| Course | NUR 550 Evidence-Based Practice and Scholarly Inquiry |
|---|---|
| Module | Module 2 |
| Paper type | PICOT question development (paper) |
| Length | About 1,060 words, 6 pages |
| Format | APA 7 student paper |
| School | Southern New Hampshire University |
| Program | MSN |
| Updated | September 2026 |
Free sample paper for NUR 550 Module 2
From "Our Patients Get Confused" to a Searchable Question: Developing a PICOT Question on Delirium Prevention
[Student Name]
Southern New Hampshire University
NUR 550: Evidence-Based Practice and Scholarly Inquiry
PICOT Question Paper
[Instructor Name]
[Date]
The organization, setting and figures below are a composite written as a model document. No real employer, client, colleague or patient is described.
From "Our Patients Get Confused" to a Searchable Question: Developing a PICOT Question on Delirium Prevention
A good clinical question does two jobs. It tells the searcher where to look, and it tells the team what to measure. The PICOT format, population, intervention, comparison, outcome and time, does both when each element is specific (Melnyk & Fineout-Overholt, 2023). This paper develops a PICOT question for the problem introduced in Module 1, delirium among older patients on a 30-bed medical unit. It shows that the question only became answerable once the intervention was defined as a bundle of named nursing actions and the outcome was tied to a validated screening tool, and it explains why the 4AT was chosen over the Confusion Assessment Method for this unit.
Three Drafts
The first draft read: "Does delirium prevention help older patients?" It names a topic, not a question. It has no population boundary, no defined intervention, no comparison and no measurable outcome; a search built from it returned thousands of irrelevant records.
The second draft read: "In elderly inpatients, does nursing care reduce confusion?" It is closer, but elderly and inpatients are too broad, nursing care could mean anything, and confusion is not a measurable outcome. Two nurses reading it would have designed different projects.
The third and final draft is: In hospitalized adults aged 70 and older on an acute medical unit (P), does a nurse-led multicomponent delirium prevention bundle of orientation, early mobility, non-drug sleep support, hydration and use of glasses and hearing aids (I), when set against the unit's current usual care (C), lower the share of patients who screen positive for delirium on the daily 4AT (O) during the hospital stay (T)?
Justifying Each Element
Population. Adults 70 and older were chosen because delirium risk rises steeply with age and because the unit's audit covered this group. Limiting the question to an acute medical unit excludes intensive care and surgical settings, where causes and interventions differ.
Intervention. Naming the five components turns an idea into something that can be searched, taught and audited. The components reflect the risk factors that multicomponent programs target, and the Cochrane review of non-intensive care patients found that such programs, taken together, probably reduce delirium incidence (Burton et al., 2021). The word nurse-led signals who will deliver it on this unit.
Comparison. Usual care is the honest comparison for a unit that currently has no structured prevention. Describing usual care during the project will matter, since some units already do parts of the bundle informally.
Time. The hospital stay is the natural window, since delirium prevention acts during admission. Longer follow-up would be valuable but is beyond the unit's reach.
Choosing the Outcome Measure
The outcome needed the most thought, because delirium that is not detected cannot be counted. Two validated tools were considered. The Confusion Assessment Method (CAM) calls delirium present when a sudden, fluctuating change comes with poor attention plus one of two further features, jumbled thinking or an unusually drowsy or keyed-up state. Compared with psychiatrists' diagnoses in its original validation, it showed sensitivity of 94% to 100% and specificity of 90% to 95% (Inouye et al., 1990). Its accuracy depends on a structured cognitive assessment and trained raters.
The 4AT is a four-item test designed for busy clinicians that requires no special training. A meta-analysis of 17 studies found pooled sensitivity and specificity of 0.88 each (Tieges et al., 2021). Table 1 compares the tools for this unit.
Table 1
Comparing Two Delirium Detection Tools for Daily Unit Screening
| Feature | CAM | 4AT |
|---|---|---|
| Original or pooled accuracy | Sensitivity 94-100%, specificity 90-95% in original validation | Pooled sensitivity 0.88, specificity 0.88 across 17 studies |
| Training | Needs training and a cognitive assessment to score reliably | Designed for use without special training |
| Time | Several minutes with the underlying assessment | About two minutes |
| Fit with a busy night shift | Harder to sustain daily | Easier to complete on every older patient |
The 4AT was chosen. The CAM's accuracy was higher in its original, carefully controlled validation, but a screening tool used once daily by every nurse on every shift must be practical, and a less demanding tool used consistently will detect more delirium than a better one used occasionally. The decision is a trade-off, and the project will check a sample of 4AT results against CAM assessments by the unit's clinical nurse specialist.
Secondary Outcomes and What the Question Leaves Out
A single outcome keeps the question answerable, but the team will want to know more than delirium incidence. Falls are the obvious secondary outcome, since most of the unit's falls in the audit involved confused patients, and pooled results from Hospital Elder Life Program sites showed falls dropping among patients in the program (Hshieh et al., 2018). Length of stay, discharge to a nursing facility and night-time use of sedative medicines are also worth tracking. None of these belongs in the PICOT sentence itself, where they would blur the question, but they will shape the search and the evaluation plan.
The question also leaves some things out on purpose. It does not ask whether any single component works alone, because the evidence and the unit's problem both point to a bundle. It does not address the treatment of delirium once it occurs, which is a different question with different evidence. And it does not include patients in intensive care, whose delirium has different drivers. Naming these exclusions now will keep the search focused.
Question Type, Designs and Search Terms
This is an intervention question, so the strongest answers would come from systematic reviews of randomized trials and from well-designed randomized or controlled trials, followed by quality improvement reports that show how programs were implemented (Melnyk & Fineout-Overholt, 2023). The PICOT elements translate directly into search concepts: delirium; aged, 70 and over; hospitalized or inpatient; multicomponent, non-pharmacological or the Hospital Elder Life Program; and prevention or incidence. Subject headings such as Delirium and Aged will be combined with keywords in Module 3.
Conclusion
The final PICOT question names a population with clear boundaries, an intervention made of five teachable actions, an honest comparison, an outcome measured by a validated tool and a time frame the unit controls. Its most important choice, the 4AT as the outcome measure, trades a little accuracy for a great deal of practicality, with a plan to check the trade-off. The question now points to a search that can be repeated and a project that can be measured.
References
Burton, J. K., Craig, L. E., Yong, S. Q., Siddiqi, N., Teale, E. A., Woodhouse, R., Barugh, A. J., Shepherd, A. M., Brunton, A., Freeman, S. C., Sutton, A. J., & Quinn, T. J. (2021). Non-pharmacological interventions for preventing delirium in hospitalised non-ICU patients. Cochrane Database of Systematic Reviews, 2021(7), Article CD013307. https://doi.org/10.1002/14651858.CD013307.pub2
Hshieh, T. T., Yang, T., Gartaganis, S. L., Yue, J., & Inouye, S. K. (2018). Hospital Elder Life Program: Systematic review and meta-analysis of effectiveness. The American Journal of Geriatric Psychiatry, 26(10), 1015-1033. https://doi.org/10.1016/j.jagp.2018.06.007
Inouye, S. K., van Dyck, C. H., Alessi, C. A., Balkin, S., Siegal, A. P., & Horwitz, R. I. (1990). Clarifying confusion: The confusion assessment method. Annals of Internal Medicine, 113(12), 941-948. https://doi.org/10.7326/0003-4819-113-12-941
Melnyk, B. M., & Fineout-Overholt, E. (2023). Evidence-based practice in nursing & healthcare: A guide to best practice (5th ed.). Wolters Kluwer.
Tieges, Z., MacLullich, A. M. J., Anand, A., Brookes, C., Cassarino, M., O'Connor, M., Ryan, D., Saller, T., Arora, R. C., Chang, Y., Agarwal, K., Taffet, G., Quinn, T., Shenkin, S. D., & Galvin, R. (2021). Diagnostic accuracy of the 4AT for delirium detection in older adults: Systematic review and meta-analysis. Age and Ageing, 50(3), 733-743. https://doi.org/10.1093/ageing/afaa224
What the NUR 550 Module 2 instructions ask for
Module 2 of NUR 550 commonly asks you to turn your practice problem into a PICOT or PICO question and to justify it. Typical prompts want the question itself, an explanation of each element, the type of question it is, the kinds of studies that would best answer it and the search terms it suggests. Some sections ask you to show how the question evolved. Expect roughly two to four pages in APA 7. Write the question in one sentence with each element labeled, then spend most of your words on justification, especially of the outcome, because a question whose outcome cannot be measured on your unit will cause trouble in every later module of the course. Ask a colleague to read the question cold and tell you what project it describes.
How this NUR 550 Module 2 picot question paper example is built
The sample develops a PICOT question on delirium prevention for older patients on a composite medical unit. It shows three drafts and names the flaw in each, then justifies the population, intervention, comparison and time frame with reasons from the setting and a Cochrane review. The outcome gets its own section, comparing the Confusion Assessment Method and the 4AT on published accuracy, training and time in a table, and explaining why the more practical tool was chosen with a plan to check it. The paper closes by naming the question type, the best designs and the search concepts, with four real sources.
Where the NUR 550 Module 2 rubric puts the points
PICOT papers are generally graded on the clarity and specificity of each element, the justification offered, the fit between the question type and the designs named, the link to search terms and writing. Specificity is the most common weakness: interventions such as education or nursing care and outcomes such as improvement are too vague to earn full credit. Justification should draw on the setting and on evidence, not only restate the element. Graders also notice when the outcome has no measurement plan. Showing how the question changed from earlier drafts often adds depth, because it proves the final version was reasoned rather than written in one pass.
NUR 550 Module 2 help: the mistakes that cost points
PICOT questions often go wrong by bundling two questions into one, by naming an intervention that cannot be searched or taught, or by choosing an outcome no one on the unit measures. Another frequent issue is a time element that is arbitrary. Write the question in one sentence, make the intervention concrete, tie the outcome to a validated measure you could use, choose a time frame that matches how the intervention works and explain each choice. Then list the search concepts the question produces. Read it aloud; if it takes two breaths, it is probably two questions. If your practice problem is different, we can develop and justify a PICOT question around it for your course.
Get NUR 550 Module 2 written to your instructions
Send your practice problem, any draft question you have and the rubric. A PICOT paper with a specific question, a justification for every element and a measurable outcome is ready in 24 to 48 hours, and the first one is free. The paper above is an original model document written by our desk, not a submitted student paper and not an official Southern New Hampshire University document.
More NUR 550 papers and related MSN samples
- NUR 550 Module 1 Discussion: Framing Delirium on a Medical Unit as a Practice Problem
- NUR 550 Module 3 Milestone One: A Documented, Repeatable Literature Search on Delirium Prevention
- NUR 550 Module 4 Critical Appraisal: Appraising the Landmark Multicomponent Delirium Prevention Trial
- NUR 550 Module 5 Evidence Synthesis: What the Evidence on Multicomponent Delirium Prevention Says Together
- NUR 550 Module 6 Milestone Two: Applying the i-PARIHS Framework to a Delirium Prevention Project
- NUR 550 Module 7 Implementation Plan: An Implementation Plan for a Delirium Prevention Bundle
- NUR 550 Module 8 Evaluation Plan: Evaluating a Delirium Prevention Bundle With RE-AIM
- NUR 550 Module 9 Final Project: A Complete Evidence Translation Proposal for Delirium Prevention
- NUR 550 Module 10 Journal: The Gap Between Knowing the Evidence and Changing Practice
- NUR 545 Module 2 Screening Tools Paper: Comparing Health Literacy Screening Tools
- NUR 530 Module 7 Milestone Two: A Draft Implementation Plan for Afternoon Discharge Huddles
- NUR 508 Module 5 Competency Gap Assessment
- NUR 502 Module 8 Teaching Philosophy Discussion
NUR 550 Module 2 questions, answered
Where can I find a free NUR 550 Module 2 PICOT Question Paper sample?
The complete paper on this page is free to read: three drafts of a delirium prevention question, a justification for each element, a comparison of the CAM and 4AT as outcome measures and four real sources.
What does PICOT stand for?
Population, intervention, comparison, outcome and time. Together they define who, what, compared with what, measured how and over what period.
How do I make a PICOT outcome measurable?
Tie it to a validated tool or routinely collected data, such as a delirium screen completed daily, rather than a general term such as improvement.
What study designs answer an intervention question?
Systematic reviews of randomized trials and well-designed randomized or controlled trials provide the strongest evidence for intervention questions.
What is the 4AT?
A brief four-item delirium screening test that needs no special training. A meta-analysis found pooled sensitivity and specificity of 0.88.