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While there may be no bad questions, there is a way to format questions that can give you the best answer. Davies (2011) stated that questions are essential in cultivating a culture of evidence-based practice (EBP). Formatting a question to reduce the time and effort it takes to locate useful information is a skill that takes practice and requires reflection (Davies, 2011). This discussion will describe the PICO(T) question format and how to search databases using the terms within the question effectively.
The spirit of inquiry is what drives EBP. Stillwell, Fineout-Overholt, Melnyk, and Williamson (2010) reported asking clear, formatted questions leads to improved patient outcomes. An example of this is I noticed a lot of clients seen in the clinic said their mental health declining after a car accident. These accidents ranged in severity, but none had any long-lasting physical limitations. From this curious observation, I reflect on my question and then develop a PICO(T) formatted inquiry. Are adults who have been in minor car accidents more prone to developing a mental illness? Is undiagnosed posttraumatic stress disorder (PTSD) leading to increased diagnoses of depression and anxiety? Is PTSD overlooked in patients without significant injuries? Would treating the underlying PTSD make a difference in patient outcomes? Would a quicker diagnosis of PTSD improve patient outcomes and lead to less compounded mental illnesses such as PTSD with depression and anxiety? Would referring patients to a psychiatric provider following a possibly traumatic event for early intervention improve outcomes? Are patients willing to see a psychiatric provider before their mental health is causing prominent life disturbances?
P: Do adults with PTSD who
I: have received early intervention
C: compared to those who put off treatment until comorbid depression and anxiety surface
O: have more positive outcomes?
T: (I didn’t add a time-frame limitation to generate more results)
The spirit of inquiry is intertwined with the process of using informatics to gain wisdom. When one question is answered, many more are ignited because of the new information. It becomes a circular process and requires evaluation to draw relevant conclusions and continue the state of curiosity seeking knowledge. For example, how can I bring awareness of this issue to providers who would most likely be in contact with a patient who has just suffered a traumatic event? How can I bring awareness to the public about the importance of early intervention and the benefits of following through on psychiatric referrals? The Institute of Medicine would like 90% of all healthcare decisions to be made using EBP (Melnyk, Fineout-Overholt, Stillwell, & Williamson, 2009). Empowering nurses to seek knowledge and critically analyze research to inform decisions is vital for this goal to be reached.
I chose to search the Cumulative Index to Nursing & Allied Health Literature (CINAHL) Plus with Full Text and Joanna Briggs Institute (JBI) databases to explore my inquiry. I brainstormed a list of possible search words and came up with adults, posttraumatic stress disorder, PTSD, early intervention, early treatment, comorbid depression and anxiety, and depression and anxiety. I began my search on CINAHL with PTSD using the Boolean operators AND early intervention AND depression AND/OR anxiety. This gave me 25 results. Then I put in the limitations of full text, peer-reviewed articles, and publications within the last five years. This narrowed the search to 13 results. Walden University Library (n.d.) recommended using systematic reviews and evidence summaries to find the most beneficial research regarding changing practice based on evidence. CINAHL didn’t have the option of evidence summaries, so I chose systematic reviews. This narrowed my search to three. All three were very relevant and applicable to my inquiry. Then I changed my search terms to PTSD OR posttraumatic stress disorder OR post-traumatic stress disorder OR post traumatic stress disorder, AND early intervention OR early detection OR early diagnosis, AND depression OR depressive symptoms OR depressive disorder OR major depressive disorder OR anxiety. This gave me five results, which surprised me because I thought I would get more with that many Boolean operators. If I leave those search terms and take out the parameter of systematic reviews, I can peruse 66 publications.
The second database I wanted to search was JBI. I have never used this database before, or even heard of it, so I was excited to check it out. Using the same search that retrieved 66 articles from CINAHL, I was able to get only six results on JBI. When I narrowed the parameters to publications within the last five years and only searched the keyword PTSD, I got 43 results. No articles on JBI were exactly what I was looking for, but they did have some useful information regarding EBP and PTSD. I like that this database specializes in providing EBP research. If I were to continue my search, I would be sure to utilize a few other nursing databases, such as MEDLINE, PubMed, ScienceDirect, and Cochrane, to get more relevant results for my PICO question.
Formatting nursing questions in a way that will help facilitate efficient search results is a skill that requires practice. One strategy that I use often is looking at the subject lines in the search results I am browsing. I can get ideas of other wording and related concepts that might be useful to add to my keywords and broaden or focus my search results. While I like to use the Boolean operators AND and OR, I don’t usually use the operator NOT unless I am consistently running into a topic in my search results that I don’t want to explore. Using an asterisk at the end of a word, so the search picks up all variations of that word, is another strategy I use often. The example I used in this discussion was nurs*, which would search for nurse, nursing, nurses, etc. Separating the major concepts from the clinical inquiry, searching several databases, and using multiple search techniques is crucial to find the best publications to inform healthcare changes in practice.
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. doi: 10.18438/B8WS5N
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. American Journal of Nursing, 110(3), 58-61. doi: 10.1097/01.NAJ.0000368959 .11129.79
Walden University Library. (n.d.). Evidence-based practice research: Joanna Briggs Institute
Discussion – Week 4
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Clinical inquiry is a demand in all aspects of nursing. The basis of these inquiries is the driving factor that sets forth the constant improvement and betterment of our profession. At the basis utilizing evidence-based practice (EBP) and proper research helps to perform that. Performing these searches can be challenging and hard to navigate through the research process. The push for EBP in the world of healthcare is now more prevalent then ever. The Institute of Medicine would like 90% of all healthcare decisions to be made using EBP (Melnyk, Fineout-Overholt, Stillwell, & Williamson, 2009). With the introduction of the internet it is readily and easily accessible. (Laureate Education Producer, 2018). Using One way to perform these searching is using the PICOT method.
PICOT format (i.e., P: population of interest; I: intervention or issue of interest; C: comparison of interest; O: outcome expected; and T: time for the intervention to achieve the outcome) is the best approach to developing a research question (Melnyk & Fineout-Overholt, 2018). Using this technique when combined with proper searching of clinical information online is key factor to understanding and finding quality research. One must question research to ensure it authentication and it purposeful and make it improve our clinical practice. Questions are essential in cultivating a culture of evidence-based practice (EBP) (Davies, 2011). Formatting a question to reduce the time and effort it takes to locate useful information is a skill that takes practice and requires reflection (Davies, 2011). As mentioned above we will explore the PICOT method utilization.
In the world of surgery there are many opportunities to use this method. At one of the jobs I work at is surgical services. One of the procedures we perform at least 3 days a week are total joint replacements (TJR). One inquiry we could focus on is the development of post-operative infections versus those that have not from a TJR. So, our question purposed, what is percentage of those who have developed versus those that did not develop post-operative infection by the third postoperative appointment at week 6? Now the third appointment was chosen as this is the process that our orthopedic surgeons follow.
P- Patients undergoing TJR
I-Post-operative infection acquired
C- Those that did not develop an infection
O- Length of recover
T- By the third appointment
When searching my first database was ProQuest Nursing & Allied Health Database, initially it yielded 6125 results using post-operative infection rate and TJR. I changed up my limits to full text and peer-reviewed. This was a decent search site, but I probably would not use it again. I then used the CINAHL Plus with Full Text using the same pattern as above. This generated 7 results using full text reviews. When changing to peer-reviewed it showed 10 results. I have used this site many times in the past for research and papers. It is a great resource.
If the world of searching for research, it can be difficult to navigate. Learning how to review research effectively and purposefully can change the results you get and give you adequate quality resource and research that can be applied to improve the practice. Once you learn how to separate the content it can shape the outcome of the results and the EBP we use to utilize to move and enhance the industry. As mentioned above EBP is the focus of the world of healthcare and knowing the best and most effective ways to utilize this will make the process of finding the information easier.
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. Retrieved from
Laureate Education (Producer). (2018). Searching the Evidence [Video file]. Baltimore, MD:
Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare:
A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer.
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. Retrieved from