Evidence Based Practice in Nursing & Specialization: Research Report

This report addresses the research question of whether inexperienced newly graduated nurses should be assigned to care for terminally ill patients. It provides an evidence-based literature review, framing the research question, evaluating relevant literature, and utilizing a step-by-step process. The report highlights the challenges faced by newly graduated nurses in palliative care, emphasizing the need for training within the nursing curriculum. The methodology includes a PICOT framework to structure the research question and database searches using CINAHL and PubMed. The search strategy focuses on key terms such as 'Palliative Care,' 'Terminally Ill,' and 'Care Giver,' using operators like AND and OR, as well as techniques such as truncation, phrase searching, and wildcards to broaden and narrow the search results. The report includes a table illustrating the PICO components and search results from PubMed, showcasing the process of refining the search strategy to identify relevant literature. References to key resources like the ANA Centre of Ethics and Human Rights and NYU Libraries are also included.

Running Head: Evidence based Practice in Nursing & Specialization
Assessment 3
Evidence Based Practice in Nursing & Specialization
Student Name:
Student ID:
University:

Evidence based Practice in Nursing & Specialization 2
Research Question: Should inexperienced Newly Graduated Nurses be given duty to care
for terminally ill patients?
Evidence based Literature Review use a step by step process to frame the research question,
evaluating it, assessing and repeating when required. The above question addresses the
effectiveness of therapeutic intervention and care provided in hospice care especially through the
perceptions and experiences of inexperienced nurses while caring for the terminally ill patients
(Northern Arizona University, 2019).
The literature answering the above question would be mostly a qualitative study to illustrate the
challenges faced by the nurses while treating the patients with terminal illness. Semi structured
interviews would be conducted to collect the information and thematic analysis of the responses
may be done to retrieved the experiences of newly graduated nurses. The articles would finally
conclude that the Graduate Nurses are not sufficiently prepared to care for hospice patients in
Palliative Care units. It demands the need for providing them training to care for terminally ill
patients during the nursing Curriculum.
Background
The scenario shows that the newly graduated Nurse having 2 year of experience in Acute care
have no experience in terminal care. They may lack the confidence to provide care for intense
and dynamic hospice environment (ANA Centre of Ethics and Human Rights, 2016). They might
be incompetent to provide quality care to meet the need of the palliative care patients.

Evidence based Practice in Nursing & Specialization 3
The clinical question can also be answered by using design of convergent mixed methods with a
survey of open ended questions. Standard instruments like Practice Environment Scale Australia
and Manchester Clinical Supervision Scale may be used (Hussein, Everett, Ramjan, et al., 2017)
PICOT Search
The PICOT formula is used in nursing to develop consistent formula for finding the answers to
the researchable questions. The formula has five components- Patient/Problem/Population,
Intervention, Comparison, Outcome and Timeframe or Type of Study (NYU Libraries, 2019).
However the timeframe component is not applicable in majority of the questions, so it is omitted.
According to PICO structure, the key concepts used to address the various elements of the
research question may be-
Inexperienced graduate Nurse, Terminally Ill Patients, Palliative Care, Hospice Care etc
However if we identify the individual components of the question we will see the components as
follows:
Table 1
PICO Components Examples
Patient /Problem Terminally ill Patients or Palliative Care or Hospice Care
Intervention Delivering Care
Comparison Experienced RNs caring for Palliative patients
Outcome Improved Quality of Life; Reduced Suffering
The two databases searches for the evidence are: CINAHL and PubMed. These databases were
chosen to search the question because they are mostly used at different institutes for research and
are known to majority of the nursing care practitioners working at palliative care (NYU
Libraries, 2019).

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For best results, the number of elements in the search strategy should be kept as fewer as
possible. Search Strategy should start with the Problem / Patient (P) and the Intervention (I) only
to broaden the results.
So, The Search Strategy using PubMed Database may be:
(Palliative OR Terminally ill OR Hospice) AND Care Giver.
We can also search for the terms separately however, the terms cam be combined using AND
and OR operators. The increasing number of terms are combined with AND, the fewer would be
the number of number of items retrieved.
OR increases the number of items retrieved as only one of the terms is searched.
Table 2 (Search Using PubMed Database)
Set Number Search Hits
#1 Palliative Care 265,00, 000
#2 Terminally Ill 111,00,000
#3 Hospice Care 802,00,000
#4 Care Giver 13,20,000,00
#5 #1 OR #2 OR #3 121,00,000
#6 #4 AND #5 9150
After retrieving the initial results of the search, the search can be narrowed in terms of
comparison, type of study, time and outcomes. Additionally the database filters can also help in
filtering the evidence. The abstracts, results and the full text may be reviewed in detail to view
the outcome and the comparison. The evidences can be filtered by expanding the search or
narrowing the search.

Evidence based Practice in Nursing & Specialization 5
We can identify the potential synonyms in the thesaurus. These terms can be searched in form of
free text keyword in additional to the associated terms of thesaurus. The key subjects related to
Palliative care in PubMed may be as follows:
Attitude to Death
Life Support Care
Terminal Care
Resuscitation Order
Hospices
Bereavement
Euthanasia
Care Givers
Death
In PubMed the operators AND and OR are capitalized. Three main strategies are used to search
databases. These are Truncation, Wildcards and Phrase Searching.
Truncation
All the possible variations of a word can be searched in the PubMed Specific, using *. For
instance a search of Pallia* will bring all the literatures starting with Pallia having anything at the
end. Such as Palliating or Palliative or Palliation. It increases the number of retrievals.
Phrase Searching

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It allows us to search for a group of words near to each other. For example the Quotations are
used to enclose the terms associated with the symbols. For example the phrase “The Terminally
Ill Patients” will find exactly these three words in the same order in all the articles.
In PubMed Specific, it is flexible to narrow down the research by turning off the default settings.
Wildcards
The wildcards help us to retrieve the variations in a single word.
The proximity syntax can be constructed to use it again when needed and the relevant thesaurus
terms may be put in the code. The syntax for free text terms can be added to the abstract title.
Initially the exact phrases and one word synonyms can be added. Later on all the terms can be
combined together to form a single search strategy.
("Palliative, Care"[mh] OR (Hospice[tiab] OR Pallia*[tiab]))AND (“ New Graduate Nurse"[mh]
OR (Inexperience* [tiab]))
However, making the search very specifc will result into fewer hits. That’s why we have made a
general search of the key terms involving just the P and I.

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References
ANA Centre of Ethics and Human Rights (2016). Nurses’ role and responsibilities in providing
care and support at the end of life. Retrieved from
https://www.nursingworld.org/~4af078/globalassets/docs/ana/ethics/endoflife-
positionstatement.pdf
Hussein, R., Everett, B., Ramjan, L. M., Hu, W., & Salamonson, Y. (2017). New graduate
nurses' experiences in a clinical specialty: a follow up study of newcomer perceptions of
transitional support. BMC nursing, 16, 42. doi:10.1186/s12912-017-0236-0
Northern Arizona University (2019). Evidence based Practice. Retrieved from
https://libraryguides.nau.edu/c.php?g=665927&p=4682772
NYU Libraries (2019). Health Nursing: Search Strategies: Framing the Question (PICO).
Retrieved from https://guides.nyu.edu/c.php?g=276561&p=1847897