NURS-FPX4030 Assessment 3: PICO(T) Questions and an Evidence-Based Approach

Capella University | School of Nursing and Health Sciences | NURS-FPX4030: Making Evidence-Based Decisions | Fall Quarter 2026

Course level: Baccalaureate completion, 4000 level. Assessment type: Individual scholarly paper, third of four assessments in the course. Length: 3 to 5 pages, excluding title page and reference list. Format: APA 7th edition, double spaced, 12 pt Times New Roman or 11 pt Calibri, one inch margins. Points: set by the scoring guide published in the courseroom. Submission: Word document to the Assessment 3 dropbox, with a copy saved to the ePortfolio.

Assessment Context

Capella University publishes its scoring guides before students write, and NURS-FPX4030: Making Evidence-Based Decisions is built around that contract. Assessment 3: PICO(T) Questions and an Evidence-Based Approach asks for a decision document, not a literature review. You take a practice problem you have seen at the bedside or in a clinic, express it as a searchable clinical question, retrieve current evidence, and then judge how far that evidence can carry a decision. Faculty look for four things: a named practice issue drawn from your own current or past nursing practice, a PICO(T) question whose parts hold together, four current scholarly sources, and a close reading of the two sources that matter most.

Nothing in the task rewards volume. A tight five page paper with two sources analysed properly scores above twenty pages of summary. Skip the history of evidence-based practice, skip textbook definitions of the acronym, and spend the space on what the evidence actually found and what a nurse manager should do with it.

Source note. The full instruction page sits behind the courseroom login. Task wording, competencies, and additional requirements below restate what Capella publishes for this assessment. Confirm the due date and point values in your own section before submitting.

What the Scoring Guide Rewards

Five criteria carry the grade, each tied to a course competency and each rated as Non-performance, Basic, Proficient, or Distinguished.

• Competency 3, apply an evidence-based practice model to a practice issue: define a practice issue worth exploring through a PICO(T) approach.
• Competency 2, analyse the relevance and potential effectiveness of evidence: identify sources that could answer the question and explain how their findings bear on a decision.
• Competency 1, interpret findings from quantitative, qualitative, and outcomes research: explain what the chosen sources found.
• Competency 5, professional and scholarly communication: organise ideas logically, write clean sentences, and format citations and references in APA 7th edition.

Scenario and Permitted Topics

Use an issue from your current or past nursing practice. Where no practice issue is available, select one of the optional unfolding case studies listed in the courseroom resources and state that choice in the introduction. Vila Health activities in the course prepare you for the same reasoning and may be referenced as context, though the analysis must still rest on published evidence rather than on the simulation.

Strong topics share one trait: the intervention belongs to nursing. Removal criteria, screening tools, rounding structures, patient education, and assessment frequency all sit inside nursing scope, which keeps the question answerable and the recommendation actionable. Topics that hinge on prescribing authority or surgical technique tend to stall, because nursing evidence cannot resolve them.

Task Instructions

1. Define the practice issue, its setting, and the population affected, in enough detail that a reader from another hospital recognises the problem.
2. Explain why this issue suits a PICO(T) approach, with attention to the ambiguity that a precise question removes.
3. Write the PICO(T) question as a single interrogative sentence, then unpack each element in its own sentence.
4. Identify the sources of evidence that could answer the question, naming the databases and search terms that produced them.
5. Select the two most relevant sources for close analysis and interpret their specific findings and recommended practices.
6. Explain how those findings would shape a decision, including the barriers, costs, and measurement questions that sit between evidence and action.

Naming the Practice Issue

Anchor the issue in a setting with a measurable outcome. A description such as “catheters stay in too long on my unit” is a start; the version that earns a Distinguished rating names the unit type, the current removal workflow, and the indicator the unit already tracks. Where hospital data are unavailable, use published prevalence figures and say so.

Building the Question

Each element must narrow the search rather than decorate it. A comparison element of “no intervention” weakens the analysis, because reviewers will ask what the current standard actually is. Time frames belong in the question only when the outcome is time dependent, which covers most infection and readmission questions and fewer knowledge or satisfaction questions.

Choosing and Analysing Sources

Four sources, published within the last five years, from peer reviewed journals, government agencies, or professional bodies. Guidelines count as scholarly evidence when the issuing body is authoritative. Two of the four carry the analysis; the remaining two establish the scope of the problem and the direction of current practice. For each of the two, state the design, the sample, the outcome measure, the reported effect, and the limitation that constrains the claim.

Translating Evidence into a Decision

Competency 2 is where most submissions lose points. Summarising a study is not the same as explaining its relevance. Show the link: what the unit would stop doing, start doing, and keep measuring if the recommendation were adopted next quarter. Note who would resist and why, since the honest answer usually involves workflow, staffing, or a physician order set.

Anatomy of the PICO(T) Question

Element	What belongs there	Test question	Worked example
P	Population, problem, or setting, stated precisely enough to exclude unrelated studies	Could another nurse point to these patients on a ward?	Adults with indwelling urinary catheters on an acute inpatient unit
I	The nursing action under consideration	Is the action inside nursing scope and specific enough to audit?	Nurse-driven removal protocol with daily necessity review
C	The real comparator, meaning current practice	What happens now, not what happens nowhere?	Physician-directed removal as the default
O	One process measure and one patient outcome	Can the unit report this indicator quarterly?	Catheter days and CAUTI per 1,000 catheter days
T	Only when the effect is time dependent	Would a shorter or longer window change the answer?	Three months of post-implementation measurement

Search Strategy Minimum Standard

• Search at least three databases, with CINAHL and PubMed as the base and Cochrane Library for synthesised evidence where the question allows.
• Record the keyword strings, including MeSH terms and Boolean operators, in a short paragraph or appendix table.
• Apply limits for publication date, language, and peer review, and name those limits in the text rather than leaving them implicit.
• Report how many records the search returned and why the four retained sources survived screening.

Required Submission Structure

1. Title page: title, your name, School of Nursing and Health Sciences, Capella University, course number and name, faculty name, date.
2. Introduction, roughly 150 to 200 words: the practice issue, the setting, and the purpose of the paper, closing with the PICO(T) question.
3. Practice issue and rationale, roughly 250 to 350 words: why the issue matters and why a structured question helps.
4. Sources of evidence, roughly 200 to 300 words: search approach, database choices, and the four retained sources with their level of evidence.
5. Findings and relevance, roughly 400 to 500 words: the two sources in depth, then the decision each supports.
6. Conclusion, roughly 120 to 150 words: what the evidence permits, where it remains thin, and the next measurement step.
7. Reference list: APA 7th edition, alphabetical, hanging indent, four or more entries.

Heading levels follow APA 7th edition conventions. Level 1 headings are centred and bold. Level 2 headings are flush left and bold. Do not use the word Introduction as a heading, since APA expects the paper title in that place.

Additional Requirements

• Length of submission: 3 to 5 pages of body text, which usually lands between 900 and 1,300 words when double spaced.
• Number of references: a minimum of four scholarly or professional sources, none older than five years, cited in text and listed in the reference list.
• Formatting: APA 7th edition title page, in-text citations, headings, and reference list. No abstract, no running head, no appendices unless the search log exceeds half a page.
• Artefact: save the finished assessment to the ePortfolio and note the date in your course journal.
• Originality: paraphrase and cite. Direct quotation should not appear in this paper, because the task rewards interpretation.

Marking Rubric

Criterion and competency	Non-performance	Basic	Proficient	Distinguished
Defines a practice issue to be explored through a PICO(T) approach (Competency 3)	Issue is absent or names a topic rather than a problem	Issue is named in general terms with no setting or population detail	Issue is named, sited in a practice area, and linked to an indicator	Issue is sharply defined with setting, population, current workflow, and why a structured question resolves the ambiguity
Identifies sources of evidence that could answer the PICO(T) question (Competency 2)	Sources are missing or irrelevant to the question	Sources are listed with no explanation of fit	Four current sources are listed with a credible fit to the question	Sources are selected against explicit search criteria, with levels of evidence and reasons for exclusion of weaker material
Explains findings from the chosen sources (Competency 1)	No findings reported	Findings are restated from abstracts without design or sample detail	Findings are explained with design, sample, and reported outcome	Findings are interpreted, inconsistencies between sources are surfaced, and limitations are weighed against the question
Explains the relevance of findings to a PICO(T) decision (Competency 2)	Relevance is unaddressed	Relevance is asserted without a traceable link to the decision	Relevance is explained with a clear link to a decision in the practice setting	Relevance is argued through resource, workflow, and measurement implications, with dissenting evidence acknowledged
Communicates with clear, logical, APA compliant writing (Competency 5)	Organisation and APA errors prevent comprehension	Frequent grammar or APA errors interrupt the argument	Occasional minor errors, argument flows, APA largely correct	Precise, economical prose with a scoring guide order that mirrors the task and near flawless APA formatting

Academic Integrity and Generative AI

• Capella applies its academic honesty policy to this assessment, and the courseroom runs an originality check on submitted files.
• Disclose any permitted use of writing tools according to the course policy, and note that fabricated citations fail at both the integrity and the competency level.
• Verify every source before citing it: open the DOI, confirm the authors, year, journal, volume, and pages, and check that the claim you attribute to the source appears in the source.

References and Learning Materials

Connor, L., Dean, J., McNett, M., Tydings, D. M., Shrout, A., Gorsuch, P. F., Hole, A., Moore, L., Brown, R., Melnyk, B. M., & Gallagher-Ford, L. (2023). Evidence-based practice improves patient outcomes and healthcare system return on investment: Findings from a scoping review. Worldviews on Evidence-Based Nursing, 20(1), 6–15. https://doi.org/10.1111/wvn.12621

Dang, D., Dearholt, S. L., Bissett, K., Ascenzi, J., & Whalen, M. (2022). Johns Hopkins evidence-based practice for nurses and healthcare professionals: Model and guidelines (4th ed.). Sigma Theta Tau International. https://www.sigmarepository.org/book_excerpts/64

Jones, A. E., Nagle, C., Ahern, T., & Smyth, W. (2023). Evidence for a nurse-led protocol for removing urinary catheters: A scoping review. Collegian, 30(1), 190–197. https://doi.org/10.1016/j.colegn.2022.08.008

Patel, P. K., Advani, S. D., Kofman, A. D., Lo, E., Maragakis, L. L., Pegues, D. A., Pettis, A. M., Saint, S., Trautner, B., Yokoe, D. S., & Meddings, J. (2023). Strategies to prevent catheter-associated urinary tract infections in acute-care hospitals: 2022 update. Infection Control & Hospital Epidemiology, 44(8), 1209–1231. https://doi.org/10.1017/ice.2023.137

Su, L. (2025). Effectiveness of nurse-driven protocols in reducing catheter-associated urinary tract infections: A systematic review and meta-analysis. Journal of Nursing Care Quality, 40(1), 39–45. https://doi.org/10.1097/NCQ.0000000000000811

Sample Response: Framing the Question

Catheter-associated urinary tract infection remains the most common device-related healthcare-associated infection in United States hospitals, and much of the avoidable harm traces to one decision: whether an indwelling catheter stays in place past the point of clinical need (Patel et al., 2023). On the surgical trauma unit where I completed my preceptorship, catheter days were charted faithfully while removal waited on a physician order that often arrived a day late. Framing that concern as a PICO(T) question converted a familiar complaint into a testable proposition. In adults with indwelling urinary catheters on an acute inpatient unit (P), does a nurse-driven removal protocol built on daily necessity review (I), compared with physician-directed removal as the default (C), lower catheter days and CAUTI incidence per 1,000 catheter days (O) across a three month measurement window (T)? Each element earns its place. The population specifies the unit type, the intervention fixes who may remove the device and against which criteria, the comparison preserves the existing workflow rather than inventing a straw man, and the outcome pairs a process measure with a patient measure so early progress becomes visible before infection rates move. Nurse-driven protocols that reduce catheter-associated urinary tract infections give the question a quantitative anchor, because pooled trial data associate nurse-initiated removal with lower device utilization and fewer infections (Su, 2025).

Sample Response: Weighing Two Sources

Two of the four sources answer the question more directly than the rest. A scoping review of nurse-led protocols for removing urinary catheters examined thirteen studies and reported reductions in CAUTI incidence in eleven of them, while rating the overall quality of that evidence as low because sample sizes were small, definitions of infection varied, and follow-up windows were short (Jones et al., 2023). Pooled results published two years later sharpen the picture, with nurse-driven protocols outperforming usual physician-directed removal on both catheter utilization and infection occurrence (Su, 2025). Read together, the two sources yield a defensible position rather than a slogan: the direction of effect is consistent and the magnitude is uncertain. The scoping review supplies the caution that keeps a proposal honest, and the meta-analysis supplies the estimate that makes a case to a unit practice council. Neither source specifies which patients still need a catheter, so the protocol itself must be written from guidance that does, and the 2022 compendium provides recommended indications alongside daily review expectations (Patel et al., 2023). Evidence of this shape supports implementation with measurement attached, not a promise of guaranteed savings.

Business Case for Unit Councils

The argument usually stalls on cost, and the cost question has an answer that most students never look for. A scoping review of 636 evidence-based practice projects found that only 19 percent measured return on investment, and of those, 94 percent reported a positive return with none reporting a negative one (evidence-based practice improves patient outcomes and healthcare system return on investment, Connor et al., 2023). Nurse-driven catheter removal fits that pattern well, since the main expense is education time and the main saving is a device that is no longer purchased, inserted, maintained, or cultured. Framing the proposal around catheter days per 1,000 patient days turns an opinion into an audit trail, which is the language a practice council can act on. Reviewers reward this move because it demonstrates Competency 2 in its harder form: the relevance of evidence to a real decision rather than to a theoretical one. The caution is symmetrical, though, since a scoping review that finds low quality primary studies cannot be used to promise a specific reduction in infection rates (Jones et al., 2023). Claim the direction confidently and the size of the effect carefully.

Does PICO(T) Need a Time Frame?

The T element confuses students because it appears in the acronym and then vanishes from half the published examples. A time frame belongs in the question when the effect depends on elapsed time, which holds for infection prevention, readmission, wound healing, and length of stay, and rarely holds for knowledge, confidence, or satisfaction measures. When a time frame would narrow the search unhelpfully, leave it out and say why, then note in the analysis that the primary studies used differing windows. Three practical tests settle the decision quickly.

1. Ask whether a shorter or longer window would change the conclusion, and include T when the answer is yes.
2. Check that the outcome can plausibly move inside the stated window, since a three month window cannot detect a change in a rare event without very large samples.
3. Confirm the window matches the data your setting can actually report, because a measurement plan that the unit cannot sustain will not survive the next quarter.

The Johns Hopkins model treats the question as the entry point to a practice, evidence, and translation sequence, and that framing explains why the time element sits inside a decision rather than inside a definition (Johns Hopkins evidence-based practice for nurses and healthcare professionals, Dang et al., 2022). A question with a workable T produces a translation plan with a review date. A question without one produces a paper that ends at the reference list.

Where Competency Two Slips

Most lost points in this assessment cluster in three habits, and each is fixable before submission. Restating an abstract counts as reporting, not analysing, because the reader finishes it without knowing what the nurse would do differently on Monday. Treating a guideline as self-justifying is the second habit, since a recommendation from a professional body still needs a stated link to the population in the question. Overlooking contradictory evidence is the third, and it costs the most, because an examiner reads a one-sided account as evidence of a narrow search rather than as confidence. Naming the tension between a low quality scoping review and a more precise meta-analysis demonstrates exactly the judgement the competency describes. Write the decision sentence first, then ask whether the preceding paragraph actually supports it.

Conclusion

My paper would begin with the unit rather than with the acronym, because the reader needs to see the practice problem before the framework makes sense. Four sources are enough when two of them are read properly, and the two I would keep are the scoping review and the meta-analysis, since together they show both the direction of the effect and how much confidence it deserves. Writing the PICO(T) sentence before the search saved me time, mostly because the comparison element forced me to describe what the unit already does. The recommendation I would make is a nurse-driven removal protocol with daily necessity review, launched with catheter days as the primary measure and reviewed at ninety days. What stays unresolved is the local baseline, since published rates vary by unit and my figures come from the literature rather than from hospital data. That gap belongs in the paper instead of being smoothed over, because a limitation stated plainly reads as competence rather than weakness.

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PICO(T) Question and Evidence-Based Decision for Nurse-Driven Catheter Removal

Title Page
PICO(T) Question and Evidence-Based Decision for Nurse-Driven Catheter Removal
[Student Name]
School of Nursing and Health Sciences, Capella University
NURS-FPX4030: Making Evidence-Based Decisions
[Faculty Name]
November 9, 2026

Catheter-associated urinary tract infection remains the most common device-related healthcare-associated infection in acute-care hospitals. On a surgical trauma unit, catheter days were tracked accurately, yet removal still depended on a physician order that often lagged a full day after clinical need ended. The delay produced avoidable catheter-days and elevated infection risk. Framing the problem as a structured clinical question converts a familiar unit complaint into a decision that evidence can inform.

In adults with indwelling urinary catheters on an acute inpatient unit (P), does a nurse-driven removal protocol that includes daily necessity review (I), compared with physician-directed removal as the default (C), reduce catheter-days and CAUTI incidence per 1,000 catheter-days (O) over a three-month measurement window (T)?

Practice Issue and Rationale
The practice issue centers on delayed catheter removal after the original clinical indication has resolved. On the surgical trauma unit, nurses documented daily catheter presence but lacked independent authority to discontinue the device. Physicians completed rounds at variable times, so a catheter that met removal criteria in the morning frequently remained until the next afternoon. Published prevalence data confirm that prolonged dwell time is the dominant modifiable risk factor for CAUTI (Patel et al., 2023).

A PICO(T) structure is useful because the problem contains clear elements that can be isolated and tested. Ambiguity about who may remove the catheter, under what criteria, and against which measurable outcomes is removed once each component is named. The resulting question directs the literature search toward nurse-initiated protocols rather than broad infection-control bundles or physician education campaigns.

Sources of Evidence
Three databases were searched: CINAHL, PubMed, and the Cochrane Library. Keyword strings combined “nurse-driven protocol” OR “nurse-led removal” with “urinary catheter” AND “CAUTI,” limited to English-language, peer-reviewed publications from 2020 through 2026. The initial yield exceeded 180 records. After title and abstract screening for direct relevance to nurse-initiated removal and adult acute-care populations, four sources were retained.

Su (2025) provides a systematic review and meta-analysis of ten studies. Jones et al. (2023) offer a scoping review of thirteen studies. Patel et al. (2023) supply the most recent multi-society guideline recommendations. Kamel et al. (2025) report a single-site pre/post observational study that implemented a nurse-driven protocol with a utilization dashboard. Levels of evidence range from Level I (meta-analysis) to Level III (observational) and Level IV (guideline).

Findings and Relevance
Su (2025) pooled data from 27,965 patients managed under nurse-driven protocols and 30,230 controls. Catheter utilization fell from 49.40 % to 34.84 %, a relative reduction of approximately 29 %. CAUTI incidence dropped from 6.503 % to 2.867 %, corresponding to a risk ratio of 0.50 (95 % CI 0.38–0.66). The analysis used a fixed-effects model and acknowledged heterogeneity in follow-up duration, which ranged from three to thirty-six months.

Jones et al. (2023) examined thirteen studies of nurse-led removal protocols. Eleven reported reductions in CAUTI rates. The authors rated overall evidence quality as low because of small samples, inconsistent infection definitions, and short observation windows. The direction of effect remained consistent even when methodological quality varied.

Taken together, the two sources support a clear operational decision. A unit that adopts a nurse-driven protocol with daily necessity criteria can expect fewer catheter-days and a measurable decline in infection rates. The magnitude of reduction will vary by baseline rates and adherence, yet the direction is reproducible.

Implementation requires attention to workflow barriers. Nurses must receive clear, written criteria (for example, the HOUDINI mnemonic or equivalent). Physician order sets must be revised so that removal does not require a new signature each time. Staff education occupies roughly two hours per nurse. Measurement begins with catheter-days per 1,000 patient-days and CAUTI rates reported monthly; a formal review occurs at ninety days. Resistance typically arises from concern about reinsertion rates or from physicians who prefer direct control of device decisions. Early data showing stable reinsertion rates and falling utilization ratios address those concerns more effectively than policy statements alone.

Patel et al. (2023) reinforce the same pathway by listing daily assessment of continued need and nurse-empowered removal among essential practices. Kamel et al. (2025) demonstrate that pairing the protocol with a simple dashboard further accelerates uptake and sustains the reduction in both utilization and infection.

Conclusion
Evidence from a recent meta-analysis and a supporting scoping review indicates that nurse-driven catheter-removal protocols reduce device utilization and CAUTI incidence relative to physician-directed removal. The practical decision for an acute-care unit is therefore to implement a criteria-based protocol with daily nursing review, revise order sets accordingly, and track catheter-days and infection rates for at least three months. Local baseline rates remain the principal uncertainty; published figures cannot substitute for unit-specific data. Once those numbers are known, the same measurement plan that demonstrates improvement also sustains it.

References
Jones, A. E., Nagle, C., Ahern, T., & Smyth, W. (2023). Evidence for a nurse-led protocol for removing urinary catheters: A scoping review. Collegian, 30(1), 190–197. https://doi.org/10.1016/j.colegn.2022.08.008

Kamel, M., Harris, N., Berry, A., Warsavage, T., Bessesen, M. T., & Kon, S. E. (2025). Implementation of a nurse-driven protocol for indwelling urinary catheter removal and novel utilization dashboard: A pre/postintervention observational study. Therapeutic Advances in Infectious Disease, 12, 20499361251317900. https://doi.org/10.1177/20499361251317900

Patel, P. K., Advani, S. D., Kofman, A. D., Lo, E., Maragakis, L. L., Pegues, D. A., Pettis, A. M., Saint, S., Trautner, B., Yokoe, D. S., & Meddings, J. (2023). Strategies to prevent catheter-associated urinary tract infections in acute-care hospitals: 2022 update. Infection Control & Hospital Epidemiology, 44(8), 1209–1231. https://doi.org/10.1017/ice.2023.137

Su, L. (2025). Effectiveness of nurse-driven protocols in reducing catheter-associated urinary tract infections: A systematic review and meta-analysis. Journal of Nursing Care Quality, 40(1), 39–45. https://doi.org/10.1097/NCQ.0000000000000811

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