· Hospital Readmissions Reduction Program. (2015) Colleen McIlvennan, Zubin Eapen, Larry Allen. Larry. https://www.ahajournals.org/doi/full/10.1161/circulationaha.114.010270 (Links to an external site.)
·
Hospital Readmissions Re
duction Program. (2015) Colleen McIlvennan, Zubin Eapen, Larry Allen.
Larry.
https://www.ahajournals.org/doi/full/10.1161/circulationaha.114.010270
(Links to
an
external site.)
Hospital Readmissions Reduction Program. (2015) Colleen McIlvennan, Zubin Eapen, Larry Allen.
Larry. https://www.ahajournals.org/doi/full/10.1161/circulationaha.114.010270 (Links to an
external site.)
Running Heading - Critical Appraisal 1
2
CRITICAL APPRAISAL
KARANVIR KAUR
Grand Canyon University
NRS-433V
May 24, 2020
Quantitative Studies
Introduction
Fall prevention in nursing and long-term care facilities for older and vulnerable population remains critical issue better health care results for millions of aged people. In this article make a critical appraisal of two quantitative research studies in relation to addressing the PICOT question in the study of falls among adults based on the research critique guidelines.
Backgrounds
In their study, Albert, assessed the quality and importance of using non-randomized study is for principal prevention of fall for older adults. Albert also gave information about the current models in falls prevention Is all depend on the use of both secondary and other strategies that increased risk of falls. This article is most significantly to the nursing practice all the nurses work in the long term and rehabilitation nursing care facilities that deal with the elderly adults who are very highly risk to the falls. Comment by Melissa Reedy: Include the date of the publication in () Comment by Melissa Reedy: Significant
Be sure to either use the writing center of GCU or download Grammarly to help you proof read your papers so that your sentences are complete and flow well.
In this study, Albert identify the lack of research on the effectiveness of these strategies. Through the development of a non-randomized trial in the state of Pennsylvania, the researcher Comment by Melissa Reedy: Identifies
Question for the study was, does a combination of education on falls and screening as well as referrals reduce risk factors for falls among the target population. Comment by Melissa Reedy: No need to capitalize
The second quantitve study by Alvarez how the falls can be reduced by the all the vulnerable and older populat.
1. · Hospital Readmissions Reduction Program. (2015) Colleen
McIlvennan, Zubin Eapen, Larry Allen.
Larry. https://www.ahajournals.org/doi/full/10.1161/circulation
aha.114.010270 (Links to an external site.)
·
Hospital Readmissions Re
duction Program. (2015) Colleen McIlvennan, Zubin Eapen,
Larry Allen.
Larry.
https://www.ahajournals.org/doi/full/10.1161/circulationaha.114
.010270
(Links to
an
external site.)
McIlvennan, Zubin Eapen, Larry Allen.
Larry.
https://www.ahajournals.org/doi/full/10.1161/circulationaha.114
.010270 (Links to an
external site.)
2. Running Heading - Critical Appraisal
1
2
CRITICAL APPRAISAL
KARANVIR KAUR
Grand Canyon University
NRS-433V
May 24, 2020
Quantitative Studies
3. Introduction
Fall prevention in nursing and long-term care facilities for older
and vulnerable population remains critical issue better health
care results for millions of aged people. In this article make a
critical appraisal of two quantitative research studies in relation
to addressing the PICOT question in the study of falls among
adults based on the research critique guidelines.
Backgrounds
In their study, Albert, assessed the quality and importance of
using non-randomized study is for principal prevention of fall
for older adults. Albert also gave information about the current
models in falls prevention Is all depend on the use of both
secondary and other strategies that increased risk of falls. This
article is most significantly to the nursing practice all the nurses
work in the long term and rehabilitation nursing care facilities
that deal with the elderly adults who are very highly risk to the
falls.Comment by Melissa Reedy: Include the date of the
publication in () Comment by Melissa Reedy: Significant
Be sure to either use the writing center of GCU or download
Grammarly to help you proof read your papers so that your
sentences are complete and flow well.
In this study, Albert identify the lack of research on the
effectiveness of these strategies. Through the development of a
non-randomized trial in the state of Pennsylvania, the researcher
Comment by Melissa Reedy: Identifies
Question for the study was, does a combination of education on
falls and screening as well as referrals reduce risk factors for
falls among the target population. Comment by Melissa
Reedy: No need to capitalize
The second quantitve study by Alvarez how the falls can
be reduced by the all the vulnerable and older population in the
Assisted Living and long-term care facilities by giving the
knowledge about the exercise and using the exercise training.
Alvarez also recommended that use of the training exercise
means for professionals LNS to provide the education to the
4. CNA to monitor the patients during changing the patient helping
them to manage the falls in the older population. The study
problem was effectiveness of the strategies and exercising
program and fall incidents in the same older population.
Comment by Melissa Reedy: Any time you have an
author’s name you need a date of the publication or use n.d. if
no date is available
This article main focus is to improve the nursing and
prepared the nurses to develop strategies’ and make intervention
by providing the knowledge to the staff in order e to prevent the
fall in the older adults. Purpose of the study is to find the
connection between if nurse provide the education and use the
exercise strategies how is the fall reduction happened in the
staff. The goal of the study is assessing the results between the
aerobic exercise and practice exercise in the models to reducing
the fall and related injuries in the long-term care facilities.
Research question was Is there any exercise is making any
difference in the fall number and fall related injuries after
giving the education about the exercise to the older population
in the long-term care facilities? Comment by Melissa
Reedy: The main focus of this article Comment by Melissa
Reedy: Delete this e
Article supporting the selected issues Comment by Melissa
Reedy: Capitalize your words as this is a title
PICOT Question: In a patient older population with memory
problems (P) what is the effect of the strategies’ and
intervention(i) in comparison to the different interventions(c) in
promote their health and wellness is coming 6th months (T)?
Comment by Melissa Reedy: You need to state what your
intervention actually is
Older adult is very prone to the falls and get injuries from
the fall which can lead to more serious condition and rare cases
death. Falls occur because of the long-term diseases and less
confidence and long hospitalization.as i worked in the long term
for one year and most of the population Is prone to the have fall
because of their age and their health condition due to that
5. expectation from nurse to use evidenced based practice and
intervention to manage falls in the long-term care facilities in
the older population. Older population is naturally deal with the
memory problems which make them prone to the falls. Albert
non-randomized article can be used to reduce the falls among
the older adults. Albert work Is checking the effectiveness of
the using the exercise strategies in the older population.
secondly the effectiveness of the intervention that is connect
with the exercise and use with the non-randomized trial to
evaluate its effectiveness the fall reduction with in 1 year. Third
to comparison between the different studies and all the
intervention took for improve this issue. fourthly. This research
gave the answer of the PICOT question by all the time and
duration of the use of the intervention and the to improve the
quality care. Albert this study conducts for the 6 to 12 months.
According to the Albert this study was conduct in the long-term
care facilities for the 6 and 8 months. Comment by Melissa
Reedy: Are prone Comment by Melissa Reedy: Refrain from
using first person
interventions and comparison groups in the articles
in PICOT question
the intervention and group are same in the studies which is
PICOT question wants to address. Firstly, PICOT question
assesses the impact of the strategies’ and intervention
promoting the health of the older people. The research and
article by Albert and coworker evaluate the non-randomized
population and on the other hand Alvarez and co-worker assess
the intervention for the fall in the Long-term care facility. All
the intervention and groups are used in the PICOT question and
article is the same. Comment by Melissa Reedy: Capitalize as
you are beginning a sentence
Method of study
In the research studies Albert evaluated the effectiveness of the
study which is done for the safety for the older adult population
in the state of the Pennsylvania to decrease the number if the
older population. There were 2 groups of people they were
6. enrolled in the group for 12 ./’months between 2010 to
2011.third group was enrolled but did not take healthy steps but
attend and learn from the work.in the second article by
Alvarez.in this study participant enrolled for the five years in
privately owned and profit in which they offer independent and
in long term care and in this they provide the memory care for
the dementia people. Comment by Melissa Reedy:
Capitalize
The advantage of this study is non-randomized approach
by the research provide the outcome and it helps to comparing
the intervention.in this study people identified the goals and
study provide by the Alvarez and provide all the insight fullness
information about the falls to the all the older people in the
long-term care facility.
Result of the study
In this study, researcher found that in the time of the two year
60 falls incidents were reported and more of the half of the fall
happened 2 times in one person and main reason for the fall
happened in the loss of balance due to the normal age process
and further they found out that in the study negative link
between falls incidents and training as well as.the participant
who had participant In the exercise program they have no
incident of fall and further in the study they found the link
between fall incidents and exercise. All the participant the one
participant in the exercise training they have less chances of the
fall. And the other study by Albert find the result about the non-
randomized design is helpful in making the approaches to the
falls prevention.in this study they teach all the nurses about the
intervention about the about the fall prevention to the target
population. all the nurses in the long-term care facility have to
have education about the exercise program about the older
population and teach them about the importance and benefit of
the exercise.
Outcome
The Outcome in the PICOT question is that the evaluate that
how older adult can improve their mobility with the exercise.
7. Teach them use all the intervention in order to prevent the fall.
secondly the outcome is expected to the PICOT question the
relationship between the intervention and result is reduction in
the falls in the older population.
Comment by Melissa Reedy: Move this to the next page
and place in hanging indent format
REFRENCES
Albert, S. M., Edelstein, O., King, J., Flatt, J., Lin, C. J.,
Boudreau, R., & Newman, A. B. (2015). Assessing the quality
of a non-randomized pragmatic trial for primary prevention of
falls among older adults. Prevention Science, 16(1), 31-40.
https://doi.org/10.1007/s11121-014-0466-2
Alvarez, K. J., Kirchner, S., Chu, S., Smith, S., Winnick-
Baskin, W., &Mielenz, T. J. (2015). Falls reduction and
exercise training in an long term care facility . Journal of aging
research, 2015. http://dx.doi.org/10.1155/2015/957598
8. Research Critique Guidelines – Part II
Use this document to organize your essay. Successful
completion of this assignment requires that you provide a
rationale, include examples, and reference content from the
studies in your responses.
Quantitative Studies
Background
1. Summary of studies. Include problem, significance to
nursing, purpose, objective, and research question.
How do these two articles support the nurse practice issue you
chose?
1. Discuss how these two articles will be used to answer your
PICOT question.
2. Describe how the interventions and comparison groups in the
articles compare to those identified in your PICOT question.
Method of Study:
1. State the methods of the two articles you are comparing and
describe how they are different.
2. Consider the methods you identified in your chosen articles
and state one benefit and one limitation of each method.
Results of Study
1. Summarize the key findings of each study in one or two
comprehensive paragraphs.
2. What are the implications of the two studies you chose in
nursing practice?
Outcomes Comparison
1. What are the anticipated outcomes for your PICOT question?
2. How do the outcomes of your chosen articles compare to your
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imply its endorsement or recommendation by Jones & Bartlett
Learning, LLC
and such reference shall not be used for advertising or product
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purposes. All trademarks displayed are the trademarks of the
parties noted
herein. Nursing Research: Reading, Using, and Creating
Evidence, Fourth
Edition is an independent publication and has not been
authorized, sponsored,
or otherwise approved by the owners of the trademarks or
service marks
referenced in this product.
There may be images in this book that feature models; these
models do not
necessarily endorse, represent, or participate in the activities
represented in
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the images. Any screenshots in this product are for educational
and instructive
purposes only. Any individuals and scenarios featured in the
case studies
throughout this product may be real or fictitious, but are used
for instructional
purposes only.
The author, editor, and publisher have made every effort to
12. provide accurate
information. However, they are not responsible for errors,
omissions, or for any
outcomes related to the use of the contents of this book and take
no
responsibility for the use of the products and procedures
described.
Treatments and side effects described in this book may not be
applicable to all
people; likewise, some people may require a dose or experience
a side effect
that is not described herein. Drugs and medical devices are
discussed that
may have limited availability controlled by the Food and Drug
Administration
(FDA) for use only in a research study or clinical trial.
Research, clinical
practice, and government regulations often change the accepted
standard in
this field. When consideration is being given to use of any drug
in the clinical
setting, the health care provider or reader is responsible for
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5
Contents
Preface
Acknowledgments
Contributors
About the Author
Part I: An Introduction to Research
1 The Importance of Research as Evidence in Nursing
Research as Evidence for Nursing Practice
What Is Nursing Research?
Research: A Fundamental Nursing Skill
The Evolution of Research in Nursing
Contemporary Nursing Research Roles
Research Versus Problem Solving
Research as Evidence in Nursing Practice
Evidence-Based Practice
The Importance of Evidence-Based Practice in Nursing
How Can Evidence Be Used in Health Care?
15. Strategies for Implementing Evidence-Based Practice
Strategies for Overcoming Barriers
Reading Research for Evidence-Based Practice
Using Research in Evidence-Based Practice
Creating Evidence for Practice
Future Directions for Nursing Research
Summary of Key Concepts
For More Depth and Detail
References
2 The Research Process and Ways of Knowing
Introduction
The Research Process
Classification of Research by Philosophical Assumptions About
the Nature of the World
Choosing a Design
Classifications of Research by the Intent of the Researcher
Classifications of Research by the Nature of the Design
Classifications of Research by the Time Dimension
Reading Research for Evidence-Based Practice
16. Using Research in Evidence-Based Practice
Creating Evidence for Practice
Summary of Key Concepts
For More Depth and Detail
References
6
3 Ethical and Legal Considerations in Research
Introduction
Learning from the Past, Protecting the Future
International Guides for the Researcher
National Guidelines for the Nurse Researcher
The Ethical Researcher
Legal and Regulatory Guidelines for Conducting Research
Institutional Review Boards
Research Involving Animals
Research Misconduct
The HIPAA Privacy Rule
Reading Research for Evidence-Based Practice
17. Using Research in Nursing Practice
Creating Evidence for Practice
Summary of Key Concepts
For More Depth and Detail
References
Part II: Planning for Research
4 Finding Problems and Writing Questions
Introduction
Finding and Developing Research Problems
Developing the Research Question
Reading Research for Evidence-Based Practice
Using Research in Evidence-Based Practice
Creating Evidence for Practice
Summary of Key Concepts
For More Depth and Detail
References
5 The Successful Literature Review
An Introduction to the Literature Review
Purpose, Importance, and Scope of the Literature Review
18. Types of Literature Used in the Review
Searching for the Evidence in a Research Problem
Competencies for Information Literacy
Reading the Literature Review Section
Using Evidence-Based Literature in Nursing Practice
Creating a Strong Literature Review
Summary of Key Concepts
For More Depth and Detail
References
6 Selecting an Appropriate Research Design
Introduction
What Is a Design?
7
The Basis for Design Selection
The Design Decisions
Reading Research for Evidence-Based Practice
Using Research in Evidence-Based Practice
19. Creating Evidence for Practice
Summary of Key Concepts
For More Depth and Detail
References
Part III: Research Process
7 The Sampling Strategy
Introduction
Selection Strategy: How Were the Subjects Chosen?
The Sample Selection Strategy
Reading the Sampling Section of a Research Study
Using Research as Evidence for Practice
Creating an Adequate Sampling Strategy
Summary of Key Concepts
For More Depth and Detail
References
8 Measurement and Data Collection
Introduction
Measurement
The Measurement Strategy
20. Strategies to Minimize Measurement Error
Collecting Data Using Instruments
Data Management Procedures
Reading About Measurement and Data Collection
Using Measurements from a Research Study
Creating Measures and Collecting Data
Summary of Key Concepts
References
9 Enhancing the Validity of Research
Introduction
Minimizing Threats to Internal Validity
Factors That Jeopardize Internal Validity
Factors That Jeopardize External Validity
Balancing Internal and External Validity
Trustworthiness in Qualitative Research
Strategies to Promote the Validity of Qualitative Research
Reading a Research Study to Determine Validity
Using Valid Studies as Evidence for Nursing Practice
Creating a Valid Research Study
21. Summary of Key Concepts
8
For More Depth and Detail
References
Part IV: Research That Describes Populations
10 Descriptive Research Questions and Procedures
Introduction
Descriptive Research Studies
Characteristics of a Descriptive Design
Describing Groups Using Surveys
Describing Groups Relative to Time
Describing the Responses of Single Subjects
Designs That Describe Relationships
Reading Descriptive Research
Using Descriptive Research in Evidence-Based Nursing Practice
Creating Descriptive Research
Summary of Key Concepts
22. References
11 Summarizing and Reporting Descriptive Data
Introduction
An Overview of Descriptive Data Analysis
Understanding Levels of Measurement
Identifying Shape and Distribution
Describing the Center and Spread
Common Errors in Summarizing Data
Reading the Descriptive Data Section in a Research Study
Using Descriptive Data Analysis in Practice
Creating Descriptive Data Summaries for a Research Study
Reporting Descriptive Results
Summary of Key Concepts
References
Part V: Studies that Measure Effectiveness
12 Quantitative Questions and Procedures
Introduction
Quantitative Research Questions
Characteristics of a Quantitative Design
23. The Gold Standard: Experimental Design
More Common: Quasi-Experimental Designs
Designs That Focus on Intact Groups
Time-Series Designs
Reading Quantitative Research
Using Quantitative Research in Evidence-Based Nursing
Practice
Generalizing the Results of Quantitative Studies
Creating Quantitative Research
9
Summary of Key Concepts
References
13 Analysis and Reporting of Quantitative Data
Introduction
Some General Rules of Quantitative Analysis
Types of Quantitative Analysis
An Overview of Quantitative Analysis
Selecting the Appropriate Quantitative Test
24. Reading the Analysis Section of the Research Report
Using Quantitative Results as Evidence for Practice
Creating a Quantitative Analysis
Summary of Key Concepts
References
Part VI: Research That Describes the Meaning of an Experience
14 Qualitative Research Questions and Procedures
An Introduction to Qualitative Research
Characteristics of Qualitative Research Methods
Enhancing the Trustworthiness of Qualitative Studies
Classifications of Qualitative Traditions
Reading Qualitative Research Studies
Using Qualitative Research Studies as Evidence
Creating Qualitative Evidence
Summary of Key Concepts
References
15 Analyzing and Reporting Qualitative Results
Introduction to Qualitative Analysis
The Qualitative Analysis Process
25. Management and Organization of Data
Software for Qualitative Analysis
Reliability and Validity: The Qualitative Version
Reporting Qualitative Results
Reading the Qualitative Analysis Section of a Report
Using Qualitative Analysis in Nursing Practice
Creating Qualitative Analyses
Summary of Key Concepts
References
Part VII: Research Translation
16 Translating Research into Practice
Introduction
The Nurse’s Role in Knowledge Translation
Identifying Problems for Knowledge Translation
Communicating Research Findings
10
Finding and Aggregating Evidence
Models for Translating Research into Practice
26. Summary of Key Concepts
References
Glossary
Index
11
The Pedagogy
Nursing Research: Reading, Using, and Creating Evidence,
Fourth Edition
demonstrates how to use research as evidence for successful
nursing
practice. Fully updated and revised, this readerfriendly new
edition provides
students with a fundamental understanding of how to appraise
and utilize
research, translating it into actionable guidelines for practice.
Organized
around the different types of research that can be used in
evidence-based
practice, it addresses contemporary methods including the use
of technology
in data collection, advice for culturally competent research, and
suggestions
for accessing hard-to-reach subjects. Additionally, it explores
both quantitative
and qualitative traditions and encourages students to read, use,
and
participate in the research process. The pedagogical aids that
appear in most
27. chapters include the following:
12
13
14
15
16
17
18
Preface
This nursing research text is based on the idea that research is
essential for
nurses as evidence for practice. Its contents are intended to be
relevant for
nursing students, and practicing nurses who must apply
28. evidence to practice.
All nurses should be able to read research, determine how to use
it
appropriately in their practice, and participate in the research
process in some
way during their careers as professionals. This text is intended
to support all
these efforts.
Evidence-based practice is one of the most exciting trends in
nursing practice
to emerge in decades. However, its integration into daily
practice requires a
solid understanding of the foundations of research design,
validity, and
application. This text is intended as a reader-friendly approach
to a complex
topic so that beginners can grasp the fundamentals of appraising
research,
experienced nurses can use research in practice, and practicing
nurses can
gain skills to create bedside research projects or participate
effectively on
research teams.
This text is presented in an uncluttered, straightforward manner.
Although it
uses many bulleted lists to make the material visually
interesting, the sidebars,
figures, and tables are limited to those that illustrate truly
important concepts.
This format allows the reader to grasp the information quickly
and to navigate
the text efficiently. Margin notes provide definitions of new
terms when they
first appear, and the Gray Matter features offer information
29. about key concepts
that are of particular importance.
This text differs in its approach from traditional texts in that it
does not focus
primarily on interpreting inferential research; rather, it seeks to
impart a
fundamental understanding of all types of research that may be
used as
evidence. It adds depth by considering the use of qualitative
research in
nursing practice—a natural fit with this holistic profession. This
text also
addresses contemporary concerns for today’s nurses, including
ethical and
legal issues. Although both ethics and legal issues are
mentioned in many
research texts, a full chapter is devoted to these topics in this
text so that the
intricacies of these issues can be thoroughly considered.
The integrated discussion of both the quantitative and the
qualitative traditions
is another unique facet of this text’s coverage of the research
process. Most
nurse researchers have learned to appreciate the need to
consider all
paradigms when approaching a research question; separating the
two
approaches when discussing the fundamental interests of
researchers results
in a polarized view. Intuitively, nurses know that the lines
between quantitative
19
30. and qualitative designs are not always so clear in practice and
that they should
consider multiple ways of knowing when evaluating research
questions. The
planning process covered here helps the novice researcher
consider the
requirements of both approaches in the context of sampling,
measurement,
validity, and other crucial issues they share. Detailed
descriptions of the
procedures for each type of design are given attention in
separate chapters.
The chapters are organized around the types of research
processes that make
up the evidence base for practice. The first section of the text
provides
information that is applicable to all research traditions, whether
descriptive,
quantitative, or qualitative. Part I provides an overview of
issues relevant to all
researchers: understanding the way research and practice are
related, the
ways that knowledge is generated, and legal and ethical
considerations. Part II
describes the processes that go into planning research. The
chapters in Part
III consider the various decisions that must be made in each
phase of the
research process.
The evidence generated by descriptive, survey, and qualitative
designs is
placed in the context of both the definition of evidence-based
31. practice and
application in practice guidelines. In Parts IV, V, and VI, each
major
classification of research is explored in depth through review of
available
designs, guidelines for methods and procedures, and discussion
of
appropriate analytic processes. Brief examples of each type of
research are
provided, along with notes explaining the features demonstrated
in each case
in point. Finally, Part VII details the models and processes used
to translate
research into clinical practice.
Many chapters begin with a feature called “Voices from the
Field” that relates
a real-life story of a nurse’s experience with the research
process, illustrating
the way that the material covered in that chapter might come to
life. The main
content for each chapter is broken into five parts:
A thorough review of the topic under consideration is presented
first. This
review lays out the fundamental knowledge related to the topic.
Next, the nurse isa guided to consider the aspects of a study that
should
be appraised when reading research. All nurses—regardless of
their
experience—should be able to read research critically and apply
it
appropriately to practice, and the second section of each chapter
addresses this skill. Added features include advice on where to
look for the
key elements of a research paper, the wording that might be
32. used to
describe them, and specific things to look for during the
evaluation
process. Evaluation checklists support this process.
The third section of the chapter focuses on using research in
practice. This
section supports the nurse in determining if and how research
findings
might be used in his or her practice.
20
The fourth section is intended for nurses who may be involved
with teams
that are charged with creating research or who may plan bedside
research
projects to improve practice. This section gives practical advice
and
direction about the design and conduct of a realistic, focused
nursing
research project.
The final section of each chapter contains summary points and a
critical
appraisal exercise so that the nurse can immediately apply the
chapter
concepts to a real research report.
All of these features are intended to help the reader gain a
comprehensive
view of the research process as it is used to provide evidence
for professional
nursing practice. The use of this text as a supportive resource
for learning and
for ongoing reference in clinical practice has been integrated
33. into the design of
each element of the text. The goal is to stimulate nurses to read,
use, and
participate in the process of improving nursing practice through
the systematic
use of evidence. Accomplishing this goal improves the
profession for all of us.
21
Acknowledgments
It is a bit misleading to conclude that a text is produced solely
by the person
whose name appears on the cover. Help and support are needed
from many
people on both professional and personal fronts to complete a
project of this
size. The help of editorial staff is always welcome; advice from
Amanda Martin
was invaluable in merging the interests of writing with those of
producing a
book that others will want to read. I appreciate Amanda
Clerkin’s calm and
steady approach after our sixth manuscript together, and I’ve
learned a lot
from reading Jill Hobbs’s edits, which I must begrudgingly
admit make my
writing much better.
My family—my husband, Floyd; my sisters, Anne and Ande; my
niece, Stef;
and mini-me, Amanda—provided me with enough
encouragement to keep
going, even as they reminded me there is life beyond the pages
34. of a book.
I must thank Regis University profusely for providing me with
inspirational
colleagues and a place that supports my work. Pat Ladewig, as
always,
provided pragmatic advice and guidance from her impressive
experience
publishing her own texts. My contributors and reviewers each
provided a
unique viewpoint and helped me discover the best way to ensure
that students
“get it.”
Writing always makes me realize how much I miss my mom,
Marty, who
encouraged me to publish from the time she surreptitiously sent
one of my
poems to Highlights magazine when I was 9 years old. She was
proud of that
poem, framed the issue, and had my grandmother embroider it
on a pillow.
Seeing this book in print would have impressed her only
slightly more, but I
know she’s smiling.
22
Contributors
Michael Cahill, MS, CPHQ
Parker Adventist Hospital
Parker, Colorado
Summarizing and Reporting Descriptive Data
35. Sheila Carlon, PhD, RHIA, FAHIMA
Regis University
Denver, Colorado
Ethical and Legal Considerations in Research
Phyllis Graham-Dickerson, PhD, RN, CNS
Regis University
Denver, Colorado
Qualitative Research Questions and Procedures Analyzing and
Reporting Qualitative Results
LeeAnn Hanna, PhD, RN, CPHQ, FNAHQ
HCA, TriStar Centennial Medical Center
Nashville, Tennessee
Finding Problems and Writing Questions
Kimberly O’Neill, MS, MLIS
Dayton Memorial Library, Regis University
Denver, Colorado
The Successful Literature Search
23
About the Author
Janet Houser, PhD, RN
Regis University
Dr. Janet Houser is currently Provost at Regis University in
Denver, Colorado.
Prior to her appointment, she was Dean of the Rueckert-
Hartman College for
Health Professions and the Vice Provost for Resource Planning.
36. Dr. Houser has a BSN, an MN in Maternal-Child Health, an MS
in healthcare
administration, and a PhD in applied statistics and research
methods. She has
taught nurses, administrators, pharmacists, and physical therapy
students
from undergraduate through doctoral level, primarily in the
subjects of
research methods, biostatistics, and quantitative methods.
Previous to her
position as Dean, Dr. Houser was faculty and Associate Dean
for Research
and Scholarship.
Dr. Houser spent 20 years in healthcare administration with the
Mercy Health
System. Her last position was as Regional Director for
Professional Practice
for Mercy Health Partners in Cincinnati, Ohio, where she was
responsible for
professional practice and clinical research in 29 facilities.
Dr. Houser has published five books, Clinical Research in
Practice: A Guide
for the Bedside Scientist, Nursing Research: Reading, Using,
and Creating
Evidence, which is in its fourth edition, and Evidence-Based
Practice: An
Implementation Guide. She has more than 30 peer-reviewed
publications in
journals and has presented her research at regional, national,
and
international conferences.
24
38. of
nursing.
Read research and appraise the credibility of the journal,
authors,
and publication process.
KEY TERMS
Blinded
Evidence-based practice
Evidence-based practice guideline
External validity
Journal club
Magnet status
National Institute of Nursing Research (NINR)
Nursing process
Nursing research
Outcomes measurement
Peer review
Principal investigator
Quality improvement
Randomized controlled trial
Replication
39. Systematic review
28
Research as Evidence for Nursing Practice
The practice of nursing is deeply rooted in nursing knowledge,
and nursing
knowledge is generated and disseminated through reading,
using, and
creating nursing research. Professional nurses rely on research
findings to
inform their practice decisions; they use critical thinking to
apply research
directly to specific patient care situations. The research process
allows nurses
to ask and answer questions systematically that will ensure that
their decisions
are based on sound science and rigorous inquiry. Nursing
research helps
nurses in a variety of settings answer questions about patient
care, education,
and administration. It ensures that practices are based on
evidence, rather
than eloquence or tradition.
VOICES FROM THE FIELD
I was working as the clinical nurse specialist in a busy surgical
intensive
care unit (ICU) when we received a critically ill patient. He was
fresh
from cardiac surgery and quite unstable; he needed multiple
drugs and
an intra-aortic balloon pump just to maintain his perfusion
40. status. The
patient was so sick that we were not able to place him on a
special bed
for pressure relief. For the first 24 hours, we were so busy
trying to
keep him alive that we did not even get a chance to turn him.
Approximately 36 hours into his ICU admission, he was stable
enough
to place on a low-air-loss mattress for pressure-ulcer
prevention. When
we were finally able to turn him, we noted he had a small stage
II
pressure ulcer on his coccyx. Despite the treatments that we
used, the
pressure ulcer evolved into a full-thickness wound. The patient
recovered from his cardiac surgical procedure but,
unfortunately,
required surgeries and skin grafts to close the pressure ulcer
wound.
The experience I had with this patient prompted me to review
the
evidence-based practice (EBP) guidelines we had in place to
prevent
pressure ulcers in critically ill patients. I wanted to make sure
we could
prevent this kind of incident from happening again, but I had a
lot of
questions. Could we preventively place high-risk patients on
low-air-
loss mattresses while they were still in the perioperative
service? Did
we even know which patients were at risk for pressure ulcers?
Which
assessment tools did nurses use to assess the patient’s risk?
41. When a
high-risk patient was identified, which interventions did the
nurses use
to prevent pressure ulcers? How were the ulcers treated once
they
appeared?
I was fortunate that my chief nursing officer (CNO) was a
strong
advocate for EBP, and she encouraged me to initiate an EBP
review of
pressure ulcer prevention and treatment. Specifically, I wanted
to find
out which nursing interventions were supported by research
evidence
when we were trying to prevent pressure ulcers in the surgical
ICU. As
29
part of my review, I contacted other inpatient units at the
hospital to
determine what they were doing.
I discovered that the surgical ICU was no different from the
other
inpatient units in this regard: There was no standard, evidence-
based
nursing practice for pressure ulcer prevention. Units were not
consistently using the same skin assessment tools, so it was
difficult to
objectively communicate risk from one unit to another. The
tools we
were using were not necessarily based on research. It was clear
42. that
we needed to identify the best available evidence and devise a
protocol.
We started by establishing an evidence-based skin care council
for the
hospital. This team consisted of bedside nurses from all
inpatient units
and the perioperative service. Initially the council reviewed the
hospital’s current nursing skin assessment forms, and we
conducted a
review of the literature on pressure ulcer prevention and
interventions.
We discovered the Agency for Healthcare Research and Quality
(AHRQ) guidelines on pressure ulcer prevention and
treatment—a key
source of evidence for healthcare practices.
Over the course of the next year, we revised our nursing policy
and
procedure, incorporating the AHRQ evidence into a treatment
guideline.
This guideline included a procedure for skin assessment and
nursing
documentation, and pressure ulcer assessment and treatment
decision
algorithms. We reviewed skin-care products and narrowed down
the list
of products to those that were supported by evidence. One
algorithm
helped staff make selections between products that maximized
prevention and treatment. Another algorithm guided nurses in
the use
of therapeutic surfaces (e.g., low-air-loss mattresses) to prevent
pressure ulcers. To monitor our progress, we began quarterly
pressure
43. ulcer prevalence studies. As part of the implementation, we
scheduled
a skin-care seminar featuring a national expert on skin care.
At the beginning of our EBP skin-care journey, our facility’s
pressure
ulcer prevalence was 9%. Since implementing our EBP skin-
care
initiatives, it has dropped by two …
