NURS 4300 Week 3 Capstone Search Strategy Example

Capstone Search Strategy: Overnight Care Clustering and Sleep in Older Inpatients

Student Name

College of Nursing, Walden University

NURS 4300: BSN Capstone

Instructor Name

Month Day, Year

Capstone Search Strategy: Overnight Care Clustering and Sleep in Older Inpatients

This strategy carries the Week 2 PICOT question into database language. The question asks whether grouping routine overnight care into planned rounds, rather than doing each task as it comes due, improves patient-reported sleep over the first three nights for patients 65 or older on a medical unit. The population, intervention and outcome became search concepts; the comparison and time frame were applied at screening. Stillwell et al. (2010) recommend searching on the population, intervention and outcome, since those are the elements indexers reliably tag, and that advice shaped the term map below.

Term Map

Table 1

Search Terms by PICOT Element

Searches as Run

Table 2

Search Log

Reasons for limits. The window begins in 2000 because the questionnaire most used to measure inpatient sleep, the Richards-Campbell Sleep Questionnaire, was published that year (Richards et al., 2000). English was required because no translation support was available. Adults of all ages were included rather than only those 65 and older, because a trial run limited to older adults returned too few intervention studies; applicability to older patients is judged at appraisal instead.

Decisions Made During the Search

Three decisions changed the strings between the first trial run and the searches logged above. First, a trial using only the subject heading for sleep returned more than 4,000 records in CINAHL, most about sleep disorders in the community. Requiring a hospital or inpatient term cut that to a workable number without losing any of the studies already known from the problem pitch.

Second, the phrase clustered care alone found very few records, because authors describe the same idea in many ways: bundled care, sleep protocols, quiet time and minimizing nighttime interruptions. The intervention line was widened with those synonyms and with earplugs, which appear in many sleep bundles.

Third, delirium was kept out of the search strings even though several retained studies measure it. Including it pulled in hundreds of delirium studies with no sleep component. Delirium is instead used at screening, so that studies linking sleep with delirium are kept when they appear under the sleep terms.

I also hand-checked the citations at the back of the Cochrane review that survived screening. That step added no new studies, which suggests the database strings captured the main literature for this question.

Inclusion and Exclusion Criteria

Included: studies of adult hospital inpatients in intensive care or ward settings; studies describing sources of overnight disruption, testing a non-drug sleep intervention, validating a sleep measure for inpatients, or examining links between inpatient sleep and delirium; primary research, systematic reviews and instrument development studies.

Excluded: pediatric and neonatal populations; studies of sleep medications only; studies in outpatient, home or nursing home settings; commentaries, editorials and conference abstracts; studies of shift workers' sleep rather than patients' sleep.

Screening Flow

The flow below follows the stages of a PRISMA diagram (Page et al., 2021).

Table 3

Records Through Each Stage of Screening

Most retained intervention studies come from intensive care units, which is a limitation to carry into the review: evidence for a general medical unit will partly be borrowed from a more intensive setting.

References

Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., ... Moher, D. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ, 372, Article n71. https://doi.org/10.1136/bmj.n71

Richards, K. C., O'Sullivan, P. S., & Phillips, R. L. (2000). Measurement of sleep in critically ill patients. Journal of Nursing Measurement, 8(2), 131-144. https://doi.org/10.1891/1061-3749.8.2.131

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. https://doi.org/10.1097/01.NAJ.0000368959.11129.79