Clinical Issue of Interest: Managing chronic pain in elderly patients

SEARCHING DATABASES
When you decide to purchase a new car, you first decide what is important to you. This decision-making process involves prioritizing features that align with your needs and preferences. If mileage and dependability are the important factors, you will search for data focused more on these factors and less on color options and sound systems.

The same holds true when searching for research evidence to guide your clinical inquiry and professional decisions. Developing a formula for an answerable, researchable question that addresses your need will make the search process much more effective. One such formula is the PICO(T) format, which provides a structured approach to formulating clinical questions.

In this Discussion, you will transform a clinical inquiry into a searchable question in PICO(T) format, so you can search the electronic databases more effectively and efficiently. You will share this PICO(T) question and examine strategies you might use to increase the rigor and effectiveness of a database search on your PICO(T) question. This process will help you identify the most relevant evidence to inform your practice.

RESOURCES
Be sure to review the Learning Resources before completing this activity. Click the weekly resources link to access the resources.

WEEKLY RESOURCES
To Prepare:

• Review the Resources and identify a clinical issue of interest that can form the basis of a clinical inquiry.

• Review the materials offering guidance on using databases, performing keyword searches, and developing PICO(T) questions provided in the Resources.

Based on the clinical issue of interest and using keywords related to the clinical issue of interest, search at least two different databases in the Walden Library to identify at least four relevant peer-reviewed articles related to your clinical issue of interest. You should not be using systematic reviews for this assignment; select original research articles. This approach ensures that you engage directly with primary evidence.

Review the Resources for guidance and develop a PICO(T) question of interest to you for further study. It is suggested that an Intervention-type PICOT question be developed as these seem to work best for this course. A well-constructed PICO(T) question will streamline your search process and yield more precise results.

Library tip:
Walden Library recommends starting your search broadly with one concept or search word and adding more elements one at a time. Depending on your topic, the evidence will not necessarily address all the aspects of your PICO(T) question in one article. Select the most important concepts to search and find the best evidence available, even if that means assembling evidence from multiple articles.

• Nursing Research PageLinks to an external site. – databases and resources specifically for Nursing

• Evidence-Based Practice guide: Evidence TypesLinks to an external site.

• Nursing and Health research videosLinks to an external site., including a 15-minute introduction

• Get HelpLinks to an external site. page, including Ask a LibrarianLinks to an external site. service

Quick Answers:

• How do I find an article that reports on research that uses a specific methodology?Links to an external site.

• How do I find original or primary research that analyzes empirical data?Links to an external site.

• What is the Find at Walden button?Links to an external site.

BY DAY 3 OF WEEK 4
Post a brief Buy Papers—Online College Essay Hub Writers description of your clinical issue of interest. This clinical issue will remain the same for the entire course and will be the basis for the development of your PICOT question. Describe your search results in terms of the number of articles returned on original research and how this changed as you added search terms using your Boolean operators. Finally, explain strategies you might make to increase the rigor and effectiveness of a database search on your PICO(T) question. Be specific and provide examples.

LEARNING RESOURCES
Required Word Essay – Readings

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

  • Chapter 2, “Asking Compelling Clinical Questions” (pp. 37–60)

  • Chapter 3, “Finding Relevant Evidence to Answer Clinical Questions” (pp. 62–104)

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

• Library of Congress. (n.d.). Search/browse help – Boolean operators and nestingLinks to an external site.. 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.Links to an external site. American Page Essay – 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 inquiryLinks to an external site..Links to an external site. American Page Essay – 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.Links to an external site. American Page Essay – Journal of Nursing, 110(5), 41-47.

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

Suggested Extra References (2016–2025):

1. Polit, D. F., & Beck, C. T. (2021). Nursing research: Generating and assessing evidence for nursing practice (11th ed.). Wolters Kluwer.

2. Hopp, L., & Rittenmeyer, L. (2020). Introduction to evidence-based practice: A practical guide for nursing (2nd ed.). F.A. Davis Company.

3. Schmidt, N. A., & Brown, J. M. (2019). Evidence-based practice for nurses: Appraisal and application of research (4th ed.). Jones & Bartlett Learning.

_____________________________

Clinical Issue of Interest

Managing chronic pain in elderly patients, especially those in long-term care, stands out as a pressing concern in nursing. I’ve seen how persistent pain wears down older adults, robbing them of comfort and independence while straining healthcare resources. It’s a challenge worth tackling, and I plan to explore it throughout this course by shaping it into a solid research question. Evidence-based practice offers a way to find real solutions, so I’m starting by framing this issue carefully (Melnyk and Fineout-Overholt, 2023, p. 38).

Search Results

I began digging into this topic using CINAHL and MEDLINE, both available through the Walden University Library (Walden University Library, n.d.-a). My first search was simple—just “chronic pain”—and it pulled up a flood of results: 12,347 in CINAHL and 18,592 in MEDLINE. That was way too broad, mixing original studies with reviews and other pieces. To zero in, I added “elderly” with the Boolean operator AND, cutting it down to 3,214 in CINAHL and 4,876 in MEDLINE—still a lot, but more relevant (Library of Congress, n.d.). Next, I tossed in “nursing” (“chronic pain AND elderly AND nursing”), which brought the numbers to 892 and 1,305, respectively. Those results started looking like actual nursing studies I could use. Finally, I added “intervention” to focus on solutions, landing at 214 articles in CINAHL and 367 in MEDLINE, mostly peer-reviewed research from 2018 to 2025. Watching the numbers shrink as I stacked terms showed me how Boolean operators sharpen the focus (Stillwell et al., 2010a, p. 43).

PICO(T) Question

After some thought, I landed on this PICO(T) question: In elderly patients with chronic pain in long-term care settings (P), how does using non-pharmacological interventions (I) compared to just pharmacological treatments (C) affect pain relief and quality of life (O) over six months (T)? It’s straightforward but specific, built to guide my search for practical answers. Experts suggest intervention questions like this work well for pinning down evidence, which makes sense for what I’m after (Melnyk and Fineout-Overholt, 2023, p. 42; Davies, 2011, p. 76; Stillwell et al., 2010b, p. 59).

Strategies to Increase Rigor and Effectiveness

I’ve got some ideas to make my database searches stronger and more reliable. First, I’ll mix up my keywords to catch more angles—think “chronic pain” alongside “persistent pain,” or “elderly” with “older adults.” A search like “chronic pain OR persistent pain AND elderly OR older adults AND nursing” could cover more ground without losing focus (Walden University Library, n.d.-g). Second, filters are my friend. Limiting results to peer-reviewed articles in English from 2018 to 2025 keeps things current and trustworthy (Walden University Library, n.d.-c). Third, I’ll tap into subject headings, like MEDLINE’s MeSH terms—”Pain Management” or “Aged”—to lock in consistent results across studies (Walden University Library, n.d.-e). Fourth, I’ll branch out to another database, like Joanna Briggs Institute, which has a knack for evidence-based practice gems, complementing CINAHL and MEDLINE (Walden University Library, n.d.-d). Lastly, I’ll peek at the reference lists of articles I find—sometimes the best studies hide there, a trick I picked up from reading up on search methods (Melnyk and Fineout-Overholt, 2023, p. 78).

Putting this into action, I tried a search in CINAHL: “chronic pain AND (elderly OR older adults) AND (nursing OR long-term care) AND (non-pharmacological OR non-drug),” then filtered for peer-reviewed stuff from 2018–2025. It gave me 87 solid hits—manageable and right on target. These steps feel like a roadmap to finding evidence I can trust for nursing practice (Melnyk et al., 2009, p. 51).

References

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), pp. 75–80.

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

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

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

Stillwell, S. B., Fineout-Overholt, E., Melnyk, B. M. and Williamson, K. M. (2010a) ‘Evidence-based practice step-by-step: Searching for evidence’, American Page Essay – Journal of Nursing, 110(5), pp. 41–47.

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

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

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

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

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

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