DNP 820 Discussions & Critical Appraisal of Practice Guidelines

DNP 820 Discussions & Critical Appraisal of Practice Guidelines

DNP 820 Discussions & Critical Appraisal of Practice Guidelines

Topic 1 DQ 1

Describe a situation in which a new clinical practice was put into place. Was there a DNP-prepared nurse leading the translation of the practice from research to practice? If so, describe the process that individual took for translation and why it made a difference in the translation. If there was not a DNP-prepared nurse, describe the process and what would have been different about the process had there been a DNP-prepared nurse leading the practice translation?

DNP 820 Topic 1 DQ 2

Compare the PhD and DNP degrees. Define the differences in roles and education associated with the two degrees. Describe future opportunities for DNP-prepared nurses.

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DNP 820 Topic 2 Discussions

DQ 1 Which research methodology would be the most appropriate for your project and how does it align with your clinical question, data collection, and data analysis? Demonstrate an example of when you might use the opposite methodology in your EBP projects and why.

DQ 2 Within nursing, the patient’s perception is recognized as the patient’s reality. How does this way of knowing in nursing fit within an objective or subjective paradigm of the world? Explain your reasoning.

Example Topic 2 DQs Approach

Which research methodology would be the most appropriate for your project and how does it align with your clinical question, data collection, and data analysis? Demonstrate an example of when you might use the opposite methodology in your EBP projects and why.

This project will use quantitative methodology with quasi-experimental design. It aligns with my project due to the fact that there will be a certain quantity of charts reviewed in a certain time frame. That data will be reviewed and a chart of before and after the intervention can be drafted.  Quantitative research basically provides definite numbers and to test a hypothesis ( Eddy, 2016, p.7).  An example of when qualitative research could be used in an EBP project would be to perform a study on the effects of the educational training on the medical assistants. This would be to understand how the training affects their behaviors. Eddy, A. (2016). Understanding quantitative research methodology results — what do the numbers mean? Midwifery News, (83), 7-8.

Topic 2 DQ 2 Within nursing, the patient’s perception is recognized as the patient’s reality. How does this way of knowing in nursing fit within an objective or subjective paradigm of the world? Explain your reasoning. Being that nurses are advocates for our patients, we have to develop a trusting relationship with our patients. There will be subjective and objective cues mixed together to build the relationship. Trying to understand a patient where they are is essential to the idea of knowing your patient. Carper’s pattern of knowing suggest that if the nurse caring for the patient knows themselves, they will be able to know the patient (Mantzorou and Mastrogiannis, 2011, p.254). We as nurses must be truthful and honest with ourselves as well as patients in order to advocate for their well-being. Advocating for our patients sometimes involves advocating to the patient for the patient. Mantzorou, M. & Mastrogiannis, D. (2011). The value and significance of knowing the patient for professional practice, according to the Carper’s pattern of knowing. Health Science Journal (5)4,254-261.

DNP 820 Topic 3 DQ 1

Which method do you prefer in determining levels of evidence? Describe two advantages to the method and one disadvantage to the method. Explain how you have used this method in your current practice or education. Why are levels of evidence important in selecting empirical articles for your ROL (Chapter 2 of your DPI project)?

DNP 820 Discussions & Critical Appraisal of Practice Guidelines Topic 3 DQ 2

Research can take between 10-20 years to be translated into practice. Discuss your thoughts on the reasons why this may occur and describe the barriers within your own practice that prevent you from practicing from a 100% evidence base.

DNP 820 Topic 4 DQ 1

Reliability and validity are often misunderstood and not given much notice in research articles. Using any example, demonstrate how you would correctly describe these two terms to a nurse prepared at a bachelor’s degree level or below. Then describe why the reliability and validity of a study is important for translation.

DNP 820 Topic 4 DQ 2

What are the criteria for selecting qualitative versus quantitative resources in relation to your literature review? Which method(s) of research are you selecting? Why?

DNP 820 Topic 5 DQ 1

What effect does a meta-synthesis or meta-analysis have on research translation? Describe a clinical practice in place that is supported by this level of evidence.

DNP 820 Discussions & Critical Appraisal of Practice Guidelines Topic 5 DQ 2

Comparative effective research is important in translating research. Describe one study that used comparative effective research. What were the findings and were they translated into practice?

DNP 820 Topic 6 DQ 1

There is a heavy focus on achieving statistical significance when evaluating outcomes. Often in research or EBP projects, there is no statistical significance, only possible clinical significance. When is it appropriate to deem a project’s outcomes successful only using clinical significance as the only measure of success?

Topic 6 DQ 2

The three components of EBP include clinical expertise, best evidence, and patient preference. Often, patient preference and clinical expertise are at odds with each other. Describe a scenario where you might need to mediate this issue and what is the solution when this occurs. It can be a real-life example as well.

DNP 820 Topic 7 DQ 1

Choose one model for EBP implementation. Describe its components and why you believe this model is most appropriate for assisting in translational activities. Contrast this model with another.

DNP 820 Topic 7 DQ 2

Discuss the role of the DNP-prepared nurse in sustaining an EBP culture. What are two effective methods the DNP can use in sustaining an EBP culture?

DNP 820 Discussions & Critical Appraisal of Practice Guidelines Topic 8 DQ 1

Describe and discuss the differences between research, research utilization, and evidence-based practice. Provide examples.

DNP 820 Discussions & Critical Appraisal of Practice Guidelines Topic 8 DQ 2

Describe how you will assist others to generate their own evidence-based practice questions. Discuss what your professional obligation as a DNP-prepared nurse is related to evidence-based practice, patients, and other nurses?

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EXAMPLE Critical Appraisal of Practice Guidelines

The AGREE II (Appraisal of Guidelines for Research & Evaluation) tool is used internationally to assess the methodological transparency in which a guideline is developed (Brouwers, Kerkvliet&Spithoff, 2016). The AGREE II provides a framework for the researcher in the assessment of evaluating a clinical practice guideline (Brouwers, Kerkvliet&Spithoff, 2016). The AGREE II is a valuable tool that is used by policymakers, educators, guideline developers, and practitioners to critically appraise the evidence that is used to improve patient health and guide practices (Brouwers, Kerkvliet&Spithoff, 2016). The tool covers twenty-three core components and has six domains that use a rating score of tools that ranges from 1 strongly disagree, and 7 strongly agree (Brouwers, Kerkvliet&Spithoff, 2016). The guidelines for perioperative management of antithrombotic medication that cover the assessment of perioperative thromboembolic risk that are secondary to the medical condition and that are related to procedures will be analyzed using the AGREE tool which will cover the domains and overall guideline assessment and score (see Appendix A) and reporting checklist (see Appendix B) to identify if the evidence that supports the guidelines used in perioperative management of thromboembolic (Hornor et al., 2018).

Practice Guideline

The guidelines focus on several areas such as the thromboembolic risk if the antithrombotic agent is discontinued perioperatively (Section I) (Hornor et al., 2018). Section II determines the bleeding risk of the surgical procedure and patient factors that modify this risk (Hornor et al., 2018). Section III further develops an evidence-based perioperative antithrombotic medication management strategy for elective surgical patients (Hornor et al., 2018). Section IV developed an evidenced-base perioperative antithrombotic medication management intervention for the patient having elective surgery (Hornor et al., 2018). Lastly, Section V outlines perioperative antithrombotic medication management in the nonelective surgical setting (Hornor et al., 2018).The application of AGREE II will assist in assessing the quality of the guideline and address the perioperative management of antithrombotic medications to improve patient outcomes.

Agree II Evaluation

Domain 1: Scope and Purpose

1. The overall objective(s) of the guideline is (are) specifically described.

Strongly Disagree 1 2 3 4 5 67 Strongly Agree

Comments: The document is intended to update, summarize, and combine information into aclinically rigorous format suitable for a broad surgical readership for surgeon. The objective of these guidelines is to update the surgeon reader in the multiple areas that affect the management of antithrombotic medication in the perioperative area (Hornor et al., 2018).The following sections were the focus: determines the bleeding risk of the surgical procedure and patient factors that modify this risk; develop an evidence-based perioperative antithrombotic medication management strategy for elective surgical patients; development of an evidenced-base perioperative antithrombotic medication management intervention for the patient having elective surgery; outlines perioperative antithrombotic medication management in the nonelective surgical setting (Hornor et al., 2018). The objectives were clear and concise as they were updates from previous work that had been conducted in the perioperative management of antithrombotic medication.

2. The health question(s) covered by the guideline is (are) specifically described.

Strongly Disagree 1 2 3 4 5 6 7 Strongly Agree

Comments: The aging surgical population that is on chronic anticoagulation therapy and their risk factors along with preferred treatment regimen that is associated with their risks were identified. The objective was to update prior information regarding the use of antithrombotic medication during the perioperative phase. The information was a bit hard to find with the different topics being addressed. The guidelines to be addressed throughout were identified in summary on page 521, then further elaborated on throughout the article.

3. The population (patients, public, etc.) to whom the guideline is meant to apply is

     specifically described.

Strongly Disagree 1 2 3 4 5 6 7 Strongly Agree

Comments: The population to whom the guidelines were specifically meant for was the surgeon as to give guidance on the complex care of patients on anticoagulation in the perioperative setting. Due to the lack of evidence that has contributed to bleeding risk stratification guidelines in the operating room the surgeon should focus on his or her bleeding risk regarding the risk of bleeding based on the patient’s individual pathology, anatomy, risk factors, and their clinical experience with the surgical procedure at hand (Hornoret al., 2018). With nearly thirty million prescriptions for warfarin that have been written annually the clinician must be equipped with a strategy to address the most common complication of these therapies (Simon, Streitz, Sessions, &Kaide, 2018).

Domain 2: Stakeholder Involvement

4. The guideline development group includes individuals from all relevant professional

     groups. 

Strongly Disagree 1 2 3 4 5 6 7 Strongly Agree

Comments:The panel for the perioperative management of antithrombotic medication management was conducted by seven medical doctors that had a with a wide range of specialties i.e., MPH, MS, MBA, CPE, FACS, FASMB, Ph.D., MSc, FRCS, and MSHS. The locations and affiliation organization was from the American College of Surgeons, Division of Research and Optimal Patient Care, Chicago, IL; John Peter Smith Health Network, Fort Worth, TX; the Departments of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH; The FaculdadeMedicina, Universidade de Lisboa, Hospital Garcia de Orta, Almada, Portugal; UPMC/Pinnacle/Lancaster, Department of Cardiothoracic Surgery, Lancaster, PA; Moffitt Cancer Center, University of South Florida, Tampa, FL; University of California, Los Angeles, Los Angeles, CA; Roger Williams Medical Center, Providence, RI; University of Minnesota Medical Center, Minneapolis, MN; and the University of Washington, Seattle, WA (Hornor, et al., 2018).DNP 820 Discussions & Critical Appraisal of Practice Guidelines

5. The views and preferences of the target population (patients, public, etc.) have been sought.  

Strongly Disagree 1 2 3 4 5 6 7 Strongly Agree

Comments: Inside the framework of the existing guidelines, specific topics were recognized through an iterative process that involved current literature and review of existing guidelines as well as multi-iterative feedback from an internal expert panel (Hornor et al., 2018). Brouwers, Kerkvliet&Spithoff (2016) suggested that evidence from literature review and information gathered that is used to inform the guideline development process is what makes up the stakeholder involvement.

6. The target users of the guideline are clearly defined.

Strongly Disagree 1 2 3 4 5 6 7 Strongly Agree

Comments: The AGREE II collaboration has clearly defined the quality of the guideline as the confidence that the potential biases involved in the development of the guideline has been addressed adequately and the recommendations are both internally and externally valid and feasible for practice. The guidelines for perioperative management of antithrombotic medication that cover the assessment of perioperative thromboembolic risk that are secondary to the medical condition and that are related to procedures clearly identifies the target users. For instance, the target users involve patients with perioperative thromboembolic risk and information that could be obtained from the patient’s reviews. There guideline also contains literature reviews from the patient’s experiences, which could be taken into consideration by the group. Also, the target group includes the practitioners, as well as patients having elective surgery. Therefore, it is important to clearly define the target end-users or target audience so that it becomes easy to determine whether the guideline if beneficial to them in the long-run.

 

Domain 3: Rigour of Development

7. Systematic methods were used to search for evidence.

Strongly Disagree 1 2 3 4 5 6 7 Strongly Agree

Comments: It is important to ensure that the guideline is pre-tested to assist in further validation, especially among the target users before its publication. For instance, it is crucial to ensure that the guideline is piloted in one or several primary care practices or in healthcare facilities and the processes should be adequately documented. The agreement clearly indicates the systematic methods that have been used to develop the guideline through evidence-based practice. Also, relevant literature was obtained through searchers from relevant databases through the use of appropriate terms and vocabulary. The specific key terms were included although the results were restricted through systematic reviews. Besides, the evidence based searchers from the relevant databases were appropriately reviewed, updated and incorporated in the most current version of the agreement.

8. The criteria for selecting the evidence are clearly described.

Strongly Disagree 1 2 3 4 5 6 7 Strongly Agree

Comments: The details of the approach used to search for evidence was given including appropriate search terms. Also, the sources consulted coupled with the dates of the literatures searches were also covered were documented. The sources used included electronic databases, such as MEDLINE, coupled with databases from systemic reviews. The strategy also included hand-searching journals as well as reviewing of conference proceedings as well as other necessary guidelines. Furthermore, the quality of the evidence used in the guideline were rated using the criteria and recommendations displayed in a tabular manner to optimize the quality of the reviewer. Also, when developing the guideline, the quality of the evidence coupled with the classification of recommendations were provided to assist in generating of summary statements as well as recommendations of each section. The AGREE II guideline also included description of the study design through the application of data extraction with an exclusion criteria included.DNP 820 Discussions & Critical Appraisal of Practice Guidelines

 

9. The strengths and limitations of the body of evidence are clearly described.

Strongly Disagree 1 2 3 4 5 6 7 Strongly Agree

Comments: when developing the guideline, criteria for exclusion and inclusion of evidence should be identified by the search. It is also important to ensure that the criteria is explicitly described together with the reasons for including and excluding the evidence, which should be clearly stated. The authors of the guideline included evidence from randomized trial and excluded articles that were not written in English. The strengths of the AGREE II guideline for assessing the quality of the perioperative management of antithrombotic medications to improve patient outcomes include recommendations that are consistent with other credible and validated guidelines that mainly target health care practitioners to offer evidence-based perioperative antithrombotic medication management strategy for elective surgical patients.

There are other strengths in each of the summary statements that coupled with recommendations offered in the guidelines that are assigned with  quality for evidence-based perioperative antithrombotic medication management strategy for elective surgical patients to offer standardized care. In addition, the evidence are based on a number of current sources coupled with evidence obtained when making comparisons with other healthcare practices to take care for elective surgical patients.

The limitation of the first section of the agreement indicates that most part of the summary statements as well as recommendations constitute evidence obtained from well designed clinical trials from several research groups. As such, there are potential reasons for the moderate quality of evidence as well as recommendations that do not provide assistance in the collection of reliable data to determine the use of evidence-based perioperative antithrombotic medication management strategy for elective surgical patients. It is also important to include in the discussion of selection bias, risk bias, which should also be incorporated in the summary statements. However, there is lack of applied evidence in the summary statements as well as recommendations.

 

 

 

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10. The methods for formulating the recommendations are clearly described.

Strongly Disagree 1 2 3 4 5 6 7 Strongly Agree

11. The health benefits, side effects, and risks have been considered in formulating the recommendations.

Strongly Disagree 1 2 3 4 5 6 7 Strongly Agree

 

12. There is an explicit link between the recommendations and the supporting evidence.

Strongly Disagree 1 2 3 4 5 6 7 Strongly Agree

Comments:

12. There is an explicit link between the recommendations and the supporting evidence.

Strongly Disagree 1 2 3 4 5 6 7 Strongly Agree

Comments:

 

13. The guideline has been externally reviewed by experts prior to its publication.

Strongly Disagree 1 2 3 4 5 6 7 Strongly Agree

Comments:

 

14. A procedure for updating the guideline is provided.

Strongly Disagree 1 2 3 4 5 6 7 Strongly Agree

Comments:

Domain 4: Clarity of Presentation

15. The recommendations are specific and unambiguous.

Strongly Disagree 1 2 3 4 5 6 7 Strongly Agree

Comments:

 

16. The different options for management of the condition or health issue are clearly

       presented. 

Strongly Disagree 1 2 3 4 5 6 7 Strongly Agree

 

 

 

 

 

 

17. Key recommendations are easily identifiable.

Strongly Disagree 1 2 3 4 5 6 7 Strongly Agree

Comments:

Domain 5: Applicability

18. The guideline describes facilitators and barriers to its application.

Strongly Disagree 1 2 3 4 5 6 7 Strongly Agree

Comments:

 

 

 

 

 

 

19. The guideline provides advice and/or tools on how the recommendations can be put

       into practice.

Strongly Disagree 1 2 3 4 5 6 7 Strongly Agree

Comments:

 

 

 

 

 

 

20. The potential resource implications of applying the recommendations have been

       considered.

Strongly Disagree 1 2 3 4 5 6 7 Strongly Agree

Comments:

 

 

 

 

 

 

 

 

Domain 6: Editorial Independence

22. The views of the funding body have not influenced the content of the guideline.

Strongly Disagree 1 2 3 4 5 6 7 Strongly Agree

Comments:

 

23. Competing interests of guideline development group members have been recorded

       and addressed.

Strongly Disagree 1 2 3 4 5 6 7 Strongly Agree

 

Overall Guideline Assessment:

1.     Scope and Purpose:

2.     Stakeholder Involvement:

3.     Rigour of Development:

4.     Clarity of Presentation:

5.     Applicability:

6.     Editorial Independence:

Overall Total:  / 161 =

Rate the overall quality of this guideline

Lowest possible quality 1 2 3 4 5 6 7 Highest possible quality

I would recommend this guideline for use.

Yes No

Notes:

 

 

Conclusion

References

Brouwers, M. C., Kerkvliet, K., &Spithoff, K. (2016). The AGREE Reporting Checklist: A tool         to improve reporting of clinical practice guidelines. BMJ352(i1152), 1-2.      http://dx.doi.org/10.1136/bmj.i1152

Hornor, M. A., Duane, T. M., Ehlers, A. P., Jensen, E. H., Brown, P. S., Pohl, D.&Laronga, C.          (2018). American college of surgeons’ guidelines for the perioperative management of antithrombotic medication. Journal of the American College of Surgeons227(5), 521-            536.https://doi.org/10.1016/j.jamcollsurg.2018.08.183

Lam, H., Katyal, N., Parker, C., Natteru, P., Nattanamai, P., Newey, C. R., & Kraus, C. K.   (2018). Thromboelastography with platelet mapping is not an effective measure of      platelet inhibition in patients with spontaneous intracerebral hemorrhage on antiplatelet     therapy. Cureus10(4). https://doi.org/10.7759/cureus.2515

Simon, E. M., Streitz, M. J., Sessions, D. J., &Kaide, C. G. (2018). Anticoagulation Reversal. Emergency medicine clinics of North America36(3), 585-601.

Appendix A

Overall Guideline Assessment

Domain Score
Domain 1: Scope and Purpose
1. The overall objective(s) of the guideline is (are) specifically described. 6
2. The health question(s) covered by the guideline is (are) specifically described. 6
3. The population (patients, public, etc.) to whom the guideline is meant to apply is specifically described 7
 ORDER NOW Domain Total: 19
Domain 2: Stakeholder Involvement
4.The guideline development group includes individuals

from all relevant professional groups.

7
5. The views and preferences of the target population

(patients, public, etc.) have been sought.

5
6. The target users of the guideline are clearly identified.  
  Domain Total:
Domain 3: : Rigour of Development
7. Systematic methods were used to search for evidence.  
8. The criteria for selecting the evidence are clearly described.  
9. The strength and limitations of the body of evidence are clearly described.  
10. The methods for formulating the recommendations are clearly described.  
11. The health benefits, side effects, and risks have been considered in formulation the recommendations.  
12. There is an explicit link between then recommendations and the supporting evidences.  
13. The guideline has been externally reviewed by experts prior to its publication.  
14. A procedure for updating the guideline is provided.  
  Domain Total:
Domain 4: Clarity of Presentation
15. The recommendations are specific and unambiguous.  
16. The different options for management of thecondition or health issue are clearly presented.  

 

17. Key recommendations are easily identifiable.  
  Domain Total: 18
Domain 5: Applicability
18. The guideline describes facilitators and barriers to itsapplication.  
19. The guideline provides advice and/or tools on how the recommendations can be put into practice.  
20. The potential resource implications of applying the

recommendations have been considered.

 
21. The guideline presents monitoring and/or auditing

criteria. DNP 820 Discussions & Critical Appraisal of Practice Guidelines

 
  Domain Total:
Domain 6: Editorial Independence
22. The views of the funding body have not influencedthe content of the guideline.  
23.Competing interests of guideline development groupmembers have been recorded and addressed.  
  Domain Total:
Overall Score: /161 =  

DNP 820 Discussions & Critical Appraisal of Practice Guidelines

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