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NR439_Week 2: Search for Literature and Levels of Evidence

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Week 2 Discussion Posts

This is a graded discussion: 50 points possible

Reflect on your practice, and identify a significant nursing clinical issue or change project that you would like to search for evidence in online sources. Formulate searchable, clinical questions in the PICO(T) format for your nursing clinical issue.
Next, review the guidelines for the PICOT Assignment due Week 3. Use your PICOT elements to search for one report of a single, original study that has been published within the last 5 years from the CCN Library that is relevant to your nursing clinical issue.
Briefly describe how it is relevant to your nursing clinical issue. Remember to give a complete reference to the study.
This topic is closed for comments.
Nursing research is a dynamic process that includes multiple phases: defining the research problem; literature review; selecting a theoretical framework; choosing an appropriate design; defining a sampling strategy; collecting and analyzing data; sharing the findings, and using the evidence in practice.

The Course Outcomes (COs) we will apply for Week 2 include:

  • Examine the sources of evidence that contribute to professional nursing practice.
  • Apply research principles to the interpretation of the content of published research studies.

To begin our investigation into research evidence, please reflect on your experience and identify a significant clinical issue about which you would like to find evidence. Create a PICOT from your specific clinical issue.

Best practice for writing is supported by citations. Have a great week of learning Everyone!

Burnout and patient safety Picot

The significant nursing clinical issue that I have chosen is nurse burnout and patient safety.  PICOT FORMAT about my clinical nursing issue is as follows:

P= Problem – Nurse Burnout and Patient Safety.

I=Intervention – Adequate Staff Patient Ratio.

C=Comparison – Reduced staff-patient ratio.

O=Outcome – Reduced staff burnout and increased patient safety.

T=Time – Within one month.

(Topic)Question: Among nursing professionals (P), do adequate staffing (I) reduce burnout, turnover, increase patient safety, and improve patient outcomes (O) compared to inadequate staff-patient ratio (C) within one month (T)?

It is known that job satisfaction among nurses directly impacts patient outcomes, and therefore, it is so important for hospitals’ management to create reasonable working conditions and supportive environments at work.  The article by Aiken et al. (2016) has addressed the problem of nursing understaffing and its impact on the quality of care offered to patients and nurses’ job satisfaction.  Currently, the U. S. healthcare system is experiencing a shortage of nursing personnel in varied areas and at various levels (Aiken et al., 2015).  As a result, staffing becomes a challenge for nurse leaders because not enough professionals are available to cover the existing needs.  In hospitals with the high patient to nurse ratios, patients are provided with lower quality care, and nurses are more prone to experience burnout and job dissatisfaction as indicated by Aiken et al. (2016).  Overall, this journal article gave me an insight into nurse shortage, burnout, and patient safety.  It also has pointed out how to improve staff level reduction, turnover rates, burnout, patient safety, and nurses’ job dissatisfaction.


Aiken, L.H., Slone, D., Griffiths, P. Rafferty, A.M, Bruyneel, L., McHugh, M., Maier, C.B., Moreno-Casbas, T., Ball, J.E., Ausserhofer, D., & Serveus, W. (2016). Nursing skill mix in Eurpoean hospitals: Cross-sectional study of the association with mortality, patient ratings, and quality of care. BMJ Quality and Safety Online. doi: 10.1136/brnjqs-2016-005567

Houser, J. (2015). Nursing research: Reading, using and creating evidence (3rd ed.). Denver, C.O.: Jones & Bartlett Publishers.

Dear Yeni

If you look at the instructions for week 3 assignment you must have a clinical topic that you can consider/research. The assignment requires that an MD order is not required or a large financial issue. Your topic is not approved for next week. Please redo your topic and PICOT according to week 3 instructions.


Thank you for your feedback. Please comment if you think this option can meet the requirement of having the focus on clinical issues related to the work of nursing professionals for week 3 project:

In African-American women older than 45 (P), how effective is nursing education regarding lifestyle changes combined with medical treatment (I) compared with medical treatment only (C) for hypertension management (O) within a one-year period (T)?

Dear Yenisleydi,

That will work. Good job. You just need to find a good research article to go along with your post. Your topic is approved for next weeks assignment.


Hello Yenisleydi

I like your research topic about 45 years old or older African American women and high blood pressure. As a black woman and seeing my mom and aunts having high blood pressure just for being black, I would love to see the different factors that can affect them.

Uche Fernes

I enjoyed your post.  It is something I would of chosen myself.  This is something we all can relate to. Nurses do have a lot on their plate with the increasing responsibilities and extensive workload that continues to make us feel overwhelmed.  As nurses we need to manage are stress whether through exercise, healthy easting or even mediation.

Good evening Professor and classmates.

I chose to do smoking cessation.The reason I chose this subject is because my facility is going to be a nonsmoking building to promote a healthier environment.The facility is going to be offering respiratory therapy to CHF and COPD patients from the community. We have several residents who stated they want to be discharged.There are some who have cardiac diagnosis and still continue to smoke.

P smoking cessation

I offer smoking cessation aids

C quitting without any assistance

O not smoking and no symptoms of withdrawl

T 1 month

The article that I found in the library is Chronic Obstructive pulmonary Disease:smoking cessation.This author states that pharmacotherapy and counselling are the best ways to quit smoking.


Coronary Heart Disease (Secondary Prevention): Smoking Cessation.

Your topic is approved however you need to work on your PICOT. This week you must be able to put a PICOT together because next week’s assignment is worth 50 points. Please do some research on the PICOT and rewrite.


Dr. Taulbee

Professor and Class,

Hope everyone is having a good week so far. The topic I chose was postpartum depression education for new mothers post-delivery of their infant.

Research Question: What is the effect of postpartum depression education and screening post-delivery to new mothers compared to no screening or post-delivery education on mothers seeking treatment of the condition within 6 months of delivery.

(P) Problem: Postpartum depression

(I) Intervention: Bedside education and screening

(C) Comparison: No bedside education or screening

(O) Outcome: Decreased instances of lag in mothers seeking help with postpartum depression

(T) Time Limit: 6 Months

Women are taught that the birth of a child should be their most joyous experience in life, yet many women suffer from debilitating depression after delivery. Postpartum depression can affect the bond between the mother and infant and can also affect the family dynamic (Farr, Denk, Dahms, & Dietz, 2014). I found some informative articles on the importance of postpartum depression education in the online library. I believe that as nurses we can help educate our new mothers on how to recognize the signs of postpartum depression and help them to understand that seeking help is normal and does not indicate the failure in their abilities as mothers.

Farr, S. L., Denk, C. E., Dahms, E. W., & Dietz, P. M. (2014). Evaluating Universal Education and Screening for Postpartum Depression Using Population-Based Data. Journal Of Women’s Health (15409996)23(8), 657-663. doi:10.1089/jwh.2013.458

Kimberly and Class,

Good job this week. Your PICOT and article are approved for next week’s assignment.  What do you look for in a peer-reviewed article?


Dr. Taulbee

Professor and class,

     In response to your question,” What do you look for in a peer-reviewed article?” In CCN library, we are able to select peer-reviewed and year published for the selection process, in our search for articles. This narrows our articles found in the data base. Without this search engine guideline, we would have to carefully review articles. The editorial peer-viewed reviewer board should be in the very beginning with the title and the author. ” The names of the actual reviewers are rarely published, however; the peer reviewed process is mostly likely a blinded one, meaning that article authors do not know the identity of the manuscript reviewer, and the reviewer does not know the identity of authors” ( Houser, 2018, pg. 20). This process prevents biased and research not validated appropriately. It promotes looking at the article and its conclusion without prior preconceived  ideas. .

Thank you, Audrey

Houser, J. (2018). Nursing research: reading, using and creating evidence. Sudbury, MA; Jones & Bartlett.

Dr. Taulbee,

Personally, I look for the date of the article and if the article was published in a journal. Because research and practices change so swiftly, it is important to find research and articles that are current. As far as if the article was published in a journal or not, that is just a way to determine if the article was peer-reviewed and determined to be legitimate research or not. Houser (2018) gives a few more suggestions on what to look for when researching peer-reviewed articles such as checking to see if the article writers have the correct credentials to perform the study. Another suggestion is to determine if the article is published in an unbiased journal or not. Some organizations will pay researchers and journals to publish articles that benefit the organization and while the research may be sound, the fact that the study was conducted for and by a specific organization has the possibility of affecting the outcome of the study. And we don’t want to use bought and biased opinions for our research.

Houser, J. (2018). Nursing research: Reading, using, and creating evidence (4th ed.). Sudbury, MA: Jones & Bartlett.


Great topic. I believe this is a topic that isn’t addressed enough for mothers, especially new mothers. I had a friend who recently had her first child and she suffered from postpartum depression and no one really explained to her that it can happen. She told me she didn’t know how to feel and what to do about it. She finally told her doctor and they helped her work through it but if I wouldn’t have asked her what was wrong and encouraged her to seek help, no telling how long she would’ve been suffering.


I totally agree with you. Mental illness, whether triggered by the overwhelming phenomenon of new motherhood or some other stressful event in one’s life, is such a taboo subject at times. Even now, after so many strides to bring more awareness to the subject. Many that face mental illness feel that either they are int he wrong for feeling the way they do or that topics such as depression are thrown around so flippantly, that it can be hard to determine if someone is actually depressed or if they are having a bad day. I found it almost startling in the article I found that while mood disorders are most common among non-pregnant women, new mothers are less likely to seek treatment (Farr, Denk, Dahms, & Dietz, 2014). That’s got to be a terrible feeling to feel so alone and that you are failing as a mother because no one told you that it is okay for you to go through this. I’m glad that you were able to be there for your friend and encourgae her to seek help for something that could have spun out to be much worse later down the road.

Thank you for your comments

Adding the citation for the article to my reply to Melissa.

Farr, S. L., Denk, C. E., Dahms, E. W., & Dietz, P. M. (2014). Evaluating Universal Education and Screening for Postpartum Depression Using Population-Based Data. Journal Of Women’s Health (15409996)23(8), 657-663. doi:10.1089/jwh.2013.4586


Thank you for your post and the very interesting topic. I think that postpartum depression has not been taken as seriously  as it should be because it is a very serious disease. I remember after I gave birth to my son, my doctor asked me repeatedly about my feelings as a mother and she even asked my husband about my emotional state and my interactions with my son. I did not have postpartum depression but I do know people that have experienced it and I have been told that it is a difficult thing to deal with. I appreciate your research on such an important topic.

Hello Kimberly,

Great topic.  For me it hits close to home.  I suffered from post- partum depression and honestly, I thought I was losing my mind not understanding what was going on with me. I began to read literature on the topic and it help me understand the emotional roller-coaster I was going through.  Fortunately, it only lasted about 3 weeks. One day I just woke up and it was gone. I know some women are not as fortunate.

Hello Professor and Class:

The nursing clinical issue I have chosen is hand washing with soap or hand sanitizer and the prevention of spreading infection. The PICOT format about my clinical nursing issue is as follows:

Problem -Hand washing with hand sanitizer vs. hand washing with soap

Intervention – Washing of hands with sanitizer

Comparison – Hand washing with soap

Outcome- Prevention of infection spread

Time -Hospital stay duration

Hand washing plays an important role in preventing the spread of infection in the hospital. The patients need to wash their hands several times during their stay in the hospital and health professionals every time they come into contact with the patient in order to prevent the spread of infection. Studies show that washing of hands using hand sanitizer is effective because the sanitizer kills germs that cause illnesses (Mathur, 2011). As such, patients and health workers are encouraged to wash their hands using sanitizer to reduce the spread of germs from healthcare workers to patients. Further, washing hands using sanitizer is important in battling the rise of antibiotic resistance. The nurses often administer antibiotics to their patients and their hygiene tends to affect patient response to treatment. The nurses are required to maintain high standard of hygiene because they are often in direct contact with several  patients throughout their shift and often exposed to different illnesses.

Washing of hands using sanitizer as opposed to soap is an important nursing practice because it directly affects disease control and prevention of new illnesses. Soaps help in cleaning the hands, but some may not kill the germs that cause diseases. Thus, it is important to use the sanitizer because it would readily kill the germs. Fighting germs is in important practice in hospital setting hence the need to use the sanitizer to prevent the spread of infections (Kampf, Loffler & Gastmeier, 2009). The assumption is that patients battle various infections; some are communicable and easily spread in poor hygiene. It follows that nurses can easily control spread of new infections by maintaining a high standard of hygiene in the hospital.


Kampf, G., Loffler, H., & Gastmeier, P., (2009). Hand Hygiene for the Prevention of Nosocomial Infections. Dtsch Arztebl Int (Links to an external site.)ernational 106(40), 649-655.

Mathur, P. (2011). Hand hygiene: Back to the basics of infection control. Indian Journal of Medical Research 134(5), 611-620.

Dear Lucy,

You don’t really state what the problem/population is in your PICOT. Your topic is approved for next week. Both of your articles are too old to be considered good evidence. Could you present to a group of nurses with an article written in 2011 and 2009?


Dr. Taulbe

Dr. Taulbee and Class,

A problem that is common with Home Health Care, is that of Medication reconciliation or Medication review. The PICO that I came up with is:

P: Home care clinicians are required to assess medication knowledge, compliance and potential for errors.

I: Compete medication reconciliation and review at every visit.

C: Compared to using a medication list

O: Patients are more knowledgeable and compliant with their medications and have fewer medication errors by omission, duplication, dosing or drug interactions.

T: 60 days

The article that I found in CCN library is entitled, “In-home medication reviews: a novel approach to improving patient care through coordination of care”. It discusses how the Geriatric population often requires a good number of medications to manage their chronic illnesses. As such, they are more at risk for falls and injuries related to medication errors or drug interactions. It also discusses that many patients are not knowledgeable regarding their medications uses, potential side effects and correct administration. Accurate medication reviews and reconciliation are essential by the clinicians.

The article depicts a study of students being trained in appropriate in -home medication review and reconciliation. It included checking the medications in their original containers; verifying the correct name, strength, dose, and use for drug.

Medication review/reconciliation may not prevent every error or drug interaction, but with consistency, it can increase compliance and significantly reduce medication errors.



Willis, J. S., Hoy, R. H., & Jenkins, W. D. (2011). In-home medication reviews: a novel approach to improving patient care through coordination of care. Journal Of Community Health, 36(6), 1027-1031. doi:10.1007/s10900-011-9405-3

Dear Germaine,

Your topic and PICOT is approved for next week’s assignment. Please review the standards for a research article. Does the date of your article meet the guidelines? Why or why not?


Dr. Taulbee

  • g adherence and using it to search for a research report can help in identifying ways of addressing the drug non-compliance problem.

    One of the ways that nurses can use to improve drug compliance is daily reminders. Thus, the PICOT question is, “In patients who are ready for discharge, how does text-messaging compared to patient education as a single intervention facilitate adherence to medications in three months?” The ‘terms text-messaging’ and ‘adherence’ where used to search for a research report, and they helped in arriving at a study conducted by Park et al. (2014). This study has high-level evidence since the researchers utilized a randomized controlled trial to recommend text messaging as a measure of increase drug compliance.

    The identified study is relevant to nursing practice since it can help in taking patient contacts during discharge. Then, nurses can implement the text messaging approach to help patients remember to take their drugs at home. This method can facilitate recovery and reduce the readmission rates since patients will experience maximum therapeutic effects of drugs.

    In conclusion, personal experience with patients revealed that non-compliance is still an issue that needs proper attention. Reliable research evidence shows that healthcare providers can use text-messaging to promote drug adherence. Thus, searching for clinical evidence regarding this issue and using it appropriately in nursing care can help in improving the outcomes of patients.



    Hain, D. J., & Kear, T. M. (2015). Using evidence-based practice to move beyond doing things the way we have always done them. Nephrology Nursing Journal, 42(1), 11-21. Retrieved from

    Park, L. G., Howie-Esquivel, J., Chung, M. L., & Dracup, K. (2014). A text messaging intervention to promote medication adherence for patients with coronary heart disease: A randomized controlled trial. Patient Education and Counseling, 94(2), 261-268. doi: 10.1016/j.pec.2013.10.027.

    Peterson, M. H., Barnason, S., Donnelly, B., Hill, K., Miley, H., Riggs, L., & Whiteman, K. (2014). Choosing the best evidence to guide clinical practice: Application of AACN levels of evidence. Critical Care Nurse, 34(2), 58-68. doi:10.4037/ccn2014411.

    P- Breast feeding mothers

    I- Feeding from the breast

    C-Pumping and feeding from a bottle

    O-Feeding from the breast allows a longer period of breast feeding

    T-4 months

    Breast feeding is one topic I have researched a lot here recently. There is so much education and so many people who try to tell you how they experienced breast feeding. I choose this nursing topic because as nurses we tell patients to wait to introduce a bottle until the 4th week if the mother wants to solely breast feed. This education has been told from nurses, counselors and consultants. “Nurses may also have experiences as family members or as patients themselves. This unique perspective, in which nurses view nursing care from the other side of the bed, gives rise to the opportunities to transform that care (Houser, 2018).” Some mothers can’t do this due to the baby being in NICU or other reasons like difficulty feeding at the breast or even elective reasons. I want to know if feeding at the breast sustains the ability to breast feed the baby longer or if using a pump to feed the baby with a bottle allows the mother to breast feed longer. The article I choose is a great example because it compared different pumping options in a breast-fed mother were associated with shorter feeding durations than a baby fed at the breast who only pumped occasionally.


    Felice J, Cassano P, Rasmussen K. Pumping human milk in the early postpartum period: its impact on long-term practices for feeding at the breast and exclusively feeding human milk in a longitudinal survey cohort. The American Journal Of Clinical Nutrition [serial online]. May 2016;103(5):1267-1277. Available from: MEDLINE Complete, Ipswich, MA. Accessed November 2, 2017.

    Houser, J. (2018). Nursing research: reading, using and creating evidence. Sudbury, MA; Jones & Bartlett.

    Dear Class,

    You have done a great job this week in thinking about your PICO(T) question.  Your experience on your units or areas of nursing will guide you in using research to enhance your professionalism.  I hope that you are starting to understand how important EBP is to your patient care.  Remember that research articles are systematic and have specific characteristics. I would also like for you to consider the different databases that house the articles of research. I hope you all have access to quality databases in your professional setting. I have enjoyed reading your posts.

    Dr. Taulbee

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