RE: Discussion – Week 2
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NURS 6052: Essentials of Evidence-Based Practice
Using evidence-based practice (EBP) is an essential tenant of nursing practice. Therefore it is imperative to develop the skills necessary to gather, interpret, and evaluate scientifically based data. To begin my research for this week’s assignment, I first did a Google search of nursing research topics to help myself generate ideas and narrow down a problem that interested me. After considering several topics, I decided to write about delirium in acutely ill patients. Acute Delirium is something that I have a lot of experience with, both personally and professionally. The aim of my research will be to find out how non-pharmacological interventions compare to pharmacological treatment of acute delirium.
Search Results Analysis
Once my topic was selected, I went to the Walden library to search for evidence-based literature on delirium management. According to Walden University (2018), the levels of evidence pyramid determines the quality and amount of evidence available. The top three sections of the pyramid are referred to as filtered results. Filtered results are comprised of systematic reviews at the pinnacle of the pyramid, followed by critically appraised topics, and critically appraised individual articles. The next three sections of the pyramid are referred to as unfiltered results and include randomized controlled trials, cohort studies, and case-controlled studies. Background information and expert opinions make up the base of the pyramid (Walden University, 2018).
I began searching for resources from the top of the evidentiary pyramid, systematic reviews. I used the Joanna Briggs Institute EBP Database, and then limited my search results to systematic reviews, and set a date range of 2014 to current. I used the keywords “delirium” and “interventions” this search yielded four systematic reviews. When I search the term “acute confusion” I found three results. I also utilized the Cochrane Database of Systematic Reviews, and found two systematic reviews by searching for “delirium” in the first text box, and “nursing interventions” in the second text box, again searches were limited to full text with a date range of 2014 to current. I also used the Joanna Briggs Institute EBP Database to search for critically appraised topics. My search for “delirium interventions” yielded just one result. However, when I searched for “delirium” I found ten results. I also searched those same terms on Guideline Central and found four critically appraised topics results. Finally, I searched for critically appraised individual articles using the Evidence Alerts database, and the terms “delirium and acute confusion” this search yielded 23 critically appraised individual articles.
Next, I searched for nonfiltered resources utilizing the CINAHL Plus database. I first looked for randomized controlled trials by searching for the terms “delirium” and “nursing interventions” in the first and second text boxes respectively; this search query yielded four randomized controlled trials. To find cohort studies, I typed “delirium” in the first text box, “interventions” in the second text box, and “cohort studies” in the third text box, this search resulted in 27 articles. I searched for case studies using the same search terms in the first and second text boxes and limited the publications to case studies, this search yielded 56 results. However, when I adjusted the filters to include case studies published within the past five years, the number of results reduced to 14 case studies.
I found congruency between the evidentiary pyramid and my search results; the further down the pyramid, the more resources I found; but, the quality of the information decreased concurrently. While the systematic reviews were not as numerous, they are superior in terms of scientific rigor and evidentiary support. Moreover, the information I found within the systematic reviews were very consistent with my chosen topic compared to information further down the period like cohort and case studies. When search terms were altered, for example, searching for “delirium” versus “acute confusion,” the results remained more consistent when searching for the higher level filtered results whereas alteration of search terms would create a wide variation in results further down the pyramid, in the unfiltered resources.
Polit and Beck (2017), contend that systematic reviews are the best resources for EBP because they contained synthesized information about a topic from numerous evidenced-based studies. However, it is important to recognize that the quality of evidence can vary significantly regardless of its position within the evidentiary hierarchy (Pilot & Beck, 2017). Overall, I found greater quality and consistency of information within the systematic reviews and critically appraised topics and articles. Nonetheless, I found several high quality randomized controlled trials and cohort studies that provide high-quality information for making a comparison between pharmacological and non-pharmacological interventions for managing delirium.
Helpful Tips for Literature Reviews
I found the course guide for this discussion post extremely helpful. I followed the guide to conduct my searches, find my articles, and evaluate the information. I also like to use Google Scholar because the search algorithm pulls a lot of information, it does have some drawbacks, the main one being that the articles are not always available in full text. But, it is very user-friendly, and because it casts a wide net, I can easily find pertinent information. If I see an article that peaks my interest that is not available in full text, I copy the title or other vital information and then plug that information into the Walden University Library. I have always been able to find the article I want using this method. I also find it helpful to organize my search results within folders, and to tag my articles with the types of studies. I also find that the National Center for Biotechnology Information (2019) is a great resource for locating free, full text, peer-reviewed, scholarly articles (National Center for Biotechnology Information, 2019). If I find a study I know that I definitely want to use in my work, I will create a citation and save it in a word document. When I begin writing, I can use my reference list that I started during my literature review as a guide. I have found that this method of source organization is both helpful and time-saving.
National Center for Biotechnology Information. (2019). Retrieved March 4, 2019, from https://www.ncbi.nlm.nih.gov/
Polit, D. F., & Beck, C. T. (2017). Nursing research generating and assessing evidence for nursing practice. Philadelphia: Wolters Kluwer.
Walden University. (2018). Evidence-Based Practice Research: Levels of Evidence Pyramid. Retrieved from https://academicguides.waldenu.edu/healthevidence/evidencepyramid#s-lg-box-8700027
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