Transform a clinical inquiry into a searchable question in PICO(T)

Discussion: Searching Databases – Transform a clinical inquiry into a searchable question in PICO(T)

Transform a clinical inquiry into a searchable question in PICO(T)

In Evidence-based practice, questions are the motivation to focus and find answers to clinical issues or problems (Davies, 2011). For EBP to be completely applied, nurses need to have the desire to investigate and to have the culture to advocate for it (Stillwell, Fineout-Overholt, Melnyk, & Williamson, 2010). By using patient population (P), intervention or issue of interest (I), comparison intervention or issue of interest (C), outcome(s) of interest (O), and time (T) for the intervention or issue to achieve income (PICOT) the format helps to identify the parts of the clinical issue in a systematic way (Stillwell et al., 2010). Thus, by using the PICOT format to construct the clinical question will assist in filtering these parts or components that will lead the way for the evidence needed (Stillwell et al., 2010).

Since I have migrated here in the United States, most of my nursing experience has been working with the older population. One of the challenges we have always faced was falls, especially the severe injuries related to falls. Falls are a common problem among older adults and are a leading cause of severe injury and death worldwide (Shuman, Montie, Galinato, Todd, Heggstad, & Titler, 2016). Thus, lead me to my PICOT question: In older adults (P), how does involvement of patient’s perception of fall prevention (I) compared to no involvement (C) affect prevention of falls (O) during hospitalization or inpatient stay (T)? NURS-6052 week 4 Discussion: Searching Databases

In searching for important PICOT answers clinicians use databases to find the sources that hold the best evidence (Melnyk & Fineout-Overholt, 2018). The two databases used for my PICOT question are the CINAHL and MEDLINE. Using keywords from the PICOT question is an essential strategy in searching using the databases (Melnyk & Fineout-Overholt, 2018). The keywords I used are fall prevention, patient perception, & hospitalization. In my initial search, when the keywords were entered, CINAHL resulted in 298 articles while Medline showed 52 articles. When BOOLEAN terms were used in CINAHL and MEDLINE showed 12 articles that narrowed it down to search for evidence for, sixteen articles resulted in my clinical inquiry.

Strategies are used to increase the rigor and effectiveness of a database search. Appropriate keywords need to be selected by taking the main parts of the clinical question or topic (example: fall prevention, patient perception, & hospitalization). Using Boolean terms or operators is another strategy to connect keywords to generate a logical phrase that the database can understand (Walden University Library, n.d.). Using Boolean terms facilitates generating more precise and robust searches to provide pertinent results (Walden University Library, n.d.) An example of the Boolean term is using AND helps find items that use both keywords, OR uses either of the keywords and NOT which excludes items that use the keywords (Walden University Library, n.d.). Furthermore, truncation of root words by putting an asterisk at the end of the root word (example: old*) tells the database to search for the word with any ending which expands search for more articles (Walden University Library, n.d.). Limiting searches is also another strategy to help clinicians review to decide whether what is relevant to the clinical question (Melnyk & Fineout-Overholt, 2018). An example is that in CINAHL uses “Limit to” by using parameters such as publication year (example: 2016-2020) (Melnyk & Fineout-Overholt, 2018). NURS-6052 week 4 Discussion: Searching Databases. Database search skills are vital to the success of a researcher to obtain the best result (Walden University Library, n.d.). It takes time to develop database search skills, using strategies to develop these skills will result in a robust and effective database search.

Reference

Davies, K.S. (2011). Formulating the evidence based 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. Retrieved from https://ejournals.library.ualberta.ca/index.php/EBLIP/article/viewFile/9741/8144

Melnyk, B.M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare. A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer.

Shuman, C., Liu, J., Montie, M., Galinato, J. G., Todd, M. A., Hegstad, M., & Titler, M. (2016).Patient perceptions and experiences with falls during hospitalization and after discharge. Applied Nursing Research, 31,79-85. https://doi.org/10/1016/j.apnr.2016.

01.009 NURS-6052 week 4 Discussion: Searching Databases

Stillwell, S.B., Fineout-Overholt, E., Melnyk, B.M., & Williamson, K.M. (2010b). Evidence-  Based practice, step by step: Searching for evidence. American Journal of Nursing,

110(5), 41-47. doi:10.1097/01.NAJ.0000372071.24134.7e. Retrieved from https://Journals.lww.com/ajonline/Fulltext/2010/05000/Evidence_Based_Practice,_Step_  Step_Searching.24.aspx

Walden Library University. (n.d.). Databases A-Z: Nursing. Retrieved from https://academicguides.waldenu.edu/az.php?s=19981

Walden Library University. (n.d.). Keyword searching: Finding articles on your topic: Booleanterms. Retrieved from https://academicguides.waldenu.edu/library/keyword/boolean NURS-6052 week 4 Discussion: Searching Databases

Searching Databases (APA 7 format and at least 3-4 references)

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.
Mike RE: Discussion – Week 4/Initial (at least 2-3 references and APA 7 format)
Given the diverse nature of the health care industry, the ubiquitous array of multi faceted axillary services, the sector we service the most sometimes becomes the focus of our interest given the opportunity and longevity in such an institution. For the purpose of this discussion post I will be posing a question on post operative pain management since this sector happens to be a critical pivotal point in patient recovery following either inpatient or outpatient surgical interventions. Using the PICOT question format; Does the management of pain using pharmacological and non pharmacological interventions on a post operative surgical adult patient improve pain control in four days post surgery? Following from the PICOT abbreviation, the P represents the population which refers to our surgical patients, I represents the intervention; pain management, C represents comparison; the comparison of pharmacological and alternate pain management strategies, O represents the outcome which is pain management while T speaks to our time frame for achieving this goal which is four days post surgery. According to Melnyk, (2018, p34) “the desire to gather the right information in the right way at the right time is not sufficient. Mastering practical, lifelong learning skills (e.g., asking focused questions, learning to systematically search) is required to negotiate the information rich environment that clinicians encounter.”
For the purpose of this post, the search engines I utilized were ProQuest and CINAHL Plus database. My key word search was pain management, which returned 20,494 results and 21,460 respectively. After the utilization of limiters for full text, peer review, date range of 2016 to 2020 the streamlined search result was 13,601 and 15,787 respectfully. The inclusion of Boolean search parameter for surgical patients further helped narrow down the search as follows; 3,070 and 5,179 respectfully, my inclusion of a final modifier for the most recent year of publication “2020” further help streamline my search results as follows ProQuest 232, while CINAHL Plus with full text returned 203 searches. “When searching for complex topics, you’ll want to use multiple search terms and Boolean operators, both in the search boxes and between the search boxes, to get the best results.” (Retrieved September 6th, 2019)
With the desire to increase the rigor and effectiveness on my data base search results, some of the strategies I will employ will be the refining of my search limiters which will help streamline my research to the most current year, using year of publication limiters, I will also include key words from my PICOT question like surgical, post surgical, pharmacological and or non pharmacological to help narrow in on the much desired research article that mirrors my PICOT question. “Keyword searching is the process of choosing search terms and entering them into the database search boxes to locate information on your topic.” (Retrieved September 19th, 2018)
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.-c). Evidence-based practice research: CINAHL search help. Retrieved September 6, 2019, from https://academicguides.waldenu.edu/library/healthevidence/cinahlsearchhelp
Walden University Library. (n.d.-g). Keyword searching: Finding articles on your topic: Introduction to keyword searching. Retrieved September 19, 2018, from http://academicguides.waldenu.edu/library/keyword/searching-basics 
Lau RE: Discussion – Week 4 
I work on an IMCU, and it is hectic. Patient care is often interrupted for transferring improved patients to lower levels of care units to make room for admissions. About 1/3 of the unit will be newly admitted on my shift. The admission process includes asking patients about suicide and depression. I don’t feel awkward asking patients directly about the subject, but I see that patients are surprised that I ask even when I tell them in advance that I will be doing so. I have queried the significance of asking about suicidal ideation when patients are being admitted for a physical illness unrelated to psychiatric disorders.
P-         patients admitted for physical illness unrelated to psychiatric disorders
I-  hospital staff asking about suicidal ideation on admission to acute care settings
C-  not asking about suicidal ideation on admission to acute care settings
O-        value; decrease in the number of suicide attempts, an increase in patients seeking assistance in mental health care
T-         one year
PICO question: Is there value in asking patients admitted to an acute care setting for physical illness unrelated to psychiatric disorder, about suicidal ideation, compared to not asking over one year.
Search phrases could include ask suicide, medical admission, suicide screening, and asq suicide. I used Sage journals and queried “ask suicide” and received 39,212 results (Sage Journals, 2020). Using the same search terms on Taylor & Francis Online there were 75,136 results (Taylor & Francis Online, 2020). Using Boolean operators changed the results returned. Using “and” narrowed my search and “or” broadened my results. Adding more search terms linked together further narrowed the results  by approximately 75% by using “and.” Both databases have the ability for the user to narrow searches by searching for terms in specific article type, journal type as well as the publication date.
Strategies to increase the rigor and effectiveness of a database search might include using more than one database (UTHealth, 2019). One study on search strategies found a higher number of systematic reviews were obtained using a 2 PICO element search rather than a 4 element search. Additionally, it was found that it was essential to combine at least three databases together to achieve a 90% retrieval of relevant literature (Ho, Liew, Ng, Shunmugam, & Glasziou, 2016). This could provide me with the opportunity to find more significant studies to review. Another strategy would be to combine search terms and phrases with Boolean operators to refine my search. UTHealth libguides also points out that all databases are not created the same (UTHealth, 2019). They each have different rules and quirks. I must familiarize myself with the tool I choose to use, or it will not be effective.

References

Ho, G. J., Liew, S. M., Ng, C. J., Shunmugam, R. H., & Glasziou, P. (2016, 12). Development of a Search Strategy for an Evidence Based Retrieval Service. PLoS One, 11(2), e0167170. doi:10.1371/journal.pone.0167170
Sage Journals. (2020). Search Results. Retrieved 12 22, 2020, from Sage Journals: https://journals-sagepub-com.ezp.waldenulibrary.org/action/doSearch?AllField=Ask+Suicide
Taylor & Francis Online. (2020). Your search for All: ask suicide. Retrieved 12 22, 2020, from Taylor & Francis Online: https://www-tandfonline-com.ezp.waldenulibrary.org/action/doSearch?AllField=ask+suicide
UTHealth. (2019). Best Practices for Developing Search Strategies: Home. Retrieved 12 22, 2020, from UTHealth: https://libguides.sph.uth.tmc.edu/c.php?g=543359

Post by Day 3 and Respond by Day 6 of Week 4