NURS 6052 Assignment EBP Part 3 Critical Appraisal of Research
NURS 6052 Assignment EBP Part 3 Critical Appraisal of Research
NURS 6052 Assignment EBP Part 3 Critical Appraisal of Research
Main Post: Clinical Issue of Interest and Searching Databases
For this discussion, my clinical issue of interest is the medical underlying causes for mental health unaddressed. There are external and medical causes for mental health disorders in children and adults, but many times, these underlying causes are not treated as priority or even completely ignored. Rather than confining mental health to be purely psychosis, it will be beneficial to delve into the possibility that health-related issues, social and economic situations, and emotional well-being are significant contributors to mental illness.
Research work has inadvertently exposed how some mental health symptoms are dismissed in younger individuals, and never diagnosed or identified too late, which only further creates a sense of alienation for children suffering from mental illnesses. An underlying or untreated medical condition is a contributor to typical signs of mental instability. For example, chronic diseases such as diabetes, hypothyroidism, hyperthyroidism, and lack of vitamin D can result in mental health disorders like mood swing, anxiety, depression, and unexplained weight changes. Oftentimes, the build-up of multiple chronic diseases significantly decreases the quality of life for an individual leading to mental health issues. For this work, a literature search was conducted using EBSCOhost databases. Two peer-reviewed articles were selected using two different databases in the Walden Library. Respectively, Cumulative Index to Nursing & Allied Health Literature Database, and Eric Database.
To search, I identify the keywords to the related article and use this as the prompt. “Mental health”. This initial search generated 28,397 results. I Combined keywords to narrow or broaden search results “Underlying mental health causes”. Three results generated. Using Boolean operator AND, “Mental health and Underlying causes” Nine results generated.
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With this, I would say that the strategies to use for better and effective database search for my PICO(T) question will be using more than one database to view variety of articles and select what is relevant like peer-reviewed, full article and date range (within 5 years recommended)
It also works best to breakdown the content. Pick a topic from the most related subject, like nursing. When we type everything into the database, we get nothing. It is always better to type in the main idea and concept. Select full article, peer-reviewed, relevant date, and search.
Boolean terms AND, OR, NOT connects the keywords to create a more precised logical phrase that the database can understand and use to look for multiple terms or concepts at once. AND finds items that uses both keywords, OR find items that use either of the keywords and NOT excludes items that use the keywords. I have lots of resources to work with, and a PICOT question in progress. Changes may occur as needed.
PICOT- Problem– Mental health causes unaddressed, Intervention–Treating the underlying causes, Comparison-Findings will emphasize the correlation between mental health and other underlying issues, Outcome-Positive improvement with treatment, Time frame-Within 72 hours of treatment, re-evaluation will be done.
References
Hussain, R., Wark, S., Janicki, M.P., Paramenter, T., & Knox, M. (2020). Multimorbidity in
Older People with Intellectual Disability. Journal of Applied Research in Intellectual Disabilities, 33(6), 1234-1244
Martin-Denham, S. (2021). Defining, identifying, and recognizing underlying causes of
social, emotional, and mental health difficulties: thematic analysis of interviews
with headteachers in England. Emotional & Behavioral Difficulties, 26(2), 187
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, LLC. (Producer). (2018). Searching the Evidence [Video file]. Baltimore, MD: Author.
Realtors rely on detailed property appraisals—conducted using appraisal tools—to assign market values to houses and other properties. These values are then presented to buyers and sellers to set prices and initiate offers.
Research appraisal is not that different. The critical appraisal process utilizes formal appraisal tools to assess the results of research to determine value to the context at hand. Evidence-based practitioners often present these findings to make the case for specific courses of action.
In this Assignment, you will use an appraisal tool to conduct a critical appraisal of published research. You will then present the results of your efforts.
To Prepare:
- Reflect on the four peer-reviewed articles you selected in Module 2 and the four systematic reviews (or other filtered high- level evidence) you selected in Module 3.
- Reflect on the four peer-reviewed articles you selected in Module 2 and analyzed in Module 3.
- Review and download the Critical Appraisal Tool Worksheet Template provided in the Resources.
The Assignment (Evidence-Based Project)
Part 3A: Critical Appraisal of Research
Conduct a critical appraisal of the four peer-reviewed articles you selected by completing the Evaluation Table within the Critical Appraisal Tool Worksheet Template. Choose a total of four peer- reviewed articles that you selected related to your clinical topic of interest in Module 2 and Module 3.
Note: You can choose any combination of articles from Modules 2 and 3 for your Critical Appraisal. For example, you may choose two unfiltered research articles from Module 2 and two filtered research articles (systematic reviews) from Module 3 or one article from Module 2 and three articles from Module 3. You can choose any combination of articles from the prior Module Assignments as long as both modules and types of studies are represented.
Part 3B: Critical Appraisal of Research
Based on your appraisal, in a 1-2-page critical appraisal, suggest a best practice that emerges from the research you reviewed. Briefly explain the best practice, justifying your proposal with APA citations of the research.
By Day 7 of Week 7
Submit Part 3A and 3B of your Evidence-Based Project.
Submission and Grading Information
To submit your completed Assignment for review and grading, do the following:
- Please save your Assignment using the naming convention “WK7Assgn+last name+first initial.(extension)” as the name.
- Click the Week 7 Assignment Rubric to review the Grading Criteria for the Assignment.
- Click the Week 7 Assignment link. You will also be able to “View Rubric” for grading criteria from this area.
- Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK7Assgn+last name+first initial.(extension)” and click Open.
- If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
- Click on the Submit button to complete your submission.
Grading Criteria
To access your rubric:
Week 7 Assignment Rubric
Check Your Assignment Draft for Authenticity
To check your Assignment Draft for Authenticity
Submit your Week 7 Assignment Draft and review the originality report
Submit Your Assignment by Day 7 of Week 7
To participate in this Assignment:
Week 7 Assignment
Next Module
Module 4: Critical Appraisal, Evaluation/Summary, and Synthesis of Evidence (Weeks 6-7)
Laureate Education (Producer). (2018). Critical Appraisal [Video file]. Baltimore, MD: Author.
Due By | Assignment |
Week 6, Days 1-4 | Read the Learning Resources. Begin to compose Part A of your Assignment.. |
Week 6, Days 5-7 | Continue to compose Part B of your Assignment. Begin to compose Part B of your Assignment. |
Week 7, Days 1-6 | Continue to compose Part A and B of your Assignment. |
Week 7, Day 7 | Deadline to submit Part A and B of your Assignment. |
Learning Objectives
Students will:
- Evaluate peer-reviewed articles using critical appraisal tools
- Analyze best practices based on critical appraisal of evidence-based research
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Learning Resources
Note: To access this module’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.
Required Readings
Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer.
- Chapter 5, “Critically Appraising Quantitative Evidence for Clinical Decision Making” (pp. 124–188)
- Chapter 6, “Critically Appraising Qualitative Evidence for Clinical Decision Making” (pp. 189–218)
Fineout-Overholt, E., Melnyk, B. M., Stillwell, S. B., & Williamson, K. M. (2010a). Evidence-based practice step by step: Critical appraisal of the evidence: Part I. American Journal of Nursing, 110(7), 47–52. doi:10.1097/01.NAJ.0000383935.22721.9c
Note: You will access this article from the Walden Library databases.
Fineout-Overholt, E., Melnyk, B. M., Stillwell, S. B., & Williamson, K. M. (2010b). Evidence-based practice, step by step: Critical appraisal of the evidence: Part II: Digging deeper—examining the “keeper” studies. American Journal of Nursing, 110(9), 41–48. doi:10.1097/01.NAJ.0000388264.49427.f9
Note: You will access this article from the Walden Library databases.
Fineout-Overholt, E., Melnyk, B. M., Stillwell, S. B., & Williamson, K. M. (2010c). Evidence-based practice, step by step: Critical appraisal of the evidence: Part III: The process of synthesis: Seeing similarities and differences across the body of evidence. American Journal of Nursing, 110(11), 43–51. doi: 10.1097/01.NAJ.0000390523.99066.b5
Note: You will access this article from the Walden Library databases.
Williamson, K. M. (2009). Evidence-based practice: Critical appraisal of qualitative evidence. Journal of the American Psychiatric Nurses Association, 15(3), 202–207. doi:10.1177/1078390309338733
Note: You will access this article from the Walden Library databases.
Document: Critical Appraisal Tool Worksheet Template (Word document)
Required Media
Laureate Education (Producer). (2018). Appraising the Research [Video file]. Baltimore, MD: Author.
Laureate Education (Producer). (2018). Interpreting Statistics [Video file]. Baltimore, MD: Author.
Mental health disorders have far-reaching consequences on patients, health care practitioners, and families. As a result, evidence-based care interventions that engage patients in care and promote self-management are recommended. Telehealth provides a tech-based platform for health care and health education (Zhao et al., 2021). If applied effectively and its risks controlled, telehealth can optimize care effectiveness and reduce mental health burdens in many populations. The purpose of this worksheet is to critically appraise research on the role and effectiveness of telehealth interventions in improving treatment outcomes among patients with depression.
Full APA formatted citation of selected article. | Article #1 | Article #2 | Article #3 | Article #4 |
Bellanti, D. M., Kelber, M. S., Workman, D. E., Beech, E. H., & Belsher, B. E. (2022). Rapid review on the effectiveness of telehealth interventions for the treatment of behavioral health disorders. Military Medicine, 187(5–6), e577–e588. https://doi.org/10.1093/milmed/usab318 | Egede, L. E., Dismuke, C. E., Walker, R. J., Acierno, R., & Frueh, B. C. (2018). cost-effectiveness of behavioral activation for depression in older adult veterans: In-person care versus telehealth. The Journal of Clinical Psychiatry, 79(5), 3853. https://doi.org/10.4088/JCP.17m11888 | Scott, A. M., Clark, J., Greenwood, H., Krzyzaniak, N., Cardona, M., Peiris, R., Sims, R., & Glasziou, P. (2022). Telehealth v. face-to-face provision of care to patients with depression: a systematic review and meta-analysis. Psychological Medicine, 52(14), 2852–2860. https://doi.org/10.1017/S0033291722002331 | Zhao, L., Chen, J., Lan, L., Deng, N., Liao, Y., Yue, L., Chen, I., Wen, S. W., & Xie, R. (2021). Effectiveness of telehealth interventions for women with postpartum depression: Systematic review and meta-analysis. JMIR MHealth and UHealth, 9(10), e32544. https://doi.org/10.2196/32544 | |
Evidence Level * (I, II, or III)
| Level I (review of randomized controlled trials). | Level I (randomized, non-inferiority trial) | Level I (systematic review and meta-analysis of randomized controlled trials) | Level I (systematic review of RCTs and meta-analysis. |
Conceptual Framework Describe the theoretical basis for the study (If there is not one mentioned in the article, say that here).** | No conceptual framework has been identified in the article. | None has been identified. | No framework has been identified in the article. | No framework has been identified in the article. |
Design/Method Describe the design and how the study was carried out (In detail, including inclusion/exclusion criteria). | The study involved a systematic search of PubMed and hand-searching relevant systematic reviews. To enhance reliability and validity, the articles were also dual screened and single-person abstraction data were verified by a second person. The articles included were full-text, peer-reviewed randomized controlled trials published in English. Articles that were not randomized controlled trials or with a wrong population, intervention, or comparator were excluded. | The study was a randomized, non-inferiority trial for examining whether telehealth is more effective than in-person care in delivering behavioral activation for depression. Eligible participants were assigned to 1 of 2 arms of 8-week behavioral activation therapy. Veterans with depression were included, while those who did not exhibit measures of depression for DSM-IV were excluded. | The study was a systematic review and meta-analysis of RCTs that compared real-time telehealth to face-to-face therapy for depressed individuals. All randomized controlled trials of any design were included provided that participants received car for chronic and symptomatic depressive disorder regardless of their age. All other studies (not RCTs) were excluded. | The study was a systematic review of RCTs form PubMed, The Cochrane Library, CINAHL and other credible databases evaluating the effectiveness of telehealth interventions for women with postpartum depression (PPD). Included studies targeted adult women with PPD, using telehealth interventions, published in English or Chinese, and assessing the primary outcome of depression symptoms using the Edinburgh Postnatal Depression Scale (EPDS). RCTs protocol or duplicate and studies where women had severe illnesses or a history of mental illness were excluded. |
Sample/Setting
The number and characteristics of patients, attrition rate, etc. | Bellanti et al. (2022) analyzed twenty-two randomized controlled trials (RCTs) – eight were non-inferiority trials. | The study included 241 participants (veterans) with depression. | Researchers reviewed nine trials (28 references with 1268 patients) comparing telehealth to face-to-face care delivery to patients with a depressive disorder. | 9 RCTs with a total of 1958 participants (women with PPD) were reviewed. |
Major Variables Studied
List and define dependent and independent variables | Dependent variable: the effectiveness of behavioral health treatments. These (treatments included psychotherapy and psychiatry). Independent variable: care delivered in person and telehealth (telephone or video conference). | Researchers studied whether delivering behavioral activation for depression (independent variable) through telehealth is cost-effective (dependent variable) compared to in-person care. Cost-effectiveness is the dependent variable since it varies with the treatment interventions. | Dependent variables include care outcomes, such as therapeutic alliance care satisfaction, and quality of life. Independent variables were the treatment/intervention methods (telehealth and face-to-face) care delivery for depression or depressive symptoms. | The dependent variable was depressive symptoms and anxiety while the independent variable was telehealth interventions. |
Measurement
Identify primary statistics used to answer clinical questions (You need to list the actual tests done). | After screening, a single reviewer extracted essential data characteristics that were further verified by a second reviewer. For each RCT, two reviewers completed the Cochrane Risk of Bias Assessment and discussed findings to resolve disagreements. | Researchers used the 36-Item Short Form Health Survey to evaluate health services utilization costs between 1 year pre-intervention and 1 year post-intervention. | Data were extracted by independent authors and discrepancies resolved via consensus. The risk of Bias Tool 1.0 was used to assess biases. | Two independent researchers extracted data and performed quality assessment using the Cochrane risk-of-bias tool. The meta-analyses was conducted using RevMan 5.4 software. |
Data Analysis Statistical or Qualitative findings (You need to enter the actual numbers determined by the statistical tests or qualitative data). | Most RCTs and 7/8 of the non-inferiority trials found no difference between telehealth (TH) and in person (IP) treatment delivery. Two studies found patients with higher symptom severity in the telehealth group exhibited worse treatment-related outcomes than in person participants. | Post-intervention, veterans treated via telehealth had a mean of $870.91 higher costs relative to pre-invention while those treated in-person had a mean of $2,998 health care utilization costs. | Researchers found no significant differences between the treatment interventions for depression severity at post-treatment except at 9 months post-treatment. No major differences were found between telehealth and face-to-face care in treatment satisfaction while most studies, except one, showed the same for therapeutic alliance. | The primary statistical finding was a significantly lower EPDS (p<.001) and anxiety (p=.005) scores in the telehealth group compared to the control group. |
Findings and Recommendations
General findings and recommendations of the research | Based on the evidence from the RCTs, telehealth and in person treatment (face-to-face) modalities produces similar outcomes for psychotherapy and psychiatry services. | The study confirmed the practicality of telehealth in lowering health utilization costs for depression treatment among veterans. As a result, it should be utilized more in health care settings to improve outcomes for patients and care practitioners. | Evidence shows that telehealth and face-to-face care can be used interchangeably for depression treatment and deliver similar outcomes. However, additional trials with longer follow-up are necessary to ascertain the findings. | Telehealth effectively reduces depression and anxiety symptoms among women with PPD. However, large scale RCTs targeting specific therapies are crucial. |
Appraisal and Study Quality
Describe the general worth of this research to practice. What are the strengths and limitations of study? What are the risks associated with implementation of the suggested practices or processes detailed in the research? What is the feasibility of use in your practice? | The research is significant to mental health practice since it demonstrates the effectiveness of treatment modalities. The primary strength is that the article is high-level evidence. Reliability and validity are also high due to the involvement of a third/independent researcher. The most notable limitation is the lack of meta-analysis due to the heterogeneity of results. Rapid reviews also omit relevant research. Telehealth is associated with privacy and security issues. The article is feasible for use in mental health practice since it demonstrates the effectiveness of telehealth and face-to-face interventions for treating behavioral health disorders. | The research is significant to mental health practice since it explains the importance of telehealth in care delivery as a cost-effective method. The article’s main strengths include high-level evidence and a large sample size. The main limitation was utilizing one survey tool hence possible analysis bias. The main risks associated with implementing telehealth are privacy breaches, although they can be controlled through appropriate safeguards. The article is feasible for use in mental health practice since it explains the appropriateness of telehealth as a cost-effective intervention for delivering mental health care for people with depression. | The research demonstrates the effectiveness of telehealth in mental health care in the evolving practice. It highlights why telehealth should be integrated into care delivery and potential outcomes. Study strengths include comprehensive searches and rigorous methodologies. The findings also support previous research. Limitations include a sort trial follow-up in majority of the patients in most studies. All trials were conducted in the United States, which limits their generalizability. No major risks associated with telehealth implementation have been noted in the study. The article is feasible for use in mental health practice since it demonstrates the effectiveness of telehealth as a viable alternative for face-to-face care provision for depression. | The research is worth to practice since it explains the role of telehealth in treating depression and anxiety. The main strengths are high-level evidence and rigorous search. The study is also generalizable since it was conducted in both developed and developing countries. Limitations include possible bias and meta-analysis being limited by major heterogeneity. No risk regarding telehealth implementation has been detailed in the research. The research is feasible for use in mental health practice since it demonstrates the importance of telehealth in mental health support. |
Key findings
| Care delivered via telehealth is as effective as in person care. As a result, mental health practitioners can use videoconferencing, telephone, and other tech-based interventions to provide mental health support. | Care delivered via telehealth is more cost-effective compared to in-person care. | For patients with depression, telehealth is a viable alternative for care provision for in-person (face-to-face) care. This is because there were no significant differences in treatment outcomes, including satisfaction, between the two methods. | Telehealth is highly effective in treating depression and anxiety among women with PPD. |
Outcomes
| The primary outcome is effective behavioral health treatments. In this case, psychiatry and psychotherapy treatments can be offered effectively via telehealth. | The primary clinical outcome was measures of depression at 12 months while the economic differences included differences in health care utilization costs. | The study’s primary outcome was depression severity. Other (secondary) outcomes were the quality of life, client-care provider therapeutic alliance, and satisfaction with care. | Main outcomes are PPD measured by the EPDS. |
General Notes/Comments | The article informs mental health practitioners on the suitability of telehealth in facilitating behavioral health interventions for patients with mental health problems. | The article informs mental health practitioners on the need for adopting telehealth for better clinical and economic outcomes in treatment for mental disorders such as depression. As used in treating and supporting veterans with depression, telehealth can be implemented to provide care to other individuals with mental disorders. | The study underlines the role and effectiveness of telehealth as an effective intervention for face-to-face care provision for patients with depression. It shows that telehealth has the potential to increase accessible, evidence-based interventions for patients with depression. | The study supports the application of telehealth in delivering care to women with PPD. As a result, it is a valuable article for mental health practitioners and other professionals interested in optimizing health outcomes via technology. |
Conclusion
As reviewed in the above grid, telehealth interventions effectively improve outcomes in managing depression. The other major highlight is that telehealth complements face-to-face care, and the two interventions can be used interchangeably. Besides, telehealth has emerged as a more cost-effective intervention than face-to-face care. As a result, it should be explored more in mental health practice.
References
Bellanti, D. M., Kelber, M. S., Workman, D. E., Beech, E. H., & Belsher, B. E. (2022). Rapid review on the effectiveness of telehealth interventions for the treatment of behavioral health disorders. Military Medicine, 187(5–6), e577–e588. https://doi.org/10.1093/milmed/usab318
Egede, L. E., Dismuke, C. E., Walker, R. J., Acierno, R., & Frueh, B. C. (2018). Cost-effectiveness of behavioral activation for depression in older adult veterans: in-person care versus telehealth. The Journal of Clinical Psychiatry, 79(5), 3853. https://doi.org/10.4088/JCP.17m11888
Scott, A. M., Clark, J., Greenwood, H., Krzyzaniak, N., Cardona, M., Peiris, R., Sims, R., & Glasziou, P. (2022). Telehealth v. face-to-face provision of care to patients with depression: a systematic review and meta-analysis. Psychological Medicine, 52(14), 2852–2860. https://doi.org/10.1017/S0033291722002331
Zhao, L., Chen, J., Lan, L., Deng, N., Liao, Y., Yue, L., Chen, I., Wen, S. W., & Xie, R. (2021). Effectiveness of telehealth interventions for women with postpartum depression: Systematic review and meta-analysis. JMIR MHealth and UHealth, 9(10), e32544. https://doi.org/10.2196/32544
Patient Outcomes Effected by Nursing Burnout
Patient outcomes are at the forefront of all healthcare organizations. We want the best for our patients and their families. As healthcare workers, this can be a challenge. With staffing shortages, and constantly changing work requirements, burnout is becoming more and more prominent. Exacerbated by the COVID-19 pandemic nursing burnout is a challenge we must overcome. Decreased work-related stressors such as workload, and time pressures, and increasing communication, and interpersonal relationships by having a more conducive work environment can minimize burnout in nursing (Afriyie, 2020). This clinical issue must be addressed to prevent further deterioration of staff and patient outcomes (Canadas-DelaFuente et al., 2015). Overall, nursing burnout has negative implications for patient outcomes and healthcare organizations (Peirson, 2021).
Research Strategies
I first had to develop a strategy for researching to find articles that did not include systematic reviews, this week’s resource section provided excellent explanations of the different types of research and where to go to find them. I did find that while searching different databases having fewer words helped with the search results. My original search term Nursing Burnout resulted in 45 articles to choose from, alternatively when using the term Patient Outcomes over 1600 articles populated. This made searching for my specific topic more challenging since there were only a few articles that had both specifications addressed. Some way to overcome these challenges is to speak the research engine’s “language” so to speak. I researched the topic of interest and utilized the word AND in addition to the second word in my topic of interest which narrowed down the amount articles to 40, which resulted in the best articles that addressed the complete topic in its entirety.
References:
Afriyie, D. (2020). Reducing work-related stress to minimize emotional labour and burn-out syndrome in nurses. Evidence-Based Nursing, 24(4), 141–141. https://doi.org/10.1136/ebnurs-2020-103321Links to an external site.
Cañadas-De la Fuente, G. A., Vargas, C., San Luis, C., García, I., Cañadas, G. R., & De la Fuente, E. I. (2015). Risk factors and prevalence of burnout syndrome in the nursing profession. International Journal of Nursing Studies, 52(1), 240–249. https://doi.org/10.1016/j.ijnurstu.2014.07.001Links to an external site.
Peirson, J. (2021). Staff burn-out has implications for organizational and patient outcomes: Would an open culture of support with structures in place prevent burn-out? Evidence-Based Nursing, 25(3), 99–99. https://doi.org/10.1136/ebnurs-2021-103437
In health practice, clinical problems vary, prompting health care providers to adopt different interventions depending on the nature of a problem. Practice change based on current, relevant, and scientific research evidence is among the widespread interventions. However, not all research evidence is relevant in practice, necessitating research appraisal. According to Melnyk and Fineout-Overholt (2018), research appraisal involves systematically evaluating research evidence to determine its relevance and value. The primary aim is to assess the reliability and validity of the research. This paper appraises research on workplace incivility and analyzes the best practice that emerges from the reviewed research.
Part 1: Evaluation Table
Full APA formatted citation of selected article. | Article #1 | Article #2 | Article #3 | Article #4 |
Shi, Y., Guo, H., Zhang, S., Xie, F., Wang, J., Sun, Z., … & Fan, L. (2018). Impact of workplace incivility against new nurses on job burn-out: A cross-sectional study in China. BMJ Open, 8(4), e020461. doi:10.1136/ bmjopen-2017-020461 | Armstrong, N. (2018). Management of nursing workplace incivility in the health care settings: A systematic review. Workplace Health & Safety, 66(8), 403-410. https://doi.org/10.1177%2F2165079918771106 | Abdollahzadeh, F., Asghari, E., Ebrahimi, H., Rahmani, A., & Vahidi, M. (2017). How to prevent workplace incivility?: Nurses’ perspective. Iranian Journal of Nursing and Midwifery Research, 22(2), 157-163. https://doi.org/10.4103/1735-9066.205966 | Kile, D., Eaton, M., deValpine, M., & Gilbert, R. (2019). The effectiveness of education and cognitive rehearsal in managing nurse‐to‐nurse incivility: A pilot study. Journal of Nursing Management, 27(3), 543-552. https://doi.org/10.1111/jonm.12709 | |
Evidence Level * (I, II, or III)
| III | I | III | II |
Conceptual Framework Describe the theoretical basis for the study (If there is not one mentioned in the article, say that here).** | The study is based on the premise that anxiety predicts workplace incivility, which generates job burnout among nurses. Resilience moderates the incivility-burnout connection. | No exact framework has been mentioned. | No theory has been mentioned. | Bandura’s social learning theory was used as the underpinning for introducing educational interventions and cognitive rehearsal techniques. |
Design/Method Describe the design and how the study was carried out (In detail, including inclusion/exclusion criteria). | The study was a cross-sectional survey through anonymous questionnaires. Participants included nurses with a maximum of three years in service. Irregular nurses, those who had served for more than three years, and unwilling participants were excluded. | Armstrong (2018) critiqued and summarized relevant evidence on workplace incivility and management. Only English articles were reviewed. Articles published before 2010 were excluded. | The descriptive study design was used to describe nurses’ perspective on workplace incivility. Nurses selected had at least one year practice experience and a bachelor’s degree in nursing. | The study was a mixed method, pilot study design. It involved conducting educational programs about incivility in practice and cognitive rehearsal techniques. All registered nurses in the PACU participated in the study. Ancillary personnel and those unable to read and write in English were excluded. |
Sample/Setting
The number and characteristics of patients, attrition rate, etc. | 696 nurses completed the questionnaire. The study took place in a hospital in China. | The final sample had 10 articles for systematic review and analysis. | Sampling was continuous as the analysis of interviews continued. The pilot study was conducted at educational hospitals of Tabriz University of Medical Sciences. | The study used a convenient sample of registered nurses. It was conducted in a community hospital (post-anesthesia care unit) in Virginia. |
Major Variables Studied
List and define dependent and independent variables | The dependent variable was workplace incivility. Independent variables included anxiety, burnout, and resilience. | The dependent variable was workplace incivility whose levels can be reduced through education training, awareness training, and active learning behaviors (independent variables). | The structured interviews concentrated on nurses’ views on workplace incivility prevention. | The study variables included education on incivility and cognitive rehearsal techniques (independent variables) on workplace incivility (dependent variable). |
Measurement
Identify primary statistics used to answer clinical questions (You need to list the actual tests done). | Shi et al. (2018) explored the relationship between variables using descriptive statistical analysis. In particular, Pearson’s correlation coefficient and multiple linear regression analysis were used. | Intervention research about managing workplace incivility was the primary focus. Evidence strength was scored to determine information inclusion. | The MAXQDA software version 10 was used to analyze data on 36 interviews and 8 field notes. | Quantitative data for the Nursing Incivility Survey (NIS) was rated using 5-point Likert scale. Sources of incivility were divided into subscale. Data was analyzed using IBM SPSS website. |
Data Analysis Statistical or Qualitative findings (You need to enter the actual numbers determined by the statistical tests or qualitative data). | Workplace incivility was found to be positively correlated with anxiety and job burnout. Anxiety (r=0.371, p<0.01) Burnout ((r=0.238, p<0.01) Resilience moderated (β=−0.564, p<0.01) the workplace incivility-job burnout connection. | Education programs were ranked the highest followed by effective communication and active learning programs in workplace incivility prevention. | 3 subthemes and 1 core theme emerged from the analysis. Subthemes- nurse, organization, and public. Core theme- a need for comprehensive attempt. | Items under nurse incivility subscale included hostile climate, gossip and rumors, and free-riding. Displaced frustration p=0.042 was found to be the most statistically significant factor. |
Findings and Recommendations
General findings and recommendations of the research | Due to the prevalence nature of workplace incivility in nursing, administrators should consider resilience training to reduce incivility, particularly among new nurses. | Workplace incivility can be prevented by combining educational, awareness, and training programs. The emphasis should be civil behaviors. | Workplace incivility in nursing is complex and requires nurses, health care organizations, and the general public’s commitment to address effectively. It is an issue requiring concerted effort to minimize. | Nursing incivility can be effectively addressed by recognition and ability to confront it. |
Appraisal and Study Quality
Describe the general worth of this research to practice. What are the strengths and limitations of study? What are the risks associated with implementation of the suggested practices or processes detailed in the research? What is the feasibility of use in your practice? | The study is a useful and detailed resource for understanding workplace incivility from a cause-and-prevention viewpoint. The main strength includes the study innovatively examining the relationship between incivility and burnout and the moderating role of resilience. However, self-reports from participants were potential source of response bias. On risks associated with resilience training, it can lead to physical and mental exhaustion of some nurses. The approach can also lead to the normalization of workplace incivility. Overall, it is feasible for use in practice since it addresses a major problem in the current practice and practical solutions. | The study expands literature on workplace incivility by illustrating how it can be prevented in nursing practice. Majority of the studies used in the systematic review used psychometrically tested instruments. However, which was a main limitation, low research quality characterized majority of the studies. No major risk is associated with implementing the suggested practices. They would be fairly convenient to reproduce without any risks to participants. It is crucial to address workplace incivility by improving communication and nurses’ self-efficacy regarding the same. Thus, the study is feasible for use in practice. | The study illustrates the need for concerted effort in workplace incivility management, which health care organizations should emulate. The study showed how workplace incivility can be prevented from a broadened perspective. Randomization of participants’ selection could have led to selection bias. No significant risk is associated with implementing the proposed intervention programs. The study explains the diverse nature of workplace incivility prevention strategies; thus, feasible in practice. | The study illustrates how job satisfaction can be improved by recognizing incivility and how to confront it. Regarding strengths, it is a mixed method study highly detailed on workplace incivility. However, the pilot study had a small initial sample size (limitation). No risks are associated with implementing the suggested practices in practice since the study proposes behavioral approaches. Its usefulness and convenience in applying the proposed strategies confirm its feasibility. |
Key findings
| Workplace incivility is prevalent among new nurses. Anxiety is a reliable predictor, leading to workplace burnout. The adverse outcomes of incivility can be moderated through resilience-based interventions, such as resilience training. | Education training on workplace incivility is among the most effective strategies in combating the prevalent nursing problem. However, it should be supplemented with other strategies to enhance outcomes. | Nursing administrators and nursing staff cannot succeed while working alone to address workplace incivility. A broadened focus is vital to address the problem successfully. | Enhanced awareness is vital in enabling nurses cope with workplace incivility. Cognitive rehearsal techniques can help nurses to confront workplace incivility. |
Outcomes
| Highly resilient nurses could buffer the negative influence of workplace incivility regardless of their experience. Therefore, resilience should be adopted in health care settings as a coping style. | Improving nurses’ ability to recognize and manage workplace incivility should be the guiding principle in education programs on workplace incivility. | Workplace incivility is preventable through a comprehensive and systematic attempt. Nurses should improve their skills as the health care managers work on other strategies such as improving the image of the profession and position of nurses in organizations. | Highly aware and prepared nurses are excellently positioned to deal with workplace incivility. Awareness programs should be intensified in health care settings as buffers. |
General Notes/Comments | The study is highly informative on workplace incivility, predictors, outcomes, and feasible solutions. It will be pivotal in developing the PICOT by illustrating the importance of resilient training as part of awareness programs for reducing workplace incivility. | The article is a useful resource to expand literature on workplace incivility management. | The study is highly informative on the need for a more comprehensive and systematic approach in workplace incivility management. | The study expands literature on workplace incivility recognition and prevention. |
Part B: Best Practice
Research on workplace incivility is expansive and explores many strategies that can be used to prevent or buffer the prevalent nursing problem. Among the many practices suggested in the studies, enabling nurses to recognize and confront the problem through cognitive rehearsal is a highly effective strategy in incivility management. From a practice viewpoint, cognitive rehearsal involves imagining a situation that produces self-defeating behavior and applying the necessary coping mechanism (Clark, 2019). It is a strategy that admits a problem and its adverse impacts and prepares the affected group to adopt appropriate behavior when they face the same problem.
In nursing, cognitive rehearsal can help nurses cope with workplace incivility to a considerable extent. According to Clark and Gorton (2019), cognitive rehearsal involves equipping nurses with the relevant skills to respond to situations that can be emotionally and mentally harming such as workplace incivility. It is a practical intervention in preventing workplace problems since it prepares nurses mentally to face everyday issues dominating the nursing practice. To justify its relevance in practice, cognitive rehearsal enables nurses to protect themselves and the patients. However, nurses need to implement cognitive rehearsal with other strategies to enhance outcomes.
Generally, workplace incivility is prevalent among nurses and cannot be overlooked. New nurses are more vulnerable to the devastating effects of workplace incivility since they are not used to the problem, and their resilience is low (Mohamed & MahdyAttia, 2020; Muliira et al., 2017). To avoid frustration and possible turnover, nurses should be helped to recognize incivility and respond to it effectively. Awareness and educational programs are highly effective. Training nurses through cognitive rehearsal programs is also an effective intervention to prepare them to cope with the prevalent nursing problem mentally.
Conclusion
Workplace incivility has devastating effects on nurses’ well-being and ability to provide optimal care. In response, it is crucial to apply evidence-based interventions from current and relevant research. The above research appraisal evaluates the appropriateness of various research articles as evidence sources for addressing workplace incivility. The proposed interventions such as cognitive rehearsal have been proven effective in addressing workplace incivility and can be used across settings.
References
Abdollahzadeh, F., Asghari, E., Ebrahimi, H., Rahmani, A., & Vahidi, M. (2017). How to prevent workplace incivility?: Nurses’ perspective. Iranian Journal of Nursing and Midwifery Research, 22(2), 157-163. https://doi.org/10.4103/1735-9066.205966
Armstrong, N. (2018). Management of nursing workplace incivility in the health care settings: A systematic review. Workplace Health & Safety, 66(8), 403-410. https://doi.org/10.1177%2F2165079918771106
Clark, C. M. (2019). Combining cognitive rehearsal, simulation, and evidence-based scripting to address incivility. Nurse Educator, 44(2), 64-68. doi: 10.1097/NNE.0000000000000563
Clark, C. M., & Gorton, K. L. (2019). Cognitive rehearsal, HeartMath, and simulation: An intervention to build resilience and address incivility. Journal of Nursing Education, 58(12), 690-697. https://doi.org/10.3928/01484834-20191120-03
Kile, D., Eaton, M., deValpine, M., & Gilbert, R. (2019). The effectiveness of education and cognitive rehearsal in managing nurse‐to‐nurse incivility: A pilot study. Journal of Nursing Management, 27(3), 543-552. https://doi.org/10.1111/jonm.12709
Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Wolters Kluwer.
Mohamed, A., & MahdyAttia, N. (2020). Factors associated with incivility behaviors, coping strategies and level of engagement among post graduate nursing students. IOSR Journal of Nursing and Health Science (IOSR-JNHS), 9(01), 2020. doi: 10.9790/1959-0901141727
Muliira, J. K., Natarajan, J., & Van Der Colff, J. (2017). Nursing faculty academic incivility: perceptions of nursing students and faculty. BMC Medical Education, 17(1), 1-10. doi: 10.1186/s12909-017-1096-8
Shi, Y., Guo, H., Zhang, S., Xie, F., Wang, J., Sun, Z., … & Fan, L. (2018). Impact of workplace incivility against new nurses on job burn-out: A cross-sectional study in China. BMJ Open, 8(4), e020461. doi:10.1136/ bmjopen-2017-020461
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Evaluation Table
Use this document to complete the evaluation table requirement of the Module 4 Assessment, Evidence-Based Project, Part 3A: Critical Appraisal of Research
Full APA formatted citation of selected article. | Article #1 | Article #2 | Article #3 | Article #4 |
(Davis et al., 2018) | (Tolia et al., 2018) | (Sutter et al., 2022) | (Gullickson et al., 2019) | |
Evidence Level * (I, II, or III)
| I | III | I | III |
Conceptual Framework Describe the theoretical basis for the study (If there is not one mentioned in the article, say that here).** | The novel weight and sign-based approach to control withdrawal method used in treating neonatal abstinence informed this study. It compared the effectiveness of the approach with the traditional treatment based on infant’s weight and severity of neonatal abstinence syndrome. | Not stated | Not stated | Not stated |
Design/Method Describe the design and how the study was carried out (In detail, including inclusion/exclusion criteria). | This study was a randomized controlled trial. Inclusion criteria was infants born to mothers treated with methadone or buprenorphine for an opioid use disorder or for chronic pain and receiving prenatal care in third trimester. The exclusion criteria were infants born to mothers who consumed more than 3oz of alcohol per week during the pregnancy period, infants born at 37 weeks gestation or more, premature infants, and those with sepsis were also excluded. | The study was cohort research. The researchers obtained data for the research from the Pediatrix Clinical Data Warehouse (CDW). Data on all infants without congenital abnormalities discharged from participating NICUS between 2011 and 2015 with NAS were included. | The study was a single-site, open-label, randomized controlled pilot study. The research ran from October 1, 2016 to September 30, 2018. The inclusion criteria were if an infant had in-utero drug exposure to heroine, oral opioids, or methadone and born at or greater than 34 weeks of gestation. The exclusion included infants with serious medical comorbidities and primary in-utero exposure to buprenorphine. | The study was retrospective cohort study. The inclusion included all infants born to mothers residing in Nova Scotia since 1988 with coded Finnegan score or ICD-10 code of P96.1 and treated at the IWK Health Center. |
Sample/Setting
The number and characteristics of patients, attrition rate, etc. | 116 infants with neonatal abstinence syndrome were used in this research. | The CDW data from participating NICUs in 33 states and Puerto Rico. | 61 infants that met the above inclusion criteria | 174 infants exposed to opioids between 2006 and 2015. |
Major Variables Studied
List and define dependent and independent variables | They included length of hospital stay (LOS) and LOS attributable to neonatal abstinence syndrome and drug treatment. | Total hospital LOS, NICU LOS, use of medications for NAS, and NICU discharge disposition. | Length of hospital stay, length of treatment, need for a second treatment agent, need for assisted nutritional or feeding support, total morphine equivalents, adverse events, and breastfeeding. | Length of treatment, length of stay, need for breakthrough dose and peak morphine/clonidine dose. |
Measurement
Identify primary statistics used to answer clinical questions (You need to list the actual tests done). | The statistics included Poisson distribution analysis, negative binomial regression, linear regression, and logistic regression. | Median and IQR values for continuous variables and counts and percentages. Univariate analyses, non-Gaussian distributions, multivariate Cox analysis, and Hazard ratios. | Means or medians, bivariate analyses, and parametric and non-parametric analyses. | Fisher’s exact test, and Maan-Whitney U-test. |
Data Analysis Statistical or Qualitative findings (You need to enter the actual numbers determined by the statistical tests or qualitative data). | Methadone was associated with decreased number of days for LOS by14% relating to a difference of 2.9 days and 14% reduction in LOS due to neonatal abstinence syndrome. It also contributed to a difference of 2.7 days length of drug treatment. Methadone also reduced the median LOS (16 vs 20 days p=0.05), LOS due to neonatal abstinence syndrome (16 vs 19 days) and length of drug treatment (11.5 days vs 15 days). | There was shorter median hospital stay for infants treated with morphine (LOS 18 days vs 23 days and shorter median NICU LOS (17 days vs 21 days). The methadone group was less likely to need 2 medications (18% vs 26%; p<0.001) or 3 medications (6 vs 8%; P<0.001). multivariate analysis showed methadone treatment to be associated with shorter LOS (HR, 1.24; 95% CI, 1.11-1.37; P<0.01) compared to morphine treatment. | Length of stay was not statistically significant or different among the two treatment groups (methadone 15.1 vs morphine 17.9 days, p=0.50). Infants in the methadone group received more morphine equivalents of medications (33 vs. 9.68, p<0.05). More infants in the morphine group needed additional caloric support, but the difference was statistically insignificant (73% vs 46%, p<0.25). There were statistically insignificant differences in rooming in among the two groups also. | Infants in morphine + clonidine group had longer stay of treatment (19.7 vs 11.3 days). This group also had a higher peak dose (0.14 mg/kg q3h) as compared to morphine alone group (0.10 mg/kg q3h, p=0.04). There was statistically insignificant difference in the needed morphine breakthrough in both groups. |
Findings and Recommendations
General findings and recommendations of the research | The use of weight and sign-based treatment for neonatal abstinence syndrome was associated with improved short-term outcomes in infants receiving methadone as compared to those receiving morphine. | Methadone treatment is associated with shorter LOS for infants born at or more than 26 weeks gestation as compared to morphine treatment. Future trials should aim at identifying comparative effectiveness of these treatments in infants with NAS. | There were no significant differences in LOT or LOS in the morphine vs methadone treatments. Infants treated with methadone were three times more likely to receive opioid equivalent treatments as compared to morphine group. | There was an increase in the incidence rate of NAS by fivefold from 1.48/1000 live births in 2007 to 7.50/1000 live births in 2015. The use of combined morphine plus clonidine was associated with higher peak morphine dose and longer length of treatment as compared to morphine alone. Future studies should examine the impact of clinical characteristics such as antidepressant and methadone exposure on the outcomes. |
Appraisal and Study Quality
Describe the general worth of this research to practice. What are the strengths and limitations of study? What are the risks associated with implementation of the suggested practices or processes detailed in the research? What is the feasibility of use in your practice? | The study is worthy to nursing practice. The strengths include randomization of participants while its weaknesses include a small sample size. The risks associated with the implementation of the intervention include the lack of generalizability. The research is feasible for use in my practice. | The study is highly generalizable because of its larger sample size. Its findings impact practice. The strength of the study is its use of a large sample size while the lack of randomization is its weakness. The risk of selection bias threatens its application to practice. The intervention is feasible for use in practice. | The study is worthy for nursing practice. The strength of the study includes randomization and control of variables. The weakness is its use of a small sample size. The risks associated with the implementation of the intervention is the lack of data on its generalizability to larger populations. The intervention is feasible to my practice. | This research is worth for practice. It is associated with the strength of following participants for a long time. It has the disadvantage of a small sample size, which affect the use of the intervention in nursing practice. The intervention is not currently feasible for practice. |
Key findings
| Weight and sign-based treatment for neonatal abstinence syndrome have better short-term outcomes in infants receiving methadone as compared to morphine. | Methadone-treated infants born at or more than 26 weeks of gestation have more improved outcomes such as LOS as compared to morphine treated infants. | The key outcomes such as LOS and LOT are insignificant in morphine and methadone treatments for NAS. | The use of combined morphine and clonidine is associated with longer length of treatment and higher peak morphine dose. |
Outcomes
| There are improved NAS outcomes such as LOS and length of treatment in methadone than morphine. | There is the reduction of LOS with methadone treatment as compared to morphine. | They include insignificant differences in LOS and LOT. Methadone treated group required more of morphine equivalent treatments and transfers to the NICU because of oversedation. | Increased length of treatment and peak morphine dose. |
General Notes/Comments | The research has significant implications to nursing practice. | The research reports findings that are generalizable to a larger population. | The study informs the need for a large study to determine the impact of the two treatments on NAS outcomes. | There is a need for another study to examine the impact of the intervention on a larger population sample. |
Critical Appraisal of Research
The analysis of the above studies shows that treatment of neonatal abstinence syndrome (NAS) is a challenge in nursing end medical practice. However, the reviewed studies demonstrate some potentials in the use of methadone in treating NAS. For example, the research by Davis et al., (2018) the use of methadone for infants born with NAS was associated with a reduction in the length of hospital stay and median length of hospital stay. It also the length of treatment because of NAS. A reduction in hospital stay has additional benefits that include cost reduction in healthcare and improved outcomes among the affected populations. Similar findings on the effectiveness of methadone have been replicated in the study by Tolia et al., (2018) where it led to shorter length of hospital stay as compared to morphine treatment alone. Despite this, evidence provided by Sutter et al., (2022) contradicts those reported by the above authors. Accordingly, their study showed that there were no significant differences in the length of treatment or hospital stay in the morphine vs methadone treatments. Infants treated with methadone were three times more likely to receive opioid equivalent treatments as compared to morphine group (Sutter et al., 2022). Therefore, future studies should utilize large sample sizes to determine the potential impact of the intervention in improving outcomes among patients suffering from NAS.
References
Davis, J. M., Shenberger, J., Terrin, N., Breeze, J. L., Hudak, M., Wachman, E. M., Marro, P., Oliveira, E. L., Harvey-Wilkes, K., Czynski, A., Engelhardt, B., D’Apolito, K., Bogen, D., & Lester, B. (2018). Comparison of Safety and Efficacy of Methadone vs Morphine for Treatment of Neonatal Abstinence Syndrome: A Randomized Clinical Trial. JAMA Pediatrics, 172(8), 741–748. https://doi.org/10.1001/jamapediatrics.2018.1307
Gullickson, C., Kuhle, S., & Campbell-Yeo, M. (2019). Comparison of outcomes between morphine and concomitant morphine and clonidine treatments for neonatal abstinence syndrome. Acta Paediatrica, 108(2), 271–274. https://doi.org/10.1111/apa.14491
Sutter, M. B., Watson, H., Yonke, N., Weitzen, S., & Leeman, L. (2022). Morphine versus methadone for neonatal opioid withdrawal syndrome: A randomized controlled pilot study. BMC Pediatrics, 22(1), 345. https://doi.org/10.1186/s12887-022-03401-3
Tolia, V. N., Murthy, K., Bennett, M. M., Greenberg, R. G., Benjamin, D. K., Smith, P. B., & Clark, R. H. (2018). Morphine vs Methadone Treatment for Infants with Neonatal Abstinence Syndrome. The Journal of Pediatrics, 203, 185–189. https://doi.org/10.1016/j.jpeds.2018.07.061
Currently, I work on an Oncology floor and most of our patients have deteriorating disease processes. A lot of our patients will develop pressure ulcers even when placed on strict turn schedules and nutrition requirements. This problem led me to wonder if there is a better way to prevent pressure ulcers in patients who are hospitalized for long periods of time. Due to this being my area of interest, I wanted to start my research on different methods to prevent pressure ulcers and which methods or multiple methods have proved to be the most effective.
I am most familiar with the EBSCO database so I started my search there and found an article pertaining to education surrounding pressure sore prevention. This study actually took two sample groups from India and gave them both differing levels of education and then monitored the groups for a year to determine which education methods were effective (Kaur, et.al, 2018). I started my search by searching for information on pressure sores and added the prevention component. I also limited my search to research that had been done between 2018 and 2022.
I continued my search in PUBMED, as that is another database that I was familiar with and had good experience with in the past. I found two articles on PUBMED using pretty broad search terms. I again searched for pressure sore prevention and found articles that discussed the topic. The first study took place in a Brazilian hospital and used the Braden scale to determine patients at risk for sores, and then placed pressure dressings on the patients. These dressings were placed in the same areas and changed at the same times the only thing that differed was the type of dressing used on the two groups of patients (da Silva et. al, 2019). Another study compared different types of pressure sore preventing mattresses and the effects that they had on the skin that is most commonly affected by pressure injuries (Tomova-Simitchieva et. al, 2018). For both of these articles I also limited my search time frame to ensure that I was getting the most recent data available as health care technology is constantly changing.
Improving Data Search
As I continue in my research, I hope to find more specific information on the prevention of pressure injuries. As I develop my PICOT question, this will also aid in the finding of research material and searching on more specific topics. I plan to search more specific topics which may include pressure injury prevention beds, pressure injury prevention dressings, and pressure injury prevention turn schedules. I would also like to do more research on how length of stay may contribute to pressure injury formation in patients.
References
da Silva Augusto, F., Blanes, L., Ping, P. Z. X., Saito, C. M. M., & Masako Ferreira, L. (2019). Hydrocellular Foam Versus Hydrocolloid Plate in the Prevention of Pressure Injuries. Wounds : a compendium of clinical research and practice, (31(8), 193–199.
Kaur, S., Singh, A., Tewari, & Kaur. (2018, January 1). Comparison of Two Intervention Strategies on Prevention of Bedsores among the Bedridden Patients: A Quasi Experimental Community-based Trial. ebscohost.com. https://search.ebscohost.com/login.aspx?direct=true&AuthType=shib&db=rzh&AN=127438747&site=ehost-live&scope=site&custid=s6527200
Tomova-Simitchieva, T., Lichterfeld-Kottner, A., Blume-Peytavi, U., & Kottner, J. (2018). Comparing the effects of 3 different pressure ulcer prevention support surfaces on the structure and function of heel and sacral skin: An exploratory cross-over trial. International wound journal, 15(3), 429–437.
Critical Appraisal of Research
Mental health disorders have far-reaching consequences on patients, health care practitioners, and families. As a result, evidence-based care interventions that engage patients in care and promote self-management are recommended. Telehealth provides a tech-based platform for health care and health education (Zhao et al., 2021). If applied effectively and its risks controlled, telehealth can optimize care effectiveness and reduce mental health burdens in many populations. The purpose of this worksheet is to critically appraise research on the role and effectiveness of telehealth interventions in improving treatment outcomes among patients with depression.
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Content
Name: NURS_6052_Module04_Week07_Assignment_Rubric
Excellent | Good | Fair | Poor | ||
Part 3A: Critical Appraisal of Research Conduct a critical appraisal of the four peer-reviewed articles you selected and analyzed by completing the Critical Appraisal Tool Worksheet Template. Be sure to include: · An Evaluation Table | Points Range: 45 (45%) – 50 (50%) The critical appraisal accurately and clearly provides a detailed evaluation table. The responses provide a detailed, specific, and accurate evaluation of each of the peer-reviewed articles selected. | Points Range: 40 (40%) – 44 (44%) The critical appraisal accurately provides an evaluation table. The responses provide an accurate evaluation of each of the peer-reviewed articles selected with some specificity. | Points Range: 35 (35%) – 39 (39%) The critical appraisal provides an evaluation table that is inaccurate or vague. The responses provide an inaccurate or vague evaluation of each of the peer-reviewed articles selected. | Points Range: 0 (0%) – 34 (34%) The critical appraisal provides an evaluation table that is inaccurate and vague or is missing. | |
Part 3B: Evidence-Based Best Practices Based on your appraisal, suggest a best practice that emerges from the research you reviewed. Briefly explain the best practice, justifying your proposal with APA citations of the research. | Points Range: 32 (32%) – 35 (35%) The responses accurately and clearly suggest a detailed best practice that is fully aligned to the research reviewed. The responses accurately and clearly explain in detail the best practice, with sufficient justification of why this represents a best practice in the field. The responses provide a complete, detailed, and specific synthesis of two outside resources reviewed on the best practice explained. The response fully integrates at least two outside resources and two or three course-specific resources that fully support the responses provided. Accurate, complete, and full APA citations are provided for the research reviewed. | Points Range: 28 (28%) – 31 (31%) The responses accurately suggest a best practice that is adequately aligned to the research reviewed. The responses accurately explain the best practice, with adequately justification of why this represents a best practice in the field. The responses provide an accurate synthesis of at least one outside resource reviewed on the best practice explained. The response integrates at least one outside resource and two or three course-specific resources that may support the responses provided. Accurate and complete APA citations are provided for the research reviewed. | Points Range: 25 (25%) – 27 (27%) The responses inaccurately or vaguely suggest a best practice that may be aligned to the research reviewed. The responses inaccurately or vaguely explain the best practice, with inaccurate or vague justification for why this represents a best practice in the field. The responses provide a vague or inaccurate synthesis of outside resources reviewed on the best practice explained. The response minimally integrates resources that may support the responses provided. Inaccurate and incomplete APA citations are provided for the research reviewed. | Points Range: 0 (0%) – 24 (24%) The responses inaccurately and vaguely suggest a best practice that may be aligned to the research reviewed or are missing. The responses inaccurately and vaguely explain the best practice, with inaccurate and vague justification for why this represents a best practice in the field, or are missing. A vague and inaccurate synthesis of no outside resources reviewed on the best practice explained is provided or is missing. The response fails to integrate any resources to support the responses provided. Inaccurate and incomplete APA citations are provided for the research reviewed or is missing. | |
Written Expression and Formatting—Paragraph Development and Organization: Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction is provided which delineates all required criteria. | Points Range: 5 (5%) – 5 (5%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity. A clear and comprehensive purpose statement, introduction, and conclusion is provided which delineates all required criteria. | Points Range: 4 (4%) – 4 (4%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time. Purpose, introduction, and conclusion of the assignment is stated yet is brief and not descriptive. | Points Range: 3.5 (3.5%) – 3.5 (3.5%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60–79% of the time. Purpose, introduction, and conclusion of the assignment is vague or off topic. | Points Range: 0 (0%) – 3 (3%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity less than 60% of the time. No purpose statement, introduction, or conclusion was provided. | |
Written Expression and Formatting—English Writing Standards: Correct grammar, mechanics, and proper punctuation. | Points Range: 5 (5%) – 5 (5%) Uses correct grammar, spelling, and punctuation with no errors. | Points Range: 4 (4%) – 4 (4%) Contains a few (one or two) grammar, spelling, and punctuation errors. | Points Range: 3.5 (3.5%) – 3.5 (3.5%) Contains several (three or four) grammar, spelling, and punctuation errors. | Points Range: 0 (0%) – 3 (3%) Contains many (five or more) grammar, spelling, and punctuation errors that interfere with the reader’s understanding. | |
Written Expression and Formatting—The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running head, parenthetical/in-text citations, and reference list. | Points Range: 5 (5%) – 5 (5%) Uses correct APA format with no errors. | Points Range: 4 (4%) – 4 (4%) Contains a few (one or two) APA format errors. | Points Range: 3.5 (3.5%) – 3.5 (3.5%) Contains several (three or four) APA format errors. | Points Range: 0 (0%) – 3 (3%) Contains many (five or more) APA format errors. | |
Total Points: 100 | |||||
Name: NURS_6052_Module04_Week07_Assignment_Rubric
When it comes to educating the general public about prolonged emergency wait times and the effect that it has on patient outcomes, it is clear that the only way we can reach the majority of the population is through social media or mass communications (for example commercials, billboards, etc.) I would create a digital design that could be published on social media sites about appropriate visit types for primary care offices, urgent care centers, and for emergency rooms. There has also been an increase in urgent care that specializes in orthopedic care, which would be another topic that could be addressed. If we can get the proper patients to the proper level of care, then we could decrease the volume of the emergency rooms and be able to appropriately treat those patients.
The second dissemination strategy that I would use is the spread of billboards. I would show the same information, just in smaller amounts, on billboards, ideally in a sequence, and all in a row. This would catch the attention of people and would mainly be effective if these billboards were in a location that had urgent care and could give the appropriate exit.
The dissemination strategy that I would not use is publishing my research or direct presentation to staff. As staff hospital employees, we already know this information and deal with it daily. The most appropriate strategy that would make this research effective would be a presentation to the public. The barriers we would most likely see are if people do not have social media or maybe use transportation in an area where they would not see the billboards. In a perfect world, we would try to educate 100% of the population, but logically we know that is not possible. We need to look at ways that we can reach the maximum amount. If we see that there is not much change, or the same patient population is still misusing the ER, we would look and see if there would be a different strategy that would be more efficient.
Dang, D., Dearholt, S. L., Bissett, K., Ascenzi, J., & Whalen, M. (2021). Johns Hopkins Evidence-Based Practice for Nurses and Healthcare Professionals: Model and Guidelines, Fourth Edition. Sigma Theta Tau.
Tucker, S. J., & Gallagher-Ford, L. (2019). EBP 2.0: From Strategy to Implementation. AJN The American Journal of Nursing, 119(4), 50. https://doi.org/10.1097/01.NAJ.0000554549.01028.afLinks to an external site.
Schipper, K., Bakker, M., De Wit, M., Ket, J. C., & Abma, T. A. (2016). Strategies for disseminating recommendations or guidelines to patients: a systematic review. Implementation Science: IS, 11(1), 82. https://doi.org/10.1186/s13012-016-0447-xLinks to an external site.
The key to successful patient care for any healthcare professional is to stay informed and be updated on the latest evidence-based practice guidelines (Melnyk & Fineout-Overholt, 2018). Clinicians must articulate the clinical issue of their interest to maximize the information retrieved with the least amount of time invested. Clinical questions must be written in a PICO format to avoid confusion and maintain the rigor of evidence-based practices (EBP) to address issues of clinical inquiry. PICO(T) format stands for P-population of interest; I-issue or Intervention of interest; C-comparison; O-outcome expected; and T -time for the intervention to achieve the outcome (Davies, 2011).
Healthcare-associated infections (HAI) are significant threats to patient safety besides being the most critical factor that causes an increase in patient morbidity and mortality in any country, irrespective of economic status or quality of health care (Mong et al., 2022). Catheter-associated urinary tract infections (CAUTI) are considered one of the most prevalent hospital-acquired conditions. In the United States, statistics show an estimated 500 000 cases of CAUTI are reported annually, contributing to prolonged length of stay, increased morbidity, mortality, and rising medical costs (Tyson et al.,2020). Evidence from various research in this field showed that nurse-driven interventions would significantly improve patient outcomes related to CAUTI prevention and will also aid in improving the quality of nursing care delivered at the bedside.
My clinical issue of interest is preventing Catheter-associated Urinary Tract Infections (CAUTI) utilizing nurse-driven protocol among patients in acute care settings, and My PICO question is:
Can nurse-driven catheter removal protocol reduce CAUTI among patients in acute care settings?
P: Patient with foley catheters in acute care settings
I: Nurse-driven catheter removal protocol.
C: no intervention or normal care
T: no time frame
The keywords used for the original search were “urinary catheter, infection, Nurse driven, protocol and impacts or outcomes or prevention,” resulting in 180 articles.
Strategies Used to Increase the Effectiveness of Database Search
When performing the search, the first strategy I used to improve the effectiveness by using specific keywords or the Boolean method of operation to assist a researcher by providing more focused and productive results. The Boolean process of searching uses simple words as conjunctions to combine or exclude keywords (Library of Congress, n. d). These operators help narrow search results to 120 from 180 articles of interest. This strategy allows me to reduce the time spent researching and scanning many databases.
The second strategy to get more systemic reviews was to filter databases such as CINAHL and ScienceDirect in the Walden university library. In filtered databases, the researcher can utilize additional limiters that can help refine the search to a specific area of interest or format addressed in the PICO question of choice (Walden Library n. d). Through these strategies and checking boxes for peer-reviewed scholarly articles within five years narrowed, results to 12 out of 120 articles.
These strategies greatly help me minimize the time spent researching and filtering through databases and articles to find resources with the most relevant information for my clinical area of interest.
References
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.
Library of Congress. (n.d.). Search/ Browse help -Boolean operators and nesting. Retrieved March 21, 2023, from https://catalog.loc.gov/vwebv/ui/en_US/htdocs/help/searchBoolean.html
Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer.
Mong, I., Ramoo, V., Ponnampalavanar, S., Chong, M. C., & Wan Nawawi, W. N. F. (2022). Knowledge, attitude, and practice with catheter-associated urinary tract infection (CAUTI) prevention: A cross-sectional study. Journal of Clinical Nursing, 31(1-2), 209–219.
Tyson, A. F., Campbell, E. F., Spangler, L. R., Ross, S. W., Reinke, C. E., Passaretti, C. L., & Sing, R. F. (2020). Implement a nurse-driven protocol for catheter removal to decrease catheter-associated urinary tract infection rate in a Surgical Trauma ICU. Journal of Intensive Care Medicine, 35(8), 738–744. https://doi.org/10.1177/0885066618781304
Walden University Library. (n. d). Quick Answers: How do I find a systematic review article related to health, medicine, or nursing?/ Retrieved March 21, 2023, from https://academicanswers.waldenu.edu/faq/72670
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