Critical Appraisal   

           As advanced practice nurses, it is vital to critically appraise research studies.  Barr-Walker (2017) discusses that critical appraisal is the practice of systematically analyzing research to evaluate its trustworthiness, value, and pertinence in a specific situation (p. 71).  When critically appraising quantitative studies, it is imperative to assess three factors.  

Quantitative Studies 

Validity, reliability, and applicability are three essential components of quantitative studies that must be assessed.  Melnyk and Fineout-Overholt (2015) discuss that the validity of a study addresses whether the results of the specific study were acquired from valid scientific resources (p. 93).  If confounding variables are identified in the study, one can conclude that the findings are in jeopardy.  Melnyk and Fineout-Overholt (2015) explain that quantitative studies utilize statistics to release their conclusions (p. 96).  As a provider, one must evaluate the statistics in order to gain an understanding of the reliability of the reviewed study.  Melnyk and Fineout-Overholt (2015) point out that the primary considerations are the breadth of the intervention’s effect and how accurately that effect was predicted.  Combined, these decide the reliability of the study findings (p. 97).  In order to properly assess for accountability, providers must exhaustingly evaluate if the quantitative study is directly applicable to the specific patient population.  Melynyk and Fineout-Overholt (2015) discuss that each study addresses explicit questions that, when addressed, help providers in critically appraising the study in order to determine its worth in the practice setting (p. 107).  

Although each of these three factors are vital components to assess, applicability is the most important.  If the quantitative study results cannot be directly applied to the specific patient population, the results can simply not be utilized.  Melynk and Fineout-Overholt (2015) emphasize that analysis of quantitative study results requires the provider to consider the clinical significance of the findings (p. 93).  Consequently, if the quantitative study findings are not directly applicable to one’s specific practice setting, the study results lack pertinence.  

Conclusion 

LoBiondo-Wood and Haber (2014) explain that it is essential to initially examine the level of evidence that is supported by the design and how the promising strength and quality of the findings can be utilized to improve or alter practice (p. 177).   As advanced practice nurses, it is key to consistently critically appraise studies in order to boost patient outcomes.  Furthermore, consistent appraisal of quantitative studies will assist in expanding one’s clinical knowledge base.  

References 

Barr-Walker, J. (2017). Evidence-based information needs of public health workers: A 

              systematized review. Journal of the Medical Library Association, 105(1), 69-79. 

LoBiondo-Wood, G., & Haber, J. (2014). Nursing research: Methods and critical appraisal for 

evidence-based practice (8th ed.). St. Louis, MO: Mosby Elsevier.

Melnyk, B. M., & Fineout-Overholt, E. (2015). Evidence-based practice in nursing and healthcare: 

A guide to best practice (3rd ed.). Philadelphia, PA: Wolters Kluwer Health.  

Respond to this post with a positive response :

Ask questions to help clarify the scenario and application of data, or offering additional/alternative ideas for the application of nursing informatics principles.

                                                           Main Post

The development of the electronic medical record (EMR) has been a pivotal advancement within nursing and to the delivery of healthcare. I have been a nurse for 19 years. While the electronic medical record was difficult to embrace in the beginning, it has proven to be a reliable and necessary tool. EMR has evolved over time impacting delivery of care and improving outcomes including time sensitive acute care patient scenarios resulting in positive outcomes (Sweeney BSN, 2017).   The availability of viewing labs and health records simultaneously allows nurses and critical care team members, i.e. pharmacist and intensivist, the ability to make safe time sensitive decisions for patients.  

     As a critical care nurse, things can go bad quickly at the bedside. For example, a patient arrives to the ED in an acute CHF exacerbation.  Lab work, radiologic studies and a baseline of vital signs are crucial to fast and effective care. If this patient is established in the system, baseline lab values, previous radiologic test for comparison and possibly even notes from a specialist i.e. cardiology/nephrology are available while waiting on new test to arrive and stabilizing the patient.  This information is available to the entire team instantaneously through his/her EMR. EMR has allowed physicians, nurses and other medical team members to make safe and effective decisions producing favorable and effective outcomes. For example, knowledge of the patient’s renal function or availability to notes from his/her renal physician will direct the ED physician to the appropriate treatment. This could potentially avoid possible long-term effects to this patients’ kidneys and provides insight to treatment options that have worked well for this patient in the past.  The Agency for Healthcare Research and Quality (AHRQ) supports this with study results noting fewer medication errors, improved quality of care with and cost savings as a result of fewer medical errors from utilizing the EMR (“Electronic Health Reporter,” 2018).

    Nurses have contributed to the evolution of the EMR and applications centered toward favorable outcomes. The role of the informatic nurse has changed with the evolution of healthcare redefining roles and forms, it is not consistent and will change as healthcare evolves (Nagle, Sermeus, Junger, & Bloomberg, 2017). Nurses will continue to play a profound role in the development of EMR and other tools available to provide safe and effective patient care.

                                                                                                                 References

How Nurses Are Using Health Informatics to Improve Patient Care. (2018). Retrieved from https://electronichealthreporter.com/nurses-using-health-            informatics-improve-patient-care/

Nagle, L. M., Sermeus, W., Junger, A., & Bloomberg, L. S. (2017). Evolving Role of the Nursing Informatics Specialist []. Forecasting Informatics                             Competencies for Nurses in the Future of Connected Health, 212-221. https://doi.org/doi:10.3233/978-1-61499-738-2-212

Sweeney BSN, N, J. (2017). Healthcare Informatics [Entire issue]. Online Journal of Nursing Informatics (OJNI), 21(1). Retrieved from                             https://www.himss.org/library/healthcare-informatics

Respond using one or more of the following approaches:

Ask a probing question, substantiated with additional background information, and evidence.

    Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.

    Validate an idea with your own experience and additional sources.

    Make a suggestion based on additional evidence drawn from readings or after synthesizing multiple postings.

    Expand on your colleagues’ postings by providing additional strategies for addressing barriers to EBP based on readings and evidence.

                                                          INITIAL POST

            Evidence-based practice is the standard that guides clinical practices within the nursing profession. Adams (2010) asserts that evidence-based practice “is defined as the integration of best research evidence with clinical expertise and patient values to facilitate clinical decision making” (Adams, 2010, p. 274). Polit and Beck (2017) maintain that there is no consensus about what does or does not constitute evidence. There are, however, agreed upon sources of evidence which exist within a hierarchy. Systematic reviews are at the pinnacle because information is derived from multiple sources.  Randomized controlled trials are next, followed by cohort studies, single case-control studies, cross-sectional studies, qualitative studies, and finally expert opinion reports. Knowledge translation is the process of using evidence to evoke systemic change within the clinical practice (Polit & Beck, 2017).

Managing Delirium

While working on a busy surgical floor, I was caring for a confused, combative, elderly patient with a urinary tract infection who had fallen and broken her hip. During report, the night shift nurse told me that she gave the patient multiple doses of haloperidol and lorazepam which were ineffective. The patient continued to be confused and agitated, and because she was a danger to herself by continually trying to get out of bed, the night shift nurse obtained an order for soft restraints. Springer (2015) contends that the nurse should determine if the utilization of restraints is appropriate based on the patient’s current behavior, and should only be used when all other options such as distraction and de-escalation are exhausted (Springer, 2015). Because I was not there, I must assume that the nurse used evidence-based practice to decide that the restraints were necessary.

When I went in to assess the patient, she was sleeping; and in my professional opinion, the restraints were no longer appropriate. I removed the soft restraints and put the patient on one to one observation with a nursing assistant. Not long into the shift, the light for that room came on, and I heard staff in the patient’s room yelling. I walked in to find the patient screaming and striking the nursing assistant as he was attempting to change the patient. It was clear that the patient was still experiencing acute delirium. However, the television was on, the blinds were open, and every light in the room was on. Instead of using a chemical or physical restraint, I turned off the television, lights, and closed the blinds. I sat down beside the patient, spoke softly and attempted to reorient her. Although she was still confused, she was calm.

Bull (2015) asserts that nursing interventions to manage delirium include providing a therapeutic environment, frequent re-orientation, anticipating the patient’s needs, ensuring sensory assistance devices such as glasses or hearing aids are in use, observing the patient’s response, and proceeding accordingly. Non-invasive interventions should be exhausted prior to restraining a patient chemically or physically (Bull, 2015). In this case, the patient responded to non-invasive interventions. I continued to use the one to one observation to ensure safety throughout the shift but did not need to escalate to using chemical or physical restraints. By implementing evidence-based practice, I kept the patient safe without using restraints.

Background and PICOT Question

    Background questions are broad, generalized questions that focus on a clinical issue (Polit & Beck, 2017). In this case, my background questions would be: what is delirium? And, what causes delirium? The acronym PICOT (population, intervention, comparison, outcome, and time) is a format used to create a research question with the subsequent goal of finding evidence-based solutions to implement into clinical practice (Polit & Beck, 2017). My PICOT question is: in delirious patients (population), what are the effects of non-invasive management techniques (intervention), compared to restraints (comparative intervention), on patient experience (outcome) and does either intervention increase or decrease the recovery period (time)?

Organizational Critique

I work as a float nurse in my organization, with previous experience in critical care. As a float nurse, I have a unique perspective on organizational culture because I work in multiple units. Overall, my organization does facilitate a culture of safety that promotes an environment where nurses learn from mistakes and do not place blame on one another. Written policies and procedures are easily accessible on the intranet. Moreover, my organization utilizes nursing shared governance which has a special committee devoted to practices and standards. Nurses are encouraged to bring practice issues to members of shared governance, and clinical practices are continually being updated and reviewed. If a nurse has an immediate question about a clinical practice situation, Clinical Nurse Specialists are available as a resource in addition to written policies and procedures.

Organizational Barriers

            Majid et al. (2011) report that most nurses have positive attitudes about evidence-based practice. However, some barriers which reduce the utilization of evidence-based practice include inadequate time to learn and implement evidence-based practice; nurses lack understanding of statistical terminology and research jargon, and technological deficiencies which inhibit informational searches (Majid et al., 2017). I believe that inadequate time is the primary barrier to evidence-based practice implementation within my organization. Time is finite, and working 12-hour shifts means nurses do not want to stay in late or come in early for any type of training. I propose that team nursing would provide individual nurses with the opportunity to attend training during regular working hours. Dickerson and Latina (2017) maintain that team nursing is the practice of nurses working in pairs to deliver patient care. A pair of nurses make up a team; both nurses get report on all patients shared by the team, Then, when one nurse needs to step away for a break, or in this case for training, their partner is already ready to take care of their patients.  

References

Adams, J. S. (2010). Utilizing evidence-based research and practice to support the infusion alliance. Journal of Infusion Nursing,33(5), 273-277. doi:10.1097/nan.0b013e3181ee037e

Bull, M. J. (2015). Managing delirium in hospitalized older adults. American Nurse Today,10(10). Retrieved from https://www.americannursetoday.com/managing-delirium-hospitalized-older-adults/.

Dickerson, J., & Latina, A. (2017). Team nursing. Nursing,47(10), 16-17. doi:10.1097/01.nurse.0000524769.41591.fc

Majid, S., Foo, S., Luyt, B., Zhang, X., Theng, Y., Chang, Y., & Mokhtar, I. A. (2011). Adopting evidence-based practice in clinical decision making: Nurses perceptions, knowledge, and barriers. Journal of the Medical Library Association : JMLA,99(3), 229-236. doi:10.3163/1536-5050.99.3.010

Polit, D. F., & Beck, C. T. (2017). Nursing research generating and assessing evidence for nursing practice. Philadelphia: Wolters Kluwer.

Springer, G. (2015). When and how to use restraints. American Nurse Today,10(1). Retrieved from https://www.americannursetoday.com/use-restraints/.

 

                                                                  Article Critique

Directions: For this assignment, you will select and critique one article from a popular media source (e.g., newspaper, magazine, news journal, etc.) that provides information regarding a health disparity within a population group and complete the questions below. 

Please make sure to use complete sentences when answering each question. 

Make sure the health disparity is different from your research assignment.

 

In addition, the article must have been published within the last 2 years.

1)  Provide the article reference and link. (1point)

2)  What health disparity is the article highlighting? (1point)

3)  Why is this information newsworthy? How would it benefit the public health community? (3 points)

4)  What causes and factors contributed to the health disparity? (2 points)

5)  How does the health disparity affect health outcomes? (3 points)

6)  Does the article make any recommendations or suggest resources that could benefit the public? If not, what suggestions or recommendations would you suggest? (2 points)

7)  Was the article well-written? Justify your rationale? (3 points)

8)  Did it include all pertinent information? Justify your rationale? (2 points)

9)  Was there information or a perspective that the article should have included? If so, what? What else would you have like to have seen? (3 points)

Score calculation:  Total earned   / 20 x 10 =

 

There are several professional nursing organizations including the American Nursing Association (ANA), National League for Nursing (NLN), National Council State Boards of Nursing (NCSBN) and so on. These organizations work to the favor of nurses and delivered their voice to the policy makers, which makes the big impact to the nursing workforce development, health care delivery, patient outcomes and other issues of concern to the nursing profession (Minority Nurse 2017). Moreover, these nursing organizations helping nurses with their continuing education, updated research articles on specialty areas, competencies, encouraging the use of evidence-based practice, as well as many other professional and personal advantages. Many nursing organizations hold annual nursing conferences. These conferences bring nurses together from across the country, and oftentimes worldwide, to share advanced nursing education and best practice. These organizations also offer the opportunity to network with nursing colleagues from around the globe. According to Guerrieri, “Belonging to a professional nursing organization brings increased professionalism, autonomy, and self-regulation while offering additional benefits such as social interactions and peer support” (Guerrieri, 2010).

The nursing organizations work carefully and ensure that today’s nursing workforce is well prepared to meet the demands of providing high-quality health care services in an ever-changing complex and challenging health care environment. The nursing organizations and associations are critical for generating the energy, idea and positive work needed to maintain a healthy profession that advocates for the clients and nurses, and the accountability of society (Mathews, 2012). These organizations work with congress and state legislatures to have the needs of nurses and general public and changes for the betterment of both. The goals of professional nursing organization advocacy include greater nurse involvement in providing access to care, determining the scope and authority of practice, and increasing and improving the healthcare workforce. These professional organizations provide webinars, scholarly manuscripts and publish the latest advanced knowledge in a specialty area and the profession that help nurses maintain current knowledge of changes in practices and continued education in their nursing career.