Evidence-Based Project, Part 2: Advanced Levels Of Clinical Inquiry And Systematic Reviews

Your quest to purchase a new car begins with an identification of the factors important to you. As you conduct a search of cars that rate high on those factors, you collect evidence and try to understand the extent of that evidence. A report that suggests a certain make and model of the automobile has high mileage is encouraging. But who produced that report? How valid is it? How was the data collected, and what was the sample size?

In this Assignment, you will delve deeper into clinical inquiry by closely examining your PICO(T) question. You also begin to analyze the evidence you have collected.

To Prepare:

Review the Resources and identify a clinical issue of interest that can form the basis of a clinical inquiry.
Develop a PICO(T) question to address the clinical issue of interest you identified in Module 2 for the Assignment. This PICOT question will remain the same for the entire course.
Use the keywords from the PICO(T) question you developed and search at least four different databases in the Walden Library. Identify at least four relevant systematic reviews or other filtered high-level evidence, which includes meta-analyses, critically-appraised topics (evidence syntheses), critically-appraised individual articles (article synopses). The evidence will not necessarily address all the elements of your PICO(T) question, so select the most important concepts to search and find the best evidence available.
Reflect on the process of creating a PICO(T) question and searching for peer-reviewed research.
The Assignment (Evidence-Based Project)

Part 2: Advanced Levels of Clinical Inquiry and Systematic Reviews

Create a 6- to 7-slide PowerPoint presentation in which you do the following:

Identify and briefly describe your chosen clinical issue of interest.
Describe how you developed a PICO(T) question focused on your chosen clinical issue of interest.
Identify the four research databases that you used to conduct your search for the peer-reviewed articles you selected.
Provide APA citations of the four relevant peer-reviewed articles at the systematic-reviews level related to your research question. If there are no systematic review level articles or meta-analysis on your topic, then use the highest level of evidence peer-reviewed article.
Describe the levels of evidence in each of the four peer-reviewed articles you selected, including an explanation of the strengths of using systematic reviews for clinical research. Be specific and provide examples.

Required Readings

Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer.

· Chapter 2, “Asking Compelling Clinical Questions” (pp. 33–54)

· Chapter 3, “Finding Relevant Evidence to Answer Clinical Questions” (pp. 55–92)

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.

Library of Congress. (n.d.). Search/browse help – Boolean operators and nesting. Retrieved September 19, 2018, from https://catalog.loc.gov/vwebv/ui/en_US/htdocs/help/searchBoolean.html

Stillwell, S. B., Fineout-Overholt, E., Melnyk, B. M., & Williamson, K. M. (2010). Evidence-based practice, step by step: Asking the clinical question: A key step in evidence-based practice. American Journal of Nursing, 110(3), 58–61.

Melnyk, B. M., Fineout-Overholt, E., Stillwell, S. B., & Williamson, K. M. (2009). Evidence-based practice: Step by step: Igniting a spirit of inquiry. American Journal of Nursing, 109(11), 49–52. doi:10.1097/01.NAJ.0000363354.53883.58

Stillwell, S.B., Fineout-Overhold, E., Melnyk, B.M., & Williamson, K.M. (2010). Evidence-based practice step-by-step: Searching for evidence. American Journal of Nursing, 110(5), 41-47.

Walden University Library. (n.d.-a). Databases A-Z: Nursing. Retrieved September 6, 2019, from https://academicguides.waldenu.edu/az.php?s=19981

Walden University Library. (n.d.-c). Evidence-based practice research: CINAHL search help. Retrieved September 6, 2019, from https://academicguides.waldenu.edu/library/healthevidence/cinahlsearchhelp

Walden University Library. (n.d.-d). Evidence-based practice research: Joanna Briggs Institute search help. Retrieved September 6, 2019, from https://academicguides.waldenu.edu/library/healthevidence/jbisearchhelp

Walden University Library. (n.d.-e). Evidence-based practice research: MEDLINE search help. Retrieved September 6, 2019, from https://academicguides.waldenu.edu/library/healthevidence/medlinesearchhelp

Walden University Library. (n.d.-f). Keyword searching: Finding articles on your topic: Boolean terms. Retrieved September 19, 2018, from http://academicguides.waldenu.edu/library/keyword/boolean

Walden University Library. (n.d.-g). Keyword searching: Finding articles on your topic: Introduction to keyword searching. Retrieved September 19, 2018, from http://academicguides.waldenu.edu/library/keyword/searching-basics

Walden University Library. (n.d.-h). Quick Answers: How do I find a systematic review article related to health, medicine, or nursing? Retrieved September 6, 2019, from https://academicanswers.waldenu.edu/faq/72670

Walden University Library. (n.d.-i). Systematic review. Retrieved January 22, 2020, from https://academicguides.waldenu.edu/library/healthevidence/types#s-lg-box-1520654

Matrix Worksheet Template

Matrix Worksheet Template


Use this document to complete Part 2 of the Module 2 Assessment, Evidence-Based Project, Part 1: An Introduction to Clinical Inquiry, and Part 2: Research Methodologies



Full citation of the selected article Article #1 Article #2 Article #3 Article #4
  Brooks Carthon, J., Hatfield, L., Plover, C., Dierkes, A., Davis, L., & Hedgeland, T. et al. (2019). Association of Nurse Engagement and Nurse Staffing on Patient Safety. Journal of Nursing Care Quality34(1), 40-46. https://doi.org/10.1097/ncq.0000000000000334



Driscoll, A., Grant, M., Carroll, D., Dalton, S., Deaton, C., & Jones, I. et al. (2017). The effect of nurse-to-patient ratios on nurse-sensitive patient outcomes in acute specialist units: a systematic review and meta-analysis. European Journal of Cardiovascular Nursing17(1), 6-22. https://doi.org/10.1177/1474515117721561 Griffiths, P., Maruotti, A., Recio Saucedo, A., Redfern, O., Ball, J., & Briggs, J. et al. (2018). Nurse staffing, nursing assistants and hospital mortality: retrospective longitudinal cohort study. BMJ Quality & Safety28(8), 609-617. https://doi.org/10.1136/bmjqs-2018-008043 Griffiths, P., Recio-Saucedo, A., Dall’Ora, C., Briggs, J., Maruotti, A., & Meredith, P. et al. (2018). The association between nurse staffing and omissions in nursing care: A systematic review. Journal of Advanced Nursing74(7), 1474-1487. https://doi.org/10.1111/jan.13564
Why you chose this article and/or how it relates to the clinical issue of interest (include a brief explanation of the ethics of research related to your clinical issue of interest)  

The researchers in the article address the correlation between regulated dependable nurse ratios to delivery of quality care. In other words, the paper addresses how modern healthcare has assumed a patient-centric approach resulting in the needs of nursing practitioners being ignored.


The researchers in the article assess the correlation between the nurse staffing levels to inpatient mortality and nurse sensitivity to patient needs. The study reviewed data from 2006 to 2017 investigating the effects of nurse-patient ratio and patient outcome in acute units.


The article was selected as the national issue relating to shortage of nurses is a problem plaguing the healthcare care sector. In the US, the shortage of nurses has been growing for the past few decades resulting in the reduction of quality of care as remaining nursing practitioners are overworked.





The researchers evaluate the implications of disregarded nursing care and the undesirable patient outcome. The research is approached through the analysis of nurse shortage and its implications on essential care. The researchers also identify the potential consequences of the missed care and its prevalence.

Brief description of the aims of the research of each peer-reviewed article  

The objective of the study was to evaluate the correlation between nurses’ valuation of patient safety and the differentiation under varying staffing and engagement requirements.


The goal of the study is to evaluate the published data investigating the association between nurse staffing levels and patient sensitivity. In other words, if higher nurse staffing reduces the risk of inpatient mortality.


The study assesses the implication of low nursing and assistant nursing staff on inpatient death rates in England hospitals.


The purpose of the study is to recognize nursing care responsibilities that are frequently missed in acute care and creating correlations to nurse staffing.

Brief description of the research methodology used Be sure to identify if the methodology used was qualitative quantitative , or a mixed-methods approach. Be specific.  

The researchers approached the study by conducting a secondary assessment of two linked data sources in four states. The data for the assessment was sourced from the 2006-2007 Penn Multi-State Nursing Care and Patient Safety Survey and the 2007 annual survey by the ANA (American Hospital Association). The researchers applied a mixed-method approach. They applied a cross-sectional study where they assessed the survey retorts from thousands of nurses in numerous hospital settings.


The researchers employed PICOT and meta-analyses in the review. It entailed the utilization of cross-sectional studies and random-effect models in homogeneous studies. Thus, the main research method was quantitative research as the study was investigating the impact of the relationship between nurses and patients to improve the overall outcome.


When the study is summarized, it entails longitudinal observational research. The researchers collected their data from nurse staffing from 0ver 30 adult medical units of large facilities in the South of England. Thus, it is evident that the study employed a quantitative approach. The objective was to create a correlation between nurse staffing and patient mortality.


The research methodology employed has high similarities to the quantitative approach method. It entailed a systematic review of 18 cross-sectional samples that range from just over 200 to approximately 31,000 nurses. BERNCA was employed as a research tool assessing the number of care not offered to patients within a week. In other words, it assessed the frequency of missed care initiatives.

A brief description of the strengths of each of the research methodologies used, including reliability and validity of how the methodology was applied in each of the peer-reviewed articles you selected.  

The ore strength of the study is that it adheres to the Donabedian concept model of health care where the nurse-patient relationship is carefully studied. The survey each nurse responded to entailed over 50 questions that examined global safety articles by exploiting the 5-

point Likert scale. The reliability and viability of the study were enforced by the fact that it was conducted in 599 facilities in Florida, New Jersey, California, and Pennsylvania.


The PRISMA statement was employed in the study further strengthening the quality of the review approach. Moreover, the NOS (Newcastle Ottawa

scale) was also applied to evaluate the quality of the nonrandomized reviews. Other tools employed in the study to support its reliability and validity include professional information technologies, electronic databases, and custom-developed data mining tools.


The core strength of the study was the utilization of SHMI (Summary Hospital Mortality Indicator) where the researchers employed demographic and diagnostic factors to compute the projected risk of death. By comparing the results associated with low nurse staffing, the researchers were confident that low nurse staffing increased the mortality risk


Each study was evaluated by exploiting the guidance, methods, and outlines described by NICE (The National Institute for Health and Care Excellence). It facilitated the quality appraisal of studies that met the needed criteria. It allowed for any biases in all selected literature to be acknowledged allowing for the overall research to reliable and valid.

General Notes/Comments  

Through the study of the relationship between patient safety and satisfactory patient-nurse relations where better relations resulted in greater patient satisfaction. Additionally, the survey identified that nurses have great concern for patient safety, short staffing, and larger workloads.






A close assessment of the research identified a large degree of differences between the data used. The notion is most expressed when comparing the nurse-patient relationship and the type of nurse-sensitive patient result. The overall outcome was the inability to make standardized recommendations.


The study was able to conclude that patient mortality due to nurse staffing shortage is seldom expected to improve with the replacement of RNs with assistant nurses. Though assistant nurses are essential members of the healthcare community, they cannot substitute the role and functionality of RNs.


The overall outcome of the study was the recognition of higher patient satisfaction and safety through the development of positive nurse-patient relations as well as patient welfare.



© 2018 Laureate Education Inc. 2

The growth of travel nursing has grown in recent years because of the increase in demand for healthcare services Faller et al., (2018). Understanding the role of travel nurses (TRN’s) and how the travel nursing business has become its own nursing specialty is essential to identify the impact TRN’s have on the facilities where they work. With this in mind, I chose to propose the following question. Does utilizing travel nurses have an impact on the patient experience?

When we consider the formulation of a PICOT question, the proposed question fits the criteria. Understanding each of the components of the PICOT question can offer a distinctly clear question (Melnyk & Fineout-Overholt, 2018). The Population of interest is travel nurses. The Intervention or issue of interest is the quality of care provided by TRN’s. The Comparison of interest will be addressed by comparing data between TRN’s and full-time staff. The expected Outcome is that there will be research pertaining to TRN’s contribution to healthcare excellence. A Timeframe of one week will be sufficient for the review.

A broad search was conducted using Walden library using the words Travel Nursing which brought up 983 articles. The date range was changed to 2016-2021, which reduce the articles to 169. Using the Boolean terms (Library of Congress n.d), quality of care was added to the search parameter reducing the articles to 5; however, these articles did not specifically look at TRN’s. Similarly, travel nursing and patient quality of care were used as search parameters. Only three articles were found using those criteria, and none of the articles related to travel nursing. Therefore, all other search terms were eliminated, leaving only travel nursing.

A search of the CINHAL and MEDLINE databases combined was used using the same search terms, revealing no difference in results; there were fewer results. A search of ‘Travel Nursing’ in Science Direct was inconclusive to appropriate studies. Interestingly when leaving the date range open, many more studies were available, indicating that more recent research understanding the impact of utilizing TRN’s must be undertaken.

Whilst there were articles pertaining to travel nursing and patient care, there were severely limited studies directly related to travel nursing and the quality of patient care. Four articles were chosen based on the travel nursing criteria and relating to the quality of the patient experience with the last five years.


Faller, M., Dent, B., & Gogek, J. (2018). The ROI of Travel Nursing: A Full-Cost Comparison of Core Staff Pay Rates to Travel Nurse Bill Rates. Nursing Economics, 36(4), 177–181. ProQuest. https://doi.org/https://www-proquest-com.ezp.waldenulibrary.org/nahs/docview/2096469984/363EF201D2C64880PQ/1?accountid=14872

Library of Congress. (n.d.). Search/Browse Help – Boolean Operators and Nesting: LC Catalog (Library of Congress). Catalog.loc.gov. https://catalog.loc.gov/vwebv/ui/en_US/htdocs/help/searchBoolean.html

Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer.

This is an interesting topic to study. Here is some advice on your PICOT question

The Population of interest is travel nurses (this is ok)

The Intervention or issue of interest is the quality of care provided by TRN’s. (change this as you cannot actually manipulate it. A standard is for all nurses to give quality care. You need to select some intervention that would be imposed such as a specific orientation or a group for collaboration etc

The Comparison of interest will be addressed by comparing data between TRN’s and full-time staff. (no, the comparison is travel nurses NOT HAVING the intervention your suggest.

The expected Outcome is that there will be research pertaining to TRN’s contribution to healthcare excellence. (no, you need to state a particular outcome you expect to see as a result of the intervention suggested.

Time: A timeframe of one week will be sufficient for the review. (this depends on the idea)

Module 1 And 3