NURS-6052 Discussion: Searching Databases

 NURS-6052 Discussion: Searching Databases

 NURS-6052 Discussion: Searching Databases

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NURS-6052 Discussion: Searching Databases

I began the process by learning more about the ‘PICO-T’ phenomenon. It is an acronym for methodically breaking down what kind of information a good research question should ask, and it is important to ask questions this way because it represents a systemic breakdown of the components of a research issue (Stillwell et al., 2010). Medication errors and prevention are a particular interest of mine. I wasn’t sure how much I wanted to learn about medication errors. I thought it would be interesting to look into reconciliation, but I couldn’t narrow the results down to a specific intervention. I started by searching for’medication errors,’ which led me to a slew of references ranging from pediatrics to pharmacist involvement. I knew I didn’t want any pediatrics information. And it appears too complicated to ask to what extent pharmacist involvement affected medication errors. Furthermore, when I checked that box, the results were minimal. Then it occurred to me: why not broaden the question to include all interventions? I looked through the Walden Library, PubMed.gov, and the Cochrane Library. All of this produced a plethora of results when I searched for medication error prevention policies. After all, that is my area of expertise. I suppose it is best to see where your colleges have already traveled before embarking on an entirely new experiment of study, right? As a result, I devised the following PICO-T question: What inpatient medication prevention policies have been shown to reduce medication errors in adult patients admitted for at least 24 hours? After reading the resources for this discussion/assignment, I wondered if this was too general or vague. On ohsu.edu, there is a good breakdown of background versus foreground questions, as well as examples of questions that are either too generalized or specific enough to meet the PICO-T criteria (ohsu.edu, 2021). So I decided to expand my search and try to zero in on a specific intervention that was effective. Are electronic medical records more effective than handwritten records at reducing medication errors in adult hospital patients? What happened to my timetable? Is the phrase “hospital setting” implied? These are the questions I’m pondering. Then I realize I’m getting too hung up on this timeframe thing. But I think that’s a good PICO; I’m just not sure if the “handwritten” comparison is necessary. When I include it in my search criteria, my results suffer greatly. So, if I can avoid the comparison, I will.

References

(September 13, 2021) ohsu.edu. https://libguides.ohsu.edu/nursing/PICO (accessed September 20, 2021).

S. B. Stillwell, E. Fineout-Overholt, B. M. Melnyk, and K. M. Williamson (2010). Step-by-step evidence-based practice: A critical step in evidence-based practice is asking the clinical question. 58-61 in the American Journal of Nursing.

 

RE: Week 4 COLLAPSE Discussion

“Evidence-based practice questions center on real-world problems and issues.” The more pressing the question, the more important it is to place it in an EBP context.” Davies (2011) This week, I used the question “How do I prevent deep vein thrombosis in inpatients over the age of forty?” to inform my PICO(T). I chose this topic because I work in a medical-surgical setting, but I previously worked on an acute rehabilitative floor where anticoagulation was a clinical priority for all of my patients. I still work with adults, the majority of whom are elderly, and many of them are not anticoagulated for a variety of reasons. I recently requested a rapid response for one of my patients, who turned out to have bilateral pulmonary emboli, so this topic has piqued my interest more than ever. “P-patient or Problem: Who is the Patient?” Davies breaks down the elements of the PICO(T) inquiry for us. What are the patient’s most important characteristics? What is the primary issue, disease, or co-occurring condition? I – Intervention: What is the primary intervention under consideration? C – Comparison: What is the main intervention in comparison? “What are the anticipated measures, improvements, or effects?” “When a nurse possesses a spirit of inquiry within a supportive EBP culture, she or he can routinely ask questions about clinical practice while care is being delivered,” Melnyk et al remind us. In the spirit of inquiry, I formulated the following from my initial question: (P) in patients over 40 at risk for deep vein thrombosis, (I) is an anticoagulant the most effective prevention (C) compared to physical therapy (O) in preventing deep vein thrombosis (T) while in the hospital. “Boolean operators and nesting allow you to look for combinations of words or phrases that have been processed in a specific order” (Boolean Operators and Nesting, 2018). I searched “deep vein thrombosis prevention” in Walden’s library’s CINAHL database, which yielded 123 results. When I entered “in elderly patients” as my Boolean operator in the advanced search box, I received only three results, which are much easier to sort through than 123. When I am conducting research in online databases, I use several strategies to narrow down the results. One such strategy is to check the ‘peer-reviewed’ box, as I only want to use reliable research. I also select ‘only inpatients’ on occasion because I work in an inpatient setting.

References

Nesting and Boolean Operators (2018). The Library of Congress https://catalog.loc.gov/vwebv/ui/en US/htdocs/help/searchBoolean.html

K. S. Davies (2011). A Review of the Frameworks for Formulating the Evidence-Based Practice Question 75-80 in Evidence-Based Library and Information Practice. https://doi.org/10.18438/B8WS5N

B. Melnyk, E. Fineout-Overholt, S. Stillwell, and K. Williamson (2009).

Evidence-Based Practice: Step by Step: Creating an Inquiry Spirit

doi: 10.1097/01.NAJ.0000363354.53883.58. AJN, American Journal of Nursing, 109 (11), 49-52.

S. Stillwell, E. Fineout-Overholt, B. Melnyk, and K. Williamson (2010).

Evidence-Based Practice, Step by Step: Finding Evidence

doi: 10.1097/01.NAJ.0000372071.24134.7e. AJN, American Journal of Nursing, 110 (5), 41-47.

 

RE: Week 4 COLLAPSE Discussion Week 4 Featured Post

I’ve chosen ventilator-associated pneumonia as my clinical topic of interest (VAP). For four years, I worked in a neuro/medical ICU, and VAP prevention was a regular part of my daily nursing tasks. Ventilator-associated pneumonia affects 10% of ventilated patients and is a major cause of inpatient morbidity and mortality (Modi & Kovacs, 2020). VAP appears to be becoming more common over time, accounting for 22% of all hospital acquired infections in 2014. (Modi & Kovacs, 2020). Effective clinical research and evidence-based practice can have a significant impact on lowering VAP rates (Emparanza et al, 2015). Emparanza et al discovered that using evidence-based practice (EBP) in the clinical setting reduced the risk of death and lengthened hospital stays (2015). I started with a background question when thinking about my PICO(T) question. “How do you prevent ventilator-associated pneumonia in intubated ICU patients?” was my background question. This question was designed to help provide a broader understanding of the subject. The PICO(T) method enabled me to develop a foreground question that aids clinical decision making by providing evidence (Stillwell et al, 2010). To address this issue, my PICO(T) question would be, (P) does the use of a ventilator care bundle (C) compared to not using a ventilator care bundle (O) reduce rates of ventilator associated pneumonia in ventilated patients in the ICU?

I began by searching the Walden Library for articles about VAP, which yielded 18,823 results. There were a lot of search results, and it was difficult to find articles about using ventilator bundles. I then Googled “ventilator care bundle to prevent ventilator-associated pneumonia.” This produced only seven results, which were reduced to six after I applied the peer-reviewed filter. I realized I needed to find a happy medium with my search question. I began by searching specific databases, first selecting CINAHL with full text and searching “ventilator care bundle,” which yielded 25 results produced between 2015 and 2021. Many of these findings are primary research sources. With the same filters, MEDLINE yielded 27 results with full text.

Using filters is one strategy for increasing the rigor and effectiveness of a database search. Filters such as peer-reviewed journals, a range of years that a journal was published, and full text improve the search’s efficiency. The use of Boolean operators in the search question aids in the creation of a query that a database can understand. The word “and” allows the database to find items that contain both keywords, “or” finds items that contain either keyword, and “not” excludes titles that contain that keyword.

References

Emparanza, J. I., Cabello, J. B., & Burls, A. J. (2015). Does evidence-based Practice improve patient outcomes? An analysis of a natural experiment in a Spanish hospital. Journal of Evaluation in Clinical Practice, 21(6), 1059–1065. https://doi.org/10.1111/jep.12460

Modi, A. R., & Kovacs, C. S. (2020). Hospital-acquired and ventilator-associated pneumonia: Diagnosis, management, and prevention. Cleveland Clinic Journal of Medicine, 87(10), 633–639. https://doi.org/10.3949/ccjm.87a.19117

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

What are boolean operators? What are Boolean operators? – Quick Answers. (n.d.). Retrieved September 21, 2021, from https://academicanswers.waldenu.edu/faq/72773.

RE: Discussion – Week 4 Initial Post

The Clinical Issue that interested me was “Overcrowding in the Emergency Room,” Overcrowding in the emergency department is a significant public health issue. It leads to a decline in the overall quality of health care, which includes, but is not limited to, higher waiting times, delays in diagnosis and treatment, more significant financial load, and general patient discontent, among other things (Akbar Baig, Muhammad, Mian, Asad, Najeeb, Fatima, & Shahzhad, Hira, 2015). The PICOT question that I have developed was Emergency Room patients + interventions to reduce overcrowding + Daily Operation + Patient Satisfaction After entering Overcrowding as the first keyword in the CINAHL & MEDLINE Combined Search database, I received 2,068 hits, which I considered a significant search. Using the terms Emergency Room and Overcrowding in the investigation, the results were reduced to 616 hits; by including the word “solution” in the Boolean expression, the results were further reduced to 64 hits. The purpose of developing a search strategy is to identify the pool of relevant citations on the topic. The quality of searches can be formally evaluated by recall and retrieval rates (Hempel, 2020).Strategies for enhancing the rigor and effectiveness of a database search include the following: knowing the nature and content of the databases being searched; Utilizing Boolean Operators, Parentheses, Truncation, and Wildcard Symbols; Recognizing the Limitations of the Search Interface Used to Conduct the Literature Search. In the planning stage of any research project, the process of conducting an intensive and complete literature search is crucial (Spurlock, Darrell, 2019).

References

Akbar Baig, Muhammad, Mian, Asad, Najeeb, Fatima, & Shahzhad, Hira. (2015). Overcrowding in the emergency departments: Challenges and opportunities for improvement. Journal of Pakistan Medical Association, 65(12), 1344-1345. https://advance-lexis-com.ezp.waldenulibrary.org/document/?pdmfid=1516831&crid=54613b69-5b87-48a6-8bee-7a5bb1ef96b0&pddocfullpath=%2Fshared%2Fdocument%2Fnews%2Furn%3AcontentItem%3A5HMS-M781-JD09-30CX-00000-00&pdcontentcomponentid=400876&pdteaserkey=sr0&pd

Hempel, S. (2020). How to look: Developing search strategies. In S. Hempel, Conducting Your Literature Review (pp. 37-48). Washington DC: American Psychological Association. doi:http://dx.doi.org.ezp.waldenulibrary.org/10.1037/0000155-004

Spurlock, Darrell. (2019, August). Searching the Literature in Preparation for Research: Strategies That Matter. Journal of Nursing Education, 58(8), 441-443. doi:DOI:10.3928/01484834-20190719-02

RE: Discussion – Week 4

My clinical issue of interest is the current staffing of inpatient acute psychiatric facilities. As any nurse who has ever done a rotation or worked in a hospital in the last decade will tell you, staffing correctly can make or break your day. Not only this but has a direct impact on patient care outcomes. At the facility that I work at, and other psychiatric facilities in my state, we are staffed based on numbers at the end of the previous night. So at midnight, whatever the patient count is, this is how we are staffed for the next day. Patients continue to admit throughout the night and through the next day, whether we have staff or not. There is no consideration put into the acuity of these patients. While most of our patients are inpatient with us due to increasing depression and suicide attempts, there are in fact patients who come to us severely psychotic, completely out of touch with reality, and some manic. This means that to help them, we are understaffed and struggling to give them the care they need. There are no current staffing laws at the state level to change this policy. “Formulating a clinical question in a systematic way makes it possible to find an answer more quickly and efficiently, leading to improved processes and patient outcomes” (Stillwell et al, 2010).

According to Melnyk and Fineout-Overholt, “Finding the right information in a timely way amid an overwhelming amount of information is imperative” (2019, p. 37). First I tried to search on the CINAHL database with just the words “staffing acuity”. This brought me to 120 results. I then always like to turn on the “peer-reviewed scholarly journals” and the “full text”. This brought me to about 101 results. To narrow this down further, I added after the “and” the word “psychiatric”. This brought my results down to 4. Using the word “and” in the search allows for the search to include more than the original words, making the search produce better results (Library of Congress, n.d.). My search is a difficult one as not much research has been done into psychiatric facilities staffing levels. I plan to also use the plans that have been used in multi-specialties hospitals, and relate them to psychiatric staffing needs.

Library of Congress. (n.d.). Search/browse help – Boolean operators and nesting. Retrieved September 20, 2021, 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. , Fineout-Overholt, E. , Melnyk, B. & Williamson, K. (2010). Evidence-Based Practice, Step by Step: Asking the Clinical Question. AJN, American Journal of Nursing, 110 (3), 58-61.

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