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.
The PICOT framework was designed to break down clinical questions into keywords that are searchable in databases, leading directly to related scholarly articles. The abbreviation of PICOT is Patient or Problem, Intervention, Comparison, Outcome, and Timeframe. As an emergency room nurse dealing with patients going for elective procedures, such as orthopedic surgeries, or colonoscopies is quite stressful due to strict NPO after-midnight guidelines. As a nurse, I always wondered why a specific rule pertains to every patient expecting a procedure, regardless of what time the procedure is scheduled. I was wondering WHY DOES EVERYONE HAVE TO BE NPO AFTER MIDNIGHT? Using the PICOT framework, I developed a question asking whether it’s necessary to adhere to a standard NPO after midnight, or if there is another way to make patients more comfortable by decreasing hunger, thirst, dehydration, and risk for other health issues.
P – Patients needing procedures
I – Intervention: Relaxing Strict NPO Guidelines
C – Comparison: Timeframe from NPO and procedure start
O – Outcome: Decrease Discomfort and other health issues
T- NPO time to Procedure time.
Using the PICOT framework, it was easier to find 1 more specific article in the Walden University databases, showing important evidence that lethal complications of aspiration pneumonia are rare when not adhering to NPO after midnight, making the whole strict guidelines need to be reconsidered (Sharma, et al. 2022). Before discovering the PICOT framework, I had issues connecting keywords and typing them into the search toolbar to find evidence-based related articles. From now on, I will now use the PICOT framework throughout my master’s degree career to find articles needed to find credible information and prove the research I’ve done.
My clinical issue of interest for this PICOT discussion is pressure ulcers in inpatient care facilities. My interest in pressure ulcers is driven by the high number of cases recorded annually in care facilities. The disease affects approximately 2.5 million people in hospitals annually (Borojeny et al., 2020). A pressure ulcer is an injury on the skin and underlying tissues due to prolonged pressure on the skin. The condition affects patients who lie on their beds for a long without repositioning.
I used PICOT questions for easy searching of the relevant research resources. PICOT is a mnemonic made of initials for; patient, interventions, comparison, and objective/time (Duquesne University School of Nursing, 2020). In my PICOT question, P is for the patients getting pressure ulcers in clinical settings, I represents repositioning, C is for comprehensive skin assessment, while O represents preventing pressure ulcers in hospitals.
I searched my question in the Walden University Library using the keywords ‘pressure ulcer prevention’ under the PubMed database, where 8,870 results appeared. After filtering sources within the last five years, I remained with 1,690 results. I further used the Boolean operator ‘and’ to search ‘pressure injury repositioning and comprehensive skin assessment,’ and received 6 results. Only one source was found to be published between 2017 and 2022 (Walden University Library, n.d.).
I also searched the question, ‘pressure ulcers prevention and management using the TRIP database, and received 1,768 results. After searching ‘Pressure ulcer repositioning and comprehensive skin assessment,’ I received 79 results. I filtered to get the sources within the last 5 years and received 28 results.
In the two databases, I used the filter option to increase the effectiveness and rigor of the database search on my PICO question. I chose the sources that have been authored from 2017 to 2022 to minimize the number of results from the database. I also used more specific keywords in searching (Walden University Library, n.d.).
Research Techniques
Clinical Issue
The clinical issue I chose was to evaluate the effects animal-assisted therapy (AAT) has on elderly dementia residents living in a nursing home setting. Of the four articles I found, they all indicated that allowing pet therapy with residents improved depressive symptoms, anxiety, feelings of isolation and behaviors associated with dementia in residents by promoting positive social interactions.
PICOT Question
Does animal-assisted therapy reduce behaviors associated with dementia in patients living in care facilities?
Research Method
My research method was through the nursing research page and the Boolean search bar. The first term I searched was ‘animal-assisted therapy’ which generated 3,215 results. I then added the word dementia and narrowed the publication dates from 2018-2022. I also limited the journals to peer-reviewed and full text which reduced the number to 152 results. One article that populated indicated that behaviors during the AAT study showed improved behaviors associated with aggression and irritability (Baek et al., 2020).
How to improve
To increase effectiveness and rigor in my searching strategies I plan to use key-word searching, subject heading searching, and title searching. Combining all three of these strategies will promote the best evidence available and increase results (Melnyk & Fineout-Overhold, 2018). Organizing and planning my strategy is another way I can improve research methods as I am, at times, quite disorganized. I can also utilize truncating, which is searching part of a word to identify similar words to increase results (Timmins & McCabe, 2005). Implementing these strategies will greatly improve my ability to identify appropriate articles in future researching.
Clinical Issue
My clinical issue in question is the presence of family members at the bedside in adult Intensive Care Units during cardiac arrest and resuscitation efforts. At my personal organization, it is not often considered or offered. I have been present during a handful of cardiac arrests in which family was offered the opportunity to be present. I felt that it was distressing for everyone involved, however it did offer families the chance to see the resuscitation efforts, know that the healthcare team did everything possible to save their loved one, and end resuscitation efforts in a timelier manner, reducing potential patient suffering and reduce use of unnecessary resources.
The most important part of a PICO(T) question is whether it is an answerable question (Davies, 2011). I feel that this question is complex, but indeed answerable. What may not be best for one family may be acceptable for another, but guidelines and best practices should be in place, even if the guidelines are simply to offer family presence during every cardiac arrest and resuscitation effort in Adult Intensive Care Units.
PICOT Question
Patient population/disease: Critically ill adults in Intensive Care Units suffering cardiac arrest and undergoing resuscitation efforts.
Intervention/issue of interest: Allowing family members to be present at the bedside during cardiac arrest and resuscitation efforts.
Comparison intervention or issue of interest: Not allowing family members to be present at the bedside during cardiac arrest and resuscitation efforts; asking family to leave the room if patient begins decompensating.
Outcome: Discover best practices and initiate standards of practice for allowing/not allowing family to be present during cardiac arrest and resuscitation efforts; surveying those present regarding their experience and perspectives.
Time: Survey families three, six and twelve months after cardiac arrest/resuscitation events to determine their perspectives and initiate standards of practice after at least one year for Intensive Care Units.
Database and Search Terms
I utilized CINAHL & MEDLINE Combined Search through the Walden Library. First, I searched “family presence during resuscitation” and that yielded 493 results. I narrowed my search years from 2018-2022, and this reduced results to 108. I added “intensive care unit” and this decreased results to only seven. It is clear from the number of results more research should be conducted on this topic to determine best practices.
Database Strategies to Increase Rigor and Effectiveness
It is difficult to find resources if research is unavailable or has not been conducted, which seems to be the issue with the lack of resources for my specific clinical issue. Many articles are from studies conducted outside of the United States. I find this interesting as the priorities and practices in healthcare throughout the world differ than those in the United States. Many sources found are also literature review of older research, which falls outside of the date range of 2018-2022 that I utilized for my search to narrow relevant results. Testing out different search terms, adding, or removing certain words may help.
Introduction
The PICOT framework was created so that complex clinical questions could be broken down into searchable terms that assisted researchers with the discovery of data (Davies, 2011). The framework is an acronym that is as follows, P is for patient/problem, I is for intervention, C is for comparison, O is for outcome, and T is for time (Davies, 2011). This framework guides researchers to format clinical questions into simple, searchable terms. The purpose of this discussion assignment is to describe the clinical issue that I have selected and how I searched for it, as well as how to effectively narrow down and choose relevant, factual articles to use for my research.
PICOT Question and Search
My PICOT question is as follows, do adult patients experience fewer medication errors when at a facility that uses a Barcode Medication Administration (BCMA) system compared to those who do not during their hospital stay? Medication errors most commonly occur during prescribing, distributing, and administering of medication (van der Veen et al., 2020). BCMA is a technology that is used to reduce medication errors by providing higher accuracy in identifying the correct patient, drug, and dose (Barakat & Franklin, 2020). I chose this clinical question because I worked as a medication nurse for a few years and experienced different facilities with different medication administration systems. I noticed that there was a lot more consistency when a barcode system was used as opposed to paper MARs. To search this topic I used the Walden Library and found numerous articles supporting my theory that BCMA systems improve effectiveness and patient safety. I found that the NIH National Library of Medicine has the most relevant and applicable research and data. To search for my topic, I started with the search for “barcode scanning medication administration”. This led me to find out that barcode medication administration is shortened to BCMA. This was helpful as it assisted me to use the correct term to search for more accurate and targeted articles. I used a few more techniques to be able to find exactly what I was looking for that I will discuss below.
Strategies for Effectiveness
An effective search is important when researching peer-reviewed articles, especially when we will be focusing on the same clinical issue that we chose for the entire semester. It is important that there is enough research and evidence that provides us with numerous studies to look at. After I discovered that BCMA was the correct term for my clinical issue, I refined my search. First, I changed the dates shown to only show me articles that were published within the last five years. This ensures that I am only looking at the most current research. I always do this first because I do not want to accidentally find a perfect article and then realize later on that it falls outside of this timeframe. I also make sure that I am only looking at peer-reviewed articles. The Walden Library makes this easy as we only have to check a box for this feature. Then, I utilize the “and” search box the most. I added “patient safety” and “medication errors” to my search and it made all the difference when narrowing down articles. After all of this, I was left with a decent amount of articles that were directly related to my clinical issue about BCMA systems and how they can reduce medication errors therefore also improving patient safety.
Conclusion
In conclusion, PICOT questions are an important aspect of research and it is vital that we know how to format them correctly. When this occurs, data gathering is made simple which saves time and energy that can be used elsewhere. I look forward to continuing to research my clinical question regarding BCMA systems and their effects on patient safety and medication errors. Overall, learning how to research clinical issues through the PICOT framework has improved my research abilities.
The process of making clinical inquiry entails the identification of the clinical practice problem followed by searching databases. It is essential to search databases to locate best practice evidence to address the clinical practice problem (Melnyk & Fineout-Overholt, 2018; Stillwell et al., 2010). High rates of medication errors among hospitalized adults have become a concern in healthcare facilities. The hospital intends to implement a barcode medication administration (BCMA) system to reduce the rates of medication errors. It can only do so when there is evidence that supports the use of BCMA in medication error prevention (Melnyk & Fineout-Overholt, 2018). The population, intervention, comparison, and time period (PICOT) question related to this issue is that:
“In hospitalized adult patients (P), how does the implementation of a barcode medication administration (BCMA) technology (I) compared with the lack of the technology (C) affect rates of medication errors (O) within a period of six weeks (T)?”
The database search involved two major nursing databases from the Walden library: MEDLINE, and ScienceDirect. I selected the MEDLINE database from the Walden university library A-Z databases page and typed the keyword ‘barcode medication administration’ (Walden University Library, n.d.). The search initially yielded 58 results. I added the Boolean operators, limited my search to the peer-reviewed article, and within 5 years of publication. The search yielded 39 results. Two of the articles was about the impact of barcode medication administration on patient safety. Also, I selected the Science direct database and typed the key phrase ‘The effect of implementing bar-code medication administration’. It initially yielded 3,365 results. I limited my search again to the peer-reviewed and 5 years of publication. My result came down to 284 articles. Luckily, the first three articles aligned with my topic of interest. Adding Boolean operators reduced the number of articles developed from the databases (Library of Congress, n.d.). The strategies the researcher can use to increase the effectiveness and rigor of database search include using the limiters, incorporating indexing terms, and using synonyms. Using abbreviations can help the researcher refine and locate suitable articles from a database.
Telehealth vs. Face-to-Face and Patient Outcomes
PICOT
PICOT can be defined as P- What is the patient population? I- What is the interest or intervention? C- Comparing the intervention, O- What is the Outcome? T- What is the timespan for the outcome (MeInyk & Overholt, 2018)? The PICOT for this assignment and our four-part assignment is P- Patients of all ages I- receiving telehealth services C- vs. in person/face to face O- affect patient outcomes (safety, costs, satisfaction, ER/re-hospitalization) T- over a year.
Description of Topic
The topic of choice for this discussion and our four-part assignment was telehealth vs. face-to-face and patient outcomes. We have all seen an increase in the use of telehealth services, especially since the pandemic went through the country. I know that in the clinic I work in, we have embraced this change and keep getting more and more providers and services done via telehealth. Since 2010, the use of telehealth in hospitals has grown from 35 to 76%. The use of telehealth has many positive aspects, such as being a time saver, reducing costs, reducing ER visits, and providing fewer costs for payers (American Hospital Association, 2022).
Search Results
When beginning to research, I went to the Walden Library, typed in my PICOT question, and did not change any filters to the left, such as the year or peer-reviewed articles. From this, it took me to EBSCO and brought up 10,800,625, which I felt was interesting because when I was searching for part one of the assignment, I felt like I had somewhat of a difficult time. Some of the articles pulled from the search were about partial hospitalization treatment, physical therapy services, and telehealth vs. in-person (Walden University Library, 2022). Without clicking on them, they looked like ones that I may have dug deeper into researching. I then narrowed the search one step further to the time range of 2017-2022, and it decreased the number of articles to 3,707,814. I then narrowed it even more to peer-reviewed articles and decreased it to 3,304,643. The Walden Library has many databases and options and is a great resource, and in fact, most of my articles were found in this database and Google Scholar in part one of our assignment. Boolean operators are the words and, or, and not (University of Leads, 2022). If I wanted more specific information on each topic, such as safety, costs, and satisfaction, I changed my question to include just that topic, such as patient satisfaction and telehealth. This brought up a narrowed search regarding patient satisfaction levels with telehealth.
Database Strategies to Increase Rigor and Effectiveness
I feel that when you are searching for information, you first must choose a topic that you know you can find enough information on. I knew that telehealth was a hot topic, especially since the pandemic. Second, I feel you must start off broad and work your way to a more specific topic when researching. For part one of the assignment, I found articles when I started off broad and then had to be more specific throughout. Third, we must narrow our searches by adding the year ranges and ensuring we can find current information. Full text and peer-reviewed articles are also needed to complete these assignments effectively. In the end, it was not that hard to find information, I just had to be patient and take the time to find what I needed.
There seems to be a lot of depression in our community lately. Here in Minnesota, it is cold. There are people who enjoy gardening, going for walks, sitting outside, and being a bit more active. In the winter months, people are not as active and find themselves sitting inside more. There are adults who do not want to go to the doctor due to the cost of the visits and the cost of medication. There are links between depression and exercise, with people feeling better after physical activity (Schuch et al., 2016). The question arises, what if you could educate on an intervention instead of prescribing medications that could save people money? What is the research on exercise and depression? The PICOT question is as follows:
In a population of adults, does physical activity compared to not exercising at all help to decrease symptoms of depression over a year time?
The databases that I searched for PICOT keywords were Ebsco, ProQuest, CINAHL, PubMed, and BMC psychiatry. To get the best evidence, the PICOT question must be well-built (Melnyk & Fineout-Overholt, 2009). During the search, Walden University Library was used to search for different research articles. I search the different databases and in the first search, the keywords used were exercise, depression, and geriatrics. I found 437 articles and after filtering to peer-reviewed and dated 2018 to the present, 87 articles were found. (Walden University Library, n.d.). I did change my question at this time and changed my population to adults, as I wanted to have a broader range. The other keyword that I used after needing more articles to review was “physical activity”. I reviewed so many articles and found that there are many trials going on. After accidentally reviewing and writing many trial articles that ended with no results, I learned to start checking on this prior to spending the time. Using adults and physical activity as keywords did give me some more research to focus on.
Clinical Issue of Interest
Miscommunications occur daily between the communicator and the recipient, especially among healthcare providers in acute care settings. An estimated 4,000 plus handoffs occur daily in hospitals (The Joint Commission, 2017). Literature determined that the transition of care is where most of these miscommunications occur. Whether it is between the off going or incoming nurse, patients, family members, or when transitioning care, this gap in communication affects the quality-of-care patients receive as it affects the nurses’ awareness of the situation and their decision-making, ultimately affecting patient safety. According to the Joint Commission (2017), inadequate handoffs are responsible for 30% of malpractice claims, almost two billion in malpractice costs, and 1744 lives coming to an end in a year. By examining stakeholders’ perspectives, I aim to answer this PICO question: In acute care settings, does bedside reporting improve communication between stakeholders and the quality of care of patients compared to nurse station reports?
Research Strategies and Results
Research began by utilizing a common and reliable database such as CINAHL, which I was comfortable using. In the initial search, keywords used included synonyms for shift reports such as handoff, change of shift, and bedside report while utilizing “OR,” one of the three Boolean terms (AND, OR, and NOT), which produced 1,984 options (Walden University, n.d.). Utilizing synonyms and Boolean terms such as OR helps produce a more flexible question that produces more results (LoBiondo-Wood & Haber, 2022). Another tool used was truncation for the term report so that it can find this term with any ending that expands the search (Walden University, n.d.). To get more updated information, I narrowed the search by utilizing advanced search tools or filters to find literature between 2017 and 2022, decreasing the results to 615 articles. Filtering out non-peer-reviewed journals reduced results by 65. I added quality of care as it was my outcome in the PICO question, a measurement for care being rendered, reducing results further to 83 articles. A different strategy for finding other key terms and relevant articles was using cited referencing. The databases searched were PubMed, ProQuest Nursing & Allied Health database, and MEDLINE.
Improving Rigor and Effectiveness
To improve rigor, I will identify additional concepts related to my clinical issue PICO question to expand the results. Melnyk & Fineout-Overholt (2019) suggests using subject headings to help locate all materials on a topic regardless of terms used by the author to broaden the search. Another strategy I intend on using is the reference manager to help keep track of relevant information found if Walden offers it.
My clinical issue of interest will be about hand hygiene compliance among health care workers. I have always enjoyed talking about this with my supervisors at work. I noticed often healthcare workers are too busy and sometimes don’t take handwashing seriously. Hand hygiene among professionals plays a crucial role in preventing healthcare-associated infections, yet poor compliance in hospital settings remains a lasting reason for concern. Nudge theory is an innovative approach to behavioral change first developed in economics and cognitive psychology, and recently spread and discussed in clinical medicine (Elia et al., 2022).
My Picot question is among healthcare workers, how do hand hygiene compliance compared with noncompliance affect hospital infections. The purpose of a PICOT question is simple: It is the mechanism to identify the terms to be used to search for the best evidence to answer a burning clinical question. In other words, the PICOT question is the search strategy. The search strategy leads to an unbiased and effective search. The unbiased and effective search leads to the evidence (Gallagher & Melnyk, 2019) .
P(patient or population): Population is health care workers
I (Intervention): The use of hand hygiene
C (Comparison): The ability for health care workers to comply or not comply
O (Outcome): From this Picot Question, we hope to see a reduction in hospital infections and see more compliance among health care workers.
In searching for my research articles, I focused on using the Walden Library website and the various resources provided by it. I used mainly CINAHL plus with full text. I enjoy their collection of journal articles and topics focused on nursing. I was able to get some informative articles on here.
My clinical issue of interest is researching how nursing burnout affects the quality of patient care. My interest in exploring nursing burnout started as a personal experience as an inpatient nurse. I have witnessed fellow nurses leaving their job firsthand, and the frustration and Burnout branch out to affect nurses and patient care.
PICOT Question
Well-written PICOT question is fundamental to the evidence-based practice process. PICOT question has five components, and they are as follows: (Melnyk, B. M., & Fineout-Overholt, E. (2018).
Patient population/disease- include age, gender, ethnicity, and specific disorder.
Intervention or Issue of interest- therapy, exposure to disease, prognostic factor A, risk behavior
Comparison intervention/issue of interest- alternative therapy, no disease, prognostic factor B, absence of risk factors
Outcome- outcome expected, risk of disease, the accuracy of diagnosis, rate of occurrence of adverse outcome
Time- the time involved in demonstrating an outcome
The clinical interest of choice for this research paper was How do inpatient nurses(P) with Burnout (I) impact patient outcome (O) during patients’ hospitalization(T)?
The PICOT question I have formulated doesn’t contain “C” as the question presented doesn’t require a comparison with nursing burnout and the impact of patient outcomes during patients’ stay at a hospital.
Method
As instructed, my research method was through the nursing research page provided by the Walden University library. The terms I’ve picked to start my research were “nursing” and “burnout.” I received numerous articles by simply putting in these two terms. I have selected four dated papers within the last five years to keep my research current. The four pieces chosen indicated that a better support system improved the nursing work environment and improved patient outcomes (Carthon., M., B., & Hatfield., L., & Brom., H., & Houston., M. & Kelly-Hellyer., E., & Schlak., A., & Aiken., L., H. (2021). However, most nurses either have Burnout or are at high risk of Burnout (Qedair, J., T., & Balubaid, R., & Almadani, R., & Ezzi, S., & Qumosani, T., & Zahid., R & Alfayea., T. (2022) the nursing workload, work-family conflict, job control, and social support didn’t seem to impact the quality of nursing service provided to patients. (Agustina & Tahlil, T., & Manina. (2022), yet, nursing burnout was positively associated with turnover rate. (Al Sabei., S., & Labrague., L., J., & Al-Rawajfah., O., & Abualrub., R., & Burney., I., A., & Jayapal., S., K. (2021).
Conclusion
For a rigorous evidence-based practice research paper, the best levels of evidence are suggested for each type of clinical question. Systematic reviews and meta-analyses, single RCTs, and well-controlled, nonrandomized experimental studies were presented for intervention questions. For prognosis questions, case-control or cohort studies were suggested as the best level of evidence. In future research, I plan to expose myself to as many articles as possible and look for the methodology section in each piece to search for different levels of evidence used for each article.
Clinical Issue
The clinical issue I chose is the benefits of implementing bedside and what barriers exist to proper implementation of this process. Recently, the organization I work for had a big push to implement bedside shift report and audit the compliance from nursing. After implementing bedside shift report, we have seen slight improvement with patient satisfaction and patient safety. Although bedside shift report is beneficial, if not done correctly, patient safety measures are missed. The goal is to see what barriers are faced with implementing bedside shift report and if patient satisfaction and safety are improved with implementation of bedside shift report.
Searching for evidence is easier by utilizing the PICOT process because it helps develop a careful and thoughtful question (Duquesne University, 2020). The question I chose has multiple components, but the research goes hand in hand with the topic selected. There are positive benefits to patient satisfaction and patient safety if bedside shift report is implemented correctly, however, barriers are faced while attempting to implement this process.
PICOT Question
Patient Population: Inpatients in acute care settings.
Interventions/Issues of interest: Implementation of bedside shift report while nurses communicate hand-off report to one another.
Comparison issue of interest: The positive impact on patient satisfaction and patient safety when proper implementation of bedside shift report occurs.
Outcome: Discover barriers that exist to inpatients units implementing bedside shift report.
Time: Survey nurses and supervisors in inpatient units and discover barriers that exist to bedside shift report. Reevaluate the same nurses 3-6 months post bedside shift report implementation.
Database and Search Terms
I utilized the Walden Library and used CINAHL & Pubmed as my database. I searched “bedside shift report” on CINAHL with advanced search criteria of “peer reviewed” and within years 2008 to current, which yielded twenty results. Unfortunately, not much research has been done regarding barriers to bedside shift report and further data needs to be collected. Due to the lack of studies performed on this topic, research articles were limited and made finding specific data difficult. Some articles were not relatable because they were performed outside of the United States or did not pertain to barriers faced by nurses. Hopefully in the future, with increased drive to implement bedside shift report within organizations, more research will be performed.
PICOT Question
The United States has millions of adults living with diabetes, a chronic disease that has an adverse impact on the body’s ability to control blood sugar levels. Studies have shown that there is a genetic component associated with type 2 diabetes that leads to a decline in the ability of the pancreatic beta-cells to function, resulting in insulin resistance and hyperglycemia (Zappas & Granger, 2017). Further, Young et al., 2016 have described diabetes as a complex disease that is largely self-managed and requires the patient to monitor his blood glucose levels, take medication, eat a healthy diet, and engage in physical activity to keep well. Diabetic patients must take medication, modify their diet, and modify their lifestyles to manage diabetes, which can be a challenging task. PICOT question: In people with type 2 diabetes (P), how does lifestyle modification and diet (I) compare to medication use (C) in terms of reducing diabetes complications (T) during the first year after diagnosis (P)?
Database Search
Following the formulation of my PICOT clinical question, I refined my search by using Boolean operators and combining keywords such as diabetes, lifestyle changes, diet, and medications into a single search query. I used a variety of databases, including ProQuest Nursing & Allied Health Source, PubMed, CINAHL Plus with full text, and MEDLINE with full text. To ensure that I received the most recent, evidence-based literature, I limited my search to peer-reviewed articles published within the last six years. According to studies, recent research articles are preferred since they contain the most recent evidence-based practices and are more current (Wolf, 2019). A number of peer-reviewed articles were found to be relevant to my clinical question during the search.
One method I find extremely useful when searching databases during clinical research is combining keywords or concepts with Boolean operators. With this method, one is able to successfully combine relevant research keywords so that only articles that pertain to the keywords appear in the search results.
PICOT question
The key to rigorous, evidence-based research lies in the development of a well-defined PICOT question. A PICOT question is formed as follows: P = patient population; I = intervention; C = comparison intervention or group; O = outcome; and T = time frame. Using the PICOT method has proven to be effective in providing relevant information as well as saving time (Melnyk & Fineout-Overholt, 2018). My clinical area of interest is treatment interventions for diabetic foot ulcers (DFUs). My PICOT question is, “In diabetic foot ulcers, how does debridement therapy compared to hyperbaric oxygen therapy affect healing within six months?”
Search terms
The keywords/phrases that I used for my searches were “diabetic foot ulcer”, “debridement”, and “hyperbaric oxygen therapy”.
Databases Utilized for search
I used three databases from the Walden library in my search – CINAHL Plus with full text, Medline with full text, and TRIP.
Search results, articles returned, and changes from the boolean operators
CINAHL: diabetic foot ulcers = 1,413 results. Diabetic foot ulcers AND debridement = 123 results. Diabetic foot ulcers AND debridement AND hyperbaric oxygen therapy = 5 results.
Medline: diabetic foot ulcers = 3,126 results. Diabetic foot ulcers AND debridement = 263 results. Diabetic foot ulcers AND debridement AND hyperbaric oxygen therapy = 10 results.
I also used the TRIP database PICO format with the keywords “diabetic foot ulcer”, “debridement”, hyperbaric oxygen therapy”, and “healing”. This search yielded 8 results.
Database strategies to increase rigor and effectiveness
I always use the nursing category, boolean phrases, select peer-reviewed, and set the time frame published between 2017 and 2022. PubMed has a PICO tool and is a comprehensive database that can be used when conducting an exhaustive literature review (Brown, 2019). I have used PubMed many times and always find quality, peer-reviewed articles that support the research I am conducting. I found a great article about the importance of evidence-based practice (EBP) and clinical inquiry. This article by JoAnn Mick summarizes and simplifies the EBP process: Step 1: Ask (the PICOT question). Step 2: Gather (information). Step 3: Appraise (the evidence). Step 4: Act (propose changes). Step 5: Evaluate (the effect of the changes). Step 6: Disseminate (share results) (Mick, 2017).
Working in cardiology, we have a lot of “repeat offenders,” patients that are frequently readmitted to the hospital. Specifically, we see patients with heart failure frequently. One study showed a 18.2 % 30-day readmission rate and a 31.2% 90-day readmission rate (Khan, et. al, 2021). As a new nurse, this always intrigued me. I would wonder, “Why does this specific patient population have high readmission rates?” Now, as a more experienced nurse, I have realized some of the pitfalls within our system that make it harder for cardiology patients to adhere to post-admission care and instructions. Being said, it is incredibly important for these patients to get adequate follow up care to ensure the best patient outcomes. We can try to identify ways to help these patients through research and using clinically applicable questioning. For me this question is, “For heart failure patients (P), does early post hospital admission follow up (I), when compared to no hospital follow up (C), make a significant difference in readmission rates (O)?”
The use of PICO(T) format is imperative when performing research. It allows us to “find the needle in the haystack” by identifying the clinical issue at hand (Melnyk & Fineout-Overholt, 2018). The use of PICOT leads to a more effective search, thus leading to more appropriate search results. using key works from my PICO question resulted in 6 relevant articles on pubmed. I could use the advanced search tool to specify what years I wanted the results to be from and I will, of course, consult other databases in my continuing effort to answer this question. These will increase the rigor and effectiveness of my database searches.
Questions are the chief reasoning behind evidence-based practice (EBP). EBP helps to answer clinical questions and inquiries which focus on real-world, practical problems and issues (Davies, 2021). Articulating clinical inquiries and questions is an essential and beneficial skill. Every clinician must be able to formulate a clinical question to maximize the amount of pertinent information retrieved with the least amount of time invested. To develop a research question, the PICOT format is known to be the best approach. The PICOT format stands for 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 (Melnyk & Fineout-Overholt, 2018). This discussion will address the clinical issue of nursing bedside shift report and assess barriers to its successful implementation.
Clinical Issue
Nursing shift report, is the process in which vital patient information, responsibility, and accountability are exchanged between off going and oncoming nurses. This has typically been done at various places in the unit. However, recent literature shows the importance of bringing this key handoff to the bedside and involving the patient and/or family in this process. In addition to patient satisfaction, nursing bedside shift report is known to minimize errors and improve nursing quality of care and patient safety. There has, however, been reluctance and obstacles to its successful implementation (Dorvil, 2018).
PICOT Question
In the initiation phase of implementing a nursing bedside shift report initiative, are there any barriers that nursing staff and nurse leaders face that prevent consistency of nursing bedside shift report within the first 12 weeks?
P- Population of Interest: Nursing staff involved in bedside shift report
I- Intervention of Interest: Consistent performance of nursing bedside shift report by nursing staff during handoff
C- Comparison of Interest: Inconsistent or limited nursing bedside shift report performed, shift report completed in places other than at the bedside.
O- Outcome Expected: Identifying barriers to successfully implementing nursing bedside shift report initiatives.
T- Time: 12 weeks
In answering this clinical question, this insight has the potential to minimize barriers and provide improvements to make implementing nursing bedside shift report in clinical areas successful.
Search Results
I searched for information regarding this clinical question using CINAHL Plus with Full Text through the Walden University Library’s A-Z databases page. I limited the search to selecting only full-text and peer-reviewed scholarly journals. I typed in the words “nursing bedside shift report” in the search bar to generate results. In addition, I made sure the publication date only ranged within five years. This yielded 13 articles. To increase findings, I utilized the Boolean operator AND, searching bedside AND shift report, generating 45 results. Using the same filters, I also utilized ProQuest Nursing & Allied Health Database through the Walden University Library. This generated 15 articles. In utilizing the Boolean operator AND, and searching beside AND shift report, the results increased to 40.
Strategies to Increase Rigor and Effectiveness
A strategy to increase the rigor of the database search toward the clinical question would be utilizing Boolean operators. In my experience, using Boolean operators increased the number of results yielded from the databases. According to Walden University (n.d.), Boolean operators help to create more exact and powerful searches, yielding a higher percentage of relevant results. Additionally, using filters to limit results can help the user tailor the results to their specifications which can be a strategy to increase the effectiveness of the database search. In using filters, the user can limit the search to only full-text articles, peer-reviewed articles, and publication dates within a specified time frame.
My clinical interest is an evaluation of face-to-face visits compared to telehealth visits in managing chronic conditions such as diabetes, hypertension, and chronic obstructive pulmonary disease. Investigating how telehealth can best be utilized in primary care and rural health.
My health center steers away from telehealth visits in acute care situations. Acute care is unpredictable and often requires an in-depth physical exam and evaluation to develop a diagnosis and differential diagnosis. There is a greater risk in using telehealth with acute care. For example, a patient presents via telehealth visit with abdominal pain and vomiting. A telehealth consultation with this patient may lead a clinician to treat it as a viral illness; however, if the same patient presents in a face-to-face encounter and a full physical exam is completed with findings such as rebound tenderness and guarding, it will lead to a differential diagnosis of appendicitis which may need emergent intervention.
My health center is still trying to define the best use of telehealth in chronic care associated with conditions such as diabetes, dementia, hypertension, etc. Can we effectively or better manage chronic health conditions with telehealth or remote patient monitoring in rural areas? When barriers such as transportation and limited mobility due to age, loss of vision from diabetes, total care due to dementia, oxygen therapy due to lung disease, etc., decrease compliance to follow-up visits due to the many challenges of just accessing care.
The PICOT format is a systematic approach to developing a clinical question. (Melnyk & Fineout-Overholt, 2019) Using this format based on my area of interest, the patient population (P)= patients with chronic conditions; the intervention (I) = telehealth or telemedicine in addition to face-to-face encounters, the comparison (C)= face-to-face encounters only; the outcome (O) = improved outcomes in chronic conditions, and the time (T)=over one year. My formulated PICOT question: Do patients with chronic care conditions such as diabetes and hypertension have better outcomes over a year if telehealth is used in conjunction with face-to-face encounters versus only face-to-face encounters?
I utilized databases CINAHL Plus, Cochrane, and Medline. I applied a Boolean phrase that utilizes connecting words such as and, or, and not to produce a more specific search phrase. (Walden University Library, n.d.) Telehealth, telemedicine, or remote patient monitoring in the phase yielded 58,617 results. I applied additional limitations using filters such as peer-reviewed, full text, publication dates 2018-2023, and journal articles; this narrowed search down to 123. I then added specific topics such as hypertension, diabetes, and chronic health and narrowed it to 47 articles.
My PICOT research question:
In hospitalized patients, how do healthcare workers and patients washing their hands with soap and water compare with not washing or using hand sanitizer affect infection transmission during hospital stay?
To find a suitable clinical problem for research, one must determine the goal one has in mind first. We are taught in school that patient safety always comes first. This could mean preventing harm, reducing medication errors during patient care, or keeping patients safe from infectious diseases through policies and protocols. I chose this question because hand hygiene is necessary to protect ourselves and others from dangerous situations that could have been avoided. Hand hygiene is one of the essential measures to prevent the spread of SARS-CoV-2, which causes coronavirus disease (COVID-19) (Haston et al., 2020). The PICOT is used to form a clinical research question and covers all areas for an efficient search with accurate information (Melnyk & Fineout-Overholt, 2018). This type of question format falls under the foreground question because it is a specific question (Stillwell, Fineout-Overholt, Melnyk & Williamson, 2010) and helps narrow down what you need to focus on and saves valuable research time.
I began my search using the keywords “Hand Hygiene” and “Hand Hygiene Compliance” in the Walden Library’s default Thoreau database. Using them is the first step because the main key points of the question should be searched separately (Stillwell et al., 2010). There were 37,039 results on hand hygiene, which was a broad number and was different from what I needed. On the other hand, there were 6,426 results on hand hygiene compliance, most of which I saw were related to healthcare workers. Playing around with wordings in this database while using the keyword in my question helps to refine it even more. I added “Patient” and “Healthcare Professional,” adjusted the filter settings to change the date to the last five years and checked the peer-reviewed box. It produced 87 articles about healthcare workers, patients, and hand hygiene. Another database I decided to search was CINAHL, and when I started using the exact keywords and filters, the search went from 1,963 to 23 results. All focused on just healthcare and hand hygiene compliance. This second database has narrowed the search significantly. The last database I checked was the Cochrane Central Register of Controlled Trials, and I used the exact keywords and filters as the other two. There were only 22 articles in the database this time, but when I tried to use more words, I eventually had none. I did not find this helpful for my question. The only Boolean operator I used was “AND.” This is because many helpful journal articles are displayed in this way. One strategy to expand my research is to try more keywords from my PICOT question and play with more Boolean operators to try different combinations of them. There are also many database options for searching articles. You must look for something that fits your theme.
The clinical topic I have chosen for this week’s discussion is “Is the combination of two or more antipsychotics more effective and safer than the use of one antipsychotic in individuals with psychotic disorders?” I decided to search for “mental disorders” and selected databases recognized by the Walden University Libraries.
I started my search from the Cochrane database of systemic reviews. This is considered “the strongest evidence for the intervention question because it has the best study design and is generally the most rigorous” (Stillwell, S.B., Fineout-Overholt, E., Melnyk, B.M. & Williamson, KM, 2014). An unfiltered search of the Cochrane Database of Systematic Reviews yielded 9 results. Most of them were related to drugs and their effects. Then I added two more databases: CINAHL and full-text and psych information. Just adding those two gave us 31,509 unfiltered results. From here, I’ve added additional search terms and identifiers to narrow my search. I selected psychotic disorders and single antipsychotics and combination therapy as search terms. In my search expander, I selected a boolean expression containing full-text, peer-reviewed scientific papers from 2014 to 2022. For the Cochrane database, we selected Cochrane reviews from 2015 to 2022. The specific limiters used for psych information were peer-reviewed journals from 2015 to 2022, and in CINAHL plus I used evidence-based practices in psychiatry/psychology. This search yielded 7,259 results, which is a lot. From there, adding the Boolean search term “medicine” yielded 783 results. Then, adding the Boolean search term “safe” yielded 35 results from the main article discussing specific medications for psychotic disorders. Removing the two Boolean search terms and adding combination therapy to the search returned 36 articles.
I selected specific keywords from PICOT questions and used database-driven vocabulary to further narrow the results. Something specific that might help is to select “Nursing” from the Topic Resource drop-down box on the Walden University Library home page. On this page, you can choose from various databases where research material is available (Walden University, n.d. a).
PICOT Question
In evidence-based practice (EBP), the PICOT format is used to formulate a clinical question (Mazurek Melnyk & Fineout-Overholt, 2019). PICOT is an acronym that stands for P is for population, I is for intervention, C is for comparison, O is for the outcome, and T stands for the timeframe (Mazurek Melnyk & Fineout-Overholt, 2019). My PICOT question is in regard to an intervention, and is as follows:
In patients who have undergone coronary artery stenting, what is the optimal length of dual antiplatelet therapy (DAPT) before transitioning to monotherapy to decrease the incidence of in-stent restenosis and other related events in the one-to-two-year period after coronary artery stenting?
In regard to the clinical question, Davies (2011) says, “One of the most challenging aspects of EBP is to actually identify the answerable question.” (p. 75). PICO is first mentioned in the text in 1995 by Richardson, Wilson, Nishikawa and Hayward, and in 2005, Fineout-Overholt & Johnson suggested adding the “T” for the timeframe (Davies, 2011).
Search Terms
I utilized the search terms “dual antiplatelet therapy”, “monotherapy” and “coronary intervention”. I also set the date range from 2016 to 2023, and in the CINAHL and Medline combined database, I was able to select a search option that returned randomized control trials (RCT’s) only.
Databases Utilized for Search
For my search, I used the CINAHL and Medline Combined, the ProQuest Health and Medical, and the Google Scholar databases to find the articles for my research. I accessed these databases through the Walden University Library.
Search Results, Articles Returned, and Changes from use of Boolean Operators
I received a lot more results than I expected, even with the date range being relatively small. I had to make several changes to the search terms to find the best articles. I kept the Boolean Operator to “AND” to get results that included my search terms. Boolean Operator can also be referred to as a Boolean Connector, and are the words “AND” and “OR” (Hartzell & Fineout-Overholt, 2019). I also had to sift through them to find primary research. I eventually settled on these articles related to recent primary research:
Chichareon, P., Modolo, R., Kawashima, H., Takahashi, K., Kogame, N., Chang, C.-C., . . . Serruys, P. W. (2020, March). DAPT Score and the Impact of Ticagrelor Monotherapy During the Second Year After PCI. JACC: Cardiovascular Interventions, 13(5). doi:https://doi.org/10.1016/j.jcin.2019.12.018
Hahn, J.-Y., Song, Y., Oh, J.-H., Chun, W., Park, Y., Jang, W., . . . Gwon, H.-C. (2019, June 25). Effect of P2Y12 Inhibitor Monotherapy vs Dual Antiplatelet Therapy on Cardiovascular Events in Patients Undergoing Percutaneous Coronary Intervention: The SMART-CHOICE Randomized Clinical Trial. JAMA, 321(24), 2428-2437. doi:10.1001/jama.2019.8146
Hong, S.-J., Kim, J.-S., Hong, S., Lim, D.-S., Lee, S.-Y., Yun, K., . . . Hong, M.-K. (2021, August). 1-Month Dual-Antiplatelet Therapy Followed by Aspirin Monotherapy After Polymer-Free Drug-Coated Stent Implantation: One-Month DAPT Trial. JACC: Cardiovascular Interventions, 14(16), 1801-1811. doi:https://doi.org/10.1016/j.jcin.2021.06.003
Koo, B.-K., Kang, J., Rhee, T.-M., Yang, H.-M., Won, K.-B., Rha, S.-W., . . . Kim, Y. (2021). Aspirin versus clopidogrel for chronic maintenance monotherapy after percutaneous coronary intervention (HOST-EXAM): an investigator-initiated, prospective, randomised, open-label, multicentre trial. The Lancet, 397(10293), 2487-2496. doi:https://doi.org/10.1016/S0140-6736(21)01063-1
I chose the clinical issue of catheter-associated urinary tract infections (CAUTI). In my facility, we have a new urologist working in surgery. She would like catheters placed prior to some of her surgeries. It has been pounded into nurses’ brains for the past few years that catheters should be a last resort. When I was tasked with picking a topic, I chose CAUTI. In hopes of finding out the ins and outs protecting patients from getting an infection as we are increasing our catheter usage. PICO is a model used to assist in starting with the right questions when starting research (Davies, 2011). The acronym PICO stands for patient, intervention, comparison, and outcome (Davies, 2011). I found a template on-line that lays out PICO nicely and thought I would share (Claude Moore Health Sciences Library, n.d.) the link is below in my references. My initial search using the acronym CAUTI and search returned three thousand nine hundred and seventy-one results, returned seven thousand one hundred and twenty-six results. That decreased by about six hundred when I searched only peer reviewed articles. I used a Boolean operator by using the full term, catheter-associated urinary tract infections, and it returned seven thousand one hundred and twenty-six results. I plan to dig deeper into CAUTI’s and find best practices. I will work with my educator to make sure we are utilizing best-practice to assure patient safety.
As an inpatient dialysis nurse working with different institutions, it has been brought to my attention that one facility has had skyrocketing CLABSI rates while the others have not. Both facilities enforce different CVC dressing policies, which raises my curiosity as to whether these practices are more beneficial—maintaining current trends and best practices vital for providing optimal patient care (Melnyk & Overholt, 2018).
For this discussion, my area of interest focuses on adult patients with CVC and how their engagement and nurse compliance in CLABSI prevention guidelines affect this highly preventable healthcare-associated infection. To help improve processes and patient outcomes, clinical questions must be made in a way that searches for solutions that are as efficient as possible (Stillwell et al., 2010). To make this possible with my inquiry, I utilized the PICOT format, which stands for Population of interest, Intervention or issue of interest, comparison of interest, the outcome expected, and time for the intervention to achieve the result (Melnyk & Overholt, 2018).
PICOT QUESTION
P – Adult patients with CVC
I – patient engagement and nurse compliance
C- no or low patient engagement and nurse compliance
O – affect CLABSI rates
T – within 12 months
In searching for articles related to my PICOT question, I learned I could use Boolean terms. Using Boolean terms, I used similar terms in another terminology to increase yield results (Walden University Library, n.d.). I searched for CLABSI, or Central Line-Associated Infection while adding patient engagement and nurse compliance. I also searched for CLABSI or Central Line-Associated Infection and hemodialysis or haemodialysis patients. All said terminologies yielded high volumes of recent articles as CLABSI has been an ongoing problem in hospitals globally. I then select articles that I found to relate to my topic.
PICOT
P- What type of patients are in this population? I – What is the intervention or the interest? C – Contrasting the intervention, and O – determining the outcome. T – How long will it take for the result to become apparent? (MeInyk & Overholt, 2018)? The PICOT for this assignment and our four-part assignment is P– People of every age I – getting services through telehealth C– vs. face to face/in person O– affect patient outcomes (safety, costs, satisfaction, ER/re-hospitalization, etc.) T– more than a year.
Topic Description
Our four-part assignment’s chosen subject was telemedicine vs face-to-face care and patient outcomes. Since the nation was hit by the epidemic, we have all seen a rise in the usage of telehealth services. I am aware that at the clinic where I work, we have welcomed this transition and continue to use telehealth to access an increasing number of doctors and services. Hospital telehealth use increased from 35% to 76% since 2010 (Hoare et al., 2013). The use of telehealth has various benefits, including time savings, cost savings, a decrease in emergency room visits, and lower expenses for payers.
Search Results
I went to the Walden Library to start my research and put in my PICOT query without changing any of the criteria on the left, like the year or peer-reviewed papers. This led me to EBSCO and produced the result 10,800,625, which I found intriguing since I felt like I struggled a little bit while looking for part one of the homework. Physical therapy services, telemedicine vs. in-person health care, and partial hospitalization treatment were some of the topics covered in the search results articles (Hoare & Hoe, 2013). They seemed to be ones that I may have looked into more thoroughly had I not clicked on them. When I further restricted the search to the years 2017–2022, there were 3,707, 814 less articles to choose from. I then reduced it to 3,304,643 by further limiting it to peer-reviewed literature. In reality, the majority of my papers for the first portion of our project were discovered in this database and Google Scholar, which is a terrific resource that the Walden Library offers. The terms and, or, and not are known as Boolean operators. I updated my inquiry to include just that issue, such as patient satisfaction and telehealth, if I needed more detailed information on each subject, such as safety, costs, and satisfaction. This led to a more focused inquiry on telehealth patient satisfaction rates.
Database Strategies
When looking for information, I believe that the first step should be to decide on a subject about which you are certain that you can obtain a sufficient amount of data. I was aware that telehealth was becoming an increasingly popular issue, particularly after the epidemic. When doing research, I believe it is important to begin with a wide subject and then narrow down to one that is more focused as you go. The first section of the project required me to find articles by beginning with a wide focus and then narrowing it down as I progressed through the task. Third, we need to refine our searches by include year ranges and checking to see if we can locate material that is up to date. In order to successfully complete these projects, you will also need to consult publications with both full texts and peer reviews. In the end, locating the information I need was not nearly as difficult as I had anticipated; nonetheless, I did need to exercise patience and put in some effort before I was successful (Walden University Library, n.d.-a).
PICOT
PICOT is used to help condense research questions and examine interventions. The (P, population) represents your sample size. The (I, intervention) references the treatment options that may be provided to the sample size. The ( C, comparison) is used for comparing the interventions. (O, outcome) refers to the results you measure to examine the effectiveness of your intervention, and the (T, time) is based on the duration of your data collection (Stillwell, 2010) .
Clinical Issue
The clinical issue I chose to research for this PICOT discussion is: How does hourly rounding decrease falls in hospitals (all ages)? I chose this topic because prevention is key in healthcare, if patients fall during their hospital stay it greatly impacts their overall health. Depending on the age and condition of the patient sometimes things such as falls can lead to longer hospital stays, other serious issues and may even be fatal (Spano, 2019).
Database and Search Terms
The search terms I used we’re: “Benefits to hourly rounding”. The database I utilized was Medline in Full Text. The search results came back with only one article from 2022 titled: Nurses’ perceptions of hourly rounding in Jordanian hospitals: A national survey. I used the Boolean (and) search option “hourly rounding AND fall prevention” and received 10 results back. The results had publishing dates from 2013-2021 (Walden University Library, n.d.).
I also used CINAHL Plus with Full Text and searched “fall prevention interventions”. It came back with 1,275 articles, I further searched limiting the texts to “scholarly (peer reviewed)” and the results and back with 571 articles from 2018 to 2022. Using the Boolean option, I searched “fall prevention AND interventions or strategies or best practices”, peer reviewed. The results came back with 2095 articles also ranging from 2018 to 2022 (Walden University Library, n.d.).
Strategies for Effectiveness
I found that filtering my search options was the most effective strategy I could implement when researching this topic. Making sure I checked off the box for peer reviewed articles, only searching specific dates was helpful, and using the Boolean search option and, and or. When I’m really trying to filter out my search options, sometimes I also use location as far as US or out of country and particular state etc; Especially when it comes to laws and regulations.