When you decide to purchase a new car, you first decide what is important to you. If mileage and dependability are the important factors, you will search for data focused more on these factors and less on color options and sound systems.
The same holds true when searching for research evidence to guide your clinical inquiry and professional decisions. Developing a formula for an answerable, researchable question that addresses your need will make the search process much more effective. One such formula is the PICO(T) format.
In this Discussion, you will transform a clinical inquiry into a searchable question in PICO(T) format, so you can search the electronic databases more effectively and efficiently. You will share this PICO(T) question and examine strategies you might use to increase the rigor and effectiveness of a database search on your PICO(T) question.
RESOURCES
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
WEEKLY RESOURCES
LEARNING RESOURCES
Required Readings
Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer.
Chapter 2, Asking Compelling Clinical Questions(pp. 33-54)
Chapter 3, Finding Relevant Evidence to Answer Clinical Questions (pp. 55-92)
Davies, K. S. (2011). Formulating the evidence based practice question: A review of the frameworksLinks to an external site. for LIS professionals. Evidence Based Library and Information Practice, 6(2), 75-80.
Library of Congress. (n.d.). Search/browse help – Boolean operators and nestingLinks to an external site.. Retrieved September 19, 2018, from https://catalog.loc.gov/vwebv/ui/en_US/htdocs/help/searchBoolean.html
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.Links to an external site. American Journal of Nursing, 110(3), 58-61.
Melnyk, B. M., Fineout-Overholt, E., Stillwell, S. B., & Williamson, K. M. (2009).Evidence-based practice: Step by step: Igniting a spirit of inquiryLinks to an external site..Links to an external site. American Journal of Nursing, 109(11), 49-52. doi:10.1097/01.NAJ.0000363354.53883.58
Stillwell, S.B., Fineout-Overhold, E., Melnyk, B.M., & Williamson, K.M. (2010). Evidence-based practice step-by-step: Searching for evidence.Links to an external site. American Journal of Nursing, 110(5), 41-47.
Walden University Library. (n.d.-a). Databases A-Z: NursingLinks to an external site.. Retrieved September 6, 2019, from https://academicguides.waldenu.edu/az.php?s=19981
Walden University Library. (n.d.-c). Evidence-based practice research: CINAHL search helpLinks to an external site.. Retrieved September 6, 2019, from https://academicguides.waldenu.edu/library/healthevidence/cinahlsearchhelp
Walden University Library. (n.d.-d). Evidence-based practice research: Joanna Briggs Institute search helpLinks to an external site.. Retrieved September 6, 2019, from https://academicguides.waldenu.edu/library/healthevidence/jbisearchhelp
Walden University Library. (n.d.-e). Evidence-based practice research: MEDLINE search helpLinks to an external site.. Retrieved September 6, 2019, from https://academicguides.waldenu.edu/library/healthevidence/medlinesearchhelp
Walden University Library. (n.d.-f). Keyword searching: Finding articles on your topic: Boolean termsLinks to an external site. Retrieved September 19, 2018, from http://academicguides.waldenu.edu/library/keyword/boolean
Walden University Library. (n.d.-g). Keyword searching: Finding articles on your topic:Â Introduction to keyword searchingLinks to an external site.. Retrieved September 19, 2018, from http://academicguides.waldenu.edu/library/keyword/searching-basics
Walden University Library. (n.d.-h). Quick Answers: How do I find a systematic review article related to health, medicine, or nursing?Links to an external site. Retrieved September 6, 2019, from https://academicanswers.waldenu.edu/faq/72670
Walden University Library. (n.d.-i). Systematic review.Links to an external site. Retrieved January 22, 2020, from https://academicguides.waldenu.edu/library/healthevidence/types#s-lg-box-1520654
Required Media : Check Youtube for the video below please.
Walden University, LLC. (Producer). (2018). Searching the Evidence [Video file]. Baltimore, MD: Author.
To Prepare:
Review the Resources and identify a clinical issue of interest that can form the basis of a clinical inquiry.
Review the materials offering guidance on using databases, performing keyword searches, and developing PICO(T) questions provided in the Resources.
Based on the clinical issue of interest and using keywords related to the clinical issue of interest, search at least two different databases in the Walden Library to identify at least four relevant peer-reviewed articles related to your clinical issue of interest. You should not be using systematic reviews for this assignment, select original research articles.
Review the Resources for guidance and develop a PICO(T) question of interest to you for further study.It is suggested that an Intervention-type PICOT question be developed as these seem to work best for this course.
*Library tip:
Walden Library recommends starting your search broadly with one concept or search word and adding more elements one at a time. Depending on your topic, the evidence will not necessarily address all the aspects of your PICO(T) question in one article. Select the most important concepts to search and find the best evidence available, even if that means assembling evidence from multiple articles.
Nursing Research PageLinks to an external site. databases and resources specifically for Nursing
Evidence-Based Practice guide: Evidence TypesLinks to an external site.
Nursing and Health research to an external site., including a 15-minute introduction
Quick Answers:
How do I find an article that reports on research that uses a specific methodology?Links to an external site.
How do I find original or primary research that analyzes empirical data?
What is the Find at Walden button?
Post a brief description of your clinical issue of interest. This clinical issue will remain the same for the entire course and will be the basis for the development of your PICOT question. Describe your search results in terms of the number of articles returned on original research and how this changed as you added search terms using your Boolean operators. Finally, explain strategies you might make to increase the rigor and effectiveness of a database search on your PICO(T) question. Be specific and provide examples.
Respond to at least two of your colleagues and provide further suggestions on how their database search might be improved.
First Response
CLINICAL ISSUE: HEALTHCARE ASSOCIATED INFECTIONS IN THE INTENSIVE CARE UNIT.
PICOT question: In the Intensive Care Unit, how effective is the use of chlorhexidine gluconate baths in preventing Healthcare Associated Infections within 12 months?
Healthcare Associated Infections among adult patients admitted to the intensive care unit have been shown to increase length of stay, the cost of care, morbidities, and in some cases increased the risk of hospital death. Daily bathing with chlorhexidine gluconate wipes (CHG) has been shown to decrease the risk of infections in the ICU (Frost et al., 2018). However, due to varying estimates of effectiveness, CHG bathing is not universally practiced. As a result, current opinion of the merit of CHG bathing to reduce hospital acquired infections in the ICU, is divergent, suggesting a state of clinical equipoise (Musuuza et al., 2019)
Search results and effect of Boolean operators
Using the Walden library database, I searched for the literature and evidence-based practices regarding prevention of Health Care Associated Infections (HAI) in the intensive care unit. Walden library has two main ways of searching for an article: through database or by article type. Searches can be done by use of the Keyword, Subject Heading and Title Search strategies. The three strategies should be used in combination to provide high levels of certainty that best evidence is not missed (Melnyk & Fineout-Overholt 2018). The keyword was derived from the clinical issue/ PICOT question.
According to Melnyk & Fineout-Overholt (2018) the Cochrane Handbook recommends that the search should begin with the population (ICU), and intervention (CHG baths). Other scholars have also recommended, beginning the search with the outcome (HAI) and intervention (Stillwell et al., 2010).
Typing the keyword Healthcare Associated Infections on Medline-EBSCO database, the results yielded 21, 380 articles on this topic. When I added the keyword CHG bathing, the results were narrowed down to 39 articles. Further additions of Boolean phrases, ICU, produced 18 articles. Some of the keyword results were highlighted in the title, while others were captured on the article abstract. Use of Boolean produced more focused and productive results.
Searching the keyword: healthcare Associated Infections on the PubMed database yielded 863 study results. The database allows a student to filter the result under text availability, year of publication, article attribute, and article type. When I filtered the results under full text, meta-analysis and 5 years, the search produced 11 results.
Strategies to increase the rigor and effectiveness of a database search on the PICOT question.
To increase the rigor and effectiveness of a database search on the PICOT question, it is important for a researcher to understand both the structure and content of a particular information source before attempting to search. It is also important to understand both the clinical area of investigation and the current literature that exists (Melnyk & Fineout-Overholt 2018). Some licensed databases such as MEDLINE has references to journals in life sciences, indexed with the National Library of Medicine and can yield great information on life science articles (Walden University Library, n.d.).
A clinician should determine which database to use to yield relevant evidence. For instance, PubMed has quality controls with many scholarly articles from biomedical research which are evidence-based and has NIH-funded research projects from major grantors (Ossom & Minter, 2019). Other consideration is to determine if the subject headings /keywords will be more effective in getting the best evidence quickly and how frequent the database is updated. ProQuest Central database upgrades information weekly and can yield articles dated back in the 1800’s. ProQuest central has large selection of scholarly publications, and other materials like newspapers, dissertations, and business information (Walden University Library, n.d.).
Searching the articles by Keyword, Subject Heading, and Title Search Strategies increases the certainty that the best evidence is not missed. Systematically and uniformly searching the same articles across the databases using the same approach ensures consistency with the yield of the search results. Searching the word Healthcare Associated Infections and CHG bathing in MEDLINE and PubMed yielded results which were relevant to my PICOT question.
REFERENCES
Frost, S. A., Hou, Y. C., Lombardo, L., Metcalfe, L., Lynch, J. M., Hunt, L., Alexandrou, E., Brennan, K., Sanchez, D., Aneman, A., & Christensen, M. (2018). Evidence for the effectiveness of chlorhexidine bathing and health care-associated infections among adult intensive care patients: a trial sequential meta-analysis. BMC infectious diseases, 18(1), 679. https://doi.org/10.1186/s12879-018-3521-yLinks to an external site.
Huang, H. P., Chen, B., Wang, H. Y., & He, M. (2016). The efficacy of daily chlorhexidine bathing for preventing healthcare-associated infections in adult intensive care units. The Korean journal of internal medicine, 31(6), 1159–1170. https://doi.org/10.3904/kjim.2015.240Links to an external site.
Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer.
Musuuza, J. S., Guru, P. K., O’Horo, J. C., Bongiorno, C. M., Korobkin, M. A., Gangnon, R. E., & Safdar, N. (2019). The impact of chlorhexidine bathing on hospital-acquired bloodstream infections: a systematic review and meta-analysis. BMC infectious diseases, 19(1), 416. https://doi.org/10.1186/s12879-019-4002-7Links to an external site.
Ossom Williamson, P., & Minter, C. (2019). Exploring PubMed as a reliable resource for scholarly communications services. Journal of the Medical Library Association: JMLA, 107(1), 16–29. https://doi.org/10.5195/jmla.2019.433Links to an external site.
Stillwell, S.B., Fineout-Overholt, E. Melynk, B.M., & Williamson, K. (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.
Walden University Library. (n.d.). Databases A-Z: NursingLinks to an external site.Links to an external site.. https://academicguides.waldenu.edu/az.php?s=19981Links to an external site.
2nd Response
Introduction
The healthcare system needs evidence-based practice (EBP) to provide the most advanced scientific and technical care (Melnyk, Fineout-Overholt, Stillwell, & Williamson, 2009). The result of asking pertinent questions through a systematic and comprehensive procedure is EBP. A topic one is interested in should provide an excellent starting point, as suggested by Walden University Library (n.d.). Formulating a question in a way that makes getting an answer quicker and more effective is the key to enhancing patient outcomes (Stillwell, Fineout-Overholt, Melnyk, & Williamson, 2010).
Clinical issue: Opioid overdose
Since 1999, the Opioid crisis has been out of control and has not improved. According to the CDC, 130 individuals die from an Opioid overdose daily. In addition, the incidence of overdose deaths involving opioids, stimulants, and stimulants alone varied by age in 2020.
The death rate among people aged 35-44 (24.2 per 100,000) was most significant for deaths using opioids and stimulants.
The death rate for opioid-related deaths without stimulants was highest among people aged 25-34 (27.8 per 100,000) and 35-44 (27.6 per 100,000).
The fatality rate for accidents involving stimulants but no opioids was 8.5 per 100,000 in people aged 45 to 54.
The epidemic is undoubtedly worsening, yet some of these tragic overdoses can be prevented by using Narcan. Narcan, which reverses the lethal effects of opioids, doesn’t require medical training. Because I work in a Psychiatric Hospital, I chose Opioid overdose. Below is the question I formulated with Opioid use disorder using the PICO(T) method.:
(P) Opioid users who have
(I) access to Narcan compared with those without
(C) access to Narcan at risk of
(O) having a fatal overdose while using opioids.
Search terms and Databases
For my research topic, the databases used were EBSCO, PubMed, Medline, and CINHAL Plus with Full Text. In addition, Narcan or naloxone, opioid overdose, emergency room, prevention, and mortality were the search keywords utilized.
Search Results
It is essential to access scholarly websites and not only Google when looking for information when conducting research. Often, journals and scientific publications do not appear on Google. It is also wise to refer to studies published within the past five years unless the survey is ground-breaking evidence-based research (Laureate Education, 2018). I used the CINAHL Plus with Full Text, PubMed, and Medline databases to research my clinical topic of interest.
Six articles were found in the initial search, but over 2382 were found when the investigation was refined to include the generic term naloxone rather than just Narcan. The search was further refined to include the dates 2018 through 2023, and the results included 485 publications on Medline with Full-text databases. The following search had a combined PubMed and Medline search. Adding the terms Narcan or naloxone, Opioid overdose, AND prevention further refined the results, limiting the language to only English, Evidence-based practice, and peer-reviewed studies, generating 2385 results.
Strategies to increase Rigor and Effectiveness of Database Search
I’ll use the following strategies to make a more thorough and productive database search for my PICO(T) review. I will utilize particular strategies to find scholarly publications that have been evaluated and supported by evidence by accessing scholarly websites. It is essential to use the correct database for the best match, suggest Melnyk, Fineout-Overholt, & Co. (2018). Several “levels of evidence pyramids that provide a means to view both the quality of evidence and the amount of available evidence” can be produced using various databases (Walden Library, n.d.). Also, searching for articles requires time and, initially, may be stressful. But spending quality time finding the most relevant keywords and using recent studies supports my research.
References
Centers for Disease Control and Prevention. (2022, June 22). Drug overdose deaths in 28 states and the District of Columbia: 2020 data from the State Unintentional Drug Overdose Reporting System. Centers for Disease Control and Prevention., https://www.cdc.gov/drugoverdose/databriefs/sudors-1.htmlLinks to an external site.
Laureate Education (Producer). (2018). Searching the Evidence
https://class.content.laureate.net/431ca31b5a00b6103cbdf450b3c5edd8Links to an external site.
Melnyk, B. M., Fineout-Overholt, E., Stillwell, S. B., & Williamson, K. M. (2010). Evidence-based practice: step by step: the seven steps of evidence-based practice. The American journal of nursing, 110(1), 51-53. https://doi.org/10.1097/01.NAJ.0000366056.06605.d2Links to an external site.
Stillwell, S. B., Fineout-Overholt, E., Melnyk, B. M., & Williamson, K. M. (2010). Evidence-based practice, step by step: asking the clinical question: a key step in evidence-based practice. The American journal of nursing, 110(3), 58-61. https://doi.org/10.1097/01.NAJ.0000368959.11129.79Links to an external site.
Walden University. (n.d.). Academic guides: Evidence-based research: Levels of Evidence Pyramid.https://academicguides.waldenu.edu/library/healthevidence/evidencepyramid#s-lg-box-wrapper-10260503Links to an external site.
 Walden University. (n.d.). Evidence-Based Practice Research: CINAHL search help.
https://academicguides.waldenu.edu/library/healthevidence/medlinesearchhelpLinks to an external site.
This is an additional response. I just put it in here just incase it might be of importance to you as well.
Manage Discussion Entry
CLNICAL ISSUE: Glycemic control in hospitalized patients
P: hospitalized patients
I: continuous glucose monitoring with CGM device
C: intermittent POC blood glucose monitoring
O: improved patient outcome
PICO QUESTION: Does continuous glucose monitoring improve patient outcomes in hospitalized patients as compared to intermittent POC glucose monitoring?
Glucose has been considered the fifth vital sign for many years. Uncontrolled glucose levels contribute to higher morbidity, mortality, increased length of stay, increased healthcare costs, negative impacts on patient safety, and overall poor patient outcomes. The current standard of practice is to perform intermittent blood glucose monitoring with finger sticks multiple times daily, with frequency as often as every hour. Some patients only receive glucose monitoring at meals and bedtime, leaving them vulnerable to hypoglycemic events during the night time hours.
Patients are now using wearable continuous glucose monitors to manage their blood sugars, Studies have shown significant improvements in HgA1C levels in outpatients using CGM devices (Gilbert TR, 2021). Patients also continue to wear their devices while hospitalized, yet hospitals do not recognize the data from the device and continue to perform finger sticks. COVID saw an increase in the use of CGM devices without adverse effects on patient safety (Ehrhardt & Hirsch, 2020). So, why isn’t continuous glucose monitoring the standard in hospitals to improve patient outcomes through improved glycemic control- whether to prevent hyper/hypoglycemic events or to improve time in range?
SEARCH TERMS and DATABASES
Forming the right questions to ask in order to find the right information is imperative. Background questions and foreground questions lead the research in the right direction (Fineout-Overholt & Stillwell, 2019).
Using the phrase advantages of continuous glucose monitoring in critically ill patients in the search bar for the Walden University Library, I found 0 results. When I typed that phrase into the google search bar for scholarly articles, I found 8,000 results. For me, this is always the starting point when I search for topics. Other databases I use are Western Governors University Library, Open Athens, and library databases that are available through my employer. I also typed in other phrases into the Walden University Library search bar using terms like glycemic control in critically ill patients, CMG devices, blood glucose monitoring in hospitals, etc. and had little to no results. But typing those terms into google gave me articles that I could enter into the search bar for the Walden Library that would bring up that article.
References
Ehrhardt , N., & Hirsch, I. (2020, November). The Impact of COVID-19 on CGM Use in the Hospital. Diabetes Care, 43, 2628-2630. Retrieved from https://doi.org/10.2337/dci20-0046
Fineout-Overholt, E., & Stillwell, S. (2019). Asking Compelling Clinical Questions. In B. Melnyk, & E. Fineout-Overholt, Evidence-Based Practice in Nursing and Healthcare: A Guide to Best Practice (4th ed., pp. 37-38). Philadelphia: Wolters Kluwer.
Gilbert TR, N. A. (2021). Change in Hemoglobin A1c and Quality of Life with Real-Time Continuous Glucose Monitoring Use by People with Insulin-Treated Diabetes in the Landmark Study. DIABETES TECHNOLOGY & THERAPEUTICS, 23((S1)), s35-s39. doi:10.1089/dia.2020.0666