EVIDENCE-BASED PROJECT PART 2: ADVANCED LEVELS OF CLINICAL INQUIRY AND SYSTEMATIC REVIEWS NURS 6052

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 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.

The 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.

By Day 7 of Week 5

Submit Part 2 of your Evidence-Based Project.

Submission and Grading Information

To submit your completed Assignment for review and grading, do the following:

Please save your Assignment using the naming convention “WK5Assgn+last name+first initial.(extension)” as the name.
Click the Week 5 Assignment Rubric to review the Grading Criteria for the Assignment.
Click the Week 5 Assignment link. You will also be able to “View Rubric” for grading criteria from this area.
Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK5Assgn+last name+first initial.(extension)” and click Open.
If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
Click on the Submit button to complete your submission.

A Sample Answer For the Assignment: EVIDENCE-BASED PROJECT PART 2: ADVANCED LEVELS OF CLINICAL INQUIRY AND SYSTEMATIC REVIEWS NURS 6052

Title: EVIDENCE-BASED PROJECT PART 2: ADVANCED LEVELS OF CLINICAL INQUIRY AND SYSTEMATIC REVIEWS NURS 6052

The researchers systematically search, appraise, and summarize all available literature for a particular topic. Consequently, only the best and relevant evidence is provided.

The approach used to search and select the research articles minimizes bias resulting in reliable and accurate conclusions.

EVIDENCE-BASED PROJECT PART 2 ADVANCED LEVELS OF CLINICAL INQUIRY AND SYSTEMATIC REVIEWS NURS 6052

A systematic review sums up findings from various studies, and thus the information is easier to read and understand.

Systematic reviews provide precise estimates of interventions that benefit clinical research. For instance, a systematic review can provide accurate results on the outcomes of cognitive training in AD patients.

When used in clinical research, they reveal gaps in knowledge, which informs future research studies.

Clinical Issue of Interest

Clinical issue- Central line bloodstream infection
A lab-confirmed bloodstream infection
It affects patients with central line catheters
CDC estimate about 41,000 CLABSI annually
Contributes to: prolonged hospital stays
High patient care costs & mortality
Prevention: Aseptic techniques, surveillance, & management

Central line bloodstream infection (CLABSI) is my chosen clinical issue of interest. It is a laboratory-confirmed bloodstream infection not associated with an infection at another site, which occurs within 48 hours of a central line placement (Bell & O’Grady, 2017). CLABSI affects hospitalized patients with central line catheters. It occurs when microorganisms enter a patient’s central line and then into their bloodstream.

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CLASI is an issue of interest since the CDC estimates that about 41,000 bloodstream infections are caused by contaminated central lines in U.S. hospitals annually (Bell & O’Grady, 2017). Besides, it contributed to prolonged hospital stays and increased patient care costs and mortality. Nevertheless, most CLABSI cases can be prevented through appropriate aseptic techniques, surveillance, and management interventions (Bell & O’Grady, 2017). The CDC and Infectious Diseases Society of America (IDSA) have developed CLABSI prevention guidelines during central line insertion and maintenance.

PICO

In hospitalized patients with central lines, does daily chlorhexidine baths compared with daily bath with regular soap and water decrease the incidence of CLABSI infections during the hospital stay?

Developing the PICO Question

Identified population of interest- patients with central line
Researched for an EBI from peer-reviewed articles
Intervention- use of daily chlorhexidine baths
Comparison intervention- bath with regular soap and water
Indentified outcome- decreasing CLABSI infections

Research Databases

I used several research databases to search peer-reviewed articles on interventions effective in addressing CLABSI among hospitalized patients. The databases include:

PubMed, MEDLINE, Cochrane Library, and CINAHL Plus.

Peer-Reviewed Articles

Musuuza, J. S., Guru, P. K., O’Horo, J. C., Bongiorno, C. M., Korobkin, M. A., Gangnon, R. E., & Safdar, N. (2019). The impact of chlorhexidine bathing on hospital-acquired bloodstream infections: a systematic review and meta-analysis. BMC infectious diseases, 19(1), 1-10. https://doi.org/10.1186/s12879-019-4002-7

Reyes, D. C. V., Bloomer, M., & Morphet, J. (2017). Prevention of central venous line-associated bloodstream infections in adult intensive care units: a systematic review. Intensive and Critical Care Nursing, 43, 12-22. https://doi.org/10.1016/j.iccn.2017.05.006

Reynolds, S. S., Woltz, P., Keating, E., Neff, J., Elliott, J., Hatch, D., … & Granger, B. B. (2021). Results of the Chlorhexidine Gluconate Bathing implementation intervention to improve evidence-based nursing practices for prevention of central line-associated bloodstream infections Study (Changing Baths): a stepped wedge cluster randomized trial. Implementation Science, 16(1), 1-16. https://doi.org/10.1186/s13012-021-01112-4

Scheier, T., Saleschus, D., Dunic, M., Fröhlich, M. R., Schüpbach, R., Falk, C., … & Schreiber, P. W. (2021). Implementation of daily chlorhexidine bathing in intensive care units for reduction of central line-associated bloodstream infections. Journal of Hospital Infection, 110, 26-32. https://doi.org/10.1016/j.jhin.2021.01.007

Levels of Evidence

Musuuza et al. (2019)- Level I evidence
Reyes et al. (2017)- Level I evidence
Reynolds et al. (2021)- Level II evidence
Scheier et al. (2021)- Level III evidence

Musuuza et al. (2019) is a level I evidence article. It employs a systematic review and meta-analysis of randomized controlled trials, cluster-randomized trials, and quasi-experimental studies.

Reyes et al. (2017) is a level I evidence. It conducted a systematic review of Randomized controlled trials and observational studies.

Reynolds et al. (2021) is a level II evidence article since it uses evidence from a stepped wedge cluster randomized trial.

Scheier et al. (2021) is a level III evidence article since it uses evidence obtained from well-designed controlled trials but without randomization.

Strengths of Using Systematic Reviews for Clinical Research

Minimizes bias- reliable & accurate conclusions
Information is easier for the reader to understand
Produce reliable estimates on interventions’ impact
Disclose where knowledge is lacking
Save time for research discoveries & implementation
Increase generalizability & consistency of outcomes

Systematic reviews concentrate on a specific clinical question and carry out an extensive literature search to discover studies with sound methodology (Møller et al., 2018).

Advantages of using systematic reviews in clinical research include:

The method employed to find and select the studies minimizes bias and thus highly likely to lead to reliable and accurate conclusions (Møller et al., 2018).
Systematic reviews sum up findings from multiple studies, making the information easier for the reader to understand.
They abide by a strict scientific design founded on explicit, pre-specified, and reproducible methods. Consequently, they produce reliable estimates about the impact of interventions to make defensible conclusions (Møller et al., 2018).
They disclose where knowledge is lacking, which guides future clinical research.
They save time used in research discoveries and implementation (Møller et al., 2018).
Systematic reviews also increase the generalizability and consistency of outcomes.

References

Bell, T., & O’Grady, N. P. (2017). Prevention of Central Line-Associated Bloodstream Infections. Infectious disease clinics of North America, 31(3), 551–559. https://doi.org/10.1016/j.idc.2017.05.007

Møller, M. H., Ioannidis, J. P., & Darmon, M. (2018). Are systematic reviews and meta-analyses still useful research? We are not sure. Intensive Care Medicine, 44(4), 518-520. https://doi.org/10.1007/s00134-017-5039-y

A Sample Answer 2 For the Assignment: EVIDENCE-BASED PROJECT PART 2: ADVANCED LEVELS OF CLINICAL INQUIRY AND SYSTEMATIC REVIEWS NURS 6052

Title: EVIDENCE-BASED PROJECT PART 2: ADVANCED LEVELS OF CLINICAL INQUIRY AND SYSTEMATIC REVIEWS NURS 6052

Introduction

The provision of safe, high quality and efficient care in nursing is important for the health and wellbeing of the patients. Often, nurses utilize practice interventions such as patient centeredness and evidence-based practices to ensure that the care needs of the patients are met. They also use the interventions to minimize the risk of occurrence of safety and quality issues in patient care. An example is the use of best practice interventions to ensure that the risk of medication errors in nursing practice is reduced. Despite the efforts adopted by nurses to ensure safety and quality, institutional and provider factors may still predispose patients to unintended safety and quality issues. For example, provider factors such as burnout due to the influence of institutional factors such as staff shortage may threaten the safety and quality of patient care. Therefore, this presentation examines the proposed intervention that can be used to reduce and prevent burnout among registered nurses.

Selected Clinical Issue

The selected clinical issue that relates to nursing practice is burnout among nurses. Burnout has been defined as the consequence of prolonged, persistent and chronic exposure of nurses to work-related stressors. The prolonged exposure to work stressors result in depersonalization, exhaustion, and reduced personal accomplishments. Nurses affected by burnout experience challenges in undertaking their clinical roles due to low levels of motivation and job satisfaction. Burnout among nurses has an adverse effect on the quality and safety of patient care (Ahola et al., 2017). For example, it increases the risk of medication errors by nurses due to lack of concentration in the care giving process. Burnout also causes low level of job satisfaction and motivation among the nurses. As a result, the rate of turnover among them increases significantly. In addition, the operational costs in healthcare organization rises due to the need for frequent hiring of new staffs to replace those who left the organization. Therefore, burnout among nurses should be addressed to ensure safety, quality and efficiency in healthcare organizations (Melnyk et al., 2020).

Development of PICOT

The developed question is: In acute care nurses, does the use of cognitive interventions result in the reduction of burnout levels when compared to no intervention, within eight month period?

I developed the above PICOT question through a number of steps. The first one was performing a clinical inquiry of the common issues that affect quality and safety of patient care in healthcare settings. I also utilized knowledge from my clinical experience to identify issues in practice that can be addressed by adopting evidence-based interventions. This led to the identification of the clinical issue of burnout in nursing. The second step entailed the determination of the populations that the problem affect. This led to the identification of nurses as the most prone group of professionals to be affected by burnout. The other step was performing a literature search of the databases to determine practice interventions that can be used to address the issue. This stage led to the identification of cognitive therapies as the most effective intervention to address burnout in nursing. The next step was determining a way in which I could determine the effectiveness of the intervention. As a result, I considered a comparative intervention to be no use of any approach to address the issue of burnout among nurses. I then developed the outcomes to be achieved by the implementation of the intervention and the timeline of evaluating its effectiveness.

Identified Articles

The database search led to the above articles that explore the effectiveness of cognitive interventions in reducing and preventing burnout among nurses.

´Ahola, K., Toppinen-Tanner, S., & Seppänen, J. (2017). Interventions to alleviate burnout symptoms and to support return to work among employees with burnout: Systematic review and meta-analysis. Burnout Research, 4, 1–11.

´Interventions to alleviate burnout symptoms and to support return to work among employees with burnout: Systematic review and meta-analysis. (2017). Burnout Research, 4, 1–11. https://doi.org/10.1016/j.burn.2017.02.001

´Melnyk, B. M., Kelly, S. A., Stephens, J., Dhakal, K., McGovern, C., Tucker, S., Hoying, J., McRae, K., Ault, S., Spurlock, E., & Bird, S. B. (2020). Interventions to Improve Mental Health, Well-Being, Physical Health, and Lifestyle Behaviors in Physicians and Nurses: A Systematic Review. American Journal of Health Promotion, 34(8), 929–941. https://doi.org/10.1177/0890117120920451

´Nayeri, N., Nukpezah, R., & Kiwanuka, F. (2021). Article no.AJRNH.71848 (1) Prof. Sharon Lawn, Flinders University, Australia. (2) Dr. Asmaa Fathi Moustafa Hamouda. Asian Nursing Research, 18–36.

´Zhang, X., Song, Y., Jiang, T., Ding, N., & Shi, T. (2020). Interventions to reduce burnout of physicians and nurses: An overview of systematic reviews and meta-analyses. Medicine, 99(26), e20992. https://doi.org/10.1097/MD.0000000000020992

Levels of Evidence

The study by Ahola et al., (2017) provides level I evidence. The study was a systematic review of randomized controlled trials without meta-analysis. The study by Melnyk et al., (2020) provided level I evidence too. It was a systematic review of randomized controlled trials without meta-analysis. The study by Nayeri et al., (2021) provided level III evidence. It was a systematic review of a combination of quasi-experimental, randomized controlled trials, and non-experimental studies. It also lacked meta-analysis. The study by Zhang et al., (2020) provided level II evidence. The study was a systematic review of quasi-experimental and randomized controlled trials with meta-analysis.

Strengths of Using Systematic Reviews

One of the strengths of using systematic reviews is the transparency in its processes. The processes of each of the phases of a systematic review are transparent, increasing the trust towards the obtained findings. Transparency also enables readers to determine the merits and demerits of the decisions that the authors made in synthesizing the data. The other benefit of using systematic reviews is that they provide comprehensive review of a topic. The use of multiple sources of data on a topic increases the relevance and implications of the data reported in a systematic review. The review of multiple studies also assists in the identification of gaps in research and practice. As a result, nurses can use the information from systematic reviews to inform their future research and practice. The last strength of systematic reviews is that it provides highly reliable results. The results have minimum bias due to the transparency in methods used. The focus on the results obtained in multiple studies also eliminates potential threats to validity and reliability of the obtained results.

References

Ahola, K., Toppinen-Tanner, S., & Seppänen, J. (2017). Interventions to alleviate burnout symptoms and to support return to work among employees with burnout: Systematic review and meta-analysis. Burnout Research, 4, 1–11.

Interventions to alleviate burnout symptoms and to support return to work among employees with burnout: Systematic review and meta-analysis. (2017). Burnout Research, 4, 1–11. https://doi.org/10.1016/j.burn.2017.02.001

Melnyk, B. M., Kelly, S. A., Stephens, J., Dhakal, K., McGovern, C., Tucker, S., Hoying, J., McRae, K., Ault, S., Spurlock, E., & Bird, S. B. (2020). Interventions to Improve Mental Health, Well-Being, Physical Health, and Lifestyle Behaviors in Physicians and Nurses: A Systematic Review. American Journal of Health Promotion, 34(8), 929–941. https://doi.org/10.1177/0890117120920451

Nayeri, N., Nukpezah, R., & Kiwanuka, F. (2021). Article no.AJRNH.71848 (1) Prof. Sharon Lawn, Flinders University, Australia. (2) Dr. Asmaa Fathi Moustafa Hamouda. Asian Nursing Research, 18–36.

Zhang, X., Song, Y., Jiang, T., Ding, N., & Shi, T. (2020). Interventions to reduce burnout of physicians and nurses: An overview of systematic reviews and meta-analyses. Medicine, 99(26), e20992. https://doi.org/10.1097/MD.0000000000020992