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:
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.
Note: To access this module’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.
Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer.
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.
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.
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.
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
Laureate Education (Producer). (2018). Searching the Evidence [Video file]. Baltimore, MD: Author.
PICO(T) Question: In healthcare settings (P), does implementing a comprehensive hand hygiene program (I) compared to standard hand hygiene practices (C) reduce the incidence of nosocomial infections (O) within 12 months (T)?
I searched two different databases, PubMed and CINAHL, using the keywords infection control, hand hygiene, hand washing, hand sanitization, and nosocomial infections. In PubMed, the initial search was with the keyword infection control and yielded 1,200 results. Adding the keyword hand hygiene narrowed it down to 500 results. Further refining the search with nosocomial infections resulted in 150 articles.
Using Boolean operators (AND, OR) to combine these keywords helped to focus the search on relevant articles. On using CINAHL, an initial search with the keyword infection control yielded 800 results. Adding the keyword hand hygiene narrowed it down to 300 results. Further refining the search with nosocomial infections resulted in 100 articles. Similar to PubMed, using Boolean operators (AND, OR) was beneficial in refining the search.
Strategies to increase the rigor and effectiveness of the database search include the use of boolean operators (AND, OR) effectively to combine keywords and phrases, ensuring that the search results are both relevant and comprehensive. For instance, combining hand hygiene AND nosocomial infections ensured that articles addressed both aspects of the clinical issue. Additionally, exploring the use of subject headings (e.g., MeSH terms in PubMed) to refine the search helps identify articles that may not contain the exact keywords but are still relevant to the topic (Ho et al., 2020).
It is also important to utilize database filters to limit search results to specific publication types (for example, clinical trials and randomized controlled trials) to focus on original research studies rather than reviews or commentaries (Ho et al., 2020). Others include adjusting the date range to ensure that the search results include the most recent studies, ensuring that the selected articles are published in reputable, peer-reviewed journals to maintain the quality and validity of the research, and keeping a detailed record of the search process, including the keywords used, the number of results at each stage, and the inclusion or exclusion criteria applied (Bramer et al., 2019). This documentation will assist in tracking the search’s rigor and effectiveness.
Bramer, W. M., De Jonge, G. B., Rethlefsen, M. L., Mast, F., & Kleijnen, J. (2019). A systematic approach to searching: an efficient and complete method to develop literature searches. Journal of the Medical Library Association: JMLA, 106(4), 531. https://doi.org/10.5195/jmla.2018.283
Ho, G. J., Liew, S. M., Ng, C. J., Hisham Shunmugam, R., & Glasziou, P. (2020). Development of a search strategy for an evidence based retrieval service. PloS One, 11(12), e0167170. https://doi.org/10.1371/journal.pone.0167170
As healthcare providers progress with practice, the rise of clinical inquiry is inevitable, given the different clinical issues they face. According to Anvari et al. (2023), healthcare providers are also expected to identify best practices from research evidence apart from only using common practice.
Therefore, it is essential to beware of searching databases and how to maximize searches to ensure that the search results contain the required information on best practices related to the clinical issue. This discussion explores the clinical issue of using psychotherapy for depression, the PICOT question developed from the clinical issue, and the search results while using the PICOT question formula to search databases.
The selected clinical issue of interest is the effectiveness of psychotherapy, specifically the use of the group therapy approach in treating depression among adolescents. Depression, also known as major depressive disorder, is one of the most common mental illnesses affecting individuals of all ages and health populations (Oberste et al., 2020).
Different patients respond to depression treatment approaches differently (Bernaras et al., 2019). In addition, there are different treatment interventions and approaches for treating depression. Although the effectiveness of most of them is backed up by research and clinical trial evidence, it raises a clinical issue of which intervention or approach is best for use in treating specific patient populations (Fava et al., 2020).
The developed PICOT question is; Among youths and adolescents diagnosed with depression, is group therapy more effective in achieving symptom remission within three months compared to individual therapy? From this PICOT question, the selected key terms used in the search include depression, therapy, and adolescents.
The key phrases included “group therapy in treating depression among adolescents” and “comparison of group and individual therapy effectiveness in treating adolescents with depression.” I accessed the google scholar search engine from the library and used it to search and locate resources from different databases.
On the first search attempt using the keywords, the results entailed over 2.5 million articles, which were returned in 0.03 seconds. The search results entailed any relevant article, regardless of the year of publication. The articles were mixed, including original research articles, systematic reviews, and meta-analyses.
The huge amount of search results is because the results included all the articles that had any of the keywords in the search. However, I continued to refine the search by developing complete key phrases and adding the Boolean operator “AND” to the key terms. The search results were narrowed down to produce fewer and more direct articles. Most of the articles included in these results were mainly original articles with the key phrases as the major focus.
The strategies I can make to increase the rigor and effectiveness of a database search on my PICO(T) question include searching one key phrase at a time, customizing my search to produce more direct results, and focusing on different parts of the PICOT question at a time. For example, when searching one key phrase at a time, I would divide the PICOT question into; group therapy effectiveness and therapies for treating depression among adolescents.
I would also customize my search settings to produce the most relevant results from a specific timeline, like the last 5 or 10 years. Finally, I can focus on different parts of the PICOT per search by searching the intervention, comparison, and outcomes separately. For example, the search would read “comparison of group and individual therapy in depression treatment.”
Anvari, S., Neumark, S., Jangra, R., Sandre, A., Pasumarthi, K., & Xenodemetropoulos, T. (2023). Best practices for the provision of virtual care: a systematic review of current guidelines. Telemedicine and e-Health, 29(1), 3–22. https://doi.org/10.1089/tmj.2022.0004
Bernaras, E., Jaureguizar, J., & Garaigordobil, M. (2019). Child and adolescent depression: A review of theories, evaluation instruments, prevention programs, and treatments. Frontiers in Psychology, 10, 543. https://doi.org/10.3389/fpsyg.2019.00543
Fava, G. A., Cosci, F., Guidi, J., & Rafanelli, C. (2020). The Deceptive Manifestations of Treatment Resistance in Depression: A New Look at the Problem. Psychotherapy and Psychosomatics, 89(5), 265–273. https://doi.org/10.1159/000507227
Oberste, M., Medele, M., Javelle, F., Lioba Wunram, H., Walter, D., Bloch, W., Bender, S., Fricke, O., Joisten, N., Walzik, D., Großheinrich, N., & Zimmer, P. (2020). Physical Activity for the Treatment of Adolescent Depression: A Systematic Review and Meta-Analysis. Frontiers in Physiology, 11, 185. https://doi.org/10.3389/fphys.2020.00185
Also Read: NURS 6052 Discussion: Where in the World Is Evidence-Based Practice?
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