Assignment: Evidence-Based Project, Part 3: Advanced Levels of Clinical Inquiry and Systematic Reviews
Your quest to purchase a new car begins with an identification of the factors important to you. As you conduct a search of cars that rate high on those factors, you collect evidence and try to understand the extent of that evidence. A report that suggests a certain make and model of automobile has high mileage is encouraging. But who produced that report? How valid is it? How was the data collected, and what was the sample size?

In this Assignment, you will delve deeper into clinical inquiry by closely examining your PICO(T) question. You also begin to analyze the evidence you have collected.

To Prepare:

Review the Resources and identify a clinical issue of interest that can form the basis of a clinical inquiry.
Develop a PICO(T) question to address the clinical issue of interest you identified in Module 2 for the Assignment. This PICOT question will remain the same for the entire course.
Use the key words from the PICO(T) question you developed and search at least four different databases in the Walden Library. Identify at least four relevant systematic reviews or other filtered high-level evidence, which includes meta-analyses, critically-appraised topics (evidence syntheses), critically-appraised individual articles (article synopses). The evidence will not necessarily address all the elements of your PICO(T) question, so select the most important concepts to search and find the best evidence available.
Reflect on the process of creating a PICO(T) question and searching for peer-reviewed research.
The Assignment (Evidence-Based Project)

Part 3: Advanced Levels of Clinical Inquiry and Systematic Reviews

Create a 6- to 7-slide PowerPoint presentation in which you do the following:

Identify and briefly describe your chosen clinical issue of interest.
Describe how you developed a PICO(T) question focused on your chosen clinical issue of interest.
Identify the four research databases that you used to conduct your search for the peer-reviewed articles you selected.
Provide APA citations of the four relevant peer-reviewed articles at the systematic-reviews level related to your research question. If there are no systematic review level articles or meta-analysis on your topic, then use the highest level of evidence peer reviewed article.
Describe the levels of evidence in each of the four peer-reviewed articles you selected, including an explanation of the strengths of using systematic reviews for clinical research. Be specific and provide examples.Learning Resources
Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings
Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer.

Chapter 2, “Asking Compelling Clinical Questions” (pp. 33–54)
Chapter 3, “Finding Relevant Evidence to Answer Clinical Questions” (pp. 55–92)
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. doi:10.1097/01.NAJ.0000368959.11129.79

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. doi:10.1097/01.NAJ.0000363354.53883.58

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. doi:10.1097/01.NAJ.0000372071.24134.7e

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.-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

Required Media
Laureate Education (Producer). (2018). Searching the Evidence [Video file]. Baltimore, MD: Author.
Video transcricpt
Searching for Evidence
Program Transcript
NARRATOR: Searching for answers to clinical questions.
NOLA SCHMIDT: The nurse on the unit was using PCAs with adults and she
wondered, why can\’t we do this with children? And so she went into the literature
and she found articles that supported the position that indeed, children could use
PCA pumps.
NARRATOR: Using reliable resources.
MARIANNE SHAUGHNESSY: The internet has made that wonderfully easy, and
it makes it very easy for nurses to access databases– either databases that are
within their institutions, or they can utilize the National Library of Medicine or
PubMed. It\’s a very easy tool to use, in terms of identifying information regarding
a particular clinical phenomenon.
NARRATOR: Finding and evaluating the evidence.
NOLA SCHMIDT: Evidence is all over. We use evidence in our day-to-day
practice. When we don\’t know something, frequently we go to another nurse or a
physician and say, what would you do in this situation? And that\’s OK evidence, I
mean, these people have experience, but I think the best evidence is in the
literature published from research, summaries of research that\’s been conducted.
NARRATOR: This week, Dr. Janet Brown, Dr. Nola Schmidt and Dr. Marianne
Shaughnessy share strategies for finding and evaluating evidence.
JANET BROWN: Healthcare is changing dramatically. When students graduate,
it isn\’t very long before what they have learned is already obsolete. And so, it is
essential that students learn how to learn. There is no way that any student in
any program can learn all that there is to know anymore. And consequently, the
hallmark of a prepared graduate is to be able to weigh new knowledge and
decide, is this something that needs to be implemented into practice? And then
proceed in making strategies that will get that change to the bedside.
So it is absolutely imperative that graduates understand their role in evidencebased practice, how to make a patient care change, and then, how to evaluate it.
Because just when you think that you\’re done, you really are not done, because
there is no ending point. Because the change has to be evaluated, and then it
has to be fed back, and the change reviewed, modified, measured again. And
then you\’re off to see how that affects other procedures and other outcomes.
When searching for evidence, you want to pay particular attention that you\’re
looking in scholarly works. The web is a wonderful thing. Google is a way of life.
Searching for Evidence
© 2018 Laureate Education, Inc. 2
We use Google on a daily basis, and everything anymore that one does says,
well, I\’ll look it up. I\’ll Google that. It\’s become a verb.
When it comes to looking for literature, we are not in the Google phase. We are
looking for scholarly works through research journals, scholarly publications–
those don\’t Google. So know your library. Learn a search engine. You don\’t have
to learn every one, but find a comfort level with one search engine. Learn how to
use search terms.
I have heard so often from my own students, there is nothing in the library on that
topic. And I have to pause and say, you\’re telling me that there is nothing in the
library on pain? I find that a little hard to believe. Let\’s go back and put in some
search parameters so that we could really find a topic, so that you can really
mine out the literature. And that, I think, is probably one of the biggest barriers to
searching for evidence, is learning how to do it.
NOLA SCHMIDT: The most important thing I can remind you is that the librarian
is your friend. I know I go to the library, I do it myself sometimes. And I feel like,
ooh, I shouldn\’t bother the librarian, she\’s probably busy working. Or he looks like
he\’s doing something.
But that\’s what they\’re there for, they\’re there to help you find the information you
need, and so do rely on the librarian. They can give you an abundant number of
tips about how to search, where to search, words that are important to use.
Let me give you an example. I once had a student who wanted to do a paper on
why the baccalaureate degree should be the degree for earning an RN. And she
had done all these words that were trying– she had entered many keywords and
couldn\’t come up with anything. And I said, the keywords you need to use are,
\”entry into practice.\” and once she started to use those words, she got all the
literature she needed to write her paper. And sometimes you just don\’t know the
word to use. And the librarian can help you find those keywords that will open up
the literature to you. And so knowing those keywords is critical. That\’s important.
So what are some of the therapies you see there?
Also remember that it\’s a skill, it takes practice, and you aren\’t going to be able to
walk in the first time and try to search and find everything you need. And that as
you get in important databases like Joanna Briggs, Cochrane collection, of
course, CINAHL and Medline, you will hone your skills and learn how to search
better. And it will go much more efficiently.
It\’s also really important that you learn to read abstracts well. A lot of times, a title
looks totally awesome and exactly what you want. And then when you get the
article printed out, and you take it home, and read it, and you\’re like, this has
Searching for Evidence
© 2018 Laureate Education, Inc. 3
nothing to do with what I was talking about. And then you would avoid having
printed out an article that\’s not useful to you.
I think it\’s really important, as a consumer of nursing research and of evidence, to
be clear about what\’s good evidence and what\’s not good evidence. And
certainly, anyone can Google in anything and end up at a website and find some
health information. It\’s really up to us to help patients discern what\’s strong
evidence and what isn\’t. And hopefully as you are learning more about research,
you\’ll learn more about what makes a good study or what makes evidence good,
and that you\’ll be better prepared to help patients understand what is good
Certainly, lay information on the web can be helpful because it\’s in terms patients
can understand, but that isn\’t always the most reliable evidence. I know a lot of
practicing nurses like to use their trade journals, AJN, Nursing 2009, and those
can be very helpful in terms of bringing you up-to-date on something. But if you\’re
really talking about changing practice and want to form a team and really look at
your clinical question, then you need to be starting at the top of the evidence
pyramid, looking at summaries and guidelines that have already been created.
It\’s especially helpful if you can find a summary or guideline, because then you
don\’t have to do the whole search.
Certainly, don\’t make it harder than it needs to be. Don\’t reinvent the wheel. If
there is a summary or a guideline out there that\’s fairly recent, your work may be
done for you.
MARIANNE SHAUGHNESSY: Well, I subscribe to a number of nursing journals,
and not only nursing journals, also some medical ones, as well. Because my
discipline is stroke, and care of older adults and stroke patients, in particular,
tends to be multidisciplinary. So I have to keep up on not only the rehab nursing
literature, but also the medical literature, as well, and some physical therapy
journals. So I receive a number of those. You go through first glance to see if
there\’s anything in this journal that\’s really pertinent to my practice, and those
articles I make sure to read right away. And then I save the rest for while I\’m
standing in line at the grocery store.
The role of the baccalaureate prepared nurse is a little bit different because that
education allows nurses to look at literature critically. That\’s part of the skill set
that comes from the baccalaureate level programs. And what we\’re trying to work
toward, is to give the nurses the skills to look at a piece of published research
and make their own independent assessment about whether a study was done
well, whether its results can be judged as valid, and whether that piece of
evidence– in addition to other pieces of published evidence on the same topic–
can lead us to defining what is a best nursing practice.
Searching for Evidence
© 2018 Laureate Education, Inc. 4
So you begin by searching a database and collecting information in terms of
research articles that have recently been published. And generally speaking,
we\’d like to define recent knowledge as five years, unless you\’re looking at a
piece of research that really was groundbreaking in a field. So once all of those
research articles have been collected, then it\’s time for the baccalaureate
prepared nurse to sit them down and read through the research articles with a
critical eye. And this is why it\’s important to have a little bit of the background in
the research process.
So when they\’re reading these articles, they can read an article and make an
assessment about whether or not a research study was well done, or whether
their findings i


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