My PICO subject involves post-operative pain management using a numerical pain scale over the use of the Critical Care Pain Assessment Tool ( CPOT) to minimize opioid use. My question is will the implementation of a collective assessment approach in acute care nursing at the PACU, containing the Critical Care Pain Observation Tool (CPOT) and comparative pain score, decrease post-operative use of narcotics compared to the comparative pain scale alone? NURS 6052 Discussion: Searching Databases Assignment
I selection of search terms used to get posts, feedback and other information are as follows: Terms of research analgesia, post-operative analgesia, preventive analgesia, non-opioid, pain, post-operative, fentanyl, multimodal treatment, preoperative nursing, analgesia, vital signs, pain effect, pain scale, postoperative pain, preoperative care, surgical procedures, surgical treatment, and pain management.
I started using the Walden library but I still haven’t received any search returns even with all the parameters remaining. I started using Google Scholar which I am pretty familiar with. I started searching for only the top three of Meta-Analysis, Systematic Reviews, and Critically Appraised Topics in the hierarchy because these are the three most reliable results and three of the four that can be filtered. My three top search topics got the following: On the subject of (The criteria is the search sentence and the type of review method) Analgesia-(Meta-Analysis- 166,000). (Systematic Reviews-267,000), Topic Critically Assessed-13,500) Primary Care Pain Assessment Method -(Meta Research-120,000), (Systematic Reviews-235,000), (Topic Objectively Appraised-19,000) Multi-model Pain Treatment-(Meta-Analysis-46,300), (Systemic-Reviews-57,500). (Topics Critically Appraised-4,030).
The reason I searched for only three types of review methods is that they contain the most reliable information that my PICO question needs to be answered with the greatest precision. Depending on the type of research that I am doing, it depends on where I look for the information from the evidence hierarchy. I look more towards the Meta-Analysis if I am looking for statistical evidence. I have taken a closer look at the Systemic Reviews that fit my pre-specified eligibility criteria. The most useful ones in my view are the Critically Appraised Topics, as they are brief summaries of findings that may be close to my area of concern as they concentrate on a particular issue (Polit, D.F., & Beck, C. T., 2017).
Some of the information I found was that the result of one meta analyst outcomes indicated the CPOT’s reliability and validity was acceptable. “Strong intra-class correlations varying from 0.74 to 0.91supported the inter-rater reliability. Significant associations between CPOT scores and both FLACC 0.87-0.92 and pain intensity Numeric Rating Scale Score 0.50-0.69 were found for criterion-related validity” (Buttes, et al., 2015). A key point to my question has been that a comprehensive, multimodel analgesic regimen will not only provide the most complete control of pain but will also minimize the need for opioids and thus reduce the resulting side effects. (Carlson, R.H., 2015).
References
Buttes, P., Keal, G., Cronin, S. N., Stocks, L., & Stout, C. (2015). Validation of the Critical-Care Pain Observation Tool in Adult Critically Ill Patients. Dimensions of Critical Care Nursing,33(2), 78-81. doi:10.1097/dcc.0000000000000021
Carlson, R. H. (2015). Multimodal Pain Management Minimizes Need for Opioids. Oncology Times,37(9), 36-37. doi:10.1097/01.cot.0000465759.66907.be
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.
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 materials offering guidance on using databases, performing keyword searches, and developing PICO(T) questions provided in the Resources.
- Review the Resources for guidance and develop a PICO(T) question of interest to you for further study.
By Day 3 of Week 4
Post your PICO(T) question, the search terms used, and the names of at least two databases used for your PICO(T) question. Then, 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.
Grading Criteria
To access your rubric:
Week 4 Discussion Rubric
Post by Day 3 and Respond by Day 6 of Week 4
To participate in this Discussion:
Week 4 Discussion
PICO(T) is a mnemonic used to describe the four elements of a good clinical question. It stands for Patient/Problem, Intervention, Comparison, Outcome. Many people find that it helps them clarify their question, which in turn makes it easier to find an answer (Cooke, Smith, & Booth, 2012). My PICO(T) question is, In hospitalized inpatient psychiatric patients (P), how does forcing medication (I), compare with not forcing medication (C), effect quality of care (O), during the duration of the inpatient admission (T). A well-built PICOT question increases the likelihood that the best evidence to inform practice will be found quickly and efficiently (Stillwell, Fineout-Overholt, Melnyk, & Williamson, 2010). My original search yielded no results in any database.
I had to reduce my search terms quite a bit to yield a result of 57 articles. Not many were very relevant however one such article, Forced medication in psychiatric care: Patient experiences and nurse perceptions, was adequately related to my original question. My search terms were, psychiatric patients forced medication care. I searched the databases EBSCO and CINAHL, both retrieved from the Walden University library.
Cooke, A., Smith, D., & Booth, A. (2012). Beyond PICO: The SPIDER tool for qualitative evidence synthesis. Qualitative Health Research, 22(10), 1435-1443. doi:10.1177/1049732312452938
Haglund, K., Von Knorring, L., & Von Essen, L. (2003). Forced medication in psychiatric care: Patient experiences and nurse perceptions. Journal of Psychiatric and Mental Health Nursing, 10(1), 65–72. https://doi-org.ezp.waldenulibrary.org/10.1046/j.1365-2850.2003.00555.x
Stillwell, S. B., Fineout-Overholt, E., Melnyk, B. M., & Williamson, K. M. (2010). Asking the clinical question: a key step in evidence based practice. A successful search strategy starts with a well-formulated question. American Journal of Nursing, 3, 58.
Walden University Library. (2020). Keyword searching: Finding articles on your topic: Boolean terms. Retrieved from http://academicguides.waldenu.edu/library/keyword/boolean
Just as with searching for a new car, I wanted to develop a PICO(T) question and perform research that is meaningful not only to my future but also that resonates with some of my previous areas of experience. I of course want my research to be meaningful and evidenced-based.
I have worked with the adolescent psychiatric population ages 5-17 in outpatient and level one hospitals. There have been many interventions carried out with great success and others with very limited positive outcomes. I have transformed my clinical inquiry into a searchable question in order to search electronic databases step by step with efficiency which is as follows (Stillwell, Fineout-Overholt, Melnyk, Williamson (2010):
In Attention Deficit Hyperactive Disorder (ADHD) (Problem), how does diet (Intervention) compared to other treatments (Comparison) affect behavior and quality of life (Outcome) within the youth population (Time-Frame).
This will assist to develop and examine successful strategies that may increase the rigor and effectiveness of the most current evidence-based research. Specific examples include accessing search engines such as the Walden Library, Ebsco, and other scientifically reputable sites in order to get the most credible and value-rich material for evidenced-based research that I am looking for.
References
MD Anderson Library. (2020). Research guides: Evidence-based medicine: Searching techniques. MD Anderson Library Center. https://mdanderson.libguides.com/c.php?g=249812&p=2314759
Stillwell, S. B., Fineout-Overholt, E., Melnyk, B., & Williamson, K. M. (2010). Evidence-based practice, step by step: Asking the clinical question. AJN, American Journal of Nursing, 110(3), 58–61. https://doi.org/10.1097/01.naj.0000368959.11129.79
Walden University Library. (n.d.). Databases A-Z: Nursing. Retrieved October 4, 2019, from https://academicguides.waldenu.edu/az.php?s=19981