NUR 670

Rita Perez

Abstract Evidence-based practice is an essential part of psychiatric mental health nursing because it supports safe, effective, and patient-centered care. Psychiatric mental health nurse practitioners (PMHNPs) must use current research to guide clinical decision-making and improve patient outcomes. The PICO framework helps healthcare providers develop focused clinical questions that support evidence-based practice and literature searches. The selected PICO question for this discussion examines whether the Columbia-Suicide Severity Rating Scale improves early identification of suicide risk and patient safety outcomes among adult psychiatric patients diagnosed with depression and anxiety disorders. This discussion reviews the databases used to gather evidence-based research related to the selected PICO question and explains the inclusion and exclusion criteria used to refine the literature search process. Using organized search strategies and carefully selected research criteria helps PMHNPs identify high-quality evidence that is relevant to psychiatric practice. Evidence-based suicide prevention strategies are especially important in psychiatric care because early identification of suicide risk may improve patient safety, reduce psychiatric crises, and support timely intervention.

Introduction Evidence-based practice plays a major role in psychiatric mental health nursing because it helps providers make informed clinical decisions using current scientific evidence. As future psychiatric mental health nurse practitioners (PMHNPs), it is important to understand how to search for reliable scholarly evidence and apply research findings to patient care. One of the most commonly used tools for developing focused clinical questions is the PICO framework. PICO stands for population, intervention, comparison, and outcome. This framework allows healthcare providers to narrow broad clinical concerns into searchable research questions that guide evidence-based practice (Melnyk & Fineout-Overholt, 2023). The selected PICO question for this discussion is: In adult psychiatric patients with depression and anxiety disorders (P), does the use of the Columbia-Suicide Severity Rating Scale during routine psychiatric evaluations (I), compared to standard clinical assessment without a structured screening tool (C), improve early identification of suicide risk and patient safety outcomes (O)? Suicide prevention remains one of the most important responsibilities in psychiatric healthcare because many patients experiencing suicidal thoughts may not openly discuss their symptoms unless directly asked. As a result, PMHNPs must use evidence-based suicide screening tools that support early identification and patient safety.

Databases Used to Gather Evidence-Based Research Several scholarly databases were used to gather evidence-based research related to the selected PICO question. Using multiple databases increases the likelihood of identifying high-quality and peer-reviewed psychiatric research studies. The primary databases searched included PubMed, CINAHL, PsycINFO, Cochrane Library, and Google Scholar. PubMed was one of the primary databases used because it provides access to a large collection of peer-reviewed biomedical and psychiatric research articles. PubMed contains evidence-based

studies, systematic reviews, clinical practice guidelines, and psychiatric research related to suicide prevention, mental health disorders, and evidence-based screening tools. Keywords used in the PubMed search included “Columbia-Suicide Severity Rating Scale,” “suicide risk assessment,” “depression,” “anxiety disorders,” “psychiatric patients,” and “suicide prevention.” Boolean operators such as AND and OR were also used to narrow and organize the search results. The Cumulative Index to Nursing and Allied Health Literature (CINAHL) was another important database used during the literature search process. CINAHL focuses heavily on nursing and allied health research, making it highly relevant for PMHNP practice. This database provided evidence related to nursing interventions, suicide screening practices, psychiatric assessment tools, and patient safety outcomes. CINAHL was especially useful for identifying nursing- focused evidence regarding suicide prevention strategies in outpatient psychiatric settings. PsycINFO was also used because it specializes in behavioral health and psychological research. This database provided scholarly literature related to psychiatric disorders, suicide risk factors, psychological assessment tools, and evidence-based psychiatric interventions. PsycINFO helped identify research studies specifically related to depression, anxiety disorders, suicidal ideation, and suicide risk screening in mental health populations. The Cochrane Library was searched to identify systematic reviews and evidence summaries related to suicide prevention and psychiatric assessment tools. Systematic reviews are considered high levels of evidence because they evaluate and summarize findings from multiple research studies. This database helped support the evidence-based foundation of the selected PICO question. Google Scholar was also used to supplement the database search process. Although Google Scholar contains a broader range of literature, it helped identify additional peer-reviewed articles, clinical guidelines, and recent publications related to suicide prevention and psychiatric assessment practices. Google Scholar was especially useful when cross-referencing articles found within other scholarly databases. According to Aromataris and Pearson (2021), conducting a literature review requires a structured and organized process to identify relevant evidence, evaluate the quality of studies, and synthesize findings related to a clinical question. Using multiple databases strengthens the literature review process because it increases access to current and diverse scholarly evidence.

Inclusion and exclusion criteria Inclusion and exclusion criteria were used to refine the literature search process and ensure that the selected research studies were relevant, current, and evidence-based. Inclusion criteria help identify studies appropriate for the clinical question, while exclusion criteria remove irrelevant or low-quality studies from the review process (Lansing Community College, 2022). The inclusion criteria for the selected PICO question included peer-reviewed scholarly articles published within the last five years. Only current research studies were included to ensure that the evidence reflected current psychiatric practice standards and suicide prevention guidelines. Studies involving adult psychiatric patients diagnosed with depression and anxiety disorders were included because this population directly matched the selected PICO question. Additional inclusion criteria included studies focused on suicide risk assessment, suicide prevention, structured screening tools, and the Columbia-Suicide Severity Rating Scale. Research studies

conducted within psychiatric or behavioral health settings were also included because they were most relevant to PMHNP practice. Systematic reviews, randomized controlled trials, evidence- based clinical guidelines, and quantitative research studies were prioritized because these sources provide strong levels of evidence. Several exclusion criteria were also applied during the literature search process. Studies published more than five years ago were excluded unless they involved foundational information regarding the development of the Columbia-Suicide Severity Rating Scale. Pediatric populations were excluded because the selected PICO question specifically focused on adult psychiatric patients. Studies unrelated to suicide risk assessment, depression, anxiety disorders, or psychiatric populations were also excluded. In addition, non-peer-reviewed articles, opinion papers, editorials, and duplicate studies were excluded to improve the quality and reliability of the evidence. Research focused primarily on medical or neurological conditions without psychiatric relevance was also excluded from the review process. Using inclusion and exclusion criteria helped narrow the search results to the most relevant and evidence-based studies. Schiavenato and Chu (2021) explained that the PICO framework improves evidence-based research by helping healthcare providers identify specific and clinically meaningful concepts that guide literature searches and support clinical decision-making.

Conclusion The PICO framework is an important component of evidence-based psychiatric nursing practice because it helps PMHNPs create focused clinical questions that guide research and improve patient outcomes. Several scholarly databases, including PubMed, CINAHL, PsycINFO, Cochrane Library, and Google Scholar, were used to gather evidence-based research related to the selected PICO question regarding suicide risk assessment. Inclusion and exclusion criteria helped refine the literature search process and ensured that the selected studies were current, peer-reviewed, and clinically relevant. Evidence-based suicide prevention strategies remain essential in psychiatric healthcare because early identification of suicide risk may improve patient safety, reduce psychiatric crises, and support timely intervention for vulnerable patient populations.

Tanesha Wilson

Abstract

Evidence-based practice is fundamental to psychiatric mental health nursing because it allows psychiatric mental health nurse practitioners (PMHNPs) to integrate current research evidence into clinical decision-making to improve patient outcomes. This discussion looks at the literature search process for our PICO question. This query looks at adult psychiatric patients with substance use issues. I examined how well SBIRT, done by PMHNPs, stacks up against standard assessments. The goal is to see how well each method detects early substance misuse and gets patients into treatment programs, with SBIRT being the focus. The discussion outlines the databases searched, keywords utilized, and inclusion and exclusion criteria applied to identify relevant evidence. Various databases such as PubMed, CINAHL Complete, PsycINFO, Cochrane Library, and SAMHSA materials were used to find up-to-date information about SBIRT. The inclusion and exclusion criteria were developed to determine whether the retrieved information would be relevant, credible, and useful to psychiatric mental health nursing practices. Findings from the literature search reveal the efficacy of SBIRT in treating substance abuse disorders in psychiatry patients.

Literature Search Strategy for the PICO Question

The use of evidence-based practice is essential in psychiatric mental health nursing because it enables psychiatric mental health nurse practitioners (PMHNPs) to integrate current scientific evidence into clinical decision-making to improve patient outcomes. Many psychiatric patients experience co-occurring substance use disorders, that contribute to other complex clinical challenges such as treatment nonadherence, psychiatric hospitalization, homelessness, suicidal behaviors, and medical comorbidities. The selected PICO question for this discussion is: In adult psychiatric patients with co-occurring substance use disorders (P), how does the implementation of Screening, Brief Intervention, and Referral to Treatment (SBIRT) by psychiatric mental health nurse practitioners (I), compared to standard psychiatric assessment alone (C), affect early identification of substance misuse and treatment engagement outcomes (O)?

Databases and Evidence-Based Resources

Several scholarly databases and evidence-based resources were utilized to identify current and relevant literature addressing the selected PICO question. A comprehensive search was conducted using PubMed, CINAHL Complete, PsycINFO, the Cochrane Library, Google Scholar, and resources from the Substance Abuse and Mental Health Services Administration (SAMHSA).

PubMed is a valuable database because it has many resources with peer-reviewed content on substance use and mental health issues. CINAHL Complete is also fantastic; it focuses on nursing and health care texts, which makes it ideal for PMHNP work. PsycINFO offers research on psychological and behavioral health stuff, like motivational interviewing, treatment engagement, and assessments for substance misuse.

The Cochrane Library was another resource used as it gives systematic reviews and meta- analyses that assess intervention effectiveness through rigorous methods. Treatments grounded in evidence genuinely help people struggling with substance use disorders, according to Kelly et al. (2020). Besides, SAMHSA (2023) supplies the current guidelines on how to implement SBIRT and other evidence-based approaches for addressing substance use problems. Altogether, these sources gave a thorough look at current practices for screening and treating substance use within psychiatric settings.

Search Terms and Search Strategy

I made the literature search very specific, utilizing keywords and Boolean operators. I used terms like SBIRT, substance use disorder, psychiatric patient, co-occurring disorders, motivational interviewing, treatment engagement, behavioral health, psychiatric nurse practitioner, and integrated behavioral healthcare were essential. I utilized AND, OR, and NOT to narrow my searches to get the most relevant information.

For example, I searched for “SBIRT AND psychiatric patients,” “co-occurring disorders AND treatment engagement,” and “substance use disorder AND psychiatric mental health nurse practitioner.” According to Savic et al. (2021), structured screenings, such as SBIRT, help to identify substance use disorders early and increase access to behavioral health care. This focused approach was essential to ensuring that only studies directly relevant to the PICO question were pulled.

Inclusion Criteria

Specific inclusion criteria were established to identify the most relevant and had current evidence to support the PICO question. Peer-reviewed scholarly articles published between 2020 and 2025 were included to ensure that the literature reflected contemporary clinical practice and evidence. Studies involving adult psychiatric patients with co-occurring substance use disorders were selected as they were directly related to the population identified in the PICO question.

The studies looked at included those that examined SBIRT interventions, motivational interviewing, psychiatric assessments, integrated behavioral healthcare, treatment adherence, and treatment engagement. Both quantitative and qualitative studies, along with systematic reviews, meta-analyses, and evidence-based clinical practice guidelines, were used to fully understand how SBIRT works.

I only used English-language publications to make sure we accurately interpreted everything. Also, I focused on studies directly related to advanced psychiatric nursing practice, those dealing with PMHNP practice, psychiatric nursing interventions, and integrated mental health and substance use treatments.

Exclusion Criteria

To fit the essay to the PICO question, several exclusion criteria were used. Anything published before 2020 was usually cut, save for key studies that showed SBIRT's effectiveness. We also took out research strictly about kids or teens; our focus was adults with psychiatric issues.

Studies in primary care alone, with no psychiatric patients, were omitted unless they help with understanding dual diagnoses. And I omitted editorials, opinions, and comments, as well as anything that wasn't peer-reviewed. This kept our evidence credible and high quality.

Importance of the Literature Search Process

Using several databases and clear inclusion-exclusion criteria boosted the credibility and validity of the literature review. The systematic approach made sure the selected evidence was relevant, current, and useful for psychiatric mental health nursing. The findings show that SBIRT is an effective intervention; it helps spot substance misuse sooner, ramps up treatment involvement, lessens stigma, and improves results for those with both psychiatric and substance use issues.

Conclusion

Literature searching is a crucial step in evidence-based practice that facilitates evidence- based decision making in PMHNPs. With the help of various academic databases and using stringent inclusion and exclusion criteria, relevant literature has been gathered to answer the proposed PICO question. It is clear from the literature that there is substantial support for the use of SBIRT as an intervention for the early detection of substance abuse disorders and engagement with therapy for adult psychiatric patients.