Feb 23, 2024 EVIDENCE-BASED PROJECT, PART 2: ADVANCED LEVELS OF CLINICAL INQUIRY AND SYSTEMATIC REVIEWS NURS 6052
EVIDENCE-BASED PROJECT, PART 2: ADVANCED LEVELS OF CLINICAL INQUIRY AND SYSTEMATIC REVIEWS NURS 6052 EVIDENCE-BASED PROJECT, PART 2: ADVANCED LEVELS OF CLINICAL INQUIRY AND SYSTEMATIC REVIEWS NURS 6052 Introduction This presentation will discuss: A clinical issue of interest- CLABSI Developing my PICOT question Research Databases used Peer-reviewed articles Strengths of Systematic Reviews The following presentation will discuss a clinical issue of interest that I have identified. I will describe how I developed my PICOT question. In addition, I will state the databases I used to conduct my search for the peer-reviewed articles and list the articles used. Besides, I will describe the level of evidence for each article and explain the strengths of using systematic reviews for clinical research. Clinical Issue of Interest Clinical issue- Central line bloodstream infection A lab-confirmed bloodstream infection It affects patients with central line catheters CDC estimate about 41,000 CLABSI annually Contributes to: prolonged hospital stays High patient care costs & mortality Prevention: Aseptic techniques, surveillance, & management Central line bloodstream infection (CLABSI) is my chosen clinical issue of interest. It is a laboratory-confirmed bloodstream infection not associated with an infection at another site, which occurs within 48 hours of a central line placement (Bell & O’Grady, 2017). CLABSI affects hospitalized patients with central line catheters. It occurs when microorganisms enter a patient’s central line and then into their bloodstream. CLASI is an issue of interest since the CDC estimates that about 41,000 bloodstream infections are caused by contaminated central lines in U.S. hospitals annually (Bell & O’Grady, 2017). Besides, it contributed to prolonged hospital stays and increased patient care costs and mortality. Nevertheless, most CLABSI cases can be prevented through appropriate aseptic techniques, surveillance, and management interventions (Bell & O’Grady, 2017). The CDC and Infectious Diseases Society of America (IDSA) have developed CLABSI prevention guidelines during central line insertion and maintenance. Struggling to Meet Your Deadline? Get your assignment on EVIDENCE-BASED PROJECT, PART 2: ADVANCED LEVELS OF CLINICAL INQUIRY AND SYSTEMATIC REVIEWS NURS 6052 done on time by medical experts. Don’t wait – ORDER NOW! Meet my deadline Click here to ORDER an A++ paper from our Verified MASTERS and DOCTORATE WRITERS: EVIDENCE-BASED PROJECT, PART 2: ADVANCED LEVELS OF CLINICAL INQUIRY AND SYSTEMATIC REVIEWS NURS 6052 PICO In hospitalized patients with central lines, does daily chlorhexidine baths compared with daily bath with regular soap and water decrease the incidence of CLABSI infections during the hospital stay? EVIDENCE-BASED PROJECT, PART 2: ADVANCED LEVELS OF CLINICAL INQUIRY AND SYSTEMATIC REVIEWS NURS 6052 Developing the PICO Question Identified population of interest- patients with central line Researched for an EBI from peer-reviewed articles Intervention- use of daily chlorhexidine baths Comparison intervention- bath with regular soap and water Indentified outcome- decreasing CLABSI infections Research Databases I used several research databases to search peer-reviewed articles on interventions effective in addressing CLABSI among hospitalized patients. The databases include: PubMed, MEDLINE, Cochrane Library, and CINAHL Plus. Peer-Reviewed Articles Musuuza, J. S., Guru, P. K., O’Horo, J. C., Bongiorno, C. M., Korobkin, M. A., Gangnon, R. E., & Safdar, N. (2019). The impact of chlorhexidine bathing on hospital-acquired bloodstream infections: a systematic review and meta-analysis. BMC infectious diseases, 19(1), 1-10. https://doi.org/10.1186/s12879-019-4002-7 Reyes, D. C. V., Bloomer, M., & Morphet, J. (2017). Prevention of central venous line-associated bloodstream infections in adult intensive care units: a systematic review. Intensive and Critical Care Nursing, 43, 12-22. https://doi.org/10.1016/j.iccn.2017.05.006 Reynolds, S. S., Woltz, P., Keating, E., Neff, J., Elliott, J., Hatch, D., … & Granger, B. B. (2021). Results of the Chlorhexidine Gluconate Bathing implementation intervention to improve evidence-based nursing practices for prevention of central line-associated bloodstream infections Study (Changing Baths): a stepped wedge cluster randomized trial. Implementation Science, 16(1), 1-16. https://doi.org/10.1186/s13012-021-01112-4 Scheier, T., Saleschus, D., Dunic, M., Fröhlich, M. R., Schüpbach, R., Falk, C., … & Schreiber, P. W. (2021). Implementation of daily chlorhexidine bathing in intensive care units for reduction of central line-associated bloodstream infections. Journal of Hospital Infection, 110, 26-32. https://doi.org/10.1016/j.jhin.2021.01.007 Levels of Evidence Musuuza et al. (2019)- Level I evidence Reyes et al. (2017)- Level I evidence Reynolds et al. (2021)- Level II evidence Scheier et al. (2021)- Level III evidence Musuuza et al. (2019) is a level I evidence article. It employs a systematic review and meta-analysis of randomized controlled trials, cluster-randomized trials, and quasi-experimental studies. Reyes et al. (2017) is a level I evidence. It conducted a systematic review of Randomized controlled trials and observational studies. Reynolds et al. (2021) is a level II evidence article since it uses evidence from a stepped wedge cluster randomized trial. Scheier et al. (2021) is a level III evidence article since it uses evidence obtained from well-designed controlled trials but without randomization. Strengths of Using Systematic Reviews for Clinical Research Minimizes bias- reliable & accurate conclusions Information is easier for the reader to understand Produce reliable estimates on interventions’ impact Disclose where knowledge is lacking Save time for research discoveries & implementation Increase generalizability & consistency of outcomes Systematic reviews concentrate on a specific clinical question and carry out an extensive literature search to discover studies with sound methodology (Møller et al., 2018). Advantages of using systematic reviews in clinical research include: The method employed to find and select the studies minimizes bias and thus highly likely to lead to reliable and accurate conclusions (Møller et al., 2018). Systematic reviews sum up findings from multiple studies, making the information easier for the reader to understand. They abide by a strict scientific design founded on explicit, pre-specified, and reproducible methods. Consequently, they produce reliable estimates about the impact of interventions to make defensible conclusions (Møller et al., 2018). They disclose where knowledge is lacking, which guides future clinical research. They save time used in research discoveries and implementation (Møller et al., 2018). Systematic reviews also increase the generalizability and consistency of outcomes. References Bell, T., & O’Grady, N. P. (2017). Prevention of Central Line-Associated Bloodstream Infections. Infectious disease clinics of North America, 31(3), 551–559. https://doi.org/10.1016/j.idc.2017.05.007 Møller, M. H., Ioannidis, J. P., & Darmon, M. (2018). Are systematic reviews and meta-analyses still useful research? We are not sure. Intensive Care Medicine, 44(4), 518-520. https://doi.org/10.1007/s00134-017-5039-y Nursing Staff Shortages The clinical issue of interest I selected is nursing staff shortages in relation to nurse burnout and patient outcomes. For as long as I have been a nurse, I have experienced this issue firsthand. I wonder, though, how many people are affected by this. How many other nurses are putting in almost double the workload and resulting in burnout? How many patients are affected from a safety and quality of care standpoint? Evidence-Based Practice Evidence-based practice (EBP) is a problem-solving approach used in order to develop and provide the highest quality of care for the best patient outcomes (Stillwell et al., 2010). In order to retrieve relevant information, it is first necessary to establish a clearly defined question. The approach most commonly used to define this information is the PICO framework: P- Patient or Problem, I- Intervention, C- Comparison, and O- Outcome (Davies, 2011). Research To begin, I started a broad search on the nursing research page through Walden. I first typed in “nursing staff shortages” which produced 850 results. In an attempt to narrow down my research, I added “patient outcomes” in addition. This cut my options down to only 15, so I removed the “patient outcomes” phrase and replaced it with “quality of care” which resulted in 148. I then performed an advanced search to limit articles to “peer-reviewed scholarly journals only”, bringing the results down to 124. Finally, I wanted to be sure I was reviewing the most recent data, so I set a parameter to include articles only between the years 2018 to 2022. This really helped to simplify the process by reducing the number of articles to a manageable 65. PICO My PICO question for my chosen topic became more solidified as I continued my research. The problem (P) is nursing shortages have an impact on patient safety and quality of care (Tang et al., 2019). Interventions (I) are aimed at autonomy, recognition, and communication. Comparison (C) is done via three different instruments: the Maslach Burnout Inventory, the Job Satisfaction Scale, and the Basel Extent of Rationing of Nursing Care-R (BERNCA-R) and included feedback from 594 nurses (Uchmanowicz et al., 2020). Finally, the outcome (O) reveals that retaining expert nurses will have a positive effect on quality patient care. 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. https://doi.org/10.18438/B8WS5N Stillwell, S. B. , Fineout-Overholt, E. , Melnyk, B. M. & Williamson, K. M. (2010). Evidence-Based Practice, Step by Step: Asking the Clinical Question. AJN, American Journal of Nursing, 110 (3), 58-61. doi: 10.1097/01.NAJ.0000368959.11129.79. Tang, J. H.-C., Hudson, P., Smith, M., & Maas, R. (2019). Evidence-Based Practice Guideline: Nurse Retention for Nurse Managers. Journal of Gerontological Nursing, 45(11), 11–19. https://doi.org/10.3928/00989134-20191011-03 Uchmanowicz, I., Karniej, P., Lisiak, M., Chudiak, A., Lomper, K., Wiśnicka, A., Wleklik, M., & Rosińczuk, J. (2020). The relationship between burnout, job satisfaction and the rationing of nursing care—A cross‐sectional study. Journal of Nursing Management (John Wiley & Sons, Inc.), 28(8), 2185–2195. https://doi.org/10.1111/jonm.13135 From a practice viewpoint, clinical issues represent the care aspects prioritized when performing clinical interventions. They are primarily the everyday events in health care delivery that adversely affect health outcomes. Clinical issues often inform research problems. In this case, they are the basis for evidence-based application in health practice where nurses and other care providers integrate scientific evidence with clinical expertise and patient preference to enhance health outcomes. This presentation describes the clinical issue of interest, PICOT development, and the databases used to conduct the search process. It also identifies the research databases used, APA citations for the peer-reviewed articles used, and levels of evidence. The last part is a detailed analysis of the strengths of systematic reviews as the highly recommended evidence type for clinical research. To provide optimal patient care, nurses should always be in the right physical and mental health state. Unfortunately, clinical issues hamper nurses’ ability to provide quality and satisfactory care. Workplace incivility in nursing is among the common clinical issues profoundly affecting health outcomes. Typical among nurses, workplace incivility involves rude and disrespectful actions towards colleagues. Incivility shows disregard for others’ feelings and needs, often intending to harm or hurt them. The effects of incivility are far-reaching since it is positively correlated with anxiety and job burnout besides lowering nurses’ self-esteem (Shi et al., 2018). Other effects necessitating evidence-based interventions include the affected nurses negatively perceiving the nursing profession (Alshehry et al., 2019) and being highly vulnerable to medical errors (Abdollahzadeh et al., 2017). The outcomes are detrimental to the quality of patient care. The PICOT approach is highly recommended in health practice when developing interventions for clinical problems. When creating the PICOT question, the problem or population in question is first identified. It should be vivid too. The issue of interest is workplace incivility among nurses. The other central components include the intervention and comparison. The intervention suggested to reduce workplace incivility is policy interventions and awareness programs compared to no intervention. From a practice viewpoint, the intervention should lead to a specific objective: reducing workplace incivility to promote a healthy working environment. The time frame defines the time it will take for an intervention to realize the desired outcome. In this case, six months. To make informed decision about a clinical issue, nurses and other health care providers should search for evidence from the leading research databases. Since workplace incivility is a nursing issue, the search was limited to nursing research databases. As a reliable source of scholarly and peer-reviewed sources, CINAHL Plus with Full Text provides access to literature related to nursing and allied health. JAMAevidence has many nursing and health care articles. Trip Pro is largely a search engine that enables a nurse to access research evidence relevant to clinical practice. Systematic reviews and practice guidelines can be accessed via Trip Pro. Google Scholar facilitates search for peer-reviewed articles. The full citations of the above articles have been provided in the reference list. As indicated, the articles focus on different research areas related to workplace incivility. The broadened focus enhances understanding of the topic to justify why evidenced-based interventions are necessary. The article by Kile et al. (2019) examined the effectiveness of education and cognitive rehearsal in managing workplace incivility. Both interventions enhance awareness of workplace incivility. Abdollahzadeh et al. (2017) examined how to prevent workplace incivility from a nurses’ perspective. Armstrong (2018) primarily focused on nursing workplace incivility prevention. The last article by Shi et al. (2018) examined the link between workplace incivility and job burnout. Nurses should use the highest level of evidence to guide decision-making in health practice. Systematic reviews provide high-level evidence since they comprehensively search for evidence from multiple credible sources. Besides the high quality of evidence, systematic reviews narrowly focus on a clinical question. By synthesizing available evidence of a particular topic, systematic reviews help nurses and other health care providers to make more informed decisions regarding practice issues. Most systematic reviews identify research biases and flaws in the synthesized literature and propose areas that require further research based on the research gaps. As a result, they inform decision-making and guide future research. This presentation primarily focused on workplace incivility as the clinical issue of interest. It deserves maximum attention due to its adverse impacts, including reducing nurses’ self-esteem, contributing to burnout and anxiety, and increasing the chances of nurses committing medication errors. Nursing and health care research should always be informed by the highest evidence level possible. As a result, systematic reviews are highly encouraged due to their high level of evidence and in-depth analysis of a clinical problem. Their use enhances understanding of a clinical problem and ensures that the evidence used to guide interventions is relevant to the reviewed issue. 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 Shi, Y., Guo, H., Zhang, S., Xie, F., Wang, J., Sun, Z., … & Fan, L. (2018). Impact of workplace incivility against new nurses on job burn-out: A cross-sectional study in China. BMJ Open, 8(4), e020461. doi:10.1136/ bmjopen-2017-020461 Introduction The provision of safe, high quality and efficient care in nursing is important for the health and wellbeing of the patients. Often, nurses utilize practice interventions such as patient centeredness and evidence-based practices to ensure that the care needs of the patients are met. They also use the interventions to minimize the risk of occurrence of safety and quality issues in patient care. An example is the use of best practice interventions to ensure that the risk of medication errors in nursing practice is reduced. Despite the efforts adopted by nurses to ensure safety and quality, institutional and provider factors may still predispose patients to unintended safety and quality issues. For example, provider factors such as burnout due to the influence of institutional factors such as staff shortage may threaten the safety and quality of patient care. Therefore, this presentation examines the proposed intervention that can be used to reduce and prevent burnout among registered nurses. Selected Clinical Issue The selected clinical issue that relates to nursing practice is burnout among nurses. Burnout has been defined as the consequence of prolonged, persistent and chronic exposure of nurses to work-related stressors. The prolonged exposure to work stressors result in depersonalization, exhaustion, and reduced personal accomplishments. Nurses affected by burnout experience challenges in undertaking their clinical roles due to low levels of motivation and job satisfaction. Burnout among nurses has an adverse effect on the quality and safety of patient care (Ahola et al., 2017). For example, it increases the risk of medication errors by nurses due to lack of concentration in the care giving process. Burnout also causes low level of job satisfaction and motivation among the nurses. As a result, the rate of turnover among them increases significantly. In addition, the operational costs in healthcare organization rises due to the need for frequent hiring of new staffs to replace those who left the organization. Therefore, burnout among nurses should be addressed to ensure safety, quality and efficiency in healthcare organizations (Melnyk et al., 2020). Development of PICOT The developed question is: In acute care nurses, does the use of cognitive interventions result in the reduction of burnout levels when compared to no intervention, within eight month period? I developed the above PICOT question through a number of steps. The first one was performing a clinical inquiry of the common issues that affect quality and safety of patient care in healthcare settings. I also utilized knowledge from my clinical experience to identify issues in practice that can be addressed by adopting evidence-based interventions. This led to the identification of the clinical issue of burnout in nursing. The second step entailed the determination of the populations that the problem affect. This led to the identification of nurses as the most prone group of professionals to be affected by burnout. The other step was performing a literature search of the databases to determine practice interventions that can be used to address the issue. This stage led to the identification of cognitive therapies as the most effective intervention to address burnout in nursing. The next step was determining a way in which I could determine the effectiveness of the intervention. As a result, I considered a comparative intervention to be no use of any approach to address the issue of burnout among nurses. I then developed the outcomes to be achieved by the implementation of the intervention and the timeline of evaluating its effectiveness. Identified Articles The database search led to the above articles that explore the effectiveness of cognitive interventions in reducing and preventing burnout among nurses. Levels of Evidence The study by Ahola et al., (2017) provides level I evidence. The study was a systematic review of randomized controlled trials without meta-analysis. The study by Melnyk et al., (2020) provided level I evidence too. It was a systematic review of randomized controlled trials without meta-analysis. The study by Nayeri et al., (2021) provided level III evidence. It was a systematic review of a combination of quasi-experimental, randomized controlled trials, and non-experimental studies. It also lacked meta-analysis. The study by Zhang et al., (2020) provided level II evidence. The study was a systematic review of quasi-experimental and randomized controlled trials with meta-analysis. Strengths of Using Systematic Reviews One of the strengths of using systematic reviews is the transparency in its processes. The processes of each of the phases of a systematic review are transparent, increasing the trust towards the obtained findings. Transparency also enables readers to determine the merits and demerits of the decisions that the authors made in synthesizing the data. The other benefit of using systematic reviews is that they provide comprehensive review of a topic. The use of multiple sources of data on a topic increases the relevance and implications of the data reported in a systematic review. The review of multiple studies also assists in the identification of gaps in research and practice. As a result, nurses can use the information from systematic reviews to inform their future research and practice. The last strength of systematic reviews is that it provides highly reliable results. The results have minimum bias due to the transparency in methods used. The focus on the results obtained in multiple studies also eliminates potential threats to validity and reliability of the obtained results. References Ahola, K., Toppinen-Tanner, S., & Seppänen, J. (2017). Interventions to alleviate burnout symptoms and to support return to work among employees with burnout: Systematic review and meta-analysis. Burnout Research, 4, 1–11. Interventions to alleviate burnout symptoms and to support return to work among employees with burnout: Systematic review and meta-analysis. (2017). Burnout Research, 4, 1–11. https://doi.org/10.1016/j.burn.2017.02.001 Melnyk, B. M., Kelly, S. A., Stephens, J., Dhakal, K., McGovern, C., Tucker, S., Hoying, J., McRae, K., Ault, S., Spurlock, E., & Bird, S. B. (2020). Interventions to Improve Mental Health, Well-Being, Physical Health, and Lifestyle Behaviors in Physicians and Nurses: A Systematic Review. American Journal of Health Promotion, 34(8), 929–941. https://doi.org/10.1177/0890117120920451 Nayeri, N., Nukpezah, R., & Kiwanuka, F. (2021). Article no.AJRNH.71848 (1) Prof. Sharon Lawn, Flinders University, Australia. (2) Dr. Asmaa Fathi Moustafa Hamouda. Asian Nursing Research, 18–36. Zhang, X., Song, Y., Jiang, T., Ding, N., & Shi, T. (2020). Interventions to reduce burnout of physicians and nurses: An overview of systematic reviews and meta-analyses. Medicine, 99(26), e20992. https://doi.org/10.1097/MD.0000000000020992 Evidence-Based Project, Part 1: Identifying Research Methodologies Essentials of Evidence-Based Practice Matrix Worksheet Template Matrix Worksheet Template Use this document to complete Part 1 of the Module 2 Assessment, Evidence-Based Project, Part 1: Identifying Research Methodologies. Full citation of selected articleArticle #1Article #2Article #3Article #4 Tolia, V. N., Murthy, K., Bennett, M. M., Greenberg, R. G., B
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