NUR 513 Topic 6 DQ 1

NUR 513 Topic 6 DQ 1 

NUR 513 Topic 6 DQ 1

Review the evidence-based practice project ideas you described in Topic 5 DQ 1. Based on your initial ideas, what types of scholarly nursing research (such as quantitative or qualitative research, peer-reviewed resources, etc.) would be required to further investigate the issue? Identify the criteria you would use to evaluate the appropriateness of the research. Why is it important to select research that meets these criteria?

Re: Topic 6 DQ 1

My evidenced-based project idea focuses on implementing a community education program that focuses on prevention in regard to stroke risk factors. When implementing any new program, it’s imperative to gather evidence and analyze how it can improve patient outcomes, health policies, service and programs as evidence allows for increased accountability (DeNisco & Barker, 2016). When gathering evidence for any project it’s important to understand different types of research and the different levels of evidence (Glasofer &Townsend, 2019). Evidence strength is dictated by three key characteristics, quality, quantity and consistency (Glasofer &Townsend, 2019). When selecting research for any topic it should be quality research that has results that are valid and not influenced by biases or occur by chance (art). Quantity can be evaluated by identified the number of studies on said topic, the size and population of the studies and the impact of the treatments (Glasofer &Townsend, 2019). Consistency is when results that are similar are found across a few different studies (Glasofer &Townsend, 2019).

When selecting research for my topic I would typically select research topics that are considered level on in the hierarchy of evidence. These are RCT, systematic review of an RCT and metanalysis if an RCT (Glasofer &Townsend, 2019). Under this topic I would likely consider including a mixture of quantitative and qualitative research. When working with prevention practices its important to understand how behavior plays a role in changing health practices and that why it’s important to analyze qualitative research in addition to quantitative.

NUR 513 Topic 6 DQ 1 Reference

DeNisco, S. M., & Barker, A. M. (2016). Advanced practice nursing: Essential knowledge for the profession (3rd ed.). Jones & Bartlett Learning.

Glasofer, A., & Townsend, A. B. (2019). Determining the level of evidence. Nursing Critical Care, 14(6), 22–25. https://doi.org/10.1097/01.ccn.0000580120.03118.1d

RESPOND  HERE (150 WORDS, 2 REFERENCES)

This is insightful Meagan, the implementation of the new research program requires collection and analysis of evidence to improve patient outcomes as well as increased accountability. Understanding different forms of research and levels of evidence are critical in enhancing the validity, reliability, and applicability of the research and evidence-based practice processes. When selecting the research process, it is necessary to consider the level of evidence. Levels of evidence, sometimes called the hierarchy of evidence, are always assigned to the studies on the basis of methodological quality of their validity, design, as well as applicability to patient care (Glasofer & Townsend, 2021). A combination of qualitative and quantitative research processes is always required to enhance the research processes’ effective outcomes. Quantitative research designs require adherence to the data collection and analysis processes. The quantitative approaches are necessary for ensuring the establishment of valid, reliable, as well as applicability of the research outcomes (Bansal et al., 2018). To select a viable research study process, it is necessary for the researcher to consider the hierarchy or level of evidence.

NUR 513 Topic 6 DQ 1 References

Bansal, P., Smith, W. K., & Vaara, E. (2018). New ways of seeing through qualitative research. https://doi.org/10.5465/amj.2018.4004

Glasofer, A., & Townsend, A. B. (2021). Determining the level of evidence: experimental research appraisal. Nursing2021, 51(1), 60-63. https://journals.lww.com/nursing/Abstract/2021/01000/Determining_the_level_of_evidence__Experimental.15.aspx

Re: Topic 6 DQ 1

My idea from Topic 5 DQ 1 was workplace violence (WPV), and my initial topic was much too broad. Before finding the best current evidence, I need to identify a specific clinical problem to best search for an answerable question (DeNisco & Barker, 2016). Using the PICOT template: population, intervention, comparison, outcome, and time, will help create that searchable question.

Click here to ORDER an A++ paper from our Verified MASTERS and DOCTORATE WRITERS: NUR 513 Topic 6 DQ 1 

Population: Healthcare Workers

Intervention: Education and Training

Comparison: Workplace Violence

Outcome: Prevent or Minimize

Time: 1-year Period

The next step is searching. I recommend a good starting point in PubMed, mostly because articles are specific to nursing and many are free to access. My organization allows access to the commonly used databases such as the Cochran Library, CINAHL, Medline and is a benefit to avoid paying fees for full review articles.  GCU library also offers students access to these same resources.

After obtaining multiple sources of evidence, critical appraisal or grading evidence is next, from the strongest to weakest evidence (DeNisco & Barker, 2016). The gold standard and strongest evidence is a meta-analysis of randomized controlled trials or clinical guidelines based on systematic reviews. Evidence sources may include qualitative or quantitative studies, reviews or clinical expertise, or patient preferences and values. The need is to quickly determine whether it is valid evidence and applicable to practice. Critical appraisal tools exist and ask specific questions based on the methodology or design of the study you are evaluating. Besides validity and usefulness, other criteria to assess include when last updated, clinical context and environment, and patient values and preference. One of my personal favorites, UpToDate, uses a graded approach, 1A being strongest whereas, 2C means a weak recommendation to use an intervention based on both quality of the evidence and patient preference.

Inquiry and asking the best clinical question in a PICOT format is critical to searching and finding the best evidence. Appraising the evidence and integrating this with patient values and preferences is necessary to make evidence-based-practice decisions within nursing.  My Cochrane Library search resulted in very low-to low-quality evidence, with the common databases searched and seven studies being included. There is limited evidence that some interventions might reduce aggression toward healthcare workers (Spelten et al., 2020).  April is National WPV Month and a great place to start to recognize that more research is needed. I recognize I need more experience in this process too.

NUR 513 Topic 6 DQ 1 References

DeNisco, S. M., & Barker, A. M. (2016). Advanced practice nursing: essential knowledge for the profession. Jones & Bartlett Learning.

Spelten E;Thomas B;O’Meara PF;Maguire BJ;FitzGerald D;Begg SJ; (2020, April 29). Organizational interventions for preventing and minimizing aggression directed towards healthcare workers by patients and patient advocates. The Cochrane database of systematic reviews. https://pubmed.ncbi.nlm.nih.gov/32352565/.

RESPOND TO BARBARA HERE

This is insightful, Barbara, consideration of the PICOT question is necessary for undertaking different research processes (Abbade et al., 2016). Also, it is always necessary to identify the ideal sources of information such as databases that may be applied in supporting the research process. Most of the databases contain essential forms of information that may be applied in addressing various aspects of the project. CINAHL, Cochran Library, and Medline are some of the databases that can be applied to review some of the best sources of information that can be used to authenticate the information required in the research processes. The quality of research processes often depends on the levels of evidence (Glasofer & Townsend, 2019). The level of evidence is always assigned to the studies on the basis of methodological quality of their validity, design, as well as applicability to patient care. To better develop a quality, reliable, valid, and applicable research process, sticking to the PICOT question is necessary. In other words, different researchers need to consider the PICOT question in ensuring the achievement of quality outcomes.

NUR 513 Topic 6 DQ 1 References

Abbade, L. P., Wang, M., Sriganesh, K., Mbuagbaw, L., & Thabane, L. (2016). Framing of research question using the PICOT format in randomised controlled trials of venous ulcer disease: a protocol for a systematic survey of the literature. BMJ open, 6(11). https://bmjopen.bmj.com/content/6/11/e013175.short

Glasofer, A., & Townsend, A. B. (2019). Determining the level of evidence. Nursing Critical Care, 14(6), 22–25. https://doi.org/10.1097/01.ccn.0000580120.03118.1d

GINA

Re: Topic 6 DQ 1

My evidence-based practice would be centered around the utilization of new technologies by bedside nurses. I would do a literature review of peer-reviewed studies to further investigate this issue. Then I would develop a framework and intervention with said technology that could be both quantitatively and qualitatively measured. Both quantitative and qualitative data would be important because it would be necessary to study the numerical data regarding technology use, and it would also be important to know both nurse and patient responses to interventions, which could be gathered through surveys, questionnaires, and interviews.

When researching, data would have to be recent, within the last five years, peer-reviewed, with adequate sample sizes. DeNisco and Barker say it best, “Not all evidence is created equal, and there is a need to use the best available evidence,” (2016, p.465). Peer-reviewed research is essential, because it helps maintain the quality of the research. Critical appraisals of research by other academic minds can both validate, provide transparency, ensure professionalism, academic integrity and ethically conducted research (Kelly, et al., 2014). Additionally, research should be recent. Just like the rest of the world, data ages and isn’t always applicable as people, the world, the population, and societies adapt and change. You want sources that reflect the newest and most up to date research available. And finally, data in research can be easily statistically manipulated, so sample sizes matter. If a sample size is too small, it often holds less statistical significance and cannot often be used to generalize to a population.

NUR 513 Topic 6 DQ 1 References

DeNisco, S. M., & Barker, A. M. (2016). Advanced practice nursing: Essential knowledge for the profession (3rd ed.). Jones & Bartlett Learning.

Kelly, J., Sadeghieh, T., & Adeli, K. (2014). Peer review in scientific publications: Benefits, critiques, and a survival guide. EJIFCC, 25(3), 227–243. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4975196/

RESPOND  HERE

This is insightful, Gina; in general, the application of technology is on the rise, which calls for increased research processes to enhance the understanding of different ways to integrate technological approaches in the research processes (Spelten et al., 2020). The utilization of technology by the bedside nurses is critical in ensuring quality treatment outcomes and patient safety. Usually, the integration of technology in the healthcare processes reduces the errors associated with general care. The literature review is essential in the study processes because it enhances the understanding of past research outcomes that may be applied in addressing some of the research processes’ aspects. In the research process, it is also necessary to consider qualitative and quantitative research approaches to enhance the achievement of valid, reliable, and applicable research processes (Bansal et al., 2018). While undertaking a literature review, it is necessary for the researcher to consider different databases that have authentic, reliable, and applicable sources of information that can be utilized in identifying the required information.

NUR 513 Topic 6 DQ 1 References

Spelten E;Thomas B;O’Meara PF;Maguire BJ;FitzGerald D;Begg SJ; (2020, April 29). Organizational interventions for preventing and minimizing aggression directed towards healthcare workers by patients and patient advocates. The Cochrane database of systematic reviews. https://pubmed.ncbi.nlm.nih.gov/32352565/.

Bansal, P., Smith, W. K., & Vaara, E. (2018). New ways of seeing through qualitative research. https://doi.org/10.5465/amj.2018.4004

Prevention of hospital-acquired pressure injuries has been a prime focus in the institution I work in due to the change in reimbursement of stage 3 and 4 pressure injuries, as these are preventable harm to patients. This change came into effect in 2008 when the Centers for Medicare and Medicaid Services stopped reimbursement for all stage 3 and stage 4 hospital-acquired pressure injuries (CMS, 2020). The goal in any institution at present is to reduce the number of hospitals acquired pressure injuries and always to be below the national benchmark. The article I choose to discuss here is a qualitative improvement project by Hoedi et al. (2017) published in the Journal of Wound Ostomy and Continence Nursing in 2019. The purpose of the study was to describe the processes involved, the outcomes, and the structural indicators in pressure injury prevention and care. .

The article meets the criteria laid out by the “CRAAP (Currency, Relevance, Authority, Accuracy, Purpose) Test” article from the New Jersey Institute of Technology. The five criteria are currency, relevance, authority, accuracy and purpose. This study is an of scholarly qualitative research. The project in the article was conducted in 2017 and was published in 2019, which is relevant as it is within 5 years and is considered current. The information presented in this journal article is relevant to pressure injury prevention and care as it evaluated the structural framework of modalities used in 37 Austrian hospitals and the processes involved which included the implementation of pressure injury prevention interventions in patients. The data collected used a national standardized survey tool used nationally in Austria. The data presented is appropriate for the intended audience which is Nursing & nursing management.

 This information is enlightening as it gives hope and reinforcement of pressure injury intervention and prevention measures, we are already implementing in the U. S hospitals. The three authors who wrote the article do not have any credentials listed, thus we are unable to identify if the authors are experts in the field of pressure injuries. The source, however, is reliable as it is an academic journal which is the official journal of the Wound Ostomy Continence Society, and it is a renowned international journal that includes original peer-reviewed articles. The publisher is valid and reliable; thus, this article is a good source to cite in my references. There is supporting evidence that is cited in the text of the article and in the references. This article is peer reviewed and uses unbiased language. The information presented is factual as its analyzed well and presented to inform the audience of the severity of the problem and what’s structures and processes can be altered to achieve better outcomes in pressure injury prevention and care.

NUR 513 Topic 6 DQ 1 Reference:

Hospital-acquired conditions. CMS. (n.d.). Retrieved August 29, 2022, from

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-

Payment/HospitalAcqCond/Hospital-Acquired_Conditions

Hoedl, M., Eglseer, D., & Lohrmann, C. (2019). Structure, Process, and Quality Indicators for Pressure

Injury Prevention and Care in Austrian Hospitals: A Quality Improvement Project. Journal of 

          Wound, Ostomy, and Continence Nursing : Official Publication of The Wound, Ostomy and

          Continence Nurses Society, 46(6), 479–484. https://doi-org/10.1097/WON.0000000000000586

How to evaluate information sources: Craap Test. Research Guides. (n.d.). Retrieved September 5, 2022, from

https://researchguides.njit.edu/evaluate/CRAAP 

he evidence-based practice project idea that I had the idea of doing research on is a major problem in healthcare in general is infection control but specifically central-line associated bloodstream infections (CLABSI). According to the Arizona Department of Health Services CLABSI’s are the most serious of all healthcare-associated infections- causing thousands of deaths each year and about $700M in added costs and 25% of people that get them die from them (2022). The type of scholarly nursing research that I think would be required for further investigation on this issue is quantitative and peer-reviewed methods. The article that I selected related to my topic of CLABSI prevention is Quantitative Results of a National Intervention to Prevent Central Line–Associated Bloodstream Infection. It is important to perform a CRAAP test and make sure that the research I select meets the criteria because It will lead to more accurate research on my end as well as improve relevance. This test considers currency, relevance, authority, accuracy, and purpose when evaluating articles (New Jersey Institute of Technology, 2022). 

Using the New Jersey Institute of Technology Library CRAAP test, I will evaluate the appropriateness of the research. When it comes to currency this source was published in late 2019 and I feel like the information is very timely. This article is very relevant to my research question and meets my needs. The CDC funded the study as well as the national STRIVE team that followed out the research. The authors were a group of doctors as well as nurses with master’s in public health degree and the study is in the Annals of Internal Medicine Journal. When it comes to accuracy all of the authors involved in the research have participated in a number of other reputable research studies. I would also argue that when CDC funs a study there are many different guidelines or accuracy. The purpose of this article is for information and to figure out ways to solve a problem. The intended audience would be healthcare workers and administrators looking for better ways to improve their hospitals CLABSI rates. There is no bias present in this article and the article does show different viewpoints. 

References 

Humble, W (2022, February 23). Hospital bloodstream infection rates go online. AZ Dept. of Health Services Director’s Blog. https://directorsblog.health.azdhs.gov/hospital-bloodstream-infection-rates-go-online/ 

New Jersey Institute of Technology. (2022, September 8). How to evaluate information sources: CRAAP test. https://researchguides.njit.edu/evaluate/CRAAP 

Patel, P. K., Greene, M. T., Jones, K., Rolle, A. J., Ratz, D., Snyder, A., Saint, S., & Chopra, V. (2019, October 1). Quantitative Results of a National Intervention to Prevent Central Line–Associated Bloodstream Infection. Annals of Internal Medicine, 171(7_Supplement), S23. https://doi.org/10.7326/m18-3533 

REPLY 

Last week I discussed the problem of postoperative delirium on my orthopedic unit. This is a common complication after surgery, especially in the elderly population. Early identification and prevention of delirium is at utmost importance in this population. The use of the Confusion Assessment Method (CAM) is a quick effective tool to assess for postoperative delirium. Early identification of patients at risk of developing postoperative delirium can assist in better patient outcomes. When a patient is identified as being elevated risk preventative strategies can be put in place. Avoiding certain medication such as anticholinergics, benzodiazepines, and opioids can assist in preventing delirium (Pallaria et al., 2018). 

I believe my project would need multiple types of research including qualitative, quantitative, case studies, etc. My specific article I choose to utilize this week was a case study. This case study as written above concluded that utilizing the CAM and preventative strategies for patients at risk for delirium is important. Only having a case study would not be enough research to complete this project, but it is a good start to begin trying to solve such a major problem. Although delirium is not always preventable, assessing for risk, quickly identifying delirium, and having a multidisciplinary approach is important for safety and positive patient outcomes. 

When evaluating the appropriateness of my article I used the CRAAP Test. The CRAAP test is an excellent tool to evaluate resources. This test considers currency, relevance, authority, accuracy, and purpose when evaluating articles (New Jersey Institute of Technology). Utilizing the CRAAP test to my article was important to evaluate the appropriateness. The currency of my article was up to date and all links were functional. The relevance of this article to my problem was appropriate and I would be comfortable sourcing this in a research paper. The authors credentials were noted and links to the author’s information were provided. The information in my article was supported by evidence and referenced appropriately, and the purpose was clearly defined. When taking all the parts of the CRAAP test into consideration my article passed the test. 

References: 

New Jersey Institute of Technology. (N.D.). How to evaluate information sources: CRAAP test. https://researchguides.njit.edu/evaluate/CRAAP 

Pallaria, T., Panebianco, C., & Kamienski, M., (2018). Perioperative Delirium Protocol for the Older Patient. Journal of PeriAnesthesia Nursing, 33(3), 275. https://doi.org/10.1016/j.jopan.2016.08.015 

REPLY 

thank you for your informative post. I agree that post-operative delirium is a significant concern for the elderly. I found an interesting article that looks at the use of the Age-adjusted Charlson Comorbidity Index (ACCI) as a tool to identify patients who are at high risk for delirium post-operatively (Liu et al., 2022). This study used the Confusion Assessment Method (CAM) that you mentioned to diagnose post-operative delirium. The study looked at a total of 184 patients over the age of 60 and found that the ACCI tool is effective in identifying patients at higher risk for post-operative delirium, but also found other predictive factors. Pre-operative Mini-Mental State Examinations, serum albumin, and post-operative pain levels were all noted to influence a patient’s likelihood of developing post-operative delirium. I think this is very interesting because the causes of delirium are definitely multifactorial and this study did a good job of addressing that. I think it is great that there are already reliable tools to screen for risk for post-operative delirium, as well as to identify patients that are suffering from it. My hope is that these tools and greater awareness of this issue in the nursing profession will decrease the negative outcomes for patients associated with post-operative delirium.  

Reference 

Liu, J., Li, J., He, J., Zhang, H., Liu, M., & Rong, J. (2022). The age-adjusted charlson comorbidity index predicts post-operative delirium in the elderly following thoracic and abdominal surgery: A prospective observational cohort study. Frontiers in Aging Neuroscience, 14. https://doi.org/10.3389/fnagi.2022.979119 

The evidence-based project I choose to discuss is nurse burnout. Working in the emergency room, I tend to see many nurses jaded, as I would describe it. They have become emotionally detached from their patients, not caring as much as they should. I think the dissociation has to do with the emotional damage the ER does to one individual. As a nurse, it is our responsibility to take care of the patient, ensuring their needs are taken care of. In my mind, this ranges from needs such as hygiene, medication, and even emotional needs. My question is does nurse burnout affect patient safety? 

Looking at the research, I would prefer to look at peer-reviewed journal articles. Using the New Jersey Institute of Technology Library CRAAP test, I will evaluate the appropriateness of the research. The information of the article was received in August 2020 and later published in December 2020. The article has not been revised or updated and is still current because it has been within the last 5 years. My research article is relative to my idea because it discusses the association between nurse burnout and patient safety. The intended audience is anyone who is interested in this correlation. It especially pertains to nurses because it discusses the effects of what emotional damage does to your nursing practice. 

The author of this publication is Maria Sovariova Soosova, while the publisher is the Central Journal of Nursing and Midwifery. The author is a very respected author with numerous publications. Her most recent publication was published in June of 2022 and looked at illness cognitions and the health-related quality of life of patients with inflammatory bowel disease. The study used a cross-sectional design, where 117 nurses completed a survey. It was concluded a higher level of burnout was associated with a lower grade of patient safety (Soósová, 2021). After thoroughly reading the publication, I have decided it is unbiased and free of emotion. It speaks facts and is backed up by research and the opinions of other nurses. The purpose of this article is to inform and educate nurses across the world. Nurse burnout is a real problem and needs to be addressed. Nurses need to be taking time for themselves to prevent emotional damage. Preventing emotional damage helps prevent medication errors, thus increasing patient outcomes and patient satisfaction. 

  References: 

  Sováriová Soósová, M. (2021). Association between Nurses’ Burnout, Hospital Patient Safety Climate and Quality of Nursing Care. Central European Journal of Nursing & Midwifery, 12(1), 245–256. https://doi-org.ezp.mesacc.edu/10.15452/cejnm.2020.11.0039 

REPLY 

this is a very interesting topic of research. ED nursing is near and dear to my heart. I think a great building point for the project you proposed would be evaluating the efficacy of various methods of remediating or preventing compassion fatigue/burnout. I believe your current proposed research would show a clear correlation between increased emotional trauma in ED nurses, compassion fatigue/burn out and the subsequent negative impact this has on patients. Evaluating this carefully is very important work! The need to link nurse well-being to patient outcomes, is an objective that protects both the nursing professionals and the patients served.  Your evaluation of the CRAAP test criteria seems to fit well with your proposed research.