Fluent Essays

o 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. 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 Running Head: ESSENTIALS OF EVIDENCE-BASED PRACTICE 1 ESSENTIALS OF EVIDENCE-BASED PRACTICE 2 Essentials of Evidence-Based Practice Francis Mercado Dr. Linda Johanson Matrix Worksheet Template Use this document to complete Part 2 of the Module 2 Assessment, Evidence-Based Project, Part 1: An Introduction to Clinical Inquiry and Part 2: Research Methodologies Full citation of the selected article Article #1 Article #2 Article #3 Article #4 Steffens, E., Spriet, I., Van Eldere, J., & Schuermans, A. (2019). Compliance with evidence-based guidelines for the prevention of central line-associated bloodstream infections in a Belgian home care setting: An observational study. American Journal of Infection Control, 47(6), 723-725.  https://doi.org/10.1016/j.ajic.2018.10.019 Ting, J. Y., Goh, V. S., & Osiovich, H. (2013). Reduction of central line-associated bloodstream infection rates in a neonatal intensive care unit after implementation of a multidisciplinary evidence-based quality improvement collaborative: A four-year surveillance. Canadian Journal of Infectious Diseases and Medical Microbiology, 24(4), 185-190.  https://doi.org/10.1155/2013/781690 Conley, S. (2016). Central line-associated bloodstream infection prevention: Standardizing practice focused on evidence-based guidelines. Clinical Journal of Oncology Nursing, 20(1), 23-26.  https://doi.org/10.1188/16.cjon.23-26 De Miranda Costa, M., Santana, H., Saturno Hernandez, P., Carvalho, A., & Da Silva Gama, Z. (2020). Results of a national system-wide quality improvement initiative for the implementation of evidence-based infection prevention practices in Brazilian hospitals. Journal of Hospital Infection, 105(1), 24-34.  https://doi.org/10.1016/j.jhin.2020.03.005 Why you chose this article and/or how it relates to the clinical issue of interest (include a brief explanation of the ethics of research related to your clinical issue of interest) I chose this article because the study focused on assessing compliance of healthcare organizations with an acceptable practice that is recommended for the prevention of central line-related bloodstream infection. The study was ethical and perhaps much concerned about community health services The article was chosen because its research was aimed at collecting the data about the use of central venous catheters as a lifesaving treatment approach and perhaps find better approaches that could be deployed to reduce infections associated with a central line-associated bloodstream illness  (Ting et al., 2013). The selection of this article was based on its content that addressed a case study whereby healthcare professionals were observed during CVC care. It can be concluded that since its primary content was based on the patient interviews (Conley, 2016). I chose this article because its study aimed at analyzing the impacts of national system-wide QI that was initiated to promote HCAI prevention. The study was ethical and result-oriented (Dumpa et al., 2019). Brief description of the aims of the research of each peer-reviewed article The research majorly aimed to evaluate how compliance are healthcare organizations with respect to care practice that helps promote the well-being of patients suffering from central line related blood illness  (Steffens et al., 2019). The article aimed at identifying EBP strategies that can be implemented to for quality improvement to minimize the incidence associated with neonatal CLABSI The study aimed at determining EBP approaches that could be implemented within a comprehensive ambulatory cancer to help in standardization of neurology practices for central lines The researchers of the article intended to assess the effects of national systems that deploy to promote patient safety Brief description of the research methodology used Be sure to identify if the methodology used was qualitative , quantitative , or a mixed-methods approach. Be specific. The authors used interviews along with questionnaires to assess the compliance of home care nurses with a good practice that could help prevent central line-associated bloodstream diseases and other infections  (Steffens et al., 2019). This was a qualitative approach During the study, the researcher applied a retrospective observational technique to enable be able to a comparison of CLABSI in neonates that had been admitted to level three NICU between 2007 and 2011. This was to facilitate the assessment of the trend across the years selected. It was quantitative research. The author deployed a wide range of research methodologies in which case the nurses were given two types of tests that included post and pre-tests (Conley, 2016). As for the patients they were interviewed and this generated qualitative outcomes after which the nurses were audited while undertaking CVC care upon exposure to education. The study utilized well-designed before and after Quasi- experiments that targeted over 1869 hospitals. the study employed a quantitative research technique. The result indicated that utilization of system-wide interventions for the patient had an appositive impact in promoting A brief description of the strengths of each of the research methodologies used, including reliability and validity of how the methodology was applied in each of the peer-reviewed articles you selected. The approach used by the authors give their study strength of conducting one-on-one interviews that facilitate effectiveness and reliability of the data collected The major strengths of this research are that it applied Do-Study-Act cycles (PDSA). This method of study often generates desired and reliable outcomes  (Ting et al., 2013). Monthly peer-peer audits were one of the strengths of this article. Unlike clinical nurses, special audits peer-to-peer audits provide reliable results. The only weaknesses of the study are that patients’ interviews were subjective and this could reduce the study’s reliability. The strength of this article can be attributed with its efforts to reach out to more than 26 states during the research as this increases the accuracy of the results obtained. The assessment of HCAI prevents indicated a great improvement through the strategies deployed nationally and in the states (Dumpa et al., 2019). General Notes/Comments The need for home care is on-demand, it is, therefore, necessary to assess how homecare nurses are prepared in terms of standardized and recommended good practices that could help reduce impacts of central line-associated bloodstream infections  (Steffens et al., 2019). Findings indicated that multidisciplinary EBP and collaboration often result in a significant reduction in CLABSI  (Ting et al., 2013). Implementation of EBP policies that are standardized can help improve patient outcomes (Conley, 2016). The assessment and evaluation of HCAI prevention provided insights on how maintenance of hand hygiene by the nurse and other care providers could serve as the primary intervention. References Conley, S. (2016). Central line-associated bloodstream infection prevention: Standardizing practice focused on evidence-based guidelines. Clinical Journal of Oncology Nursing, 20(1), 23-26.  https://doi.org/10.1188/16.cjon.23-26 De Miranda Costa, M., Santana, H., Saturno Hernandez, P., Carvalho, A., & Da Silva Gama, Z. (2020). Results of a national system-wide quality improvement initiative for the implementation of evidence-based infection prevention practices in Brazilian hospitals. Journal of Hospital Infection, 105(1), 24-34.  https://doi.org/10.1016/j.jhin.2020.03.005 Steffens, E., Spriet, I., Van Eldere, J., & Schuermans, A. (2019). Compliance with evidence-based guidelines for the prevention of central line-associated bloodstream infections in a Belgian home care setting: An observational study. American Journal of Infection Control, 47(6), 723-725.  https://doi.org/10.1016/j.ajic.2018.10.019 Ting, J. Y., Goh, V. S., & Osiovich, H. (2013). Reduction of central line-associated bloodstream infection rates in a neonatal intensive care unit after implementation of a multidisciplinary evidence-based quality improvement collaborative: A four-year surveillance. Canadian Journal of Infectious Diseases and Medical Microbiology, 24(4), 185-190.  https://doi.org/10.1155/2013/781690 © 2018 Laureate Education Inc. 2 Central Line-associated Bloodstream Infections. Walden University Dr. Linda Johanson Francis Mercado 1 Identification and description of the clinical issue. The clinical issue or problem identified for my study is the central line bloodstream infections (CLABSI) Central line bloodstream infections(CLABSI) is a health condition that affects many people. It occurs when pathogens such as bacteria and other germs invade the patients central line after which they get into the bloodstream. CLABSI related infections are often serious but they can be successfully managed through appropriate treatment approaches. Femoral central venous catheters and internal jugular along with subclavian central lines have high risk of getting infected. As per the survey conducted in 2019 about the central line bloodstream infections, it was found that the infection ratio for the said infections was 0.8 per 1000 central line days. This means that over 250000 people across the world bloodstream infections occur yearly and most of them are associated with the presence of intravascular devices. 2 Identification and description of the clinical issue. Cont.……… Risk factors for Central Line-associated Bloodstream Infections (CLABSI) presence of gastrostomy tube.  ICU placement of central venous catheter. Immunosuppression. Antibiotic therapy(Steffens et al., 2019,). Poor nutrition; Multiple invasive procedures.  nonoperative cardiovascular disease. Central line bloodstream infection is associated with numerous predisposing risk factors. From healthcare stats, it can be said that central line catheters are the common causes of health callings linked to CLABSI. However there are many other risk factors that predispose patients to contracting or developing central line bloodstream infections. Contamination may occur within the central line and this may cause central line related illness. Such contamination include; non interact dressing, contaminated infusion, central venous access devices as well as patients skin flora. 3 How to develop PICOT question for CLABSI By analyzing the major components of PICOT, that is P-population, patients, or problem at hand, I-interventions required to solve the issue, C- control or alternative interventions to be compared, O-outcome or the objective to be achieved and T-time framework required to achieve desired outcome(Steffens et al., 2019). This will help formulate questions such as; Who and what is the issues that need to be addressed? What is the proposed intervention and actions to remedy the issue? What is desired outcome? How much time is required to realized anticipated results? To come up with PICOT statement of question on the clinical issues that I had chosen I had to analyze all the components of PICOT to identify their meanings so as to develop a questions that meets PICOT guidelines. The analysis of the PICOT components will help develop questions about the what are kind of population or patients affected with central line bloodstream infection in Belgian home care setting. 4 Research questions used to refine the search outcome. Numerous questions may be developed which are associated with the issue of compliance with EBP healthcare guidelines that can be used to reduce incidences of patients contracting central line associated bloodstream infections. What are main causes of CLABSI in Belgian home care setting? From the result generated, it can be said that many patients are suffering from the CLABSI health challenges as a result of incorrect insertion of a central line by healthcare professionals. Another questions for refining the EBP on the said issues was about the most applicable approaches or medical interventions that could be used to reduce increased chances of developing CLABSI CLABSI has been identified as one of the health challenge that whose causes have been associated contaminated infusion, patient’s skin flora and contamination on insertion. Such risk may be reduce if nurses and other healthcare professional get extensive understanding on the major causes and risk factors leading to occurrence of CLABSI among patients. 5 PICOT Question on CLABSI will treatment of adults patients with CLABSI (P) be effective when using intravenous antibiotics therapy (I) as opposed to use of supportive approaches such as oxygen therapy along with maintenance of hand hygiene (C) to reduce the incidence of CLABSI (O) among the adults within a period of eight months(T)? antibiotics such as ampicillin should be used as the first line of antibiotic therapy to treat adult patients with CLABSI. Also  Vancomycin, Linezolid or daptomycin may be used in serious cases where the CLABSI pathogens seem to be resistant to ampicillin. Antibiotics are type of medication that are used to treat infections caused by wide rage of pathogens. Normally the type of antibiotics given to patients largely depend on the kind of bacterial found in the blood stream of the patient. For serious infections, both antifungal and antibiotic medicine may be given via PICC line to reduce the rate of infection. 6  Four Research Databases Used To Conduct Search  I used wide range of research databases to conduct search for the clinical issues of my interest. These included; Scopus: it’s the worlds largest abstract and citation database. MedlinePlus: this contains chapters and whole articles that use @MCPHS option to locate whole test for incomplete chapters. Cochrane Library (De Miranda Costa et al., 2020). PubMed: provides medicine and science based publications. By the help of the above mentioned research databases it was much easy to collected numerous articles have been enriched with content on the adult CLABSI along with its causes, predisposing factors, diagnosis and treatment measures to be used to effectively control such conditions. PubMed, Cochrane Library, Scopus and Scopus are all better equipped in terms of articles and chapters whose content provide more insights about medicine and other healthcare related problems together with possible remedies to such issues. 7 Levels Of Evidence In Each Of The Four Peer-reviewed Articles Article #1: there was evidence acquired from a thorough examination and evaluation of how compliance are healthcare facilities based in the nursing practice that promote well-being of patients suffering from central line bloodstream infections. (level2) Artcle#2: through various trails, the article determined the best EBP approaches that could be utilized for quality improvement to reduce CLABSI cases among children. (Level 3) 8 Levels Of Evidence In Each Of The Four Peer-reviewed Articles Cont.…. Article#3: via randomized trials and systematic review of the existing approaches, the article provided that EBP treatment approaches need to deployed within a comprehensive ambulatory cancer to promote better strategies that standardize neurology practices for central line infections(level 1). Article #4. systematic review and evaluation of the impacts of existing national systems that promote patient health, well-being and safety. (Level 4) Strengths of using systematic review for clinical research is that it provides scientists and other research with opportunity to identify and select research database whose content reduce the incidence of biased projection or results. This increases the accuracy of data collected and perhaps provide reliable content that is trusted, credible and therefore can be adopted for implementation in a clinical setup. 9 References Conley, S. (2016). Central line–associated bloodstream infection prevention: Standardizing practice focused on evidence-based guidelines. Clinical Journal of Oncology Nursing, 20(1), 23-26. https://doi.org/10.1188/16.cjon.23-26 De Miranda Costa, M., Santana, H., Saturno Hernandez, P., Carvalho, A., & Da Silva Gama, Z. (2020). Results of a national system-wide quality improvement initiative for the implementation of evidence-based infection prevention practices in Brazilian hospitals. Journal of Hospital Infection, 105(1), 24-34. https://doi.org/10.1016/j.jhin.2020.03.005 Steffens, E., Spriet, I., Van Eldere, J., & Schuermans, A. (2019). Compliance with evidence-based guidelines for the prevention of central line–associated bloodstream infections in a Belgian home care setting: An observational study. American Journal of Infection Control, 47(6), 723-725. https://doi.org/10.1016/j.ajic.2018.10.019 Ting, J. Y., Goh, V. S., & Osiovich, H. (2013). Reduction of central line-associated bloodstream infection rates in a neonatal intensive care unit after implementation of a multidisciplinary evidence-based quality improvement collaborative: A four-year surveillance. Canadian Journal of Infectious Diseases and Medical Microbiology, 24(4), 185-190. https://doi.org/10.1155/2013/781690 10