Searching Databases Discussion and PICOT questions
Discussion – Week 4
Searching Databases
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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 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.
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. Then, post your PICO(T) question, the search terms used, and the names of at least two databases used for your PICO(T) 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.
Click on the Reply button below to reveal the textbox for entering your message. Then click on the Submit button to post your message.
RE: Discussion – Week 4
Nursing Shortages have been a clinical issue for a while and is growing with the pandemic and baby boomers adding to the number of patients. According to Aeschbacher & Addor (2018) “In response to the need for competitive recruitment of nurses resulting from the worldwide nursing shortage, employers need to attract and retain nurses by promoting their competitive strengths in their working conditions and by addressing their competitive weaknesses.”. Nurses are in high demand and new positions are always being posted on job forums. According to Schug et al. (2022) “Sick leave and turnover of nurses exacerbate an already existing nursing shortage during the COVID-19 pandemic in Germany and other countries.’ Many factors can affect why we have nursing shortages such as 12-hour shifts, burn out, hard dangerous work, unfair pay system, political involvement, restrictions on employees due to personal health choices. By creating a PICOT formatted question to help us research the issue for nursing shortages can help us to implement new information to improve outcome. In this discussion there will be an explanation on how to look at search engines for appropriate data and also an example of PICOT formatted question.
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I searched CINAHL database by typing in nursing shortage in the main field option. Which came up with over 8000 articles. I then decreased the search by typing in hospital in the second field option which further reduced my search to 1400 articles. I added the advanced search box and reduced the years to make sure all information was produced in the last five years then I had 326 articles to choose from. I then went to Medline with Full text to review I typed in Nursing shortage in main field. I cam up with 1925 results, further reduced sure in second filed option by typing in hospital lead to 834 articles. By further refining searches and using words that are relevant to my subject that can help to gather specific information. Recommendation to make sure to type in the last five year in the date range helped me to be able to make sure material was current.
According to Melny & Fineout-Overholt “Articles on clinical questions can be confusing with some indicating that the clinical question PICOT format (p: population of interest; I: intervention or issue of interest; C: comparison of interest; O: outcome expected; and T: time for the intervention to achieve the outcome) Is the best approach to developing a research question”.
Learning how to choose the correct question to produce a researched outcome would be with the PICOT format. With nursing shortages population could be either the patients, the hospitals, or even the staff themselves that are affected by this interest. For the purpose of this discussion the Hospital will be the selection. The Intervention can be bringing in travel nurses to decrease the need in Hospital setting. Comparison intervention can be patient satisfaction in Hospitals; if we compare it to staffing satisfaction in Hospitals. In the outcome we can try to see the percentage of satisfaction nursing staff vs patient. Time frame would be data collected for the intervention to achieve the outcome. Outcome being more satisfied staff and patients in the Hospital. According to Hospitals Step Up Recruitment Efforts to Address Nursing Shortage. (2018) “The current shortage of nurses is prompting hospitals nationwide to accelerate their recruitment and retention efforts.” According to Lindow (2021) “The world is currently experiencing a critical shortage of registered nurses, reasons for the shortage are plentiful- pandemic, hospitals furloughing nurses that they deemed non-essential instead of repurposing them to essential patient care areas, childcare, nurse patient ratios, violence against nurses, etc.”
Aeschbacher R, Addor V. Institutional effects on nurses’ working conditions: a multi-group comparison of public and private non-profit and for-profit healthcare employers in Switzerland. Human resources for health. 2018;16(1):58. doi:10.1186/s12960-018-0324-6
Hospitals Step Up Recruitment Efforts to Address Nursing Shortage. AACN Bold Voices. 2018;10(1):20. Accessed March 21, 2022. https://search.ebscohost.com/login.aspx?direct=true&AuthType=shib&db=rzh&AN=126794884&site=ehost-live&scope=site
LINDOW LK. Nurse Retention vs Recruitment. ASBN Update. 2021;25(6):6-8. Accessed March 21, 2022. https://search.ebscohost.com/login.aspx?direct=true&AuthType=shib&db=rzh&AN=154032835&site=ehost-live&scope=site
Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.).
Philadelphia, PA: Wolters Kluwer.
Schug C, Geiser F, Hiebel N, et al. Sick Leave and Intention to Quit the Job among Nursing Staff in German Hospitals during the COVID-19 Pandemic. International journal of environmental research and public health. 2022;19(4). doi:10.3390/ijerph19041947
RE: Discussion – Week 4
Great post,
Use of credible research resources provides solid foundation for research studies. Ensuring search engines avoid use of predatory articles is essential to ensuring use of accurate data (Oermann et al., 2021). Search engines such as MEDLINE and Cumulative Index to Nursing and Allied Health Literature (CINAHL) avoid use of predatory articles assuring data accuracy. In addition to identifying a credible search engine it is essential to formulate appropriate search options (Clark, et. Al, 2021). Broader searchers provide excess article options. Starting broad provides opportunity to determine article availability. Great job at utilizing key words to narrow article options specific to your topic.
References
Michael Clark, J., Beller, E., Glasziou, P., & Sanders, S. (2021). The decisions and processes involved in a
systematic search strategy: a hierarchical framework. Journal of the Medical Library Association : JMLA, 109(2), 201–211. https://doi.org/10.5195/jmla.2021.1086
Oermann, M. H., Wrigley, J., Nicoll, L. H., Ledbetter, L. S., Carter-Templeton, H., & Edie, A. H. (2021).
Integrity of Databases for Literature Searches in Nursing: Avoiding Predatory Journals. ANS. Advances in nursing science, 44(2), 102–110. https://doi.org/10.1097/ANS.0000000000000349
Hi
I thoroughly appreciated your post as the nursing shortage is such a reality that we, as nurses, are faced with daily. When I first searched for nursing shortage on the Medline site, it resulted in 24,916. Using Boolean Operators, adding “Maryland”, the search results decreased to 51, and adding “hospitals” decreased the results to 5. Being a nurse licensed in Maryland, health officials are calling it one of the worst shortages in Maryland’s history. “This is indeed a crisis and a crisis that needs to be addressed,” said Dr. Kathleen Wiser, Dean of Notre Dame of Maryland University School of Nursing (Kawata, 2021).
“A PICOT question, also known as a foreground question, is critical to finding evidence to answer that specific question” (Melnyk & Fineout-Overholt, 2019). Once the question is formulated, the components of the question are the basis for the keywords used in database searches. The purpose of the PICOT question is to guide the systematic search to find the best evidence to answer the question (Melnyk & Fineout-Overholt, 2019).
References:
Kawata, A. (2021, September 22). Maryland faces one of its worst nursing shortages in history, health officials say. CBS Baltimore. Retrieved March 22, 2022, from https://baltimore.cbslocal.com/2021/09/22/maryland-faces-one-of-its-worst-nursing-shortages-in-history-according-to-health-officials/
Melnyk, B. M., & Fineout-Overholt, E. (2019). Evidence-based practice in Nursing & Healthcare: A guide to best practice (4th ed.). Wolters Kluwer.
Maria Caridad Arnobit WALDEN INSTRUCTOR MANAGER
RE: Discussion – Week 4
Sara,
Great topic! Thank you for your post. Nursing shortage and its impact to patient safety during the unprecedented times brought attention to the leadership and management. The staff burn-out both physical and mental status have raised concerns and triggers for upper management to re-evaluate staffing models and staffing mix. Nursing staffing crisis has been linked to patient safety concerns, errors, staffing burn-out, staffing loss, and more (Lowman and Harms, 2022). The challenges for all health care organization on staff retention and recognition efforts also poses a challenge. These triggers are important factor to then consider a PICOT question.
Reference:
Lowman, G. H., & Harms, P. D. (2022). Addressing the nurse workforce crisis: a call for greater integration of the organizational behavior, human resource management and nursing literatures. Journal of Managerial Psychology.
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Lisa Sabo
RE: Discussion – Week 4 – 1st Response to Sara Wilbur
Sara,
I absolutely am interested in your PICOT question. I have been hearing about the “nursing shortage” since I began working in health care 15 years ago. You state in your post that your search first yielded over 8,000 articles! Step one in the search for EBP is to formulate a PICOT question (Melynk & Fineout-Overhold, 2019). I can see that by developing your PICOT question helped you to narrow down the number of articles. Have you attempted to use CINAHL with Full Text and Medline Full Text combined search? Using the Boolean terms and, or, and not also can increase the effectiveness of your search (Academic Guides, n.d.).
Melynk and Fineout-Overholt (2019) state that the first step in EBP is zero; encouragement to ask the tough questions and an environment that support research efforts. Do you believe that your current work environment encourages you to ask this question, and do you have a culture of support?
Lisa Sabo
References
Keyword searching: Finding articles on your topic: CONNECT KEYWORDS. Academic Guides. (n.d.). Retrieved March 23, 2022, from https://academicguides.waldenu.edu/library/keyword/boolean
Melnyk, B. M., & Fineout-Overholt, E. (2019). Evidence-based practice in Nursing & Healthcare: A guide to best practice. Wolters Kluwer.
RE: Discussion – Week 4-Response #1
Response #1
Hello Sara,
I enjoyed reading your post and I think you picked a good topic that allows different avenues of search options to yield high results in articles. Using the PICOT format: P: population of interest, I: intervention or issue of interest, C: comparison of interest, O: outcome expected, and T: time for the intervention to achieve the outcome, can yield a high result of articles. (Melnyk & Fineout-Overholt, 2018, pg. 34) The population could nurse or patients. The issue could be shortage, or outcomes. The C; comparison of interest could be something along the lines of being adequately staffed. For the O: outcome expected could be quality care, patient prognosis, patient satisfaction, or nurse satisfaction. The T: time for intervention to achieve the outcome could be hospital, or inpatient, or outpatient setting.
Other ways to research include using Boolean operators and nesting. Boolean operators include using: “and”, “or”, and “not”. By using “and”, in the search, it will retrieve inly records containing all the terms. By using” or” such as “nurse” or “nurses”, the search will retrieve records containing one or more terms. Using “not” excludes records containing the term associated with not. Nesting includes using two or more Boolean terms such as “nurse” or “nurses” and “shortage”. (Library of Congress, n.d.)
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
Library of Congress. (n.d.). Search/browse help-Boolean operators and nesting. Retrieved march 22, 2022 from https://catalog.loc.gov/vwebv/ui/en_US/htdocs/help/searchBoolean.html
Ashley Elix
RE: Discussion – Week 4
Good post Sara,
Using the Boolean operator you were able to greatly reduce the articles due to relevance (Library of Congress, n.d.). I’ll be sure to use the advance search box to focus on articles within the last five years. In previous courses I had to check each source to make sure it was within the last five years. The databases I used for this discussion post was medline and CINAHL PLUS.
Interventions to address nursing shortages in the world are necessary as the baby boomer generation gets older and either retire from the workforce or age related illnesses causing them to seek medical treatment.
PICOT format is very valuable for formulating a researchable question to be answered (Melynk & Fineout-Overholt, 2018). My only difficulty was figuring out comparison of interest and time for the intervention to achieve the outcome. What would be too long or too short of a time frame?
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Reference
Library of Congress. (n.d.). Search/browse help-boolean operators and nesting. Retrieved March 23, 2022 from https://catalog.loc.gov/vwebv/ui/en_US/htdocs/help/searchBoolean.html
Melynk, B.M. & Fineout-Overholt, E. (2018). Evidence-based practice in nursing and healthcare: A guide to best practice. (4th ed.). Philedelphia, PA: Wolters Kluwer.
UCHE OCHIA
RE: Discussion – Week 4
Hi Sara,
I enjoyed your post and could not agree with you more. I also wanted to mention that nurses have a lot of obligations, both personally and professionally. The factors you noted that nurses confront in the healthcare profession are some of the additional difficulties that nurses and healthcare workers face every day. Even with sign-on incentives provided upon recruitment, the rate of nurses retention and recruitment is low. After contract signing, some individuals do not stay very long. The required job performance and workload to satisfy nursing care standards are compromised. It is critical to highlight that using the most relevant and best data to stay current on healthcare concerns is vital for evidence-based clinical decisions. Many issues, as you mentioned, might contribute to nursing shortages, such as 12-hour days, burnout, risky work, lower pay, political participation, and constraints on staff due to personal are all plausible. And I also believe that what nurses go through daily is minimized and unsupported.
Good job!
Uche
Maria Caridad Arnobit WALDEN INSTRUCTOR MANAGER
RE: Discussion – We
Well stated, Sara!
It is crucial that nurses fully understand the content of contract signing. We seldom do not pay attention to the details of the said document. Education on this aspect in this area needs re-visiting. After all, we need to be aware of the legal aspects of nursing. You made mention of the personal and professional obligation of responding to the shortage and sometime we fall into compassion fatigue, what are your thoughts about this?
Dr. Arnobit
Michelle Widdows
RE: Discussion – Week 4
Hi Sara,
I enjoyed reading your post.
I agree that creating a PICOT questions aids in researching necessary data to support an evidence base. Upon reading your post, I felt as though I understood the PICOT process on a greater level than simply reading an abstract on the research. According to Melnyk & Fineout-Overholt (2018), “PICOT stands for “Patient population, Issue of interest, Comparison intervention or group, Outcome and Time frame.” I am still uncertain if we are meant to be choosing the research with boolean terms to develop PICOT or if PICOT develops the boolean terms. The Nurse Practitioner (NP) I work with took a look at the assignment and was confused as to which term is assisting the research.
What are your thoughts on the matter?
Michelle
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.
ISATU JOHNSON
RE: Discussion – Week 4 RESPONSE #
Hello Sara,
Great post i totally agree with the Nursing shortage has been an ongoing issue in health care.
The American Nurse Association discusses that there will be high demand for nurses starting in 2022 going forward because the united states bureau of labor and statistics projects a 9% increase in job opportunities for nurses since there will be a need for over 275, 000 nurses.
Therefore, healthcare facilities need to develop strategies to reduce nurse turnover rates and reduce nursing shortages by providing favorable working conditions for nurses and using appropriate staffing ratios that will reduce nurse burnout (Marć et al., 2019). In so doing, delivery of high-quality services, as well as reduced medical error, will be achieved because nurses will work for an appropriate number of hours thus giving enough time for rest. Haddad, Annamaraju, & Toney-Butler, (2020) add that the use of appropriate staffing ratios will greatly help in the development of new staffing models that will favor all the nurses including the nursing moms and family male nurses to attend to their professional and domestic duties effectively and efficiently at the right time.
References
Haddad, L. M., Annamaraju, P., & Toney-Butler, T. J. (2020). Nursing shortage. StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK493175/
Mackieson, P., Shlonsky, A., & Connolly, M. (2019). Increasing rigor and reducing bias in qualitative research: A document analysis of parliamentary debates using applied thematic analysis. Qualitative Social Work, 18(6), 965-980. https://doi.org/10.1177/1473325018786996
Marć, M., Bartosiewicz, A., Burzyńska, J., Chmiel, Z., & Januszewicz, P. (2019). A nursing shortage–a prospect of global and local policies. International nursing review, 66(1), 9-16. https://doi.org/10.1111/inr.12473
Maria Caridad Arnobit WALDEN INSTRUCTOR MANAGER
RE: Discussion – Week 4 RESPONS
Hello Isatu and Sara,
Pandemic challenged the healthcare workforce. Though the increase is manpower is much needed as a result of increasing healthcare manpower due to COVID 19 fatalities of our colleagues, education, training, and nurse residence programs has been expanded and revisited. What are your thoughts of importing or migrating nurses from other countries? Do you agree or disagree and why?
Dr. Arnobit
Jolly Murithi
RE: Discussion – Week 4 Initial Post
In healthcare, one of the main challenges that not only affect patients but also clinicians are medication errors. Medication errors cause devastating challenges to clinicians and may have catastrophic effects to the patients though occasionally may cause less to no harm to the patient (Alshehri et al., 2017). The incidence rates of medication errors continue to raise, healthcare organizations are in dilemma as to how to decrease the annual cases of medication errors in health sector. Translating clinical problem into searchable question allows healthcare practitioners to gather evidence-based information in literature to support clinical decision (Melnyk & Fineout-Overholt 2018). To determine the best way to reduce medication errors, I used the following PICOT statement to search through CINAHL Plus, Medline, and Walden library databases for research evidence.
P- Psychiatric patients
I- Use of six rights of medication
C- Comparison to no intervention
O- Reduced medication errors
I used both the data bases and searched for “six rights of medication”, guide and medication errors, medication reconciliation and medication errors. “Six rights of medication” and drug administration errors, this resulted in 173 articles in CINAHL plus Boolean operators like, AND, OR, and NOT were essential in connecting my search key terms to actualize my search that helped me get broad results that incorporated different aspects of my PICOT question, and this resulted in 241 articles. Medline plus initially resulted to 3, but after using the Boolean operators, it resulted to 73 articles Various strategies help in boosting the search and making it more effective these may include finding specific key words, various terms, subject headings, these can lead to a more impactful search.
To refine the search for evidence through the data basses, various strategies like Boolean operators such as AND, OR, and NOT, help in connecting search keys terms to broaden the search results while use of symbols such as quotation marks tell the database to search for the quoted words or phrase rather than individual words (Walden University Library, n.d.). There are several filters in the database search boxes that help narrow down the search and help search the peer reviewed content. CINAHL Plus with full text database has filters for publication type that allows researchers to narrow the search type to either systemic review, randomized controlled trials, and others. Publication data filters are also useful and help pick current best research article over old research. Medline with full text database has options where there are additional filters or limiters that help find specific type of study, this can be done by using the clinical queries which help with picking the options available based on research (Walden University Library, n.d.).
Reference
Walden University Library (n.d.) Database search skills. https://academicguides.waldenu.edu/library/databasessearchskills.
Alshehri, G. H., Keers, R. N., & Ascroft, D. M. (2017). Frequency and nature of medication errors and adverse drug events in mental health hospitals: a systemic review. Drug safety, 40(10), 871-886.https://doi.org/10.1007/s40264-017-0557-7
Melneyk, 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.). Evidence-Based Research: MEDLINE search Help. https://academicguides.waldenu.edu/library/healthevidence/medlinesearchhelp.
Sara Wilbur
RE: Discussion – Week 4 Initial Post.
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Completing this assignment was actually an eye opener for me! I learned quite a bit to help research and refine down to specific articles, which I was unable to do before. Along with being able to search for a topic appropriatly I learned a new way of approaching a question for research study. According to Melny & Fineout-Overholt “Articles on clinical questions can be confusing with some indicating that the clinical question PICOT format (p: population of interest; I: intervention or issue of interest; C: comparison of interest; O: outcome expected; and T: time for the intervention to achieve the outcome) Is the best approach to developing a research question”. This formula can great narrow down the information so the results will not have greater room for error. Ensuring search engines avoid use of non verified and non related articles is essential to ensuring use of accurate data (Oermann et al., 2021). Learning all this information will help me to have better access to Evidence based practice, and when I have a clinical question how to properly go about researching that information.
Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.).
Philadelphia, PA: Wolters Kluwer.
Oermann, M. H., Wrigley, J., Nicoll, L. H., Ledbetter, L. S., Carter-Templeton, H., & Edie, A. H. (2021).
Integrity of Databases for Literature Searches in Nursing: Avoiding Predatory Journals. ANS. Advances in nursing science, 44(2), 102–110. https://doi.org/10.1097/ANS.0000000000000349
Maria Caridad Arnobit WALDEN INSTRUCTOR MANAGER
RE: Discussion – Week 4 Initial Post.
Hello Sara,
I appreciate your comment and recognition of the importance of this research and review of articles from your peer discussion. The opinion, contributions, and perspectives of different areas of our nursing practice are so vast that we sometimes forget and do not recognize the impact of other areas and topics in our nursing practice.
Regards,
Maria Caridad Arnobit WALDEN INSTRUCTOR MANAGER
RE: Discussion – Week 4 Initial Post
Jolly Murithi
RE: Discussion – Week 4 Initial Post
Dr. Arnobit.
Though nurses have the unique role and responsibility in medication administration in that they are the final person to ensure medication is correctly prescribed, dispensed, and administered , its standard for nurses to understand the 5 rights of medication (Handson, & Haddad,2021). Considering that these rights come to existence when errors committed by providers were providers sole responsibly it has become important to incorporate other rights of medication administration to prevent risk of errors. The six rights where by documentations is considered becomes vital in the nursing profession.
Medication errors account for an estimated 1.5million preventable adverse drug effects in the United state annually with 30% being committed at the point of administration (Lee,& Wessol, 2022). it is important to consider each case by case in medication administration, governed by the 5 rights and adding the right documentation to it to make the six, its important that many factors may be considered to include right to refuse, right to advise, and right response. Medication administration is a multifactorial process that is complex that involves medication skills, closer supervision, improved education on technology and consistency in a number of rights of medications administration is required (Stolic, & Sheridan, 2022). The practical action when considering medication errors, is to incorporate other rights inconsideration to each patient care and needs.
References
Hanson, A., Haddad, L. M. (2021). Nursing Rights of Medication. https://www.ncbi.nlm.nih.gov/books/NBK560654/
Lee, k. & Wessol, J. (2022). Clinical reasoning, Judgement, and Safe medication Administrationh Practice in Senior Nursing Students. Nurse Educator, 47(1), 51-55. doi:10.1097/NEE.0000000000001059
Stolic, S. Ng, L., Southern, J., & Sheridan, G. (2022). medication errors by nursing students on clinical practice. An integrative review. Nurse Educator Today. https://doi.org/10.1016/j.nedt.2022.105325
PATRICK IGBOKWE
RE: Discussion – Week 4 Initial Post.
Jolly Murithi
RE: Discussion – Week 4 Initial post
Hello Patrick.
Yes i would consider searching parameters that wound pull specific consequences of medication errors. Nurses play a very vital role in safe medication administration and patient safety. Medication errors are preventable errors among inpatients and result to 1.5 million preventable adverse drug effects in United states. Errors in medication use can harm patients and result to death. Though great consideration has been put to medication errors, it still remains a major patient safety issue in nursing care (Muroi & Angosta, 2017). And therefore searching to pull specific medication errors and their effects on patient is vital.
Muroi, M., Shen, J. J., & Angosta, A. (2017). Association of medication errors with drug classification, clinical units, and consequences of errors: Are they related? Applied Nursing research. 33, 180-185. https://doi.org/10.1016/j.apnr.2016,12,002
Shanaa Wheeler-Yard
RE: Discussion – Week 4 Initial Post.
Great post Jolly
Medication errors continue to plague healthcare. Although prevention initiatives have been explored, application of interventions such as the six rights must be prioritized. Researching this topic promotes efforts towards prioritizing patient safety Determining credible data use is priority in nursing research. Usage of search Medline and Cumulative Index to Nursing and Allied Health Literature (CINAHL) are important steps to ensure use of accurate information (Oermann et al., 2021). Both CINAHL and Medline have established credibility in nursing research. Once an appropriate search engine is selected identifying and narrowing search topics using search tittles specific to research question provides articles specific to research. Formulating an appropriate search question is essential in obtaining relevant research results (Clark et al., 2021). Great job of using available resources to refine your search topic. I’m sure your going to do a wonderful job researching the results of actually applying the six rights to medication administration and the results in reducing medication errors.
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References
Michael Clark, J., Beller, E., Glasziou, P., & Sanders, S. (2021). The decisions and processes involved in a
systematic search strategy: a hierarchical framework. Journal of the Medical Library Association : JMLA, 109(2), 201–211. https://doi.org/10.5195/jmla.2021.1086
Oermann, M. H., Wrigley, J., Nicoll, L. H., Ledbetter, L. S., Carter-Templeton, H., & Edie, A. H. (2021).
Integrity of Databases for Literature Searches in Nursing: Avoiding Predatory Journals. ANS. Advances in nursing science, 44(2), 102–110. https://doi.org/10.1097/ANS.0000000000000349
Alicja Stryck
RE: Discussion – Week 4 Initial Post.
Melissa Casadonti
RE: Discussion – Week 4 Initial Post.
Heidi Thornton
RE: Discussion – Week 4-Response #2
Maria Caridad Arnobit WALDEN INSTRUCTOR MANAGER
RE: Discussion – Week 4-Response #2
Hello Heidi,
Great post. Medication errors is topic that always catches the attention of all healthcare practitioners, organizations, and reporting body. Strategies to prevent the incidence of medication errors in both adults and childrens remains to have an ongoing matter. The utilization of electronic scanning, double checking, and utilization of accudose machines to track dispense and administraion is currently in use. Human errors plays a huge factor in this sense. The education, training, and compliance of each healthcare provider is indeed emphasized to make sure that all steps are followed; no short-cuts. The utilization and adoption of electronic barcode medication has been proven to improve patient safety (Strudwick, G., et.al., 2018).
Reference:
Strudwick, G., Reisdorfer, E., Warnock, C., Kalia, K., Sulkers, H., Clark, C., & Booth, R. (2018). Factors associated with barcode medication administration technology that contribute to patient safety: an integrative review. Journal of nursing care quality, 33(1), 79-85.
Ashley Elix
RE: Discussion – Week 4 Initial Post.
Great post Jolly,
I chose medication errors as my issue of interest for this course assignment. Using Boolean operators, I was able to narrow my search results from 21,000 to 9,000 results roughly. Medication therapy can be beneficial to patients but can also be harmful if medications are administered incorrect (Billstein-Leber et al., 2018). I also used medline as my second database and I was able to narrow down my search results more with their database.
PICOT format is a great way to formulate a researchable question that needs to be answered (Melynk & Fineout-Overholt, 2018).
Aside from electronic strategies to administer medications, what other strategies can be implemente to prevent medication errors? One hospital I worked at gave signs to nurses that essentially said, “do not disturb, administering medications”. We put those signs on our computer on wheels during medication pass and it would alert the interdisciplinary team to not speak to us and why.
Reference
Billstein-Leber, M., Carrillo, C. J. D., Cassano, A. T., Moline, K., & Robertson, J. J. (2018). ASHP Guidelines on Preventing Medication Errors in Hospitals. American Journal of Health-System Pharmacy : AJHP : Official Journal of the American Society of Health-System Pharmacists, 75(19), 1493–1517. https://doi.org/10.2146/ajhp170811
Library of Congress. (n.d.). Search/browse help-boolean operators and nesting. Retrieved March 23, 2022 from https://catalog.loc.gov/vwebv/ui/en_US/htdocs/help/searchBoolean.html
Melynk, B.M. & Fineout-Overholt, E. (2018). Evidence-based practice in nursing and healthcare: A guide to best practice. (4th ed.). Philedelphia, PA: Wolters Kluwer.
Lisa Sabo
RE: Discussion – Week 4 Initial Post Lisa Sabo
Discussion Week 4 – Searching Databases
The clinical issue of interest is: in patients with an eating disorder, requiring hospitalization on a specialized unit, what are the best practice guidelines and safety measures for refeeding and restoration? I currently work as a staff nurse on an inpatient unit specializing in eating disorders. The treatment of eating disorders is an underdeveloped area of research (Redgrave, et. al., 2015). Reliable methods of weight restoration are needed (Guarda et. al., 2020). Eating disorders has one of the highest mortality rates of all psychiatric disorders (Guinhut et. al., 2021).
When professionals question current practices, it is necessary to be familiar with the steps of the Evidence-Based Practice (EBP) process. Melynk and Fineout-Overholt (2019) state that the first step is zero; are we encouraged in our workplace to ask these questions and does our environment support research? This week’s discussion post reflects step one in the EBP process which is asking our question in the following format: patient population, intervention or issue, comparison, outcome and time frame or PICOT (Melynk & Fineout-Overholt, 2019). Melynk and Fineout-Overholt (2019) note that the C in PICOT, comparison, is optional depending on the question asked. Narrowing down our clinical interest in this succinct format helps later when beginning to search databases for articles. Stillwell et. al. (2010) shares that knowing the type of PICOT question you are asking will help you in your search for evidence. Melynk and Fineout-Overholt (2019) teaches that PICOT questions are one of five types: intervention, prognosis/prediction, diagnosis/diagnostic test, etiology, and meaning.
I used the CINAHL Plus with Full Text and Medline Full Text to search key terms and originally searched for key terms, “anorexia,” “eating disorders,” “protocol or guidelines,” and “refeeding or restoration,” This search resulted in 50 articles. I examined my search and changed to the following Boolean phrases “eating disorders or anorexia or bulimia or disordered eating or binge eating disorder,” “refeeding or restoration,” “guidelines or protocols or practice guideline or clinical practice guideline,” and “inpatients or hospitalization or ‘hospitalized patients’.” This yielded a result of 44 articles and helped to increase the effectiveness of my search. It is also important to narrow the publication date and limit to only scholarly peer-reviewed articles as this will increase effectiveness in obtaining the most recent research on my topic.
I need to continue to develop my PICOT question and have determined it is an intervention question. I do not have a comparison group or time for my PICOT question and adding a these will change my question and my search results. Melynk and Fineout-Overholt (2019) suggests that while both comparison and time are not always proper for every PICOT question, it is important to try to answer all components in order to achieve the best search results.
References
Guarda, A. S., Cooper, M., Pletch, A., Laddaran, L., Redgrave, G. W., & Schreyer, C. C. (2020). Acceptability and tolerability of a meal‐based, rapid refeeding, behavioral weight restoration protocol for anorexia nervosa. International Journal of Eating Disorders, 53(12), 2032–2037. https://doi.org/10.1002/eat.23386
Guinhut, M., Godart, N., Benadjaoud, M. A., Melchior, J. C., & Hanachi, M. (2021). Five‐year mortality of severely malnourished patients with chronic anorexia nervosa admitted to a Medical Unit. Acta Psychiatrica Scandinavica, 143(2), 130–140. https://doi.org/10.1111/acps.13261
Melnyk, B. M., & Fineout-Overholt, E. (2019). Evidence-based practice in Nursing & Healthcare: A guide to best practice. Wolters Kluwers.
Redgrave, G. W., Coughlin, J. W., Schreyer, C. C., Martin, L. M., Leonpacher, A. K., Seide, M., Verdi, A. M., Pletch, A., & Guarda, A. S. (2015). Refeeding and weight restoration
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Alicja Stryck
RE: Discussion – Week 4 Initial Post Lisa Sabo
I found your topic very interesting; I currently work at a residential rehabilitation center for adults with mood, eating, and substance abuse disorders. Eating disorders can be absolutely debilitating and sad to witness. I think that you may have a hard time finding research on your topic, it seems very specific and I wonder if there is a broader topic you could choose, maybe like how does cognitive behavioral therapy affect patients with eating disorders compared to other therapy modes? Your paper will be very interesting to read regardless! According to Melnyk & Fineout-Overholt (2018), searching indexed databases may not always lead to results, but searching for grey literature can be done on Google. Grey literature refers to unpublished evidence that can be from reports, unpublished drug trials, or unpublished conference proceedings (Melnyk & Fineout-Overholt, 2018, p. 87). Although you may find articles on your topics on Google, make sure to validate their reliability and check the source. Trying to add Boolean operators to your search phrases can help you get better results (Library of Congress, n.d.). Adding words such as “AND,” “OR,” or “NOT” helped me find more applicable research articles and made a big difference in my search.
Best of luck to you!
Alicja Stryck
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.
Library of Congress. (n.d.). Search/browse help- Boolean operators and nesting. https://catalog.loc.gov/vwebv/ui/en_US/htdocs/help/searchBoolean.html
Lisa Sabo
RE: Discussion – Week 4 Response to Alicja Stryck
Alicja,
Thank you for your interest in my post. Yes, my PICOT question is very specific. I wanted to choose a topic I am passionate about and eating disorders has one of the highest mortality rates of all psychiatric disorders (Guinhut et. al., 2021) which further drove me to this question. There is also a high recidivism rate in eating disorder treatment and some of that is due to its’ severe and enduring nature.
My PICOT question is an intervention-based question. My PICOT question will help me look at my current unit practices with a new perspective. Stillwell et. al. (2010) shares that it is helpful to search more than one database, curtail your search to words used in your PICOT question, and to remember that each database has its own limits.
Lisa Sabo
References
Guinhut, M., Godart, N., Benadjaoud, M. A., Melchior, J. C., & Hanachi, M. (2021). Five‐year mortality of severely malnourished patients with chronic
anorexia nervosa admitted to a Medical Unit. Acta Psychiatrica Scandinavica, 143(2), 130–140. https://doi.org/10.1111/acps.13261
Stillwell, S. B., Fineout-Overholt, E., Melnyk, B. M., & Williamson, K. M. (2010). Evidence-based practice, step by step: Searching for the evidence. AJN,
American Journal of Nursing, 110(5), 41–47. https://doi.org/10.1097/01.naj.0000372071.24134.7e
PATRICK IGBOKWE
RE: Discussion – Week 4 Initial Post Lisa Sabo
Hello Lisa,
Eating disorders (ED) is a crucial topic to study and reading your post has provided more insight into the challenges associated with the disorder. About 9% of the US population will suffer from ED in their lifetime, resulting in about 26% suicide attempts and has a substantial economic impact of about $64.7 billion annually (ANAD, 2021). The genetic link to this disorder causes about 28-78% of this disorder and results in about 10,200 deaths directly related to its yearly (ANAD, 2021).
I agree with you that your PICOT will need a comparison, timeframe, and intervention to make it an intervention-based clinical question. Would you consider comparing those with the disorder in the specialized unit and those not in the unit, using best practice guidelines as treatment/intervention, and perhaps using improved feeding or continuing adherence to therapy as outcome goals and a specific time for evaluation? My suggestions are predicated on the importance of creating study questions to serve as a guide in the planning, study, and reporting of quality research (Raich & Skelly, 2013)
References
ANAD. (2021). Eating Disorder Statistics | General & Diversity Stats | ANAD. National Association of
Anorexia Nervosa and Associated Disorders. Retrieved 24 March 2022, from https://anad.org/eating-disorders-statistics/.
Raich, A. L., & Skelly, A. C. (2013). Asking the right question: specifying your study question. Evidence-
based spine-care journal, 4(2), 68–71. https://doi.org/10.1055/s-0033-1360454
Lisa Sabo
RE: Discussion – Week 4 Initial Post Reply To Patrick Igbok
Patrick,
Thank you for your interest in my post. Yes eating disorders is linked to genetics. From a personal practice standpoint on my current unit we have cared for a multitude of twins with this disorder (usually one twin in affected, however, we have had instances of both twins having an eating disorder) and patients that are diagnosed on the Autistic spectrum. It is absolutely one of the most fascinating, heartbreaking, and challenging places I have worked as a nurse.
I am thinking of using my current unit as a comparison as we see patients as low as 40% of their ideal body weight and lack consistent measures of care based on my reading. In other words, there is no track. We have a track for stroke, sepsis, fractures, etc., but none for eating disorders. I am specifically interested in safety measures such as cardiac monitoring, complete bed rest, and nasogastric feedings for the first 48 hours.
Melynk and Fineout-Overholt (2019) tells us that comparison it is necessary to consider whether it is needed, however, I think it would provide greater depth to my research assignment. In this week’s video reference by Walden University, LLC (2018), it is described that there was a nurse that was interested in using PCA pumps in a pediatric setting. This nurse was able to find evidence and help her unit adopt this practice change. That is my goal.
Lisa Sabo
References
Melnyk, B. M., & Fineout-Overholt, E. (2019). Evidence-based practice in Nursing & Healthcare: A guide to best practice. Wolters Kluwers.
Walden University, LLC. (Producer). (2018). Searching the Evidence [Video file]. Baltimore, MD: Author.
Lisa Sabo
RE: Discussion – Week 4 Initial Post Lisa Sabo
Apologies,
My reference list appeared to have been cut off in my original post. Thank you.
Lisa Sabo
References
Guarda, A. S., Cooper, M., Pletch, A., Laddaran, L., Redgrave, G. W., & Schreyer, C. C. (2020). Acceptability and tolerability of a meal‐based, rapid refeeding, behavioral weight restoration protocol for anorexia nervosa. International Journal of Eating Disorders, 53(12), 2032–2037. https://doi.org/10.1002/eat.23386
Guinhut, M., Godart, N., Benadjaoud, M. A., Melchior, J. C., & Hanachi, M. (2021). Five‐year mortality of severely malnourished patients with chronic anorexia nervosa admitted to a Medical Unit. Acta Psychiatrica Scandinavica, 143(2), 130–140. https://doi.org/10.1111/acps.13261
Melnyk, B. M., & Fineout-Overholt, E. (2019). Evidence-based practice in Nursing & Healthcare: A guide to best practice. Wolters Kluwers.
Redgrave, G. W., Coughlin, J. W., Schreyer, C. C., Martin, L. M., Leonpacher, A. K., Seide, M., Verdi, A. M., Pletch, A., & Guarda, A. S. (2015). Refeeding and weight restoration outcomes in anorexia nervosa: Challenging current guidelines. International Journal of Eating Disorders, 48(7), 866–873. https://doi.org/10.1002/eat.22390
Stillwell, S. B., Fineout-Overholt, E., Melnyk, B. M., & Williamson, K. M. (2010). Evidence-based practice, step by step: Searching for the evidence. AJN, American Journal of Nursing, 110(5), 41–47. https://doi.org/10.1097/01.naj.0000372071.24134.7e
Sara Wilbur
RE: Discussion – Week 4 Initial Post Lisa
I find your topic very interesting. I am currently a school nurse and just had a student today that came in to get lunch since she does have a eating disorder and I ask daily that she at least come get a drink and 100 calorie snack from my drawer. Not even 1.5 hours after she got the snack she was vomiting in the bathroom. According to Lucas & Olympia (2022) ” As medical concerns are brougth to the attention of the school nurse, it is important for the school nurse to be aware of common signs and symptoms seen in students with undiagnosed or established eating disorders, as well as possible medical complications associated with untreated or poorly controlled eating disorders”. Parents are aware and student refused to continue with treatment. It is heart breaking to watch these patients continually suffer from eating disorders. I continually reach out to make sure she is doing well and follow up with her counselor but if never feels like we can do enough. According to NIshida-Hikjji et al (2021) “While anorexia is particularly common during puberty, a later age of onset is reported for bulimia”. The stages of eating disorders and ages they appear tend to make this a high priority for school nurses. I would be interested to see what preventions are currently working best to help with this illness.
Lucas C, Brady J, Olympia RP. School Nurses on the Front Lines of Healthcare: Recognizing “BONES” and Knowing When to Pick Up the Phone: Eating Disorders Among Students in the School Setting. NASN School Nurse. 2022;37(2):83-88. doi:10.1177/1942602X20942531
Nishida-Hikiji E, Okamoto M, Iwanaga R, Nakane H, Tanaka G. Mental health literacy regarding eating disorders in female Japanese university students. Eating Disorders. 2021;29(1):17-28. doi:10.1080/10640266.2019.1610629
Lisa Sabo
RE: Discussion – Week 4 Response to Sara Wilbur
Sara,
Yes. Eating Disorders (ED) are devastating. School nurses can benefit from learning the signs and symptoms of an ED. From my professional standpoint and expertise, I would suggest that the school counselor escalate to parents (if has not happened already) and insist that the parents find a treatment program for the child. I have seen children as young as 8 years old in my current practice domain. If the parents do not seek treatment for the child it should be escalated to the child protection agency in your state. It may sound harsh, however, it may save this child’s life. The age, severity, and insurance coverage will determine the level of treatment required for this child. I hope she gets help soon.
I thank you for sharing. I am very passionate about my current practice and I always try to educate about ED.
Lisa Sabo
Brenda Reese
RE: Discussion – Week 4
Hepatitis C is the most common blood-borne pathogen in the United States and the Correctional Systems. In a study conducted by the Centers for Disease Control and Prevention (CDC), it was estimated that 9.6% to 41.1% of inmates in the prison system are infected with hepatitis C (Franciscus, 2017). The clinical issue of interest for this week’s discussion is the prevalence of incarcerated males with Hepatitis C about jailhouse tattoos.
Clinicians interested in research pursuits should consider using a literature search and the PICOT format when engaging clinical researchers. This approach will provide clinicians and researchers an initial basis for mutual understanding, communication, and direction to help answer clinical study questions (Riva et al., 2012). Using the CINAHL Plus with full text, I began the data search with HCV in Prisons; this search resulted in 1,608. Filtering the time frame for 2016 – 2022 and adding peer-reviewed, it dropped the results to 548. Using the Boolean Operators adding “tattoos,” the results decreased to 17. Finally, “male” was added to the Boolean Operators, and the final search result was 14. The Walden Library and Medline were also experimented with for search data.
Looking at the PICOT question, although not 100%, I anticipate the following:
P – The population of interest is incarcerated males.
I – The intervention or area of interest is incarcerated males with HCV.
C – The comparison intervention is those incarcerated males with HCV who have tattoos compared to those with HCV and no tattoos.
O -The outcome of interest will be the percentage of incarcerated males with HCV who have tattoos.
T -The time frame is to be determined.
‘To ensure that reliable evidence is found, clinicians must move beyond unsystematic search techniques toward using available supports and strategies that help them find the needle in the haystack, the essential evidence to answer their clinical questions” (Melnyk & Fineout-Overholt, 2019). Strategies that may be taken to increase the effectiveness of a database search are as follows: narrow search to independent words instead of multiple terms, use a thesaurus to choose similar wording, pick out words unique to the topic but to nothing else. Examples that could be used in my data search would be to add the age range, grade of disease, and State of interest (Maryland).
References:
Franciscus, A. (2017, October 16). Hepatitis C in Prisons. Hep. Retrieved March 22, 2022, from https://www.hepmag.com/article/hepatitis-c-prisons
Melnyk, B. M., & Fineout-Overholt, E. (2019). Evidence-based practice in Nursing & Healthcare: A guide to best practice (4th ed.). Wolters Kluwer.
Riva, J. J., Malik, K. M. P., Burnie, S. J., Endicott, A. R., & Busse, J. W. (2012, September). What is your research question? An introduction to the picot format for clinicians. The Journal of the Canadian Chiropractic Association. Retrieved March 22, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3430448/
Maria Caridad Arnobit WALDEN INSTRUCTOR MANAGER
RE: Discussion – Week 4
HI Brenda,
I appreciate your discussion post on the process of filtering and utilizing your inclusion criteria to include the time frame (year to date) to narrow your search. Using keywords to trigger the literature search in the database plays an integral part in the process. Your topic of interest on Hepatitis C in inmates and its incidence rate has been an area of interest. Have you considered what statistical analysis you will use and describe your proposed methodology if you are to pursue this PICOT?
Dr. Arnobit
Mercedes Hovland
RE: Discussion – Week 4
Brenda,
Thank you for your post! I found your topic very interesting and something I have never read about before. Evidence based practice is a great way to challenge our mind. EBP can be seen as a way for nurses and other healthcare providers to expand their curiosity. According to Stillwell, et al., “to fully implement evidence-based practice (EBP), nurses need to have both a spirit on inquiry and a culture that supports it.” Related to your topic, how did you become interested in Hepatitis C in inmates?
I also found your searching to be very thorough! You were able to really narrow down your topic. Medical databases can be a great source for the vast topics we cover, and they can include CINAHL, which you used, and MEDLINE (Melnyk, & Fineout-Overholt, 2018, p. 64). To gather more resources, I wonder if you could reword your PICOT for further information!
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.
Stillwell, S. B., Fineout-Overholt, E., Melnyk, B. M., & Williamson, K. M. (2010). Evidence-based practice, step by step: Asking the clinical question: A key step in evidence-based practice. American Journal of Nursing, 11(3), 58-61.
Angela Johnson
RE: Discussion – Week 4
Alicja Stryck
RE: Discussion – Week 4
I chose to examine if an exercise program on adults over the age of 50 would have an affect on their fall rates. According to Teng et al. (2019), modifiable risk factors that contribute to falls include impaired gait and balance, and can be modified through exercise. Fall prevention and safety is always a goal in nursing care, and interventions are put into place for patients who are deemed a “fall risk.” Considering that patient falls occur inside and outside of the hospital, I wanted to see if exercise could help these patients, which could also prevent them from having a fall and ending up in the hospital.
Melnyk & Fineout-Overholt (2018) describe the PICOT question as a way to find the most relevant and clinically applicable research data. The PICOT question asks about the patient population, intervention or issue, comparison group, outcome, and time frame (Melnyck & Fineout-Overholt, 2018). According to Stillwell et al. (2010), using the PICOT format style of question helps guide your search for evidence, by specifying exactly what you are searching for, which will limit your results. The PICOT question I will research is, “Does an exercise program reduce the incidence of falling for adults over the age of 50 who receive the program compared to adults who do not receive the program over 1 year time frame?”
Population: adults over the age of 50
Intervention: receiving an exercise fall prevention training intervention
Control group: adults who did not receive intervention
Outcome: effect on fall rate
Time: 1 year time frame.
- Does anyone have a suggestion about what to choose as your timeline? Since we are using systematic reviews, I do not quite understand how we are supposed to choose an exact timeline that will match the many studies they have reviewed, or do we make a broad timeline of, for example, 1 year? Suggestions would be greatly appreciated!
To search for my research articles, I used the CINAHL & MEDLINE Combined Search engine within the Walden Library. In the search bar, I typed “exercise OR exercise program” and then also used the search underneath to type “fall decrease OR fall prevention.” I limited results to only full text and scholarly peer-reviewed journals. The resulting articles from that search were 2,510. I went back and changed my publication date to 2017-2022 and it resulted in 1,068 articles. I then did an advanced search, and under “publication type,” refined my results to only include systematic reviews. That brought my results down to 108 articles. I typed “adult” into one of the search bars below my other two searched and that refined my results to 71.
I also used the EMBASE search engine and typed “fall prevention AND exercise,” which yielded 3,849 results. I refined my results to be between 2017 and 2022 and my results went down to 1,258. I then refined the results to systematic reviews and got a total of 103 articles. According to the Library of Congress (n.d), using Boolean operators such as AND, OR, or NOT can help refine your results. I find that refining the data is essential in finding an applicable research article. To increase my rigor and effectiveness in researching, I will continue to search using the Boolean operators and try different keywords in combination. I will also make sure my chosen articles are scholarly, peer-reviewed and are systematic reviews. I realize how difficult it is to find specific information and find that this discussion is challenging me, but helping me understand how to research more effectively and thoroughly.
References:
Library of Congress. (n.d.). Search/browse help- Boolean operators and nesting. https://catalog.loc.gov/vwebv/ui/en_US/htdocs/help/searchBoolean.html
Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice. (4th ed.). Philadelphia, PA: Wolters Kluwer.
Stillwell. S. B., Fineout-Overholt, E., Melnyk, B. M., Williamson, K. M. (2010). 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.
Teng, B., Gomersall, S. R., Hatton, A. & Brauer, S. G. (2019). Combined group and home exercise programmes in community-dwelling falls-risk older adults: Systematic review and meta-analysis. Physiother Res Int. 25(3), 1-19. http://doi.org/10.1002/pri.1839
Maria Caridad Arnobit WALDEN INSTRUCTOR MANAGER
RE: Discussion – Week 4
Alicja Stryck
RE: Discussion – Week 4
Maria Caridad Arnobit WALDEN INSTRUCTOR MANAGER
RE: Discussion – Week 4
A great topic, Alicja!
As for your time frame, you will need to take into consideration the length of the quarter for your project completion. It usually takes 10-12 hrs or calculating your requires hours for completion. As for your project, check interventions such as implementing purposeful hourly rounding and or an integration of an evidences-based best practices and tools that has proven outcomes. Good luck!
Dr. Arnobit
Melissa Casadonti
RE: Discussion – Week 4
Hello Alicja,
Your topic of interest for your PICOT statement is a major concern for the elderly population. According to an article published by Valatka, Krizo, and
Mallat, a fall prevention program has decreased the rate of falls among the elderly. Your search was undoubtedly extensive. I am quite glad I read your
post, as I was unaware of EMBASE. Your search results between the combined Medline and Cinahl and the EMBASE shows that Medline and Cinahl have
a much larger library and database than EMBASE does. Either way, having the use of multiple search engines does provide a variety of 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.
Stillwell. S. B., Fineout-Overholt, E., Melnyk, B. M., Williamson, K. M. (2010). 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.
Valatka, R., Krizo, J., & Mallat, A. (2021). A Survey-Based Assessment of “Matter of Balance” Participant Fall-Related Experience. Journal of Trauma
Nursing, 28(5), 304–309. https://doi.org/10.1097/jtn.0000000000000602
Alicja Stryck
RE: Discussion – Week 4
Jolly Murithi
RE: Discussion – Week 4
Great post Alicja.
Falls are a great impact to health, consequences of fall places financial and logistical burdens on health care systems, exercises have shown improved balance and build muscle mass, exercise may be a very effective fall prevention and harm reduction strategy (Pierson, K. et al 2022). Falls impact all health care settings and can impact all ages, this is sure a great PICOT question. One of the most challenging aspect of evidence based practice is identification of answerable question, Unstructured collection of keywords can retrieve irrelevant literature hence it’s important to retrieve important Information and this can be attained by having a clearly defined, well structured PICOT question (Davis, K.S. 2011).
Walden library has great databases that that can help in answering your PICOT question. Through MEDLINE or CINAHL databases in the Walden Library, you can do a systemic review, this is a type of publication that addresses a clinical question by analyze research that fits certain explicitly specified criteria. It refines and reduces large amount of data and information and effectively summarize evidence to support clinical decisions (Walden University Library, n.d.). This may be a crucial too to finding out the effects of exercise program on falls.
References
Pierson, K., Maloney, M., Buvuso, A., Dowling, K. Kunsang, T., & Wong, M. E. (2022). A review of the impact of exercise on fall rates among community-dwelling older adults. American Association of Nurse Practitioners, 34(2), 247-251. https://doi.org/10.1097/JXX.000000000000636
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.
Walden University Library. (n.d-h). Quick Answers: How do i find a systemic review article related to health, medicine, or nursing? https://academicanswers.walden.edu/faq/72670
Alicja Stryck
RE: Discussion – Week 4
Jolly-
Yes I did find many systematic reviews while researching my topic, in fact, while searching for articles I used one of the refining options to include systematic reviews. I found that very helpful as it did not include articles I was not interested in, saving me some time.
Aicha Bah
RE: Discussion – Week 4_ Aicha’s Response
Great post Alicja, interesting area of research!
The nursing shortage indicates that healthcare organizations are regularly short-staffed. This shortage directly affects nursing workload and the nurse-patient ratio. This increased burden on nurses is also detrimental to patient care. The prevalence of falls is higher, especially in psycho-geriatrics units, as nurses cannot round on patients on time, especially with the increase of new patients’ admissions (Rosenberg, 2019). To create an ideal work environment, organizations should be innovative in meeting nurses’ needs to provide safe and quality of care to the patients (Pereira Lima Silva et al., 2020). Furthermore, continuous empowerment and motivating nurses are necessary to revitalize and maintain the nursing workforce. Many organizations, including the hospital I used to work for, have endorsed and pursued the Magnet Certification to provide excellent nursing practices.
References
Pereira Lima Silva, R., Gonçalves Menegueti, M., Dias Castilho Siqueira, L., Araújo, T. R., Auxiliadora, M. M., Mantovani Silva Andrade, L., & Laus, A. M. (2020). Omission of nursing care, professional practice environment and workload in intensive care units. Journal of Nursing Management (John Wiley & Sons, Inc.), 28(8), 1986–1996. https://doi.org/10.1111/jonm.13005
Rosenberg, K. (2019). RN Shortages Negatively Impact Patient Safety. American Journal of Nursing, 119(3), 51. https://doi.org/10.1097/01.NAJ.0000554040.98991.23
Alicja Stryck
AichaRE: Discussion – Week 4_ Aicha’s Response #2
Aicha-
Yes I can absolutely see how short-staffing affects patients’ safety in a direct way. It is unfortunate and one of the aspects of health care that has room for improvement. Especially while short-staffed, nurses and other health care personnel should still commit themselves to maintain safety for the patients, it is our obligation to protect them, especially the elderly, confused and frail. I find that my organization has been doing a great job at maintaining a safe environment, as we have equipment, training, protocols and staff awareness in place.
Kathleen Sease
RE: Discussion – Week 4
Hello Alicja,
I am very interested in your clinical inquiry as I am an adult over the age of 50. I know that I have become more careful as I age as far as dealing with behaviors that require the use of ladders or require more advanced balance. As a nurse, I have witnessed how devastating a fall with serious injuries can be for an older person (Estrêla & Machin, 2021). The most challenging part of research is formulating the questions that will generate the information that is desired (Stillwell et al., 2010). It appears as though you are developing a solid understanding of how to go about getting your clinical questions answered.
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Angela Johnson
RE: Discussion – Week 4
Nurses have the ability to administer sedation in critical care and emergency departments, as well as during procedures. The nurse that is administering sedation should be trained and checked off per facility guidelines. The safety and quality of sedation is reliant on the knowledge, skills, expertise, and awareness of nurses. (Varndell, 2015) Resuscitation equipment as well as reversal agents should be available. Drugs and equipment to maintain airway, breathing and circulation have to always be available in procedure rooms. (Chapman, 2010). Nurses need thorough continuing education to ensure safe and quality care for their patients. Nurses managing the care of patients receiving sedation should not be engaged in tasks that would compromise continuous monitoring of the patient. In procedures specifically, the nurse that is administering sedation should only do that, and another nurse should be in procedure to circulate. The problem comes in when there is not enough staffing to have two nurses in each procedure room.
When formulating an evidence based practice question, PICO should be utilized. P- patient or problem; I- Intervention; C- Comparison; O- Outcome; T- timeframe. I am still developing my PICO.
Initially I utilized the Walden library, searched all databases with key words nurses administering sedation. 16 articles resulted. I then narrowed my search engine option down to CINAHL plus with full text. I searched keywords nurses administering sedation in procedures. 969 articles resulted. I do not have my PICO(T) question developed yet, but if I had the question developed it would assit with performing a efficient and thorough search. Walden has an option to get assistance from a librarian. This could help with my searches for articles.
Chapman, W. (2010). Administration of Sedation on Endoscopy: Guidance, Risks and Skills Requirements. Gastrointestinal Nursing, 8(2), 14-17.
Davies, K.S. (2011). Formulating the evidence based practice question: A review of the frameworks for US professionals. Evidence Based Library & Infromation Practice, 6(2), 75-80.
Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer.
Varndell, W., Elliot, D., & Fry, M. (2015). Emergency Nurses Practice in Assessing and Administering Continuous IV Sedation for Crittically Ill Adult Patients. International Emergency Nursing, 23(2), 81-88.
Angela Johnson
RE: Discussion – Week 4
P- Patients who are having procedures that need sedation but nurse needs to administer.
I- Prepare and staff appropriately to have 2 nurses in procedure rooms.
C- Anesthesia can provide sedation for all procedures, however if they are not free then two nurses need to be in each procedure room.
O- Hire enough nurses to staff appropriately. Each procedure room either needs anesthesia involvement or two nurses present.
Gabrielle Phillips
RE: Discussion – Week 4
Hello Angela,
I was not aware that administering sedation is task emergency nurses are permitted to undertake. I found this to be intriguing and did some research on the topic. You are correct that the nursing shortage does interfere with the ability of a nurse to carry out this critical, life-saving task effectively. Moreover, efficacy relies upon the nurse’s clinical strength and ability to react quickly in such a situation (Varndell & Fry, 2015).
There are so many directions that this topic can venture in. An examination of whether it is best to allow the nurse to engage in this practice, given the nursing shortage, is one. On the contrary, one can explore how beneficial this intervention has been compared to not allowing nurses to have the autonomy to administer emergency sedation. Whichever direction you choose, Boolean words such as “and,” “or,” and “not” will assist in narrowing down helpful articles (Walden University, n.d.-f).
I truly look forward to hearing more about your topic!
References
Varndell W, Elliott D, Fry M. (2015). Emergency nurses practices in assessing and administering continuous intravenous sedation for critically ill adult patients: A retrospective record review’. Int Emerg Nurs. 23(2):81-8. doi: 10.1016/j.ienj.2014.09.005.
Walden University Library. (n.d.-f). Keyword searching: Finding articles on your topic: Boolean terms. https://academicguides.waldenu.edu/library/keyword/boolean
Mercedes Hovland
RE: Discussion – Week 4
In evidence-based practice, the whole process starts with an answerable question that drives the rest of the research (Davies, 2011). In the United States and it’s healthcare system there has been an issue that almost every household has come in contact with. According to the CDC, alcohol use is leading cause of preventable death and one in six adults binge drink (2021). My clinical interest of this topic stems from the treatment of alcohol withdrawal protocol. In the two facilities I have worked in, the standard treatment of lorazepam dosage associated with CIWA score is used. Many patients become aggressive, have seizures, and have increased heartrate. Due to these symptoms, those patients most likely end up in the ICU. My initial interest was to find if there were other treatments. Before I decided on a PICOT question, I attempted to find another treatment to compare. Upon initial searching, phenobarbital was a common researched treatment for alcohol withdrawal syndrome. I used different databases, most commonly Medline and Pubmed. This then drove my PICOT question. PICOT stands for population, intervention or issue of interest, comparison intervention or issue, outcome, and time frame (Melnyk, & Fineout-Overholt, 2018, p. 40).
P: Alcohol withdrawal syndrome
I: phenobarbital
C: lorazepam (typical treatment)
O: decrease length of stay and ICU admissions
T: within hospitalization time
PICOT QUESTION: In patients who are experiencing alcohol withdrawal syndrome, how does phenobarbital in combination with lorazepam compare to lorazepam alone affect length of stay and ICU admissions during hospitalization?
When beginning my search, I started on Pubmed, Medline, and a few other databases. I first typed in “alcohol withdrawal syndrome.” This led me to find many articles about the disease generally. I then wanted to narrow my search, so I typed “alcohol withdrawal syndrome AND treatment,” which led me to find my area of interest, as there were articles that references either phenobarbital or lorazepam. To narrow my PICOT question and research down, I typed “alcohol withdrawal syndrome AND phenobarbital.” This led me to many useful articles, comparing phenobarbital with lorazepam o lorazepam alone. I found it easy to find articles comparing the two treatments, as there are not many other treatments out there for alcohol withdrawal syndrome. Overall, I found the best results by starting broad. This gave me general information and allowed me to research the area of interest in the population. By refining my search and using the AND feature, I was able to find current and relevant articles. Phenobarbital is a newer treatment option for alcohol withdrawal syndrome and most of the articles were within the last 5 years. Had this not been the case, I could have “within the last five years” to refine my search. As I continue my search, I plan to use more tools within the databases.
References
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.
Excessive Alcohol Use. (2021, November 23). Centers for Disease Control and Prevention. Retrieved March 22, 2022, from https://www.cdc.gov/chronicdisease/resources/publications/factsheets/alcohol.htm
Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philidelhpia, PA: Wolters Kluwer.
6052wk3disc.docx (14.547 KB)
Aicha Bah
RE: Discussion – Week 4_Aicha’s Response #1
Hi Mercedes,
Your area of research is indeed interesting.
World Health Organization (WHO) states in their Global Status Report on Alcohol and Health 2014, that the highest alcohol consumption rates are in the WHO European region and the WHO Region of the Americas. Alcohol dependence is a severe type of alcohol abuse, and it may first appear when a person develops withdrawal symptoms after stopping drinking alcohol. Unfortunately, many alcohol abusers I have met in practice believe that stopping drinking alcohol causes more problems; therefore, they prefer to continue drinking. However, this misconception may be valid for those who have developed alcohol dependency due to the withdrawal symptoms (Sachdeva & Bharadwaj, 2015) such as seizures, delirium tremens, elevated blood pressure, tachycardia, diaphoresis, hallucinations; they may experience. Indeed, fascinating topic.
References
Sachdeva, A., Choudhary, M., & Chandra, M. (2015). Alcohol Withdrawal Syndrome: Benzodiazepines and Beyond. Journal of clinical and diagnostic research: JCDR, 9(9), VE01–VE07. https://doi.org/10.7860/JCDR/2015/13407.6538
World Health Organization. (2014). Global status report on alcohol and health
Lisa Sabo
RE: Discussion – Week 4 – 2nd Response to Patrick Igbokwe
Patrick,
I am interested in your post as in eating disorder patients with very low BMI we often see the potential for the development of pressure ulcers due to bony prominences and activity restrictions. We utilize preventative measures such as mepilex and repositioning; although our patients are able to reposition independently. ICU was one of my favorite places as a float nurse; it was also the most physically taxing due to patient immobility. Pressure ulcer identification and prevention is nurse driven. In a study by Choi et. al. (2016), researchers revealed that while there are many individuals on the unit to help with pressure ulcer prevention, it is ultimately the nurses responsibility. Things that can interfere with pressure ulcer prevention is lack of time, acuity, and poor staffing (Choi et. al., 2016).
It seems from what you have described that you have done a great job in narrowing down your search to 12 articles. Walden University, LLC (2018) challenges that graduate student are expected to comprehend research and know how to apply it their practice area and make changes to improve patient care. It is also important to be familiar with your librarian (work and school). I have often asked my work librarian to assist me with a search. It intrigues me that people will insist on struggling with a search rather than ask the librarian. The librarian is not only a wonderful resource but also an excellent educator! Patrick have you ever reached out to a librarian for help?
References
Choi, K. R., Ragnoni, J. A., Bickmann, J. D., Saarinen, H. A., & Gosselin, A. K. (2016). Health behavior theory for pressure ulcer prevention. Journal of Nursing Care Quality, 31(1), 68–74. https://doi.org/10.1097/ncq.0000000000000137
Walden University, LLC. (Producer). (2018). Searching the Evidence [Video file]. Baltimore, MD: Author.
PATRICK IGBOKWE
RE: Discussion – Week 4 – 2nd Response to Patrick Igbokwe
Hi Lisa,
Thanks for the response and input. The importance of the librarian is vital. I reached out to Librarians in previous courses but have not in this current class. Librarians are the best resources for students researching because they bring their expertise in resource gathering, sense of inquiry, and the power of their innovation to help students grow as researchers and learn and share evidence-based resources gleaned from research (Beck, 2022). As this course progresses, the use of the librarian to help narrow article searches will be necessary.
Reference
Beck, S. (2022). The Nonnegotiable Role of School Librarians. NASSP. Retrieved 26 March
2022, from https://www.nassp.org/2020/02/06/the-nonnegotiable-role-of-school-librarians/.
Mavis Barbara Sarbeng Boama
RE: Discussion – Week 4
PATRICK IGBOKWE
RE: Discussion – Week 4
Hello Barbara
Thanks for the response. I agree that healthcare professionals must protect their patients from developing pressure ulcers (PU) and save them the pain, cost, and extended hospital stay associated with PU. I agree that employees’ noncompliance with evidence-based PU prevention practices is part of the problem. To empower nurses with the knowledge to understand the effect of PU, such as high cost, pain, sepsis, and even death, and training on the importance of preventing PU is needed to help nurses understand why their role is vital (Gedamu et al., 2021).
Reference
Gedamu, H., Abate, T., Ayalew, E., Tegenaw, A., Birhanu, M., & Tafere, Y. (2021). Level of nurses’
knowledge on pressure ulcer prevention: A systematic review and meta-analysis study in Ethiopia. Heliyon, 7(7), e07648. https://doi.org/10.1016/j.heliyon.2021.e07648
Kathleen Sease
RE: Discussion – Week 4
Hello Patrick,
Thank you for your post regarding pressure ulcers. I was involved in wound care for several years as part of my first nursing position. Pressure ulcers can be devastating for the elderly, wheelchair-bound, and patients attempting to heal from other health-threatening conditions (McEvoy et al., 2021). Research on this subject is ongoing and there have been many breakthrough discoveries in the prevention and treatment of pressure ulcers. Learning to use research databases is essential to stay abreast of these evidence-based practices (Stillwell et al., 2010). It appears that you have a robust understanding of how to formulate a clinical question and narrow your searches to reveal the answers to that inquiry.
References
McEvoy, N., Avsar, P., Patton, D., Curley, G., Kearney, C. J., & Moore, Z. (2021). The economic impact of pressure ulcers among patients in intensive care units. A systematic review. Journal of Tissue Viability, 30(2), 168–177. https://doi.org/10.1016/j.jtv.2020.12.004
Stillwell, S. B., Fineout-Overholt, E., Melnyck, B. M., & Williamson, K. M. (2010). 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.
ISATU JOHNSON
RE: Discussion – Week 4 Initial Post
Description of Clinical Issue of Interest and Development of a Picot Question
The shortage of nurses is becoming a global concern because of the impacts it is causing in healthcare facilities thus leading to a major impact on patients. It is important to note some of the main potential reasons leading to nursing shortages which include the increasing need for healthcare services, the aging population, more nurses focusing on career and family, violence against nurses in the healthcare setting that lead to a high rate of nurse turnover, and nurse burnout that also result in nurse turnover (Haddad, Annamaraju, & Toney-Butler, 2020). The American Nurse Association discusses that there will be high demand for nurses starting in 2022 going forward because the united states bureau of labor and statistics projects a 9% increase in job opportunities for nurses since there will be a need for over 275, 000 nurses.
Therefore, healthcare facilities need to develop strategies to reduce nurse turnover rates and reduce nursing shortages by providing favorable working conditions for nurses and using appropriate staffing ratios that will reduce nurse burnout (Marć et al., 2019). In so doing, delivery of high-quality services, as well as reduced medical error, will be achieved because nurses will work for an appropriate number of hours thus giving enough time for rest. Haddad, Annamaraju, & Toney-Butler, (2020) add that the use of appropriate staffing ratios will greatly help in the development of new staffing models that will favor all the nurses including the nursing moms and family male nurses to attend to their professional and domestic duties effectively and efficiently at the right time Searching Databases Discussion and PICOT questions.
Picot Question
Among healthcare facilities facing nursing shortages (P), how does the use of appropriate staffing ratios (I), compared to no use of appropriate staffing ratios (C) effective in reducing medical errors (O) after the implementation and adoption of appropriate staffing ratios (T)?
Search Terms and Databases
The databases used for my picot question included PubMed, Cochrane, Medline, CINAHL, and Walden University library. The search process was interesting since I could reduce the number of sources I needed using appropriate search terms and used the sources to obtain important data about the picot question. Some of the search terms that I used included appropriate staffing ratios, appropriate nurse-to-patient ratios, nursing shortages, medical errors, and staffing models. The first search resulted in 12 articles but did not address the main issues in my picot question and after adding nursing shortages and appropriate staffing ratios; it resulted in 453 research articles. I narrowed down the search by adding medical errors AND nurse to patient ratio AND putting a period of between 2017-2022, it resulted in 167 articles. However, I narrowed it down even further by changing the language to English only thus resulting in four articles.
Strategies to Increase the Rigor and Effectiveness of Database Search
Some of the strategies that can be applied to improve the rigor and effectiveness of database search include the use of appropriate vocabulary and the combination of terms and concepts by incorporating the Boolean operators (Mackieson, Shlonsky, & Connolly, 2019). Additionally, the evaluation of search strategies, having a conceptualized search, as well as using more than one database, and understanding the uniqueness and rules of the are other strategies that can be used to increase the rigor and effectiveness of database search.
References
Haddad, L. M., Annamaraju, P., & Toney-Butler, T. J. (2020). Nursing shortage. StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK493175/Mackieson, P., Shlonsky, A., & Connolly, M. (2019). Increasing rigor and reducing bias in qualitative research: A document analysis of parliamentary debates using applied thematic analysis. Qualitative Social Work, 18(6), 965-980. https://doi.org/10.1177/1473325018786996Marć, M., Bartosiewicz, A., Burzyńska, J., Chmiel, Z., & Januszewicz, P. (2019). A nursing shortage–a prospect of global and local policies. International nursing review, 66(1), 9-16. https://doi.org/10.1111/inr.1247
Sara Wilbur
RE: Discussion – Week 4 Initial Post
Mavis Barbara Sarbeng Boama
RE: Discussion – Week 4 Initial Post
Reply 1
Hi Isatu, thank you for your post. Indeed, the nursing shortage is an issue of great concern in recent times due to the numerous impacts on quality healthcare delivery and patient outcomes. Leaders of healthcare organizations are working tremendously to identify better solutions to the problem. Some scholars are of the view that providing competitive salaries may help to combat the problem. In contrast, others believe that a competitive salary is not a better solution to the problem as nurses seek better working conditions such as safe staffing, positive workplace culture, good interpersonal relationships with team members, and leadership (Perkins, 2021).
The use of reliable databases such as Cochrane, Medline, and CINAHL is adequate in identifying relevant evidence-based solutions to problems (Walden University Library, n.d.). Most of the articles retrieved from these sources are peer-reviewed, which helps obtain reliable information to solve problems.
References
Perkins, A. (2021). Nursing shortage: Consequences and solutions. Nursing Made Incredibly Easy!, 19(5), 49–54. https://doi.org/10.1097/01.NME.0000767268.61806.d9
Walden University Library. (n.d.). Databases A-Z: Nursing. Retrieved September 6, 2019, from https://academicguides.waldenu.edu/az.php?s=19981
Shanaa Wheeler-Yard
RE: Discussion – Week 4
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Gabrielle Phillips
RE: Discussion – Week 4
Hello Shanaa,
We are like-minded when it comes to the effects of falls and our desire to keep our patients safe and reduce unnecessary expenditure (Florence et al.,2018). Unfortunately, older adults are at higher risk of falling and developing falls, with expenditures in the billions for non-fatal and millions for fatal (Florence et al.,2018).
I admire that your PICOT inquiry focused on hourly rounding. Evidence suggests that hourly rounding decreases falls and nursing responsiveness to calling light use (Mitchell et al., 2014). PICOT consists of “population, issue or intervention of interest, comparison of interest, outcome, and time for intervention to achieve the outcome” (Melnyk & Fineout-Overholt, 2018, p.33). Perhaps the PICOT question could be reducing patient falls in elderly adults (or a population of your choice) by the use of hourly rounds in patients in a given setting ( hospital or in a nursing home) between a specific period (one of your choice).
Your chosen articles are recent, which is essential to evidence-based practice (Melnyk & Fineout-Overholt, (2018. It is often difficult to find relevant articles that are up to date from my search of scholarly databases. I will use your method of inputting recent years as it is a way to eliminate outdated articles.
References
Florence, C. S., Bergen, G., Atherly, A., Burns, E., Stevens, J., & Drake, C. (2018). Medical costs of fatal and nonfatal falls in older adults. Journal of the American Geriatrics Society, 66(4), 693–698. https://doi.org/10.1111/jgs.15304
Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice(4th ed.). Wolters Kluwer.
Mitchell, M. D., Lavenberg, J. G., Trotta, R. L., & Umscheid, C. A. (2014). Hourly rounding to improve nursing responsiveness: a systematic review. The Journal of Nursing Administration, 44(9), 462–472. https://doi.org/10.1097/NNA.0000000000000101
Shanaa Wheeler-Yard
RE: Discussion – Week 4
Hi Gabrielle,
You are correct, older adults experience falls at at higher rate than all other patient populations. Identifying fall precaution barriers has been an ongoing health care focus. Hourly rounding has proven to decrease falls significantly in some patient settings, it’s my hope to customize this initiative to focus on patient specific needs to further decrease patient falls.
Mavis Barbara Sarbeng Boama
RE: Discussion – Week 4
Several clinical issues in the healthcare system affect quality healthcare delivery and outcomes. In this discussion, my focus will be on falls among elderly patients 65 years and above admitted to the medical-surgical unit. This issue is of great concern considering the number of complications associated with falls among the elderly. This affects mobility, prolonged hospital stay, increases medical cost, and even death. The leaders of healthcare institutions thrive on putting ineffective measures to prevent inpatient falls and protect the patients from harm or injury. According to Davies (2011), “successfully retrieving relevant information begins with a clearly defined, well-structured question (p. 75). This can be achieved by using the PICOT method. My clinical question related to the issue of interest is, “Among the elderly inpatients aged 65 years and above admitted to the medical-surgical unit, will the evidenced-based multifactorial fall intervention be effective in preventing falls compared to the regular fall risk interventions within six months? This method helps to identify relevant keywords to enhance the search results.
The following search strategies were employed to search for relevant peer-reviewed articles related to the clinical issue of interest; firstly, identifying relevant databases. The Walden University library provides access to relevant databases A to Z to support students’ success (Walden University, n.d.). I decided to select the CINAHL, and MEDLINE combined search and the CINAHL Plus with Full Text to yield reliable results. The next step was to select the appropriate keywords. Keywords used in the search include falls in the elderly, inpatient falls, fall prevention. This method yielded 1922 results but to help refine the results, I used the Boolean operators and nestling method to connect the keywords. According to the Library of Congress(n.d.), the Boolean operators assist one in searching for a combination of words and phrases. During my search for relevant articles, Boolean operators such as ‘AND’ were used to combine phrases such as; Falls in the elderly, fall prevention, and inpatient falls. This helped refine search results to 62 articles related to the clinical issue of interest.
To increase the rigor and effectiveness of a database search, one needs to consider employing search limiters. Examples of search limiters include Full Text, peer-reviewed scholarly journals, and current publication dates. Articles with a publication date of not more than five years may be considered. The search was also be limited to evidence-based articles to retrieve results (Melnyk & Fineout-Overholt, 2018). The following four articles were selected for review:
Chan, S. Q., Wadsley, M., & Ferriere, S. (2017). Quality assurance of falls reduction in an orthopedic ward using a novel bedside trolley table set-up strategy. Australasian Journal on Ageing, 36(4), 318–323. https://doi.org/10.1111/ajag.12428
Shyu, M.-L., Huang, H.-C., Wu, M.-J., & Chang, H.-J. (2018). Development and Validation of the Self-Awareness of Falls in Elderly Scale Among Elderly Inpatients. Clinical Nursing Research, 27(1), 105–120. https://doi.org/10.1177/1054773817714663
Wallis, A., Aggar, C., & Massey, D. (2022). Multifactorial falls interventions for people over 65 years in the acute hospital setting: An integrative review. Collegian, 29(1), 100–108. https://doi.org/10.1016/j.colegn.2021.05.003
Yaw-Wen Chang, Ying-Hsue Chang, Yu-Ling Pan, Tung-Wei Kao, Senyeong Kao, Chang, Y.-W., Chang, Y.-H., Pan, Y.-L., Kao, T.-W., & Kao, S. (2017). Validation and reliability of Falls Risk for Hospitalized Older People (FRHOP): Taiwan version. Medicine, 96(31), 1–5. https://doi.org/10.1097/MD.0000000000007693
References
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.
Library of Congress. (n.d.). Search/browse help – Boolean operators and nesting. Retrieved September 19, 2018, from https://catalog.loc.gov/vwebv/ui/en_US/htdocs/help/searchBoolean.html
Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer.
Walden University Library. (n.d.-a). Databases A-Z: Nursing. Retrieved September 6, 2019, from https://academicguides.waldenu.edu/az.php?s=1998
Angela Johnson
RE: Discussion – Week 4
Mavis,
I enjoyed your post. There is a multifactorial fall risk assessment is an assessment with multiple components that aims to identify a person’s risk factors for falling. It has been my experience that every patient, inpatient and outpatient be considered a fall risk. They are given slop resistant socks. Inpatients are given yellow slippers if they are high risk for falls.
There are steps to the evidence based practice process. 1. get excited about researching evidence based practice 2. develop question in PICOT format 3. search for evidence 4. integrate the best evidence with one’s clinical expertise 5. evaluate outcomes of the practice decision or change based on evidence 6. disseminate the outcomes of the EBP decision or change.
Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer
Heidi Thornton
RE: Discussion – Week 4-Main Post
Main Post
Antibiotic Misuse and Resistance
The prescribing and misuse of antibiotics has become common practice, however with the rise of antibiotic resistance, common practice needs to be reevaluated to determine if it’s best practice.
When patient’s present to their primary care doctor or an urgent care facility for upper respiratory symptoms, they often expect to be prescribed an antibiotic, even if they have a virus. Some practitioners prefer to prescribe the stronger, newer generation antibiotics, when amoxicillin would likely be efficient. Nearly all surgical patients receive antibiotics at the time of their surgery, to ward off any potential post operative infections. Patient’s may to the education provided by the prescriber regarding proper use of antibiotics and may stop their prescribed antibiotics when they start feeling better, and save the rest to take the next time they feel under the weather. Healthcare workers need to reexamine prescribing practices of antibiotics and examine the role they are playing in the rise of antibiotic resistance.
PICOT Format
When researching about this issue, it is important for the researcher to utilize the PICOT format which is comprised of components of answerable and searchable questions composed of: the patient population or disease, the intervention or issue of interest, the comparison intervention, the outcome, and the time. A potential PICOT question for this issue could be: In patients, how does antibiotic use compared with no antibiotics affect prognosis in upper respiratory infections? (Melnyk & Fineout-Overholt, 2018, pg. 34)
Other examples utilizing the PICOT format include: P: population could be patients, surgical patients, for prescribers or nurse practitioners, or doctors. The I: intervention or issue could be antibiotic use, antibiotic prophylaxis, or overuse. The C: comparison of interest could be no antibiotic use. The O: outcome expected could be infection, or post operative infection, or resistance. The T: time for the intervention to achieve the outcome could be during hospitalization, or postoperatively, or in an outpatient setting.
My initial searches were conducted through Thoreau Multi-Database on the Walden Library. Another search engine option is the CINAHL Plus with full text database which is an unfiltered database containing over 750 nursing and allied health related journals and indexes (Walden University Library, n.d.-c). I refined my search by clicking peer reviewed articles. Boolean terms connect keywords together to create phrases that the database can understand. The terms “and”, “or”, and “not” can be used to help create more precise search results. (Walden University Library, n.d.-f) My initial Boolean search phrases were “antibiotic” “and” “resistance” “and” “prevention” which provided 612 results. Switching “prevention” to “causes” yielded 1,717 results.
Research Strategies to Further My Research
To further hone in on my research to include articles that included healthcare workers role in antibiotic overuse and resistance, my Boolean search included: “prescribers” and antibiotics” and “patients”. This search provided results much more in line with the topics I was looking for including 1,702 results with many about the abuse of antibiotics.
On CINAHL, I clicked peer reviewed articles, and changed the criteria to provide only the last five years of articles. I typed in “prescribers or physicians or nurse practitioners or doctors” and antibiotics. This provided 5,091 articles including articles regarding prescribers’ knowledge and perceptions about antibiotics. It is important for the researcher to be educated on the various research techniques in order to obtain the information they are looking for in a timely manner.
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
Walden University Library. (n.d.-f). Keyword searching: finding articles on your topic: Boolean terms. Retrieved March 20, 2022 from https://academicguides.waldenu.edu/library/keyword/boolean
Walden University Library. (n.d.-c). Evidence-based practice research: CINAHL search help. Retrieved March 20, 2022 from https://academicguides.waldenu.edu/library/healthevidence/cinahlsearchhelp
Brenda Reese
RE: Discussion – Week 4-Main Pos
Good Morning Heidi
Thank you for the exciting discussion post. I agree that antibiotics are often overprescribed. The overuse of antibiotics promotes further resistance. According to the CDC, about one-third of antibiotic use in people is not medically indicated nor appropriate (2022). I found the statement about Amoxicillin exciting and was wondering if you could provide any further data for this finding. At my place of practice, Amoxicillin is rarely prescribed.
Researching for data, several options can be used as a search engine. CINAHL Plus, available with full text, covers nursing, biomedicine, health sciences, consumer health, and numerous other allied health disciplines (Duchon, n.d.). I appreciate the ability to filter the needs of my search and use the Boolean Operators to narrow the findings. Before this course, I did not use all the available features to assist with research results. I would spend a lot of time skimming through titles, looking for the best options. My searches are more thorough and concise with the additional information I have gained.
References:
Duchon, C. (n.d.). Cinahl plus with full text (EBSCO): Introduction. LibGuides. Retrieved March 26, 2022, from https://maag.guides.ysu.edu/CINAHL
Mayo Foundation for Medical Education and Research. (2022, March 11). Antibiotics: Are you misusing them? Mayo Clinic. Retrieved March 25, 2022, from https://www.mayoclinic.org/healthy-lifestyle/consumer-health/in-depth/antibiotics/art-20045720
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Heidi Thornton
RE: Discussion – Week 4
Hello Brenda,
Thank you for your response. The Amoxicillin was in response to personal experiences at my kids pediatrician’s office. Amoxicillin is effective at treating strep, however a few times, stronger antibiotics were initially discussed. After discussion with the prescriber, Amoxicillin was prescribed, and worked just fine.
Erica Elliott
RE: Discussion – Week 4
The clinical issue of interest to me is maternal and infant morbidity and mortality in the minority community. The most current statistics report that in 2019, most American states reported a rate of five to seven infant deaths per 1,000 live births. Additionally, African Americans have the highest stake in this population. Equally as concerning is the fact that in 2020, maternal mortality was 23.8 per 1,000 live births. This number was up from 20.1 in 2019. Being a registered nurse and future advanced practice nurse with a specialty in pediatrics and family health, this is an issue that will continually be addressed in my current and future practice.
With a simple google search for my clinical area of interest, I was directed to the CDC website where I found statistics for 2018-2020. These search results, however, did not give me very much insight to the role healthcare providers can play in this issue. Next, I routed my search to both Google Scholar and the Walden University library. Between them both, I was given approximately three million results. This extensive group was only reduced with the use of Boolean operators. My initial search “maternal mortality in the United States” became “maternal AND infant mortality in the United States” and “Maternal mortality in the United States in 2019 AND 2020”, etc.
The use of more specific phrases reduces the search results and made the articles easier to read and apply to my clinical issue of interest. As I further develop my PICOT question, I will continue to use the resources and tools common to evidence-based practice.
References
Connolly, P. Keenan, C., & Urbanska, K. (2018). the trials of evidence-based practice in education: A systematic review of randomised controlled trials in education research 1980-2016. Education Research, 60(3), 276-291.
Hoyert, D.L.. (2020). Maternal mortality rates in the United States, 2020. NCHS Health E-Stats. DOI: https://dx.doi.org/10.15620/cdc:113967.
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, LLC. (producer). (2018). The Value of Clinical Inquiry [Video file]. Baltimore, MD: Author.
Ashley Elix
RE: Discussion – Week 4
Medication therapy can beneficial, but there are significant risk when medication errors happen (Billstein et al. 2018.). An array of interventions have been implemented to improve medication administration safety. One intervention implemented in an acute care hospital I worked in was to have “Do not disturb” sign on the nurses computer on wheels while administering medications. It alert anyone approaching the nurse to wait until she was done with administering the patient medication before communicating with him or her. My initial search for clinical issue of interest is medication errors and it yielded 21, 796 results in CINAHL PLUS. Clinical setting of interest is acute care medication errors. Boolean operators help you search for key terms in a certain order (Library of Congress, n.d.). It utilizes the words “and” and “not” to include or exclude articles not wanted in the search. When I used the Boolean operator’s system to search for medication errors in acute care setting or hospital only 9, 084 results in CINAHL PLUS appeared. An initial review of search results it appears it narrowed down the search to specifically provide articles about medication errors in acute care setting or hospital. I narrowed my search using the PICOT format, which stands for population of interest, intervention or issue of interest, comparison of interest, outcome expected, and time for the intervention to achieve the outcome(Melnk & Fineout-Overholt, 2018). I focused on population of interest to narrow the search from medication errors in general to medication errors in acute care setting or hospital. The next database I used was medline, I obtained 10,565 search results when I entered medication errors in the first column of the search. When I added acute care setting or hospital in the second search column it narrowed search results to 5,873. Reference Billstein-Leber, M., Carrillo, C. J. D., Cassano, A. T., Moline, K., & Robertson, J. J. (2018). ASHP Guidelines on Preventing Medication Errors in Hospitals. American Journal of Health-System Pharmacy : AJHP : Official Journal of the American Society of Health-System Pharmacists, 75(19), 1493–1517. https://doi.org/10.2146/ajhp170811 Library of Congress. (n.d.). Search/browse help-boolean operators and nesting. Retrieved March 23, 2022 from https://catalog.loc.gov/vwebv/ui/en_US/htdocs/help/searchBoolean.html Melynk, B.M. & Fineout-Overholt, E. (2018). Evidence-based practice in nursing and healthcare: A guide to best practice. (4th ed.). Philedelphia, PA: Wolters Kluwer.
Ashley Elix
RE: Discussion – Week 4
Medication therapy can beneficial, but there are significant risk when medication errors happen (Billstein et al. 2018.). An array of interventions have been implemented to improve medication administration safety. One intervention implemented in an acute care hospital I worked in was to have “Do not disturb” sign on the nurses computer on wheels while administering medications. It alert anyone approaching the nurse to wait until she was done with administering the patient medication before communicating with him or her.
My initial search for clinical issue of interest is medication errors and it yielded 21, 796 results in CINAHL PLUS. Clinical setting of interest is acute care medication errors. Boolean operators help you search for key terms in a certain order (Library of Congress, n.d.). It utilizes the words “and” and “not” to include or exclude articles not wanted in the search. When I used the Boolean operator’s system to search for medication errors in acute care setting or hospital only 9, 084 results in CINAHL PLUS appeared. An initial review of search results it appears it narrowed down the search to specifically provide articles about medication errors in acute care setting or hospital. I narrowed my search using the PICOT format, which stands for population of interest, intervention or issue of interest, comparison of interest, outcome expected, and time for the intervention to achieve the outcome(Melnk & Fineout-Overholt, 2018). I focused on population of interest to narrow the search from medication errors in general to medication errors in acute care setting or hospital.
The next database I used was medline, I obtained 10,565 search results when I entered medication errors in the first column of the search. When I added acute care setting or hospital in the second search column it narrowed search results to 5,873.
Reference
Billstein-Leber, M., Carrillo, C. J. D., Cassano, A. T., Moline, K., & Robertson, J. J. (2018). ASHP Guidelines on Preventing Medication Errors in Hospitals. American Journal of Health-System Pharmacy : AJHP : Official Journal of the American Society of Health-System Pharmacists, 75(19), 1493–1517. https://doi.org/10.2146/ajhp170811
Library of Congress. (n.d.). Search/browse help-boolean operators and nesting. Retrieved March 23, 2022 from https://catalog.loc.gov/vwebv/ui/en_US/htdocs/help/searchBoolean.html
Melynk, B.M. & Fineout-Overholt, E. (2018). Evidence-based practice in nursing and healthcare: A guide to best practice. (4th ed.). Philedelphia, PA: Wolters Kluwer.
Erica Elliott
RE: Discussion – Week 4
Hello Ashley,
I agree with your stance on the importance of medication therapy and the protocol your hospital put in place to ensure that nurses are able to perform administration with reduced distractions. I admire how you were able to fit your clinical inquiry into the PICOT format in order to specify your search in the various databases you used. Your method and explanation will assist me as I continue to develop what my PICOT question will address. I especially want to give my question specificity and you outlined that same sentiment in this discussion post. In the references below, I was also able to gain more understanding of how to formulate a solid PICOT question.
References
Fandino, W. (2019). Formulating a good research question: Pearls and pitfalls. Indian journal of anaesthesia, 63(8), 611.
Lira, R. P. C., & Rocha, E. M. (2019). PICOT: Imprescriptible items in a clinical research question. Arquivos Brasileiros de Oftalmologia, 82, 1-1.
Wania Imran
RE: Discussion – Week 4
Patients in the hospital have a greater risk of developing venous thromboembolism (VTE) that can result in mortality or even morbidity. To decrease the chance of this life-threatening complication, VTE prophylaxis is commonly in place for hospitalized patients. Anticoagulation therapy such as low-molecular-weight heparin is the usual form of pharmacological prevention of VTEs. Non-pharmacological mechanisms include the use of compression stockings and intermittent compression devices. My clinical issue of interest is whether VTE prophylaxis reduces complications in patients. I used the CINAHL and MEDLINE databases to find my research articles. I used Boolean terms in my search so that the database could look for multiple terms or concepts within one attempt so a more precise result of articles is produced (Walden University Library, n.d.-a). In my initial search of ‘VTE prophylaxis’, there were 616 results and when I added a Boolean term like ‘OR DVT prophylaxis’ it resulted in 808 articles. Then I added the term ‘AND nursing intervention’ and got 331 results. I used the filters ‘research articles’ and ‘peer review articles’ to further narrow my results.
The PICOT format is an effective way to formulate research questions that evaluate interventions such as treatment efficacy (Riva, et. al., 2012). Having the ability to compose effective research questions in clinical practice is an important part of mapping out the research strategy and composing productive research. My clinical issue in the PICOT format is- in post-surgical patients, what is the effect of VTE prophylaxis on VTE-related complication rate compared with no prophylaxis treatment? I can increase the effectiveness of a database search on my PICOT question by doing more advanced searches. I can filter results by checking off ‘randomized controlled trials’, ‘clinical trial’, and ‘evidence-based practice’. Experimental and randomized controlled trials are ranked as level I in the hierarchy of evidence and considered to have higher validity (Walden University Library, n.d.-b).
Reference:
Riva, J. J., Malik, K. M., Burnie, S. J., Endicott, A. R., & Busse, J. W. (2012). What is your research question? An introduction to the PICOT format for clinicians. The Journal of the Canadian Chiropractic Association, 56(3), 167–171. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3430448/
Walden University Library. (n.d.-a). Keyword searching: Finding articles on your topic: Boolean terms. Retrieved March 23, 2022, from https://academicguides.waldenu.edu/library/keyword/boolean#s-lg-box-20133343
Walden University Library. (n.d.-b). Evidence-based research: Evidence types. Retrieved March 23, 2022, from https://academicguides.waldenu.edu/library/healthevidence/types#s-lg-box-1520654
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