Searching Databases

Evidence-based practice (EBP) is founded on clinical inquiry. However, researchers need to conduct clinical inquiry using a framework known as PICOT (population, Intervention, comparison, outcome and time (Melnyk & Fineout-Overholt, 2019). The clinical area of interest or topic is the high rate of readmissions for heart failure patients over 65 years after their discharge in thirty days (Boyde et al., 2018). Based on this issue, the paper develops a PICT question to address issue by establishing interventions aimed at reducing the rate of admission. Consequently, the paper develops the PICOT question:

In heart failure patient (HF) above 65 years and discharged from health facilities (P), doe

s multidisciplinary nurse-led education provision and team (I) compared to usual care (C) reduce the rate of readmission (O) within 30 days after their discharge?

Searching for evidence after formulation of PICOT question requires one to use a host of strategies and terms. In this case, the use of peer-reviewed articles is essential in generating sufficient evidence base to support the PICOT question. The terms used included “peer reviewed articles,” “heart failure,” “rate of readmission,” “within 30 days,” “nurse-led educational interventions,” “multidisciplinary team approaches,” and “patients aged over 65.”

The two search databases that I used include PubMed and CINAHL. Utilizing these databases, I entered the key terms in the search engine to generate studies that corresponded to them. The first attempt produced over 30,000 studies. However, I filtered the search based on data of publication, and excluded systematic reviews and meta-analyses (Melnyk & Fineout-Overholt, 2019). After using the search terms and other critical filters, the studies that met the criteria reduced to 20 articles. These were specific article that addressed the different interventions that can be used to tackle the issue.

One can enhance the vigor, specificity, and effectiveness of their database search by using in-built filters in the database. An example is filtering the search to only produce certain types of studies like randomized control trials (RCTs) (Seferovic et al., 2019). Further, the search also employed synonyms of search terms as well as repeating the searches to attain only relevant articles.

References

Boyde, M., Peters, R., New, N., Hwang, R., Ha, T., & Korczyk, D. (2018). Self-care educational

intervention to reduce hospitalizations in heart failure: a randomized controlled trial. European Journal of Cardiovascular Nursing, 17(2), 178-185. https://doi.org/10.1177/1474515117727740

Melnyk, B. M., & Fineout-Overholt, E. (2019). Writing a successful grant proposal to fund

research and evidence-based practice implementation projects. & Ward, R. Editor, Evidence-based practice in nursing and healthcare, 654-680.

Seferovic, P. M., Ponikowski, P., Anker, S. D., Bauersachs, J., Chioncel, O., Cleland, J. G., … &

Coats, A. J. (2019). Clinical practice update on heart failure 2019: pharmacotherapy, procedures, devices and patient management. An expert consensus meeting report of the Heart Failure Association of the European Society of Cardiology. European journal of heart failure, 21(10), 1169-1186. doi: 10.1002/ejhf.1531.

Evidence-based practice is based on clinical inquiry, integration of patient preferences, and provider’s expertise. Healthcare providers like nurses actualize the clinical inquiry through investigation using models like the PICOT question. The PICOT question is a problem-solving approach deployed in various healthcare situations to introduce changes in practice and improve the quality of care services. Catering to and meeting patient needs is critical to quality and safe care delivery. The PICOT strategy entails population, intervention, comparison, outcomes, and time required to implement changes in practice. Melnyk and Fineout-Overholt (2019) observe that the PICOT framework is the best strategy for formulating a clinical question. Researchers can collect sufficient and necessary evidence to support their proposed interventions using the PICOT framework.

The clinical issue of interest in this case is the rising rates of patient falls, especially among elderly patients in healthcare settings. Falls are a patient safety issue because of their effects on patients and the overall cost of care (Hartholt et al., 2019). According to the Centers for Disease Control and Prevention (CDC) (2023), over 36 million falls happen each year leading to more than 32,000 deaths. Again, an estimated 3 million older adults get treated in emergency departments for fall injuries each year. The CDC asserts that one in every five falls leads to a serious injury that can include broken bones or a head injury. New environment, limited number of staff, rising patient acuity, insufficient working space for nurses, and poor leadership are critical factors that contribute to patient falls among the elderly, particularly in acute care facilities (Vaishyaet al., 2020). Based on these factors, my PICOT question is on falls.

PICOT Question

Among the elderly patients (P), does hourly rounding (I) compared to routine practice (no hourly rounding) (C), reduce and prevent patient falls (O) within six months (T)?

Search Terms and Databases

Having the right search terms and accessing better databases are critical to collecting sufficient evidence on the proposed interventions to reduce patient falls in the selected health setting based on the population. In this case, the initial step was to use key search terms that included falls among the elderly, use of hourly rounding, patient safety, and quality, and statistics on elderly patient falls. The two databases that I used include PubMed and CINNAHL Complete. I also applied filters to the search. The filters include peer-reviewed, full-text, and publications within the last five years.

The initial search results produced over 2000 articles based on the terms that I used. The results included peer-reviewed articles produced within five years. Majority of the articles were related to the topic of interest, falls among elderly patients. However, the use of Boolean operators narrowed down the results as they produced about 50 articles. Boolean operators included reducing the search terms and being specific. For instance, I combined search terms with the Boolean operator “AND” and used other filters that resulted in the final articles. These articles were specific and dealt with interventions addressing the practice issue of falls.

Increasing research rigor and effectiveness of a database search on the PICOT question entails deploying in-built filters and using synonyms of the terms in repeat searches. For instance, the filtering can entail searching only for randomized controlled trials (Melnyk et al., 2019). The use of synonyms ensures the capturing of even articles having similar words or terms relevant to the practice problem in the search.

References

Centers for Disease Control and Prevention (CDC). (2023). Keep on Your Feet—Preventing

Older Adult Falls. https://www.cdc.gov/injury/features/older-adult-falls/index.html

Hartholt, K. A., Lee, R., Burns, E. R., & Van Beeck, E. F. (2019). Mortality from falls among

US adults aged 75 years or older, 2000-2016. Jama, 321(21), 2131-2133.

DOI:10.1001/jama.2019.4185

Melnyk, B. M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing &

healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer

Vaishya, R., & Vaish, A. (2020). Falls in older adults are serious. Indian Journal of orthopaedics,

54, 69-74. DOI: 10.1007/s43465-019-00037-x

Grid View

	Excellent	Good	Fair	Poor
Main Posting	45 (45%) – 50 (50%) Answers all parts of the discussion question(s) expectations with reflective critical analysis and synthesis of knowledge gained from the course readings for the module and current credible sources. Supported by at least three current, credible sources. Written clearly and concisely with no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.	40 (40%) – 44 (44%) Responds to the discussion question(s) and is reflective with critical analysis and synthesis of knowledge gained from the course readings for the module. At least 75% of post has exceptional depth and breadth. Supported by at least three credible sources. Written clearly and concisely with one or no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.	35 (35%) – 39 (39%) Responds to some of the discussion question(s). One or two criteria are not addressed or are superficially addressed. Is somewhat lacking reflection and critical analysis and synthesis. Somewhat represents knowledge gained from the course readings for the module. Post is cited with two credible sources. Written somewhat concisely; may contain more than two spelling or grammatical errors. Contains some APA formatting errors.	0 (0%) – 34 (34%) Does not respond to the discussion question(s) adequately. Lacks depth or superficially addresses criteria. Lacks reflection and critical analysis and synthesis. Does not represent knowledge gained from the course readings for the module. Contains only one or no credible sources. Not written clearly or concisely. Contains more than two spelling or grammatical errors. Does not adhere to current APA manual writing rules and style.
Main Post: Timeliness	10 (10%) – 10 (10%) Posts main post by day 3.	0 (0%) – 0 (0%)	0 (0%) – 0 (0%)	0 (0%) – 0 (0%) Does not post by day 3.
First Response	17 (17%) – 18 (18%) Response exhibits synthesis, critical thinking, and application to practice settings. Responds fully to questions posed by faculty. Provides clear, concise opinions and ideas that are supported by at least two scholarly sources. Demonstrates synthesis and understanding of learning objectives. Communication is professional and respectful to colleagues. Responses to faculty questions are fully answered, if posed. Response is effectively written in standard, edited English.	15 (15%) – 16 (16%) Response exhibits critical thinking and application to practice settings. Communication is professional and respectful to colleagues. Responses to faculty questions are answered, if posed. Provides clear, concise opinions and ideas that are supported by two or more credible sources. Response is effectively written in standard, edited English.	13 (13%) – 14 (14%) Response is on topic and may have some depth. Responses posted in the discussion may lack effective professional communication. Responses to faculty questions are somewhat answered, if posed. Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.	0 (0%) – 12 (12%) Response may not be on topic and lacks depth. Responses posted in the discussion lack effective professional communication. Responses to faculty questions are missing. No credible sources are cited.
Second Response	16 (16%) – 17 (17%) Response exhibits synthesis, critical thinking, and application to practice settings. Responds fully to questions posed by faculty. Provides clear, concise opinions and ideas that are supported by at least two scholarly sources. Demonstrates synthesis and understanding of learning objectives. Communication is professional and respectful to colleagues. Responses to faculty questions are fully answered, if posed. Response is effectively written in standard, edited English.	14 (14%) – 15 (15%) Response exhibits critical thinking and application to practice settings. Communication is professional and respectful to colleagues. Responses to faculty questions are answered, if posed. Provides clear, concise opinions and ideas that are supported by two or more credible sources. Response is effectively written in standard, edited English.	12 (12%) – 13 (13%) Response is on topic and may have some depth. Responses posted in the discussion may lack effective professional communication. Responses to faculty questions are somewhat answered, if posed. Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.	0 (0%) – 11 (11%) Response may not be on topic and lacks depth. Responses posted in the discussion lack effective professional communication. Responses to faculty questions are missing. No credible sources are cited.
Participation	5 (5%) – 5 (5%) Meets requirements for participation by posting on three different days.	0 (0%) – 0 (0%)	0 (0%) – 0 (0%)	0 (0%) – 0 (0%) Does not meet requirements for participation by posting on 3 different days.
Total Points: 100

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Lopes Write Policy

For assignments that need to be submitted to Lopes Write, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me.

Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes.

Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own?

Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score.

Late Policy

The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.

Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.

If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.

I do not accept assignments that are two or more weeks late unless we have worked out an extension.

As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.

Communication

Communication is so very important. There are multiple ways to communicate with me:

Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.

Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.

Important information for writing discussion questions and participation

Welcome to class

Hello class and welcome to the class and I will be your instructor for this course. This is a -week course and requires a lot of time commitment, organization, and a high level of dedication. Please use the class syllabus to guide you through all the assignments required for the course. I have also attached the classroom policies to this announcement to know your expectations for this course. Please review this document carefully and ask me any questions if you do. You could email me at any time or send me a message via the “message” icon in halo if you need to contact me. I check my email regularly, so you should get a response within 24 hours. If you have not heard from me within 24 hours and need to contact me urgently, please send a follow up text to

I strongly encourage that you do not wait until the very last minute to complete your assignments. Your assignments in weeks 4 and 5 require early planning as you would need to present a teaching plan and interview a community health provider. I advise you look at the requirements for these assignments at the beginning of the course and plan accordingly. I have posted the YouTube link that explains all the class assignments in detail. It is required that you watch this 32-minute video as the assignments from week 3 through 5 require that you follow the instructions to the letter to succeed. Failure to complete these assignments according to instructions might lead to a zero. After watching the video, please schedule a one-on-one with me to discuss your topic for your project by the second week of class. Use this link to schedule a 15-minute session. Please, call me at the time of your appointment on my number. Please note that I will NOT call you.

Please, be advised I do NOT accept any assignments by email. If you are having technical issues with uploading an assignment, contact the technical department and inform me of the issue. If you have any issues that would prevent you from getting your assignments to me by the deadline, please inform me to request a possible extension. Note that working fulltime or overtime is no excuse for late assignments. There is a 5%-point deduction for every day your assignment is late. This only applies to approved extensions. Late assignments will not be accepted.

If you think you would be needing accommodations due to any reasons, please contact the appropriate department to request accommodations.

Plagiarism is highly prohibited. Please ensure you are citing your sources correctly using APA 7th edition. All assignments including discussion posts should be formatted in APA with the appropriate spacing, font, margin, and indents. Any papers not well formatted would be returned back to you, hence, I advise you review APA formatting style. I have attached a sample paper in APA format and will also post sample discussion responses in subsequent announcements.

Your initial discussion post should be a minimum of 200 words and response posts should be a minimum of 150 words. Be advised that I grade based on quality and not necessarily the number of words you post. A minimum of TWO references should be used for your initial post. For your response post, you do not need references as personal experiences would count as response posts. If you however cite anything from the literature for your response post, it is required that you cite your reference. You should include a minimum of THREE references for papers in this course. Please note that references should be no more than 5 years old except recommended as a resource for the class. Furthermore, for each discussion board question, you need ONE initial substantive response and TWO substantive responses to either your classmates or your instructor for a total of THREE responses. There are TWO discussion questions each week, hence, you need a total minimum of SIX discussion posts for each week. I usually post a discussion question each week. You could also respond to these as it would count towards your required SIX discussion posts for the week.

I understand this is a lot of information to cover in 5 weeks, however, the Bible says in Philippians 4:13 that we can do all things through Christ that strengthens us. Even in times like this, we are encouraged by God’s word that we have that ability in us to succeed with His strength. I pray that each and every one of you receives strength for this course and life generally as we navigate through this pandemic that is shaking our world today. Relax and enjoy the course!

Hi Class,

Please read through the following information on writing a Discussion question response and participation posts.

Contact me if you have any questions.

Important information on Writing a Discussion Question

Your response needs to be a minimum of 150 words (not including your list of references)
There needs to be at least TWO references with ONE being a peer reviewed professional journal article.
Include in-text citations in your response
Do not include quotes—instead summarize and paraphrase the information
Follow APA-7th edition
Points will be deducted if the above is not followed

Participation –replies to your classmates or instructor

A minimum of 6 responses per week, on at least 3 days of the week.
Each response needs at least ONE reference with citations—best if it is a peer reviewed journal article
Each response needs to be at least 75 words in length (does not include your list of references)
Responses need to be substantive by bringing information to the discussion or further enhance the discussion. Responses of “I agree” or “great post” does not count for the word count.
Follow APA 7th edition
Points will be deducted if the above is not followed
Remember to use and follow APA-7th edition for all weekly assignments, discussion questions, and participation points.
Here are some helpful links
Student paper example
Citing Sources
The Writing Center is a great resource