Part 2: Advanced Levels of Clinical Inquiry and Systematic Reviews Latest
NURS 6052 Assignment: Evidence-Based Project, Part 2: Advanced Levels of Clinical Inquiry and Systematic Reviews
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Your quest to purchase a new car begins with an identification of the factors important to you. As you conduct a search of cars that rate high on those factors, you collect evidence and try to understand the extent of that evidence. A report that suggests a certain make and model of automobile has high mileage is encouraging. But who produced that report? How valid is it? How was the data collected, and what was the sample size?
In this Assignment, you will delve deeper into clinical inquiry by closely examining your PICO(T) question. You also begin to analyze the evidence you have collected.
- Review the Resources and identify a clinical issue of interest that can form the basis of a clinical inquiry.
- Develop a PICO(T) question to address the clinical issue of interest you identified in Module 2 for the Assignment. This PICOT question will remain the same for the entire course.
- Use the key words from the PICO(T) question you developed and search at least four different databases in the Walden Library. Identify at least four relevant systematic reviews or other filtered high-level evidence, which includes meta-analyses, critically-appraised topics (evidence syntheses), critically-appraised individual articles (article synopses). The evidence will not necessarily address all the elements of your PICO(T) question, so select the most important concepts to search and find the best evidence available.
- Reflect on the process of creating a PICO(T) question and searching for peer-reviewed research.
NURS 6052 Assignment: Evidence-Based Project, Part 2: Advanced Levels of Clinical Inquiry and Systematic Reviews
Create a 6- to 7-slide PowerPoint presentation in which you do the following:
- Identify and briefly describe your chosen clinical issue of interest.
- Describe how you developed a PICO(T) question focused on your chosen clinical issue of interest.
- Identify the four research databases that you used to conduct your search for the peer-reviewed articles you selected.
- Provide APA citations of the four relevant peer-reviewed articles at the systematic-reviews level related to your research question. If there are no systematic review level articles or meta-analysis on your topic, then use the highest level of evidence peer reviewed article.
- Describe the levels of evidence in each of the four peer-reviewed articles you selected, including an explanation of the strengths of using systematic reviews for clinical research. Be specific and provide examples.
Assignment: Evidence-Based Project, Part 2: Advanced Levels of Clinical Inquiry and Systematic Reviews
Clinical issue of interest- nurse burnout
Characteristics: fatigue, cognitive dysfunction, depression, and impaired sleep (Rudman et al., 2021).
Causes: Job dissatisfaction, poor quality of the work environment, and unhealthy work relationships
Implications: reduced output and high turnover (Rudman et al., 2021).
Nurses should work as comfortably as possible in order to maintain a healthy work environment and maximize patient outcomes. Nurse burnout, on the other hand, has a negative impact on nurses’ output and work relationships. It is also a major source of nurse turnover. According to Rudman et al. (2021), nurse burnout is characterized by fatigue, cognitive dysfunction, depression, and poor sleep. In this case, it affects multiple aspects of nurses’ health, implying that they are unable to provide efficient and effective care. Job dissatisfaction and increased workload are common causes. Evidence-based interventions are required due to the negative consequences of unhealthy workplaces and turnover. One of the most effective interventions is resilience training.
Burnout in nurses is a problem.
Resilience training is an intervention.
Contrast: no intervention
Reduced burnout as a result
Timeline: six months
The PICOT process aids in the development of a thoughtful question that will guide the search for evidence. I used the same method to create the PICOT question. The entire process begins with identifying the patient or problem that requires intervention. Nurses experiencing burnout are the target population in this scenario. Resilience training is the proposed intervention to improve nurses’ resilience to burnout. Other alternatives are considered in the comparison, but none have been considered. The result indicates the desired goal, which is to reduce nurse burnout. Because evidence-based practice projects must be completed within a specific time frame, the time required to achieve the desired outcome must be specified.
PICOT Question: Can resilience training (I) reduce nurse burnout (O) in six months (T) in nurses with burnout (P) compared to no intervention (C)?
Scholarly and peer-reviewed sources should be used to obtain evidence-based practice research. The university library has access to numerous nursing databases that contain numerous articles on a variety of topics. CINAHL Plus with Full Text, an extensive collection of journals and e-books on nursing topics, was one of the research databases I used. The Cochrane Database of Systematic Reviews contains full-text versions of evidence-based sources to help inform nursing and health-care decision-making. PubMed provides access to full-text journal articles. The CINAHL/MEDLINE Combined Search includes peer-reviewed articles from the nursing and allied health literature, as well as case studies, systematic reviews, and EBP reports.
|Deldar et al. (2018)||relationship between resiliency and burnout|
|Yu et al. (2019)||Personal and work-related factors associated with nurse resilience|
|De Oliveira et al. (2019)||prevention actions of burnout syndrome|
|Klein et al. (2019)||benefits of mindfulness-based interventions on burnout|
The above four studies met the inclusion criteria for scholarly and peer-reviewed articles. Besides being scholarly and peer-reviewed, the studies recommend resilience training as an evidence-based strategy for addressing nurse burnout. Deldar et al. (2018) conducted a meta-analysis examining the effects of resiliency on nurse burnout. Yu et al. (2019) deduced that increased nurse resilience reduces emotional exhaustion and increases work engagement. Resilience is a key theme in de Oliveira et al. (2019) article, which can be taught or developed through coping skills training. Klein et al. (2019) examined the effectiveness of interventions that increase resilience, such as mindfulness-based activities. Their primary objective is to pursue a state of mind characterized by self-control and free from self-judgmental feelings.
|Deldar et al. (2018)||a systematic review and meta-analysis||Level 1|
|Yu et al. (2019)||a systematic review||Level 1|
|De Oliveira et al. (2019)||an integrating literature review||Level 1|
|Klein et al. (2019)||a systematic review||Level 1|
In the evidence pyramid, systematic reviews and meta-analyses occupy the first level of evidence (Level 1). At this level, research studies contain evidence from systematic reviews or meta-analyses of good quality sources on a given topic. Systematic reviews provide a summary of the clinical literature. In this case, the chosen studies critically assess and evaluate many other research studies that address nurse burnout and resilience. On the other hand, a meta-analysis combines the results of independent studies. It also synthesizes summaries and conclusions from the same studies quantitatively. The defining element of a meta-analysis is being an overview of clinical trials, which differentiates such studies from systematic reviews.
Answer a focused research question
Clear and comprehensive evidence overview
Identify research gaps
Enhanced precision of effect estimate
Minimal research bias
As sources of high level of evidence, systematic reviews are designed to answer a focused research question. In this process, researchers using the systematic review approach identify and synthesize the available scholarly research on a particular topic. For instance, Deldar et al. (2018) first extracted 227articles that were screened to end up with 108 studies for their review on resiliency and burnout. Such in-depth exploration of a nursing topic provides a clear and comprehensive overview of research evidence. The other dominant strength is identifying research gaps. After the synthesis and analysis, systematic reviews indicate areas where further research is required. Importantly, systematic reviews are associated with better precision of effect estimate and minimal bias compared to individual studies.
de Oliveira, S. M., de Alcantara Sousa, L. V., Vieira Gadelha, M., & do Nascimento, V. B. (2019). Prevention Actions of Burnout Syndrome in Nurses: An Integrating Literature Review. Clinical Practice and Epidemiology in Mental Health : CP & EMH, 15, 64–73. https://doi.org/10.2174/1745017901915010064
Deldar, K., Froutan, R., Dalvand, S., Gheshlagh, R. G., & Mazloum, S. R. (2018). The Relationship between Resiliency and Burnout in Iranian Nurses: A Systematic Review and Meta-Analysis. Open access Macedonian Journal of Medical Sciences, 6(11), 2250–2256. https://doi.org/10.3889/oamjms.
Klein, A., Taieb, O., Xavier, S., Baubet, T., & Reyre, A. (2020). The benefits of mindfulness-based interventions on burnout among health professionals: A systematic review. Explore, 16(1), 35-43. https://doi.org/10.1016/j.explore.2019.09.002
Rudman, A., Arborelius, L., Dahlgren, A., Finnes, A., & Gustavsson, P. (2020). Consequences of early career nurse burnout: A prospective long-term follow-up on cognitive functions, depressive symptoms, and insomnia. EClinicalMedicine, 27, 100565. https://doi.org/10.1016/j.eclinm.2020.100565
Yu, F., Raphael, D., Mackay, L., Smith, M., & King, A. (2019). Personal and work-related factors associated with nurse resilience: A systematic review. International Journal of Nursing Studies, 93, 129-140. https://doi.org/10.1016/j.ijnurstu.2019.02.014
Solution- EBP Part 1: Identifying Research Methodologies for Personality Disorders
The philosophy of practice that is premised on the use of only interventions that have been proven by research to be efficacious is referred to as evidence-based practice or EBP. But the body of EBP knowledge is not static but dynamic as it keeps on changing day by day as new evidence of efficacy emerges. This new knowledge for EBP is generated by a process known as clinical inquiry which is undertaken by using the PICOT model.
This model requires the identification of the clinical issue of interest or problem
(P) requiring evidence-based interventions. Alternatively, the patient population
(P) this issue affects is identified as well as the problem itself.
This is followed by the intervention to be investigated (I),
the comparison or current intervention (C),
the expected outcome (O),
and the timeframe for the application of the intervention (T) (Melnyk & Fineout-Overholt, 2019).
In this EBP project, the clinical issue of interest chosen is the treatment of personality disorders. For this, the PICOT statement or question is “In adult patients diagnosed with a personality disorder (P),
does the use of psychotherapy combined with pharmacotherapy (I),
compared to pharmacotherapy alone (C),
result in better symptom remission (O) within a span of six months (T)?” The purpose of this paper is therefore to analyze four peer-reviewed articles from research databases CINAHL, PubMed, Cochrane, and ProQuest that provide evidence for the best intervention to manage personality disorders.
|Full citation of selected article||Article #1||Article #2||Article #3||Article #4|
|Choi-Kain, L.W., Albert, E.B., & Gunderson, J.G. (2016). Evidence-based treatments for borderline personality disorder. Harvard Review of Psychiatry, 24(5), 342–356. https://doi.org/10.1097/hrp.0000000000000113||Ellison, W.D. (2020). Psychotherapy for borderline personality disorder: Does the type of treatment make a difference? Current Treatment Options in Psychiatry, 7, 416-428. https://doi.org/10.1007/s40501-020-00224-w||Pearce, S., Scott, L., Attwood, G., Saunders, K., Dean, M., De Ridder, R., Galea, D., Konstantinidou, H., & Crawford, M. (2018). Democratic therapeutic community treatment for personality disorder: Randomised controlled trial. The British Journal of Psychiatry, 210(2), 149-156. https:/doi.org/10.1192/bjp.bp.116.184366||Timäus, C., Meiser, M., Bandelow, B., Engel, K.R., Paschke, A.M., Wiltfang, J., & Wedekind, D. (2019). Pharmacotherapy of borderline personality disorder: What has changed over two decades? A retrospective evaluation of clinical practice. BMC Psychiatry, 19(393), 1-11. https://doi.org/10.1186/s12888-019-2377-z|
|Why you chose this article and/or how it relates to the clinical issue of interest (include a brief explanation of the ethics of research related to your clinical issue of interest)||This article was chosen as it relates to the clinical issue of interest in that it investigates evidence-based treatments for borderline personality disorder. BPD is one of the personality disorders as classified by the DSM-5 (Sadock et al., 2015). The ethics of research have been avoided in this research as it is a review of previous trials on therapies for PDs.||This article was chosen because it relates to the clinical issue of interest. It is about reviewing the current evidence-based psychotherapeutic treatments that are available for BPD as one of the PDs. The issue of ethics did not arise as the research was not a primary study but a filtered one.||This article was chosen because it is about investigating the efficacy of democratic therapeutic community (DTC) treatment for personality disorders. This is how it relates to the clinical issue of interest. On ethics, the subjects were allowed to give informed consent (autonomy) and they were not harmed in any way during the study (nonmaleficence). Lastly but not least, they were assured that the study would benefit them, respecting beneficence (Haswell, 2019).||The choice of this article was informed by the fact that it addresses the issue of pharmacotherapy in the management of BPD. Being retrospective, the confidentiality of the patient information in the charts used was maintained to avoid causing psychological harm by breaching privacy in a violation of the principle of nonmaleficence (Haswell, 2019).|
|Brief description of the aims of the research of each peer-reviewed article||The aim of this review was to evaluate four major available peer-reviewed therapies for BPD.||The aims were (i) to provide a summary of available evidence-based psychotherapeutic treatments for BPD, and (ii) to evaluate their effectiveness and the evidence supporting that.||The aim of te study was to assess whether DTC could reduce in-patient admission and improve the mental health of personality disorder patients.||The aim was to assess the quality of the available drug treatment for BPD in inpatients.|
|Brief description of the research methodology used Be sure to identify if the methodology used was qualitative, quantitative, or a mixed-methods approach. Be specific.||The methodology was a systematic quantitative review of existing literature. Each of these modalities was assessed individually and their merits and demerits and compared against the others.||The methodology is a qualitative systematic review of the available scholarly evidence.||This was a quantitative study in the form of a randomized controlled study/ trial or RCT.||The methodology was a quantitative retrospective evaluation of practice.|
|A brief description of the strengths of each of the research methodologies used, including reliability and validity of how the methodology was applied in each of the peer-reviewed articles you selected.||The strength of this paper is in its being a review of several primary research articles on the subject. It is therefore a summary of sorts which is better than a single study focussing on one therapy. Its reliability and validity depends on the collective reliability and validity of the four articles reviewed. Being a review, its validity and reliability are sound.||The major strength of this methodology is that filtered research provides the best and highest evidence in the pyramid of evidence at level 1. As a sum of the primary studies reviewed, the validity and reliability or generalizability of this study is beyond reproach (good).||The main strength of this study design is that it is experimental in nature and is therefore the best way to establish causality.||The strength of this study is that it is a primary study that generated new knowledge to enrich existing EBP. The sample size was n = 87 and this was enough to guarantee validity and generalizability of the results.|
|General Notes/Comments||The findings of this study are instrumental in generating new knowledge for enriching EB clinical practice.||This study adds to the body of knowledge available for EBP.||Being an experimental primary research study, this work is invaluable in generating entirely new knowledge about causality for EBP.||The study provides required evidence for pharmacotherapeutic interventions against BPD which is a PD.|
This identification of research methodologies has been conducted systematically according to the tenets of clinical inquiry. A clear issue of clinical interest has been identified and a PICOT statement generated with it to facilitate the search for evidence from published peer-reviewed literature.
Reputable research databases have been used to search for evidence and finally four of the several articles retrieved have been reviewed in the matrix above. They show clearly that psychotherapy is the best intervention for personality disorders, but that prudent clinical practice requires that a combination of psychotherapy and pharmacotherapy be used for the best patient outcomes.
Choi-Kain, L.W., Albert, E.B., & Gunderson, J.G. (2016). Evidence-based treatments for borderline personality disorder. Harvard Review of Psychiatry, 24(5), 342–356. https://doi.org/10.1097/hrp.0000000000000113
Ellison, W.D. (2020). Psychotherapy for borderline personality disorder: Does the type of treatment make a difference? Current Treatment Options in Psychiatry, 7, 416-428. https://doi.org/10.1007/s40501-020-00224-w
Haswell, N. (2019). The four ethical principles and their application in aesthetic practice. Journal of Aesthetic Nursing, 8(4), 177-179. https://doi.org/10.12968/joan.2019.8.4.177
Melnyk, B.M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing & healthcare: A guide to best practice, 4th ed. Wolters Kluwer.
Pearce, S., Scott, L., Attwood, G., Saunders, K., Dean, M., De Ridder, R., Galea, D., Konstantinidou, H., & Crawford, M. (2018). Democratic therapeutic community treatment for personality disorder: Randomised controlled trial. The British Journal of Psychiatry, 210(2), 149-156. https:/doi.org/10.1192/bjp.bp.116.184366
Sadock, B.J., Sadock, V.A., & Ruiz, P. (2015). Synopsis of psychiatry: Behavioral sciences clinical psychiatry, 11th ed. Wolters Kluwer.
Timäus, C., Meiser, M., Bandelow, B., Engel, K.R., Paschke, A.M., Wiltfang, J., & Wedekind, D. (2019). Pharmacotherapy of borderline personality disorder: What has changed over two decades? A retrospective evaluation of clinical practice. BMC Psychiatry, 19(393), 1-11. https://doi.org/10.1186/s12888-019-2377-z.
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