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NUR 424 | Nursing Informatics & Health Policy

This is a guide to research, resources, theory, and practice in nursing informatics and healthy policy domains. It is designed to help students in NURS 424 as they develop wikis on current and emerging trends in informatics.

Starting your research

 The informatics umbrella 

Take a look at the following visual, and consider these questions:

  • What does this visual mean to you?
  • What makes sense, and what doesn't make sense?
  • What information do we get from this visual?

A picture of informatics subcategories

Image by Hersh (2009)


 Defining our terms 

Understanding informatics means also knowing what we're talking about when we use terms like technology and information.

While both of these words are widely used, that doesn't mean that we know what they mean. Just for fun, try defining both information and technology:

Information is _________________________________________________________________________________________

Technology is _________________________________________________________________________________________

(for that matter, how do we even define "people"?!?)

It is very important that we know the words we use when we adopt them for our research. For that reason, let's take the first part of this guide to read through papers that provide working definitions of informationtechnologyinformatics, and nursing informatics.


 Background information 

Before you dive into your research, you will likely need to find background information related to your topic of interest.

background information is the general health information typically available to the public. That doesn't mean it's easy to follow, but it should be less robust, and more summative than your average peer-reviewed study.

Practice guidelines provide one useful source for background information. For the most part, they are short, designed to be understood, and closely reviewed by professionals. To get an idea what a practice guideline looks like, check out this example for working with transgender patients from the World Professional Association for Transgender Health: WPATH Standards of Care.

Additionally, you can find a trove of background information on informatics and nursing through organizational websites. A few examples include:

Informatics:
Nursing:
Other resources for background information:

 Social media 

Here's a helpful way to keep up with background information: did you know that many of the websites and organizations mentioned above have Twitter feeds? One way to ensure that you are keeping in touch with their publications, editorials, and news is by connecting with them on Twitter. 

This will be particularly useful when you start focusing on specific subjects within the field of informatics. 

For instance, when you are preparing your Wiki, make it a point to follow applicable journals, authors, and scientists who work in your domain (ie: mHealth).

 Further reading 

It is also helpful to dive into the current literature regarding informatics theory and practice. As you read the following papers, pay attention to the language the authors use to describe informatics. Annotate, circle, comment on words that stand out or make you curious. Later, when you begin your research, you can build these words into search strings.

 Constructing a question... 

Before you ever begin your research, you want to have a research question (also called a line of inquiry, and in evidence-based practice, a PICO question). Your research question should: 1) meet the criteria for your assignment; and 2) refer to a research interest that you have. You also need to frame it around your specific field of research, in this case, nursing informatics as it relates to prevention, prognosis, quality of life, therapy, and etiology. In EBP research, we call these fields clinical domains

It can be helpful to classify your question based on the clinical domain it falls under. A clinical domain refers to the type of study you wish to locate. For instance, a question involving quality of life (such as mhealth apps for persons with diabetes) falls under the the clinical domain, Quality of Life


 Clinical domains 

See the examples below for examples of a question for each of these domains:

Prevention

How can perioperative nurses assist in the analysis of electronic health records to determine rate of infection with prolonged in-patient care?

Prognosis

How can telehealth applications affect the long-term health of rural patients living with HIV?

Quality of life

How do limited sex/gender fields in the electronic health record affect perceived quality of care by transgender patients?

Therapy

How do  mhealth apps compare to in-person rehabilitation in promoting cognitive rehabilitation in persons recovering from traumatic brain injury?

Etiology

How do public Naloxone sales track with fatality data for admits with overdose symptoms?


 Research Questions for a QI Project 

If you look closely, each of the research questions noted above follow a similar pattern. For the most part, they include information about:

  • Patients / populations
  • Interventions
  • Comparisons / controls
  • Outcomes

That's because they follow the PICO question format. This is a strategy used in evidence-based practice to ensure that you find research meeting the criteria needed for clinical practice.


 Questions for a QI Project 

Keep in mind: a PICO question is not always desirable when forming a search query.

For our purposes today, we're going to focus on research questions that adhere to your QI projects.

  • For QI 1, you'll want at least 6 current, scholarly sources
  • For QI 2, you'll want another 6 current, scholarly sources
  • For QI 3, you'll want at least 3 current, scholarly sources

Consider for a moment: what constitutes a current, scholarly source for a project on quality improvement in clinical and hospital settings?

This question, though it's broad, is very similar to what you'll be asking as you form your search strategy.

For your own search strategy, you'd break it down further, and make it specific to finding information about the procedures, policies, and processes relevant to your topic.

For instance, if my topic was: practicing gender-affirming care in clinical settings, my question, and my subsequent research should focus on this subject.

My question might look like this: What can healthcare organizations do to improve the quality of care for transgender patients?

EVERYTHING else should follow from that!

 Deconstructing your question... 

Now that you have a research question, you need to reduce it to its barest parts. This means taking the major concepts from your question; if it's PICO, that would be the P, I, C, and O. 

Your concepts will determine what search terms you use, and consequentially, what results you will find. For that reason, you want to make certain that your concepts + search terms are conducive to the databases you're searching.

The best way to do this is by following the controlled vocabulary used in different databases. The most prominent example in health science literature is MeSH, which stands for Medical Subject Headings. MeSH is employed in PubMed, one of the largest research portals online. It is also used in CINAHL, a database for nursing and allied health research. 

MeSH

It can be challenging to find exactly what you're looking for when searching databases. For that reason, it's valuable to adhere to the controlled vocabulary in the different databases you search. One of the most well-regarded is MeSH, which stands for "Medical Subject Headings". MeSH terms are an important part of the search experience in PubMed, one of the largest research platforms in the world. 

MeSH terms are created by the National Library of Medicine. Using them will help you formulate keywords for your search. Follow this link to go to the MeSH database: https://www.ncbi.nlm.nih.gov/mesh

For help with MeSH, see this short tutorial:


 Forming a search string 

Now that you've put together your primary search concepts using MeSH, let's conduct a search in PubMed.

PubMed is more than a single database. Rather, it's an entire ecosystem of databases. Basically, there is a lot of information in PubMed. For that reason, you will need a concise search string in order to produce efficient results.

As you think about your clinical queries search keep in mind the following:

  • When you begin formulating a search strategy, aim for a search with high recall rather than precision. In many cases, this will generate a larger number of results than is necessary; however, it is sometimes easier to narrow your search over time instead of doing so from the outset.
  • Avoid using too many search concepts; concepts are the primary terms that align with your search needs. At the same time, a variety of synonymous search terms should be combined in conjunction with each concept.
    • IE: Intervention (concept) = hip strengthening | "hip flexor" OR "hip extension" OR "hip exercise" OR "hip stretch" OR ""hip stretches" OR hip stretching" OR "foam roll" OR "foam roller" OR "foam rolling" (search terms)
  • Familiarize yourself with Boolean operators AND, OR & NOT, and apply them within your search string, both between concepts and between search terms.
    • AND separates concepts | "cerebral palsy" AND "whole body vibration" narrows your search, such that you receive papers about both cerebral palsy and vibration.
    • OR separates search terms | "children" OR "pediatrics" broadens your search to include both of these key words.
    • NOT excludes unwanted concepts | "stroke" NOT ("heat stroke" OR "breast stroke") makes it more likely your search results will be limited to cerebrovascular accidents.
  • Two other rules to keep in mind involve parentheses and quotation marks:
    • Parentheses include phrases in your search, but will not limit to exact phrasing.
      • IE: (disorders of sexual development) will return any combination of those keywords.
    • Quotation marks limit search results to exact phrasing.
      • IE: "disorders of sexual development" will return this exact phrase.

Here's an example of a well-formed search string:

an image of an advanced search in PubMedIt can also be framed as:

((("brain injury, traumatic"[mesh] OR "traumatic brain injury" OR "severe concussion")) AND ("mhealth" OR "mobile health app" OR "mobile app" OR "patient education app" OR "patient education interface" OR "phone-based intervention")) AND "cognition"[mesh]

For more help building these strategies into a search string, check out the University of Arizona search strategy builder.


 Revising a search 

Often, you will need to search multiple times to find the most appropriate information for your research. This will mostly depend on the number of results you obtain, and the relevance of those results to your initial research question. Did you get 500 results? You'll likely want to add more search terms in order to narrow your search. Did you get nil results? You may want to cut out some search terms. 

In this sense, you are constantly reiterating your search string in new ways. Don't be afraid to experiment!

 Understanding your results 

Check out the image below to get a quick rundown of a results page in PubMed:

An image of a results page in PubMed


 Saving your results 

MyNCBI

More than likely, PubMed is the most common place you'll go for your research. It's an an enormous platform, and houses the MEDLINE, PMC, MeSH, and NCBI Bookshelf databases. It also has its own citation management tool, which you should access before using any other part of the service. 

This tool can be accessed as soon as you've set up a MyNCBI account. Doing so is fairly simple. Simply click Sign in to NCBI from the top right corner of the PubMed homepage. From there, you need only create a new account.

For more help, check out this walkthrough video from VCU Libraries on setting up an account: 

Zotero

Once you have compiled at least one promising study or review, you should consider a citation management platform like Zotero. This will help you keep your research organized, which is particularly helpful if you're writing a literature review or annotated bibliography!

Getting started with Zoteroo is easy (although it does require a NAU login ID). Simply navigate to: https://www.zotero.org and create an account from there. 

If you need help with Zotero, visit the Library's Research Support Services page, and click on Citation Management Apps.

Document Delivery Services

When you find studies that you can't access through NAU, that doesn't mean you can't read them! Instead, you'll need to use the library's Document Delivery Services tool to secure the paper from another source.

DDS is easy to use once you've set it up. Typically, it only takes 1 - 2 days to receive a requested study, which will be sent as a .PDF for you to save and use later.

To learn more about DDS, see this link: nau.edu/library/document-delivery-services/