NURS 6052 EVIDENCE-BASED PROJECT, PART 3: CRITICAL APPRAISAL OF RESEARCH

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The Assignment (Evidence-Based Project)

Part 3A: Critical Appraisal of Research

Conduct a critical appraisal of the four peer-reviewed articles you selected by completing the Evaluation Table within the Critical Appraisal Tool Worksheet Template. Choose a total of four peer- reviewed articles that you selected related to your clinical topic of interest in Module 2 and Module 3.

Note: You can choose any combination of articles from Modules 2 and 3 for your Critical Appraisal. For example, you may choose two unfiltered research articles from Module 2 and two filtered research articles (systematic reviews) from Module 3 or one article from Module 2 and three articles from Module 3. You can choose any combination of articles from the prior Module Assignments as long as both modules and types of studies are represented.

Part 3B: Critical Appraisal of Research

Based on your appraisal, in a 1-2-page critical appraisal, suggest a best practice that emerges from the research you reviewed. Briefly explain the best practice, justifying your proposal with APA citations of the research.

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Title: NURS 6052 EVIDENCE-BASED PROJECT, PART 3: CRITICAL APPRAISAL OF RESEARCH

Evidence-Based Project, Part 4A: Critical

Introduction

A critical appraisal assists in reducing the research burden by enabling a researcher to identify and focus more on relevant articles to their research question. The research can either provide support or disapprove the claims made by the researcher through the utilization of quality, and evidence-based practice interventions. The selected topic for the research study is use of resilience training to redice the problem of nurse burnout among nurses in different care settings. Nurse burnout remains a critical problem that impacts the quality of care and patient outcomes in different care setting. Resilience training allows nurses to develop and use evidence-based interventions to reduce burnout and enhance their overall performance and improve the quality of care.

Evidence-based practice (EBP) incorporates best practices from studies and patient care information with clinician experience and patient preferences leading to the delivery of highest quality of care, and improving patient outcomes. The use of EBP requires care providers to formulate a clinical question of interest. In this case, the PICOT question is: Among nurses with burnout (P), does resilience training (I) compared to no intervention (C) reduce burnout(O) in six months (T)? The purpose of this assignment is to appraises critically peer-reviewed article for evidence to support resilience training among nurses with burnout to reduce its prevalence.

NURS 6052 EVIDENCE-BASED PROJECT, PART 3 CRITICAL APPRAISAL OF RESEARCH

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Full APA formattedArticle #1Article #2Article #3Article #4
citation of selected articleWang, Q. Q., Lv, W. J., Qian, R. L., & Zhang, Y. H. (2019). Job burnout and quality of working life among Chinese nurses: A cross‐sectional study. Journal of Nursing Management27(8), 1835-1844. https://doi.org/10.1111/jonm.12884Yu, F., Raphael, D., Mackay, L., Smith, M., & King, A. (2019). Personal and work-related factors associated with nurse resilience: A systematic review. International Journal of Nursing Studies, 93, 129-140. https://doi.org/10.1016/j.ijnurstu.2019.02.014Brook, J., Aitken, L. M., MacLaren, J. A., & Salmon, D. (2021). An intervention to decrease burnout and increase retention of early career nurses: A mixed methods study of acceptability and feasibility. BMC Nursing, 20(1), 1-12. https://doi.org/10.1186/s12912-020-00524-9Deldar, K., Froutan, R., Dalvand, S., Gheshlagh, R. G., & Mazloum, S. R. (2018). The Relationship between Resiliency and Burnout in Iranian Nurses: A Systematic Review and Meta-Analysis. Open access Macedonian Journal of Medical Sciences, 6(11), 2250–2256. https://doi.org/10.3889/oamjms.2018.428
     
     
     
     
     
     
     
Evidence Level * (I, II, or III)IIIIIII
Conceptual Framework   Describe the theoretical basis for the study (If there is not one mentioned in the article, say that here).**Not providedNot mentionedBehavioral change involving use of interventions like cognitive realignment, mindfulness and psychological skills trainingBehavior change through increased resiliency training and interventions to improve coping mechanisms.
Design/Method   Describe the design and how the study was carried out (In detail, including inclusion/exclusion criteria).Cross-sectional survey where 2504 nurses participated in Eastern China. The researchers invited nurses to complete self-report questionnaire online.Systematic Review with the aims of identifying the linked personal and work-related factors of nurse resilience.The article’s design was explanatory sequential mixed methods. The participants were final year pre-registration nursing students in a UK university and healthcare organizations. The article used a meta-analysis to conduct the study aimed at determining the effects of resiliency on various components of nurses’ professional burnout.
Sample/Setting   The number and characteristics of patients, attrition rate, etc.The study was conducted virtually with 2504 nurses completing self-report online questionnairesThe study used data from literature review in five databases based on terms like resilience, occupation, job, nursing and work.The sample included 74 pre-registration nursing students and 7 academics in a UK university and healthcare organizations.The researchers used data based on targeted literature review in national and international databases in Persian and English.
Major Variables Studied List and define dependent and independent variablesDependent-Quality of life Independent- Job burnoutDependent Variable-Various components in nursing care Independent Variable-Job burnoutDependent Variable-Multiple Interventions Independent-Retention of nursesDependent-Resiliency & burnout Independent-Conducting nursing education
Measurement   Identify primary statistics used to answer clinical questions (You need to list the actual tests done).The researchers measured the quality of working life based on different aspects like age, income and patient-nurse ratio. The study used a total of 38 articles that met the criteria through a systematic review and narrative synthesis. The authors also used different scales leading to being unfeasible to synthesize the evidence.Pre and Post measure of acceptability using an Acceptability Theoretical FrameworkResearchers used heterogeneity to measure the results by I2 test.
Data Analysis Statistical or Qualitative findings   (You need to enter the actual numbers determined by the statistical tests or qualitative data).The study used Pearson’s correlation and multiple regression to analyze collected data. The study used a quality assessment tool to analyze articles that met the criteria where 23 were rated as good, 15 as fair and 20 as risky due to significant levels of bias.The researchers used the COREQ guidelines to analyze collected data in a thematic manner.The researchers used STATA software v.14 to analyze the data.
Findings and Recommendations   General findings and recommendations of the researchThe findings show that close to two-thirds of nurses experienced job burnout leading to a moderate level of quality of life.Knowing nurse resilience can assist proactively in the identification and potential issues, this fostering job resources and ultimately attaining personal and professional growth. The study recommends more research to explore resilience and develop a regular instrument to measure resilience.The authors assert that the interventions equipped nursing students with skills and experience to attain personal endurance.The authors assert that the meta-analysis conducted on the observational studies illustrated a correlation between resiliency and burnout with values of -0.57 at a 95% confidential interval. The authors assert that there is a relationship between resiliency and burnout and recommend the planning for the interventional and resilient training courses in nursing education.
Appraisal and Study Quality     Describe the general worth of this research to practice.   What are the strengths and limitations ofstudy?The research has significant value to practice as it shows the relationship between job burnout and the quality of life among nurses. The main strength of the study is its use cross-sectional survey where nurses from different setting accepted to have online self-report questionnaire. However, a limitation of the study could be a possible bias from the self-reporting nurses.The study is significant as it shows the need to enhance knowledge on resilience among nurses. Therefore, it is worth for practice interventions in nursing care. The strengths of the study include its design that allows collection of a wide-range of data with various outcomes, and better outcomes that can be applied in nursing care. However, bias is significant based on the application of different outcomes from the study. The main strength of the study is its study design and the sample selected. The design allowed them to engage both academics and nursing students on ways to enhance resilience and fight job burnout. However, a limitation is its use of the sample since it does not involve the nurses who practically handle patients.The research is essential to practice because it demonstrates the need to incorporate resiliency education in nursing to prepare nursing students and even practitioners. A primary strength of this study is the use of systematic review and meta-analysis that allows them to collect a wide-range of data on the issue at hand. The main limitation is that the data can lead to formulation and testing of research hypotheses based on false impressions.
What are the risks associated with implementation of the suggested practices or processes detailed in the research?   What is the feasibility of use in your practice?The risk may include bias leading to misguided interventions among nurses and healthcare facilities. The feasibility of using the findings in my practice is high based on its outcomes.The risk include misinterpretation due to possible bias. The feasibility of using the article’s findings is significant due to its outcomes and recommendations.The risk inherent to implementation is that it may not capture the real work-life experience of burnout based on its selected sample. The study has no feasibility of being used in my practice due to its population sample as it does not capture practical nursing care situation.The implementation of the recommended practices or processes does not have any risks except those associated with misinterpretation and possible false impression based on the multiple sources of data. The study’s findings can be used in my practice with a high feasibility based on the level of knowledge among the practitioners.
Key findingsThe key findings suggest that job burnout has negative impact on the quality of nurse’s working life. The authors recommend consideration of work-associated factors to enhance nurses’ quality of life.Key findings include the need to assist nurses establish strategies to deal with adversity and understand the impacts of job demands and research to discover nurse resilience and develop consistent tools to enhance resilience.The findings show the need enhance endurance training for nursing students for their future career’s challenges as it will improve their ability to tackle job burnouts.The study is emphatic that a relationship exists between resilience and nurse burnout as it demonstrates that through education, nurses can have reduced levels of burnout.
OutcomesThe outcomes suggest that a majority of nurses’ experience job burnouts that have negative effects on their working life.The outcomes include understanding that increased nurse resilience assists nurses to reduce emotional exhaustion and enhance work engagement and function when they encounter challenges in the workplace.The outcomes recommend feasibility of new knowledge concerning the importance of the suggested intervention to enhance resilience in dealing with nurse burnout.The outcomes emphasize the need to plan and develop interventional approaches that enhance the level of evidence and implementation of educational training to increase nurses’ knowledge on the burnout and resiliency.
General Notes/CommentsThe article is critical in enhancing understanding and the need for interventions to reduce job burnout among nurses and enhance use of evidence-based practice. The article’s findings are essential in development of effective understanding about the effects of burnout and should be used in practice to highlight the significance of evidence-based practice interventions.The study suggests effective use of endurance training to prepare nursing students to understand the nature of the nursing environment for better care provision.The need to reduce burnout among nurses is essential and the article is emphatic that increased nursing education can assist in such endeavors. Therefore, the findings are critical in improving overall application of evidence-based practice interventions in different areas in nursing practice.

These levels are from the Johns Hopkins Nursing Evidence-Based Practice: Evidence Level and Quality Guide

Level I

Experimental, randomized controlled trial (RCT), systematic review RTCs with or without meta-analysis

Level II

Quasi-experimental studies, systematic review of a combination of RCTs and quasi-experimental studies, or quasi-

experimental studies only, with or without meta-analysis

Level III

Nonexperimental, systematic review of RCTs, quasi-experimental with/without meta-analysis, qualitative, qualitative

systematic review with/without meta-synthesis

Level IV

Respected authorities’ opinions, nationally recognized expert committee/consensus panel reports based on scientific evidence

Level V

Literature reviews, quality improvement, program evaluation, financial evaluation, case reports, nationally recognized

expert(s) opinion based on experiential evidence

**Note on Conceptual Framework

Part 3B: Critical Appraisal of Research

Nurse burnout is a leading cause of increasing rate of nurse turnover and nursing staff shortage in different care settings. The increasing demand for healthcare across the various demographics implores healthcare providers and organizations and their management to develop interventions based on evidence-based practice to address the issue of burnout. Nurse burnout leads to poor care delivery and outcomes for patients and low levels of satisfaction (The Joint Commission, 2019).

As such, the best practice that emerges from the reviewed research is the need to enhance effective nurse training and education to help nursing professional deal with the issue and apply innovative ways in their care practice for better delivery and patient outcomes (Yılmaz, 2017). The research review demonstrates the need for stakeholders, especially leaders to invest in training programs to enhance resilience of nurses. The increased demand for health care across the demographics divide imply that nurses should understand the care environment and know that the possibility of burnout is significant but can be tackled using innovative approaches to lessen their emotional and psychological burden.

NURS 6052 EVIDENCE-BASED PROJECT, PART 3 CRITICAL APPRAISAL OF RESEARCH
NURS 6052 EVIDENCE-BASED PROJECT, PART 3 CRITICAL APPRAISAL OF RESEARCH

The best practice should focus in resiliency training as identified by different research studies highlighted in the first part of this paper. Resiliency has a positive interaction with nurse burnout as it allows nurses to adopt the best practices to lessen effects of burnout and remain focused on effective care interventions. As opined by Brook et al. (2021), both nursing students and professionals need effective resilience training to enhance their skills and have a positive attitude to solving rising demand and diversity in the healthcare environment. The training should incorporate cultural competence as an effective approach to improving overall understanding about the concept to tackle the adverse effects of burnout.

Conclusion

Nurse burnout remains a critical health issue and leads to nursing shortage and turnover that impact quality care among different patient populations. The critical appraisal exercise and paper illustrate the need to develop interventions that will enhance overall care delivery by training nurses and nursing students on resilience framework to prepare them better in handling stressful situation associated with increased demand for care. Again, resilience training will impact their perspective on different and innovative ways to engage patients and ensure that they tackle the issue of burnout.

References

Brook, J., Aitken, L. M., MacLaren, J. A., & Salmon, D. (2021). An intervention to decrease burnout and increase retention of early career nurses: A mixed methods study of acceptability and feasibility. BMC Nursing, 20(1), 1-12. https://doi.org/10.1186/s12912-020-00524-9

Deldar, K., Froutan, R., Dalvand, S., Gheshlagh, R. G., & Mazloum, S. R. (2018). The Relationship between Resiliency and Burnout in Iranian Nurses: A Systematic Review and Meta-Analysis. Open access Macedonian Journal of Medical Sciences, 6(11), 2250–2256. https://doi.org/10.3889/oamjms.2018.428

The Joint Commission (2019). Quick Safety: Developing resilience to combat nurse burnout. https://www.jointcommission.org/-
            /media/tjc/newsletters/quick_safety_nurse_resilience_final_7_19_19pdf.pdf

Wang, Q. Q., Lv, W. J., Qian, R. L., & Zhang, Y. H. (2019). Job burnout and quality of working life among Chinese nurses: A cross‐sectional study. Journal of Nursing Management27(8), 1835-1844. https://doi.org/10.1111/jonm.12884

Yılmaz, E. B. (2017). Resilience as a strategy for struggling against challenges related to the nursing profession. Chinese Nursing Research, 4(1),

            9-13. https://doi.org/10.1016/j.cnre.2017.03.004

Yu, F., Raphael, D., Mackay, L., Smith, M., & King, A. (2019). Personal and work-related factors associated with nurse resilience: A systematic review. International Journal of Nursing Studies, 93, 129-140. https://doi.org/10.1016/j.ijnurstu.2019.02.014

Nursing practices influence the risks for CAUTIs among the patients in ICU. Therefore, there is need to develop evidence-based practices that will help reduce the burden of CAUTIs among the patients on catheters. The current study appraises the various sources providing recommendations on the best practices to reduce CAUTIs.

Evaluation Table

Full APA formatted citation of selected article.Article #1Article #2Article #3Article #4
  Parker, V., Giles, M., Graham, L., Suthers, B., Watts, W., O’Brien, T., & Searles, A. (2017). Avoiding inappropriate urinary catheter use and catheter-associated urinary tract infections: a pre-post control intervention study. BMC Health Services, 17(314). doi: 10.1186/s12913-017-2268-2.         Ferguson, A. (2018). Implementing a CAUTI Prevention Program in an Acute Care Hospital Setting. Urologic Nursing,38(6), 273–302. DOI: 10.7257/1053-816X.2018.38.6.273.  Scanlon, K. A. (2017). Saving Lives and Reducing Harm: A CAUTI Reductions Program. Nursing Economics, 35(3):134-141.Menegueti, M. G., Ciol, M. A., Bellissimo-Rodrigues, F., Auxiliadora-Martins, M., Gaspar, G. G., Canini, S. R. M. da S., Bakir., M. (2019). Long-term prevention of catheter-associated urinary tract infections among critically ill patient through the implementation of an educational program and a daily checklist for maintenance of indwelling urinary catheter: A quasi-experimental study. Medicine. 98(8). DOI: 10.1097/MD.0000000000014417
Evidence Level * (I, II, or III)IIIIII
Conceptual Framework   Describe the theoretical basis for the study (If there is not one mentioned in the article, say that here).**      No theoretical framework mentioned in the text.  No theoretical or conceptual framework defined.The study was based on the dry bag Concept”, innovative modifications and root cause analysis concept.No theoretical framework indicated
Design/Method   Describe the design and how the study was carried out (In detail, including inclusion/exclusion criteria).The study used the multiple pre-post control intervention design based on the phased mixed method. The sample population included four acute care hospitals from the two Health Districts in NSW.  The point data were collected from all the adult inpatient wards in the hospital.The study involved the use of survey design to assess the effects of offering on-time educational program to enhance nurses’ knowledge about CAUTIs.  The study involved quantitative measures in determining the overall success of standardized infection ratio, rations and catheter days in intensive care unit and non-critical areas in the facilityThe study involved a quasi-experimental study conducted in an intensive care unit of hospital for over 12 years.
Sample/Setting The number and characteristics of patients, attrition rate, etc.The sample used in the study were obtained from the acute care hospital. A total of 500 patients per Health District were targeted.        The sample population included two units in a 393-bed acute care facility and a total of 59 nurses completed the education program in three months-termThe study was conducted in non-ICU setting.The study was conducted in the intensive care unit setting. Sample size not defined
Major Variables Studied List and define dependent and independent variables  The dependent variable was the catheter-associated urinary tract infections (CAUTI) while the dependent variable was appropriate urinary catheter insertion practices.The dependent variable was education on CUATIs prevention while the independent variable was CAUTIs risk.The dependent variable was risk for CAUTIs while independent variables included the interventions developed such as standardized infection ratio, rations and catheter days in intensive care unit and non-critical areas in the facilityThe independent variables included healthcare workers (HCWs) educational program and a daily checklist for indwelling urinary catheter indications. The dependent variable included CAUTIs.
Measurement Identify primary statistics used to answer clinical questions (You need to list the actual tests done).Descriptive statistics were used to determine the trends in the CAUTIs.Descriptive statistics were used to compare the outcomes before and after the intervention.The study involved the use of descriptive statistics.Descriptive statistics were used in the study.
Data Analysis Statistical or Qualitative findings   (You need to enter the actual numbers determined by the statistical tests or qualitative data).No actual data indicated.The mean value for the knowledge on institutional policies before and after the interventions were 9.71 and 12.3 respectively. Mean for the method to prevent catheter-related infections were 4.59 and 5.24 respectively.The CAUTIs reduced by h, 2015 reduced by 57% with a SIR of .67, following the intervention.The study reports that the urinary catheter utilization decreased from phase I to phase IV (73.1%, 74.1%, 54.9%, and 45.6%, respectively). The rate of CAUTI decreased from phase I to phase IV (14.9, 7.3, 3.8, and 1.1 per 1000 catheter-days, respectively
Findings and Recommendations General findings and recommendations of the researchThe study findings indicated that regular evaluation in the clinical practices can significantly help in reducing the burden on CAUTIs.The study recommends the provision of education to the nurses on CAUTIs prevention.Healthcare institution should consciously develop measures to minimize CAUTIs.Providing education to healthcare workers on CAUTIs prevention can be implemented to address the high burden of infections among patients in ICU.
Appraisal and Study Quality Describe the general worth of this research to practice.   What are the strengths and limitations of study?   What are the risks associated with implementation of the suggested practices or processes detailed in the research?   What is the feasibility of use in your practice?The strength of the study is that it used a multifaceted approach where the intervention focused on mixed methods to provide the answer to the research question. On the other hand, the main weakness in the study is that it fails to provide statistical evidence to the effectiveness of the improvement protocols developed in the hospitals. The findings from the study be supplemented with the results from other study.The study’s strength is that it includes a multifaceted nature, interactive program that is consistent with literature on evidence-based care practice. On the other hand, the weakness is that the sample population was not adequate to provide data to be inferred to the general population. The study findings are feasible and can be used to address CAUTIs issues in hospitals.The main strength in the article is that it provides data to show the effectiveness of developing and transferring best practices in all areas of care in the facility, especially in critical. On the other hand, the main weakness is that the study does not define the sample population characteristics. Findings from the study are feasible and can be used in clinical practice.The study has strengths as it was carried out for over ten years and so provides tested and verified results. On the other hand, the weakness is that the study does not provides the approaches used in monitoring the practices in the ICU unit. Findings from the study are reliable and feasible for clinical practice.
    Key findings      The critical care nurses can reduce CAUTIs by understanding the effects of indwelling catheters and catheterization.Education can help reduce the burden of CAUTIs in hospitals.Continuous education on infection prevention reduces the risk for CAUTIs.Healthcare workers (HCWs) educational program and a daily checklist for indwelling urinary catheter indications reduced the risk of CAUTIs.
Outcomes      Reduced CAUTIsImproved level of knowledge on CAUTIs preventionRisk for CAUTIsRisk for CAUTIs
General Notes/CommentsHealthcare facilities should engage continuous quality improvement process.      Healthcare facilities should have standard measures to prevent CAUTIs.The study indicates that generation of data is a critical aspect of improving overall patient delivery and safety, especially in infection control.The study indicates that effective programs over a duration provides a comprehensive outlook of the benefits of safety interventions focused on improving quality of care delivered to patients.

Part 3

The burden presented by CAUTIs among the patients in the intensive care units cannot be underestimated. Therefore, healthcare institutions should be deliberate in providing quality improvement and safety protocols for the healthcare workers in the units. The review of literature indicates the need to provide continuous education to the healthcare providers and ensuring that they promote the safety of their patients and minimize the risks of CAUTIs transmission. The role of education in reducing the burden of CAUTIs among the patients in ICU was highly emphasized (Ferguson, 2018).

The education should be provided continuously to the healthcare provider to increase their level of consciousness in promoting safety during the catheter insertion. Besides, the regular insertions and prolonged stay of the catheters were also associated with increased risk for infection. The findings from the studies provide relevant guidelines that can be implemented to promote safe treatment environment for the patients in needs of catheter insertion and they are supported by Durant (2017). It is apparent that some of the healthcare providers are not aware of the safety measures needed for the ICU practice and so may predispose the patients to CAUTIs by failing to observe the aseptic measures.

Finally, the results from the analysis are essential and can be used to promote safety in the ICU departments. The risk for CAUTIs is high among the patients with prolonged catheterizations (Carr, 2017). Therefore, the nurses and healthcare providers must observe aseptic protocols. However, such can only be effective with standardized protocols and procedures for ICU nursing practice.

Conclusion

CAUTIs are significant factors in the delivery of healthcare. Several studies have analyzed the interventions that could help facilities to address them. There is a consensus amongst the studies that education of healthcare providers will play a fundamental role in reducing the incidences of CAUTIs in facilities.

References

Carr, A. N. (2017). CAUTI Prevention: Streaming Quality Care in a Progressive Care Unit. Medsurg Nursing, 26(5).

Durant, D. J. (2017). Nurse-driven protocols and the prevention of catheter-associated urinary tract infections: a systematic review. American journal of infection control, 45(12), 1331-1341. https://doi.org/10.1016/j.ajic.2017.07.020

Ferguson, A. (2018). Implementing a CAUTI Prevention Program in an Acute Care Hospital Setting. Urologic Nursing, 38(6). DOI: 10.7257/1053-816X.2018.38.6.273.

Menegueti, M. G., Ciol, M. A., Bellissimo-Rodrigues, F., Auxiliadora-Martins, M., Gaspar, G. G., Canini, S. R. M. da S., Bakir., M. (2019). Long-term prevention of catheter-associated urinary tract infections among critically ill patient through the implementation of an educational program and a daily checklist for maintenance of indwelling urinary catheter: A quasi-experimental study. Medicine. 98(8). DOI: 10.1097/MD.0000000000014417

Parker, V., Giles, M., Graham, L., Suthers, B., Watts, W., O’Brien, T., & Searles, A. (2017). Avoiding inappropriate urinary catheter use and catheter-associated urinary tract infections: a pre-post control intervention study. BMC Health Services, 17(314). doi: 10.1186/s12913-017-2268-2. 

Scanlon, K. A. (2017). Saving Lives and Reducing Harm: A CAUTI Reductions Program. Nursing Economics, 35(3):134-141.