Clinical Issue of Interest Assignment Paper

The focal clinical issue I am examining pertains to patient safety within the context of heightened nursing workload, resulting from shortages in nursing staff. This topic is of significant importance due to the potential ramifications such as increased incidence of medical errors, compromised quality of care, nurse burnout, and adverse patient outcomes. Research by Arnetz et al., (2020) found that sufficient staffing can actually reduce the risk of medication related errors, aligning with my objective to enhance patient safety through optimal nurse-to-patient ratios. My aim is to explore these challenges comprehensively and identify strategies to enhance patient care and safety within the current landscape of nursing practice.  Clinical Issue of Interest Assignment Paper

Search Results

In my initial search of literature I used the broad terms “patient safety” and “nursing shortage”, the search initially returned an overwhelming 1,100 results. To refine my focus towards research-oriented articles, I included the term “workload” using the Boolean operator “and”, which reduced the resulta to approximately 160 articles. I then added more specific terms such as “hospital and adverse events”, which resulted in only three articles. The article from Alaskan Nurse (2023) related to my clinical interest noting that only 13% of nurses felt adequately staffed to ensure patient safety; however, this article was not peer-reviewed. I then broadened my search further by incorporating terms such as “staffing levels” and “patient outcomes”. This led me to an additional 51 articles using the peer-reviewed journals filter.

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Strategies to Increase Rigor and Effectiveness of Database Search:

Employing Boolean operators such as AND, OR, and NOT enhances the relevance and accuracy of the search results. For instance, using AND refines the search by combining terms, while OR will broaden the results by including both terms (Melnyk & Fineout-Overholt, 2023). I have also found that utilizing the references in relevant articles can help save time by utilizing the research that was previously cited known as Citation Tracking.

PICO(T) Question: 

In hospitalized patients, how does increasing nurse staffing levels, compared to standard staffing levels, affect the incidence of medication errors within a six-month time period? 

According to Davies (2011), a significant challenge in evidence-based practice is formulating a question that is actually answerable. In formulating my PICO(T) question within my clinical area of interest, I concentrated on investigating the influence of nurse staffing levels on medication errors.  Clinical Issue of Interest Assignment Paper

References 

Arnetz, B., Goetz, C., Arnetz, J., Sudan, S., vanSchagen, J., Piersma, K., & Reyelts, F. (2020). Enhancing healthcare efficiency to achieve the Quadruple Aim: An exploratory study. BMC Research Notes, 13(1), 1–6. https://doi.org/10.1186/s13104-020-05199-8

Davies, K. S. (2011). Formulating the evidence based practice question: A review of the frameworks for LIS professionals. Evidence Based Library and Information Practice, 6(2), 75–80.

Melnyk, B. M., & Fineout-Overholt, E. (2023). Evidence-based practice in nursing & healthcare: A guide to best practice (5th ed.). Wolters Kluwer.

The Consequences of Unsafe Staffing. (2023). Alaska Nurse, 74(1), 8–10

Discussion Response (Stacy)
Your post on patient safety and its impact on nursing workload is well presented and detailed. It denotes great progress, more so regarding refining your search strategy. However, in addition to the established approach, you can use diverse or additional approaches to enhance the rigor and effectiveness of your database search.
One is through the use of synonyms and other related terms. According to Abu-Baker et al. (2021), changing and expanding your search terms to include related phrases, concepts, and synonyms would foster capturing a wide range of relevant studies. For example, regarding your selected clinical issue, ‘nursing shortage,’ you can consider using words such as nurse staffing or nurse-patient ratio. Secondly, you can utilize advanced search practices provided as a feature in many databases as search options, including publication type, date range, and subject, among other filters that foster getting more specific resources or narrowing down on search results.
Getting help from experts such as a tutor and librarian may be an added option to refine one’s search. Working with a librarian specializing in health sciences may help refine search and search methods to get more relevant resources. On the other hand, it may be healthful to consider PICOT refinement. While I agree your PICOT question is well formulated, ensuring that each component is defined and considering additional sub question may help ensure more targeted searches.  Clinical Issue of Interest Assignment Paper There is also proximity searching, whereby some databases allow for the inclusion of some words or phrases in one’s search; this would allow one to search different phrases in one search (Johnson et al., 2020).
Finally, other options to refine the search include utilizing different databases and their unique features that may result in more precise searches, i.e. CINAHL offers a subject heading, which can greatly help refine one’s searches. One may also factor in grey literature, reviews on meta-analysis, and reviews of articles. In summary, by integrating these additional strategies, you will be able to refine your search, enhance the depth and precision of resource search, and comprehensively address your clinical issue of interest.

References
Abu-Baker, N. N., AbuAlrub, S., Obeidat, R. F., & Assmairan, K. (2021). Evidence-based Practice Beliefs and Implementations: a Cross-sectional Study among Undergraduate Nursing Students. BMC Nursing, 20(1), 1–8. https://doi.org/10.1186/s12912-020-00522-x
Johnson, J. L., Adkins, D., & Chauvin, S. (2020). A Review of the Quality Indicators of Rigor in Qualitative Research. American journal of pharmaceutical education, 84(1), 7120. https://doi.org/10.5688/ajpe7120 Clinical Issue of Interest Assignment Paper