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.
RESOURCES
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
WEEKLY RESOURCES
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 Page
Links to an external site.
– databases and resources specifically for Nursing
Evidence-Based Practice guide:
Evidence Types
Links to an external site.
Nursing and Health research videos
Links to an external site.
, including a 15-minute introduction
Get Help
Links to an external site.
page, including
Ask a Librarian
Links to an external site.
service
Quick Answers:
How do I find an article that reports on research that uses a specific methodology?
Links to an external site.
How do I find original or primary research that analyzes empirical data?
Links to an external site.
What is the Find at Walden button?
Links to an external site.
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.
Search entries or author
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Robinson Orakwue
Robinson Orakwue
Dec 19, 2022
Dec 19, 2022 at 8:55pm
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For the sake of this discussion post, I would want to submit a question about post-operative pain management because it is an important topic that is central to patient rehabilitation following either inpatient or outpatient surgical procedures. Can pain management improve pain control in four days following surgery utilizing pharmacological and non-pharmacological therapy on post-operative surgical adult patients? using the PICOT question style. The PICOT acronym stands for “population that corresponds to our surgical patients,” “I” stands for “operation” and “pain control,” “C” stands for “comparison,” “O” stands for “product of pain treatment” and “T” stands for “time period or achieving this purpose,” which in this case is four days after surgery. According to Melnyk, the capacity to gather information in the appropriate manner at the appropriate time is insufficient (2018,p34 ). To navigate the data-rich world that clinicians deal with, one must develop practical, lifelong learning skills (such as asking targeted questions and learning to search methodically).
I conducted my research for this topic using ProQuest and the CINAHL Plus database. My minimum word search was for “pain management,” and it produced 20,494 and 21,460 hits, respectively. After applying limiters for the entire text, peer review, and date range from 2017 to 2020, the results of the streamlined search were 13,601 and 15,787, respectively. The following research was further honed with the use of the Boolean search parameter for surgical patients: The seamless operation of my study was further aided by my inclusion of a final criteria for one of the most recent publication years, 2020, as follows: ProQuest produced 232 results, whereas CINAHL Plus returned 203 full-text searches. When searching for complex topics, you should utilize multiple search terms and Boolean operators to get the best results, both within and between search fields (Retrieved September 6th, 2019)
In order to increase the rigor and effectiveness of my data base search results, I will additionally include important terms from my PICOT inquiry like “surgery” and “pharmacological.” Some of the tactics I will employ include narrowing my search limiters to the most recent year of publication. “Keyword searching” is the process of choosing search terms and typing them in the database search boxes to find information on your topic. (Accessible as of September 19, 2018)
References:
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
Kendall Alba
Kendall Alba
Dec 21, 2022
Dec 21, 2022 at 10:26am
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Response #1
Thanks for sharing, Robinson. I enjoyed your clinical topic. When I first searched for my topic, I received a lot of articles as well. Narrowing down the articles by specific years was a great idea that I did not think of. I would suggest using Boolean operators. Boolean operators are the words “and” “not” and “or” that allows for a more specific search based on search terms and concepts (Library of Congress, n.d.).
I noticed you used ProQuest and CINAHL Plus database as the main databases for research. Those are both great databases. I also like MEDLINE. MEDLINE has over millions of journal articles related to life sciences with a focus on biomedicine (Walden University Library, n.d.). When I searched “pain management” on MEDLINE, it produced 56,596 journals. You have a great topic and should not have any issues finding journal articles for research.
References
Library of Congress. (n.d.).
Search/browse help – Boolean operators and nesting
. Retrieved December 19th, 2022, from
https://catalog.loc.gov/vwebv/ui/en_US/htdocs/help/searchBoolean.html
Links to an external site.
Walden University Library. (n.d.-a).
Databases A-Z: Nursing
. Retrieved December 21, 2022, from https://academicguides.waldenu.edu/az.php?s=19981
Doris Hill
Doris Hill
Dec 21, 2022
Dec 21, 2022 at 9:27pm
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Hello Robinson,
Good overview of your search, the databases and key terms used. Good start to your PICOT question and addressing each component.
Enion Hampton
Enion Hampton
Dec 23, 2022
Dec 23, 2022 at 8:11pm
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Hi Robinson- I enjoyed reading your post because post-operative pain medicine is near and dear to my heart and the statistic still amaze me; thus I would like to see more information on this. I also used Cinahl and ProQuest for my searches and found a whole lot of resources until I used the Boolean operator and was able to specialize my results to be aligned with what I was looking for.
I agree with Melnyk in stating we must know how to search to generate appropriate responses for scholarly writing. In my research, I found a really good article in alignment with VAP and oral care, my topic. However, the article was about nurses in Iran. I didn’t feel that taking data from that article would’ve been pertinent to me. For that reason, I also try to keep my articles based in the US. The way VAP and oral care may or may not be the same in the US and Iran – but I do not know, so I stick to articles written about US nursing. What are your thoughts about using ex-US articles?
Melnyk, B. M., & Fineout-Overholt, E. (Eds.). (2011).
Evidence-based practice in nursing & healthcare: A guide to best practice
. Lippincott Williams & Wilkins.
Zurmehly, Joyce, PhD, DNP,R.N., N.E.A.-B.C. (2013). Oral care education in the prevention of ventilator-associated pneumonia: Quality patient outcomes in the intensive care unit.
The Journal of Continuing Education in Nursing, 44
(2), 67-75. doi:https://doi.org/10.3928/00220124-20121203-16
PLACE ORDER HERE
Marjacha Mbah Christina
Marjacha Mbah Christina
Dec 24, 2022
Dec 24, 2022 at 10:58pm
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Reply post 2
Hi Robinson,
Great post, I enjoy reading your post. Pain management is one of the most important aspects of treatment espescially when it come to inpatient r out patient procedures like you said. some first-line treatments are physical, pharmacological drugs, therapy, occlusal splints, laser therapy, oxygen–ozone therapy extracorporeal shockwave therapy, and transcutaneous electrical nerve stimulation (Ferrillo, M. et al 2022). When attempting to answer a PICO(T) question, it is important to use high-level evidence. You may ensure that you are using the best evidence that is currently available to answer your issue by searching multiple databases and giving careful consideration to the evidence that you find.
References
Ferrillo, M., Giudice, A., Marotta, N., Fortunato, F., Di Venere, D., Ammendolia, A., Fiore, P., & de Sire, A. (2022). Pain Management and Rehabilitation for Central Sensitization in Temporomandibular Disorders: A Comprehensive Review.
International Journal of Molecular Sciences
,
23
(20), 12164–N.PAG.
https://doi.org/10.3390/ijms232012164
Links to an external site.
Echevarria, I. M., & Walker, S. (2014). To make your case, start with a PICOT question.
Nursing
,
44
(2), 18–19.
https://doi.org/10.1097/01.NURSE.0000442594.00242.f9
Links to an external site.
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Vaibhav Patel
Vaibhav Patel
Dec 20, 2022
Dec 20, 2022 at 4:11am
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Since migrating here to the United States, most of my nursing experience has been working with the older population. One of the challenges we have always faced was falling, especially the severe injuries related to falls. Falls are common problem among older adults and are a leading cause of severe injury and death worldwide (Shuman, Montie, Galinato, Todd, Heggstad, & Titler, 2016). This led me to my PICOT question: In older adults (P), how does the involvement of patients’ perception of fall prevention (I) compared to no involvement (C) affect the prevention of falls (O) during hospitalization or inpatient stay (T)?
In searching for important PICOT answers clinicians use databases to find the sources that hold the best evidence (Melnyk & Fineout-Overholt, 2018). The two databases used for my PICOT question are CINAHL and MEDLINE. Using keywords from the PICOT question is an essential strategy in searching using the databases (Melnyk & Fineout-Overholt, 2018). The keywords I used are fall prevention, patient perception, & hospitalization. In my initial search, when the keywords were entered, CINAHL resulted in 298 articles while Medline showed 52 articles. When BOOLEAN terms were used in CINAHL and MEDLINE showed 12 articles that narrowed it down to search for evidence for, sixteen articles resulted in my clinical inquiry.
Strategies are used to increase the rigor and effectiveness of a database search. Appropriate keywords need to be selected by taking the main parts of the clinical question or topic (example: fall prevention, patient perception, & hospitalization). Using Boolean terms or operators is another strategy to connect keywords to generate a logical phrase that the database can understand (Walden University Library, n.d.). Using Boolean terms facilitates generating more precise and robust searches to provide pertinent results (Walden University Library, n.d.) An example of the Boolean term is using AND helps find items that use both keywords OR uses either of the keywords and NOT which excludes items that use the keywords (Walden University Library, n.d.). Furthermore, truncation of root words by putting an asterisk at the end of the root word (example: old*) tells the database to search for the word with any ending which expands search for more articles (Walden University Library, n.d.). Limiting searches is also another strategy to help clinicians review to decide whether what is relevant to the clinical question (Melnyk & Fineout-Overholt, 2018). An example is that in CINAHL uses “Limit to” by using parameters such as publication year (example: 2016-2020) (Melnyk & Fineout-Overholt, 2018). Database search skills are vital to the success of a researcher to obtain the best result (Walden University Library, n.d.). It takes time to develop database search skills, using strategies to develop these skills will result in a robust and effective database search.
Reference
Shuman, C., Liu, J., Montie, M., Galinato, J. G., Todd, M. A., Hegstad, M., & Titler, M. (n.d.).
Patient perceptions and experiences with falls during hospitalization and after discharge
. Applied nursing research. Retrieved December 20, 2022, from
https://pubmed.ncbi.nlm.nih.gov/27397823/
Links to an external site.
Melnyk , B. M., & Fineout-Overholt, E. (2018).
Evidence-based practice: Step by step: The seven steps of evidence-based practice
. The American journal of nursing. Retrieved December 20, 2022, from
https://pubmed.ncbi.nlm.nih.gov/20032669/
Links to an external site.
College of Nursing
. Walden University. (2020, October 28). Retrieved December 20, 2022, from
https://www.waldenu.edu/college-of-nursing
Links to an external site.
Academic guides: Keyword searching
. Academic Guides at Walden University. (n.d.). Retrieved December 20, 2022, from
https://academicguides.waldenu.edu/library/keyword/boolean
Links to an external site.
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Doris Hill
Doris Hill
Dec 21, 2022
Dec 21, 2022 at 9:32pm
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Hello Vaibhav,
The process outlined in your posting did a good job of showing important steps to consider such as using boolean operators and key words. Good start to your PICOT question. One part of your question notes perception and the other involvement. Were you able to find relevant articles for ‘perception’ compared to some other terms you could use for falls?
Vaibhav Patel
Vaibhav Patel
Dec 21, 2022
Dec 21, 2022 at 10:41pm
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Hello Dr Hill,
Thank you for giving me your input on my discussions, yes I was able to narrow down my search on articles and I was able to find few relevant articles on patient’s perceptions of fall prevention.
Tiffanie Lundy
Tiffanie Lundy
Dec 23, 2022
Dec 23, 2022 at 1:23pm
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Vaibhav,
Great post!! Falls are a common problem among medical facilities both near and far (Shuman, Montie, Galinato, Todd, Heggstad, & Titler, 2016). It has been a struggle to try to find ways to decrease falls among patients. Some say bed and chair alarms are not good and startle patients others say they help. It is tough to know as each patient is different. The facility I used to work at did a trial without them and falls actually increased. I do believe that hourly rounding helps significantly to decrease falls. I also used CINAHL in my search. It was fairly easy. I do think that the use of BOOLEAN was helpful in my search. Boolean facilitates more specific detailed searches to narrow down articles related to the search (Walden University Library, n.d.). If I can ask, where did you migrate from? I am always eager to learn different aspects of nursing cultures.
References
Shuman, C., Liu, J., Montie, M., Galinato, J. G., Todd, M. A., Hegstad, M., & Titler, M. (n.d.).
Patient perceptions and experiences with falls during hospitalization and after discharge
. Applied nursing research. Retrieved December 20, 2022, from
https://pubmed.ncbi.nlm.nih.gov/27397823/
Links to an external site.
College of Nursing
. Walden University. (2020, October 28). Retrieved December 20, 2022, from
https://www.waldenu.edu/college-of-nursing
Links to an external site.
Academic guides: Keyword searching
. Academic Guides at Walden University. (n.d.). Retrieved December 20, 2022, from
https://academicguides.waldenu.edu/library/keyword/boolean
Lami Ibrahim
Lami Ibrahim
Dec 23, 2022
Dec 23, 2022 at 8pm
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Great topic Vaibahav and thank you for discussion post regarding falls. I actually enjoyed reading your clinical issue of interest about falls. Falls are very common among the elderly. Every 11 seconds, an older adult is
treated in the emergency room for a fall; every 19 minutes, an older adult dies from a fall (Stillwell, et. al, 2010). Fall subject has always been very interesting subject to learn. Falls are often alarming mostly do debilitate older residents. It decreases the residents’ health and comfort. Most residents that experience fall develops a fear of falling again as it restricts their activities (AHRQ,n.d.). A
lso, I find it very helpful in how you narrow down your search articles and the use of CINHAL and Medline. As per Stillwell, et.al, (2010) The PICOT format is a form of a clinical question to filter part in the search for evidence. It organized the clinical question to refine the search faster and more systematically. Boolean was helpful and facilitates in narrowing it down in article that is related to my clinical issue of interest.
Reference
AHRQ, (n.d). Fall Management Program: A Quality Improvement Initiative for Nursing Facilities. https://wwwlahrq.gov/patient-safety/sttings/long-term-care/resource/injuries/fallspx/man1.html
College of Nursing
. Walden University. (2020, October 28). Retrieved December 23, 2022, from
https://www.waldenu.edu/college-of-nursing
Stillwell.S.B., Fineout-Overholt, E.,MelnykB.M. & Williamson,K.M.(2010). Evidence-Based Practice step by step: Asking the Clinical Question AJN,
American Journal of Nursing,
110(3),58
https://doi.org/10.1097/01.naj0000368959.111.29.7
Links to an external site.
Leslie Sandoval
Leslie Sandoval
Dec 23, 2022
Dec 23, 2022 at 8:50pm
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Hello Vaibhav,
Thanks for sharing such a great story about emigrating to the United States. The topic of fall risk in the elderly population is much appreciated. In gerontology, RNs must exercise great caution for fall-risk education and prevention.
Fall risk
is a vital safety area that RNs need to address on every shift. Accidental injuries rank eighth as a cause of death for older people, and falls are the most common cause of nonfatal injuries and hospital admissions. (Hinkle & Cheever, 2018). Falls rise with age, and one out of five falls in older adults result in serious injuries such as broken bones or a head injury. (Id).
A recent article suggested a multi-step protocol including screening for falls, comprehensive fall assessment, and gait and balance screening when necessary. An individualized fall intervention program addressing specific fall risks is presented. (Kruschke & Butcher, 2017). Nurses should encourage the elderly and their families to make lifestyle and environmental changes to prevent falls. Adequate lighting should be installed. The bathtub and shower should have grab bars, and the toilet should be helpful. Loose clothing, improperly fitting shoes, throw rugs, small objects, and pets increase fall risk. As future nursing leaders, we must always emphasize fall-risk prevention strategies for older patients.
I also used CINAHL & MELINE combination database. I appreciate your advice on narrowing down the number of articles in a search using various Boolean operators. I also used the drop-down menus within the database inquiry options to narrow my searches for this assignment. Walden University Library, n.d.). The PICOT format is something that I will need much more practice to improve my research skills. Good job, and thanks for the exciting topic.
References
Hinkle, J. L., & Cheever, K.H. (2018). Brunner & Suddarth’s textbook of medical-surgical nursing (14th ed., Vol. 2). Wolters Kluwer.
Kruschke, C., & Butcher, H. K. (2017). Evidence-Based Practice Guideline: Fall Prevention for Older Adults. Journal of Gerontological Nursing, 43(11), 15-21. https:.//doi.org/10.3928/00989134-20171016-01.
Walden University Library. (n.d.-a). Databases A-Z: Nursing. Retrieved December 23, 2022, from
https://academicguides.waldenu.edu/az.php?s=19981
Links to an external site.
.
Romario Lewis
Romario Lewis
Dec 23, 2022
Dec 23, 2022 at 10:31pm
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Hey Vaibhav,
Falls are such a serious thing especially for the elderly. I work in the icu and typically have a severe fall injury patient each week. Many of times it is a repeated event. However it seems like not much had been put into place since the last fall to prevent future occurrences. “Every second of every day, an older adult (age 65+) suffers a fall in the U.S, making falls the leading cause of injury and injury death in this age group” (CDC, 2020). You chose a really good clinical issue to focus on.
Your keyword searches are spot on for your clinical inquiry. I do suggest finding fall prevention strategies that can lower the risk of falls such as making one’s home fall proof (Elsevier, n.d.). That would be a great way to add patient education which is a great way to decreases readmission for the same complaint. I am sure they have great research on fall prevention strategies which does tie in to one’s perception.
Reference
Centers for Disease Control and Prevention. (2020, December 16).
Keep on your feet-preventing older Adult Falls
. Centers for Disease Control and Prevention. Retrieved December 23, 2022, from https://www.cdc.gov/injury/features/older-adult-falls/index.html
Patient education fall prevention in the home, adult
. Elsevier. (n.d.). Retrieved December 23, 2022, from https://elsevier.health/en-US/preview/fall-prevention-in-home
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Kendall Alba
Kendall Alba
Dec 20, 2022
Dec 20, 2022 at 10:48am
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Main post: Week 4
My clinical issue of interest is nurse-to-patient ratios affecting patient outcomes. My clinical question would be: does nurse to patient ratios affect patient outcomes? Developing a PICOT format allows clinicians to search for the most relevant information (Melnyk & Fineout-Overholt, 2018). The population of interest would be inpatients in a hospital setting. The intervention would be having fewer patients per nurse per shift than normal. The comparison would be monitoring the nurse with a set number of patients before the intervention is applied. The expected outcome would be that nurses who care for fewer patients on a given shift have better patient outcomes.
I used the Walden library to search for my topic. I search by using the words “staffing ratios.” This search yielded 5,997 articles. Boolean operators allow for a more specific search based on search terms and concepts (Library of Congress, n.d.). I then used the words “staffing ratios” “and” “patient outcomes,” which populated 534 articles. During my first search, there were too many articles to search through, so using a Boolean operator such as “and” helped define my search the second time.
There are a few ways I could improve my research. I could focus more specific nursing databases. When I did my research, I used Walden Library and needed to pay more attention to which database the articles were coming from. CINAHL Plus with Full-Text database has over 750 nursing-related journals ( Walden University Library, n.d.). Another way I could be more defined in my research is by being more specific with my patient population. If I focused on just med/surg patient populations, I might find a few articles to choose from and more detailed information related to that patient population.
References
Library of Congress. (n.d.).
Search/browse help – Boolean operators and nesting
. Retrieved December 19th, 2022, 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.
Walden University Library. (n.d.-c). Evidence-based practice research: CINAHL search help. Retrieved December 20th, 2022, from https://academicguides.waldenu.edu/library/healthevidence/cinahlsearchhelp
Matthew Mormann
Matthew Mormann
Dec 21, 2022
Dec 21, 2022 at 10:13am
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6052 response #1
Hello Kendall,
Your clinical issue of interest of the nurse to the patient is such an important aspect of nursing. I dream of a day when it gets the attention that it needs. Most nurses don’t understand this until they have been on both sides. I have worked with the 3:1 ratio and 6:1 ratio. Increasing the ratio causes mistakes of all kinds, lack of care, burnout, and anger (Gutsan et al.). Once this issue is addressed and federally regulated, I believe this will directly raise the nursing standard of better patient care and less burnout (Chen et al., 2019).
For the sake of nursing, patients, and healthcare I hope your passion for this clinical interest yields fruitful results and you have the tools and support you need to accomplish a safer, thriving environment for nurses and their patients. I look forward to the change for our future nurses embracing their careers and looking forward to coming into work to change people’s lives by making a positive impact because they can focus on their patients and the tasks at hand.
References
Chen, Y.-C., Guo, Y.-L. L., Chin, W.-S., Cheng, N.-Y., Ho, J.-J., & Shiao, J. S.-C. (2019). Patient–nurse ratio is related to nurses’ intention to leave their job through mediating factors of burnout and job dissatisfaction.
International Journal of Environmental Research and Public Health
,
16
(23), 4801. https://doi.org/10.3390/ijerph16234801
Gutsan, E., Patton, J., Willis, W. K., & Alberto Coustasse, D. P. H. M. D. (n.d.).
Burnout syndrome and nurse-to-patient ratio in the workplace
. Marshall Digital Scholar. Retrieved December 21, 2022, from https://mds.marshall.edu/mgmt_faculty/196/
Justino Cosentino
Justino Cosentino
Dec 22, 2022
Dec 22, 2022 at 2:09pm
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Hi Kendall,
I too chose the clinical issue of nurse-to-patient ratios and how it affects patient’s outcomes. Your overview is much like mine with the same intervention and same expected outcome. I did notice that you used a different database than me and you received a higher number of generated results. I think that your PICOT question is formatted well. This is an important stage in being able to hopefully find the best information available. The PICOT question format is an essential guide to help conduct a systematic, efficient and thorough search (Melnyk & Fineout-Overholt, 2018). I also took notice that when you refined your search phrase your number of articles that resulted significantly decreased. Some other filters I learned about while working on my discussion board is that according to Duquesne University (2020) to obtain more reliable content one can select “only scholarly articles” or select “research documents.” Overall, you seem to certainly be on the right track and it will be interesting to compare how your researching compares and contrasts from mine. Great post!
Duquesne University. (2020, September 26).
Formulating a picot question
. Duquesne University: https://onlinenursing.duq.edu/blog/formulating-a-picot-question/
Melnyk, B. M., & Fineout-Overholt, E. (2018).
Evidence-based practice in nursing & healthcare: A guide to best practice
(4th ed.). Philadelphia, PA: Wolters Kluwer.
Robinson Orakwue
Robinson Orakwue
Dec 22, 2022
Dec 22, 2022 at 6:31pm
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Hi Kendall,
Your clinical issue of interest is an interesting one which has been an issue of concern for nurses over the years. I’m sure you will easily find the required material that you may need. The quality of nursing care would increase with ideal nurse to patient ratios, improving patient outcomes. Low staffing levels and patient mortality are closely related, and this has a significant impact on nurses’ job satisfaction and incidences of burnout. Nurses are essential contributors on the front lines of healthcare delivery, preventing adverse occurrences, coordinating treatment, and assisting patients in achieving the best results.
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.
Athsicia Gooden
Athsicia Gooden
Dec 22, 2022
Dec 22, 2022 at 9:11pm
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1
st
Response
Hi Kendall,
This is a great subject because nurse-to-patient ratio seems to be a problem everywhere unless you work in California or in a specialty unit like ICU. According to McHugh, Aiken, Sloane, Windsor, Douglas, & Yates (2021), minimum nurse-to-patient ratio policies are a practical way to improve nurse staffing and patient outcomes with good return on stake because there is significant evidence to indicate that patient outcomes are more favorable in hospitals with better nurse staffing (p. 1906). I believe that there may be policies in place at hospitals and other facilities, however, they are almost never carried out although nurses constantly complain.
Nurses are a critical part of healthcare and make up the largest section of the health profession. According to the World Health Statistics Report, there are approximately 29 million nurses and midwives globally. Improving work environment, increasing nurse staffing levels, and providing enough support for nurses to spend more time on direct patient care would be beneficial to patient safety improvement (Haddad, Annamaraju, & Toney-Butler, 2022).
References
Haddad, L. M., Annamaraju, P., & Toney-Butler, T. J. (2022). Nursing shortage. In
StatPearls
[Internet]
. StatPearls Publishing.
McHugh, M. D., Aiken, L. H., Sloane, D. M., Windsor, C., Douglas, C., & Yates, P. (2021).
Effects of nurse-to-patient ratio legislation on nurse staffing and patient mortality,
readmissions, and length of stay: a prospective study in a panel of hospitals.
The
Lancet
,
397
(10288), 1905-1913.
Marjacha Mbah Christina
Marjacha Mbah Christina
Dec 22, 2022
Dec 22, 2022 at 11:55pm
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Reply post 1
Hi Kendall,
Great post, I like your clinical issue question. The nurse to patient ratio has been one of the main issues in healthcare and this affects patient outcome like you stated. According to an article by (Shuldam. C. et al 2009) lower patients to nurse ratio are associated with better outcomes. When attempting to answer a PICO(T) question, it is critical to make use of high-level evidence, PubMed, Cochrane Database of Systematic Reviews, EBSCOhost and others are important resources to consult.
Reference
Shuldham, C., Parkin, C., Firouzi, A., Roughton, M., & Lau-Walker, M. (2009). The relationship between nurse staffing and patient outcomes: A case study.
International Journal of Nursing Studies
,
46
(7), 986–992.
https://doi.org/10.1016/j.ijnurstu.2008.06.004
Links to an external site.
Echevarria, I. M., & Walker, S. (2014). To make your case, start with a PICOT question.
Nursing
,
44
(2), 18–19.
https://doi.org/10.1097/01.NURSE.0000442594.00242.f9
Links to an external site.
Arabi, Y. M., Al Ghamdi, A. A., Al-Moamary, M., Al Mutrafy, A., AlHazme, R. H., & Al Knawy, B. A. (2022). Electronic medical record implementation in a large healthcare system from a leadership perspective.
BMC Medical Informatics & Decision Making
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22
(1), 1–10. https://doi.org/10.1186/s12911-022-01801-0
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Ismail Al Al Huwaitat
Ismail Al Al Huwaitat
Dec 23, 2022
Dec 23, 2022 at 5:17pm
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Hello Kendall,
I really like your discussion post, as it was very informative and elaborated. I want to add that with the current nurse-to-patient ratios in most states, RNs are developing musculoskeletal disorders and severe emotional exhaustion (Shieh et al., 2016). A more extensive staff will not only keep nurses healthier, but it will keep them more energized and eliminate many of the above-listed complaints. Adopting “safe-staffing ratios” is proven to help healthcare institutions administer better services (Griffiths et al., 2019). While the RN in the hospital remains in the pivotal position for coordinating care in hospitals, sometimes, as a case manager, the nurse assistant (NA) position has been changing. In some institutions, it is being upgraded, with NAs assuming, under the direction of the RN, increasing responsibility for more direct care activities than in the past. This results in an increasing level of management and supervisory skills being required of RNs. In some hospitals, the redesign of the nurse assistant role has occurred in conjunction with the redesign of other support activities such as dietary, housekeeping, and transportation services (Shieh et al., 2016). The integration of these functions is viewed as one way to have fewer people interacting with the patient while also providing the potential for cost savings.
References
Griffiths, P., Maruotti, A., Saucedo, A. R., Redfern, O. C., Ball, J. E., Briggs, J., … & Smith, G.B. (2019). Nurse staffing, nursing assistants and hospital mortality: Retrospective longitudinal cohort study.BMJ Quality & Safety,28(8), 609-617.
Shieh, S. H., Sung, F. C., Su, C. H., Tsai, Y., & Hsieh, V. C. R. (2016). Increased low back pain risk in nurses with high workload for patient care: A questionnaire survey.Taiwanese Journal of Obstetrics and Gynecology,55(4), 525-529.
Doris Hill
Doris Hill
Dec 23, 2022
Dec 23, 2022 at 10:43pm
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Hello Justino,
Good detail to your search discussion and what PICOT represents. What is your specific PICOT research question?
Jenna C. Alford
Jenna C. Alford
Dec 24, 2022
Dec 24, 2022 at 10:16am
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Hi Kendall,
Great post and significant clinical issues to further research! Nurse-to-patient ratios are always a hot topic in my current health system. The more patients a nurse cares for during their shift causes high-stress levels, which help leads to nurse burnout (Eltaybani, et. al., 2021). Nurse burnout leads to short staffing, which turns into a vicious cycle. The Boolean term is a great option, and another great option is to filter further your research results to ensure their articles are based on EBP. Great start, I am curious to see your final research results!
Eltaybani, S., Yamamoto-Mitani, N., Ninomiya, A., & Igarashi, A. (2021). The association between nurses’ burnout and objective care quality indicators: a cross-sectional survey in long-term care wards.
BMC Nursing
,
20
(1), 1–10. https://doi.org/10.1186/s12912-021-00552-z
Walden University Library. (n.d.-f). Keyword searching:
Finding articles on your topic: Boolean terms Links to an external site.
Links to an external site.
. Retrieved September 19, 2018, from
http://academicguides.waldenu.edu/library/keyword/boolean
Links to an external site.
Tiffanie Lundy
Tiffanie Lundy
Dec 24, 2022
Dec 24, 2022 at 4:26pm
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Reponse 2:
Kendall,
Great post! I am eager to see more of your posts as I am interested in the research that you come across with this topic. I think we all know that staffing ratios directly impact patient outcomes but I feel that sometimes hospitals forget about that. I was glad that it yeilded almost six thousand hits with the searching of staffing ratios. Boolean is a great way to define your search using search terms and concepts (Library of Congress, n.d.). I also used CINAHL for one of my databases. I found it easy to use and I like that it has over 750 nursing-related journals ( Walden University Library, n.d.).
At the facility I am currently working at the inpatient staffing ratio is 6:1 but they push them to 7:1. In the ER, the ratio is 4:1 but can be much higher than that depending on staffing. As a supervisor, we are constantly put in the middle between administration and the staff. It is not a good place to be in and I feel sorry for the staff when we are told to push them. I hope that there is something passed soon that will cap the ratio. We cannot provide good nursing care if we are stretched too far. It is just not safe for anyone involved.
References
Library of Congress. (n.d.).
Search/browse help – Boolean operators and nesting
. Retrieved December 19th, 2022, from
https://catalog.loc.gov/vwebv/ui/en_US/htdocs/help/searchBoolean.html
Links to an external site.
Walden University Library. (n.d.-c). Evidence-based practice research: CINAHL search help. Retrieved December 20th, 2022, from https://academicguides.waldenu.edu/library/healthevidence/cinahlsearchhelp
Romario Lewis
Romario Lewis
Dec 24, 2022
Dec 24, 2022 at 7:27pm
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Hey Kendall,
You brought up a very important clinical issue which has been at the forefront these past several years. “Nurse-to-patient ratios influence many patient outcomes, most markedly inhospital mortality”(Driscoll, 2018). I have seen this time and time again where patients are seen maybe once in a 6 hour span and next thing a code blue is called. In your research, I would love to see statistical data on the severity of nurse to patient ratios and the causal effect it has on both patients and nursing staff. I like CINAHL database because it certainly has quality nursing evidence based research articles. So I am sure you will find current articles addressing this issue.
Reference
Driscoll , A. (2018, January).
The effect of nurse-to-patient ratios on nurse-sensitive patient outcomes in acute specialist units: A systematic review and meta-analysis
. European journal of cardiovascular nursing. Retrieved December 24, 2022, from https://pubmed.ncbi.nlm.nih.gov/28718658/
Walden University Library. (n.d.-c). Evidence-based practice research: CINAHL search help. Retrieved December 20th, 2022, from https://academicguides.waldenu.edu/library/healthevidence/cinahlsearchhelp
Esther O Adeyemo
Esther O Adeyemo
Dec 25, 2022
Dec 25, 2022 at 12:55am
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Hello Kendall,
Your subject is one that is very significant to the nursing profession. Increased levels of job satisfaction among nurses are associated with improved nurse-to-patient staffing ratios, and improved overall working conditions. It fosters a spirit of collaboration, which, in turn, results in increased engagement in patient care in various capacities. When there is a greater emphasis on responsibility, there is an accompanying improvement in patient outcomes. A reduction in death rates, an improvement in the ability to manage infections, and an increase in the percentage of patients who are satisfied with their care are all results of improved patient outcomes (Sharma & Rani, 2020). If you apply filters to your search and conduct it the Walden Library, you will be able to get the results you are looking for. This is one of the other methods you may use to find the articles. It is also advised that you utilize Boolean phrases in order to provide more specific and relevant results; thus, you should include the Boolean terms to your search.
Reference
Sharma, S. K., & Rani, R. (2020). Nurse-to-patient ratio and nurse staffing norms for hospitals in India: A critical analysis of national benchmarks.
Journal of Family Medicine and Primary Care
,
9
(6), 2631. https://doi.org/10.4103/jfmpc.jfmpc_248_20
Justino Cosentino
Justino Cosentino
Dec 20, 2022
Dec 20, 2022 at 3:10pm
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The clinical issue I chose for my matrix and now for this discussion post is how too high of nurse-to-patient ratios has a negative effect on patients. We have all experienced as a nurse feeling overwhelmed at some point in our career. Unfortunately, the feeling of being overwhelmed in nursing can come from understaffing, leading to increased nurse-to-patient ratios which then leads to a negative effect on patients. The PICOT acronym stands for population of interest, intervention, comparison of interest, outcome expected, and time the intervention will be achieved (Melnyk & Fineout-Overholt, 2018). The PICOT format is one of the most standard and leading ways to develop a research question (Melnyk & Fineout-Overholt, 2018). The population would be the patients themselves. The intervention for my PICOT question would be setting a standard and safe nurse-to-patient ratio. The comparison in the PICOT format would be to compare the current nurse-to-patient ratios with a lower nurse-to-patient ratio. The expected outcome would be improved outcomes for patients such as decreased mortality rates and less adverse events. Lastly, the time frame for this intervention to achieve the outcome would be one year from the implementation of lower nurse-to-patient ratios.
To research my clinical issue, I used two databases on the Walden University Library. The two databases I used were PubMed and Medline. Originally, I typed into the search bar “nurse-to-patient ratios.” The total amount of articles that resulted were 397 articles dating all the way from 1977 up until 2022. Boolean operators create a more logical statement that a database can better understand (Walden University Library, 2022). The Boolean operator I added was “and.” I then typed in to the PubMed and Medline database “nurse-to-patient ratios and patient outcomes.” This then lowered the number of results to 176 articles over the course of 18 pages to scroll through ranging from the years of 1997-2022.
According to the University of Washington Health Sciences Library (2020) there are a multitude of strategies to increase the rigor and effectiveness of database searching such as removing terms that are unlikely to be used by the author and choosing the most specific subheading possible. Some other ways to increase the effectiveness of database searching is by filtering the years to within the past five years and also filtering to only see peer reviewed articles. Both of these filters can be selected on Walden University Library and significantly can increase the rigor of the research shown. Effective and reliable research can sometimes be difficult to find, but with the proper filters, Boolean operators, and databases appropriate research can be found.
Melnyk, B. M., & Fineout-Overholt, E. (2018).
Evidence-based practice in nursing & healthcare: A guide to best practice
(4th ed.). Philadelphia, PA: Wolters Kluwer.
University of Washington Health Sciences Library. (2020, March 17).
How to improve database search results: home
. University of Washington Health Sciences Library: https://guides.lib.uw.edu/hsl/improving
Walden University Library. (2022).
Keyword searching: finding articles on your topic: connect keywords
. Walden University Library: https://academicguides.waldenu.edu/library/keyword/boolean
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Isaac Okai
Isaac Okai
Dec 20, 2022
Dec 20, 2022 at 3:54pm
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My clinical issue of interest is suicide. About two years ago, a patient at my hospital completed suicide. A mutual friend of mine was the nurse on duty and on the unit where this unfortunate incident occurred. Since this happened, I have volunteered and joined nurse practice and zero suicide committees to ensure that the zero-suicide goal would be achieved. Suicide is a major global health challenge. According to the World Health Organization, nearly 703,000 people die by suicide each year, and 90% of these individuals suffer from psychiatric pathology (Chammas et al.,2022). My goal is to study suicide extensively and ascertain the pathologies that lead to it and if interventions could be put in place to prevent it from occurring. Nurses must ask important clinical questions about the care of their patients to ensure good patient outcomes. According to Melnyk, the ability of healthcare professionals to stay as informed and up to date as possible on the latest best practices leads to successful patient care (2018, p34). My PICOT question was derived from my clinical issue of interest and current practice: In hospitalized inpatient psychiatric patients with major depressive disorder with suicidal ideation(P), how does continuous observation status (I), compared with fifteen minutes safety checks (C) affect the number of suicidal attempts and self-harm behaviors during the first three-month period(T)?
I searched the Walden library, then Databases A-Z to pub med, including the MEDLINE database and NIH-funded research projects. My initial search for suicide yielded 30,043. I amended the search to include suicide in an inpatient setting with the application of articles less than five years. I limited the search to only peer reviewed articles which resulted in 281 articles. When I amended the search to Medline, peer-reviewed, and applied Boolean operators. It resulted in 77 articles. Surprisingly when I included constant observation with Boolean operators, I came across an article that was evidenced based and suited the clinical issue I was interested in. MEDLINE contains about 5,000 full-text journals and is mainly related to biomedical health. It is my preferred health database because I learned how to search specifically for unfiltered studies (Walden University Library, n.d.).
In the exercise, I realized that it is more efficient to include the components of the issue of interest in the initial database search PICO(T). My initial search for suicide was vague and yielded too many articles. When I refined the search while utilizing the PCO(T) guidelines worth the inclusion of Boolean, this resulted in fewer but evidenced-based articles useful for my studies in the future.
References
Chammas, F., Januel, D., & Bouaziz, N. (2022). Inpatient suicide in psychiatric settings: Evaluation of current prevention measures. Frontiers in psychiatry, 13, 997974. https://doi.org/10.3389/fpsyt.2022.997974
Melnyk, B. M., & Fineout-Overholt, E. (Eds.). (2011). Evidence-based practice in nursing & healthcare: A guide to best practice. Lippincott Williams & Wilkins.
Walden University Library. (n.d.-e). Evidence-based practice research: MEDLINE search help Links to an external site. Retrieved December 20, 2022, from https://academicguides.waldenu.edu/library/healthevidence/me
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Robinson Orakwue
Robinson Orakwue
Dec 21, 2022
Dec 21, 2022 at 2:32am
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Hi Isaac,
Your PICOT question seems very interesting because it is a resultant effect of major depressive disorder which has a great impact on our society. When sentinel events happen in the hospital, it even become a major issue of concern because one will think that such event will unlikely happen in the hospital. A lot of hospital has adopted one on one observation for any patient with suicidal ideation in order to avoid sentinel events. Personally, I do not believe that 15 minutes observation will prevent suicide in patients with major depressive disorder as it only takes less than 2 minutes to take one’s life.
Lastly, nurses should make screening for suicide an ongoing assessment instead of asking those questions only during admission or only when patient is assumed to be depressed. I cannot wait to see the result of your research.
Isaac Okai
Isaac Okai
Dec 22, 2022
Dec 22, 2022 at 4:53pm
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Thanks for reading my post and responding. I will be more than happy to send you a copy when all is said and done.
Senait Bahiru
Senait Bahiru
Dec 24, 2022
Dec 24, 2022 at 8:45am
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Hi Isaac!
Great work! The PICOT questions discuss suicidal ideation as an excellent chance to identify the disease and determine the risk factors to reduce self-infliction. The word “Suicide” is a keyword to indicate answers about how diseases can be screened in advance. (Nagata, C. 2022) Suicide is the 10th leading cause of death in the United States, and suicide rates have increased 33% in the last decade. It has been found that 83% of those who die by suicide received healthcare services in their last year of life; thus, healthcare providers are uniquely suited to play a role in identifying suicidality. It is essential to know how often and when the disease causes clinical symptoms. It is also essential to know how knowledge can be used in classifying the illnesses of mental health that lead to suicide. The PICOT question for any database research is the method and statements that make it easy to form once the main elements have been discovered. Databases accessed included PubMed, CINAHL, and MEDLINE easy to use keywords for this search suicide, suicide screening, and suicide prevention. (Bowers, A. 2018) PICO questions were then created to help identify relevant studies pertaining to screening patients with suicidal ideation in the emergency department
Reference
Nagata, C. (2022). Screening for Suicide Risk in the Outpatient Electroconvulsive Therapy Population
.
Bowers, A., Meyer, C., Hillier, S., Blubaugh, M., Roepke, B., Farabough, M., … & Vassar, M. (2018). Suicide risk assessment in the emergency department: Are there any tools in the pipeline?. The American journal of emergency medicine, 36(4), 630-636.
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Lami Ibrahim
Lami Ibrahim
Dec 20, 2022
Dec 20, 2022 at 9:45pm
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Main Post: Discussion #2
The chosen research area is nurse’s work environment associated psychological risk and mental wellbeing causse by workload, quantitate demands, role conflict, emotional demand, and work pace in having significant connections among nurses would lead to burnout and having stress level that is high. Nurses are, in most cases, subjected to various strenuous working conditions compared to the other healthcare. However, different approaches can be used in the management while enabling the nurses to cope properly. Whenever stress and burnout are properly managed, it is possible that nurses would meet the goals with which they attend to patients, and this would lead to increased job satisfaction.
I used three databases, Medline, PubMed, and Google Scholar to search through numerous different search terms, key words, and Boolean operators to study how each database acts and reacts to my queries (Melnyk & Fineout-Overholt, 2018). The purpose of this search was primarily to learn for my own understanding. Secondarily, of course it was to refine my area of research for my selected area, stress, and burnout management among nurses. I would like to state that several PICO combinations were tried within the last five years’ time range, and each brought different results which were similar but different. There is no other way to confirm which result is closer than the other, so I manually read the results on three pages to compare if one result is better than the other.
The following PICO combinations were tried, and I reached these questions after using keywork search strategies with Booleans. Does nurse tress management make a difference compared to nurses without stress management? Do stress management strategies help nurses cope with workplace stress better than those that do not know the strategies? As literature suggests, the key is to use relevant terminologies and keywords that are frequently used in a discipline’s register, so these PICO combinations brought very high and diversified results, and some were not even in the nursing profession which rang a bell for me, and following literature, I located specific term, burnout, and added to my Final PICO above which brough highly relevant results (Melnyk & Fineout-Overholt, 2018).
I was surprised that Medline brought very few results, within 100. Whereas Google Scholar returned neatly 15,000. When I researched further, I learned that Medline has full text, highly credible publication; whereas, Google Scholar mostly has indexes publications that may also include substandard publication (except the ones available through open-source license). The third database u used, PubMed, didn’t bring any results for the PICO question, but returned roughly 20,000 for different keywords such as Nurses and stress management; Nurse and coping with stress and workplace or hospital; nurses and stress and burnout. It was also surprising for me.
I think not every database is tuned to PICO question format. What I have learned is that if the whole PICO question does not return relevant and recent result, probably, we might want to narrow it to relevant keywork combinations so that relevant results may appear. For instance, though the PICO was probably too complex for PubMed to process, it did return nearly 20,00 results when I tried main keywords. I think we should keep this important observation in mind when doing future searches. In addition, to increase the rigor and effectiveness of my database search result, adding terms “burnout” is very important in getting a great result.
Reference
Davies, K. S. (2011). Formulating the evidence-based practice question: A review of the frameworks for LIS professionals. Evidence Based Library and information Practice, 6(2), 75-80.
https://doi.org/10.18438/B8WS5N
Links to an external site.
Library of Congress. (n.d.). Search/browse help – Boolean operators and nesting. Retrieved December 19, 2022, from
https://catalog.loc.gov/vwebv/ui/en_US/jtdpcs/help/searchBoolean.html
Links to an external site.
Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4
th
ed.). Philadelphia, PA: Wolters Kluwer.
Stillwell, S. B., Fineout-Overholt, E., Melnyk, B. M., & Williamson, K. M (2010a). Evidence-based practice, step by step: asking the clinical question: A key step in evidence-based practice. American Journal of nursing, 110(3), 58-61 doi:10.1097/01.NAJ.0000368959.11129.79
Senait Bahiru
Senait Bahiru
Dec 22, 2022
Dec 22, 2022 at 9:49pm
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Hi Lami,
I enjoy your post! The purpose of a PICOT question is to find the terms to be used to search for the best evidence to answer clinical questions. It is search strategies that lead to efficient search. It is helpful for scoping searches to find key studies and to get an idea of the potential size of the evidence-based. I use CINAHL and MEDLINE databases which have been a quick way of searching PICOT questions. As you mentioned, the PICOT was complicated for most databases. However, CINAHL and MEDLINE have full-text and credible publications; It gives better results if we use the appropriate keyword. The patient is part of the population’s health risk. Thorough information about the patient should be collected. This helps in making informed decisions and forming answers that would be based on data and not just assumptions. (McClinton, T. D. (2022)The evidence-based practice (EBP) competencies of cultivating inquiry and formulation of Population, Intervention, Outcome, and Time (PICOT) questions are essential to quality improvement, healthcare outcomes, and the development of Doctor of Nursing Practice (DNP) scholarly projects.
Reference
McClinton, T. D. (2022). A guided search: Formulating a PICOT from assigned areas of inquiry. Worldviews on Evidence‐Based Nursing, 19(5), 426-427.
Doris Hill
Doris Hill
Dec 23, 2022
Dec 23, 2022 at 10:45pm
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Hello Lami,
Your search offers insights that can be used to search multiple databases, use different terms and the significance of the PICOT themselves.
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Matthew Mormann
Matthew Mormann
Dec 20, 2022
Dec 20, 2022 at 10:35pm
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Initial Post
One measurement tool used to evaluate a clinical issue is the P.I.C.O.T question, this entails P (population), I (intervention), C (control), O (outcome), and T (time) (Lira & Rocha, 2019). The clinical issue that I chose to evaluate is the effectiveness of telemedicine. Telemedicine has been around for several decades, but due to Covid-19 telemedicine, it grows immensely in different healthcare areas.
Using google scholar and typing “telemedicine” the search result yielded 901,000 results. Using the same search engine and utilizing a Boolean operator to narrow the search and provide more specific and relevant information I clicked on the “time” column from 2018 to current, and this narrowed the search to 82,900. I would then utilize the word “telemedicine” and combine it with each word of the acronym P.I.C.O.T. For example, “telemedicine effectiveness on population” which reduced the results to 19,100. This yielded very specific articles to reference such as how telemedicine impacts diabetes, hypertension, and dyslipidemia patients. These are all common good examples because of the different aspects of the disease processes with teaching skills, follow up and assessments of this common disease found in the population. (Timpel et al., 2020).
Another strategy that I would use is examining the article’s size of the study and the scientific approach utilized in the research. If the length of the study or the size of the population was small, I would attempt to find another article that had a larger experimental group. Another is the disease process or situation under investigation in the study. To encompass a topic that covers all angles and aspects of telemedicine such as assessing, teaching skills, and following up with the patient to see if the teaching was effective. For example, during covid-19 cancer patients had an especially hard to accommodate to weakened immune systems and other complications of their cancer. This opportunity for telemedicine showed an excellent proving ground for testing and results (Shirke et al., 2020).
References
Lira, R. P., & Rocha, E. M. (2019). Picot: Imprescriptible items in a clinical research question.
Arquivos Brasileiros De Oftalmologia
,
82
(2). https://doi.org/10.5935/0004-2749.20190028
Shirke, M. M. ., Shaikh, S. A. ., & Harky, A. (2020). Implications of Telemedicine in Oncology during the COVID-19 Pandemic.
Acta Biomedica Atenei Parmensis
,
91
(3), e2020022. https://doi.org/10.23750/abm.v91i3.9849
Timpel, P., Oswald, S., Schwarz, P. E., & Harst, L. (2020). Mapping the evidence on the effectiveness of telemedicine interventions in diabetes, dyslipidemia, and hypertension: An umbrella review of systematic reviews and meta-analyses.
Journal of Medical Internet Research
,
22
(3).
https://doi.org/10.2196/16791
Links to an external site.
Isaac Okai
Isaac Okai
Dec 22, 2022
Dec 22, 2022 at 4:51pm
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Hi Mathew,
Telehealth has been part of healthcare for some time now. Before the pandemic, there was only 0.3% patronage among traditional Medicare beneficiaries across the United States (Chen et al.,2022). However, the Covid-19 pandemic has accelerated and increased the usage of telemedicine. Telehealth use among Medicare beneficiaries increased from 840,000 visits in 2019 to 52.7 million in 2020 (Jezewski et al.,2022). Telehealth can be effective in many aspects of Health care. Underserved and rural areas benefit more from telehealth because it provides opportunities to expand treatment access and reduce barriers to care (Butner et al.,2021). I recall a conversation with a provider who indicated that he has had about 100% of his patients attending telehealth appointments and wished that majority of his patients would remain virtual. I worked as a home care nurse a while back, and most of my clients receiving VA services connected with their Healthcare providers. Patients’ vital signs and blood sugars are automatically transferred to their healthcare providers. The provider, in turn, reaches out to the patients and provides timely treatments accordingly. Telehealth should be expanded even with the worse of Covid-19, hopefully behind us. Thank you for the well written post.
References
Butzner, M., & Cuffee, Y. (2021). Telehealth interventions and outcomes across rural communities in the United States: Narrative review. Journal of Medical Internet Research, 23(8).
https://doi.org/10.2196/29575
Links to an external site.
Chen, K., Davoodi, N. M., Strauss, D. H., Li, M., Jiménez, F. N., Guthrie, K. M., & Goldberg, E. M. (2022). Strategies to Ensure Continuity of Care Using Telemedicine with Older Adults during COVID-19: A Qualitative Study of Physicians in Primary Care and Geriatrics. Journal of Applied Gerontology, 41(11), 2282–2295.
https://doi.org/10.1177/07334648221109728
Links to an external site.
Jezewski, E., Miller, A., Eusebio, M., & Potter, J. (2022). Targeted Telehealth Education Increases Interest in Using Telehealth among a Diverse Group of Low-Income Older Adults. International Journal of Environmental Research and Public Health, 19(20). https://doi.org/10.3390/ijerph192013349
Justino Cosentino
Justino Cosentino
Dec 23, 2022
Dec 23, 2022 at 12:10pm
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Hi Matthew,
Telemedicine is a great topic to pick. The first thing that comes to mind for me when I think about telemedicine is just like how you mentioned it grew immensely during the COVID-19 pandemic. The way that you narrowed your search results seems to be effective due to the fact that you went from almost a million results to 82,900. Another affective strategy to utilize is by using “and” as a Boolean operator to narrow your search (The Libraries, n.d.). I noticed you added in additional keywords from your PICOT, but maybe if you separated it by “and” this would help to further narrow your search results. The ultimate purpose of a PICOT question is to find evidence to answer a certain clinical question throughout databases (Melnyk & Fineout-Overholt, 2018). After reading your PICOT question it appears that your PICOT question should certainly be able to help you find and identify further evidence on telemedicine and its affect on various disease ailments. Great overall post!
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 Libraries . (n.d.).
How do i narrow or broaden my search results?
The Libraries : https://libanswers.libraries.wsu.edu/faq/345448#:~:text=Adding%20keywords%2Fchanging%20your%20keywords,Spinning%20Jenny%20or%20Cotton%20Gin.
Margaret M Pieper
Margaret M Pieper
Dec 24, 2022
Dec 24, 2022 at 12:16am
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Matthew,
You will definitely not have a shortage of literature when it comes to telehealth/telemedicine, as your initial search showed. According to the US Government Accountability Office (2022), the number of telehealth visits rose from five million to 53 million between 2019 and 2020. You mentioned the topic of how telemedicine impacts diabetes, hypertension, and dyslipidemia patients, which are common diagnoses in the elderly population. Khairat et al. (2022), found that the number of virtual visits among patients 65 years and older nearly tripled after the Covid 19 expansion waivers. These visits included both video and audio-only telecommunications. The audio-only delivery of healthcare was expanded during this time as well. Previously, audio-only services were rarely reimbursed, so providers did not utilize them. During the pandemic these regulations were eased to increase access to care, especially for the large population of at-risk patients. While the telemedicine option benefited many patients, it also created a surge in virtual visit demand and increased wait times for appointments.
References
Khairat, S., Yuxiao Yao, Coleman, C., McDaniel, P., Edson, B., & Shea, C. M. (2022). Changes in Patient Characteristics and Practice Outcomes of a Tele-Urgent Care Clinic Pre- and Post-COVID-19 Telehealth Policy Expansions.
Perspectives in Health Information Management
,
19
(2), 109–119.
US Government Accountability Office. (2022).
Medicare Telehealth
. https://www.gao.gov/products/gao-22-104454
Doris Hill
Doris Hill
Dec 25, 2022
Dec 25, 2022 at 4:51pm
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Hello Matthew,
Good overview of your search. What is your PICOT question?
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Deborah Mulemia Malanga
Deborah Mulemia Malanga
Dec 21, 2022
Dec 21, 2022 at 7:48am
Manage Discussion Entry
My clinical issue of interest is fall-related injuries in hospitals and how to prevent them. A significant public health issue is falls and injuries brought on by falls. The Prevention of Falls Network for Dissemination (ProFouND) defines a fall as “an unanticipated incident that results in the individual falling to the ground, floor, or a lower level.” The World Health Organization (WHO) estimates that 28–35% of adults over 65 fall at least once each year. In those above 70, this percentage increases to 32-42% (Kenis et al., 2022).
About half of these people experience multiple falls per year. Because biological, environmental, behavioral, and socioeconomic factors are significant, the etiology of falls is complicated (Sam&Lee,2022). Fall accidents can have physical, emotional, and economic repercussions. For instance, significant injuries such as fractures, tissue injuries, or head trauma occur in 5–10% of fall events (Ganz et al., 2022).On a psychological level, it is possible to experience a quality of life decline, social isolation, and fear of falling. Financial implications might also result from falls and injuries caused by falls. In the USA, the direct medical expenses associated with fatal and non-fatal falls are projected to total $50 billion in 2015. These expenses are almost entirely attributed to non-fatal falls. Additionally, the financial toll of falls appears to vary by sex, with older women needing more medical attention than younger ones (Hogan Quigley et al., 2021).
Patient population (P), intervention or issue of interest (I), comparison intervention or problem of interest (C), outcome(s) of interest (O), and time required for the intervention to produce the outcome(s) are the components of the clinical question, abbreviated as PICO(T). The PICOT inquiry is significant because it offers a consistent, organized method for determining the elements of a clinical problem. Clarifying these elements by structuring the clinical question using the PICOT method will assist in directing the search for the information. The likelihood of finding the best evidence to guide practice will rise with a well-constructed PICOT inquiry (Stillwell et al., 2010). From the data I gathered, only some articles could address all the PICOT questions. However, through research from different articles, I found what I needed.
I have used two databases from the Walden library: MEDLINE and CINAHL. At first, when I keyed in fall injuries in the search button, I received 1348 results; using Boolean terms, I added prevention, and the results came down to 577. I further narrowed down and added hospitals; the results finally came to 294. A higher percentage of relevant results can be obtained from searches when Boolean phrases are used to assist in creating them. I can use Boolean operators to make a database search for my PICO (T) inquiry more thorough and effective. The target population or environment can then be specified.
Additionally, I can mention the results of related studies and the precise dates that I would like to appear in my research. For example, Walden wants documents that are less than five years; therefore, I will consider that. Furthermore, I will start my database search with my main thoughts in mind to maximize its effectiveness. I will narrow down and focus on the topic further. For example, in my topic, I can narrow down and choose a specific age group or people from a particular geographical location or with certain underlying conditions; this will help narrow down my search.
References
Ganz, D. A., Yuan, A. H., Greene, E. J., Latham, N. K., Araujo, K., Siu, A. L., Magaziner, J., Gurwitz, J. H., Wu, A. W., Alexander, N. B., Wallace, R. B., Greenspan, S. L., Rich, J., Volpi, E., Waring, S. C., Dykes, P. C., Ko, F., Resnick, N. M., McMahon, S. K., . . . Gill, T. M. (2022). Effect of the STRIDE fall injury prevention intervention on falls, fall injuries, and health‐related quality of life. Journal of the American Geriatrics Society, 70(11), 3221–3229. https://doi.org/10.1111/jgs.17964
Hogan Quigley, B., Renz, S. M., & Bradway, C. (2021). Fall Prevention and Injury Reduction Utilizing Continuous Video Monitoring. Journal of Nursing Care Quality, 37(2), 123–129. https://doi.org/10.1097/ncq.0000000000000582
Kenis, C., Decoster, L., Flamaing, J., Debruyne, P. R., De Groof, I., Focan, C., Cornélis, F., Verschaeve, V., Bachmann, C., Bron, D., Van den Bulck, H., Schrijvers, D., Langenaeken, C., Specenier, P., Jerusalem, G., Praet, J. P., De Cock, J., Lobelle, J. P., Wildiers, H., & Milisen, K. (2022). Incidence of falls and fall-related injuries and their predictive factors in frail older persons with cancer: a multicenter study. BMC Geriatrics, 22(1). https://doi.org/10.1186/s12877-022-03574-7
Sam, P. R., & Lee, P. (2022). Perception: A Critical Analysis of the Hospitalized Patients on Falls. International Journal of Nursing Education, 14(3), 127–130. https://doi.org/10.37506/ijone.v14i3.18365
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