NR 505 Advance Research Method: Evidence-based Practice Sample Assignment & Discussions

Week 4 Assignment: Research Literature, Design Approach and Sampling Guidelines P URPOSE : This assignment provides the opportunity for the student to continue development of a MSN EBP scholarly project that started with the identification of a nursing issue and PICOT/PICo question. The focus of this assignment is to discuss the research literature support, identify an appropriate research design approach and sampling method. Students are to attach this completed assignment to their Assignment 1 (remove the conclusion from the first assignment) using the headings indicated below. Students are to have revised assignment one based on faculty feedback for this presentation. C OURSE O UTCOME : This assignment enables the student to meet the following course outcome: CO #4 Develop knowledge related to research and evidence-based practice as a basis for designing and critiquing research studies (PO 1, 2, 6, 9) D UE D ATE Sunday 11:59 PM MT at the end of Week Four T OTAL P OINTS P OSSIBLE : 145 POINTS R EQUIREMENTS Description of the Assignment: This continues the development of a MSN EBP scholarly project by requiring the student to identify the research approach and sampling method. Criteria for Content 1. Using the Research Critique Table from Week 2 Assignment, students discuss the applicable elements of each research study article that directly support the PICOT/PICo question. This section of the proposal is to be presented as Research Literature Support and includes:  Discuss each research article presented in the Research Critique Table; one paragraph for each article  Include the article purpose, research design, sample, intervention, results, strengths, and limitations of the study.  Identified literature supports the PICOT/PICo question  Solution Description 2. Theoretical Framework and Change Model  Identify the Theoretical Framework and Change model that will be used in this project NR505_W4_Assignment_Research Lit_Design_Sampling_V2_June 2017_AR 1 Chamberlain College of Nursing NR505 Advanced Research Methods: Evidenced Based Practice  Discuss how using a framework and model will promote success and sustainability of the project intervention 3. Research Approach and Design:  Identification of the research approach as quantitative or qualitative or mixed methods; students are expected to identify the type of design focus under the larger research approach such as quasi-experimental for quantitative or phenomenology for qualitative  If quantitative, each element of PICOT is presented  If qualitative, each element of PICo is presented  Description of the design approach selected  Rationale for the design approach selected  Identifies one advantage of the design approach selected & rationale  Identifies one disadvantage of the design approach selected & rationale 4. Sampling Method:  Describe the target population.. Preventing Surgical Site Infections In the following text, we will be dissecting the clinical practice guidelines on preventing surgical site infections (SSI). I will be describing the scope and purpose, the stakeholder involvement, the rigor of development, apply the practice to clinical experience, and provide recommendations for further critique. Clinical practice guidelines(CPG) serve as educational information/guidelines based on evidence based practice. They contain recommendations that are based on systematic review of literature regarding clinical questions. Surgical site infections is a world- wide dilemma that all hospitals and health care facilities have to face and are constantly striving for improvements to reduce occurrence. Surgical site infections is one of the most prevalent health care associated infections. Over 500,000 surgical patients develop an SSI after a surgery each year. Not only are SSI’s detrimental to the patient, which can cause longer hospital stays, readmissions, along with increased mortality /morbidity rates, but also to the hospital. SSI can also affect the costs associated and portray poor quality in providers and health care facilities. Often, a SSI occurs due to errors that occur before or after surgical intervention, versus the surgery itself ( Cima, Dankbar, Lovely, & Pendlamari, 2014). Now, we will begin to dig deeper in this clinical practical guideline. Scope and Purpose of the Clinical Practice Guideline The purpose of this clinical practice guideline is to provide guidance and recommendations, and provide evidence based literature on proven measures to resolve/help decrease occurrence to clinical questions/issues- this specific one being prevention of surgical site infections. Clinical practice guidelines also serve to be a resource to health care providers in order to treat the clinical issue. Week 6 Mr. Lowell, the nursing executive at St. Louis Medical Center in Summerville, hears about your consultant work for the cities of Ironridge and Summerville and he asks you to help him evaluate the hospital’s evidence-based practice program and recommend an EBP model. He strengthened the staff education department a few years ago with a new MSN-prepared director who could use a consultant to get the evidence-based practice program off the ground. Threaded Discussion – EBP Models Read the box above about Mr. Lowell and his facility. As an advanced practice nurse, you will looking at various evidence based practice models and choosing two of them to compare and contrast here. After you compare and contrast them, discuss which one you would recommend to this facility and why? Remember to support your posts with scholarly research in APA 6th edition format. This future advanced practice nurse reviewed the articles by Loversidge (2016) and Rangamani, Coppens, Greenwald, & Keintz (2016) in an attempt to compare and contrast the two evidence based practice (EBP) models they discuss. Loversidge (2016) discusses the Evidence-Informed Health Policy Model and Rangamani et al. (2016) covers The Triad Model. As Loversidge (2016) explains in the article, EBP models help nurses to identify and tackle issues and increase effective and scientific care. The evidence-informed health policy (EIHP) is a combination of EBP, expertise and ethics in order to combine the best of all worlds to create the best policy for nursing care (Loversidge, 2016). The Triad Model is a method to combine academic faculty, clinical supervisors and students on the importance of EBP, in turn ensuring all three are on the same page (Rangamani et al., 2016). The EIHP and Triad Model are similar because they both stress the importance of EBP in the nursing profession and on decision making (Loversidge, 2016; Rangamani et al., 2016). While they both promote EBP, they do it differently. The Triad Model is focused on teaching and emphasizing EBP in a graduate program as opposed to solely in the classroom or the clinic (Rangamani et al., 2016). The EIHP is focused on the administrative side and policy making rather than academics (Loversidge, 2016). This author would recommend The Triad Model to Mr. Lowell. His needs are more academic in nature. He needs his staff and facility to understand the importance of EBP and needs to create a foundation. By adopting the Triad Model, Mr. Lowell can ensure his instructors, clinical faculty and student are all educated on the importance and ways to use EVP (Rangamani et al., 2016). Once all the individuals in all of the areas are familiar and knowledgeable, they will better be able to institute policies. When they have sufficient policy in place, moving to the EIHP model may make sense but until that time, they need to create a plan and educate. NR 505 week 4 _ initial posting The researchers take subject or participants into a laboratory to interview or observe them; the result is numbers ( Chamberlain College of Nursing, 2017) . The sample size is usually large. The advantage is that researchers can control over study conditions and variables are an advantage in quantitative research. It defines as a true experimental study by researchers because the researchers can manipulation of variables or treatments, random assignment to study group, then these control over study conditions. In contrast, the researchers identify the phenomena of interest in the qualitative research approach ( Chamberlain College of Nursing, 2017) . Since researchers interested in the overall phenomena of interest, there is seldom identifying variables, less control over study condition. The advantage is participants are to be natural, comfortable and willing to share in-depth information since there is less control. Refinement of a Nursing Concern REFINEMENT OF A NURSING CONCERN 2 Overview of selected Evidence-based Practice proposal project This research project will focus on patients with End Stage Renal Disease educating patients on important of fluid restriction and management to decrease hospital readmission for CHF related to intradialytic weight gains. Understanding the relationship between research and evidence-based practice is essential. Research is a systematic investigation into and study of materials and sources to establish facts to create new knowledge or to prove knowledge that already exists. In scientific research, researchers predict a hypothesis which is the relationship between two or more variables (Cherry, 2018). Analysis enables scientist to investigate new knowledge systemically by using scientific reasoning. Evidence-based practice is an interdisciplinary approach to clinical practice that is based on research and clinical expertise. The critical aspect of EBP is to identify each patient’s unique health state, diagnosis, individual risks and benefits of potential interventions, and client preferences and values. A significant intended effect of EBP is to standardize healthcare practices to science and best evidence and to reduce illogical variation in care, which is known to produce unpredictable health outcomes. Evidence- based practice provides accountability in safety and quality improvement in health care. Another contribution EBP has given the nursing profession is the development of (QSEN) competencies. QSEN stands for Quality and Safety Education in Nursing According to the American Nurse Association (ANA), QSEN formed in response to calls for improved quality and safety in nursing. QSEN competencies challenge future nurses with the knowledge, skills, and attitudes necessary to continuously improve the quality and safety of the healthcare systems. My specialty track is the Nurse Practitioner. Nurse Practitioners is a master’s prepared nurse, educated in one of the following patient populations: family practice, pediatrics (acute or REFINEMENT OF A NURSING CONCERN 3 primary care), neonatal, psychiatric/mental health, adult/gerontology (acute or primary care), and woman’s health (Cahill, Alexander, & Gross, 2014). Nurse Practitioner skills consists of taking health histories, perform physical exams to diagnose, treat and evaluate acute and chronic illness, manage medications and prescribes, promote healthy behavior by utilizing education and identify the needs of patients that require more specialized care by referring them to appropriate care provider (Cahill Alexander,& Gross, 2014). Nurse Practitioners work with physicians, office settings, clinic, hospitals, long-term care facilities and ambulatory care settings (Whitmire & Kindschuh, 2016). Nurse Practitioners can provide care independently and offer a wide range of initial, ongoing, comprehensive care to a wide range of patient population. In many states, NP’s Week 1: Identification of Area of Interest State your area of research or evidence-based practice (EBP) interest: The area of interest to me at this time is with gastric sleeve patients and weight loss/regain post- surgery. 2. State your MSN program specialty track and defend how your selected area of research or EBP interest is consistent with your selected MSN program track. The MSN program specialty track that I am pursuing is the Family Nurse Practitioner track. In Ironridge community, there are several safety issues such as: tire in the middle of the street, broken street light, several open fires, Homeless and what looks like a prostitute in an open area by the bus stop, a man standing on the corner with a tool with a stance, several trash bags on the street, a hazardous waste plant that is not properly secured, and finally an unusual amount of smoke throughout the community that is causing air pollution. In Summervile, there aren’t as many safety issues, but they are still very important. Some of the safety issues are: many loose dogs around the community, several rats in the streets, dumpsters not properly secures, several bikes laying behind cars and on the ground rather than in a bike rack, and lastly children riding bikes with no supervision and no helmets. Both communities are different is safety concerns but all of them require intervention in order to have a safe environment that will be beneficial to the civilians. ystemic Research Review A Systematic Research Review (SRR) is considered a highly trustworthy source that directs clinical practice. Its purpose is give a detailed summary of available primary research regarding a particular research question. This paper will critique a SRR in relation to evaluate efficacy of neuraminidase inhibitors (i.e. Tamiflu) in the prevention and management of influenza. Relevance of Research Problem Influenza is an upper respiratory illness that can include a variety of symptoms. Those symptoms are muscle ache, headache, fever, fatigue, cough, sore throat, congestion and runny nose. The cough and fatigue may last up to two weeks but the fever and body aches typically lasts three to five days. It is a mostly mild, self-limiting infection, but occasionally patients can develop complications and progress to other illnesses such as otitis media, dehydration, and pneumonia (Jefferson, et al., 2014). Influenza cannot be distinguished clinically from influenza-like illnesses but can be diagnosed by a laboratory test. Influenza A and B cause most infections internationally. It is these two types that the laboratory test is sensitive for. According to Jefferson, et al. (2014), neuraminidase inhibitors (NIs) are the treatment of choice for influenza. They are comprised of oral, inhaled, and parenteral medications. The most common medication prescribed is the oral medication, oseltamivir (Tamiflu). Its primary mechanism action is to inhibit the influenza virus from exiting host cells. This does not prevent the infection but reduces the duration of symptoms by decreasing the spread, viral load, and release of cytokines. This helps lessen the risk of problems and interrupts the person-to-person spread of the illness. SYSTEMATIC RESEARCH REVIEW 3 This problem impacts the patients, nurses and physicians. It is important to know if these medications are truly beneficial for the treatment of influenza for both the caregiver and patient. The patients are the ones directly affected because they are the ones that suffer the symptoms of the illness and have to pay for this medication. The healthcare team of nurses and physicians are impacted by this because they are the individuals evaluating, treating, prescribing medications and educating the patients about their illness and the medications. NR505 Wk2 TD The focus for Week 2 is on questions: PICOT/PICo and practice questions. Dr. Pat and Classmates, The subject matter has been changed from my original area of interest from NR500. For week one’s topic to be utilized, I had chosen effective communication. However, my multi-organ transplant unit is beginning to study the cause and effects of increasing frequency of chlorhexidine baths to prevent infection of the post-transplant surgical incisions. I am enrolled in the family nurse practitioner tract and my goal is to care for this population of patients in the community setting. Since there are many factors influencing the recovery of the post-transplant patients after surgery, preventative measures must be strictly enforce to ensure positive outcomes for the patients. I will be using a descriptive quantitative approach to for my approach to the EBP project proposal since I will attempt to utilize an online data search to support my study. According to Evidence-based wound care focuses on reducing the risk of infections and promoting primary healing. Evidence-based clinical practice guidelines (CPGs), standards and position statements relating to promoting wound healing and preventing wound infections have been published by peak professional (Lin, 2014). However, evidence- based practice are only used in 50% of surgical units, exposing patients to various routes of infection (Swan, Ashton, Bui, Pham, Shirkey, Blackshear & Ochoa, 2016) Research Literature, Design, Sampling and Implementation Literature Review Health care system is like gold to human health. Without health, wealth does not really matter so much because one has to be healthy to enjoy wealth. The First research I read is about health care disparities in rural communities. The purpose of this research is to identify health care disparities in rural communities across all racial and ethnic background. According to James et al, 2017, although rural communities have less number of diverse ethnic and racial background, their health care outcome is worse and they have reduced access to health care. The research approach used was quantitative type of research using Behavioral Risk Factor Surveillance System (BRFSS). Data was collected through random- digit- dialed telephone number that is used to carry out the survey (James et al, 2017). The participants did self-reporting using the BRFSS method. The strength of the report is that the participants were free to report their behavior without feeling judged and this could lead to most people being open to report their behavior and their health care access situation. This research had some limitations. The fact that it was self-reporting, some people may underreport certain behaviors, while some other people may not report accurate information leading to a bias that affects the reliability of the research (James et al, 2017). The second research is carried out in Germany. The purpose of the research was to investigate access to health care among undocumented immigrants in Germany with communicable disease ( Mylius & Frewer, 2015) Undocumented migrants in Germany have no access to health care. However, those with communicable diseases are supposed to be treated accordingly ( Mylius & Frewer, 2015). The research approach used was quantitative research study. Data collection was done through e-mail survey. Ten page questionnaires were sent to the RESEARCH LITERATURE, DESIGN, SAMPLING AND 3 local public health authorities (LPHA) throughout Germany. A great strength of this research was the ability of the researchers to gather large quantities of the vital information related to the research. This was mainly due to the fact that the research questionnaire was sent to health care workers who were involved in treating migrants and were very knowledgeable about the research topic. However, one of the limitations of this research was over representation in certain geographical areas of the country. This was because LPHAs’ in urban areas responded frequently and returned larger questionnaires as compared to LPHAs’ in smaller towns and cities ( Mylius & Frewer, 2015). This type of unequal response could be due to the fact that most LPHAs’ in the Title of your Clinical Practice Guideline (Include an introduction here, but the heading “Introduction” is not used according to the 6 th edition APA reference. Your introduction states why you are writing this paper) Scope and Purpose of the Clinical Practice Guideline ( Describes the scope and purpose of the document.) Stakeholder Involvement ( Describes the stakeholder involvement in the development of the document.) Rigor of Development (Critiques the rigor of the development and levels of evidence of the studies used to develop the CPG) Recommendations ( Provides the major recommendations of the document.). According to Yilmaz (2013) quantitative research explains occurrences with data that are statistically analyzed. Quantitative research often attempts to evaluate the effect of an intervention on a dependent variable. The greater the control over study conditions the stronger the statistical correlation can be with great control a causal relationship can be determined. As control diminishes the strength of the correlation diminishes (CCN, 2018). Quantitative research with its tight research control doesn’t allow for exploring and fully understanding lived experiences and phenomena. Yilmaz (2013) defines qualitative research as the emergent, inductive, explanatory and representational study of people and phenomena in real life settings to provide description of meanings. Qualitative research attempts to explore and understand phenomena rather than evaluate the impact of an intervention as you find with quantitative research. In order to accomplish this the study evaluates a few subjects in great depth. Type 2 Diabetes Education: Facing the Need Research and nursing are inextricably linked. Over one hundred years ago Florence Nightingale first pioneered research and practice modification based on the results of her studies. (Brower & Nemic, 2017). Florence Nightingale proved that observing a problem and then researching the implementation of change can result in better outcomes for patients. Since then, research has been a pivotal part of nursing and has been changing standards of care for patients for years. Research is used to create evidence-based projects, which are then transformed into evidence-based practice (EBP) (Brower & Nemic, 2017). The purpose of EBP is to improve the quality of care we provide to patients in our daily practice. As advanced practice nurses, (APN) performing research for evidence-based projects is possibly one of the most important aspects of nursing care (Hallburg, 2018). Research for an evidence-based project is performed based on the project needs and subject (Shrivastava, Shah, & Navaid, 2018). The decided choice of method is called the research methodology and depends on the type of research being conducted (Shrivastava et al., 2018). The most often used research methodology are the qualitative and quantitative methods but other methods do exist and are applicable in special circumstances (Polit & Beck, 2018). Quantitative research is used when studying information and data while qualitative research focuses more on subjective information (Barczak, 2015). Understanding the proper research process is pivotal to the creation of an evidence-based project to produce EBP. EBP is the creation of standards of practice or care provided based on evidence-based research projects (Brower & Nemic, 2017). EBP is a combination of three aspects: patient preference, proven clinical research, and clinical knowledge (Brower & Nemic, 2017). The process involves a combination of taking patients concerns, clinical expertise and specific researched data and creating a standardized method of caring for or educating patients. EBP differs from research as it the result of turning research into a project and then using the TYPE 2 DIABETES EDUCATION: FACING THE NEED 3 knowledge gleaned from a project and putting it into practice (Hallburg, 2018). Often, more than one project is needed to create an EBP standard of practice but the process varies depending on the subject being studied (Hallburg, 2018). Because of the nature of EBP, contributing understanding and using EBP is very important as a future family nurse practitioner (FNP). EBP is at the core of caring for patients in the nursing practice ( Florczak, 2016). The use of EBP is essential for APN’s but especially for family nurse practitioners as clinical outcomes are affected by a lack of use of the standardization that EBP creates ( Florczak, 2016). Research Summary Paper – Bedside Shift Report Author (year) Purpose Sample/Number of Participants (provide descriptive statistics) Design Level of Evidence Findings (provide any inferential statistics) Limitations Sand- Jecklin & Sherman (2014) To quantify quantitative outcomes of a practice change to a blended form of bedside shift report Sample size of 302 patients/families pre- implementation and 250 post- implementation using the “Patient Views on Nursing Care” patient survey tool adapted from the Larrabee “Patient Judgements of Nursing Care” instrument. Items had a 5 point response option (5 for excellent and 1 for poor care). Instrument reliability was 0.96 with interitem correlations from 0.20 – 0.71. 233 patients completed the baseline survey, 157 patients after the 3 month BSR implementation and 154 patients at the 13 month post- implementation of BSR. Family members completed 70 baseline surveys, 72 (3 months after) and 53 (13 months after). Rating was at 4.2 of 5 points on all 3 surveys. Baseline nurse perceptions done by 148 nurses, 98 at the 3 month post- implementation, and 54 at the 13 month completion. Quasi-experimental pre- and post- implementation design. Recorded and blended shift report done before change. Nurse education and bedside shift report was implemented with the guidance from clinical preceptors and nurse managers. A month after implementation, a nurse survey was done to learn about the new change. Another survey was done 3 months after that to obtain patient and nurse satisfaction data. Final data implementation was gathered 13 months after Level III: Evidence obtained from well-designed controlled trials without randomization , quasi- experimental Patient falls during shift change decreased from 20 pre- implementation to 13 at the 3 month mark, and 4 at the 13 month mark. Medication errors decreased from 20 pre- implementation to 10 at the 3 month mark. Between the 3 and the 13 month post- implementation, changes were made in incident reporting and no data was able to be collected. Better nurse-to- nurse communication, more patient involvement and better patient identification of nurses. Higher nurse accountability, and increased patient safety. Participation sampling limited to patients scheduled for discharge and nurses on medical surgical units only. This does not represent the total population of patients and nurses. Some nurses could have answered more than one survey and inconsistencies in the use of blended bedside reports. Moco Morgado & Mateus Nunes, (2016) To translate, adapt and validate 2 data collection questionnaire s about BSR in surgical units in Portuguese Non-probability sampling of 137 nurses and 96 patients. Translation, back-translation and adaptation of questionnaires in 7 surgical units between 08/22/2008 and 06/28/2009.

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