NURS 6052 Module 4: Critical Appraisal, Evaluation/ Summary, and Synthesis of Evidence (Weeks 6-7)

NURS 6052 Module 4 Critical Appraisal, Evaluation/ Summary, and Synthesis of Evidence (Weeks 6-7)

NURS-6052 Module 4: Critical Appraisal, Evaluation/ Summary, and Synthesis of Evidence (Weeks 6-7)

Laureate Education (Producer). (2018). Critical Appraisal [Video file]. Baltimore, MD: Author.

Due By	Assignment
Week 6, Days 1-4	Read the Learning Resources. Begin to compose Part A of your Assignment.
Week 6, Days 5-7	Continue to compose Part B of your Assignment. Begin to compose Part B of your Assignment.
Week 7, Days 1-6	Continue to compose Part A and B of your Assignment.
Week 7, Day 7	Deadline to submit Part A and B of your Assignment.

Learning Objectives

Students will:

Evaluate peer-reviewed articles using critical appraisal tools
Analyze best practices based on critical appraisal of evidence-based research

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Learning Resources for NURS 6052 Module 4 Critical Appraisal, Evaluation/ Summary, and Synthesis of Evidence (Weeks 6-7)

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

NURS 6052 Module 4 Critical Appraisal, Evaluation/ Summary, and Synthesis of Evidence (Weeks 6-7) Required Readings

Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer.

Chapter 5, “Critically Appraising Quantitative Evidence for Clinical Decision Making” (pp. 124–188)

Chapter 6, “Critically Appraising Qualitative Evidence for Clinical Decision Making” (pp. 189–218)

Fineout-Overholt, E., Melnyk, B. M., Stillwell, S. B., & Williamson, K. M. (2010a). Evidence-based practice step by step: Critical appraisal of the evidence: Part I. American Journal of Nursing, 110(7), 47–52. doi:10.1097/01.NAJ.0000383935.22721.9c

Note: You will access this article from the Walden Library databases.

Fineout-Overholt, E., Melnyk, B. M., Stillwell, S. B., & Williamson, K. M. (2010b). Evidence-based practice, step by step: Critical appraisal of the evidence: Part II: Digging deeper—examining the “keeper” studies. American Journal of Nursing, 110(9), 41–48. doi:10.1097/01.NAJ.0000388264.49427.f9

Note: You will access this article from the Walden Library databases.

Fineout-Overholt, E., Melnyk, B. M., Stillwell, S. B., & Williamson, K. M. (2010c). Evidence-based practice, step by step: Critical appraisal of the evidence: Part III: The process of synthesis: Seeing similarities and differences across the body of evidence. American Journal of Nursing, 110(11), 43–51. doi: 10.1097/01.NAJ.0000390523.99066.b5

Note: You will access this article from the Walden Library databases.

Williamson, K. M. (2009). Evidence-based practice: Critical appraisal of qualitative evidence. Journal of the American Psychiatric Nurses Association, 15(3), 202–207. doi:10.1177/1078390309338733

Note: You will access this article from the Walden Library databases.

Document: Critical Appraisal Tool Worksheet Template (Word document)

Also Read:

NURS-6052 Assignment: Evidence-Based Capstone Project, Part 6: Disseminating Results

NURS-6052 Module 6: Changing the World Through Evidence-Based Practice (Weeks 10-11)

NURS-6052 Week 8 Discussion: Patient Preferences and Decision Making

NURS6052 Week 9 Assignment: Evidence-Based Project, Part 5: Recommending an Evidence-Based Practice Change

NURS-6052 Module 5: Evidence-Based Decision Making (Weeks 8-9)

NURS-6052 Assignment: Evidence-Based Project, Part 4: Critical Appraisal of Research

NURS 6052 Module 4 Critical Appraisal, Evaluation/ Summary, and Synthesis of Evidence (Weeks 6-7) Required Media

Laureate Education (Producer). (2018). Appraising the Research [Video file]. Baltimore, MD: Author (Weeks 6-7)

Laureate Education (Producer). (2018). Interpreting Statistics [Video file]. Baltimore, MD: Author.

Laureate Education (Producer). (2018). Review of research: Hierarchy of evidence pyramid [Mutlimedia file]. Baltimore, MD: Author.

Schulich Library McGill. (2017, June 6). Types of reviews [Video file]. Retrieved from https://youtu.be/5Rv9z7Mp4kg

Assignment: Evidence-Based Project, Part 4: Critical Appraisal of Research

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.

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:

Review the Resources and consider the importance of critically appraising research evidence.
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 4A: Critical Appraisal of Research

Conduct a critical appraisal of the four peer-reviewed articles you selected and analyzed by completing the Evaluation Table within the Critical Appraisal Tool Worksheet Template.

Part 4B: 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 NURS 6052 Module 4 Critical Appraisal, Evaluation/ Summary, and Synthesis of Evidence (Weeks 6-7).

By Day 7 of Week 7

Submit Part 4A and 4B of your Evidence-Based Project.

Submission and Grading Information

To submit your completed Assignment for review and grading, do the following:

Please save your Assignment using the naming convention “WK7Assgn+last name+first initial.(extension)” as the name.
Click the Week 7 Assignment Rubric to review the Grading Criteria for the Assignment.
Click the Week 7 Assignment link. You will also be able to “View Rubric” for grading criteria from this area.
Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK7Assgn+last name+first initial.(extension)” and click Open.
If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
Click on the Submit button to complete your submission.

NURS 6052 Week 1 Assignment – Evidence-Based Practice and the Quadruple Aim

Healthcare organizations continually seek to optimize healthcare performance. For years, this approach was a three-pronged one known as the Triple Aim, with efforts focused on improved population health, enhanced patient experience, and lower healthcare costs NURS 6052 Module 4 Critical Appraisal, Evaluation/ Summary, and Synthesis of Evidence (Weeks 6-7).

More recently, this approach has evolved to a Quadruple Aim by including a focus on improving the work life of healthcare providers. Each of these measures are impacted by decisions made at the organizational level, and organizations have increasingly turned to EBP to inform and justify these decisions.

To Prepare:

Read the articles by Sikka, Morath, & Leape (2015); Crabtree, Brennan, Davis, & Coyle (2016); and Kim et al. (2016) provided in the Resources.

Reflect on how EBP might impact (or not impact) the Quadruple Aim in healthcare.
Consider the impact that EBP may have on factors impacting these quadruple aim elements, such as preventable medical errors or healthcare delivery.

To Complete:

Write a brief analysis (no longer than 2 pages) of the connection between EBP and the Quadruple Aim.

Your analysis should address how EBP might (or might not) help reach the Quadruple Aim, including each of the four measures of:

Patient experience
Population health
Costs
Work life of healthcare providers

NURS 6052 Week 2 & 3 Assignment – Evidence-Based Project

Is there a difference between common practice and best practice?

When you first went to work for your current organization, experienced colleagues may have shared with you details about processes and procedures. Perhaps you even attended an orientation session to brief you on these matters NURS 6052 Module 4 Critical Appraisal, Evaluation/ Summary, and Synthesis of Evidence (Weeks 6-7). As a rookie you likely kept the nature of your questions to those with answers that would best help you perform your new role.

Over time and with experience, perhaps you recognized aspects of these processes and procedures that you wanted to question further. This is the realm of clinical inquiry.

Clinical inquiry is the practice of asking questions about clinical practice. To continuously improve patient care, all nurses should consistently use clinical inquiry to question why they are doing something the way they are doing it. Do they know why it is done this way, or is it just because we have always done it this way? Is it a common practice or a best practice?

In this Assignment, you will identify clinical areas of interest and inquiry and practice searching for research in support of maintaining or changing these practices. You will also analyze this research to compare research methodologies employed.

To Prepare:

Review the Resources and identify a clinical issue of interest that can form the basis of a clinical inquiry.

Based on the clinical issue of interest and using keywords related to the clinical issue of interest, search at least four different databases in the Library to identify at least four relevant peer-reviewed articles related to your clinical issue of interest.
Review the results of your peer-reviewed research and reflect on the process of using an unfiltered database to search for peer-reviewed research.
Reflect on the types of research methodologies contained in the four relevant peer-reviewed articles you selected.

Part 1: An Introduction to Clinical Inquiry

Create a 4- to 5-slide PowerPoint presentation in which you do the following:

Identify and briefly describe your chosen clinical issue of interest.
Describe how you used keywords to search on your chosen clinical issue of interest.
Identify the four research databases that you used to conduct your search for the peer-reviewed articles you selected.

Provide APA citations of the four peer-reviewed articles you selected.

Part 2: Identifying Research Methodologies

After reading each of the four peer-reviewed articles you selected, use the Matrix Worksheet template to analyze the methodologies applied in each of the four peer-reviewed articles NURS 6052 Module 4 Critical Appraisal, Evaluation/ Summary, and Synthesis of Evidence (Weeks 6-7). Your analysis should include the following:

The full citation of each peer-reviewed article in APA format.

A brief (1-paragraph) statement explaining why you chose this peer-reviewed article and/or how it relates to your clinical issue of interest, including a brief explanation of the ethics of research related to your clinical issue of interest.
A brief (1-2 paragraph) description of the aims of the research of each peer-reviewed article.
A brief (1-2 paragraph) description of the research methodology used. Be sure to identify if the methodology used was qualitative, quantitative, or a mixed-methods approach. Be specific.
A brief (1- to 2-paragraph) description of the strengths of each of the research methodologies used, including reliability and validity of how the methodology was applied in each of the peer-reviewed articles you selected.

NURS 6052 Week 5 Assignment – Evidence-Based Project, Part 3: Advanced Levels of Clinical Inquiry and Systematic Reviews

Your quest to purchase a new car begins with an identification of the factors important to you. As you conduct a search of cars that rate high on those factors, you collect evidence and try to understand the extent of that evidence. A report that suggests a certain make and model of automobile has high mileage is encouraging. But who produced that report? How valid is it? How was the data collected, and what was the sample size?

In this Assignment, you will delve deeper into clinical inquiry by closely examining your PICO(T) question. You also begin to analyze the evidence you have collected.

To Prepare:

Review the Resources and identify a clinical issue of interest that can form the basis of a clinical inquiry.

Develop a PICO(T) question to address the clinical issue of interest for the Assignment.
Use the key words from the PICO(T) question you developed and search at least four different databases in the Library to identify at least four relevant peer-reviewed articles at the systematic-reviews level related to your research question.
Reflect on the process of creating a PICO(T) question and searching for peer-reviewed research.

The Assignment (Evidence-Based Project)

Part 3: Advanced Levels of Clinical Inquiry and Systematic Reviews

Create a 6- to 7-slide PowerPoint presentation in which you do the following:

Identify and briefly describe your chosen clinical issue of interest.
Describe how you developed a PICO(T) question focused on your chosen clinical issue of interest.
Identify the four research databases that you used to conduct your search for the peer-reviewed articles you selected.

Provide APA citations of the four peer-reviewed articles you selected.

Describe the levels of evidence in each of the four peer-reviewed articles you selected, including an explanation of the strengths of using systematic reviews for clinical research. Be specific and provide examples NURS 6052 Module 4 Critical Appraisal, Evaluation/ Summary, and Synthesis of Evidence (Weeks 6-7).

NURS 6052 Week 7 Assignment – Evidence-Based Project, Part 4: Critical Appraisal of Research

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.

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

To Prepare:

Review the Resources and consider the importance of critically appraising research evidence.

Reflect on the four peer-reviewed articles you selected in Module 2 and analyzed in Module 3.
Review and download the Critical Appraisal Tools document provided in the Resources.

The Assignment (Evidence-Based Project)

Part 4A: Critical Appraisal of Research

Conduct a critical appraisal of the four peer-reviewed articles you selected and analyzed by completing the Critical Appraisal Tools document. Be sure to include:

An evaluation table
A levels of evidence table
An outcomes synthesis table

Part 4B: Critical Appraisal of Research

NURS 6052 Week 9 Assignment – Evidence-Based Project, Part 5: Recommending an Evidence-Based Practice Change

The collection of evidence is an activity that occurs with an endgame in mind. For example, law enforcement professionals collect evidence to support a decision to charge those accused of criminal activity. Similarly, evidence-based healthcare practitioners collect evidence to support decisions in pursuit of specific healthcare outcomes.

In this Assignment, you will identify an issue or opportunity for change within your healthcare organization and propose an idea for a change in practice supported by an EBP approach.

To Prepare:

Reflect on the four peer-reviewed articles you critically appraised in Module 4.
Reflect on your current healthcare organization and think about potential opportunities for evidence-based change.

The Assignment: (Evidence-Based Project)

Part 5: Recommending an Evidence-Based Practice Change

Create an 8- to 9-slide PowerPoint presentation in which you do the following:

Briefly describe your healthcare organization, including its culture and readiness for change. (You may opt to keep various elements of this anonymous, such as your company name.)
Describe the current problem or opportunity for change. Include in this description the circumstances surrounding the need for change, the scope of the issue, the stakeholders involved, and the risks associated with change implementation in general.
Propose an evidence-based idea for a change in practice using an EBP approach to decision making. Note that you may find further research needs to be conducted if sufficient evidence is not discovered.
Describe your plan for knowledge transfer of this change, including knowledge creation, dissemination, and organizational adoption and implementation.
Describe the measurable outcomes you hope to achieve with the implementation of this evidence-based change.

Be sure to provide APA citations of the supporting evidence-based peer reviewed articles you selected to support your thinking.

Add a lessons learned section that includes the following:

A summary of the critical appraisal of the peer-reviewed articles you previously submitted
An explanation about what you learned from completing the evaluation table (1 slide)
An explanation about what you learned from completing the levels of evidence table (1 slide)
An explanation about what you learned from completing the outcomes synthesis table (1 slide)

Evidence-Based Project, Part 5: Recommending an Evidence-Based Practice Change : Probiotics use in the Management of Antibiotics- Associated GI Symptoms Sample Slides

SLIDE 1 : Effects of Antibiotics on Gut Microbiota

The gut microbiota has an impact on important human physiological activities like digestion, inflammation and metabolism.
Short-term antibiotic treatment can cause the gut microbiota to shift into long-term dysbiotic conditions.
This promotes disease development and exacerbation.
Post- antibiotic dysbiosis increases the risk of Antimicrobial resistance.
Probiotics manage the post- antibiotic dysbiosis by reconstitution of the host’s gut mucosal microbiome niche.

SLIDE 2 : Our Healthcare Organization Description

Vision: Provide world class patient – centered care.
Mission: To optimize patients’ experiences by providing specialized care drawn from evidence-based practices.
PICOT description of the Hospital’s Problem
Population: Adult patients(male and female).
Intervention: Antibiotics use in the management of GI disorders
Comparison: Use of probiotics
Outcome: Gastrointestinal upset in 30% of patients
Time: Study carried out in the last 1 year.

SLIDE 3 : Dissemination Strategy

Knowledge creation: We will conduct a Comparative Effectiveness Research during the pilot phase of the prebiotics program.
Our aim is to be supported by research institutions such as AHRQ Effective Healthcare Program funds.
Dissemination strategy: Multifaceted including both active and passive techniques.
We will use educational outreach and academic detailing as they have proven to be more effective (Munn et al., 2018).
Communication techniques will include:
Tailoring the message
Using narratives
Framing the message in alternate ways.
Adoption and implementation: the research findings will determine buy – in of the project.
There shall be a phase roll out of the project among different departments till probiotics use become the hospital culture.

SLIDE 5 : Expected Outcomes from the Probiotic Use

Expected outcomes can be classified as individual, institutional and community.

Individual

i. Reduction of antibiotics associated GI upset to < 10% within the first year.

ii. Decreased morbidity

iii. Decreased hospital stay and readmissions

iv. Decreased overall cost of management

Institutional

i. Increased employee motivation

ii. Better hospital reputation

iii. Reduction of costs

Community

i. Decreased risk of antibiotic resistance

SLIDE 6 : RESEARCH 1 APPRAISAL

Topic	The Effectiveness and Safety of Multi-Strain Probiotic Preparation in Patients with Diarrhea-Predominant Irritable Bowel Syndrome
Research Design	Randomized Control Study
Strengths	It was a Double Blind Placebo Random Controlled Study. Long study period (7months).
Weaknesses	Small sample size(58). Use of an outdated Rome Criteria to define patients. Limited duration of intervention (8 weeks). Use of secondary endpoints.
Relevance to the Topic of Interest	Patients with Inflammatory Bowel Disease represent a population with a very sensitive gut therefore if prebiotics were effective for them the results are generalizable to other populations
Notes	A preparation consisting of Lactobacillus, Bifidobacterium, and Streptococcus thermophilus probiotic strains and administrated at a dose of 5 billion CFU daily for 8 weeks has superior effects in comparison with a placebo.

SLIDE 7 : RESEARCH 2 APPRAISAL

Topic	Probiotic or synbiotic alters the gut microbiota and metabolism in a randomized controlled trial of weight management in overweight adults
Research Design	Randomized Controlled Trial
Strengths	It was a Double Blind Placebo Random Controlled Study. Study participants recruited from four different research centers. The study lasted from December 2013 to October 2014
Weakness	Difficult to deduce the causality of health benefits in obese patients after the consumption of B420 and LU. Increased variability of the subjects’ fecal metabolic results
Relevance to the Topic of Study	The research aims to explain the mode of action of probiotics in GI upset and the effect of co – administration with a pre- biotic.
Notes	Consumption of the probiotic B420 with or without a prebiotic LU resulted in alterations of the gut microbiota and metabolism. The modification of the gut microbiota to a more favorable composition may contribute to improved gut barrier function and obesity related markers.

SLIDE 8 : Research 3 Appraisal

Topic	A retrospective study of probiotics for the treatment of children with antibiotic-associated diarrhea
Research Design	Retrospective Cohort Study
Strengths	Study participants were equally assigned to the treatment and control group. The study addresses the research gap on efficacy and safety of probiotics.
Weaknesses	Lack of randomizations All patients were selected from one center. Limited sample size of 72 children. The children were followed up for the seven – day treatment period only.
Relevance to the Topic of Study	The study focused on Antibiotics Associated Diarrhea, the most common form of anti – biotic dysbiosis.
Notes	Probiotics were shown to reduce the duration of AAD, intensity of abdominal pain and improved the stool consistency among children with no side effects.

SLIDE 9 : Research 4 Appraisal

Topic	Probiotics for gastrointestinal symptoms and quality of life in autism: A placebo-controlled pilot trial.
Research Design	A randomized crossover feasibility pilot trial.
Strengths	Participants were randomly assigned 1:1 to probiotic or placebo. Participants followed up for 19 weeks in total.
Weaknesses	A small sample size of 13 participants with 2 leaving the trial. Use of 16S sequencing without metagenome analysis.
Relevance to the Topic of Interest	The study sought to assess the feasibility , safety and suggestion for implementation of probiotics use. Findings from the study will form a stepping stone in the adoption of the programme in our hospital.
Notes	The crossover study design was not practical. The study recommends use of parallel group design for larger randomized controlled trials.

SLIDE 10 : Conclusion

The peer reviewed articles support the use of probiotics in the management of Antibiotics associated GI side effects.
The articles reviewed different populations: children, obese, autistic children and patients with Inflammatory bowel disease.
Positive outcomes in all the populations, means the results are generalizable for the general population.
The articles addressed key factors: efficacy, effectiveness, mode of action and safety.
Moreover, the fourth research outlines on the best fitting research design when adopting probiotics use in a facility.
Generally, probiotics were well tolerated and induced an improvement of GI symptoms and should be adopted in our facility for the prevention of antibiotics associated GI symptoms.

NURS 6052 Module 4 Critical Appraisal, Evaluation/ Summary, and Synthesis of Evidence (Weeks 6-7) References

Arnold, L. E., Luna, R. A., Williams, K., Chan, J., Parker, R. A., Wu, Q., Hollway, J. A., Jeffs, A., Lu, F., Coury, D. L., Hayes, C., &Savidge, T. (2019). Probiotics for gastrointestinal symptoms and quality of life in autism: A placebo-controlled pilot trial. Journal of Child and Adolescent Psychopharmacology, 29(9), 659–669. https://doi.org/10.1089/cap.2018.0156

Gargon, E., Gorst, S. L., & Williamson, P. R. (2019). Choosing important health outcomes for comparative effectiveness research: 5th annual update to a systematic review of core outcome sets for research. PloS one, 14(12), e0225980. https://doi.org/10.1371/journal.pone.0225980

Hibberd, A. A., Yde, C. C., Ziegler, M. L., Honoré, A. H., Saarinen, M. T., Lahtinen, S., Stahl, B., Jensen, H. M., &Stenman, L. K. (2019). Probiotic or synbiotic alters the gut microbiota and metabolism in a randomized controlled trial of weight management in overweight adults. Beneficial Microbes, 10(2), 121–135. https://doi.org/10.3920/BM2018.0028

Kong, C., Gao, R., Yan, X., Huang, L., & Qin, H. (2019). Probiotics improve gut microbiota dysbiosis in obese mice fed a high-fat or high-sucrose diet. Nutrition, 60, 175-184. https://doi.org/10.1016/j.nut.2018.10.002

Munn, Z., Stern, C., Porritt, K., Lockwood, C., Aromataris, E., & Jordan, Z. (2018). Evidence transfer: ensuring end users are aware of, have access to, and understand the evidence. JBI Evidence Implementation, 16(2), 83-89. https://journals.lww.com/ijebh/FullText/2018/06000/Evidence_transfer__ensuring_end_users_are_aware.2.aspx

Rui, X., & Ma, S.-X. (2020). A retrospective study of probiotics for the treatment of children with antibiotic-associated diarrhea. Medicine, 99(23), e20631. https://doi.org/10.1097/MD.0000000000020631

Skrzydto-Radomańska, B., Prozorow-Król, B., Cichoż-Lach, H., Majsiak, E., Bierła, J. B., Kanarek, E., Sowińska, A., &Cukrowska, B. (2021). The effectiveness and safety of multi-strain probiotic preparation in patients with diarrhea-predominant irritable bowel syndrome: A randomized controlled study. Nutrients, 13(3), 756. https://doi.org/10.3390/nu13030756

NURS 6052 Week 11 Assignment – Evidence-Based Capstone Project, Part 6: Disseminating Results

The dissemination of EBP results serves multiple important roles. Sharing results makes the case for your decisions. It also adds to the body of knowledge, which creates opportunities for future practitioners. By presenting results, you also become an advocate for EBP, creating a culture within your organization or beyond that informs, educates, and promotes the effective use of EBP.

To Prepare for NURS 6052 Module 4 Critical Appraisal, Evaluation/ Summary, and Synthesis of Evidence (Weeks 6-7):

Review the final PowerPoint presentation you submitted in Module 5, and make any necessary changes based on the feedback you have received and on lessons you have learned throughout the course.
Consider the best method of disseminating the results of your presentation to an audience.

To Complete NURS 6052 Module 4 Critical Appraisal, Evaluation/ Summary, and Synthesis of Evidence (Weeks 6-7):

Create a 5-minute, 5- to 6-slide narrated PowerPoint presentation of your Evidence-Based Project.
Be sure to incorporate any feedback or changes from your presentation submission in Module 5.
Explain how you would disseminate the results of your project to an audience. Provide a rationale for why you selected this dissemination strategy.

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