NURS 6052 Evidence-Based Project, Part 2: Advanced Levels of Clinical Inquiry and Systematic Reviews

NURS 6052 Evidence-Based Project, Part 2: Advanced Levels of Clinical Inquiry and Systematic Reviews

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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 you identified in Module 2 for the Assignment. This PICOT question will remain the same for the entire course.
  • Use the key words from the PICO(T) question you developed and search at least four different databases in the Walden Library. Identify at least four relevant systematic reviews or other filtered high-level evidence, which includes meta-analyses, critically-appraised topics (evidence syntheses), critically-appraised individual articles (article synopses). The evidence will not necessarily address all the elements of your PICO(T) question, so select the most important concepts to search and find the best evidence available.
  • Reflect on the process of creating a PICO(T) question and searching for peer-reviewed research.

The Assignment (Evidence-Based Project)

Part 2: 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 relevant peer-reviewed articles at the systematic-reviews level related to your research question. If there are no systematic review level articles or meta-analysis on your topic, then use the highest level of evidence peer reviewed article.
  • 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.

By Day 7 of Week 5

Submit Part 2 of your Evidence-Based Project.

RUBRIC

Excellent Good Fair Poor
Part 2: 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. 81 (81%) – 90 (90%)The presentation clearly and accurately identifies and describes in detail the chosen clinical issue of interest.

The presentation clearly and accurately describes in detail the developed PICO(T) question.

The presentation clearly and accurately identifies four or more research databases used to conduct a search for the peer-reviewed articles selected.

The presentation clearly and accurately provides full APA citations for at least four peer-reviewed articles selected, including a thorough and detailed explanation of the strengths of using systematic reviews for clinical research.

The presentation includes specific and relevant examples that fully support the research.

The presentation provides a complete, detailed, and accurate synthesis of two outside resources related to the peer-reviewed articles selected, and fully integrates at least two outside resources and two or three course-specific resources that fully support the presentation.

72 (72%) – 80 (80%)The presentation accurately identifies and describes the chosen clinical issue of interest.

The presentation accurately describes the developed PICO(T) question focused on the chosen clinical issue of interest.

The presentation accurately identifies at least four research databases used to conduct a search for the peer-reviewed articles selected.

The presentation accurately provides APA citations for at least four peer-reviewed articles selected, including an adequate explanation of the strengths of using systematic reviews for clinical research.

The presentation includes relevant examples that support the research presented.

The presentation provides an accurate synthesis of at least one outside resource related to the peer-reviewed articles selected. The response integrates at least one outside resource and two or three course-specific resources that may support the presentation.

63 (63%) – 71 (71%)The presentation inaccurately or vaguely identifies and describes the chosen clinical issue of interest.

The presentation inaccurately or vaguely describes the developed PICO(T) question focused on the chosen clinical issue of interest.

The presentation inaccurately or vaguely identifies at least four research databases used to conduct a search for the peer-reviewed articles selected.

The presentation inaccurately or vaguely provides APA citations for at least four peer-reviewed articles selected, including an inaccurate or vague explanation of the strengths of using systematic reviews for clinical research.

The presentation includes inaccurate or vague examples to support the research presented.

The presentation provides a vague or inaccurate synthesis or outside resources related to the peer-reviewed articles selected. The response minimally integrates resources that may support the presentation.

0 (0%) – 62 (62%)The presentation inaccurately and vaguely identifies and describes the chosen clinical issue of interest or is missing.

The presentation inaccurately and vaguely describes the developed PICO(T) question, or is missing.

The presentation inaccurately and vaguely identifies less than four research databases used to conduct a search for the peer-reviewed articles selected or is missing.

The presentation inaccurately and vaguely provides APA citations for at least four peer-reviewed articles selected, including an inaccurate and vague explanation of the strengths of using systematic reviews for clinical research, or is missing.

The presentation includes inaccurate and vague examples to support the research presented or is missing.

The presentation provides a vague and inaccurate synthesis of no outside resources related to the articles selected and fails to integrate any resources to support the presentation or is missing.

Written Expression and Formatting—Paragraph Development and Organization:
Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction is provided, which delineates all required criteria.
5 (5%) – 5 (5%)Paragraphs and sentences follow writing standards for flow, continuity, and clarity.

A clear and comprehensive purpose statement, introduction, and conclusion are provided, which delineates all required criteria.

4 (4%) – 4 (4%)Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time.

Purpose, introduction, and conclusion of the assignment is stated yet is brief and not descriptive.

3.5 (3.5%) – 3.5 (3.5%)Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60–79% of the time.

Purpose, introduction, and conclusion of the assignment is vague or off topic.

0 (0%) – 3 (3%)Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time.

No purpose statement, introduction, or conclusion are provided.

Written Expression and Formatting—English Writing Standards:
Correct grammar, mechanics, and proper punctuation.
5 (5%) – 5 (5%)Uses correct grammar, spelling, and punctuation with no errors. 4 (4%) – 4 (4%)Contains a few (one or two) grammar, spelling, and punctuation errors. 3.5 (3.5%) – 3.5 (3.5%)Contains several (three or four) grammar, spelling, and punctuation errors. 0 (0%) – 3 (3%)Contains many (five or more) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.
Total Points: 100

Solution- EBP Part 1: Identifying Research Methodologies for Personality Disorders

The philosophy of practice that is premised on the use of only interventions that have been proven by research to be efficacious is referred to as evidence-based practice or EBP. But the body of EBP knowledge is not static but dynamic as it keeps on changing day by day as new evidence of efficacy emerges. This new knowledge for EBP is generated by a process known as clinical inquiry which is undertaken by using the PICOT model.

This model requires the identification of the clinical issue of interest or problem

(P) requiring evidence-based interventions. Alternatively, the patient population

(P) this issue affects is identified as well as the problem itself.

This is followed by the intervention to be investigated (I),

the comparison or current intervention (C),

the expected outcome (O),

and the timeframe for the application of the intervention (T) (Melnyk & Fineout-Overholt, 2019).

In this EBP project, the clinical issue of interest chosen is the treatment of personality disorders. For this, the PICOT statement or question is “In adult patients diagnosed with a personality disorder (P),

does the use of psychotherapy combined with pharmacotherapy (I),

compared to pharmacotherapy alone (C),

result in better symptom remission (O) within a span of six months (T)?” The purpose of this paper is therefore to analyze four peer-reviewed articles from research databases CINAHL, PubMed, Cochrane, and ProQuest that provide evidence for the best intervention to manage personality disorders.

Full citation of selected article Article #1 Article #2 Article #3 Article #4
Choi-Kain, L.W., Albert, E.B., & Gunderson, J.G. (2016). Evidence-based treatments for borderline personality disorder. Harvard Review of Psychiatry, 24(5), 342–356. https://doi.org/10.1097/hrp.0000000000000113 Ellison, W.D. (2020). Psychotherapy for borderline personality disorder: Does the type of treatment make a difference? Current Treatment Options in Psychiatry, 7, 416-428. https://doi.org/10.1007/s40501-020-00224-w   Pearce, S., Scott, L., Attwood, G., Saunders, K., Dean, M., De Ridder, R., Galea, D., Konstantinidou, H., & Crawford, M. (2018). Democratic therapeutic community treatment for personality disorder: Randomised controlled trial. The British Journal of Psychiatry, 210(2), 149-156. https:/doi.org/10.1192/bjp.bp.116.184366 Timäus, C., Meiser, M., Bandelow, B., Engel, K.R., Paschke, A.M., Wiltfang, J., & Wedekind, D. (2019). Pharmacotherapy of borderline personality disorder: What has changed over two decades? A retrospective evaluation of clinical practice. BMC Psychiatry, 19(393), 1-11. https://doi.org/10.1186/s12888-019-2377-z
Why you chose this article and/or how it relates to the clinical issue of interest (include a brief explanation of the ethics of research related to your clinical issue of interest) This article was chosen as it relates to the clinical issue of interest in that it investigates evidence-based treatments for borderline personality disorder. BPD is one of the personality disorders as classified by the DSM-5 (Sadock et al., 2015). The ethics of research have been avoided in this research as it is a review of previous trials on therapies for PDs. This article was chosen because it relates to the clinical issue of interest. It is about reviewing the current evidence-based psychotherapeutic treatments that are available for BPD as one of the PDs. The issue of ethics did not arise as the research was not a primary study but a filtered one. This article was chosen because it is about investigating the efficacy of democratic therapeutic community (DTC) treatment for personality disorders. This is how it relates to the clinical issue of interest. On ethics, the subjects were allowed to give informed consent (autonomy) and they were not harmed in any way during the study (nonmaleficence). Lastly but not least, they were assured that the study would benefit them, respecting beneficence (Haswell, 2019). The choice of this article was informed by the fact that it addresses the issue of pharmacotherapy in the management of BPD. Being retrospective, the confidentiality of the patient information in the charts used was maintained to avoid causing psychological harm by breaching privacy in a violation of the principle of nonmaleficence (Haswell, 2019).
Brief description of the aims of the research of each peer-reviewed article The aim of this review was to evaluate four major available peer-reviewed therapies for BPD. The aims were (i) to provide a summary of available evidence-based psychotherapeutic treatments for BPD, and (ii) to evaluate their effectiveness and the evidence supporting that. The aim of te study was to assess whether DTC could reduce in-patient admission and improve the mental health of personality disorder patients. The aim was to assess the quality of the available drug treatment for BPD in inpatients.
Brief description of the research methodology used Be sure to identify if the methodology used was qualitativequantitative, or a mixed-methods approach. Be specific. The methodology was a systematic quantitative review of existing literature. Each of these modalities was assessed individually and their merits and demerits and compared against the others.   The methodology is a qualitative systematic review of the available scholarly evidence. This was a quantitative study in the form of a randomized controlled study/ trial or RCT. The methodology was a quantitative retrospective evaluation of practice.
A brief 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. The strength of this paper is in its being a review of several primary research articles on the subject. It is therefore a summary of sorts which is better than a single study focussing on one therapy. Its reliability and validity depends on the collective reliability and validity of the four articles reviewed. Being a review, its validity and reliability are sound. The major strength of this methodology is that filtered research provides the best and highest evidence in the pyramid of evidence at level 1. As a sum of the primary studies reviewed, the validity and reliability or generalizability of this study is beyond reproach (good). The main strength of this study design is that it is experimental in nature and is therefore the best way to establish causality. The strength of this study is that it is a primary study that generated new knowledge to enrich existing EBP. The sample size was n = 87 and this was enough to guarantee validity and generalizability of the results.
General Notes/Comments The findings of this study are instrumental in generating new knowledge for enriching EB clinical practice. This study adds to the body of knowledge available for EBP. Being an experimental primary research study, this work is invaluable in generating entirely new knowledge about causality for EBP. The study provides required evidence for pharmacotherapeutic interventions against BPD which is a PD.

Conclusion

This identification of research methodologies has been conducted systematically according to the tenets of clinical inquiry. A clear issue of clinical interest has been identified and a PICOT statement generated with it to facilitate the search for evidence from published peer-reviewed literature.

Reputable research databases have been used to search for evidence and finally four of the several articles retrieved have been reviewed in the matrix above. They show clearly that psychotherapy is the best intervention for personality disorders, but that prudent clinical practice requires that a combination of psychotherapy and pharmacotherapy be used for the best patient outcomes.

References

Choi-Kain, L.W., Albert, E.B., & Gunderson, J.G. (2016). Evidence-based treatments for borderline personality disorder. Harvard Review of Psychiatry, 24(5), 342–356. https://doi.org/10.1097/hrp.0000000000000113

Ellison, W.D. (2020). Psychotherapy for borderline personality disorder: Does the type of treatment make a difference? Current Treatment Options in Psychiatry, 7, 416-428. https://doi.org/10.1007/s40501-020-00224-w  

Haswell, N. (2019). The four ethical principles and their application in aesthetic practice. Journal of Aesthetic Nursing, 8(4), 177-179. https://doi.org/10.12968/joan.2019.8.4.177

Melnyk, B.M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing & healthcare: A guide to best practice, 4th ed. Wolters Kluwer.

Pearce, S., Scott, L., Attwood, G., Saunders, K., Dean, M., De Ridder, R., Galea, D., Konstantinidou, H., & Crawford, M. (2018). Democratic therapeutic community treatment for personality disorder: Randomised controlled trial. The British Journal of Psychiatry, 210(2), 149-156. https:/doi.org/10.1192/bjp.bp.116.184366

Sadock, B.J., Sadock, V.A., & Ruiz, P. (2015). Synopsis of psychiatry: Behavioral sciences clinical psychiatry, 11th ed. Wolters Kluwer.

Timäus, C., Meiser, M., Bandelow, B., Engel, K.R., Paschke, A.M., Wiltfang, J., & Wedekind, D. (2019). Pharmacotherapy of borderline personality disorder: What has changed over two decades? A retrospective evaluation of clinical practice. BMC Psychiatry, 19(393), 1-11. https://doi.org/10.1186/s12888-019-2377-z.

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