Juliet Anyanwu RE: Discussion – Week 4COLLAPSE

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

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

PICOT Question

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

Search Terms used

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

Database used

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

Search Results

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

Addition of Boolean Operator

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

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

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

References

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

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

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

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

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

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

PICOT Component

Description

Patient population

Sexual assault survivors

Intervention/issue of interest

Ongoing treatment and support/cultivating community support culture

Comparison intervention/issue of interest

Challenging traditional beliefs and attitudes with awareness and education

Outcome

Increased rates of reporting and support networks

Time

Post-assault through three months

PICOT Question

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

Search Terms Used and Databases Used for PICOT Question

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

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

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

Search Results and Changes Noted with Boolean Operators 

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

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

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

Strategies to Increase Rigor and Effectiveness of Database Search for PICOT

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

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

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

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

References

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

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

Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in

           nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA:

           Wolters Kluwer.

Walden University Library. (n.d.-a).  Databases A-Z: Nursing. https://academicguides.waldenu.edu/az.php?s=19981

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

3SOURCES FOR EACH DISCUSSION

M2: Lesson 4 – Discussion

1. Create an original posting with a minimum of 250-300 words.
2. Back up your arguments with reliable evidence.

Asking the Relevant Clinical Questions

Evidence-based nursing is a process founded on the collection, interpretation, appraisal, and integration of valid, clinically significant, and applicable research. It is not about developing new knowledge or validating existing knowledge, but rather translating existing evidence so that it can be applied to clinical decision making. This process starts with formulating a sound PICO question. PICO is a format for developing a good clinical research question prior to starting a review or research. It is a mnemonic used to describe the four elements of a sound clinical foreground question.

Scenarios:

#1   A nurse in the PACU is interested in ways to decrease the use of pain medication in post-op patients. She’s wondering if classical music or guided imagery might be efficacious.

#2   A 17-year-old African American woman, just diagnosed with hepatitis B, has been taking acetaminophen for headaches. Her mother has heard that acetaminophen can cause liver problems, and she asks you if her daughter should continue taking the drug for her headaches, considering her hep-b diagnosis.

#3   You are on a hospital committee exploring best practices in inpatient oncology nursing. The first question to come before the committee is, “how can we improve patients’ sleep quality and quantity without resorting to sleep medication?” The committee decides to explore relaxation techniques (e.g., massage; music), noise reduction, bed/pillow comfort, and ambient temperature changes. Your assignment is to find the best practices to reduce noise levels on the unit.

#4   A 53-year-old woman with rheumatoid arthritis wants to possibly change her medication to short-term low-dose corticosteroids instead of NSAIDS, which are upsetting her stomach. Will the corticosteroids be as effective?

#5   Jeff, a smoker of more than 30 years, has tried to quit unsuccessfully in the past. A friend of his recently quit with acupuncture. He wonders if he should try it.

Instructions:

1. Choose one (1) clinical scenario above, and answer the following questions:
   1. What is evidence-based nursing practice and why is it important?
   2. What is the PICO process?
   3. Formulate a well defined clinical question that will yield the most relevant and best evidence.
   4. Describe the background of the question
   5. Present the question using PICOT format
   6. Indicate what will be the best study to answer the clinical question.

N492 Assignment Mod 2:

Assignment:

Identify an older adult age 65 +, use a 1st and last initial. Execute a therapeutic assessment interview with them for at least two interview sessions assessing their self-identified:

• Demographics,      life time education and career/employment
• Two      most significant (positive) times in their lives
• What      past hardship or loss has the client successfully negotiated in the past?
• Two      personal strengths
• Engage      them in identifying what is healthy versus non-healthy coping skills
  • Inquire       of 2 healthy coping skills they have used in the past and/or now
• Three      (3) pieces of advice they would give to their younger self if they could?
• Support      the client in taking the Geriatric Depression Scale.pdf
• Support      the client in taking the Fulmer SPICES Assessment.pdf
• Perform      a Mini Mental State Exam.pdf and Patient_Stress_Questionnaire.pdf (attach here)
• Perform      a Hall, Hall, and Chapman Article.pdf
• Report      the findings from the Geriatric Depression Scale, Fulmer Spices, Patient      stress questionnaire and the mini mental status exam
• Discuss      your older adult’s level of ego integrity vs. despair as described by      psychoanalyst Erik Erikson. If you had to rate them on a scale of 1-10,      with 1 representing a full state of despair and 10 representing full ego      integrity, what rating would you give your older adult?
• Describe      at least two nursing diagnoses for this client.  
• Create      a plan of care for the client to include at least three nursing goals with      two nursing interventions each.

The assignment should be written in an APA-formatted essay. The essay should be at least 1500 words in length and include at least two scholarly sources other than provided materials.

Record the time you spend interviewing the client and writing the assessment report as practice experience hours in Project Concert as ‘Older Adult Interview’ for Module 2. (Discussion Board work does not apply). It is expected to take you between 2-4 hours. Access Project Concert. Minimum required hours must be entered into Project Concert for Module 2. Some states/entities require hour logs for certification or employment. It is the student’s professional responsibility to ensure all hours are entered correctly in order to meet these requirements. Please see the Project Concert directions document in the Learning Materials on how to enter hours.

The discussion assignment provides a forum for discussing relevant topics for this week on the basis of the course competencies covered. For this assignment, make sure you post your initial response to the Discussion Area by the due date assigned and complete your participation for this assignment by Day 7. To support your work, use your course and text readings and also use resources from the South University Online Library.

As in all assignments, cite your sources in your work and provide references for the citations in APA format. Support your work, using your course lectures and textbook readings. Helpful APA guides and resources are available in the South University Online Library. Below are guides that are located in the library and can be accessed and downloaded via the South University Online Citation Resources: APA Style page. The American Psychological Association website also provides detailed guidance on formatting, citations, and references at APA Style.
• APA Citation Helper
• APA Citations Quick Sheet
• APA-Style Formatting Guidelines for a Written Essay
• Basic Essay Template

TASK

Post your initial response to one of the two topics below.

Topic 1: Community-Based Nursing

Nursing services play an important role in caring for patients and families in the community and providing them the support they need. For patients with problems ranging from chronic health conditions to need of elder care, nursing has proved itself an important part of the healthcare team. In fact, many people now prefer sending their elderly parents to a daycare for nursing, rather than to a long-term care facility.

For this topic, interview a community-based nurse or nurse practitioner who sees individuals in the home setting. Describe the nurse’s responses to the following questions:

• What are your job responsibilities?
• Does a correlation exist between your job description and your practice?
• Are you involved in policy formulation that affects client services?
• Do you belong to a professional organization related to your current job position?

Topic 2: Economics of Health Care

The cost of healthcare in the U.S. is often discussed by the press. Trends in healthcare spending are determined by public and private decisions about health care delivery and reflect the values and beliefs of society and policy makers.

Compare the distribution of healthcare expenses for 2017.
https://www.cms.gov/research-statistics-data-and-systems/statistics-trends-and-reports/nationalhealthexpenddata/nationalhealthaccountshistorical(Nation’s health dollar: where it came from and where it went with those of 2011 [see textbook]).

Write a summary of your findings and their meaning in terms of health care spending.

Minimum of 350 words with at least 2 peer review reference in 7th edition apa style

Reflect upon your selected practice problem DIABETES to determine a possible solution and address the following.

• Create an action plan using a translation theory or model to implement the proposed solution. 
• Provide a description of each component in the translation model.
• What are the barriers to implementation? What are the facilitators to overcome these barriers?
• Who are the stakeholders involved? What are their roles?
• What resources are needed for successful implementation of the solution?