NURS 6052 Critical Appraisal

NURS 6052 Critical Appraisal

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.

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.

Rubric

NURS_6052_Module04_Week07_Assignment_Rubric
NURS_6052_Module04_Week07_Assignment_Rubric
Criteria Ratings Pts

Part 3A: Critical Appraisal of ResearchCritical 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.

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—Paragraph Development and Organization:Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither 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 60–79% of the time. …Purpose, 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—English 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

Introduction

            This paper systematically and carefully examines four studies to determine their relevance, value, and trustworthiness in addressing the issue of HAIs influencing good health outcomes in clinical settings. It includes a literature evaluation table, a level of evidence table, and an outcomes synthesis table. For nurses to safeguard public health and provide high-quality services, valid and reliable information is needed on what is likely or not likely to harm patients and the approaches to care that represent good value.

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 citation of selected article Article #1 Article #2 Article #3 Article #4
Ford, C., & Park, L. J. (2018). Hand hygiene and handwashing: key to preventing the transfer of pathogens. British Journal of Nursing, 27(20), 1164–1166. 

 

 

 

Hovi, T., Ollgren, J., & Savolainen-Kopra, C. (2017). Intensified hand-hygiene campaign including soap-and-water wash may prevent acute infections in office workers, as shown by a recognized-exposure -adjusted analysis of a randomized trial. BMC Infectious Diseases, 17, 1–9 Kingston, L. M., O, C. N. H., & Dunne, C. P. (2018). A comparative study of hand hygiene and alcohol-based hand rub use among Irish nursing and medical students. Nurse Education Today, 63, 112–118. Halm, M., & Sandau, K. (2018). Skin Impact of Alcohol-Based Hand Rubs Vs Handwashing. American Journal of Critical Care, 27(4), 334–337.
Conceptual Framework 

Describe the theoretical basis for the study

 

Not provided Not provided Not provided Not provided
Design/Method Describe the design 

and how the study

was carried out

Design- Clinical practice guidelines 

Method-clinical guidelines based on the review of literature of hand hygiene and handwashing by NICE, WHO and other studies.

Design-Randomized control trial 

Method-1270 people from designated clusters were randomized to two different interventions (either the use of alcohol hand-rubs or water and soap).On a weekly basis self-reported data of GTI and RTI symptoms were collected through emails. The multilevel binary regression model was used to analyze data.

Design-Observational cross-sectional design 

Method-a questionnaire was administered electronically to 872 medical and nursing students in a university and outcome data analysed using relevant software.

Design-Systematic review 

Method-a comprehensive search was conducted in the electronic databases of MEDLINE and CINAHL using the keywords: contact dermatitis, handwashing, dermatitis and hand hygiene.

Sample/Setting 

The number and

characteristics of

patients,

attrition rate, etc.

Step by step clinical guidelines on how to maintain hand hygiene and to conduct handwashing in the clinical setting. 

 

1270 people from designated clusters were randomized to two different interventions (either the use of alcohol hand-rubs or water and soap). 323 medical and nursing students responded to online questionnaires on the barriers to adherence to hand hygiene guidelines. 3 studies which assessed the impact of handwashing vs. alcohol-based handrubs on the skin were reviewed.
Major Variables Studied 

List and define dependent and independent variables

Dependent variable-none 

Independent variable-none

 

Dependent variable-RTI and GTI symptoms 

Independent variable-alcohol hand rubs, water and soap

 

Dependent variables-body fluid exposure, patient surrounding 

Independent variable– alcohol hand rubs, use of soap and water NURS_6052_wk_6-7_assign_CriticalAppraisalTools_template

 

Dependent variable-dermatitis 

Independent variable-alcohol-based handrubs and handwashing

 

Measurement 

Identify primary statistics used to answer clinical questions

Guidelines provided by NICE and the WHO on hand hygiene and handwashing. Weekly prevalence of RTI and GTI symptoms Compliance with WHO hand hygiene model, compliance with hand hygiene practices after contact with the surrounding of a patient or exposure to body fluids. Incidence and prevalence of dermatitis/contact dermatitis
Data Analysis 

Statistical or

qualitative

findings

Decontamination of the hands through handwashing using soap and water is the most effective and easy way to prevent the spread of infections in the clinical setting. 

 

Within 16 months of the trial, 238 people who used alcohol-based handrubs, 297 who used soap and water and 230 who used nothing provided their reports. An increase in RTI and GTI exposure was reported in both the intervention and control groups. Among those who used soap and water, the prevalence of GTI reduced to 24% as compared to the control group. Alcohol rubs did not affect the prevalence of the symptoms. 

 

 

 

NURS_6052_wk_6-7_assign_CriticalAppraisalTools_template 

Of the 872 participants, 323 responded. Nursing students complied more with the WHO “my five moments for hand hygiene” model as compared to medical students. Compliance with hand hygiene was high after being exposed to body fluids (MS 91%. NS 99.5%) and low after contact with a patient’s environment (MS-57.5%, NS-61.5%). Both disciplines had a positive attitude towards hand rubbing. 45% of MS and 16% of NS were not aware of the clinical contraindications to using ABHR. 36% of MS and 9% of NS did not know when to use ABHR and when to use soap and water. 22% NS and 46% MS routinely used ABHR for decontamination.  

3 relevant studies were retrieved. ABHRs were not linked to reduced skin hydration, allergic reactions and disruption of the skin barrier. Skin tolerance of ABHRs was high with reports from healthcare providers on less irritation of the skin and less dryness in comparison to the use of lotions, creams or handwashing. 

 

 

 

Findings and Recommendations 

General findings and recommendations of the research

Washing hands with soap and water is the best decontamination method in preventing HAIs. Handwashing with soap and water safeguarded the participants from GTI and RTI. In clinical settings, it should be adopted as an infection control measure to prevent/reduce the incidence and prevalence of HAIs. 

 

 

 

 

Gaps in knowledge on hand hygiene and handwashing are a potential barrier to deficits in hand hygiene practice and use of ABHRs. In clinical settings, leadership should identify potential knowledge gaps, frequently review hand hygiene policies and address them as required. Evidence on how ABHRs influence contact dermatitis and the effectiveness of antiseptic hand hygiene protocols in preventing dermatitis was level II and III. Lipid-emulsifying alcohols or agents disrupt the skin barrier and cause a lot of skin irritation thus should be avoided.
Appraisal 

Describe the general worth of this research to practice. What are the strengths and limitations of the study? What are the risks associated with the implementation of the suggested practices or processes detailed in the research? What is the feasibility of

use in your practice?

Adds to clinical knowledge on how to prevent the transfer of pathogens in healthcare settings through handwashing and hand hygiene. It has no risks associated with implementation in clinical practice and is highly feasible in my practice. The study adds to the nursing knowledge on how to prevent RTI and GTI infections in the clinical setting. 

A major strength is that since a wide study sample was used, the results can be applied to wide population settings. However, since the data collected on RTI and GTI symptoms were based on electronic self-reporting; varied reports might include biased data which affects the validity and reliability of the results. The research is however feasible in my practice.

The research adds to nursing knowledge on the potential barriers in observing hand hygiene practices in clinical settings. Its major limitation is that since it had a self-reporting design, the likelihood of potential biases is high. However, the huge random study sample increases the validity, reliability and applicability of the results. The study is highly feasible in my practice. The study adds to the nursing knowledge on health worker perceptions that influence compliance with hand hygiene practices and its influence on the rates of HAIs. Since it is a systematic review that included only 3 articles, the reliability and applicability of its findings is not entirely guaranteed. A major strength of the study is that it recommends the use of ABHRs to reduce bacterial count since it causes less irritation to the skin. 

NURS_6052_wk_6-7_assign_CriticalAppraisalTools_template

General Notes/Comments Will be included in the EBP project since it matches the scope and proposed EBP-intervention. 

 

 

 

Will be included in the EBP project since it matches the scope and proposed EBP-intervention. 

 

Will be included in the EBP project since it matches the scope and proposed EBP-intervention. 

 

Will be included in the EBP project since it matches the scope and proposed EBP-intervention. 

 

 

Levels of Evidence Table

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

Author and year of selected article Article #1 Article #2 Article #3 Article #4
 

Ford, C., & Park, L. J. (2018). Hand hygiene and Handwashing: key to preventing the transfer of pathogens. British Journal of Nursing, 27(20), 1164–1166.

 

 

 

 

Hovi, T., Ollgren, J., & Savolainen-Kopra, C. (2017). Intensified hand-hygiene campaign including soap-and-water wash may prevent acute infections in office workers, as shown by a recognized-exposure -adjusted analysis of a randomized trial. BMC Infectious Diseases, 17, 1–9 Kingston, L. M., O, C. N. H., & Dunne, C. P. (2018). A comparative study of hand hygiene and alcohol-based hand rub use among Irish nursing and medical students. Nurse Education Today, 63, 112–118. Halm, M., & Sandau, K. (2018). Skin Impact of Alcohol-Based Hand Rubs Vs. Handwashing. American Journal of Critical Care, 27(4), 334–337.
Study Design 

Theoretical basis for the study

 

Clinical practice guideline that is based on the review of literature on hand hygiene and handwashing by NICE, WHO and other studies. 

 

 

Randomized control trial where 1270 people from designated clusters were randomized to two different interventions (either the use of alcohol hand-rubs or water and soap).On a weekly basis self-reported data of GTI and RTI symptoms were collected through emails. The multilevel binary regression model was used to analyze data. Observational cross-sectional design where a questionnaire was administered electronically to 872 medical and nursing students in a university and outcome data analysed using relevant software. Systematic review that involved a comprehensive search of literature in the electronic databases of MEDLINE and CINAHL using the keywords: contact dermatitis, handwashing, dermatitis and hand hygiene.
Sample/Setting 

The number and

characteristics of

patients

Step by step clinical guidelines on how to maintain hand hygiene and to conduct handwashing in the clinical setting. 

 

1270 people from designated clusters were randomized to two different interventions (either the use of alcohol hand-rubs or water and soap). 323 medical and nursing students responded to online questionnaires on the barriers to adherence to hand hygiene guidelines. 3 studies which assessed the impact of handwashing vs. alcohol-based handrubs on the skin were reviewed.
Evidence Level * 

(I, II, or III)

 

Level VII Level II Level IV Level I
Outcomes 

 

 

 

Decontamination of the hands through handwashing using soap and water is the most effective and easy way to prevent the spread of infections in the clinical setting. NURS_6052_wk_6-7_assign_CriticalAppraisalTools_template 

 

Within 16 months of the trial, 238 people who used alcohol-based handrubs, 297 who used soap and water and 230 who used nothing provided their reports. An increase in RTI and GTI exposure was reported in both the intervention and control groups. Among those who used soap and water, the prevalence of GTI reduced to 24% as compared to the control group. Alcohol rubs did not affect the prevalence of the symptoms. 

 

 

Of the 872 participants, 323 responded. Nursing students complied more with the WHO “my five moments for hand hygiene” model as compared to medical students. Compliance with hand hygiene was high after being exposed to body fluids (MS 91%. NS 99.5%) and low after contact with a patient’s environment (MS-57.5%, NS-61.5%). Both disciplines had a positive attitude towards hand rubbing. 45% of MS and 16% of NS were not aware of the clinical contraindications to using ABHR. 36% of MS and 9% of NS did not know when to use ABHR and when to use soap and water. 22% NS and 46% MS routinely used ABHR for decontamination.   3 relevant studies were retrieved. ABHRs were not linked to reduced skin hydration, allergic reactions and disruption of the skin barrier. Skin tolerance of ABHRs was high with reports from healthcare providers on less irritation of the skin and less dryness in comparison to the use of lotions, creams or handwashing. 

 

 

 

General Notes/Comments Low evidence 

 

 

 

 

High evidence 

 

 

Medium evidence 

 

 

 

High evidence 

 

 

* Evidence Levels:

  • 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

A 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 NURS_6052_wk_6-7_assign_CriticalAppraisalTools_template

 

Outcomes Synthesis Table

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

Author and year of selected article Article #1 Article #2 Article #3 Article #4
Ford, C., & Park, L. J. (2018). Hand hygiene and handwashing: key to preventing the transfer of pathogens. British Journal of Nursing, 27(20), 1164–1166. 

 

 

 

 

 

Hovi, T., Ollgren, J., & Savolainen-Kopra, C. (2017). Intensified hand-hygiene campaign including soap-and-water wash may prevent acute infections in office workers, as shown by a recognized-exposure -adjusted analysis of a randomized trial. BMC Infectious Diseases, 17, 1–9 Kingston, L. M., O, C. N. H., & Dunne, C. P. (2018). A comparative study of hand hygiene and alcohol-based hand rub use among Irish nursing and medical students. Nurse Education Today, 63, 112–118. Halm, M., & Sandau, K. (2018). Skin Impact of Alcohol-Based Hand Rubs Vs Handwashing. American Journal of Critical Care, 27(4), 334–337.
Sample/Setting 

The number and

characteristics of

patients

Step by step clinical guidelines on how to maintain hand hygiene and to conduct handwashing in the clinical setting. 

 

1270 people from designated clusters were randomized to two different interventions (either the use of alcohol hand-rubs or water and soap). 323 medical and nursing students responded to online questionnaires on the barriers to adherence to hand hygiene guidelines. 3 studies which assessed the impact of handwashing vs. alcohol-based handrubs on the skin were reviewed.
Outcomes 

 

 

NURS_6052_wk_6-7_assign_CriticalAppraisalTools_template
Key Findings 

 

Washing hands with soap and water is the best decontamination method in preventing HAIs. 

 

Handwashing with soap and water safeguarded the participants from GTI and RTI. In clinical settings, it should be adopted as an infection control measure to prevent/reduce the incidence and prevalence of HAIs. 

 

Gaps in knowledge on hand hygiene and handwashing are a potential barrier to deficits in hand hygiene practice and use of ABHRs. In clinical settings, leadership should identify potential knowledge gaps, frequently review hand hygiene policies and address them as required. Evidence on how ABHRs influence contact dermatitis and the effectiveness of antiseptic hand hygiene protocols in preventing dermatitis was level II and III. Lipid-emulsifying alcohols or agents disrupt the skin barrier and cause a lot of skin irritation thus should be avoided.
Appraisal and Study Quality 

 

Adds to clinical knowledge on how to prevent the transfer of pathogens in healthcare settings through handwashing and hand hygiene. It has no risks associated with implementation in clinical practice. 

Medium  quality

The study adds to the nursing knowledge on how to prevent RTI and GTI infections in the clinical setting. 

A major strength is that since a wide study sample was used, the results can be applied to wide population settings. However, since the data collected on RTI and GTI symptoms were based on electronic self-reporting; varied reports might include biased data which affects the validity and reliability of the results.

High quality

The research adds to nursing knowledge on the potential barriers in observing hand hygiene practices in clinical settings. Its major limitation is that since it had a self-reporting design, the likelihood of potential biases is high. However, the huge random study sample increases the validity, reliability and applicability of the results. 

Medium quality

The study adds to the nursing knowledge on health worker perceptions that influence compliance with hand hygiene practices and its influence on the rates of HAIs. Since it is a systematic review that included only 3 articles, the reliability and applicability of its findings is not entirely guaranteed. A major strength of the study is that it recommends the use of ABHRs to reduce bacterial count since it causes less irritation to the skin. 

High quality

General Notes/Comments Highly feasible in practice Feasible in practice Feasible in my practice Feasible in my practice

 

Conclusion

Based on this critical appraisal, the studies recommend routine hand hygiene with soap and water as the effective decontamination method to reduce the spread of pathogens and rates of HAIs in the clinical setting.

 

References

Ford, C., & Park, L. J. (2018). Hand hygiene and handwashing: key to preventing the transfer of pathogens. British Journal of Nursing, 27(20), 1164–1166. NURS_6052_wk_6-7_assign_CriticalAppraisalTools_template

Hovi, T., Ollgren, J., & Savolainen-Kopra, C. (2017). Intensified hand-hygiene campaign including soap-and-water wash may prevent acute infections in office workers, as shown by a recognized-exposure -adjusted analysis of a randomized trial. BMC Infectious Diseases, 17, 1–9.

Kingston, L. M., O, C. N. H., & Dunne, C. P. (2018). A comparative study of hand hygiene and alcohol-based hand rub use among Irish nursing and medical students. Nurse Education Today, 63, 112–118.

Halm, M., & Sandau, K. (2018). Skin Impact of Alcohol-Based Hand Rubs Vs Handwashing. American Journal of Critical Care, 27(4), 334–337. NURS_6052_wk_6-7_assign_CriticalAppraisalTools_template

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