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NUR508: Research and Evidence-Based Practice

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Researching Your PICOT Question

Search for Evidence-Based Research on your PICOT

The CINAHL database is your best bet  It has nursing-specific search options. Click the link below:

Searching in CINAHL

For this research, you will use only primary studies. You will learn how to find and select primary articles that are either quantitative or qualitative. Click the tabs above to learn about primary vs. secondary research, quantitative studies and qualitative studies.

The steps below will help you get started using CINAHL.

Step 1: Identify keywords in your PICOT question.

Write out your PICOT question. Circle or underline the main ideas.

Hint: the main ideas are usually found in the elements of your PICOT question (population, intervention, comparison, outcome, timeline).

Example: For pregnant women (P), how does taking calcium supplements (I) compared to not taking calcium supplements (C) influence the risk of developing pre-eclampsia (O)?
Step 2: Consider synonyms and related terms

For each main idea, list synonyms and related terms to use in your search. Example:

  • pregnant women: expectant mothers, pregnancy
  • calcium supplements: calcium
  • pre-eclampsia: preeclampsia
Step 3: Enter keywords in your search

List each main idea on a separate line and connect related terms with OR:

pregnant women OR expectant mothers OR pregnancy
AND calcium
AND pre-eclampsia OR preeclampsia

Note: For populations defined by age (example: patients aged 65 and over), do not enter this as a search term. Instead, use a descriptive term such as "older adults."

Step 4: Use search options to effectively limit the results

Select the following limiters for your search:

  • Peer Reviewed
  • Date Published: Enter the appropriate date range
Step 5: Analyze the results and revise the search

Review the results of your search by reading the article abstracts. If not enough articles are relevant to your PICOT question, revise:

  • consider using different synonyms for your search terms
  • consider broadening the search by removing one or more search terms (for example, if your search contains 3-4 PICOT elements, try searching with only 2-3 PICOT elements)
  • consider using another database, see suggestions below
Other Recommended Databases

If you don't find enough articles using CINAHL, try the following databases:

What is Primary Research?

Primary research describes a new study the authors conducted with participants. Types of primary studies include surveys (descriptive), experiments, quasi-experiments, cohort, or correlational studies. You must use primary articles when researching your PICOT question.

What is Secondary Research?

In contrast, secondary research compiles, reviews, comments on, or interprets work that was previously reported on by the authors or other researchers. Types of secondary studies include meta-analyses, literature reviews, scoping reviews, and systematic reviews. When researching your PICOT question, avoid using secondary research -- including all types of reviews and meta-analyses.

How to Find Primary Research in Library Databases

You must use primary articles to research your PICOT question. There is no precise method of excluding all secondary articles while including only primary articles. However, these strategies may help:

  • Use the Publication Type search option to select primary research types, such as randomized controlled trials
  • Add keywords to your search, such as "randomized controlled trial" OR "cohort study" OR "survey" OR "questionnaire" OR "interview"

Identifying Primary and Secondary Research

Read the article abstracts. The following example describes a new study that was conducted by the authors, with participants.

Preeclampsia is an important cause of maternal and perinatal morbidity and mortality. Previous studies have tested calcium supplementation and aspirin separately to reduce the incidence of preeclampsia but not the effects of combined supplementation. The objective of this study was to investigate the effectiveness of aspirin combined with calcium supplementation to prevent preeclampsia in women with chronic hypertension. A double-blind, placebo-controlled randomized clinical trial was carried out at the antenatal clinic of a large university hospital in São Paulo, SP, Brazil. A total of 49 women with chronic hypertension and abnormal uterine artery Doppler at 20-27 weeks gestation were randomly assigned to receive placebo (N = 26) or 100 mg aspirin plus 2 g calcium (N = 23) daily until delivery. The main outcome of this pilot study was development of superimposed preeclampsia. Secondary outcomes were fetal growth restriction and preterm birth. The rate of superimposed preeclampsia was 28.6% lower among women receiving aspirin plus calcium than in the placebo group (52.2 vs 73.1%, respectively, P=0.112). The rate of fetal growth restriction was reduced by 80.8% in the supplemented group (25 vs 4.8% in the placebo vs supplemented groups, respectively; P=0.073). The rate of preterm birth was 33.3% in both groups. The combined supplementation of aspirin and calcium starting at 20-27 weeks of gestation produced a nonsignificant decrease in the incidence of superimposed preeclampsia and fetal growth restriction in hypertensive women with abnormal uterine artery Doppler.

Souza, E. V., Torloni, M. R., Atallah, A. N., dos Santos, G. M. S., Kulay Jr, L., & Sass, N.. (2014). Aspirin plus calcium supplementation to prevent superimposed preeclampsia: a randomized trial. Brazilian Journal of Medical and Biological Research, 47(5), 419–425. https://doi.org/10.1590/1414-431X20143629

The article excerpted above is licensed under a CC Attribution 4.0 International License.

 

Identifying secondary research can be tricky because it sometimes follows a similar format, with methods, results, and discussion. However, note that in the following example, the authors compile information from previous studies, rather than report on a new study. A lack of a participant group is often an indicator of secondary research.

Background: Hypertension in pregnancy stand alone or with proteinuria is one of the leading causes of maternal mortality and morbidity in the world. Epidemiological and clinical studies have shown that an inverse relationship exists between calcium intake and development of hypertension in pregnancy though the effect varies based on baseline calcium intake and pre-existing risk factors. The purpose of this review was to evaluate preventive effect of calcium supplementation during pregnancy on gestational hypertensive disorders and related maternal and neonatal mortality in developing countries.
Methods: A literature search was carried out on PubMed, Cochrane Library and WHO regional databases. Data were extracted into a standardized excel sheet. Identified studies were graded based on strengths and limitations of studies. All the included studies were from developing countries. Meta-analyses were generated where data were available from more than one study for an outcome. Primary outcomes were maternal mortality, eclampsia, pre-eclampsia, and severe preeclampsia. Neonatal outcomes like neonatal mortality, preterm birth, small for gestational age and low birth weight were also evaluated. We followed standardized guidelines of Child Health Epidemiology Reference Group (CHERG) to generate estimates of effectiveness of calcium supplementation during pregnancy in reducing maternal and neonatal mortality in developing countries, for inclusion in the Lives Saved Tool (LiST).
Results: Data from 10 randomized controlled trials were included in this review. Pooled analysis showed that calcium supplementation during pregnancy was associated with a significant reduction of 45% in risk of gestational hypertension [Relative risk (RR) 0.55; 95 % confidence interval (CI) 0.36-0.85] and 59% in the risk of pre-eclampsia [RR 0.41; 95 % CI 0.24-0.69] in developing countries. Calcium supplementation during pregnancy was also associated with a significant reduction in neonatal mortality [RR 0.70; 95 % CI 0.56-0.88] and risk of pre-term birth [RR 0.88, 95 % CI 0.78-0.99]. Recommendations for LiST for reduction in maternal mortality were based on risk reduction in gestational hypertensive related severe morbidity/mortality [RR 0.80; 95% CI 0.70-0.91] and that for neonatal mortality were based on risk reduction in all-cause neonatal mortality [RR 0.70; 95% CI 0.56-0.88].
Conclusion: Calcium supplementation during pregnancy is associated with a reduction in risk of gestational hypertension, pre-eclampsia neonatal mortality and pre-term birth in developing countries.

Imdad, A., Jabeen, A. & Bhutta, Z.A. Role of calcium supplementation during pregnancy in reducing risk of developing gestational hypertensive disorders: a meta-analysis of studies from developing countries. BMC Public Health 11 (Suppl 3), S18 (2011). https://doi.org/10.1186/1471-2458-11-S3-S18

The article excerpted above is licensed under a CC Attribution 2.0 Generic License.

What is a Quantitative Study?

Quantitative studies collect data in the form of numbers and statistics. They typically use large sample sizes (numbers of participants). They can be primary or secondary. Primary quantitative studies include experiments, quasi-experiments, cohort studies, correlational studies, and surveys.

Finding Quantitative Studies in Library Databases

The following two methods may help you find quantitative studies (be sure to verify)!

  • Use the Publication Type search option to select quantitative study types, such as randomized controlled trials.
  • Add keywords to your search, such as "randomized controlled trial" OR "cohort study" OR "survey" OR "questionnaire."

Identifying Quantitative Studies

Read the article abstracts. The abstract may state directly if the study used an experimental design, a survey / questionnaire, or if it was a correlational or cohort study. The methods may describe numerical data that were collected. The results and discussion may describe statistical models that were developed. 

Preeclampsia is an important cause of maternal and perinatal morbidity and mortality. Previous studies have tested calcium supplementation and aspirin separately to reduce the incidence of preeclampsia but not the effects of combined supplementation. The objective of this study was to investigate the effectiveness of aspirin combined with calcium supplementation to prevent preeclampsia in women with chronic hypertension. A double-blind, placebo-controlled randomized clinical trial was carried out at the antenatal clinic of a large university hospital in São Paulo, SP, Brazil. A total of 49 women with chronic hypertension and abnormal uterine artery Doppler at 20-27 weeks gestation were randomly assigned to receive placebo (N = 26) or 100 mg aspirin plus 2 g calcium (N = 23) daily until delivery. The main outcome of this pilot study was development of superimposed preeclampsia. Secondary outcomes were fetal growth restriction and preterm birth. The rate of superimposed preeclampsia was 28.6% lower among women receiving aspirin plus calcium than in the placebo group (52.2 vs 73.1%, respectively, P=0.112). The rate of fetal growth restriction was reduced by 80.8% in the supplemented group (25 vs 4.8% in the placebo vs supplemented groups, respectively; P=0.073). The rate of preterm birth was 33.3% in both groups. The combined supplementation of aspirin and calcium starting at 20-27 weeks of gestation produced a nonsignificant decrease in the incidence of superimposed preeclampsia and fetal growth restriction in hypertensive women with abnormal uterine artery Doppler.

Souza, E. V., Torloni, M. R., Atallah, A. N., dos Santos, G. M. S., Kulay Jr, L., & Sass, N.. (2014). Aspirin plus calcium supplementation to prevent superimposed preeclampsia: a randomized trial. Brazilian Journal of Medical and Biological Research, 47(5), 419–425. https://doi.org/10.1590/1414-431X20143629

The article excerpted above is licensed under a CC Attribution 4.0 International License.

What is a Qualitative Study?

Qualitative studies collect data in the form of descriptive words. They typically use smaller sample sizes (numbers of participants). Qualitative studies can be primary or secondary. A study that uses interviews is a good example of a primary qualitative study.

Finding Qualitative Studies in Library Databases

The following two methods may help you find qualitative studies.

  • Select "interview" from the Publication Type search option menu. Note: This may yield too few results and exclude some valid qualitative articles.
  • Add keywords to your search, such as "interview."

Identifying Qualitative Studies

Read the article abstracts. The abstract may state directly if the study used an interview methodology. It may describe open-ended questions, meaning that participants respond with words instead of checking a box or being scored on a test. The methods may also describe how participants' responses were "coded," meaning classified and organized by concepts or ideas.

Introduction: Obesity in Sweden has doubled to 14% over the last 20 years. New strategies for treatment and prevention are needed. Excessive gestational weight gain has been found to contribute substantially to obesity, and there is a consistent association between postpartum weight retention and obesity later in life. We aimed to explore what factors women perceive as reasons for having substantial postpartum weight retention, to identify areas for new and improved interventions. Methods: Qualitative interview study (semi-structured) using an emergent design. Fifteen women, with a postpartum weight retention ≥ 10 kg, were interviewed by a trained cognitive therapist. Eight women had pre-pregnancy BMI below 30 kg/m2. Interviews were transcribed verbatim and data analysed using inductive manifest content analysis. Salient text passages were extracted, shortened, coded and clustered into categories. Results: Participants reported no knowledge of current gestational weight gain recommendations or of risks for adverse pregnancy outcomes with excessive weight gain or postpartum weight retention. Excessive eating emerged as a common strategy to provide relief of psychological, emotional and physical discomfort, such as depression and morning sickness. Women perceived medical staff as being unconcerned about weight, and postpartum weight loss support was scarce or absent. Some women reported eating more due to a belief that breastfeeding would automatically lead to weight loss. Conclusion: There is a need to raise awareness about risks with unhealthy gestational weight development and postpartum weight retention in women of childbearing age. The common strategy to cope with psychological, emotional or physical discomfort by eating is an important factor to target with intervention. The postpartum year is a neglected period where additional follow-up on weight and weight loss support is strongly indicated.

Christenson A, Johansson E, Reynisdottir S, Torgerson J, Hemmingsson E (2016) Women's Perceived Reasons for Their Excessive Postpartum Weight Retention: A Qualitative Interview Study. PLoS ONE 11(12): e0167731. https://doi.org/10.1371/journal.pone.0167731

The article excerpted above is licensed under a CC Attribution 4.0 International license.

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