planning, progressive exercise, and behavioural support. This comprehensive, patient-specific strategy promotes prolonged glucose control.

Evidence: Goyal Mehra et al. (2022) conducted a retrospective study showing that patients who participated in a multi-interventional lifestyle program experienced significant reductions in HbA1c, fasting blood sugar levels, and weight. The study suggests tailored, systematic lifestyle treatments are better than broad advice or education for controlling T2DM.

Comparison of Interest: Standard care includes pharmaceutical therapy and short counselling or lifestyle suggestions without continuous assistance for the comparison group. Standard care may help with short-term glycemic control but lacks involvement and structure for long-term success.

The outcome of Interest is long-term glycemic control, measured by HbA1c levels. HbA1c is the gold standard for diabetes, showing two—to three-month average blood glucose levels. The test is trustworthy and verified, making it a suitable intervention efficacy indicator.

Timeframe: The implementation and follow-up period is 12 months, allowing for adequate time to implement lifestyle changes and monitor trends in glycemic control across quarterly HbA1c assessments.

Conclusion

In conclusion, developing well-structured PICOT questions is essential in guiding evidence-based nursing practice and improving patient outcomes. This paper addresses three clinical questions—hand hygiene compliance in hospitals, screen time and childhood obesity, and lifestyle modification and T2DM glycemic control—highlighting the importance of targeted interventions supported by research. Each PICOT question was specific, quantifiable, and related to healthcare issues. Nurses and healthcare professionals may critically assess interventions, adopt evidence-based adjustments, and track their efficacy using the PICOT framework. Each intervention is supported by substantial literature, demonstrating the usefulness of research-based practice.

References

Bruchez, S. A., Duarte, G. C., Sadowski, R. A., Custódio da Silva Filho, A., Fahning, W. E., Belini Nishiyama, S. A., Bronharo Tognim, M. C., & Cardoso, C. L. (2020). Assessing the Hawthorne effect on hand hygiene compliance in an intensive care unit. Infection Prevention in Practice, 2(2), 100049. https://doi.org/10.1016/j.infpip.2020.100049

Goyal Mehra, C., Raymond, A. M., & Prabhu, R. (2022). A personalized multi-interventional approach focusing on customized nutrition, progressive fitness, and lifestyle modification resulted in the reduction of HbA1c, fasting blood sugar and weight in type 2 diabetes: a retrospective study. BMC Endocrine Disorders, 22(1). https://doi.org/10.1186/s12902-022-01212-2

Haghjoo, P., Siri, G., Soleimani, E., Farhangi, M. A., & Alesaeidi, S. (2022). Screen time increases overweight and obesity risk among adolescents: a systematic review and dose-response meta-analysis. BMC Primary Care, 23(1). https://doi.org/10.1186/s12875-022-01761-4