Searching Databases – NURS 6052 Module 3 Week 4 discussion post
Searching Databases – NURS 6052 Module 3 Week 4 discussion post
BY DAY 3 OF WEEK 4
Post a brief description of your clinical issue of interest. This clinical issue will remain the same for the entire course and will be the basis for the development of your PICOT question. Describe your search results in terms of the number of articles returned on original research and how this changed as you added search terms using your Boolean operators. Finally, explain strategies you might make to increase the rigor and effectiveness of a database search on your PICO(T) question. Be specific and provide examples.
BY DAY 6 OF WEEK 4
Respond to at least two of your colleagues on two different days and provide further suggestions on how their database search might be improved.
Searching Databases – NURS 6052 Module 3 Week 4 discussion post
The clinical issue I want to further explore is depression. I want to know how certain factors can help alleviate the feelings of depression or even combat it. Many factors play an important role in treating depression which is why I will focus on the impact of physical activity on depression. My PICOT research question is as follows. In patients with mental health issues, does exercise compared to any other intervention help reduce/alleviate depression within two months? Physical activity is important for managing symptoms of depression and anxiety (Lewis et al., 2021). PICOT is an acronym that stands for population, intervention, comparison, outcome, and time which sometimes is optional. The purpose of the PICOT question is to guide the systematic search of healthcare databases to find the best available evidence to answer the question (Melnyk, B. M., & Fineout-Overholt, E. (2018).
I then went into Walden’s library to make the most out of my searching process. I went ahead and chose Medline and searched for exercise and depression as minimal word searches, I could use. Right of the bat, I came across 19,304 articles. I then made good use of the Boolean search parameters and limiters. Using Boolean terms helps to create more precise and powerful searches with a higher percentage of relevant results (Walden University Library, n.d.). I checked peer reviewed articles, full text and changed the years to 2017 to 2022. My research was then narrowed down to only 5,678 articles which consists of plenty of information to yield a good answer to my PICOT research question. I also used CINAHL plus with full text. I retrieved 21,331 articles with the Boolean parameters used which were physical activity and mental health. I then checked a few preferences as well as with Medline. It then got simplified to 5,326 articles that I can work with.
Strategies to increase the effectiveness and rigor of a database search are on my PICOT question is to maybe add a check box for PICOT. This way, the databases can focus on the question and pull all the pertinent information. This can decrease the time we spend searching for the needed information. Another strategy is to always use the search limiters and check all the pertinent boxes for a much accurate search. Fixing the years to the most recent information is also a good idea because EBP information changes quickly.
GET WRITING HELP HERE
Academic guides: Keyword searching. Academic Guides at Walden University. (n.d.). Retrieved December 20, 2022, from https://academicguides.waldenu.edu/library/keyword/boolean Links to an external site.
Lewis, R., Roden, L. C., Scheuermaier, K., Gomez-Olive, F. X., Rae, D. E., Iacovides, S., Bentley, A., Davy, J. P., Christie, C. J., Zschernack, S., Roche, J., & Lipinska, G. (2021). The impact of sleep, physical activity and sedentary behaviour on symptoms of depression and anxiety before and during the COVID-19 pandemic in a sample of South African participants. Scientific Reports, 11(1), 24059. https://doi.org/10.1038/s41598-021-02021-8
Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer
Matthew Mormann 6052 response #2
Hello Janet
Your clinical issue of choice, depression is such an issue in our global society and its ramifications are seen everywhere. It has always been there, but it appears that lately, it’s getting the attention that it needs to make a change for the better. The example of an exercise that you chose is an excellent focus to make a difference in people’s lives. Because depression causes so many other negative by-products such as clinical, biological, social, and psychological problems exercise can treat all of these and according to studies affect the dopamine and serotonin in the brain (Schuch & Stubbs, 2019). Some of the contributing factors of depression are being addressed inside the workplace with nurses and with the right interventions can help nurses do a better job of coping and treating patients (Kalkan Uğurlu et al., 2020). With addressing depression being addressed in the workplace of nurses and proving the resources needed, nurses can do their job in a much healthier fashion giving better care to their patients and embracing nursing during their entire careers.
References
Kalkan Uğurlu, Y., Mataracı Değirmenci, D., Durgun, H., & Gök Uğur, H. (2020). The examination of the relationship between nursing students’ depression, anxiety and stress levels and restrictive, emotional, and external eating behaviors in covid‐19 Social Isolation Process. Perspectives in Psychiatric Care, 57(2), 507–516. https://doi.org/10.1111/ppc.12703
Schuch, F. B., & Stubbs, B. (2019). The role of exercise in preventing and treating depression. Current Sports Medicine Reports, 18(8), 299–304. https://doi.org/10.1249/jsr.0000000000000620
Isaac Okai Hi Janet,
I have worked as a psychiatric and mental health nurse for the past nine years. I have had the opportunity to work with patients with Depression. It is a major global healthcare challenge. It was estimated globally that over 320 million people were affected by Depression in 2015(Fellinger et al.,2022). As challenging as it is, it is much more rewarding when you see the effectiveness of interventions put in place by the treatment team. Depressing is a significant health challenge around the world. It is a risk factor for suicide and the most common psychiatric disorder diagnosed in persons with completed suicide (Paljarvi et al.,2023). I like your PICOT research question comparing exercise with other interventions within two months. What are you implying stating within two months? Is it within two months of inpatient psych hospitalization? Please expound on it. I have used Medline for most of my research projects. I find the articles to be peer-reviewed and detailed.
I am looking forward to your final project on Depression. Thank you, and good luck. Searching Databases – NURS 6052 Module 3 Week 4 discussion post
References
Fellinger, M., Waldhör, T., Serretti, A., Hinterbuchinger, B., Pruckner, N., König, D., Gmeiner, A., Vyssoki, S., Vyssoki, B., & Fugger, G. (2022). Seasonality in major depressive disorder: Effect of sex and age. Journal of Affective Disorders, 296, 111–116. https://doi.org/10.1016/j.jad.2021.09.051
Paljärvi, T., Tiihonen, J., Lähteenvuo, M., Tanskanen, A., Fazel, S., & Taipale, H. (2023). Psychotic depression and deaths due to suicide. Journal of Affective Disorders, 321, 28–32. https://doi.org/10.1016/j.jad.2022.10.035
Jenna C. Alford Hi Janet!
I enjoyed reading your post! Your clinical issue of depression is a great choice. Healthcare has changed dramatically since the Covid-19 pandemic, and some of the things healthcare workers have gone through have increased this clinical issue. Your PICO(T) question is a well-thought-out question. Exercise can make us feel better mentally and physically. We have some great databases to help with our research. This ability to identify the question is essential to locating relevant information to answer the question (Davies, 2011). Boolean terms are a great resource in helping to narrow our searches for that relevant information and can make researching simpler.
References
Davies, K. S. (2011). Formulating the evidence based practice question: A review of the frameworks Links to an external site.for LIS professionals. Evidence Based Library and Information Practice, 6(2), 75–80.
Walden University Library. (n.d.-f). Keyword searching: Finding articles on your topic: Boolean terms Links to an external site.Links to an external site.. Retrieved September 19, 2018, from http://academicguides.waldenu.edu/library/keyword/booleanLinks to an external site.
Collapse SubdiscussionKrishnaben Patel PICOT inquiries are used by healthcare practitioners to clarify clinical difficulties in a way that facilitates effectively and swiftly locating the relevant data to address the clinical inquiry (Melnyk & Fineout-Overholt, 2018). The PICOT inquiry’s objective is to direct a thorough search of medical databases to get the best accessible facts to respond to the question (Melnyk & Fineout-Overholt, 2018). To effectively start the EBP process, it is essential to comprehend how to properly write a clinical query in PICOT format and use it methodically in your search (Melnyk & Fine-out-Overholt, 2018). A clinical question that is formulated methodically can be answered more quickly and effectively, improving techniques and patient outcomes (Stillwell et al., 2010).
Question
Does hand washing with soap and water instead of hand sanitizers help reduce the incidence of hospital-acquired infections within three months in geriatric inpatients?
PICOT Question
In geriatric inpatients (P), does hand hygiene using soap and water (I) compared to the use of hand sanitizers(C), help in lessening Hospital Acquired Infection (HAIs) incidences (O) within three months (T)?
Search Terms used
The search terms used were Hand Hygiene, hand washing, Hospital-acquired infections, inpatient geriatrics, and hand sanitizers.
Database used
The two databases used were CINAHL Plus with Full Text and MEDLINE with Full Text.
Search Results
There were 120 results for CINAHL Plus with Full Text and 80 for MEDLINE with Full Text (Walden University Library, n.d. – a). These included both systematic reviews and original research pieces. The search was limited to five-year-old articles. Additionally, the search article related to the research query was used. Everything has to do with hand washing, hand sanitizer use, and hospital-acquired infection control. Two of the papers were based on the original study.
Addition of Boolean Operator
My search was drastically altered once I added the search phrases and used the Boolean operators. In accordance with the papers that are available and their importance to my study, the amounts of records returned have risen exponentially and reduced. It sped up the completion of more thorough results and aided with time savings as the outcomes improved to meet my needs. It also gets rid of inappropriate content. One can look for combinations of words or phrases that have been processed in a certain order using boolean operators and nesting (Library of Congress, n.d.).
Strategies to increase the rigor and effectiveness of a database search and example
Using Boolean operators is one of the tactics I’ll use to make a database search for my PICOT query more thorough and productive. Boolean operators make the search easier and more focused by limiting the search to the most pertinent results limiting the search to the most pertinent results, Boolean operators make it easier and more focused. I’ll also restrict the search to a specific time frame of years. Limiting the year range makes it easier to find current searches and conducts my search across multiple databases because each one might have more articles. I’ll look for a librarian to assist me with the initial research. Using parenthesis is a different tactic. Parentheses will enable me to conduct the search I want.
References
Academic guides: Home: Library. Library – Home – Academic Guides at Walden University. (n.d.). Retrieved December 21, 2022, from https://academicguides.waldenu.edu/library
KM;, F.-O. E. M. B. M. S. S. B. W. (n.d.). Evidence-based practice, step by Step: Critical appraisal of the evidence: Part III. The American journal of nursing. Retrieved December 21, 2022, from https://pubmed.ncbi.nlm.nih.gov/20980899/
Library of Congress. (n.d.). Search/browse help-Boolean Operator and nesting. Retrieved September 22, 2020, from https://catalog.loc.gov/vwebv/ui/en_US/htdocs/help/searchBoolean.html . (n.d.).
Wolters Kluwer Health single signon result. (n.d.). Retrieved December 21, 2022, from https://medicine.lww.com/Book/Show/865601
Doris Hill Hello Krishnaben,
Your search provide relative results for your topic. Good formatting of the PICOT question.
Esther O Adeyemo Hello Krishnaben,
Your topic is quite essential, hand washing is a critical step in the prevention of infectious disease transmission. . Handwashing has historically been considered to be one of the most efficient methods of preventing sickness. When it comes to keeping ourselves well and safe, it is a simple act that offers huge returns in the long run. Infection control continues to be a big concern across the globe, but by following safety measures, the transmission of illness among the general public may be kept to a bare minimum (Mouajou et al., 2021). We can all help to avoid the spread of many illnesses by practicing effective infection control. Ultimately, handwashing is one of the most critical aspects in the prevention and control of HAI. Also, The importance of hand cleanliness cannot be overstated as we embrace the new normal and live with COVID-19. As we live through this pandemic and beyond, hand hygiene must become a vital part of our daily routine and lives in order to protect us from illnesses, viruses, and bacteria. In addition to using different databases, you could try using alternative or related terms in your search such as “infection control”. Utilizing these terms helps expand the search process to retrieve more article.
References
Mouajou, V , Adams , K , DeLisle, G. & Quach, C (2021). Hand hygiene compliance in the Prevention of Hospital-Acquired Infections: A systematic review. The Journal of hospital infection. Retrieved December 24, 2022, from https://pubmed.ncbi.nlm.nih.gov/34582962/
Janet Alvarado Hello Patel,
I believe your research question is a major issue we have worldwide. We cannot seem to overcome this issue as it continues to exist in our hospitalized and already vulnerable patients. Health care associated infection is associated with increase morbidity, mortality, prolonged hospital stay, increased health care costs, and antibiotic resistance in both acute and long term care facilities (Tan & Olivo, 2015). More research is required to come up with better ideas to at least decrease the incidence of HAI’s.
Also, I myself like searching my date in CINAHL and Medline. Those are my go-to databases because the amount of information I come across. Thanks to the combinations and boolean operators and nesting, we can get an immense number of articles to choose from.
Thank you for sharing.
Tan, J. . A. K., & Olivo, J. (2015). ORIGINAL PAPER. Assessing Healthcare Associated Infections and Hand Hygiene Perceptions amongst Healthcare Professionals. International Journal of Caring Sciences, 8(1), 108–114.
Library of Congress. (n.d.). Search/browse help-Boolean Operator and nesting. Retrieved September 22, 2020, from https://catalog.loc.gov/vwebv/ui/en_US/htdocs/help/searchBoolean.html . (n.d.).
Collapse SubdiscussionTiffanie Lundy Initial post:
Improved patient safety and outcomes are always the goal for healthcare providers and facilities. As evidence and research data are revealed, healthcare facilities use that data to implement changes and quality improvements into practices to improve patient safety and outcomes. Using the PICOT method, I was able to write a focused research question (National Center for Biotechnology Information, n.d.). Can Implementing bedside nursing report on patients improve patient outcomes? The “P” in PICOT represents the population focused on. In this case, it will represent any patient from newborn to geriatric on any floor. The “I” represents the intervention. In this case, that would be the implementation phase of bedside report. The “C” represents comparison. In this case, it would be bedside report versus no bedside report on patients. The “O” represents the outcome. In this case, it would represent improved patient outcomes such as safety and patient satisfaction. The “T” represents tie. In this case, it should be all the time as long as during the implementation phase there are not any contraindications.
I conducted my search using CINAHL Plus and ProQuest One Academic databases. I used the initial search using bedside nursing report that gave me 304 results. I tightened down the search by adding filters such as peer reviewed, language, and health. CINAHL Plus gave me 84 initially and then I chose scholarly articles which narrowed it down to 80. Using multiple search words and Boolean operators will give you the best results.
I can improve my search results by narrowing down to key words such as improved, outcomes, and patient safety. I can also narrow thing down based off of the year of publication and where the publications come from such as journals, scholarly articles, magazines, and newspapers. Using keywords in the search box will tighten up the search to improve your search site (Glasziou et al., 2009, p. xx).
ReferencesGlasziou, P. P., Mar, C. D., & Salisbury, J. (2009). Evidence-based practice workbook. John Wiley & Sons.
Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice. LWW.
(n.d.). National Center for Biotechnology Information. https://www.ncbi.nlm.nih.govLinks to an external site.
Vaibhav Patel Hi Tiffanie
I enjoy reading your post, You stated that your PICO(T) was: (I) will standardizing bedside shift reporting (C) as opposed to reporting at the nursing station (O) be effective in improving patient satisfaction, increasing patient involvement, and nurse satisfaction(T) over a three-month period in any patient from newborn to geriatric on any floor? This is an intriguing and frequently discussed topic in my hospital.
Nursing reports are critical to ensuring continuity of care, and I believe that reporting will increase patient involvement in their care. Going to do nursing report at the bedside, for example, allows the patient to meet the oncoming nurse immediately, giving the patient a sense of security and an opportunity to express any needs to the nurse. I ran a MEDLINE Full Text search in the first category with the keywords “bedside handover or bedside handoff or bedside report or bedside shift report” and the AND Boolean operator keywords effectiveness and acute care hospital. When I limited the search to full-text and peer-reviewed scholarly journals, the results were reduced to 24 articles. Using the key terms mentioned above resulted in most of the articles being unrelated to your PICO(T) question. The Boolean operators assist the researcher in producing more focused and productive results. However, the operators were overly restrictive in this case.
References
Glasziou, P., Del, mar.. c., Salisbury, J. (2007). evidence- based practice workbook, 2nd edition. Blackwell Publishing Ltd., Oxford, UK. (n.d.). Retrieved December 21, 2022, from http://www.sciepub.com/reference/281915Links to an external site.
Melnyk, B. M., Williamson, K. M., Stillwell, S. B., & Fineout-Overholt, E. (n.d.). Evidence-based practice: Step by step: The seven steps of evidence-based practice. The American journal of nursing. Retrieved December 21, 2022, from https://pubmed.ncbi.nlm.nih.gov/20032669/Links to an external site.
Doris Hill Hello Tiffanie,
Good overview of your search. Noted that there are two elements of the PICOT not addressed in your question. Revise to add the population and time.
Lami Ibrahim Hi Tiffanie
Thank you for your great post and I enjoyed reading your discussion post. You stated your PICOT was: in healthcare facilities, The “P” in PICOT represents the population focused on, the “I” represents the intervention, The “C” represents comparison, The “O” represents the outcome, The “T” represents tie? this is a very interesting and often talked about topic in the hospital that I work at.
Nursing report is essential to continuity of care, and I also believe that bedside reporting will increase the patient’s involvement in their care. For instance, going to do nursing report at the bedside allows the patient to meet the oncoming nurse right away and it gives the patient a sense of security and an opportunity to express any needs to the nurse. I conducted a MEDLINE with Full Text search using “bedside handover or bedside handoff or bedside report or bedside shift report” in the first category and the AND Boolean operator keywords effectiveness and the result in 32 articles when I selected limit to full test and peer reviewed scholarly journals the results were narrowed to 24 articles. I chose to add acute care to see if the result would be any different from your search. Utilizing the above-mentioned key terms resulted in most of the articles being unrelated to your PICO(T) question. This purpose of the Boolean operators are to assist the researcher to obtain more focused and productive result however, in this case the operators were to restrict.
Reverence
Library of Congress. (n.d.). Search/browse help – Boolean operators and nesting. Retrieved December 19, 2022, from https://catalog.loc.gov/vwebv/ui/en_US/jtdpcs/help/searchBoolean.htmlLinks to an external site.
Stillwell, S. B., Fineout-Overholt, E., Melnyk, B. M., & Williamson, K. M (2010a). Evidence-based practice, step by step: asking the clinical question: A key step in evidence-based practice. American Journal of nursing, 110(3), 58-61 doi:10.1097/01.NAJ.0000368959.11129.79
Collapse SubdiscussionEnion Hampton Hello again, fellow classmates and professor,
For this discussion, I will discuss the following topic: My area of clinical issue is Ventilator Assisted Pneumonia. I wanted to discuss this issue because HAIs are entirely preventable; however, with the rates of Covid-19 and Respiratory Syncytial Virus(RSV) going up, so is VAP. Since the best way to prevent a HAI is aseptic care, I want to know how oral care affects VAP. Thus, my clinical inquiry is: Does providing suitable oral hygiene assist in helping Mechanically Vented Patients decrease Ventilator Associated Pneumonia (VAP)?
VAP is a healthcare-associated infection (HAI) that can be minimalized if not prevented. Episodes of VAP are rising due to the Covid-19 pandemic and the Respiratory Syncytial Virus (RSV) spike. While most healthy people will recover from these viruses without the need for mechanical ventilation, the risk increases for those who are elderly, babies, and those who are immunocompromised – leaving this population with adverse physiological effects (Boltey et al.,2017).
PICOT is an acronym mnemonic that stands for Patient, Intervention, Comparison, Outcomes, and Time. In the field of clinical research, or even nursing research – a PICOT formulation helps the researcher develop a cognizant question. All 5 elements become queries that can be used to search peer-reviewed articles, thus eliciting the need to find evidence that supports the question.
In this week’s instructions, the metaphor of buying a car was used (in buying a car, you will research cars to see which one aligns with what you are most looking for). In research – it’s the same process but slightly different. We are developing questions that can be supported by peer-reviewed by our colleagues. While Google and Carfax are good enough for a car, for this realm – we must have a level of reliability in our research. We want to have the highest level of integrity when we are writing scholarly to support our answers; thus, where we search must be steadfast.
Here is my PICOT
P – mechanically vented ICU patients
I – oral hygiene
C- no oral hygiene, or non – adequate oral hygiene
O- lower rate of VAP
T -Duration of mechanical vent during ICU timeIn researching my articles – I found the following :
Database:
CINAHL – restraints -articles from 2017-2022, full articles, peer-reviewed. Keywords: ventilator, ICU, VAP, Ventilator-Associated Pneumonia, ICU, chlorhexidine, mouth care, oral care. Articles were more specified when I searched ventilator-associated pneumonia and used the Boolean operator (and) oral care.
o Article 1: Oral Hygiene Care to Prevent Ventilator-Associated Pneumonia in Critically Ill Patients.
o Article 2: Does oral care with chlorhexidine reduce ventilator-associated pneumonia in mechanically ventilated adults?
ProQuest Nursing and Allied Database- I repeated the process I did with CINAHL. It worked, so I was not going to fix it: restraints -articles from 2017-2022, full articles, peer-reviewed. Keywords: ventilator, ICU, VAP, Ventilator-Associated Pneumonia, ICU, chlorhexidine, mouth care, oral care. Articles were more specified when I searched ventilator-associated pneumonia and used the Boolean operator (and) oral care.
o Article 1: Why it’s time to abandon antiseptic mouthwashes. I choose this article because it is the opposition, and I like to review both sides.
o Article 2: Oral Care Education in the Prevention of Ventilator-Associated Pneumonia: Quality Patient Outcomes in the Intensive Care UnitThe ProQuest database had many systemic reviews that were not allowed for this topic. I picked the best two out of the 4 that qualified. Overall, I generated a good amount of information that assisted with my topic.
Blot, S., Labeau, S. O., & Dale, C. M. (2022). Why it’s time to abandon antiseptic mouthwashes. Intensive & Critical Care Nursing, 70 doi:https://doi.org/10.1016/j.iccn.2022.103196
Boltey, E., Yakusheva, O., & Costa, D. K. (2017). 5 Nursing strategies to prevent ventilator-associated pneumonia. American nurse today, 12(6), 42–43.
Cooper, A. S. (2021). Oral Hygiene Care to Prevent Ventilator-Associated Pneumonia in Critically Ill Patients. Critical Care Nurse, 41(4), 80–82. https://doi.org/10.4037/ccn2021314
Jackson, L., & Owens, M. (2019). Does oral care with chlorhexidine reduce ventilator-associated pneumonia in mechanically ventilated adults? British Journal of Nursing, 28(11), 682–689. https://doi.org/10.12968/bjon.2019.28.11.682
Melnyk, B. M., & Fineout-Overholt, E. (Eds.). (2011). Evidence-based practice in nursing & healthcare: A guide to best practice. Lippincott Williams & Wilkins.
Zurmehly, Joyce, PhD, DNP,R.N., N.E.A.-B.C. (2013). Oral care education in the prevention of ventilator-associated pneumonia: Quality patient outcomes in the intensive care unit. The Journal of Continuing Education in Nursing, 44(2), 67-75. doi:https://doi.org/10.3928/00220124-20121203-16
Collapse SubdiscussionKrishnaben Patel Hi Enion, Your PICOT question seems very interesting. The research topic I’d like to investigate is whether routine dental care for mechanically ventilated patients should use chlorhexidine or another sort of oral care product to prevent infections like pneumonia. According to Nicolosi et al. (2014), a quasi-experimental study was conducted utilizing 0.12% chlorhexidine oral rinse on mechanically ventilated patients 72 hours before cardiovascular surgery to avoid ventilator-associated pneumonia. I visited the Walden University Library and performed a database search on ProQuest Health and Medical Collection. I put the phrases “oral care,” “chlorhexidine,” and “pneumonia” in the Boolean boxes. Twenty research studies, comprising quantitative, qualitative quasi-experimental investigations, were found through the search. The study is academic in style and follows evidence-based guidelines. Zand (2017) asserts that VAP, which affects 9–27% of patients admitted to the ICU, is the most common infection among ICU patients. Currently, the cost of VAP in the US exceeds $2 billion.
References
Nicolosi, L. N., del Carmen Rubio, M., Martinez, C. D., Gonzalez, N. N., & Cruz, M. E. (2014). Effect of oral hygiene and 0.12% Chlorhexidine gluconate oral rinse in preventing ventilator-associated pneumonia after cardiovascular surgery. (n.d.).
S;, O. T. O. B. (n.d.). Ventilator-associated pneumonia, liver disease, and oral chlorhexidine. British journal of nursing (Mark Allen Publishing). Retrieved December 23, 2022, from https://pubmed.ncbi.nlm.nih.gov/24261090/
Enion Hampton Hi Krishnaben-
Part of my discussion for our project will continue the positives and negatives of chlorhexidine. I went and read your cited articles and found them very interesting. While I was able to find a lot of articles, a lot of the ones discussing chlorhexidine did not fit my parameters. For instance, according to the Ventilator-assisted pneumonia, liver disease and chlorhexidine was written by the British Journal of Nursing. The article states, “The Department of Health (DH) in the U.K. recommends the use of chlorhexidine (CHX) for oral care to prevent the occurrence of ventilator-associated pneumonia” I am not sure if this would be an article I would choose, because it was written in 2013 and it states the DOH in the UK. I currently live in Pennsylvania; US and I don’t know if our standards are the same as the US. According to Melnyk the PICOT formula will help us derive a formulated question. However, when we compete our search, we want to make sure they are aligned and recent within 5 years. How do you feel about this?
Melnyk, B. M., & Fineout-Overholt, E. (Eds.). (2011). Evidence-based practice in nursing & healthcare: A guide to best practice. Lippincott Williams & Wilkins.
Nicolosi, L. N., del Carmen Rubio, M., Martinez, C. D., Gonzalez, N. N., & Cruz, M. E. (2014). Effect of oral hygiene and 0.12% Chlorhexidine gluconate oral rinse in preventing ventilator-associated pneumonia after cardiovascular surgery. (n.d.).
S;, O. T. O. B. (n.d.). Ventilator-associated pneumonia, liver disease, and oral chlorhexidine. British journal of nursing (Mark Allen Publishing). Retrieved December 23, 2022, from https://pubmed.ncbi.nlm.nih.gov/24261090/
Collapse SubdiscussionSenait Bahiru Fall prevention and staff training in the nursing home
Evidence-based medicine (EBM) is defined as the integration of the best available evidence from scientific studies with clinical experience (and context) and with patients’ values and preferences. (Romero-Robles, M. A. el.al 2022). I have been a nurse for 15 years. The first seven years of my nursing career have been spent working in nursing homes and rehab with the older population. The number one issue in long-term care we used to experience was falling and sustaining severe injuries. ( Worum, H. el.al2020) Due to the increasing proportion of older people, efficient and effective evidence-based practice (EBP) strategies for managing fall prevention in primary health care are very important. Identifying problems to find an effective solution to prevent falls in the nursing home is essential, which will increase patients’ quality of life and safety. A compelling clinical question using the PICOT format sets the stage for a successful search for relevant evidence (Bell, S. el. al. (2021).
Each year, about 600,000 falls worldwide result in death, meaning falls are one of the leading causes of traumatic deaths (World Health Organization, 2018). The PICOT question that I used falls in all older adults aged nursing homes (P), patient’s awareness of fall prevention (I) Efficient staff training focus on the identification of risk factor (C) Improved fall prevention measured (O) No special education (T) time achieving this purpose is six months to one year. (Schoberer, D.el.al. 2022) Due to biological changes, older adults have a higher risk of falling. About half of nursing home residents suffer a fall at least once a year. I used the Walden library, then Databases A-Z to CINAHL (Cumulative Index to Nursing and Allied Health Literature) and MEDLIN (Medical Literature Analysis and Retrieval System Online) databases for my PICOT question. When I searched for PICOT questions, I entered the keywords fall prevention and staff training in the nursing home; CINAHL showed 3,491 articles, while Medline indicated 6,787 articles. When I used BOOLEAN terms, CINAHL and MEDLINE showed 1,690 articles. I narrowed the search to only peer-reviewed articles, resulting in 675 articles. When I amended the search to CINAHL peer-reviewed and applied Boolean operators, it resulted in 109 articles. It was exciting to work using Boolean operators because it was the fastest and most effective way to get an article I was searching for. The purpose of most studies status of this research is related to fall prevention in the elderly population in a nursing home. (Chan, D. el. al., 2019) The most commonly cited barriers were limited knowledge and skills, staff concerns regarding their ability to control fall management, staffing issues, and poor communication, while the most commonly cited facilitators were good communication and the availability of suitable equipment (Vlaeyen et al., 2017). I have usually used CINAHL and MEDLINE databases since I started working on research papers in nursing school because it contains full-text journals mostly related to biomedical health and can be fast to use, particularly for filtered studies. We must work hard to develop strong database search skills to achieve better and more effective results.
References
Schoberer, D., Breimaier, H. E., Zuschnegg, J., Findling, T., Schaffer, S., & Archan, T. (2022). Fall prevention in hospitals and nursing homes: Clinical practice guideline. Worldviews on Evidence‐Based Nursing, 19(2), 86-93.
Worum, H., Lillekroken, D., Roaldsen, K. S., Ahlsen, B., & Bergland, A. (2020). Reflections of older people about their experience of fall prevention exercise in the community- a qualitative study exploring evidence-based practice. BMC Public Health, 20(1), 1671. https://doi.org/10.1186/s12889-020-09630-4Links to an external site.
Chan, D. K. Y., & Chan, L. K. M. (2019). Falls in nursing homes: challenges from a nursing perspective. British Journal of Community Nursing, 24(1), 6–9. https://doi.org/10.12968/bjcn.2019.24.1.6Links to an external site.
Bell, S. G., & O’Donovan, P. (2021). Steps 1 and 2: Asking a Compelling Clinical Question and Searching for the Best Evidence. Neonatal Network, 40(4), 262-266.
Romero-Robles, M. A., Soriano-Moreno, D. R., García-Gutiérrez, F. M., Condori-Meza, I. B., Sing-Sánchez, C. C., Bulnes Alvarez, S. P., Alarcon-Ruiz, C. A., Taype-Rondan, A., & Viteri-García, A. (2022). Self-perceived competencies on evidence-based medicine in medical students and physicians registered in a virtual course: a cross-sectional study. Medical Education Online, 27(1), 2010298. https://doi.org/10.1080/10872981.2021.2010298
Walden Library University. (n.d.). Databases A-Z: Nursing. Retrieved from https://academicguides.waldenu.edu/az.php?s=19981
Deborah Mulemia Malanga I have enjoyed going through Senait’s post because my clinical inquiry issue falls injuries and their prevention. To add to this discussion, each year, around half of the people fall more than once. The etiology of falls is complex since biological, environmental, behavioral, and socioeconomic factors are important (Sam&Lee, 2022). According to the World Health Organization (WHO), 28-35% of adults over 65 falls at least once a year. This percentage rises to 32-42% in those over 70. Accidental falls can have adverse physical, psychological, and monetary effects. For instance, 5-10% of fall incidents result in serious injuries such as fractures, tissue injuries, or head trauma.
On a psychological level, it is possible to suffer from a decline in quality of life, social isolation, and a fear of falling. Falls and injuries caused by falls may also have financial consequences. Direct medical expenses associated with fatal and non-fatal falls in the United States are expected to total $50 billion in 2015. These costs are almost entirely due to non-fatal falls. Furthermore, the financial toll of falls appears to differ by gender, with older women requiring more medical attention than younger women (Hogan Quigley et al., 2021).
References
Hogan Quigley, B., Renz, S. M., & Bradway, C. (2021). Fall Prevention and Injury Reduction Utilizing Continuous Video Monitoring. Journal of Nursing Care Quality, 37(2), 123–129. https://doi.org/10.1097/ncq.0000000000000582
Sam, P. R., & Lee, P. (2022). Perception: A Critical Analysis of the Hospitalized Patients on Falls. International Journal of Nursing Education, 14(3), 127–130. https://doi.org/10.37506/ijone.v14i3.18365
Doris Hill Hello Senait,
Good detail to your literature search and defining the PICOT acronym. State your specific PICOT question.
Collapse SubdiscussionJitendra Kumar Verma Post a brief description of your clinical issue of interest. This clinical issue will remain the same for the entire course and will be the basis for the development of your PICOT question. Describe your search results in terms of the number of articles returned on original research and how this changed as you added search terms using your Boolean operators. Finally, explain strategies you might make to increase the rigor and effectiveness of a database search on your PICO(T) question. Be specific and provide examples.
PICOT is typically used in evidence-based practice to ask, structure, and answer health-related inquiries. It is used in evidence-based nursing practice and other evidence-based research. The P represents the population, which can be sex, age, and ethnicity. The I represents the intervention that has been done. The C represents a comparison, O represents the outcome, and T represents the time frame (White, 2019). It helps in the etiology of an illness process, diagnosis, understanding of research, and epidemiology of disorders. My PICO question is, ” For patients with long hospital stays (P), can the nursing team adherence to a routine alcohol-based hand rub (I), as compared to deficiency of adherence to ordinary hand rub (C), the outcome in decreased rates of HAIs, within three months (T)?”
One of the issues of the health care system globally is hospital-acquired infection. It impacts patients, families, and healthcare workers. Nosocomial infections, otherwise named hospital-acquired infections, can only be gained in the healthcare setting. The most standard of these infections is urinary tract infection and pneumonia. These infections impact the genitourinary and respiratory systems and also other systems if not appropriately treated. Different microorganisms are responsible for these infections. The common bacteria is the Pseudomonas aeruginosa because it can survive and adapt in different habitats, including soil, water, sewage, and hospitals, making this opportunistic pathogen the most typical cause of nosocomial infection (White, 2019).
The databases explored were CINAHL, PubMed, and CINAHL & MEDLINE Combined Search in Walden Library. My search was narrowed to a search for peer review, where I used a date range of 2015 to 2020 (5 years) to display the most recent research articles in evidence-based practice. In PubMed, an advanced search filtered the articles to narrow the search. The filtered research articles were the studies completed on humans and published between 2015-2020. Furthermore, another strategy that I used is a feature of PubMed that is referred to as Clinical Inquiries. Clinical Inquiries provide the ideal answers to clinical questions: using a critical appraisal, structured search, authoritative recommendations, rigorous peer review, and clinical perspective. Clinical Inquiries give the best evidence for point-of-care use. Clinical Inquiries are designed to enhance search results by linking the type of question (prognosis, therapy, etiology, and diagnosis) to a stored search strategy that retrieves the appropriate research methodology (White, 2019). Via these techniques, there will be an improvement in the search results, which will be utilized to find vital peer-reviewed articles. Immediately, I added a filter and searched with a term. I got over two hundred results when I added my filters and searched the terms “Hospital Acquired Infection” in the Walden Library. The university recommends that students should use boolean terms to create a more precise search with more relevant results (Walden Library, 2022). Immediately, I added the boolean terms to my next search and got over eighty thousand results. A study concluded that it is essential to search with a minimum of three different databases to get approximately ninety percent of all essential literature on the topic. In addition, a strategy to increase the significance of a database search is to use alternative terms (Ho et al., 2016). Regardless, to enhance my search results, alternative terms such as “Nosocomial infection,” “Proper hand hygiene,” or alcohol-based hand sanitizers” can be used to improve the chance of valuable evidence-based research.
References
Ho, G. J., Liew, S. M., Ng, C. J., Hisham Shunmugam, R., & Glasziou, P. (2016). Development of a search strategy for an evidence based retrieval service. PLOS ONE, 11(12). https://doi.org/10.1371/journal.pone.0167170
Walden University Library. (2022). Keyword searching: Finding articles on your topic: Boolean terms. Retrieved from http://academicguides.waldenu.edu/library/keyword/boolean
White, K. M. (2019). Evidence-based practice and its implementation in healthcare. Translation of Evidence Into Nursing and Healthcare. https://doi.org/10.1891/9780826147370.0001
Vaibhav Patel Hi Jitendra
Healthcare-acquired infections (HCAI) remain a major concern, and as you stated, hand hygiene has a significant impact on those outcomes. I would advise you to use more broad search terms as you look for resources. HCAI, hand washing, hand sanitizer, hand hygiene, nurses, and emergency rooms are a few examples (ER). These are two of the best search techniques that yield the most precise results: using these keywords or subject headings (Melnyk & Fineout-Overholt, 2018). For words with multiple endings, another recommendation would be to use truncation (Walden University Library, n.d.). As this term can be used to refer to both nurses and nursing, an example would be “nurse.” Using truncation will allow you to find resources with any possible endings, yielding more results.
I’d also advise changing the date range for the results of your search parameter when searching databases. You can make sure you are getting the most recent information on your subject by adjusting the date range.
References
Melnyk, B. M., & Fineout-Overholt, E. (n.d.). Evidence-based practice: Step by step: The seven steps of evidence-based practice. The American journal of nursing. Retrieved December 22, 2022, from https://pubmed.ncbi.nlm.nih.gov/20032669/Links to an external site.
Library – Walden University – Acalog ACMS™. (n.d.). Retrieved December 22, 2022, from https://catalog.waldenu.edu/content.php?catoid=41&navoid=5230Links to an external site.
Deborah Mulemia Malanga I agree with Jitendra’s discussion. Additionally, a higher percentage of relevant results can be obtained from searches when Boolean phrases are used to assist in creating them. You can use Boolean operators to make a database search for your PICO (T) inquiry more thorough and effective (Walden University, n.d.). The target population or environment can then be specified. Patient population (P), intervention or issue of interest (I), comparison intervention or problem of interest (C), outcome(s) of interest (O), and time required for the intervention to produce the outcome(s) are the components of the clinical question, abbreviated as PICO (T).
The PICO (T) inquiry is significant because it offers a consistent, organized method for determining the elements of a clinical problem. Clarifying these elements by structuring the clinical question using the PICOT method will assist in directing the search for the information. The likelihood of finding the best evidence to guide practice will rise with a well-constructed PICOT inquiry (Stillwell et al., 2010). Only some articles could address all the PICOT questions from the data I gathered. However, you can find what you need through research from different pieces.
References
Stillwell, S. B., Fineout-Overholt, E., Melnyk, B. M., & Williamson, K. M. (2010). Evidence-Based Practice, Step by Step: Asking the Clinical Question. AJN, American Journal of Nursing, 110(3), 58–61. https://doi.org/10.1097/01.naj.0000368959.11129.79
Walden University (n.d.) Academic Guides: Keyword Searching: Finding Articles on Your Topic: Connect Keywords. https://academicguides.waldenu.edu/library/keyword/boolean
Doris Hill Hello Jitendra,
The literature search was enhanced by determining the results from a variety of databases. Good construction of your PICOT question.
Collapse SubdiscussionLeslie Sandoval Les Sandoval
Discussion Post Week 4
Clinical Issue
The clinical issue I selected for this discussion post relates to the risk of acquiring a hospital-acquired infection with an increased length of stay. Hospital-acquired infections (HAI) are defined as infections developing after 48 hours of hospitalization or stay at a healthcare facility that was not present or incubating at the time of admission. (Hensley & Monson, 2015). Hensley & Monson (2015) report that HAIs have been associated with increased medical costs, length of stay, complication rates, and worsening overall morbidity and mortality. These infections have recently killed more than 100,000 people, and nosocomial infections kill more Americans yearly than AIDS and breast cancer combined. (Jason Di Marco, 2017).
HAI infections include central line-associated bloodstream infections (CLABSI), catheter-associated urinary tract infections (CAUTI), surgical site infections (SSI), Hospital-acquired Pneumonia (HAP), Ventilator-associated Pneumonia (VAP), Clostridium difficile infections (CDI). (Monegro et al., 2019). The risk factors for HAI include immunosuppression, older age, length of stay in the hospital, multiple underlying comorbidities, frequent visits to healthcare facilities, mechanical ventilatory support, recent invasive procedures, indwelling devices, and stay in an intensive care unit (ICU). (Monegro et al., 2019). For this discussion post, the PICOT question will focus on ventilator-associated Pneumonia (VAP) and the length of time on the ventilator.
Statement Regarding PICOT
PICOT is an acronym used in nursing research and stands for population, intervention, comparison, outcome, and time. (Melnyk & Fineout-Overholt, 2019). Population (P) stands for the specific patient group under study, intervention (I) stands for the actions whose effects will be monitored or measured during the study, comparison (C) stands for the events that would be observed in the absence of the intervention, the outcome (O) stands for the results that the nursing researcher expects to obtain after the study, and time (T) is the duration that the desired results are expected to appear. (Melnyk & Fineout-Overholt, 2019). The PICOT question for this discussion post is: “In mechanically ventilated ICU patients, does prolonged duration on a ventilator result in a higher incidence of ventilator-acquired pneumonia when compared to shorter periods on a ventilator?”
Databases Used for ResearchThe two databases selected from the online library at Walden University were PubMed and the combined database of MEDLINE & CINAHL. My initial clinical inquiry using a Boolean phrase of “ventilator acquired or associated infection and length of stay” resulted in 3,692 articles. In contrast, my first search using a general keyword search of “ventilator acquired infection and length of stay” resulted in 28 articles on the MEDLINE & CINAHL database. My initial search on the PubMed database was “ventilator acquired infection and length of stay,” resulting in 606 articles. Modifying the search using the Boolean phrase “ventilator and acquired an infection and increased stay” reduced the number of articles to 339.
Strategies to Increase Rigor and Effectiveness of Database Search
Strategies that would increase the rigor and effectiveness of a database search on PICOT questions include limiting the search to a specific period or selecting a filter that limits the search to only peer-reviewed articles. Both strategies would significantly limit the number of articles and result in more current and only peer-reviewed articles. A combination of keyword searches, Boolean operators, various databases, and the selection of different filters are productive strategies to increase the vigor and effectiveness of database research.
References
Hensley, B.J., & Monson, J. R. T. (2015). Hospital-acquired infections. Surgery (Oxford), 33(11), 528-533. https://doi.org/10.1016/j.mpsur.2015.08.008Links to an external site..
Jason Di Marco. (2017, September 14). Prevention and Control Strategies for Nosocomial Infections. Chthealthcare.com; CHT Healthcare. https://www.chthealthcare.com/blog/nosocomial-infectionsLinks to an external site..
Monegro, A. F., Muppidi, V., & Regunath, H. (2019). Hospital Acquired Infections. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK441857/Links to an external site.
Melnyk, B., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Wolters Kluwer.
Jitendra Kumar Verma Dear Leslie,
Thank you for your excellent post. Well-crafted questions show the systematic planning of the study. Formulating questions enables the design of a study with a good chance of answering them (Echevarria & Walker, 2015). Most research questions should be narrower at first. The narrower the focus, the easier the question is to research. For example, the researchable question is what is the usefulness or accuracy of the current 1-10 pain scale assessment in treating a patient’s pain, and what are other options that may prove more useful? A good study question’s characteristics are feasible, interesting, novel, ethical, and relevant. The PICOT format is P= population, I= interest area, C= comparisons intervention, O= outcome, and T=time. PICOT format is a valuable tool to help structure an answerable question (Rios et al., 2010). It is used to formulate clinical questions and breaks down the question into five essential elements. Intervention can be the type of treatment (therapy, procedure, drug), intervention level (dosage, frequency), stage of intervention (prevention, early, advanced), and delivery (who delivers the intervention and where?).
References
Echevarria, I. M., & Walker, S. (2015). Start with a Picot question to make your case. Nursing Critical Care, 10(3), 14–16. https://doi.org/10.1097/01.ccn.0000464307.39978.1a
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(1). https://doi.org/10.1186/1471-2288-10-11
Collapse SubdiscussionDoris Hill Hello Les,
Good overview of topic and resulting PICOT question development. Certainly, the number of articles changes with focused key words and using the boolean operators. In regards to your PICOT question, define prolonged and short periods. This will help know the specific comparison and result due to the intervention and the timeframe.
Leslie Sandoval Thank you for the feedback,, Dr. Hill. I will need practice formulating better PICOT questions and using better combinations of key words with boolean operators. I am so used to googling simple phrases in regular English and getting instant satisfaction with search results. PICOT is not easy and finding quality, peer reviewed articles that are on point is something will need to get better at.
Collapse SubdiscussionIsmail Al Al Huwaitat In reviewing resources and identifying a clinical issue that forms a clinical inquiry, I chose to discuss a mental health issue, specifically cognitive-behavioral therapy (CBT). My clinical area of interest is to address the efficiency of CBT in treating depression in adolescents. Two of the databases that I performed keyword searches on are the PsycINFO and PubMed databases (Melnyk & Fineout-Overholt, 2018). During my search on PsycINFO, I employed the keyword “cognitive-behavioral therapy” and “depression” separately, and it generated about 1000 results. To generate lesser results, I narrowed my search by using the keyword “Cognitive-behavioral therapy in adolescents,” which helped me generate about 250 results. To get more detailed results, I searched for a “randomized controlled trial on cognitive-behavioral therapy on adolescents” and finally got about 22 results. In my second search on PubMed, I utilized the keywords “depression” and “cognitive-behavioral therapy,” which generated 1800 results. To get fewer results, I narrowed my search by adding the word “adolescents” to the search, generating around 800 results (Oud et al., 2019). I further narrowed my search by searching “cognitive-behavioral therapy adolescents,” which generated approximately 46 results. My general search generated about 68 relevant peer-reviewed articles assessing the efficiency of cognitive-behavioral therapy in treating adolescents with depression.
Moreover, some of the strategies that I included to increase the rigor and effectiveness of the database search on addressing the efficiency of cognitive-behavioral therapy in depressed adolescents is I try searching the resources using more specific keywords that cover my topic for a clinical issue such as “Treating depression amongst adolescents” and “Impact of cognitive-behavioral therapy amongst depressed adolescents,” this will help generate lesser results. In terms of databases used, I could try to employ Cochrane Library as my third database since it specializes in systematic reviews and evidence-based medicine (Stikkelbroek et al., 2020). Moreover, I could employ more advanced search techniques, such as nesting or truncation, which will enable me to get relevant articles.
Lastly, I can consult with a librarian or reach out to medical experts to offer me additional guidance on search techniques that will help me capture all the relevant articles.
References
Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer.
Oud, M., De Winter, L., Vermeulen-Smit, E., Bodden, D., Nauta, M., Stone, L., . . . Stikkelbroek, Y. (2019). Effectiveness of CBT for children and adolescents with depression: A systematic review and meta-regression analysis. European Psychiatry, 57, 33-45. doi: 10.1016/j.eurpsy.2018.12.008
Stikkelbroek, Y., Vink, G., Nauta, M. H., Bottelier, M. A., Vet, L. J. J., Lont, C. M., van Baar, A. L., & Bodden, D. H. M. (2020). Effectiveness and moderators of individual cognitive behavioral therapy versus treatment as usual in clinically depressed adolescents: a randomized controlled trial. Scientific reports, 10(1), 14815. https://doi.org/10.1038/s41598-020-71160-1
Doris Hill Hello Ismail,
Good overview of your literature search process and the results. Do you have some definition of the PICOT components and your research questions. How did the search relate to your PICOT question?
Collapse SubdiscussionYassine Hicham Greetings class,
Type 2 diabetes is increasingly becoming widespread in modern society. While some people choose not to take any treatment to manage the disorder, others choose drug therapy to manage the situation (Silva, 2021). With these factors in mind, the following PICOT question was formulated;
In patients with diabetes type 2 diabetes, how does drug therapy, compared to no treatment, affect their sugar levels over one year?
After searching for the PICOT question in the Library, I got a few articles that did not address critical aspects of the question. However, searching the specific terms, such as drug therapy and type 2 diabetes, I got more articles describing how this treatment affects patients (Walden University, n.d.). To escalate the rigor and effectiveness and rigor of a database search on my question, I intend to search specific terms. The measure will enable me to find articles addressing my question’s significant aspects.
References
Silva, W. (2021). Pharmacological Management of the Diabetic Patient: A Staff Education Project (Doctoral dissertation, Walden University).
Walden University (n.d.). Walden University Library. Retrieved from https://academicguides.waldenu.edu/library
Leslie Sandoval Hello Yassine,
Your discussion post regarding Type 2 Diabetes is much appreciated. Type 2 Diabetes is a significant health problem worldwide. Type 2 diabetes is a metabolic disease indicated by high blood glucose levels due to insufficient insulin production by the pancreas. An inflammatory response occurs because of an immune system response to high blood glucose levels and inflammatory substances found in fat tissue. This low and chronic inflammation damages the pancreatic beta cells and leads to insufficient insulin production, which results in hyperglycemia. (Hinkle & Cheever, 2018). Type 2 diabetes is dangerous when left untreated. Sometimes, it can lead to debilitating complications such as kidney damage, heart disease, stroke, and blindness. (Prevent Complications, 2019).
PICOT is a process in which clinical questions are phrased to yield the most relevant information from a search. P stands for Patient/Population, I for Intervention or issue of interest, C for Comparison intervention or status, O for Outcome, and T, for the time frame for (I) to achieve the (O). (Melnyk & Fineout-Overholt, 2019). Box 2.2 in our text provides a useful template to assist in formulating a PICOT question. Using this template, I developed a PICOT question regarding Type 2 Diabetes as follows: Do type 2 diabetics (P) improve their blood sugar level (O) with an improved diet as a primary treatment (I) over time (T). (Melnyk & Fineout-Overholt, 2019) at p. 44.
I found this question to be beneficial because, in my experience, many type 2 diabetics that I have cared for do nothing to change their diet or exercise. Instead, they rely solely on medications and refuse to make lifestyle changes. As students in the master’s program, we must all get good at formulating PICOT questions and searching various databases to improve our research skills. You did a good job and picked an excellent subject for your discussion post.
References
Hinkle, J. L., & Cheever, K.H. (2018). Brunner & Suddarth’s textbook of medical-surgical nursing (14th ed., Vol. 2). Wolters Kluwer.
Prevent Complications. (2019). Centers for Disease Control and Prevention. https://www.cdc.gov/diabetes/managing/problems.htmlLinks to an external site..
Melnyk, B., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Wolters Kluwer.
Collapse SubdiscussionJenna C. Alford Searching Databases
Nurses like to know how we practice and what we do is in the best interest of our patients. Evidence-based practice is an excellent resource for understanding why we do such things. Without EBP, patients don’t receive the highest quality of care, health outcomes may be poor, and healthcare costs will rise. A nurse using their EBP resources will have greater autonomy in their practices and a higher level of job satisfaction (Melnyk, et.al., 2009). For the last seven years, I have worked in the perioperative department of a rural hospital. One step we took before surgery was to use chlorohexidine wipes before surgery. We stopped for about six months when the wipes warmer broke, then restarted once it was fixed. So the clinical issue I have chosen is postoperative infections. So this leads me to my PICO(T) question: Do surgical patients with incisions during surgery(P), that use chlorohexidine wipes(I) before surgery compared (C) to those not using the chlorohexidine wipes, (O) have a lower rate of infections (T) in 30 days following their surgical procedure?
In searching for information on this topic, I went to the central Walden Library and typed in “postoperative infection.” This yielded 49, 224 articles. Using the Boolean terms and adding “chlorohexidine” resulted in 882 articles with quality journal articles. To increase the effectiveness of my search for my PICO(T) question, I could use the individual database and do a more focused search. Maintaining an awareness of the different options for structuring searches broadens the potential uses (Davies, 2011).
References
Davies, K. S. (2011). Formulating the evidence based practice question: A review of the frameworks Links to an external site.Links to an external site.for LIS professionals. Evidence Based Library and Information Practice, 6(2), 75–80.
Melnyk, B. M., Fineout-Overholt, E., Stillwell, S. B., & Williamson, K. M. (2009).Evidence-based practice: Step by step: Igniting a spirit of inquiry Links to an external site.Links to an external site.. Links to an external site.Links to an external site.American Journal of Nursing, 109(11), 49–52. doi:10.1097/01.NAJ.0000363354.53883.58
Walden University Library. (n.d.-a). Databases A-Z: Nursing Links to an external site.Links to an external site.. Retrieved September 6, 2019, from https://academicguides.waldenu.edu/az.php?s=19981Links to an external site.
Walden University Library. (n.d.-f). Keyword searching: Finding articles on your topic: Boolean terms Links to an external site.Links to an external site.. Retrieved September 19, 2018, from http://academicguides.waldenu.edu/library/keyword/booleanLinks to an external site.
Melnyk, B. M., Fineout-Overholt, E., Stillwell, S. B., & Williamson, K. M. (2009).Evidence-based practice: Step by step: Igniting a spirit of inquiry Links to an external site.Links to an external site.. Links to an external site.Links to an external site.American Journal of Nursing, 109(11), 49–52. doi:10.1097/01.NAJ.0000363354.53883.58
Jessica Baumgartner Hi Jenna,
I wanted to respond to your post because as a current and former surgical ICU nurse, I completely understand and can relate to your topic of inquiry and am curious what your finding were. I agree that evidence-based practice (EBP) and research is important for many reasons. EBP assist us with providing “high quality patient care, outcomes, and reduced healthcare costs” and nurses have “greater autonomy and higher job satisfaction” (Melnyk et al., 2010). With that being said, making sure our research articles are developed with EBP standards is key. To ensure we get the most out of our database searches to obtain credible EBP articles, there are several steps we can do. According to Stillwell et al. (2020) gathering keywords from our PICOT question to use in our database search is the first step. We can then combine search term or phrases to further streamline the number of articles generated. For example, you mentioned using “postoperative infections” and “chlorhexidine” which is great, but you could also try “number of postoperative infections” and “using chlorhexidine” and “effects of preoperative chlorhexidine” to see if that results in a more manageable list of articles. Lastly, don’t forget to also use advanced search options to ensure your articles are peer reviewed and evidence based.
References:
Melnyk, B. M., Fineout-Overholt, E., Stillwell, S. B., & Williamson, K. M. (2009).Evidence-based practice: Step by step: Igniting a spirit of inquiry. American Journal of Nursing, 109(11), 49–52. doi:10.1097/01.NAJ.0000363354.53883.58
Stillwell, S.B., Fineout-Overhold, E., Melnyk, B.M., & Williamson, K.M. (2010). Evidence based practice step-by-step: Searching for evidence. American Journal of Nursing, 110(5), 41-47.
Athsicia Gooden Hi Jenna,
Berrondo Ahn, & Shnorhavorian (2019) informs us that as a means to reduce surgical site infections (SSI), many institutions utilize pre-operative antisepsis with chlorhexidine gluconate (CHG) baths and/or wipes. While CHG does reduce bacterial colonization of the skin, it is actually unclear whether it reduces SSI, and current guidelines from the American College of Surgeons, the Centers for Disease Control, and the World Health Organization do not support this practice (p. 652). This is concerning pediatric patients. However, after a higher-than-expected surgical site infection rate was identified at a hospital, a hysterectomy-specific surgical site infection prevention, that included chlorhexidine-impregnated preoperative wipes, was implemented to determine if it affected the surgical site infection rate, length of hospital stay, and 30-day postoperative readmission rate. Results showed that implementation of a gynecologic perioperative surgical site infection prevention bundle, to include chlorhexidine-impregnated preoperative wipes, was associated with a large reduction in surgical site infection rate in patients undergoing hysterectomy (Andiman et al. 2018).
References
Andiman, S. E., Xu, X., Boyce, J. M., Ludwig, E. M., Rillstone, H. R., Desai, V. B., & Fan, L. L.
(2018). Decreased surgical site infection rate in hysterectomy: effect of a gynecology-specific
bundle. Obstetrics & Gynecology, 131(6), 991-999.
Berrondo, C., Ahn, J. J., & Shnorhavorian, M. (2019). Pre-operative skin antisepsis with
chlorhexidine gluconate baths and wipes does not prevent postoperative surgical site infection
in outpatient pediatric urologic inguinal and scrotal surgery. Journal of pediatric
urology, 15(6), 652-e1.
Yassine Hicham Hi Jenna,
Evidence-based practice allows the nursing practice to grow by using research findings to apply the best care practices and clinical decisions. PICOT is a useful tool to ask a focused question and discover evidence that can be used for important issues related to specific patient populations. You chose a great topic for your PICOT question because the number of surgical patients each year is high and increasing. Surgical infections are a serious issue in healthcare and usually show up within the first thirty days of surgery (Andersen, 2019). It is well known that hygienic conditions reduce the risk of infection, but how much do CHG wipes contribute to the reduction in infection rates? You mentioned that your hospital stopped using wipes for six months. Did you notice an increase in infections during that time period?.
Andersen, B. M. (2019). Prevention of postoperative wound infections. Prevention and Control of Infections in Hospitals, 377–437. https://doi.org/10.1007/978-3-319-99921-0_33
Gallagher Ford, L., & Melnyk, B. M. (2019). The underappreciated and misunderstood Picot question: A critical step in the EBP process. Worldviews on Evidence-Based Nursing, 16(6), 422–423. https://doi.org/10.1111/wvn.12408
Alice Irene Rios Original post
By following the Stillwell et al step-by-step example of the population, intervention, comparison, outcome, time (PICOT) question outline, I was able to formulate the question that I believe encompasses my goal for this class. My original question lacked specifics and fell short of ensuring PICOT variables were accounted for. It changed from “what is the most prevalent reason frontline health care workers sought mental health services,” to “how do the reasons frontline healthcare workers sought mental health services, differ from first COVID-19 winter surge to the second winter surge?” The original question lacked comparison, time, and boxed the research into a single answer. The second question was more specific but helped formulate a better discussion around the topic of reasons behind seeking services. My population is frontline staff who worked during the original and secondary surge of COVID-19 in an acute care hospital setting. The reason for seeking mental health services is the intervention of interest. The comparison would be between the first and second COVID-19 pandemic surges. The outcome is the most prevalent reason for seeking healthcare. The time would span between the first surge in winter of 2020 to winter of 2021. (Stillwell et al. 2010)
I searched the databases ProQuest and CINAHL Plus to gather articles that could potentially aid in my research topic. In ProQuest I found 14,447 articles when I searched “COVID mental health” and only 781 articles were found in CINAHL Plus when I searched “frontline healthcare workers.” Both searches provided a wealth of peer reviewed articles that can aid in my research topic (Walden University. 2018). To refine my search, I used Boolean operators with the following search words; COVID-19 pandemic, frontline healthcare workers, and mental health. This search resulted in 204 articles that had full text and were peer reviewed. To further refine and identify the articles that would support my research best, I would need to read the titles, discussions, and conclusions to identify the type of article and the type of research that was conducted to utilize the most credible sources (Menlyk & Fineout-Overholt. 2018).
References
Melnyk, B.M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer
Stillwell, S.B., Fineout-Overholt, E,, Menlyk, B.M. & Williamson, K.M. (2010). Evidence-based practice, step by step: Asking the clinical question. AJN, American Journal of Nursing, 110 (3), 58-61. Doi:10.1097/01.NJA.0000368959.11129.79.
Walden University, LLC. (Producer). (2018). Searching the evidence [Video file]. Baltimore, MD: Author
Collapse SubdiscussionMarjacha Mbah Christina Initial post
The occurrence of pressure ulcers in the intensive care unit is a clinical issue of interest that might serve as the foundation for a clinical investigation (Dunzweiler, S., Gammons, K., & Hinson, L. 2011). Up to thirty percent of patients in an intensive care unit (ICU) are at risk of developing pressure ulcers, which are one of the most prevalent complications that can arise there. Pressure ulcers caused by pressure are a substantial cause of morbidity and mortality in intensive care units (ICUs), and they are linked to longer hospital stays, higher expenses, and a lower quality of life for patients who suffer from them. In the intensive care unit (ICU), preventing pressure ulcers is one of the Primary focuses of quality improvement activities (Karimian. M. et al 2020), However, it is not generally understood how common pressure ulcers are in intensive care units (ICUs). This clinical investigation’s goal is to count the number of patients in the intensive care unit who have developed pressure ulcers. The clinical investigation will involve performing a retrospective chart analysis on all of the patients who were hospitalized in the intensive care unit for over one year. All of the patient’s medical records are going to be looked at, and data gathered on their length of stay, demographics, comorbidities, and whether or not they have pressure ulcers. Calculations will be done to establish the prevalence of pressure ulcers, and subgroup analyses will be carried out to identify the factors that are linked to the formation of pressure ulcers. The results of this clinical investigation into the prevalence of pressure ulcers in the intensive care unit will provide crucial information. This data will be utilized to take quality improvement measures in the intensive care unit that are geared toward the prevention of pressure ulcers.
An electronic medical record (EMR) is a computerized version of a paper medical chart, (Arabi, Y. M. et al 2022). They are used by medical professionals to capture and preserve information about patient health. EMRs have the potential to enhance patient care and safety, reduce the number of medical errors, and boost overall productivity. Systematic reviews are essential for developing an answer to a PICO(T) question. The best way to find relevant reviews and other high-level evidence is to use the keywords from the question. It is also important to search for grey literature – sources that are not typically published in peer-reviewed journals. When attempting to answer a PICO(T) question, it is critical to make use of high-level evidence. PubMed, Cochrane Database of Systematic Reviews, and EBSCOhost are the three most important resources to consult. With the help of EMRs, pressure ulcer documentation and follow-ups will be easy hence, mitigating and improving care (Kaucher, J. et al 2022).
References
Kaucher, J., Bohnenkamp, S., Kennedy-Evans, K. L., & Bohnenkamp, M. (2022). Legal Documentation in Pressure Ulcer/Injury Cases. MEDSURG Nursing, 31(2), 77–121.
Karimian, M., Khalighi, E., Salimi, E., Borji, M., Tarjoman, A., & Mahmoudi, Y. (2020). The effect of educational intervention on the knowledge and attitude of intensive care nurses in the prevention of pressure ulcers. International Journal of Risk & Safety in Medicine, 31(2), 89–95. https://doi.org/10.3233/JRS-191038Links to an external site.
Antle, D., & Leafgreen, P. (2001). Reducing the Incidence of Pressure Ulcer Development in the ICU. AJN American Journal of Nursing, 101(5), 24EE. https://doi.org/10.1097/00000446-200105000-00035Links to an external site.
Dunzweiler, S., Gammons, K., & Hinson, L. (2011). Taking the pressure off in the ICU. Nursing Management, 42(8), 50–52. https://doi.org/10.1097/01.NUMA.0000399806.99080.73Links to an external site.
Echevarria, I. M., & Walker, S. (2014). To make your case, start with a PICOT question. Nursing, 44(2), 18–19. https://doi.org/10.1097/01.NURSE.0000442594.00242.f9Links to an external site.
Arabi, Y. M., Al Ghamdi, A. A., Al-Moamary, M., Al Mutrafy, A., AlHazme, R. H., & Al Knawy, B. A. (2022). Electronic medical record implementation in a large healthcare system from a leadership perspective. BMC Medical Informatics & Decision Making, 22(1), 1–10. https://doi.org/10.1186/s12911-022-01801-0
Doris Hill Hello Marjacha,
Tell us about your literature search and the results. What is your PICOT question?
Collapse SubdiscussionAthsicia Gooden Main Post
As I pondered on what has puzzled me often while working in healthcare, I knew that my clinical inquiry or interest is the use of ACE inhibitors in African American people or people of color with hypertension. Many studies have been conducted with data results showing that ACE inhibitors should not be initiated as monotherapy in African American patients and showed that the use with a calcium channel blocker and thiazide diuretic was more efficient (Helmer, Slater, & Smithgall, 2018). Other studies showed that there is a distinct ethnic predisposition, since African–Americans or Hispanics show a higher commonness of angioedema secondary to the used of ACE inhibitors compared to Caucasians (Montinar & Cicardi, 2020). According to Melnyx & Fine-Overholt (2018), in step one of EBP, clinical questions are asked in PICOT format to get the most relevant and best evidence from a search (p. 17). In developing a PICOT question for my inquiry, it would read: In African American people (patient population) how does Ace Inhibitor (experimental intervention) when compared to its use among Caucasians (comparison) affect the body (outcome) over a period of time (time taken for intervention to achieve the outcome).
When searching different databases, I used CINAHL PLUS, MEDLINE, ProQuest Nursing and Allied Health Database, and PubMed. The CINAHL PLUS search yielded 44 articles. The MEDLINE database had 163 articles. ProQuest Nursing had 42 articles and PubMed had 335 articles. When using Boolean operators, CINAHL had 10 articles, MEDLINE had 157 articles, ProQuest and PubMed did not give options for a Boolean search.
To increase the rigor and effectiveness of the search, I could limit articles to the last five years, search full text articles, be age group specific, and search peer-reviewed articles only. I had to use specific words from my PICOT questions to obtain the search results that I desired.
References
Helmer, A., Slater, N., & Smithgall, S. (2018). A Review of ACE Inhibitors and ARBS in Black
Patient with Hypertensions. Annala of Pharmacotherapy, 52(11), 1143-1151.
https://doi.org/10.1177/1060028018779082
Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare:
A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer.
Montinaro, V., & Cicardi, M. (2020). Ace inhibitor-mediated angioedema. International
Immunopharmacology, 78, 106081. http://doi.org/10.1016/j.intimp.2019.106081
Walden University Library. (n.d.-a). Databases A-Z: Nursing Links to an external site.
Retrieved September 6, 2019, from https://academicguides.waldenu.edu/az.php?s=19981
Collapse SubdiscussionJessica Baumgartner Hi Athsicia,
Thank you for taking the time to create such an informative post. I thoroughly enjoyed reading your post because your topic of inquiry would be beneficial to know for many of my patients. As an ICU nurse at a very large teaching hospital in Baltimore, MD I see a large population of African American patients who unfortunately do have hypertension. I agree this topic is important since African Americans are predisposed to having this comorbidity and reviewing optimal evidence-based interventions is something we should look into. According to Musemwa & Gadegbeku (2017) African Americans are 50% more likely to have hypertension in the United States compared to Caucasians and this creates a burden of excess morbidity and mortality. I can appreciate how you utilized several databases to search for relevant articles and found it interesting ProQuest and PubMed did not have an option to apply Boolean operators. My suggestion to you would be to continue using the databases who do allow this and do the following steps as outlined by Stillwell et al. (2010). First, pull keywords from your PICOT that relates to your topic of inquiry. Then using Boolean operators and combining several keywords and/or phrases see if that generates a manageable and accurate list of articles. You could try “African Americans” and “hypertension” and “ACE inhibitors” in the search boxes. Lastly, you mentioned limiting your search to filter articles from date published, full text, peer-reviewed, etc. and I think that’s a great idea.
References:
Musemwa, N., & Gadegbeku, C. A. (2017). Hypertension in African Americans. Current cardiology reports, 19(12), 1-11.
Stillwell, S.B., Fineout-Overhold, E., Melnyk, B.M., & Williamson, K.M. (2010). Evidence based practice step-by-step: Searching for evidence. American Journal of Nursing, 110(5), 41-47.
Athsicia Gooden Hi Jessica,
thank you so much for your very thorough response. It is greatly appreciated! I would also like to thank you for your guidance on how I could better search for articles relevant to my topic of inquiry.
Collapse SubdiscussionEsther O Adeyemo CAUTIs are linked with increased mortality and morbidity rates, high risk of sepsis and drug resistant organisms, increased medical expenses for hospitals and patients, and longer hospital stays (Noto et al., 2018). Catheters are generally one of the most extensively used medical device in healthcare. Also, catheter-associated urinary tract infections (UTI) are prevalent nosocomial infections resulting in several medical complications, ranging from mild catheter bladder stones and encrustation to severe pyelonephritis, septicemia, and endotoxic shock. The intervention to be investigated is chlorhexidine bath, proper use, and timely removal of catheters. My PICOT question is; “How does daily chlorhexidine (CHG) bath, appropriate use and timely removal of catheter compare to daily water and soap bath affect reduction of catheter-associated urinary tract infections?”
One technique that I have found to be effective in locating research that has been evaluated by a peer group is to make use of a database that is specific to the area of research that is under consideration. As a direct result of this, it is of the utmost importance to plan the investigation while simultaneously putting an emphasis on the essential phrases that have been derived from the subject of the research. It is essential to make use of filters in order to narrow relevant search results. One of the most helpful features of this facility is the Walden University Library’s organization of its databases in a way that is separate for each academic year of study. This is one of the many reasons why this resource is so valuable.
The databases searched were Pubmed as well as CINAHL. I narrowed the search to peer reviewed articles and changed the dates so they ranged from 2017 to 2022 to show the most recent articles in evidence-based practice. On PubMed, I used the advanced search filters to narrow my search. I clicked to view articles only studied humans and were published within 5 years. CINAHL Plus is the database that I use since it offers articles that are written with nurses and other medical professionals in mind particularly. Other databases may also provide similar content. Because of this, I want to make use of CINAHL since it is simple to use and gives users the option to choose just articles that have been submitted to a round of peer review. The website also provides a recording of a helpful webinar that walks users through how to use the site by demonstrating how to filter their search results by making use of important themes and subtopics. Utilizing additional databases in addition to the ones offered by the Walden Library may further assist in locating peer-reviewed articles that is dependable, reputable, and up to date.
When I add my filters and search in the Walden Library, I get 152 results. Walden Library (2020), recommends using Boolean terms to create a more precise with more relevant results. I added the Boolean terms to my next search and got 75,734 results. A study concluded that it is essential to search at least three different databases to achieve approximately 90% of all relevant literature on the subject. A strategy to increase the rigor and effectiveness of a database search is to use alternative terms (Ho et al., 2016).
References
Ho, G. J., Liew, S. M., Ng, C. J., Hisham Shunmugam, R., & Glasziou, P. (2016). Development of a Search Strategy for an Evidence Based Retrieval Service. PloS one, 11(12), e0167170.doi: 10.1371/journal.pone.0167170
Noto, M.J., Domenico, H.J., Byrne, D.W., Talbot, T., Rice, T.W., Bernard, G.R., & Wheeler, A.P.
(2015). Chlorhexidine bathing and health care-associated infections: A randomized clinical trial. https://pubmed.ncbi.nlm.nih.gov/25602496/.
Scanlon, K., Wells, C., Woolforde, L., Khameraj, A., & Baumgarten, J. (2017, May). Saving
lives and reducing harm: A CAUTI reduction program. https://insights.ovid.com/nursing-economic/nrsec/2017/05/000/saving-lives-reducing-harm-cauti-reduction-program/5/00006073
Walden University Library. (2020). Keyword searching: Finding articles on your topic: Booleanterms.Retrieved from http://academicguides.waldenu.edu/library/keyword/boolean Searching Databases – NURS 6052 Module 3 Week 4 discussion post