Discussion: Searching Databases
My clinical issue of interest and PICO(T) questions is:
In newly admitted elderly patients in the Assisted Living Facility (ALF) (P), what is the effect of higher levels of monitoring (I) when compared to current practice (C) on rates of fall occurrences (O) within the first six months from admission (T)?
At first, I researched in the Walden Library for “falls in the long-term care facility” yet was astounded to find that it did not create numerous results. Luckily, after investigating the current week’s learning resources, I discovered how to complete a more in-depth search in the Walden Library. I picked CINAHL Plus and SAGE to lead the inquiry on my PICOT question. Formulating the PICOTs that target the theme of research saves time. (Ho et al.,2016)
CINAHL Plus with Full Text
Initially, I made a couple of search efforts prior to drawing near to the kind of data I was searching for. I looked through long-term care AND admission, AND falls which returned no outcomes. Discussion: Searching Databases Thus, I adjusted to the words fall*, “ALF,” and various blends of the term admission*, which after marking Full text, delivered four peer-reviewed academic articles from 2016-2020. Interestingly, when I eliminated admission and just utilized fall* AND assisted living* I got 47 results. I attempted another search utilizing Boolean terms fall* AND long-term care (without the reference marks), which created 13 outcomes. At last, I continued searching utilizing Boolean terms fall, at that point utilized the drop-down menu to choose ALF and long-term care. This inquiry technique delivered the most outcomes consisting of 448 articles. By adding a third Boolean term, it reduced the pertinent articles to 67.
SAGE Journals
I utilized Sage diary and entered the “falls in ALF” in the drop-down menu, restricting the search to dates 2016-2021 and subject: Health Science, generated 616 outcomes. I selected the relevant sorting filter, which suggests the most relevant articles first. Discussion: Searching Databases The highlighting of the searched word features is very helpful. SAGE delivered a greater number of results than CINAHL. However, articles were much more accurate in CINAHL.
Strategies to increase the rigor and effectiveness of a database search on the PICO(T) question
After experimenting with the different search tools, I intend to utilize the boolean search to increase the list of articles Discussion: Searching Databases. I saw the merit in utilizing the word OR between terms in the search bar to widen my research lists. I will also use quotation marks around expressions to help refine the result lists. Utilizing the asterisk towards the end of root words helps scan the data set for similar root words, making research more comprehensive (Walden University, n.d.- a). After learning these strategies and experimenting with them in SAGE and CINAHL, I feel confident that I will be able to locate relevant articles for my future research endeavors.
References
Ho, G. J., Liew, S. M., Ng, C. J., Hisham Shunmugam, R., & Glasziou, P. (2016). Development of a Search Strategy for an Evidence-Based Retrieval Service. PLoS ONE, 11(12), 1–14. https://doi-org.ezp.waldenulibrary.org/10.1371/journal.pone.0167170
Walden University. (n.d.-b). Keyword searching: finding articles on your topic: ConnectKeywords. https://academicguides.waldenu.edu/library/keyword/boolean
Discussion: Searching Databases
When you decide to purchase a new car, you first decide what is important to you. If mileage and dependability are the important factors, you will search for data focused more on these factors and less on color options and sound systems.
The same holds true when searching for research evidence to guide your clinical inquiry and professional decisions. Developing a formula for an answerable, researchable question that addresses your need will make the search process much more effective. One such formula is the PICO(T) format Discussion: Searching Databases.
In this Discussion, you will transform a clinical inquiry into a searchable question in PICO(T) format, so you can search the electronic databases more effectively and efficiently. You will share this PICO(T) question and examine strategies you might use to increase the rigor and effectiveness of a database search on your PICO(T) question.
To Prepare:
Review the Resources and identify a clinical issue of interest that can form the basis of a clinical inquiry.
Review the materials offering guidance on using databases, performing keyword searches, and developing PICO(T) questions provided in the Resources.
Based on the clinical issue of interest and using keywords related to the clinical issue of interest, search at least two different databases in the Walden Library to identify at least four relevant peer-reviewed articles related to your clinical issue of interest. You should not be using systematic reviews for this assignment, select original research articles.
Review the Resources for guidance and develop a PICO(T) question of interest to you for further study. It is suggested that an Intervention-type PICOT question be developed as these seem to work best for this course.
By Day 3 of Week 4
Post a brief description of your clinical issue of interest. This clinical issue will remain the same for the entire course and will be the basis for the development of your PICOT question. Describe your search results in terms of the number of articles returned on original research and how this changed as you added search terms using your Boolean operators. Finally, explain strategies you might make to increase the rigor and effectiveness of a database search on your PICO(T) question. Be specific and provide examples.
By Day 6 of Week 4
Respond to at least two of your colleagues on two different days and provide further suggestions on how their database search might be improved.
Week 4 Discussion: Searching Data Bases
Introduction
Along with the initiation of the affordable care act in 2010 came new standards of care and a focus on evidenced based practice (Laureate Education, 2018). Evidenced based practice (EVP) was a specific, organized way of looking at a real-life clinical issue with the intent to identify the best interventions (Davies, 2011). Research states that if there is a clinical situation that is urgent, it increases the importance of taking an EVP approach to determine best practice (Davies, 2011). Furthermore, not using evidenced based practice results in decreased healthcare quality and increased cost (Melnyk, B.M., et al., 2009). In 2009 it was projected that by 2020 almost every healthcare organization would be using evidenced based research as the foundation of care (Melnyk, B.M., et al., 2009).
With the insurgence of evidenced based practice, it was soon discovered that random literature searches could be time consuming and nonproductive. PICO was an acronym that was developed in the nineties as a structured way to approach a clinical question (Davies, 2011) Discussion: Searching Databases. Researchers also realized that the quality of the PICO question effects: (1) the efficiency of the research and (2) the quality of the evidence located (Stillwell, et al., 2010). Creating an organizational environment that encourages best practice guidelines and encourages employees to challenge stagnant thinking will lead to the best patient outcomes (Melnyk, B.M., et al., 2009).
Clinical Issue of Interest
The clinical issue that I am interested in researching is about the effects of sleep position on sudden infant death (SIDS). The CDC reports over 3000 sleep related deaths annually (CDC, n.d.). They recommend that infants remain supine while sleeping and report that prone position results in increased risk of mortality (CDC, n.d.).
PICO Question
Question: In infants, (POPULATION) what is the effect of supine position (Intervention) compared to prone position (Comparison) on the rates of Sudden Infant Death SIDS (Outcome) Discussion: Searching Databases.
P – Patient or Problem: Who is the patient? Infants
I – Intervention: What is the main intervention being considered? Sleeping Supine
C – Comparison: What is the main comparison intervention? Sleeping Prone
O – Outcome: What are the anticipated measures, improvements, or affects? Rates of SIDS
Part 2 – Data Base Searches (Two Databases)
Search terms using Boolean operators
Database used
Number of Hits
Notes on any outstanding articles, what level of evidence were found
SIDS + Sleep + Position.
CINAHL Full Text
284
Research Level II to IV.
Examples articles.
Young Mee Ahn, Kyung-moo Yang, Hong Il Ha, & Jung Ae Cho. (2020). Risk Factors for Sudden Infant Death Syndrome and Sleeping Practices in Korea. Child Health Nursing Research, 26(1), 82–89. https://doi-org.ezp.waldenulibrary.org/10.4094/chnr.2020.26.1.82
Colson ER, Stille CJ, Payton J, Bernstein B, & Dworkin P. (2000). Not yet “back to sleep”: sleep position for infants in two inner-city clinics…including commentary by Ferber R. Ambulatory Child Health, 6(4), 269–275. https://doi-org.ezp.waldenulibrary.org/10.1046/j.1467-0658.2000.00096.x
Lahr MB, Rosenberg KD, & Lapidus JA. (2005). Health departments do it better: prenatal care site and prone infant sleep position. Maternal & Child Health Journal, 9(2), 165–172. https://doi-org.ezp.waldenulibrary.org/10.1007/s10995-005-4868-4
Ostfeld BM, Perl H, Esposito L, Hempstead K, Hinnen R, Sandler A, Pearson PG, & Hegyi T. (2006). Sleep environment, positional, lifestyle, and demographic characteristics associated with bed sharing in sudden infant death syndrome cases: a population-based study. Pediatrics, 118(5), 2051–2059. https://doi-org.ezp.waldenulibrary.org/10.1542/peds.2006-0176
Sleep position +infant + mortality.
CINAHL Full Text
27
Level II-IV
Walcott, R. L., Salm Ward, T. C., Ingels, J. B., Llewellyn, N. A., Miller, T. J., & Corso, P. S. (2018). A Statewide Hospital-Based Safe Infant Sleep Initiative: Measurement of Parental Knowledge and Behavior. Journal of Community Health, 43(3), 534–542. https://doi-org.ezp.waldenulibrary.org/10.1007/s10900-017-0449-x
Senter L, Sackoff J, Landi K, & Boyd L. (2011). Studying sudden and unexpected infant deaths in a time of changing death certification and investigation practices: evaluating sleep-related risk factors for infant death in new york city. Maternal & Child Health Journal, 15(2), 242–248. https://doi-org.ezp.waldenulibrary.org/10.1007/s10995-010-0577-8
Sleep position + Infant +mortality.
Medline
51
Fleming, P., Blair, P., & Pease, A. (2017). Why or how does the prone sleep position increase the risk of unexpected and unexplained infant death? Archives of Disease in Childhood. Fetal and Neonatal Edition, 102(6), F472–F473. https://doi-org.ezp.waldenulibrary.org/10.1136/archdischild-2017-313331
Bass, J. L., Gartley, T., Lyczkowski, D. A., & Kleinman, R. (2018). Trends in the Incidence of Sudden Unexpected Infant Death in the Newborn: 1995-2014. The Journal of Pediatrics, 196, 104–108. https://doi-org.ezp.waldenulibrary.org/10.1016/j.jpeds.2017.12.045
Infant + Safe+ sleep position.
Medline
76
Level I-IV
Sobaihi, M., Banjari, M. A., & Alahmadi, T. S. (2020). Implementation of Safe Sleep Practice Recommendations for Infants in Inpatient Wards. Cureus, 12(10), e11155. https://doi-org.ezp.waldenulibrary.org/10.7759/cureus.11155
Carlin, R. F., Abrams, A., Mathews, A., Joyner, B. L., Oden, R., McCarter, R., & Moon, R. Y. (2018). The Impact of Health Messages on Maternal Decisions About Infant Sleep Position: A Randomized Controlled Trial. Journal of Community Health, 43(5), 977–985. https://doi-org.ezp.waldenulibrary.org/10.1007/s10900-018-0514-0
Discussion: Searching Databases
Strategies you might make to increase the rigor and effectiveness of a database search on your PICO(T) question. Be specific and provide examples.
One of the things I realized from this exercise is that it is a good idea start with a very general search when trying to develop a PICO question. I started over on this exercise about ¾ of the way through because I was not finding a lot of supportive research about my initial topic which was a comparison between the effect of breast and bottle feeding on SIDS. After re-writing my PICO statement I found more relevant information and the data bases yielded more results. I would consider the initial general search a keyword search (Melnyk & Fineout-Overholt, 2018). Other ways to increase the effectiveness of a search is to apply the Boolean expressions and, or, and not, to see how varying combinations impact search results (Library of Congress, n.d.). Finding the most comprehensive literature takes time and the appropriate data base and search combinations.
References
CDC (n.d.). Breastfeed your Babies to Reduce Risk of SIDS. Retrieved March 24, 2021 from
https://www.nichd.nih.gov/sites/default/files/2018-11/Breastfeed_Baby_SIDS_final.pdf
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.
Laureate Education (Producer). (2018). Evidence-based Practice and the Quadruple Aim [Video
file]. Baltimore, MD: Author.
Discussion: Searching Databases Laureate Education (Producer). (2018). Searching the Evidence [Video file]. Baltimore, MD: Author.
Melnyk, B. M., Fineout-Overholt, E., Stillwell, S. B. & Williamson, K. M. (2009). Evidence-Based Practice: Step by Step: Igniting a Spirit of Inquiry. AJN, American Journal of Nursing, 109(11), 49-52. doi: 10.1097/01.NAJ.0000363354.53883.58.
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)
Stillwell, Susan, DNP, RN, Fineout-Overholt, Ellen, PhD, RN, FNAP, FAAN, Melnyk, Bernadette, et al. (2010). Evidence-Based Practice, Step by Step: Asking the Clinical Question: A Key Step in Evidence-Based Practice. AJN, American Journal of Nursing, 110, 58-61. https://doi.org Discussion: Searching Databases
