Evidence-Based Practice (EBP) Part 3: Critical Appraisal of Research.

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.

Evidence-Based Practice (EBP) Part 3: 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.

SOLVED: Evidence-Based Practice (EBP) Part 3: Critical Appraisal of Research

Part A: Critical Appraisal of Research

Full APA formatted citation of selected article.	Article #1	Article #2	Article #3	Article #4
	Demarré, L., Van Lancker, A., Van Hecke, A., Verhaeghe, S., Grypdonck, M., Lemey, J., Annemans, L., & Beeckman, D. (2015). The cost of prevention and treatment of pressure ulcers: A systematic review. International Journal of Nursing Studies, 52(11), 1754–1774. https://doi.org/10.1016/j.ijnurstu.2015.06.006	Gaspar, S., Peralta, M., Marques, A., Budri, A., & Gaspar de Matos, M. (2019). Effectiveness on hospital-acquired pressure ulcers prevention: A systematic review. International Wound Journal, 16(5), 1087-1102. http://dx.doi.org/10.1111/iwj.13147	Hekmatpou, D., Mehrabi, F., Rahzani, K., & Aminiyan, A. (2018). The effect of Aloe Vera gel on prevention of pressure ulcers in patients hospitalized in the orthopedic wards: A randomized triple-blind clinical trial. BMC Complementary and Alternative Medicine, 18(1), 1-11. https://doi.org/10.1186/s12906-018-2326-2	Tayyib, N., & Coyer, F. (2016). Effectiveness of pressure ulcer prevention strategies for adult patients in intensive care units: A systematic review. Worldviews on Evidence-Based Nursing, 13(6), 432–444. https://doi.org/10.1111/wvn.12177
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).**	This is implied and not explicit. It is that preventing pressure ulcers would be cheaper than treating established pressure ulcers.	No explicit conceptual framework. It is implied, that there are practical ways of preventing pressure ulcers.	No explicit conceptual framework. This is implicit and is that there could be benefits derived from the use of natural alternative therapies in preventing PUs.	No explicit conceptual framework.It is implied, that there are practical ways of preventing pressure ulcers.
Design/MethodDescribe the design and how the study was carried out (In detail, including inclusion/exclusion criteria).	A systematic review. For inclusion articles must have been published in the period up to 2013 and report pressure ulcer prevention and treatment costs.	A systematic review. Inclusion criteria included: published from 2009 to 2018; articles in English, French, Portuguese and Spanish; and studies on incidence of PUs.	A randomized controlled triple-blind study. Had a study group and a control group.Inclusion criterion: risk of pressure ulcer (PU).	A systematic review.Inclusion criteria: all participants to be ≥ 18 years, studies to be RCTs, comparative studies, and quasi-experimental studies.
Sample/Setting The number and characteristics of patients, attrition rate, etc.	The sample was n = 17 articles that met inclusion criteria out of 2,542 retrieved.	The sample was n = 26 articles. A total of 258 articles were retrieved.	Sample was n = 80 patients (n = 39 intervention and n = 38 control group).N = 3 patients were excluded. Setting: an orthopedic ward in an Iranian metropolitan hospital.	Sample was n = 25 studies.Setting: Intensive care unit (ICU).
Major Variables StudiedList and define dependent and independent variables	Independent variable: Pressure ulcersDependent variable: Cost of prevention & treatment.	Independent variable: Preventative measures.Dependent variable: Emergence of PUs.	Independent variable: Use of normal care plus aloe vera.Dependent variable: occurrence of pressure ulcer.	Independent variable: Preventive measures.Dependent variable: development of PUs.
MeasurementIdentify primary statistics used to answer clinical questions (You need to list the actual tests done).	Evers’ Consensus on Health Economic Criteria(CHEC-) checklist	EBL Critical Appraisal checklist.	·         Descriptive statistics (charts and tables).·         Chi-square tests & Fisher’s exact test. ·         ANOVA. ·         Friedman, & ·         Independent t-test.	Means and standard deviations.
Data Analysis Statistical orQualitative findings (You need to enter the actual numbers determined by the statistical tests or qualitative data).	A Braden score of ≤18 was used to determine need for prevention in n = 3 studies.Cost of pressure ulcer prevention was between 37,699 & 405,523 euros per 100,000 habitants.	Commonest study design were RCTs (n = 6).Support surfaces, staff education, and repositioning with early mobilization were the dominant interventions.	Difference in hip temperature (p = 0.0001).Increasing pain in control group cf to study group (p = 0.003)	Effect size (silicon foam dressing strategy) = 4.62, 95% CI, p <0.00001.
Findings and RecommendationsGeneral findings and recommendations of the research	It was cheaper to prevent pressure ulcers than to treat ulcers that had already occurred.	Effective interventions for prevention: repositioning & early mobilization, support surfaces, prophylactic dressings, risk assessment tools like Braden scale, skin care, & staff education.	Alternative natural therapies such as aloe vera could be effective in preventing the development of PUs.	Use of silicon foam dressing strategy effective at PU incidence reduction.
Appraisal and Study QualityDescribe the general worth of this research to practice. What are the strengths and limitations of study? What are the risks associated with implementation of the suggested practices or processes detailed in the research? What is the feasibility of use in your practice?	The research is invaluable for practice in terms of preventative practice.The main strength of the study is that it is a level I evidence study. The limitations include that it is not primary research, broad methodological heterogeneity, and publication bias. The risk of applying the suggested practices is loss of fiscal resources in futile prevention. He study is very feasible n practice.	Research is important for clinical practice.Strength is that it is a level I evidence study. Limitations include that it is not primary research and that methodological errors in the included studies would be transferred to the systematic analysis. Risks of implementing the recommendations are in using some of them in isolation, which is not effective. The study findings are very feasible in applicability to practice.	The research is very important to practice.The strengths include being a primary study, being of experimental design, & being triple blinded. The limitation is basically the initial purposive sampling. Risks associated with implementing the intervention is neglect of conventional interventions. The application of aloe vera is feasible in practice.	Study crucial for practice.Strength is in being a level I evidence study. Limitations include not being a primary study and error duplication from the component studies reviewed. The risk is applying an intervention whose reported efficacy was based on faulty methodology or research design. The findings are easy to implement in practice, meaning feasibility is high.
Key findings	Prevention of pressure ulcers is cheaper than treatment of the same.	A bundled approach of several measures as outlined above is effective.	Aloe vera as a natural alternative therapy is effective in preventing the occurrence of PUs.	Silicon foam dressing is effective in reducing the chances of developing PUs
Outcomes	Savings on pressure ulcer prevention.	Reduced PU incidence with preventive measures.	Lower rates of PUs in the study group.	Reduced incidence rate for PUs.
General Notes/Comments	The study enriches evidence-based practice (EBP) by providing evidence for prevention.	The study increases EBP knowledge (Melnyk & Fineout-Overholt, 2019).	Considering alternatives in complementary and alternative medicine (CAM) remedies is an act of beneficence (Haswell, 2019).	This study is instrumental in increasing EBP knowledge (Melnyk & Fineout-Overholt, 2019).

Part 3B: Critical Appraisal of Research

Evidence-based practice is unique compared to common practice in that it makes use of only those interventions that have proven efficacy supported by scholarly evidence. This evidence is in the form of research that is peer-reviewed and published in reputable journals (Melnyk & Fineout-Overholt, 2019).

Evidence-Based Practice (EBP) Part 3: Critical Appraisal of Research.

Pressure ulcers are some of the most concerning hospital-acquired conditions that reduce the quality of healthcare. Hey are effectively a quality benchmark used to evaluate the quality of care offered by healthcare institutions by quality enforcement organizations such as the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). Pressure ulcers being a quality improvement (QI) issue, there is need to institute clinical inquiry into evidence-based interventions that can prevent them. In this case, four peer-reviewed studies have been critically appraised and found to offer some of the strategies that are efficacious and able to accomplish the task.

Evidence-Based Practice (EBP) Part 3: Critical Appraisal of Research.

The studies propose the best practice (EBP) through the following measures:

1. Allocating fiscal resources on pressure ulcer prevention strategies because studies show that the financial input required to treat PUs after they have occurred are more (Demarré et al., 2015). In other words, it is more expensive to treat PUs than to prevent them.
2. Bundled interventions in the form of repositioning & early mobilization, support surfaces, prophylactic dressings, risk assessment tools like Braden scale, skin care, & staff education have evidence backing them as effective PU preventive measures (Gaspar et al., 2019).

Evidence-Based Practice (EBP) Part 3: Critical Appraisal of Research.

• Alternative natural remedies such as aloe vera are also efficacious in preventing PUs, according to scholarly evidence available (Hekmatpou et al., 2018).

The use of silicon foam dressing is also an evidence-based strategy that is effective in preventing pressure ulcers (Tayyib & Coyer, 2016). Evidence-Based Practice (EBP) Part 3: Critical Appraisal of Research.

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