Archive for category: Nursing

[Revision] Nursing 709 research and evidence based practice

1. Search the scholarly literature to select and appraise evidence for best practice (i.e., what is already known) about the selected issue. Identify database(s) used to locate 6 current articles (published within last 5 years). Five of the 6 articles for discussion must be primary sources (limit of only 1 qualitative study to be included) and one article must be a systematic review. If you use any Quality Improvement Project articles or more than 1 systematic review article, points will be deducted. Use search terms related to your IV, DV, and condition. In a paragraph explain what databases, search words, etc. you used to find your studies.

2. Present the evidence in two modes: Tables and narrative. (Focus on the nursing intervention)

a. Complete the literature review matrix to delineate the essential parts of each study. Students will attach the completed matrix as a Table to the end of the paper (use APA 7th ed.; table should not be within body of paper).

Reference the tables in the text of the paper at least once (e.g., Table 1) .If you use a table within the paper (e.g., for your conceptual definitions, make sure number of table is correct in order it appears in the paper)

b. Write a narrative review of the literature within the body of the paper. This section of the paper should include an introduction, a review of research studies, a synthesis, and a decision point explanation:

i. Start with an introductory paragraph describing the methodology of the search process used for retrieving the articles. Include factors such as the databases searched, keywords used in search, range of dates, etc.

ii. Discuss each of the 6 articles using active voice. This discussion should concisely, yet comprehensively, present the essential information of each article. Typically, two paragraphs are needed per article.

Typical Paragraph 1 includes:

o Study purpose

o Study design

o Sampling essential information

o Method of data collection

Typical for Paragraph 2 to include

o Study results (data) and the findings (were study hypotheses supported or not (related to your focus); if significant results are reported, include the p value)

o Limitations of the study

o Implications for practice/research

c. Write a summary section that provides a synthesis of the evidence based on these six articles. Compare and contrast what is known (sample sizes, designs, similar findings, conclusions) and what remains unknown (researchable due to inconsistent findings, gaps in literature, etc.). Include citations to the articles that you presented. Identify the strength of the evidence.

d. EBP decision point – State clearly your recommendation (in at least one paragraph ) based on the information you reviewed from the selected scholarly literature. Choose one of the following options:

1. Decide there is enough strong consistent evidence to support a pilot project to test a practice change in your area. Provide at least two strategies to include when planning the study that will address some of the methods limitations identified in the literature. Consider design selection, sampling size and eligibility criteria, frequency and duration of intervention, data collection methods).

2. Decide more research is needed as the published evidence is too weak or inconsistent in its findings to support a practice change. Describe the plan for a follow-up study to identify an effective way to solve the problem identified in the paper. Consider study design, the intervention, outcomes to be measured, and other methodologic strategies that might assist in overcoming limitations. The plan should detail 2 to 3 parts of the study plan.

N.B.: Paper should be written using the 7th ed. of the APA Style Manual with attention to title page, headings, references and other style elements. Writing should follow a scholarly style with attention to spelling, sentence structure, etc. Matrices are part of the Appendix. An abstract is not required.

Matrix for Primary Articles

Table 1. Review of Primary Sources (This should be in alphabetical order by author).

Database # Study/Article/

Country Theoretical basis of study Study Design with Study Question or Study Purpose Sampling Frame/

Size Independent variables (IV); Dependent variables (DV); Variables Measurement of variables (name of instrument, etc.) Statistics used to answer research question Design with Hierarchy Level of Research (or Nonresearch Evidence);

Study Limitations

CINAHL (EBSCO) #1 Hajinezhad, M.S., Rafii J, E.J., & Haghani, H. (2007). Relationship between nurse caring behaviors from patients’ perspectives & their satisfaction. Iran Journal of Nursing, 20 (49), 73-83.

Iran

Full citation. Include country of origin if NOT United States.

Author/s. (year). Article title. Journal title (in italics). pg #s. Watson, human caring theory; Donabedian, Structure, Process, Outcome

If no theory is explicitly identified; state “NO explicit theory” rather than leave blank Cross-sectional observational design; Purpose: to explore the relationship between patients’ demographic attributes and perceptions of nurse caring with patients’ scores on satisfaction with hospitalization

Identify design clearly – is it experimental design or non-experimental; write study purpose or the study question Quota sampling

N = 250

Identify sampling frame as random or non-random; provide total sample size and size of each study group; note if there was significant attrition between start of study and data analysis Perceptions of nurse caring (IV); patient satisfaction with hospitalization (DV)

Identify the study independent variable (IV); identify the study dependent variable (DV) – note if there are more than one IV and/or DV Caring Behaviors Inventory 42 (CBI-42); Patient Satisfaction Instrument (PSI); CBI-42, alpha = 0.976; PSI, alpha = 0.91

Describe the instrument(s) used for data collection; provide reliability and validity information per the article Pearson r = 0.72, p = <0.001; CBI, M = 184.14, SD = 46.90; PSI, M = 84.76, SD = 15.65

Name the primary statistical test used; provide results with test value, and p value (if < .05). Correlational design; Level VI

Identify two study limitations

Identify the specific design; also, provide number using the Polit & Beck hierarchy of evidence

Name two limitations that may influence study validity

Matrix for Systematic Review

Table 2. Matrix Elements of Systematic Review

Type of review & Identify Article

Purpose/aim of the review (identify any

major concepts, phenomena, and variables if not stated in purpose) Inclusion criteria for primary studies

Databases searched; search terms Sample size for review (number initially retrieved and final number included in review): &

Range of sample sizes of included primary studies Data extraction and appraisal process

(quality assessment) Conclusions drawn Rating Strength of Evidence; Recommendations/limitations

Systematic review & meta-analysis

Blackwood, B., Alderdice, F., Burns, K., Cardwell, C., Lavery, G., & O’Halloran, P. (2011). Use of weaning protocols for reducing duration of mechanically ventilated critically ill adult patients: Cochrane systematic review and meta-analysis. British Medical Journal, 342, 7237 – 7250.

Identify type of review (systematic review, meta-analysis, integrative review, etc.)

Provide full reference. To examine the effects of standardized weaning protocols on the total duration of mechanical ventilation, mortality, adverse events, weaning duration, and length of stay of critically ill adults in ICUs

Write the purpose statement for the review. Identify the specific variables if this is not clear in the purpose statement. Primary studies were included if they: 1) examined a formalized weaning protocol compared to usual practice; 2) used either an experimental or quasi-experimental design; 3) adults only who were receiving mechanical ventilation with nasotracheal or orotracheal tube

Identify how the researchers selected the articles for review; i.e., the criteria to be included in the review Medline, Embase, CINAHL, Web of Science, LILACS

Mechanical ventilation, ventilators, negative pressure ventilators, ventilator weaning, weaning protocols

Name the databases that were used in the search for studies; provide the keywords that were searched Retrieved 6016 citations; only 11 trials met all inclusion criteria

Total sample size of subjects in review: 1971

Range of study sample sizes: 15 to 357

Describe the process of filtering from all studies identified to the final number included in the review; also, include the range of sample sizes from the included studies (if available) Three researchers independently extracted data using Cochrane form; if disagreement, a 4th person was consulted to resolve

Studies were assessed for six risks of bias using Cochrane’s evaluation domains

How were the articles appraised (was a specific tool/process described); how were disagreements in the review resolved Formal protocols reduced:

1) duration of mechanical ventilation by 25% (95% CI = 9% to 39%)

2) duration of weaning process by 78%

3) LOS in ICY by 10%

No significant findings were found related to mortality, adverse events, or overall stay in hospital

Concluded that there is evidence pointing toward benefits of formal weaning protocols, but due to the substantial variations among studies and the final small number of studies evaluated, it was difficulty to state which protocol was most effective

Rate the strength of the evidence that was found; what were recommendations for use of results; what were identified limitations of the review/original studies

See Polit, D. F., and Beck, C. T. (2020). Essentials of nursing research: Appraising evidence for nursing practice (11th ed.). Philadelphia: Wolters Kluwer.

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