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.
Resources Provided
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.
Library of Congress. (n.d.). Search/browse help – Boolean operators and nesting. Retrieved September 19, 2018, from https://catalog.loc.gov/vwebv/ui/en_US/htdocs/help/searchBoolean.html
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.
Walden University Library. (n.d.-a). Databases A-Z: Nursing. Retrieved September 6, 2019, from https://academicguides.waldenu.edu/az.php?s=19981
Walden University Library. (n.d.-c). Evidence-based practice research: CINAHL search help. Retrieved September 6, 2019, from https://academicguides.waldenu.edu/library/healthevidence/cinahlsearchhelp
Walden University Library. (n.d.-d). Evidence-based practice research: Joanna Briggs Institute search help. Retrieved September 6, 2019, from https://academicguides.waldenu.edu/library/healthevidence/jbisearchhelp
Walden University Library. (n.d.-e). Evidence-based practice research: MEDLINE search help. Retrieved September 6, 2019, from https://academicguides.waldenu.edu/library/healthevidence/medlinesearchhelp
Walden University Library. (n.d.-f). Keyword searching: Finding articles on your topic: Boolean terms. Retrieved September 19, 2018, from http://academicguides.waldenu.edu/library/keyword/boolean
Walden University Library. (n.d.-g). Keyword searching: Finding articles on your topic: Introduction to keyword searching. Retrieved September 19, 2018, from http://academicguides.waldenu.edu/library/keyword/searching-basics
Walden University Library. (n.d.-h). Quick Answers: How do I find a systematic review article related to health, medicine, or nursing? Retrieved September 6, 2019, from https://academicanswers.waldenu.edu/faq/72670
Walden University Library. (n.d.-i). Systematic review. Retrieved January 22, 2020, from https://academicguides.waldenu.edu/library/healthevidence/types#s-lg-box-1520654
Answer Rubric
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 peer-reviewed articles you selected. · 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.
Written Expression and Formatting—Paragraph Development and Organization:
Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction is provided, which delineates all required criteria.
Written Expression and Formatting—English Writing Standards:
Correct grammar, mechanics, and proper punctuation.
Title of Project
(should be the same topic you have been working on this term)
Name and Date
create an 6-7 slide power point
Slide one
Description of Clinical Issue of Interest
Central lines are essential for purposes such as monitoring hemodynamic instability, delivering total parenteral nutrition, and administering renal replacement therapy (Yu, Lu, Meng, Zhao, & Zheng, 2017).
Central line-associated bloodstream infections (CLABSIs) account for one-third of healthcare-associated infections (HAIs) and have a mortality rate between 12% to 25% (Woodward & Umberger, 2016).
Longer hospitalizations, increased hospital costs, poor patient outcomes, and increased mortality are negative issues associated with CLABSIs (Storey et al.,
Public reporting of CLABSIs are mandatory and negatively affect Medicare reimbursement (Woodward & Umberger, 2016).
By implementing evidence-based practices such as daily chlorhexidine (CHG) baths, nurses are successfully lowering CLABSI rates in hospitals across the United States (Frost et al., 2018; Woodward & Umberger, 2016).
Identify and briefly describe your chosen clinical issue of interest.
Remember same topic as you have been using all along
2
Example
2
Slide 2
PICOT question
In acute care hospitalized patients, what is the effect of using daily chlorhexidine (CHG) bathing on patients with central lines compared to patients with central lines not receiving daily CHG bathing on CLABSI rates?
Describe how you developed a PICO(T) question focused on your chosen clinical issue of interest
3
Example
Debbie D. Sullivan (DDS) –
Slide 4
Cochrane Review
From the website https://www.cochrane.org/about-us
To produce high-quality, relevant, up-to-date systematic reviews and other synthesized research evidence to inform health decision making
Joanna Briggs (JBI)
From the website:https://joannabriggs.org/about-jbi
JBI develops and delivers unique evidence-based information, software, education and training designed to improve healthcare practice and health outcomes.
CINAHL Plus with Full Text
Provides access to allied health topics and nursing-related literature through electronic books and journals (Walden University Library, n.d.).
Turning Research Into Practice (TRIP) Database
A database capable of locating evidence-based synopses, systematic reviews, tools, clinical answers, and guidelines (Walden University Library, n.d.).
.
4
Identify the four research databases that you used to conduct your search for the peer-reviewed articles you selected.
Example of databases
remember these are filtered databases where you are looking for higher level evidence, for example Cochrane Review or Joanna Briggs
Slide 5
Provide APA citations of the four peer-reviewed articles you selected. Remember these at the systematic-reviews level related to your research question.
5
Example-Remember they should be at the systematic-reviews level related to your research question.
Slide 6
The following use the Johns Hopkins Levels of Evidence
The article by Afonso, Blot, K., and Blot, S. (2016) uses Level I evidence to review four previous research projects by experts to analyze the effects of CHG washcloths on decreasing the rate of CLABSIs on intensive care unit (ICU) patients.
The article by Frost et al. (2018) is a systemic review analyzing Level I evidence by experts to randomly determine the effects of CHG bathing on hospitalized patients.
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.
6
Example
Slide 10
References
Be sure to provide APA citations of the supporting evidence-based peer reviewed articles you selected to support your thinking.
7
My Instructor’s advice
As I was reviewing discussion posts from last week, I noticed that some of you are struggling with identifying the components of your PICOT question. You can find detailed information in your Melnyk & Fineout-Overholt (2019) textbook, pages 34-52, I will summarize below the steps that you can take to develop your question. Some of you have already worked through this process either through this structure process or worked it out in other ways.
1. Background questions
1. You will identify a problem that you see in your nursing practice. Perhaps you are seeing new nurses leave after 6 months. Maybe you are seeing patient satisfaction scores dip or patients have expressed that they feel they are not being listened to. Another issue you may have seen is that CLABSI rates in your unit are higher than they should be.
2. To start off with, you will ask background questions, usually the answers to these type of questions can be answered in a textbook or a Google search.
3. Example 1: What is the best approach to nurse retention?
4. Example 2: How does a clinical decision support system (CDSS) help clinicians provide best care?
5. Example 3: What are better ways to avoid CLABSI
2. Foreground questions
1. Once you have explored your background questions and found some answers, you will formulate some foreground questions and do some research in the library to find research related to you topic.
2. Example 1: In newly graduated licensed nurses, how does a nurse residency program compared with traditional precepted orientation affect retention rates after 1 year?
3. Example 2: In acute care clinicians, how does an electronic health record (EHR) with a CDSS compared with an EHR without a CDSS affect a clinician’s adheranceto clinical pathway choices, documentation or care, and completions of documentation within his or her given shift?
4. Example 3: In critical care patients, what is the effect of using alcohol-impregnated disinfection caps compared to current practice of standard cleaning protocol, which involves scrubbing the catheter hub with an alcohol disinfectant wipe prior to accessing the lines on rates of CLABSI?
3. Once you have explored reviewing articles related to you your foreground questions.
1. Develop a PICOT question and find higher level articles that help you answer the question.
4. After finding supporting evidence, which should reveal a nursing practice that is evidence based.
1. In answer to you PICOT question what is the nursing practice that your would recommend
1. this could be a change in practice or that the current practice is appropriate
I look forward to reviewing your power points this week.
Another question has been about how identify levels of evidence.
· First to identify the type of article refer to this previously posted document Category of articles.docx
· As far as identifying levels of evidence, I would first mention that there are many versions of what is included in the levels. For example, you textbook uses a Levels of evidence from Melynk and Fineout-Overholt, 2019.docx , the library uses another version https://academicguides.waldenu.edu/library/healthevidence/evidencepyramid (the library link will provide more guidance on identifying the level), but this course uses the Johns Hopkins version as copied below and attached here Level of evidence.docx . Which ever version you use, be sure to cite the source. When you do your next matrix you will use the Johns Hopkins version, so I would suggest you go ahead and start using it.
Evidence Levels:
• Level I
Experimental, randomized controlled trial (RCT), systematic review RTCs with or without meta-analysis
• Level II
Quasi-experimental studies, systematic review of a combination of RCTs and quasi-experimental studies, or quasi-experimental studies only, with or without meta-analysis
• Level III
Nonexperimental, systematic review of RCTs, quasi-experimental with/without meta-analysis, qualitative, qualitative systematic review with/without meta-synthesis
• Level IV
Respected authorities’ opinions, nationally recognized expert committee/consensus panel reports based on scientific evidence
• Level V
Literature reviews, quality improvement, program evaluation, financial evaluation, case reports, nationally recognized expert(s) opinion based on experiential evidence
