Essentials of Evidence-Based Practice
3/21/23, 4:07 PM Topic: Module 3: Discussion
https://waldenu.instructure.com/courses/53151/discussion_topics/255505?module_item_id=1043726 1/35
This is a graded discussion: 100 points possible due Mar 22 at 10:59pm
27 27
Back to Module at a Glance (https://waldenu.instructure.com/courses/53151/modules/items/1043722)
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.
SEARCHING DATABASES
RESOURCES
3/21/23, 4:07 PM Topic: Module 3: Discussion
https://waldenu.instructure.com/courses/53151/discussion_topics/255505?module_item_id=1043726 2/35
To Prepare:
Review the Resources and identify a clinical issue of interest that can form the basis of a clinical inquiry. Review the materials offering guidance on using databases, performing keyword searches, and developing PICO(T) questions provided in the Resources. Based on the clinical issue of interest and using keywords related to the clinical issue of interest, search at least two different databases in the Walden Library to identify at least four relevant peer-reviewed articles related to your clinical issue of interest. You should not be using systematic reviews for this assignment, select original research articles. Review the Resources for guidance and develop a PICO(T) question of interest to you for further study. It is suggested that an Intervention-type PICOT question be developed as these seem to work best for this course.
*Library tip:
Walden Library recommends starting your search broadly with one concept or search word and adding more elements one at a time. Depending on your topic, the evidence will not necessarily address all the aspects of your PICO(T) question in one article. Select the most important concepts to search and find the best evidence available, even if that means assembling evidence from multiple articles.
Nursing Research Page (https://academicguides.waldenu.edu/library/subject/nursing) – databases and resources specifically for Nursing Evidence-Based Practice guide: Evidence Types (https://academicguides.waldenu.edu/library/healthevidence/types) Nursing and Health research videos (https://academicguides.waldenu.edu/library/webinararchives/nursing) , including a 15- minute introduction Get Help (https://academicguides.waldenu.edu/library/help) page, including Ask a Librarian (https://academicguides.waldenu.edu/library/ask) service
Quick Answers:
Be sure to review the Learning Resources before completing this activity. Click the weekly resources link to access the resources.
WEEKLY RESOURCES (https://waldenu.instructure.com/courses/53151/modules/items/1043729)
3/21/23, 4:07 PM Topic: Module 3: Discussion
https://waldenu.instructure.com/courses/53151/discussion_topics/255505?module_item_id=1043726 3/35
Search entries or author
Reply
How do I find an article that reports on research that uses a specific methodology? (https://academicanswers.waldenu.edu/faq/72633) How do I find original or primary research that analyzes empirical data? (https://academicanswers.waldenu.edu/faq/72640) What is the Find at Walden button? (https://academicanswers.waldenu.edu/faq/73252)
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.
Respond to at least two of your colleagues on two different days and provide further suggestions on how their database search might be improved.
BY DAY 3 OF WEEK 4
BY DAY 6 OF WEEK 4
Unread Subscribe
3/21/23, 4:07 PM Topic: Module 3: Discussion
https://waldenu.instructure.com/courses/53151/discussion_topics/255505?module_item_id=1043726 4/35
(https:// Emily F Keyes (She/Her) (https://waldenu.instructure.com/courses/53151/users/2872)
Yesterday
Reply
Hi, All,
This week is *the* week for you to select your final topic of interest for your remaining work in the course. It must be a researchable topic, of course! You may or may not have your complete PICO(T) in place, but you must at least describe your topic and aims with it in detail! You must have your PICO(T) in place for next assignment! Of note: the T means timeframe over which you would collect data on all subjects in your study. It is not necessary to include a timeframe unless you wish!
Hope this helps! :)
Dr. Keyes
(https:// Samantha Hrabik (https://waldenu.instructure.com/courses/53151/users/76342)
Yesterday
For my clinical issue of interest, I chose birth control and sexual education for adolescents. I chose this topic because it is something I feel strongly about, teens and adolescents deserve quality and competent sexual education along with knowledge and education about birth control and contraception. “A quality sexual health education curriculum includes medically accurate, developmentally appropriate, and culturally relevant content and skills that target key behavioral outcomes and promote healthy sexual development” (Center for Disease Control and Prevention, 2020). There are many benefits to quality sexual education and different types of birth control access such as fewer experiences of unprotected sex, increase in protection, fewer partners, and even a delay in initiation of sexual intercourse (Centers for Disease Control and Prevention, 2020).
The PICOT format of research helps with research questions by effectively identifying the P- population, I- intervention of interest, C- comparison of interest, O- outcome, and T- time for the intervention to achieve the outcome (Melnyk & Fineout,
3/21/23, 4:07 PM Topic: Module 3: Discussion
https://waldenu.instructure.com/courses/53151/discussion_topics/255505?module_item_id=1043726 5/35
Reply
2018). Using the PICOT format for research helps dial in what you are looking for and provides better results. When I used the basic search of “adolescents and birth control” I had 9,341 results through the “Nursing Research Page”. I then narrowed my search by limiting years from 2018-2023 and that gave me 2,442 results. I was able to find a couple of articles with that search, but I then added a sub search of “sexual education” this gave me 181 results.
I always like to start by using the Walden Library Nursing Database, I have found the best results starting here. Starting off with a solid topic also helps, with this topic I started with just birth control and added more specifications as I went. Knowing more about the PICOT format of research would have helped prior to this assignment. When I researched only birth control my results were very broad with many different populations, ages groups, and reasons for birth control use. When I decided to do a more specific population search of adolescents it brought my focus in a lot better and I was able to research more efficiently. Adding in key words, specific years, and full text limiters also helped bring down the results to specifically what I was looking for.
Centers for Disease Control and Prevention. (2020, February 3). What Works: Sexual Health Education. CDC. https://www.cdc.gov/healthyyouth/whatworks/what-works-sexual-health-education.htm (https://www.cdc.gov/healthyyouth/whatworks/what-works-sexual-health-education.htm)
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) Links to an external site. (https://academicguides.waldenu.edu/az.php?s=19981) . Retrieved September 6, 2019, from https://academicguides.waldenu.edu/az.php?s=19981
(http Wemimo Ojetunde (https://waldenu.instructure.com/courses/53151/users/74061)
Yesterday
Samantha, I appreciate your insight into your clinical interest in teenage sexual education and contraception. The PICOT style is a great approach to organize questions for research and narrow down the results when looking for scholarly publications, as you said. You were able to locate more specifically tailored content thanks to this style. Database searches
3/21/23, 4:07 PM Topic: Module 3: Discussion
https://waldenu.instructure.com/courses/53151/discussion_topics/255505?module_item_id=1043726 6/35
may be optimized in a number of different ways, by deciding on a subject in advance and then narrowing it down using keywords and other filters. (Melnyk, et., al 2009).
The database search might be enhanced by including more databases, such as PubMed, CINAHL, and Cochrane database. These databases have a plethora of nursing and healthcare publications and may therefore provide a more comprehensive selection of resources. The database is also additional source of evidence since these sorts of research give an in-depth study of several studies and provide a greater degree of evidence. Library of Congress. (n.d.).
To further refine the database search, it may be useful to include additional search terms related to social and cultural factors, such as "stigma," "gender norms," or "culture." Additionally, limiting the search to specific study designs, such as randomized controlled trials or systematic reviews, can help to identify high-quality evidence. (Lopez et al., 2016).
References
Library of Congress. (n.d.). Search/browse help – Boolean operators and nesting. Retrieved March 20, 2023, from https://catalog.loc.gov/vwebv/ui/en_US/htdocs/help/searchBoolean.html
Lopez, L. M., Grey, T. W., Chen, M., Tolley, E. E., Stockton, L. L., & Chen, M. (2016). Theory-based interventions for contraception. The Cochrane database of systematic reviews, (11), CD007249. https://doi.org/10.1002/14651858.CD007249.pub4 (https://doi.org/10.1002/14651858.CD007249.pub4)
Melnyk, B. M., Fineout-Overholt, E., Stillwell, S. B., & Williamson, K. M. (2009). Evidence-based practice: Step by step: Igniting a spirit of inquiry Links to an external site. Links to an external site. American Journal of Nursing, 109(11), 49–52. doi:10.1097/01.NAJ.0000363354.53883.58
3/21/23, 4:07 PM Topic: Module 3: Discussion
https://waldenu.instructure.com/courses/53151/discussion_topics/255505?module_item_id=1043726 7/35
Reply
(http Emily F Keyes (She/Her) (https://waldenu.instructure.com/courses/53151/users/2872)
11:36am
Samantha,
I love your topic of interest! I am with you that our teens must know about birth control options early on! I hear you about knowing more concerning PICOT before your search, yet it should not have hindered your ability to search very much! The options are to choose a topic, to see what is there in the published literature, and then, formulate your PICO(T) as you go! I can pass along your opinion to our course designers for consideration; they may be able to introduce it somewhere earlier. I do not design our courses (no faculty member does!), and we are not allowed to alter the structure of any course, at all!
Thanks for your good review of literature, and for all material otherwise! :)
3/21/23, 4:07 PM Topic: Module 3: Discussion
https://waldenu.instructure.com/courses/53151/discussion_topics/255505?module_item_id=1043726 8/35
Reply
Dr. Keyes
(http Samantha Hrabik (https://waldenu.instructure.com/courses/53151/users/76342)
2:27pm
Reply
Thank you, Dr. Keyes! I do agree with you that it did not ultimately hinder my search or ability to do the assignment. I think some of the resources that were provided this week could have been helpful for last week, but I did feel like I was adequately prepared and able to complete last week's assignment without anything from this week.
Samantha
(http Joshua Albert Rangel (https://waldenu.instructure.com/courses/53151/users/78224)
2:33pm
Reply #1
Hello Samantha Hrabik,
This week’s discussion topics are endless; some are highly important, and others are hot topics of government debates. I love that your topic of choice is birth control and sexual education. It is such a controversial topic with so many crucial elements and options. I read an article recently about the topic was to not addressing sexual education or gender until a certain age. Pushing this critical education off simply because we want to protect our children is very naïve. Kids are becoming more and more sexually active among younger generations. Evidence-based practice shapes healthcare practice (Melnyk & Fineout-Overholt, 2018). With the recent changes to abortions and decreased sexual education, I fear for our futures. As a foster parent, I fear how many more children will be added to the numerous children already in foster care. Great topic of discussion; I am sure choosing a topic for the assignment will be complex.
3/21/23, 4:07 PM Topic: Module 3: Discussion
https://waldenu.instructure.com/courses/53151/discussion_topics/255505?module_item_id=1043726 9/35
Reply
Melnyk, B. M., & Finest-Overholt, E. (2019). Evidence-Based Practice in Nursing & Healthcare (4th ed.). Wolters Kluwer.
Walden University Library. (n.d.-c). Evidence-based practice research: CINAHL search, Retrieved from https://academicguides.waldenu.edu/library/healthevidence/cinahlsearchhelp
(https:// Joshua Albert Rangel (https://waldenu.instructure.com/courses/53151/users/78224)
Yesterday
Initial Post:
Hello Colleagues,
My clinical issue of choice is diabetes; I choose diabetes because, as a nurse, we often care for patients with diabetes. These patients we care for often have unmanaged diabetes and lack education on adequately managing it. To improve patient outcomes, new knowledge must be transformed into clinically useful forms and measured in terms of how it impacts the patient's health (Stevens, 2013). To research a question, you first have to identify the health issue and then identify a problem. My research question is, "does diabetes education reduce the future risk of complications compared to none?" In the last several years of education, I have seen many patients who lack the knowledge to manage diabetes properly. I have had patients who need to learn their HbA1C levels or daily blood glucose. To begin my research, I went to Walden's Library nursing database. I utilized the CINAHL search by using the words diabetic, education, and complications, to name a few.
I refined the outcomes by limiting the years and selecting peer articles only. A hand full of articles were left for the choosing. Most, if not all, related to my interests and research topic. In the textbook, I utilized the PICOT question template (Melnyk & Finest-Overholt, 2019). The PICOT question template identifies the population, intervention of interest, comparison of interest, outcome, and time for the intervention to achieve the outcome (Melnyk & Fineout, 2019). Using the PICOT format for research helps dial in what you seek and provides better results. The Walden Library also has links to PubMed and Science Digest; I utilized these searches to find additional search articles.
Reference
3/21/23, 4:07 PM Topic: Module 3: Discussion
https://waldenu.instructure.com/courses/53151/discussion_topics/255505?module_item_id=1043726 10/35
Reply
Melnyk, B. M., & Finest-Overholt, E. (2019). Evidence-Based Practice in Nursing & Healthcare (4th ed.). Wolters Kluwer.
Stevens, K. R. (2013). The Impact of Evidence-Based Practice in Nursing and the Next Big Ideas.
The Online Journal of Issues in Nursing, 18 (2).
Walden University Library. (n.d.-c). Evidence-based practice research: CINAHL search, Retrieved from https://academicguides.waldenu.edu/library/healthevidence/cinahlsearchhelp
(http Emily F Keyes (She/Her) (https://waldenu.instructure.com/courses/53151/users/2872)
11:40am
Reply
Joshua,
This is a wonderful presentation of your search process, as well as of your topic of interest! T2 DM is widespread, and when our patients lack education about how to manage or even prevent it, we must take action to help them!
Great job! Thanks! :)
Dr. Keyes
(https:// Wemimo Ojetunde (https://waldenu.instructure.com/courses/53151/users/74061)
Yesterday
Current healthcare system and patient care are being shaped by evidence-based practice (Melnyk & Fineout-Overholt, 2018). Health-related concerns inspired the creation of the PICO framework and its variants. PICO(T) stands for patient, intervention, comparison, outcome, and timeframe (Davies, 2011). My clinical issue of interest is diabetes and my PICO(T) question is:
3/21/23, 4:07 PM Topic: Module 3: Discussion
https://waldenu.instructure.com/courses/53151/discussion_topics/255505?module_item_id=1043726 11/35
In patients with Type 2 diabetes, does intermittent fasting compared to no intervention or usual care lead to a significant improvement in glycemic control (HbA1c level) after 12 weeks?
P: Patients with Type 2 diabetes.
I: Intermittent fasting
C: No intervention or usual care
O: Improvement in glycemic control (HbA1c level)
T: 12 weeks
The two databases used to search these questions were PubMed and CINAHL Plus in the Walden University Library (Walden University Library, n.d.). The initial search using the keywords "Type 2 diabetes", "intermittent fasting", "glycemic control", and "HbA1c level" yielded a total of 126 articles on original research in the PubMed database. As additional search terms were added using Boolean operators, the number of articles returned decreased. When "12 weeks" was added as a search term, the number of articles decreased to 52. When the term "usual care" was added as a search term, the number of articles decreased to 36.
Many techniques may be used to improve the thoroughness and accuracy of a database search for this PICO(T) question using Pub Med:
Firstly, guaranteeing complete search coverage by using both free-form keywords and restricted vocabulary phrases (MeSH terms). Diabetic coma, fasting, and glycosylated hemoglobin A are all examples of restricted vocabulary phrases that may be used in conjunction with the keywords. Secondly, to accommodate for any terminology differences, truncate strings and generic symbols can be used. Just appending the truncation symbol "*" to the word "diabetes" will return results including the phrases "diabetic," "diabetes mellitus," and "diabetes insipidus," among others. Thirdly, making use of many databases to assure completeness. Cinahl Plus, the Ebsco database, are some of the other useful databases that may be searched in addition to PubMed. Fourthly, establish criteria for what to include and what to leave out of your search. Because of this, only relevant articles will be included in the study. Articles may be disregarded for a variety of reasons, including not being written in English, not including human subjects; and not reporting on relevant outcomes (in this case, glycemic control). Library of Congress. (n.d.) If these methods are used, the search will provide more complete, accurate, and relevant results for the PICO(T) inquiry.
3/21/23, 4:07 PM Topic: Module 3: Discussion
https://waldenu.instructure.com/courses/53151/discussion_topics/255505?module_item_id=1043726 12/35
After conducting a search on CINAHL Plus using the initial search terms "Type 2 diabetes" and "intermittent fasting," a total of 5 articles were returned. When using Boolean operators to refine the search, the search terms "Type 2 diabetes AND intermittent fasting" yielded 5 articles, "Type 2 diabetes AND intermittent fasting AND glycemic control" yielded 2 articles, and "Type 2 diabetes AND intermittent fasting AND HbA1c" yielded 1 article.
To increase the rigor and effectiveness of a database search on this PICO(T) question with CINAHL, one strategy is to use a combination of controlled vocabulary and keywords. Controlled vocabulary includes standardized terms used in a specific database to describe concepts, which can help ensure that all relevant articles are retrieved. For example, in CINAHL Plus, the controlled vocabulary term for Type 2 diabetes is "diabetes mellitus, type 2." Using this term in addition to the keyword "Type 2 diabetes" could potentially retrieve more relevant articles. Another strategy is to use the search filters provided by the database to narrow down the results by publication type, study design, and other relevant criteria. Additionally, it may be helpful to search multiple databases and to review the reference lists of retrieved articles for additional relevant studies.
References
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.
Library of Congress. (n.d.). Search/browse help – Boolean operators and nesting. Retrieved March 20, 2023, 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: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer.
Walden University Library. (n.d.). Databases A-Z: Nursing. Retrieved March 20, 2023, from https://academicguides.waldenu.edu/az.php?s
3/21/23, 4:07 PM Topic: Module 3: Discussion
https://waldenu.instructure.com/courses/53151/discussion_topics/255505?module_item_id=1043726 13/35
3/21/23, 4:07 PM Topic: Module 3: Discussion
https://waldenu.instructure.com/courses/53151/discussion_topics/255505?module_item_id=1043726 14/35
Reply
(http Emily F Keyes (She/Her) (https://waldenu.instructure.com/courses/53151/users/2872)
11:42am
Reply
Wemimo,
Beautiful presentation of your search process, and on your important topic! I like your PICOT just as it stands! Great work!
Thanks! :)
Dr. Keyes
3/21/23, 4:07 PM Topic: Module 3: Discussion
https://waldenu.instructure.com/courses/53151/discussion_topics/255505?module_item_id=1043726 15/35
(https:// Christine Marquardt (https://waldenu.instructure.com/courses/53151/users/79244)
Yesterday
In 2021, more than 107,000 Americans died from drug overdoses (FDA, n.d.). Today’s drug overdose crisis is multifaceted and has evolved beyond prescription pain medications. Illicit opioids, largely driven by fentanyl and heroin, have become key contributors. Naloxone is a safe medication that is widely used by emergency medical personnel and other first responders to prevent opioid overdose deaths (NIDA, n.d.). Naloxone can quickly restore normal breathing and save the life of a person who is overdosing. Improving Naloxone access and carrying to persons who inject drugs (PWID) may reduce overdose mortality associated with the influx of fentanyl and heroin in the market (Buresh et al., 2020).
Using the PICO(T) acronym (Stillwell et al., 2010), the following clinical question was developed: Among PWID and are participants in a syringe exchange program, how effective is the distribution of free Naloxone in reducing fatal overdoses during a time span of 12 months?
Database #1 Embase, had a PICO search tool which was helpful. After several attempts in adjusting the search words, I recovered 52,000 articles, then using the quick search mode with two – three words, I recovered approximately 17 articles, and these seemed to be most relevant to my research question. Database #2 CINAHL, required a little time to get the hang of using it and after several attempts, I was able to recover 1,797 articles related to my research question. Using the Boolean operator AND restricted the results and I found this to be unsuccessful, while using OR was helpful in providing articles for me to then go review and determine if they would be applicable to my research question.
Strategies I will use to increase the rigor of the database search will be experimenting with different words, phrases and trying different Boolean operators to obtain a series of articles that I am satisfied with. Also, if time permits, I will try a different database or refine the search parameters even more. There were times where I felt frustrated during the database search, so taking a few minutes for a break, then coming back to resume my search is a helpful strategy as well!
Buresh, M., Gicquelais Id, R. E., Astemborski, J., Kirk, G. D., Mehta, S. H., & Genberg Id, B. L. (2020). Fatal overdose prevention and experience with naloxone: A cross-sectional study from a community-based cohort of people who inject drugs in
3/21/23, 4:07 PM Topic: Module 3: Discussion
https://waldenu.instructure.com/courses/53151/discussion_topics/255505?module_item_id=1043726 16/35
Reply
Baltimore, Maryland. https://doi.org/10.1371/journal.pone.0230127
FDA’s Overdose Prevention Framework Aims to Prevent Drug Overdoses and Reduce Death | FDA. (n.d.). Retrieved March 19, 2023, from https://www.fda.gov/news-events/fda-voices/fdas-overdose-prevention-framework-aims-prevent-drug-overdoses-and- reduce-death
Naloxone for Opioid Overdose: Life-Saving Science | National Institute on Drug Abuse (NIDA). (n.d.). Retrieved March 17, 2023, from https://nida.nih.gov/publications/naloxone-opioid-overdose-life-saving-science
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. American Journal of Nursing, 110(3), 58–61. https://doi.org/10.1097/01.NAJ.0000368959.11129.79
(http Maria Bryceland (https://waldenu.instructure.com/courses/53151/users/10972)
5:27am
Christine,
I had also planned to select a subject related to patients who struggle with opioid usage. I encounter many people with addiction while working in the emergency room, and I witness the effects of how the misuse mutilates their bodies. This includes overdosing, wrecking their home lives, uncontrollable infections brought on by self-injecting, and death. It's a tragic issue that exists all across the world.
To help with your research project, when using the Walden Library type in Narcan and wait to see the list that automatically populates before moving your mouse away. I have found this helpful when I know what topic I want but need to zone into something more specific. I used this method to search Narcan and one of the suggestions was “Narcan or naloxone or take- home Narcan or take-home naloxone”. Here is a cited article I found using this method:
3/21/23, 4:07 PM Topic: Module 3: Discussion
https://waldenu.instructure.com/courses/53151/discussion_topics/255505?module_item_id=1043726 17/35
Reply
Ericson, Ø. B., Eide, D., Lobmaier, P., & Clausen, T. (2022). Risks and overdose responses: Participant characteristics from the first seven years of a national take-home naloxone program. Drug and Alcohol Dependence, 240, 1–7. https://doi.org/10.1016/j.drugalcdep.2022.109645 (https://doi.org/10.1016/j.drugalcdep.2022.109645)
Hope this helps you!
Maria
(http Christine Marquardt (https://waldenu.instructure.com/courses/53151/users/79244)
2:07pm
Reply
Hi Maria,
Thanks so much for your response, tips and reference. I will certainly check it out. I look forward to reading your post about opioid use disorder.
Christine
(http Emily F Keyes (She/Her) (https://waldenu.instructure.com/courses/53151/users/2872)
11:46am
Christine,
3/21/23, 4:07 PM Topic: Module 3: Discussion
https://waldenu.instructure.com/courses/53151/discussion_topics/255505?module_item_id=1043726 18/35
Reply
This is a compelling topic; great choice! I know that in some states/cities of US, improved Naloxone access and carrying to persons who inject drugs is legal and in play! Far too many other places, though, have chosen to not implement this process! When we can save lives, we must at least try to help! I hear you about using the Boolean operator, and will look forward to reading your work as we go!
Thanks! :)
Dr. Keyes
(http Christine Marquardt (https://waldenu.instructure.com/courses/53151/users/79244)
2:05pm
Reply
Thank you, Dr. Keyes.
Only 1 naloxone kit/prescription is dispensed for every 70 high dose opioid prescriptions (CDC, n.d.). Naloxone is available in all 50 states and many pharmacies have standing orders where naloxone can be dispensed without a prescription. Needle exchange and health department programs also make access to naloxone easy. Most states have regulations in place that encourage the consideration of naloxone prescriptions to be provided at the same time as other opioid prescriptions or for individuals with opioid use disorder. As of 2019, 17 states have implemented new regulations called co-prescribing, where instead of the consideration of providing a naloxone prescription, it is required to be written along with any prescription for opioids to individuals at risk of overdosing (Haffajee et al., 2020).
Haffajee, R. L., Cherney, S., & Smart, R. (2020). Legal requirements and recommendations to prescribe naloxone. Drug and Alcohol Dependence, 209. https://doi.org/10.1016/J.DRUGALCDEP.2020.107896
Naloxone | Opioids | CDC. (n.d.). Retrieved March 20, 2023, from https://www.cdc.gov/opioids/naloxone/index.html
3/21/23, 4:07 PM Topic: Module 3: Discussion
https://waldenu.instructure.com/courses/53151/discussion_topics/255505?module_item_id=1043726 19/35
(https:// Maria Bryceland (https://waldenu.instructure.com/courses/53151/users/10972)
Yesterday
Nurse Burnout
All nursing specialties have different kinds of pressures, which contributes to nursing burnout.
Burnout is a side effect of prolonged workplace stress and is accompanied by a lack of energy,
a decrease in patient concern, avoidance, and pessimism (Maslach et al., 2016). For the
purpose of lowering nurse turnover, enhancing patient safety, and enhancing both the physical
and mental well-being of nurses, nurse burnout prevention must be given top importance.
Among other things, burnout symptoms include substance usage, a propensity to quit one's
job, frequent absences from work, and low self-esteem (Kurosaka & Payton, 2020). Less
patient care, a rise in medical errors, and decreased patient safety are all closely connected to
burnout (Sharifi et al., 2020). Ultimately, nurse burnout is a substantial issue that can have
negative effects on patients, healthcare organizations, and nurses themselves. Taking a
proactive approach to creating nurse burnout prevention methods may help avoid it altogether.
Mindfulness-based interventions (MBIs) may help nurses prevent burnout. Some of the
techniques used in MBIs are yoga and breathing techniques. The goal of mindfulness therapies
is to promote an accepting and open awareness of one's thoughts and feelings, as well as an
attentive attitude toward the mental processes and physical sensations that take place while
one is feeling extremely anxious (Creswell, 2017).
3/21/23, 4:07 PM Topic: Module 3: Discussion
https://waldenu.instructure.com/courses/53151/discussion_topics/255505?module_item_id=1043726 20/35
The PICO (T) question: Can registered nurses that implement mindfulness-based interventions
reduce nurse burnout as compared to those that have no intervention?
Population: Registered nurses
Intervention: Mindfulness-base interventions
Comparison: No intervention or a control group receiving care
Outcome: Reduced burnout levels
Timeframe: no specific timeframe
References
Creswell, J. (2017). Mindfulness interventions. Annual Review of Psychology, 68(1), 491–516. Retrieved March 20, 2023, from https://doi.org/10.1146/annurev-psych-042716-051139 (https://doi.org/10.1146/annurev-psych-042716-051139)
Kurosaka, A., & Payton, J. (2020). Prevention Strategies to Cope with Nurse Burnout in Nephrology Settings. Nephrology Nursing Journal, 47(6), 539–563. https://doi.org/10.37526/1526-744X.2020.47.6.539 (https://doi.org/10.37526/1526- 744X.2020.47.6.539)
Maslach, C., & Leiter, M. P. (2016). Understanding the burnout experience: recent research and its implications for psychiatry. World psychiatry: official journal of the World Psychiatric Association (WPA), 15(2), 103–111. https://doi.org/10.1002/wps.20311
Sharifi, M., Asadi-Pooya, A. A., & Mousavi-Roknabadi, R. S. (2020). Burnout among Healthcare Providers of COVID-19; a Systematic Review of Epidemiology and Recommendations. Archives of academic emergency medicine, 9(1), e7. https://doi.org/10.22037/aaem.v9i1.1004 (https://doi.org/10.22037/aaem.v9i1.1004)
Wampole, D. M., & Bressi, S. (2020). Exploring a social work lead mindfulness-based intervention to address burnout among inpatient psychiatric nurses: a pilot study. Social Work in Health Care, 59(8), 615–630. https://doi.org/10.1080/00981389.2020.1827123
3/21/23, 4:07 PM Topic: Module 3: Discussion
https://waldenu.instructure.com/courses/53151/discussion_topics/255505?module_item_id=1043726 21/35
Reply
(http Emily F Keyes (She/Her) (https://waldenu.instructure.com/courses/53151/users/2872)
11:49am
Reply
Maria,
Great topic, all of us will benefit from reading your work as we go over time! Nursing burnout manifests as mild to severe as you note! I will be interested to see how your work progresses as we go forward! Your PICO is fine as is, no T needed, of course!
Thanks! :)
Dr. Keyes
(https:// Rezel Aganio (https://waldenu.instructure.com/courses/53151/users/78083)
Yesterday
I have chosen dialysis treatment modalities as a clinical issue of interest. As a dialysis nurse of ten years, I have witnessed how some patients struggle because they are unaware of other modalities available for them and fit their lifestyle. Most of them think they can no longer do what they usually do, work or even visit different places. Often, when diagnosed with End Stage Renal Disease (ESRD) requiring dialysis treatment, they take longer to recover from depression, and they forget to ask questions about the disease (Goh & Griva, 2018). The patient’s lifestyle may be restricted in some ways, but with education from healthcare staff, there are alternative ways they can go on with their lives and keep living.
I used databases in Walden library to search for research articles about my clinical issue of interest. I typed the Boolean/phrase “dialysis modalities” in Walden library’s search bar, and yielded 5,794 search results. By checking the box “peer-reviewed scholarly journals only,” I narrowed my search down to 5.088 search results. Although, the results relate to the clinical issue I have chosen, I wanted to be more specific, so I changed my phrase to “hemodialysis versus peritoneal.” The search results
3/21/23, 4:07 PM Topic: Module 3: Discussion
https://waldenu.instructure.com/courses/53151/discussion_topics/255505?module_item_id=1043726 22/35
Reply
narrowed down to 357 total. I chose the studies that differentiate the modalities and patient satisfaction with chosen modality. It is essential to learn what is a peer-reviewed, academic, or scholarly article. The database must also be a data collection organized mainly for your chosen area (Research Guides: Databases: Finding Journal Articles: Home, 2022).
In the future, to increase the rigor and effectiveness of a database search on my PICO(T) question, I will use keywords that will limit my search to the topic of interest. For example, instead of “dialysis modalities” or “hemodialysis versus peritoneal dialysis,” I will type “different dialysis treatment for elderly patients” to focus my search on the adult population. Another strategy is to check for the newest research by changing the “relevance filter” to the latest data. Evidence-based peer-reviewed scholarly journals with new ways to improve healthcare must be utilized to support clinical decision-making for the best patient health outcomes (Ghassemi et al., n.d.). The Walden library is an excellent tool for searching for evidence-based studies. Walden’s library collection has 167 databases, 256,461 E-books, 96,001 full-text journals, 5,593,202 all dissertations, and 18,466 Walden dissertations (Academic Guides: Collections: Home, n.d.).
References:
Academic Guides: Collections: Home. (n.d.). Home - Collections - Academic Guides at Walden University. https://academicguides.waldenu.edu/library/collections/home
Ghassemi, A. H., AghazadeAsl, E., Bigdeli, Z., & SakiMalehi, A. (2015). Surveying the familiarity and usage of up-to-date database among nurses working in the hospitals affiliated with Ahvaz Jundishapur University of Medical Sciences. Journal of medicine and life, 8(Spec Iss 4), 65–71.
Goh, Z. S., & Griva, K. (2018). Anxiety and depression in patients with end-stage renal disease: impact and management challenges - a narrative review. International journal of nephrology and renovascular disease, 11, 93–102. https://doi.org/10.2147/IJNRD.S126615 (https://doi.org/10.2147/IJNRD.S126615)
Research Guides: Databases: Finding Journal Articles: Home. (2022, April 28). Home - Databases: Finding Journal Articles - Research Guides at Auraria Library (UCD, MSCD, CCD). https://guides.auraria.edu/databases/home
3/21/23, 4:07 PM Topic: Module 3: Discussion
https://waldenu.instructure.com/courses/53151/discussion_topics/255505?module_item_id=1043726 23/35
(http Emily F Keyes (She/Her) (https://waldenu.instructure.com/courses/53151/users/2872)
11:52am
Reply
Rezel,
Excellent topic, so many dialysis patients are suffering as you have noted! I appreciate reading all details of your literature search! How you limited your search, using specific keywords is a great tip for others to learn!
Thanks! :)
Dr. Keyes
(https:// Emily Laine Lyman (https://waldenu.instructure.com/courses/53151/users/68111)
Yesterday
Module 3: Initial Discussion Post
I hope everyone is having a great week so far! The clinical area of interest that I have chosen to research, analyze, and discuss for this course is the opioid crisis/opioid epidemic. I work at a medication assisted treatment (MAT) clinic, so the opioid epidemic is an issue that hits home for me. From 1999-2020, more than 564,000 individuals have died from an opioid overdose, which include prescription and illicit opiates (Centers for Disease Control and Prevention, 2022). In 2021, the opiate crisis resulted in over $35 billion in healthcare costs due to opioid overdose, opioid dependence, and opioid misuse, making this a very prevalent clinical issue that needs to be addressed (Pew Charitable Trusts, 2021).
The mnemonic “PICO-T” stands for patient/population, intervention, comparison, outcome that is expected, and time. Using the PICO-T format is beneficial when researching, as it helps one to locate the best, evidence-based research without bias, and with the most relevant information and data. When forming a PICO-T question, it should not be wordy. PICO-T should also only be used to find out what is best practice, not to find evidence to support solutions that clinicians have already deemed to be the correct answer (Ford & Melnyk, 2019).
3/21/23, 4:07 PM Topic: Module 3: Discussion
https://waldenu.instructure.com/courses/53151/discussion_topics/255505?module_item_id=1043726 24/35
In regards to the opioid crisis, the PICO-T question I have formulated to use as a tool to gather the top evidence-based practice articles is: In adults who use illicit substances (population), does the use of fentanyl test strips as harm reduction(intervention) versus not using fentanyl test strips (comparison) reduce the number of opiate overdoses (outcome) in six months (time). When I was first creating my PICO-T question, I did not specify on type of harm reduction strategy to combat opiate overdoses and 414 results were populated on PubMed and 482 results populated on CINAHL Plus. This is why I decided to make my question more specific and solely address the use of fentanyl test strips as harm reduction. Using Boolean operators, my search looked like “adults AND substance abuse OR OUD AND fentanyl test strips AND overdose AND six months”. I found some great articles including: Perspectives on rapid fentanyl test strips as a harm reduction practice among young adults who use drugs: A qualitative study (https://doi.org/10.1186/s12954-018-0276-0), Fentanyl test strips as an opioid overdose prevention strategy: Findings from a syringe services program in the Southeastern United States (https://doi.org/10.1016/j.drugpo.2018.08.007 (https://doi.org/10.1016/j.drugpo.2018.08.007) ), and Drug checking: a potential solution to the opioid overdose epidemic? (https://doi.org/10.1186/s13011-018-0156-3 (https://doi.org/10.1186/s13011-018- 0156-3) ).
Some strategies that can be used to increase the rigor and effectiveness of a database search on one’s PICO-T question when no references or too few references populate include looking for misspellings in the search, remove terms that aren’t likely to be used by an author, replace term that are too specific, increase the number of synonyms for a term, or try running a search under a different database. To increase the rigor and effectiveness of a database search on one’s PICO-T question when too many references populate, chose the most specific headings or key words, make sure that synonyms are grouped with parentheses, and ask that significant words be in the title of the article (University of Washington, 2020).
References
Centers for Disease Control and Prevention. (2022). Understanding the opioid overdose epidemic. https://www.cdc.gov/opioids/basics/epidemic.html#combatting-the-epidemic (https://www.cdc.gov/opioids/basics/epidemic.html#combatting-the-epidemic)
3/21/23, 4:07 PM Topic: Module 3: Discussion
https://waldenu.instructure.com/courses/53151/discussion_topics/255505?module_item_id=1043726 25/35
Reply
Ford, L., & Melnyk, B. (2019). The underappreciated and misunderstood PICO-T question: A critical step in the EBP process. Worldviews Evidence Based Nursing, 16(6), 422-423. doi: 10.1111/wvn.12408.
Pew Charitable Trusts. (2021). The high price of the opioid crisis: 2021. https://www.pewtrusts.org/en/research-and- analysis/data-visualizations/2021/the-high-price-of-the-opioid-crisis-2021 (https://www.pewtrusts.org/en/research-and- analysis/data-visualizations/2021/the-high-price-of-the-opioid-crisis-2021)
University of Washington. (2020). How to improve database search results. https://guides.lib.uw.edu/hsl/improving (https://guides.lib.uw.edu/hsl/improving)
(http Emily F Keyes (She/Her) (https://waldenu.instructure.com/courses/53151/users/2872)
11:57am
Reply
Emily,
Terrific choice of topics! Our opioid crisis/epidemic continues, as you have noted! Using Fentanyl strips as harm reduction may help to prevent needless deaths, yet we will learn more by reading your work as the weeks progress! I like your PICOT as it stands! We need much more research in this area of decreasing opioid use/abuse, and yes, about how to prevent needless deaths secondary to this usage!
Thanks! :)
Dr. Keyes
(https:// Risikat Adebiyi (https://waldenu.instructure.com/courses/53151/users/75624)
12:19am
3/21/23, 4:07 PM Topic: Module 3: Discussion
https://waldenu.instructure.com/courses/53151/discussion_topics/255505?module_item_id=1043726 26/35
Delivering healthcare services across a variety of platforms, including video calls and regular phone calls, is referred to as telehealth. According to Painter et al., despite its claims to lower costs, many healthcare providers are still spending a lot of money on its implementation (2021). Notwithstanding the good reviews surrounding the use of telehealth in mental health services, there are still worries aboutits possible impact on the therapeutic relationship between patients and healthcare providers. Despite the many benefits of telehealth, both patients and healthcare professionals have had conflicting reactions to its use. It was discovered in 2020 that COVID-19 had considerably changed how patients and staff perceived online healthcare sessions.
I. Talarico estimates that around 15 million Americans with mental illnesses or substance abuse problems reside in rural areas. 3,075 rural areas around the nation don't have access to psychiatric services (2021). The system for treating mental illness was disrupted by the pandemic's quick rise. As a result, rural mental health professionals received training to enhance their services. According to Schroeder et al., mental health agencies have been slow to implement telehealth despite its rapid development in the U.S. (2021). The epidemic in the world's health in 2020 forced mental health professionals to switch to tele-mental health. The lack of training in tele-mental health made this immediately necessary.
Rural populations were already having trouble getting access to mental health care prior to the global health pandemic (COVID19). This issue has continued despite the availability of many resources and services. The rates of mental health care use and accessibility are higher in urban regions. Yet, due to a number of issues like internet access restrictions and a lack of technological literacy, rural areas have less access to these services. In March 2020, a large number of American health groups relocated their offices to rural areas in response to the rising number of persons with mental health problems.
According to several studies, the PICOT question is the ideal way to formulate a clinical inquiry, as observed by Melnyk and Fineout-Overholt (2019). A well-crafted clinical question can assist researchers in assembling the data they need to back up their conclusions. My PICOT question was structured according to the Stillwell et al. (2010) intervention method, using P for the patient population, I for intervention, C for comparison, O for outcome, and T for time (duration, interval). Consequently, my clinical issue is: How do Telehealth visits, as opposed to in-person visits, improve compliance with medication adherence and follow-up appointments in patients with mental illnesses? I started a search by putting in the keywords in italics.
Using CINAHL and Medline with full-text on the university library, I searched for Telehealth or Telemedicine resulting in over 55000 articles with filters like “5 years and below”, “peer-reviewed” and “full-text”. The inclusion of mental health in my search terms reduced the results drastically to less than 10000. I was able to narrow my search to about 1605 articles with a more refined search.
3/21/23, 4:07 PM Topic: Module 3: Discussion
https://waldenu.instructure.com/courses/53151/discussion_topics/255505?module_item_id=1043726 27/35
Reply
I struggled with the use of Boolean operators because I’m not sure exactly where to apply them maybe I’d have gotten more detailed results.
Moving forward, I think I’d learn to better use the Boolean operators for a more effective search. The use of relevant keywords, and filters essential to the PICOT question improves the precision of the database search. It is important to have a well defined clinical question to ensure that the search turns up with the most relevant articles as much as possible.
References:
Melnyk, B. M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing and healthcare: A guide to best practice (4* ed.). Wolters Kluwer.
Painter, J. , Turner, J. & Procter, P. (2021). Understanding and Accommodating Patient and Staff Choice When Implementing Video Consultations in Mental Health Services. CIN: Computers, Informatics, Nursing, 39 (10), 578-583. doi: 10.1097/CIN.0000000000000804
Schroeder, S., Roberts, H., Heitkamp, T., Clarke, B., Gotham, H. J., & Franta, E. (2021). Rural mental health care during a global health pandemic: Addressing and supporting the rapid transition to tele-mental health. Journal of Rural Mental Health, 45(1), 1-13. https://doi.org/10.1037 /rmh0000169
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. The American journal of nursing, 110(3), 58–61. https://doi.org/10.1097/01.NAJ.0000368959.11129.79 (https://doi.org/10.1097/01.NAJ.0000368959.11129.79)
Talarico, I. (2021). The use of telehealth to increase mental health services access and promote medication adherence in rural locations. Journal of the American Association of Nurse Practitioners, Publish Ahead of Print. https://doi.org/10.1097/xx. 0000000000000495
(http Emily F Keyes (She/Her) (https://waldenu.instructure.com/courses/53151/users/2872)
12:03pm
3/21/23, 4:07 PM Topic: Module 3: Discussion
https://waldenu.instructure.com/courses/53151/discussion_topics/255505?module_item_id=1043726 28/35
Reply
Risikat,
Fascinating topic, great! How mental health patients respond or do not respond to telehealth visits vs. in person visits is very interesting! As you note, many populations do not have access to in-person mental health services, and many lack access to telehealth services, as well! That said, I believe that your research will help to elucidate this issue in better detail!
About Boolean searches: I understand some of your frustration! Knowing where and how to place the "and"...or "or"...can be challenging. Try a few different combinations using keywords as that should help!
Thanks! :)
Dr. Keyes
(https:// Timothy Walrod (https://waldenu.instructure.com/courses/53151/users/70757)
1:54pm
My current area of research interest is end-of-life care. I am currently transitioning from psychiatric nursing into my first home hospice agency. In my five years of nursing, I have had many instances where death was a significant issue for my patients. I’ve seen patients and families deal with death in graceful and less graceful ways, so I am curious to know what the research says about it. I’m also very interested in the ability of psychedelic-assisted therapy to treat existential distress in patients with a terminal illness. However, that area of research is only beginning to be academically explored. When I go to my preferred search engine on the EBSCO research platform, I type in end-of-life care and am yielded over 41,000 results for 2018 through 2023 alone. When I add keywords such as psychedelics, I am shown eight results, only a few of which tie in end-of-life care with psychedelics. I intend to gear my PICO(T) question toward psychedelic-assisted therapy focusing on hospice and palliative care, although this may be amended later in the course.
I wish to focus more on relieving existential distress at the end of life, so I add that as a keyword that returns 70 results. One article of interest to me explored migrants’ experiences of death and dying. This is particularly interesting to me, having an aging parent who immigrated from Poland to Canada and then to the United States. The study explored ideas of dual identities
3/21/23, 4:07 PM Topic: Module 3: Discussion
https://waldenu.instructure.com/courses/53151/discussion_topics/255505?module_item_id=1043726 29/35
and how they can create cognitive dissonance, especially where death and dying are a factor. Life review was also cited as an observation during end-of-life care; migrants often thought about their decisions to immigrate, the changes in their dreams, often due to the illness, and maintaining a connection to their original country (Bray et al., 2018). I enjoy articles that look at specific facets of my interest; I love working with migrant people and their different attitudes toward the new country they inhabit.
Another article by Philip et al. (2019) discusses the ethics of introducing triage into hospice care. Each patient deals with a different degree of terminality, pain, and existential distress over another. This article asks how a triage officer prioritizes one over another. The article dives into the deep complexity through a qualitative study with semi-structured interviews. With limited resources, we must be careful with our decisions to commit or not to commit to end-of-life care. The article also points out that triage in emergency rooms or surgical departments is much more discussed than in hospice; in fact, it has been largely silent. (Philip et al., 2019).
Regarding PICO(T), I might apply the idea of psychedelic-assisted therapy as a new modality toward end-of-life care. Niles et al. (2021) talk about current treatment modalities for existential distress at the end of life as inadequate. It reflects that in 18 participants, psychedelic-assisted therapy served to lessen and even cure them of this despair. However, this treatment modality is confronted by the stigma already in place from the societal history of using these substances for illicit purposes. So the “P” in Pico would be populations suffering from existential distress at end of life. The “I” for Intervention would be psychedelic-assisted therapy versus “C” Comparing to more traditional end-of-life care. The “O” outcome would be improving hospice care using psychedelic-assisted therapy. The “T” timeframe would largely depend on research efforts concerning psychedelic-assisted therapy and future state and national legislation, allowing for larger research sample sizes (Davis, 2011). Also, future legislation can focus more on palliative and hospice care as it arises.
References
Bray, Y., Wright-St Clair, V., & Goodyear-Smith, F. (2018). Exploring the lived experience of migrants dying away from their country of origin. Quality of Life Research, 27(10), 2647–2652. https://doi.org/10.1007/s11136-018-1909-1 (https://doi.org/10.1007/s11136-018-1909-1)
Davies, K. S. (2011). Formulating the evidence-based practice question: A review of the frameworksLinks to an external site. (https://doi.org/10.18438/B8WS5N) for LIS professionals. Evidence Based Library and Information Practice, 6(2), 75–80.
3/21/23, 4:07 PM Topic: Module 3: Discussion
https://waldenu.instructure.com/courses/53151/discussion_topics/255505?module_item_id=1043726 30/35
Reply
Niles, H., Fogg, C., Kelmendi, B., & Lazenby, M. (2021). Palliative care provider attitudes toward existential distress and treatment with psychedelic-assisted therapies. BMC Palliative Care, 20(1), 1–14. https://doi.org/10.1186/s12904-021-00889-x
Philip, J., Russell, B., Collins, A., Brand, C., Le, B., Hudson, P., & Sundararajan, V. (2019). The Ethics of Prioritizing Access to Palliative Care: A Qualitative Study. American Journal of Hospice & Palliative Medicine, 36(7), 577–582. https://doi.org/10.1177/1
(https:// Jessica Cleven (https://waldenu.instructure.com/courses/53151/users/86690)
2:29pm
Main Post
The clinical issue of interest that I chose is nurse-patient ratios that has become more of a safety issue more recently. The Covid-19 pandemic has changed healthcare in many ways which has caused lots of nurses to change positions or leave healthcare all together. This has caused nursing shortages which has resulted in higher nurse-patient ratios. More patients means less time that is able to be spent with each patient thus affecting patient care and potential for safety events. As described by Anders (2021):
Many facilities were forced to expand capacity beyond their normal operating limits to meet surging patient admissions. The added number of patients placed additional burden on the nursing staff already stretched to their limits, which meant that the normal RN-to-patient ratio changed. Covid-19 hit when many nurses were burned out and working in understaffed conditions (p. 1039).
As I developed my PICOT question, I used the key words in the question as the subject of my search in databases (Melynk & Fineout-Overholt, 2019). I used CINAHL Plus with Full Text as the primary database for my research. I typed in "nurse patient ratio" in the search box. This initial search yielded 3,792 results. Then, I changed the publication date to only show articles published between 2018-2023, and this resulted in 738 articles. Next, I selected "peer-reviewed scholarly journals" as an option, and this resulted in 473 articles. As the results were narrowed down, I was able to select relevant articles related to nurse-patient ratios. I may be able to narrow the search even more by adding more key words like "patient safety" or "nurse burnout."
3/21/23, 4:07 PM Topic: Module 3: Discussion
https://waldenu.instructure.com/courses/53151/discussion_topics/255505?module_item_id=1043726 31/35
Reply
References
Anders, R.L. (2021). Patient safety time for federally mandated registered nurse to patient ratios. Nursing Forum, 56(4), 1038– 1043. https://doi.org/10.1111/nuf.12625
Melnyk, B. M., & Finout-Overholt, E. (2019). Evidence-based practice in nursing & healthcare (4th ed.). Wolters Kluwer.
Walden University Library. (n.d.-c). Evidence-based practice research: CINAHL search help. Retrieved from https://academicguides.waldenu.edu/library/healthevidence/cinahlsearchhelp
(https:// Ephraim G Njora (https://waldenu.instructure.com/courses/53151/users/80283)
2:29pm
Hello Colleagues,
Healthcare team and health institutions have been of the headline news as front foot soldiers and war front in the fight against the devastating pandemic scourge. The COVID effects indicate they may last for quite a while before a sigh of relief by human race. This is due to the burden of exhaustion, disruption and loss of every aspect of family dynamic not to mention the economic cloud of uncertainty the pestilence still exact. The initial cases of infection made every COVID case be handled with such disdain and depersonalization that many "initial-case-infected" people felt excluded, prejudiced and outrightly discriminated.
My topic of choice to help me view this health scare, exhaustion and prejudice is stigma associated with illness. However, stigma is such a broad and I considered narrowing it down to stigma associated with mental illness. As a clinical issue, stigma affects not only the patient but also the health care givers, significant others and the general population at large. This discordance do have ramifications on care delivery and of course interrupts quality of care and the wellness of the population. As psychiatric nurse student, this topic has a profound meaning and bearing in my discharge of duties to help guard myself appropriately and be of much benefit to patients, healthcare team and nursing discipline as a profession at large. Provision of effective education and support to persons undergoing stigmatization is critical in the holistic care and individual wellness.
3/21/23, 4:07 PM Topic: Module 3: Discussion
https://waldenu.instructure.com/courses/53151/discussion_topics/255505?module_item_id=1043726 32/35
As a society, we are faced by myriad of determinants of health that can bolster or effectively deny access to care, pinning down specific obstacles to any individual attainment of health can be daunting more so the ones dealing with stigma against their illness. Stigma can easily give rise to branding persons or communities and stereotyping societies in very negative ways. The COVID-19, HIV-AIDS, Malaria, Tuberculosis are ailments that have seen stereotyped conversations and prejudicial treatment to members of society that arise from such singled out geographical areas.
I utilized nursing CINHAL - EBSCO and medline with full text databases to search for my topic. Having settled on stigma, there were too many articles that filtered under the "stigma keyword" choice. Quite a few were very shallow in information, others with diverses analysis. My boolean operators to narrow and refine my search under stigma were; nursing and allied health journals, from year 2018 to 2023, including "AND" subject terms of "mental health, mental illness", refined to peer-reviewed journals, full text and those that have PDF format availed for access. I encountered major problem while choosing the year range (2018 to 2023), it kept defaulting to only single year 2021. This resulted very few articles listed. I would browse through the article for its layout format, read the abstract, introduction, conclusion parts as I eyeballed the methodology to access validity and acceptability of the article. Most of the articles had PICOT design P-mental health patients, I-issue of concern/Stigma or intervention, C-control group with no interventions introduced, O- results after intervening, T- duration/period of study test.
References
Bogart, K. R., Dunn, D. S., Young, R. E., Goldberg, J. O., Struthers, C. W., McCann, D., & Phills, C. E. (2019). The Subtle Side of Stigma: Understanding and Reducing Mental Illness Stigma from a Contemporary Prejudice Perspective. Journal of Social Issues, 75(3), 943. https://doi.org/10.111/josi.12343 (https://doi.org/10.111/josi.12343)
Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer.
Nakanishi, E., Tamachi, M., & Hashimoto, T. (2022). Effectiveness of a Co-Production with Dialogue Program for Reducing Stigma against Mental Illness: A Quasi-Experimental Study with a Pre-and Post-Test Design. International Journal of Environmental Research and Public Health, 19(21). https://doi.org/10.3390/ijerph192114333 (https://doi.org/10.3390/ijerph192114333)
3/21/23, 4:07 PM Topic: Module 3: Discussion
https://waldenu.instructure.com/courses/53151/discussion_topics/255505?module_item_id=1043726 33/35
Reply
Walden University Library. (n.d.). Databases A-Z: Nursing. Retrieved March 20, 2023, from https://academicguides.waldenu.edu/az.php?s
(https:// Jolly Joseph (https://waldenu.instructure.com/courses/53151/users/70579)
3:37pm
Discussion Main post
The key to successful patient care for any healthcare professional is to stay informed and be updated on the latest evidence- based practice guidelines (Melnyk & Fineout-Overholt, 2018). Clinicians must articulate the clinical issue of their interest to maximize the information retrieved with the least amount of time invested. Clinical questions must be written in a PICO format to avoid confusion and maintain the rigor of evidence-based practices (EBP) to address issues of clinical inquiry. PICO(T) format stands for P-population of interest; I-issue or Intervention of interest; C-comparison; O-outcome expected; and T -time for the intervention to achieve the outcome (Davies, 2011).
Healthcare-associated infections (HAI) are significant threats to patient safety besides being the most critical factor that causes an increase in patient morbidity and mortality in any country, irrespective of economic status or quality of health care (Mong et al., 2022). Catheter-associated urinary tract infections (CAUTI) are considered one of the most prevalent hospital-acquired conditions. In the United States, statistics show an estimated 500 000 cases of CAUTI are reported annually, contributing to prolonged length of stay, increased morbidity, mortality, and rising medical costs (Tyson et al.,2020). Evidence from various research in this field showed that nurse-driven interventions would significantly improve patient outcomes related to CAUTI prevention and will also aid in improving the quality of nursing care delivered at the bedside.
3/21/23, 4:07 PM Topic: Module 3: Discussion
https://waldenu.instructure.com/courses/53151/discussion_topics/255505?module_item_id=1043726 34/35
My clinical issue of interest is preventing Catheter-associated Urinary Tract Infections (CAUTI) utilizing nurse-driven protocol among patients in acute care settings, and My PICO question is:
Can nurse-driven catheter removal protocol reduce CAUTI among patients in acute care settings?
P: Patient with foley catheters in acute care settings
I: Nurse-driven catheter removal protocol.
C: no intervention or normal care
T: no time frame
The keywords used for the original search were “urinary catheter, infection, Nurse driven, protocol and impacts or outcomes or prevention,” resulting in 180 articles.
Strategies Used to Increase the Effectiveness of Database Search
When performing the search, the first strategy I used to improve the effectiveness by using specific keywords or the Boolean method of operation to assist a researcher by providing more focused and productive results. The Boolean process of searching uses simple words as conjunctions to combine or exclude keywords (Library of Congress, n. d). These operators help narrow search results to 120 from 180 articles of interest. This strategy allows me to reduce the time spent researching and scanning many databases.
The second strategy to get more systemic reviews was to filter databases such as CINAHL and ScienceDirect in the Walden university library. In filtered databases, the researcher can utilize additional limiters that can help refine the search to a specific area of interest or format addressed in the PICO question of choice (Walden Library n. d). Through these strategies and checking boxes for peer-reviewed scholarly articles within five years narrowed, results to 12 out of 120 articles.
These strategies greatly help me minimize the time spent researching and filtering through databases and articles to find resources with the most relevant information for my clinical area of interest.
References
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.
3/21/23, 4:07 PM Topic: Module 3: Discussion
https://waldenu.instructure.com/courses/53151/discussion_topics/255505?module_item_id=1043726 35/35
Reply
Library of Congress. (n.d.). Search/ Browse help -Boolean operators and nesting. Retrieved March 21, 2023, from https://catalog.loc.gov/vwebv/ui/en_US/htdocs/help/searchBoolean.html (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.
Mong, I., Ramoo, V., Ponnampalavanar, S., Chong, M. C., & Wan Nawawi, W. N. F. (2022). Knowledge, attitude, and practice with catheter-associated urinary tract infection (CAUTI) prevention: A cross-sectional study. Journal of Clinical Nursing, 31(1-2), 209–219.
https://doi.org/10.1111/jocn.15899 (https://doi.org/10.1111/jocn.15899)
Tyson, A. F., Campbell, E. F., Spangler, L. R., Ross, S. W., Reinke, C. E., Passaretti, C. L., & Sing, R. F. (2020). Implement a nurse-driven protocol for catheter removal to decrease catheter-associated urinary tract infection rate in a Surgical Trauma ICU. Journal of Intensive Care Medicine, 35(8), 738–744. https://doi.org/10.1177/0885066618781304 (https://doi.org/10.1177/0885066618781304)
Walden University Library. (n. d). Quick Answers: How do I find a systematic review article related to health, medicine, or nursing?/ Retrieved March 21, 2023, from https://academicanswers.waldenu.edu/faq/72670