Ranking The Evidence Discussion Paper
Ciccu-Moore, R., Grant, F., Niven, B., Paterson, H., Stoddart, K., & Wallace, A. (2014). Care and comfort rounds: Improving standards.
This article was about an SCN designing and implementing hourly rounding. The main aim of the study was to deliver proactive rounding, hourly to help reduce patient safety risks (Ciccu-Moore, 2014). Using data that was routinely collected throughout all Scotland hospitals, information was gathered on call light usage within a 24-hour period before and after the practice was implemented so comparisons could be made (Ciccu-Moore, 2014). From the data gathered not only in the way mentioned above but also through patient surveys as well, the study showed that rounding is a successful practice as patient satisfaction increased and there was a decrease in patient falls and call light usage (Ciccu-Moore, 2014).
This study falls under the level four, quasi-experimental design block of the evidence hierarchy because it is a causal-comparative/quasi-experimental research study. It takes pre-study data that has been gathered on the hospital along with patient surveys to draw comparisons and conclusions from the data gathered during and after the study. Though the groups were not randomized as they were formed naturally through the nurse’s assignments for the day (Ciccu-Moore, 2014)Ranking The Evidence Discussion Paper.
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Harris, R., Sims, S., Levenson, R., Gourlay, S., Cbe, F. R., Davies, N., . . . Grant, R. (2017). What aspects of intentional rounding work in hospital wards, for whom and in what circumstances? A realist evaluation protocol.
This study examines the delivery of IHR and the experience of the practice from the patient’s perspective as well as their family and hospital staff (Harris, 2017). It implemented the practice in four different phases to find the effectiveness of IHR (Harris, 2017). The study examined how staff viewed IHR and how that affected the care they provided to the patient (Harris, 2017). When the study is complete the data will be reviewed to find trends and barriers to implementing the practice (Harris, 2017).
This study is a quantitative correlation research study, making it fall under level five of the evidence hierarchy of nonexperimental designs. It is a nonexperimental design study because it is exploring how nursing staff experience and view IHR as a practice as well as how they feel about the new practice. The study also talks about how patients and their families view the practice which would also make it fall under nonexperimental designs. The study is not randomly assigned to conditions or participants and there is no manipulation of an independent variable.
Harrington, A., Bradley, S., Jeffers, L., Linedale, E., Kelman, S., & Killington, G. (2013). The implementation of intentional rounding using participatory action research.
The aim of this study was to use participatory action research to implement IHR as a practice to improve the care given to patients, increase the satisfaction of staff and patients, and increase staff productivity (Harrington, 2013). Due to staff being more reactive to call lights than proactive with patients to prevent call lights was the reason for the study (Harrington, 2013). Conclusions were drawn from the study that there was a decrease in call light usage and patient safety threats and an increase in patient and staff satisfaction (Harrington, 2013)Ranking The Evidence Discussion Paper.
This is an Ethnography, PAR qualitative study, making it fall under qualitative studies, level seven of the evidence hierarchy. It does not use numerical data to research and draw results from the study. It uses lived experiences from patients and nursing staff during the implementation of a new practice to find out if the practice is successful and positive for future use. During the study, the focus was on the patient and their preferences on care based on their lifestyle and used a small population (Harrington, 2013).
Kirk, K., & Kane, R. (2016). A qualitative exploration of intentional nursing round models in the emergency department setting: Investigating the barriers to their use and success.
This study was about IHR performed in emergency departments. It used semi-structured interviews with nurses working the in the emergency department (Kirk & Kane, 2016). Through these staff interviews, it was found that IHR could possibly lead to improvements in patient safety, satisfaction, and experience in emergency departments (Kirk & Kane, 2016). Staff also found that it might be difficult to implement or keep any consistency of performing the practice due to the quick changes and all the unknowns the emergency department often has to deal with (Kirk & Kane, 2016).
This study is a phenomenological qualitative study which would make it fall under level seven, qualitative research, under the evidence hierarchy. The study falls at this level because it uses interviews done with staff to share their perspectives on how well the process was implemented and the positive and negatives of implementing the practice. It uses no numerical data to show if the practice was successful, it just relies on staff perceptions and opinions.
Strength of Evidence
For the study, “Care and comfort rounds: Improving standards”, fell under level four, quasi-experimental design study on the evidence hierarchy but would rank as moderate for GRADE criteria as high. The study would first rank as moderate as further research would most likely impact and relate to the results shown from this study as well as back up the information already gathered (Grading quality of evidence and strength of recommendations, 2004). The GRADE would increase from moderate to high based on the fact that there is very strong evidence of association among similar research studies with no direct threat to validity (Grading quality of evidence and strength of recommendations, 2004)Ranking The Evidence Discussion Paper.
The second study, “What aspects of intentional rounding work in hospital wards, for whom and in what circumstances? A realist evaluation protocol”, would begin as a low ranking on the GRADE scale. To begin the study is not complete so all data has not been gathered and a conclusion cannot be drawn. If further research is completed after the study has finally concluded, this research may impact our confidence on the results of the study (Grading quality of evidence and strength of recommendations, 2004). The study may drop to a GRADE of very low as there is sparse data since the study has not concluded yet. There may also be some uncertainty about directness when staff was surveyed and explaining about effective the practice was.
The third study, “The implementation of intentional rounding using participatory action research”, would first be assigned a GRADE of low because it focuses on patient preferences and changes the practice to better fit the patient. Due to this factor, there may be many inconsistencies when trying to apply the same practice to a different population without change patient preferences as well. Since there are inconsistencies and the IHR practice was changed throughout the study to better fit the patient the GRADE should drop minus one but since other studies published like this one has shown the same data and results we would add positive one to the GRADE making the two cancel each other out and leaving the GRADE level at low (Grading quality of evidence and strength of recommendations, 2004).
The last article, “A qualitative exploration of intentional nursing round models in the emergency department setting: Investigating the barriers to their use and success,” would receive a GRADE of low as further research may have an important impact on how we view the results of this study and may change our estimate on the results of the study (Grading quality of evidence and strength of recommendations, 2004). The studies interviews had mixed reviews and the practice of IHR has not been studied enough in emergency departments to draw defiantly conclusions on the practice within this unit of a hospital. There could have been many inconsistencies in the data gathered for this study as patient load and assignment varied as well as how much time each patient spent down in the emergency department during the study. Due to this factor, we would lower the GRADE to very low as data is sparse, inconsistent, and there have not been enough studies done for the practice of IHR in the emergency department setting.
Title of your project
Overview of Work Practice Area
RN to BSN students – Discuss your work practice area here. Are you in long-term or acute care settings? What is the size of your facility? How many beds in your unit? What is the typical patient population? How long do they stay? What is the typical nurse to patient ratio? How many nurses are on per shift? How many nursing assistants are on per shift? What is the role of the supervisor and the manager? Make sure that you are not writing in first person
A-BSN students – Discuss something that is of concern to you in a current clinical setting or something you are interested learning more about in a future clinical experience.
Overview of Topic
What is your topic of interest? Why is it of interest to you? Provide an example if possible of something related to you topic that makes this topic interesting to you.
RN to BSN students – Perhaps you have a high fall rate and are interested in learning ways to help lower the incident of falls. Or maybe you are interested in introducing a new intervention into your practice setting. Maybe you work in the NICU and see a high population of babies born to addicted mothers and want to learn better ways to help those infants.
A-BSN students – You may be going to a critical care area and are interested in learning more about Ventilator Safety. Or maybe you are going to Maternity and are interested in water birth safety compared to c-section or vaginal deliver Ranking The Evidence Discussion Paper.
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Population
What is the patient population that you are interested in? Be specific about age, gender, etc.
Maternity example – Pregnant women
ICU example – Patients requiring CPR
Infant – Infants with Neonatal Abstinence Syndrome (NAS)
Intervention
What is the intervention you are interested in learning more about?
Maternity example- Water births
ICU example – automated compression delivery machine
Infant – Breastfeeding and use of medication
Comparison
What are you comparing the new intervention to? Usually you are comparing something new to something that is already in place.
Maternity example – vaginal delivery
ICU example – manual compressions
Infant – use of medication
Outcome
What is the outcome that you are hoping to prove with this new intervention?
Maternity example – Water births are safer and the women experience less pain during delivery.
ICU example – Improved neurologic function
Infant – decrease severity of symptoms within 4 weeks of life
PICO(T) Question
Does the use of water birth improve quality of delivery by decreasing pain during the delivery process compared with vaginal delivery experience?
In patients requiring who suffer VFib arrest, does the use of an automated compression delivery machine compared with manual compressions improve neurologic outcomes?
In infants with NAS, does utilizing methadone and breastfeeding, compared with methadone alone, decrease the severity of symptoms within 4 weeks of life.
Principle of Respect
Discuss the ethical principle of respect. How can this be integrated into your project?
Assurance of Autonomy
Discuss the ethical principle of autonomy. How will this be intergrated into your project?
Beneficence
Discuss the ethical principle of beneficence. How will this be intergrated into your project?
Justice
Discuss the ethical principle of justice. How will this be intergrated into your project?
Quantitative Study One
APA formatted reference should be written here
Provide an overview of study one. (Note that quantitative studies provide statistical analysis of data. They are all about the numbers)Ranking The Evidence Discussion Paper.
Type of Study
Discuss the specific type of quantitative study that was performed. Summarize the information provided in the journal article.
Threats to Internal and External Validity
What are the internal threats to the validity of the study?
What are the external threats to the validity of the study?
Where there any other threats that you thought of that were not mentioned?
How do these threats affect the study validity?
Applicability
Will this study be applicable to your project? Why or why not? Remember that you are not to be writing in first person
Quantitative Study Two
APA formatted reference should be written here
Provide an overview of study one
Type of Study
Discuss the specific type of quantitative study that was performed. Summarize the information provided in the journal article.
Threats to Internal and External Validity
What are the internal threats to the validity of the study?
What are the external threats to the validity of the study?
Where there any other threats that you thought of that were not mentioned?
How do these threats affect the study validity?
Applicability
Will this study be applicable to your project? Why or why not? Remember that you are not to be writing in first person
Qualitative Study One
APA formatted reference should be written here
Provide an overview of the qualitative study.
Type of Study
Discuss the type of qualitative study that was performed. Note that qualitative studies look at the lived experience and do not have statistical analysis of data.
Credibility, Confirmability, Dependability, and Transferability
In this section you will discuss how researchers establish validity in qualitative research. This is different from the evaluation of quantitative research.
- Credibility – believability and trustworthiness of the findings. Think of this as internal validity
- Confirmability – describes how well the research finding are supported by the actual data collected
- Dependability – refers to the consistency with which the results could be repeated. Did the researches document any changes or unexpected occurrences that might have affected their findings. Think of this as reliability.
- Transferability – the degree tha the findings of the research can be transferred to other contexts. Can the information be applied to other similar settings, population or sitatuions? Think of this as external validity Ranking The Evidence Discussion Paper
Applicability
Will this study be applicable to your project? Why or why not? Remember that you are not to be writing in first person.
Qualitative Study Two
APA formatted reference should be written here
Provide an overview of the qualitative study.
Type of Study
Discuss the type of qualitative study that was performed. Note that qualitative studies look at the lived experience and do not have statistical analysis of data.
Credibility, Confirmability, Dependability, and Transferability
In this section you will discuss how researchers establish validity in qualitative research. This is different from the evaluation of quantitative research.
- Credibility – believability and trustworthiness of the findings. Think of this as internal validity
- Confirmability – describes how well the research finding are supported by the actual data collected
- Dependability – refers to the consistency with which the results could be repeated. Did the researches document any changes or unexpected occurrences that might have affected their findings. Think of this as reliability.
- Transferability – the degree tha the findings of the research can be transferred to other contexts. Can the information be applied to other similar settings, population or sitatuions? Think of this as external validity
Applicability
Will this study be applicable to your project? Why or why not? Remember that you are not to be writing in first person.
Ranking the Evidence
Quantitative Study I (Tehrani, A., Farajzadegan, X., Rajabi, F., & Zamani, A. (2011). Belonging to a peer support group enhance the quality of life and adherence rate in patients affected by breast cancer: a non-randomized controlled clinical trial)
Tehrani et al. (2011) presents the results of a non-randomized controlled trial. This is a level II evidence that can be considered as a decision analysis that is intended to develop a behavior model to show how alternative (either being or not being part of a support group) affects behavior (quality of life and adherence rate) for breast cancer patients. It presents a sensible model with alternatives with the values obtained from a single study and subjected to multi-way sensitivity analysis. This is good evidence that is effective, appropriate and feasible. The evidence is effective because the intervention peer support group) is shown to work, with a clear listing of the associated harms and benefits, as well as the persons who will benefit from the intervention (breast cancer patients). The evidence is appropriate because it collects information from the perspective of the patients using their experiences thus making it beneficial to breast cancer patients as the target population. The evidence is feasible since the resources requirement to implement peer support groups are readily, with the information being acceptable and useful to medical personnel (Melnyk & Fineout- Overholt, 2015). In this respect, the article presents level II evidence that offers sound basis for clinical practice at low risk of error although it has been generated by a single study thus requiring replication to ascertain the results.
Quantitative Study II (Taleghani, F., Babazadeh, S., Mosavi, S., & Tavazohi, H. (2012). The effects of peer support group on promoting quality of life in patients with breast cancer)
Taleghani et al. (2012) presents the results of a clinical trial. This is level II evidence that is concerned with decision analysis, particularly the sensibility of using peer support groups to promote the quality of life for breast cancer patients. The information contained in the article was obtained from a well-designed controlled trial. It presents good evidence that is generated by a single study and offers sound basis for clinical practice at low risk of error. In fact, the evidence is effective, appropriate and feasible. It is effective because the intervention is shown to work with clear listing of the benefits and harm, as well as a clear acknowledgment of breast cancer patients as the study’s beneficiaries. It is appropriate because the collected data is based on what the patients experienced, with the intervention being important to them since it is beneficial. It is feasible because the intervention requires the use of resources that are available, with the intervention acceptable to medical personnel and easy to implement. Also, it has acceptable economic implications in terms of costs for holding the support group sessions (Melnyk & Fineout- Overholt, 2015). As a result, the article presents level II evidence.
Qualitative Study I (Ono, M., Tsuyumu, Y., Ota, H. & Okamoto, R. (2017). Subjective evaluation of a peer support program by women with breast cancer: a qualitative study)
Ono et al. (2012) presents the results of a qualitative study that makes of interviews. This is level VI evidence since it is a single qualitative study that evaluates the participants’ response to an actual health intervention. It purposes to explore the relationship between the intervention and care outcome. It presents fair evidence in terms of effectiveness and appropriateness. It is effective because it shows whether the intervention will work, its benefits as well as who will benefit from the intervention. It is appropriate because it highlights the experiences of breast cancer patients thus discussing a health issue that is important to them with the outcomes being beneficial to patients in showing them what to expect when subjected to peer support programs (Melnyk & Fineout- Overholt, 2015). Therefore, the article presents level VI evidence.
Qualitative Study II (Schellekens, M. P. J., Jansen, E. T. M., Willemse, H. H. A., van Laarhoven, H. W. M., Prins, J. B. & Speckens, A. E. M. (2016). A qualitative study on mindfulness-based stress reduction for breast cancer patients: how women experience participating with fellow patients) Ranking The Evidence Discussion Paper
Schellekens et al. (2016) presents the results of a qualitative study that used focus groups and interviews to collect primary data. The article presents level VI evidence from a single qualitative study that reviews patients’ experiences with an intervention. The evidence is fair in terms of effectiveness and appropriateness. It is effective because it looks at whether the intervention achieves the desired outcome and who will benefit from applying the intervention. It is appropriate because it allows breast cancer patients to explore experiences that they would expect from applying the intervention. Also, it discusses an issue that is of importance to breast cancer patients (Melnyk & Fineout- Overholt, 2015). Thus, the article presents level VI evidence.
Strength of Evidence
The four articles have been graded for strength of evidence. Firstly, Tehrani et al. (2011) offers level II evidence that can be considered moderate grade of evidence since the true effects are assumed to be probably close to the estimated. However, additional study is required with more participants to improve the confidence that the true effects of the study are actually similar to the estimated effects (BMJ, 2018). Secondly, Taleghani et al. (2012) offers level II evidence that can be considered as moderate grade of evidence since the actual effects of the treatment are probably close to the estimate effect. Additional participants should be recruited and more data collected to improve the confidence that the true effects are similar to the estimated study effects (BMJ, 2018). Thirdly, Ono et al. (2012) offers level VI evidence the can be considered as moderate grade of evidence since it relies on qualitative data collected from close interactions with the study population but presents the possibility of bias since this is a single study. The grade of the evidence can be improved to high grade by recruiting more participants and conducting more studies (BMJ, 2018). Schellekens et al. (2016) presents level VI evidence that can be considered as moderate evidence. That is because although there is a lot of confidence that the estimate effects are close to true effects, this was a single study that presents the possibility of bias by the researchers. Additional studies should be conducted to reduce the possibility of bias (BMJ, 2018).
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Practice Recommendations
Based upon the research articles that you have reviewed, what are two practice recommendations that you would put into place?
Strength of Recommendations
Once you have decided what you would recommend, you should then evaluate each individual practice recommendation using the GRADE criteria and determine the overall strength of each recommendation.
Key Stakeholders
Who are three key stakeholders and why are they important to your project?
Engagement Strategies
How will you engage the stakeholders? What strategies will you use to get them to help you make your project a success? A work group? A committee?
Resistance Strategies
Resistance to change is a frequent occurrence. What can you do to help decrease resistance and improve the success of the project? What interventions can you put into place to improve participation?
Evaluation
How will you evaluate the results of your intervention? Be specific including methods used and timeframe.
References
BMJ (2018). What is grade? Retrieved from https://bestpractice.bmj.com/info/us/toolkit/learn-ebm/what-is-grade/
Melnyk, B. & Fineout- Overholt, E. (2015). Evidence-based practice in nursing and healthcare: A guide to best practice (3rd ed.). Philadelphia, PA: Wolters Kluwer
Ono, M., Tsuyumu, Y., Ota, H. & Okamoto, R. (2017). Subjective evaluation of a peer support program by women with breast cancer: a qualitative study. Jpn J Nurs Sci., 14(1), 38-48. doi: 10.1111/jjns.12134
Schellekens, M. P. J., Jansen, E. T. M., Willemse, H. H. A., van Laarhoven, H. W. M., Prins, J. B. & Speckens, A. E. M. (2016). A qualitative study on mindfulness-based stress reduction for breast cancer patients: how women experience participating with fellow patients. Support Care Cancer, 24, 1813-1820. doi: 10.1007/s00520-015-2954-8
Taleghani, F., Babazadeh, S., Mosavi, S., & Tavazohi, H. (2012). The effects of peer support group on promoting quality of life in patients with breast cancer. Iranian Journal of Nursing and Midwifery Research, 17(2 Suppl1): S125-S130. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3696969/
Tehrani, A., Farajzadegan, X., Rajabi, F., & Zamani, A. (2011). Belonging to a peer support group enhance the quality of life and adherence rate in patients affected by breast cancer: a non-randomized controlled clinical trial. Journal of Research in Medical Services, 16(5), 658-665. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3214378/
Appendix A
National Institues of Health Protecting Human Research Participants Certificate
Ranking The Evidence Discussion Paper