The Walden library, MEDLINE, and CINAHL Plus with full text were the three main databases I used for my information search. CLABSI was the first acronym I used for my PICO(T) investigation. Because CLABSI is the central concept and a well-known big problem in our hospitals, I have chosen to use the specific phrase. CINAHL Plus full text yielded roughly 512 results, while peer-reviewed yielded 455. The total number of results obtained from MEDLINE full text was 599. In these findings, I feel there were numerous publications and data to work with. I narrowed my search by focusing on the years 2013 to 2020, and the results were essentially the same. Searching employing Boolean expressions such as AND, OR, and AND, according to Skelly and Ecker (2010), can help focus results. I used AND to narrow down my information. When I searched for “prevention AND intervention” to lower CLABSI in hospitalized patients, for example, 52 peer-reviewed articles came up.

Techniques for improving the PICO(T) question’s rigor and effectiveness

First, I was specific by using CLABSI to improve the rigor and effectiveness of my PICO(T) investigation. The keyword’s precision produced the expected outcomes. Then I used database filters. According to UAMS (2020), researchers should use database filters to filter results in order to acquire evidence-based information. To effectively narrow my findings in the CINAHL database, I used advance search with the Boolean keyword, limiters such as full text, peer-reviewed, and between 2010-2020. My score was around 63, which is a decent start. Then, using the search widgets on the right side of the screen, I immediately obtained the complete texts of CINAHL Plus and MEDLINE Plus.

Introduction

This discussion focuses on my Clinical issue of interest, which is CLABSI, my PICO(T) statement, literature search results, and Strategies to increase the rigor and effectiveness of my PICO(T) question database search.

A central line is a catheter inserted through an internal jugular vein, subclavian, femoral, or peripheral vein that terminated in the proximity of the heart in the superior or inferior vena cava (Khalid et al, 2013). A central line-associated bloodstream infection (CLABSI) is a serious infection that occurs when germs (usually bacteria or viruses) enter the bloodstream through the central line (CDC, n. d.). CLABSIs are a preventable infection, yet it results in thousands of deaths each year and billions of added costs to the U.S. healthcare system (CDC, n. d.).

Read Also: Discussion: Where in the World Is Evidence-Based Practice

PICO(T) question

Would using the CLABSI bundle decrease the incidence of CLABSI cases in hospitalized patients throughout their hospitalization period? PICO(T) format is popularly used when it comes to formulating

NURS 6052 Discussion Searching Databases Assignment

questions in evidence-based practice. According to Melnyk et al (2019), a PICO(T) question should be formulated before starting literature research. Having a well-constructed PICO(T) question helps find the best available results.

References

Khalid, I., Al Salmi, H., Qushmaq, I., Al Hroub, M., Kadri, M., & Qabajah, M. R. (2013). Itemizing the bundle: Achieving and maintaining “zero” central line-associated bloodstream infection for over a year in a tertiary care hospital in Saudi Arabia. AJIC: American Journal of Infection Control, 41(12), 1209–1213. https://doi-org.ezp.waldenulibrary.org/10.1016/j.ajic.2013.05.028

Melnyk, B.M., Fineout-Overholt, E., Stillwell, S.B., & Willamsom, 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. Retrieved from https://journals.iww.com/ajnonline/fulltext/2009/11000/Evidence_Based_Practice_Step_By_Step_Igniting_a.28.aspx

+Skelly, A. & Ecker, E. (2010). Conducting a winning literature search. Evidence-based spine-care journal, 1(1), 9-14.https://doi.org/10.1055/s-0028-1100887

University of Arkansas for medical science (2020). Developing a search strategy for primary literature. Retrieved from https://www.//libguides.uams.edu/evidence_based_medicine/acquiring

What are some of the things that healthcare providers are doing to prevent CLABSI? Retrieved from https://www.cdc.gov/hai/bsi/clabsi-resources.html

NURS 6052 Discussion: Searching Databases Assignment

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

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. NURS 6052 Discussion: Searching Databases Assignment

By Day 6 of Week 4

Respond to at least two of your colleagues on two different days and provide further suggestions on how their database search might be improved.

Submission and Grading Information

Grading Criteria

To access your rubric:

Week 4 Discussion Rubric

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

To participate in this Discussion:

Week 4 Discussion

RE: Discussion – Week 4

Top of Form

My PICO subject involves post-operative pain management using a numerical pain scale over the use of the Critical Care Pain Assessment Tool ( CPOT) to minimize opioid use. My question is will the implementation of a collective assessment approach in acute care nursing at the PACU, containing the Critical Care Pain Observation Tool (CPOT) and comparative pain score, decrease post-operative use of narcotics compared to the comparative pain scale alone? NURS 6052 Discussion: Searching Databases Assignment

I selection of search terms used to get posts, feedback and other information are as follows: Terms of research analgesia, post-operative analgesia, preventive analgesia, non-opioid, pain, post-operative, fentanyl, multimodal treatment, preoperative nursing, analgesia, vital signs, pain effect, pain scale, postoperative pain, preoperative care, surgical procedures, surgical treatment, and pain management.

I started using the Walden library but I still haven’t received any search returns even with all the parameters remaining. I started using Google Scholar which I am pretty familiar with. I started searching for only the top three of Meta-Analysis, Systematic Reviews, and Critically Appraised Topics in the hierarchy because these are the three most reliable results and three of the four that can be filtered. My three top search topics got the following: On the subject of (The criteria is the search sentence and the type of review method) Analgesia-(Meta-Analysis- 166,000). (Systematic Reviews-267,000), Topic Critically Assessed-13,500) Primary Care Pain Assessment Method -(Meta Research-120,000), (Systematic Reviews-235,000), (Topic Objectively Appraised-19,000) Multi-model Pain Treatment-(Meta-Analysis-46,300), (Systemic-Reviews-57,500). (Topics Critically Appraised-4,030).

The reason I searched for only three types of review methods is that they contain the most reliable information that my PICO question needs to be answered with the greatest precision. Depending on the type of research that I am doing, it depends on where I look for the information from the evidence hierarchy. I look more towards the Meta-Analysis if I am looking for statistical evidence. I have taken a closer look at the Systemic Reviews that fit my pre-specified eligibility criteria. The most useful ones in my view are the Critically Appraised Topics, as they are brief summaries of findings that may be close to my area of concern as they concentrate on a particular issue (Polit, D.F., & Beck, C. T., 2017).

Some of the information I found was that the result of one meta analyst outcomes indicated the CPOT’s reliability and validity was acceptable. “Strong intra-class correlations varying from 0.74 to 0.91supported the inter-rater reliability. Significant associations between CPOT scores and both FLACC 0.87-0.92 and pain intensity Numeric Rating Scale Score 0.50-0.69 were found for criterion-related validity” (Buttes, et al., 2015). A key point to my question has been that a comprehensive, multimodel analgesic regimen will not only provide the most complete control of pain but will also minimize the need for opioids and thus reduce the resulting side effects. (Carlson, R.H., 2015).

References

Buttes, P., Keal, G., Cronin, S. N., Stocks, L., & Stout, C. (2015). Validation of the Critical-Care Pain Observation Tool in Adult Critically Ill Patients. Dimensions of Critical Care Nursing,33(2), 78-81. doi:10.1097/dcc.0000000000000021

Carlson, R. H. (2015). Multimodal Pain Management Minimizes Need for Opioids. Oncology Times,37(9), 36-37. doi:10.1097/01.cot.0000465759.66907.be

Discussion: Searching Databases

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

By Day 6 of Week 4

Respond to at least two of your colleagues on two different days and provide further suggestions on how their database search might be improved.

Submission and Grading Information

Grading Criteria

To access your rubric:

Week 4 Discussion Rubric

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

To participate in this Discussion:

Week 4 Discussion

RE: Discussion – Week 4

PICO(T) is a mnemonic used to describe the four elements of a good clinical question. It stands for Patient/Problem, Intervention, Comparison, Outcome. Many people find that it helps them clarify their question, which in turn makes it easier to find an answer (Cooke, Smith, & Booth, 2012). My PICO(T) question is, In hospitalized inpatient psychiatric patients (P), how does forcing medication (I), compare with not forcing medication (C), effect quality of care (O), during the duration of the inpatient admission (T). A well-built PICOT question increases the likelihood that the best evidence to inform practice will be found quickly and efficiently (Stillwell, Fineout-Overholt, Melnyk, & Williamson, 2010). My original search yielded no results in any database.

I had to reduce my search terms quite a bit to yield a result of 57 articles. Not many were very relevant however one such article, Forced medication in psychiatric care: Patient experiences and nurse perceptions, was adequately related to my original question. My search terms were, psychiatric patients forced medication care. I searched the databases EBSCO and CINAHL, both retrieved from the Walden University library.

Cooke, A., Smith, D., & Booth, A. (2012). Beyond PICO: The SPIDER tool for qualitative evidence synthesis. Qualitative Health Research, 22(10), 1435-1443. doi:10.1177/1049732312452938

Haglund, K., Von Knorring, L., & Von Essen, L. (2003). Forced medication in psychiatric care: Patient experiences and nurse perceptions. Journal of Psychiatric and Mental Health Nursing, 10(1), 65–72. https://doi-org.ezp.waldenulibrary.org/10.1046/j.1365-2850.2003.00555.x

Stillwell, S. B., Fineout-Overholt, E., Melnyk, B. M., & Williamson, K. M. (2010). Asking the clinical question: a key step in evidence based practice. A successful search strategy starts with a well-formulated question. American Journal of Nursing, 3, 58.

Walden University Library. (2020). Keyword searching: Finding articles on your topic: Boolean terms. Retrieved from http://academicguides.waldenu.edu/library/keyword/boolean

RE: Discussion – Week 4

Just as with searching for a new car, I wanted to develop a PICO(T) question and perform research that is meaningful not only to my future but also that resonates with some of my previous areas of experience. I of course want my research to be meaningful and evidenced-based.

I have worked with the adolescent psychiatric population ages 5-17 in outpatient and level one hospitals. There have been many interventions carried out with great success and others with very limited positive outcomes. I have transformed my clinical inquiry into a searchable question in order to search electronic databases step by step with efficiency which is as follows (Stillwell, Fineout-Overholt, Melnyk, Williamson (2010):

In Attention Deficit Hyperactive Disorder (ADHD) (Problem), how does diet (Intervention) compared to other treatments (Comparison) affect behavior and quality of life (Outcome) within the youth population (Time-Frame).

This will assist to develop and examine successful strategies that may increase the rigor and effectiveness of the most current evidence-based research. Specific examples include accessing search engines such as the Walden Library, Ebsco, and other scientifically reputable sites in order to get the most credible and value-rich material for evidenced-based research that I am looking for.

References

MD Anderson Library. (2020). Research guides: Evidence-based medicine: Searching techniques. MD Anderson Library Center. https://mdanderson.libguides.com/c.php?g=249812&p=2314759

Stillwell, S. B., Fineout-Overholt, E., Melnyk, B., & Williamson, K. M. (2010). Evidence-based practice, step by step: Asking the clinical question. AJN, American Journal of Nursing, 110(3), 58–61. https://doi.org/10.1097/01.naj.0000368959.11129.79

Walden University Library. (n.d.). Databases A-Z: Nursing. Retrieved October 4, 2019, from https://academicguides.waldenu.edu/az.php?s=19981

Name: NURS_6052_Module03_Week04_Discussion_Rubric

	Excellent	Good	Fair	Poor
Main Posting	Points Range: 45 (45%) – 50 (50%) Answers all parts of the discussion question(s) expectations with reflective critical analysis and synthesis of knowledge gained from the course readings for the module and current credible sources. Supported by at least three current, credible sources. Written clearly and concisely with no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.	Points Range: 40 (40%) – 44 (44%) Responds to the discussion question(s) and is reflective with critical analysis and synthesis of knowledge gained from the course readings for the module. At least 75% of post has exceptional depth and breadth. Supported by at least three credible sources. Written clearly and concisely with one or no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.	Points Range: 35 (35%) – 39 (39%) Responds to some of the discussion question(s). One or two criteria are not addressed or are superficially addressed. Is somewhat lacking reflection and critical analysis and synthesis. Somewhat represents knowledge gained from the course readings for the module. Post is cited with two credible sources. Written somewhat concisely; may contain more than two spelling or grammatical errors. Contains some APA formatting errors.	Points Range: 0 (0%) – 34 (34%) Does not respond to the discussion question(s) adequately. Lacks depth or superficially addresses criteria. Lacks reflection and critical analysis and synthesis. Does not represent knowledge gained from the course readings for the module. Contains only one or no credible sources. Not written clearly or concisely. Contains more than two spelling or grammatical errors. Does not adhere to current APA manual writing rules and style.
Main Post: Timeliness	Points Range: 10 (10%) – 10 (10%) Posts main post by day 3.	Points Range: 0 (0%) – 0 (0%)	Points Range: 0 (0%) – 0 (0%)	Points Range: 0 (0%) – 0 (0%) Does not post by day 3.
First Response	Points Range: 17 (17%) – 18 (18%) Response exhibits synthesis, critical thinking, and application to practice settings. Responds fully to questions posed by faculty. Provides clear, concise opinions and ideas that are supported by at least two scholarly sources. Demonstrates synthesis and understanding of learning objectives. Communication is professional and respectful to colleagues. Responses to faculty questions are fully answered, if posed. Response is effectively written in standard, edited English.	Points Range: 15 (15%) – 16 (16%) Response exhibits critical thinking and application to practice settings. Communication is professional and respectful to colleagues. Responses to faculty questions are answered, if posed. Provides clear, concise opinions and ideas that are supported by two or more credible sources. Response is effectively written in standard, edited English.	Points Range: 13 (13%) – 14 (14%) Response is on topic and may have some depth. Responses posted in the discussion may lack effective professional communication. Responses to faculty questions are somewhat answered, if posed. Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.	Points Range: 0 (0%) – 12 (12%) Response may not be on topic and lacks depth. Responses posted in the discussion lack effective professional communication. Responses to faculty questions are missing. No credible sources are cited.
Second Response	Points Range: 16 (16%) – 17 (17%) Response exhibits synthesis, critical thinking, and application to practice settings. Responds fully to questions posed by faculty. Provides clear, concise opinions and ideas that are supported by at least two scholarly sources. Demonstrates synthesis and understanding of learning objectives. Communication is professional and respectful to colleagues. Responses to faculty questions are fully answered, if posed. Response is effectively written in standard, edited English.	Points Range: 14 (14%) – 15 (15%) Response exhibits critical thinking and application to practice settings. Communication is professional and respectful to colleagues. Responses to faculty questions are answered, if posed. Provides clear, concise opinions and ideas that are supported by two or more credible sources. Response is effectively written in standard, edited English.	Points Range: 12 (12%) – 13 (13%) Response is on topic and may have some depth. Responses posted in the discussion may lack effective professional communication. Responses to faculty questions are somewhat answered, if posed. Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.	Points Range: 0 (0%) – 11 (11%) Response may not be on topic and lacks depth. Responses posted in the discussion lack effective professional communication. Responses to faculty questions are missing. No credible sources are cited.
Participation	Points Range: 5 (5%) – 5 (5%) Meets requirements for participation by posting on three different days.	Points Range: 0 (0%) – 0 (0%)	Points Range: 0 (0%) – 0 (0%)	Points Range: 0 (0%) – 0 (0%) Does not meet requirements for participation by posting on 3 different days.
Total Points: 100

Name: NURS_6052_Module03_Week04_Discussion_Rubric

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NURS 6052 Discussion: Searching Databases Assignment

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