To Prepare:
- Review the Resources and identify a clinical issue of interest that can form the basis of a clinical inquiry.
- Review the materials offering guidance on using databases, performing keyword searches, and developing PICO(T) questions provided in the Resources.
- Based on the clinical issue of interest and using keywords related to the clinical issue of interest, search at least two different databases in the Walden Library to identify at least four relevant peer-reviewed articles related to your clinical issue of interest. You should not be using systematic reviews for this assignment, select original research articles.
- Review the Resources for guidance and develop a PICO(T) question of interest to you for further study. It is suggested that an Intervention-type PICOT question be developed as these seem to work best for this course.
*Library tip:
Walden Library recommends starting your search broadly with one concept or search word and adding more elements one at a time. Depending on your topic, the evidence will not necessarily address all the aspects of your PICO(T) question in one article. Select the most important concepts to search and find the best evidence available, even if that means assembling evidence from multiple articles.
- Nursing Research PageLinks to an external site. – databases and resources specifically for Nursing
- Evidence-Based Practice guide: Evidence TypesLinks to an external site.
- Nursing and Health research videosLinks to an external site., including a 15-minute introduction
- Get HelpLinks to an external site. page, including Ask a LibrarianLinks to an external site. service
Quick Answers:
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.
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initial Post
Searching Databases
Clinical Issue of Interest
The clinical issue of interest is hand hygiene and hospital-acquired infections. Hand hygiene is becoming one of the common issues among healthcare workers. It is one of the suitable practices for reducing escalated infections. Hand hygiene is necessary since it reduces the rate of spreading germs that are likely to expose health workers and patients to dangers. Unfortunately, some health workers and patients do not take such practices seriously, which is a critical threat. Approximately 1 out of 31 patients are exposed to hospital-acquired infection, an issue that should worry the medical society (Asadollahi et al., 2015). Ideally, health workers should be at the forefront when it comes to hand hygiene. Infection control can only be feasible whenever the healthcare workers work collaboratively with the patients and maintain high standards of hand hygiene. Poor hand hygiene mainly exposes the patients to specific hospital-acquired infections, including ventilator-associated pneumonia and surgical site infection. Other infections that it may cause are CAUTI AND CLABSI (Atif et al., 2019). Therefore, proper hand hygiene interventions are necessary. Based on the clinical issue, the PICOT question is:
PICOT question
Among the patients (P) in the hospital settings, does handwashing (I) instead of sanitization (C) reduce hospital-acquired infections (O) within one week of stay (T)?
Search Results
The two major databases searched in the Walden Library were the CINAHL database and PubMed. However, the focus was on only five years old articles to reduce outdated data or information and embrace evidence-based practice. During the search in CINAHL, the feasible solution Clinical Inquires (CI) was considered making it easy to identify necessary information. According to Melnyk & Fineout-Overholt (2018), CI is necessary since it provides viable evidence for a clinical question. CI is critical since it correlates the stored data and the clinical question. Therefore, I took such methods seriously during the database search. After filtering out specific elements such as articles beyond five years, systematic reviews, and searching for the word ‘proper hand hygiene,’ I retrieved 167 results from the University library. However, to ensure precise data, I considered the Boolean terms. The Boolean terms allowed me to retrieve a different set of 11,674 results. Indeed, it is justifiable that Boolean terms play a critical role in making the data precise.
Strategies for Increasing Effectiveness and Rigor of the Search
Regardless of the database search, there must be other options for increasing the rigor and effectiveness of the database search on my clinical question. The primary strategy is adding more keywords and linking them. For instance, I would use terms like ‘proper hand hygiene and hospital-acquired infection’ and ‘hand-washing and sanitization in healthcare settings.’ Therefore, the strategy would make research rigorous and concise.
Conclusively, hand hygiene is necessary since it reduces the rate of spreading germs that are likely to expose health workers and patients to health dangers. Ideally, health workers should be role models in hand hygiene. Infection control can only be successful whenever the healthcare workers work collaboratively with the patients and ensure proper hygiene. Therefore, using an appropriate database search would provide an evidence-based solution to hand hygiene and quality health for patients.
References
Asadollahi, M., Bostanabad, M. A., Jebraili, M., Mahallei, M., Rasooli, A. S., & Abdolalipour, M. (2015). Nurses’ knowledge regarding hand hygiene and its individual and organizational predictors. Journal of caring sciences, 4(1), 45. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4363651/Links to an external site.
Atif, S., Lorcy, A., & Dubé, E. (2019). Healthcare workers’ attitudes toward hand hygiene practices: Results of a multicentre qualitative study in Quebec. Canadian Journal of Infection Control, 34(1). https://www.ipac-canada.org/photos/custom/CJIC/CJIC_Spring2019_Atif.pdfLinks to an external site.
Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice. Lippincott Williams & Wilkins.
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Collapse SubdiscussionBertina Boma Soh I like the topic you chose, Rita. The importance of proper hand hygiene in preventing hospital-acquired illnesses The importance of maintaining good hand hygiene cannot be overstated as it is quickly becoming one of the most frequently raised concerns among healthcare professionals. The development of antibiotic resistance and the spread of infectious illnesses pose a significant risk to human health that is on par with climate change. Hand hygiene is one of the essential components of efficient infection prevention and control (IPC) programs, which are the primary means of avoiding healthcare-associated infections avoiding healthcare-associated infections. Despite this, adequate HH compliance (HHC) continues to be a global concern, which suggests that knowledge and awareness alone are not enough to bring about behavior change (Kostadinov et al., 2021).
There is a wealth of information available on the significance of practicing good hand hygiene, which, according to evidence-based practice (EBP), is the most effective method of preventing the spread of infection. Hand hygiene (HH) has received unprecedented attention and publicity in the wake of the recent pandemic caused by the coronavirus disease 2019 (CVD 2019). This attention has been directed toward healthcare professionals (HCWs) and the general public (Mouajou et al., 2022).Works Cited
Mouajou, V., Adams, K., DeLisle, G., & Quach, C. (2022). Hand hygiene compliance in the prevention of hospital-acquired infections: a systematic review. Journal of Hospital Infection, 119, 33-48.
Stangerup, M., Hansen, M. B., Hansen, R., Sode, L. P., Hesselbo, B., Kostadinov, K., … & Calum, H. (2021). Hand hygiene compliance of healthcare workers before and during the COVID-19 pandemic: a long-term follow-up study. American Journal of Infection Control, 49(9), 1118-1122. -
Collapse SubdiscussionLeslie Rasmussen Module 3: Response 1
Hi Rita,
This is a great topic to research more because I think more healthcare professionals need to learn about it. There are many things that can be prevented in healthcare and spreading bacteria by washing our hands is one those of those things. I have looked up two separate studies regarding hand washing, alcohol, and sanitization stations in the rooms. The CDC had reported that frequent handwashing with staff can range anywhere from 5-81%, but on average it was only 40% of people (Breidablik et al., 2020). That number seems crazy to me because handwashing is something that is engraved into our brain in nursing school and while at work. Handwashing is the most important tool in reducing the spread of transmissible infections, as contaminated hands are the number one spread of pathogenic diseases (Toney-Butler et al., 2021). There has been a lot of research on this topic, and I feel you will have a lot of information to dissect.
This topic is great for a PICOT question and can affect so many different areas of nursing. You had great resources available with your searches. One way to help get more information that is topic specific is to utilize the left-hand side and pick and choose different areas that you want to focus on so that all the articles that do not fit in that description can be removed, this will save you a lot of time when you are doing your research.
References
Breidablik, H., Lysebo, D., Johannessen, L., Skare, A., Andersen, J., & Kleivene, O. (2020). Effects of hand
disinfection with alcohol hand rub, ozonized water, or soap and water: time for
reconsideration?. The Journal of Hospital Infection, 105(2), 213-215. doi:
10.1016/j.jhin.2020.03.014
Toney-Butler, TJ., Gasner, A., & Carver, N. (2021). Hand hygiene. StatPearls Publishing.
https://www.ncbi.nlm.nih.gov/books/NBK470254/#_NBK470254_pubdet_
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Collapse SubdiscussionMaxine A Lewis Hi Rita, in reading your post I began thinking I might have improperly utilized the Boolean operators as I got fewer articles than when I use broader terms. I also realized I neglected to use parentheses or quotation marks which is also a part of the “Boolean Operators” as the search engine will only look for the “search phrase inside the parenthesis first, and then combine the search phrases with each other” (Arcada University of Applied Sciences, 2022). I totally agree with you that there must be a way to increase rigor and effectiveness in data base searches one such strategy is formulating and refining a primary research question that focuses on both the phenomenon of interest and the context in which it lies is essential to the accuracy and quality of the research (John, Adkins and Chauvin, 2020).
References
Arcada University of Applied Sciences, Boolean Operators,November 30,2022, ttps://libguides.arcada.fi/informationliteracy/searchtechniques#:~:text=Use%20parentheses%20(%20)%20in%20the%20search,search%20phrases%20with%20each%20other.
Johnson, J. L., Adkins, D., & Chauvin, S. (2020). A Review of the Quality Indicators of Rigor in Qualitative Research. American journal of pharmaceutical education, 84(1), 7120. https://doi.org/10.5688/ajpe7120
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Collapse SubdiscussionCheron Massonburg Hi Rita, I enjoyed reading your post.
Search engines ProQuest and CINAHL Plus database. Key words searches included hand hygiene, and hospital acquired infections returned 20,494 results and 21,460 respectively. After the utilization of limiters for full text, peer review, date range of 2018 to 2022 the streamlined search result was 13,601 and 15,787 respectfully. The inclusion of Boolean search parameter for hand washing further helped narrow down the search as follows; 3,070 and 5,179 respectfully, my inclusion of a final modifier for the most recent year of publication “2022” further help streamline the search results as follows ProQuest 232, while CINAHL Plus with full text returned 203 searches. “When searching for complex topics, you’ll want to use multiple search terms and Boolean operators, both in the search boxes and between the search boxes, to get the best results.” (Retrieved December 22th, 2022)
With the desire to increase the rigor and effectiveness of your data base search results, some of the strategies you can employ would be to refine your search limiters which will help streamline your research to the most current year, using year of publication limiters, “Keyword searching is the process of choosing search terms and entering them into the database search boxes to locate information on your topic.” (Retrieved December 22th, 2022)
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.
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Collapse SubdiscussionCrystal Lewis Hi, Rita,
Why should nurse researchers explore various databases?
Excellent post!
Dr. Lewis
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Collapse SubdiscussionAndrea M Allen Initial Post
Clinical Issue of Interest
My Clinical issue of interest is to find The Most Effective Combination of Self-Management Approaches, therapy for bipolar disorder in Adolescents.
Bipolar disorder which is also called manic depression is a disorder that is often associated with episodes of mood swings ranging from depressive lows to manic highs. Some manic episodes include having high energy, reduction in sleep and loss of reality while depressive episodes may include symptoms of low energy and loss of interest in in daily activities. The changes in mood can last from days to months and can progress to suicidal thoughts.
Databases Search
In deciding on my topic, I explored issues that interest me and a very vulnerable population that is affected mostly. On the Walden Library I chose my diagnosis as the subject in the search box. After receiving several hundred research articles with my subject head, I started to narrow my search using Boolean operators by adding phrases and checking boxes labeled full text, health and medicine, peer reviewed scholarly journal, health medicine and publication date within the past year until I was down to 600 topics or concepts. In searching for useful research topics relating to my PICO (T) question, I was able to focus on topics and articles that had information for expansion.
Strategies to increase the rigor and effectiveness of a database search
To increase Rigor and effectiveness of my PICO(T) search I will decrease the number of concepts search or search a broader search term such as using keywords, search for exact phrases, using Boolean logic, or citation search. I can also use terms like subject heading list from the thesaurus and use related articles or similar articles feature.
References
References
JANG, I.-W. et al. Status of Medications Prescribed for Psychiatric Disorders in Korean Pediatric and Adolescent Patients. Children, [s. l.], v. 9, n. 1, p. 68, 2022. DOI 10.3390/children9010068. Disponível em: https://search.ebscohost.com/login.aspx?direct=true&AuthType=shib&db=edb&AN=154804920&site=eds-live&scope=site. Acesso em: 22 dez. 2022.
QIN, K. et al. Network-level functional topological changes after mindfulness-based cognitive therapy in mood dysregulated adolescents at familial risk for bipolar disorder: a pilot study. BMC psychiatry, [s. l.], v. 21, n. 1, p. 213, 2021. DOI 10.1186/s12888-021-03211-4. Disponível em: https://search.ebscohost.com/login.aspx?direct=true&AuthType=shib&db=mnh&AN=33910549&site=eds-live&scope=site. Acesso em: 22 dez. 2022.
ARMAN, S. et al. Efficacy of Group Cognitive-behavioral Therapy in Maintenance Treatment and Relapse Prevention for Bipolar Adolescents. Advanced biomedical research, [s. l.], v. 7, p. 41, 2018. DOI 10.4103/abr.abr_168_16. Disponível em: https://search.ebscohost.com/login.aspx?direct=true&AuthType=shib&db=mnh&AN=29657926&site=eds-live&scope=site. Acesso em: 22 dez. 2022
BRICKMAN, H. M.; FRISTAD, M. A. Psychosocial Treatments for Bipolar Disorder in Children and Adolescents. Annual review of clinical psychology, [s. l.], v. 18, p. 291–327, 2022. DOI 10.1146/annurev-clinpsy-072220-021237. Disponível em: https://search.ebscohost.com/login.aspx?direct=true&AuthType=shib&db=mnh&AN=35216522&site=eds-live&scope=site. Acesso em: 22 de
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Collapse SubdiscussionRita Osei Response 1
Hi Andrea,
Thank you for your post this week. This is a great topic and finding the right PICOT question will ensure your research will guide you to the appropriate articles needed. (Melnyk &Fineout-Overholt, 2019). Boolean operators are a great tool to use as it helps advance one’s search. One Database I can suggest for Psych-related articles is the Cochrane Database; THIS Database is great for generating the most evidenced based and they have the best study designs (Stillwell, S. B., Fineout-Overholt, E., Melnyk, B., & Williamson, K.M. (2010). I have found it to be helpful anytime I search for psych-related articles.
reference
Melnyk, B.M., & Fineout-Overholt, E. (2019). Evidenced-based practice in nursing & healthcare: a guide to best practice. Fourth edition.
Stillwell, S. B., Fineout-Overholt, E., Melnyk,B., & Williamson, K.M. (2010). Research guides: 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
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Collapse SubdiscussionAnupa Mukundram Mehta Hi Andrea,
I think you did a great job with your database search, as you narrowed your search with Boolean operators and checked boxes similar to what I had done (Walden University, n.a) (Library of Congress, n.d). What I would recommend for your PICO question, is also having a comparison group, so if your population is adolescents with bipolar disorder, your intervention is self-management, and your outcome is improvement in bipolar disorder, then perhaps your comparison would be to those using only medication and not self-management. That might also help you find more articles as you can see the comparison to what you are looking for. You can even add the time portion to PICO, such as improvement of bipolar symptoms within 5 years.
References:
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=19981
Library of Congress. (n.d.). Search/browse help – Boolean operators and nesting Links to an external site.Links to an external site.. Retrieved September 19, 2018, from https://catalog.loc.gov/vwebv/ui/en_US/htdocs/help/searchBoolean.html
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Collapse SubdiscussionLeslie Rasmussen Module 3: Response 2
Hi Andrea,
This is a great topic and I enjoyed researching some articles on it as well because I do not know much about self-management with bipolar disorder especially with children. Self-management techniques and digital technologies can improve the quality of life and help them cope (Michalak et al., 2019). It was very surprising to me that 2.2% of adolescents in the U.S. have bipolar disorder but only 20% of those individuals are receiving any type of treatment for it (Post & Grunze, 2021). I would be very interested in reading your final research because it is intriguing to me.
You have a great start at finding articles, its sad to me that there are so many articles related to bipolar disorder in children, I never knew the prevalence of it. I have found that being able to use the left hand side and pick through the areas that you know you are looking for has been a great way to sift through all the articles and just get left over with the information you are looking for!
References
Michalak, E., Morton, E., Barnes, S., Hole, R., Crest, B., & Murray, G. (2019). Supporting self-
management in bipolar disorder: Mixed-methods knowledge translation study. JMIR Mental
Health, 6(4). doi: 10.2196/13493
Post, R., & Grunze, H. (2021). The challenged of children with bipolar disorder. Multidisciplinary Digital
Publishing Institute (MDPI), 57(6), 601. doi: 10.3390/medicina57060601
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Collapse SubdiscussionErica Dentaa Darko Hello Andrea, great post!
I really liked the clinical topic you chose to discuss. Adolescents with bipolar disorder. According to the Mayo Clinic, bipolar disorder, formerly known as manic depression, is a mental health condition characterized by extreme mood swings, including emotional highs (mania or hypomania) and lows (depression) ((Mayo Foundation for Medical Education and Research, 2022). A young adult must have manic episodes that last at least a week or are severe enough to require hospitalization to be diagnosed with bipolar I (Mayo Foundation for Medical Education and Research, 2022). For nearly 70 years, lithium has been the treatment of choice for patients suffering from bipolar disorder (BD) (Nasution, 2019). All relevant guidelines recommend it as a first-line treatment for maintenance therapy.
I agree that using the Boolean operators to narrow down your search was a wise decision. The key is to use the filters and check off a few things that are more relevant to what you are looking for, allowing you to focus more on the topic. Your suggestion to increase rigor and effectiveness made a lot of sense to me, and you did an excellent job with your discussion post!
Volkmann, C., Bschor, T., & Köhler, S. (2020, April 15). Lithium treatment over the lifespan in bipolar disorders. Frontiers. Retrieved December 24, 2022, from https://www.frontiersin.org/articles/10.3389/fpsyt.2020.00377/full
Mayo Foundation for Medical Education and Research. (2022, December 13). Bipolar disorder. Mayo Clinic. Retrieved December 24, 2022, from https://www.mayoclinic.org/diseases-conditions/bipolar-disorder/symptoms-causes/syc-20355955
Nasution, T., Yunita, R., Pasaribu, A., & Ardinata, F. M. (2019, October 14). Effectiveness hand washing and hand rub method in reducing total bacteria colony from nurses in Medan. Open access Macedonian journal of medical sciences. Retrieved December 16, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6980800/
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Collapse SubdiscussionJordyn Simons Andrea,
Thank you for the read! The word PICOT is a mnemonic derived from the elements of a clinical research question: patient, intervention, comparison, outcome, and time. The PICOT process begins with a case scenario, and the question is phrased to elicit an answer. The question needs to identify the patient or population we intend to study, the intervention or treatment we plan to use, the comparison of one intervention to another (if applicable) and the outcome we anticipate (Duquesne University, 2020). You can use data bases that support evidence-based practice such as PubMEd, CINAHL, Cochrane, Embase just to name a few. To have an effective search you must pick key words and use Boolean operators. Best of luck with your studies!
Jordyn
References
Formulating a Picot question: Duquesne University. Duquesne University School of Nursing. (2020, September 26). Retrieved from https://onlinenursing.duq.edu/blog/formulating-a-picot-question/
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Collapse SubdiscussionJaushai Henry Great post! I agree with you. Using certain tools such as Boolean operators and keywords will help you broaden your search. I learned that using truncated and wildcard searches influence better research answers(Martin et al., 2022). Also using CINAHL database and waldenu library also helps an individual by using credible libraries to find accurate research and information(Walden University Library. (n.d.-c. ).
References:
Martin, C. L., Weinfurter, E. V., Alpi, K. M., & Sittig, S. (2022). Leveraging Library and Information Science to Discover Consumer Health Informatics Research. In Personal Health Informatics (pp. 305-327).
Walden University Library. (n.d.-c). Evidence-based practice research: CINAHL search help Links to an external site. Links to an external site.. Retrieved December 17, 2022, from https://academicguides.waldenu.edu/library/healthevidence/cinahlsearchhelp
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Collapse SubdiscussionAndrea M Allen Addendum
PICO(T) for What is the most effective combination of Self Management approaches, therapy for bipolar adolescents.
P = Population
I = Intervention
C = comparing groups
O = Outcomes
T = Timing
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Collapse SubdiscussionJordyn Simons The adolescent psychiatric population in vulnerable and while often can be difficult to manage, it often can be very rewarding. The psychiatric community has determined that the use of restraints/seclusion on adolescent psychiatric inpatients is never a therapeutic intervention and can lead to exacerbation of the situation, harm to the patient and staff, psychological trauma to the patient, and in some cases death (Smith, & Bowman, 2009).
PICOT: In the pediatric psychiatric population does daily group education on coping skills/behavior management compared to no daily group education reduce the usage of restraints within the average 10 day in patient stay?
When using the Walden Library, I was able to find several databases, but Walden recommends a few to start your search. Both CINAHL and MEDLINE First, using CINAHL, I typed “adolescent psychiatric inpatient treatment” and received 33 results. I then used the Boolean operators and typed, “adolescent psychiatric inpatient AND restraints” and received 13 results. Next, I used MEDLINE. First, I typed, “adolescent psychiatry and restraint use” and received 19 results. I then searched “adolescent psychiatry AND nursing AND restraints” and received 14 results. I can increase the rigor and effectiveness of a database search by using more terms such as “coping skills” or “education.” Boolean operators are words that connect search terms (keywords) to create a logical phrase that a database can understand. They allow you to create a complex search that could include multiple concepts and alternative keywords (Walden, n.d.). Using Boolean operators, more specific wording, and further use of more databases I can refine my search and find the best available articles.
References
Smith, M., & Bowman, K. (2009). The restraint spiral: emergent themes in the perceptions of the physical restraint of juveniles. Child Welfare, 88(3), 57-83.
What are boolean operators? What are Boolean operators? – Walden University. (n.d.). Retrieved from https://academicanswers.waldenu.edu/faq/72773
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Collapse SubdiscussionAndrea M Allen Hi Jordyn,
Thanks for the read.
In regards to the adolescents patient with mental health issues, though I have never had the opportunity to take care of this population in my field of nursing, I can only imagine some of the challenges. The basic needs are belonging, power, enjoyment and Independence for the average adolescents coupled with mental illness must be quite challenging where these needs are even stronger. In addition to the current website choices, I find Psych Central and the National alliance on Mental Illness (NAM) are very resourceful mental health website. Using Boolean operators will guide you with your PICOT project.
Best,
Melnyk, B.M., & Fineout-Overholt, E. (2019). Evidenced-based practice in nursing & healthcare: a guide to best practice. Fourth edition.
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Collapse SubdiscussionOdion Iseki Hi Jordyn,
i like your presentation, you did justice to the topic. Walden recommends a handful to start. CINAHL/MEDLINE CINAHL found 33 results for “adolescent psychiatric inpatient therapy.” I typed “adolescent psychiatric inpatient AND shackles” and got 13 results. MEDLINE was next. “Adolescent psychiatry and restraint use” returned 19 results. The search terms “adolescent psychiatry AND nursing AND shackles” produced 14 results. Using phrases like “coping skills” and “education” increases the rigor and effectiveness of a database search. Boolean operators connect keywords to create a logical database phrase. They let you search using multiple concepts and keywords (Walden, n.d.). I may narrow my search using Boolean operators, more specific terminology, and more databases.
References
Smith, M., & Bowman, K. (2009). The restraint spiral: emergent themes in the perceptions of the physical restraint of juveniles. Child Welfare, 88(3), 57-83.
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Collapse SubdiscussionErica Dentaa Darko Hello, Jordyn! Great topic and post that you chose to discuss. I believe that anything related to psychology is rewarding. Restrains The use of physical force, mechanical devices, or chemicals to immobilize a person is an example of restraint (Richards et al., 2017). The concept of restraint in general refers to measures that restrict an individual’s freedom of movement and includes various types of restraints; an essential feature of restraint in psychiatry is its fundamentally coercive nature ( (Richards et al., 2017). Physical restraint was described as unpleasant, challenging, risky, and associated with dilemmas and conflicts in one article (Richards et al., 2017).
I appreciate the resources Walden has included to help with research topics. You did an excellent job with your method of searching for articles. Using filters, which are typically located on the page’s side, can help even more.
Richards, J. R., Steinert, T., Busch, B., Salize, H. J., Mayoral, F., Dix, R., Richmond, J. S., & Smith, G. M. (2017, June 27). On the concept of restraint in psychiatry. The European Journal of Psychiatry. Retrieved December 25, 2022, from https://www.sciencedirect.com/science/article/abs/pii/S0213616316300143
Vedana, K., Silva, D., Ventura, K., & Giacon, B. (2018, June). Physical and mechanical restraint in psychiatric units: Perceptions and experiences of nursing staff. Science Direct. Retrieved December 2022, from https://www.sciencedirect.com/science/article/abs/pii/S0883941717302492
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Collapse SubdiscussionCheron Massonburg Hi Jordyn, great topic. Below I have shared some of the ways I have researched my topic.
PICO(T) is a framework that helps breakdown the question into searchable keywords (Davies, 2011). The question framework, PICO(T), standardizes the format for asking questions, which is the motivating force in evidence-based practice (EBP) (Davies, 2011). As nurses, we continuously ask and formulate questions out of curiosity and inquiry to provide the highest quality of care to our patients (Melnyk et al., 2009).
The two databases I used were PubMed and MEDLINE. It was a great start to my interest in the topic. The database allowed me to advance my research by allowing me to choose the article type, change the publication date range, and search with Boolean operators. These features helped narrow down my search to the specific articles I was looking for specifically with the Boolean operators. Boolean operators allowed me to search combinations of keywords and phrases in a specified order . Having a question framework such as PICO(T) maximized the effectiveness of the search as it helped guide the search results for the specific topic.
Davies, K. S. (2011). Formulating the evidence-based practice question: A review of the frameworks. Evidence-Based Library and Information Practice, 6(2), 75. Retrieved March 21, 2022, from https://journals.library.ualberta.ca/eblip/index.php/EBLIP/article/view/9741/8144Links to an external site.
Melnyk, B.M., & Fineout-Overholt, E. (2019). Evidenced-based practice in nursing & healthcare: a guide to best practice. Fourth edition.
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Collapse SubdiscussionMaxine A Lewis Clinical research question using the PICOT method
The health issue chosen for this assignment is the scrutiny of the practice of subcutaneous heparin administration in relation to preparation and preferred administration site to increase efficacy as well as decrease bruising and pain. I have often wondered if changing the needle prior to administering the injection (which I have always done and still doing) really decreased bruising and if this intervention is a customary practice or best practice, A part “B’ of my inquire is the effectiveness and less bruising of the anticoagulant administration in sites other than the abdomen.
A search was completed in CINAHL which yielded 2,227 peer reviewed articles however obtain 18 articles when the PICOT method was incorporated I.e., P –problem: heparin preparation and administration, I- intervention: heparin injection and results (effectiveness and bruising complication); C –comparison: comparison not changing the needle versus changing needle and comparing varying injection sites; O-Outcome –does changing the needle between preparation and administration of heparin injection decreases or prevent bruising as well as effectiveness of using alternate sites: Time-frame 24-72 hours (about 3 days). Adding the Boolean operators (and, and, not) yielded 2 results.
In search PubMed yielded 60 general articles however when narrowed down to reviewed resulted in 4 articles. Amazingly when the same search was performed using Boolean operators the result was 5 articles. Boolean operators “simple words (AND, OR, NOT or AND NOT) used as conjunctions to combine or exclude keywords in a search, resulting in more focused and productive results. This should save time and effort by eliminating inappropriate hits that must be scanned before discarding” (Allient Library).
Strategies to increase rigor and effectiveness of a database search on my PICO(T) question is to a). Create a clearly defined review question and inclusion criteria to serve at the foundation for the search strategy (Aromataris, and Riitano, 2014); b). brainstorm terminologies authors might use to describe my research topic (Aromataris, and Riitano, 2014) ; c). seek assistance in formulating a more effective PICOT inquiry. Given the complexities of the various indexing languages and rules governing the various databases, it is recommended that one consult with an experienced research librarian who can examine one’s search strategy and provide assistance (Aromataris, and Riitano, (2014). To uncover all of the evidence and get the most impartial sense of what is known about a specific phenomenon or practice, a clear and systematic method of searching is required (McGrath, Brown, and Samra, 2012).
References
Allient Library, “What is a Boolean Operator?”, https://library.alliant.edu/screens/boolean.pdfLinks to an external site.
Aromataris, E. & Riitano, D. (2014). Systematic Reviews. AJN, American Journal of Nursing, 114 (5), 49-56. doi: 10.1097/01.NAJ.0000446779.99522.f6.
McGrath, J. M., Brown, R. E., & Samra, H. A. (2012). Before You Search the Literature: How to Prepare and Get the Most Out of Citation Databases. Newborn and Infant Nursing Reviews, 12(3), 162–170. https://doi.org/10.1053/j.nainr.2012.06.003
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Collapse SubdiscussionSheila Ankrah Response 1
Hi Maxine,
Thank you for your post. I, too, work in an ICU, and the types of shift change report I receive range from horrible to excellent. On several occasions, I’ve also seen physicians get upset because something important was not communicated to the oncoming shift. We have tried using shift report tools to improve communication, but they usually need to be remembered fairly quickly. Has your hospital ever tried implementing a handoff tool? I’m curious to see what the literature says!
I used Thoreau to search several databases at once (Walden University Library, n.d.) and came up with fewer results than I expected. I used the keywords “shift report” OR “nursing handoff” AND “effective” AND “critical care,” which yielded 34 results. Using interchangeable terms has helped tremendously. I’m sure several different terms are used for “bedside shift report,” so maybe using several in one search with appropriate Boolean terms can help open up your search while also narrowing it down to relevant articles (Library of Congress, n.d.).
References
Library of Congress. (n.d.). Search/browse help – Boolean operators and nesting. Retrieved December 23, 2022, from https://catalog.loc.gov/vwebv/ui/en_US/htdocs/help/searchBoolean.htmlLinks to an external site.
Walden University Library. (n.d.). Databases A-Z: Nursing. Retrieved December 23, 2022, from https://academicguides.waldenu.edu/az.php?s=19981Links to an external site.
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Collapse SubdiscussionJordyn Simons Maxine,
I enjoyed reading your post!
Nurses, nursing students, researchers, medical librarians, and nurse educators depend on EBSCO’s databases for a comprehensive collection of evidence-based medical literature from reliable sources. It is important to note that EBSCO has several options to make research easy. Researchers also enjoy many other features including searchable cited references, the ability to create multiple citation styles, personal folders, alerts and RSS feeds, the ability to generate links to information, mobile access, help resources and much more (EBSCO, n.d.).
Jordyn
References
Support nursing research: EBSCO. EBSCO Information Services, Inc. | www.ebsco.com. (n.d.). Retrieved from https://www.ebsco.com/health-care/benefits/support-nursing-research
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Collapse SubdiscussionMellissa Rodriguez Clinical issue of interest: The clinical issue of interest is patient safety regarding falls. Patient safety education is imperative during admission and consistent education regarding the risk of falls and how to prevent them makes a positive impact on the well-being of patients. If educating patients on the risk for falls helps eliminate the issue then it is worth spending more time on. “Falls represent a leading cause of preventable injury in hospitals and a frequently reported serious adverse event. Hospitalization is associated with an increased risk for falls and serious injuries including hip fractures, subdural hematomas, or even death” (Dykes et al., 2020, p.1). Nurses are with patients continuously, so it is crucial that we educate on preventing falls and involve families so that we do not risk further injury to already ill patients. “The role that patients can play in preventing falls whilst in hospital has received less attention”, so it is clear that both nurses and patients participate in education (Heng et al., 2020, p.1).
PICO(T): For hospitalized patients does frequent patient safety education regarding falls compared to just once upon admission, reduce the number of patients falls within a 6 month period.
Search results: I initially used Medline to search my clinical issue. With only using “patient falls” as my search topic, about 15,000 articles populated. With that said, patient falls has a large amount of research articles regarding patient falls but it is important to narrow down by ensuring the articles are peer reviewed and recent. By adding other key words such as “education” it narrowed down the results and geared them more toward what I was looking for. From those 15,000 it reduced the number of results to about 600 simply by adding key words, selecting peer reviewed and also change the publication to only populate articles from the last 5 years. Medline is great because it includes Boolean terms in the search itself and you can add about 2 or 3 additional search terms. PUBMED is another great database that populated hundreds of articles regarding patient falls that were relevant.
Strategies: To increase the rigor and effectiveness of a database search on my PICO(T) question I will use various databases to ensure I am getting a variety of articles. I will, as mentioned before, narrow down results be only using articles published on or after the year 2017. I will get concise results using multiple key words and ensuring the use of Boolean terms and checking off results that are peer reviewed. Placing limits “can eliminate articles written in languages other than English” and is another strategy to narrow down results (Stillwell et al., 2010, p. 43).
References
Dykes, P. C., Burns, Z., Adelman, J., Benneyan, J., Bogaisky, M., Carter, E., Ergai, A., Lindros, M. E., Lipsitz, S. R., Scanlan, M., Shaykevich, S., & Bates, D. W. (2020). Evaluation of a Patient-Centered Fall-Prevention Tool Kit to Reduce Falls and Injuries: A Nonrandomized Controlled Trial. JAMA network open, 3(11), e2025889. https://doi.org/10.1001/jamanetworkopen.2020.25889Links to an external site.
Heng, H., Jazayeri, D., Shaw, L., Kiegaldie, D., Hill, A.-M., & Morris, M. E. (2020). Hospital falls prevention with patient education: a scoping review. BMC Geriatrics, 20(1), 140. https://doi.org/10.1186/s12877-020-01515-wLinks to an external site.
Stillwell, S.B., Fineout-Overhold, E., Melnyk, B.M., & Williamson, K.M. (2010). Evidence-based practice step-by-step: Searching for evidence. Links to an external site.Links to an external site.American Journal of Nursing, 110(5), 41-47.
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Collapse SubdiscussionBertina Boma Soh Dear Melissa, your topic selection is excellent. Every year, one-third of older persons fall, and fifty percent of those that fall are repeated fallers (Jehu et al., 2021). One of the most prevalent adverse events among hospitalized patients is falling. Falls resulting from injuries can lengthen a patient’s hospital stay and increase the risk of complications and fatality, especially among the elderly. Multifactorial therapies should lead to a more targeted assessment and change of fall risk variables. Even though the fact that biological aging is the primary risk factor for most chronic diseases, the relationship is bidirectional since chronic diseases, so-called geriatric syndromes, and/or unfavorable treatment outcomes may accelerate biological aging. Frailty, sarcopenia, and dementia, all precursors to disability and hastened aging, are among the most important conditions ( Izquierdo et al., 2021). Patients with cognitive impairment, delirium, and dementia must be the primary focus of prevention efforts to avoid falls. Other strategies include implementing patient-specific interventions and applying an inpatient risk assessment tool that aids in developing a personalized care plan based on identified fall and injury risks. It is also beneficial to highlight patients with fall risks in their electronic health records. Using technology such as gait belts, walkers, and ceiling lifts to increase patient safety during transfers and mobility.
Works Cited
Jehu, D. A., Davis, J. C., Falck, R. S., Bennett, K. J., Tai, D., Souza, M. F., … & Liu-Ambrose, T. (2021). Risk factors for recurrent falls in older adults: A systematic review with meta-analysis. Maturitas, 144, 23-28.Izquierdo, M., Merchant, R. A., Morley, J. E., Anker, S. D., Aprahamian, I., Arai, H., … & Singh, M. F. (2021). International exercise recommendations in older adults (ICFSR): expert consensus guidelines. The journal of nutrition, health & aging, 25(7), 824-853.
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Collapse SubdiscussionChristiana Nuworsoo Mellissa,
Thank you for your post. In reading your post, I realized that every hospital is different in terms of procedures that are considered essential. At my current hospital, nurses are required to perform a fall assessment and education every shift. One cannot choose to do it, it is part of each shift nursing task. At a previous hospital, nurses are required to perform a fall assessment each shift, but it is not part of your task; however, each patient is required to sign a Fall contract at admission in which patients agree to adhere to fall protocols. Also, I find that fall education is only challenging with confused and dementia patients. With that group, you can educate them one minute; the next minute, they attempt to get out of bed, forgetting that they cannot walk. Currently, there isn’t enough evidence to endorse the reduction of fall interventions for people with dementia in any setting (Peek et al., 2020). Therefore, more evidence-based research needs to be done to find a solution to the problem.
It might be more time-consuming to look through different databases/search engines about your PICOT questions. To minimize time and be more efficient in your search, familiarize yourself with one search engine and know which key terms to use (Walden University, 2018). Using different databases, you will find some of the same articles.
Reference
Peek, K., Bryant, J., Carey, M., Dodd, N., Freund, M., Lawson, S., & Meyer, C. (2020). Reducing falls among people living with dementia: A systematic review. Dementia, 19(5), 1621-1640.
Walden University, LLC. (Producer). (2018). Searching the Evidence [Video file]. Baltimore, MD: Author.
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Collapse SubdiscussionSheila Ankrah Main Post
Discussion: Searching Databases
Throughout nursing school, I was always taught that bedside shift reports were the safest and most effective way to give reports at the end of a shift. So why is it a practice not regularly practised within healthcare organizations? Despite multiple attempts by organizations to implement bedside shift reports, units have a hard time sustaining the practice due to nurses feeling that bedside shift reports are not very beneficial and take up too much time to give a report, especially if the nurse has to report to multiple different nurses. Despite research and evidence-based practice saying bedside shift reports reduce falls, increase patient satisfaction, and improve patient outcomes, it still needs to be regularly practised. This is a clinical area of interest to me and will be the topic of this discussion. The PICOT question that this issue is based on will be; In adult patients admitted to acute care facilities (population), how effective is bedside shift report (Intervention) compared to reporting the nurse’s station (Comparison) at preventing falls and improving patient outcomes (Outcomes), during the end of shift report (Time)? According to Overholt (2019, pg. 40), “The purpose of the PICOT question is to guide the systemic search of healthcare databases to find the best available evidence to answer the question.”
Once I logged into the Walden Library, I hit the Research by Subject tab. The subject I chose was Nursing. I started my search by simply typing “bedside shift report.” My search produced 316 articles all about the topic. Next, I began searching terms using Boolean operators. Boolean operators “help to create more precise and powerful searches with a higher percentage of relevant results” (Boolean Terms, n.d).
I searched “bedside shift report and patient safety or patient satisfaction.” At that time, my search produced 256,879 research articles. When I searched “bedside shift report and patient safety,” I received 110 results; when I searched “bedside shift report and patient satisfaction,” I received 76 results.
Strategies that I can use to improve the effectiveness of my research include using the filters on the left-hand side of the screen, which helps narrow my search results. Davies (2011, pg. 75) states, “An unstructured collection of keywords can retrieve irrelevant literature, which wastes time and effort eliminating inappropriate information.” Filters that I can apply include only peer-reviewed, full-text articles. Also, the years can be adjusted to include research articles written within the past five years.
References
Davies, K. S. (2011). Formulating the evidence-based practice question: A review of the frameworks. Evidence-Based Library and Information Practice, 6(2), 75. Retrieved March 21, 2022, from https://journals.library.ualberta.ca/eblip/index.php/EBLIP/article/view/9741/8144Links to an external site..
Keyword searching: Finding articles on your topic: CONNECT KEYWORDS. Academic Guides. (n.d.). Retrieved March 21, 2022, from https://academicguides.waldenu.edu/library/keyword/booleanLinks to an external site.
Melnyk, B. M., & Fineout-Overholt, E. (2019). Asking Compelling Clinical Questions. In Evidence-based Practice in Nursing & Healthcare: A guide to best practice (4th ed., p. 40). essay, Wolters Kluwers.
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Collapse SubdiscussionCrystal Lewis Hi, Sheila,
Why is the PICOT question important in nursing research?
Excellent post!
Dr. Lewis
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Collapse SubdiscussionAndrea M Allen Dear Sheila,
I enjoy reading your post. Bedside shift report appears as a thing of the past. Bedside shift reports promotes patients safety by providing patients with an opportunity to correct miscommunications. It also allows the patient the ability to contribute to his/her care plan ( Mason et al.,(2012). We have gotten so caught up with dotting our I’s and crossing t’s that we are more focus on making sure all requirements are accomplished. In doing so we are not able to communicate effectively to peers or patients.
Using the boolean search I find that once you get a better understanding of how the boolean operators function and ways in which to narrow your searches, I find it saves time and gives you the advantage of a successful search.
Best,
Melynk, BM., I & Finest-overholt E. (20190. Asking Compelling Clinical questions in Evidence -basedPractice in nursing & healthcare: A guide to best practice (4th ed.)., p.40). essay. Wolters Kluwer
Maxon, PM., Derby, KM, Wrobleski DM, Ross DM. (2012). Bedside -nurse -to-nurse handoff promotes patient safety.Mednurse Nurs. 2012 May-June;21(3):140-4, 145
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Collapse SubdiscussionVictavian Jackson 1st Response to Peer Discussion Question
Good Point Sheila,
The PICOT question is a valid concern that’s failed to be consistently practiced on many hospital units. Nurse Managers (NM) would start off enforcing the bedside shift report (BSR), but when the overtime start affecting their budget, then they forget about the possibility of a patient fall or safety concern. Falls are the 2nd leading cause of death from accidental injury and in the United States alone, the cost can lead up to $50 billion annually (Bedside handoffs report improve the quality of care and fall prevention (Sun et al., 2020, p. 355). Which is why BSR is important and should be practiced consistently. BSR prevents patient falls and enables accurate and timely communication between nurses and patients on the hospital units (Mardis et al., 2016, p. 55). I currently practice at the bedside and have witnessed many patients safety concerns that keeps my initial assessment in front of the patient during hand-off report. During my search, I have used the filters on the left side of the Walden library website to adjust the publish dates, peer reviewed articles and linked keywords on the boolean operators. It has helped tremendously on identifying relative articles to support my argument on many assignments.
References:
Sun, C., Fu, C. J., O’Brien, J., Cato, K. D., Stoerger, L., & Levin, A. (2020). Exploring practices of bedside shift report and hourly rounding. Is there an impact on patient falls? JONA: The Journal of Nursing Administration, 50(6), 355–362. https://doi.org/10.1097/nna.0000000000000897Links to an external site.
Mardis, T., Mardis, M., Davis, J., Justice, E. M., Riley Holdinsky, S., Donnelly, J., Ragozine-Bush, H., & Riesenberg, L. A. (2016). Bedside shift-to-shift handoffs. Journal of Nursing Care Quality, 31(1), 54–60. https://doi.org/10.1097/ncq.0000000000000142
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Collapse SubdiscussionVictavian Jackson Good Point Sheila,
The PICOT question is a valid concern that’s failed to be consistently practiced on many hospital units. Nurse Managers (NM) would start off enforcing the bedside shift report (BSR), but when the overtime start affecting their budget, then they forget about the possibility of a patient fall or safety concern. Falls are the 2nd leading cause of death from accidental injury and in the United States alone, the cost can lead up to $50 billion annually (Bedside handoffs report improve the quality of care and fall prevention (Sun et al., 2020, p. 355). Which is why BSR is important and should be practiced consistently. BSR prevents patient falls and enables accurate and timely communication between nurses and patients on the hospital units (Mardis et al., 2016p. 55). I currently practice at the bedside and have witnessed many patients safety concerns that keeps my initial assessment in front of the patient during hand-off report. During my search, I have used the filters on the left side of the Walden library website to adjust the publish dates, peer reviewed articles and linked keywords on the boolean operators. It has helped tremendously on identifying relative articles to support my argument on many assignments.
References:
Sun, C., Fu, C. J., O’Brien, J., Cato, K. D., Stoerger, L., & Levin, A. (2020). Exploring Practices of Bedside Shift Report and Hourly Rounding. Is There an Impact on Patient Falls? JONA: The Journal of Nursing Administration, 50(6), 355–362. https://doi.org/10.1097/nna.0000000000000897Links to an external site.
Mardis, T., Mardis, M., Davis, J., Justice, E. M., Riley Holdinsky, S., Donnelly, J., Ragozine-Bush, H., & Riesenberg, L. A. (2016). Bedside shift-to-shift handoffs. Journal of Nursing Care Quality, 31(1), 54–60. https://doi.org/10.1097/ncq.0000000000000142Links to an external site.
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Collapse SubdiscussionStephen Chege Response 1
Great Post, Sheila.
Healthcare organizations strive to enhance the safety of patients. Patient safety is critical to preventing medical complications, prolonged hospital stays, or increased medical costs. According to your post, a bedside report at the end of the shift promotes patient safety and satisfaction. In my experience, I have found bedside reports to be essential in understanding patients. Immediate needs at the beginning of the shift. During the bedside report, the nurses can address any immediate needs. For example, if a patient wants to use the bathroom, assess pain, assess intravenous access, or attend to immediate medical needs. Bressan et al. (2019) appraise bedside reports as ideal when changing shifts. During the bedside report, the nurses know critical information about the patient. Essential information includes the patient’s diagnosis, medical history, and procedures completed. Also, the nurse can verify the patient’s medications and care plan. At the bedside, the patient can validate the information passed to the incoming nurse and rectify any missed information.
When searching for the literature, it is also essential to utilize multiple databases and compare the results (www.academicguides.walden.eduLinks to an external site.)
References
Bressan, V., Cadorin, L., Stevanin, S., & Palese, A. (2019). Patients experiences of bedside handover: Findings from a meta‐synthesis. Scandinavian Journal of Caring Sciences, 33(3), 556–568. https://doi.org/10.1111/scs.12673
https://academicguides.waldenu.edu/library/keyword/identifyrelevantdatabases
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Collapse SubdiscussionChristiana Nuworsoo Sheila,
I enjoyed reading your post because although studies have proven that it is essential, it is not consistently enforced; however, it depends on where you work. I once worked for a company that was very adamant about it, and to ensure that it is done, the charge nurse goes around checking to confirm adherence. Bedside shift reporting allows the patient to contribute to their care plan and allows the oncoming nurse to visualize the patient and ask questions (Maxson et al., 2012). Although it is time-consuming, it is essential because it allows the nurse to visualize the patient and know their outlook before commencing their shift.
Nursing is a functional chaos type of work. Meaning it gets chaotic, but we are so used to it that it is no longer a factor but rather how to tackle it. Imagine getting a shift report, but your shift started with a declining patient, so you prioritize ensuring that the patient is stable. When things settle, one or two hours have passed, and you go to check on the rest of your patients and find one unresponsive. You did not do a bedside shift report, so you cannot say if the patient was alive when your shift began. This happened to one of my colleagues, and her savior was the telemetry machine because it showed when the patient went into asystole. Thus, shift report is beneficial for both patient and the nurse.
When doing your search, select the time frame box on the left pane to ensure the results come from the most current sources, which will also decrease the number of search results.
References
Maxson, P. M., Derby, K. M., Wrobleski, D. M., & Foss, D. M. (2012). Bedside nurse-to-nurse handoff promotes patient safety. Medsurg nursing : official journal of the Academy of Medical-Surgical Nurses, 21(3), 140–145.
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Collapse SubdiscussionUrsla Anyizi-Taku First Response
Hi Sheila,
Great post. In nursing research, PICOT stands for population, intervention, comparison, outcome, and time. According to (Guyatt et al., 2008), a PICOT question’s purpose is to identify the terms to be used to search for the best evidence to answer a burning clinical question. In other words, the PICOT question is the search strategy. Achieving the named goal is possible with a PICOT question because it usually contains essential elements that every nursing research must entail. The elements include the patient population, the nursing intervention, the expected outcome, patient care, and nursing practice.
Clinicians interested in research pursuits related to patient care should consider the use of a literature search and the PICOT format when engaging clinical researchers (Antwi et al., 2024). This approach will provide clinicians and researchers with an initial basis for mutual understanding, communication, and direction to help answer clinical study questions of most relevance.
Reference
Antwi, M., & Kale, M. (2014). Change management in healthcare. Ottawa, Ontario: The Monieson Centre for Business Research in Healthcare.
Guyatt G, Drummond R, Meade M, Cook D. The Evidence Based-Medicine Working Group Users’ Guides to the Medical Literature. 2nd edition. McGraw Hill; Chicago: 2008.
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Collapse SubdiscussionSulaiman Yassin Jalloh Hi Sheila,
I enjoyed reading your post. Having an effective search strategy is a crucial step in research because of the vast collection of articles in databases. The use of the intervention and outcome components of the PICOT question provides an effective approach to searching relevant resources (Melnyk & Fineout-Overholt, 2022). The Boolean operators facilitate the combination of different keywords for more specific results. The strategy helps save effort by eliminating unnecessary searches. The application filters also allow the identification of specific results. In addition to the date, I would recommend the limitation of the publication type to clinical trials, randomized controlled trials, and systematic reviews. Not all articles found in research databases have reliable information that contributes to evidence-based practice. The selected articles should contain original research based on clinical trials or reviews of experimental studies (Grove & Gray, 2018). The structured search strategy produces relevant and reliable results.
References
Grove, S. K., & Gray, J. R. (2018). Understanding nursing research: Building an evidence-based practice. Elsevier Health Sciences.
Melnyk, B. M., & Fineout-Overholt, E. (2022). Evidence-based practice in nursing & healthcare: A guide to best practice. Lippincott Williams & Wilkins.
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Collapse SubdiscussionNtumba Kabongo Response #1
Hi Sheila, your subject selection regarding shift change report is excellent. This subject is as of a big importance because it is the safest and effective way to relay information amongst colleagues during shift change. You asked the question about why this practice is not regularly put in place. For me, bed side shift change had many challenges at first : as a new graduate student ,giving report in front of patient can be intimidating at first because of being insure about the information you are giving, not having the self-confidence, not having the answers to questions when asked by the other nurses nor patients, but as I became more confidant about myself and my knowledge of the job , It became more important for me to do a bedside shift report. This was easy and helpful because it reduced errors during exchange of information, it insures accurate information, improves the quality of care (Sun et al., 2020, p. 355). it makes the care personal because it involves the patient in their care, and it is the best practice based on evidence.
Sun, C., Fu, C. J., O’Brien, J., Cato, K. D., Stoerger, L., & Levin, A. (2020). Exploring practices of bedside shift report and hourly rounding
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Collapse SubdiscussionBertina Boma Soh Sheila, your remark regarding the reports made at shift changes is correct. The transfer of responsibility and accountability for a patient’s care from one nurse to another consideration of a patient from one nurse to another is what is referred to as a change-of-shift report. The communication that takes place as a result of this procedure is directly connected to the safety of the patient and the consistency of their caregiving. When implementing and maintaining practice change, having the finest evidence, unit-based champions, leadership support, project coordinators, and tenacity are all essential components (Becker et l., 2021). Bedside shift reports are vital to ensure nurse communication and are considered an opportunity to eliminate errors. Bedside report models that include the patient as part of the triad have boosted patient engagement while improving the education and support provided to caregivers. To establish a hierarchical framework for the nursing handoff to guarantee the reliable transmission of patients (Elendu et al., 2021).
Works Cited
Becker, S., Hagle, M., Amrhein, A., Bispo, J., Hopkins, S., Kogelmann, M., … & Smith, M. M. (2021). Implementing and sustaining bedside shift report for quality patient-centered care. Journal of Nursing Care Quality, 36(2), 125-131.Elendu, R. N. (2021). Providing Quality Patient Care through Bedside Nurse Handoff & Shift Report.
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Collapse SubdiscussionCassie L Bozard Mental Health Crisis
The nation’s mental health crisis has been exacerbated since the COVID19 pandemic. According to the National Alliance on Mental Illness (2022), 1 in 5 adults experience mental illness each year, 1 in 20 experience a serious mental illness, and 17 million adults experience substance use disorder and mental illness. According to my organization, Sentara’s Leadership has stated there has been an 85% increase in mental health patients in the Emergency Department (ED). With there being a high percentage of individuals suffering from mental illness, this has increased the number of mental health patients waiting for an inpatient bed in Sentara’s Emergency Department (ED). This Sentara Hospital does not have a behavioral health unit or any in-house mental health professionals. Since there are no in-house mental health professionals, this patient population doesn’t receive any individualized psychiatric interventions while in the ED, which causes the majority of the patient population to wait for an inpatient bed. Our psychiatric population stays in the ED anywhere from 2-7 days without specialized mental health interventions besides medication management. Sentara is doing their psychiatric population a dis-service without providing the proper mental health services in the ED. My PIOCT question pertaining to my clinical issue is: In Psychiatric patients in the Emergency Department (population), how effective is immediate psychiatric interventions (intervention) compared to no psychiatric interventions (comparison) on reducing the length of stay (outcome) by going to a lower level of psychiatric care besides inpatient on discharge from the emergency department (time)? PICOT is an element for asking a clinical question which stands for population, intervention or issue of interest, comparison intervention or issue of interest, outcomes of interest, and time it takes for the intervention to achieve the outcomes (Stillwell et al., 2010).
When researching articles pertaining to my PICOT question, I first searched articles through the Cinahl database. The Cinahl database reports to have over 750 nursing and allied health related journals, which fit into the category of my PICOT question (Walden University Library, n.d.). I searched nurse-led psychiatric interventions through Cinahl, and the database only resulted with four articles. These articles did not support my PICOT question. I then changed my search words, and researched comprehensive psychiatric emergency programs, and only two articles resulted. Once again, these articles did not support my research question. I decided I needed to change databases to be more efficient in my article search. I went back to the Walden University Library and found the SAGE Journal database, which I have had success in the past when researching articles. I researched comprehensive psychiatric emergency programs, and I was able to gather 12,638 articles. Yes, some of the articles did not pertain to my research question, but I was able to find 4-9 journal articles within the first three pages that supported my PICOT question.
To be successful when researching articles pertaining to a PICOT question, I need to be specific in the word search, use the advanced search method if needed, find the database that works best with what is being researched, and contact the Walden Librarian for assistance if needed.
References
National Alliance on Mental Illness. (2022). Mental health by the numbers. https://www.nami.org/mhstatsLinks to an external site.
Stillwell, S. B., Fineout-Overholt, E., Melnyk, B. M., & Williamson, K. M. (2010). Evidence-based practice, step by step: Asking the clinical question: A Links to an external site.
key step in evidence-based practice. Links to an external site.Links to an external site.American Journal of Nursing, 110(3), 58–61.
Walden University Library. (n.d.). Evidence-based practice research: CINAHL search help Links to an external site.Links to an external site..
https://academicguides.waldenu.edu/library/healthevidence/cinahlsearchhelp
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Collapse SubdiscussionCrystal Lewis Hi, Cassie,
How does the nurse researcher benefit by formulating a PICOT question?
Great post!
Dr. Lewis
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Collapse SubdiscussionCassie L Bozard A PICOT questions allows the nurse researcher to find evidence-based research to influence current practice.
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Collapse SubdiscussionStephen Chege Response 2.
I enjoyed reading your post, Casie.
Unfortunately, patients have to wait that long before receiving specialized care or getting referred to a different facility proI enjoyed reading your post, Casie.
Unfortunately, the patients wait t longer before receiving specialized care or getting referred to different facilities providing mental health services. It would be beneficial to the staff and the patients if your organization could consider establishing a treatment plan for individuals with mental illness. Your organization should consider having psychiatric providers and supportive staff, to ensure patient and staff safety.
Cherner et al.(2022) report a burden in the emergency department due to the increased admission of a patient with mental health illnesses. Patients with mental illness are likely to become frequent fliers in the ED. Cherner et al. (2022) further report that about 60% of mental health patients do not have a primary care provider or do not follow up with a psychiatric doctor. Lack of follow up appointments increasing chances of going back to the ED.
You have established a great PICOT question. It would be beneficial to the staff and the patients if your organization could consider establishing a treatment plan for individuals suffering from mental illness. Also, your organization should consider having psychiatric providers on board, and supportive staff to ensure patient and staff safety.
Cherner et al.(2022) report a huge burden in the emergency department due to the increased admission of a patient with mental health illnesses. The patients with mental illness are like to become frequent fliers in the ED. Cherner et al. (2022) further report that about 60% of mental health patients do not have a primary care provider, or do not follow up with a psychiatric doctor; increasing the likelihood of returning to the ED.
You have established a great PICOT question. Adding to your search strategies, using multiple search engines and narrowing search period to five years is beneficial.
Reference
Cherner, R., Polillo, A., Samosh, J., Sylvestre, J., Rae, J., Pettey, D., & Aubry, T. (2022). Bridging the gap between Hospital and Community Mental Health Services for frequent emergency department visitors. Canadian Journal of Community Mental Health, 41(1), 1–17. https://doi.org/10.7870/cjcmh-2022-001Links to an external site.
https://academicguides.waldenu.edu/library/keyword/boolean
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Collapse SubdiscussionStephen Chege sorry the reply post pasted twice.
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Collapse SubdiscussionOdion Iseki Hi Cassie,
this is a great post i find it insightful Since COVID-19, the country’s mental health situation has worsened. According to the National Alliance on Mental Illness, 1 in 5 people will have a mental health problem, 1 in 20 will have a significant problem, and 17 million individuals will have both a mental health problem and a drug misuse problem (2022). Sentara leaders say mental health ER visits are up 85%, but our data says otherwise (ED). Sentara’s Emergency Department often has a significant wait list for individuals needing inpatient care due to mental illness (ED).
References
National Alliance on Mental Illness. (2022). Mental health by the numbers. https://www.nami.org/mhstatsLinks to an external site.
Stillwell, S. B., Fineout-Overholt, E., Melnyk, B. M., & Williamson, K. M. (2010). Evidence-based practice, step by step: Asking the clinical question: A
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Collapse SubdiscussionMleh Porter Hello Cassie,
I enjoyed reading about your clinical issue of interest and agree that mental healthcare access is a challenge in the United States. The statistics in your discussion post are alarming. Unfortunately, one-fifth of adults with mental healthcare needs do not have a primary source of care, and more than half of adults with mental health needs report affordability as a barrier to access (Coombs et al., 2021). Research allows one to provide care based on the best practice available. In looking up research, multiple databases may need to be searched to find one that fits the area of interest. One database I suggest is the APA PsychInfo, the most extensive resource for scholarly peer-reviewed research on mental health. Walden University library database lists this as one of the best bets (Walden University, n.d.). Using PsychInfo, articles can be limited using specific keywords using the Boolean operators, populations, and articles within the last five years, which allows one to get the most recent evidence.
References
Coombs, N. C., Meriwether, W. E., Caringi, J., & Newcomer, S. R. (2021). Barriers to healthcare access among U.S. adults with mental health challenges: A population-based study. SSM – population health, 15, 100847. https://doi.org/10.1016/j.ssmph.2021.100847Links to an external site.
Walden University Library. (n.d.). Databases A-Z: counseling: journals. https://academicguides.waldenu.edu/az.php?s=35808&t=620
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Collapse SubdiscussionLeslie Rasmussen Module 3: Main Post
Clinical Interest
Diabetes is a common problem that affects all age ranges and parts of the world. Being able to manage your diagnosis of diabetes means that you need to be knowledgeable about the disease, the interventions that need to be done to keep it controlled and how to shape your life around this disease (Fink et al., 2019). Having the right discussions with your providers or diabetic educators can teach you the information that you need to know and follow. They can follow up with you to see that it is effective but being competent in learning the information is important and providers need to keep those individuals that have different learning abilities in mind as well (Azami et al., 2018). The clinical area that interests me is those individuals that have been diagnosed with diabetes, the difference it makes when they get proper education versus none. The PICOT question is: Does counseling with a diabetic educator increase compliance for diabetic patients compared to patients who do not meet with a diabetic educator?
Being a successful provider means providing excellent patient care, with that, you should try to stay informed on the latest best practices and educate your patients (Melnyk & Fineout-Overholt, 2018). If this information can benefit them, it is best to make sure they understand, and that the education is provided to them in the first place.
Search Results
When researching this topic, I started with the Walden Library and went to the CINAHL database. The first terms I used were “Diabetic education”, this brought up 616 articles, the second term I used was “Diabetic compliance” which brought up only 86 articles. When adding Boolean operators, I used “diabetic education and compliance”, that showed 76 articles, “Diabetes and compliance” brought up 4,753 articles.
The easiest way to make my searches more effective is to utilize the “refine results” portion of the website, this lets me choose what types of articles I am looking for such as research articles. I can narrow down the date range for the last five years and even choose full text. Being able to pick and choose the important features of the articles that I am looking for really helps me narrow down the articles that will be useful for me with my research.
References
Azami, G., Soh, K., Sazlina, S., Salmiah, S., Aazami, S., Mozafari, M., & Taghidejan, H. (2018)
Effect of a nurse-led Diabetes self-management education program on glycosylated
hemoglobin among adults with type 2 diabetes. Journal of Diabetes Research.
https://doi.org/10.1155/2018/4930157
Fink, A., Fach, E., & Schroder, S., (2019). ‘Learning to shape life’ – A qualitative study on the
challenges posed by a diagnosis of diabetes mellitus type 2. International Journal for
Equity in Health, 18(19). https://doi.org/10.1186/s12939-019-0924-3Links to an external site.
Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing &
healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer.
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Collapse SubdiscussionCrystal Lewis Hi, Leslie,
Discuss the benefits for following the PICOT format.
Good post!
Dr. Lewis
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Collapse SubdiscussionCassie L Bozard Leslie,
The purpose of using scholarly journal articles in the academic setting is to advance knowledge though evidence-based research studies (Walden University, n.d.). I agree that refining your search within a database allows for more effective evidence-based research pertaining to your research topic. A strategy I use for an efficient article search is to utilize the advance search section. This narrows my search even more than a regular search in order to populate the most useful articles for my research question. Sometimes it’s overwhelming when a lot of articles populate from a word search. A strategy I use to eliminate articles that aren’t useful is to read the introduction of the article first. This doesn’t mean the abstract, this is the actual introduction of the article. By reading the introduction first, I have a good understanding if this research article is going to provide enough information needed to do a thorough research analysis. Using the steps to synthesize literature also helps to eliminate articles that aren’t valuable for my research. Synthesizing literature requires analysis, decision making, evaluation of information, and forming your own ideas through the evidence being provided (Shellenbarger, 2016).
Shellenbarger, T. (2016). Simplifying synthesis. Nurse Author & Editor, 26(3). http://naepub.com/reporting-research/2016-26-3-3/Links to an external site.
Walden University Library. (n.d). Evaluating resources: Journals. https://academicguides.waldenu.edu/library/evaluating/resource-types/journalsLinks to an external site.
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Collapse SubdiscussionMleh Porter Hello Leslie,
Thank you for your post. Evidence-based practice is essential to improving the quality of healthcare and patient outcomes. Through research, new knowledge is gained, but the evidence from the research must be implemented effectively to achieve beneficial outcomes (Chien, 2019). To implement best practices, nurses and other healthcare professionals must become efficient at finding quality evidence to support professional practice.I agree that we must stay informed on the latest best practices out there. In order to look up articles efficiently, we must be effective at finding the proper research for our clinical areas of interest. Identifying evidence requires using suitable database systems (Gusenbauer & Haddaway, 2020). Like you, I used the CINHAL database. An additional suggestion to improve a database search is to add more keywords. More specific keywords allow one to locate articles related to the clinical area of interest. When using the CINAHL database, there is an option to limit research articles to specific types of research, evidence-based practice, peer-reviewed articles, and other specific inclusion criteria.
References
Chien L. Y. (2019). Evidence-Based Practice and Nursing Research. The Journal of Nursing Research: JNR, 27(4), e29. https://doi.org/10.1097/jnr.0000000000000346Links to an external site.
Gusenbauer, M., & Haddaway, N. R. (2020). Which academic search systems are suitable for systematic reviews or meta-analyses? Evaluating retrieval qualities of Google Scholar, PubMed, and 26 other resources. Research synthesis methods, 11(2), 181–217. https://doi.org/10.1002/jrsm.1378Links to an external site.
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Collapse SubdiscussionSulaiman Yassin Jalloh Hi Leslie,
I like your topic and the search strategy. The objective of your literature search is to locate articles with reliable evidence about the efficacy of diabetes education in improving treatment adherence (Melnyk & Fineout-Overholt, 2022). The Boolean operators and search filters are ideal tools that facilitate the retrieval of relevant articles by narrowing the results. However, for relevant results, the search strategy should incorporate the use of various research databases. MEDLINE and Embase are ideal databases with hast collection of articles on diabetes education and other healthcare topics. All search results must be reviewed before inclusion in the research project (LoBiondo-Wood & Haber, 2017). Nurse researchers must critically appraise every article to eliminate resources with inappropriate information.
References
LoBiondo-Wood, G., & Haber, J. (2017). Nursing research: methods and critical appraisal for evidence-based practice. Elsevier Health Sciences.
Melnyk, B. M., & Fineout-Overholt, E. (2022). Evidence-based practice in nursing & healthcare: A guide to best practice. Lippincott Williams & Wilkins.
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Collapse SubdiscussionAnupa Mukundram Mehta Hi Leslie,
I think you did a great job with your database search, as you narrowed your search with Boolean operators and checked boxes similar to what I had done (Walden University, n.a) (Library of Congress, n.d). Your PICOT question is great as well, since it has all parts of PICOT and is broad enough to help you find enough articles. I ended up narrowing down my PICOT question when I found there were many articles focusing on the same type of study. I went from searching for mouth care and ventilator-associated pneumonia, to chlorhexidine mouthwash and ventilator-associated pneumonia. It helped narrow my search as well, so perhaps you may find a specific type of diabetes educator counseling that some patients are receiving that is more beneficial than others, and that will help focus your search and PICOT question.
References:
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=19981
Library of Congress. (n.d.). Search/browse help – Boolean operators and nesting Links to an external site.Links to an external site.. Retrieved September 19, 2018, from https://catalog.loc.gov/vwebv/ui/en_US/htdocs/help/searchBoolean.html
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Collapse SubdiscussionNtumba Kabongo MAIN POST
PICO(T)
The PICO(T) structure helps to provide direction when beginning a search for evidence-based practice (EBP) and helps to ensure that the question is focused and answerable (Stillwell et al., 2010). To convert a clinical inquiry into a PICO(T) searchable question, one must first identify the population of interest, the studied intervention, and the comparator (if any). Additionally, the research must specify the patient outcome of interest and define the study’s time frame. For example, let’s say you are interested in finding evidence-based research on the effects of a low-sodium diet on blood pressure levels in adults with hypertension. According to Melnyk et al. (2009), EBP combines the best available research evidence with clinical knowledge, patient choices, and values.
The PICO(T) question would look like this: In adults with high blood pressure (P), how does a low-sodium diet (I) compared to a regular-sodium diet (C) affect blood pressure levels (O) over six months (T)? Once this question is formulated, it is crucial to consider methods to improve the accuracy and efficacy of a database search for the PICO(T) query. One such strategy is to combine the search terms in the question with Boolean operators (Melnyk & Fineout-Overholt, 2012). For example, searching for “adults AND hypertension AND low-sodium diet AND blood pressure levels AND 6 months” would help to narrow the search results and provide more accurate results. It is also important to use the filters available in the database to narrow the search results even further, such as limiting the results to only randomized controlled trials. Formulating a PICO(T) question is an effective way to structure a clinical inquiry and search for evidence-based research. Using techniques to improve a database search’s rigor and effectiveness can help to ensure accurate and trustworthy results.
References
Melnyk, B. M., & Fineout-Overholt, E. (2012). Evidence-Based Practice Step by Step. Wolters Kluwer Health. https://www.nursingcenter.com/upload/journals/documents/b01694356.htmLinks 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: An Essential Foundation For Evidence-Based Practice. The American Journal Of Nursing, 109(11), 49–52. https://doi.org/10.1097/01.NAJ.0000363354.53883.58Links to an external site.
Stillwell, S. B., Fineout-Overholt, E., Melnyk, B. M., & Williamson, K. M. (2010). Evidence-Based Practice, Step By Step: Searching For The Evidence. The American Journal Of Nursing, 110(5), 41–47. https://doi.org/10.1097/01.NAJ.0000372071.24134.7eLinks to an external site.
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Collapse SubdiscussionCrystal Lewis Hi, Ntumba,
Discuss why nurse researchers may need to use more than one database.
Good post!
Dr. Lewis
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Collapse SubdiscussionStephen Chege Main Discussion Post
Description of Clinical Issue of Interest
The healthcare organization strives to prevent infection during the hospital stay. Different interventions are implemented to ensure the safety of the patients, prevent medical complications, prolong hospital stays, and reduce medical expenses due to infection. Frost et al. (2018) report that infection during an acute hospital stay complicates the medical response and can increase the death risk. Possible hospital-acquired disorders include; surgical site infections, central line-associated bloodstream infections (CLABSI), and catheter-associated urinary tract infections (CAUTI). The purpose of this discussion is to discuss the effectiveness of using antiseptic baths to prevent hospital-acquired infections using the PICOT Question.
Does using an antiseptic bath prevent or reduce hospital-acquired infections?
Population- Young and Old Adults
Intervention- Antiseptic bath using Chlorhexidine Gluconate HCG 2% or 4% during an acute hospital stay.
Comparing with regular water baths or no antiseptic baths.
Outcome- decrease hospital-acquired infections.
Time- in the course of acute hospital/rehab stay.
Description of Search Results
Melnyk & Fineout-Overhault (2018, pp 56) emphasize the importance of clinicians acting swiftly in finding answers to clinical questions. Searching for information from reliable sources is essential to get feedback from credible and reliable research sources. In response to my PICOT questions, the initial search from CINAHL Plus with flutist yielded nine peer-reviewed scholarly articles after searching antiseptic baths. The same database produced 149 peer-reviewed articles after changing the wording to Chlorhexidine bath.
Strategies to Increase the Effectiveness of a Database Search on PICO(T) Question
Some effective strategies for finding reliable scholarly articles include understanding Boolean terms and using appropriate keywords. Also, contacting the librarian and using the provided library resources is critical to getting relevant articles(academicguides.waldenu.edu). Other strategies include using different databases and filtering articles for the PICOT question.
References
Frost, S. A., Hou, Y. C., Lombardo, L., Metcalfe, L., Lynch, J. M., Hunt, L., Alexandrou, E., Brennan, K., Sanchez, D., Aneman, A., & Christensen, M. (2018). Evidence for the effectiveness of chlorhexidine bathing and health care-associated infections among adult intensive care patients: A trial sequential meta-analysis. BMC Infectious Diseases, 18(1). https://doi.org/10.1186/s12879-018-3521-y
Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer.
https://academicguides.waldenu.edu/library/keyword/boolean
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Collapse SubdiscussionCrystal Lewis Hi, Stephen,
Discuss the meaning of a PICOT question.
Great post!
Dr. Lewis
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Collapse SubdiscussionSheila Ankrah Response to Stephen Chege,
Hi Stephen,
Effective Search Techniques
Thanks for your informative post. I genuinely embrace your idea of utilizing keywords from the first article you found to search for your subsequent searches. Your suggestion narrow-down to specifics can be obtained through the use of keywords. I honestly gain from that brilliant idea. Constructing appropriate search strategies to retrieve relevant literature for clinical questions is fundamental to systematic reviews (Hirt et al., 2020). Search for relevant evidence-based information could sometimes be challenging. According to Boswell & Cannon (2018), the most important thing is to know where to look and appropriate search words to use—getting the correct information, subjects to having the suitable sources of information.
References
Boswell, C., & Cannon, S. (2018). Introduction to nursing research. Jones & Bartlett Learning.
Hirt, J., Nordhausen, T., Meichlinger, J., Braun, V., Zeller, A., & Meyer, G. (2020). Educational interventions to improve literature searching skills in the health sciences: a scoping review. Journal of the Medical Library Association, 534–546. https://doi-org.ezp.waldenulibrary.org/10.5195/jmla.2020.954
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Collapse SubdiscussionVictavian Jackson PICOT Question
The clinical area of interest is nosocomial infections, specifically catheter-associated urinary infections (CAUTI); a horrible event that continues to plague healthcare facilities yearly. In research, CAUTIs is a proven preventable healthcare-associated infection (HAI) that adds on an additional $400 to 500 million yearly in the United States (Russell et al., 2019, p. 81). There is plenty research suggesting that 50-70% of CAUTI can be prevented by evidence-based research, yet the problem persist. In order to address this national clinical problem, a PICOT model will be used to define the clinical research question, develop search strategies and identify potentially relevant evidence-based practices (Eriksen & Frandsen, 2018, p. 3). In hospitalized patients (Patient), how does the use of nurse-driven protocol for evaluating the appropriateness of short-term urethral catheter continuation or removal (Intervention), compared with no protocol (Comparison), affect the number of catheter-days (Outcome) and CAUTI rates over a six-month post-intervention period (Time) (Eriksen & Frandsen, 2018, p. 4).
Whenever I research a clinical topic, I start searching in the CINAHL and PubMed database under the Walden library. For example, I input the keyword CAUTI, and then a list of related topics pops up: CAUTI or catheter associated urinary tract infection, CAUTI Bundle and CAUTI prevention evidence-based practice. I click CAUTI prevention evidence-based practice and it transferred me too the CINAHL database where 500 articles were listed related to the keyword. The next page had the Boolean operators, which are two additional columns available to connect topics for a keener search; I added my second keyword called PICOT, clicked the peer review option below the column, adjusted my published dates for 5 years and re-clicked the search button. There was a total of 100 articles popped up, but the best article to support my PICOT question is called “an EBP mentor and unit-based EBP team: a strategy for successful implementation of a practice change to reduce catheter-associated urinary tract infections”, by Tina L. Magers. In order to increase the rigor and effectiveness of my databases search on a PICOT question, I will continue to make my topics narrow by focusing on a specific keyword. Search databases using Boolean operators, such as concepts or subject phrases which makes it pretty simple to locate information on the topic (Abbade et al., 2016). For example, if I wanted research on alternative external indwelling urinary catheter, I would link two subjects in the Boolean operator; external urinary catheter and alternative. This search will give me over 300 articles about the different studies done on external catheters versus using urinary catheters.References:
Russell, J. A., Leming-Lee, T. S., & Watters, R. (2019). Implementation of a nurse-driven CAUTI prevention algorithm. Nursing Clinics of North America, 54(1), 81–96. https://doi.org/10.1016/j.cnur.2018.11.001Links to an external site.
Eriksen, M. B., & Frandsen, T. F. (2018). The impact of patient, intervention, comparison, outcome (PICO) as a search strategy tool on literature search quality: a systematic review. Journal of the Medical Library Association, 106(4). https://doi.org/10.5195/jmla.2018.345Links to an external site.
Magers, T. L. (2014). an EBP mentor and unit-based EBP team: a strategy for successful implementation of a practice change to reduce catheter-associated urinary tract infections. Worldviews on Evidence-Based Nursing, 11(5), 341–343. https://doi.org/10.1111/wvn.12056Links to an external site.
Abbade, L. P. F., Wang, M., Sriganesh, K., Mbuagbaw, L., & Thabane, L. (2016). Framing of research question using the PICOT format in randomised controlled trials of venous ulcer disease: a protocol for a systematic survey of the literature. BMJ Open, 6(11), e013175. https://doi.org/10.1136/bmjopen-2016-013175
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Collapse SubdiscussionCrystal Lewis Hi, Victavian,
How is a PICOT used to make evidence-based practice decisions?
Great post!
Dr. Lewis n
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Collapse SubdiscussionSulaiman Yassin Jalloh The selected problem for the research project is patient falls in hospital settings. Falls are prevalent, devastating complications, especially in older adults. Epidemiologic reports have indicated that the fall rate is 5 per 1000 bed days (Agency for Healthcare Research and Quality, 2019). Approximately 700,000 hospitalized patients experience falls annually in the US. Patients in assisted living facilities are at high risk of falls that lead to significant injuries, including fractures, wounds, and head injuries (Agency for Healthcare Research and Quality, 2019). Evidence-based strategies are needed to prevent falls.
The database search gave different results based on the applied search terms. The initial search using the term “fall prevention” gave about 727 results. However, the search results are limited as other search terms are added using the Boolean operators. The search generated 548 articles when the search term “older adults’ was added. The search results were reduced further when the search terms’ patient education’ and ‘exercise interventions” were added to the search. The exercise demonstrates the significance of database searches tailored to produce relevant and original searches.
Nurses must apply strategies to increase the effectiveness and rigor of the database search. One of the strategies is to limit the search to specific information that makes the search precise (McGonigle & Mastrian, 2021). For example, the search terms should include subjects contained in the PICOT question. The search terms should contain controlled vocabulary that summarizes the topics of focus (Grove & Gray, 2018). Another strategy is to limit the search based on criteria such as public type, date, and type of publications (McGonigle & Mastrian, 2021). The publication date is set not later than five years to ensure the evidence is updated. Also, the search is limited to original research articles, including randomized controlled trials, clinical trials, and systematic reviews (Grove & Gray, 2018). Having relevant articles lead to quality research that transforms practice to prevent falls.
References
Agency for Healthcare Research and Quality. (2019). Patient Safety: Falls. https://psnet.ahrq.gov/primer/falls#:~:text=Falls%20are%20a%20common%20and,hospitalized%20patients%20fall%20each%20year.
Grove, S. K., & Gray, J. R. (2018). Understanding nursing research: Building an evidence-based practice. Elsevier Health Sciences.
McGonigle, D., & Mastrian, K. (2021). Nursing informatics and the foundation of knowledge. Jones & Bartlett Publishers.
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Collapse SubdiscussionCrystal Lewis Hi, Sulaiman,
Please share and discuss your PICOT question.
Good post!
Dr. Lewis
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Collapse SubdiscussionUrsla Anyizi-Taku Searching Databases: Communication Errors
Problem Description
Communication in healthcare is crucial and ensures the nursing process occurs without exposing patients to risks. Thus, communication errors can have devastating effects, which include death and negative health outcomes for patients. Poor communication between clinicians and patients undermines client satisfaction, which increases the occurrence of other nursing errors. According to Tiwary et al. (2019), poor communication in healthcare has devastating effects: poor patient adherence to treatment, low satisfaction, and ineffective use of resources. To decrease the impact of poor communication strategies, healthcare practitioners should receive training to improve their communication skills (Tiwary et al., 2019). Additionally, using optimal communication channels that reduce errors can be useful in promoting the health outcomes of patients, which cultivates positive clinician-patient relationships. Thus, resolving communication is paramount in handling other nursing errors, including misdiagnosis, which can negatively affect clients.
My PICO Question
The Problem of Interest: The effects of communication errors between healthcare professionals and patients.
Intervention: Improving nurses’ communication skills through training and creating awareness about the effects of poor communication.
Comparison: The benefits of optimal communication skills and channels in healthcare.
Outcome: Reduced clinical errors such as misdiagnosis resulting in positive health outcomes among clients.
Describe your search results regarding the number of articles returned on original research and how this changed as you added search terms using your Boolean operators.
A database search requires utilizing the correct combination of keywords and Boolean operators to achieve feasible results. Using the filters provided on the university’s library website enabled me to perform a thorough search to identify articles and databases that address my topic of interest. According to the Walden University Library (n.d.), the term ‘nursing’ provided ten databases, which recommended five best databases, including PubMed, ProQuest Nursing and Allied Health Database, Cumulated Index to Nursing and Allied Health Literature (CINAHL), and Embase. Further search using different terms such as ‘communication’ delivered fourteen results in all the databases indexed by the library’s search engine. Among the recommended databases, I chose CINAHL Plus with Full text and Cochrane Library because they provided filtered and unfiltered databanks, respectively (Walden University, n.d.). For example, searching the keywords in Cochrane Library and CINAHL provided 15 and 11 articles, respectively. However, adding Boolean terms and other keywords, such as ‘in’ and ‘nursing’ in the search bar, provided 3 and 1 results, respectively. However, the results in the CINAHL database were not relevant to the study topic, prompting me to use articles from the Cochrane Library. The selected articles include Interventions for providers to promote a patient-centered approach in clinical consultations, Diagnostic test accuracy of telehealth assessment for dementia and mild cognitive impairment, Communication modalities between centers and patients should decrease stress and costs by limiting errors: results of a large survey, and Effectiveness of different nursing handover styles for ensuring continuity of information in hospitalized patients. Therefore, using correct keywords and Boolean operators is crucial in obtaining optimal search results, especially in nursing issues such as communication errors.
Explain strategies you might make to increase the rigor and effectiveness of a database search on your PICO(T) question
Searching databases requires applying basic search engine skills that entail understanding how to use a combination of terms to achieve practical results. A database search entails utilizing various skills and tools to achieve feasible results. Thus, familiarizing oneself with the basic searching process that includes creating a research question, identifying the first step of the search, crafting a technique using the PICO model, outlining key terms that are relevant to the study question, and evaluating the indexed databases for articles is optimal to achieve possible results (Rush University Medical Sector, 2022). Adhering to the predetermined process prevents search errors, such as a lack of meaningful keywords, which might result in poor results. Therefore, choosing suitable keywords and Boolean operators is paramount to increase the effectiveness and rigor of the database search on communication errors in nursing choosing suitable keywords and Boolean operators is paramount to increase the effectiveness and rigor of the database search on communication errors in nursing.
References
Barriere, P., Avril, C., Benmahmoud-Zoubir, A., Dejager, S., Bernard, N., & Velkoski-Rouyer, M. (2017). Communication modalities between centers and patients should decrease stress and costs by limiting errors: results of a large survey. Human Reproduction, 32(8), 391-391. https://www.cochranelibrary.com/central/doi/10.1002/central/CN-01398600/full?highlightAbstract=communic%7Cin%7Cnursing%7Cnurs%7Ccommunication%7Cerror%7CerrorsLinks to an external site.
Dwamena, F., Rovner, M. H., Gaulden, C. M., Jorgenson, S., Sadigh, G., Sikorskii, A., Lewin, S., Smith, R. C., Coffey, J., Olomu, A., & Beasley, M. (2012). Interventions for providers to promote a patient‐centred approach in clinical consultations. Cochrane database of systematic reviews, (12). https://doi.org/10.1002/14651858.CD003267.pub2Links to an external site.
McCleery, J., Laverty, J., & Quinn, T. J. (2021). Diagnostic test accuracy of telehealth assessment for dementia and mild cognitive impairment. Cochrane Database of Systematic Reviews, (7). https://doi.org/10.1002/14651858.CD013786.pub2Links to an external site.
Rush University Medical Center Library. (2022). How to construct a search strategy. RUMC. https://rushu.libguides.com/familymedicine/search_strategyLinks to an external site.
Smeulers, M., Lucas, C., & Vermeulen, H. (2014). Effectiveness of different nursing handover styles for ensuring continuity of information in hospitalised patients. Cochrane Database of Systematic Reviews, (6). https://doi.org/10.1002/14651858.CD009979.pub2Links to an external site.
Tiwary, A., Rimal, A., Paudyal, B., Sigdel, K. R., & Basnyat, B. (2019). Poor communication by health care professionals may lead to life-threatening complications: examples from two case reports. Wellcome Open Research, 4. https://doi.org/10.12688/wellcomeopenres.15042.1Links to an external site.
Walden University (n.d.), How do I find a systematic review article related to health, medicine, or nursing? Walden Library. https://academicanswers.waldenu.edu/faq/72670Links to an external site.
Walden University Library. (n.d.). Databases A-Z: Clinical Psychology: Journals. Walden University. https://academicguides.waldenu.edu/az.php?s=144881&t=620Links to an external site.
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Collapse SubdiscussionNtumba Kabongo Hi Ursula, I enjoyed reading your post and thank you for your input on communication among interprofessional and patients. This issue is as old as time. communication is key in everything that we do. The continue awareness of lack of it is very important. you are right that the lack of this action can be very devastating for all the participants.
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Collapse SubdiscussionCassie L Bozard Ursla,
I agree with you that you must have a thorough database search to be successful in finding articles that will be useful for your PICOT question. I did find it overwhelming the first time I opened the Walden Library to find an article. There were so many different databases to choose from and I had a hard time narrowing down my search. Once I started searching databases by a subject that is when I found things easier to decide which database to use. I have found two awesome databases under the subject of behavioral health. On the Walden University Library website (2022) under the subject behavioral health, I highly recommend the APA PsycArticles and PsychiatryOnline databases for your PICOT question. The Walden University Library also has a variety of tutorials that might be beneficial to enhance your knowledge when it comes to researching scholarly journals. The following tutorials are provided to Walden students on the Fundamentals of Library Research page; becoming a scholar, evaluating types of resources, database search skills, and critical reading and evaluation (Walden University Library, 2021).
Walden University Library. (2022). Databases A-Z: Behavioral Health. https://academicguide.waldenu.edu/az.php?s=19981Links to an external site.
Walden University Library. (2021). Instructional Media/ Fundamental of Library Research.
https://academicguides.waldenu.edu/library/instructionalmedia/researchfundamentals
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Collapse SubdiscussionVictavian Jackson Great Post Ursla,
Current research indicates that ineffective communication among health care professionals is one of the leading causes of medical error with patients (Kaldjan, 2021, p. 990). The appropriate training and creative awareness will greatly improve professional communication. I believe most of the time, communication fall through the cracks because of rushing and not slowing down to pay attention. The medication errors on my unit happen 99% of the time because the nurse failed to look at the medication dosage before scanning and communicate with the patient about the dosage. Effective communication involves the ability to actively listen, acknowledge a patient’s concern have been heard, ensure their agenda is elicited and addressed (Leonard, 2017, p. 2). I do agree about using different types of communication channels can also reduce errors. When searching for the articles I used the boolean operators and linked two keywords; communication issues and healthcare professionals. My search opens up over 200 articles on communication issues in the healthcare field. It is vital to use suitable and meaningful keywords when looking for articles to support your opinion.
References:
Kaldjian, L. C. (2021). Communication about medical errors. Patient Education and Counseling, 104(5), 989–993. https://doi.org/10.1016/j.pec.2020.11.035
Leonard, P. (2017). Exploring ways to manage healthcare professional—patient communication issues. Supportive Care in Cancer, 25(S1), 7–9. https://doi.org/10.1007/s00520-017-3635-6
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Collapse SubdiscussionJasmine London Workplace violence against healthcare workers has been a prevalent problem within healthcare organizations. Workplace violence is most perpetrated by patients, family and visitors. It is a common problem that often goes unreported. Unfortunately, the underreporting of incidents to healthcare administration can lead to the issue being overlooked and not being prioritized (Kvas & Seljak, 2016).
This is a clinical interest to me because of my own experiences of violence out in the field. Workplace violence is so common in all areas of nursing. From my experience in the emergency department, I have seen firsthand the effects that workplace violence has on nurses such as physical and emotional toll. Healthcare organizations should prioritize health promotion activities such as safety training programs and security committees to ensure the safety of their staff (Havaei & MacPhee, 2020).
PICOT question: What effect does educational training compared to no educational training have on violence against nurses in the healthcare setting during a 6-month period?
After logging in to Walden library, I went to the research by subject tab and selected nursing. In the nursing search bar, I entered in workplace violence. From there, I was presented with thousands of search results on the topic. Next, I began to utilize Boolean operators, which are words used to create more accurate results. I searched “workplace violence and the effect on nurses”. This narrowed the results to journals specific to the subject. I can improve the effectiveness of my research by using filters and better keywords to help narrow the search results.
Kvas, A., & Seljak, J. (2016). Unreported workplace violence in nursing. International Nursing Review, 61(3), 344–351. https://doi.org/10.1111/inr.12106Links to an external site.
Havaei, F., & MacPhee, M. (2020). The impact of heavy nurse workload and patient/family complaints on workplace violence: An application of human factors framework. Nursing Open, 7(3). https://doi.org/10.1002/nop2.444
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Collapse SubdiscussionCrystal Lewis Hi, Jasmine,
What is the advantage, for nurse researchers, to utilize a PICOT format?
Good post!
Dr. Lewis
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Collapse SubdiscussionChristiana Nuworsoo Persisting pain for at least three months is considered chronic, affecting about 50 million Americans (Zegel et al., 2021). The use of alcohol to treat pain is not new; some studies confirm that it reduces pain in humans and animals (National Institute on Alcohol Abuse and Alcoholism, 2021). Being a bedside nurse, I have only seen over-the-counter (OTC) and prescribed medication used for pain. I have never seen alcohol as a means of pain management. I have taken care of patients withdrawing from alcohol and also taken care of polysubstance abusers that were overdosed.
About a year ago, my uncle underwent surgery on his shoulder and complained of pain. Seven months ago, he told a family member that he uses alcohol to treat his pain and that the pain medications do not work. On December 7, 2022, he complained of chest pain and shortness of breath; the friend preparing to take him to the hospital left him in his room to get him water because he was thirsty. While getting the water, my uncle had an unwitnessed fall and became unresponsive; the friend called the paramedics and immediately began CPR. The paramedics worked on him for about 45 minutes upon arrival at his home without success, and he was pronounced dead after that. After everything was done, we found empty and untouched liquor bottles when cleaning his room. I realized then that the alcohol to treat pain might have become more than medication and possibly become a problem.
Now I’m curious as to how much alcohol is needed to treat pain, for how long it is safe, and when it can become a problem. The PICOT format is a process of phrasing clinical questions to produce the most relevant information. The question must include the patient/population, intervention/issue, comparison/status, outcome, and the time frame to achieve the outcome (Melnyk & Fineout-Overholt, 2018). My PICOT question: in adult males (patient/population), how much alcohol is needed to alleviate pain (intervention/issue) compared to prescribed medications (comparison/status), effectiveness on pain reduction (outcome), and for how long before it becomes a problem (timeframe)?
My search began in PubMed because that usually is my preferred search engine, but I wasn’t satisfied with the results, so I used Medline since my question was more geared towards biomedicine. In the original search, the criteria were not phrases but single words, producing 5240 search results (Walden University Library, n.d.). When I looked through some of the results, any research that had those words in my search was included. Using two-word phrases and Boolean operators decreased the search results to 311. However, I noticed that using suggested words or phrases that had a similar meaning to my search words helps keep the information specific to the subject matter. Therefore, I will incorporate suggested terms with similar meanings to get more accurate search results when searching for information in the future. Also, it is good to be specific, know precisely what you are looking for, and know the keywords you want to use (Walden University, 2018). Sometimes not knowing what to search for makes it difficult to get the information you want.
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.
The National Institute of Alcohol Abuse and Alcoholism. (2021). Using alcohol to relieve your pain: what are the risk. National Institute of Health. Retrieved December 20, 2021 from https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/using-alcohol-to-relieve-your-painLinks to an external site.
Walden University Library. (2022). Databases A-Z: Nursing. Retrieved December 20, 2022, from https://academicguides.waldenu.edu/az.php?s=19981Links to an external site.
Walden University, LLC. (Producer). (2018). Searching the Evidence [Video file]. Baltimore, MD: Author.
Walden University Library. (n.d.). Searches: MEDLINE with full text. Retrieved December 21, 2022 from https://web.s.ebscohost.com/ehost/resultsadvanced?vid=3&sid=f86c4212-d731-4437-aeac-b80fcb98bf60%40redis&bquery=alcohol+AND+pain&bdata=JkF1dGhUeXBlPXNoaWImZGI9bW5oJmNsaTA9RlQmY2x2MD1ZJnR5cGU9MSZzZWFyY2hNb2RlPUFuZCZzaXRlPWVob3N0LWxpdmUmc2NvcGU9c2l0ZQ%3d%3dLinks to an external site.
Zegel, M., Rogers, A. H., Vujanovic, A. A., & Zvolensky, M. J. (2021). Alcohol use problems and opioid misuse and dependence among adults with chronic pain: The role of distress tolerance. Psychology of Addictive Behaviors : Journal of the Society of Psychologists in Addictive Behaviors, 35(1), 42–51. https://doi.org/10.1037/adb0000587Links to an external site.
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Collapse SubdiscussionSheri Estes Hi Christiana,
I find great interest in your post, and I had never realized the number of articles on this subject. According to ( Zambelli, 2021), studies focusing on the impact of alcohol on acute pain in healthy participants suggest that alcohol-induced analgesia correlates with a blood alcohol level of 0.08%. However, this blood alcohol level equals consuming at least three standard drinks, which can lead to health problems. Alcohol increases the intensity of some pain relievers, and alcohol withdrawal can cause pain. Thank you for posting such an interesting topic.
References
Zambelli, V. O., Alcantara, Q. A., & Gross, E. R. (2021). Alcohol and analgesia: a fine wine getting better with age. British Journal of Anaesthesia, 127(2), 177–181. https://doi.org/10.1016/j.bja.2021.05.003
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Collapse SubdiscussionOdion Iseki BRIEF DESCRIPTION OF YOUR CLINICAL ISSUE OF INTEREST
Given the ever-changing nature of the healthcare sector, the pervasiveness of a wide range of multi-faceted ancillary facilities, and the potential and sustainability of such a business, the field we present most frequently becomes the focus of our investigation. To focus this thread, I’d want to submit a question related to postoperative pain management, which is an integral part of any patient’s recovery after hospitalization or outpatient surgery. The PICOT question format asks, “Can pain management improve pain control in postoperative surgical adults in the first four days following surgery utilizing pharmacological and non-pharmacological treatments?”. P stands for “population,” which is our post-surgical patients. I stand for ” pharmacological and non-pharmacological treatments, C stands for “comparison,” O stands for “product, ” which is the result of pain treatment by contrasting pharmacological and alternative pain management methods, and T stands for “period or time achieving this purpose,” which is the first four days after surgery. To paraphrase Melnyk, “just collecting the appropriate data at the right time isn’t good enough” (2018, p. 34). To work well in the data-rich environment in which doctors work, they need to learn practical, lifelong learning skills, such as asking targeted questions and searching systematically.
My research for this essay relied on ProQuest and CINA2HL + databases. Using the terms “pain management” and “pain relief,” I obtained 20,494 and 21,460 results, respectively. After applying filters for full text, peer review, and a period range of 2016–2020, the reduced search result was 13,601. Including a Boolean search parameter exclusive to surgery patients further refined the investigation, yielding the following results: I added a final criterion for one of the most recent publication years, 2020, and my search went smoothly across both databases (ProQuest 232 and CINAHL Plus 5179), obtaining 232 and 203 full-text results, respectively. When searching for complex topics, it’s ideal to utilize a combination of keywords and Boolean operators to narrow down your results (Retrieved September 6th, 2019)
In addition to using phrases from my PICOT inquiry, like “surgical” and “pharmacological,” I want to use search limiters to narrow my research to the most recent years of publication. The process of selecting search phrases and typing them into database search fields to discover information on your subject is known as “keyword searching.” On September 19th, 20128,
REFERENCE
Melnyk, B. M., & Fineout-Overholt, E. (Eds.). (2011). Evidence-based practice in nursing & healthcare: A guide to best practice. Lippincott Williams & Wilkins.
Glasziou, P. P., Del Mar, C., & Salisbury, J. (2009). Evidence-based practice workbook. John Wiley & Sons.
Chicago
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Collapse SubdiscussionMona Bourbour Shirazi Kordi Main post:
The clinical issue of my interest is indwelling urinary catheters in hospitals patients, the PICO questions are listed below:
_Patients who are admitted to the hospital and have indwelling urinary catheters
_Inserting foley catheters in patients and providing necessary care
_A care bundle for before and after urinary catheter insertion
_To prevent a possible infection from urinary catheter insertion in hospitalized patients
_proper care related to urinary catheter insertion and maintaining
_compared to non-utilization of a catheter insertion and care bundle
All of these questions should have a systematic way in order to discover the best answers fast and efficiently. To find the answer electronically on a huge database I used catheter and urinary tract infection. CINAHL and MEDLINE are databases that need to be searched. I limited my research to research after 2015 and selected to get the full text. I also selected to show peer-reviewed research as well. Any filter added to my research decrease the number of articles it reveals but it narrowing my result to get the best answers (Walden University Library, n.d.-c).
The strategies that may increase the rigor and effectiveness of the research on PICO(T) questions are utilizing a controlled wordlist term not only for saving time but also to prevent missing data. As a result, all of the main clinical questions will be answered properly (Stillwell, Fineout & Williamson, 2010). In addition, finding the keywords on PICO questions will help to know how to make any changes in order to get the favorite results.
References
Stillwell, S., Fineout-Overholt, E., Melnyk, B., & Williamson, K. (2010a). Evidence-based practice, step by step: Asking the clinical question: A key step in evidence-based practice.
Walden University Library. (n.d.-c). Evidence-based practice research: CINAHL search help Links to an external site.Links to an external site.. Retrieved September 6, 2019, from https://academicguides.waldenu.edu/library/healthevidence/cinahlsearchhelp
Waldrop, M., & Horton, L. (2020). NURS 360: PICO Question: In males, do external urinary catheters or indwelling urinary catheters provide better outcomes for the patient.
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Collapse SubdiscussionEsther Davis Discussion: Searching Databases
A medication error is any preventable event that may lead to inappropriate use of medications by patients, which may cause harm while the medication is in the control of the health professional or the patient. They occur throughout the medication-use system, during prescription, when entering information into the computer system, when preparing or dispensing the drug, or when the patient takes the drug (Ciapponi et al., 2021). Medication errors are among the worst mistakes by nurses that lead to unpleasant patient results.
Nurses and other healthcare providers must be aware of the potential dangers of medication errors and develop mechanisms that will ensure patient safety and prevent the occurrence of these errors, as they may be costly to both the patients and the healthcare organizations (Tariq & Scherbak, 2022). This will improve the quality of care, patient outcomes, and patient experience on their way to recovery.
This clinical issue is of interest to me because of the number of medication errors that are being made daily in healthcare and the impact it has on the patient outcomes and what can be done to reduce these errors especially with the advent of technology in the health care. Advancements in technology have significantly impacted medication error rates and contributed to improved patient care (Vaidotas et al, 2019). The PICOT format is a helpful approach for summarizing research questions. The question must include the patient/population, intervention/issue, comparison/status, outcome, and the time frame to achieve the outcome (Melnyk & Fineout-Overholt, 2018)
PICOT question: In an adult inpatient mental health unit (P), what is the effect of Barcoded Medication Administration (BCMA) (I) in reducing medication errors (O) compared to paper medication administration (C) within three months (T).
When I logged into Walden library, I found about 173 different types of databases. I used the EBSCO host and CINAHL plus with full text database as the search engines for my articles.
To increase the rigor and effectiveness of my database search for the articles in the various databases, I included the key terms of my PICOT question search as causes of medication errors, BCMA, reporting of medical errors, and patient safety.
A quick search for medication errors and BCMA brought about 11,483 and 195 results respectively. The simplified search brought 2128 and 119 after using limiters for the complete text, peer review and year range from 2018-2022. I used the Boolean operators to filter the results for more accurate results. The search limiters will is also very useful to narrow search and increase effectiveness.
References
Ciapponi, A., Fernandez Nievas, S. E., Seijo, M., Rodríguez, M. B., Vietto, V., García-Perdomo, H. A., Virgilio, S., Fajreldines, A. V., Tost, J., Rose, C. J., & Garcia-Elorrio, E. (2021). Reducing medication errors for adults in hospital settings. Cochrane Database of Systematic Reviews, 2021(11). https://doi.org/10.1002/14651858.cd009985.pub2Links to an external site.
Melnyk, B. M., & Fineout-Overholt, E. (Eds.). (2011). Evidence-based practice in nursing & healthcare: A guide to best practice. Lippincott Williams & Wilkins.
Tariq, R. A., & Scherbak, Y. (2022, July 3). Medication dispensing errors and prevention. National Library of Medicine; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK519065/Links to an external site.
Vaidotas M, Yokota PKO, Negrini NMM, Leiderman DBD, Souza VP, Santos OFPD, Wolosker N. Medication errors in emergency departments: is electronic medical record an effective barrier? Einstein (Sao Paulo). 2019 Jul 10;17(4):eGS4282. doi: 10.31744/einstein_journal/2019GS4282. PMID: 31291385; PMCID: PMC6611086.
Walden University Library. (n.d). Evaluating resources: Journals. https://academicguides.waldenu.edu/library/evaluating/resource-types/journalsLinks to an external site.
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Collapse SubdiscussionSheri Estes Clinical Issue of Interest
What
Patients aged 65 and older, and the Flu vaccine.
PICOT question
For patients aged 65 and older, how does using an influenza vaccine compared to no vaccine influence the risk of developing pneumonia during the flu season? Studies show that repeated vaccinations with the Influenza vaccine may influence the effectiveness of current vaccination strategies (Satoko, et al., 2020).
Search Results
For the first search, I went to PUBMED and typed in Flu, Elderly, and Pneumonia. The first search returned zero results, so I used the Influenza vaccine and the elderly. The second search returned 61 results that I narrowed down to one. The next database was Embase, Influenza vaccine, and elderly returned 8,409 results. Adding pneumonia reduced the results to 1,296, which I narrowed to one. For the next search, I used Medline with search words influenza or flu vaccine, elderly or geriatric, and pneumonia. The search yielded 33 results, and number three was the best article. The final search was done with CINAHL, using the search words flu vaccine or influenza and pneumonia in older adults, which returned 11 results.
Strategies for Increasing Effectiveness and Rigor of the Search
The final search on CINAHL produced the best results with the topic narrowed down. Using the correct Boolean operators is essential in researching the topics.
References
Satoko Kitamura, Masahide Matsushita, Naoki Komatsu, Yusuke Yagi, Seisho Takeuchi, Hiromi Seo, Impact of repeated yearly vaccination on immune responses to influenza vaccine in an elderly population, American Journal of Infection Control,Volume 48, Issue 12, 2020,Pages 1422-1425, ISSN 0196-6553,
Mosaed R, Fasihi H, Norouzi A, Anjomanian V, Ardalan M A, et al. Influenza Vaccine and COVID-19 Pandemic: Could This Vaccine Help Limit the Potential Adverse Consequences of SARS-CoV-2?. Iran J Pharm Res. 2022;21(1):e127032. doi: 10.5812/ijpr-127032Links to an external site..
Jackson, M. L., Nelson, J. C., Weiss, N. S., Neuzil, K. M., Barlow, W., & Jackson, L. A. (2008). Influenza vaccination and risk of community-acquired pneumonia in immunocompetent elderly people: a population-based, nested case-control study. Lancet (London, England), 372(9636), 398–405. https://doi.org/10.1016/S0140-6736(08)61160-5Links to an external site.
Manzur, A., Izquierdo, C., Ruiz, L., Sousa, D., Bayas, J.-M., Celorrio, J.-M., Varona, W., Nebot, M., Salleras, L., Domínguez, A., & Carratalà, J. (2011). Influence of Prior Pneumococcal and Influenza Vaccination on Outcomes of Older Adults with Community-Acquired Pneumonia. Journal of the American Geriatrics Society, 59(9), 1711–1716. https://doi.org/10.1111/j.1532-5415.2011.03541.x
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Collapse SubdiscussionMellissa Rodriguez Sheri,
great post and very interesting PICO(t) question. Your question is well structured and specific enough for you to be able to find the information you’re looking for. “Successfully retrieving relevant information begins with a clearly defined, well-structured question”, and your question does just that (Davies, 2011, p. 75). You mentioned the various databases used for your search results and that’s great that you were able to narrow down to a number that is more manageable. “No matter what type of question is being asked, it’s wise to search more than one database”, in doing so you are able to gather articles and research studies from different sources (Stillwell et al., 2010). Other strategies for narrowing down results when databases populate a large number of articles is by narrowing down the publication date to ensure that you are reading articles that are relevant and updated.
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.
Stillwell, S.B., Fineout-Overhold, E., Melnyk, B.M., & Williamson, K.M. (2010). Evidence-based practice step-by-step: Searching for evidence. Links to an external site.American Journal of Nursing, 110(5), 41-47.
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Collapse SubdiscussionSheri Estes Hi Mellissa,
Thank you for your reply. As you said, narrowing the results by year helped tremendously. When I began the search, the year format was preselected; narrowing it to current years made the database more manageable.
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Collapse SubdiscussionCrystal Lewis Hi, Sheri,
As a nurse researcher, what are the benefits of exploring various databases?
Great post!
Dr. Lewis
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Collapse SubdiscussionSheri Estes Hi Dr. Lewis,
Thank you for your thought-provoking question on various database searches as a nurse researcher. To have an effective review of nursing literature, there must be an adequate review of various reliable and credible databases (Oermann et. al., 2021). Exploring various databases allows the researcher to achieve more accurate results when using different databases.
References
Oermann, M. H., Wrigley, J., Nicoll, L. H., Ledbetter, L. S., Carter-Templeton, H., & Edie, A. H. (2021). Integrity of Databases for Literature Searches in Nursing: Avoiding Predatory Journals. ANS. Advances in nursing science, 44(2), 102–110. https://doi.org/10.1097/ANS.0000000000000349
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Collapse SubdiscussionJimmy Jesse Ortega Technology in health has the potential to reduce health care costs, improve efficiency, and enhance quality of care and patient safety (Blumenthal et al., 2008). One of these technologies that has helped to improve patient care is the Electronic Medical Record and medication scanning. Scanning medications before administration has shown to improve patient safety by decreasing the amount of medication administration errors. The medication administration process is complex and influenced by interruptions, multi-tasking, and responding to patient’s care needs, and is consequently prone to errors (Tolley et al., 2022). Interventions such as Barcode Medication Administration (BCMA), electronic prescribing, and scanning of patient barcodes, have all been associated with reduced errors and harm, and improved efficiency (Tolley et al., 2022). Nurses’ compliance with bar-code medication administration procedure is essential to maximize the benefits (Othman et al., 2020).
My Proposed PICO(T) question for this clinical issue is: For patients admitted in a hospital setting, does scanning medications into an electronic medical record, as compared to administering medications without scanning, decrease the amount of medication errors throughout the patients stay in the hospital?
My search results using several databases from the Walden Library yielded an average of 600 articles at first. Once I added search terms specific to my clinical issue and Boolean operators such as “and” or “or”, my search results were cut by at least half. This helped me to target the appropriate articles that I needed for my research on the topic. Some strategies that I used were using databases that only contained peer-reviewed articles so that I did not have to worry about mistakenly using an article that was not peer-reviewed. I also used key words relevant to my topic that included: “medication scanning and error prevention”. Using these specific key words narrows down the search and saves time while finding appropriate research journals.
References
Blumenthal D, DesRoches C, Donelan K, Ferris T, Jha A, Kaushal R, Rao S, Rosenbaum S, Shield A. Health Information Technology in the United States, 2008: Where We Stand. Princeton, NJ: Robert Wood Johnson Foundation. http://www.rwjf.org/files/research/3297.31831.hitreport.pdfLinks to an external site.
Othman, Elham, MSN, RN, Darawad, Muhammad & PhD, RN. (2020). Nurses’ Compliance With Bar-code Medication Administration Technology: Results of Direct Observation of Jordanian Nurses’ Practice. CIN: Computers, Informatics, Nursing, 38, 256-262. https://doi.org/10.1097/CIN.0000000000000591
Tolley, C.L., Watson, N.W., Heed, A., Einbeck, J., Medows, S., Wood, L., Campbell, L., & Slight, S.. (2022). The impact of a novel medication scanner on administration errors in the hospital setting: a before and after feasibility study. BMC Medical Informatics Decision Making 22, 86. https://doi.org/10.1186/s12911-022-01828-3Links to an external site.
Walden University Library. (n.d.-a). Databases A-Z: Nursing Links to an external site. https://academicguides.waldenu.edu/az.php?s=19981Links to an external site.
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Collapse SubdiscussionCrystal Lewis Hi, Jimmy,
Discuss the meaning of each letter in a PICOT question.
Good post!
Dr. Lewis
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Collapse SubdiscussionJimmy Jesse Ortega Hi Dr. Lewis,
The PICOT question is a mnemonic derived from the elements of a clinical research question. Each letter stands for Patient or Population, Intervention, Comparison, Outcome, and Time frame. When formulating a PICOT question, one must identify who is the patient or populations being targeted, what intervention or treatment is going to be considered, what is that intervention being compared to, the desired outcome or objective, and lastly how long it will take to reach the desired outcome. After the PICOT question is constructed and researched, the information gathered is used to determine which type of study is most appropriate. Study types include meta-analysis, systematic review, randomized controlled trial, cohort study, case-control study and case report. (Duquesne University School of Nursing, 2020). The PICOT model is by far the most widely used model for formulating clinical questions. It forces the researcher to focus on what the patient or client believes to be the single most important issue and outcome, and facilitates the research by making the clinical issue at hand very clear (Eriksen & Frandsen, 2018).
References
Eriksen, M. B., & Frandsen, T. F. (2018). The impact of patient, intervention, comparison, outcome (PICO) as a search strategy tool on literature search quality: a systematic review. Journal of the Medical Library Association : JMLA, 106(4), 420–431. https://doi.org/10.5195/jmla.2018.345Links to an external site.
Duquesne University School of Nursing. Formulating a PICOT Question. (2020, September 26). https://onlinenursing.duq.edu/blog/formulating-a-picot-question/
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Collapse SubdiscussionBertina Boma Soh Pressure ulcers are the primary topic that interests me. Ulcers caused by pressure can develop in any region of the body that is consistently subjected to it. They are particularly common on the skeletal sections of the body, like the elbows, heels, hips, and the base of the spine
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Collapse SubdiscussionBertina Boma Soh ADDITIONAL INFORMATION
Post a brief description of your clinical issue of interest.
As a nurse, I chose this topic because I know firsthand how important it is to understand pressure ulcers and take preventative measures. This is extremely helpful for the patient’s well-being and the peace of mind of their loved ones. Alshahrani et al. (2021) put together all the research on the best nursing interventions to keep critical care patients from getting pressure injuries.
Describe your search results regarding the number of articles returned on original research and how this changed as you added search terms using your Boolean operators.
These keywords will help me find more PICOT-related publications. When choosing my keywords, I will pinpoint the central idea of my query, use synonyms, and spell abbreviations (Walden University Library, n.d). The core premise of the PICOT question is the prevention of pressure ulcers; I also used the terms decubitus ulcers and bedsores as synonyms. I will also use Boolean expressions like AND, OR, and NOT to connect my keywords into a logical statement that the database can comprehend (Walden University Library, n.d). Since my research is health-related, I selected the health-related databases CINAHL Plus with full text and Pubmed from the Walden University Library (Walden University Library, n.d.-a).The PICOT question’s central idea is preventing pressure ulcers, and other synonyms that I used are decubitus ulcers or bedsores. I will also use Boolean terms such as AND, OR, and NOT in my searches to connect my keywords to create a logical phrase that the database can understand (Walden University Library, n.d-f).
Using the keyword and Boolean phrases such as preventing pressure ulcer or decubitus ulcer and bedsores, I limited the search to peer-reviewed studies published within the last five years, yielding ten results. I observed that when I did not filter the search, I obtained many irrelevant results and that the investigation would fail when I used the wrong synonym or incorrect phrase. The probe would die when I used the wrong synonym or inaccurate phrase.Finally, explain strategies to increase the rigor and effectiveness of a database search on your PICO(T) question. Be specific and provide examples.
EBP aims to improve healthcare quality and patient outcomes, lower healthcare costs, and empower practitioners (Melnyk & Lineout-Overholt, 2018).To begin, utilizing the appropriate keywords will be the first step in the techniques I may implement to improve the efficiency of my database search. I must use the right keywords because doing so can give me several resources for my PICOT query, but it can only do so if the term in question is appropriate. Also, before I start writing a paper, I need to look for scholarly work by reading research journals and academic publications, becoming familiar with search engines, and staying away from google when I’m looking for proof. As a Walden University student, I can significantly improve the efficiency of my database search if I familiarize myself with the Walden Library’s resources and ask the librarian questions. Reading the abstract will inform me if the article is the right resource since the article’s title may correspond with my PICOT question, but the content is different from what I need ( Laureate Education, 2018).
Works Cited
Alshahrani, Sim, J., & Middleton, R. (2021). A systematic review of nursing interventions for pressure injury prevention among critically ill patients systematic review of nursing interventions for pressure injury prevention among critically ill patients. Journal of Clinical Nursing, 30(15-16), 2151–2168. https://doi.org/10.1111/jocn.15709
https://www.ahrq.gov/patient-safety/resources/measures/index.htmlLinks to an external site.
Laureate Education (Producer). (2018). Searching the Evidence [Video file]. Baltimore, MD: Author
Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer
Walden University Library. (n.d.-a). Databases A-Z: Find the best library databases for your research. Retrieved September 6, 2019, from https://academicguides.waldenu.edu/az.php?s=19981Links to an external site.
Walden University Library. (n.d.-d) Keyword searching: Finding articles on your topic: Introduction to keyword search. Retrieved September 19, 2018, from http://academicguides.waldenu.edu/library/keyword/searching-basicsLinks to an external site.
Walden University Library. (n.d.-f). Keywords searching: finding articles on your topic: Boolean terms. Retrieved September 19, 2018, from http://academicguides.waldenu.edu/library/keyword/booleanLinks to an external site.
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Collapse SubdiscussionCheron Massonburg Racial Discrimination in Healthcare Organizations
Racial and ethnic disparities in access to, and quality of, health care are pervasive and contribute to the persistent negative health outcomes seen among communities of color (Benjamin & Middleton 2019). Racial discrimination within healthcare is a major concern that is perceived by quality of care surveys. However, this clinical issue has affected minority groups at large and has been a concern for both minority patients and healthcare providers. Workplace discrimination is associated with such negative consequences as stress, fatigue, demoralization, loss of professional commitment, tension and conflicts at work, and resignation (Fatemeh et al. 2022). Rarely do we see qualified, minority healthcare professionals in senior leadership positions. The c-suite positions within healthcare are almost always held by those that identify as white. Another caveat to racial discrimination within the healthcare setting is the level of care that minority groups such as Blacks, Asians, and Hispanics receive. Leaving minorities at greater risk for chronic medical conditions and increased death rates. The PICOT question: In the healthcare sector how does racial discrimination of care compared to diversity of care affect patient outcomes over any length of time?
Database Search
To research the clinical issue, three nursing databases were used to search keywords. The databases included CINAHL, MEDLINE, and EBSCO. CINAHL (Cumulative Index of Nursing and Allied Health Literature) is a general database for nurses (Wright et al, 2015). MEDLINE (Medical Literature Analysis) is a bibliographic database of life sciences and biomedical information, which is utilized by both tutors and nursing. Finally, EBSCO is a database that provides top nursing journals and other healthcare resources to students and professors. Keywords that were used include but are not limited to: Ethnicity, Racial discrimination, Health inequalities, Minority ethnic groups, Ethnic minorities, and Health outcomes.
Reference
Benjamins, M. R., & Middleton, M. (2019). Perceived discrimination in medical settings and perceived quality of care: A population-based study in Chicago. PloS one, 14(4).
Rakatansky, H. (2017). Addressing patient biases toward physicians. R I Med J ;100(12):11-12.
Wright, K., Golder, S., & Lewis-Light, K. (2015). What value is the CINAHL database when searching for systematic reviews of qualitative studies?. Systematic reviews, 4(1), 104.
ZareKhafri F, Torabizadeh C, Jaberi A. Nurses’ perception of workplace discrimination. Nursing Ethics. 2022;29(3):675-684. doi:10.1177/09697330211015291
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Collapse SubdiscussionJimmy Jesse Ortega Cheron,
Your topic of racial discrimination in healthcare is a very important issue, and I am glad you are bringing light to the situation. While doing research on the topic I was shocked to see the history of racial discrimination in the United States. The Hospital Survey and Construction Act of 1946 provided funding to construct hospitals throughout the country and allowed for racial segregation in hospital access. This engrained overt healthcare segregation for nearly twenty years before passage of the Civil Rights Act of 1964 and Medicare legislation in 1965. However, despite these acts being passed, hospital access remains unequal because socioeconomic factors such as wealth, insurance coverage, education, and trust of healthcare providers are influenced by systemic racism and curtail the likelihood of hospitals locating in historically marginalized communities (Horvath, L., 2022). I also found it very interesting that discrimination not only effects the patients, but also the healthcare providers. To fight racism and discrimination, we need to recognize, name, and understand these attitudes and actions. We need to be open to identifying and controlling our own implicit biases, and we need to be able to manage overt bigotry safely, learn from it, and educate others. These themes need to be a part of medical education, as well as institutional policy. (“Racism and discrimination in health care,” 2017).
References
Horvath, L. (2022, March 8). Health Equity: Inequitable Access To Healthcare’s Racist Roots. RTI Health Advance. https://healthcare.rti.org/insights/health-equity-racism-and-proximity-to-hospitals?gclid=EAIaIQobChMIuejjra-R_AIVyhWtBh29FAd_EAAYASAAEgJ49vD_BwELinks to an external site.
Racism and discrimination in health care: Providers and patients. Harvard Health. (2017, January 16). Retrieved December 23, 2022, from https://www.health.harvard.edu/blog/racism-discrimination-health-care-providers-patients-2017011611015
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Collapse SubdiscussionCrystal Lewis Hi, Cheron,
Discuss the meaning of a PICOT question.
Great post!
Dr. Lewis
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Collapse SubdiscussionMellissa Rodriguez Cheron,
very interesting PICO(T) question that will generate a good variety of results through the databases you mentioned. Racial discrimination is an ongoing issue in healthcare. “One of the most challenging aspects of EBP is to actually identify the answerable question” and hopefully you will find the answer to your question (Davies, 2011). Some strategies I used to narrow down my results were by using Boolean terms that would be helpful to you as well, if the issue arises that thousands of articles populate. “Boolean operators AND, OR, and NOT can be searched as keywords” and allow for you to narrow down and target relevant articles relating to your pico(t) question (Library of Congress, n.d.). Another strategy I used for narrowing down results was by checking off peer reviewed articles on the left-hand side of data bases that had the option, as well reducing the publication date to the last 5 years to ensure I was getting results that were the most recent.
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.
Library of Congress. (n.d.). Search/browse help – Boolean operators and nesting Links to an external site.Links to an external site.. https://catalog.loc.gov/vwebv/ui/en_US/htdocs/help/searchBoolean.htmlLinks to an external site.
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Collapse SubdiscussionUrsla Anyizi-Taku Second response
Great post Cheron,
Thank you for bringing up this vital issue. The standard of evidence-based medicine requires physicians to come up with clinical questions that address issues in terms of the problem/population, intervention, comparison, outcome, and time. This is referred to as the PICOT frame. (Riva et al., 2012). To formulate these questions in EBP, the PICOT statement format is used. The word PICOT is a mnemonic derived from the elements of a clinical research question – patient, intervention, comparison, outcome, and time. The PICOT process begins with a case scenario, and the question is phrased to elicit an answer.
P: Population/disease (age, gender, ethnicity, with a specific disorder)
I: Intervention or Variable of Interest (exposure to a disease, risk behavior, prognostic factor)
C: Comparison: (could be a placebo or “business as usual” as in no disease, absence of risk factor, Prognostic factor B)
O: Outcome: (risk of disease, the accuracy of a diagnosis, rate of occurrence of adverse outcome)
T: Time: The time it takes to demonstrate an outcome (for instance, the time it takes for the intervention to achieve an outcome or how long participants are observed).
Reference
Walden University (n.d.), How do I find a systematic review article related to health, medicine, or nursing? Walden Library. https://academicanswers.waldenu.edu/faq/72670Links to an external site.
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Collapse SubdiscussionJaushai Henry Initial post:
The expectant mothers may have blood pressure issues that negatively impact the fetus’s growth, and high blood pressure levels also endanger the pregnant woman’s life (Karanasiou et al., 2021). In some cases, it is recommended to have an early birth through a surgical operation commonly known as a cesarean operation to save both lives.The recovery period from the two types of births is believed to vary. Therefore, the clinical issue to be determined through the PICOT approach is whether there is a significant difference in recovery between high blood pressure-induced births and normal births.
PICOT Question
What is the period of recovery (O) for pregnant mothers (P) who developed high blood pressure (I) compared to those who did not (C) within the first eight weeks of recovery (T)?
Search Results
The original research for the PICOT question above returned two major articles with the most relevant information about how long cesarian wounds take to heal after high blood pressure-induced childbirth. The first article by Tucker et al., 2022 suggests that conducting an operation on mothers whose lives are at risk due to childbearing and high blood pressure saves their lives. However, the researchers find that these mothers may take longer to heal due to the high depression and fear of losing the immature infant. The study finds that these children are mostly incubated since most are born before the lapse of nine months.
The second article by de Souza Silva et al., 2020 , identifies high blood pressure as a major obstacle to quick healing from labor pains. The researchers assert that mothers who undergo the CS operation earlier than the expected period suffer wounds that do not heal faster and emotional discomfort due to the risk of losing the fetus.
PICOT Search Strategies
The application of the Boolean operators in searching for the PICOT question in the database will increase the effectiveness of the results. The use of words or connectors such as “AND” and “OR” helps the database system establish the inherent relationship between the inherent subjects and connected search results. Also, searching for exact PICOT question phrases and using the subject headings of the clinical issue would yield more related and valuable results from the database search (Martin et al., 2022).
References
de Souza Silva, G. A., da Silva, S. P., da Costa, M. A. S., da Silva, A. R., de Vasconcelos Alves, R. R., Tenório, F. D. C. Â. M., … & de Melo, C. M. L. (2020). SARS-CoV, MERS-CoV and SARS-CoV-2 infections in pregnancy and fetal development. Journal of gynecology obstetrics and human reproduction, 49(10), 101846. https://www.sciencedirect.com/science/article/pii/S2468784720301902Links to an external site.
Karanasiou, E. A., Karnava, T., & Rizothanasi, K. (2021). A study of blood pressure levels and other factors that contribute to a good pregnancy outcome. International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 10(4), 1310-1321. https://go.gale.com/ps/i.do?id=GALE%7CA659742160&sid=googleScholar&v=2.1&it=r&linkaccess=abs&issn=23201770&p=AONE&sw=wLinks to an external site.
Martin, C. L., Weinfurter, E. V., Alpi, K. M., & Sittig, S. (2022). Leveraging Library and Information Science to Discover Consumer Health Informatics Research. In Personal Health Informatics (pp. 305-327). Springer, Cham. https://link.springer.com/chapter/10.1007/978-3-031-07696-1_15Links to an external site.
Tucker, K. L., Mort, S., Yu, L. M., Campbell, H., Rivero-Arias, O., Wilson, H. M., … & BUMP Investigators. (2022). Effect of self-monitoring of blood pressure on diagnosis of hypertension during higher-risk pregnancy: the BUMP 1 randomized clinical trial. JAMA, 327(17), 1656-1665. https://jamanetwork.com/journals/jama/article-abstract/2791695Links to an external site.
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Collapse SubdiscussionMona Bourbour Shirazi Kordi Response#2
Hi Jaushai
Thanks for the great post. I enjoyed reading your post. The clinical issue you selected is very interesting and important. the PICOT questions you selected help to get the best research and results. It is important to find the most relevant PCOT questions. Utilizing the words “AND” and “OR” to get more results, can give you more databases to find the best research. In addition, making a little change to the keywords can help to access more data and narrow the research (Martin, Weinfurter, Alpi & Sitting, 2022).
Reference
Martin, C. L., Weinfurter, E. V., Alpi, K. M., & Sittig, S. (2022). Leveraging Library and Information Science to Discover Consumer Health Informatics Research. In Personal Health Informatics (pp. 305-327). Springer, Cham. https://link.springer.com/chapter/10.1007/978-3-031-07696-1_15Links to an external site.
Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer
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Collapse SubdiscussionAmanda Sutherland Post #3
Hello Jaushai, great post! This is an interesting topic because these complications are still not well understood. For the PICOT question, I am wondering if you are only looking at hypertension alone or if are you also plan to include preeclampsia and/or eclampsia? One way that you could further focus your results would be to choose a specific and measurable indicator of recovery (Gallagher Ford &Melnyk, 2019). It is more difficult to find high quality evidence if the outcome is subjective or based on self-report. It would be easier to find evidence if you have a clear definition of recovery. For example, looking for articles that discuss post-operative outcomes in patients with preeclampsia like time elapsed following delivery before blood pressure, liver function tests, or kidney function tests return to baseline; or a comparison between the number of patients with surgical site infections or wound dehiscence or any other surgical complication in the hypertensive versus normotensive groups.
An additional suggestion is to look at maternal fetal health databases in order to find primary sources. For example, the Society for Maternal Fetal Medicine (2021) has a list of links to databases including the Centers for Disease Control Wide-Ranging Data for Epidemiologic Research (CDC WONDER) and the Pregnancy Risk Assessment Monitoring System (PRAMS), both of which will provide useful statistics and evidence. It is very interesting and I look forward to reading more of your writing on this topic!
References
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
Society for Maternal Fetal Medicine Data Sets for Maternal Fetal Specialists (2021). Accessed December 24, 2022 at https://www.smfm.org/research/datasets
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Collapse SubdiscussionCrystal Lewis Hi, Jaushai,
As a nurse researcher, why should you be familiar with different databases?
Great post!
Dr. Lewis
Edited by Crystal Lewis on Dec 25, 2022 at 5:32pm
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Collapse SubdiscussionMleh Porter PICO(T) Question Development
The clinical issue of interest is pressure injury. Patients in intensive care units (ICU) are at risk for pressure injuries due to being severely ill or immobile for a long time. It is estimated that pressure injuries affect about 3 million people in the United States annually, with the risk for pressure injuries differing between clinical settings. Prevalence of pressure. The number of people affected by pressure injuries is significantly higher in long-term facilities and ICUs (Etafa et al., 2018). Pressure injuries result in harm, significantly expensive treatments, pain, and poor outcomes for the patient. Pressure injuries cost the United States healthcare system about $26.8 billion annually, making preventing this issue crucial (Padula & Delarmente, 2019). To address this clinical issue, the PICOT question was developed: In critically ill hospitalized adult patients (P), how effective is the implementation of a pressure injury prevention bundle compared to standard pressure injury prevention (C) at reducing the incidence of pressure injury (O), within 3 months (T)? This PICOT question aims to compare pressure injury prevention bundles to standard pressure injury prevention on the incidence of pressure ulcers in patients at an increased risk for developing press ulcers, such as critically ill patients.
I logged into the Walden University library database and accessed CINAHL. My initial search for “pressure ulcers” returned 10,700 results. When I added the term “Prevention” using the Boolean operator “AND,” the results decreased to 1,200. When I added the term “Critically ill patients” using the Boolean operator “AND,” the results decreased to 142. Finally, limiting the search criteria to articles within the last 5 years and adding the term “bundle” using the Boolean operator “AND,” the results decreased to 10.
Using different terms will increase the rigor and effectiveness of a database search on my PICOT question. I would use different search terms and Boolean operators to make the search criteria more specific (Jaffe & Cowell, 2018). For example, instead of using the term “pressure ulcers,” I could use more specific terms such as “pressure injuries” or “pressure wounds.” Moreover, I could use more specific Boolean operators such as “OR” and “NOT” to narrow my search results. For example, I could use the terms “pressure ulcers OR pressure injuries OR pressure sores OR pressure wounds” in conjunction with “Prevention” to further refine my search. I could also use the Boolean operator “NOT” to exclude irrelevant results from my search. For example, I could use the term “pressure ulcers, NOT diabetes” to exclude results related to diabetes from my search. I would also use filters to limit my search results to only those relevant to my question (Davies, 2011).
The outcome of the information gained from research on this clinical issue could provide valuable information to healthcare professionals on the importance of effectively implementing pressure injury prevention bundles. Evidence-based practice is an essential aspect of professional nursing practice. When the best evidence is utilized in clinical decisions, the healthcare team can ensure that patients receive the highest quality of care.
References
Davies, K. S. (2011). Formulating the evidence-based practice question: a review of the frameworks. Evidence Based Library and Information Practice, 6(2), 75-80.
Etafa, W., Argaw, Z., Gemechu, E., & Melese, B. (2018). Nurses’ attitude and perceived barriers to pressure ulcer prevention. BMC Nursing, 17(1). https://doi.org/10.1186/s12912-018-0282-2
Jaffe, R., & Cowell, J. M. (2018). Approaches for improving literature review methods. The Journal of School Nursing, 30(4), 236-239. https://doi.org/10.1177/1059840514540427Links to an external site.
Padula, W. V., & Delarmente, B. A. (2019). The national cost of hospital-acquired pressure injuries in the United States. International Wound Journal, 16(3), 634–640. https://doi.org/10.1111/iwj.13071
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Collapse SubdiscussionMona Bourbour Shirazi Kordi Hi Mleh,
Thanks for sharing the great post. The PICOT question you selected is relevant to your topic and will meet the criteria to develop the best answers. You also clearly mentioned how to get access to Walden library and how did you process your research in order to get a good result. The keywords you selected are also important and guide you to the best answers. I like the idea you mentioned about utilizing different keywords and seeing the results, it may give you different results by just changing a word. In my research, I was getting more articles by changing keywords.
References
Davies, K. S. (2011). Formulating the evidence-based practice question: a review of the frameworks. Evidence-Based Library and Information Practice, 6(2), 75-80.
Walden University Library. (n.d.-c). Evidence-based practice research: CINAHL search help Links to an external site.Links to an external site.. Retrieved September 6, 2019, from https://academicguides.waldenu.edu/library/healthevidence/cinahlsearchhelp
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Collapse SubdiscussionEsther Davis Hi Mleh,
Great post on your choice of clinical issue of interest. According to Moyer et al, (2022) hospital-acquired pressure injuries among children in the intensive care setting leads to significant morbidity and associated costs due to prolonged illness, immobilization, and increased device utilization. In this research, care bundles have been proved to be efficient in pressure reduction, there was a 57% reduction in pressure injuries in the pediatric hospitals that were sampled. Using care bundles to avoid pressure injuries is a quality improvement method which is currently gaining popularity (Frank et al, 2017).
Your PICO(T) question was clearly written and which I think would make your search for evidence easy to find and your clinical inquiry is very relevant. Gallagher Ford & Melnyk, (2019) identified Boolean operators as a strategy and a great tool to successful research evidence. I used the same database, the CINAHL Plus with Full Text. It’s a good research tool and it covers a range of topics on Nursing.
Reference
Frank, G., Walsh, K. E, Wooton, S., Bost, J., Dong, W., Keller, L., Miller, M., Zieker, K., & Brilli, R.J. (2017). Impact of a Pressure Injury Prevention Bundle in the Solutions for Patient Safety Network. 16;2(2):e013. doi: 10.1097/pq9.0000000000000013. PMID: 30229152; PMCID: PMC6132915.
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
Moyer, L.B, Lauderbaugh, D.L, Worten, K., Carter, C., Holub, P., Santos Manrique, R. A, Bergman, J.H., Dilloway, M.A., Hamid, M. & Glenn, L. (2022). High-stage Device-related Pressure Injury Reduction in a Neonatal Intensive Care Unit: A Quality Improvement Project. 14;7(3):e554. doi: 10.1097/pq9.0000000000000554. PMID: 35720865; PMCID: PMC9197377.
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Collapse SubdiscussionCrystal Lewis Hi, Mleh,
Why use different databases for research?Excellent post!Dr. Lewis
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Collapse SubdiscussionAmanda Sutherland Initial Post: Searching Databases
Clinical Issue of Interest
A few years ago, one of my childhood friends died following an opioid overdose. She was a shy and sensitive person who suffered from depression and entered medication assisted treatment (MAT) several times in order to attempt to stop using opioids. Her family is still unsure whether the overdose was accidental or intentional because she did not leave a suicide note and there were no clear indicators regarding intent. I became interested in the question of how healthcare providers identify those at risk and prevent suicide in patients in general and also specifically in those with opioid use disorder (OUD).
The Agency for Healthcare Research and Quality (AHRQ) recommends the use of screening for suicidality among patients receiving treatment for opioid use disorder and allows for the use of mental health screening tools such as the Patient Health Questionnaire-9 (PHQ-9) in ambulatory care settings (2019). The PHQ-9 includes questions about mood and suicide and serves as a suicide screening tool. In addition, the AHRQ advises practices to develop an Office Protocol for Suicidal Patients to assist healthcare staff to respond when a patient at risk for suicide is identified (AHRQ, 2019). A lack of standardized suicide assessment training in nursing educational programs, as well as stigmatizing views of suicide, are possible barriers to consistent and effective patient assessment and referral to mental health treatment for patients in medication-assisted treatment for opioid dependence (Beeber, 2019).
PICOT Question
In patients undergoing medication-assisted treatment (MAT) for opioid use disorder (OUD), does suicide risk and depression screening using the patient health questionnaire-9 (PHQ-9) increase identification and referral to depression treatment during MAT?
Search Results
A review of the evidence was conducted using databases accessed via the internet through the Walden Library, including PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Cochrane Database of Systematic Reviews, The AHRQ (Agency for Healthcare Research and Quality), and Evidence-Based Reports database. Free-text and Medical Subject Heading (MESH) were utilized in different arrangements to search the above-mentioned databases. Keywords: patient health questionnaire-9, PHQ-9, opioid use disorder, opioid, medication-assisted treatment. The language of publication was limited to English. The inclusion criteria comprised systematic reviews and randomized controlled trials published during the last 5 years of depression screening in patients 15-85 years of age in primary care using the PHQ-9.
Strategies for Increasing Search Effectiveness
There are a number of strategies nurse researchers employ in order to maximize search outcomes. First, formulating a PICO(T) question provides a framework for establishing the topic of interest and searching for evidence-based research articles (Davies, 2011). Choosing the correct databases according to the subject of interest also increases search effectiveness (Stillwell et al., 2010). For example, using medical and nursing databases rather than general science databases for searching healthcare topics and searching Cochrane Database of Systematic Reviews if one is looking for systematic reviews will help to hone results. After identifying appropriate databases, the use of Boolean operators along with focused terms from the PICOT question yields targeted results. For example, connecting PICOT terms with AND limits the search results and provides fewer and more pertinent articles. The use of filters within a database also targets the search results. The researcher can opt for filters including peer-reviewed, articles published within the last 5 years, publication language of English, and article type including high quality evidence such as clinical practice guidelines, systematic reviews with meta-analysis, randomized controlled trials, and cohort studies. At any point during the research process, it may be helpful to consult with research librarians, who are highly educated regarding search strategies and can provide guidance (Melnyk & Fineout-Overholt, 2018).
References
Beeber, L.S. (2018). Mental health issues and substance use in the United States: Pulling the power levers. Journal of the American Psychiatric Nurses Association, 25(1), 19-26.
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.
Medication-assisted treatment for opioid use disorder playbook. (2019). Welcome to the AHRQ Academy. The Academy. https://integrationacademy.ahrq.gov/products/playbooks/opioid-use-disorder
Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer.
Runeson, B., Odeberg, J., Pettersson, A., Edbom, T., Jildevik Adamsson, I., & Waern, M. (2017). Instruments for the assessment of suicide risk: A systematic review evaluating the certainty of the evidence. PLoS One, 12(7):e0180292. DOI: 10.1371/journal.pone.0180292
Stillwell, S. B., Fineout-Overholt, E., Melnyk, B. M., & Williamson, K. M. (2010). Evidence-Based practice, step by step: Searching for the evidence. The American Journal Of Nursing, 110(5), 41–47. https://doi.org/10.1097/01.NAJ.0000372071.24134.7e
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Collapse SubdiscussionCassie L Bozard Amanda,
You have a great PICOT question! When it comes to mental health, I always like to see what databases people find useful, so I can broaden my knowledge for my Psychiatric Mental Health Nurse Practitioner studies. I did find it overwhelming the first time I opened the Walden Library to find an article. There were so many different databases to choose from and I had a hard time narrowing down my search. Once I started searching for databases by a subject that is when I found things easier to decide which database to use. I have found two databases under the subject of behavioral health that have a lot of excellent articles. On the Walden University Library website (2022) under the subject behavioral health, I highly recommend the APA PsycArticles and PsychiatryOnline databases for your PICOT question. I like how the Walden University Library has a variety of tutorials to enhance your knowledge when it comes to researching scholarly journals. The following tutorials are provided to Walden students on the Fundamentals of Library Research page; becoming a scholar, evaluating types of resources, database search skills, and critical reading and evaluation (Walden University Library, 2021).
Walden University Library. (2022). Databases A-Z: Behavioral Health. https://academicguide.waldenu.edu/az.php?s=19981Links to an external site.
Walden University Library. (2021). Instructional Media/ Fundamental of Library Research.
https://academicguides.waldenu.edu/library/instructionalmedia/researchfundamentals
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Collapse SubdiscussionAnupa Mukundram Mehta My clinical issue of interest is the importance of mouth care in patients on ventilators. I have cared for many patients with a tracheostomy on a ventilator. I recall being taught by my preceptors when I first joined the floor the importance of mouth care with these patients, as bacteria from the mouth will go down and cause ventilator-associated pneumonia. I always focused on mouth care with my vented patients, and this assignment has given me a chance to find scholarly articles that support this practice.
I used Walden Library’s CINAHL Plus Full Text database (Walden University, n.d). At first, I typed in mouth care for patients on ventilators and did not receive any results. I then typed mouth care in the first line, and ventilator-associated pneumonia in the second line with the Boolean operator of “and”, and received 232 results. One article discussed using chlorhexidine for mouth care with vented patients and how it was found to decrease pneumonia (Jackson and Owens, 2019). Another article found that CHG mouth rinse decreased VAP from 26% to 18% but did not affect the risk of death (Cooper, 2021).
I then shortened the results by checking the box for peer-reviewed and shortening the time frame to within the last 5 years. That gave 42 results. I believe using peer-reviewed articles increases the rigor and effectiveness of my database. I used CINAHL plus full text, so all my articles were already full text, which is also very important, as I should read the full article before discussing it in my responses.
Since most of the articles discussed chlorhexidine mouthwash, I changed my search terms to chlorhexidine mouthwash AND ventilator-associated pneumonia, while also checking the box for peer-reviewed and within the past 5 years and came up with 6 results. My PICO question is, Does chlorhexidine mouthwash decrease the risk of ventilator-associated pneumonia as opposed to not using chlorhexidine mouthwash for patients on ventilators?
References:
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.2019.28.11.682Links to an external site.
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/ccn2021314Links to an external site.
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=19981
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Collapse SubdiscussionEsther Davis Hello Anupa,
Great post on your clinical issue of interest. I worked as a home care nurse for many years and precisely worked with ventilator patients. The oral hygiene protocol was the daily use of mouth swab, tooth brushing and oral rinse with regular mouth wash. As I was researching on this clinical issue, I found out that the Center for Disease Control and Prevention (CDC) has also developed evidence-based patient care treatment practices for reducing Ventilator- Associated Pneumonia (VAP) which was found to reduce VAP incidence rate as much as 60% (NIH, 2022).
I used the same database that you used through the Walden library, and for me, it was very easy to navigate and finding articles was not an issue, but I believe that the main thing according to Gallagher Ford & Melnyk (2019) is writing the PICO (T) correctly for effective search. These authors also identify PICO as a search strategy. When written correctly, will lead to unbiased and effective database search that leads to evidence.
References
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
National Institute of Health. NIH (2022). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4760051/#:
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Collapse SubdiscussionRita Osei response 2
Hello Anupa,
I enjoyed reading your post as mouth care is very important in preventing Ventilated- Associated Pneumonia. According to Lewis, Dirken & Heitkemper, Ventilator dependent patients are at the highest risk of acquiring Pneumonia (2011). CINAHL Plus is a useful database in research specifically healthcare-related (Walden University Library. n.d.).
reference
Lewis N, Dirken J, & Heitkemper, J. (2011). Diagnosis of ventilator-associated Pneumonia: a systematic review of the literature.
Walden University Library. (n.d.c). Evidence-based practice research; CINAHL search help. retrieved 3/1/20 from https;//academicguides.waldenu.edu/library/healthcare
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Collapse SubdiscussionCrystal Lewis Hi, Anupa,
What are the benefits of exploring various databases?
Great post!
Dr. Lewis
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Collapse SubdiscussionErica Dentaa Darko Clinical Issue:
Opioid use disorder is the clinical issue I chose to discuss for this week’s discussion. Opioid use disorder (OUD) is still a major problem in the United States today. According to a 2010 global analysis, 15.5 million people over the age of 15 with opioid use disorder contributed 9.2 million disability-adjusted life years to the global disease burden (Romero, 2017). Although opioids are typically prescribed to control pain, reduce coughing, or relieve diarrhea, they also produce feelings of euphoria, tranquility, and sedation, which may lead the patient to continue taking these drugs despite the development of serious side effects (Schuckit, 2016).
As we all know, opioid use can lead to addiction and, sadly, overdoses. These drugs, whether legal or illegal, stolen or shared, are responsible for the vast majority of overdose deaths in the United States today. According to the Mayo Clinic, addiction is a condition in which something that began as pleasurable becomes something you can’t live without. Opioids are highly addictive because they stimulate the brain’s powerful reward centers. As a nurse, I am passionate about this topic because I have seen many cases where inappropriate use of opioids has resulted in one of the most serious public health issues.
PICOT question:
In younger adults who experience or struggle with opioid use (Population), how effective is emergency medications such as Buprenorphine (Intervention) compared to referral to treatment programs (Comparison) to assess the rates of patient continuity for patients receiving buprenorphine treatment (Outcome) during a two year period? (Time)
Buprenorphine is a medication used to treat opioid use disorder. Romero claims (2017), According to a retrospective study, buprenorphine treatment was effective for young adults. I began my research on OUD by using the Walden Library databases, which are listed as one of our helpful student resources. PubMed and Medline are two of my favorite databases that I frequently use. Both databases are clear in their information, helpful, and to the point. I chose the Medline database with full texts for this particular discussion paper. I typed “opioid use disorder, opioid use disorder treatment, or opioid use treatment” into the text box. Approximately 8,000 articles with extensive information to support this topic appeared. I knew I needed to narrow my search even more. I can filter and limit certain articles that may not be relevant on the Medline website database. First, I restricted the date range and ensured that the articles contained the most recent information.
Some of the eight thousand articles listed dated back to the 1900s. That strategy alone reduced the number of articles to about 5,000 to look through. This is just one of the ways I intend to improve the rigor and effectiveness of a database search for the above-mentioned PICOT question. Narrowing my search also allows me to stay more focused on the question and topic.
Davies, K. S. (2011). Formulating the evidence-based practice question: A review of the frameworks. Evidence-Based Library and Information Practice, 6(2), 75. Retrieved December 12, 2022, from https://journals.library.ualberta.ca/eblip/index.php/EBLIP/article/view/9741/8144 Links to an external site.Links to an external site..
Novneet, S. (2022). EBSCOhost Research Platform: EBSCO. EBSCO Information Services, Inc. | www.ebsco.com. Retrieved December 22, 2022, from https://www.ebsco.com/products/ebscohost-research-platform
Romero, G. (2017). Buprenorphine-naloxone treatment responses differ between young adults with heroin and prescription opoiud use disorders. The American Journal on addictions, p. 838-844. Retreived December 12, 2022, from https://web.s.ebscohost.com/ehost/detail/detail?vid=4&sid=8430cff9-9a00-4d5d-8d51-00baffd59714%40redis&bdata=JkF1dGhUeXBlPXNoaWImc2l0ZT1laG9zdC1saXZlJnNjb3BlPXNpdGU%3d#AN=29143399&db=mnhLinks to an external site.
Schuckit, M. A. (2016, October 20). Treatment of opioid-use disorders. New England Journal of Medicine. Retrieved December 22, 2022, from https://www.nejm.org/doi/full/10.1056/NEJMra1604339
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Collapse SubdiscussionAmanda Sutherland Hi Erica, great post! I wanted to respond because we are both interested in issues related to opioid use disorder. I think that you might also get great results by searching the Cochrane database of systematic reviews because efficacy of buprenorphine for opioid withdrawal has been heavily researched during the past 5 years, so there should be a lot of evidence upon which to base systematic reviews with meta-analyses. When I searched “opioid”, I found an article that describes the benefit of psychosocial interventions along with medication for opioid cessation (Amato et al., 2011). I am not sure if I understand your PICOT question. Are you asking about duration of buprenorphine use depending on whether patients are given buprenorphine immediately, say in the ER, or days later after being referred to another treatment setting? Or are you wondering if buprenorphine alone or referral to outpatient therapy with the presumption that there will be medication plus counseling or psychosocial interventions is more likely to result in longer duration of treatment participation? I have heard of one adult program that requires ongoing use of buprenorphine for participation in outpatient groups, but I am not sure if this would also be the case for adolescents. It may be more difficult to find studies on the adolescent population. The Henry Ford Health Sladen Library has a page devoted to pediatrics databases that might also be helpful in your search at https://henryford.libguides.com/peds.
References
Amato L, Minozzi S, Davoli M, Vecchi S. Psychosocial and pharmacological treatments versus pharmacological treatments for opioid detoxification. Cochrane Database of Systematic Reviews, 2011(9). DOI: 10.1002/14651858.CD005031.pub4
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
Pediatrics: Databases & Resources. The Henry Ford Health Sladen Library. Accessed December 23, 2022 at https://henryford.libguides.com/peds
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