Respond to the four colleagues and provide further suggestions on how their database search might be improved. please include at least 2 references each

1) In pediatrics, clinicians are constantly searching for ways to refrain from or reduce the amount of pain we inflict on patients. That may involve less frequent lab work or making the choice to leave out a PIV that is lost. Though efforts are made to reduce pain in healthcare settings, we are not able to guarantee painless experiences. One of the most notable examples of unavoidable pain is childhood immunizations. Since I am a current pediatric nurse and in the primary care pediatric NP track, this is and will even more so, become a common practice issue for me. I wanted to figure out what methods of distraction work for infants when receiving immunizations. Using Richardson and colleagues’ concept (1995, as cited by Davies, 2011) I created the PICO question: 
In infants, do distraction techniques during immunization administration result in lower pain scores when compared to no intervention? 

Using the CINAHL and MEDLINE combined database, I searched the terms “distraction + immunization”. 106 articles resulted. After adding the term “infant” and excluding duplicates, reviews, and studies that involve study groups other than infants,10 articles remained. I used search techniques recommended by Stillwell et al. (2010). I searched using relevant keywords from my PICO question and used infant as my final limit on the articles that resulted. To improve my database searches, I could ask a librarian for help, use subject terms, or increase the publication date range on my search (Melnyk & Fineout-Overholt, 2023, pp. 62–87). 

2) The PICO(T) question is, “Among hospitalized patients, does using two identifiers compared to one reduce medical errors?” My clinical issue of interest is the reduction of medical errors. Medical errors are gaps in care that bear potential or actual capacity to harm the patient, such as inaccurate diagnosis and incomplete diagnosis (Aljabari & Kadhim, 2021). These have the ripple effect of inappropriate investigations and treatment, then adverse care outcomes (Aljabari & Kadhim, 2021). Some solutions to medical errors include proper identification of patients, thorough history taking, and comprehensive physical examination. One evidence-based method for patient identification is using two identifiers rather than one (Mroz et al., 2019). Therefore, I am prompted to investigate whether using two identifiers compared to one among hospitalized patients reduces medical errors.

Search results discussion

Regarding my search results, 19,600 articles appeared on the initial original search. As I added search terms such as two identifiers, one identifier, medical errors, and hospitalized patients using Boolean operators such as AND, NOT, and AND NOT, the number of articles appearing kept reducing. At first, they declined to 18,500, then to 17,200, and so on, in a declining trend.

Strategies to optimize database search on my PICO(T) question

There are several strategies I can apply to optimize how effective a database search is while searching my PICO(T) question. These include having a specific search question, using Boolean operators, using more specific keywords, and using fewer synonyms (Degbelo & Teka, 2019). An example of a particular question is a PICO(T) question, which narrows down to a particular population, intervention, control, outcome, and timing. A more specific example is my PICO(T) question that reads, “Among hospitalized patients, does the use of two identifiers compared to one identifier reduce medical errors?” Besides, examples of Boolean operators are OR, AND, NOT, and AND NOT (Degbelo & Teka, 2019). Specific keywords, like particular search questions, direct the search further, optimizing it to give the best results. An example of keywords in my case includes “hospitalized patients,” “two identifiers,” “one identifier,” and “reduce medical errors.” Lastly, using fewer synonyms helps fetch more search results, broadening your search outcome and choosing relevant resources (Degbelo & Teka, 2019). Applying such strategies helps to make the search process more effective and thorough.

3) Hospital beds are constantly full of patients who are there for preventable reasons. Some are hospitalized with a COPD flareup, while others can be hospitalized with high blood sugars due to their uncontrolled diabetes. Drs McDermott and Jiang through research found that 77.1% of hospitalizations in 2017 were from potentially preventable cases (McDermott, Jiang, 2020). Due to all of these hospitalizations, I have developed my PICO question of: 
In patients who have chronic conditions, does education from their primary care provider help prevent frequent hospitalizations due to the condition?

The two databases that I will be using for my research data include the Walden University Library and PubMed. I started by searching “primary prevention” on both Walden University Libary and then on PubMed. I got  139,620 results between the years of 2018-2023. I then included “hospitalization” as one of my boolean operators. This decreased the results down to 52,083. Finally, I added “education” as one of my boolean operators and now just have 9,784 articles to sift through. 

There are a few different strategies that can be used when increasing the rigor and effectiveness of a database search. One strategy is acknowledging that most data over 5 years old is not relevant, however at times you might need to go beyond the 5-year exception to find enough information in the databases (Melnyk and Fineout-Overholt, 2023). While I will try to abide by finding information written in the past 5 years, if I am unable to find enough primary resources in that time frame, then I will look earlier than 2018. I will also use a tip that was identified by Chan (2021), I will use databases to help with researching instead of just searching the key phrases. This will help to narrow the categories down even further. 

4) With America recently fighting its longest ongoing war, post-traumatic stress disorder (PTSD) rates are at an all-time high, according to Department of Veterans Affairs statistics (Hurley 2018). PTSD can occur across all age groups and be caused by many traumatic events. Still, war-related traumatic events place victims at the highest risk for developing PTSD (Kachadourian et al., 2023) .

PICO(T) Question

How do veterans treated with trauma-focused cognitive therapy compare to those treated with pharmacological therapy? The databases used to develop this question were SocINDEX and APAPsycInfo.

Search Terms

When starting the research for this PICOT question, the Walden Library was used. In the first search blank, the words post-traumatic stress disorder were used. In the second blank, the word veterans were used. Results were limited to full-text and peer-reviewed scholarly journals only, with a publication date between 2018 and 2023. This returned 11,151 results. To broaden these results to the first blank, I added “or PTSD” and “or service members or military ” in the second blank.” This returned 18,063 results. I added trauma-focused therapy to narrow the results based on my PICOT question in the third blank. This returned 339 results. I then changed the third blank to pharmacological therapy, returning 85 results.

Strategies to Increase Rigor and Effectiveness

To increase the rigor and effectiveness of the research for this PICOT question, I will use the resources provided in the Walden Library. To do this, go to the Walden library home page and click ” get help ” in the top right-hand corner. Then, select the library skills guide, and multiple resources exist. Some specific ideas gained from these resources are avoiding implied concepts while searching. You can avoid words like compare, contrast, best, worse, advantages, and disadvantages( Walden Library n.d.).