NURS 6052 Wk 4 Discussion: Searching Databases

The clinical issue of interest to me is mental health issues among adolescents due to the COVID-19 pandemic.  This subject interested me because having worked as a Psych/behavioral health nurse for over 2 years, I witnessed firsthand how the number of adolescent patients increased at our hospital.  I worked at a 20-bed inpatient behavioral health/psych facility and within a matter of months after COVID, we were getting twice as many adolescent admission packets than adult admissions.  In six months, the hospital went from 20 adolescents to a 50-adolescent inpatient facility.  

I started my search using the Walden library resource.  I started with the broad subject of mental health.  I narrowed my search result to adding adolescents to the search criteria.  I selected “peer-reviewed articles” and changed the years to include searches between 2016 and 2022.  I also included COVID-19 in the search criteria as well.  This narrowed the search result down to 495 articles which is a lot more manageable to go through rather than going through thousands of articles.  

I found a great article on this topic titled “The impact of COVID-19 on adolescents’ mental health.”  In this article, the author discusses that several studies show that emergency department visits for peds patients increased after the first lockdown.  The author also talks about the underlying causes of pandemic-induced distress, with social isolation and loneliness due to social distancing being the main culprit in increased anxiety, depression, self-harm, and suicidal ideation among this population.   I will continue to read through the list of articles on this subject matter and the COVID-19 timeframe of the last year will develop my PICOT question.  I will also research how this pandemic over the last year has increased substance abuse among adolescents.  

I enjoyed reading your post. This topic of interest is near to my heart since I have three children of my own and I know first-hand how the pandemic affected them. My oldest is now 16 but 13 at the time of COVID-19 and I would say that was her hardest years of adolescence. According to the world health organization, social withdrawal can exacerbate isolation and loneliness and this can lead to depression (2021). The whole school year, of the pandemic, my school-aged children were isolated in our own home away from family and friends. The following year my oldest daughter was clinically diagnosed with anxiety and depression. We have endured an inpatient stay, outpatient therapy, and lots of prescription medications, but have finally turned the corner to a brighter future. Overall, the pandemic undoubtedly affected the mental health of everyone and especially children. On another note, I do think that utilizing the Boolean terms properly will help your research efforts. According to the clinical information access portal depending on what you want to research that will determine which term to utilize, AND is for narrowing your search, OR is for broadening, and NOT is for excluding certain items (1996). This website also had infographics that helped me understand how to utilize Boolean terms properly. I hope you find it as resourceful as I did.

A Sample Answer For 6 the Assignment: NURS 6052 Wk 4 Discussion: Searching Databases
Title: NURS 6052 Wk 4 Discussion: Searching Databases

References:

Clinical Information Access Portal. (1996). Combining terms with Boolean Operators (AND, OR, NOT). Combining terms with Boolean Operators (AND, OR, NOT) – CIAP Clinical Information Access Portal. Retrieved December 20, 2022, from https://www.ciap.health.nsw.gov.au/training/ebp-learning-modules/module2/combining-terms-with-boolean-operators-and-or-not.html#:~:text=Combining%20terms%20with%20Boolean%20Operators%20%28AND%2C%20OR%2C%20NOT%29,search%20result%20will%20contain%20both%20the%20…%20Links to an external site.

World Health Organization. (2021, November 17). Adolescent mental health. World Health Organization. Retrieved December 20, 2022, from https://www.who.int/news-room/fact-sheets/detail/adolescent-mental-health#:~:text=Depression%20is%20estimated%20to%20occur%20among%201.1%25%20of,disorders%20can%20profoundly%20affect%20school%20attendance%20and%20schoolwork Links to an external site..

The development of clinical guidelines to improve nursing practice is a rigorous process. Healthcare providers should utilize the most accurate sources of data that will enhance the effectiveness of the outcomes. Therefore, this paper explores the search strategy that will be used to obtain the data related to the proposed PICOT question.

A Sample Answer For 7 the Assignment: NURS 6052 Wk 4 Discussion: Searching Databases
Title: NURS 6052 Wk 4 Discussion: Searching Databases

PICOT Question

            The PICOT question that is appropriate for the identified clinical issue is:

In hospitalized elderly patients (P), does the use of hourly nursing rounds and call lights (I) reduce the rates of falls (O) when compared to normal routine of care (C) in a six-month period (T)?

Search Terms Used

            According to Melnyk and Fineout-Overholt (2018), search terms for a clinical inquiry question (PICOT) can be obtained by doing database search using the key words of the PICOT question. The keywords that were used in this research that relate to the PICOT question include falls, elderly patient falls, falls prevention, hourly nursing rounds and falls, call lights and falls, and nursing rounds and falls. The use of these keywords in selected databases yielded 59 articles. The number reduced to 30 when the search criterion was limited to peer-reviewed articles alone. The second search strategy that was utilized was the use of database-controlled vocabulary.

This approach entails the use of specific keywords such as nursing rounds and elderly patient falls to obtain the needed articles. The databases produce all the articles that contain these keywords, thereby, increasing the accuracy of the obtained results (Melnyk & Fineout-Overholt, 2018). The use of this approach resulted in 45 articles related to the PICOT statement. Despite the effectiveness of these methods, they have the weakness of producing a large number of articles that might not be relevant to the issue under investigation. Consequently, the use of Boolean operation search is appropriate.

            Boolean search is an effective approach to obtaining relevant research articles due to the accuracy of its results. The use of this approach allows for the searching of word combinations in a specified order (Stillwell et al., 2010). Often, combinations are used to increase the relevance and accuracy of the obtained resulted. For instance, Library of Congress (n.d.) recommend that Boolean OR expressions should be executed first, followed by AND or NOT expressions. The search can be done in either lower or upper cases. The use of this approach to searching articles yielded 16 articles that were related to the PICOT statement. Therefore, it became evident that the use of Boolean search is highly accurate when compared to the utilization of random search of key words in the PICOT statement.

Names of Databases

            A number of nursing databases were used in this research. They included CINAHL, Medline, Embase, and TRIP databases. These databases were considered effective for the assignment because they publish peer-reviewed content. The sources contained in them are also credible for use in generating information for evidence-based practice.

Search Results

            As shown above, the initial search that was undertaken using random search of the key words of the PICOT question yielded 59 articles. This number reduced to 30 when the selected articles were specified to peer-reviewed articles only. The use of database-controlled vocabulary yielded 45 articles while Boolean search resulted in 16 peer-reviewed articles related to the PICOT statement.

Strategies to Increase Rigor and Effectiveness of a Database Search on PICOT Question

            A number of strategies will be utilized to increase the rigor as well as effectiveness of the database search for the relevant literature in the PICOT question. One of them will be the use of many databases. According to Ho et al. (2016), the use of a combination of different databases has been shown to result in an increased proportion of studies alongside questions. Restricting the search of the relevant sources of data to a single database would lead to one missing many articles, hence, skewed results.

            The second strategy that will be utilized to increase the rigor and effectiveness of the database search on the PICOT question is limiting the period in which the appropriate articles were published. Often, evidence-based practice focuses on the use of the most recent, highly accurate clinical data in improving processes (Melnyk & Fineout-Overholt, 2018). This implies that recently published data should be utilized in coming up with new clinical guidelines. As a result, the search strategy for the articles on the PICOT question will be limited to articles that were published in the last five years. The use of this approach will increase the relevance of the findings to the current issues being reported in the clinical environments.

            The last strategy that will be utilized to enhance the rigor and effectiveness of the database search on the PICOT statement is ensuring that the articles only relate to nursing practice. Evidence-based practice applies to all areas of healthcare. However, it is important that nurses explore the need for clinical practices that relate to their professional practice (Ellis, 2019). The need for this focus is to promote professional growth and advancement. Therefore, the search for the needed resources will only be specific to nursing.

References

Ellis, P. (2019). Evidence-based practice in nursing. Learning Matters.

Ho, G. J., Liew, S. M., Ng, C. J., Shunmugam, R. H., & Glasziou, P. (2016). Development of a search strategy for an evidence based retrieval service. PloS one, 11(12).

Library of Congress. (n.d.). Search/browse help – Boolean operators and nesting. Retrieved June 14, 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: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer.

Stillwell, S. B., Fineout-Overholt, E., Melnyk, B. M., & Williamson, K. M. (2010). Evidence-based practice, step by step: Searching for the evidence. AJN The American Journal of Nursing, 110(5), 41-47.

PICOT questions form the basis of clinical inquiry with a significant focus on improving patient outcomes (Melnyk  & Fineout-Overholt, 2018). The implication is that a clinical issue is identified, and an appropriate question in the PICOT format is formulated (Nieswiadomy & Bailey, 2018). The chosen clinical issue is catheter-associated urinary tract infections (CAUTI) in the emergency department. CAUTIs are common in the emergency department due to the need to catheterize patients who come in for admission. CAUTIs lead to undesirable problems, such as longer hospital stays, and even more adverse outcomes, such as death, hence a need to prevent and properly manage them (Ohanian & Gaines-Hill, 2019).  An appropriate database search strategy is necessary when searching databases for appropriate evidence regarding clinical issues. For instance, one can start the search broadly with a concept or a word and add more specific keywords to the search process to narrow down on more appropriate evidence.

Using the Walden database search, a search was conducted starting with the word catheter-associated urinary tract infections. Nursing databases were specifically used during this search. The first search was general and yielded 46,800 results. However, most of these resources were irrelevant, so more words were added to help narrow the search. The word emergency department was added to the search, reducing the number of articles to 10,600 and making them more specific. This was made possible by using the Boolean operator “And” (Grove & Gray, 2018). After formulating the PICOT question, it is expected that more specific terms will be included in the search strategy to help narrow down the most appropriate articles or evidence. For instance, the search still does not include a possible intervention to be used in the emergency department to reduce the chances of patients getting CAUTI.

PICOT question: Among adult patients admitted to the emergency department, what is the efficacy of using CAUTI bundles as compared to normal practice in lowering the rates of CAUTI in 12 weeks?

References

Grove, S. K., & Gray, J. R. (2018). Understanding nursing research e-book: Building an evidence-based practice. Elsevier Health Sciences.

Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer.

Nieswiadomy, R. M., & Bailey, C. (2018). Foundations of nursing research. 1073.

Ohanian, S., & Gaines-Hill, S. (2019). Reduction of CAUTI rates organization-wide begins in the Emergency Department. American Journal of Infection Control, 47(6), S37. https://doi.org/10.1016/j.ajic.2019.04.086

I enjoyed reading your post. This topic of interest is near to my heart since I have three children of my own and I know first-hand how the pandemic affected them. My oldest is now 16 but 13 at the time of COVID-19 and I would say that was her hardest years of adolescence. According to the world health organization, social withdrawal can exacerbate isolation and loneliness and this can lead to depression (2021). The whole school year, of the pandemic, my school-aged children were isolated in our own home away from family and friends.

The following year my oldest daughter was clinically diagnosed with anxiety and depression. We have endured an inpatient stay, outpatient therapy, and lots of prescription medications, but have finally turned the corner to a brighter future. Overall, the pandemic undoubtedly affected the mental health of everyone and especially children. On another note, I do think that utilizing the Boolean terms properly will help your research efforts. According to the clinical information access portal depending on what you want to research that will determine which term to utilize, AND is for narrowing your search, OR is for broadening, and NOT is for excluding certain items (1996). This website also had infographics that helped me understand how to utilize Boolean terms properly. I hope you find it as resourceful as I did.

References:

Clinical Information Access Portal. (1996). Combining terms with Boolean Operators (AND, OR, NOT). Combining terms with Boolean Operators (AND, OR, NOT) – CIAP Clinical Information Access Portal. Retrieved December 20, 2022, from https://www.ciap.health.nsw.gov.au/training/ebp-learning-modules/module2/combining-terms-with-boolean-operators-and-or-not.html#:~:text=Combining%20terms%20with%20Boolean%20Operators%20%28AND%2C%20OR%2C%20NOT%29,search%20result%20will%20contain%20both%20the%20…%20

Links to an external site.

World Health Organization. (2021, November 17). Adolescent mental health. World Health Organization. Retrieved December 20, 2022, from https://www.who.int/news-room/fact-sheets/detail/adolescent-mental-health#:~:text=Depression%20is%20estimated%20to%20occur%20among%201.1%25%20of,disorders%20can%20profoundly%20affect%20school%20attendance%20and%20schoolwork Links to an external site..

I really enjoyed the information you provided on this topic. I feel as though many nurses, if not all, experience nurse burnout. Unfortunately, it seems inevitable. There are over 195,000 open registered nurse positions each year and many will not be filled (Advent Health, 2021). I know firsthand, I am currently facing this hardship in my career. I am extremely interested in knowing and understanding the results you find from researching this topic. All of the strategies you have used to narrow your search results are helpful in limiting the number of relevant articles you find. I also recommend using the Boolean operators to narrow your search results as well. The Boolean operators use the terms “AND”, “OR”, and “NOT” to filter your results. This helps to specifically find articles relating to your topic but forcing the database to look for more than one term at a time (Walden University, n.d.). For example in your case you could use, nursing shortages AND patient outcomes. This way you will retrieve articles solely related to nursing shortages and the effects it has on patient outcomes. 

References

AdventHealth University, & AdventHealth University. (2021, December 29). Nurse staffing and patient outcomes: Strategies for        improvement. AdventHealth University. Retrieved December 24, 2022, from https://www.ahu.edu/blog/nurse-staffing-and-patient-outcomes

Walden University Library. (n.d.). Keyword Searching: Finding Articles on Your Topic: Boolean Terms. Retrieved December 24, 2022. from, http://academicguides.waldenu.edu/library/keyword/boolean

       I really thoroughly enjoyed reading your description of patient safety, as it relates to staff burnout. Over the years, I have come to believe that safety always starts with taking care of ourselves. We all have, at some point or another , experienced circumstances that tested our mental capacity and stress levels. It is well known that nurses are faced with varying job stressors, depending on what duties and positions they perform, some more than others (Chang et al., 2021). As most of us know, there are areas of patient care that are prone to more stressful and uncomfortable situations than others. Having worked as an intensive care nurse for a few years, during third shift, I believe that you absolutely are onto something very important with your PICOT question.

            As nurses, we must always be on top of our game, but as you mentioned, we are all human, and to be human is to err. We make mistakes, no matter how good we are at something, the day may come where circumstance meets opportunity and then an error is made. The reason why I bring this up, just as you did, is that we can use it to our advantage and me constantly cautious of our own wellbeing and our own mental status. Being stressed during an inherently stressful environment, such as the ICU, can cause many a good nurse to feel overwhelmed and slowly, or sometimes quickly, become burned out.

The intensive care unit (ICU) nurse are at a particularly high risk of burnout, and as you mentioned, especially during COVID-19 times (Bruyneel et al., 2021). By noticing and being self-aware of things that are affecting us professionally or personally, we are able to seek help and adapt strategies to prevent those negative feelings that come with feeling burned out. It is a shame that so many of my collogues and close friends have left the nursing profession altogether due to the development of negative feelings towards healthcare and the stressful environments they endured over the years. Looking forward to reading more about this from you.

A Sample Answer For the Assignment:
Title:

Searching Databases

            Clinical inquiry is the process of gathering data using specific and clear clinical parameters to evaluate the existing options of treatment to find the most suitable choice of action (Melnyk & Fineout-Overholdt, 2018). An efficient and successful way to begin conducting that sort of clinical inquiry or research is by developing a PICO(T) style question (i.e., P: population of interest; I: intervention; C: comparison of interest; O: outcome expected; and optional T: time for the intervention to achieve the outcome)(Melnyk & Fineout-Overholdt, 2018). From this question, the researcher can investigate for answers through relevant databases to determine an answer based on evidence that may be then applied to their own clinical practice or organizational policies.  

PICO Question and Search

            The search begins with my PICO(T) question: In patients hospitalized in an inpatient behavioral health unit (P), does nurse implementation of a violence prevention assessment tool (I) compared with absence of violence assessment tool (C) effect the number of violent outbursts by patients (O)? I did not include a time frame for my clinical inquiry as it was not pertinent to the topic.  Then, using the databases Cumulative Index to Nursing and Allied Health Literature (CINAHL) and ProQuest Nursing and Allied Health Source. CINAHL database is a diverse assortment of journals and e-books on nursing and allied health topics and ProQuest Nursing data base includes articles focused on nursing, allied health, alternative, and complementary medicine (Walden University Library, n.d.).  I searched these databases for articles derived from my PICO question, using the variations of the terms “violence assessment tool”, “inpatient psychiatric unit or ward or hospital” and “nursing”.

Search Results

            CINAHL

To initiate the CINAHL search, I first used the terms “violence assessment tool”, and “inpatient behavioral health”, and “nursing”. This returned no results.  I then modified my criteria and changed “inpatient behavioral health” to “inpatient psychiatric unit or ward or hospital” and received 4 results.

            ProQuest Nursing and Allied Health Source.

The second data base search included the terms “violence assessment tool”, “psychiatric inpatient”, and “nursing”. There was a sizable return of 1,962 dissertations and theses, scholarly journals, books, trade journals, magazines, and reports.  Upon further refinement by only scholarly journals, 758 articles remained.

Strategies for Future Searches

            As I continue to utilize databases to search for peer reviewed research articles, I will remain flexible with the search terms.  Stillwell et al. (2010) recommends using the database’s-controlled vocabulary to save on search time and avoid missing articles that may be relevant to the clinical question.  The index terms generally automatically populate when typing in search criteria to guide the searcher toward a more successful result. 

            In conclusion, when nurse scholars identify a topic of clinical inquiry, developing a PICO(T) format is an important step in the search processes.  Search terms can then be easily identified from that PICO(T) question. Choosing an appropriate database, one that focuses on the type of subject (i.e. nursing) will produce a more topic centric return. And finally, allowing the database to guide search input to align with their controlled library will further assist the search in relevant articles. 

References

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

healthcare: A guide to best practice (4^th ed.). Wolters Kluwer.

Stillwell, S.B., Fineout-Overholt, E., Melnyk, B.M., & Williamson, K.M. (2010). Evidence-

based practice, step by step: Searching for the evidence. American Journal of

Nursing, 110(5), 41–47. https://doi-org.ezp.waldenulibrary.org/10.1097/01.NAJ.0000372071.24134.7e

Walden University Library. (n.d.). Databases A-Z: Nursing.

https://academicguides.waldenu.edu/az.php?s=19981

Every few months, I’ve witnessed at least twenty nurses leave the profession—both new graduates and seasoned professionals—and either resign right away or postpone their departure until the conclusion of their six-month probationary period. The significant nursing turnover rate in recent years, particularly after Covid, is due to various factors. Due to the high burnout rate among nurses, you chose a popular and alarming topic. The care provided to residents can suffer from high staff turnover, hurting their health. Any reason can lead a nurse to leave a job, although retirement, career changes, and switching employers are the most frequent. The stresses of challenging physical and mental work, feeling unappreciated, and inadequate staffing are some of the most common reasons nurses leave their jobs. One of healthcare leaders’ many challenges is determining what factors contribute to nursing turnover and what can be done to reduce it. Staffing methods like patient-to-nurse ratios and workload measurement systems are crucial for nursing turnover. To support nurses, organizations should consider adopting innovative technologies that automate clinical workflows, remove repetitive and redundant administrative tasks and enable nurses to connect at a more personal level with patients (Wood, 2022)

MBIs have been used to increase the psychological well-being of nurses. Although the benefits of mindfulness for nurses have been studied more and more, researchers still do not have a complete understanding of the types of MBIs that have been used to improve nurses’ psychological well-being, the outcome measures used to assess nurses’ psychological well-being, or the overall efficacy of MBIs in enhancing nurses’ psychological well-being( Sulosaari et al., 2022). Many organizations should implement the use of MBIs to reduce nurse burnout.

Sulosaari, V., Unal, E., & Cinar, F. I. (2022). The effectiveness of mindfulness-based interventions on the psychological well-being of nurses: A systematic review. Applied Nursing Research, 64, 151565. https://doi.org/10.1016/j.apnr.2022.151565

Wood, heather. (2022, November 18). Reducing nursing turnover rates with help of current technologies. Health Data Management. Retrieved March 23, 2023, from https://www.healthdatamanagement.com/articles/reducing-nursing-turnover-rates-with-help-of-current-technologies?id=130439