Assignment: Evidence-Based Project Part 3 Critical Appraisal of Research Paper

Assignment: Evidence-Based Project Part 3 Critical Appraisal of Research Paper

Assignment: Evidence-Based Project Part 3 Critical Appraisal of Research Paper

Evaluation Table

Part 3A: Critical Appraisal of Research

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Full APA formatted citation of the selected article.	Article #1	Article #2	Article #3	Article #4
	Mitchell, B. G., Gardner, A., Stone, P. W., Hall, L., & Pogorzelska-Maziarz, M. (2018). Hospital Staffing and Health Care-Associated Infections: A Systematic Review of the Literature. The Joint Commission Journal on Quality and Patient Safety, 44(10), 613–622. https://doi.org/10.1016/j.jcjq.2018.02.002	Griffiths, P., Recio-Saucedo, A., Dall’Ora, C., Briggs, J., Maruotti, A., Meredith, P., Smith, G. B., & Ball, J. (2018). The association between nurse staffing and omissions in nursing care: A systematic review. Journal of Advanced Nursing, 74(7), 1474–1487. https://doi.org/10.1111/jan.13564 ‌ Struggling to meet your deadline ? Get assistance on Assignment: Evidence-Based Project Part 3 Critical Appraisal of Research Paper done on time by medical experts. Don’t wait – ORDER NOW! Meet My Deadline	Nelson, D., Hearld, L. R., & Wein, D. (2018). The Impact of Emergency Department RN Staffing on ED Patient Experience. Journal of Emergency Nursing, 44(4), 394–401. https://doi.org/10.1016/j.jen.2018.01.001	Wolf, L. A., Delao, A. M., Perhats, C., Moon, M. D., & Zavotsky, K. E. (2018). Triaging the Emergency Department, Not the Patient: United States Emergency Nurses’ Experience of the Triage Process. Journal of Emergency Nursing, 44(3), 258–266. https://doi.org/10.1016/j.jen.2017.06.010
Evidence Level * (I, II, or III)	Level I	Level I	Level II	Level I
Conceptual Framework   Describe the theoretical basis for the study (If there is not one mentioned in the article, say that here).**	The conducted systemic review was guided by the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines.	The systemic review was guided by the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines.	A conceptual framework was utilized in guiding this study.	None
Design/Method   Describe the design and how the study was carried out (In detail, including inclusion/exclusion criteria).	A systemic review of literature sources from Electronic databases PubMed and CINAHL. The inclusion criteria comprised all observational studies which examined the relationship between healthcare-associated infection (HAI) and staffing in the hospital setting, published between 1/1/2000, and 30/11/2015.	A systemic review research design was utilized. Sources were drawn from  CINAHL, Embase, Medline, and Cochrane library. Only qualitative studies evaluating the relationship between missed care and nursing staffing were reviewed.	Responses were collected from all the eligible study participants who comprised patients visiting the emergency department of a huge academic medical Centre located in the southeastern United States. The study was conducted to determine the relationship between patient experience rating and ED RN staffing between 1/3/2015 and 30/11/2015.	A mixed-method study design was utilized, retrieving patient information from electronic health records and triangulating it with data from focus groups.
Sample/Setting   The number and characteristics of patients, attrition rate, etc.	A total of 1,247 articles were reviewed.	A total of 88 studies met the inclusion criteria for the conducted review. All the reviewed articles were cross-sectional with average participants ranging from 232-31,627 nurses, most of which were RNs	A total of 3120 adults participated in this study.	A total of five ED located on the United States east coast were recruited for this study. All the ED recorded a total of over 30,000 patient visits every year, with EHR, systems and utilize ESI for triage.
Major Variables Studied   List and define dependent and independent variables	Independent variable- nursing staffing Dependent Variable- healthcare-associated infection (HAI)	Independent variable- Nursing staffing Dependent variable- missed care	Independent variable-ED registered nurse staffing Dependent variable- patient experience	Independent variable- emergency nurse perception. Dependent variable- pain level, HR, SBP
Measurement   Identify primary statistics used to answer clinical questions (You need to list the actual tests done).	From all the eligible studies, the following measurements were extracted to answer the clinical question: HAI incidences, HAI types, staffing variables and parameters, staffing data source, and unity analysis.	Quality measures for this study include missed nursing care and nurse staffing. Missed care included nursing omissions and medication errors. Nurse staffing was measured in terms of nurse-patient ratio and RN Hours per patient day	Measurements that were taken to answer the study question include the overall ED patient experience ratings, ED RN tasks/roles, and Nurse to patient ratio.	To collect relevant information for this study, the following measurements were taken, patients’ age, heart rate, SBP, last menstrual period, pain level, and ESI level assigned at triage.
Data Analysis Statistical or Qualitative findings   (You need to enter the actual numbers determined by the statistical tests or qualitative data).	The collected data were synthesized and tabulated. Due to the heterogeneity of the eligible studies utilized in the systemic review, it was not feasible to extract data in a meta-analysis.	Cochran Q statistic was used to explore the heterogeneity. The study findings were categorized and tabulated for presentation.	Ordinal logistic regression models were utilized by the researchers in examining the relationship between patient care ratings and the two nursing staff variables.	SPSS software was utilized for the analysis of demographic and chart review data. Chi-square statistics were used to test the subgroup differences with a P< 0.05 considered as an indication of statistical significance.
Findings and Recommendations   General findings and recommendations of the research	Even though the findings of most studies varied, the researcher discovered that an increase in nursing staffing is directly proportional to a decrease in the risks of acquiring HAIs. However, more consistent and rigorous studies need to be conducted to determine the actual number of staff that is appropriate for the lowest risks of HAIs.	The study findings demonstrate that low levels of nursing staffing were associated with increased reports of missed nursing care in the hospital setting. However, the researchers recommended further investigations on the extent to which the observed relationship represents actual failures.	A high level of ED RN staffing was associated with a high patient satisfaction rate as most of their expectations during times of complex cases and high patient volume were met. However, the significance and strength of the relationship between nursing staffing and patient experience varied based on several factors including patient discharge status and how staffing is measured, which should be addressed in future studies.	The study findings demonstrate a significant deficit in knowledge among healthcare professionals in care for patients with high-risk medical conditions associated with pregnancy. Improving educational needs and the triage processes in addition to managing workflow issues is crucial in promoting positive care outcomes for such patients.
Appraisal and Study Quality     Describe the general worth of this research to practice.   What are the strengths and limitations of the study?   What are the risks associated with the implementation of the suggested practices or processes detailed in the research?   What is the feasibility of use in your practice?	At every stage of the selection of studies for this review, the lead author randomly selected 10% of the articles and cross-checked the validity, credibility, and eligibility of the studies. However, the varying definitions and measures, in addition to the design limitations and methodological flaws led to mixed results. The findings however attained statistical significance to be incorporated into actual nursing practice.	Quality appraisal for this study was based on the NICE quality appraisal checklist. The risks of bias for most studies included in this review were low expressed in terms of external and internal validity. However, the instrument utilized for quality appraisal of this study was designed to mainly assess cross-sectional studies based on the NICE methodology, and thus assigning low risks of bias to all the reviewed studies fails to assure a causal interpretation. As such, further studies are needed to provide the actual relationship between nursing staffing and care misses for substantial evidence for incorporation into current practice.	First-hand information was collected from patients to build on the data utilized in answering the research question. This proves the credibility and reliability of the information provided. The risks of bias were also low, as patients’ anonymity was maintained. However, certain factors were not considered in this study, such as patient discharge status and how staffing is measured, which undermined the significance of this evidence for application in current practice.	A critical appraisal guide for qualitative studies was utilized to ensure that only credible and reliable resources were used to answer the clinical question. However, in the data collection process, it was reported that due to language barriers, a family member who made the translations may have increased the risks of biases. Consequently, the sample was geographically limited reducing the feasibility of utilizing these interventions in current practice.
Key findings	Most studies examined the relationship between HAIs and nurse staffing and HAIs (92.6%) and discovered that increased nurse staffing was associated with reduced incidences of HAIs. Physician staffing was also associated with similar results.	Subjective reports on missed nursing care were provided by 88 studies. Out of these studies in 75% of them, nurses reported some kind of omitted care, while in 14% of the studies, low nurse staffing was associated with high reports of missed care.	High levels of emergency department RN staffing were associated with improved patient experience ratings.	Pregnancy status was not documented in about 86.5% of cases. A total of 94% of study participants who recorded a systolic BP over 140 mmHg were under- triaged. Identified barriers to acuity blindness include educational needs, workflow issues, and the triage process.
Outcomes	Despite the lack of rigorous study designs and consistent findings, the researchers were able to provide adequate evidence supporting the directly proportional relationship between nursing staffing and rates of HAIs.	Nurse staff levels in hospitals are directly associated with adverse effects for patients due to care misses that increase hospital mortality rates.	Nursing staffing levels in the emergency department, such as the nurse-to-patient ratio, nurse experience, qualification, and skills play a significant role in promoting patient satisfaction rates.	The study participants reported no cohesive or comprehensive obstetric education, which led to poor patient outcomes.
General Notes/Comments	HAIs have been a very challenging healthcare issue undermining the quality of care and causing adverse outcomes like increased duration of hospital stay, and medical costs. However, this systemic review provides a solution, which involves increasing nursing staffing, to help reduce the risks of HAIs in hospital settings.	Nurses play a crucial role in the provision of care services and in making sure that all the patient’s needs are met for a positive outcome. As such, this study demonstrates that a reduced nurse staffing level is associated with high care misses, undermining the health of the patient. Most of the reviewed studies associated low nurse levels with increased medical errors and omitted procedures, which increased the rate of in-hospital mortality.	Given the complexity of conditions handled in the emergency department and the high patient volume, RN staffing levels can greatly affect the way patient needs are met. Based on the evidence provided in this study, it is crucial to maintain a nursing staffing level in such a department, to promote time satisfaction of patient expectations and improve their overall experience.	The care outcome for pregnancy patients with high-risk conditions is associated with educational needs, workflow issues, and the triage process. As such, clinicians working in maternal care should undergo adequate training and promote patient education for positive outcomes.

 Part 3B: Critical Appraisal of Research

Promoting evidence-based practice is a great problem-solving approach that can help nurses improve the quality and safety of the care provided. The four articles critically appraised articles in the table above focused on two main clinical problems. While Mitchell et al. (2018), Nelson et al. (2018), and Griffiths et al. (2020) aimed at promoting nursing staffing levels concerning reducing care misses and promoting patient outcomes, Wolf et al. (2018) aimed at promoting nursing care for the pregnant patient with high-risk conditions. However, all four studies were governed with a similar goal of improving patient experience and clinical outcomes in the emergency department. As a result, two main evidence-based approaches were drawn from this study, including the implementation of obstetric education and increasing nursing staffing.

To support the use of the above intervention, Mitchell et al. (2018) conducted a study that discovered that an increase in nursing staffing is directly proportional to a decrease in the risks of acquiring HAIs. Consequently, Nelson et al. (2018) reported that high levels of emergency department RN staffing were associated with improved patient experience ratings. Wolf et al. (2018) also provided evidence supporting the need of improving educational needs and the triage processes. In addition to managing workflow issues is crucial in promoting positive care outcomes for pregnant patients with high-risk conditions. As reported by Fineout-Overholt et al. (2020) in Part I and III articles most of the studies reviewed in this article are level I evidence, the findings can be incorporated into current practice. However, several other factors such as implementation costs and the kind of healthcare facility should be considered for the successful implementation of such evidence-based interventions. Future studies need to be conducted on the same to improve the quality of care and treatment outcomes of patients in the emergency department.

References

Fineout-Overholt, E., Melnyk, B. M., Stillwell, S. B., & Williamson, K. M. (2010). Evidence-Based Practice, Step by Step: Critical Appraisal of the Evidence Part III. AJN, American Journal of Nursing, 110(11), 43–51. https://doi.org/10.1097/01.naj.0000390523.99066.b5‌

Fineout-Overholt, E., Melnyk, B. M., Stillwell, S. B., & Williamson, K. M. (2010). Evidence-Based Practice Step by Step: Critical Appraisal of the Evidence: Part I. AJN, American Journal of Nursing, 110(7), 47–52. https://doi.org/10.1097/01.naj.0000383935.22721.9c

Griffiths, P., Recio-Saucedo, A., Dall’Ora, C., Briggs, J., Maruotti, A., Meredith, P., Smith, G. B., & Ball, J. (2018). The association between nurse staffing and omissions in nursing care: A systematic review. Journal of Advanced Nursing, 74(7), 1474–1487. https://doi.org/10.1111/jan.13564

Mitchell, B. G., Gardner, A., Stone, P. W., Hall, L., & Pogorzelska-Maziarz, M. (2018). Hospital Staffing and Health Care-Associated Infections: A Systematic Review of the Literature. The Joint Commission Journal on Quality and Patient Safety, 44(10), 613–622. https://doi.org/10.1016/j.jcjq.2018.02.002

Nelson, D., Hearld, L. R., & Wein, D. (2018). The Impact of Emergency Department RN Staffing on ED Patient Experience. Journal of Emergency Nursing, 44(4), 394–401. https://doi.org/10.1016/j.jen.2018.01.001

Wolf, L. A., Delao, A. M., Perhats, C., Moon, M. D., & Zavotsky, K. E. (2018). Triaging the Emergency Department, Not the Patient: United States Emergency Nurses’ Experience of the Triage Process. Journal of Emergency Nursing, 44(3), 258–266. https://doi.org/10.1016/j.jen.2017.06.010

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Realtors rely on detailed property appraisals—conducted using appraisal tools—to assign market values to houses and other properties. These values are then presented to buyers and sellers to set prices and initiate offers.
Please be sure to put paper in 7th edition APA format
Please reference rubric
Please fill out template according to rubric
the references that have been uploaded in the files are the needed to be used for the Critical Appraisal from Module 2 and Module 3
there must me a 2-3 inside class resources used which will be sent to you via
message and at least two outside references
Research appraisal is not that different. The critical appraisal process utilizes formal appraisal tools to assess the results of research to determine value to the context at hand. Evidence-based practitioners often present these findings to make the case for specific courses of action.

In this Assignment, you will use an appraisal tool to conduct a critical appraisal of published research. You will then present the results of your efforts.

To Prepare:

Reflect on the four peer-reviewed articles you selected in Module 2 and the four systematic reviews (or other filtered high- level evidence) you selected in Module 3.
Reflect on the four peer-reviewed articles you selected in Module 2 and analyzed in Module 3.
Review and download the Critical Appraisal Tool Worksheet Template provided in the Resources.
The Assignment (Evidence-Based Project)

Part 3A: Critical Appraisal of Research

Conduct a critical appraisal of the four peer-reviewed articles you selected by completing the Evaluation Table within the Critical Appraisal Tool Worksheet Template. Choose a total of four peer- reviewed articles that you selected related to your clinical topic of interest in Module 2 and Module 3.

Note: You can choose any combination of articles from Modules 2 and 3 for your Critical Appraisal. For example, you may choose two unfiltered research articles from Module 2 and two filtered research articles (systematic reviews) from Module 3 or one article from Module 2 and three articles from Module 3. You can choose any combination of articles from the prior Module Assignments as long as both modules and types of studies are represented.

Part 3B: Critical Appraisal of Research

Based on your appraisal, in a 1-2-page critical appraisal, suggest a best practice that emerges from the research you reviewed. Briefly explain the best practice, justifying your proposal with APA citations of the research.