Discussion Responses
Respond to at least two of your colleagues on two different days and provide further suggestions on how their database search might be improved.
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Hi Everyone,
For this discussion, we are first developing your PICO(T) question. Try to use a topic that is important to you. From my experience, it is usually easier to use an intervention-type question, but you can use any format suggested in your textbook chapter 2, page 40, table 2.2 and there are some templates on page 44, table 2.2. Here is the intervention type format to use (if you like).
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In_____________________(POPULATION) how does __________________(Intervention) compared with ___________________(Comparison) affect _______________________(Outcome) within______________________(time, optional).
Example: In acute care hospitalized patients (Population) what is the effect of using CHG caps on all central line ports (intervention) compared to current ports used (comparison) on rates of CLABSI (outcome sure it is measurable), over 6 months (time)?
The second part of this discussion post is to describe your experience in your database searches. Chapter 3 in your textbook offers some great strategies for database searches. This can be a narrative description, or some students like to use a chart. Something like this:
Search terms using Boolean operators
Database used
Number of Hits
Notes on any outstanding articles, what level of evidence was found
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.
Be sure to include a reference page including all the resources you used for this discussion post.
Do not forget these resources are available to help:
Essentials of Evidence-Based Practice: Library Tips
Library Course Guide for NURS 6052 with links to Library readings
Essentials of Evidence-Based Practice: Walden Library Tips
- Library Course Guide for NURS 6052 with links to Library readings
- Nursing Databases in the Walden Library – 15 recommended databases for scholarly research
- Assignment Guide for Week 2 with recommended steps
- Evidence-Based Practice Research Guide – includes help forming a PICOT Question, Evidence Types
- Reliability & Validity – part of our Tests & Measures guide
- Recorded Nursing Webinars – Introduction to Nursing Research in the Walden Library; Advanced Library Research
- See also: Get Help – for library, writing, academic skills, and technical issues
I look forward to reading about your experiences.
Dr. Sullivan
Zaida Alba
RE: Discussion – Week 4
Developing PICOT Question
In developing a research study, the critical first steps are creating a clearly stated hypothesis. PICO is a guiding question that stands for (P) Patient or population, (I) Intervention, (C) comparison group, (O) Outcome. Sometimes (T) time is used if the researcher is interested in the intervention\’s effect within a period. The PICO question will guide the researcher in selecting data to be used and to outline the study that is to be conducted (Hastings & Fisher, 2014).
In this discussion, I formulated a PICO question below in my area of interest. I chose to focus on Falls since I work in a Trauma/Medical-Surgical Unit wherein we take care of patients that fell or at risk of falling.
PICO Question
In the medical-surgical inpatient unit (P), how does implementing fall education or post-fall huddle form (I) compared to previous and current fall rates (C) reduce the number of patient falls (O)?
Database Search
Keywords
Database
Number of Hits
Notes
fall education or fall prevention and medical-surgical or med surg
CINAHL Plus with Full text
33, 639
Articles on this database resulted in 33,639 relevant results to the topic with all levels of evidence.
post-fall huddle fall education or fall prevention and inpatient or adult medical surgical unit
Medline with Full Text
323
Level II, Level VI
education or post-fall huddle and inpatient
ProQuest Nursing and Allied Health
20
Level VI, Level IV
To increase the effectiveness of a database search for my PICO, it is critical to narrow down your search and find synonyms related to the topic. Using Boolean operators is also a great way to search for a combination of words in a specified order (Library of Congress, n.d.). For instance, in the table above, I used Boolean operators such as \”and\” and \”or\” to retrieve articles related to my study. When searching for databases for evidence, we should know which databases are mostly used like CINAHL and MEDLINE databases. These databases are licensed and list only the journals compared to Google, which is only a search engine and is not recommended (Melnyk & Fineout-Overholt, 2018).
References
Hastings, C., & Fisher, C. A. (2014). Searching for proof: Creating and using an actionable PICO question. Nursing Management, 45(8), 9–12. https://doi-org.ezp.waldenulibrary.org/10.1097/01.NUMA.0000452006.79838.67
Library of Congress. (n.d). Search/browse help-Boolean operators and nesting. https://catalog.loc.gov/vwebv/ui/en_US/htdocs/help/searchBoolean.html
Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer.
Chapter 3, \”Finding Relevant Evidence to Answer Clinical Questions\” (pp. 65–66)
Walden University Library. (n.d.). Databases A-Z: Nursing. https://academicguides.waldenu.edu/az.php?s=19981
The second one is on its way.
References
I need two references per response.
Davies, K. S. (2011). Formulating the evidence based practice question: A review of the frameworks for LIS professionals. Evidence Based Library and Information Practice, 6(2), 75–80. https://doi.org/10.18438/B8WS5N
Note: You will access this article from the Walden Library databases.
Library of Congress. (n.d.). Search/browse help – Boolean operators and nesting. Retrieved September 19, 2018, from https://catalog.loc.gov/vwebv/ui/en_US/htdocs/help/searchBoolean.html
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
Note: You will access this article from the Walden Library databases.
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
Note: You will access this article from the Walden Library databases.
Stillwell, S. B., Fineout-Overholt, E., Melnyk, B. M., & Williamson, K. M. (2010b). Evidence-based practice, step by step: Searching for the evidence. American Journal of Nursing, 110(5), 41–47. doi:10.1097/01.NAJ.0000372071.24134.7e
Note: You will access this article from the Walden Library databases.
Walden University Library. (n.d.-a). Databases A-Z: Nursing. Retrieved September 6, 2019, from https://academicguides.waldenu.edu/az.php?s=19981
Walden University Library. (n.d.-c). Evidence-based practice research: CINAHL search help. Retrieved September 6, 2019, from https://academicguides.waldenu.edu/library/healthevidence/cinahlsearchhelp
Walden University Library. (n.d.-d). Evidence-based practice research: Joanna Briggs Institute search help. Retrieved September 6, 2019, from https://academicguides.waldenu.edu/library/healthevidence/jbisearchhelp
Solution
Discussion Responses
Response to Harleen
Hey Harleen, I’m glad to hear from you
In response to your post, I agree that a high readmission rate among chronic heart failure (CHF) patients is a pertinent issue in the healthcare industry that deserves a careful evaluation using the best evidence. Indeed, CHF is attributed to be the leading cause of hospital readmissions among Medicare patients, hence contributing to the ever-increasing costs of care (Chamberlain, Sond, Mahendraraj, Lau, & Siracuse, 2018). Significantly, furosemide, a common diuretic used in managing the condition, shows high variability in terms of bioavailability depending on whether it is administered orally or intravenously.
It is therefore critical to establish whether the mode of administration influences the rate of readmission in patients reporting fluid overload. Regarding your database search, there are additional techniques you can apply to find articles that are more relevant to the topic. For instance, Embase has unique query features that could allow you to either widen or narrow your search. Such features include “explode”, “no explode”, and “Emtree” features. For example, the “no explode” feature allows one to search for content indexed using a specific term. For databases such as CINAHL, you can limit the search results by using the special interest feature (Melnyk & Fineout-Overholt, 2018). This feature can allow you to limit results to evidence-based articles only.
Response to Zaida Alba
Hey Zaida, I am happy to hear from you
Falls is an interesting area considering that a significant number of health facilities are grappling with how to reduce injuries from falls. According to Slade, Carey, Hill, and Morris (2017) fall contribute to increased length of stay, hospital readmissions, and poor patient outcomes. Consequently, fall prevention is significant to health facilities seeking to improve the quality of care provided.
Fall education is one of how nurses can effectively manage falls. Other strategies that have been widely applied include frequent rounding, use of bed alarms, safety companions, and others. It might be interesting to compare how fall education compares to other strategies, such as frequent rounding in fall prevention. Regarding database searches, there are other ways you may improve the rigor of search results. For instance, besides applying limiters to search results, you can use MeSH terms in MEDLINE and PubMed to improve the efficacy of your search. According to Melnyk and Fineout-Overholt (2018), effective searches in these databases should rely on both keywords and MeSH terms.
References
Chamberlain, R. S., Sond, J., Mahendraraj, K., Lau, C. S., & Siracuse, B. L. (2018). Determining 30-day readmission risk for heart failure patients: the Readmission After Heart Failure scale. International journal of general medicine, 11, 127–141. https://doi.org/10.2147/IJGM.S150676
Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer
Slade, S. C., Carey, D. L., Hill, A. M., & Morris, M. E. (2017). Effects of falls prevention interventions on falls outcomes for hospitalised adults: protocol for a systematic review with meta-analysis. BMJ open, 7(11), e017864. https://doi.org/10.1136/bmjopen-2017-017864