NURS 6052 Discussion: Searching Databases Assignment

Introduction

This discussion focuses on my Clinical issue of interest, which is CLABSI, my PICO(T) statement, literature search results, and Strategies to increase the rigor and effectiveness of my PICO(T) question database search.

A central line is a catheter inserted through an internal jugular vein, subclavian, femoral, or peripheral vein that terminated in the proximity of the heart in the superior or inferior vena cava (Khalid et al, 2013). A central line-associated bloodstream infection (CLABSI) is a serious infection that occurs when germs (usually bacteria or viruses) enter the bloodstream through the central line (CDC, n. d.). CLABSIs are a preventable infection, yet it results in thousands of deaths each year and billions of added costs to the U.S. healthcare system (CDC, n. d.).

PICO(T) question

Would using the CLABSI bundle decrease the incidence of CLABSI cases in hospitalized patients throughout their hospitalization period? PICO(T) format is popularly used when it comes to formulating

questions in evidence-based practice. According to Melnyk et al (2019), a PICO(T) question should be formulated before starting literature research. Having a well-constructed PICO(T) question helps find the best available results.

Literature search

The three primary databases I searched for information were CINAHL Plus with full text, MEDLINE with full text, and the Walden library. The initial term I used for my PICO(T) question was CLABSI. I decided to use the exact term because CLABSI is the main concept and a known serious issue in our hospitals. With CINAHL Plus full text, the search result was about 512, and 455 for peer-reviewed. With MEDLINE with full text, the result was 599. I think these results were considerable numbers of articles and data to work with. I went on to filter my search by narrowing down the years between 2013-2020, and the results came almost the same. Skelly & Ecker (2010) find that using Boolean terms such as AND, OR AND when researching can narrow down information. So, to narrow down my information, I used AND. For instance, I searched for ‘prevention AND intervention’ to reduce CLABSI in hospitalized patients, and the results were 52 peer-reviewed articles.

Strategies to increase the rigor and effectiveness of the PICO(T) question

To increase the rigor and effectiveness of my PICO(T) question, first, I was specific by using CLABSI. It produced needed results being that the keyword was precise. Next, I used the database filters. UAMS (2020) agrees that to get evidence-based information, researchers should filter results by using database filters. To really filter my results in the CINAHL database, I used advance search with the Boolean term, limiters like full text, peer-reviewed, and between 2010-2020. My result was about 63, which would be reasonable to work with. Moving on, I also searched for articles by clicking on the search widgets on the right side for quick access to CINAHL Plus full text and MEDLINE Plus full text.

References

Khalid, I., Al Salmi, H., Qushmaq, I., Al Hroub, M., Kadri, M., & Qabajah, M. R. (2013). Itemizing the bundle: Achieving and maintaining “zero” central line-associated bloodstream infection for over a year in a tertiary care hospital in Saudi Arabia. AJIC: American Journal of Infection Control, 41(12), 1209–1213. https://doi-org.ezp.waldenulibrary.org/10.1016/j.ajic.2013.05.028

Melnyk, B.M., Fineout-Overholt, E., Stillwell, S.B., & Willamsom, K. M. (2009).Evidence-based practice: step by step: Igniting a spirit of inquiry. American Journal of Nursing. 109(11), 49-52. Doi:10. 1097/01. NAJ.0000363354.53883.58. Retrieved from https://journals.iww.com/ajnonline/fulltext/2009/11000/Evidence_Based_Practice_Step_By_Step_Igniting_a.28.aspx

+Skelly, A. & Ecker, E. (2010). Conducting a winning literature search. Evidence-based spine-care journal, 1(1), 9-14.https://doi.org/10.1055/s-0028-1100887

University of Arkansas for medical science (2020). Developing a search strategy for primary literature. Retrieved from https://www.//libguides.uams.edu/evidence_based_medicine/acquiring

What are some of the things that healthcare providers are doing to prevent CLABSI? Retrieved from https://www.cdc.gov/hai/bsi/clabsi-resources.html

Clinical Issue: Medication error is defined as “a preventable event that may cause or lead to inappropriate medication use or patient harm (Food and Drug Association, 2019). The Issue of medication error has proven its prevalence in the US as approximately one in every 5 medication doses given during hospitalizations are given in error (DataRay, 2002). To add to this, the Patient Safety Network revealed an alarming statistic that the median medication error rate during medication administration is 8%-25% (2021). With nurses being the gatekeeper of medication administration it is undeniable that we play a pivotal role in preventing medication errors as we are often times the last line of defense for our patients. Therefor my clinical issue of interest is to analyze the impact of employee engagement and motivation on medication errors caused by nurses within the clinical setting.

Clinical Question: Are nurses that are motivated through employee engagement less likely to make medication errors than nurses that are not engaged at work and are unmotivated?

P- medication errors caused by nurses

I- employee engagement

C- motivated versus unmotivated nurses

O- decrease in medication error

Databases Used and Results

I used the Embase database and initially searched for the phrase “nursing medication errors” which resulted in 6460 articles being populated with a few having relevance to my clinical interest. I also used the CINHAL Plus with full text database and searched for the same phrase and 251 articles populated as a result.

I then refined my searches on both databases using Boolean operators. The key words used were “nursing” AND “medication errors” AND “employee engagement”. Embase produced 3 articles only 1 of which was relevant to my clinical interest. CINHAL Plus also produced 3 articles, two of which was relevant. Further refinement was needed in the Embase database as I was not able to locate enough articles with relevance. I then had to use the key words “Medication” AND ‘Error” AND “Prevention” AND “nurses” in the Boolean operator to obtain more appropriate articles. I was then able to gather four articles for future use.

How to Increase Rigor and Effectiveness of Database Searches

One way to increase the rigor and effectiveness of searches on the Embase database is to use the PICO option. There is an option on this database to insert the PICO information of the topic you would like to research and relevant articles will populate. Additionally, in CINHAL Plus searches can be refined by filtering the search options. I filtered my search to show peer reviewed articles and full text articles only. Lastly, I also found it synonyms useful to refine my searches.

References

DataRay.(2002). Medication error statistics. Retrieved from: https://datarayusa.com/resources/stats/Links to an external site.

MacDowell, P., Cabri, A., and Davis, M. (2021). Patient Safety Network: Medication Administration Errors.Retrieved from: https://psnet.ahrq.gov/primer/medication- administration-errorsLinks to an external site.

Food and Drug Administration. (2019). Working to Reduce Medication Errors. Retrieved from: https://www.fda.gov/drugs/information-consumers-and-patients-drugs/working-reduce-medication-errorsLinks to an external site.

Walden University Library. (n.d.-c).Evidence-based practice research: CINAHL search helpLinks to an external site.. Retrieved September 6, 2019, from https://academicguides.waldenu.edu/library/healthevidence/cinahlsearchhelpLinks to an external site.

ReplyReply to Comment

Click here to ORDER NOW FOR AN ORIGINAL PAPER ASSIGNMENT: NURS 6052 Discussion: Searching Databases Assignment

Clinical issue of interest

My clinical issue of interest is nurse to patient ratios and how they relate to patient outcomes including length of stay, mortality, readmissions, and medical errors. This is a topic that is dear to all of us given the dramatic change of the staffing panorama across the country. It has become more challenging for hospitals to support adequate staffing given the already pre existing nursing shortage with the loss of full time staff to travel nursing and such. This is a multifaceted issue with many affecting factors but its dire effect on patient outcomes deserves to be analyzed so that the most appropriate ethical decisions can then be taken for both staff and patients. As discussed by McHugh et al. (2021), decreased nurse to patient ratios do not only improve patient outcomes but also aid in retaining staff due to the favorability of the working conditions. By providing nurses to adequate tools to render quality, ethical patient care, morale is then increased and working environment improves. Decreasing nurse turnover is a key factor to maintaining decreased patient ratios.

PICOT question

Research of clinical significance must identify a legitimate issue with a valid research questions. In order to determine the best study design the question should be formatted in a precise manner. According to Lira and Rocha (2019), the PICOT acronym (Population, Intervention, Control, Outcome, and Time) encompasses all the ingredients needed for a research of question that will yield clinical significance. My PICOT question given my topic of interest is: For nurses in acute care settings if given decreased nurse to patient ratios , as opposed to increased, will lead to improved patient outcomes including decreased length of stay, mortality, readmissions, and medical errors. Two of the databases that yielded the most valuable research that was not a systematic or literature review were CINAHL and Proquest.

Search Results/Use of Boolean Operators

As described by Bramer et al. (2018), the use of Boolean operators utilized correctly will yield for specific material to the issue in question and facilitate the research process. During my research process, when conducting a search using the term “nurse to patient ratios” and selecting dates from 2017 to current, peer reviewed journals, and full text available, 146 results This was using CINAHL plus with full text. The articles provided were of interest, value and validity.

Research Strategies

Graduate school has been challenging for me. It had been a while since I had completed my bachelors and I do not recall so much from my ADN program in terms of meaningful research and APA format. So all this has been of learning experience for me. I have found that using databases such as CINHAL, Medline, Pubmed, and Proquest will yield for meaningful articles. As well as selecting the dates of 2017 to current, peer reviewed , full text and currently avoiding the terms systematic and literature review will also help the search be of more rigorous research.

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.

In evidence-based practice gathering data and scientific evidence coupled with clinical experience, interpret best practice methods. Clinical inquiry through research is a way to understand and evaluate interventions and outcomes. PICOT is an acronym to help you formulate a clinical question and guide your search for evidence, and using this format can help you find the best evidence available in a quicker, more efficient manner (Bonsall, 2015). PICOT stands for P: patient, population, interest, I: intervention, exposure, C: comparison, O: outcome, T: time (Melnyk & Fineout-Overholt, 2019). After developing a PICOT question research will be conducted through appropriate databases to yield articles relevant to the PICOT question.

PICOT Question:

In nurses with less than five years of experience (P) what is the effect of a workplace bullying intervention program (I) on a reduction in the incidence of workplace bullying (O) compared with no intervention (C) within a one-year period (T)?

The databases used were the Cumulative Index to Nursing and Allied Health Literature (CINHAL) plus full text and Medline plus full text. The CINHAL database yielded nine articles using search terms “bullying,” “intervention,” and “nurse.” The Medline database produced ten articles using search terms “bullying,” intervention,” and “nurse.” After receiving the results, I added search terms, “support,” “solutions,” on top of “nurse” and “bullying,” and it yielded fewer results.

Strategies I will utilize are; investigating database research, looking at the articles yielded, and finding keywords within and using them as Boolean operators. A few other strategies are brainstorming synonyms, expanding acronyms, and looking at subjects. Evidence-based practice is based on developing a PICOT question as a guide for research and part of clinical inquiry. Promoting clinical investigation in evidence-based practice allows scholars to understand and compartmentalize research processes to aid in successful navigation.

References

Bonsall, L. (2015, October). What is your question? Retrieved June 24, 2020, from https://www.nursingcenter.com/ncblog/october-2011/what-is-your-question

Melnyk, B. M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing & healthcare: A guide to best practice. Philadelphia: Wolters Kluwer.

Hanrahan, K., Wagner, M., Matthews, G., Stewart, S., Dawson, C., Greiner, J., . . . Williamson, A. (2015). Sacred Cow Gone to Pasture: A Systematic Evaluation and Integration of Evidence-Based Practice. Worldviews on Evidence-Based Nursing, 12(1), 3-11. doi:10.1111/wvn.12072

RE: Discussion – Week 4

Collapse

My PICO subject involves post-operative pain management using a numerical pain scale over the use of the Critical Care Pain Assessment Tool ( CPOT) to minimize opioid use. My question is will the implementation of a collective assessment approach in acute care nursing at the PACU, containing the Critical Care Pain Observation Tool (CPOT) and comparative pain score, decrease post-operative use of narcotics compared to the comparative pain scale alone?

I selection of search terms used to get posts, feedback and other information are as follows: Terms of research analgesia, post-operative analgesia, preventive analgesia, non-opioid, pain, post-operative, fentanyl, multimodal treatment, preoperative nursing, analgesia, vital signs, pain effect, pain scale, postoperative pain, preoperative care, surgical procedures, surgical treatment, and pain management.

I started using the Walden library but I still haven’t received any search returns even with all the parameters remaining. I started using Google Scholar which I am pretty familiar with. I started searching for only the top three of Meta-Analysis, Systematic Reviews, and Critically Appraised Topics in the hierarchy because these are the three most reliable results and three of the four that can be filtered. My three top search topics got the following: On the subject of (The criteria is the search sentence and the type of review method) Analgesia-(Meta-Analysis- 166,000). (Systematic Reviews-267,000), Topic Critically Assessed-13,500) Primary Care Pain Assessment Method -(Meta Research-120,000), (Systematic Reviews-235,000), (Topic Objectively Appraised-19,000) Multi-model Pain Treatment-(Meta-Analysis-46,300), (Systemic-Reviews-57,500). (Topics Critically Appraised-4,030).

The reason I searched for only three types of review methods is that they contain the most reliable information that my PICO question needs to be answered with the greatest precision. Depending on the type of research that I am doing, it depends on where I look for the information from the evidence hierarchy. I look more towards the Meta-Analysis if I am looking for statistical evidence. I have taken a closer look at the Systemic Reviews that fit my pre-specified eligibility criteria. The most useful ones in my view are the Critically Appraised Topics, as they are brief summaries of findings that may be close to my area of concern as they concentrate on a particular issue (Polit, D.F., & Beck, C. T., 2017).

Some of the information I found was that the result of one meta analyst outcomes indicated the CPOT’s reliability and validity was acceptable. “Strong intra-class correlations varying from 0.74 to 0.91supported the inter-rater reliability. Significant associations between CPOT scores and both FLACC 0.87-0.92 and pain intensity Numeric Rating Scale Score 0.50-0.69 were found for criterion-related validity” (Buttes, et al., 2015). A key point to my question has been that a comprehensive, multimodel analgesic regimen will not only provide the most complete control of pain but will also minimize the need for opioids and thus reduce the resulting side effects. (Carlson, R.H., 2015).

References

Buttes, P., Keal, G., Cronin, S. N., Stocks, L., & Stout, C. (2015). Validation of the Critical-Care Pain Observation Tool in Adult Critically Ill Patients. Dimensions of Critical Care Nursing,33(2), 78-81. doi:10.1097/dcc.0000000000000021

Carlson, R. H. (2015). Multimodal Pain Management Minimizes Need for Opioids. Oncology Times,37(9), 36-37. doi:10.1097/01.cot.0000465759.66907.be

Patient Outcomes Effected by Nursing Burnout

Patient outcomes are at the forefront of all healthcare organizations. We want the best for our patients and their families. As healthcare workers, this can be a challenge. With staffing shortages, and constantly changing work requirements, burnout is becoming more and more prominent. Exacerbated by the COVID-19 pandemic nursing burnout is a challenge we must overcome. Decreased work-related stressors such as workload, and time pressures, and increasing communication, and interpersonal relationships by having a more conducive work environment can minimize burnout in nursing (Afriyie, 2020). This clinical issue must be addressed to prevent further deterioration of staff and patient outcomes (Canadas-DelaFuente et al., 2015). Overall, nursing burnout has negative implications for patient outcomes and healthcare organizations (Peirson, 2021).

Research Strategies

I first had to develop a strategy for researching to find articles that did not include systematic reviews, this week’s resource section provided excellent explanations of the different types of research and where to go to find them. I did find that while searching different databases having fewer words helped with the search results. My original search term Nursing Burnout resulted in 45 articles to choose from, alternatively when using the term Patient Outcomes over 1600 articles populated. This made searching for my specific topic more challenging since there were only a few articles that had both specifications addressed. Some way to overcome these challenges is to speak the research engine’s “language” so to speak. I researched the topic of interest and utilized the word AND in addition to the second word in my topic of interest which narrowed down the amount articles to 40, which resulted in the best articles that addressed the complete topic in its entirety.

References:

Afriyie, D. (2020). Reducing work-related stress to minimize emotional labour and burn-out syndrome in nurses. Evidence-Based Nursing, 24(4), 141–141. https://doi.org/10.1136/ebnurs-2020-103321Links to an external site.

Cañadas-De la Fuente, G. A., Vargas, C., San Luis, C., García, I., Cañadas, G. R., & De la Fuente, E. I. (2015). Risk factors and prevalence of burnout syndrome in the nursing profession. International Journal of Nursing Studies, 52(1), 240–249. https://doi.org/10.1016/j.ijnurstu.2014.07.001Links to an external site.

Peirson, J. (2021). Staff burn-out has implications for organizational and patient outcomes: Would an open culture of support with structures in place prevent burn-out? Evidence-Based Nursing, 25(3), 99–99. https://doi.org/10.1136/ebnurs-2021-103437

Discussion: Searching Databases

When you decide to purchase a new car, you first decide what is important to you. If mileage and dependability are the important factors, you will search for data focused more on these factors and less on color options and sound systems.

The same holds true when searching for research evidence to guide your clinical inquiry and professional decisions. Developing a formula for an answerable, researchable question that addresses your need will make the search process much more effective. One such formula is the PICO(T) format.

In this Discussion, you will transform a clinical inquiry into a searchable question in PICO(T) format, so you can search the electronic databases more effectively and efficiently. You will share this PICO(T) question and examine strategies you might use to increase the rigor and effectiveness of a database search on your PICO(T) question.

To Prepare:

Review the materials offering guidance on using databases, performing keyword searches, and developing PICO(T) questions provided in the Resources.
Review the Resources for guidance and develop a PICO(T) question of interest to you for further study.

By Day 3 of Week 4

Post your PICO(T) question, the search terms used, and the names of at least two databases used for your PICO(T) question. Then, 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.

Patient Outcomes Effected by Nursing Burnout

Research Strategies

References:

Afriyie, D. (2020). Reducing work-related stress to minimize emotional labour and burn-out syndrome in nurses. Evidence-Based Nursing, 24(4), 141–141. https://doi.org/10.1136/ebnurs-2020-103321

Links to an external site.

RE: Discussion – Week 4

Collapse

PICO(T) is a mnemonic used to describe the four elements of a good clinical question. It stands for Patient/Problem, Intervention, Comparison, Outcome. Many people find that it helps them clarify their question, which in turn makes it easier to find an answer (Cooke, Smith, & Booth, 2012). My PICO(T) question is, In hospitalized inpatient psychiatric patients (P), how does forcing medication (I), compare with not forcing medication (C), effect quality of care (O), during the duration of the inpatient admission (T). A well-built PICOT question increases the likelihood that the best evidence to inform practice will be found quickly and efficiently (Stillwell, Fineout-Overholt, Melnyk, & Williamson, 2010). My original search yielded no results in any database.

I had to reduce my search terms quite a bit to yield a result of 57 articles. Not many were very relevant however one such article, Forced medication in psychiatric care: Patient experiences and nurse perceptions, was adequately related to my original question. My search terms were, psychiatric patients forced medication care. I searched the databases EBSCO and CINAHL, both retrieved from the Walden University library.

Cooke, A., Smith, D., & Booth, A. (2012). Beyond PICO: The SPIDER tool for qualitative evidence synthesis. Qualitative Health Research, 22(10), 1435-1443. doi:10.1177/1049732312452938

Haglund, K., Von Knorring, L., & Von Essen, L. (2003). Forced medication in psychiatric care: Patient experiences and nurse perceptions. Journal of Psychiatric and Mental Health Nursing, 10(1), 65–72. https://doi-org.ezp.waldenulibrary.org/10.1046/j.1365-2850.2003.00555.x

Stillwell, S. B., Fineout-Overholt, E., Melnyk, B. M., & Williamson, K. M. (2010). Asking the clinical question: a key step in evidence based practice. A successful search strategy starts with a well-formulated question. American Journal of Nursing, 3, 58.

Walden University Library. (2020). Keyword searching: Finding articles on your topic: Boolean terms. Retrieved from http://academicguides.waldenu.edu/library/keyword/boolean

RE: Discussion – Week 4

Collapse

Just as with searching for a new car, I wanted to develop a PICO(T) question and perform research that is meaningful not only to my future but also that resonates with some of my previous areas of experience. I of course want my research to be meaningful and evidenced-based.

I have worked with the adolescent psychiatric population ages 5-17 in outpatient and level one hospitals. There have been many interventions carried out with great success and others with very limited positive outcomes. I have transformed my clinical inquiry into a searchable question in order to search electronic databases step by step with efficiency which is as follows (Stillwell, Fineout-Overholt, Melnyk, Williamson (2010):

In Attention Deficit Hyperactive Disorder (ADHD) (Problem), how does diet (Intervention) compared to other treatments (Comparison) affect behavior and quality of life (Outcome) within the youth population (Time-Frame).

This will assist to develop and examine successful strategies that may increase the rigor and effectiveness of the most current evidence-based research. Specific examples include accessing search engines such as the Walden Library, Ebsco, and other scientifically reputable sites in order to get the most credible and value-rich material for evidenced-based research that I am looking for.

References

MD Anderson Library. (2020). Research guides: Evidence-based medicine: Searching techniques. MD Anderson Library Center. https://mdanderson.libguides.com/c.php?g=249812&p=2314759

Stillwell, S. B., Fineout-Overholt, E., Melnyk, B., & Williamson, K. M. (2010). Evidence-based practice, step by step: Asking the clinical question. AJN, American Journal of Nursing, 110(3), 58–61. https://doi.org/10.1097/01.naj.0000368959.11129.79

Walden University Library. (n.d.). Databases A-Z: Nursing. Retrieved October 4, 2019, from https://academicguides.waldenu.edu/az.php?s=19981

Main Post

The clinical issue of interest is Diabetes Mellitus (DM) type 1 and why it’s usually misdiagnosis and how to prevent it. However, I recently identified ten patients with glucose levels of 350 to 400 who were unaware of they were typed 1 DM. These individuals were told they were type 2 and their treatment was not effective. They spent a lot of time in the hospital for uncontrolled DM and suffered from kidney disease, and neuropathy.

However, searching for the subject I used the Walden library and Medline database. I modified the search four times to obtain quality scholarly articles and I found four scholarly articles. The language I use was -misdiagnosis type 1 DM. Therefore, the rigor will occur by confirming a valid question by following the PICOT format which will ensure I have the correct patient population, intervention, comparison intervention, group outcome, and timeframe (Melnyk & Fineout-Overholt, 2019). The second step is searching for evidence-based practice (EBP) to evaluate the best practice (Melnyk & Fineout-Overholt, 2019). It would be interesting to learn about the components which contribute to the misdiagnosis. However, the third step involves massaging the information for validation and sustainability, and feasibility (Melnyk & Fineout-Overholt, 2019). Hence, it is essential to follow all the steps, but steps 4 & 5 ensure the outcomes and clinical decisions. Step 4 guides PICOT to integrate the information to decide if it is EBP and if it’s understandable. The goal is to justify the research and evaluate the outcomes based on the evidence (Melnyk & Fineout-Overholt, 2019). The last step is to share the information among those whom it will affect, to change their behavior.

In addition, to the research, there will be challenges, and how to overcome negative outcomes. The acuity of the patients, shortage of nurses, and lack of knowledge of EBP are challenges (Melnyk & Fineout-Overholt, 2019). As clinicians learn about the research, it becomes rigorous and effective. It is essential to assess and evaluate frequently to identify challenges.

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 development of clinical guidelines to improve nursing practice is a rigorous process. Healthcare providers should utilize the most accurate sources of data that will enhance the effectiveness of the outcomes. Therefore, this paper explores the search strategy that will be used to obtain the data related to the proposed PICOT question.

PICOT Question

The PICOT question that is appropriate for the identified clinical issue is:

In hospitalized elderly patients (P), does the use of hourly nursing rounds and call lights (I) reduce the rates of falls (O) when compared to normal routine of care (C) in a six-month period (T)?

Search Terms Used

According to Melnyk and Fineout-Overholt (2018), search terms for a clinical inquiry question (PICOT) can be obtained by doing database search using the key words of the PICOT question. The keywords that were used in this research that relate to the PICOT question include falls, elderly patient falls, falls prevention, hourly nursing rounds and falls, call lights and falls, and nursing rounds and falls. The use of these keywords in selected databases yielded 59 articles. The number reduced to 30 when the search criterion was limited to peer-reviewed articles alone. The second search strategy that was utilized was the use of database-controlled vocabulary. This approach entails the use of specific keywords such as nursing rounds and elderly patient falls to obtain the needed articles. The databases produce all the articles that contain these keywords, thereby, increasing the accuracy of the obtained results (Melnyk & Fineout-Overholt, 2018). The use of this approach resulted in 45 articles related to the PICOT statement. Despite the effectiveness of these methods, they have the weakness of producing a large number of articles that might not be relevant to the issue under investigation. Consequently, the use of Boolean operation search is appropriate.

Struggling to Meet Your Deadline?

Get your assignment on NURS 6052 Discussion: Searching Databases Assignment done on time by medical experts. Don’t wait – ORDER NOW!

Meet my deadline

Boolean search is an effective approach to obtaining relevant research articles due to the accuracy of its results. The use of this approach allows for the searching of word combinations in a specified order (Stillwell et al., 2010). Often, combinations are used to increase the relevance and accuracy of the obtained resulted. For instance, Library of Congress (n.d.) recommend that Boolean OR expressions should be executed first, followed by AND or NOT expressions. The search can be done in either lower or upper cases. The use of this approach to searching articles yielded 16 articles that were related to the PICOT statement. Therefore, it became evident that the use of Boolean search is highly accurate when compared to the utilization of random search of key words in the PICOT statement.

Names of Databases

A number of nursing databases were used in this research. They included CINAHL, Medline, Embase, and TRIP databases. These databases were considered effective for the assignment because they publish peer-reviewed content. The sources contained in them are also credible for use in generating information for evidence-based practice.

Search Results

As shown above, the initial search that was undertaken using random search of the key words of the PICOT question yielded 59 articles. This number reduced to 30 when the selected articles were specified to peer-reviewed articles only. The use of database-controlled vocabulary yielded 45 articles while Boolean search resulted in 16 peer-reviewed articles related to the PICOT statement.

Strategies to Increase Rigor and Effectiveness of a Database Search on PICOT Question

A number of strategies will be utilized to increase the rigor as well as effectiveness of the database search for the relevant literature in the PICOT question. One of them will be the use of many databases. According to Ho et al. (2016), the use of a combination of different databases has been shown to result in an increased proportion of studies alongside questions. Restricting the search of the relevant sources of data to a single database would lead to one missing many articles, hence, skewed results.

The second strategy that will be utilized to increase the rigor and effectiveness of the database search on the PICOT question is limiting the period in which the appropriate articles were published. Often, evidence-based practice focuses on the use of the most recent, highly accurate clinical data in improving processes (Melnyk & Fineout-Overholt, 2018). This implies that recently published data should be utilized in coming up with new clinical guidelines. As a result, the search strategy for the articles on the PICOT question will be limited to articles that were published in the last five years. The use of this approach will increase the relevance of the findings to the current issues being reported in the clinical environments.

The last strategy that will be utilized to enhance the rigor and effectiveness of the database search on the PICOT statement is ensuring that the articles only relate to nursing practice. Evidence-based practice applies to all areas of healthcare. However, it is important that nurses explore the need for clinical practices that relate to their professional practice (Ellis, 2019). The need for this focus is to promote professional growth and advancement. Therefore, the search for the needed resources will only be specific to nursing.

References

Ellis, P. (2019). Evidence-based practice in nursing. Learning Matters.

Ho, G. J., Liew, S. M., Ng, C. J., Shunmugam, R. H., & Glasziou, P. (2016). Development of a search strategy for an evidence based retrieval service. PloS one, 11(12).

Library of Congress. (n.d.). Search/browse help – Boolean operators and nesting. Retrieved June 14, 2020, from https://catalog.loc.gov/vwebv/ui/en_US/htdocs/help/searchBoolean.html

Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer.

Stillwell, S. B., Fineout-Overholt, E., Melnyk, B. M., & Williamson, K. M. (2010). Evidence-based practice, step by step: Searching for the evidence. AJN The American Journal of Nursing, 110(5), 41-47.

PICOT questions form the basis of clinical inquiry with a significant focus on improving patient outcomes (Melnyk & Fineout-Overholt, 2018). The implication is that a clinical issue is identified, and an appropriate question in the PICOT format is formulated (Nieswiadomy & Bailey, 2018). The chosen clinical issue is catheter-associated urinary tract infections (CAUTI) in the emergency department. CAUTIs are common in the emergency department due to the need to catheterize patients who come in for admission. CAUTIs lead to undesirable problems, such as longer hospital stays, and even more adverse outcomes, such as death, hence a need to prevent and properly manage them (Ohanian & Gaines-Hill, 2019). An appropriate database search strategy is necessary when searching databases for appropriate evidence regarding clinical issues. For instance, one can start the search broadly with a concept or a word and add more specific keywords to the search process to narrow down on more appropriate evidence.

Using the Walden database search, a search was conducted starting with the word catheter-associated urinary tract infections. Nursing databases were specifically used during this search. The first search was general and yielded 46,800 results. However, most of these resources were irrelevant, so more words were added to help narrow the search. The word emergency department was added to the search, reducing the number of articles to 10,600 and making them more specific. This was made possible by using the Boolean operator “And” (Grove & Gray, 2018). After formulating the PICOT question, it is expected that more specific terms will be included in the search strategy to help narrow down the most appropriate articles or evidence. For instance, the search still does not include a possible intervention to be used in the emergency department to reduce the chances of patients getting CAUTI.

PICOT question: Among adult patients admitted to the emergency department, what is the efficacy of using CAUTI bundles as compared to normal practice in lowering the rates of CAUTI in 12 weeks?

References

Grove, S. K., & Gray, J. R. (2018). Understanding nursing research e-book: Building an evidence-based practice. Elsevier Health Sciences.

Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer.

Nieswiadomy, R. M., & Bailey, C. (2018). Foundations of nursing research. 1073.

Ohanian, S., & Gaines-Hill, S. (2019). Reduction of CAUTI rates organization-wide begins in the Emergency Department. American Journal of Infection Control, 47(6), S37. https://doi.org/10.1016/j.ajic.2019.04.086

Searching Databases

At the core of evidence-based practice (EBP) is the developing a clinical inquiry which is actualized through the PICOT model (Saunders et al., 2019). As such, the clinical issue of interest is the increased prevalence of incivility in nursing and its impacts on the overall quality of care offered to patients. The use of cognitive rehearsal as an intervention to reduce incivility is considered one of the most effective ways to prepare nurses handle such situations because of its benefits (Kang et al., 2019). The PICOT question would be, “In nursing practice with high levels of incivility (P) does the use of cognitive rehearsal approach and training (I), compared to normal civility measures (C), reduce the rate of incivility by 40% (O) within 6 months (T)? Therefore, searching for evidence to answer the clinical issue of interest implores one to implement strategies by focusing on nursing databases that offer precise information about the phenomenon (Oh et al., 2019). The two research databases utilized in searching for scholarly evidence include PubMed Central and CINAHL.

The core terms entered into the search engines of the selected databases to get appropriate studies that align with the terms and topic of interest. In the first phase, over 10,000 studies came up. This was before filtering the search bases on the publication date, and exclusion of systematic reviews as well as meta-analyses and utilization of Boolean operation (Melnyk et al., 2018). On combining the search terms with the Boolean operator “AND” as well as utilizing other filters, the overall results showed 23 articles. These articles were specific and dealt with the interventions which tackle the practice issue.

The strategies that may enhance the rigor, effectiveness and specificity of searching databases on the PICOT question comprise of ensuring that one uses an in-built filter, and use of synonymous terms in repeat searches (Li et al., 2019). The use of filters to search databases can be only to produce certain articles like randomized controlled trials while synonyms ensures that even articles written using similar terms and relevant to the issue are capture during the search.

References

Kang, J., & Jeong, Y. J. (2019). Effects of a smartphone application for cognitive rehearsal intervention on workplace bullying and turnover intention among nurses. International Journal of Nursing Practice, 25(6), e12786. https://doi.org/10.1111/ijn.12786

Li, S., Cao, M., & Zhu, X. (2019). Evidence-based practice: Knowledge, attitudes,

implementation, facilitators, and barriers among community nurses—systematic review. Medicine, 98(39). DOI: 10.1097/MD.0000000000017209.

Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing &

healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer.

Oh, E. G., & Yang, Y. L. (2019). Evidence-based nursing education for undergraduate students:

A preliminary experimental study. Nurse education in practice, 38, 45-51.

DOI: 10.1016/j.nepr.2019.05.010

Saunders, H., Gallagher‐Ford, L., Kvist, T., & Vehviläinen‐Julkunen, K. (2019). Practicing

healthcare professionals’ evidence‐based practice competencies: An overview of systematic reviews. Worldviews on Evidence‐Based Nursing, 16(3), 176-185. DOI: 10.1111/wvn.12363.

For this discussion, my clinical issue of interest is the medical underlying causes for mental health unaddressed. There are external and medical causes for mental health disorders in children and adults, but many times, these underlying causes are not treated as priority or even completely ignored. Rather than confining mental health to be purely psychosis, it will be beneficial to delve into the possibility that health-related issues, social and economic situations, and emotional well-being are significant contributors to mental illness.

Research work has inadvertently exposed how some mental health symptoms are dismissed in younger individuals, and never diagnosed or identified too late, which only further creates a sense of alienation for children suffering from mental illnesses. An underlying or untreated medical condition is a contributor to typical signs of mental instability. For example, chronic diseases such as diabetes, hypothyroidism, hyperthyroidism, and lack of vitamin D can result in mental health disorders like mood swing, anxiety, depression, and unexplained weight changes. Oftentimes, the build-up of multiple chronic diseases significantly decreases the quality of life for an individual leading to mental health issues. For this work, a literature search was conducted using EBSCOhost databases. Two peer-reviewed articles were selected using two different databases in the Walden Library. Respectively, Cumulative Index to Nursing & Allied Health Literature Database, and Eric Database.

To search, I identify the keywords to the related article and use this as the prompt. “Mental health”. This initial search generated 28,397 results. I Combined keywords to narrow or broaden search results “Underlying mental health causes”. Three results generated. Using Boolean operator AND, “Mental health and Underlying causes” Nine results generated.

With this, I would say that the strategies to use for better and effective database search for my PICO(T) question will be using more than one database to view variety of articles and select what is relevant like peer-reviewed, full article and date range (within 5 years recommended)

It also works best to breakdown the content. Pick a topic from the most related subject, like nursing. When we type everything into the database, we get nothing. It is always better to type in the main idea and concept. Select full article, peer-reviewed, relevant date, and search.

Boolean terms AND, OR, NOT connects the keywords to create a more precised logical phrase that the database can understand and use to look for multiple terms or concepts at once. AND finds items that uses both keywords, OR find items that use either of the keywords and NOT excludes items that use the keywords. I have lots of resources to work with, and a PICOT question in progress. Changes may occur as needed. PICOT- Problem- Mental health causes unaddressed, Intervention–Treating the underlying causes, Comparison-Findings will emphasize the correlation between mental health and other underlying issues, Outcome-Positive improvement with treatment, Time frame-Within 72 hours of treatment, re-evaluation will be done.