NR449 Evidence-Based Practice Search Strategy Guidelines Essay

NR449 Evidence-Based Practice Search Strategy Guidelines Essay

NR449 Evidence-Based Practice Search Strategy Guidelines Essay

Clinical Question

Complications of prolonged length of hospital stay (PLOS) are the identified problem focus for the group. Length of hospital stay refers to the period from admission to discharge. Although there is no constant cutoff point for PLOS, it is described as the number of bed days occupied by a hospitalized patient for more than the projected length of stay for a certain medical condition or procedure. The length of hospitalization is frequently used to assess the quality of care and efficient utilization of resources (Ofori-Asenso et al., 2020). Due to the scarce healthcare resources and the aim to contain medical costs, prolonged hospital stay has attracted increased attention in many healthcare systems globally.

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Significance of the Clinical Problem

Prolonged hospital stay delays the discharge of patients and increases the risk for readmission, contributing to increased utilization of health resources and high medical costs. The medical complications attributed to prolonged hospital stay include hospital-acquired pneumonia, urinary tract infection, deep venous thrombosis, pulmonary embolism, pressure ulcers, falls, and severe constipation increasing mortality rates (Ofori-Asenso et al., 2020). Bedridden patients who develop pressure ulcers stay significantly longer than other patients. Besides, the development of pressure ulcers during hospitalization is an independent and significant PLOS predictor. Bereded et al. (2020) explain that various factors influence the development of pressure ulcers, including moisture, friction, sensory perception, immobility, patient positioning, length of hospital stay, patient’s nutritional status, age, and utilization of medical relieving devices.

PICOT Question

The PICOT question is: In immobilized patients with prolonged hospital stay (P), does frequent patient repositioning (I) compared to no intervention (C) decrease the advancement of the pressure ulcers (O) within six months (T)?

The purpose of this paper is to describe the levels of evidence that would answer the PICOT question and discuss the search strategy to apply in searching for evidence.

Levels of Evidence

The above PICOT statement falls under therapy type of questions. Therapy questions query the efficacy of a particular intervention or approach in improving the health outcomes of a particular patient population. Therapy questions are treatment questions aimed at achieving a particular health outcome (Dahlgren Memorial Library, 2021). The ideal type of evidence to answer therapy questions like the PICOT question is Randomized Controlled Trials (RCTs). An RCT refers to a trial wherein the participants are randomly assigned to two groups, an experimental or control group. Participants in the experimental group receive or are exposed to the tested intervention (Dahlgren Memorial Library, 2021). On the other hand, participants in the control group are exposed to a different intervention, given a placebo, provided routine care, or are not provided any intervention.

Search Strategy

This section will outline the search terms used in the literature search, the results, databases used, and decisions to refine the search strategy. In addition, the two most relevant articles will be identified.

Search Terms and Results

The search terms for the evidence search were sourced from the PICOT question. They include: “immobilized patients,” “prolonged hospital stay,” “patient repositioning,” “prevent pressure ulcers,” and “slow progression of pressure ulcers.”  The first search brought more than 30 articles discussing diverse topics, including the impact of PLOS, the impact of pressure ulcers, nursing interventions to prevent pressure ulcers, patient positioning in bedridden patients, and management of pressure ulcers. Therefore, most were not relevant to the PICOT question. In addition, the articles produced from the search had different publication years ranging from the 1980s to the 2020s. Besides, not all the articles were published in English, and I encountered some published in Spanish and Portuguese, which I am not conversant with.

Databases Used

The Chamberlain University Library was the primary research database used in the literature search. However, various other databases were used since a thorough evidence search cannot rely on a single research database. Multiple databases are recommended in a literature search to identify all literature connected to the topic of interest. In addition, it reduces geographic bias and bias against the dissemination of negative outcomes (Dahlgren Memorial Library, 2021). The other databases used in the literature search are Cochrane Handbook for Systematic Reviews of Interventions, MEDLINE and Cochrane Central, and Embase since they include reports of RCTs, which are the ideal evidence for the topic.

Refinement Decisions

Some decisions were made during the search since the first search produced many irrelevant and outdated articles. The first decision was to restrict the search to peer-reviewed articles published in English, which lowered the number of articles produced. Next, the search was limited to peer-reviewed articles published from January 2018 to date to ensure they were recent. In addition, the  search terms were narrowed down to “immobilized patients,” “patient repositioning,” and “prevent pressure ulcers.” Refining the search reduced the articles produced to 10.

Most Relevant Articles

The two most relevant articles are Cortés et al. (2021) and De Meyer et al. (2018). Cortés et al. (2020) examine the efficacy in preventing pressure ulcers acquired during a hospital stay, particularly with regard to two frequency levels of repositioning or manual posture switching in adults admitted to different intensive care units. De Meyer et al. (2018) assessed the efficacy of tailored patient repositioning and a turning and repositioning system on patients’ body posture after repositioning, the occurrence of pressure ulcers and incontinence-related dermatitis, and nurses’ and patients’ comfort, preferences, and acceptability.

Conclusion

Prolonged hospital stay increases the risk of contracting hospital-acquired infections and injuries such as pressure ulcers. It also increases healthcare costs and the risk of readmission. The PICOT question seeks to answer whether frequent patient repositioning would slow the advancement of pressure ulcers in bedridden patients with prolonged hospital stays. An RCT would best answer the PICOT question by having some patients (experimental group) frequently repositioned while other patients (control group) are provided routine care without repositioning.

References

Bereded, D. T., Salih, M. H., & Abebe, A. E. (2018). Prevalence and risk factors of pressure ulcer in hospitalized adult patients; a single-center study from Ethiopia. BMC research notes, 11(1), 1-6. https://doi.org/10.1186/s13104-018-3948-7

Cortés, O. L., Herrera-Galindo, M., Villar, J. C., Rojas, Y. A., Del Pilar Paipa, M., & Salazar, L. (2021). Frequency of repositioning for preventing pressure ulcers in patients hospitalized in ICU: protocol of a cluster randomized controlled trial. BMC nursing, 20(1), 121. https://doi.org/10.1186/s12912-021-00616-0

Dahlgren Memorial Library. (2021). Guides: Evidence-based medicine resource guide: Clinical questions, PICO, & study designs. Guides at Dahlgren Memorial Library. https://guides.dml.georgetown.edu/ebm/ebmclinicalquestions

De Meyer, D., Van Hecke, A., Verhaeghe, S., & Beeckman, D. (2019). PROTECT – Trial: A cluster RCT to study the effectiveness of a repositioning aid and tailored repositioning to increase repositioning compliance. Journal of advanced nursing, 75(5), 1085–1098. https://doi.org/10.1111/jan.13932

Ofori-Asenso, R., Liew, D., Mårtensson, J., & Jones, D. (2020). The Frequency of, and Factors Associated with Prolonged Hospitalization: A Multicentre Study in Victoria, Australia. Journal of clinical medicine, 9(9), 3055. https://doi.org/10.3390/jcm9093055

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“Analysis of Complications that Arise from prolonged hospital Stay” please follow the rubric, paper must give a green result on turnitin for full marks as it indicates no plagiarism was practiced.

Purpose

NR449 Evidence-Based Practice RUA: Topic Search Strategy Guidelines

The Topic Search Strategy paper is the first of three related assignments. The purpose of this initial paper is to briefly describe your search strategies when identifying two articles that pertain to an evidence-based practice topic of interest.

Course outcomes: This assignment enables the student to meet the following course outcomes. CO 1: Examine the sources of knowledge that contribute to professional nursing practice. (PO 7)

CO 2: Apply research principles to the interpretation of the content of published research studies. (POs 4 and 8)

Due date: Your faculty member will inform you when this assignment is due. The Late Assignment Policy applies to this assignment.

Total points possible: 160 points

Preparing the assignment:

Follow these guidelines when completing this assignment. Speak with your faculty member if you have questions.

• Students will be placed into groups by the end of the second week of the session. The groups will work together to select a practice problem of interest as the focus for the three RUA assignments in this The practice topic of interest will also be used to complete week 3 and week 5 independent student assignments, as well as a group PowerPoint presentation in week 7.
  5. Individuals will complete this assignment independently for weeks 3 and
  6. Teams must assure that members do not use the same articles when completing this
  7. Please make sure you do not duplicate articles within your
  8. Paper should be 3-4 content pages in Title and reference pages are required but are excluded from 3-4 page length.
• The paper will include the following sections:
  1. Clinical Question (45 points/28%)
     • Describe the What is the focus of your group’s work?
     • Explain the significance of the problem in terms of patient What health outcomes result from your problem? Or what statistics document this is a problem? You may find support on websites for government or professional organizations.
     • PICOT question in support of the group
     • State the purpose of your paper. What will your paper do or describe? This is similar to a problem

statement. “The purpose of this paper is to . . .”

1. Levels of Evidence (20 points/13%)
   • Identify the type of question being asked (therapy, prognosis, meaning, ).
   • What is the best type of evidence to answer that question (e.g., RCT, cohort study, qualitative study,)?
2. Search Strategy (65 points/41%)
   • List search terms and
   • Databases used (start with the CU library). Link your search with the PICOT question described
   • Refinement As you did your search, what decisions did you make in refinement to get your required articles down to a reasonable number for review? Were any limits used? If so, what?
   • Identification of two (2) most relevant articles (primary sources published within the last 5 years).
3. Format (30 points/18%)
   • Correct grammar and
   • Include a title
   • Use of headings for each
     • Clinical Question, Levels of Evidence, Search Strategy, and Conclusion
   • Adheres to current APA formatting and

NR449 Evidence-Based Practice RUA: Topic Search Strategy Guidelines

• 3-4 pages in length, excluding title and reference

For writing assistance (APA, formatting, or grammar) visit the APA Citation and Writing page in the online library.

Please note that your instructor may provide you with additional assessments in any form to determine that you fully understand the concepts learned.

NR449 Evidence-Based Practice RUA: Topic Search Strategy Guidelines

Grading Rubric Criteria are met when the student’s application of knowledge demonstrates achievement of the outcomes for this assignment.

Assignment Section and Required Criteria (Points possible/% of total points available)	Highest Level of Performance	High Level of Performance	Satisfactory Level of Performance	Unsatisfactory Level of Performance	Section not present in paper
Clinical Question (45 points/28%)	45 points	40 points	37 points	33 points	0 points
Required criteria 1.       Describe the problem. What is the focus of your group’s work? 2.       Explain the significance of the problem in terms of patient outcomes. What health outcomes result from your problem? Or what statistics document this is a problem? You may find support on websites for government or professional organizations. 3.       PICOT question in support of the group topic. 4.       State the purpose of your paper. What will your paper do or describe? This is similar to a problem statement. “The purpose of this paper is to . . .”	Includes 4 requirements.	Includes 3 requirements.	Includes 2 requirements.	Includes 1 requirement.	No requirements for this section presented.
Levels of Evidence (20 points/13%)	20 points	16 points	10 points	0 points
Required criteria 1.       Identify the type of question being asked (therapy, prognosis, meaning, etc.). 2.       What is the best type of evidence to answer that question (e.g., RCT, cohort study, qualitative study, etc.)?	Includes 2 requirements.	Includes 1 requirement.	Incomplete or inaccurate information presented.	No requirements for this section presented.
Search Strategy (65 points/41%)	65 points	58 points	54 points	48 points	0 points
Required criteria 1.       List search terms and results. 2.       Databases used (start with the CU library). Link your search with the PICOT question described above. 3.       Refinement decisions. As you did your search, what decisions did you make in refinement to get your required articles down to a reasonable number for review? Were any limits used? If so, what? 4.       Identification of two (2) most relevant articles (primary sources published within the last 5 years).	Includes 4 requirements.	Includes 3 requirements.	Includes 2 requirements.	Includes 1 requirement.	No requirements for this section presented.
Organization and APA Style (30 points/18%)	30 points	27 points	25 points	15 points	0 points
Required criteria 1.       Correct grammar and spelling. 2.       Include a title page. 3.       Use of headings for each section. 4.       Clinical Question, Levels of Evidence, Search Strategy, and Conclusion 5.       Adheres to current APA formatting and guidelines. 6.       3-4 pages in length, excluding title and reference pages.	Includes 6 requirements.	Includes 5 requirements.	Includes 3-4 requirements.	Includes 1-2 requirements.	No requirements for this section presented.
Total Points Possible = 160 points

 

NR449_RUA_Topic_Search_Strategy_Guidelines