Forming hypothetical clinical inquiries

Forming hypothetical clinical inquiries

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Working in healthcare is arguably one of the most stressful careers: over 85% of nurses polled in a recent study agreed that they experience significant stress and/or anxiety at work (Machova et al, 2019; Jones-Schneck, 2020). This tension has been amplified among healthcare workers during the novel challenges the covid-19 pandemic has created. A solution to remedy this rampant burnout and unrest is desperately needed to salvage the healthcare workforce (Jones-Schneck, 2020). Research shows that animal assisted therapy (AAT) can be used to reduce anxiety and depression among healthcare workers and has been shown to decrease levels of burnout (Machova et al., 2019). As both an animal lover and someone who has seen AAT successfully used to improve the health of my patients, it led me to the clinical inquiry of whether AAT can be used to decrease stress and burnout among healthcare workers in a hospital setting.

In daily practice, nurses are constantly forming hypothetical clinical inquiries in their minds in order to provide patients with the highest level of care (Laureate Education, 2018). Davies (2011) describes questions as “the driving force behind evidence based practice (EBP)” (p. 75). Healthcare workers who are motivated to improve patient care and the work environment are continuously creating questions, whether hypothetical or for research purposes (Laureate Education, 2018). Forming a PICOT question is the first step in the research process as it helps narrow down and organize important inquiries (Melnyck & Fineout-Overhault, 2018). The PICOT question I formulated for this discussion is: In adult healthcare workers ages 18-75 working in a hospital setting, how does the use of animal assisted therapy (AAT) compared with no intervention effect levels of stress and burnout?

Several methods can be used to ensure literary searches produce the best and most relevant data while encompassing the widest selection of articles. To begin my research, I used the CINAHL Plus with Full Text database and chose the limit words “animal assisted therapy” and “healthcare workers”. To ensure the results were both relevant and rigorous, I changed the search options to display only full text, peer reviewed research conducted since 2016 (Walden University, n.d.). This initial search resulted in only one single article, which was obviously not sufficient to gather data. To remedy the low number of resulting articles, I revisited the original CINAHL page and used the Boolean phrase option to change my search terms to include “animal assisted therapy or pet therapy or animal therapy or animal intervention or animal assisted activity” and “healthcare workers or healthcare professional or healthcare provider or healthcare personnel or doctor or nurse”. The “and” connector in Boolean phrase terms is a restrictive search term to ensure both phrases are included in the results, whereas “or” allows one or the other to be included (Melnyck & Fineout-Overhault, 2018). Boolean phrases, such as these, are useful to broaden search results; indeed, the second search resulted in 48 articles, 23 of which were relevant to my clinical question, versus one in the first search (Melnyck & Fineout-Overhault, 2018). To refine my search even further, I reviewed the subject headings of the ten resulting articles and tried adding in a third limit: “burnout or burn-out or burn out or stress or occupational stress or compassionate fatigue”. This changed my results to only six articles, however, two were different from the second search so although the addition of a third limit word narrowed my results, it did help in data collection (Walden University, n.d.).

After using CINAHL, I searched the PubMed database, which is simple to use and holds a wealth of information on clinical phenomenon (Laureate Education, 2018). I searched PubMed for “healthcare workers + animal assisted therapy + burnout”, which resulted in five articles, one of which was different from the results of CINAHL. To increase the number of articles, I removed “burnout” from the search terms and ended up with 40 articles, 15 of which were relevant to my research inquiry. Pubmed allows the useful option to refine search results by article type, which is helpful when searching for a specific research method, such as a systematic review.



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.

Jones-Schneck, J. (2020). Animal-assisted support: Actionable intervention for burnout. The Journal of Continuing Education in Nursing, 51(11), 496-497. doi: 10.3928/00220124-20201014-03

Laureate Education (Producer). (2018). Searching the Evidence [Video file]. Baltimore, MD: Author.

Machova, K., Souckova, M., Prochazkova, R., Vanickova, Z, & Mezian, K. (2019). Canine-Assisted therapy improves well-being in nurses. International Journal of Environmental Research and Public Health,16(19), 3760. doi: 10.3390/ijerph16183670

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

Walden University Library. (n.d.). Evidence-based practice research: CINAHL search help. Retrieved June 21, 2021 from




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Initial Discussion Post Week Four,

Working in the post-anesthesia recovery room, we often see unnecessary urinary catheters left in place by the operating room. The first thing I do is look at the given surgery. If the patient has had open abdominal surgery or a spinal anesthetic, often this catheter will remain in place for 4 to 24 hours. Knowing the surgeons and the surgeries, I still look for an order, and if there is not one in place, I will question the catheter and if it is warranted. This leads to my PICOT question: Does implementing nurse-driven protocols to remove unnecessary urinary catheters decrease the number of days of use for indwelling catheters and ultimately reduce the number of catheters associated with urinary tract infections (CAUTIs)? Going into the Walden library, I did an advanced search of nurse-driven catheter removal protocol. The very first peer-reviewed article I found was a study on “The purpose of this study was to examine the feasibility and acceptability of a nurse-driven catheter removal protocol among nurses in a hospital setting.” ( Blodgett & Sheets, 2021). When searching the Walden library, I found numerous peer-reviewed articles from many different databases, one of the best ones I found stated that “The PICU CAUTI rate declined from 4.8 (per 1,000 device days) in 2017 to 0.8 in 2018, 1 year after protocol implementation.” ( Schiessler et al. 2019). The third peer-reviewed article had a specific quote that hit home to me as a nurse, “You can’t have a CAUTI if you don’t have a foley.” (Girio-Herrera et al., 2019). There has never been a more accurate statement spoken, as it is 100 percent correct. Unfortunately, sometimes physicians and nurses are just too quick to place a foley and too lazy to question them. “The purpose of this performance improvement (PI) initiative is to decrease CAUTIs for inpatients.” (Stancovici & Galvan-Anderson, 2019). As I stated earlier in my post, CAUTI’s are very near and dear to my heart as a nurse, with most of them being completely avoidable, I feel we can do better as healthcare workers.





Blodgett, T. J., & Sheets, C. (2021). Perceptions of a Nurse-Driven Urinary Catheter Removal Protocol in a Hospital Setting. Clinical Nurse Specialist: The Journal for Advanced Nursing Practice, 35(2), 73–79.

Schiessler, M. M., Darwin, L. M., Phipps, A. R., Hegemann, L. R., Heybrock, B. S., & Macfadyen, A. J. (2019). Don’t Have a Doubt, Get the Catheter Out: A Nurse-Driven CAUTI Prevention Protocol. Pediatric Quality & Safety, 4(4), e183.

Girio-Herrera, L., Clay, C. M., Younus, F., Ahmed, Z., & Zimand, P. (2019). 964. Journey to Zero Harm: Eliminating Catheter-Associated Urinary Tract Infections (CAUTIs) for 12 Consecutive Months at Two Community Hospitals. Open Forum Infectious Diseases, 6, S30.

Stancovici, A., & Galvan-Anderson, B. (2019). Taking Every Precaution – an Inter-professional Approach to Reducing Catheter Associated Urinary Tract Infections in an Acute Care Medical Center. American Journal of Infection Control, 47, S13.


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