Cardiac mechanical circulatory support technology can extend patients’ lives and end-of-life and goals of care discussions should be ongoing. Is there a process that can be implemented by the multidisciplinary team that can improve the dying experience in this subset of critically ill patients?
The search for evidence to address a clinical issue is both a rewarding and daunting experience. Finding evidence that can improve patient outcomes and work environments is exciting. At the same time the shear mass of evidence that is uncovered leads to bewilderment on what exactly needs to be changed to reach the goal of best practice. As I search for evidence to support a practice change in my facility, I need to focus on a clear question and work toward answering that question with the evidence I find.
What is Working?
I have delved into the Walden library on previous occasions and am familiar with the search engines therein. The CIHNAHL and Medline combined search engine tends to be my favorite as it is easy to use and results in a myriad of relevant articles. Boolean operators and specific search parameters have enabled me to pin down articles that best fit my critical question of “How can incident reporting systems be used to create a stronger culture of patient safety within the hospital setting?” By searching Culture of safety and incident reporting, I was able to find a plethora of appropriate articles. I have been able to further whittle the results down by clarifying parameters to include only peer reviewed articles published since 2018. Reading the summaries of the resulting studies has allowed me to find articles most suited to answer my question.
Challenges and Concerns
The challenge I am facing is in reading those articles with a critical eye on how this information can be utilized to change the safety culture of my facility. Is this article relevant to the needs of and resources available to my hospital? I am also plagued with the doubt that I am not asking the right question. When I was presented with this clinical, I only had a vague idea of what was needed. As I have conducted my literature search, I have come across so much information that it is hard to find a focus. Do I concentrate on educational methods to overcome the barriers to incident reporting or is it better to focus on providing timely responses to reported incidents? Ultimately, to find my aim, I need to consult with management. They can help steer me in the direction that will yield the needed results.
Conclusion
Overall, I feel that the research is going well. I have found many articles and studies that will help with a practice change proposal. Once I am able to focus the goal of my search, I am confident that I will be able to make a positive change in my facility’s safety of patient culture.
Literature Search Experience
While I haven’t decided on the final details of my project clinical question, I have an idea of what topic I’d like to explore. I started my literature search by breaking down my search topics into smaller, less specific categories and then looking for common themes among the articles I found. I used the strategy discussed by Dang & Dearholt by using “searchable keywords from the answerable EBP question” to help focus on the core components of the question (Dang & Dearholt, 2018). After pulling a number of articles, I began scanning them for quality and pertinent information. As recommended by Westlake in “Practical Tips for Literature Synthesis”, I used a word document to track my search and subject topics and then linked the journal article under each database used (Westlake, 2012). While I didn’t do any searches under specific databases, I wanted to be able to track back where the article was obtained. I found this very helpful as I began my search because it became a bit overwhelming. As I continue my search, I will likely need to further explore specific databases such as CINAHL and PubMed for primary sources from nurses’ perspective. One of the challenges I am facing is finding literature that is published within five years. There is an abundance of literature outside of that time window that would be helpful but I know I need to focus on current evidence.
References
Chapter 4: The practice question. (2018). In Dang, D., & Dearholt, S. L. (Eds.), Johns Hopkins nursing evidence-based practice: Model and guidelines (3rd ed., pp. 63–78). Sigma Theta Tau International.
Walden University Writing Center. (n.d.). Synthesizing your sources. https://academicguides.waldenu.edu/writingcenter/assignments/literaturereview/synthesizing
Westlake, C. (2012). Practical tips for literature synthesis. Clinical Nurse Specialist, 26(5), 244–249. https://doi.org/10.1097/NUR.0b013e318263d766
I like your suggestion of tracking your subject topics, and although you mention that you haven’t search other databases yet, I think this tip will help you even more as you expand that search. Perhaps once you find the terms that are giving you the most relevant articles back, you can search the other search engines and narrow the time window to the past 5 years to find your most reliable sources. It is a challenge to balance the most relevant with the most current research but doing so will help steer your project in the right direction.. Thank you for sharing your experience with us!
Scholarly databases, such as CINAHL Complete and Cochrane Library, are reliable databases to access research articles to support evidence-based practice proposals. CINAHL (Cumulative Index to Nursing and Allied Health Literature) provides top nursing and allied health literature which includes nursing journals, and publications from nursing organizations such as the National League for Nursing and the American Nurses Association. Through CINAHL you can also access health care books, nursing dissertations, conference proceedings and standards of practice. Research and clinical trials are available as well (EBSCO, 2019). The Cochrane Library is a collection of databases that includes high-quality, independent evidence to inform healthcare decision-making. It has databases of systematic reviews, a register of controlled trials, and clinical answers, the latter which provides clinically focused information in an easy to understand format providing a clinical question, a short answer and data for the outcomes from the most relevant research (Schultz, 2017).
References
EBSCO. (2019). CINAHL Database. EBSCO Health: https://health.ebsco.com/products/the-cinahl-database
Schultz, M. (2017). Comparing test searches in PubMed and Google Scholar. Journal of the Medical Library Association, 95(4), 442-445. doi:https://dx.doi.org/10.3163%2F1536-5050.95.4.442Links to an external site.
