Problem Statement (PICOT) Veterans homelessness

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Capella University

MSN Practicum and Capstone

Assessment 2 Problem Statement (PICOT)

Nicole DuBack

March 03, 2022

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Need Statement

Coronavirus disease 2019 (COVID-19) is a public health disaster that has not been

encountered for a hundred years (2021). The World Health Organization confirmed and named

the coronavirus which caused unexplained pneumonia as a severe respiratory syndrome

coronavirus 2 (SARS-CoV-2) on January 12, 2020 (2021). In the early stages of the COVID-19

epidemic, most of the pediatric cases, children ages 1-17 years old, had occurred as a part of a

family cluster. This means the source of infection for children was from the adults within the

family. The widespread COVID-19 vaccination amongst adults is much higher than that of

children making increased pediatric infections as a leading source of community transmission.

The pediatric population accounts for 10,603,034 reported cases and children represent 18.4% of

all cases as of January 20, 2022 (APA, 2022). Children are an important part of the whole

population to build an immune barrier of COVID-19, children infected with COVID-19 bring a

burden to families and society and COVID-19 can become severe as well as fatal to children.

Progressive vaccination of the pediatric population for COVID-19 is important for the overall

prevention and control of this virus.

Population and Setting

The Children’s Hospital Colorado organization will serve as the setting identified and the

target population is the community in which the organization serves over all campuses. COVID-

19 cases in children can result in hospitalizations, MIS-C (inflammatory syndromes), long-term

complications and death. Vaccination along with other preventative measures can protect

children from this virus. It is important that we address the pediatric population and their need

for the COVID-19 vaccine for many reasons. In the summer of 2021 from late June to the end of

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August the hospitalizations amongst children and adolescents had increased fivefold

(Coronavirus Disease 2019, 2021).

In the Children’s Hospital Colorado organization, we have several campuses and clinics

where we see the opportunity to address the vaccination concerns of parents and caregivers to

promote the COVID-19 vaccine amongst the pediatric population. There are hundreds of

children and family that come in and out of our organization’s multiple campuses daily. Many of

these patients are battling congenital issues, cancer, organ transplants, severe injury, and multiple

other diagnosis that places them into a higher mortality rate without having to contend with the

complications of COVID-19. Children are our future, safe and effective vaccines are available to

thousands of pediatric healthcare providers, pharmacies, and federally qualified centers to

support our nation’s fight against COVID-19.

Intervention Overview

The long-term effect of COVID-19 infection in children is still unknown, which makes

balancing the benefits and risks of vaccination accurately are difficult. The studies on COVID-19

are being updated and published monthly, prior to peer review. Unfortunately, several initial

influential papers have been retracted after the peer review process was completed due to

detection of flaws in the study. This initial information is shared on social media quickly making

it difficult to disprove the false information provided. Pressure has been put on to pediatricians to

vaccinate the pediatric population, having the data of potential risks and benefits not always

being straightforward. The intervention that is scientifically proven to help combat the virus is a

2-dose vaccine.

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The indirect risks to COVID-19 in the pediatric population are isolation, reduced interactions,

and a disruption in their education. Children who are vaccinated have less of a risk to contract

the virus if in a classroom with a child who is COVID-19 positive, which reduces the days of

missing class when falling ill. Children who are vaccinated are protected from serious illness

making complications due to COVID-19 less likely as well as lower viral loads. Vaccinated

children have a reduced duration of shedding the disease and the initial vaccine effectiveness in

children is currently 95% (Emonts,2022).

Comparison of Approaches

As of February 2022, there is not another form of medical treatment approaches to COVID-

19 prevention amongst the pediatric population. We can however compare preventative

behaviors that are initial interventions against the vaccine amongst the pediatric population.

These behaviors include but are not limited to wearing a mask when going out, staying home as

much as possible, social distancing, and washing hands frequently.

Initial Outcome Draft

The proposed intervention is to create an organizational change within the organization to

improve the family experience of care, pediatric populations health and overall decreasing the

cost of care within the organization when it relates to covid-19.The primary goal is to increase

family education and awareness to the benefits and need for the COVID-19 vaccine amongst the

pediatric population. The increase in education and awareness would hopefully. Influence more

patients and families to vaccinate their children while reduce hospital stays and costs related to

COVID-19 admissions.

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Time Frame

The approval process will start with Children’s Hospital Colorado’s epidemiology

department, move through leadership in perioperative services, and then the executive

leadership team within the organization’s education department. To predict the implementation of

this new process in an organization such as Children’s Hospital Colorado is difficult to do

currently. The time frame is variable and based on not only the approval process mentioned

above but on a trial period, staffing education, and any other unforeseen obstacles that may

occur.

Creating an Implementation Timeline is helpful in listing tasks, responsible parties and

estimate time for execution. Having already defined our goal, increasing education surrounding

the COVID-19 vaccine in the pediatric population through perioperative services is the first step.

We have researched the need for this information to be disseminated to the families and patients

in this area and are now waiting approval to move forward with the how we can get that

information out efficiently and effectively. The next steps are to implement the change, evaluate

the outcomes and maintain.

Literature Review

There are approximately 28 million children between the ages of 5 and 11 years old in the

United States, and there are nearly 2 million cases of COVID-19 within this age group during the

pandemic(COVID-19 Vaccines for Children & Teens, 2022). COVID-19 can make children very

ill and at times cause them to be hospitalized and complications can lead to death. As of mid-

October 2021, children ages 5 to 11 years have experienced more than 8,300 COVID-19 related

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hospitalizations, nearly 100 deaths and is one of the top 10 cause of death amongst this

population(COVID-19 Vaccines for Children & Teens, 2022).

Multisystem inflammatory syndrome associated with COVID-19 in children (MIS-C) is

condition where different body parts can become inflamed, including the heart, lungs,

kidneys, brain, skin, eyes, or gastrointestinal organs. We do not yet know what causes MIS-C

associated with COVID-19(Multisystem Inflammatory Syndrome(MIS), 2020). However, we

know that many children with MIS-C had the virus that cause COVID-19, or had been around

someone with COVID-19. MIS-C can be serious, even deadly, but most children who were

diagnosed with this condition have gotten better with medical.

Researchers at Denver-based University of Colorado led a study involving patients 18 years

and younger tested for COVID-19 at 56 U.S. National COVID Cohort Collaborative facilities up

to Sept. 24, before the emergence of omicron coronavirus variant(Masson, 2022). Among 10,245

hospitalized children, 1,423 (13.9%) met the criteria for MIS-c related to COVID-19 with 8

percent needing mechanical ventilation and 1.3 percent died(Masson, 2022).

The risks the pediatric population not being vaccinated seem to be significantly higher than

the risk of being vaccinated. The COVID_19 vaccination was 94% effective at preventing

hospitalization and 98% effective at preventing the need for serious medical intervention

according to a study performed by Dr. Adrienne Randolph, a critical care physician at Boston

Children’s Hospital(Fliesler, 2022). A second study led by Dr. Randolph showed the risk of

MIS-C in unvaccinated children to COVID-19 is likely higher and more severe than the risk of

myocarditis, which is generally rare and when it occurs, symptoms are generally mild and

subside quickly (Fliesler, 2022).

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References

A.A.P. (2022, January 20). Children and COVID-19: Data Report. AAP. Retrieved January 25,

2022, from https://www.aap.org/en/pages/2019-novel-coronavirus-covid-19-

infections/children-and-covid-19-state-level-data-report/

American Academy of Pediatrics. (2022, February 25). COVID-19 Vaccines. Retrieved March 2,

2022, from https://www.aap.org/en/pages/2019-novel-coronavirus-covid-19-

infections/covid-19-vaccine-for-children/about-the-covid-19-vaccine-frequently-asked-

questions/

Coronavirus Disease 2019. (2021, November 2). Centers for Disease Control and Prevention.

Retrieved January 25, 2022, from https://www.cdc.gov/media/releases/2021/s1102-

PediatricCOVID-19Vaccine.html

COVID-19 Vaccines for Children & Teens. (2022, January 11). Centers for Disease Control and

Prevention. Retrieved March 1, 2022, from https://www.cdc.gov/coronavirus/2019-

ncov/vaccines/recommendations/children-teens.html#:%7E:text=Teens%20ages

%2012%20to%2017,younger%20than%2012%20years%20old.

COVID-19 in babies and children. (2022, January 28). Mayo Clinic. Retrieved March 2, 2022,

from https://www.mayoclinic.org/diseases-conditions/coronavirus/in-depth/coronavirus-

in-babies-and-children/art-20484405

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Emonts, M. (2022, February 1). COVID-19 interventions in children: a balancing act. Archives

of Disease in Childhood. Retrieved March 1, 2022, from https://adc.bmj.com/content/107/3/e12

Fliesler, N. (2022, January 10). COVID-19 vaccination in teens: Benefits far outweigh risks.

Boston Children’s Answers. Retrieved March 2, 2022, from

Healthcare Workers. (2020, February 11). Centers for Disease Control and Prevention. Retrieved

February 11, 2022, from https://www.cdc.gov/coronavirus/2019-ncov/hcp/pediatric-

hcp.html

How to Talk with Parents about COVID-19 Vaccines. (2021, November 29). Centers for Disease

Control and Prevention. Retrieved January 25, 2022, from

https://www.cdc.gov/vaccines/covid-19/hcp/pediatrician.html

Masson, G. (2022, February 10). 8 risk factors tied to severe COVID-19, MIS-C in kids. 8 Risk

Factors Tied to Severe COVID-19, MIS-C in Kids. Retrieved March 1, 2022, from

https://www.beckershospitalreview.com/patient-safety-outcomes/8-risk-factors-tied-to-

severe-covid-19-mis-c-in-kids.html

Multisystem Inflammatory Syndrome(MIS). (2020, February 11). Centers for Disease Control

and Prevention. Retrieved March 1, 2022, from https://www.cdc.gov/mis/mis-c.html

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N.C.B.I. (2021, October 7). Expert Consensus on COVID-19 vaccination in Children.

Https://Www.Ncbi.Nlm.Nih.Gov/Pmc/Articles/PMC8494629/. Retrieved January 25,

2022, from https://www.ncbi.nlm.nih.gov

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Problem Statement (PICOT)
MSN Practicum and Capstone

Ashli Smith
Capella University

Dr. Dewitt

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Problem Statement (PICOT)

Need Statement

For over a year, the nation has been ravaged by one of the most significant pandemics the

nation has experienced in history. This infectious virus mutated from a family group of viruses

called Coronaviridae (World Health Organization, 2021). Serve acute respiratory syndrome

coronavirus 2 (SARS-CoV-2) or coronavirus disease of 2019 (COVID-19) mutated to a highly

contagious novel virus (He, Deng and Li, 2020). The suspected origin of COVID-19 is from a

wet market in Wuhan, China (Platto et al., 2020). COVID-19 can be transmitted in several

different ways. The primary transmission mode is through droplets from either a person’s mouth,

nose, or eyes. These small particles can be transmitted from talking, coughing, sneezing, or even

breathing. Coronavirus affects the respiratory system, which could lead to pneumonia and other

long-term effects (Fauci, Lane, and Redfield, 2020)

According to Murphy and Wu, over four million people have died worldwide from

COVID-19, and a little over seven hundred thousand of those deaths came from the United

States. (Murphy and Wu, 2021). Since the beginning of the pandemic, there has been misleading

information circulating in the media. This project will aim to identify evidence-based practice

that justifies steps to prevent the spread of the coronavirus within the community and educate the

community on vaccines and the number of cases in Jackson, Tennessee.

Population Setting

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Jackson Madison General Hospital (JMGH)is a six hundred forty-two-bed hospital that also has

various outpatient clinics located in the heart of Jackson, Tennessee (West Tennessee Healthcare,

2021). Jackson is known for its live music scene and cultural diversity. JMGH and clinics

encounter a larger number of clients/patients that are over the age of forty. Studies have shown

that the elderly population is more at risk of communicable disease due to the lack of proper

recourses or education (Friebe and Schmidt-Hertha, 2021).

According to Bernhard and colleagues, the elderly population’s participation in education has

decreased due to their education level or background. For instance, some of the elders in the

population can be compromised of migrants’ or below standard living, which can affect the way

they learn or participate in education on health (Friebe and Schmidt-Hertha, 2021). The project’s

target audience is the vulnerable population, such as the elderly and children who are

patients/clients at JMGH and the outpatient clinic at risk of contracting the coronavirus. As a

result of the increasing number of cases in the Jackson area, serval interventions will be

implemented.

Intervention Overview

One of the critical interventions will be education. A website will be created that contains

information about COVID-19. The information will consist of weekly updates on the number of

cases within Jackson, ways to prevent the virus, steps to maintain the symptoms, and any

changing clinical protocols. The informatics team will update the website with any new

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information. The importance of updating the clinical portion will aid in successfully execute the

intervention. Giving the patients, clients, and staff accurate information is the primary goal.

Another intervention has seminars within the community to educate people on steps to

prevent the spread of the virus. The seminars will be held at the regional inter-faith association

(RIFA), an outreach ministry that caters to the community’s needs. Its located heavily populated

area of Jackson and serves over two hundred people daily. RIFA serves the elderly population by

giving them food boxes that consist of meals for seven days. (RIFA, 2021). When the food boxes

are being delivered, the staff will educate the person on handwashing and wearing a mask while

in public.

Along with education, the person will receive a gift bag with hand sanitizer and mask.

The seminars will be held at RIFA monthly. The goal is to educate as many people in the

community as possible about taking proper precautions to prevent the coronavirus.

Comparison of Approaches

An interprofessional approach to raising awareness on the prevention of the virus is to

ensure that all staff is trained on proper COVID-19 protocols and education materials.

Translators will also be trained to assist with the education. Another approach can be getting the

community leaders involved with educating the community. Even though JMGH clinics treat

countless people, some people in that vulnerable population cannot communicate or lack the

recourses to come to the clinical office. So having the community leaders such as RIFA teaching

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the vulnerable population about how to prevent coronavirus or maintain their symptoms will aid

in accomplishing the goal.

Initial Outcome

The overall goal is to decrease the spread of COVID-19 by creating a site that educates

the JMGH staff and community with accurate material about COVID-19. Many websites and

media outlets present misinformation. The JGMH website will contain updates on new cases and

guide instructions on preventing the spread of the virus. It will have illustrations and serval

different languages to appeal to all educational levels. Along with the website, community

seminars will be held specifically for the vulnerable population. The seminars will be available to

everyone regardless of social status. Partnering with RIFA will help spread accurate information

to patients at the JMGH clinics and through the community.

In addition, this project correlates with one of the Healthy People 2030 goals. The

Healthy People 2030 goal is to decrease infectious disease rates and improve the health of

individuals with chronic infections (Healthy People 2030, 2021). Health People 2030 has created

a national action plan to reduce the number of infections, including the coronavirus. The project

provides an intervention that will assist with the hopes of decreasing the coronavirus to the

vulnerable populations.

Time Estimate

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The estimated development of the project will be executed in twelve months. Since

JGMH has over twenty clinics, the project will be implemented at two clinics. After three

months, another two clinics will be added. This type of pilot plan is being applied to ensure

project control and receive feedback to make changes before launching the project to other

facilities. Once the first implementation is completed, another two clinics will be added.

With any project, there are possible problems to arise. A few barriers would be technical mishaps

with the website and ensuring that everyone has access to it. Since the website will be public, it

runs the potential risk of a data breach. These are potential barriers that could affect the estimated

time frame.

Literature Review

JMGH COVID19 website is an asset to the organization. Studies provide that contacting

and prodiving information on COVID19 reducing the risk of spreading the coronavirus().It will

alson improve the econoimic aspect of the hospital and improve quality of care and patient

satisfaction. Another study created a mobile appolication to track and montioer people that have

COVID or under superaviiorn . The appolication has proven to assit patients and others around

with information. When a patient comes in contact or has been vefited positive for coronvirsucs

but does not required hospitilizan the provider will prescribe them with a ID to login into the

application. The application is called Covidom. It allows the provider and nurses to monitor

patient while at home. Notifiaction are sent several times a day to keep an update on patients

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conidtionn (Chrysler et al., 2021). Reserchers has started that Covidom has proven to help patient

that has come in contact and confirmed cases.. It provides the community with acessable

resourse information and resources that notify of positive cases (Chrysler et al., 2021). The

mobile applivation aide the community in preventingthth futher spread of coronavirus .

Researchers have found other benefits of contact tracing and having accessable

information about the coronamvirus. Accoridign Lunz and colleges, utlixing mobile appplcueijon

for COVID-19 tracing can minmizine sociencoimicn strain. The cornivrius virus has greatly

disrupted ecomony. It effected jobs, bussiniess , shipments, and public tranpstion etc. Almost

levels of education and traveling were also canceld to prevent a wide spread of the coronavirus.

These differestn factors caused a huge disruption within the edcomy .

Mosti of phamrmacticeil ,health producats and other material are imported from China. Along

with others,facotiers in China were shut down and borders were closed. It created downfall with

the demand and supply algthrome (Srivastava et al., 2020).

Demand is the person willingness or ability to buy something. Supply is the actual item

that is available. For instance, during the beginning of the pandemic paper products such as

paper towel and tissue became in high demand. With this sudden increase in demand, the supply

was not available to keep up with the demand. In result the supply prices increased

tremendously for the company to make a profit.

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Another example, the short supply of ventilators and personal protective equipment

(PPE) in the hospital (Lunz et al., 2021). As previously stated, medical supplies have been

limited since the start of the pandemic. With the increased number of COVID-19 case people are

being put on ventilators at a alarming rate. In result with the hospital is not equipped to supply

ventilators to every patient in need of the device which made for some hard decisions for

providers and staff. These are only a few examples on how the supply and demand balance was

disrupted.

Reviewing recent literature and research studies has proven that implementing a

accessible website with accurate and updated information will benefit JGMH. It will aide in

educating patient, staff, and the community on COVID-19 while reducing socioeconomic strain

and the spread of the infectious disease.

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References

Chrysler, A., Warnars, H., & Utomo, W. (2021). Mobile application to track people in covid19

monitoring and patients under covid19 supervision. IOP Conference Series: Earth And

Environmental Science, 729(1), 012032. doi: 10.1088/1755-1315/729/1/012032

Fauci, A., Lane, H., and Redfield, R., 2020. Covid-19 — Navigating the Uncharted. New

England Journal of Medicine, 382(13), pp.1268-1269.

Friebe, J. and Schmidt-Hertha, B., 2021. Activities and barriers to education for elderly

people. Journal of Contemporary Educational Studies, 64(1), pp.10-27.

He, F., Deng, Y. and Li, W., 2020. Coronavirus disease 2019: What we know?. Journal of

Medical Virology, 92(7), pp.719-725.

Health.gov. 2021. Infectious Disease – Healthy People 2030 | health.gov. [online] Available at:

<https://health.gov/healthypeople/objectives-and-data/browse-objectives/infectious-disease>

[Accessed 14 October 2021].

Lunz, D., Batt, G. and Ruess, J., 2021. To quarantine, or not to quarantine: A theoretical

framework for disease control via contact tracing. Epidemics, 34, p.100428.

Murphy, J. and Wu, J., 2021. Map: Track coronavirus deaths around the world. [online] NBC

News. Available at: <https://www.nbcnews.com/news/world/world-map-coronavirus

deaths-country-covid-19-n1170211> [Accessed 14 October 2021].

Platto, S., Xue, T. and Carafoli, E., 2020. COVID19: an announced pandemic. Cell Death &

Disease, 11(9).

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RIFA | Reaching out. Lifting Up. 2021. Home | RIFA. [online] Available at:

<http://www.rifajackson.org> [Accessed 15 October 2021].

Srivastava, A., Meena, A., Srivastava, K., Gupta, V., & Kaushal, K. (2020). Socio Economic

Impact of COVID- A Review. Asian Journal Of Research In Chemistry, 13(6), 497-501.

doi: 10.5958/0974-4150.2020.00088.7

Who.int. 2021. COVID-19 Mythbusters – World Health Organization. [online] Available at:

<https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-

public/myth-busters> [Accessed 16 October 2021].

UTHSC. 2021. West Tennessee Healthcare. [online] Available at: <https://uthsc.edu/jackson-

family-medicine/west-tennessee-healthcare.php> [Accessed 14 October 2021].