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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: 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. https://journals.sagepub.com/action/saml2post https://oce-ovid-com.ezp.waldenulibrary.org/article/00000446-201011000-00027?sequence=0&clickthrough=y https://oce-ovid-com.ezp.waldenulibrary.org/article/00000446-201009000-00024?sequence=0&clickthrough=y https://oce-ovid-com.ezp.waldenulibrary.org/article/00000446-201007000-00026?sequence=0&clickthrough=y 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 Jadiam Lopez MSN, Walden University NURS-6052C Dr. Emily Keyes 09/04/2021 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 selected article Article #1 Article #2 Article #3 Article #4 Kapucu, S., & ÖZden, G. (2017). Nursing Interventions to Prevent Ventilator-Associated Pneumonia in ICUs. Konuralp Tıp Dergisi. https://doi.org/10.18521/ktd.285554 Jam, R., Mesquida, J., Hernández, S., Sandalinas, I., Turégano, C., Carrillo, E., Delgado-Hito, P. (2018). Nursing workload and compliance with non-pharmacological measures to prevent ventilator-associated pneumonia: a multicentre study. Nursing in Critical Care, 23(6), 291–298. https://doi.org/10.1111/nicc.12380 Frota, M. L., Campanharo, C. R. V., Lopes, M. C. B. T., Piacezzi, L. H. V., Okuno, M. F. P., & Batista, R. E. A. (2019). Good practices for preventing ventilator-associated pneumonia in the emergency department. Revista Da Escola de Enfermagem Da USP, 53. https://doi.org/10.1590/s1980-220x2018010803460 Al-Rabeei, N., Al-jaradi, A., Al-Wesaby, S., & Alrubaiee, G. (2019). Nursing Practice for Prevention of Ventilator-Associated Pneumonia in ICUs at Public Hospitals in Sana’a, City-Yemen. Al-Razi University Journal of Medical Sciences, 3(2), 69–80. 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 it outlines common nursing interventions to prevent ventilated-associated pneumonia in the ICU. The clinical issue of interest is ventilated-associated pneumonia (VAP) specifically the common and best interventions used by nurses to prevent the infection. The ethics related to the clinical issue is non-maleficence which requires medical professionals to do no harm and ensure a patient’s safety. I chose this article because it describes the influence of the nurse’s workload in complying and embracing common practices that are designed to prevent ventilator-associated pneumonia. The study is related to the clinical issue since evidence-based guidelines do not guarantee compliance and acceptance of VAP prevention interventions. Nurses frequently fail to apply common practices due to inadequate training, excessive workload, and lack of clinical outcomes. Nurses are ethically required to select interventions that produce the best outcomes and improve patient safety. I selected this article because it outlines best practices used by nurses to prevent VAP in the emergency department. All hospitals have guidelines and instructions that guide nurses during the prevention and treatment of VAP in different healthcare settings. The guidelines are considered to be the best practices since they facilitate decision-making and lead to the best outcomes. The article is related to the clinical issue since it evaluates the compliance of nurses to recommended interventions and suggests ways to improve care. Nurses are required to do no harm to patients and perform procedures that increase the quality of care. I selected the article because it describes common nursing practices used in the ICU to prevent ventilator-associated pneumonia. The nursing interventions outlined in the research article are based on scientific knowledge and produce the best outcomes. The article is related to the clinical issue since it recognizes the role of nurses in preventing VAP and seeks to assess the effectiveness of common prevention practices. Nurses are vital in ensuring the highest standards of care in the ICU especially during the prevention of common infections. Brief description of the aims of the research of each peer-reviewed article The article aimed to investigate interventions used to prevent ventilated-associated pneumonia in the ICU among nurses in four Ankara university hospitals. The researchers sought to understand common practices used in the ICU to prevent VAP. The study described common primary practices embraced by nurses to prevent VAP and the reasons for non-adherence to recommended interventions. The study aimed to find out the impact of the nurses workload on the prevention of VAP. The researchers also sought to evaluate nursing knowledge on various non-pharmacological measures used to prevent the infection. The study also describes the nurse’s attitudes to compliance with non-pharmacological measures. The impact of nurse’s workload was assessed in two adult intensive care units. The study aimed to evaluate the nurses compliance to good practices designed to prevent VAP in a university hospital. Ventilated-associated pneumonia is frequently discovered in the ICU but mostly begins in the emergency room during intubation. The research study aimed to emphasize the importance of adopting good practices at the beginning of pre-hospital service and during the entire care process. The research was conducted in a Sao-Paulo University Hospital. The research study aimed to describe common nursing practices used in Yemen public hospitals to prevent VAP. The researchers also identified factors associated with reduced knowledge among nurses and ineffective hospital practices. Public hospitals were chosen since they provide primary, secondary, and tertiary care to Yemen citizens. Prevention of VAP rewires the highest standard of care and interventions based on scientific evidence. 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 article is a quantitative descriptive study. The researchers incorporated questionnaires to collect data from 290 ICU nurses. The questionnaires collected data on participant characteristics and common interventions used by the nurses. Data were analyzed using the statistical package for social sciences (SPSS). After analysis, data was presented through numbers and percentages describing common practices. The researchers used a quantitative methodology to collect and analyze data. The article is a cross-sectional observational study. Observation and questionnaires were used to collect data. Nurses working in the ICU completed a knowledge questionnaire and compliance was assessed later through observation. The data collection tools measured nursing knowledge, overall workload, and compliance. Quantitative data were analyzed using the statistical package for social sciences. Data was presented through tables and graphs. The article is a cross-sectional analytical study. The researchers adopted a quantitative approach during data collection and analysis. Data collection methods included observation of good practices used by nurses in the emergency room and patient hospital records. The researchers observed practices such as raising the patient’s head, reducing sedative infusion, and maintaining oral hygiene. Hospital records were observed for signs such as low white blood cells count, high temperature, and worsening radiology. Data were presented using tables. The article is a descriptive cross-sectional study. A quantitative methodology was adopted by researchers to collect and analyze data. Data was collected for three months through observation. An observation checklist was used to carefully detect common practices used by Yemen nurses. After collection, quantitative data were analyzed using the statistical package for social sciences. Data were presented using tables and pie charts. 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 descriptive study was quick and easy to conduct. It provided an in-depth understanding of the clinical issue specifically the diverse nursing interventions used to prevent VAP in the ICU. However, the researchers do not describe ways through which reliability and validity were increased throughout the research process. The strength of the cross-sectional observational research methodology is it provided a multifaceted approach that gives a broad view of the data. The study setting comprised of two ICUs with huge workloads making observation an effective method of data collection. Reliability and validity were increased through familiarizing the participants with the assessment and motivating respondents. The strength of the cross-sectional analytical study is it was cheap and easy to conduct. The data on all selected variables was collected once thereby saving time. The methodology was effective since the researchers measured the prevalence of the factors that were identified during the literature review. Reliability and validity were ensured through the measurement of multiple outcomes of compliance to good practices. The strength of the descriptive, cross-sectional study was the unique description of nursing experiences in the ICU. Observation is effective in describing individual experiences because it removes academic barriers and allows the researcher to observe ways through which other people experience events. The validity of the research collection tools was ensured through expert review. Reliability was guaranteed through the Cronbachs Alpha tool. General Notes/Comments The results are biased and cannot be generalized since data were obtained from specific settings in a hospital. The researchers recommend that nurses should receive training and specific protocols should be observed during the prevention of VAP. Since nurses were aware they were being observed, they may have changed their behaviors thereby altering the results. Non-compliance and skepticism of the interventions are not related to the level of knowledge or the nurse’s workload. The best practices identified by the researchers include head elevation and oral hygiene. The findings are limited since the study was conducted in a single setting thereby the results cannot be generalized to other study sites. The study discovered that nurses have a poor perception of VAP and limited knowledge of interventions to prevent the infection. Nurses should be effectively trained to help them critically assess the best and common practices to implement in the ICU and hospital emergency settings. Matrix Worksheet Template © 2018 Laureate Education Inc. 2 EVIDENCE BASED PROJECT MSN, Walden University NURS-6052C Dr. Emily Keyes 10/01/2021 INTRODUCTION Most of the health care facilities have implemented Evidence Based Practices mostly in nursing EBP involves the use of research evidence, clinical expertise as well as patient’s preferences There is a confusion on the pros and cons of EBP in nursing Thus, PICOT questions are based on the use of EBP in each day’s nursing project. PICOT QUESTION With the mechanically ventilated patients in the ICU aged 40 years or older, does the use of oral chlorhexidine in comparison to no chlorhexidine aid in reducing the incidence of VAP in 5 weeks? population intervention comparison outcome Time mechanically ventilated patients in the ICU aged 40 years or older use of oral chlorhexidine use of no oral chlorhexidine reducing the incidence of VAP 5 weeks DATABASES USED FOR THE RESEARCH PubMed: The database aids in ensuring easy search per topic by using the search terms in order to filter results and find certain peer reviewed articles Google Scholar Allows me to easily navigate as well as filter the results to fit in my research Cochrane Library The database offers a wide range of systematic reviews as well as peer reviewed articles CINAHL Provides access to associated health topics as well as nursing based literature using electronic books and journals. PEER REVIEWED ARTICLES LEVELS OF EVIDENCE STRENGTHS OF SYSTEMATIC REVIEWS REFERENCES Eastern Illinois University. (2018). Why Is Evidence-Based Practice In Nursing So Important? Retrieved from https://learnonline.eiu.edu/articles/rnbsn/evidence-based-practice-important.aspx Davies, K. S. (2011). Formulating the Evidence Based Practice Question: A Review of the Frameworks. Evidence Based Library and Information Practice, 6(2), 75–80.