DNP 820 TOPIC 2 DQ 1

DNP 820 TOPIC 2 DQ 1

DNP 820 TOPIC 2 DQ 1

Review the article “Translating Research for Evidence-Based Practice,”  provided in the topic Resources. Then answer the following questions in your initial post.  

Find a research article that supports the intervention of your project. Determine if the article is peer-reviewed or if this a practice-based publication that offers expert opinions.  Explain.  

What type of research was conducted?  Where does it fall on the hierarchy of research designs? (Refer to Figure 1 in “Translating Research for Evidence-Based Practice”). What possible sources of bias are present in the study?

Topic 2 DQ 1

What type of research was conducted?

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The research article identified that supports the intervention of my DNP project was written by Wada, et al., (2020). It is a peer-reviewed article and scholarly publication written by one or more people/authors with similar competencies for the work.

 Where does it fall on the hierarchy of research designs? (Refer to Figure 1 in “Translating Research for Evidence-Based Practice”). Explain. 

According to Bowen, & Forrest, (2017) in translating Research for Evidence-Based Practice (levels of evidence in research), the research article I picked for my DPI project can be appraised to fall on the level 2 hierarchy of research designs

Level 2: Quasi-experimental study, a systematic review of quasi-experimental studies +/− RCTs, +/− meta-analysis: This is a primary, experimental study perspective, and tests treatment. To formulate a specific PICO question, the learner needs to ask a good clinical question to identify why the study was conducted, the research question(s) the researcher examined, if a clear statement of purpose was present and if objectives were stated at the beginning of the article. A PICO question identifies the (P) patient or population problem, (I) intervention, (C) comparison, (O) outcome(s), and sometimes (T) time frame is important.

My PICOT Question

(P) Among adult patients in a home health care setting, (I) does the implementation of the American Association of Clinical Endocrinology Clinical Practice Guideline on the use of continuous glucose monitoring (C) compared to current practices (O) impact hemoglobin A1C (T) over 12 weeks?

According to my PICO Question and Wada, et al., (2020) research studies;

The intervention identifies and used was, flash glucose monitoring helps achieve better glycemic control than conventional self-monitoring of blood glucose in non-insulin-treated type 2 diabetes.

– It is a randomized controlled trial (1:1), multicenter, open-label, parallel-group and was compared using analysis of covariance model that included baseline values and the group as covariates with forty-eight participants. It falls in level 2- Quasi-experimental study, a systematic review of quasi-experimental studies +/− RCTs, +/− meta-analysis, it’s an original research study, done by two or more authors/research with similar interest and qualification, and within the five years allowed by GCU.

The research article for my project shows the significance of the study, which includes what is already known about the subject

-Flash glucose monitoring (FGM) has been shown to reduce hypo/hyperglycemia and improve glycated hemoglobin (HBAIC). it was compared with self-monitoring of blood glucose (SMBG), and the conventional finger-pricking method in patients with type 1 and type 2 diabetes treated with insulin.

What are the new findings?

– As measured by Wada, et al., (2020) in Diabetes Treatment Satisfaction Questionnaire score in patients with non-insulin treated type 2 diabetes, compared with SMBG, FGM significantly improved mean glucose levels, glucose variability indices, time in hypo/hyperglycemia treatment, and patient’s satisfaction. Intervention with FGM preserved good glycemic control even after the cessation of glucose monitoring.

Possible sources of bias that are present in the study and how these might result to change the focus of research or clinical practice are;

-For future research studies it is imperative to clarify whether the intervention with FGM leads to lifestyle improvement in patients with type 2 diabetes during or even after glucose monitoring.

Reference

Bowen, D. M. & Forrest, J. (2017). Translating Research for Evidence-Based Practice. 10-14.

Wada, E., Onoue, T., Kobayashi, T., Handa, T., Hayase, A., Ito, M., Furukawa, M., Okuji, T.,

Okada, N., Iwama, S., Sugiyama, M., Tsunekawa, T., Takagi, H., Hagiwara, D., Ito, Y., Suga, H., Banno, R., Kuwatsuka, Y., Ando, M., & Goto, M. Hiroshi Arima. (2020). Flash glucose monitoring helps achieve better glycemic control than conventional self-monitoring of blood glucose in non-insulin-treated type 2 diabetes: a randomized controlled trial. Retrieved from https://drc.bmj.com/content/bmjdrc/8/1/e001115.full.pdf

RESPOND HERE

Margaret I agree with you that quasi-experimental study, a systematic review of quasi-experimental are categorized under the second level of evidence in the pyramid. Translating research for evidence-based practice guarantees factual decision-making process (Granger et al., 2022).  Therefore, researchers ensure that they use evidence rated in the highest hierarchy in the pyramid.  First and second level evidence are considered to be the most accurate and factual information that can be used in research. However, reviewing and examining the evidence is important in determining the relevance and relevancy of research article (Decker & Hamilton, 2018). Peer-reviewed articles in most cases are ranked at the top of the evidence pyramid. The authoring and approval processes of peer-reviewed publications make these materials to be considered as more accurate and credible. The hierarchy of research designs is also important in directing researchers on the right research articles to incorporate in their activities. PICOT question is important in clinical decision-making process.  Therefore, PICOT question helps healthcare providers using evidence in their clinical work.

References

Decker, V. B., & Hamilton, R. M. (2018). The nursing knowledge pyramid: A theory of the structure of nursing knowledge. Advances in Nursing Science41(3), 293-302. doi: 10.1097/ANS.0000000000000204

Granger, B. B., Mall, A., & Reynolds, S. S. (2022). Advancing Nursing Science Through Site-Based Clinical Inquiry: Designing Problem Pyramids. AACN Advanced Critical Care33(2), 212-219. https://doi.org/10.4037/aacnacc2022750

Patients who are critically ill are vulnerable and susceptible to worsening illness, long-term disability or even death. This group of patients is experiencing a serious illness or injury and this predisposes them to sequelae of consequences when admitted into an intensive care unit. Healthcare continues to improve, and people do survive. However, according to Detsky et al. (2017), only one-third of those who survived their intensive care stay returned to their baseline after six months. In order to help people not only survive their critical illness but also thrive, there is an ABCDEF bundle to help optimize outcomes and reduce delirium and disability associated with an ICU stay (Marra et a., 2018). The ‘E’ part of this bundle stands for early mobilization for critically ill patients. This is what my DPI project will focus on.

           Wang et al. (2022) conducted a study examining the impact of early mobility which reduced ICU-acquired weakness for critical care patients. This study was published in Disease Markers journal. This is a peer-reviewed journal published by Hindawi publishing. This journal entry had a panel of scientific experts review the article prior to publishing. By using a peer-reviewed journal article, the manuscript has been rigorously reviewed and deemed to be quality research and accurate data (Bowen & Forrest, 2017).

           This study was a randomized trial with a sample size of 95. There is a control group and an intervention group. Due to the randomization of this experiment, it is the top tier in the hierarchy of research. It is a primary research study as the authors of this study conducted this study. There are different types of bias that is possible. While 95 participants were involved in this study, there could have been a larger sample size. A larger sample size is more representative of the population and can reduce bias. Further, this study was only located in one hospital and was overseas. There could be a selection bias based on this fact. There may be cultural bias built in as this particular study was conducted in China. Lastly, there were patients excluded, which may skew the results of the experiment.  

References

Bowen, D. M., & Forrest, J. L. (2017). Translating research for evidence-based practice. Access, 10-14. https://www.researchgate.net/profile/Denise-Bowen/publication/313297984_Translating_research_for_evidence_based_practice/links/5899e9344585158bf6f8a44c/Translating-research-for-evidence-based-practice.pdf?origin=publication_detail

Detsky, M. E., Harhay, M. O., Bayard, D. F., Delman, A. M., Buehler, A. E., Kent, S. A., Ciuffetelli, I. V., Cooney, E., Gabler, N. B., Ratcliffe, S. J., Mikkelsen, M. E. & Halpern, S. D. (2017). Six-month morbidity and mortality among intensive care unit patients receiving life-sustaining therapy. A prospective cohort study.  Annals of the American Thoracic Society, 14(10), 1562-1570.

Marra, A., Ely, E. W., Pandharipande, P. P., Pstel, M. B. (2018). The ABCDEF bundle in critical care. Critical Care Clinician, 33 (2), 225-243. Doi: 10.106/j.ccc.2016.12.005.

Wang, J., Ren, D., Liu, Y., Wang, Y., Zhang, B., & Xiao, Q. (2022). Effects of early mobilization on the prognosis of critically ill patients: A systematic review and meta-analysis. International Journal of Nursing Studies110https://doi-org.lopes.idm.oclc.org/10.1016/j.ijnurstu.2020.103708. Permalink: https://lopes.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=psyh&AN=2020-76430-001&site=eds-live&scope=site&custid=s8333196&groupid=main&profile=eds1.

REPLY

ANGELA it is true that sick people are susceptible to worsening illness, long-term disability or even death. Therefore, the group relies on quality healthcare services from healthcare providers. Incompetent healthcare professionals may expose patients to more complicated situation. This group of patients may overstay in intensive care unit due to their vulnerability to long-term disability and health complications. In the ICU, patients get close scrutiny and immediate healthcare services from healthcare professionals. Healthcare continues to improve, and people do survive. The improvement improves the quality of healthcare services. Frequently, these changes target the weaknesses while stabilizing on the strengths (Maughan et al., 2021). Most recoveries and survival in the ICU indicates the advanced nursing care in the sector. Unfortunately, less incompetent healthcare providers can interfere with the treatment and recovery process of patients admitted in the intensive care unit. Using accurate research articles in handling cases related to patients in the ICU improves the accuracy of decisions (Öhlén et al., 2021). Peer-reviewed journals and meta-analysis are considered to be accurate and ranked highly in the evidence pyramid. 

References

Maughan, E. D., Johnson, K. H., Gryfinski, J., Lamparelli, W., Chatham, S., & Lopez-Carrasco, J. (2021). Show me the evidence: COVID-19 and school nursing in the 21st century. NASN School Nurse36(1), 46-51. https://doi.org/10.1177/1942602X20974770

Öhlén, J., Bramstång, A., Lundin Gurné, F., Pihlgren, A., Thonander, M., & Kirkevold, M. (2021). Complexities in Studying and Practicing Nursing—A Theoretical Elaboration Based on Reflections by Nurses and Nursing Students. Advances in Nursing Science44(4), 368-383. DOI: https://doi.org/10.1097/ANS.0000000000000379

My Picot-D question for this project is: For older adults in a psychiatric primary setting, does the translation of Hilton, Lara (2017) on Meditation (mindfulness-based stress reduction decrease the prevalence of Post-Traumatic Stress Disorder (PTSD) symptoms compared to current practice in eight weeks?

Posttraumatic stress disorder (PTSD) is a condition that can develop after exposure to a traumatic event. PTSD is characterized by four hallmark clusters of symptoms: reexperiencing, avoidance, negative cognitions or mood, and hyperarousal (American Psychiatric Association, 2018)

This is a level 1 of evidence and a systematic review and meta-analysis that synthesized evidence from randomized controlled trials of meditation interventions to provide estimates of their efficacy and safety in treating adults diagnosed with posttraumatic stress disorder (PTSD). This review was based on an established protocol and is reported according to PRISMA guidelines (Gallegos AM, et al, 2017).

 Meditation-based approaches are being widely implemented, but there is minimal research rigorously assessing their effectiveness. This article reviews meditation as an intervention for PTSD, considering three major types of meditative practices: mindfulness, mantra, and compassion meditation. The mechanisms by which these approaches may effectively reduce PTSD symptoms and improve quality of life are presented. Empirical evidence of the efficacy of meditation for PTSD is very limited but holds some promise. Additional evaluation of meditation-based treatment appears to be warranted. Meditation is a mind–body technique that refers to a broad variety of practices with the general goal of training the mind through regulation of attention and/or emotion to affect body functions, symptoms, and state of being. Categories of meditation include focused attention (voluntary focusing of attention on a chosen object), open monitoring (nonreactive monitoring of the content of experience from moment to moment), and automatic self-transcending meditation (absence of focus and individual control or effort. Similar to previous reviews in this area, across intervention type, meditation improved PTSD symptoms and depression symptoms (Hilton, L., Maher, et al, 2017).

References

American Psychiatric Association. (2018). The diagnostic and statistical manual of mental disorders, fifth edition (DSM–5). Washington, DC: American Psychiatric Publishing.

Gallegos AM, Crean HF, Pigeon WR, Heffner KL. Meditation and yoga for posttraumatic stress disorder: A meta-analytic review of randomized controlled trials. Clin Psychol Rev.2017;58:115-124. doi: 10.1016/j.cpr.2017.10.004.

Hilton, L., Maher, A. R., Colaiaco, B., Apaydin, E., Sorbero, M. E., Booth, M., Shanman, R. M., & Hempel, S. (2017). Meditation for posttraumatic stress: Systematic review and meta analysis. Psychological Trauma: Theory, Research, Practice, and Policy, 9(4), 453–460. https://doi.org/10.1037/tra0000180

RESPOND HER

I agree with you that a systematic review and meta-analysis synthesize evidence from randomized controlled trials of meditation interventions to provide estimates of their efficacy and safety in treating adults diagnosed with posttraumatic stress disorder. Other research articles are categorized in different levels of the hierarchy (Sullivan et al., 2019). However, most researchers and academicians assume that research sources in level one and two are more accurate the other pieces of evidence listed in the pyramid. Therefore, top level evidence has high traction.  Still, critiquing and examining the research articles is necessary in affirming the accuracy of a research article. Meditation-based approaches are being widely implemented, but there is minimal research rigorously assessing their effectiveness (Harris et al., 2021). Sadly, people prioritize different interests when researching. Different priorities interfere with the implementation process. However, research activities may expand to consider diverse priorities. Peer-reviewed articles possess accurate information from different stakeholders and related organizations. Therefore, these peer-reviewed articles can be used to handle clinical issue.

References

Harris, M., Melillo, K. D., Keilman, L. J., Peraza-Smith, G. B., Bronner, S., Walmer, M., … & Cacchione, P. Z. (2021). Supporting evidence for geropsychiatric nursing as a subspecialty of gerontological advanced practice nursing. Geriatric Nursing42(1), 247-250. https://doi.org/10.1016/j.gerinurse.2020.11.008

Sullivan, N., Swoboda, S. M., Breymier, T., Lucas, L., Sarasnick, J., Rutherford-Hemming, T., … & Kardong-Edgren, S. S. (2019). Emerging evidence toward a 2: 1 clinical to simulation ratio: a study comparing the traditional clinical and simulation settings. Clinical Simulation in Nursing30, 34-41. https://doi.org/10.1016/j.ecns.2019.03.003

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