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Assignment: Evidence-Based Project, Part 3: Critical Appraisal of Research 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: 1.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. 2.Reflect on the four peer-reviewed articles you selected in Module 2 and analyzed in Module 3. 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. Resources https://www.youtube.com/watch?v=5Rv9z7Mp4kg&feature=youtu.be https://go.openathens.net/redirector/waldenu.edu?url=https://doi.org/10.1177/1078390309338733 Evaluation Table Use this document to complete the evaluation table requirement of the Module 4 Assessment, Evidence-Based Project, Part 4A: Critical Appraisal of Research Full APA formatted citation of selected article. Article #1 Article #2 Article #3 Article #4 Evidence Level * (I, II, or III) Conceptual Framework Describe the theoretical basis for the study (If there is not one mentioned in the article, say that here).** Design/Method Describe the design and how the study was carried out (In detail, including inclusion/exclusion criteria). Sample/Setting The number and characteristics of patients, attrition rate, etc. Major Variables Studied List and define dependent and independent variables Measurement Identify primary statistics used to answer clinical questions (You need to list the actual tests done). Data Analysis Statistical or Qualitative findings (You need to enter the actual numbers determined by the statistical tests or qualitative data). Findings and Recommendations General findings and recommendations of the research 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? Key findings Outcomes General Notes/Comments * These levels are from the Johns Hopkins Nursing Evidence-Based Practice: Evidence Level and Quality Guide · Level I Experimental, randomized controlled trial (RCT), systematic review RTCs with or without meta-analysis · Level II Quasi-experimental studies, systematic review of a combination of RCTs and quasi-experimental studies, or quasi-experimental studies only, with or without meta-analysis · Level III Nonexperimental, systematic review of RCTs, quasi-experimental with/without meta-analysis, qualitative, qualitative systematic review with/without meta-synthesis · Level IV Respected authorities’ opinions, nationally recognized expert committee/consensus panel reports based on scientific evidence · Level V Literature reviews, quality improvement, program evaluation, financial evaluation, case reports, nationally recognized expert(s) opinion based on experiential evidence **Note on Conceptual Framework · The following information is from Walden academic guides which helps explain conceptual frameworks and the reasons they are used in research. Here is the link https://academicguides.waldenu.edu/library/conceptualframework · Researchers create theoretical and conceptual frameworks that include a philosophical and methodological model to help design their work. A formal theory provides context for the outcome of the events conducted in the research. The data collection and analysis are also based on the theoretical and conceptual framework. · As stated by Grant and Osanloo (2014), “Without a theoretical framework, the structure and vision for a study is unclear, much like a house that cannot be constructed without a blueprint. By contrast, a research plan that contains a theoretical framework allows the dissertation study to be strong and structured with an organized flow from one chapter to the next.” · Theoretical and conceptual frameworks provide evidence of academic standards and procedure. They also offer an explanation of why the study is pertinent and how the researcher expects to fill the gap in the literature. · Literature does not always clearly delineate between a theoretical or conceptual framework. With that being said, there are slight differences between the two. References The Johns Hopkins Hospital/Johns Hopkins University (n.d.). Johns Hopkins nursing dvidence-based practice: appendix C: evidence level and quality guide. Retrieved October 23, 2019 from https://www.hopkinsmedicine.org/evidence-based-practice/_docs/appendix_c_evidence_level_quality_guide.pdf Grant, C., & Osanloo, A. (2014). Understanding, Selecting, and Integrating a Theoretical Framework in Dissertation Research: Creating the Blueprint for Your House. Administrative Issues Journal: Education, Practice, and Research, 4(2), 12-26. Walden University Academic Guides (n.d.). Conceptual & theoretical frameworks overview. Retrieved October 23, 2019 from https://academicguides.waldenu.edu/library/conceptualframework Critical Appraisal Tool Worksheet Template © 2018 Laureate Education Inc. 2 Clinical inquiry by Clinical Inquiry Clinical Inquiry Submission date: 18-Sep-2021 11:26AM (UTC-0500) Submission ID: 1651455474 File name: Clinical_inquiry_APA.docx (19.89K) Word count: 1319 Character count: 7379 1 1\% SIMILARITY INDEX 1\% INTERNET SOURCES 0\% PUBLICATIONS 0\% STUDENT PAPERS 1 1\% Exclude quotes Off Exclude bibliography On Exclude matches Off Clinical inquiry ORIGINALITY REPORT PRIMARY SOURCES www.coursehero.com Internet Source Evaluation Table Use this document to complete the evaluation table requirement of the Module 4 Assessment, Evidence-Based Project, Part 4A: Critical Appraisal of Research Part 3A: Critical Appraisal of Research Full APA formatted citation of selected article. Article #1 Article #2 Article #3 Article #4 Anand, S., Baishya, M., Singh, A., & Khanna, P. (2020). Effect of awake prone positioning in COVID- 19 patients- A systematic review. Trends in Anaesthesia and Critical Care. https://doi- org.ezp.waldenulibrary. org/10.1016/j.tacc.2020 .09.008 Singh, P., Jain, P., & Deewan, H. (2020). Awake prone positioning in COVID-19 patients. Indian Journal of Critical Care Medicine: Peer-Reviewed, Official Publication of Indian Society of Critical Care Medicine, 24(10), 914-918. https://doi- org.ezp.waldenulibrary.org/ 10.5005/jp-journals-10071- 23546 Elharrar, X., Trigui, Y., Dols, A.-M., Touchon, F., Martinez, S., Prud’homme, E., & Papazian, L. (2020). Use of prone positioning in non-intubated patients with COVID-19 and hypoxemic acute respiratory failure. JAMA, 323(22), 2336- 2338. https://doi- org.ezp.waldenulibrary.org/ 10.1001/jama.2020.8255 Solverson, K., Weatherald, J., & Parhar, K. K. S. (2020). Tolerability and safety of awake prone positioning COVID-19 patients with severe hypoxemic respiratory failure. Canadian Journal of Anesthesia = Journal Canadien d’anesthesie. https://doi- org.ezp.waldenulibrary.or g/10.1007/s12630-020- 01787-1 Evidence Level * (I, II, or III) Level I Level III Level II Level III © 2018 Laureate Education Inc. 1 Critical Appraisal Tool Worksheet Template https://doi-org.ezp.waldenulibrary.org/10.1016/j.tacc.2020.09.008 https://doi-org.ezp.waldenulibrary.org/10.1016/j.tacc.2020.09.008 https://doi-org.ezp.waldenulibrary.org/10.1016/j.tacc.2020.09.008 https://doi-org.ezp.waldenulibrary.org/10.1007/s12630-020-01787-1 https://doi-org.ezp.waldenulibrary.org/10.1007/s12630-020-01787-1 https://doi-org.ezp.waldenulibrary.org/10.1007/s12630-020-01787-1 https://doi-org.ezp.waldenulibrary.org/10.1001/jama.2020.8255 https://doi-org.ezp.waldenulibrary.org/10.1001/jama.2020.8255 https://doi-org.ezp.waldenulibrary.org/10.1001/jama.2020.8255 https://doi-org.ezp.waldenulibrary.org/10.5005/jp-journals-10071-23546 https://doi-org.ezp.waldenulibrary.org/10.5005/jp-journals-10071-23546 https://doi-org.ezp.waldenulibrary.org/10.5005/jp-journals-10071-23546 Conceptual Framework Describe the theoretical basis for the study (If there is not one mentioned in the article, say that here).** The reviews theoretical basis and mission were to highlight the effect of pronation in awake patients and improve oxygenation status and mortality rates for COVID-19 patients (Anand, Baishya, Singh & Khanna, 2020). This retrospective observational studys theoretical basis and mission was to see the effect of awake prone positioning therapy in COVID-19 patients in a hospital unit (Singh, Jain & Deewan, 2020). The studys theoretical basis and objective were to evaluate the efficacy, feasibility, and tolerance of prone positioning in awake COVID-19 patients who are hospitalized but not in the ICU (Elharrar et al., 2020). This historical cohort studys theoretical basis and objective were to assess the tolerability and safety of awake prone positioning in COVID-19 patients with hypoxemic respiratory failure (Solverson, Weatherald & Parhar, 2020). Design/Method Describe the design and how the study was carried out (In detail, including inclusion/exclusion criteria). Two authors systematically searched Google Scholar and PubMed databases that were published up until July 5th, 2020 (Anand, Baishya, Singh & Khanna, 2020). The study describes COVID-19 pneumonia patients requiring oxygen that were admitted to the hospital from June 15th to July 1st, 2020 (Singh, Jain & Deewan, 2020). This prospective study was conducted among awake, non-intubated, and spontaneously breathing COVID-19 patients with hypoxemic acute respiratory failure (Elharrar et al., 2020). This study was performed across four hospitals in Calgary, Canada, for patients with COVID-19 and hypoxemic respiratory failure between April and May 2020 (Solverson, Weatherald & Parhar, 2020). Sample/Setting The number and characteristics of patients, attrition rate, etc. A total of 220 patients from 13 studies were included. Males accounted for 151/220 patients, and the mean age of the patients at presentation was above 50 years old (Anand, Baishya, Singh & The sample setting included 15 patients, all of whom were hemodynamically stable and had a SpO2 of <90\% on initial presentation (Singh, Jain & Deewan, 2020). The mean age of the sample size was 51.5 years, The sample setting included 24 patients admitted to Aix-en- Provence Hospital in France from March 27th to April 8th, 2020 (Elharrar et al., 2020). Both men and women were used in the sample setting, with some The sample setting included seventeen patients with COVID-19, including both men and women (Solverson, Weatherald & Parhar, 2020). Comorbidities such as elevated BMI, OSA, CAD, and © 2018 Laureate Education Inc. 2 Khanna, 2020). Ninety comorbidities were reported from the authors, but only in five studies (Anand, Baishya, Singh & Khanna, 2020). and eight of the patients had a history of comorbidities (Singh, Jain & Deewan, 2020). noting comorbidities of obesity and high blood pressure (Elharrar et al., 2020). hypertension were noted (Solverson, Weatherald & Parhar, 2020). The patients mean age was 53 years old (Solverson, Weatherald & Parhar, 2020). Major Variables Studied List and define dependent and independent variables The dependent variables of the study were COVID-19 positive status and pronation. The studys independent variables are the timing and duration of pronation and the oxygen delivery apparatus. The dependent variables of the study were COVID-19 hospitalized patients with pneumonia who required oxygen therapy. The studys independent variables were oxygen delivery devices, and time pronation was performed (Singh, Jain & Deewan, 2020). The dependent variables for inclusion criteria consisted of a COVID-19 diagnosis and supplemental oxygenation requirement (Elharrar et al., 2020). The independent variables were the length of time the patient was able to tolerate pronation (Elharrar et al., 2020). The dependent variables for inclusion criteria were hospitalized patients diagnosed with COVID-19 that required supplemental oxygen (Solverson, Weatherald & Parhar, 2020). The independent variables were hospital unit (medical ward versus ICU) and oxygen delivery device (nasal cannula versus high flow) (Solverson, Weatherald & Parhar, 2020). Measurement Identify primary statistics used to answer clinical questions (You need to list the actual tests done). Awake pronation was assessed for its improvement in oxygenation by evaluating the SpO2, P/F ration, PO2, and SaO2 (Anand, Baishya, SpO2 was improved through the use of oxygen therapy, but a further rise was seen with the change in position from supine to prone and was noted in all patients (Singh, Jain & Arterial blood gases were measured just before and during pronation and 6 to 12 hours after resupination and were the basis of judgment to determine if oxygenation levels had Pronation in awake COVID-19 patients requiring oxygen was measured by the oxygen saturation level and the respiration rate (Solverson, Weatherald © 2018 Laureate Education Inc. 3 Singh & Khanna, 2020). Deewan, 2020). improved after pronation (Elharrar et al., 2020). & Parhar, 2020). Data Analysis Statistical or Qualitative findings (You need to enter the actual numbers determined by the statistical tests or qualitative data). A majority of the patients (11/3 studies including 199 of the patients) showed marked improvement in SpO2, P/F ratio, PO2, and SaO2 were reported by 7/13 (54\%), 5/13 (38\%), 2/13 (15\%), and 1/13 (8\%) of the studies (Anand, Baishya, Singh & Khanna, 2020). The intubation and mortality rates after prone positioning were 23.80\% (50/210) and 5.41\% (5/203), respectively (Anand, Baishya, Singh & Khanna, 2020). The mean P/f ratio in the supine position was 98.8 ± 29.7 mm Hg, which improved to 136.6 ± 38.8 mm Hg after proning (p- value = 0.005) (Singh, Jain & Deewan, 2020). Similarly, findings were consistent when observing over the next few days until discharge. The mean P/f ratio in the supine position was 142.4 ± 40.9, 178.3 ± 38.3, and 210.3 ±37.9, which increased to 173.9 ± 46.6, 214.8 ± 44.2, and 218.6 ± 32.5 from day 4 to 6, day 7 to 10, and day 11 to till discharge, respectively (p-value = 0.050, 0.033, and 0.692) (Singh, Jain & Deewan, 2020). Of the 24 patients, 4 (17\%) did not tolerate PP for more than 1 hour, 5 (21\%) tolerated it for 1 to 3 hours, and 15 (63\%) tolerated it for more than 3 hours (Elharrar et al., 2020). Among patients who sustained PP for 3 hours or more, PaO2 increased from a mean of 73.6 (SD, 15.9) mm Hg before PP to 94.9 (SD, 28.3) mm Hg during PP (difference, 21.3 [95\% CI, 6.3-36.3] mm Hg; P = .006) (Elharrar et al., 2020). While in the prone position, all patients showed improvements in oxygenation: SpO2 supine position 91\% (84– 95) versus prone position 98\% (92–100). The respiratory rate also showed improvement with a decrease of 28 (18–38) in supine patients while 22 (15–33) during pronation (Solverson, Weatherald & Parhar, 2020). The prone positioning was initiated a median of six days after the onset of symptoms and hospitalization of the COVID-19 patients (Solverson, Weatherald & Parhar, 2020). Findings and Recommendations General findings and Results were promising that were observed when the pronation was started early, and The mean duration of stay was ten days, and only two patients out of 15 required intubation in view of The results found that pronation aided in the improvement of oxygenation status. Four of Pronation for patients with severe acute hypoxemic respiratory failure was found to have © 2018 Laureate Education Inc. 4 recommendations of the research there was a definite reduction in the requirement for oxygen therapy (Anand, Baishya, Singh & Khanna, 2020). progressing disease or deteriorating consciousness (Singh, Jain & Deewan, 2020). the patients did not sustain prone positioning for 1 hour or more and required intubation within 72 hours (Elharrar et al., 2020). decreased the respiratory rate while increasing the oxygenation saturation level (Solverson, Weatherald & Parhar, 2020). 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? As COVID-19 continues to challenge healthcare, this articles general worth is immense in treating positive patients. The studys strengths include a large number of studies and thereby patients from which the data is derived. This articles limitations were self-identified as a lack of control population and a noted absence of a thorough discussion on patient discomfort while in the prone position (Anand, Baishya, Singh & Khanna, 2020). The risks associated with the implementation of pronation were discussed in this article Assessing the effects of pronation in COVID-19 patients is relevant during the current pandemic. One strength of the study is that it gained approval, and a waiver of the consent was obtained from the institutional ethics committee before commencement (Singh, Jain & Deewan, 2020). The studys limitation was a small sample size and no randomization to a control group (Singh, Jain & Deewan, 2020). The risks of implementation include deteriorating patients despite interventions, with possible intubation resulting from the declining oxygenation status. Pronation is highly feasible to achieve in Improving oxygenation status is a way to lift the burden on overcrowded ICUs during the current pandemic. The studys strengths include institutional review board approval, and written informed consent from patients was required (Elharrar et al., 2020). The studys limitation included a small sample size where a single episode of pronation was evaluated (Elharrar et al., 2020). A risk noted from the pronation implementation in this study was that ten patients reported back pain (42\%) during pronation (Elharrar et al., 2020). Feasibility is considered high for awake, conscious patients to perform Sustaining higher levels of oxygenation status and lower respiratory rates in COVID-19 patients requiring oxygen can help lower ICU admissions and subsequent intubations. The Conjoint Health Research Ethics Board institutional research ethics board approved the study, which is a strength to the study. Limitations of the study include patients maintaining the prone positioning were experiencing back or shoulder pain (12\%), general discomfort (35\%), and delirium (6\%) (Solverson, Weatherald & Parhar, 2020). The small sample size of patients is also a © 2018 Laureate Education Inc. 5 as precautions to be aware of, such as back pain, obesity, pressure injuries, and the need for increased monitoring (Anand, Baishya, Singh & Khanna, 2020). practice with awake, conscious patients after proper explanation of the positioning. pronation (Elharrar et al., 2020). limitation. The study risks include increasing oxygen demands that do not respond to pronation (Solverson, Weatherald & Parhar, 2020). Key findings The improvement in oxygenation after awake pronation was not as long-lasting in the studies, although it did reduce the need for oxygen therapy (Anand, Baishya, Singh & Khanna, 2020). The study found that the median P/f ratio significantly improved from supination to pronation from the first day to the tenth (Singh, Jain & Deewan, 2020). The study reduced the intubation rates and avoided the problems related to invasive ventilation (Singh, Jain & Deewan, 2020). The study found that early and prolonged (at least 12 hours daily) prone positioning (PP) improves oxygenation and decreases mortality (Elharrar et al., 2020). The study also noted that oxygenation increased during pronation was not sustained in half of the patients after resupination, suggesting pronation is a temporary measure for improved oxygenation (Elharrar et al., 2020). The study demonstrated that awake prone positioning for non- intubated, hypoxemic COVID-19 patients is feasible (Solverson, Weatherald & Parhar, 2020). All patients were noted to improve oxygenation status and decrease respiratory rate while in the prone position but did revert back following resupination (Solverson, Weatherald & Parhar, 2020). Outcomes Awake pronation in COVID-19 patients is a low cost, easy, and less resource utilizing strategy that can be used to improve Awake prone positioning had a significant increase in P/f ratio and SpO2 in COVID-19 patients with improved clinical symptoms and minimal The primary outcome was the proportion of responders whose partial pressure of arterial oxygen (PaO2) increased ≥20\% before and during In this cohort, 35\% of the patients had pronation lengths of less than an hour, but even the short duration demonstrated pronation’s effects on the © 2018 Laureate Education Inc. 6 oxygenation (Anand, Baishya, Singh & Khanna, 2020). The pronation provides increased oxygenation status, if even only for a short while. complications (Singh, Jain & Deewan, 2020). Pronation aided in reducing intubation rates, which helped conserve resources (Singh, Jain & Deewan, 2020). pronation (Elharrar et al., 2020). Another was the feasibility of pronation, which measured how long the patients were able to tolerate the position (Elharrar et al., 2020). patients (Solverson, Weatherald & Parhar, 2020). Pronation is potentially helpful in mitigating the need for mechanical ventilation (Solverson, Weatherald & Parhar, 2020). General Notes/Comments There are no official guidelines that have been developed for pronation in patients. The clinician advises patients to remain in the prone position for as long as possible (Anand, Baishya, Singh & Khanna, 2020). There is a hemogeneous distribution of the gas in the prone position, which reduces the ventilation- perfusion (VQ) mismatch (Singh, Jain & Deewan, 2020). Exclusion criteria for patients in this study included those with acute respiratory failure requiring intubation and those with impaired consciousness (Elharrar et al., 2020). The same supplemental oxygenation device was used during the study (Elharrar et al., 2020). The study did not observe any iatrogenic removal of lines or tubes associated with the act of prone positioning (Solverson, Weatherald & Parhar, 2020). No pressure ulcers, aspiration events, or hemodynamic instability was observed during the study either (Solverson, Weatherald & Parhar, 2020). * These levels are from the Johns Hopkins Nursing Evidence-Based Practice: Evidence Level and Quality Guide  Level I Experimental, randomized controlled trial (RCT), systematic review RTCs with or without meta-analysis  Level II Quasi-experimental studies, systematic review of a combination of RCTs and quasi-experimental studies, or quasi-experimental studies only, with or without meta- analysis  Level III Nonexperimental, systematic review of RCTs, quasi-experimental with/without meta-analysis, qualitative, qualitative systematic review with/without meta-synthesis © 2018 Laureate Education Inc. 7 https://www.hopkinsmedicine.org/evidence-based-practice/_docs/appendix_c_evidence_level_quality_guide.pdf  Level IV Respected authorities’ opinions, nationally recognized expert committee/consensus panel reports based on scientific evidence  Level V Literature reviews, quality improvement, program evaluation, financial evaluation, case reports, nationally recognized expert(s) opinion based on experiential evidence **Note on Conceptual Framework  The following information is from Walden academic guides which helps explain conceptual frameworks and the reasons they are used in research. Here is the link https://academicguides.waldenu.edu/library/conceptualframework  Researchers create theoretical and conceptual frameworks that include a philosophical and methodological model to help design their work. A formal theory provides context for the outcome of the events conducted in the research. The data collection and analysis are also based on the theoretical and conceptual framework.  As stated by Grant and Osanloo (2014), “Without a theoretical framework, the structure and vision for a study is unclear, much like a house that cannot be constructed without a blueprint. By contrast, a research plan that contains a theoretical framework allows the dissertation study to be strong and structured with an organized flow from one chapter to the next.”  Theoretical and conceptual frameworks provide evidence of academic standards and procedure. They also offer an explanation of why the study is pertinent and how the researcher expects to fill the gap in the literature.  Literature does not always clearly delineate between a theoretical or conceptual framework. With that being said, there are slight differences between the two. © 2018 Laureate Education Inc. 8 https://academicguides.waldenu.edu/library/conceptualframework References The Johns Hopkins Hospital/Johns Hopkins University (n.d.). Johns Hopkins nursing dvidence-based practice: appendix C: evidence level and quality guide. Retrieved October 23, 2019 from https://www.hopkinsmedicine.org/evidence-based- practice/_docs/appendix_c_evidence_level_quality_guide.pdf Grant, C., & Osanloo, A. (2014). Understanding, Selecting, and Integrating a Theoretical Framework in Dissertation Research: Creating the Blueprint for Your House. Administrative Issues Journal: Education, Practice, and Research, 4(2), 12-26. Walden University Academic Guides (n.d.). Conceptual & theoretical frameworks overview. Retrieved October 23, 2019 from https://academicguides.waldenu.edu/library/conceptualframework © 2018 Laureate Education Inc. 9 https://academicguides.waldenu.edu/library/conceptualframework https://www.hopkinsmedicine.org/evidence-based-practice/_docs/appendix_c_evidence_level_quality_guide.pdf https://www.hopkinsmedicine.org/evidence-based-practice/_docs/appendix_c_evidence_level_quality_guide.pdf Part 3B: Critical Appraisal of Research Introduction The COVID-19 virus quickly appeared and affected the lives of everyone around the globe. From quarantines to lockdowns, no one has escaped COVID-19s consequences. Scientists worldwide are conducting research related to COVID-19, and most of the research is focused on the prevention of spread and treatments for the disease (Alexandra Barley & Coghlan, 2020). As nurses, we have a unique opportunity to support the recovery of COVID-19 patients (Alexandra Barley & Coghlan, 2020). In order to treat COVID-19 patients effectively, nurses must remain current on information and research regarding the virus. Critically appraising relevant research articles can help nurses find up to date information for the treatment of COVID-19 patients. Critical Appraisal Methodically evaluating a study for its worth, such as reliability, validity, and applicability to clinical practice, is called critical appraisal (Melnyk & Fineout-Overholt, 2018). Differentiating between the best evidence and unreliable sources forms the basis of how clinicians’ actions produce their intended outcomes for patients (Melnyk & Fineout-Overholt, 2018). When searching for research articles, it is crucial to appraise the article to determine if the evidence found therein has strong standing and, therefore, useful for implementation in daily practice. The grading of articles is standardized in levels from one to five, with one being the most rigorous and trusted evidence level and five being the least (The Johns Hopkins Hospital/Johns Hopkins University, n.d.). Deciding which level a research article falls into can allow the nurse to realize if a treatment modality is evidence-based immediately. © 2018 Laureate Education Inc. 10 The research for COVID-19 is plentiful and vast because of the extensive research base, as this is currently a worldwide endeavor. The four articles within this document consistently demonstrate and thereby conclude that pronation in COVID-19 patients involves an increase in patients oxygenation status. Improvement of the SpO2 was noted following pronation and decreased the need for oxygen demand (Anand, Baishya, Singh & Khanna, 2020). Length of time in the pronation position is a critical factor in improving oxygenation status, and starting it early can help decrease admissions to the ICU (Solverson, Weatherald & Parhar, 2020). All four of the research articles noted that the effects of pronation were not long-lasting and that resupination caused patients’ oxygenation status to drop (Elharrar et al., 2020). Best Practice The studies all focused on COVID-19 patients who required supplemental oxygen in the management of their disease. Adequate oxygen with the proper oxygen delivery device is vital when caring for COVID-19 patients. Pronation was shown in the literature to positively affect patient outcomes regarding oxygenation status (Singh, Jain & Deewan, 2020). Proper monitoring and intervention are also necessary for nurses to ascertain if pronation is working well for the patient or if an upgrade is required. Conclusion New and emerging information on COVID-19 is being created and used daily. To decipher through the abundant amount © 2018 Laureate Education Inc. 11 of information regarding COVID-19, nurses must critically acclaim any and all research articles to ensure their respective validity and reliability (Melnyk & Fineout-Overholt, 2018). Using our deductive reasoning skills, we can assess research articles with the sample precise methodology used in evaluating our patients to determine if the content is valuable for practice implementation. During the current pandemic, it is imperative to truly vet research articles related to COVID-19 so that patients will receive the best possible evidence-based care regarding such a deadly virus. © 2018 Laureate Education Inc. 12 References Anand, S., Baishya, M., Singh, A., & Khanna, P. (2020). Effect of awake prone positioning in COVID-19 patients- A systematic review. Trends in Anaesthesia and Critical Care. https://doi-org.ezp.waldenulibrary.org/10.1016/j.tacc.2020.09.008 Elharrar, X., Trigui, Y., Dols, A.-M., Touchon, F., Martinez, S., Prud’homme, E., & Papazian, L. (2020). Use of prone positioning in non-intubated patients with COVID-19 and hypoxemic acute respiratory failure. JAMA, 323(22), 2336-2338. https://doi-org.ezp.waldenulibrary.org/10.1001/jama.2020.8255 Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer. Singh, P., Jain, P., & Deewan, H. (2020). Awake prone positioning in COVID-19 patients. Indian Journal of Critical Care Medicine: Peer-Reviewed, Official Publication of Indian Society of Critical Care Medicine, 24(10), 914-918. https://doi-org.ezp.waldenulibrary.org/10.5005/jp-journals-10071-23546 Solverson, K., Weatherald, J., & Parhar, K. K. S. (2020). Tolerability and safety of awake prone positioning COVID-19 patients with severe hypoxemic respiratory failure. Canadian Journal of Anesthesia = Journal Canadien d’anesthesie. https://doi-org.ezp.waldenulibrary.org/10.1007/s12630-020-01787-1 © 2018 Laureate Education Inc. 13 https://doi-org.ezp.waldenulibrary.org/10.1007/s12630-020-01787-1 https://doi-org.ezp.waldenulibrary.org/10.5005/jp-journals-10071-23546 https://doi-org.ezp.waldenulibrary.org/10.1001/jama.2020.8255 https://doi-org.ezp.waldenulibrary.org/10.1016/j.tacc.2020.09.008