Weighing the evidence in nursing research essay example papers

Week 10 Main Discussion Post

Weighing the Evidence

“The demand for health care practices that are evidence-based, standardized, consistent, and promote optimal outcomes within the constraints of limited resources is growing” (Katapodi & Northouse, 2011). When weighing the value of evidence, it is important to study the hierarchies that “grade the evidence for its reliability and generalizability to larger populations based on research design and sampling method” (Stichler, 2010). Hierarchies offer a structure for grading the strength of the existing evidence (Stichler, 2010). weighing the evidence in nursing research essay example papers.

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Citation

Keyt, H., Faverio, P., & Restrepo, M. I. (2014). Prevention of ventilator-associated pneumonia in the intensive care units: A review of the clinically relevant recent advancements. The Indian Journal of Medical Research, 814-821. Retrieved from http://web.b.ebscohost.com.ezp.waldenulibrary.org/ehost/pdfviewer/pdfviewer?sid=5f6f3c89-eb57-4ed5-af8a-e2084725cbda%40sessionmgr103&vid=1&hid=118

Article Summary

The authors of this study reviewed the literature about evidence-based ventilator-associated pneumonia (VAP) prevention measures. This literature was reviewed because “the pathophysiology, epidemiology, treatment and prevention of VAP have been extensively studied for decades, but a clear prevention strategy has not yet emerged” (Keyt, Faverio, & Restrepo, 2014). In their research, Keyt, Faverio, and Restrepo discovered that any patient placed on a mechanical ventilator was at risk of developing VAP. Several strategies were identified as prevention measures: non-invasive positive pressure ventilation (NPPV), sedation holidays, weaning trials, avoiding re-intubation, and early tracheostomy weighing the evidence in nursing research essay example papers.

Data and Analysis

The article is a case-control study. Three authors reviewed “interventions currently available that have a clinical impact with regards to a reduction in the incidence of VAP” (Keyt, Faverio, & Restrepo, 2014). The authors looked for research on how VAP occurs, VAP prevention: reducing the time at risk, VAP prevention: targeting endotracheal tube colonization and microaspiration, VAP prevention: infection control in the ICU, and VAP prevention: reducing colonization. After reading multiple articles with similar results, they concluded that a multidisciplinary strategy showed more enhanced patient outcomes than strictly focusing on prevention approaches directed towards the pathophysiologic mechanism of VAP. The multidisciplinary strategy includes non-invasive positive pressure ventilation (NPPV), sedation holidays, weaning trials, avoiding re-intubation, and early tracheostomy (Keyt, Faverio, & Restrepo, 2014).

The weaknesses noted from the study was the lack of information about how the study was performed, how many studies were read, how they specifically came to their conclusions, and how the authors chose the articles and eliminated pieces. weighing the evidence in nursing research essay example papers. There was no information given about what roles each researcher played and how they obtained their articles to review. However, they did suggest that future research that studies clinical outcomes as primary endpoints will hopefully develop more thorough prevention strategies.

Additional Study

Based on their research, I learned that the use of ventilator bundles was most beneficial to prevent VAP. The study did not specify what interventions were the best to include in the ventilator bundles but stated that multiple interventions were favorable. Additional research could be completed on which interventions should be paired together to make up a ventilator bundle.

weighing the evidence in nursing research essay example papers References

Katapodi, M. C., & Northouse, L. L. (2011). Comparative Effectiveness Research: Using Systematic Reviews and Meta-Analyses to Synthesize Empirical Evidence. Research and Theory for Nursing Practice, 25(3), 191-209.

Stichler, J. (2010). Evaluating the Evidence in Evidence-Based Design. JONA: The Journal of Nursing Administration, 40(9), 348-351.

6052 Discussion Week 10

Weighing the Evidence

Throughout this course, many lessons have been learned regarding the intricacies of research. When conducting original research, we have learned there are many steps and decisions to be made before embarking upon any research project. weighing the evidence in nursing research essay example papers. One of the final steps of research is determining a meaningful conclusion and formulating explanations for the meaning of their data. According to Polit and Beck (2017), research is the step-by-step inquiry that utilized an orderly and disciplined method to answer questions and to solve problems (Polit & Beck, 2017).

APA Citation

Ansari, S., & Szallasi, A. (2011). ‘Wrong blood in tube’: Solution for a persistent problem.

International Journal of Transfusion Medicine, 100(1), 298-302.

Research Article and Statistical Analysis

Data can be synthesized by using a systematic review or meta-analysis (Katapodi & Northouse, 2011). The article reviewed: ‘Wrong blood in tube’: solutions for a persistent problem (Ansari & Szallasi, 2011). In this study, the objective was to determine the occurrence of WBITs at Monmouth Medical Center. The study aims to assess the effectiveness of safe methods enforced in 2006. The method used in this study was the collection of data from 2005 to 2009. The researchers found that within a four-year period, 59,373 samples were collected and 0.04% of the significant errors were WBITs. It was recorded that 8 of the errors from the 0.04% were due to errors in typing results. weighing the evidence in nursing research essay example papers. The hospital mandated in 2006 that two witnesses (nurses) must check all blood sample collections. Implementing a two-verifier program has helped decrease the rate of WBITs from 11 in 2006 to 5 in 2007, but the WBITs have not been eradicated. It was concluded that WBITs is still the primary cause of wrong blood transfusion at Monmouth Medical Center. In the article by Ansari & Szallasi (2011) we see that after MMC adopted the two-verifier program, the rate of WBITs reduced from 11 to five which does not seem much but we see a decrease in situations that could have caused serious harm or be fatal to the patient.

An identified weakness in the study and recommendation is that the check-type method is not a foolproof method. The nurses and phlebotomist may beat the system by collecting both tubes at the same time from the wrong patient and also the check-type system cannot prevent silent WBITs weighing the evidence in nursing research essay example papers.

References

Ansari, S., & Szallasi, A. (2011). ‘Wrong blood in tube’: Solution for a persistent problem.

International Journal of Transfusion Medicine, 100(1), 298-302.

Katapodi, M. C., & Northouse, L. L. (2011). Comparative effectiveness research: Using

systematic reviews and meta-analyses to synthesize empirical evidence. Research and Theory for Nursing Practice: An International Journal, 25(3), 191-209. Retrieved from the Walden Library databases.

Polit, D. F., & Beck, C. T. (2017). Nursing research: Generating and assessing evidence for

nursing practice (10^th ed.). Philadelphia, PA: Wolters Kluwer

Weighing the Evidence

Evidence-based practice has increasingly come to be valued in the provision of quality health care (Stichler, 2010). However, one must recognize that “not all evidence is created equal” (Stichler, 2010). After locating appropriate research articles, Stichler (2010) suggests that we must appraise the rigor of the research design, note the generalizability of the findings to other situations, and view the applicability of the research to your current situation. weighing the evidence in nursing research essay example papers. The purpose of this discussion is to provide a summary of my selected research article, describe the data and statistics used, and explain how researchers reached their conclusion. Additionally, I will propose one additional research study that could be done to further investigate the topic.

Citation:

Chen, Y., Chi, M., Chen, Y., Chan, Y., Chou, S., & Wang, F. (2013). Using a Criteria-Based Reminder to Reduce Use of Indwelling Urinary Catheters and Decrease Urinary Tract Infections. American Journal of Critical Care, 22(2), 105-114. doi:10.4037/ajcc2013464.

Summary of Article

The article “Using a Criteria-Based Reminder to Reduce Use of Indwelling Urinary Catheters and Decrease Urinary Tract Infections” written by Chen, Chi, Chen, Chou, & Wang (2013) describes a randomized controlled trial (RCT) which was performed in 2 respiratory intensive care units (ICUs) in Taiwan. A RCT is level 2 evidence according to Polit & Beck (2017). The researchers desired to determine the effect of a criteria-based catheter reminder system on urinary catheter utilization and catheter-associated urinary tract infection (CAUTI). The intervention included criteria for initial catheter use along with removal of the urinary catheter once the same criteria was no longer met. Investigators would contact the physician to discuss catheter removal once criteria were no longer being met. The results showed that “utilization rate of indwelling urinary catheters was decreased by 22% in the intervention group” and that CAUTI incidence was reduced by 48% in the intervention group. (Chen, Chi, Chen, Chan, Chou, & Wang, 2013). weighing the evidence in nursing research essay example papers.

Description of the Data and Statistical Test Results

According to Chen, Chi, Chen, Chan, Chou, & Wang (2013), “data were analyzed by using IBM SPSS Statistics 17 software. Between-group differences were examined using the Chi-square or Fisher exact test and the categorical differences were presented in percentages and numerical forms (Chen, Chi, Chen, Chan, Chou, & Wang, 2013). The experimental results data were analyzed by utilization of a t test or the Mann-Whitney test and were presented as means, standard deviations, medians, and ranges (Chen, Chi, Chen, Chan, Chou, & Wang, 2013). The level of significance was set at .05 (Chen, Chi, Chen, Chan, Chou, & Wang, 2013). The researchers also calculated relative risk and 95% confidence intervals (Chen, Chi, Chen, Chan, Chou, & Wang, 2013). Additionally, all participant characteristic data and experimental result data were presented in charts within the research article (Chen, Chi, Chen, Chan, Chou, & Wang, 2013).

The Researchers’ Conclusions

The researchers’ conclusions were that CAUTI incidence decreased and urinary catheter utilization decreased significantly with use of a criteria-based reminder intervention. Researchers used data to support their conclusions. For CAUTI incidence reduction, researchers’ provided data for relative risk (0.47), 95% confidence interval (0.27-0.82), and level of significance (P=0.009). For catheter utilization rate reduction, the provided data were: relative risk (0.78), 95% confidence interval (0.76-0.80), and level of significance (P<0.001). According to Dingle (2011), if an outcome is 0.1% effective it is statistically significant and if an outcome is 20-30% or more effective it is clinically significant. weighing the evidence in nursing research essay example papers. Based on the information which was provided and after calculation of the absolute risk for CAUTI incidence, it appears that the data presented is statistically significant, but not clinically significant as there was only a 13% decrease in CAUTI incidence in the intervention group. The absolute risk for catheter utilization was not able to be determined because numbers were not given for the intervention and control groups.

Additional Research Study

Additional research could be conducted to see if the criteria-based reminder intervention is more effective with use of different patient populations and larger sample sizes. This research used only ICU patients and testing the intervention in various inpatient hospital units at many different facilities will allow the results to become more generalizable to other populations. A larger sample size will help to enhance the power of the conclusions (Polit & Beck, 2017).

Conclusion

As a health care provider, it is important to familiarize yourself with statistics so that appropriate evidence-based interventions can be identified through your research. According to Dingle (2011), studies have found that experienced professionals do not understand the difference between statistical and clinical significance which is a major problem because these professionals are generally required to explain the significance of an intervention to their patients and their health outcomes. As health care professionals, it is important to be able to weigh the evidence of research so that important findings can be applied to practice (Laureate Education, 2013).

References

Dingle, P. (2011). Statin Statistics: Lies and Deception. Positive Health, 1801-11. Retrieved from the Walden Library databases. weighing the evidence in nursing research essay example papers.

Laureate Education (Producer). (2013). Weighing the Evidence. Baltimore, MD: Author.

Polit, D. F., & Beck, C. T. (2017). Nursing research: Generating and assessing evidence for nursing practice (10th ed.). Philadelphia, PA: Wolters Kluwer.

Stichler, Jaynelle. (2010). Evaluating the Evidence in Evidence-Based Design. The Journal of Nursing Administration, 40(9), 348-351. doi:10.1097/NNA.0b013e3181ee42a7.

Week 10 Discussion

Response Post 1

Shannon,

Great post! I never thought about depression being a factor that comes after having a type 2 diabetes diagnosis. I can see why it happens because of the lifestyle changes that need to be made and having to learn all about the disease and how to control it. This would be difficult to comprehend for me if I wasn’t a nurse. There are so many people with type 2 diabetes now that I never really thought about how it would affect a person mentally. The researchers indicated that self-care activities included medication taking, specific diet, foot care, glucose monitoring, and exercise. These activities were not followed by all patients, but it was dependent on several factors including age, educational level, social support, complications, and education about diabetes (Kav, Yilmaz, Bulut, & Dogan, 2017). This is another great example on how important diabetes education is for patients with new diagnoses.

Because of the various risks for other diseases, such as heart disease and stroke, that comes with diabetes, I think it is imperative for us as nurses and nurse practitioners to stress the importance of keeping good glycemic control for our patients. Active diabetes education should be used to achieve effective and long-term adherence to treatment in order to reduce incidence of complications (Luan et al., 2017). Have you educated new diabetics on their condition before? My facility has a diabetic advanced practice nurse educator that goes around to all newly diagnosed patients and patients who have poor control of their diabetes. She educates them regarding their insulin dosage, best times to check sugars, and about a1c levels. weighing the evidence in nursing research essay example papers. I think this is such a great resource to have for our patients and they always state how much more comfortable they feel with their diagnosis after she spends time with them!

References

Kav, S., Yilmaz, A. A., Bulut, Y., & Dogan, N. (2017). Self-efficacy, depression and self-care activities of people with type 2 diabetes in Turkey. Collegian, 24(1), 27-35. doi:10.1016/j.colegn.2015.09.005

Luan, L. L., Yang, J., He, Y. F., Huang, Z. X., Liu, L., & Huang, Z. S. (2017). Biomedical Research, 28(3), 1172-1177.

Week 10 Discussion

Response Post 2

Dai,

Great post! I have chronic back pain and this article was interesting to me because I can see why people could become depressed because of it. Back pain is very frustrating to live with and I feel like you never know when it is going to occur. weighing the evidence in nursing research essay example papers. According to Lopez-Lopez et al. (2017), people with subacute lower back pain have a significant increase in depression regardless of gender. Their study seems very limited as they did not test to see if people already have cases of depression or other mental illness as well. I agree with you that one of the weaknesses of the study is not measuring the severity of the LBP related to depression. What do you think would be a good way for them the researchers to measure this?

According to Robertson, Kumbhare, Nolet, Srbely, and Newton (2017), people experiencing depression are 60% more likely to develop back pain in their lifetime versus non-depressed people. It would be interesting to see if this could be attributable to lower levels of activity because of depression. Do you think that there could be some level of somatic disorder with the lower back pain related to depression?

References

Lopez-Lopez, D., Vilar-Fernandez, J. M., Calco-Lobo, C., Losa-Iglesias, M. E., Rodriguez-Sanz, D., & Becerro-de-Dengoa-Vallejo, R. (2017). Evaluation of depression in subacute low back pain: A case control study. Pain Physician, 20(4), E499-E505.

Robertson, D., Kumbhare, D., Nolet, P.. Srbely, J., & Newton, G. (2017). Assocations between low back pain and depression and somatization in a Canadian emerging adult population. Journal of the Canadian Chiropractic Association, 61(2), 96-105. weighing the evidence in nursing research essay example papers.