ASSG WK 7 JULY 18

Assignment: Evidence-Based Project, Part 4: Critical Appraisal of Research
Realtors rely on detailed property appraisals—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.

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 an appraisal tool to conduct a critical appraisal of published research. You will then present the results of your efforts.

To Prepare:

Reflect on the four peer-reviewed articles you selected in Module 2 and the four systematic reviews (or other filtered high- level evidence) you selected in Module 3.
Reflect on the four peer-reviewed articles you selected in Module 2 and analyzed in Module 3.
Review and download the Critical Appraisal Tool Worksheet Template provided in the Resources.
The Assignment (Evidence-Based Project)
CHOOSE FROM THE ARTICLES BELOW.
Part 4A: 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 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.

Learning Resources
Note: To access this week’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 5, “Critically Appraising Quantitative Evidence for Clinical Decision Making” (pp. 124–188)
Chapter 6, “Critically Appraising Qualitative Evidence for Clinical Decision Making” (pp. 189–218)
Fineout-Overholt, E., Melnyk, B. M., Stillwell, S. B., & Williamson, K. M. (2010a). Evidence-based practice step by step: Critical appraisal of the evidence: Part I. American Journal of Nursing, 110(7), 47–52. doi:10.1097/01.NAJ.0000383935.22721.9c

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

Fineout-Overholt, E., Melnyk, B. M., Stillwell, S. B., & Williamson, K. M. (2010b). Evidence-based practice, step by step: Critical appraisal of the evidence: Part II: Digging deeper—examining the “keeper” studies. American Journal of Nursing, 110(9), 41–48. doi:10.1097/01.NAJ.0000388264.49427.f9

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

Fineout-Overholt, E., Melnyk, B. M., Stillwell, S. B., & Williamson, K. M. (2010c). Evidence-based practice, step by step: Critical appraisal of the evidence: Part III: The process of synthesis: Seeing similarities and differences across the body of evidence. American Journal of Nursing, 110(11), 43–51. doi: 10.1097/01.NAJ.0000390523.99066.b5

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

Williamson, K. M. (2009). Evidence-based practice: Critical appraisal of qualitative evidence. Journal of the American Psychiatric Nurses Association, 15(3), 202–207. doi:10.1177/1078390309338733

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

Document: Critical Appraisal Tool Worksheet Template (Word document)

Required Media
Laureate Education (Producer). (2018). Appraising the Research [Video file]. Baltimore, MD: Author.

Accessible player
Laureate Education (Producer). (2018). Interpreting Statistics [Video file]. Baltimore, MD: Author.
Video transcript

Appraising the Research
Program Transcript
NOLA SCHMIDT: When I think about the relationship of practice and research, I
think of it as a four-pronged stool. And on the stool, one of the legs is research,
and that’s our evidence where we get data to support our decisions. One of the
legs is practice, and that’s probably one of the most important legs because
that’s the reason we’re here is to care for others. But we also have to keep in
mind theory, and that we have theory that guides our research and that guides
our practice. And we also have to keep in mind education, and that research and
theory and practice should all be informing education.
And so, those are the four legs that hold up the stool and keeps the practice of
nursing going. And as long as all those legs are current and up to date, then
ultimately we should be giving good patient care.
NARRATOR: Dr. Marianne Shaughnessy, Dr. Nola Schmidt, and Joyce Parks
look at the basic elements of the research process, and how nurses can use
these elements to evaluate the strength of a research study.
MARIANNE SHAUGHNESSY: There are a number of theoretical frameworks
that have been published– some in nursing and some theoretical frameworks
nurses actually adopt from other disciplines. The particular framework that I use
in my research and clinical practice is a self-efficacy framework, which really
looks at a patient’s ability to perform a task or activity. And as a nurse, I’m looking
at trying to motivate stroke survivors to exercise.
So what I found to be effective is working with them on building their self-efficacy
and building their outcome expectations for what they can hope to accomplish to
actually get them to perform the behavior. And then, they see the results of their
own work, and that inspires and motivates them to continue.
NOLA SCHMIDT: Let’s talk about what is generalizability. Generalizability is
when I have findings, can I apply these to other people? Or did I have these
findings just because this unique– this sample of people was unique in this
study.
I think the easiest way to understand generalizability is to think about if we were–
think about quizzes. If I were to make a quiz about heart disease and give it to
my students, it’s likely that a teacher at another school would have very similar
quiz, and that my students would do comparably as well as the students at any
other school on this quiz. And so, the quiz findings could be generalizable to all
nursing students.
But let’s compare that now to– let’s say I gave a quiz about the conceptual model
at our school. Our school has a unique conceptual model, and so, our students
Appraising the Research
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should do very well on this quiz because we talk about how the model affects
nursing care at VU. But students at other schools who don’t know our model
aren’t going to do very well on that quiz. And so, if I gave that quiz to a student at
another school and they didn’t do well, I wouldn’t want to be making
generalizations about that’s not a very good nursing student.
That treatment– that quiz– is not applicable or generalizable to the greater
population of nursing students. And so, that’s what you have to think about when
you read a study. You have to say, I work in a nursing home. All the studies that
I’ve looked at have been done in acute care settings.
Is my patient population similar to the populations used in the hospitals? Do I feel
comfortable generalizing the findings from those studies to the people that I take
care of?
Sample size is important because it makes us feel confident about generalizing.
Typically, the larger the sample, the more confident we can be in the findings.
However, you can’t just keep getting bigger and bigger and bigger samples
because the larger the sample, the more expensive it is to do your study.
So I think what you’re seeing in the literature now is that researchers will talk
about how they’ve conducted a power analysis. And so, if you’re critiquing a
study and you see that the researchers say we conducted a power analysis, and
they said we needed 150 subjects, that then you should be looking to see, were
there 150? How close were they to 150? That’s a really good way to critique and
know that the sample size was big enough and that you can have confidence in
the findings of the study.
JOYCE PARKS: Quality of evidence is really interesting because I think journals
have gotten– have done a better job at publishing things that are at a higher
quality of evidence. But if you look at nursing, most nursing studies are not
randomized controlled trials, which is the highest level of evidence. It generally
isn’t ethical for us to be able to do that particular type of research clinically with
our population. Most of our work is quasi-experimental or descriptive,
correlational. A lot of nursing work has been done phenomenologically in
qualitative research.
So everything has a different impact. A lot of what we’ve done historically over
the years is expert opinion. I mean, we did things because that’s the way our
nursing instructors taught us and that’s the way physicians told us things needed
to be done. But it’s so fascinating to look at the wider range of evidence, and I
think as nurses, as professionals, that it’s our responsibility to continue to
educate ourselves so that we’re giving our patients the best care.
The day a nurse graduates from school, either from an undergraduate program,
from an RN to BSN program, I mean, that knowledge that we got in our classes
Appraising the Research
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is getting cold. We have to keep refreshing, and whether it’s going to classes,
courses, it also involves reading and evaluating what we’re reading.
I don’t think we have as much experience as a profession that we’re gaining
ground very quickly. I think people learn about evaluating research at first in their
nursing research courses at whatever level. But I think it’s helpful to be able to
find a way to say, OK, what type of study is this? How many people were in the
population? How many of them were chosen, or is it a random assignment or
was it a convenience population?
I can remember my master’s thesis– the first nursing research project I was ever
involved in, and I was interested in what are the words that convey caring to
psychiatric nurses and psychiatric patients, because telling someone the word
“no” is not always deemed to be very caring. So I found an instrument that
another nurse researcher had put together, gained permission, and I had
different people fill it out.
Well, the problem is if I really wanted to do a stellar job, I would have had at least
a random number– a random assignment of people. The truth is, having to do it
along with everything else that I have to do, I used a convenience sample. It
does impact the quality of the evidence, but I think we need to look at that.
I read something last month in one of my psychiatric nursing journals where the
sample size was four patients. That’s not an adequate sample size. It was–
there’s no way to do power analysis, there’s no way to be able to generalize it,
but you will find things written in the literature that way.
I think we all have to say, OK, so what is the hypothesis? What is the literature
that supports the hypothesis? How was the methodology put together? What is
the sample size, how did they choose them, and then what did they find out?
I don’t think most of us, not being a statistician, could say, oh, yes, they picked
the correct statistical test. If people can, I think that’s wonderful. I know that’s not
my forte. However, taking a look at what are the statistics and are they– did they
find something that’s significant? And then, finding what that means– I think
every nurse has to evaluate and ask themselves that question as they read any
2nd video transcript
Appraising the Research: Interpreting Statistics
Program Transcript
NARRATOR: Understanding statistical information.
NOLA SCHMIDT: My best advice to you is to not be afraid of statistics. There are
people out there who can help you muddle through it. If you’re just reading an
article, go to a masters prepared nurse to help you understand it. Join a journal
club where you can talk more about how that’s significant. It’s much easier to do
with others than to do by yourself.
NARRATOR: Finding support through journal clubs.
DEBORAH DANG: Looking at journal clubs is one way for nurses practicing at
the bedside to really begin to become comfortable and more familiar with the
skills that they’re going to need to do evidence based practice. Similar to
evidence based practice, it focuses on one topic. But usually, you’re looking at
one article and critically discussing it or evaluating it. And that’s a good way to
develop some skills.
NARRATOR: And the application of statistics to the bedside.
JOYCE PARKS: So we actually delved deeper and found out that if we could
involve people in functional fitness exercise that would improve their balance,
their reach, and their strength, that we had a good chance of decreasing falls.
And we’ve been doing that for the past nine months. And it’s really interesting.
We found that we were able to effect a statistically significant difference in the
ability to reach.
NARRATOR: This week, Dr. Nola Schmidt presents strategies for making sense
out of statistical information. Dr. Deborah Deng discusses the value of journal
clubs. And Ms. Joyce Parks shares practical examples of evidence based
practice research in the clinical setting.
[MUSIC PLAYING]
NOLA SCHMIDT: I know that you have all read a research article at one time in
your life. But I’m going to guess that many of you have read through the method
section, and then skipped the statistics section and jump straight to discussion.
And I think part of being a baccalaureate prepared nurse and of being informed
about research is that now we’re going to say we’re going to give you the tools to
be able to read that section you’ve been skipping all this time.
So what I think that you need to understand about it, first and foremost, is that no
one’s expecting you to do any math. OK? You don’t have to know how to do the
statistical test. There’s no data there anyway for you to do the statistical test.
Appraising the Research: Interpreting Statistics
© 2018 Laureate Education, Inc. 2
What you really have to comprehend, though, is have they selected the correct
statistical test given the kind of data that they’re using. And once they ran their
test, is it significant or not significant? I think if you really have to pick out the test
that you should know, I think you should be comfortable talking about
percentages.
What percentage of patients were treated? What percentage of patients were not
treated? What percentage of patients responded positively? I think that’s
important data for you to comprehend.
It’s also important when you read that area that if there are two or three groups
being studied, to know that they’re not significantly different on basic factors. Are
they all about the same age? Does each group have the same mix of race? Do
they come from the same geographic area?
So that you can know that if those groups are statistically the same that then
you’re comparing to groups you’re controlling for those variables of age, and
race, and whatever else. And so that’s important to understand to be sure that,
as you’re reading that data analysis section, that you are looking to see are the
groups the same.
The other important thing I think you should know is I think at this level you
should be able to interpret tables. And so I know that’s another area that people
like to skip over. They just read the text, and never look at the tables.
The tables can give you critical information. And in fact, sometimes I prefer to
read the tables and skip all the pros. Always start at the top. Read the title of the
table. And then, read the axis, the horizontal and the vertical, and then look at the
data in the middle.
I know that, frequently, our eye is drawn to the center. And then, you get all
flustered and confused. But if you start with the title, and look at the axis, and
then move to the center, you’ll find that it will make much more sense.
JOYCE PARKS: But when a patient comes in, they’re invited to be a part of the
functional fitness exercise project. We don’t have to get oral consent. People who
agree that they will are pre-tested on the Tinetti Balance Scale, the time up and
go, and the functional reach test.
Time up and go is a very simple test that’s used quite a bit in PT. People stand,
walk 10 feet, turn around, and sit down again. The longer that you take to be able
to do that, the more likely you are to fall. So we wanted to give people exercises
that would improve all three measures.
They participate in daily exercises. And I think the best part about this is that our
clinical associates– our unlicensed, assisted personnel– actually underwent
Appraising the Research: Interpreting Statistics
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training with our physical therapy department. And they do a lot of the exercise
group along with our activity therapist.
Nurses participate. But this is the part of the project that they actually own. The
nurses actually helped collect the pre and post-test measures. And I helped the
group to be able to do some of the statistical analysis. And it was very simple
looking at a paired t-test for all the measures.
And that’s why it’s so exciting to be able to say, aha, we have some statistically
significant results. And in that way, eventually, can we form a study where we
can say, aha, this worked with this particular population but it could be
generalized to a larger group of patients?
The other thing is there’s a tremendous gap in the literature. Most of the work
done on falls has been done with patients in the community but not in the
hospital. And I would say that we have a unique setting. Most patients probably
couldn’t participate in exercise if they were in for a medical problem, a surgical
problem.
But in our environment, it works really well. And it’s a fabulous treatment for
depression. So we’re getting to interventions that are attacking two different
issues that same time.
DEBORAH DANG: Several of our ICUs, actually, and acute care units have
established journal clubs. And in that, it’s a group of clinicians along that
committee. And you identify a topic of interest. And you select an article or two
that the group will read.
And then, the group meets on a regular basis and discusses the article. If it’s a
research article, they discuss the findings and often discuss the quality of the
study design, or the methods, and ways that you might improve it. If it’s an
opinion piece or a position statement, it provides a lot of opportunity for nurses to
engage with their peers to really expose their different perspectives and opinions.
And if it’s something that’s a question that affects some of their practice, then it
gives them an opportunity to come to some consensus about whether or not they
want to engage in an evidence based practice project. Usually, when you have
journal clubs when you’re just beginning them, you usually have a mentor or a
facilitator that participates. So usually a clin spec, or a nurse manager, or an
educator will participate until the group gets established enough to manage the
process themselves.
NOLA SCHMIDT: Another thing to remember is the difference between statistical
significance and clinical significance. Sometimes things are statistically
significant but really aren’t going to make any noticeable change in practice. And
sometimes the opposite can be true.
Appraising the Research: Interpreting Statistics
© 2018 Laureate Education, Inc. 4
Sometimes data might approach statistical significance but not be significant, but
might be really relevant for clinical practice. Let me give you an example. I did a
study with guided imagery with children who were in pain. And what we found
was that the children who did guided imagery, their average pain rating was 4.2.
The average pain rating of the control group was 5.2.
There’s not a statistically significant difference between 5.2 and 4.2. But I think if
you ask any patient, they’d rather report a pain level of 4.2 than 5.2. And so while
these findings aren’t statistically significant, I might be encouraged to do a little
more guided imagery with kids and see if they think it’s making a difference for
them.
The evidence would suggest that while there’s a trend towards guided imagery
being effective, if we have to be brutal, we’d say, no, it’s not effective. But my
clinical judgment tells me that, yes, 4.2 is better than 5.2.
And so then, the third part of it would be asking the patient. Asking the child,
would you like to learn guided imagery? Why don’t you give it a try. Is it helping
you? And for some children, they might enjoy it. And it might be very effective.
And for others, it may not. And so that’s a classic example of how evidence, my
clinical judgment, and a patient preference might all come together as to whether
a child might use guided imagery or not to treat his pain.
Appraising the Research: Interpreting Statistics
Additional Content Attribution
The National Center for Biotechnology Information, & PubMed. (n.d.). PubMed
[Screenshot]. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/
Cochrane.org. (2016). Cochrane website home page [Screenshot]. Retrieved
from http://www.cochrane.org/ Used by permission of Cochrane.
Emergency Contraception: Knowledge and Perceptions in a University
Population by Corbett, P.; Mitchell C.; Smith T.; Kemppainen, J.; in Journal of the
American Academy of Nurse Practitioners, Vol. 18/Issue 4. Copyright 2006 by
John Wiley & Sons – Journals. Reprinted by permission of John Wiley & Sons –
Journals via the Copyright Clearance Center
MUSIC:
Creative Support Services
Los Angeles, CA
Dimension Sound Effects Library
Appraising the Research: Interpreting Statistics
© 2018 Laureate Education, Inc.

Accessible player
Laureate Education (Producer). (2018). Review of research: Hierarchy of evidence pyramid [Mutlimedia file]. Baltimore, MD: Author.

Schulich Library McGill. (2017, June 6). Types of reviews [Video file]. Retrieved from https://youtu.be/5Rv9z7Mp4kg
Articles to use for this work.

1.
Dennis, B. B., Sanger, N., Bawor, M., Naji, L., Plater, C., Worster, A., Woo, J., Bhalerao, A., Baptist Mohseni, N., Hillmer, A., Rice, D., Corace, K., Hutton, B., Tugwell, P., Thabane, L., & Samaan, Z. (2020). A call for consensus in defining efficacy in clinical trials for opioid addiction: Combined results from a systematic review and qualitative study in patients receiving pharmacological assisted therapy for opioid use disorder. Trials, 21(1). https://doi.org/10.1186/s13063-019-3995-y

2. Inanli, Ikbal; Ozturk, Halil Ibrahim; Caliskan, Ali Metehan; Ozbek, Suleyman; Demirel, Basak; Er, Mehmet; Eren, Ibrahim; Heroin Addiction & Related Clinical Problems, Feb2020; 22(1): 9-16. 8p. (Article – research, tables/charts) ISSN: 1592-1638
Subjects: Temperament Evaluation; Narcotics; Substance Dependence Risk Factors; Substance Dependence Psychosocial Factors; Severity of Illness; Male
3. Dennis, B. B., Sanger, N., Bawor, M., Naji, L., Plater, C., Worster, A., Woo, J., Bhalerao, A., Baptist Mohseni, N., Hillmer, A., Rice, D., Corace, K., Hutton, B., Tugwell, P., Thabane, L., & Samaan, Z. (2020). A call for consensus in defining efficacy in clinical trials for opioid addiction: Combined results from a systematic review and qualitative study in patients receiving pharmacological assisted therapy for opioid use disorder. Trials, 21(1). https://doi.org/10.1186/s13063-019-3995-y
4.
Inanlı, İ., Çalışkan, A. M., Tanrıkulu, A. B., Çiftci, E., Yıldız, M. Ç., Yaşar, S. A., & Eren, İ. (2020). Affective temperaments in caregiver of patients with bipolar disorder and their relation to caregiver burden. Journal of Affective Disorders, 262, 189 195. https://doi.org/10.1016/j.jad.2019.10.028
5.
Messina, B. G., & Worley, M. J. (2019). Effects of craving on opioid use are attenuated after pain coping counseling in adults with chronic pain and prescription opioid addiction. Journal of Consulting and Clinical Psychology, 87(10), 918-926. https://doi.org/10.1037/ccp0000399
Moe, J., Godwin, J., Purssell, R., O’Sullivan, F., Hau, J. P., Purssell, E., Curran, J., Doyle Waters, M. M., Brasher, P. M., Buxton, J. A., & Hohl, C. M. (2020). Naloxone dosing in the era of ultra potent opioid overdoses: A systematic review. CJEM, 22(2), 178 186. https://doi.org/10.1017/cem.2019.471

6.Davies, K. S. (2011). Formulating the evidence based practice question: a review of the frameworks. Evidence Based Library and Information Practice, 6(2), 75-80.
7.Melnyk, B. M., & Fineout-Overholt, E. (Eds.). (2011). Evidence-based practice in nursing & healthcare: A guide to best practice. Lippincott Williams & Wilkins.
8.Stillwell, S. B., Fineout-Overholt, E., Melnyk, B. M., & Williamson, K. M. (2010). Evidence-based practice, step by step: asking the clinical question: a key step in evidence-based practice. AJN The American Journal of Nursing, 110(3), 58-61.
9. References
Davies, K. S. (2011). Formulating the evidence based practice question: a review of the frameworks. Evidence Based Library and Information Practice, 6(2), 75-80.
10.Melnyk, B. M., & Fineout-Overholt, E. (Eds.). (2011). Evidence-based practice in nursing & healthcare: A guide to best practice. Lippincott Williams & Wilkins.
11.Stillwell, S. B., Fineout-Overholt, E., Melnyk, B. M., & Williamson, K. M. (2010). Evidence-based practice, step by step: asking the clinical question: a key step in evidence-based practice. AJN The American Journal of Nursing, 110(3), 58-61.

1.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 Tool Worksheet Template. Be sure to include:

· An Evaluation Table
45 (45%) – 50 (50%)
The critical appraisal accurately and clearly provides a detailed evaluation table. The responses provide a detailed, specific, and accurate evaluation of each of the peer-reviewed articles selected.
2.
art 4B: Evidence-Based Best Practices

Based on your 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.
32 (32%) – 35 (35%)
The responses accurately and clearly suggest a detailed best practice that is fully aligned to the research reviewed.

The responses accurately and clearly explain in detail the best practice, with sufficient justification of why this represents a best practice in the field. The responses provide a complete, detailed, and specific synthesis of two outside resources reviewed on the best practice explained. The response fully integrates at least two outside resources and two or three course-specific resources that fully support the responses provided.

Accurate, complete, and full APA citations are provided for the research reviewed.

3.
Written Expression and Formatting—Paragraph Development and Organization:

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

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

4.
Written Expression and Formatting—English Writing Standards:

Correct grammar, mechanics, and proper punctuation.
5 (5%) – 5 (5%)
Uses correct grammar, spelling, and punctuation with no errors.

5.Written Expression and Formatting—English Writing Standards:

Correct grammar, mechanics, and proper punctuation.
5 (5%) – 5 (5%)
Uses correct grammar, spelling, and punctuation with no errors.
6.Written Expression and Formatting—The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running head, parenthetical/in-text citations, and reference list.
5 (5%) – 5 (5%)