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Evidence-Based Project, Part 3: Advanced Levels of Clinical Inquiry and Systematic Reviews

Developing a Focused Clinical Question Using PICO(T) Framework
Introduction
Healthcare providers are constantly faced with clinical questions arising from patient care. Finding reliable answers to these questions requires efficiently searching the vast and ever-growing body of medical literature. The PICO(T) framework provides a structured approach for formulating clinical questions that can then be used to guide systematic searches of relevant research databases. This paper will describe the development of a PICO(T) question focused on reducing hospital-acquired infections in neonatal intensive care units (NICUs).
Methods
The clinical issue of interest identified was reducing rates of hospital-acquired infections in NICUs. These infections pose serious risks to medically fragile newborns and are associated with increased morbidity, mortality, and healthcare costs (Melnyk et al., 2009). To focus the question, the PICO(T) framework was used to outline the key elements: Population (preterm infants in the NICU), Intervention (use of chlorhexidine baths), Comparison (standard bathing with soap and water), and Outcome (reduction in infection rates). The “T” element refers to the timeframe of 7 days. This resulted in the following PICO(T) question: In preterm infants in the NICU, how do chlorhexidine baths compared to standard soap and water bathing affect infection rates over 7 days?
Results

Four relevant research databases were searched between September 2018-2019: CINAHL, MEDLINE, Cochrane Library, and Joanna Briggs Institute. Search terms included “neonatal intensive care,” “preterm infants,” “chlorhexidine,” “infection,” and “bathing.” This yielded 4 relevant research articles.
Discussion
Systematic reviews provide high levels of evidence by comprehensively analyzing data from multiple sources. The strengths of using systematic reviews for clinical research include establishing efficacy and safety of interventions, identifying gaps in evidence, and developing evidence-based guidelines (Davies, 2011). Examples of systematic reviews that could help answer the PICO(T) question include those examining rates of infection following chlorhexidine bathing in NICUs.
Conclusion
The PICO(T) framework is an effective method for formulating focused, answerable clinical questions. Structuring inquiries this way helps ensure relevant evidence is obtained to guide clinical decision making. Further research is still needed but initial evidence suggests chlorhexidine bathing may reduce infection risks for high-risk newborns.

Assignment: Evidence-Based Project, Part 3: Advanced Levels of Clinical Inquiry and Systematic Reviews
DUE DATE: OCT. 3rd 2020.
In this Assignment, you will delve deeper into clinical inquiry by closely examining your PICO(T) question. You also begin to analyse 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.

Instructor additional email.
Hi all! This week you should continue to work on your power point assignment. Please be sure to review the rubric and instructions carefully as you develop your power point. I have copied the assignment guidelines here with a brief explanation to help clarify the expectations.
Create a 6- to 7-slide Power Point presentation in which you do the following:

Identify and briefly describe your chosen clinical issue of interest. What is your topic? Why is it important to nursing practice?
Describe how you developed a PICO(T) question focused on your chosen clinical issue of interest. What is the PICOT question? How was it developed? What information from the literature supports the need to answer the question? Why is this the best question to address the issue you’ve identified?
Identify the four research databases that you used to conduct your search for the peer-reviewed articles you selected. Summarize each article. Synthesize the information. What are common themes? What are some major differences in their findings?
Provide APA citations of the four peer-reviewed articles you selected. Be sure to use proper in text citations and cite correctly on the reference page.
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. In your summaries, include this information. Where did the study fall in the hierarchy of evidence? What were the identified strengths and limitations of the study? What are the strengths of using systematic reviews?
Be specific and provide examples. This is important! Be sure to elaborate, add examples and details to support your assertions. Pretend the reader (me) is unfamiliar with your topic. The examples are what helps the reader understand what you are trying to say.

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

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

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

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

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

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