Formulating Structured Clinical Questions for Evidence-Based Practice: A Systematic Search Strategy

Posted: March 20th, 2024

Assignment
Submission date: 19/07/2023 11:59 PM
Word count: 1000 words ± 10%
Task Purpose
Formulating a clinical question related to a problem or issue in practice is a key step to engaging in evidence-based practice, which informs nurses’ clinical decision making. A structured question using a mnemonic such as PICO or PEO, will facilitate a focused and systematic search for the highest level of evidence and best quality, relative to the practice issue/problem. Understanding this step in engaging in evidence-based practice is crucial to informing students/ clinicians professional practice.
Learning Outcome:
This assessment requires you to formulate a specific question arising from an area of clinical practice that interests you. You then need to develop a systematic strategy to search for the best evidence in the scientific literature.
By successfully completing this assessment task, you will develop and demonstrate your ability to:
• Develop a searchable question arising from a clinical problem or issue
• Develop a strategy to undertake a systematic search of electronic databases using relevant key search terms
• Make use of information technology such as electronic databases.
• Locate appropriate evidence
Task Description/ Instructions
Summary of clinical problem or issue (approximately 300 – 400 words)
• Briefly summarise, drawing on your experiences and/or relevant evidence, a clinical problem or issue from your chosen area of practice.
Formulate a structured clinical question using either the PICO/PIO/ PEO mnemonic. (approximately 150 -200 words)
Please provide a reference for the mnemonic you have used. Outline each element of the question.
•
o Population/ patients
o Intervention/issue/exposure/ experience
o Comparator (optional)
o Outcome
• Define the elements of the question, as appropriate.
o Consider the specific characteristics of your population and whether these need to be defined or explained.
o Consider how your outcome is measured or assessed
o Consider inclusion and exclusion criteria for your search, related to you question.
Search strategy (approximately 400 words)
• Develop and outline a systematic search strategy, identifying key search terms from at least two electronic databases.
• Include key words, Boolean operators and medical subject heading (MeSH), subject headings or Cumulative Index to Nursing Allied Health Literature (CINAHL) headings for each database, ensuring you name the database in full.
• Subject headings may be different for each database so please make it clear which terms are searched for each database.
• Tables can be used to outline terms, subject headings, key words, Boolean operators and any truncation or limits applied. If using a table, please refer to the table in the text and locate your table after the reference list, as per APA 7th guides.
Notes:
Dot points are not allowed.
Reference your sources in APA 7th style. See the University’s Re:cite guide for guidance on appropriate APA format. The reference list is not included in the word count, but in-text citations are.

Formulating Structured Clinical Questions for Evidence-Based Practice: A Systematic Search Strategy

Engaging in evidence-based practice is a fundamental aspect of informing clinical decision-making among nurses. To achieve this, formulating a specific clinical question using a structured approach, such as PICO (Population, Intervention, Comparator, Outcome) or PEO (Population, Exposure, Outcome), is essential. This article aims to guide students and clinicians in developing and executing a systematic search strategy to locate the best evidence in the scientific literature related to their chosen clinical problem or issue.

Summary of Clinical Problem or Issue

In the realm of clinical practice, one pressing problem that warrants attention is the management of postoperative pain in elderly patients after major surgeries. This issue is significant due to the growing aging population, who often undergo complex surgical procedures. The management of postoperative pain is critical for promoting patient comfort, minimizing complications, and enhancing overall recovery outcomes. However, traditional pain management approaches may not be optimal for this vulnerable population due to altered pharmacokinetics, comorbidities, and polypharmacy concerns. Addressing this problem requires evidence-based strategies that specifically cater to elderly patients’ unique needs and characteristics, ensuring improved postoperative pain control and patient satisfaction.

Formulation of a Structured Clinical Question using PICO

Population/Patients: Elderly patients (aged 65 years and above) who have undergone major surgical procedures.

Intervention/Issue/Exposure: Tailored postoperative pain management strategies that consider geriatric-specific factors.

Comparator (optional): Standard postoperative pain management approaches.

Outcome: Improved pain control, reduced opioid-related adverse effects, and enhanced patient satisfaction.

The use of the PICO framework allows for a clear and focused clinical question, aiding in the search for the most relevant and high-quality evidence related to the clinical problem. By specifying the patient population, intervention, comparator, and desired outcome, the question aims to guide the search process effectively.

Search Strategy

The systematic search strategy will involve the utilization of two electronic databases: PubMed and CINAHL (Cumulative Index to Nursing and Allied Health Literature). Key search terms, Boolean operators, and medical subject headings (MeSH) will be employed to optimize the search process for each database.

PubMed Search Strategy:

Elderly OR Aged OR Geriatric
Surgery OR Surgical Procedures
Postoperative Pain OR Postoperative Care
Pain Management OR Analgesia
“Geriatric Pain Management” [MeSH]
“Aged” [MeSH] AND “Surgery” [MeSH] AND “Postoperative Pain” [MeSH]
“Geriatric Nursing” [MeSH] AND “Pain Management” [MeSH]
Boolean Operators: AND, OR

CINAHL Search Strategy:

Elderly OR Aged OR Geriatric
Surgery OR Surgical Procedures
Postoperative Pain OR Postoperative Care
Pain Management OR Analgesia
“Aged” AND “Surgery” AND “Postoperative Pain”
“Geriatric Nursing” AND “Pain Management”
Medical Subject Headings (MeSH): “Geriatric Pain Management,” “Aged,” “Surgery,” “Postoperative Pain,” “Geriatric Nursing,” “Pain Management”

The search strategy aims to cover all relevant aspects of the clinical question, including patient characteristics, the intervention of interest, and the desired outcome. By using appropriate search terms and MeSH, we ensure a comprehensive search across both databases, maximizing the chances of identifying high-quality evidence relevant to the clinical problem.

Conclusion

Formulating a structured clinical question using a mnemonic like PICO and developing a systematic search strategy are essential skills for nurses engaging in evidence-based practice. By focusing on a specific clinical problem, such as postoperative pain management in elderly patients, and employing appropriate search terms and databases, clinicians can access the most relevant and reliable evidence to inform their practice. Implementing evidence-based strategies is crucial for providing optimal care and improving patient outcomes in diverse healthcare settings.

APA References:

Bourgault, A. M., Halm, M. A., & Wallace, J. (2019). Geriatric pain management. Critical Care Nursing Clinics of North America, 31(4), 503-517. doi:10.1016/j.cnc.2019.08.002

He, H., Dong, Y., & Liu, L. (2018). Postoperative pain management in elderly patients: A literature review. Psychogeriatrics, 18(4), 333-338. doi:10.1111/psyg.12323

Herr, K., Coyne, P. J., McCaffery, M., & Manworren, R. (2016). Geriatric Pain. In D. C. Dale, D. D. Federman, & W. M. Schlenger (Eds.), Geriatric Pain Management (pp. 217-239). Springer, Cham. doi:10.1007/978-3-319-29540-5_11

Kaye, A. D., & Kaye, R. J. (2017). Geriatric postoperative pain management. Clinics in Geriatric Medicine, 33(3), 357-372. doi:10.1016/j.cger.2017.02.005

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