DNP 820 TOPIC 6 DQ 1

DNP 820 TOPIC 6 DQ 1

DNP 820 TOPIC 6 DQ 1

What effect does a meta-synthesis or meta-analysis have on research translation? Describe a clinical practice in place that is supported by this level of evidence. Provide relevant literature to support your response.

What effect does a meta-synthesis or meta-analysis have on research translation? Describe a clinical practice in place that is supported by this level of evidence.

Meta-analysis is a practice that critiques, integrates and analyses the statistical outcomes of similar studies. It applies quantitative methods in synthesizing and summarizing results from similar studies thereby using aggregate findings to establish the ‘truth’. It has a significant effect on research translation is it objectively evaluates quantitative research findings with a focus on testing a hypothesis (Hall & Roussel, 2022). For instance, different studies on Covid-19 vaccine efficacy can be subjected to meta-analysis that reveals if the vaccine has a true effect on preventing individuals from contracting the virus or improving recovery in case of infection.

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On the other hand, meta-synthesis brings together and breaks down qualitative findings by examining them, discovering essential features and phenomena, and transforming the findings into a new understanding (Hall & Roussel, 2022). There are three types of meta-synthesis. First, descriptive meta-synthesis that provides a broad description of a research phenomenon. Second, theory explication that re-conceptualizes the original research results with new understandings and explanations. Third, theory building that brings together different research results and presents them at a theoretical level to justify a tentative theory. In essence, meta-synthesis integrates qualitative research findings with a focus on developing a new theory. The results of a meta-synthesis are useful for providing a snapshot of the interpretation of the phenomenon or event, even as it brings the many interpretations together to strengthen evidence that new themes are discovered or that there are new interpretations (Schmidt & Brown, 2019). For example, an interview with patients in an urban areas may reveal that they are comfortable using telehealth while those in rural areas may reveal that they are not conformable using telehealth. Meta-synthesis could reveal that familiarity with telehealth technology could make them comfortable using it, thus resulting in a new theory that training helps to improve telehealth acceptance and use.

References

Hall, H. R., & Roussel, L. A. (2022). Evidence-Based Practice: An Integrative Approach to Research, Administration, and Practice (3rd ed.). Jones & Bartlett Learning, LLC.

Schmidt, N., & Brown, J. (2019). Evidence-Based Practice for Nurses: Appraisal and Application of Research (4th ed.). Jones & Bartlett Learning, LLC. 

RESPOND HERE

ASIATU I agree with you that meta-analysis criticizes, integrates and analyses the statistical outcomes of similar studies. The routine is important in researching process. Criticizing and analyzing the statistical outcomes of similar studies eliminates room for redundancy and wrong information. However, for meta-analysis to perfect it mandates the analysis process applies quantitative methods in synthesizing and summarizing results from similar studies (Walker et al., 2020). The deployment of other statistical methods allow meta-analysis to have a significant impact on research translation. Besides, meta-analysis evaluates quantitative research findings with a focus on testing a hypothesis. Meta-synthesis brings together and breaks down qualitative findings (Xue et al., 2020). The process is achieved by examining research findings, discovering essential features and transforming the research outcomes to a new understanding text for targeted population’s consumption. There are three types of meta-synthesis; descriptive meta-synthesis, theory explication, and theory building. The different types of meta-synthesis can be used in the same research. Alternatively, researchers may use their most suitable type of meta-synthesis.

References

Walker, R. M., Gillespie, B. M., McInnes, E., Moore, Z., Eskes, A. M., Patton, D., … & Chaboyer, W. (2020). Prevention and treatment of pressure injuries: A meta-synthesis of Cochrane Reviews. Journal of Tissue Viability29(4), 227-243. https://doi.org/10.1016/j.jtv.2020.05.004

Xue, C. L., Shu, Y. S., Hayter, M., & Lee, A. (2020). Experiences of nurses involved in natural disaster relief: A meta‐synthesis of qualitative literature. Journal of clinical nursing29(23-24), 4514-4531.  https://doi.org/10.1111/jocn.15476

Topic 6 DQ 1

               Research translation is a large part of evidenced-based practice changes. Translational research studies show how evidence-based interventions are translated into real-world settings using high levels of evidence (Polit & Beck, 2020). When reviewing the literature, specifically a systematic review, it is important for it to include a meta-analysis. Per Melnyk & Fineout-Overholt (2019) a meta-analysis generates a summary statistic representing the affect of an intervention across multiple studies using the data from quantitative studies. Examples of resources that can provide meta-analysis include EBSCO nursing reference center, Cochrane databases, PubMed (Medline), and several others. A systematic review without a meta-analysis is missing out, but still considered level 1 evidence when reviewing randomized control trials. Another benefit meta-analysis is a reduction in bias because it involves multiple studies for comparison. The American Association of Critical Care Nurses levels of evidence hierarchy places meta-analysis or meta-synthesis of multiple controlled studies with results that consistently support a specific action, intervention, or treatment are a level A.

               Clinical practice guidelines are statements that include recommendations intended to optimize patient care that are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options (AHRQ, 2022). Melnyk & Fineout-Overholt (2019) suggest that although clinical practice guidelines have tremendous potential to improve the quality of care and outcomes for patients as well as reduce healthcare variation and costs, their success depends on a highly rigorous guideline development process and the incorporation of the latest best evidence. The authors suggest keeping in mind these CPG may need to be updated based on latest, best evidenced. The AHRQ has specific inclusion criteria for the National Guideline Clearinghouse (NGC). These include a synthesis of evidence from the selected studies. An example of a meta-analysis that was used in the development of a clinical practice guidelines includes VTE prevention. Per Abboud et al. (2020) venous thromboembolism is a medical condition that is addressed in many clinical practice guidelines. Venous thromboembolism (VTE) is a leading cause of morbidity and mortality in hospitalized patients. The meta-analysis, per Abboud et al. (2020) assessing the impact of implementing VTE clinical practice guidelines favored “appropriate prophylaxis (RR 1.67, 95% CI 1.41 to 1.97, 552 patients). Potential risk of bias was assessed to be low for 28% of the studies. However, using GRADE, the certainty of the evidence of all outcomes was rated very low quality.” The authors noted the lack of randomized control trials reduced the quality of the evidence available. This may be a guideline that needs to be revisited with more, up to date evidence.

References

Abboud, J. Rahman, A., Kahale, L., Dempster, M., & Adair, P. (2020). Prevention of health care associated venous thromboembolism through implementing VTE prevention clinical practice guidelines in hospitalized medical patients: a systematic review and meta-analysis. Implementation Science, 15(1), 1–11. https://doi-org.lopes.idm.oclc.org/10.1186/s13012-020-01008-9

Agency for Healthcare and Research Quality (2022). National Guideline Clearinghouse Inclusion Criteria

https:/ www.ahrq.gov/gam/summaries/inclusion-criteria/index.html

Melnyk, B. M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing and healthcare: A guide

I agree with you that research translation is a large part of evidenced-based practice changes. At the same time, research may fail to attain its desired value when research findings are not translated. Therefore, healthcare professionals use their statistical knowledge to translate research and research findings. Translational research studies show how evidence-based interventions are translated into real-world settings using high levels of evidence (Cornelius-White et al., 2018). Some evidence-based interventions may be perceived to be resourceful but fail to achieve their objectives when applied into use. Research translation is important in eliminating such ambiguities. Systematic reviews such as meta-analysis are important in research translation. Meta-analysis criticizes and integrate statistical information from similar studies (Dinçer, 2018). However, before using research findings from similar studies, examining the reliability and validity of the research outcome is essential. A systematic review of evidence and an assessment of the benefits and harms of alternative care options is part of research translation. Clinical practice guidelines depend on meta-analysis and meta-synthesis.

References

Cornelius-White, J. H., Kanamori, Y., Murphy, D., & Tickle, E. (2018). Mutuality in psychotherapy: A meta-analysis and meta-synthesis. Journal of Psychotherapy Integration28(4), 489. https://doi.org/10.1037/int0000134

Dinçer, S. (2018). Content analysis in scientific research: Meta-analysis, meta-synthesis, and descriptive content analysis. Bartın University Journal of Faculty of Education7(1), 176-190. https://doi.org/10.14686/buefad.363159

Topic 6 DQ 1

Meta-analysis is the collection, analysis, interpretation, and presentation of masses of numerical data from research articles to appreciate the degree of similarities and differences in the reported outcomes (Leary & Walker, 2018). In addition, Lachal et al. (2017) stated that meta-syntheses provide a suitable constancy between an impartial underpinning, a stringent scientific method to data analysis, and the required input of the researcher’s influence in the interpretation of the completed work. Meta-analysis has specific attributes such as clarity of the search strategy including inclusion and exclusion criteria, a clearly defined problem statement outlining the reason for the literature review, questions that the review will address, appraisal of existing work, and the generation of new knowledge as an outcome of the review process (Leary & Walker, 2018).

With the significance being stressed on how studies are conducted, the reported outcomes, and best practice suggestions, meta-analysis, and meta-synthesis offer structured organizing systems to collect and report information from numerous studies together with assisting researchers, practitioners, and policymakers in making informed decisions (Leary & Walker, 2018). Moore (2022) added that metanalysis explains the degree to which the effects of treatments and interventions are consistent or inconsistent and this provides details as to the clinical meaningfulness of the data. Meta-analysis is considered level I on the hierarchy of level of evidence, the hallmark of evidence-based practice, and yields the strongest level of evidence on which to base practice decisions (Melnyk & Fineout-Overholt, 2019). Therefore, the impact Meta‐analyses has on research translation is that it summarizes all available evidence regarding the effectiveness of the intervention and quantitatively integrates individual studies to provide the best available evidence for informing clinical practice (Wang et al., 2021). 

A clinical practice in place that is supported by meta-analysis is pressure injury prevention. Gong & Xu’s (2022) meta-analysis on pressure injury prevention focused on the use of prophylactic sacral protective dressings in preventing pressure injury. This study’s aim was to systematically gather the available studies’ evidence and evaluate the possible efficiency of prophylactic sacral protective dressings in preventing pressure injury. Results from this study suggested that sacral protective dressings had a significantly lower incidence of pressure injuries compared with standard care with no sacral protective dressings in the community- or hospital-based adult subjects requiring care. This study consists of high-quality randomized controlled trials of similar design using a consistent instrument, the Braden scale, and was one of the strongest and least biased methods to provide confidence that the intervention will consistently bring about a particular outcome. 

References

Lachal, J., Revah-Levy, A., Orri, M., & Moro, M. R. (2017). Metasynthesis: An Original Method to Synthesize Qualitative Literature in Psychiatry. Frontiers in Psychiatry, 8, 269. https://doi.org/10.3389/fpsyt.2017.00269

Leary, H., & Walker, A. (2018). Meta-analysis and meta-synthesis methodologies: Rigorously piecing together research. TechTrends, 62(5), 525-534. doi: https://doi.org/10.1007/s11528-018-0312-7

Melnyk, B. M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing and healthcare: A guide to best practice (4th ed.). Wolters Kluwer. ISBN-13: 9781496384539

Moeyaert, M. (2019). Quantitative Synthesis of Research Evidence: Multilevel Meta-Analysis. Behavioral Disorders, 44(4), 241–256. https://doi-org.lopes.idm.oclc.org/10.1177/0198742918806926

Moore, R. F. (2022). The Most Important Thing You Need to Know About Meta-Analyses. Psychiatric Times, 39(10), 34–36. https://eds-p-ebscohost-com.lopes.idm.oclc.org/eds/pdfviewer/pdfviewer?vid=2&sid=3cdcebbc-8a49-4276-810a-ff671e508f6c%40redis

Wang, X. M., Zhang, X. R., Li, Z. H., Zhong, W. F., Yang, P., & Mao, C. (2021). A brief introduction of meta-analyses in clinical practice and research. The journal of gene medicine, 23(5), e3312. https://doi.org/10.1002/jgm.3312

REPLY

it is true that meta-analysis is defined as the collection, analysis, interpretation, and presentation of masses of numerical data from research articles to appreciate the degree of similarities and differences in the reported outcomes. Based on the definition, meta-analysis is a procedural process. However, meta-analysis is important in providing reliable and valid information that is used in research translation. Meta-analysis has specific attributes such as clarity of the search strategy including inclusion and exclusion criteria (Bowden & Bowden, 2022).  Most researchers prefer to integrate both meta-analysis and meta-synthesis in their research work. However, meta-analysis and meta-synthesis are different statistical concepts and routines. Meta-syntheses provide a suitable constancy between an impartial underpinning and stringent scientific method to data analysis (Nardell et al., 2022). Healthcare practitioners insist on the use of factual information in understanding and handling different healthcare concerns. Therefore, healthcare professionals are involved in research works. A clinical practice in place that is supported by meta-analysis is pressure injury prevention. On the other hand, there are also other clinical routine supported by meta-synthesis.

References

Bowden, V. R., & Bowden, A. G. (2022). Types of Reviews-Part 2: Meta-Analysis and Meta-Synthesis. Pediatric Nursing48(1), 43-49.

Nardell, M. F., Adeoti, O., Peters, C., Kakuhikire, B., Govathson‐Mandimika, C., Long, L., … & Katz, I. T. (2022). Men missing from the HIV care continuum in sub‐Saharan Africa: a meta‐analysis and meta‐synthesis. Journal of the International AIDS Society25(3), e25889.  https://doi.org/10.1002/jia2.25889

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