| Course | NUR-4190 Exploring Evidence-Based Practice and Research in Nursing |
|---|---|
| Module | Module 1 |
| Paper type | Practice problem and PICOT question |
| Length | About 1,058 words, 6 pages |
| Format | APA 7 student paper |
| School | Thomas Edison State University |
| Program | Bachelor of Science in Nursing |
| Updated | October 2026 |
Free sample paper for NUR 4190 Module 1
From a Crying Child to a Searchable Question: Framing a PICOT Question on Cold and Vibration During Pediatric Venipuncture
Student Name
Bachelor of Science in Nursing, Thomas Edison State University
NUR-4190: Exploring Evidence-Based Practice and Research in Nursing
Mentor Name
Month Day, Year
From a Crying Child to a Searchable Question: Framing a PICOT Question on Cold and Vibration During Pediatric Venipuncture
Evidence-based practice starts with a question, and most questions start as a frustration. Mine started in the laboratory draw room of a pediatric rheumatology clinic, where I work as a registered nurse. Children with juvenile idiopathic arthritis who take methotrexate or biologic medicines need blood monitoring every one to three months, which means that a seven-year-old may have more than a dozen venipunctures in a year. Some of these children walk in calmly. Others start crying in the waiting room. This paper describes that practice problem, explains where it sits in the research process, and develops it into a focused, searchable clinical question in PICOT format.
The Practice Problem
Our clinic draws blood from roughly forty children on a typical weekday. The current approach to procedural pain is what most clinics would recognize: a topical anesthetic cream when a parent requests it and there is time for it to work, and verbal distraction by the nurse or parent during the draw. In practice the cream is used for perhaps one child in five because it needs up to an hour to take effect and most families arrive close to their appointment time. For the rest, distraction depends on the nurse's energy and the child's mood that day.
The consequences are not trivial. Needle fear in children with chronic illness can grow with repeated procedures, and Birnie et al. (2018) note that poorly managed needle pain can lead to anticipatory fear, avoidance of health care and later difficulty with medical procedures. Several parents in our clinic have asked whether anything can be done other than cream. Last spring, a family brought a small vibrating device with a detachable ice pack that they had bought online and asked whether we would use it. We did, and the child, who had cried at every previous visit, did not. One case is an anecdote, not evidence, but it raised a question that the clinic had never asked formally. When I raised it at a staff meeting, the other nurses were divided. Two had used similar devices in a previous job and thought they helped younger children most, one worried about adding another step to a busy morning, and our medical director asked whether the device would slow the draw or affect the sample. Those reactions showed me that the clinic would not change practice on enthusiasm alone; it would need evidence that answered a precise question, including what happens to the time and success of the procedure.
Where the Question Sits in the Research Process
Textbook accounts of evidence-based practice list a sequence that runs from the question through the search and the critical reading of studies, then to combining what the studies show with clinical expertise and what patients want, and finally to checking the result and telling others about it. Melnyk and Fineout-Overholt (2023) place a spirit of inquiry before all of them, and describe the question as the step that determines whether the rest of the process will be efficient or wasted. A vague question produces a search that returns thousands of irrelevant articles; a focused question produces a manageable set of studies that can be appraised.
It also matters what kind of question this is. Questions about whether an intervention works are intervention or therapy questions, and they are best answered by well-conducted trials that randomize patients, and better still by reviews that pool several such trials. That expectation will shape the search in the next module. If the question were about how children experience needle procedures, the best evidence would come from qualitative studies instead, and the search would look different. Naming the question type now saves effort later.
Building the PICOT Question
PICOT is a structure for clinical questions that names the population, the intervention, a comparison, the outcome and, when useful, the time frame. Rios et al. (2010) found that randomized trials whose research questions were framed in PICOT format tended to report their methods and results more completely, which is a reminder that a well-built question disciplines thinking on both sides of the research process. Each element of my question is set out below.
The population is school-age children having routine venipuncture for medication monitoring. I limited the age range to five to twelve years for two reasons: children in this range can rate their own pain with a validated self-report tool, and they make up most of the children in our draw room. The intervention is a combined cold and vibration device applied above the venipuncture site, used together with the distraction the clinic already provides. The comparison is distraction alone, which is current practice for most of our patients. The outcome is self-reported pain during the procedure, measured with the Faces Pain Scale-Revised, which Hicks et al. (2001) developed and tested for children aged about four to twelve. The time frame is the procedure itself, from tourniquet application to needle removal.
The Question and Its Limits
The finished question reads as follows. In school-age children aged five to twelve having routine venipuncture in an outpatient pediatric specialty clinic (P), does a combined cold and vibration device used with distraction (I), compared with distraction alone (C), reduce self-reported procedural pain on the Faces Pain Scale-Revised (O) during the venipuncture (T)?
Two limits are worth stating now. First, the question looks only at pain, although fear and distress are closely related and may matter as much to families; I plan to note any studies that also measure fear, but the primary outcome will stay narrow so the search remains manageable. Second, the question does not compare the device with topical anesthetic cream, which is the other option in our clinic. That comparison is worth asking, but it is a second question, and combining the two would make each one harder to answer.
Before searching, I also asked whether the question matters to the people it affects. Two parents I spoke with during clinic visits said that anything that made monitoring visits easier would be welcome, and the clinic's nurse manager agreed that the question fits the unit's goal of improving the family experience. Their interest is not evidence of effect, but it confirms that the question is worth the time the next modules will require.
References
Birnie, K. A., Noel, M., Chambers, C. T., Uman, L. S., & Parker, J. A. (2018). Psychological interventions for needle-related procedural pain and distress in children and adolescents. Cochrane Database of Systematic Reviews, 2018(10), Article CD005179. https://doi.org/10.1002/14651858.CD005179.pub4
Hicks, C. L., von Baeyer, C. L., Spafford, P. A., van Korlaar, I., & Goodenough, B. (2001). The Faces Pain Scale-Revised: Toward a common metric in pediatric pain measurement. Pain, 93(2), 173-183. https://doi.org/10.1016/S0304-3959(01)00314-1
Melnyk, B. M., & Fineout-Overholt, E. (2023). Evidence-based practice in nursing and healthcare: A guide to best practice (5th ed.). Wolters Kluwer.
Rios, L. P., Ye, C., & Thabane, L. (2010). Association between framing of the research question using the PICOT format and reporting quality of randomized controlled trials. BMC Medical Research Methodology, 10, 11. https://doi.org/10.1186/1471-2288-10-11
NUR 4190 Module 1 instructions, in plain terms
The first module of NUR-4190 usually asks for a practice problem and a researchable clinical question. In most terms the directions ask you to describe a problem from your own practice, explain what it costs patients and the hospital, identify the type of question you are asking, and write a question in PICOT format with each element labeled. Some mentors add a request to predict the strength of evidence you will find or to outline the stages of evidence-based practice. Thomas Edison State University keeps nursing course directions inside Moodle, so confirm the length, source requirements and whether your mentor wants the question approved before Module 2. Choose a problem you can search: narrow population, one intervention, one measurable outcome.
How the NUR 4190 Module 1 example is put together
The paper begins with the clinic and a frustration, then gives figures for the setting and describes current practice honestly, including how rarely the anesthetic cream is used. A single case is offered as the spark for the question and labeled as an anecdote. The second section places the question within the steps of evidence-based practice and identifies it as an intervention question, which tells the reader what kind of evidence the search should find. The PICOT section defines each element with a reason, including why the age range was set at five to twelve and why the Faces Pain Scale-Revised was chosen. The final section states the question in one sentence, names what it leaves out, and reports that families and the manager care about the answer.
Where the marks sit in the NUR 4190 Module 1 rubric
A Module 1 question paper is typically graded across four areas: the problem statement, the question itself, the reasons behind each element, and writing with APA style. The question row usually carries the most points: mentors check that the population is specific, that the intervention and comparison are distinct and realistic, that the outcome can be measured, and that the time frame makes sense. Justification matters because a correctly labeled question can still be unsearchable or trivial. Some rubrics add a row for significance, which rewards showing that patients, families or the organization would benefit from the answer. Scholarly sources are expected even at this stage, especially for the significance of the problem and for any measurement tool you name in the outcome.
NUR 4190 Module 1 help from the desk
Many first questions are too broad, such as asking whether nonpharmacologic methods reduce pain in children. That returns thousands of studies and cannot be appraised in one course. Another common problem is an unmeasurable outcome, for example better experience, with no instrument named. Students also mix two questions into one, for example comparing three interventions at once. Keep the comparison to current practice where you can, because that makes the eventual practice change realistic. Finally, check that your question type matches the evidence you plan to find. If you have a practice problem but cannot turn it into a clean question, the desk can draft a Module 1 paper built around your own setting.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official Thomas Edison State University document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.
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NUR 4190 Module 1 questions, answered
Where can I find a free NUR 4190 Module 1 sample paper?
This page has one in full: a practice problem and PICOT question paper for the TESU evidence-based practice course, with references and margin notes. It uses a composite pediatric clinic, so follow the structure and build your own question from a problem you see at work.
Does the PICOT question need a time element?
Only when time matters to the outcome. For a procedure, the time is usually the procedure itself; for a prevention program it may be six months. Many mentors accept PICO without a T if the time frame is obvious, but adding it shows you have thought about when the outcome is measured.
Can my comparison be no intervention at all?
It can, but questions are usually more useful when the comparison is current practice. Comparing a new approach with what your unit already does makes the eventual recommendation realistic and makes it easier to find studies with a similar control group.
How narrow should the population be in NUR-4190?
Narrow enough that studies about that group would apply to your patients, and broad enough that studies exist. An age range, a setting and a condition are usually enough. If your first search finds almost nothing, widen one element slightly rather than abandoning the question.
Do I need sources in the Module 1 paper?
Most sections expect a few, usually to show that the problem is significant and to support any measurement tool you name. A systematic review on the topic is a good first source because it tells you how much evidence exists before you begin the formal search in the next module.