Hello Robinson,

Good overview of your search, the databases and key terms used.  Good start to your PICOT question and addressing each component.

Hi Robinson- I enjoyed reading your post because post-operative pain medicine is near and dear to my heart and the statistic still amaze me; thus I would like to see more information on this. I also used Cinahl and ProQuest for my searches and found a whole lot of resources until I used the Boolean operator and was able to specialize my results to be aligned with what I was looking for.

I  agree with Melnyk in stating we must know how to search to generate appropriate responses for scholarly writing. In my research, I found a really good article in alignment with VAP and oral care, my topic. However, the article was about nurses in Iran. I didn’t feel that taking data from that article would’ve been pertinent to me. For that reason, I also try to keep my articles based in the US. The way VAP and oral care may or may not be the same in the US and Iran – but I do not know, so I stick to articles written about US nursing. What are your thoughts about using ex-US articles?

Melnyk, B. M., & Fineout-Overholt, E. (Eds.). (2011). Evidence-based practice in nursing & healthcare: A guide to best practice. Lippincott Williams & Wilkins.

Zurmehly, Joyce, PhD, DNP,R.N., N.E.A.-B.C. (2013). Oral care education in the prevention of ventilator-associated pneumonia: Quality patient outcomes in the intensive care unit. The Journal of Continuing Education in Nursing, 44(2), 67-75. doi:https://doi.org/10.3928/00220124-20121203-16

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Vaibhav,

Great post!! Falls are a common problem among medical facilities both near and far (Shuman, Montie, Galinato, Todd, Heggstad, & Titler, 2016). It has been a struggle to try to find ways to decrease falls among patients. Some say bed and chair alarms are not good and startle patients others say they help. It is tough to know as each patient is different. The facility I used to work at did a trial without them and falls actually increased. I do believe that hourly rounding helps significantly to decrease falls. I also used CINAHL in my search. It was fairly easy. I do think that the use of BOOLEAN was helpful in my search. Boolean facilitates more specific detailed searches to narrow down articles related to the search (Walden University Library, n.d.). If I can ask, where did you migrate from? I am always eager to learn different aspects of nursing cultures.

References

Shuman, C., Liu, J., Montie, M., Galinato, J. G., Todd, M. A., Hegstad, M., & Titler, M. (n.d.). Patient perceptions and experiences with falls during hospitalization and after discharge. Applied nursing research. Retrieved December 20, 2022, from https://pubmed.ncbi.nlm.nih.gov/27397823/ Links to an external site. 

College of Nursing. Walden University. (2020, October 28). Retrieved December 20, 2022, from https://www.waldenu.edu/college-of-nursing Links to an external site. 

Academic guides: Keyword searching. Academic Guides at Walden University. (n.d.). Retrieved December 20, 2022, from https://academicguides.waldenu.edu/library/keyword/boolean

 Great topic Vaibahav and thank you for discussion post regarding falls. I actually enjoyed reading your clinical issue of interest about falls.  Falls are very common among the elderly. Every 11 seconds, an older adult is treated in the emergency room for a fall; every 19 minutes, an older adult dies from a fall (Stillwell, et. al, 2010). Fall subject has always been very interesting subject to learn. Falls are often alarming mostly do debilitate older residents. It decreases the residents’ health and comfort. Most residents that experience fall develops a fear of falling again as it restricts their activities (AHRQ,n.d.).  Also, I find it very helpful in how you narrow down your search articles and the use of CINHAL and Medline. As per Stillwell, et.al, (2010) The PICOT format is a form of a clinical question to filter part in the search for evidence. It organized the clinical question to refine the search faster and more systematically. Boolean was helpful and facilitates in narrowing it down in article that is related to my clinical issue of interest. 

Reference 

AHRQ, (n.d). Fall Management Program: A Quality Improvement Initiative for Nursing Facilities. https://wwwlahrq.gov/patient-safety/sttings/long-term-care/resource/injuries/fallspx/man1.html  

College of Nursing. Walden University. (2020, October 28). Retrieved December 23, 2022, from https://www.waldenu.edu/college-of-nursing 

Stillwell.S.B., Fineout-Overholt, E.,MelnykB.M. & Williamson,K.M.(2010). Evidence-Based Practice step by step: Asking the Clinical Question AJN, American Journal of Nursing, 110(3),58 https://doi.org/10.1097/01.naj0000368959.111.29.7Links to an external site.

Hello Vaibhav,

Thanks for sharing such a great story about emigrating to the United States. The topic of fall risk in the elderly population is much appreciated. In gerontology, RNs must exercise great caution for fall-risk education and prevention. Fall risk is a vital safety area that RNs need to address on every shift. Accidental injuries rank eighth as a cause of death for older people, and falls are the most common cause of nonfatal injuries and hospital admissions. (Hinkle & Cheever, 2018). Falls rise with age, and one out of five falls in older adults result in serious injuries such as broken bones or a head injury. (Id).

A recent article suggested a multi-step protocol including screening for falls, comprehensive fall assessment, and gait and balance screening when necessary. An individualized fall intervention program addressing specific fall risks is presented. (Kruschke & Butcher, 2017). Nurses should encourage the elderly and their families to make lifestyle and environmental changes to prevent falls. Adequate lighting should be installed. The bathtub and shower should have grab bars, and the toilet should be helpful. Loose clothing, improperly fitting shoes, throw rugs, small objects, and pets increase fall risk. As future nursing leaders, we must always emphasize fall-risk prevention strategies for older patients.

I also used CINAHL & MELINE combination database. I appreciate your advice on narrowing down the number of articles in a search using various Boolean operators. I also used the drop-down menus within the database inquiry options to narrow my searches for this assignment. Walden University Library, n.d.). The PICOT format is something that I will need much more practice to improve my research skills. Good job, and thanks for the exciting topic.

References

Hinkle, J. L., & Cheever, K.H. (2018). Brunner & Suddarth’s textbook of medical-surgical nursing (14th ed., Vol. 2). Wolters Kluwer.

Kruschke, C., & Butcher, H. K. (2017). Evidence-Based Practice Guideline: Fall Prevention for Older Adults. Journal of Gerontological Nursing, 43(11), 15-21. https:.//doi.org/10.3928/00989134-20171016-01.

Walden University Library. (n.d.-a). Databases A-Z: Nursing. Retrieved December 23, 2022, from https://academicguides.waldenu.edu/az.php?s=19981Links to an external site..

Hey Vaibhav,

Falls are such a serious thing especially for the elderly. I work in the icu and typically have a severe fall injury patient each week. Many of times it is a repeated event. However it seems like not much had been put into place since the last fall to prevent future occurrences. “Every second of every day, an older adult (age 65+) suffers a fall in the U.S, making falls the leading cause of injury and injury death in this age group” (CDC, 2020). You chose a really good clinical issue to focus on.

Your keyword searches are spot on for your clinical inquiry. I do suggest finding fall prevention strategies that can lower the risk of falls such as making one’s home fall proof (Elsevier, n.d.). That would be a great way to add patient education which is a great way to decreases readmission for the same complaint. I am sure they have great research on fall prevention strategies which does tie in to one’s perception.

Reference

Centers for Disease Control and Prevention. (2020, December 16). Keep on your feet-preventing older Adult Falls. Centers for Disease Control and Prevention. Retrieved December 23, 2022, from https://www.cdc.gov/injury/features/older-adult-falls/index.html

Patient education fall prevention in the home, adult. Elsevier. (n.d.). Retrieved December 23, 2022, from https://elsevier.health/en-US/preview/fall-prevention-in-home

6052 response #1

Hello Kendall,

Your clinical issue of interest of the nurse to the patient is such an important aspect of nursing.  I dream of a day when it gets the attention that it needs.  Most nurses don’t understand this until they have been on both sides.  I have worked with the 3:1 ratio and 6:1 ratio.  Increasing the ratio causes mistakes of all kinds, lack of care, burnout, and anger (Gutsan et al.).  Once this issue is addressed and federally regulated, I believe this will directly raise the nursing standard of better patient care and less burnout (Chen et al., 2019).

For the sake of nursing, patients, and healthcare I hope your passion for this clinical interest yields fruitful results and you have the tools and support you need to accomplish a safer, thriving environment for nurses and their patients.  I look forward to the change for our future nurses embracing their careers and looking forward to coming into work to change people’s lives by making a positive impact because they can focus on their patients and the tasks at hand.

References

Chen, Y.-C., Guo, Y.-L. L., Chin, W.-S., Cheng, N.-Y., Ho, J.-J., & Shiao, J. S.-C. (2019). Patient–nurse ratio is related to nurses’ intention to leave their job through mediating factors of burnout and job dissatisfaction. International Journal of Environmental Research and Public Health, 16(23), 4801. https://doi.org/10.3390/ijerph16234801

Gutsan, E., Patton, J., Willis, W. K., & Alberto Coustasse, D. P. H. M. D. (n.d.). Burnout syndrome and nurse-to-patient ratio in the workplace. Marshall Digital Scholar. Retrieved December 21, 2022, from https://mds.marshall.edu/mgmt_faculty/196/

1^st Response

Hi Kendall,

This is a great subject because nurse-to-patient ratio seems to be a problem everywhere unless you work in California or in a specialty unit like ICU.  According to McHugh, Aiken, Sloane, Windsor, Douglas, & Yates (2021), minimum nurse-to-patient ratio policies are a practical way to improve nurse staffing and patient outcomes with good return on stake because there is significant evidence to indicate that patient outcomes are more favorable in hospitals with better nurse staffing (p. 1906). I believe that there may be policies in place at hospitals and other facilities, however, they are almost never carried out although nurses constantly complain.

Nurses are a critical part of healthcare and make up the largest section of the health profession. According to the World Health Statistics Report, there are approximately 29 million nurses and midwives globally. Improving work environment, increasing nurse staffing levels, and providing enough support for nurses to spend more time on direct patient care would be beneficial to patient safety improvement (Haddad, Annamaraju, & Toney-Butler, 2022).

References

Haddad, L. M., Annamaraju, P., & Toney-Butler, T. J. (2022). Nursing shortage. In StatPearls

     [Internet]. StatPearls Publishing.

McHugh, M. D., Aiken, L. H., Sloane, D. M., Windsor, C., Douglas, C., & Yates, P. (2021).

Effects of nurse-to-patient ratio legislation on nurse staffing and patient mortality,

readmissions, and length of stay: a prospective study in a panel of hospitals. The

     Lancet, 397(10288), 1905-1913.

Reply post 1

Hi Kendall,

Great post, I like your clinical issue question. The nurse to patient ratio has been one of the main issues in healthcare and this affects patient outcome like you stated. According to an article by (Shuldam. C. et al 2009) lower patients to nurse ratio are associated with better outcomes. When attempting to answer a PICO(T) question, it is critical to make use of high-level evidence, PubMed, Cochrane Database of Systematic Reviews, EBSCOhost and others are important resources to consult.

Reference

Shuldham, C., Parkin, C., Firouzi, A., Roughton, M., & Lau-Walker, M. (2009). The relationship between nurse staffing and patient outcomes: A case study. International Journal of Nursing Studies, 46(7), 986–992. https://doi.org/10.1016/j.ijnurstu.2008.06.004Links to an external site.

Echevarria, I. M., & Walker, S. (2014). To make your case, start with a PICOT question. Nursing, 44(2), 18–19. https://doi.org/10.1097/01.NURSE.0000442594.00242.f9Links to an external site.

Arabi, Y. M., Al Ghamdi, A. A., Al-Moamary, M., Al Mutrafy, A., AlHazme, R. H., & Al Knawy, B. A. (2022). Electronic medical record implementation in a large healthcare system from a leadership perspective. BMC Medical Informatics & Decision Making, 22(1), 1–10. https://doi.org/10.1186/s12911-022-01801-0

Hey Kendall,

You brought up a very important clinical issue which has been at the forefront these past several years. “Nurse-to-patient ratios influence many patient outcomes, most markedly inhospital mortality”(Driscoll, 2018). I have seen this time and time again where patients are seen maybe once in a 6 hour span and next thing a code blue is called. In your research, I would love to see statistical data on the severity of nurse to patient ratios and the causal effect it has on both patients and nursing staff. I like CINAHL database because it certainly has quality nursing evidence based research articles. So I am sure you will find current articles addressing this issue.

Reference

Driscoll , A. (2018, January). The effect of nurse-to-patient ratios on nurse-sensitive patient outcomes in acute specialist units: A systematic review and meta-analysis. European journal of cardiovascular nursing. Retrieved December 24, 2022, from https://pubmed.ncbi.nlm.nih.gov/28718658/

Walden University Library. (n.d.-c). Evidence-based practice research: CINAHL search help. Retrieved December 20th, 2022, from https://academicguides.waldenu.edu/library/healthevidence/cinahlsearchhelp

Hello Kendall,

Your subject is one that is very significant to the nursing profession. Increased levels of job satisfaction among nurses are associated with improved nurse-to-patient staffing ratios, and improved overall working conditions. It fosters a spirit of collaboration, which, in turn, results in increased engagement in patient care in various capacities. When there is a greater emphasis on responsibility, there is an accompanying improvement in patient outcomes. A reduction in death rates, an improvement in the ability to manage infections, and an increase in the percentage of patients who are satisfied with their care are all results of improved patient outcomes (Sharma & Rani, 2020). If you apply filters to your search and conduct it the Walden Library, you will be able to get the results you are looking for. This is one of the other methods you may use to find the articles. It is also advised that you utilize Boolean phrases in order to provide more specific and relevant results; thus, you should include the Boolean terms to your search.

Reference

Sharma, S. K., & Rani, R. (2020). Nurse-to-patient ratio and nurse staffing norms for hospitals in India: A critical analysis of national benchmarks. Journal of Family Medicine and Primary Care, 9(6), 2631. https://doi.org/10.4103/jfmpc.jfmpc_248_20

Hello Lami,

Your search offers insights that can be used to search multiple databases, use different terms and the significance of the PICOT themselves.

Hello Matthew,

Good overview of your search.  What is your PICOT question?