Part 2: Advanced Levels of Clinical Inquiry and Systematic Reviews

Part 2: Advanced Levels of Clinical Inquiry and Systematic Reviews SOLVED

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

Advanced Levels of Clinical Inquiry and Systematic Reviews EBP Part 2

Part 2: Advanced Levels of Clinical Inquiry and Systematic Reviews Completed Matrix Worksheet Template

Clinical issues impact on the quality of care, health providers’ well-being, patients’ safety, and delivery of services. Workplace incivility is a behavior characterized by disrespect and discourteous actions among employee. The behavior is typical in nursing practice and often affects the employees’ confidence, interprofessional collaboration, team work, and productivity if it is not effectively controlled. It also affects an employees’ psychological wellbeing because it leads to high levels of anxiety which fuels burnout and high job turnover. Effective control of nursing incivility is necessary in enhancing and promoting quality care and patient safety Advanced Levels of Clinical Inquiry and Systematic Reviews EBP Part 2. The following matrix worksheet template presents four research articles that addresses the issue of nursing incivility at work.

Full *citation* of the selected article	Article #1	Article #2	Article #3	Article #4
Full *citation* of the selected article	Kile, D., Eaton, M., deValpine, M., & Gilbert, R. (2019). The effectiveness of education and cognitive rehearsal in managing nurse‐to‐nurse incivility: A pilot study. Journal of Nursing Management, 27(3), 543-552. https://doi.org/10.1111/jonm.12709	Abdollahzadeh, F., Asghari, E., Ebrahimi, H., Rahmani, A., & Vahidi, M. (2017). How to prevent workplace incivility?: Nurses’ perspective. Iranian Journal of Nursing and Midwifery Research, 22(2), 157-163. https://doi.org/10.4103/1735-9066.205966 Advanced Levels of Clinical Inquiry and Systematic Reviews EBP Part 2	Armstrong, N. (2018). Management of nursing workplace incivility in the health care settings: A systematic review. Workplace Health & Safety, 66(8), 403-410. https://doi.org/10.1177%2F2165079918771106	Razzi, C. C., & Bianchi, A. L. (2019). Incivility in nursing: Implementing a quality improvement program utilizing cognitive rehearsal training. In Nursing forum (Vol. 54, No. 4, pp. 526-536). https://doi 10.1111/nuf.12366
*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)	The article has been chosen because it is comprehensively addresses the importance of enhanced awareness and use of educational programs to reduce nurse-nurse incivility. The article explains in details how cognitive rehearsal techniques can be utilized to help nurses manage and cope with effects of incivility. The article supports the role of cognitive rehearsal in helping employees to cope with problems at work as it prepares them mentally to cope with stress. The research article observed research ethics by allowing voluntary participation and treating the information provided anonymously and with confidentiality.	The article has been selected because it explains in detail the detrimental effects of workplace incivility to healthcare workers’ health and patient care. Given the psychological effects of incivility, the article delves in ways of managing it from a nurse’s perspective. The research ethics were observed by allowing willing and voluntary participation and withdrawal without getting penalized in anyway. Informed consent was sought as well as treatment of collected data with confidentiality. The aims of the research were explained in details to the participants and the Research Council and Ethics Committee affiliated to the Tabriz University of Medical Sciences approved the proposal Advanced Levels of Clinical Inquiry and Systematic Reviews EBP Part 2.	The article was chosen as it addresses the issue of workplace incivility and proposes evidence-based strategies of managing it. The researcher opines that incivility has negative effects on the emotional well-being of nurses to an extent of risking patient care and safety by increasing the occurrence of medical administration errors. The research observed ethics by summarizing ten qualitative research articles from different databases to avoid research bias.	The article was chosen as it addresses the issue of incivility in nursing by implementing a quality improvement program. The study suggested use of cognitive rehearsal training in order to improve health at workplace, enhance job satisfaction, and organizational commitment. The research observed ethics by seeking informed consent from the participants, explaining the research aims in details, maintaining confidentiality and anonymity in data collection, and allowing voluntary participation by the participants.
Brief *description of the aims* of the research of each peer-reviewed article	The aim of the research article was to create awareness among the nurses by helping them recognize incivility. In addition, the research aimed to reduce the impact of civility by using cognitive rehearsal techniques to address it.	The aim of the article was to determine how workplace incivility can be prevented in healthcare settings from perspective of nurses.	The aim of the research was to effectively control workplace incivility by proposing practical interventions that can be applied help nurses manage the problem.	The aim of this research was to educate nurses on how to identify workplace incivility and equip them with ways of dealing and addressing incivility.
Brief description of the *research methodology* used Be sure to identify if the methodology used was *qualitative, quantitative, or a mixed-methods* approach. Be specific.	The research utilized mixed method research approach which incorporate both qualitative and quantitative methods. Data was collected before nurses received cognitive rehearsal training and after. The data was collected via surveys and a comparative analysis done.	The researcher utilized qualitative methods based on conventional content analysis. Data was collected through semi-structured interviews while the sample was obtained using purposive sampling.	The study utilized quantitative research methods to conduct a systematic review of current and relevant evidence on workplace incivility using ten studies.	The research utilized quantitative research method. Data was collected using nursing incivility scale (NIS). The instrument was used to evaluate the effectiveness of cognitive rehearsal educational module. The participants completed the NIS before, immediately after, and 1 month after the program.
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 major strength of mixed methods research approach is that it enhances understanding of qualitative and quantitative results’ contradictions and avoiding the limitations of a single approach. Also, it allows a shorter data collection time when compared to sequential methods. The methods used in gathering data and information in mixed methods research approach supplement each other which strengthens data validity and reliability.	The use of qualitative research method allowed the researcher to examine the issue of workplace incivility in depth. Use of semi-structured interviews allows the researcher to ask questions, seek clarification, as well as redirect questions as the situation obliges. Reliability and validity was applied as the interviews allowed one-on-one correspondence while the interview questions were structured in a manner that all the participants were subject to same questions despite being in different locations.	The key strength of systematic review of studies is that it provides quick answers on clinical issues as derived from previous studies as information is readily available. Systematic reviews are highly reliable and valid since the research evidence used is carefully synthesized to answer specific clinical questions.	The use quantitative methods allowed the researcher to interpret data in an easier manner since the variables are already defined. The method also allow the researcher to maintain objectivity and accuracy in the process of data collection hence making results more reliable and valid.
General Notes/Comments	The article how an educational intervention (cognitive rehearsal) can be used promote a positive and civil workplace and ensure patient receive effective/safe care.	The article is very useful as it expands knowledge on workplace incivility prevention. It explains how improving communication and supporting nurses can help in reducing workplace incivility	The article is informative and provides information on implications of workplace incivility in healthcare settings as well as proposes necessary interventions in addressing incivility such as educational training on incivility to create awareness and equipping nurses’ communication skills.	The article is informative as it adds to the body by explaining how incivility programs can equip nurses with skills to identify and manage incivility by reacting in a proactive, professional manner thereby promoting a healthy work environment.

Conclusion

The research articles reviewed in the worksheet address the issue of workplace incivility among nurses, its psychological effects and interventions such as cognitive rehearsal techniques, resilience training, and creating of awareness. The articles can be further reviewed to get the best evidence to be used as evidence-based practice for reducing incivility Advanced Levels of Clinical Inquiry and Systematic Reviews EBP Part 2.

References

Abdollahzadeh, F., Asghari, E., Ebrahimi, H., Rahmani, A., & Vahidi, M. (2017). How to prevent workplace incivility?: Nurses’ perspective. Iranian Journal of Nursing and Midwifery Research, 22(2), 157-163. https://doi.org/10.4103/1735-9066.205966

Armstrong, N. (2018). Management of nursing workplace incivility in the health care settings: A systematic review. Workplace Health & Safety, 66(8), 403-410. https://doi.org/10.1177%2F2165079918771106

Kile, D., Eaton, M., deValpine, M., & Gilbert, R. (2019). The effectiveness of education and cognitive rehearsal in managing nurse‐to‐nurse incivility: A pilot study. Journal of Nursing Management, 27(3), 543-552. https://doi.org/10.1111/jonm.12709

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

Razzi, C. C., & Bianchi, A. L. (2019, October). Incivility in nursing: Implementing a quality improvement program utilizing cognitive rehearsal training. In Nursing forum (Vol. 54, No. 4, pp. 526-536). https://doi 10.1111/nuf.12366

Walden University Library. (2022). Quick Answers: What are filtered and unfiltered resources in nursing? https://academicanswers.waldenu.edu/faq/73299

Assignment: Evidence-Based Project, Part 2: 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. NURS 6052 WK5 Assign Part 2: Advanced Level of Clinical Inquiry and Systemic Review

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. NURS 6052 WK5 Assign Part 2 Advanced Level of Clinical Inquiry and Systemic Review

• 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.

Borderline Personality Disorder

I had to frame a composite question that would be the basis of my clinical inquiry, namely, that in patients who have a borderline personality disorder (P), does the use of (CBT) (I), compared to pharmacologic treatment (C), result in effect socio-occupational functioning (O), over six months (T).

Learning Resources

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

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 2, “Asking Compelling Clinical Questions” (pp. 33–54)
• Chapter 3, “Finding Relevant Evidence to Answer Clinical Questions” (pp. 55–92)

Davies, K. S. (2011). Formulating the evidence-based practice question: A review of the frameworks for LIS professionals. Evidence Based Library and Information Practice, 6(2), 75–80. https://doi.org/10.18438/B8WS5N

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

Library of Congress. (n.d.). Search/browse help – Boolean operators and nesting. Retrieved September 19, 2018, from https://catalog.loc.gov/vwebv/ui/en_US/htdocs/help/searchBoolean.html

Stillwell, S. B., Fineout-Overholt, E., Melnyk, B. M., & Williamson, K. M. (2010a). Evidence-based practice, step by step: Asking the clinical question: A key step in evidence-based practice. American Journal of Nursing, 110(3), 58–61. doi:10.1097/01.NAJ.0000368959.11129.79

Note: You will access this article from the Walden Library databases.
Melnyk, B. M., Fineout-Overholt, E., Stillwell, S. B., & Williamson, K. M. (2009). Evidence-based practice: Step by step: Igniting a spirit of inquiry. American Journal of Nursing, 109(11), 49–52. doi:10.1097/01.NAJ.0000363354.53883.58
Note: You will access this article from the Walden Library databases. NURS 6052 WK5 Assign Part 2 Advanced Level of Clinical Inquiry and Systemic Review

Stillwell, S. B., Fineout-Overholt, E., Melnyk, B. M., & Williamson, K. M. (2010b). Evidence-based practice, step by step: Searching for the evidence. American Journal of Nursing, 110(5), 41–47. doi:10.1097/01.NAJ.0000372071.24134.7e
Note: You will access this article from the Walden Library databases.

Walden University Library. (n.d.-a). Databases A-Z: Nursing. Retrieved September 6, 2019, from https://academicguides.waldenu.edu/az.php?s=19981

Walden University Library. (n.d.-c). Evidence-based practice research: CINAHL search help. Retrieved September 6, 2019, from https://academicguides.waldenu.edu/library/healthevidence/cinahlsearchhelp

Walden University Library. (n.d.-d). Evidence-based practice research: Joanna Briggs Institute search help. Retrieved September 6, 2019, from https://academicguides.waldenu.edu/library/healthevidence/jbisearchhelp

Walden University Library. (n.d.-e). Evidence-based practice research: MEDLINE search help. Retrieved September 6, 2019, from https://academicguides.waldenu.edu/library/healthevidence/medlinesearchhelp

Walden University Library. (n.d.-f). Keyword searching: Finding articles on your topic: Boolean terms. Retrieved September 19, 2018, from http://academicguides.waldenu.edu/library/keyword/boolean

Walden University Library. (n.d.-g). Keyword searching: Finding articles on your topic: Introduction to keyword searching. Retrieved September 19, 2018, from http://academicguides.waldenu.edu/library/keyword/searching-basics

Walden University Library. (n.d.-h). Quick Answers: How do I find a systematic review article related to health, medicine, or nursing? Retrieved September 6, 2019, from https://academicanswers.waldenu.edu/faq/72670 NURS 6052 WK5 Assign Part 2: Advanced Level of Clinical Inquiry and Systemic Review

Walden University Library. (n.d.-i). Systematic review. Retrieved January 22, 2020, from https://academicguides.waldenu.edu/library/healthevidence/types#s-lg-box-1520654

Required Media
Laureate Education (Producer). (2018). Searching the Evidence [Video file]. Baltimore, MD: Author.
Accessible player –Downloads–Download Video w/CCDownload AudioDownload Transcript

Advanced Level of Clinical Inquiry and Systemic Review Sample Paper

Offloading as a treatment for diabetic foot ulcers (DFU) in adults

Diabetic foot ulcers (DFU) account for roughly 60% of limb loss in diabetic patients (Gwilliam, Critz & Gustavzon, 2017). Without performing all the non-weight bearing loads, plantar foot DFU is difficult to cure. To continue to have the best quality of life, diabetic neuropathy patients generally do not know that DFU begins until the wound is completely covered. Neuropathy is one of the main causes of DFU, which can threaten the extremities. NURS 6052 WK5 Assign Part 2 Advanced Level of Clinical Inquiry and Systemic Review

Traditional debridement dressings are traditional treatment methods. Effective pressure reduction (offloading) is now the best standard treatment (Tickner et al., 2018). Other offloading devices include orthopedic shoes, braces, walking aids like walkers and foam inserts.

Describe how you Developed a PICOT Question on the chosen Clinical Issue of Interest

PICOT stands for Population, Intervention, Comparison, Results, and Time. PICO(T) problems can be expressed as a prognosis, intervention, diagnosis, and etiology. The development of the PICO(T) questions should focus on the main questions to find the correct answers and evidence for the clinical questions and eliminate the uncertainty. NURS 6052 WK5 Assign Part 2 Advanced Level of Clinical Inquiry and Systemic Review

The development of my PICO(T) began with the process of searching for diabetic foot ulcers. Different treatments have been suggested in the research, and I decided to study diabetic foot ulcers of offloading. I have found that using a total contact cast (tcc) for discharge is the gold standard for plantar ulcers as it can reduce pressure on the wound and lead to wound healing. (Tickner et al., 2018). Hence, my PICOT question is: In an adult with a diabetic foot ulcer, does offloading promote ulcer healing?

Identify Four Research Databases use to Conduct the Search for Peer-Reviewed

Articles

The Walden University Library got utilized to search for systematic reviews on diabetic foot ulcers and the use of offloading for healing. I used the below four databases. However, my search’s best results were from Cinahl Puss with Full Text and Proquest Nursing and Allied Health Database.

Cochrane
Cinahl Plus with Full Text
Embase
Proquest Nursing and Allied Health Database

APA Citation of the Peer-Reviewed Articles

The articles listed here in APA format were read to determine the level of evidence in each on the PICO(T): In an adult with a diabetic foot ulcer, does offloading promote the ulcer’s healing? NURS 6052 WK5 Assign Part 2 Advanced Level of Clinical Inquiry and Systemic Review

Cavanagh, P. R., Lipsky, B. A., Bradbury, A. W., & Botek, (2005). Treatment for diabetic foot ulcers. The Lancet, 366(9498), 1725-1735.
Elraiyah, , Tsapas, A., Prutsky, G., Domecq, J. P., Hasan, R., Firwana, B., … & Steinkraus, L. W. (2016). A systematic review and meta-analysis of adjunctive therapies in diabetic foot ulcers. Journal of vascular surgery, 63(2), 46S-58S.
Tickner, A., Klinghard, C., Arnold, J. F., & Marmolejo, (2018). Total Contact Cast Use in Patients With Peripheral Arterial Disease: A Case Series and Systematic Review. Wounds: a compendium of clinical research and practice, 30(2), 49-56.
Sahu, , Prusty, A., & Tudu, B. (2018). Total contact casting versus traditional dressing in diabetic foot ulcers. Journal of Orthopaedic Surgery, 26(3), 2309499018802486.

Describe the Levels of Evidence of the Peer-Reviewed Articles

Article

name

Type

Evidence

level

Quality

Description

Treatment for diabetic foot ulcers

Systematic Review

Four

Low Quality

In this article, a randomized controlled study is used to assess the quality of ulcer treatment. In general, a complete evaluation of the patient is important in determining treatment. This is necessary to prevent and heal ulcers. It is worth noting that the shock pressure on the affected foot has a better healing effect in the total contact cast (TCC) compared to a simple orthogonally compensated shock shoe. Compared to offloading shoes, the best outcome for TCC is reduced activity due to weight loss and inability to eliminate TCC (Cavanagh et al., 2015). After reading and reviewing, using Hopkins Medicine (n.d.), the level of evidence was determined to level four. Based on this article, low-quality evidence was established, indicating insufficient studies comparing conclusive treatments (Cavanagh et al.,

2015).

systematic review and meta- analysis of adjunctive therapies in diabetic foot ulcers

Systematic Review, Meta- analysis

One

Low to good quality

The systematic review included 18 different studies, having 1526 patients. There are nine randomized controlled trials (RCTs) that tested multiple treatments for diabetic foot ulcers. The study did not involve my PICO(T) because it was only briefly mentioned as a treatment option. This article also performed a meta-analysis of 6 studies Due to the limited number of topics, the analysis read in this article was unsuccessful. This article has good treatment options and good results, but

it does not apply to my PICO(T)

NURS 6052 WK5 Assign Part 2 Advanced Level of Clinical Inquiry and Systemic Review

(Elraiyah, et al., 2016).

Total Contact Cast Use in Patients With Peripheral Arterial Disease: A Case Series and Systematic Review

Systematic Review, Case Series

Four

Low Quality

The article’s information provides evidence for a series of cases, systematically reviewed ulcers healed on an empty stomach, and was also diagnosed with peripheral vascular disease and diabetes. This study answered my question PICO (T); however, due to the limited sample size of patients, the quality of the product is low and more research is needed on the combination of these comorbidities and the use of the full contact model for classification to heal diabetic ulcers NURS 6052 WK5 Assign Part 2 Advanced Level of Clinical Inquiry and Systemic Review

(Tickner et al., 2018).

Total contact casting versus traditional dressing in diabetic foot ulcers

Systematic Review

Three

Low to medium quality

In adults with diabetic foot ulcers, does offloading promote healing of the ulcer? This study is a small sample, but it shows that in 15 cases of diabetic foot ulcers, in addition to traditional dressings, 12 cases were cured with total contact dressings, of which 16 cases got cured with traditional treatments. This is a randomized controlled trial that only recruited 33 patients, which is a limitation and the number of studies to compare with is limited (Sahu et al.,

2018).

NURS 6052 WK5 Assign Part 2 Advanced Level of Clinical Inquiry and Systemic Review

Systematic Reviews: Strength in research

The systematic review solves a clinical problem and is carried out by searching for diverse information. Systematic reviews are time-consuming and conducted by multiple investigators. A comprehensive review of the system will reduce a large amount of information into a single document to provide evidence to answer clinical questions. The system review follows specific guidelines and a scientific design, which can reduce deviations and errors. NURS 6052 WK5 Assign Part 2 Advanced Level of Clinical Inquiry and Systemic Review

A systematic review can also determine the lack of evidence. When a large amount of statistical data is collected in a systematic review, a meta-analysis can be performed from the evidence, which is a statistical analysis of the results, usually combining the results in a table or graph (Gopalakrishnan and Ganeshkumar, 2013) NURS 6052 WK5 Assign Part 2 Advanced Level of Clinical Inquiry and Systemic Review

References

Cavanagh, P. R., Lipsky, B. A., Bradbury, A. W., & Botek, G. (2005). Treatment for diabetic foot ulcers. The Lancet, 366(9498), 1725-1735.

Elraiyah, T., Tsapas, A., Prutsky, G., Domecq, J. P., Hasan, R., Firwana, B., … & Steinkraus, L.

(2016). A systematic review and meta-analysis of adjunctive therapies in diabetic foot ulcers. Journal of vascular surgery, 63(2), 46S-58S.

Gwilliam, A., Critz, D., & Gustavson, R. G. (2017). Besst Practice Guidelines And Algorithm Established For Treatment And Referral Of Patients With Diabetic Foot Ulcers. In Journal Of Wound Ostomy And Continence Nursing (Vol. 44, No. 3, Pp. S49-S49). Two Commerce Sq, 2001 Market St, Philadelphia, Pa 19103 Usa: Lippincott Williams & Wilkins.

Gopalakrishnan, S., & Ganeshkumar, P. (2013). Systematic reviews and meta-analysis: understanding the best evidence in primary healthcare. Journal of family medicine and primary care, 2(1), 9. NURS 6052 WK5 Assign Part 2 Advanced Level of Clinical Inquiry and Systemic Review

Sahu, B., Prusty, A., & Tudu, B. (2018). Total contact casting versus traditional dressing in diabetic foot ulcers. Journal of Orthopaedic Surgery, 26(3), 2309499018802486. NURS 6052 WK5 Assign Part 2 Advanced Level of Clinical Inquiry and Systemic Review

Hopkins Medicine (n.d.). Retrieved from https://www.hopkinsmedicine.org/evidence-based- practice/_docs/appendix_c_evidence_level_quality_guide.pdf

Tickner, A., Klinghard, C., Arnold, J. F., & Marmolejo, V. (2018). Total Contact Cast Use in Patients With Peripheral Arterial Disease: A Case Series and Systematic Review. Wounds: a compendium of clinical research and practice, 30(2), 49-56.

NURS 6052/NURS5052/NRSE6052 Essent of Evidence Week 7 Assignment

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

Realtors rely on detailed property appraisal 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. NURS 6052 WK5 Assign Part 2 Advanced Level of Clinical Inquiry and Systemic Review

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 appraisal tools to conduct a critical appraisal of published research. You will then present the results of your efforts. NURS 6052 WK5 Assign Part 2 Advanced Level of Clinical Inquiry and Systemic Review

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. NURS 6052 WK5 Assign Part 2 Advanced Level of Clinical Inquiry and Systemic Review

The Assignment (Evidence-Based Project) NURS 6052 WK5 Assign Part 2: Advanced Level of Clinical Inquiry and Systemic Review

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: NURS 6052 WK5 Assign Part 2 Advanced Level of Clinical Inquiry and Systemic Review

An evaluation table

A levels of evidence table

An outcomes synthesis table

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/NURS5052/NRSE6052 Essent of Evidence 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. NURS 6052 WK5 Assign Part 2 Advanced Level of Clinical Inquiry and Systemic Review

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. NURS 6052 WK5 Assign Part 2 Advanced Level of Clinical Inquiry and Systemic Review

Reflect on your current healthcare organization and think about potential opportunities for evidence-based change.

The Assignment: (Evidence-Based Project) NURS 6052 WK5 Assign Part 2 Advanced Level of Clinical Inquiry and Systemic Review

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. NURS 6052 WK5 Assign Part 2 Advanced Level of Clinical Inquiry and Systemic Review

Describe your plan for knowledge transfer of this change, including knowledge creation, dissemination, and organizational adoption and implementation. NURS 6052 WK5 Assign Part 2 Advanced Level of Clinical Inquiry and Systemic Review

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)

NURS 6052/NURS5052/NRSE6052 Essent of Evidence 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. NURS 6052 WK5 Assign Part 2 Advanced Level of Clinical Inquiry and Systemic Review

To Prepare:

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:

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. NURS 6052 WK5 Assign Part 2: Advanced Level of Clinical Inquiry and Systemic Review

Explain how you would disseminate the results of your project to an audience. Provide a rationale for why you selected this dissemination strategy. NURS 6052 WK5 Assign Part 2 Advanced Level of Clinical Inquiry and Systemic Review

Assignment: Evidence-Based Project, Part 3: Advanced Levels of Clinical Inquiry and Systematic Reviews

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 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 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.

Learning Resources

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

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 2, “Asking Compelling Clinical Questions” (pp. 33–54)
Chapter 3, “Finding Relevant Evidence to Answer Clinical Questions” (pp. 55–92)

Davies, K. S. (2011). Formulating the evidence based practice question: A review of the frameworks for LIS professionals. Evidence Based Library and Information Practice, 6(2), 75–80. https://doi.org/10.18438/B8WS5N
Note: You will access this article from the Walden Library databases.

Library of Congress. (n.d.). Search/browse help – Boolean operators and nesting. Retrieved September 19, 2018, from https://catalog.loc.gov/vwebv/ui/en_US/htdocs/help/searchBoolean.html

Stillwell, S. B., Fineout-Overholt, E., Melnyk, B. M., & Williamson, K. M. (2010a). Evidence-based practice, step by step: Asking the clinical question: A key step in evidence-based practice. American Journal of Nursing, 110(3), 58–61. doi:10.1097/01.NAJ.0000368959.11129.79
Note: You will access this article from the Walden Library databases.

Melnyk, B. M., Fineout-Overholt, E., Stillwell, S. B., & Williamson, K. M. (2009). Evidence-based practice: Step by step: Igniting a spirit of inquiry. American Journal of Nursing, 109(11), 49–52. doi:10.1097/01.NAJ.0000363354.53883.58
Note: You will access this article from the Walden Library databases.

Stillwell, S. B., Fineout-Overholt, E., Melnyk, B. M., & Williamson, K. M. (2010b). Evidence-based practice, step by step: Searching for the evidence. American Journal of Nursing, 110(5), 41–47. doi:10.1097/01.NAJ.0000372071.24134.7e
Note: You will access this article from the Walden Library databases.

Walden University Library. (n.d.-a). Databases A-Z: Nursing. Retrieved September 6, 2019, from https://academicguides.waldenu.edu/az.php?s=19981

Walden University Library. (n.d.-c). Evidence-based practice research: CINAHL search help. Retrieved September 6, 2019, from https://academicguides.waldenu.edu/library/healthevidence/cinahlsearchhelp

Walden University Library. (n.d.-d). Evidence-based practice research: Joanna Briggs Institute search help. Retrieved September 6, 2019, from https://academicguides.waldenu.edu/library/healthevidence/jbisearchhelp

Walden University Library. (n.d.-e). Evidence-based practice research: MEDLINE search help. Retrieved September 6, 2019, from https://academicguides.waldenu.edu/library/healthevidence/medlinesearchhelp

Walden University Library. (n.d.-h). Quick Answers: How do I find a systematic review article related to health, medicine, or nursing? Retrieved September 6, 2019, from https://academicanswers.waldenu.edu/faq/72670

Walden University Library. (n.d.-i). Systematic review. Retrieved January 22, 2020, from https://academicguides.waldenu.edu/library/healthevidence/types#s-lg-box-1520654

Required Media

Laureate Education (Producer). (2018). Searching the Evidence [Video file]. Baltimore, MD: Author.

THIS IS THE MODULE 2 TO COMPLETE THIS ASSIGNMENT

The PICOT format is used to formulate questions in evidence-based practice. It is a beneficial method as it enables a researcher to identify the most effective and useful resources used in evidence-based practice and healthcare research. P stands for the population or the patient’s problem. In this threshold, one explains who is the patient, their health status, and demographic data. I stand for the interventions that should be performed on the patient. For instance, they may be tests, therapies, or medications. C stands for Comparison. It indicates other alternative plans that the healthcare practitioner may conduct on the patient. O stands for the outcomes that the health practitioner seeks. T stands for the time frame that should be used (Lira & Rocha, 2019).

One of the clinical issues that are faced in the US is an opioid overdose. The problem has increased with more reported cases of people dying from opioid overdose daily. It is estimated that more than 130 people die daily from opioid misuse. Therefore, the opioid crisis can be used to formulate a good PICOT question. Over time, self-administered drugs such as naloxone, also known as Narcan, have been developed to curb opioid misuse (Narcan, n.d).

In this case, the PICOT question that will be suitable and effective is “Can opioid users who have access to naloxone be compared to those without access to naloxone at the risk of having a fatal opioid overdose?”

In searching for peer-reviewed articles and research papers about the topic, some keywords should be used to ease the search. Some of the keywords used in this search include opioid overdose, the use of naloxone to curb opioid effects, the risk of overdosing among opioid users, overdose, emergency department, prevention, and death and opioid misuse. The databases that is used in this search include Ebsco, PubMed, and ProQuest.

When I searched how opioid users with access to naloxone and those without access to naloxone compared to the risk of suffering from an opioid overdose, there were 504 results. I narrowed down the research by limiting it only to academic journals, and the results were reduced to 120. I narrowed the research further by only limiting it to the peer-reviewed articles written within the last five years, and the results were reduced to 85.

When I searched how naloxone prevents opioid misuse, there were ten results. When the search was narrowed down to only peer-reviewed articles written in the last five years, the results were reduced to 2. When I replaced the word naloxone with Narcan, the results increased to 161, which included peer-reviewed articles written in the last five years. When I searched the term opioid overdose, the results increased further to 8432. However, when I searched for opioid overdose prevention, the search results decreased to 4483.

There are some strategies that can be used to increase the rigor and the effectiveness of the database search. According to Melnyk and Fineout-Overholt (2018), one of the factors that contribute to effectiveness in a database search is using the right databases. Some databases have been equipped with peer-reviewed articles in one field. Therefore, it is wise to search in the relevant database. For instance, when searching about healthcare issues, one should search in healthcare databases for better results.

Additionally, to come up with effective and rigorous searches, one should search in numerous databases. That gives access to the most relevant searches as different databases may contain different articles. Also, one should use the appropriate vocabulary. That will ensure that the search results are relevant to the topic of interest. Finally, one should combine terms and concepts suing the Boolean operators to ensure that the search results are effective and relevant to the topic of interest.

References

Lira, R. P. C., & Rocha, E. M. (2019). PICOT: Imprescriptible items in a clinical research question. Arquivos brasileiros de oftalmologia, 82(2), 1-1.

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

Narcan. (n.d). Retrieved June 19, 2019, from https://www.narcan.com/

ADDITIONAL INSTRUCTIONS FOR THE CLASS

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Discussion Questions (DQ)

Initial responses to the DQ should address all components of the questions asked, including a minimum of one scholarly source, and be at least 250 words. Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source. One or two-sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words. I encourage you to incorporate the readings from the week (as applicable) into your responses.

Weekly Participation

Your initial responses to the mandatory DQ do not count toward participation and are graded separately. In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies. Participation posts do not require a scholarly source/citation (unless you cite someone else’s work). Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week. Assignment: Evidence-Based Project, Part 2: Advanced Levels of Clinical Inquiry and Systematic Reviews

APA Format and Writing Quality

Familiarize yourself with the APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in Loud-cloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required). Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation. I highly recommend using the APA Publication Manual, 6th edition.

Use of Direct Quotes

I discourage over-utilization of direct quotes in DQs and assignments at the Master’s level and deduct points accordingly. As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content. It is best to paraphrase content and cite your source.

LopesWrite Policy

For assignments that need to be submitted to Lopes Write, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me. Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes. Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own? Visit the Writing Center in the Student Success Center, under the Resources tab in Loud-cloud for tips on improving your paper and SI score.

Late Policy

The university’s policy on late assignments is a 10% penalty PER DAY LATE. This also applies to late DQ replies. Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances. If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect. I do not accept assignments that are two or more weeks late unless we have worked out an extension. As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.

Communication

Communication is so very important. There are multiple ways to communicate with me: Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class. Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.

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Part 2: Advanced Levels of Clinical Inquiry and Systematic Reviews