Juliet Anyanwu RE: Discussion – Week 4COLLAPSE

Healthcare professionals use PICOT questions to clear clinical issues in a way that assists to efficiently and quickly find the right information to answer the clinical question (Melnyk & Fineout-Overholt, 2018).  The purpose of the PICOT question is to direct the systematic search of healthcare databases to find the best available evidence to answer the question (Melnyk & Fine-out-Overholt, 2018). Understanding how to appropriately formulate a clinical question in PICOT format and using it systematically in your search is vital to efficiently begin the EBP process (Melnyk & Fine-out-Overholt, 2018). Systematically formulating a clinical question makes it possible to find an answer faster and proficiently, leading to enhanced methods and patient outcomes (Stillwell et al., 2010).  

Question– In geriatric inpatients, does hand hygiene using soap and water compared to the use of hand sanitizers help in lessening the occurrences of Hospital Acquired Infection within three months?

PICOT Question

In geriatric inpatients (P), does hand hygiene using soap and water (I) compared to the use of hand sanitizers(C), help in lessening of Hospital Acquired Infection (HAIs) incidences (O) within three months (T)?

Search Terms used

The search terms used were: Hand Hygiene, hand washing, Hospital-acquired infections, inpatient geriatrics, and hand sanitizers.

Database used

The two databases used were CINAHL Plus with Full Text and MEDLINE with Full Text. 

Search Results

CINAHL Plus with Full Text produced 120 results, while MEDLINE with Full Text, which had 80 (Walden University Library, n.d. – a). These presented both original research articles and systematic reviews. The search was restricted to articles within five years. Also, to conduct the search, the article towards the research question was used. It was all related to hand hygiene, hand washing, hand sanitizers, and hospital-acquired infections management. Two articles were from original research.

Addition of Boolean Operator

Adding the search terms using the Boolean operators changed my search significantly. The amounts of records returned were remarkably decreased and increased on the articles available based on their significance to my study. It expedited the accomplishment of more detailed results and helped save time as the results became more suitable for my desires. It also gets rid of unsuitable articles. Boolean operators and nesting help one search for combinations of words or phrases processed in a particular order (Library of Congress, n.d.).

Strategies to increase the rigor and effectiveness of a database search and example

The strategies I will make to increase the rigor and effectiveness of a database search for my PICOT question include: Using Boolean operators. The use of Boolean operators helps facilitates, confines the search to the most relevant results, and is more focused. I will also limit the search to a particular year range. Limiting the year range, this helps in returning current searches and also uses more than one database for my search, because everyone may have more articles. I will seek the help of a Librarian to assist me in the preliminary inquiry. Another strategy is using parentheses. The use of Parentheses will help me get the search I want.

References

Library of Congress. (n.d.). Search/browse help-Boolean Operator and nesting. Retrieved September 22, 2020, from https://catalog.loc.gov/vwebv/ui/en_US/htdocs/help/searchBoolean.html

Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare (4th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.

Stillwell, S. B., Fineout-Overholt, E., Melnyk, B. M., & Williamson, K. M. (2010). Evidence-based practice, step by step: asking the clinical question: a key step in evidence-based practice. AJN The American Journal of Nursing, 110(3), 58-61.

Walden University Library (n.d.-a). Databases A-Z. Retrieved September 22, 2020, from    https://academicguides.waldenu.edu/az.php?s=19981

Angel Brockington-Hall RE: Discussion – Week 4: Main PostCOLLAPSE

After reviewing the five types of foreground questions, it was determined that a meaning question would be the most suitable approach for posing a question using PICOT. According to Melnyk and Fineout-Overholt (2018), meaning questions explore the relationship between an experience and an outcome, the extent or range of a rare occurrence, or “the influence of culture on healthcare” (p. 39).

PICOT Component

Description

Patient population

Sexual assault survivors

Intervention/issue of interest

Ongoing treatment and support/cultivating community support culture

Comparison intervention/issue of interest

Challenging traditional beliefs and attitudes with awareness and education

Outcome

Increased rates of reporting and support networks

Time

Post-assault through three months

PICOT Question

What is the quality of life (O) for sexual assault survivors (P) who report the incident and receive treatment and ongoing community support (I) within the first three months (T), compared to their counterparts who choose not to report (C) their lived experience?

Search Terms Used and Databases Used for PICOT Question

The search terms used included sexual assault victims or sexual assault survivors, rape and quality of life, community support, and treatment, contributing factors, reporting sexual assault, sexual assault, coping behavior, and trauma.  Boolean operators and nesting were applied to “search for combinations of words or phrases processed in a specified order” (Library of Congress, n.d.), and expanders such as “apply related words” and “search with the full text of the articles” were applied to refine results. 

CINAHL Plus with Full Text, MEDLINE with Full Text, APA PsycINFO, and APA PsycArticles were databases used to research the PICOT question.  The American Psychological Association (APA) publishes articles available in the APA PsycArticles and APA PsycINFO databases.  According to Walden University Library (n.d.), both databases are “a definitive source of full text, peer-reviewed scholarly and scientific articles in psychology” (para. 1). CINHAL Plus, with full text, offers “a robust collection of full-text nursing and allied health journals” (Walden University Library, n.d., para. 1).  It provides and permits access to nearly 800 journals indexed in the original CINAHL database. According to Walden University Library (n.d.), “CINAHL Plus with Full Text is the core research tool for all areas of nursing and allied health literature” (para. 1). 

Similarly, Medline with Full text presents “the authoritative medical information” on various health professions, including nursing. Nearly 1,500 journals are indexed in MEDLINE, which offers full text (Walden University Library, n.d., para. 1).

Search Results and Changes Noted with Boolean Operators 

  Walden University’s Library “Database search skills: Set up your search” option encourages the use of one term when searching databases to return the best and broadest results.  Entering a single word can be used to determine whether the precise term aligns with “scholarly works” (Walden University Library, Database search skills: Set up your search, n.d.-b.). Applying this recommendation produced over 20,000 articles.  Limiters such as peer-reviewed scholarly journals and a publication date no older than 2015 were used, resulting in the following results:

1. MEDLINE with Full Text (151)
2. CINAHL Plus with Full Text (120)
3. APA PsycArticles (35)
4. APA PsycInfo (6)

           Without the Boolean search operators and, or, and not, a search for sexual assault survivors returned a total of 1,039 results. The number of original research articles returned within the APA PsycINFO database was five out of six, proving a high probability of finding trustworthy, scholarly, current, and original research applied to the PICOT question.  When the Boolean search operator AND was used to include reporting sexual assault, collectively, all four databases were reduced to five total search results.  Search results increased exponentially, when an additional field of the Boolean operator OR was employed.  In the second field of the database search, the terms beliefs or perceptions or views or attitudes were added. Including the Boolean connector OR, produced greater than 400,125 results.  However, the articles resulting from adding OR produced fewer articles germane to the PICOT question.  

Strategies to Increase Rigor and Effectiveness of Database Search for PICOT

Some strategies could be applied to databases that make searching a PICOT question more efficient and rigorous. These strategies include:  

• Ensuring databases are reliable and produce trustworthy content rooted in scholarly work.
• Apply best practices in the methodological review of data.
• Utilize a combination of sources to establish evidence
• Organize citations and search strategies (Hartzell & Fineout-Overholt, 2018, p. 57).
• Solicit help from the librarian when needed.
• Select articles most germane to the PICOT question (Hartzell & Fineout-Overholt, 2018, p. 57).

According to Hartzell and Fineout-Overholt (2018), the above represent “basic and advanced behaviors that clinicians would use to competently search bibliographic databases such as the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and MEDLINE” (p. 56).  Searching databases that have relevancy to a PICOT question facilitates the evidence searching and gleaning process.  Boolean operators serve as “connectors” which can be used to expand (using OR) or narrow (using AND) searches. 

Overall, there are standard competencies expected of advanced practice clinicians, and there are various resources available to facilitate and promote honing these critical skills.

References

Hartzell, T. A. & Fineout-Overholt, E. (2018).  Chapter 3: Finding relevant evidence to answer clinical questions. In B. M. Melnyk, B. M., & E. Fineout-Overholt (Eds.), Evidence-based practice in nursing & healthcare: A guide to best practice (pp. 607-653). Philadelphia, PA: Wolters Kluwer.

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

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.-a).  Databases A-Z: Nursing. https://academicguides.waldenu.edu/az.php?s=19981

Walden University Library. (n.d.-b). Database search skills: Set up your search. https://academicguides.waldenu.edu/library/databasesearchskills/setupyoursearch

3SOURCES FOR EACH DISCUSSION

Jean Watson’s Theory of Human Caring is a conceptual thread in the USU College of Nursing’s curriculum framework. The purpose of this assignment is to offer students the opportunity to be exposed to Human Caring Science while providing students with the skills of critical appraisal of evidence.

1. Students will select one nursing research article that focuses on a study that used Jean Watson’s Theory of Human Caring as a theoretical framework.
2. Students should use as a guide, an appropriate Rapid Critical Appraisal Checklist found in Melnyk & Fineout-Overholt (2019; pp. 708-722).
3. The critiques are to be informal, although correct grammar, spelling, etc., are expected. The critique should include a brief description of the study that was reviewed and should address elements of the study relevant to critique.
4. Students will provide a written critique on a critical appraisal of the elements relevant to the nature of the research study such as type of study, design, quality of the study; and rationale, as well as implications for practice and further research and/or evaluation.

The grade will be based on accuracy, level of content and structure of the document.

 please use these Examples of research articles incorporating Jean Watson’s theory  in USU online library:

Durgun Ozan, Y., & Okumus, H. (2017). Effects of nursing care based on

   Watson’s theory of human caring on anxiety, distress, and coping when

    infertility treatment fails: A randomized controlled trial. Journal of Caring

   Sciences, 6(2), 95-109. 

Rossillao, K. (2018).  Caritas education: Theory to practice…2018 

  National Teaching Institute research abstracts presented at the AACN

  National Teaching Institute, Boston, Massachusetts, May 21-24, 2018. 

  American Journal of Critical Care, 27(3), e 14 – e15. 

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Expectations

• Length: 4-5 pages (including title and reference pages)
• Format: Formal paper in APA 6th ed format
• Citations: If used (not required) cite references according to APA 6th ed.

As you reach the conclusion of this Assignment, take a minute to appreciate your achievement. Your theoretical foundation for research represents a significant milestone not just in this course, but also in your growth as a doctoral student and a nurse scientist. Whether you retain your focus on your selected phenomenon or adjust your plans as you move forward, you will be able to build on the skills you have honed in this course to develop your program of research in the future.

To prepare

• Ensure that your paper addresses the following:
  • Your phenomenon of interest
  • Concepts (definitions, attributes, antecedents, and consequences)
  • Conceptual relationships
  • Assumptions
  • How an existing framework or theory could inform your work. (Explain how the framework/theory originated and what modifications you may need to make for it to be useful for your research.)
  • Research questions or hypotheses
  • Graphic model and narrative, as necessary, to support the model

Note: Please include your graphic model and narrative within the paper you submit.

Final Paper (due week 10 Sunday, November 8th) (called Assignment 1 again) (8-12 pages not including the title page or references – don’t worry about page limit – write and write succinctly)

Parts:

• Title page
• Introduction
• Phenomenon of interest
• Concept including definition, some ROL, antecedents, defining attributes, and consequences (you must have at least 2 citations for each defining attribute – if possible include a table starting with antecedents, then attributes, and finally consequences so you can see the flow)
• Relationships about concepts – antecedents and concept, antecedents and consequences (maybe), concept and consequences; concept and another concept (similar or opposite – hope and hopelessness, quality of life and well-being, etc.), direction of relationships – one direction or two, positive or negative; any other related concepts and their relationship with your concept (pull in text)
• you do NOT Have to include the model case and another case but if you want to you can but make sure you call out all the defining attributes in the model case and if you use a borderline case, talk about which defining attribute is missing – you can make up the case study and focus on your context (POI); you do NOT have to include empirical referents but if you want to, do so
• Assumptions (remember to keep them general)
• Theory or conceptual framework
• Research questions and/or hypotheses (research questions about concept and antecedents, concept and consequences, concept and other concepts or factors, one big global question) (remember to include the population of study and context)
• Graphic with a brief explanation of the graphic (make sure you have antecedents, defining attributes, and consequences as well as the theory – it is about the CONCEPT)
• Summary
• References (separate pages)

  

Case Study: 

A 51 year old male presents to the emergency department for epigastric pain that has lasted for 1 week. On a scale of 1 to 10, patient describes pain as a 10. The pain is constant, sharp and radiate to the right upper quadrant. It is associated with nausea, vomiting, and fatty stools with liquid consistency. It is also associated with severe puritus (itching). He denies melena or hematochezia. He has jaundice. He has no other medical problems and takes no medications. Patient’s father died of pancreatic cancer. He has weight loss of 40 lbs in 4 weeks. He denies drinking of alcohol and illicit drug use. He smokes 1-2 packs of cigarette every day for the past twenty years.

Medical diagnosis: Pancreatic cancer stage IV.

Using APA format style (6th edition): Write 3-5 pages on:

1. Treatment options for the disease process (pancreatic cancer)

2. Dedicate 2 of the pages to pathophysiology of pancreatic cancer. (Pathophysiology, 2 pages)

3. Patient’s education