Evidence Based Practice Module3
Evidence Based Practice Module3
Discussion: Searching Databases
When you decide to purchase a new car, you first decide what is important to you. If mileage and dependability are the important factors, you will search for data focused more on these factors and less on color options and sound systems.
The same holds true when searching for research evidence to guide your clinical inquiry and professional decisions. Developing a formula for an answerable, researchable question that addresses your need will make the search process much more effective. One such formula is the PICO(T) format.
In this Discussion, you will transform a clinical inquiry into a searchable question in PICO(T) format, so you can search the electronic databases more effectively and efficiently. You will share this PICO(T) question and examine strategies you might use to increase the rigor and effectiveness of a database search on your PICO(T) question.
To Prepare:
- Review the materials offering guidance on using databases, performing keyword searches, and developing PICO(T) questions provided in the Resources.
- Review the Resources for guidance and develop a PICO(T) question of interest to you for further study.
By Day 3 of Week 4 USE THE TOPIC MEDICATION ERRORS
Post your PICO(T) question, the search terms used, and the names of at least two databases used for your PICO(T) question. Then, describe your search results in terms of the number of articles returned on original research and how this changed as you added search terms using your Boolean operators. Finally, explain strategies you might make to increase the rigor and effectiveness of a database search on your PICO(T) question. Be specific and provide examples.
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 frameworks for LIS professionals. Evidence Based Library and Information Practice, 6(2), 75–80. https://doi.org/10.18438/B8WS5N
Note: You will access this article from the Walden Library databases.
Stillwell, S. B., Fineout-Overholt, E., Melnyk, B. M., & Williamson, K. M. (2010a). Evidence-based practice, step by step: Asking the clinical question: A key step in evidence-based practice. American Journal of Nursing, 110(3), 58–61. doi:10.1097/01.NAJ.0000368959.11129.79
Note: You will access this article from the Walden Library databases.
Melnyk, B. M., Fineout-Overholt, E., Stillwell, S. B., & Williamson, K. M. (2009). Evidence-based practice: Step by step: Igniting a spirit of inquiry. American Journal of Nursing, 109(11), 49–52. doi:10.1097/01.NAJ.0000363354.53883.58
Note: You will access this article from the Walden Library databases.
Stillwell, S. B., Fineout-Overholt, E., Melnyk, B. M., & Williamson, K. M. (2010b). Evidence-based practice, step by step: Searching for the evidence. American Journal of Nursing, 110(5), 41–47. doi:10.1097/01.NAJ.0000372071.24134.7e
Note: You will access this article from the Walden Library databases.
THIS IS AN EXAMPLE
A Clinical Question
The best way to form clinical question is in the form of PICO(T) (Ask: Write a focused clinical question, 2020). I have done such a thing and have found that the question formulation and changes to it were not as challenging as finding research related to the question.
The Question:
(P) In the hospital or clinical acute care setting, (I) is a 2 person double-check of insulin, (C) compared to a single person double-check of 5 rights, (O) more effective in the improvement of (01) insulin medication errors, (02) nurse satisfaction during a (T) 30-day term of observation?
Databases Used
The Walden University database was used to search databases for nursing. Of those available Science Direct, CINAHL, and Cochrane, and PubMed were used. Background questions were first asked to get a sense of what has been studied in this area. It was important to understand when and why this practice first started to determine the relevance of data acquired and to determine how recently we needed to search. Then, foreground questions began to form until finally the PICO(T) question.
During the background question period, the terms ‘double-check’ became the preferred terminology for the practice I wished to study. So using this ‘double-check’ in the PubMed database, 244 articles were found but not all pertained to my topic. Changing the text to be included only in the title or abstract, the same result achieved. Adding ‘medication errors’ reduced the yield to 21 results. At this level, the evidence is available on the basic topic of using the double-check to prevent all medication errors and relates often to high-risk medications. However, I want to know about the labor-intensive practice of using a 2 nurse double-check for subcutaneous injection of insulin. Adding a level of inquiry which includes insulin, this yielded 2 studies. One from 1983, and one from 2009. Neither of which addresses the current question other than provides background for why the practice may exist in the first place. Changing terms to highlight ‘insulin double-check” yielded two results, both relevant, and one is the most current and referred to peer-reviewed study on this topic.
Affecting Rigor and Effectiveness
To improve the effectiveness and rigor of a database search one much identify proper and strong keywords in the question or relating to the question. Use filters to find peer-reviewed data first. Use filters for the type of study if possible, including systematic studies, and work your way down the pyramid for strength of research available. If the question is somewhat original, there may not be much evidence. This is the case here. Other filters and Boolean operator’s include dates of publication, with the last 5 years preferred as ‘current’, using ‘and’ and ‘or’ and ‘not’ to include or exclude words in the title, abstract, text, or any part of the article or work.
References
Ask: Write a focused clinical question. (2020). Retrieved from Northern Arizona University: https://libraryguides.nau.edu/c.php?g=665927&p=4682772
Berdot, S., & Sabatier, B. (2018). Medication errors may be reduced by double-checking method. Evidence Based Nursing, 18(21), 67. doi:10.1136/eb-2018-102901
Chua, G., Lee, K., Peralta, G., & Heng Chi Lim, J. (2019). Medication Safety: A Need to Relook at Double-Checking Medicines? Asia-Pacific Journal of Oncology Medicine, 6(3), 246-252. doi:10.4103/apjon.apjon_2_19
Modic, B., Alber, N., Bena, J., Yager, C., Cary, T., Zhiyuan, S., . . . Kissinger, B. (2016). Does an Insulin Double-Checking Procedure Improve Patient Safety? JONA: The Journal of Nursing Administration, 46(3), 154-160. doi:10.1097/NNA.0000000000000314
Sentinel event alert: High-alert medications and patient safety. (1999, November). The Joint Commission: https://www.jointcommission.org/-/media/deprecated-unorganized/imported-assets/tjc/system-folders/topics-library/sea_11pdf.pdf?db=web&hash=CA29CB641C8749521733A05716852A1F
Westbrook, J., Ling, L., Raban, M., Woods, A., Koyama, A., Baysari, M., . . . White, L. (2020, August). Associations between double-checking and medication administration errors: a direct observational study of pediatric inpatients. BMJ Quality and Safety. doi:10.1136/bmjqs-2020-011473
ADDITIONAL INSTRUCTIONS FOR THE CLASS
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- Discussion Questions (DQ)
Initial responses to the DQ should address all components of the questions asked, including a minimum of one scholarly source, and be at least 250 words. Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source. One or two-sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words. I encourage you to incorporate the readings from the week (as applicable) into your responses.
- Weekly Participation
Your initial responses to the mandatory DQ do not count toward participation and are graded separately. In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies. Participation posts do not require a scholarly source/citation (unless you cite someone else’s work). Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week.
- APA Format and Writing Quality
Familiarize yourself with the APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in Loud-cloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required). Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation. I highly recommend using the APA Publication Manual, 6th edition.
- Use of Direct Quotes
I discourage over-utilization of direct quotes in DQs and assignments at the Master’s level and deduct points accordingly. As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content. It is best to paraphrase content and cite your source.
- LopesWrite Policy
For assignments that need to be submitted to Lopes Write, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me. Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes. Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own? Visit the Writing Center in the Student Success Center, under the Resources tab in Loud-cloud for tips on improving your paper and SI score.
- Late Policy
The university’s policy on late assignments is a 10% penalty PER DAY LATE. This also applies to late DQ replies. Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances. If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect. I do not accept assignments that are two or more weeks late unless we have worked out an extension. As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.
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