Module 4 Assessment Evidence-Based Project Table

Critical Appraisal Worksheet

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-based practice, step by step: a critical appraisal of the evidence: Part III by Ellen Fineout-Overholt, Betnadette Mazurek Melnyk, Susan Stilwell, and Kathleen Williamson. (2010)

 

 

 Evidence-based practice, step by step: a critical appraisal of the evidence: Part I by Ellen Fineout-Overholt, Betnadette Mazurek Melnyk, Susan Stilwell, and Kathleen Williamson (2010)  Critical Appraisal Tools and Reporting Guidelines for Evidence-Based Practice

Robin Buccheri Claire Sharifi 

 

 Evidence-based practice, step by step: a critical appraisal of the evidence: part II: digging deeper–examining the “keeper” studies was written by Ellen Fineout-Overholt, Betnadette Mazurek Melnyk, Susan Stilwell, and Kathleen Williamson
Evidence Level *

(I, II, or III)

 

 II III III III
Conceptual Framework

 

Describe the theoretical basis for the study (If there is not one mentioned in the article, say that here).**

 

 This study is a follow up to part II of the same research study. The researchers wanted to find out how unplanned admissions to the ICU and the number of cardiac arrest is affected by rapid response team and no rapid response team

 

 

 In this study, the researchers wanted to find out how unplanned admissions to the ICU and the number of cardiac arrest is affected by rapid response team and no rapid response team

 

 The purpose of this paper is to help healthcare workers-in particular nurses, to understand and be able to locate the appropriate tools for critical appraisal. This article is a continuation of the article Evidence-based practice, step by step: a critical appraisal of the evidence by Ellen Fineout-Overholt, Betnadette Mazurek Melnyk, Susan Stilwell, and Kathleen Williamson.

The purpose of this edition is to acquire skills and knowledge essential in implementing EBP.
Design/Method

 

Describe the design and how the study was carried out (In detail, including inclusion/exclusion criteria).

            The researchers have a well-articulated plan of how to carry out an appraisal of research. Using the hypothetical nurse scenario, a synthesis table is created from which data is extracted to compare the similarities and differences from the study. From the synthesis table, the researchers the team of researchers can deduce data with higher-level evidence and those with lower-level evidence. 

 

 The authors use the hypothetical staff nurse to discuss and answer the question “In hospitalized adults (P), how does a rapid response team (I) compared with no rapid response team (C) affect the number of cardiac arrests (O) and unplanned admissions to the ICU (O) during a three-month period (T) Fineout-Overholt, et al., 2010). Through the help of the hospital librarian, Carlos and fellow staff nurses searched three reputable databases- PubMed, the Cumulative Index of Nursing, and Allied Health Literature to acquire information about their PICOT question. A total of 79 studies were chosen by Carlos and her team-18 from PubMed, 6 from CINAHL, and 1 from the Cochrane Database of the systematic review.

 

 The authors conducted a systematic search to find the tools that are commonly used in critical appraisal as well as reporting the guidelines for Evidence-based practice. The authors created a hypothetical trial group to discuss what makes a good research and to determine the worth of a study
Sample/Setting

 

The number and characteristics of

patients, attrition rate, etc.

 The sample used by the researchers is sufficient. The research used between 218 and 662 hospital beds across the studies. In my opinion, this sample is adequate for the research because it spanned across several types of hospitals- 4 teaching, 4 community, 4 no mention, 2 acute care hospitals, and 1 public hospital. These are more than adequate to get desired results.

 

 

 

 

 The number of hospital beds ranged from 218 and 662. Several types of hospitals were represented in the interview as follows: 4 teaching hospitals, 4 community hospitals, 4 no mention, 2 acute care hospital, and 1 public hospital. A total of 150 nurses across different types of hospitals and professions were used in the study as they met the inclusion criteria. Having the skills to select the appropriate tool or guideline is an essential part of meeting EBP competencies for both practicing registered nurses and advanced practice nurses In this article, the authors use a hypothetical nursing scenario. Rebecca R., the hypothetical staff nurse, Carlos A., her hospital’s expert EBP mentor, and Chen M., Rebecca’s nurse colleague, collected the evidence to answer their clinical question: “In hospitalized adults (P), how does a rapid response team (I) compared with no rapid response team (C) affect the number of cardiac arrests (O) and unplanned admissions to the ICU (O) during a three-month period (T)

 
Major Variables Studied

 

List and define dependent and independent variables

 The variables studied are unplanned ICU admissions, the effect of RRTs-Rapid Response Teams and no RRTs unplanned ICU admissions, the effect of RRTs-Rapid Response Teams and no RRTs Critical appraisal tools and reporting guidelines unplanned ICU admissions, the effect of RRTs-Rapid Response Teams and no RRTs
Measurement

 

Identify primary statistics used to answer clinical questions (You need to list the actual tests done).

 Two articles having level-VI evidence, a study and a project, had statistically significant (less likely to occur by chance, P < 0.05) reductions in HMR, which increases the reliability of the results. The team begins to divide the 26 studies into categories according to study design. To help in this, Carlos provides a list of several different study designs. Rebecca, Carlos, and Chen work together to determine each study’s design by reviewing its abstract Nine commonly used critical appraisal tools and eight reporting guidelines were found and are described in this manuscript. Specific steps for selecting an appropriate tool as well as examples of each tool’s use in a publication are provided. The first section of every RCA checklist addresses the validity of the study. Some of the critical questions here include: did the researchers use sound scientific methods to obtain their study results? Rebecca asks why validity is so important. Carlos replies that if the study’s conclusion can be trusted
Data Analysis Statistical or

Qualitative findings

 

(You need to enter the actual numbers determined by the statistical tests or qualitative data).

 When evidence-based practice is delivered in the context of supportive organizational culture and care, patient outcomes and quality care is achieved. It is not the number of studies or projects that determines the reliability of their findings, but the uniformity and quality of their methods.  Participants were clustered into groups who discussed the evolving patterns regarding evidence-based practice. The identified patterns were recorded in a table. From the three systematic reviews (the ones with higher-level evidence) showed some bias since they included studies only from the control group. In short, these studies did not favor the initiation of RRT. Research began by first analyzing studies with highest level of evidence to see the most reliable sources/evidence
Findings and Recommendations

 

General findings and recommendations of the research

 Using the hypothetical nurse case scenario, to help the team better discuss the evidence, Carlos suggests that they refer to all projects or studies as the body of evidence. They don’t want to get confused by calling them all studies, as they aren’t, but at the same time continually referring to studies and projects is cumbersome (Fineout-Overholt, 2010). He goes on to say that, as part of the synthesis process, it’s important for the group to determine the overall impact of the intervention across the body of evidence.

 

 The team found that to determine the appropriate level of evidence, it was necessary to divide the studies into groups based on their study design. The team also included some descriptive studies that did not actively answer the PICOT question but contained critical information on the same. For example, from the studies chosen, there are many expert opinions and guidelines. 

 

 Having the skills to select the appropriate tool or guideline is an essential part of meeting EBP competencies for both practicing registered nurses and advanced practice nurses Determining the appropriate level of evidence required the researchers divide the studies into groups based on their study design. Besides, some descriptive studies that did not actively answer the PICOT question but contained critical information on the same were included in the study. For example, from the studies chosen, there are many expert opinions and guidelines. 

 
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?

 This research provides valuable information how RRTs impact on the number of cardiac arrest as well as the number of ICU admissions

 

The limitation of the study is that it relies heavily on other studies thus it does not provide any new information on critical appraisal of research.

 This article provides information on the impact of Rapid response Time-RRT on ICU admissions and the number of cardiac arrests in patients.

 

The limitation of this article is that it is a review of existing literature, it adds no new information to the field of critical appraisal of research.

 The major strength of this article is that the systemic search of the commonly used critical appraisal tools and reporting guidelines for EBP in nursing is new information that could be explored further to find evidence that supports its role in EBP This article provides information on the impact of Rapid response Time-RRT on ICU admissions and the number of cardiac arrests in patients.
 

 

Key findings

 

 

 

 Rapid response Time-RRT impacts on the number of ICU admissions Rapid response Time-RRT impacts on the number of ICU admissions Critical appraisal tools and reporting guidelines are essential in evidence-based practice. Rapid response Time-RRT impacts on the number of ICU admissions
 

 

Outcomes

 

 

 

 The faster the response time, the lower the cases of ICU admission and vice versa Healthcare facilities with improved RRTs avoided high numbers of ICU admissions. Practicing registered nurses and advance practice nurses are able to critically appraise and disseminate evidence in order to meet EBP competencies Caregiving facilities with improved RRTs avoided high numbers of ICU admissions.
General Notes/Comments The article is reliable because of its sample choice and size as well as an effective systematic review approach adopted

 

 

 This article is detailed enough to warrant reliability. While the article is not adequately-detailed, it provides enough information/data to back up the hypothesis.

 

*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.

EB004: Critical Appraisal, Evaluation/Summary, and Synthesis of Evidence

Part 2: Evidence-Based Best Practices

After the appraisal of the evidence-based research journals chosen, the best evidence-based practice that I choose for infertility is In Vitro fertilization-IVF. IVF is a series of procedures used to help infertile couples to conceive (Amorim, 2018). In this method, eggs that are mature are harvested from a woman’s ovaries and then fertilized by a male sperm in the laboratory. The fertilized eggs are then transferred to the woman’s uterus

I chose IVF as the best intervention for infertility because it the most effective form of assisted reproduction. A couple can use their own eggs and sperm or they can use ones donated by a donor. The advantage with IVF is that it can be used to intervene in numerous types of infertility such as low sperm count, problems with ovulation, poor egg quality, and infertility caused by the inability of a sperm to penetrate the egg among many other types of infertility (Pan, Le, & Jin, 2018). IVF involves the testing of ovarian reserve and semen analysis to evaluate the chances of conception. Besides, testing for infectious diseases is also done when performing an IVF. This is to ensure that the resulting embryo is not affected by such infectious diseases. While IVF has some risks, it remains the most effective approach of dealing with infertility.

References

  • Amorim, C. A. (2018). In vitro culture of ovarian preantral follicles: A promising alternative for preserving fertility in cancer patients. Fertility and Sterility, 110(6), 1041–1042. https://doi.org/10.1016/j.fertnstert.2018.08.054
  • Pan, P., Le, F., & Jin, F. (2018). In vitro oocyte maturation alters renal renin-angiotensin system expression and epigenetic modification in mice. Fertility and Sterility, 110(4). https://doi.org/10.1016/j.fertnstert.2018.07.565