EVIDENCE-BASED PROJECT PART 3: CRITICAL APPRAISAL OF RESEARCH NURS 6052

Sample Answer for EVIDENCE-BASED PROJECT PART 3: CRITICAL APPRAISAL OF RESEARCH NURS 6052 Included After Question

Realtors rely on detailed property appraisals—conducted using appraisal tools—to assign market values to houses and other properties. These values are then presented to buyers and sellers to set prices and initiate offers.

Research appraisal is not that different. The critical appraisal process utilizes formal appraisal tools to assess the results of research to determine value to the context at hand. Evidence-based practitioners often present these findings to make the case for specific courses of action.

In this Assignment, you will use an appraisal tool to conduct a critical appraisal of published research. You will then present the results of your efforts.

To Prepare:

Reflect on the four peer-reviewed articles you selected in Module 2 and the four systematic reviews (or other filtered high- level evidence) you selected in Module 3.
Reflect on the four peer-reviewed articles you selected in Module 2 and analyzed in Module 3.
Review and download the Critical Appraisal Tool Worksheet Template provided in the Resources.

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.

By Day 7 of Week 7

Submit Part 3A and 3B 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 “WK7Assgn+last name+first initial.(extension)” as the name.
Click the Week 7 Assignment Rubric to review the Grading Criteria for the Assignment.
Click the Week 7 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 “WK7Assgn+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 3: CRITICAL APPRAISAL OF RESEARCH NURS 6052

Title: EVIDENCE-BASED PROJECT PART 3: CRITICAL APPRAISAL OF RESEARCH NURS 6052

A critical appraisal assists in reducing the research burden by enabling a researcher to identify and focus more on relevant articles to their research question. The research can either provide support or disapprove the claims made by the researcher through the utilization of quality, and evidence-based practice interventions. The selected topic for the research study is use of resilience training to redice the problem of nurse burnout among nurses in different care settings. Nurse burnout remains a critical problem that impacts the quality of care and patient outcomes in different care setting. Resilience training allows nurses to develop and use evidence-based interventions to reduce burnout and enhance their overall performance and improve the quality of care.

Evidence-based practice (EBP) incorporates best practices from studies and patient care information with clinician experience and patient preferences leading to the delivery of highest quality of care, and improving patient outcomes. The use of EBP requires care providers to formulate a clinical question of interest. In this case, the PICOT question is: Among nurses with burnout (P), does resilience training (I) compared to no intervention (C) reduce burnout(O) in six months (T)? The purpose of this assignment is to appraises critically peer-reviewed article for evidence to support resilience training among nurses with burnout to reduce its prevalence.

Critical Appraisal

There is an overwhelming volume of clinical research articles that have been published over time. These papers have both similarities and differences in terms of their content, objectives, timelines, authors, methodologies, findings among other aspects. This brings difficulties for those browsing medical literature for the most relevant and helpful papers for their varied reasons. Critical Appraisal is one of the ways through which this problem can be navigated. With Critical Appraisal, research papers can be examined critically and systematically to determine their integrity, relevance, and value (Morrison, 2017). This is achieved by examining factors such as internal validity, how the study was conducted, methodology among other aspects. This paper will give an example of a critical appraisal of two qualitative research studies for a better understanding of the process.

Example 1

The first article is The perceptions and perspectives of patients and health care providers on chronic disease management in rural South Africa: a qualitative study authored by Eric Maimela, Jean-Pierre Van Geertruyden, Marianne Alberts, Sewela Modjadji, Herman Meulemans, Jesicca Fraeyman, and Hilde Bastiaens in 2015. The paper was conducted in Limpopo province in South Africa to find out and describe the perceptions and perspectives of patients and health care providers on chronic disease management. The authors report that the burden of chronic diseases is increasing worldwide. This problem is commonly addressed by chronic disease management interventions that have been developed over time. The problem is further compounded by other factors such as patients’ and physicians’ perceptions, which influence the implementation and the success of the interventions. However, the exact perception of patients and health care providers on these interventions which can either motivate or hinder their participation, successful implementation, and outcomes has not been fully established in South Africa. To address this issue, the authors developed two questions to answer;

First, how do individuals with distinct chronic diseases experience their encounters with professional health care providers (HCP) and what are their expectations and suggestions?

And secondly, how do HCP perceive the current CDM and what are their expectations and suggestions for the future CDM?

These questions and the purpose of the paper show greater relevance to the problem. This is because they will unravel how perceptions have contributed to the growing prevalence of chronic diseases in the world and how such knowledge can be used to address the situation.

The study employed focus group discussion with both patient and health care providers and the data called was audio recorded. This offered an adequate method of discussing the perceptions of both patients and nurses concerning the topic exhaustively. The authors have enriched the paper with both qualitative and quantitative research papers to develop and justify their assertions. Few of the references date back to the early 2000 and late 1990s while most of them are between 2007 and 2014. They develop a strong case through the use of available literature stating limited information as the only weakness they found. They develop no framework from their findings.

Execution of the research followed the due ethical considerations by seeking approval of the University of Limpopo Medunsa Research Committee and the Department of Health in Limpopo Province before the start. The results show that what clinicians practice is different from what is documented in research interventions. Additionally, it reports that what clinicians recommend to patients is different from what patients do at home. This is because both nurses and patients hold different perspectives and perceptions on the interventions and also, different interventions apply only to different communities, cultures, and patients. Such dynamics interfere with the success and effectiveness of the interventions. With this knowledge, health care providers can employ the most appropriate intervention and make necessary adjustments to the available ones to maximize the expected outcomes. As such, the research study relevantly answered the research questions and achieved its objectives.

Example 2

The second article is Patient perceptions of patient-centered care: empirical test of a theoretical model authored by Cheryl Rathert,

EVIDENCE-BASED PROJECT PART 3 CRITICAL APPRAISAL OF RESEARCH NURS 6052

Eric S. Williams, Deirdre McCaughey, and Ghadir Ishqaidef in 2015. The study aimed to determine the perceptions of patients concerning patient-centered care from the care they receive. The authors identify patient-centered care as an important contributor to positive clinical outcomes and patient satisfaction. Most hospitals do not offer patient-centered care but disease‐ or physician‐centered kinds of care. Patient-centered care should be offered in the manner and time required by the patients. Some nurses who think they do this confused it with process-centered care. The study, therefore, aims to establish the fact by applying the theoretical model of the Picker Institute and the IOM to collect patient perceptions data on various dimensions of patient-centered care. They tend to establish how such perceptions influence patients’ ratings of care. The authors enroot their argument on the available literature and the fact that the Picker Institute theoretical model has not been tested as a unified model to justify their approach. To achieve their objective, the authors developed two research questions;

Are the theoretical dimensions of patient‐centered care predictive of overall quality of care ratings?

Is each of the theoretical dimensions equally predictive of overall quality of care ratings?

These questions and objectives are relevant to the study questions because the will directly determine how patients’ perceptions on patient-centered care influence their understanding of care quality. It will also tell whether care ratings based on such perceptions are valid or not.

The study used questionnaires containing seven dimensions of care developed from the Picker Institute theoretical model. Participants were emailed the questionnaires to give their perceptions accordingly on a scale of 1 to 4 at most. In the end, the participants were asked to give their overall ratings and satisfaction on the care they received on a scale of 1 to 5. As such the method will adequately answer the coiled research questions. There is no specific perspective that develops the paper though the authors cite many researcher papers to support their assertions. Most of the references were published between 2012 and 2000 with only two extending into the 1990s. even though the literature reinforces the applicability of the Picker Institute theoretical model and the importance of patient-centered care, the authored reports a gap in testing the model as a unified model. No framework is developed.

The paper does not detail any ethical considerations adopted before or after the study or during data collection. The result shows that the theoretical model adopted for patient-centered care can give information that can be used to predict overall quality ratings of care. Among the seven dimensions, emotional support was found to be the top and strongest influencer of quality ratings followed by coordination of care and physical comfort. The study contributes to the possibility and necessity of incorporating patient-centered care into practice. The management can identify what is lacking from the data and provide incentives for their incorporation into practice to enhance evidence-based management for improvement of positive outcomes. The results can also direct further research by highlighting relevant areas of emphasis and interest. Therefore, the paper has achieved its objective and answered its research questions.

References

Maimela, E., Van Geertruyden, J. P., Alberts, M., Modjadji, S. E., Meulemans, H., Fraeyman, J., & Bastiaens, H. (2015). The perceptions and perspectives of patients and health care providers on chronic diseases management in rural South Africa: a qualitative study. BMC health services research, 15(1), 143.

Morrison, K. (2017). Dissecting the literature: the importance of critical appraisal. Royal college of surgeons.

Rathert, C., Williams, E. S., McCaughey, D., & Ishqaidef, G. (2015). Patient perceptions of patient‐centred care: empirical test of a theoretical model. Health Expectations, 18(2), 199-209.

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5 The clinical issue of interest is cognitive decline in patients with Alzheimer disease. 4 Cognitive decline in AD is characterized by short-term memory, language impairment, impaired reasoning, poor judgment, difficulty managing complex tasks, and visuospatial dysfunction. 5 Pharmacological therapies for AD help to slow or reverse the progression of AD but do not reverse cognitive decline. Thus, there is a major need to identify non-pharmacological approaches to improve cognitive function in the early stages of the disease before the symptoms progress. 4 The following evaluation table will analyze four peer-reviewed articles that focus on the impact of non-pharmacological approaches in improving cognitive function.

6 Full APA formatted citation of selected article.

7 Article #1 Article #2 Article #3 Article #4

5 Butler, M., McCreedy, E., Nelson, V. A., Desai, P., Ratner, E., Fink, H. A.,. & Kane, R. L. (2018). 8 Does cognitive training prevent cognitive decline? 9 A systematic review. 5 Annals of internal medicine, 168(1), 63-68. https://doi.org/10.7326/M17-1531

Hill, N. 5 T., Mowszowski, L., Naismith, S. L., Chadwick, V. L., Valenzuela, M., & Lampit, A. (2017). 10 Computerized cognitive training in older adults with mild cognitive impairment or dementia: a systematic review and meta-analysis. 5 American Journal of Psychiatry, 174(4), 329-340. https://doi.org/10.1176/appi.ajp.2016.16030360

4 Weng, W., Liang, J., Xue, J., Zhu, T., Jiang, Y., Wang, J., & Chen, S. (2019). 4 The transfer effects of cognitive training on working memory among Chinese older adults with mild cognitive impairment: 9 a randomized controlled trial. 4 Frontiers in aging neuroscience, 11, 212.

https://doi.org/10.3389/fnagi.2019.00212 Giovagnoli, A. R., Manfredi, V., Parente, A., Schifano, L., Oliveri, S., & Avanzini, G. (2017). 4 Cognitive training in Alzheimer’s disease: 11 a controlled randomized study. 4 Neurological Sciences, 38(8), 1485-1493. https://doi.org/10.1007/s10072-017-3003-9

Evidence Level *

12 (I, II, or III)

I I I I

Conceptual Framework

2 Describe the theoretical basis for the study (If there is not one mentioned in the article, say that here).**

The theoretical basis is not provided.

13 Design/Method Describe the design and how the study was carried out (In detail, including inclusion/exclusion criteria).

9 · The study conducted a systematic review of randomized controlled trials.

The authors searched Ovid MEDLINE, EMBASE, PsycINFO, and the Cochrane Central Register of Controlled Trials for pertinent literature published between January 2009 and July 2017.
Inclusion: The study included randomized trials of cognitive training interventions that enrolled adults with either normal cognition or mild cognitive impairment (MCI) if the studies:

Followed the subjects for at least 6 months;
Gave the cognitive performance or incident dementia outcomes;

iii. Were published in English.

Exclusion: Studies were excluded if they only included persons diagnosed with dementia.

9 · Systematic review and meta-analyses of randomized controlled trials.

14 · The researchers searched Embase, Medline, PsychINFO, CINAHL, and CENTRAL through July 1, 2016, for RCTs of computerized cognitive training (CCT) in older adults with mild cognitive impairment (MCI) or dementia.

Inclusion: RCT studies with at least 4 hours of drill and practice; with a clear cognitive rationale; videogames, or virtual reality. 15Studies combining CCT with other interventions were included if the control group received the same adjacent intervention.
Exclusion: RCT studies were excluded if less than 50% of the cognitive intervention was CCT or not involving interaction with a computer.

4 · Design- Randomized control trial.

Enrolled subjects (N = 65) were randomly grouped to a cognitive training group (N = 33) or a control group (N = 32).
Inclusion criteria

Age ≥60 years old.
No significant visual or auditory impairment.

iii. The Montreal Cognitive Assessment (MoCA, <26 when education level >12 years or MoCA <25 when education level ≤12 years).

Meets the MCI diagnostic criteria of the NINCDS-ADRDA.
Informed and freely to give informed consent.

Exclusion criteria:

Meets the dementia diagnostic criteria of DSM-V and NINCDS-ADRDA.
On antipsychotics, or have stopped for less than 3 months.

iii. Taking part in other cognitive training projects.

Declined to participate in the study.

4 Design- Randomized control trial.

Inclusion criteria:

Mild to moderate dementia MMSE score >15)
Probable AD

iii. Impairment in memory or executive functions

Schooling ≥5 years
Informed consent

Exclusion criteria:

11Severe hearing or visual impairment
Aphasia

iii. Unilateral spatial neglect

Stroke
Epilepsy
Traumatic brain injury

vii. History of psychosis, major depression, bipolar disorder, or substance abuse.

Sample/Setting

2 The number and characteristics of

patients, attrition rate, etc.

The researchers identified 35 publications of 34 unique RCTs of cognitive training interventions. 11 of the publications had medium or low risk of bias (5– 16).
The mean age of study subjects’ was ≥60 years old, with a diagnosis of MCI or dementia (of any etiology), confirmed by assessing the inclusion criteria or baseline scores against standardized diagnostic criteria.
Sixty-two participants with MCI above 60 years old were recruited.
Setting- Communities in China.
Sample- 39 AD patients.
Setting- Participants were recruited at one center.

2 Major Variables Studied

16 List and define dependent and independent variables · Dependent variables- cognitive performance and incident dementia · Independent variables- Cognitive training.

Dependent variables- cognition and behavior.

17 · Independent variables- Computerized cognitive training.

Dependent variables- working memory, execution function, reasoning ability, verbal ability, and ability of daily living.
Independent variables- Cognitive training · Dependent variables- initiative, episodic memory, mood, and social relationships.
Independent variables- cognitive training.

Measurement

2 Identify primary statistics used to answer clinical questions (You need to list the actual tests done).

Mean- MMSE Scores · Pooling of standardized mean differences across studies was conducted using a random-effects model.
Egger’s test of the intercepts was utilized to formally test asymmetry.
The Duval and Tweedie trim and fill was utilized to quantify the magnitude of small study effect.
ANCOVA was used to test the training effect. The data of cognitive assessments (T2) was the dependent variable, and the grouping condition was the independent variable while controlling for age, gender and baseline data (T0).
Separate paired sample t tests examined the results of other neuropsychological test, setting significance as p < 0.003 for 15 comparisons.

2 Data Analysis Statistical or

18 Qualitative findings (You need to enter the actual numbers determined by the statistical tests or qualitative data).

The study analyzed and reported cognitive test results by direction of effect and statistical significance.
Analyses were conducted for overall cognitive outcomes and for each cognitive or behavioral domain independently.
Data were analyzed by IBM SPSS and 21.0 and Mplus Version 8.2.
The independent-sample t-test and χ2 test were utilized to compare the baseline data of the cognitive training group with that of the control group.
Multiple stepwise regression analysis, entering age, schooling, group membership, and baseline test scores.

2 Findings and Recommendations

General findings and recommendations of the research · For healthy older adults, cognitive training enhanced cognitive performance in the trained domain but not in other domains, this had moderate-strength evidence.

Results for individuals with MCI showed no effect of training on performance.
There was insufficient evidence on the impact of cognitive training on prevention of cognitive decline or dementia.
The study recommends that patients be provided education on how to interpret advertising for cognitive training programs and products.
The study established that CCT is efficacious on global cognition, some cognitive domains, and psychosocial functioning in persons with MCI.
Authors recommend longer-term and larger-scale trials to assess the effects of CCT on conversion to dementia.
Compared to mental leisure activities (MLA), subjects in the cognitive training group demonstrated significant effects in both the trained (working memory) and untrained (execution function and ability of daily living) domains.

10 · The study recommends cognitive training in elderly persons with MCI to improve their working memory.

The study showed that in persons with mild to moderate AD, a defined cognitive training was associated with improved or stabilized initiative and episodic memory compared to non-cognitive therapies such as AMT and NE.
The study recommends the use of cognitive training and non-cognitive treatments to improve mood in AD patients.

2 Appraisal and Study Quality

Describe the general worth of this research to practice.

What are the strengths and limitations of study?

What are the risks associated with implementation of the suggested practices or processes detailed in the research?

What is the feasibility of use in your practice?

The research is of minimal worth since it does not offer sufficient evidence on whether cognitive training decreases the risk for future MCI or dementia.
It does not provide enough evidence for health care providers to support or encourage any particular cognitive training to lower the risk for cognitive decline or onset of dementia.
Strengths: The researchers only analyzed studies with low or medium risk of bias which reduces the potential for publication bias.
Limitations: Outcomes mostly evaluated test performance instead of global function or dementia diagnosis.
The risk of implementing cognitive training on patients with MCI is that it may have no impact in reducing the risk for cognitive decline or reducing the risk of developing dementia.
Feasibility: Cognitive training can easily be implemented in my practice since we provide care to older adults who need cognitive training to improve performance in the aspect of training.
CCT can be applied in clinical practice on patients with MCI to improve their cognition, memory, working memory, and attention. It can also be used to enhance psychosocial functioning and depressive symptoms in dementia patients.
Strengths: The study compared effect size estimates and precision in active- and passive-controlled trials.
Limitations: Functional outcomes were measured primarily using proxy measures that are prone to multiple-source bias.
Risks: Implementing CCC can be associated with lack of improved cognition or function in dementia patients.
Feasibility: CCT is feasible for use in my practice since we have embraced the use of technology among the staff and our patients. Patients with MCI can thus be provided with CCT interventions to enhance cognition.
The research is useful to clinical practice as it shows that cognitive training can be used in patients with MCI to improve cognitive function, working memory and daily life ability of daily living.
Strengths: The study employed a randomized control study, which helped to compare the impact of two treatment modalities (Cognitive training and mental leisure activities).
Limitations: The study used a small sample size and most of the subjects were female, which limits generalizability.
Risks: Implementing cognitive training can have a transfer effect on execution function.
Feasibility: The cognitive training programs can easily be implemented in our practice on AD patients.
The research is useful to clinical practice as it proves that combining cognitive training and non-cognitive therapies may have useful clinical implications.
Strengths: The study employed a randomized control study, which helped to compare the impact of two treatment modalities (Cognitive training vs. AMT and NE).
Limitations: There was a failure to control for multiple comparisons comparatively to the sample size.
Risks: Implementing cognitive training can have a transfer effect on execution function.
Feasibility: The cognitive training programs can easily be implemented in our practice on older adults with MCI.

Key findings

In older adults with supposed normal cognition, cognitive training seemed to provide some degree of protection against reducing performance in the domain of training but no broader cognitive or functional benefit.
Cognitive training enhances cognitive test performance in otherwise healthy older adults, for the domain trained.
Small- moderate effects were exhibited for global cognition, working memory, attention, learning, and memory, except nonverbal memory.
There was an impact in psychosocial functioning, including depressive symptoms.
In dementia, significant effects were seen in overall cognition and visuospatial skills, · The study revealed that the impact of cognitive training on overall cognitive function, working memory and daily life ability of daily living of MCI can be maintained for at least 3 months.
Complete mediating effects of cognitive training were found in executive function through working memory and working memory in ability of daily living though executive function.
At the end of the cognitive training, initiative significantly improved, while, at the end of active music therapy (AMT) and neuro-education (NE), it was unchanged. Episodic memory had no changes at the end of cognitive training or AMT and worsened after NE.

Outcomes

Inadequate evidence on whether cognitive training decreases the risk for future

MCI or dementia.

15 · Subjects in the CCT groups improved significantly over the intervention period, while those in the control group did not exhibit any cognitive change.

Cognition training had a high level of acceptance in the in-home MCI older adults in urban communities.
The compliance in the cognitive training process was satisfactory.
Mood and social relationships improved in the three groups, with greater changes after active music therapy (AMT) or neuro-education (NE).

General Notes/Comments · Cognitive training can be incorporated as part of health promotion interventions in healthy older adults to improve their cognitive test performance.

10 · CCT is a practical intervention for improving cognition in individuals with mild cognitive impairment.

Cognitive training can effectively improve working memory in older adults with MCI.
In patients with mild to moderate AD, cognitive training can enhance patients’ initiative and stabilize memory, while the non-cognitive measures can improve the psychosocial aspects.

1 Evidence-Based Project Part 3 B: 2 Critical Appraisal of Research

The critical appraisal of research has revealed that cognitive training effectively improves cognitive function in persons having mild cognitive impairment (MCI) and dementia. Cognitive training can also improve cognitive performance in older patients since they have a high risk of cognitive decline. MCI often precedes dementia. It is characterized by mainly normal functions in spite of objective evidence of cognitive decline. MCI is a major risk factor for dementia, falls, and high healthcare costs. The risk increases relatively with impaired cognitive domains and severity of symptoms. Cognitive training is the best practice that emerges from the research analysis. 5 Butler et al. (2018) revealed that cognitive training improved cognitive performance in healthy elderly persons. Therefore, it the training be incorporated in the preventative care of older adults to lower the risk of declined cognitive function, which is common in advanced age.

Cognitive training can be implemented using technology computerized cognitive training (CCT). 10 Hill et al. (2017) demonstrated CCT as an effective and safe approach for promoting cognitive function in the elderly. Besides, CCT value has been established in improving cognition and psychosocial functioning, including alleviating depression and neuropsychiatric symptoms and improving the quality of life of individuals MCI. Furthermore, Weng et al.’s (2019) study shows that cognitive training significantly impacts the domains of executive function, memory, and performance of ADLs. The impact on these domains can be sustained for at least three months. It can convey to other untrained areas, including executive function. Executive function also enhances the ability to carry out ADLs. The study justifies cognitive training as a practical approach to enhance working memory in elderly persons having MCI. 4 Giovagnoli et al. (2017) further show that cognitive training is useful in increasing initiative and stabilizing memory in persons with mild-moderate AD.

Conclusion

The above peer-reviewed articles include two systematic reviews of randomized controlled trials and Randomized control trials. 4 The studies sought to evaluate the impact of cognitive training in improving cognitive function in AD patients. They support my PICOT by establishing that indeed cognitive training is a feasible intervention that can improve cognitive function in AD patients. Therefore, the interventions can be incorporated in patients’’ treatment plans.

References

Giovagnoli, A. 4 R., Manfredi, V., Parente, A., Schifano, L., Oliveri, S., & Avanzini, G. (2017). 4 Cognitive training in Alzheimer’s disease: 11 a controlled randomized study. 4 Neurological Sciences, 38(8), 1485-1493. https://doi.org/10.1007/s10072-017-3003-9

6 Critical Appraisal Tool Worksheet Template

Full APA formatted	Article #1	Article #2	Article #3	Article #4
citation of selected article	Wang, Q. Q., Lv, W. J., Qian, R. L., & Zhang, Y. H. (2019). Job burnout and quality of working life among Chinese nurses: A cross‐sectional study. Journal of Nursing Management, 27(8), 1835-1844. https://doi.org/10.1111/jonm.12884	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	Brook, J., Aitken, L. M., MacLaren, J. A., & Salmon, D. (2021). An intervention to decrease burnout and increase retention of early career nurses: A mixed methods study of acceptability and feasibility. BMC Nursing, 20(1), 1-12. https://doi.org/10.1186/s12912-020-00524-9	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.2018.428

Evidence Level *

(I, II, or III)

III

Conceptual Framework

Describe the theoretical basis for the study (If there is not one mentioned in the article, say that here).**

Not provided

Not mentioned

Behavioral change involving use of interventions like cognitive realignment, mindfulness and psychological skills training

Behavior change through increased resiliency training and interventions to improve coping mechanisms.

Design/Method

Describe the design and how the study was carried out (In detail, including inclusion/exclusion criteria).

Cross-sectional survey where 2504 nurses participated in Eastern China. The researchers invited nurses to complete self-report questionnaire online.

Systematic Review with the aims of identifying the linked personal and work-related factors of nurse resilience.

The article’s design was explanatory sequential mixed methods. The participants were final year pre-registration nursing students in a UK university and healthcare organizations.

The article used a meta-analysis to conduct the study aimed at determining the effects of resiliency on various components of nurses’ professional burnout.

Sample/Setting The number and characteristics of patients, attrition rate, etc.	The study was conducted virtually with 2504 nurses completing self-report online questionnaires	The study used data from literature review in five databases based on terms like resilience, occupation, job, nursing and work.	The sample included 74 pre-registration nursing students and 7 academics in a UK university and healthcare organizations.	The researchers used data based on targeted literature review in national and international databases in Persian and English.
Major Variables Studied List and define dependent and independent variables	Dependent-Quality of life Independent- Job burnout	Dependent Variable-Various components in nursing care Independent Variable-Job burnout	Dependent Variable-Multiple Interventions Independent-Retention of nurses	Dependent-Resiliency & burnout Independent-Conducting nursing education
Measurement Identify primary statistics used to answer clinical questions (You need to list the actual tests done).	The researchers measured the quality of working life based on different aspects like age, income and patient-nurse ratio.	The study used a total of 38 articles that met the criteria through a systematic review and narrative synthesis. The authors also used different scales leading to being unfeasible to synthesize the evidence.	Pre and Post measure of acceptability using an Acceptability Theoretical Framework	Researchers used heterogeneity to measure the results by I2 test.
Data Analysis Statistical or Qualitative findings (You need to enter the actual numbers determined by the statistical tests or qualitative data).	The study used Pearson’s correlation and multiple regression to analyze collected data.	The study used a quality assessment tool to analyze articles that met the criteria where 23 were rated as good, 15 as fair and 20 as risky due to significant levels of bias.	The researchers used the COREQ guidelines to analyze collected data in a thematic manner.	The researchers used STATA software v.14 to analyze the data.

Findings and Recommendations General findings and recommendations of the research	The findings show that close to two-thirds of nurses experienced job burnout leading to a moderate level of quality of life.	Knowing nurse resilience can assist proactively in the identification and potential issues, this fostering job resources and ultimately attaining personal and professional growth. The study recommends more research to explore resilience and develop a regular instrument to measure resilience.	The authors assert that the interventions equipped nursing students with skills and experience to attain personal endurance.	The authors assert that the meta-analysis conducted on the observational studies illustrated a correlation between resiliency and burnout with values of -0.57 at a 95% confidential interval. The authors assert that there is a relationship between resiliency and burnout and recommend the planning for the interventional and resilient training courses in nursing education.
Appraisal and Study Quality Describe the general worth of this research to practice. What are the strengths and limitations of study?	The research has significant value to practice as it shows the relationship between job burnout and the quality of life among nurses. The main strength of the study is its use cross-sectional survey where nurses from different setting accepted to have online self-report questionnaire. However, a limitation of the study could be a possible bias from the self-reporting nurses.	The study is significant as it shows the need to enhance knowledge on resilience among nurses. Therefore, it is worth for practice interventions in nursing care. The strengths of the study include its design that allows collection of a wide-range of data with various outcomes, and better outcomes that can be applied in nursing care. However, bias is significant based on the application of different outcomes from the study.	The main strength of the study is its study design and the sample selected. The design allowed them to engage both academics and nursing students on ways to enhance resilience and fight job burnout. However, a limitation is its use of the sample since it does not involve the nurses who practically handle patients.	The research is essential to practice because it demonstrates the need to incorporate resiliency education in nursing to prepare nursing students and even practitioners. A primary strength of this study is the use of systematic review and meta-analysis that allows them to collect a wide-range of data on the issue at hand. The main limitation is that the data can lead to formulation and testing of research hypotheses based on false impressions.
What are the risks associated with implementation of the suggested practices or processes detailed in the research? What is the feasibility of use in your practice?	The risk may include bias leading to misguided interventions among nurses and healthcare facilities. The feasibility of using the findings in my practice is high based on its outcomes.	The risk include misinterpretation due to possible bias. The feasibility of using the article’s findings is significant due to its outcomes and recommendations.	The risk inherent to implementation is that it may not capture the real work-life experience of burnout based on its selected sample. The study has no feasibility of being used in my practice due to its population sample as it does not capture practical nursing care situation.	The implementation of the recommended practices or processes does not have any risks except those associated with misinterpretation and possible false impression based on the multiple sources of data. The study’s findings can be used in my practice with a high feasibility based on the level of knowledge among the practitioners.
Key findings	The key findings suggest that job burnout has negative impact on the quality of nurse’s working life. The authors recommend consideration of work-associated factors to enhance nurses’ quality of life.	Key findings include the need to assist nurses establish strategies to deal with adversity and understand the impacts of job demands and research to discover nurse resilience and develop consistent tools to enhance resilience.	The findings show the need enhance endurance training for nursing students for their future career’s challenges as it will improve their ability to tackle job burnouts.	The study is emphatic that a relationship exists between resilience and nurse burnout as it demonstrates that through education, nurses can have reduced levels of burnout.
Outcomes	The outcomes suggest that a majority of nurses’ experience job burnouts that have negative effects on their working life.	The outcomes include understanding that increased nurse resilience assists nurses to reduce emotional exhaustion and enhance work engagement and function when they encounter challenges in the workplace.	The outcomes recommend feasibility of new knowledge concerning the importance of the suggested intervention to enhance resilience in dealing with nurse burnout.	The outcomes emphasize the need to plan and develop interventional approaches that enhance the level of evidence and implementation of educational training to increase nurses’ knowledge on the burnout and resiliency.
General Notes/Comments	The article is critical in enhancing understanding and the need for interventions to reduce job burnout among nurses and enhance use of evidence-based practice.	The article’s findings are essential in development of effective understanding about the effects of burnout and should be used in practice to highlight the significance of evidence-based practice interventions.	The study suggests effective use of endurance training to prepare nursing students to understand the nature of the nursing environment for better care provision.	The need to reduce burnout among nurses is essential and the article is emphatic that increased nursing education can assist in such endeavors. Therefore, the findings are critical in improving overall application of evidence-based practice interventions in different areas in nursing practice.

These levels are from the Johns Hopkins Nursing Evidence-Based Practice: Evidence Level and Quality Guide

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

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

**Note on Conceptual Framework

The following information is from Walden academic guides who helps explain conceptual frameworks and the reasons they are used in research. Here is the link https://academicguides.waldenu.edu/library/conceptualframe

A Sample Answer For the Assignment: EVIDENCE-BASED PROJECT PART 3: CRITICAL APPRAISAL OF RESEARCH NURS 6052

Title: EVIDENCE-BASED PROJECT PART 3: CRITICAL APPRAISAL OF RESEARCH NURS 6052

Nurse burnout is a leading cause of increasing rate of nurse turnover and nursing staff shortage in different care settings. The increasing demand for healthcare across the various demographics implores healthcare providers and organizations and their management to develop interventions based on evidence-based practice to address the issue of burnout. Nurse burnout leads to poor care delivery and outcomes for patients and low levels of satisfaction (The Joint Commission, 2019). As such, the best practice that emerges from the reviewed research is the need to enhance effective nurse training and education to help nursing professional deal with the issue and apply innovative ways in their care practice for better delivery and patient outcomes (Yılmaz, 2017). The research review demonstrates the need for stakeholders, especially leaders to invest in training programs to enhance resilience of nurses. The increased demand for health care across the demographics divide imply that nurses should understand the care environment and know that the possibility of burnout is significant but can be tackled using innovative approaches to lessen their emotional and psychological burden.

The best practice should focus in resiliency training as identified by different research studies highlighted in the first part of this paper. Resiliency has a positive interaction with nurse burnout as it allows nurses to adopt the best practices to lessen effects of burnout and remain focused on effective care interventions. As opined by Brook et al. (2021), both nursing students and professionals need effective resilience training to enhance their skills and have a positive attitude to solving rising demand and diversity in the healthcare environment. The training should incorporate cultural competence as an effective approach to improving overall understanding about the concept to tackle the adverse effects of burnout.

Conclusion

Nurse burnout remains a critical health issue and leads to nursing shortage and turnover that impact quality care among different patient populations. The critical appraisal exercise and paper illustrate the need to develop interventions that will enhance overall care delivery by training nurses and nursing students on resilience framework to prepare them better in handling stressful situation associated with increased demand for care. Again, resilience training will impact their perspective on different and innovative ways to engage patients and ensure that they tackle the issue of burnout.

References

Brook, J., Aitken, L. M., MacLaren, J. A., & Salmon, D. (2021). An intervention to decrease burnout and increase retention of early career nurses: A mixed methods study of acceptability and feasibility. BMC Nursing, 20(1), 1-12. https://doi.org/10.1186/s12912-020-00524-9

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.2018.428

The Joint Commission (2019). Quick Safety: Developing resilience to combat nurse burnout. https://www.jointcommission.org/-/media/tjc/newsletters/quick_safety_nurse_resilience_final_7_19_19pdf.pdf

Wang, Q. Q., Lv, W. J., Qian, R. L., & Zhang, Y. H. (2019). Job burnout and quality of working life among Chinese nurses: A cross‐sectional study. Journal of Nursing Management, 27(8), 1835-1844. https://doi.org/10.1111/jonm.12884

Yılmaz, E. B. (2017). Resilience as a strategy for struggling against challenges related to the nursing profession. Chinese Nursing Research, 4(1),

9-13. https://doi.org/10.1016/j.cnre.2017.03.004

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