Assignment: Evidence Based Practice Synthesis 

Assignment: Evidence Based Practice Synthesis

Assignment: Evidence Based Practice Synthesis

N5024      Instructions for EBP (Synthesis) Paper

 Step 1:     Compose your PICO question using Table 2.1 in your textbook; this should be a question that is relevant to nursing.

Step 2:  Do a review of literature to identify research articles related to your topic.  They should be current (within the last 5-6 years) and they should all address your dependent and independent variables. Select a minimum of 5 (maximum of 7) RESEARCH articles (quantitative or qualitative).  You can include articles you have critiqued for this course  if they relate to your PICO question but they must be in addition to the required 5 articles.   It is OK to use mix method studies, i.e.meta analysis and/or meta synthesis for this assignment (see ch. 26 & 29). You cannot use systematic reviews of literature or reviews of literature articles because they are NOT research studies, merely a report of research studies.

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 Step 3:   Complete/modify the matrix (format is included in the resource folder) on the research articles you selected.  For your assessment of level of research (hierarchy) use either Evans or John’s Hopkins tools (Resource folder for Module 1).  Your matrix is your WA for module 7; check class schedule. Your final/modified matrix will be used to then write your short abstract of the article that you will include in your paper.  So make sure you have the detail there that you need.  Also, make sure you do not cut and paste from the article to the matrix.  You need bullet points; need not have complete sentences. This will help ensure you paraphrase when you write this section of your paper.

Step 4:  Write your paper.  Refer to rubric used in grading this paper!

• I nt roduct io n that addresses the theoretical model you selected (Iowa model or Stetler model); your clinical question and referenced rationale for why it is It is OK to use personal experience but you should also reference supporting rationale.
• Se arch M et hod olog y – a short explanation of how you conducted your search (databases used; parameters (i.e. how you narrowed your search); search terms; how many research studies did you find)
• Review of Literature – provide a short summary of each of your 5 studies; include pertinent information from your matrix. Be sure and include statistical findings (i.e. n, p-values, statistical tests used along with test statistics).
• Sy nt hes is of fin ding s (Discussion/Summary) – This is the MAJOR part of your paper (counts for 40%).  This is where you identify th em es across the studies; critically analyze and summarize the findings.  Are the samples similar or different?  Are the settings the same?  Was the intervention the same?

In one or two sentences, using either Evans or JHNEBP rubric, address the ov era ll level of research you found on your topic. Stating what the level is for each article is not sufficient.

• Conclusion(s) – What conclusions can you draw from your synthesis of findings? Are you able to answer your PICO question; do you have enough information to answer your question?  Using your model identify what the next step should be.
• References – correct APA citation
• Maximum length of this scientific paper is 5 pages (excluding cover sheet and references). The paper should be double spaced, 11 or 12 font, with 1 inch margins. No running head required but you do need to include page numbers. Points deducted for format or APA issues and grammar.

 Step 5:   Submit your paper via Assignments in Canvas.

A Sample Of This Assignment Written By One Of Our Top-rated Writers

EBP Synthesis Paper

            The prevalence of cardiovascular diseases, mainly stroke, has increased dramatically in the United States, becoming a significant public health concern. In the United States, approximately 605 000 and 610 000 experience their first myocardial infarction and first stroke annually (Davidson et al., 2020). Additionally, cardiovascular disease (CVD) is among the most prevalent death causes in the U.S., representing over 25% of total deaths (Davidson et al., 2020). Furthermore, the management of CDVs imposes a substantial economic burden on individual patients and their families, healthcare organizations, and the United States healthcare system. These huge finances are spent providing intensive and regular healthcare needed by people with CDVs to prevent deterioration of their illnesses and improve their quality of life and overall well-being. Consequently, U.S. health care costs are significantly high than in other developed countries. Additionally, U.S. health care was relatively high based on the country’s total Gross Domestic Product (GDP) and is anticipated to rise further following an increase in CVDs. According to the U.S., national health expenditures are expected to grow at an average rate of 5.4% annually from 2019 to 2028, representing 19.7% of the country’s total GDP. Thus, primary prevention measures should be adopted to reduce the risk of CVDs, particularly stroke, in women below 60. This paper presents the proposed evidence-based intervention for addressing this clinical issue, including the selected theoretical model, search methodology, review of literature, synthesis of research findings, and conclusion.

The Selected Theoretical Model

            Various EBP models have guided the implementation of evidence-based practice (EBP) in nursing. In this paper, the conceptual implementation of the proposed EBP was guided by the Stetler Model of evidence-based practice. The model considers research the first step in implementing an evidence-informed practice in a healthcare organization. The Stetler model allows the change team to connect research with a particular clinical issue of interest, which the proposed evidence-based intervention aims at resolving. This model provides criteria to establish the feasibility and desirability of applying research or studies in resolving a specific clinical issue. Criteria proposed by this model include substantiating evidence and current practice. These criteria are based on the extent of the need for implementing change in a healthcare organization.

            This model was selected since it contributes to successfully implementing evidence-based nursing practices (Camargo et al., 2018). Furthermore, the model is relevant to the proposed evidence-based intervention, using 81mg of low-dose aspirin daily to reduce the future risk of stroke among women below 60 years. Additionally, the model will be used in establishing the feasibility and desirability of applying research in reducing the future risk of stroke among women below 60 years. Thus, the model can determine the appropriateness of identified research in resolving this clinical issue.

Search Methodology

            An electronic search was conducted on reliable nursing databases, including CINAHL Plus, Embase, the Cochrane Library, and PubMed. Key terms, including stroke risk and low-dose aspirin, were utilized to guide the search process. Additionally, only qualitative articles on the use of low-dose aspirin in reducing stroke risk were considered for the study. Twenty-six (26) articles were obtained during the initial search. Studies that contained abstract only and those published more than 5 years ago were eliminated. Five (5) studies that met the inclusion criteria were considered for the study.

Literature Review

            Various scholars have conducted studies to assess the effectiveness of low-dose aspirin in preventing stroke. The first study was conducted by Miller et al. (2019) to evaluate the risk of stroke among women with a history of hypertensive disorders during pregnancy. The study findings indicated that women with HDP history had a high risk of developing all strokes (adjusted H.R. 95%). However, no stroke risk below 60 years. Additionally, an interaction (p = 0.18) was reported between the use of aspirin and HDP history on the risk of stroke among women below 60 years. The risk of stroke was higher among women who were not using aspirin (adjusted H.R. 95%, 1.5). On the other hand, the risk of stroke was relatively low among aspirin users (adjusted H.R. 95%, 0.8). Secondly, Hernandez (2021) conducted a study to evaluate the effectiveness of aspirin dosage in reducing the risk of death, stroke, and myocardial infarction. Patients assigned to the group receiving 325 mg were more likely to switch dosage (41.6%) than those in the group receiving 81 mg (7.1%). Additionally, the risk of stroke in the group reduced the low-aspirin dosage (81mg).

Another study was conducted by Gaziano et al. (2018) to evaluate the effectiveness and safety of aspirin in reducing the risk of experiencing a first cardiovascular incident. The study participants were divided into two equal groups: those receiving aspirin (n=6270) and the placebo (n=6276). Gastrointestinal bleeding incidents were reported in 61 (0·97%) patients in the aspirin group. On the other hand, the placebo group reported 29 (0·46%) gastrointestinal bleeding incidents. Similarly, the difference in severe adverse incidents was reported in both treatment groups. Adverse events in the aspirin group were 1266 [20·19%], while the placebo group reported 1311 [20·89%] adverse events.

Furthermore, Sugawara et al. (2019) conducted a study to assess the efficacy of low-dose aspirin in reducing the risk of cardiovascular incidents among patients with atherosclerotic risk factors. The study findings indicated that low-dose aspirin reduced the risk of cardiovascular events. Lastly, Ridker et al. (2019) conducted a study to evaluate the efficacy and safety of low-dose aspirin in preventing cardiovascular disease in women. The study findings reported 477 major cardiovascular incidents in the aspirin group, while 522 events were reported in the placebo group. The risk of stroke in the placebo group was reduced by 9%, while the aspirin group reported a 17% decline in the risk of stroke.

Synthesis of Findings

            The review was conducted on studies addressing the effectiveness of low-dose aspirin dosage in reducing the risk of cardiovascular diseases, particularly stroke. Study findings indicated that the risk of stroke was relatively low among low-dose aspirin users. Miller et al. (2019) reported that the risk of stroke was higher among women who were not using aspirin (adjusted H.R. 95%, 1.5). On the other hand, the risk of stroke was relatively low among aspirin users (adjusted H.R. 95%, 0.8). Additionally, Hernandez (2021) reported that a low aspirin dosage (81) mg effectively reduced the risk of stroke. Secondly, the studies indicated the effectiveness of low-dose aspirin in reducing the risk of cardiovascular incidents. Gaziano et al. (2018) reported the efficacy and safety of aspirin in reducing the risk of experiencing a first cardiovascular incident. Additionally, Sugawara et al.’s (2019) study reported low-dose aspirin’s efficacy in reducing the risk of cardiovascular incidents. Ridker et al. (2019) also reported the effectiveness and safety of low-dose aspirin in preventing cardiovascular disease in women. Thirdly, the reviewed studies indicated the effectiveness of aspirin in preventing myocardial infarction and related deaths. Hernandez (2021) reported the efficacy of a low dosage of aspirin in reducing the risk of myocardial infarction and death.

Conclusion

            Synthesize of the selected studies indicated that low-aspirin dosage effectively and safely reduces the risk of stroke, cardiovascular incidents, myocardial infarction, and related deaths. Therefore, information gathered from this article adequately answers the PICO question; “For women under age 60, does the daily use of 81mg low dose aspirin reduce the future risk of stroke compared with no usage of low dose aspirin?”

References

Camargo, F. C., Iwamoto, H. H., Galvão, C. M., Monteiro, D. A. T., Goulart, M. B., & Garcia, L. A. A. (2018). Models for the implementation of evidence-based practice in hospital based nursing: A narrative review1. Texto & Contexto-Enfermagem, 26. https://www.scielo.br/j/tce/a/w7YdK4vhwv74CgjSv56tFWG/?lang=en&format=pdf

Davidson, K. W., Barry, M. J., Mangione, C. M., Cabana, M., Chelmow, D., Coker, T. R., … & U.S. Preventive Services Task Force. (2022). Aspirin use to prevent cardiovascular disease: U.S. Preventive Services Task Force recommendation statement. JAMA, 327(16), 1577-1584. doi:10.1001/jama.2022.4983.

Gaziano, J. M., Brotons, C., Coppolecchia, R., Cricelli, C., Darius, H., Gorelick, P. B., … & ARRIVE Executive Committee. (2018). Use of aspirin to reduce risk of initial vascular events in patients at moderate risk of cardiovascular disease (ARRIVE): A randomized, double-blind, placebo-controlled trial. The Lancet, 392(10152), 1036-1046. Doi: 10.1016/S0140-6736(18)31924-X. Epub 2018 Aug 26.

Jones, W. S., Mulder, H., Wruck, L. M., Pencina, M. J., Kripalani, S., Muñoz, D., … & Hernandez, A. F. (2021). Comparative effectiveness of aspirin dosing in cardiovascular disease. New England Journal of Medicine, 384(21), 1981-1990. DOI: 10.1056/NEJMoa2102137

Keehan, S. P., Cuckler, G. A., Poisal, J. A., Sisko, A. M., Smith, S. D., Madison, A. J., … & Hardesty, J. C. (2020). National Health Expenditure Projections, 2019–28: Expected Rebound in Prices Drives Rising Spending Growth: National health expenditure projections for 2019–2028. Health Affairs, 39(4), 704-714. https://doi.org/10.1377/hlthaff.2020.00094

Miller, E. C., Boehme, A. K., Chung, N. T., Wang, S. S., Lacey, J. V., Lakshminarayan, K., … & Willey, J. Z. (2019). Aspirin reduces long-term stroke risk in women with prior hypertensive disorders of pregnancy. Neurology, 92(4), e305-e316. DOI:10.1212/WNL.0000000000006815.

Ridker, P. M., Cook, N. R., Lee, I. M., Gordon, D., Gaziano, J. M., Manson, J. E., … & Buring, J. E. (2019). A randomized trial of low-dose aspirin in the primary prevention of cardiovascular disease in women. New England Journal of Medicine, 352(13), 1293-1304.

Sugawara, M., Goto, Y., Yamazaki, T., Teramoto, T., Oikawa, S., Shimada, K., … & Ikeda, Y. (2019). Low-dose aspirin for primary prevention of cardiovascular events in elderly Japanese patients with atherosclerotic risk factors: subanalysis of a randomized clinical trial (JPPP-70). American Journal of Cardiovascular Drugs, 19(3), 299-311. DOI: 10.1007/s40256-018-0313-0.