Evidence for Nursing: Finding the Evidence

This assignment requires students to develop a question to address clinical uncertainty and conduct a systematic literature search using the PICO framework. Students will choose a clinical case scenario and use a worksheet to plan their search strategy. The assignment aims to assess students' ability to use PICOs and build a systematic literature search.

EVIDENCE FOR NURSING
Assessment Item 1: Finding the evidence Weight: 15% of overall mark for the subject
Submission: 11.59 pm Monday 25 March 2019, through Turnitin. No paper submission is required.
Task: Using clinical case scenarios, students will be expected to develop a question to address the area of clinical
uncertainty and demonstrate their ability to use the PICO framework and document a systematic literature search.
Instructions
This assignment will build on your learning during Week 1 and Week 2. The learning activities in Week 1 tutorial and
Week 2 online discussion forum have been designed to help you with formulating PICO questions and developing
search strategies, which is the focus of Assessment 1. A face to face library session in Week 1 lecture along with
additional library drop in sessions and online library modules will provide bonus assistance in relation to this
assessment.
In this assignment you will provide evidence of your ability to use PICOs and build a systematic literature search.
1. Choose one of the three clinical case scenarios on the next page (page 2).
2. Using the information from the case scenario, and your skills from Week 1 and Week 2, fill in the attached
PICO worksheet to plan for your systematic database search.
3. Using the information from your PICO Worksheet, record your Search Strategy in the attached search
strategy table (please do this in Microsoft Word and not by hand).
4. Enter your search terms into Medline (Ovid) and complete a search.
5. Take a screenshot of your final search and paste it into the section in the worksheet below (see example on
page 3).
a. Why Medline? It is one of many databases, you just need to show us you are able to apply your
learning into a database and in this instance we have asked you to use Medline – being able to carry
out a prescribed task is part of learning :-)
Assessment Item 1: Finding the evidence Page 1

Choose one of the following case scenarios to guide your work in Assessment Item 1 and 2
Scenario 1: Compression stockings
You are working on a surgical ward where you encounter pre- and post-operative patients. You notice that some
doctors order knee length compression stockings while others order thigh length compression stockings for your
patients. You are concerned about the diversity of practice and decide to search the literature to find any evidence
supporting the length of stockings.
Scenario 2: Postoperative pulmonary complications
You are a newly graduated registered nurse working in a cardiac surgery ward. You attend a conference and hear
that some of your peers at another hospital are providing preoperative breathing exercises to patients who will be
undergoing cardiac surgery in order to reduce their risk of pulmonary complications postoperatively. You are not
aware of any research that has investigated the beneficiary effects of preoperative interventions such as muscle
training and breathing exercises and would like to search for evidence to decide whether this is something you
should use at your hospital.
Scenario 2: Managing Chronic Heart Failure
You are working as a clinical nurse specialist in the heart failure clinic and service in Dubbo. One of your patients
travels 2 hours by car from Coonabarabran for his monthly consultation. His wife and he find the long trip from
home very difficult and an added burden in their lives. Particularly as he takes frusemide for his chronic heart failure
that causes diuresis, which means they have to stop the car often which is frustrating and makes the trip even longer
and tiring. They tell you that a friend of theirs, who also lives in regional NSW, uses a remote telemonitoring device
to monitor their condition from their home. This means that their friend doesn’t have to travel to their clinic so
much. They ask you whether you think it is better to keep coming into the clinic or to see about getting a remote
telemonitoring device to help them manage the chronic heart failure. You are a little unfamiliar with telemonitoring,
but you also don’t want your patient to have to travel unnecessarily. You tell the couple that you will search for the
available research on the management of chronic heart failure using telemonitoring and bring this back to them.
Assessment Item 1: Finding the evidence Page 2

ASSESSMENT ONE: SUBMISSION TEMPLATE
Please complete your assessment activities in the following pages and submit this into Turnitin:
 PICO Worksheet
 Search Strategy Table
 A print screen of your search in Medline (must be readable in Turnitin).
PICO Worksheet – Development of PICO and terms to be used in search (2 marks)
1. Use the following categories to help define your problem and what you are looking at in simple terms
PICO: Patient/Problem, Intervention, Comparison, and Outcome. (Remember to use your readings to help you if you
are unsure)
Patient/Problem: Post operative pulmonary complications______________________
Intervention: Breathing exercises_______
Comparison: operative precautions____________________________________________
Outcome: reduction of post operative pulmonary disorders________________________________
2. Now use these terms from the question above to create your PICO research question so that you have a clear
purpose for your search (1 mark).
In (P) Post operative pulmonary complications does (I) Breathing exercises compared with (C) operative
precautions improve/reduce (O) Post operative pulmonary complications ?
3. What type of clinical question do you think this PICO question is? (0.5 mark)
Therapeutic □ Aetiology □ Diagnostic □ Prognosis □ prognostic □ Meaning
4. The table below will help you to think of the other terms that you might also like to look up when searching for
evidence to help you answer your question – this is part of basic planning for a research search (2 marks).
We ask you to look up alternative terms because sometimes articles from health systems call things different names – for example, in
Australia we sometimes us the term ‘community nurses’, but in the UK they often talk about ‘district nurses’ – if you only searched under
‘district nurse’ you’d miss all the articles which used the other term – you would be missing some of the picture!
Population Intervention Comparison
(not commonly used in actual
database search strategy)
Outcome
(not commonly used in actual
database search strategy)
What is your population?
Main search term:
Patients who have
undergone surgery
What other terms might
have been used?
Alternative search terms:
Patients awaiting surgery
What is your intervention?
Main search term:
Postoperative pulmonary
complications
What other terms might
have been used?
Alternative search terms:
Respiratory problems
What is your comparison?
Main search term:
Operative precautions
What other terms might
have been used?
Alternative search terms:
Pre operative precautions
What is your outcome?
Main search term:
Reduction of post
operative pulmonary
complications
What other terms might
have been used?
Alternative search terms:
Quick recovery after
surgery
Assessment Item 1: Finding the evidence Page 3

5. Is there a particular group of people that you want to look at? List here any inclusion criteria you might use to
refine your search if you have too many papers (0.5 mark):
Gender: both males and females Age Range: No specific age range_____________________
Publication Dates: 2015-2019______________ Language: English______________________
6. What kind of study/studies do you think would best answer your question? Select here which type of article you
might want to access. You can also use these to refine your search if you have a lot of papers (0.5 mark).
 □ Cohort Study
 □ Randomized Controlled Trial (RCT)
 □ Case-control Study/Case Series
□ Systematic Reviews of RCTs
 □ Qualitative Study
□ Economic Evaluation
 □ Quantitative Study
Systematic Search Plan (this is what we call a Search Strategy)
7. Now that you have decided on WHAT you will be searching, you need to put down a plan of HOW you will search
for your articles. This helps you and others to see how you got your evidence and how you made sure you got the
best evidence to help you decide on your clinical action (3 marks).
Using the PICO terms in your table, enter each term in a row (group them together under the PICO categories). You can add extra rows or
delete them as appropriate.
Plan for combing your searches using ‘or’ and ‘and’ Boolean operators.
Key terms:
1 P-Peer reviewed journals, British Journal of Anaesthesia
2 I-Case studies or cohort studies
3 C-Case studies and 2017
4 O- 2017-2019
5
6
7
8
9
10
11
12 __ OR___OR___OR___ (combine alternate terms for same topic)
13 __ OR___OR___OR___ (combine alternate terms for same topic)
14 ____AND____
OR = combine alternate terms for the same topic – to get as many potential papers as possible!
AND = combine the groups of topics to get papers which cover ALL the terms!
Assessment Item 1: Finding the evidence Page 4

8. The final step is to paste in a picture (screenshot/screengrab) of the search that you did in the database. The
picture has to be readable!!! (2 marks).
In providing this you show your tutor that you are able to take your strategy and apply this into a database. You also
show us that you understand the systematic approach to searching and your understanding of how to use OR and AND
as tools to draw together the articles you are interested in. You can use limits, but you would only do this if you wanted
to refine your search because you had too many papers to search through.
Miskovic, A. and Lumb, A.B., 2017. Postoperative pulmonary complications. BJA: British Journal of Anaesthesia, 118(3),
pp.317-334.
Example of a screen shot. Yours should look something like this:
Assessment Item 1: Finding the evidence Page 5

Assessment Item 1: Finding the evidence Page 6