Searching for Evidence on Debriefing After In-Hospital Cardiac Arrest: Databases, Strings, Filters and a Count at Every Stage
Student Name
American College of Education
NUR5023: Advanced Nursing Research and Practice I
Module 2 Assignment
Instructor Name
May 10, 2027
The Question
The search supports a graduate project on debriefing after in-hospital cardiac arrest at a 320-bed community hospital, the invented setting carried through this course. The question, in PICO form, is: among adult and pediatric inpatients who experience in-hospital cardiac arrest (P), does structured team debriefing after the event (I), compared with no structured debriefing (C), improve resuscitation quality, return of spontaneous circulation and survival to discharge (O)? Pediatric studies were included deliberately, because much of the debriefing literature comes from children's hospitals, and excluding them would remove relevant evidence about the mechanism even if its outcomes do not transfer directly to adults.
A documented search differs from an informal one in that another person can repeat it and obtain the same results, allowing for new publications. Page et al. (2021) set out the PRISMA 2020 statement for reporting systematic reviews, which asks authors to report every database and date searched, the full search strategy and the number of records at each stage of screening with reasons for exclusion. A graduate search is not a systematic review, but using the same reporting logic makes its decisions visible. The purpose of documenting a search is not to prove effort but to let a reader see what could have been missed.
Databases and Why
Four sources were searched on May 3, 2027. CINAHL Complete was chosen for its coverage of nursing and allied health journals, where studies of nurse-led and interprofessional debriefing are often published. PubMed, which searches MEDLINE, was chosen for resuscitation, critical care and emergency medicine journals. For existing reviews and registered trials, the Cochrane Library and its central register were also searched. Google Scholar was used last, for the first 100 results only, as a check for articles the databases had missed, because its results are not fully reproducible.
Two additional steps followed the database searches. The reference lists of the included studies were scanned for relevant work not captured by the strings, and a citation search identified articles that had cited the included meta-analysis. These steps are reported separately so that their contribution can be seen.
Strings and Filters
The strings were built from the three main concepts of the question and combined with AND. The event concept used cardiac arrest OR heart arrest OR cardiopulmonary resuscitation OR CPR OR resuscitation OR code blue. The intervention concept used debrief OR post-event review OR post-resuscitation review OR performance feedback, with the truncation symbol capturing debrief, debriefing and debriefs. The setting concept used hospital OR inpatient* OR in-hospital OR intensive care. In PubMed, the Medical Subject Headings Heart Arrest and Cardiopulmonary Resuscitation were added to the event concept with OR, and in CINAHL the subject headings Cardiac Arrest and Resuscitation, Cardiopulmonary were added in the same way.
Four filters were applied, each for a stated reason. Publication years 2005 to 2027 were chosen because debriefing with recorded resuscitation data became feasible around 2005 with the spread of defibrillators that capture compression metrics. English language was applied because translation was not available. Human studies only was applied in PubMed. No filter was applied for study design, because the debriefing literature contains few randomized trials, and a design filter would have removed the quasi-experimental studies that make up most of the evidence. The filter left off is as much a decision as the filters applied, and it is reported for the same reason.
Terms Tried and Dropped
Two terms were tested and removed before the final search, and recording them explains the final strings. The phrase after-action review, borrowed from military and emergency management settings, returned a large number of records about disaster exercises and almost none about cardiac arrest, so it added noise without adding relevant studies. The term feedback on its own, without performance attached, returned thousands of records on patient feedback and survey methods, and restricting it to performance feedback kept the relevant resuscitation studies while removing most of the unrelated ones.
One term was added after a first pass. The first version of the event concept did not include code blue, and two relevant hospital studies were found only through reference lists because their titles and abstracts used that phrase rather than cardiac arrest. Adding it to the string and rerunning the search recovered both, along with one more study that the first version had missed. A search string is a draft until it has been tested against the studies you already know should appear.
Counts at Every Stage
The database searches identified 612 records: 188 from CINAHL, 301 from PubMed, 45 from the Cochrane Library and 78 from the first 100 Google Scholar results after removing books and non-English items. After 164 duplicates were removed with citation management software and checked by hand, 448 records remained for title and abstract screening. Of these, 401 were excluded, most because they concerned simulation training without real events, out-of-hospital arrest or debriefing after events other than cardiac arrest. Full texts of 47 articles were sought, and all 47 were obtained.
At full-text review, 38 articles were excluded with reasons: 14 described debriefing programs without reporting any outcome, 9 were conference abstracts without full reports, 7 studied simulation debriefing only, 5 were commentaries or editorials and 3 studied out-of-hospital arrest. That left 9 articles from the database searches. Reference list scanning added 2 more and the citation search added 1, for a total of 12 included sources.
The included sources span several designs, which will matter in the next module's appraisal. They include one systematic review with meta-analysis, whose pooled arrest data showed better compression performance and more patients regaining a pulse, without any detectable gain in the number leaving hospital alive (Couper et al., 2013); a before-and-after study in adults comparing debriefing using recorded compression data with a historical cohort (Edelson et al., 2008); a pediatric intensive care study of interdisciplinary debriefing (Wolfe et al., 2014); a practical guide to clinical event debriefing (Kessler et al., 2015); and several smaller implementation and survey studies.
Limits of the Search
The search has three limits that the appraisal will need to keep in mind. The English-language filter may have excluded relevant European and Asian studies, and the resuscitation literature includes active research groups outside English-speaking countries. Only the first 100 Google Scholar results were screened, so the check for missed articles was partial. And the search did not include trial registries or conference proceedings beyond those indexed in the databases, which may bias the included studies toward positive findings, since studies with null results are less often published in full. A second reader did not independently screen the records, which a systematic review would require; to reduce this risk, a random 10 percent of excluded titles and abstracts was re-screened a week later, and no exclusion was reversed.
Conclusion
The documented search for evidence on debriefing after in-hospital cardiac arrest identified 612 records and, through reported steps of duplicate removal, screening and full-text review, arrived at 12 included sources. Every database, string, filter and count is recorded so that another nurse could repeat the search and see where judgment was applied. The search found a body of evidence that is mostly quasi-experimental, with one meta-analysis at its center, and the next module will assign levels and rate the quality of what survived screening.
References
Couper, K., Salman, B., Soar, J., Finn, J., & Perkins, G. D. (2013). Debriefing to improve outcomes from critical illness: A systematic review and meta-analysis. Intensive Care Medicine, 39(9), 1513-1523. https://doi.org/10.1007/s00134-013-2951-7
Edelson, D. P., Litzinger, B., Arora, V., Walsh, D., Kim, S., Lauderdale, D. S., Vanden Hoek, T. L., Becker, L. B., & Abella, B. S. (2008). Improving in-hospital cardiac arrest process and outcomes with performance debriefing. Archives of Internal Medicine, 168(10), 1063-1069. https://doi.org/10.1001/archinte.168.10.1063
Kessler, D. O., Cheng, A., & Mullan, P. C. (2015). Debriefing in the emergency department after clinical events: A practical guide. Annals of Emergency Medicine, 65(6), 690-698. https://doi.org/10.1016/j.annemergmed.2014.10.019
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., Hrobjartsson, 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
Wolfe, H., Zebuhr, C., Topjian, A. A., Nishisaki, A., Niles, D. E., Meaney, P. A., Boyle, L., Giordano, R. T., Davis, D., Priestley, M., Apkon, M., Berg, R. A., Nadkarni, V. M., & Sutton, R. M. (2014). Interdisciplinary ICU cardiac arrest debriefing improves survival outcomes. Critical Care Medicine, 42(7), 1688-1695. https://doi.org/10.1097/CCM.0000000000000327
How this NUR 5023 Module 2 example is structured
NUR 5023 Module 2 often builds the documented search: databases, strings, filters and counts at each stage; your classroom's instructions decide the number of databases and whether a flow diagram is required. This example states the question in PICO form, justifies each database, reports the strings exactly as run, lists every filter with its reason, and then reports the flow of records with the reasons for exclusion at full-text review. A short section on the search's limits closes the paper. The structure follows the reporting logic of the PRISMA 2020 statement, adapted for a single graduate student's search, which is what makes it reproducible.
NUR5023 Module 2 questions, answered
What does NUR5023 Module 2 usually ask for?
NUR5023 Module 2 often asks for a documented literature search: the question, the databases, the exact search strings, the filters and the number of records at each stage from identification to inclusion. Many sections ask for a flow diagram or a table. Your classroom's instructions decide the number of databases and the reporting format.
What should I report at each stage of a documented search?
Report the number of records from each database, the number of duplicates removed, the number screened by title and abstract, the number excluded, the number of full texts reviewed, the number excluded at full text with reasons and the final number included. Report extra sources, such as reference list checks, separately.
Should I use a study design filter in my search?
Only if the evidence base is large enough to afford it. For many nursing questions, randomized trials are rare, and a design filter would remove the quasi-experimental studies that make up most of the evidence. Whatever you decide, report the choice and the reason, just as you would for any filter you apply.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official American College of Education document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.