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NR350 Research in Nursing Literature Search, Rapid Critical Appraisal, and Summary Rapid Critical Appraisal Checklist Article References Purpose Hypothesis Study Question(s) Variables Independent(I) Dependent(D) if Applicable Study Design /Methods Sample Size & Selection Data Collection Methods Major Finding(s) 1 (SAMPLE ARTICLE) Smith, Lewis (2013), What should I eat? A focus for those living with diabetes. Journal of Nursing Education, 1 (4) 111-112. How do educational support groups effect dietary modifications in patients with diabetes? D-Dietary modifications I-Education Quantitative N- 18 Convenience sample-selected from local support group in Pittsburgh, PA Focus Groups Support and education improved compliance with dietary modifications. 1 2 3 4 5 9/26/21, 6:42 PM Week 6: Literature Search, Rapid Critical Appraisal, and Summary https://canvas.westcoastuniversity.edu/courses/8099/assignments/130196 1/3 Week 6: Literature Search, Rapid Critical Appraisal, and Summary Due Oct 4 by 2:59am Points 200 Submitting a text entry box or a file upload NURS_350_OL - NURS350-Literature Review with Rapid Critical Appraisal Checklists Start Assignment For this assignment, you will locate two research studies related to the topic and PICOT questions that you developed in Week 2. The articles must be current (within the last five years), and one article must be quantitative, and one article must be qualitative. For this assignment all articles must be related to the field of nursing. Article choice is very important, therefore: Articles used for this assignment cannot be used for the other assignments. The selected articles should be original research studies. Review articles, concept analysis, meta-analysis, meta-synthesis, integrative review, and systemic review articles should not be used. Mixed-methods studies should not be used. There are two parts to this assignment. Part 1: Complete a Rapid Critical Appraisal Checklist (https://canvas.westcoastuniversity.edu/courses/8099/files/1750762/download? download_frd=1) Select one each: qualitative and quantitative research articles. Create a Rapid Critical Appraisal Checklist for the two research articles (one column per article). Complete with brief, concise, summarized information. Part II: Write a summary (one- to two- pages) Identify differences between quantitative and qualitative designs and research methods. Describe the differences in your article's quantitative and qualitative designs and methods. Carefully review the rubric before you submit. This summary is using your own words to examine the differences specifically between your articles. Use current APA Style for your summary paper and to cite your sources. Submit the checklist and summary. You must submit the research study articles along with your assignment. Review the rubric for further information on how your assignment will be graded. https://canvas.westcoastuniversity.edu/courses/8099/files/1750762?wrap=1 https://canvas.westcoastuniversity.edu/courses/8099/files/1750762/download?download_frd=1 9/26/21, 6:42 PM Week 6: Literature Search, Rapid Critical Appraisal, and Summary https://canvas.westcoastuniversity.edu/courses/8099/assignments/130196 2/3 Criteria Ratings Pts 10 pts 40 pts 30 pts 40 pts Two substantive research articles <br> (one qualitative and one quantitative) are clearly identified as original research studies. 10 to >8.9 pts Meets or Exceeds Expectations Two quality, substantive articles (one qualitative and one quantitative) are selected and are suitable original research studies. 8.9 to >7.5 pts Mostly Meets Expectations Two articles (one qualitative and one quantitative) are selected and are mostly substantive, but at least one is not a suitable original research study, or is not sufficiently substantive. 7.5 to >5.9 pts Below Expectations One article is selected and identified as qualitative or quantitative research, or it is not a suitable original research study. 5.9 to >0 pts Does Not Meet Expectations Articles are not original research; one qualitative and one quantitative article are not identified. Description of the research problem and purpose of each research article 40 to >35.6 pts Meets or Exceeds Expectations The research problem and the purpose for each article are expertly examined. 35.6 to >30.0 pts Mostly Meets Expectations The research problem and the purpose for each article are adequately examined with minor omissions or errors. 30 to >23.6 pts Below Expectations The research problem and the purpose for each article are vague, absent or not identified, and contain major omissions or errors. 23.6 to >0 pts Does Not Meet Expectations The research problem and its purpose are not identified for any of the articles. Description of the research methods for each research article 30 to >26.7 pts Meets or Exceeds Expectations An extensive description of the variables, the sample, and the research methods is clearly presented for each article. 26.7 to >22.5 pts Mostly Meets Expectations An adequate description of the, variables, the sample, and the research methods is presented for most articles with minor omissions or errors. 22.5 to >17.7 pts Below Expectations An unsatisfactory description of the variables, sample, and the research methods is presented for both articles with major omissions or errors. 17.7 to >0 pts Does Not Meet Expectations A description of the variables, the sample, and the research methods is not presented for any of the articles. Summary of the findings/conclusions/themes for each research article 40 to >35.6 pts Meets or Exceeds Expectations An expertly examined investigation of the findings, themes, and conclusions for both articles is skillfully presented for each article. 35.6 to >30.0 pts Mostly Meets Expectations An adequate investigation of the findings, themes, and conclusions for both is satisfactorily presented with minor omissions or errors. 30 to >23.6 pts Below Expectations An unsatisfactory investigation of the findings, themes, and conclusions for both articles is provided with major omissions or errors, or only one of the articles is investigated and presented satisfactorily. 23.6 to >0 pts Does Not Meet Expectations A description of the findings, themes, and conclusions, is not presented for either article. 9/26/21, 6:42 PM Week 6: Literature Search, Rapid Critical Appraisal, and Summary https://canvas.westcoastuniversity.edu/courses/8099/assignments/130196 3/3 Total Points: 200 Criteria Ratings Pts 60 pts 10 pts 10 pts Description of the similarities and differences among the research articles 60 to >53.4 pts Meets or Exceeds Expectations The description of the similarities and differences among the research articles is clear and thorough. 53.4 to >45.0 pts Mostly Meets Expectations The description of the similarities and differences among the research articles is adequate with minor omissions or errors. 45 to >35.4 pts Below Expectations The description of the similarities and differences among the research articles is inadequate with major omissions or errors. 35.4 to >0 pts Does Not Meet Expectations The description of the similarities and differences among the research articles is not provided. APA 10 to >8.9 pts Meets or Exceeds Expectations Uses APA Style accurately and consistently to cite sources with only 1–2 errors. Sources are expertly cited and are peer- reviewed, relevant sources. Meets all formatting requirements (length and style) of the assignment. 8.9 to >7.5 pts Mostly Meets Expectations Uses APA Style with minor citation violations with 3–4 errors. Sources are somewhat relevant, but may be limited in scholarly nature. Meets most formatting requirements (length and style) of the assignment. 7.5 to >5.9 pts Below Expectations Reflects incomplete knowledge of APA Style with 5–6 errors. Sources are not cited, or there are many errors. Sources are not scholarly in nature. Meets most formatting requirements (length and style) of the assignment. 5.9 to >0 pts Does Not Meet Expectations Does not use APA Style, or there are pervasive errors throughout the paper. Does not meet formatting requirements (length and style) of the assignment. Mechanics 10 to >8.9 pts Meets or Exceeds Expectations The writing demonstrates a sophisticated clarity, conciseness, and correctness; includes thorough details and information; and is extremely well organized. Punctuation, spelling, and capitalization are all correct. There are minimal to no errors. 8.9 to >7.5 pts Mostly Meets Expectations The writing is accomplished in terms of clarity and conciseness, includes sufficient details, and is well organized, but it may contain a few errors. Punctuation, spelling, and capitalization are generally correct with not many errors. 7.5 to >5.9 pts Below Expectations The writing lacks clarity or conciseness, contains numerous errors, and lacks organization. Errors in punctuation, spelling, and capitalization detract from the readability of the paper 5.9 to >0 pts Does Not Meet Expectations The writing is unfocused, rambling, or contains serious errors; lacks detail and relevant data and information; and is poorly organized. There are many distracting errors in punctuation, spelling, and capitalization. Appraisal and Application of Research EVIDENCE-BASED FOR NURSES PRACTICE © Ma dre dus /Sh utte rsto ck THE PEDAGOGY Evidence-Based Practice for Nurses: Appraisal and Application of Research, Fourth Edi-tion, drives comprehension through various strategies that meet the learning needs of students while also generating enthusiasm about the topic. This interactive approach addresses different learning styles, making this the ideal text to ensure mastery of key concepts. The pedagogical aids that appear in most chapters include the following: Chapter Objectives These objectives provide instructors and students with a snapshot of the key information they will encounter in each chapter. They serve as a checklist to help guide and focus study. Key Terms Found in a list at the beginning of each chapter and in bold within the chapter, these terms will create an expanded vocabulary in evidence-based practice. At the end of this chapter, you will be able to: Key terms CHAPter OBJeCtiVes ‹ Define evidence-based practice (EBP) ‹ List sources of evidence for nursing practice ‹ Identify barriers to the adoption of EBP and pinpoint strategies to overcome them ‹ Explain how the process of diffusion facilitates moving evidence into nursing practice ‹ Define research ‹ Discuss the contribution of research to EBP ‹ Categorize types of research ‹ Distinguish between quantitative and qualitative research approaches ‹ Describe the sections found in research articles ‹ Describe the cycle of scientific development ‹ Identify historical occurrences that shaped the development of nursing as a science ‹ Identify factors that will continue to move nursing forward as a science ‹ Discuss what future trends may influence how nurses use evidence to improve the quality of patient care ‹ Identify five unethical studies involving the violation of the rights of human subjects abstract applied research barriers basic research cycle of scientific development deductive reasoning descriptive research discussion section early adopters empirical evidence evidence-based practice (EBP) explanatory research inductive reasoning innovation introduction Jewish Chronic Disease Hospital study laggards list of references methods section model of diffusion of innovations Nazi experiments Nuremberg Code predictive research pyramid of evidence qualitative research quantitative research replication study research research utilization results section review of literature theoretical framework theory Tuskegee study Willowbrook studies 9781284048902_CH01_Pass2.indd 2 10/05/14 2:56 AM Critical Thinking Exercises As an integral part of the learning process, the authors present scenarios and questions to spark insight into situations faced in practice. Test Your Knowledge These questions serve as benchmarks for the knowledge acquired throughout the chapter. After an outcome has been selected and measured, data are compiled and evaluated to draw conclusions. Demonstrating the effectiveness of an innovation is a challenge, and conclusions must not extend beyond the scope of the data. Evaluation is facilitated when appropriate outcomes and associated indicators are chosen. If the outcome is not clearly defined, then the measurements and subsequent evaluation will be flawed. For example, suppose that you are a member of an interdisciplinary team that has developed a nursing protocol that reduces the amount of time the patient remains on bed rest after a cardiac catheterization procedure from 6 hours to 4 hours. The outcome selected is absence of bleeding from the femoral arterial puncture site. No other indicators are measured. The results obtained after implementing the protocol revealed that there was an increase in bleeding at the femoral arterial site in the 4-hour bed rest patients compared to the 6-hour bed rest patients. Before concluding that a shorter bed rest time leads to an increase in femoral bleeding, a few additional questions need to be considered. First, was absence of bleed- ing defined in a measurable way? Because bleeding might be interpreted in several different ways, a precise definition of bleeding should have been provided to ensure consistency in reporting. Second, when should patients be assessed for absence of bleeding? Is the absence of bleeding to be assessed when the patient first ambulates or at a later time? Input from the staff prior to changing the nursing protocol could have clarified these questions, resulting in more reliable results. Another consideration in outcome evaluation is to obtain data relative to current practice for comparison purposes. To document the need for a practice change and to support a new protocol, baseline data might need to be collected tEst YOur knOWlEdgE 18-3 true/False 1. Baseline data are unimportant in outcome measurement. 2. Precise description of indicators is essential. 3. For complex analyses, the assistance of a statistician may be needed. 4. Input from staff can help clarify outcome measurement. How did you do? 1. F; 2. T; 3. T; 4. T FYi After an outcome has been selected and measured, data are compiled and evaluated to draw conclusions. Evaluation is facilitated when appropriate outcomes and associated indicators are chosen— conversely, if the outcome is not clearly defined, then the measurements and subsequent evaluation will be flawed. 498 ChaptER 18 Evaluating Outcomes of Innovations 9781284048902_CH18_Pass2.indd 498 17/05/14 10:29 AM treatment of human response, and advocacy in the care of individuals, fami- lies, communities, and populations” (ANA, 2003, p. 6). From the early days of the profession, students have been taught that a scientific attitude and method of work combined with “experience, trained senses, a mind trained to think, and the necessary characteristics of patience, accuracy, open-mindedness, truthfulness, persistence, and industry” (Harmer, 1933, p. 47) are essential components of good practice. Harmer goes on to say, “Each time this habit of looking, listening, feeling, or thinking is repeated it is strengthened until the habit of observation is firmly established” (p. 47). This still holds true today. Benner (1984) studied nurses in practice and concluded that to become an expert nurse one has to practice nursing a minimum of 5 years. There are no shortcuts to becoming an expert in one’s field. The development of knowledge and skill takes time and work. As nurses encounter new situations, learning takes place. Nursing knowledge develops and is refined as nurses practice (Waterman, Webb, & Williams, 1995). In this way, nurses adapt theories to fit their practices. Unfortunately, much that is learned about theory during practice remains with the nurse because nurses rarely share their practice expertise through conference presentations and publications. The discipline will be enriched when nurses engage more formally in disseminating their knowledge about theory in practice. The Relationships Among Theory, Research, and Practice Practice relies on research and theory and also provides the questions that require more work by theorists and researchers. Each informs and supports the other in the application and development of nursing knowledge. When the relationships among theory, research, and practice are in harmony, the discipline is best served, ultimately resulting in better patient outcomes (Maas, 2006). The relationships are dynamic and flow in all directions. CRiTiCAL THinking ExERCisE 5-2 A nurse on a surgical floor observes that several new approaches are being used to dress wounds. She observes that some methods appear to promote healing faster than others do. While reviewing the research literature, she is unable to locate any research about the dressings she is using. How might she go about testing her theory that some methods are better than others? Can this be done deductively, inductively, or using mixed methods? Are any theories presently available related to wound healing, and if so, where might she locate these? What concepts might be important in forming the question? © Ju les_ Kita no/ Shu tter Sto ck, Inc. 5.1 How Are Theory, Research, and Practice Related? 141 9781284048902_CH05_Pass2.indd 141 10/05/14 2:44 AM FYI Quick tidbits and facts are pulled out in chapter margins to highlight important aspects of the chapter topic. THE PEDAGOGY iii Rapid Review This succinct list at the end of the chapter compiles the most pertinent and key information for quick review and later reference. Apply What You Have Learned This outstanding feature applies newly acquired knowledge to specific evidence-based practice scenarios and research studies. apparent. Organizing the review with a grid is a positive strategy to overcome the barrier of lack of time because it reduces the need to repeatedly sort through articles during future discussions. Also, within this text’s digital resources, you will find a grid to use for this exercise. Two articles (Cohen & Shastay, 2008; Tomietto, Sartor, Mazzocoli, & Palese, 2012) are summarized as an example. Read Kliger, Blegen, Gootee, and O’Neil (2009). Enter information about this article into the first two columns. In column 1, use APA format, like in the example, because this is the most commonly used style for nursing publications. Rapid Review » Today’s work environment requires that nurses be adept at gathering and appraising evidence for clinical practice and assisting patients with healthcare information needs. » Literature reviews provide syntheses of current research and scholarly literature. A well-done literature review can provide support for EBP. » An understanding of the scientific literature publication cycle provides a basis for making decisions about the most current information on a topic. » Primary sources are original sources of information presented by the people who created them. Secondary sources are resulting commentar- ies, summaries, reviews, or interpretations of primary sources. » Many research journals involve peer review. » There are many ways to categorize sources. Scholarly, trade, and popular literature is one way. Another categorizing system involves periodicals, journals, and magazines. » There are four types of review: narrative, integrative, meta-analysis, and systematic. » Understanding how sources are structured can simplify a search of the literature. » Sources can be identified through both print indexes and electronic data- bases. Topics, subject matter, and format may vary but all include citation information. » Helpful strategies to use when conducting a search include cita- tion chasing, measurements of recall and precision, keyword and controlled vocabulary searches, Boolean operators, truncation, 4.5 Keeping It Ethical 129 9781284048902_CH04_Pass2.indd 129 10/05/14 2:32 AM reFerenCes Aitken, L. M., Hackwood, B., Crouch, S., Clayton, S., West, N., Carney, D., & Jack, L. (2011). Creating an environment to implement and sustain evidence based practice: A developmental process. Australian Critical Care, 24, 244–254. American Medical Association. (1998). Information from unethical experiments (CEJA Report 5–A-98). Retrieved from http://www.ama-assn .org/resources/doc/code-medical-ethics/230a.pdf American Nurses Association. (2010). National Database of Nursing Quality Indicators: Guidelines for data collection on the American Nurses Association’s National Quality forum endorsed measures: Nursing Care Hours per Patient Day, Skill Mix, Falls, Falls with Injury. Retrieved from http://www.odh.ohio.gov/~/media/ODH/ASSETS/Files/dspc/health%20 care%20service/nursestaffing7-13-10materials.ashx Barnsteiner, J., & Prevost, S. (2002). How to implement evidence-based practice. Some tried and true pointers. Reflections on Nursing Leadership, 28(2), 18–21. Barta, K. M. (1995). Information-seeking, research utilization, and barriers to research utilization of pediatric nurse educators. Journal of Professional Nursing, 11, 49–57. Benner, P. (1984). From novice to expert: Excellence and power in clinical nursing practice. Menlo Park, CA: Addison-Wesley. aPPlY What YOu havE lEarnED Sign into a database for nursing literature (i.e., CINAHL, ProQuest, PubMed). For this chapter, you will need to obtain the following two articles: Pipe, T. B., Kelly, A., LeBrun, G., Schmidt, D., Atherton, P., & Robinson, C. (2008). A prospective descriptive study exploring hope, spiritual well-being, and quality of life in hospitalized patients. MEDSURG Nursing, 17, 247–257. Flanagan, J. M., Carroll, D. L., & Hamilton, G. A. (2010). The long-term lived experience of patients with implantable cardioverter defibrillators. MEDSURG Nursing, 19, 113–119. One of these articles used qualitative methods, and the other used quantitative methods. Identify which is which. After you have done that, for each article identify the various sections that make up a research article. You may want to share these articles with nurses during your next clinical experience and consider ways the recommendations can be incorporated into practice. ©  Li so vs ka ya N at ali a/ Sh ut te rS to ck , In c. 36 CHAPter 1 What Is Evidence-Based Practice? 9781284048902_CH01_Pass2.indd 36 10/05/14 2:56 AM iv THE PEDAGOGY Case Examples Found in select chapters, these vignettes illustrate research questions and studies in actual clinical settings and provide critical thinking challenges. Some researchers claim their work is nursing research because the researcher is a nurse or because the researcher studied nurses. But it is the focus on nurs- ing practice that defines nursing research. The mere fact that the research was conducted by a nurse or that nurses were studied does not necessarily qualify the research as nursing research. Historically, and even today, approaches to practice are often based on “professional opinion” when research is absent. Case Example 5-1 provides such a historical illustration. It also demonstrates the value of systematically studying the effects of interventions. CAsE ExAmPLE 5-1 Early methods of Resuscitation: An Example of Practice Based on Untested Theory T hroughout the past century, nursing students have been taught how to resuscitate patients who stop breathing. As early as 1912, students were taught a variety of methods for providing artificial respiration. It was theorized that moving air in and out of the lungs would be effective. One of these techniques was designed for resuscitating infants. Byrd‘s Method of Infant Resuscitation (Goodnow, 1919) directed the nurse to hold the infant‘s legs in one hand, and the head and back in the other. The nurse would then double the child over by pressing the head and the knees against the chest. Then the nurse would extend the knees to undouble the child. This would be repeated, but “not too rapidly” (Goodnow, 1919, p. 305). At intervals, the nurse would dip the child into a mustard bath in the hope that this would also stimulate respiration. The nurse would continue this until help arrived. Other methods of artificial respiration taught included Sylvester‘s method for adults (Goodnow, 1919). The patient was placed flat on his back. The nurse would grasp the patient‘s elbows and press them close to his sides, pushing in the ribs to expel air from the chest. The arms would then be slowly pulled over the head, allowing the chest to expand. The arms would be lowered to put pressure on the chest, and the cycle was then repeated. This was to be done at the rate of 18 to 20 cycles per minute. By 1939, postmortem examinations after unsuccessful resuscitations showed veins to be engorged while the arteries were empty (Harmer & Henderson, 1942). Although this evidence indicated other factors needed to be considered, resuscitation techniques continued to focus only on the respiratory system. The same methods of resuscitation that were in use in 1919 were still being taught in 1942. Although students were still being taught the Sylvester method, they were also learning the new “Schäfer method” (Harmer & Henderson, 1942, p. 9401). This method involved placing the patient in a prone position. The nurse would straddle the thighs, facing the patient‘s head, and alternatively apply and remove pressure to the thorax. Eventually, it was noted that what was believed to be best practice was not effective. Results of postmortem examinations indicated that something was missing in the techniques, and therefore research was begun to determine best practice. Today, nursing students are taught cardiopulmonary resuscitation techniques based on updated research and theories. 136 CHAPTER 5 Linking Theory, Research, and Practice 9781284048902_CH05_Pass2.indd 136 10/05/14 2:44 AM fully operational in 1996. It aims to improve the effectiveness of nursing practice and healthcare outcomes. Some initiatives include conducting systematic reviews, collaborating with expert researchers to facilitate development of practice infor- mation sheets, and designing, promoting, and delivering short courses about EBP. 2.2 keeping It Ethical Ethical research exists because international, national, organizational, and individual factors are in place to protect the rights of individuals. Without these factors, scientific studies that violate human rights, such as the Nazi experiments, could proceed unchecked. Many factors of ethical research, which evolved in response to unethical scientific conduct, are aimed at pro- tecting human rights. Human rights are “freedoms, to which all humans are entitled, often held to include the right to life and liberty, freedom of thought and expression, and equality before the law” (Houghton Mifflin, 2007). Rights cannot be claimed unless they are justified in the eyes of another individual or group of individuals (Haber, 2006). When individuals have rights, others have obligations, that is, they are required to act in particular ways. This means that when nursing research is being conducted, subjects participating in stud- ies have rights, and all nurses are obligated to protect those rights. International and National Factors: guidelines for Conducting Ethical research One of the earliest international responses to unethical scientific conduct was the Nuremberg Code. This code was contained in the written verdict at the trial of the German Nazi physicians accused of torturing prisoners during medical experiments. Writers of the Nuremberg Code (Table 2-3) identified that voluntary consent was absolutely necessary for participation in research. Research that avoided harm, produced results that benefited society, and allowed participants to withdraw at will was deemed ethical. The Nuremberg Code became the standard for other codes of conduct. Key Terms human rights: Freedoms to which all humans are entitled obligations: Requirements to act in particular ways At the end of this section, you will be able to: ‹ Discuss international and national initiatives designed to promote ethical conduct ‹ Describe the rights that must be protected and the three ethical principles that must be upheld when conducting research ‹ Explain the composition and functions of IRBs at the organizational level ‹ Discuss the nurse’s role as patient advocate in research situations 2.2 Keeping It Ethical 55 9781284048902_CH02_Pass2.indd 55 10/05/14 4:01 AM Keeping It Ethical Relevant ethical content concludes each chapter to ensure that ethics are a consideration during every step of the nursing process. THE PEDAGOGY v Appraisal and Application of Research Edited by Nola A. Schmidt, PhD, RN, CNE Professor College of Nursing and Health Professions Valparaiso University Valparaiso, Indiana Janet M. Brown, PhD, RN Professor Emeritus College of Nursing and Health Professions Valparaiso University Valparaiso, Indiana FOURTH EDITION EVIDENCE-BASED FOR NURSES PRACTICE World Headquarters Jones & Bartlett Learning 5 Wall Street Burlington, MA 01803 978-443-5000 [email protected] www.jblearning.com Jones & Bartlett Learning books and products are available through most bookstores and online booksellers. To contact Jones & Bartlett Learning directly, call 800-832-0034, fax 978-443-8000, or visit our website, www.jblearning.com. Substantial discounts on bulk quantities of Jones & Bartlett Learning publications are available to corporations, professional associations, and other qualified organizations. For details and specific discount information, contact the special sales department at Jones & Bartlett Learning via the above contact information or send an email to [email protected] Copyright © 2019 by Jones & Bartlett Learning, LLC, an Ascend Learning Company All rights reserved. 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Cella Director of Product Management: Amanda Martin Product Assistant: Christina Freitas Associate Production Editor: Alex Schab Senior Marketing Manager: Jennifer Scherzay Production Services Manager: Colleen Lamy Product Fulfillment Manager: Wendy Kilborn Composition: S4Carlisle Publishing Services Cover Design: Kristin Parker Rights & Media Specialist: Wes DeShano Media Development Editor: Troy Liston Cover Image (Title Page, Part Opener, Chapter Opener): © Madredus/Shutterstock  Printing and Binding: LSC Communications Cover Printing: LSC Communications Library of Congress Cataloging-in-Publication Data Names: Schmidt, Nola A., editor. | Brown, Janet M. (Janet Marie), 1947–     editor. Title: Evidence-based practice for nurses : appraisal and application of     research / [edited by] Nola A. Schmidt and Janet M. Brown. Description: Fourth edition. | Burlington, Massachusetts : Jones & Bartlett     Learning, [2019] | Includes bibliographical references and index. Identifiers: LCCN 2017036581 | ISBN 9781284122909 Subjects: | MESH: Nursing Research--methods | Evidence-Based Nursing Classification: LCC RT81.5 | NLM WY 20.5 | DDC 610.73072--dc23 LC record available at https://lccn.loc.gov/2017036581 6048 Printed in the United States of America 21 20 19 18 17 10 9 8 7 6 5 4 3 2 1 https://lccn.loc.gov/2017036581 © Ma dre dus /Sh utte rsto ck DEDICATION For Mom, whose love and support are endless. —N. A. S. To my husband, my children, and my granddaughters and grandson, who enrich my life in every way. —J. M. B. © Ma dre dus /Sh utte rsto ck Contributors xix Reviewers xxi Preface xxiii Acknowledgments xxix UNIT 1 Introduction to Evidence-Based Practice 1 CHAPTER 1 What Is Evidence-Based Practice? 3 Nola A. Schmidt and Janet M. Brown 1.1 EBP: What Is It? 3 1.2 What Is Nursing Research? 14 1.3 How Has Nursing Evolved as a Science? 23 1.4 What Lies Ahead? 31 1.5 Keeping It Ethical 34 CONTENTS CHAPTER 2 Using Evidence Through Collaboration to Promote Excellence in Nursing Practice 43 Emily Griffin and Marita G. Titler 2.1 The Five Levels of Collaboration 43 2.2 Keeping It Ethical 54 UNIT 2 Acquisition of Knowledge 67 CHAPTER 3 Identifying Research Questions 69 Susie Adams 3.1 How Clinical Problems Guide Research Questions 69 3.2 Developing Hypotheses 77 3.3 Formulating EBP Questions 84 3.4 Keeping It Ethical 87 CHAPTER 4 Finding Sources of Evidence 93 Patricia Mileham 4.1 Purpose of Finding Evidence 93 4.2 Types of Evidence 96 4.3 How Sources Are Organized 102 4.4 How to Search for Evidence 110 4.5 Keeping It Ethical 123 CHAPTER 5 Linking Theory, Research, and Practice 131 Elsabeth Jensen 5.1 How Are Theory, Research, and Practice Related? 131 5.2 Keeping It Ethical 141 xii CONTENTS UNIT 3 Persuasion 147 CHAPTER 6 Key Principles of Quantitative Designs 149 Rosalind M. Peters 6.1 Chart the Course: Selecting the Best Design 149 6.2 What Is Validity? 155 6.3 Categorizing Designs According to Time 161 6.4 Keeping It Ethical 166 CHAPTER 7 Quantitative Designs: Using Numbers to Provide Evidence 171 Rosalind M. Peters 7.1 Experimental Designs 171 7.2 Quasi-Experimental Designs 177 7.3 Nonexperimental Designs 180 7.4 Specific Uses for Quantitative Designs 186 7.5 Keeping It Ethical 188 CHAPTER 8 Epidemiologic Designs: Using Data to Understand Populations 193 Amy C. Cory 8.1 Epidemiology and Nursing 193 8.2 Infectious Diseases and Outbreak Investigations 195 8.3 Measures of Disease Frequency 197 8.4 Descriptive Epidemiology 200 8.5 Descriptive Study Designs 204 CONTENTS xiii 8.6 Analytic Study Designs 208 8.7 Screening 213 8.8 Evaluating Health Outcomes and Services 215 8.9 Keeping It Ethical 216 CHAPTER 9 Qualitative Designs: Using Words to Provide Evidence 221 Kristen L. Mauk 9.1 What Is Qualitative Research? 221 9.2 The Four Major Types of Qualitative Research 230 9.3 Keeping It Ethical 244 CHAPTER 10 Collecting Evidence 253 Jan Dougherty 10.1 Data Collection: Planning and Piloting 253 10.2 Collecting Quantitative Data 255 10.3 Validity and Reliability 263 10.4 Collecting Qualitative Data 271 10.5 Keeping It Ethical 278 CHAPTER 11 Using Samples to Provide Evidence 285 Ann H. White 11.1 Fundamentals of Sampling 285 11.2 Sampling Methods 290 11.3 Sample Size: Does It Matter? 299 11.4 Keeping It Ethical 302 xiv CONTENTS CHAPTER 12 Other Sources of Evidence 309 Cynthia L. Russell 12.1 The Pyramid of the 5 Ss 309 12.2 Using the Pyramid of the 5 Ss for Evidence-Based Practice 320 12.3 Keeping It Ethical 324 UNIT 4 Decision 329 CHAPTER 13 What Do the Quantitative Data Mean? 331 Rosalind M. Peters, Nola A. Schmidt, and Moira Fearncombe 13.1 Using Statistics to Describe the Sample 331 13.2 Using Frequencies to Describe Samples 333 13.3 Measures of Central Tendency 337 13.4 Distribution Patterns 341 13.5 Measures of Variability 344 13.6 Inferential Statistics: Can the Findings Be Applied to the Population? 352 13.7 Reducing Error When Deciding About Hypotheses 355 13.8 Using Statistical Tests to Make Inferences About Populations 361 13.9 What Does All This Mean for EBP? 370 13.10 Keeping It Ethical 373 CHAPTER 14 What Do the Qualitative Data Mean? 379 Kristen L. Mauk 14.1 Qualitative Data Analysis 379 CONTENTS xv 14.2 Qualitative Data Interpretation 385 14.3 Qualitative Data Evaluation 391 14.4 Keeping It Ethical 396 Running head: PICOT QUESTIONS 2 PICOT QUESTIONS 2 PICOT questions PICOT questions Background Throughout an acute hospitalization, patient’s ambulation is frequently disregarded because of their acute ailment. A patient’s functional position post-release is correlated to their movement during hospitalization. The absence of mobility during hospitalization can result in decreased quality of life, augmented length of stay, and lead to “suboptimal” care. (Dirkes, (2019). Barriers to patient mobility in critical care involve the absence of assistive tools, the absence of inspiration amongst both the patients and staff and most importantly, fear of patient falling. These factors add to the decrease of hospital-related functions due to the presence of immobility both proximately and their days post-hospitalization. Injuries from falls are the most prevalent issue in early mobility plans, particularly in critical care. For instance, patients within the hospital on factors such as surgery, medications, and diagnostic testing conditions, which wanes the body or result in confusion can have mobility difficulties. According to Filipek, (2017), ”every year, there are hundreds of cases of falls occurring in hospitals and 45% of these cases leads to injuries and sometimes death.” Therefore, controlled mobility programs during hospitalization are imperative to prevent and reduce falling cases, lessen the necessity for post-acute care in SNF (skilled nursing facility) as well as lessen LOS. Significance to nursing Early mobility is important to nursing practice because of the adverse effects lack of movement causes both immediately and thirty days post-hospitalization. Moreover, recent studies have indicated the health benefits and cost savings of getting hospital patients walking as soon after their procedures. These benefits are distinct. Physical activities strengthen muscles and joints, and movement is linked with shorter hospital stays. Brief hospital stays will in turn generate considerable savings. Mobilization programs aimed at critical care patients are estimated to save a mean of $ 940 per Medicare recipient. Though rehabilitation is guaranteed to enhance functionality position, there is an assumption that lack of mobility in hospitalization accounts for several SNF releases leading to augmented healthcare expenditure. Therefore, nurses should assist patients with mobility while keeping in mind all blockades to treatment and probable complications to lessen hospital stay and enhance patient care and wellbeing. Although nurses tend to favor EPB and regard its function in their daily practice, institution blockades might still exist leading to application difficulties. (Boehm, 2021). Thereby, nurses should be dedicated and committed to ambulating patients frequently. Through recognizing the inferences presented by immobility in the hospital and the statistical pertinent on how these adverse outcomes directly impact the patients, nurses can further engage in decision-making modifications via clinical-centered situations. PICOT questions The following questions focus on explicit interventions and how these interferences might result in particular outcomes. These PICOT questions focus on the topic of early mobility and fall prevention. 1. In hospitalized patients, do patients involved in early mobility plans have reduced LOS, and do these programs lead to lessened SNF releases in comparison to those patients who are not on mobility plans? (Boehm, (2021). The population (P) is the patients in hospitals, Intervention (I) is patients ordered on early mobility plan, Comparison(C) is between those in mobility plans and those not in the mobility program (standard activity). The outcome (O) will be to assess LOS of patients discharged to go home and those discharged to a SNF. Patients will be placed on a mobility plan for twenty-four hours of their admission. 2. In hospitalized patients, does ambulation cause patients to be at a greater risk for falls, or does the program decrease fall risks? Population(P) is the hospitalized patients, Intervention includes directives for early mobility plan to reduce or prevent fall, Comparison is the rate of fall in patients in mobility plans to those on standard activity directive, outcome (O) is to assess the rate of falls of patients in early mobility system with those in standard activity directives. The timeline will be twenty-four hours after admission. 3. In Hospitalized patients, do patients with a bed rest directive have a lengthier stay (LOS) in the hospital in comparison to patients with activity directives? Population(P) is the hospitalized patients, Intervention includes directives for physical activities, Comparison will be the LOS of patients with physical activity directive in comparison to those with bedrest directives. Outcome will be assessed with by the period of stay in hospital between these two groups, throughout their hospitalization Conclusions Dirkes, (2019) notes that early patient mobility is an essential aspect of patient care, especially in critical care. Proper mobilization of patients is crucial to lessen physical difficulties and to enhance the emotional and social wellbeing of patients. Moreover, supervised mobility programs reduce and prevent falling in patients with acute illnesses. Thus, mobility programs are crucial for decreasing hospital stay, increasing quality of care, reducing medical costs, and optimizing patient care and wellbeing. References Boehm, L. M., Lauderdale, J., Garrett, A. N., & Piras, S. E. (2021). A multisite study of multidisciplinary ICU team member beliefs toward early mobility. Heart & Lung: The Journal of Cardiopulmonary and Acute Care, 50(1), 214-219. Dirkes, S. M., & Kozlowski, C. (2019). Early mobility in the intensive care unit: evidence, barriers, and future directions. Critical care nurse, 39(3), 33-42. Filipek, C., Bennett, K. T., & Kissel, K. (2017). Lighting the Path: Fall Prevention Strategies in a Mixed Intensive Care (ICU) and Coronary Care Unit (CCU). Canadian Journal of Critical Care Nursing, 28(2).