Clinical inquiry is a demand in all aspects of nursing..
Clinical inquiry is a demand in all aspects of nursing.
Respond to Erica and Cody. Respond to at least two of your colleagues on two different days and provide further suggestions on how their database search might be improved.
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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.