Lecture Notes Vocabulary

Group 1

• Scenario: Determining if multiple sunburns in childhood/teen years increase melanoma risk later in life.
• The appropriate search format needs to be determined.
• Options: PICOTS, PEO, CoCoPopPI, PIRD

Group 2

• Scenario: A patient presents with fatigue, joint pain, sleeplessness, and depression. The healthcare provider is uncertain whether these symptoms indicate chronic fatigue syndrome or myalgia and seeks the best diagnostic evidence.
• Options: PICOTS, PEO, CoCoPopPI, PIRD

Group 3

• Scenario: A patient who was 10 weeks pregnant underwent a D & C following a spontaneous miscarriage. There's interest in determining the risk of severe or prolonged grief in this patient.
• Options: PICOTS, PEO, CoCoPopPI, PIRD

Group 4

• Scenario: A nurse wants to find out the prevalence and incidence of thyroid dysfunction in type 1 diabetic females.
• Options: PICOTS, PEO, CoCoPopPI, PIRD

Group 5

• Scenario: Patients on coronary artery bypass graft (CABG) waiting lists experience anxiety and depression. The nurse manager wants to assess the potential benefits of pre-surgical home visits and follow-up calls from a specialist cardiac nurse.
• Options: PICOTS, PEO, CoCoPopPI, PIRD

Group 6

• Scenario: A nurse assesses an elderly patient who is dizzy, unstable, and walks with a limp and needs to know the patient's risk for falls on the unit.
• Options: PICOTS, PEO, CoCoPopPI, PIRD

Group 7

• Scenario: A clinician wonders about the risk of exposure to CT radiation in children and the development of leukemia later in life.
• Options: PICOTS, PEO, CoCoPopPI, PIRD

Group 8

• Scenario: A clinician works with patients with advanced cancer & wants to know if pain diaries for patients actually improve pain control or make pain worse by making patients more aware of their pain.
• Options: PICOTS, PEO, CoCoPopPI, PIRD

Group 9

• Scenario: A clinician sees a new obstetrical patient in the office who has had 5 miscarriages and suspects Antiphospholipid syndrome (APS) is the cause. The clinician wants to find out the best diagnostic test to use to determine if she really has APS. What search terms she be used?
  • Options: PICOTS, PEO, CoCoPopPI, PIRD

Group 10

• Scenario: A nurse researcher is working with colleagues in Taiwan to find out the incidence rate of diagnosed attention-deficit/hyperactivity disorder (ADHD) in children over 12 years of age. What search format should be used?
  • Options: PICOTS, PEO, CoCoPopPI, PIRD

Group 11

• Scenario: A hospital has installed antibacterial foam dispensers & nurses are asking if the foam is just as effective as washing their hands with water and soap. What format should the clinician use to inform the search phrases?
  • Options: PICOTS, PEO, CoCoPopPI, PIRD

Group 12

• Scenario: A CRNA heard something about learning disabilities later when infants are exposed to general anesthesia and wonders what the evidence says. What search format should be used?
  • Options: PICOTS, PEO, CoCoPopPI, PIRD

Group 13

• Scenario: An ER personnel desires to find out what test to order to diagnose Listeriosis. What format should be used to conduct the search? What format should the clinician use to inform the search phrases?
  • Options: PICOTS, PEO, CoCoPopPI, PIRD

Group 14

• Scenario: The nurse is assisting at a pediatric clinic and a new mother asks about the risk of autism after measles immunization.
  • Options: PICOTS, PEO, CoCoPopPI, PIRD

Group 15

• Scenario: A 55-year old man in the clinic sees you with a history of osteoarthritis and presently complaining of right knee pain. He has been on NSAIDs for a while with little relief. He is asking if TENS (transcutaneous electrical nerve stimulation) would help relieve his knee pain. What format should the clinician use to inform the search phrases?
  • Options: PICOTS, PEO, CoCoPopPI, PIRD

Group 16

• Scenario: The nurse clinician wants to find out the incidence of peritonitis in CKD patients on continuous ambulatory peritoneal dialysis (CAPD). What format should the clinician use to inform the search phrases?
  • Options: PICOTS, PEO, CoCoPopPI, PIRD

Group 17

• Scenario: A school nurse sees a mother who wants to know if she should follow the advice of a website of a “100 uses of duct tape” listing duct tape as useful in removing warts. What format should the clinician use to inform the search phrases?
  • Options: PICOTS, PEO, CoCoPopPI, PIRD

Group 18

• Scenario: A student is doing a paper on Gout and wants to see the best way to diagnose the condition. What format should be used to help clarify phrases to search?
  • Options: PICOTS, PEO, CoCoPopPI, PIRD

Group 19

• Scenario: A researcher plans to do a cohort study and follow children for 5 years after they visited the ER room for eating lead paint to determine the risk of mental retardation. What format should be used to inform the search phrases?
  • Options: PICOTS, PEO, CoCoPopPI, PIRD

Group 20

• Scenario: The nurse searches for information on the incidence of heparin-induced thrombocytopenia in solid malignancy from adult patients in the acute care setting. What format should the clinician use to inform the search phrases?
  • Options: PICOTS, PEO, CoCoPopPI, PIRD

Group 21

• Scenario: The nurse is visiting a village in a rural part of a developing country and sees signs near the stream that say “Warning: Arsenic in the water,” and wonders if that is the cause of the high rate of blindness in the village. What search format should be used? (rate and prevalence are synonymous)
  • Options: PICOTS, PEO, CoCoPopPI, PIRD

Group 22

• Scenario: A cardiology nurse researcher was asked to find out if there is an increased incidence in cancer following up to 15 years ago in infants who had undergone cardiac catheterization. What search format should be used?
  • Options: PICOTS, PEO, CoCoPopPI, PIRD

Group 23

• Scenario: A patient suffers from chronic migraines and recently heard about botox injections. She has typically taken Imetrex injections when a migraine begins to develop. The patient would like to try botox to see if it would prevent them from coming on. What format should the clinician use to inform the search phrases?
  • Options: PICOTS, PEO, CoCoPopPI, PIRD

Group 24

• Scenario: A clinician desires to learn the best diagnostic test to detect Fatty Liver Disease. What format should be used to determine the best search terms?
  • Options: PICOTS, PEO, CoCoPopPI, PIRD

Group 25

• Scenario: An epidemiologist plans to study the incidence of spina bifida aperta after women were prescribed valproate prenatally. What format should the clinician use to inform the search phrases?
  • Options: PICOTS, PEO, CoCoPopPI, PIRD

Group 26

• Scenario: The newborn nursery nurse prepares a male infant for circumcision and knows they always cry during the whole procedure and would like to change the policy by providing pacifiers dipped in sucrose to the babies while undergoing the procedure. But the nurse needs to find the supporting evidence to convince the unit manager.
  • Options: PICOTS, PEO, CoCoPopPI, PIRD

Group 27

• Scenario: A clinician sought data on the incidence and outcomes of acute undifferentiated leukemia in adults. What search format should be used?
  • Options: PICOTS, PEO, CoCoPopPI, PIRD

Group 28

• Scenario: The nurse researcher wants to study antibiotic stewardship and plans to study children who took antibiotic courses at least twice during childhood and see if there is a risk for inflammatory bowel disease later. What format should the clinician use to inform the search phrases?
  • Options: PICOTS, PEO, CoCoPopPI, PIRD

Group 29

• Scenario: A clinician wants to find out if there is increased incidence of nephrotoxicity among male HIV patients who received Tenofovir. What format should the clinician use to inform the search phrases?
  • Options: PICOTS, PEO, CoCoPopPI, PIRD

Group 30

• Scenario: Since traffic is getting worse and worse, the graduate nurse wants to see if there is an association between traffic-related air pollution exposure and asthma in children. What format should the clinician use to inform the search phrases?
  • Options: PICOTS, PEO, CoCoPopPI, PIRD

Group 31

• Scenario: The professor seeks to determine the risk of lung cancer in railroad workers exposed to diesel exhaust. What search format should be used?
  • Options: PICOTS, PEO, CoCoPopPI, PIRD

Group 32

• Scenario: An obstetric nurse plans a study to determine what happens to the neurodevelopment of children when exposed to prenatal Tylenol in utero. What search format should be used?
  • Options: PICOTS, PEO, CoCoPopPI, PIRD

Group 33

• Scenario: An epidemiologist collaborates with a geologist to determine textile workers' mortality and morbidity rates after exposure from each of the three types of asbestos. What format should the clinician use to inform the search phrases?
  • Options: PICOTS, PEO, CoCoPopPI, PIRD

Group 34

• Scenario: The hospital nurse epidemiologist needs to find out the risk of contracting HIV during occupational blood exposure in nurses. What phrase format should they use?
  • Options: PICOTS, PEO, CoCoPopPI, PIRD

Group 35

• Scenario: The NICU clinician seeks to learn the incidence of retinopathy of prematurity (ROP) in extremely preterm infants. What search format should be used? What search format should be used?
  • Options: PICOTS, PEO, CoCoPopPI, PIRD

Group 36

• Scenario: Someone recently published a paper on the use of Oxygen in myocardial infarction patients who do not show hypoxia and showed the patient was harmed. What format should the clinician use to inform the search phrases to determine risk of harm after exposure?
  • Options: PICOTS, PEO, CoCoPopPI, PIRD

Group 37

• Scenario: Does use of the Intermittent Pneumatic Compression (IPC) device prevent thrombophlebitis when used in conjunction with pharmacologic prophylaxis in the medical population vs surgical population? What search format should be used?
  • Options: PICOTS, PEO, CoCoPopPI, PIRD

Group 38

• Scenario: The synthesized research shows maternal periodontitis doubles the risk of preterm labor but there is no consensus on how to diagnose it. What search format should be used? (even though there is a word risk the clinical question is asking about how to diagnose pre term labor)
  • Options: PICOTS, PEO, CoCoPopPI, PIRD

Group 39

• Scenario: A clinician noticed that post-kidney transplant patients who suffer from hypomagnesemia then go on to develop cardiovascular issues. To find out the risk of cardiovascular issues after exposure in this patient population, what search format should be used? What search format should be used?
  • Options: PICOTS, PEO, CoCoPopPI, PIRD

Group 40

• Scenario: Does practicing 3 feet of physical distancing just as effective as 6 feet of physical distancing in reducing the spread of COVID-19? What format should the clinician use to inform the search phrases to determine which distance is the best treatment?
  • Options: PICOTS, PEO, CoCoPopPI, PIRD

Group 41

• Scenario: The nurse caring for a teen in labor wonders if the incidence of pre-eclampsia is higher in teens than the regular pregnant population. What search format should be used?
  • Options: PICOTS, PEO, CoCoPopPI, PIRD

Group 42

• Scenario: A grandmother told her family to wrap a wool sock with a cold washcloth around the neck when experiencing a sore throat. To verify if this is an evidence-based treatment, what search format should be used?
  • Options: PICOTS, PEO, CoCoPopPI, PIRD

Group 43

• Scenario: A nutritionist recommends eating 5 nuts a day to lower cholesterol. The student wants to find out if this intervention is really evidence-based. What search format should be used?
  • Options: PICOTS, PEO, CoCoPopPI, PIRD

Group 44

• Scenario: A clinician wants to know if a biomarker is available to diagnose Bladder cancer or if the best way is still by visual inspection. What format should the clinician use to inform the search phrases and answer this specific question?
  • Options: PICOTS, PEO, CoCoPopPI, PIRD

Evidence-Based Practice (EBP)

• EBP is a process that promotes continuous learning and applies to nursing students and future nurses.
• EBP leads to improved patient outcomes, high-quality care, cost reduction, and the elimination of ineffective practices.

EBP: Why Ask Right Questions?

• Examples of EBP changes in nursing care:
  • The BRAT diet is no longer recommended for children with gastrointestinal upset; a balanced diet is advised instead.
  • Nurse-driven protocols dictate the best time to remove urinary catheters to prevent UTIs.
  • Aspirin is no longer used to control fever in children due to the risk of Reye's syndrome.

Elements of EBP

• Inquiry.
• Work in interprofessional teams.
• Reflection.
• Evidence translation.
• Best practices.
• Practice improvements.

Framing the Clinical Question

• Think of the question, not the solution or symptoms.
• Consider if it's:
  • Broken and needs fixing.
  • A risk that needs prevention.
  • New evidence to accept.
  • A message to promote.

Question Formats and Efficiency

• Question formats help construct a clear question.
• They provide the correct cue words for efficient article searching.

Learning Objectives

• Decide when to use PICOTS/PEO/CoCoPopPI/PIRD based on the clinical question.
• Choose appropriate search terms from these formats.
• Use different types of systematic reviews as an additional search term.

PICOTS Framework

• Components:
  • P: Patient population.
  • I: Intervention.
  • C: Comparison.
  • O: Outcomes.
  • T/S: Time/Situation.
• Example: What is the effectiveness of pet therapy vs. regular care on pain and nausea levels post-chemotherapy in teens?

PEO Framework

• Used for risk-related questions.
• Components:
  • Population.
  • Exposure.
  • Outcome.
• Example: Are people exposed to radon at risk for lung cancer?
• Other examples:
  • Risk of contact dermatitis from Hibiclens exposure.
  • Risk of depression from less than 4 hours of sleep.
  • Risk of chronic fatigue syndrome from sharing water bottles.
  • Risk of scurvy in geriatrics exposed to frozen dinners.
  • Risk of asthma in toddlers exposed to second-hand smoke.

CoCoPopPI Framework

• Used for incidence/prevalence questions.
• Components:
  • Condition (disease, syndrome, or symptom).
  • Context (specific setting or environment).
  • Population (detailed description).
• Example: What is the prevalence/incidence of claustrophobia in adult patients undergoing MRI?

PIRD Framework

• Goal:
  • Identify the presence/absence of a disease/condition/syndrome to develop appropriate Plan of Care.
  • To determine which diagnostic test is best when there are several options.
    *Systematic review of all the diagnostic tests for a certain condition will report accuracy, costs, feasibility of diagnostic tests.
• Components:
  • Population: Participants undergoing diagnostic test
  • Index test: Test being investigated
  • Reference test: Gold standard test
  • Diagnosis of interest: Disease, injury, disability or pathological condition
    *Examples
  • Which is better? XRAY better Than MRI TO DIAGNOSE bowel cancer in patients experiencing discomfort, bloating, nausea, diarrhea, and bloody stools
    • Is nasal molecular test (PCR) Better than the saliva antigen test In diagnosing current COVID infection In patients with fever, non-productive cough, malaise, weakness, shortness of breath, and loss of smell and taste?

Refining Search Terms

• Use one or two-word phrases.
• Example: Use "Adults + female + \"chronic fatigue syndrome\"" instead of "Adult females who have chronic fatigue syndrome."
• Use truncation (*)
• Add systematic review to search terms.
• Boolean Operators help specify ask for:
  * Effect or Effectiveness
  * Risk
  * Prevalence or Incidence
  * Diagnos*

Boolean Operators

• AND: All data points are present, exclusive.
• OR: Any data point is present, inclusive.
• NOT: One data point is present but not another.

Where to Find EBP Literature

• PubMed.
  * High Quality Clinical Research Evidence
• Google Scholar.
• TRIP.
• Cochrane Library.
• Joanna Briggs Institute (JBI).
• CINAHL.
  * Evidence-Based Practice in Nursing

TRIP Database Features

• Database is specific to EBP.

Qualitative vs. Quantitative Research

• Qualitative Research:
  • Data collected through unstructured, open-ended text/verbal responses.
• Quantitative Research:
  • Data collected through structured and controlled instruments like surveys or experiments.

Levels of Evidence (From High to Low Quality)

• Systematic Reviews.
• Critically-Appraised Topics.
• Critically-Appraised Individual Articles.
• Randomized Controlled Trials (RCTs).
• Cohort Studies.
• Case-Controlled Studies.
• Case Series/Reports.
• Background Information/Expert Opinion.

How to Find Articles

• Boolean Operators such as AND, OR, NOT

Levels of Evidence

• Level 1: Randomized control trial or Meta-analysis of RCT with homogeneous results
• Level 2: Prospective comparative study or Meta-analysis of Level 2 studies or Level 1 studieswith inconsistent results
• Level 3: Retrospective Cohort Study or Case-control Study or Meta-analysis of Level 3 studies
• Level 4: Case Series
• Level 5: Case Report, Expert Opinion or Personal Observation

How to read a research article

• Title : captivate audience
• Abstract Most Read Boolean Operator
• Introduction Always ask ?
  How did they measure that?
  Is that a reliable way to measure?

Easy appraisal

• Is the design appropriate for the PICO question being asked?
• Are the conclusions measurable and likely to be valid and reliable?
• Was there a relevant population size?
• Is the outcome generalizable to any situation?

Assesment of Survey

• Did the study address a clearly focused issue?
• Was the sample size justified?
• Could the way the sample was obtained introduce (selection) bias?
• Is the sample representative and reliable?
• Are the measurements (questionnaires) likely to be valid and reliable?
• Was the statistical significance assessed?
• Are important effects overlooked?
• Can the results be generalized?

Social Media and EBP in Nursing

• Roles of Social Media in Healthcare:
  • Impacts patient care and public health.
• Ethical Guidelines for Nurses on Social Media:
  • Professionalism and standards.
  • HIPAA compliance.

Social Media Timeline

      * 1997- The first social media site, Six Degress
      * 2002- LinkedIn launches
      * 2004- Facebook is founded
      * 2006- Twitter is Launched

The Role of Social Media in Healthcare

• Relationships with patients.
• Cost-effective marketing.
• Showcasing accomplishments.
• Security risks.
• False information.
• Lack of professional control.
• Time-consuming.
• Dangers of self-diagnosis.

Ethics of Social Media

• Privacy.
• Misinformation.
• Professional Boundaries.
• Informed consent.
• Mental Health.
• HIPAA compliance.

Considerations Before Posting

• Is is it emotional?
• Legal trouble?
• Patient confidentiality?
• Damage to employer?
• Am I compromising my own integrity?

Benefits of Social Media

• Networking and building connections.
• Continuing education.
• Knowledge sharing.
• Mentorship and support.
• Career opportunities.

Social Media literacy

• Credibility of information.

Future of Healthcare

      * Rate of medical innovations was doubling every 7 years in 1980
      * By 2010 knowledge doubled every 3-5 years
      *Now doubling approximately every 73 days

Artifical Intelligence

• Vocal Biomarkers
• Medication Management Systems
• More at home lab tests
• Metal health