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.

Library of Congress. (n.d.). Search/browse help – Boolean operators and nesting. Retrieved September 19, 2018, from https://catalog.loc.gov/vwebv/ui/en_US/htdocs/help/searchBoolean.html

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.

Walden University Library. (n.d.-a). Databases A-Z: Nursing. 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 help. 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 help. Retrieved September 6, 2019, from https://academicguides.waldenu.edu/library/healthevidence/jbisearchhelp

Walden University Library. (n.d.-e). Evidence-based practice research: MEDLINE search help. Retrieved September 6, 2019, from https://academicguides.waldenu.edu/library/healthevidence/medlinesearchhelp

Walden University Library. (n.d.-h). Quick Answers: How do I find a systematic review article related to health, medicine, or nursing? Retrieved September 6, 2019, from https://academicanswers.waldenu.edu/faq/72670

Walden University Library. (n.d.-i). Systematic review. Retrieved January 22, 2020, from https://academicguides.waldenu.edu/library/healthevidence/types#s-lg-box-1520654

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

 Mrs. Smith was a 73-year-old widow who lived alone with no significant social support. She had been suffering from emphysema for several years and had had frequent hospitalizations for respiratory problems. On the last hospital admission, her pneumonia quickly progressed to organ failure. Death appeared to be imminent, and she went in and out of consciousness, alone in her hospital room. The medical-surgical nursing staff and the nurse manager focused on making Mrs. Smith’s end-of-life period as comfortable as possible. Upon consultation with the vice president for nursing, the nurse manager and the unit staff nurses decided against moving Mrs. Smith to the palliative care unit, although considered more economical, because of the need to protect and nurture her because she was already experiencing signs and symptoms of the dying process. Nurses were prompted by an article they read on human caring as the “language of nursing practice” (Turkel, Ray, & Kornblatt, 2012) in their weekly caring practice meetings.

The nurse manager reorganized patient assignments. She felt that the newly assigned clinical nurse leader who was working between both the medical and surgical units could provide direct nurse caring and coordination at the point of care (Sherman, 2012). Over the next few hours, the clinical nurse leader and a staff member who had volunteered her assistance provided personal care for Mrs. Smith. The clinical nurse leader asked the nurse manager whether there was a possibility that Mrs. Smith had any close friends who could “be there” for her in her final moments. One friend was discovered and came to say goodbye to Mrs. Smith. With help from her team, the clinical nurse leader turned, bathed, and suctioned Mrs. Smith. She spoke quietly, prayed, and sang hymns softly in Mrs. Smith’s room, creating a peaceful environment that expressed compassion and a deep sense of caring for her. The nurse manager and nursing unit staff were calmed and their “hearts awakened” by the personal caring that the clinical nurse leader and the volunteer nurse provided. Mrs. Smith died with caring persons at her bedside, and all members of the unit staff felt comforted that she had not died alone.

Davidson, Ray, and Turkel (2011) note that caring is complex, and caring science includes the art of practice, “an aesthetic which illuminates the beauty of the dynamic nurse-patient relationship, that makes possible authentic spiritual-ethical choices for transformation—healing, health, well-being, and a peaceful death” (p. xxiv). As the clinical nurse leader and the nursing staff in this situation engaged in caring practice that focused on the well-being of the patient, they simultaneously created a caring-healing environment that contributed to the well-being of the whole—the emotional atmosphere of the unit, the ability of the clinical nurse leader and staff nurses to practice caringly and competently, and the quality of care the staff were able to provide to other patients. The bureaucratic nature of the hospital included leadership and management systems that conferred power, authority, and control to the nurse manager, the clinical nurse leader, and the nursing staff in partnership with the vice president for nursing. The actions of the nursing administration, clinical nurse leader, and staff reflected values and beliefs, attitudes, and behaviors about the nursing care they would provide, how they would use technology, and how they would deal with human relationships. The ethical and spiritual choice making of the whole staff and the way they communicated their values both reflected and created a caring community in the workplace culture of the hospital unit.

Critical thinking activities

Based on this case study, consider the following questions.

1. What caring behaviors prompted the nurse manager to assign the clinical nurse leader to engage in direct caring for Mrs. Smith? Describe the clinical nurse leader role established by the American Association of Colleges of Nursing in 2004.
2. What issues (ethical, spiritual, legal, social-cultural, economic, and physical) from the structure of the theory of bureaucratic caring influenced this situation? Discuss end-of-life issues in relation to the theory.
3. How did the nurse manager balance these issues? What considerations went into her decision making? Discuss the role and the value of the clinical nurse leader on nursing units. What is the difference between the nurse manager and the clinical nurse leader in terms of caring practice in complex hospital care settings? How does a clinical nurse leader fit into the theory of bureaucratic caring for implementation of a caring practice?
4. What interrelationships are evident between persons in this environment—that is, how were the vice president for nursing, nurse manager, clinical nurse leader, staff, and patient connected in this situation? Compare and contrast the traditional nursing process with Turkel, Ray, and Kornblatt’s (2012) language of caring practice within the theory of bureaucratic caring 

 

You will write a case study review which includes your critique. This will be worth 30 points total. Create a detailed case study review in an essay APA format and include as your final page a reference list in APA format. Your review should be double-spaced, 2 pages minimum (not including reference list), with correct grammar and spelling. 

The purpose of this summative assignment is to reflect upon the new knowledge you have obtained from this course and apply it to your chosen case study while developing your critical thinking and critique skills. Be sure to consider all information from the course content – discussion board exercises, videos and any additional readings. Revisit readings from your Gilmore text. Put thought into how well you think the case study conducted their assessment, and how you would augment or improve it. Utilizing your knowledge from our course around assessing community needs, provide a detailed description and critique of your case study. Be sure to review your case study carefully to look for any gaps or areas with which improvements could be made, and justify your thinking. Reference additional scholarly resources to reinforce your justification. Be sure to cite your work appropriately.

Provide a brief (1 – 2 paragraph) description of the population and the health concern or issue being addressed. Explain how your chosen case study did, or did not, do in the area of describing the community, justifying the need for conducting the assessment, etc. Describe how your case study did with (or if they omitted) considering learning styles and theories as well as models to promote health education. Describe how your case study assessed groups and/or individuals (if applicable) and if they considered any factors that impact health education. Using your knowledge around each weekly module, discuss three suggestions for improving your case study. You may present an alternative approach or additional steps that you believe would improve the quality of your case study. Consider these prompts as you complete your critique:

• How did the case study identify the issue and explain the importance of the specific topic within the community?
• Did the case study paint a detailed picture of the population?
• Does it include a detailed description including information on demographics, barriers and challenges?
• Does it justify the need to conduct a needs assessment?
• Does it identify and describe community resources and explain why the resources are or are not effective?
• Does it explain any process for collecting data?

Remember to discuss recommendations. As you have done previously in our discussion boards and weekly modules, apply your critical critiquing skills to suggest what improvements are needed. Finish your essay with a summative paragraph which includes your final thoughts around how your suggested improvements would enhance this case study to meet the needs, or “fill in the gaps” and provide assistance to the community or population represented. 

Finally, include in APA format, a list of references. This should include a minimum of 2 references which are scholarly sources of information no previously referenced in the course. You may use any of the resources that were referred to throughout our weekly modules. You may also include your text as a resource in addition to your 2 references.

Please follow upload guidelines to do the paper.  The paper has to have two scholarly articles within the last five years. Use proper APA citations and format. Total of six pages including reference and title along with the body of the paper needs to be 3-4 pages in APA format. Paper has to be related to the PICOT question listed here:  Do patients in the hospital (P) who wear face masks (I) have a lower risk than those who do not wear a mask (C) of contracting COVID-19 (O) within 14 days of being exposed to a positive patient (T)?