NURS 6052 Assignment: Evidence-Based Project, Part 2: Advanced Levels of Clinical Inquiry and Systematic Reviews

NURS 6052 Assignment – Evidence-Based Project, Part 2: Advanced Levels of Clinical Inquiry and Systematic Reviews

The Assignment (Evidence-Based Project)- Part 2: Advanced Levels of Clinical Inquiry and Systematic Reviews

PLEASE FOLLOW THE INSTRUCTION BELOW

NO PLAGIARISM

FIVE REFERENCES

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.

To Prepare:

  • 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 keywords 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), and 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-analyses 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

¬õClinical issue of interest- nurse burnout

¬õCharacteristics: fatigue, cognitive dysfunction, depression, and impaired sleep (Rudman et al., 2021).

¬õCauses: Job dissatisfaction, poor quality of the work environment, and unhealthy work relationships

¬õImplications: 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.

Article Focus Area
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.

Article Type Evidence Level
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. NURS 6052 Assignment: Evidence-Based Project

¬õAnswer a focused research question

¬õClear and comprehensive evidence overview

¬õIdentify research gaps

¬õEnhanced precision of effect estimate

¬õMinimal 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.

¬õde 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‚Äď73. https://doi.org/10.2174/1745017901915010064

¬õDeldar, 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‚Äď2256. https://doi.org/10.3889/oamjms.

2018.428

›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 NURS 6052 Assignment: Evidence-Based Project: 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.

NURS 6052 Assignment: Evidence-Based ProjectThis 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)?‚ÄĚ 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. NURS 6052 Assignment: Evidence-Based Project

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‚Äď356.¬†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 Tim√§us, 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. NURS 6052 Assignment: Evidence-Based Project 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.

Conclusion

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. NURS 6052 Assignment: Evidence-Based Project

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.

References

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‚Äď356.¬†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.

 
Criteria Ratings Pts

Part 3A: Critical Appraisal of Research Critical Appraisal of Research Conduct a critical appraisal of the four peer-reviewed articles you selected and analyzed by completing the Critical Appraisal Tool Worksheet Template. Be sure to include: · An Evaluation Table

45 to >40.0 pts

Excellent
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.

40 to >35.0 pts

Good
The critical appraisal accurately provides an evaluation table. …The responses provide an accurate evaluation of each of the peer-reviewed articles selected with some specificity.

35 to >31.0 pts

Fair
The critical appraisal provides an evaluation table that is inaccurate or vague. …The responses provide an inaccurate or vague evaluation of each of the peer-reviewed articles selected.

31 to >0 pts

Poor
The critical appraisal provides an evaluation table that is inaccurate and vague or is missing.
45 pts

Part 3B: Evidence-Based Best PracticesEvidence-Based Best Practices Based on your appraisal, suggest a best practice that emerges from the research you reviewed. Briefly explain the best practice, justifying your proposal with the selected resources.

35 to >31.0 pts

Excellent
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 the four peer reviewed articles. NURS 6052 Assignment: Evidence-Based Project

31 to >27.0 pts

Good
The responses accurately suggest a best practice that is adequately aligned to the research reviewed. …The responses accurately explain the best practice, with adequately justification of why this represents a best practice in the field. …The responses provide an accurate synthesis of at least one outside resource reviewed on the best practice explained.

27 to >24.0 pts

Fair
The responses inaccurately or vaguely suggest a best practice that may be aligned to the research reviewed. …The responses inaccurately or vaguely explain the best practice, with inaccurate or vague justification for why this represents a best practice in the field. …The responses provide a vague or inaccurate synthesis of outside resources reviewed on the best practice explained.

24 to >0 pts

Poor
The responses inaccurately and vaguely suggest a best practice that may be aligned to the research reviewed or are missing. …The responses inaccurately and vaguely explain the best practice, with inaccurate and vague justification for why this represents a best practice in the field or are missing. …A vague and inaccurate synthesis of no outside resources reviewed on the best practice explained is provided or is missing.
35 pts

Resource Synthesis

5 to >4.0 pts

Excellent
The response fully integrates at least two outside resources and two or three course-specific resources that fully support the responses provided.

4 to >3.0 pts

Good
The response integrates at least one outside resource and two or three course-specific resources that may support the responses provided.

3 to >2.0 pts

Fair
The response minimally integrates resources that may support the responses provided.

2 to >0 pts

Poor
The response fails to integrate any resources to support the responses provided.
5 pts

Written Expression and Formatting‚ÄĒParagraph Development and Organization:Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused‚ÄĒneither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction is provided, which delineates all required criteria.

5 to >4.0 pts

Excellent
Paragraphs and sentences follow writing standards for flow, continuity, and clarity. …A clear and comprehensive purpose statement, introduction, and conclusion are provided, which delineates all required criteria.

4 to >3.0 pts

Good
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time. …Purpose, introduction, and conclusion of the assignment are stated but are brief and not descriptive.

3 to >2.0 pts

Fair
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60‚Äď79% of the time. ‚ĶPurpose, introduction, and conclusion of the assignment is vague or off topic.

2 to >0 pts

Poor
Paragraphs and sentences follow writing standards for flow, continuity, and clarity less than 60% of the time. …No purpose statement, introduction, or conclusion is provided.
5 pts

Written Expression and Formatting‚ÄĒEnglish Writing Standards: Correct grammar, mechanics, and proper punctuation.

5 to >4.0 pts

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

4 to >3.0 pts

Good
Contains a few (one or two) grammar, spelling, and punctuation errors.

3 to >2.0 pts

Fair
Contains several (three or four) grammar, spelling, and punctuation errors. NURS 6052 Critical Appraisal

2 to >0 pts

Poor
Contains many (five or more) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.
5 pts

Written Expression and Formatting:The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running head, parenthetical/in-text citations, and reference list.

5 to >4.0 pts

Excellent
Uses correct APA format with no errors.

4 to >3.0 pts

Good
Contains a few (one or two) APA format errors.

3 to >2.0 pts

Fair
Contains several (three or four) APA format errors.

2 to >0 pts

Poor
Contains many (five or more) APA format errors.
5 pts
Total Points: 100

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