EBP Part3: Critical Appraisal of Research

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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)

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. EBP Part3: Critical Appraisal of Research

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.

WK5AssignNgodoB.NURS-6052NFinal.pptx

ADVANCED LEVELS OF CLINICAL INQUIRY AND SYSTEMATIC REVIEWS

Blessing Ngodo

Walden University

NURS 6052N

07/04/2021

Clinical issue of interest

Issue of interest- Pressure Ulcer

Pressure ulcers also known as pressure injuries, pressure sores, decubitus ulcers and bed sores are localized injuries to the skin or underlying soft tissue, or both, caused by unrelieved pressure, shear or friction (Shi et al., 2021)

Risk factors of pressure ulcer include limited mobility, poor nutrition, comorbidities, weak, dry, thin skin due to aging, pressure, friction, shear, and moisture.

70% of cases involving pressure ulcers are among individuals over 65 years of age

Injuries to the skin and underlying tissue, known as pressure ulcers (also known as pressure sores or bedsores), are most commonly caused by sustained pressure applied to the skin’s surface. Those who are confined to bed or who spend extended periods of time in a chair or wheelchair are more susceptible to developing these conditions than others. Pressure ulcers affect around 70% of adults over the age of 65, and they are seen in 9-22 percent of nursing home residents and 5-32 percent of hospitalized patients. Pressure ulcers are frequently caused by sitting or laying in the same posture for an extended period of time. Pressure ulcers are more prone to occur if the skin becomes thin, dry, or weak as a result of ageing or disease, among other factors. Pressure ulcers are more common in older persons in general, and they are particularly common in people who have trouble moving.

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Clinical issue of interest Continue

Negative pressure wound therapy (NPWT) uses suction, tubing, and wound dressing to promotes wound healing through optimization of blood flow, decreasing local tissue edema and remove excess exudate and any infectious material that may be present in the wound (Dumville, et al., 2015)

Standard moist wound therapy is the practice of keeping a wound in an optimally moist environment to promote faster healing and prevent the development of scab, promote keratinocytes cell function, facilitate autolytic debridement and stimulate collagen synthesis (Shi et al., 2021)

PICOT

P- Patient with immobility and elderly patients 60 years and above

I- Negative pressure wound therapy

C- Standard moist wound therapy

O- Improve the therapeutic process of pressure ulcer

T- two months

For elderly patients above 60 years with pressure ulcers (P), will negative pressure wound therapy (I) as opposed to standard moist wound therapy (C) improve the therapeutic process of the pressure ulcer (O) during their two-week stay at the hospital (T)?

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Description of the PICOT Question

Population/ Patient Problem: Identifies the people or patients with the clinical issue (pressure ulcer) which are patients with immobility and elderly 65 years and above.

Intervention: Represents the treatment plans to resolve the clinical issue which is the use of negative pressure wound therapy.

Comparison: Represents the alternatives to my plan, eg. different type of treatment like standard moist wound therapy

Outcome: Represents the desired/expected result of the treatment that improve the therapeutic process of pressure ulcer

Time: The period that the treatment is expected to last which is within two month

Description of the PICOT Question Continue

My PICOT questions correspond to the question type “Intervention or Therapy,” which can be used to assess which

treatment will produce the best outcomes.

the comparison illustrates the difference between negative pressure wound therapy and standard moist wound therapy.

These questions can assist me in educating and advising my patients about their ulcer injuries, treatment options, and

success rates.

Research database

Pubmed

Scopus

Google scholar

Medline

Level of evidence

Article- “Preventive interventions for pressure ulcers in long-term older people care facilities: A systematic review”

Level of evidence- level I

Systemic evidence is still lacking from randomized trials conducted on interventions for preventing pressure ulcers

No single effective way identified for preventing pressure ulcers

Only a 1/3 of the preventive interventions used were effective (Mäki-Turja-Rostedt et al., 2019)

Article- “Initial Experience Using a Novel Reticulated Open Cell Foam Dressing with Through Holes during Negative Pressure Wound Therapy with Instillation for Management of Pressure Ulcers”

Level of evidence- level IV

The case study involved 5 patents

The evidence from the study is weak due to small sample size used, lack of control group and selection bias (Fernandez et al., 2017)

Patients suffer from pressure ulcers, which also place a significant financial strain on their families. Despite the fact that most PUs could be avoided, the number of PUs has remained high. Effective PU prevention is essential in order to avoid undue suffering and expenditures. There are numerous approaches of preventing PUs in LOPC facilities; however, there is no single approach that is effective in all situations. Prevention measures in LOPC facilities were shown to be beneficial in one-third of the cases. Systematic evidence from randomized trials on preventative interventions for PUs in LOPC settings, on the other hand, is currently missing in this area. The findings can be applied in practice for the selection of PUs in LOPC facilities, and in research for the development of efficient preventive treatments for PUs in LOPC settings.

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Level of evidence cont…

Article- “Negative pressure wound therapy for treating pressure ulcers”

Level of evidence- level I

There are no strong RCT evidence regrading negative wound therapy when compared to standard moist therapy among other alternatives for treating pressure ulcers (Dumville et al., 2015)

Article- “The clinical effectiveness of negative pressure wound therapy: a systematic review”

Level of evidence- I

The systemic review presents sufficient evidence showing that negative wound therapy is safe and accelerates healing hence justifying the use of this intervention in treating pressure ulcers (Xie et al., 2010)

In order to make informed decisions about the use of negative pressure wound therapy (NPWT), it is necessary to have a comprehensive and current assessment of the available evidence. The evaluation includes four research with a total of 149 participants in the total. A total of three studies evaluated NPWT in comparison to dressings; one study evaluated NPWT in comparison to a series of gel treatments; and one study evaluated NPWT in comparison to “wet wound healing.” One study had a follow-up length of 24 weeks, two studies had a follow-up period of six weeks, and the follow-up period for one study was not known. Three of the four included studies were found to be at a high risk of bias from one or more of the ‘Risk of bias’ areas, and the overall quality of the evidence was deemed to be of very low significance. Although only one research provided adequate primary outcome data (complete wound healing), the sample size was small (12 participants), and there were only a few incidents (only one participant healed in the study). From the studies that were included, there was no further valuable information on either favorable results, such as wound healing, or negative ones, such as adverse reactions. EBP Part3: Critical Appraisal of Research

Moving on to the next article discovered 17 randomized controlled trials (RCTs), five of which had not previously been included in reviews or health technology assessments. In seven randomized controlled trials (RCTs) involving diabetic foot ulcers, there was consistent evidence of the effectiveness of NPWT when compared to control treatments. The outcomes of three randomized controlled trials on pressure ulcers were inconclusive. Evidence from five randomized controlled trials (RCTs) involving mixed wounds was encouraging, although of poor quality. Significant difficulties did not arise as a result of this. Now that there is adequate evidence to prove that NPWT is safe and will speed up the healing process, its use in the treatment of diabetes-associated chronic leg wounds can be considered justified. Evidence also suggests that healing of other wounds may be expedited, albeit the quality of the evidence is of questionable reliability.

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Conclusion

According to Walden university library (2019), a systematic review is a type of publication that addresses a clinical question by analyzing research that fits certain explicitly-specified criteria

The strengths of using systemic reviews include;

Transparency of findings

Reduced bias when drawing conclusions as it incorporates findings and views from multiple studies

They present the strongest level of evidence

While a systematic review may have some limitations, its potential strength lies in its transparency, which allows the reader to concentrate on the merits of each decision made in compiling the information rather than a simple comparison of one study to another, as is sometimes the case with other types of reviews. Because it incorporates a variety of viewpoints and findings, it helps to avoid prejudice when reaching conclusions. EBP Part3: Critical Appraisal of Research

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References

Dumville, J. C., Webster, J., Evans, D., & Land, L. (2015). Negative pressure wound therapy for treating pressure ulcers.

Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.cd011334.pub2

Shi, C., Dumville, J. C., Cullum, N., Rhodes, S., Jammali-Blasi, A., Ramsden, V., & McInnes, E.

(2021). Beds, overlays and mattresses for treating pressure ulcers. The Cochrane

Database of Systematic Reviews, 5, CD013624. https://doi

org.ezp.waldenulibrary.org/10.1002/14651858.CD013624.pub2

Fernandez, L., Ellman, C., & Jackson, P. (2017). Initial Experience Using a Novel Reticulated Open Cell Foam Dressing with Through Holes

during Negative Pressure Wound Therapy with Instillation for Management of Pressure Ulcers. Journal of Trauma & Treatment, 06(05).

https://doi.org/10.4172/2167-1222.1000410

References continue

Mäki-Turja-Rostedt, S., Stolt, M., Leino-Kilpi, H., & Haavisto, E. (2019). Preventive interventions for pressure ulcers in

long-term older people care facilities: A systematic review. Journal of Clinical Nursing, 28(13-14), 2420–2442.

https://doi.org/10.1111/jocn.14767

Walden University Library. (n.d.-i). Systematic review. Retrieved January 22, 2020, from

Xie, X., McGregor, M., & Dendukuri, N. (2010). The clinical effectiveness of negative pressure wound

therapy: a systematic review. Journal of Wound Care, 19(11), 490–495.

https://doi.org/10.12968/jowc.2010.19.11.79697
ReadngResource1.docx

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. (2010). 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

Fineout-Overhold, E., Melnyk, B.M., Stillwell, S.B., & Williamson, K.M. (2010). Evidence-based practice step-by-step: Critical appraisal of the evidence: Part II. American Journal of Nursing, 110(7), 47-52

Fineout-Overholt, E., Melnyk, B., Stillwell, S., & Williamson, K. (2010). 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

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

THE ASSIGNMENT RUBRIC

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.

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. EBP Part3: Critical Appraisal of Research

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.

5 (5%) – 5 (5%)

Uses correct grammar, spelling, and punctuation with no errors.

5 (5%) – 5 (5%)

Uses correct APA format with no errors.

TEMPLETE.doc

Evaluation Table

Use this document to complete the evaluation table requirement of the Module 4 Assessment, Evidence-Based Project, Part 4A: Critical Appraisal of Research

Full APA formatted citation of selected article.	Article #1	Article #2	Article #3	Article #4

Evidence Level * (I, II, or III)
Conceptual Framework Describe the theoretical basis for the study (If there is not one mentioned in the article, say that here).**
Design/Method Describe the design and how the study was carried out (In detail, including inclusion/exclusion criteria).
Sample/Setting The number and characteristics of patients, attrition rate, etc.
Major Variables Studied List and define dependent and independent variables
Measurement Identify primary statistics used to answer clinical questions (You need to list the actual tests done).
Data Analysis Statistical or Qualitative findings (You need to enter the actual numbers determined by the statistical tests or qualitative data).
Findings and Recommendations General findings and recommendations of the research
*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?
Key findings
Outcomes
General Notes/Comments

* 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

· The following information is from Walden academic guides which helps explain conceptual frameworks and the reasons they are used in research. Here is the link https://academicguides.waldenu.edu/library/conceptualframework

· Researchers create theoretical and conceptual frameworks that include a philosophical and methodological model to help design their work. A formal theory provides context for the outcome of the events conducted in the research. The data collection and analysis are also based on the theoretical and conceptual framework.

· As stated by Grant and Osanloo (2014), “Without a theoretical framework, the structure and vision for a study is unclear, much like a house that cannot be constructed without a blueprint. By contrast, a research plan that contains a theoretical framework allows the dissertation study to be strong and structured with an organized flow from one chapter to the next.”

· Theoretical and conceptual frameworks provide evidence of academic standards and procedure. They also offer an explanation of why the study is pertinent and how the researcher expects to fill the gap in the literature.

· Literature does not always clearly delineate between a theoretical or conceptual framework. With that being said, there are slight differences between the two. EBP Part3: Critical Appraisal of Research

References

The Johns Hopkins Hospital/Johns Hopkins University (n.d.). Johns Hopkins nursing dvidence-based practice: appendix C: evidence level and quality guide. Retrieved October 23, 2019 from https://www.hopkinsmedicine.org/evidence-based-practice/_docs/appendix_c_evidence_level_quality_guide.pdf

Grant, C., & Osanloo, A. (2014). Understanding, Selecting, and Integrating a Theoretical Framework in Dissertation Research: Creating the Blueprint for Your” House”. Administrative Issues Journal: Education, Practice, and Research, 4(2), 12-26.

Walden University Academic Guides (n.d.). Conceptual & theoretical frameworks overview. Retrieved October 23, 2019 from https://academicguides.waldenu.edu/library/conceptualframework

Critical Appraisal Tool Worksheet Template