NURS 6052 EBP Part 2 Advanced Levels of Clinical Inquiry and Systematic Reviews
NURS 6052 EBP Part 2 Advanced Levels of Clinical Inquiry and Systematic Reviews
NURS 6052 EBP Part 2 Advanced Levels of Clinical Inquiry and Systematic Reviews
Introduction
The provision of safe, high quality and efficient care in nursing is important for the health and wellbeing of the patients. Often, nurses utilize practice interventions such as patient centeredness and evidence-based practices to ensure that the care needs of the patients are met. They also use the interventions to minimize the risk of occurrence of safety and quality issues in patient care. An example is the use of best practice interventions to ensure that the risk of medication errors in nursing practice is reduced. Despite the efforts adopted by nurses to ensure safety and quality, institutional and provider factors may still predispose patients to unintended safety and quality issues. For example, provider factors such as burnout due to the influence of institutional factors such as staff shortage may threaten the safety and quality of patient care. Therefore, this presentation examines the proposed intervention that can be used to reduce and prevent burnout among registered nurses.
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Selected Clinical Issue
The selected clinical issue that relates to nursing practice is burnout among nurses. Burnout has been defined as the consequence of prolonged, persistent and chronic exposure of nurses to work-related stressors. The prolonged exposure to work stressors result in depersonalization, exhaustion, and reduced personal accomplishments. Nurses affected by burnout experience challenges in undertaking their clinical roles due to low levels of motivation and job satisfaction. Burnout among nurses has an adverse effect on the quality and safety of patient care (Ahola et al., 2017). For example, it increases the risk of medication errors by nurses due to lack of concentration in the care giving process. Burnout also causes low level of job satisfaction and motivation among the nurses. As a result, the rate of turnover among them increases significantly. In addition, the operational costs in healthcare organization rises due to the need for frequent hiring of new staffs to replace those who left the organization. Therefore, burnout among nurses should be addressed to ensure safety, quality and efficiency in healthcare organizations (Melnyk et al., 2020).
Development of PICOT
The developed question is: In acute care nurses, does the use of cognitive interventions result in the reduction of burnout levels when compared to no intervention, within eight month period?
I developed the above PICOT question through a number of steps. The first one was performing a clinical inquiry of the common issues that affect quality and safety of patient care in healthcare settings. I also utilized knowledge from my clinical experience to identify issues in practice that can be addressed by adopting evidence-based interventions. This led to the identification of the clinical issue of burnout in nursing. The second step entailed the determination of the populations that the problem affect. This led to the identification of nurses as the most prone group of professionals to be affected by burnout. The other step was performing a literature search of the databases to determine practice interventions that can be used to address the issue. This stage led to the identification of cognitive therapies as the most effective intervention to address burnout in nursing. The next step was determining a way in which I could determine the effectiveness of the intervention. As a result, I considered a comparative intervention to be no use of any approach to address the issue of burnout among nurses. I then developed the outcomes to be achieved by the implementation of the intervention and the timeline of evaluating its effectiveness.
Identified Articles
The database search led to the above articles that explore the effectiveness of cognitive interventions in reducing and preventing burnout among nurses.
Levels of Evidence
The study by Ahola et al., (2017) provides level I evidence. The study was a systematic review of randomized controlled trials without meta-analysis. The study by Melnyk et al., (2020) provided level I evidence too. It was a systematic review of randomized controlled trials without meta-analysis. The study by Nayeri et al., (2021) provided level III evidence. It was a systematic review of a combination of quasi-experimental, randomized controlled trials, and non-experimental studies. It also lacked meta-analysis. The study by Zhang et al., (2020) provided level II evidence. The study was a systematic review of quasi-experimental and randomized controlled trials with meta-analysis.
Strengths of Using Systematic Reviews
One of the strengths of using systematic reviews is the transparency in its processes. The processes of each of the phases of a systematic review are transparent, increasing the trust towards the obtained findings. Transparency also enables readers to determine the merits and demerits of the decisions that the authors made in synthesizing the data. The other benefit of using systematic reviews is that they provide comprehensive review of a topic. The use of multiple sources of data on a topic increases the relevance and implications of the data reported in a systematic review. The review of multiple studies also assists in the identification of gaps in research and practice. As a result, nurses can use the information from systematic reviews to inform their future research and practice. The last strength of systematic reviews is that it provides highly reliable results. The results have minimum bias due to the transparency in methods used. The focus on the results obtained in multiple studies also eliminates potential threats to validity and reliability of the obtained results.
References
Ahola, K., Toppinen-Tanner, S., & Seppänen, J. (2017). Interventions to alleviate burnout symptoms and to support return to work among employees with burnout: Systematic review and meta-analysis. Burnout Research, 4, 1–11.
Interventions to alleviate burnout symptoms and to support return to work among employees with burnout: Systematic review and meta-analysis. (2017). Burnout Research, 4, 1–11. https://doi.org/10.1016/j.burn.2017.02.001
Melnyk, B. M., Kelly, S. A., Stephens, J., Dhakal, K., McGovern, C., Tucker, S., Hoying, J., McRae, K., Ault, S., Spurlock, E., & Bird, S. B. (2020). Interventions to Improve Mental Health, Well-Being, Physical Health, and Lifestyle Behaviors in Physicians and Nurses: A Systematic Review. American Journal of Health Promotion, 34(8), 929–941. https://doi.org/10.1177/0890117120920451
Nayeri, N., Nukpezah, R., & Kiwanuka, F. (2021). Article no.AJRNH.71848 (1) Prof. Sharon Lawn, Flinders University, Australia. (2) Dr. Asmaa Fathi Moustafa Hamouda. Asian Nursing Research, 18–36.
Zhang, X., Song, Y., Jiang, T., Ding, N., & Shi, T. (2020). Interventions to reduce burnout of physicians and nurses: An overview of systematic reviews and meta-analyses. Medicine, 99(26), e20992. https://doi.org/10.1097/MD.0000000000020992
Strengths of Systematic Reviews for Clinical Research
}Focus on a specific clinical question & conduct an extensive literature search
}Method used to find & select the studies reduces bias
}High likelihood of reliable & accurate conclusions
}Reveal where knowledge is lacking
}Improve generalizability & consistency of results
Strengths of Systematic Reviews for Clinical Research
A Systematic Review refers to an article in which the authors have systematically searched for, appraised, and summarized all medical literature for a specific topic. Systematic reviews typically focus on a specific clinical question and conduct an extensive literature search to identify studies with sound methodology (Sriganesh et al., 2016).
An advantage of using systematic reviews in clinical research is that the method used to find and select the studies reduces bias and are highly likely to produce reliable and accurate conclusions (Sriganesh et al., 2016).
A systematic review synthesizes the results of multiple primary studies related to each other using strategies that reduce biases and random errors. It also summarizes findings from multiple studies, making the information easier for the end-user to read and understand.
Systematic reviews follow a strict scientific design based on explicit, pre-specified, and reproducible methods. As a result, they provide reliable estimates about the effects of interventions so that conclusions are defensible (Sriganesh et al., 2016).
Systematic reviews can also reveal where knowledge is lacking. This can then be used to guide future clinical research.
They help to reduce the time delay in the research discoveries to implementation.
Improve the generalizability and consistency of results (Sriganesh et al., 2016).
Reference
Sriganesh, K., Shanthanna, H., & Busse, J. W. (2016). A brief overview of systematic reviews and meta-analyses. Indian journal of anaesthesia, 60(9), 689–694. https://doi.org/10.4103/0019-5049.190628
Assignment: Evidence-Based Project, Part 2: Advanced Levels of Clinical Inquiry and Systematic Reviews
Your quest to purchase a new car begins with an identification of the factors important to you. As you conduct a search of cars that rate high on those factors, you collect evidence and try to understand the extent of that evidence. A report that suggests a certain make and model of automobile has high mileage is encouraging. But who produced that report? How valid is it? How was the data collected, and what was the sample size?
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In this Assignment, you will delve deeper into clinical inquiry by closely examining your PICO(T) question. You also begin to analyze the evidence you have collected.
Main Post
The clinical issue of interest is Diabetes Mellitus (DM) type 1 and why it’s usually misdiagnosis and how to prevent it. However, I recently identified ten patients with glucose levels of 350 to 400 who were unaware of they were typed 1 DM. These individuals were told they were type 2 and their treatment was not effective. They spent a lot of time in the hospital for uncontrolled DM and suffered from kidney disease, and neuropathy.
However, searching for the subject I used the Walden library and Medline database. I modified the search four times to obtain quality scholarly articles and I found four scholarly articles. The language I use was -misdiagnosis type 1 DM. Therefore, the rigor will occur by confirming a valid question by following the PICOT format which will ensure I have the correct patient population, intervention, comparison intervention, group outcome, and timeframe (Melnyk & Fineout-Overholt, 2019). The second step is searching for evidence-based practice (EBP) to evaluate the best practice (Melnyk & Fineout-Overholt, 2019).
It would be interesting to learn about the components which contribute to the misdiagnosis. However, the third step involves massaging the information for validation and sustainability, and feasibility (Melnyk & Fineout-Overholt, 2019). Hence, it is essential to follow all the steps, but steps 4 & 5 ensure the outcomes and clinical decisions. Step 4 guides PICOT to integrate the information to decide if it is EBP and if it’s understandable. The goal is to justify the research and evaluate the outcomes based on the evidence (Melnyk & Fineout-Overholt, 2019). The last step is to share the information among those whom it will affect, to change their behavior.
In addition, to the research, there will be challenges, and how to overcome negative outcomes. The acuity of the patients, shortage of nurses, and lack of knowledge of EBP are challenges (Melnyk & Fineout-Overholt, 2019). As clinicians learn about the research, it becomes rigorous and effective. It is essential to assess and evaluate frequently to identify challenges.
References
Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer
To Prepare:
- Review the Resources and identify a clinical issue of interest that can form the basis of a clinical inquiry.
- Develop a PICO(T) question to address the clinical issue of interest you identified in Module 2 for the Assignment. This PICOT question will remain the same for the entire course.
- Use the key words from the PICO(T) question you developed and search at least four different databases in the Walden Library. Identify at least four relevant systematic reviews or other filtered high-level evidence, which includes meta-analyses, critically-appraised topics (evidence syntheses), critically-appraised individual articles (article synopses). The evidence will not necessarily address all the elements of your PICO(T) question, so select the most important concepts to search and find the best evidence available.
- Reflect on the process of creating a PICO(T) question and searching for peer-reviewed research.
The Assignment (Evidence-Based Project)
Part 2: Advanced Levels of Clinical Inquiry and Systematic Reviews
Create a 6- to 7-slide PowerPoint presentation in which you do the following:
- Identify and briefly describe your chosen clinical issue of interest.
Medication administration errors are a pressing issue in global healthcare, with potential severe consequences for patient safety (Ayorinde & Alabi, 2019). These errors, which include administering the wrong medication or incorrect dosages, can lead to adverse drug events and even patient mortality (Härkänen et al., 2019).
Medications are a cornerstone of healthcare, and ensuring their accurate administration is vital for patient well-being. Despite advances in healthcare systems and technology, medication errors persist, posing significant risks to patient safety. These errors encompass a wide range of issues, from prescription to administration.
Understanding the causes of medication administration errors is crucial for healthcare providers, policymakers, and researchers. It not only reveals the root causes but also informs interventions to reduce and prevent errors. In this presentation, we explore research on medication administration errors, their impact on patient outcomes and mortality, and contributing factors across healthcare contexts. Through systematic reviews, we aim to promote safer medication practices and enhance patient safety.
Describe how you developed a PICO(T) question focused on your chosen clinical issue of interest.
“In healthcare settings, what is the impact of medication administration errors (P) on patient outcomes and mortality (O) compared to error-free medication administration (C), and what are the contributing factors (T)?”
Patient Population (P): We started by identifying the patient population of interest. In this case, it encompasses individuals in healthcare settings who are recipients of medication administration, spanning various age groups and medical conditions.
Intervention or Exposure (P): Next, we identified the key intervention or exposure, which is “medication administration errors.” These errors encompass a range of issues, including incorrect medication, dosages, and drug interactions.
Comparison (C): To understand the impact of medication administration errors, we needed a point of comparison. In this context, our comparison is “error-free medication administration,” which represents the ideal standard of care.
Outcomes (O): We determined the primary outcomes of interest, focusing on “patient outcomes and mortality.” These outcomes encompass a broad spectrum of effects, from minor adverse reactions to severe consequences like hospitalization or even death.
Timeframe or Type of Study (T): Lastly, we considered the timeframe or type of study design. Our interest lies in understanding not only the outcomes but also the contributing factors (T) to medication administration errors. Therefore, we adopted a systematic review approach to comprehensively analyze relevant research.
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Introduction
A spirit of inquiry is defined by Stillwell et al. (2010), as a continuous interest in the best evidence to guide decision making in the clinical arena. It is a necessary skill a nurse must have to apply evidence-based practice. Nurses tend to have a curious nature and are looking for ways to improve patient care. According to Davies (2011), being able to identify the answerable question can be a complicated process in Evidence-Based Practice. The following information in this discussion post will discuss the PICOT formatted question I have chosen and the information research process.
PICOT Question
The PICOT format is described by Melynk & Fineout-Overholt (2019) as the process where clinical questions are incorporated in a way that produces the best pertinent data from an investigation. P-patient or population, I-intervention or issue of interest, C-comparison intervention or status, O-outcome, T- the time frame for the intervention or issue of interest to achieve the outcome.
The PICOT question I have developed is the following: In surviving mourners experiencing grief over the loss of a loved one, does online grief counseling, compared with face to face counseling, provide effective grief therapy within the first year of the death of the loved one?
P- the population is survivors grieving the death of a loved one.
I- the issue of interest is online grief therapy effectiveness.
C- compared with grief counseling in person.
O- the outcome is coping with grief effectively.
T- the timeframe is within the first year of the death of a loved one.
Search Terms and Databases
Using two databases in the Walden University Library, PsycInfo, and CINAHL Plus with Full Text, I was able to come up with good results. The following is a description of the databases and terms used.
PsycInfo Database
I typed in the word bereavement, used the boolean operator word OR, and searched grief. I used the boolean operator word AND, added the words online therapy. I also narrowed the search down by adding the dates January 2015 to June 2020 and requested peer-reviewed scholarly journals. The results that came in were numbered at 1,499 articles. I changed the Boolean operator word OR to NOT for the word grief, and the results came in at zero. I reset the same Boolean operator back to OR for the word grief, changed the last Boolean operator word AND to OR, and entered online therapy. The results then came in at 2,837 articles.
CINAHL Plus with Full Text
I typed in the word grief, added the Boolean operator OR, typed in mourning. I added the Boolean operator word AND, typed in online psychotherapy. I had set the dates for January 2015 to June 2020, selected Full text and Peer-Reviewed Scholarly Journals. The results came in for 1,972 articles. I changed the Boolean operator word from OR to AND, kept the word mourning in the search, and changed the last Boolean operator word from AND to OR, kept the words online psychotherapy in the search, and applied the search. The results came in at 738.
Strategies for effective database searches
Changing the words on your subject can increase the effectiveness of your database search. As explained in the video by WaldenULibrary (2018), one can look at the headings in the articles and see if there are other terms that one can use instead to help in your research. An example used is changing the word from child to pediatric. For my topic, I could change the term from mourning to loss of a loved one, or bereavement. I can also switch the words from online therapy to in-person counseling. Narrowing the dates for more current articles can also help with improving the effectiveness of finding the research material.
Conclusion
Effective research for a PICOT formatted question involves a curiosity for evidence-based practice and knowing how to use the library databases effectively. Watching the webinars, reading the assigned readings has helped me to improve my research skills. Using the different databases and becoming comfortable with them enables one to find a wealth of information for the topic one is investigating.
References
Davies, K. S. (2011). Formulating the Evidence-Based Practice Question: A Review of the Frameworks. Evidence-Based Library and Information Practice, 6(2), 75–80. https://doi.org/10.18438/B8WS5N
Melynk, B., & Fineout-Overholt, E. (2019). Evidence-Based Practice in Nursing and Healthcare (4th ed.). Wolters Kluwer.
Stillwell, S. B., Fineout-Overholt, E., Melnyk, B., & Williamson, K. M. (2010). Evidence-Based Practice, Step by Step: Asking the Clinical Question. AJN, American Journal of Nursing, 110(3), 58–61. https://doi.org/10.1097/01.NAJ.0000368959.1112979
WaldenULibrary. (2018, February 20). CINAHL Quick Guide [Webinar]. YouTube. https://youtu.be/w_ua_p173U4
I agree with you that most adolescents experienced mental breakdown and psychological distress during the COVID-19 pandemic. Healthcare facilities received many teenagers with mental health complications. The restrictive measures such as closure of social and public amenities compelled these youngsters to stay lonely at their homes (Magson et al., 2021). However, to obtain credible and accurate materials to explain mental health issues among adolescents, locating the right platforms is important. The Walden library resource is a genuine source of academic materials. However, navigating to the right reading materials is a process guided by the keywords.
Walden library has many materials. Therefore, choosing wrong keywords may mislead someone to other sources (Ravens-Sieberer et al., 2022). Peer-reviewed articles are considered to be the best. Besides, using latest materials provide relevant and current information. Different results are obtained when searching for information about COVID-19. Hence, becoming more specific increases the accuracy of the process. Reading more articles on mental health issues among adolescents due to the COVID-19 pandemic increases clarity on the problem
References
Magson, N. R., Freeman, J. Y., Rapee, R. M., Richardson, C. E., Oar, E. L., & Fardouly, J. (2021). Risk and protective factors for prospective changes in adolescent mental health during the COVID-19 pandemic. Journal of Youth and Adolescence, 50(1), 44-57.
Ravens-Sieberer, U., Kaman, A., Erhart, M., Devine, J., Schlack, R., & Otto, C. (2022). Impact of the COVID-19 pandemic on quality of life and mental health in children and adolescents in Germany. European Child & Adolescent Psychiatry, 31(6), 879-889.
This is a great topic that is near and dear to my heart. Thank you for your information.
Among typical elementary, middle, and high school students, mental health is often overlooked. In urban and black communities, mental illness is perceived as behavioral, and the educators, who are predominately white, are not equipped, do not know how to deal with students of color and their mental issues, are burned out, and or just do not care. Eighty percent of alternative schools are made up of African Americans. (CDC, 2022)
Alternative schools are where children go due to behavioral issues and learning disabilities. These schools are not the typical educational facility, and the educational experience is overshadowed by mental issues and learning disabilities. But alternative schools are required to have the providers, counselors, resources, and behavioral health workforce needed to aid these children. If you asked children or young adults what an alternative school is, most of the time the response will be “this is where the bad kids go.”
As these children become young adults, one of two things will happen. They change for the better and learn to cope and maintain their issues and become a better student, or they don’t change, and they are accustomed to the feelings they have, think it is normal and most times, ignore the thoughts.
Since the pandemic, these children now realize these are not normal feelings, and that it is okay to have a mental health issue. Now more than ever, counselors, providers, and school-based programs are needed in a typical school setting because these young children do not know how to express or cope with these feelings, the issues surrounding them, and their everyday life. (The Hunt Institute, 2021)
According to the national healthy minds study, an astronomical amount of college students suffer from some type of mental illness. They do not get the help they need because of the fear of being judged.
The breakdown of your PICOT question was very informative, the format is a helpful approach for summarizing research questions that explore the effect of therapy or outcomes. Turning an idea into a good research question requires it to be possible, peak an interest, be ethical and relevant. (Davies, 2011). Generating new knowledge in existing gaps of healthcare provides the opportunity to help patients who previously may have had poor clinical outcomes get better ones. .
Assignment: Evidence-Based Project, Part 2: Advanced Levels of Clinical Inquiry and Systematic Reviews
Your quest to purchase a new car begins with an identification of the factors important to you. As you conduct a search of cars that rate high on those factors, you collect evidence and try to understand the extent of that evidence. A report that suggests a certain make and model of automobile has high mileage is encouraging. But who produced that report? How valid is it? How was the data collected, and what was the sample size?
In this Assignment, you will delve deeper into clinical inquiry by closely examining your PICO(T) question. You also begin to analyze the evidence you have collected.
To Prepare:
- Review the Resources and identify a clinical issue of interest that can form the basis of a clinical inquiry.
- Develop a PICO(T) question to address the clinical issue of interest you identified in Module 2 for the Assignment. This PICOT question will remain the same for the entire course.
- Use the key words from the PICO(T) question you developed and search at least four different databases in the Walden Library. Identify at least four relevant systematic reviews or other filtered high-level evidence, which includes meta-analyses, critically-appraised topics (evidence syntheses), critically-appraised individual articles (article synopses). The evidence will not necessarily address all the elements of your PICO(T) question, so select the most important concepts to search and find the best evidence available.
- Reflect on the process of creating a PICO(T) question and searching for peer-reviewed research.
The Assignment (Evidence-Based Project)
Part 2: Advanced Levels of Clinical Inquiry and Systematic Reviews
Create a 6- to 7-slide PowerPoint presentation in which you do the following:
- Identify and briefly describe your chosen clinical issue of interest.
- Describe how you developed a PICO(T) question focused on your chosen clinical issue of interest.
- Identify the four research databases that you used to conduct your search for the peer-reviewed articles you selected.
- Provide APA citations of the four relevant peer-reviewed articles at the systematic-reviews level related to your research question. If there are no systematic review level articles or meta-analysis on your topic, then use the highest level of evidence peer reviewed article.
- Describe the levels of evidence in each of the four peer-reviewed articles you selected, including an explanation of the strengths of using systematic reviews for clinical research. Be specific and provide examples.
By Day 7 of Week 5
Submit Part 2 of your Evidence-Based Project.
Submission and Grading Information
To submit your completed Assignment for review and grading, do the following:
- Please save your Assignment using the naming convention “WK5Assgn+last name+first initial.(extension)” as the name.
- Click the Week 5 Assignment Rubric to review the Grading Criteria for the Assignment.
- Click the Week 5 Assignment link. You will also be able to “View Rubric” for grading criteria from this area.
- Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK5Assgn+last name+first initial.(extension)” and click Open.
- If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
- Click on the Submit button to complete your submission.
Grading Criteria
To access your rubric:
Week 5 Assignment Rubric
Check Your Assignment Draft for Authenticity
To check your Assignment Draft for Authenticity
Submit your Week 5 Assignment Draft and review the originality report
Submit Your Assignment by Day 7 of Week 5
To participate in this Assignment:
Week 5 Assignment
Next Module
Module 3: Advanced Clinical Inquiry and PICO(T) Questions (Weeks 4-5)
Laureate Education (Producer). (2018). The Value of Clinical Inquiry [Video file]. Baltimore, MD: Author.
| Due By | Assignment |
| Week 4, Days 1-2 | Read the Learning Resources. Compose your initial Discussion post. |
| Week 4, Day 3 | Post your initial Discussion post. Begin to compose your Assignment. |
| Week 4, Days 4-5 | Review peer Discussion posts. Compose your peer Discussion responses. Continue to compose your Assignment. |
| Week 4, Day 6 | Post two peer Discussion responses. Continue to compose your Assignment. |
| Week 4, Day 7 | Wrap up Discussion. |
| Week 5, Days 1-6 | Continue to compose your Assignment. |
| Week 5, Day 7 | Deadline to submit your Assignment. |
Learning Objectives
Students will:
- Create an answerable research question using the PICO(T) question format
- Apply effective search strategies to identify relevant peer-reviewed and systematic reviewed research
- Analyze strategies to increase rigor and effectiveness of database searches for PICO(T) questions
- Analyze levels of evidence in peer-reviewed research
Learning Resources
Note: To access this module’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.
Required Readings
Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer.
- Chapter 2, “Asking Compelling Clinical Questions” (pp. 33–54)
- Chapter 3, “Finding Relevant Evidence to Answer Clinical Questions” (pp. 55–92)
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. https://doi.org/10.18438/B8WS5N
Note: You will access this article from the Walden Library databases.
Stillwell, S. B., Fineout-Overholt, E., Melnyk, B. M., & Williamson, K. M. (2010a). 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. doi:10.1097/01.NAJ.0000368959.11129.79
Note: You will access this article from the Walden Library databases.
Melnyk, B. M., Fineout-Overholt, E., Stillwell, S. B., & Williamson, K. M. (2009). Evidence-based practice: Step by step: Igniting a spirit of inquiry. American Journal of Nursing, 109(11), 49–52. doi:10.1097/01.NAJ.0000363354.53883.58
Note: You will access this article from the Walden Library databases.
Stillwell, S. B., Fineout-Overholt, E., Melnyk, B. M., & Williamson, K. M. (2010b). Evidence-based practice, step by step: Searching for the evidence. American Journal of Nursing, 110(5), 41–47. doi:10.1097/01.NAJ.0000372071.24134.7e
Note: You will access this article from the Walden Library databases.
Required Media
Laureate Education (Producer). (2018). Searching the Evidence [Video file]. Baltimore, MD: Author.
From a practice viewpoint, clinical issues represent the care aspects prioritized when performing clinical interventions. They are primarily the everyday events in health care delivery that adversely affect health outcomes. Clinical issues often inform research problems. In this case, they are the basis for evidence-based application in health practice where nurses and other care providers integrate scientific evidence with clinical expertise and patient preference to enhance health outcomes. This presentation describes the clinical issue of interest, PICOT development, and the databases used to conduct the search process. It also identifies the research databases used, APA citations for the peer-reviewed articles used, and levels of evidence. The last part is a detailed analysis of the strengths of systematic reviews as the highly recommended evidence type for clinical research.
To provide optimal patient care, nurses should always be in the right physical and mental health state. Unfortunately, clinical issues hamper nurses’ ability to provide quality and satisfactory care. Workplace incivility in nursing is among the common clinical issues profoundly affecting health outcomes. Typical among nurses, workplace incivility involves rude and disrespectful actions towards colleagues. Incivility shows disregard for others’ feelings and needs, often intending to harm or hurt them. The effects of incivility are far-reaching since it is positively correlated with anxiety and job burnout besides lowering nurses’ self-esteem (Shi et al., 2018). Other effects necessitating evidence-based interventions include the affected nurses negatively perceiving the nursing profession (Alshehry et al., 2019) and being highly vulnerable to medical errors (Abdollahzadeh et al., 2017). The outcomes are detrimental to the quality of patient care.
The PICOT approach is highly recommended in health practice when developing interventions for clinical problems. When creating the PICOT question, the problem or population in question is first identified. It should be vivid too. The issue of interest is workplace incivility among nurses. The other central components include the intervention and comparison. The intervention suggested to reduce workplace incivility is policy interventions and awareness programs compared to no intervention. From a practice viewpoint, the intervention should lead to a specific objective: reducing workplace incivility to promote a healthy working environment. The time frame defines the time it will take for an intervention to realize the desired outcome. In this case, six months.
To make informed decision about a clinical issue, nurses and other health care providers should search for evidence from the leading research databases. Since workplace incivility is a nursing issue, the search was limited to nursing research databases. As a reliable source of scholarly and peer-reviewed sources, CINAHL Plus with Full Text provides access to literature related to nursing and allied health. JAMAevidence has many nursing and health care articles. Trip Pro is largely a search engine that enables a nurse to access research evidence relevant to clinical practice. Systematic reviews and practice guidelines can be accessed via Trip Pro. Google Scholar facilitates search for peer-reviewed articles.
The full citations of the above articles have been provided in the reference list. As indicated, the articles focus on different research areas related to workplace incivility. The broadened focus enhances understanding of the topic to justify why evidenced-based interventions are necessary. The article by Kile et al. (2019) examined the effectiveness of education and cognitive rehearsal in managing workplace incivility. Both interventions enhance awareness of workplace incivility. Abdollahzadeh et al. (2017) examined how to prevent workplace incivility from a nurses’ perspective. Armstrong (2018) primarily focused on nursing workplace incivility prevention. The last article by Shi et al. (2018) examined the link between workplace incivility and job burnout.
Nurses should use the highest level of evidence to guide decision-making in health practice. Systematic reviews provide high-level evidence since they comprehensively search for evidence from multiple credible sources. Besides the high quality of evidence, systematic reviews narrowly focus on a clinical question. By synthesizing available evidence of a particular topic, systematic reviews help nurses and other health care providers to make more informed decisions regarding practice issues. Most systematic reviews identify research biases and flaws in the synthesized literature and propose areas that require further research based on the research gaps. As a result, they inform decision-making and guide future research.
This presentation primarily focused on workplace incivility as the clinical issue of interest. It deserves maximum attention due to its adverse impacts, including reducing nurses’ self-esteem, contributing to burnout and anxiety, and increasing the chances of nurses committing medication errors. Nursing and health care research should always be informed by the highest evidence level possible. As a result, systematic reviews are highly encouraged due to their high level of evidence and in-depth analysis of a clinical problem. Their use enhances understanding of a clinical problem and ensures that the evidence used to guide interventions is relevant to the reviewed issue.
References
Abdollahzadeh, F., Asghari, E., Ebrahimi, H., Rahmani, A., & Vahidi, M. (2017). How to prevent workplace incivility?: Nurses’ perspective. Iranian Journal of Nursing and Midwifery Research, 22(2), 157-163. https://doi.org/10.4103/1735-9066.205966
Armstrong, N. (2018). Management of nursing workplace incivility in the health care settings: A systematic review. Workplace Health & Safety, 66(8), 403-410. https://doi.org/10.1177%2F2165079918771106
Kile, D., Eaton, M., deValpine, M., & Gilbert, R. (2019). The effectiveness of education and cognitive rehearsal in managing nurse‐to‐nurse incivility: A pilot study. Journal of Nursing Management, 27(3), 543-552. https://doi.org/10.1111/jonm.12709
Shi, Y., Guo, H., Zhang, S., Xie, F., Wang, J., Sun, Z., … & Fan, L. (2018). Impact of workplace incivility against new nurses on job burn-out: A cross-sectional study in China. BMJ Open, 8(4), e020461. doi:10.1136/ bmjopen-2017-020461
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 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.
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