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Sample Answer for NUR 590 Discussion Evidence-Based Practice Initiatives Included After Question
NUR 590 Discussion Evidence-Based Practice Initiatives
- Discuss the importance of evidence-based practice within advanced registered nursing practice.
2. Evaluate the role of the advanced registered nurse in relation to ethical conduct in research.
3. Investigate databases to identify evidence-based practice research related to an area of interest in your practice.
Advanced Practice Nursing: Essential Knowledge for the Profession
Review Chapters 20-22 in Advanced Practice Nursing: Essential Knowledge for the Profession.
GCU Library: Nursing and Health Sciences Research Guide
Review the “Nursing and Health Sciences” research guide, located on the GCU Library website.
Defining Scholarship for the Discipline of Nursing
Read “Defining Scholarship for the Discipline of Nursing,” by Edwards, Alichnie, Easley , Edwardson, Keat ing, and Stanley (1999), located on the American Association of Colleges of Nursing website.
The Impact of Evidence-Based Practice in Nursing and the Next Big Ideas
Read “The Impact of Evidence-Based Practice in Nursing and the Next Big Ideas,” by Stevens , from Online Journal of Issues in Nursing(2013).
Explore the Cochrane Libra1y website.
Topic 7 DQ 1
Describe the steps of the evidence-based research process and the imp011ance of using them. In the initial stages of an EBP project, where do nurses in your specialty go to locate sources of infonnation that help them to detennine whether or not a practice problem is appropriate for an evidence-based practice change proposal. Include two specific sources on info1mation in your discussion.
Topic 7 DQ 2
What are some of the major ethical issues in conducting research that impacts the advanced registered nurse? Discuss the role of the advanced registered nurse in advocating for patient safety and rights in conducting research.
Topic 7 Participation
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Benchmark-Future Scope, Role and Professional Obligations Paper
Advanced practice registered nurses (APRNs) have increased scope, roles and professional obligations based on their training, education and experience in the nursing profession. with more states allowing nurse practitioners to have expanded practice scope and authority, APRNs become leaders and critical role players in the delivery of healthcare services in a fast transforming health care environment. additionally, they must understand the role of professional nursing organizations as members in their new positions as leaders and advanced care providers (Dyess et al., 2017). The role of professional bodies defines nurses’ scope of practice and their obligations in current and future specialty areas. The purpose of this paper is to research my current scope of practice for my specialty and present efforts to expand the scope and role of advanced nurse to influence the health care system positively.
Scope of Future Role as an Advanced Registered Nurses
Nurses continue to adopt greater responsibilities as leaders and managers in different healthcare settings due to current changes in legislations at state and federal levels. As the role of the nurse transforms from a physician’s assistant to an integral member of the life-saving team, the nurse leader role emerges. The scope of a nurse leader is wide but at the core of this responsibility is to guide nurses and ensure that they are complying to high standards of quality care and patient safety. In its report, the Institute of Medicine (IOM) noted the importance of nurses leading change and advancing health as essential ways of transforming the nursing profession and delivering quality and safe care to patients in diverse practice settings (Ducharme et al., 2017). The IOM report key message states that nurses should be full partners with physicians and other health professionals in redesigning healthcare in the country. As an advanced registered nurse, my future role is to be a nurse leader in clinical practice championing effective care and increased partnership between nurse practitioners, physicians and other health care professionals.
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A Sample Answer For the Assignment: NUR 590 Discussion Evidence-Based Practice Initiatives
Title: NUR 590 Discussion Evidence-Based Practice Initiatives
Evidence-Based Practice Project
Fundamentally, the focus of this project is evidence-based practice (EBP). In many instances, EBP is characterized by the potential of patient-centered care provision, cost effectiveness of care, and improved expertise of the health care providers. Due to these benefits, EBP is associated with the highest quality of care and positive patient outcomes. In particular, the focus of EBP in this project is the comparison of the best intervention between the use of hemodialysis and peritoneal dialysis in reduction of incidences of mortalities caused by end-stage renal diseases. Before the initiation of the project, the organizational readiness to embrace the project was determined. Based on the evaluation, the organization showed moderate preparedness for the integration of evidence-based practice in the organization. The proposed solution for determining the best intervention between hemodialysis treatment and peritoneal dialysis treatment was determined through a retrospective study. The Trans-Theoretical Model of behavioral change was utilized to facilitate the adoption of change in the organization. This model helped in facilitating the communication with stakeholders since provides information in a manner that prompts individuals to make decisions to change their behaviors. Consequently, an implementation plan was developed. The project allocated a period of nine months for patients follow-up to determine the clinical outcomes. Specifying the timeframe also helped in defining resources needed for the implementation of the project.
Section A: Organizational Culture and Readiness Assessment
The survey tool that was used in this research was obtained from the book authored by Melnyk and Fineout-Overholt (2011). The tool provides insights into the readiness of an organization in integrating evidence-based practice into its systems. It consists of 19 survey questions that explore various organizational issues that are critical for successful integration of evidence-based practice. The questions are rated from one to five. The lowest rate represents none at all response while the highest rate represents very much response. The score for my survey was 75%, which shows that there is moderate preparedness for the integration of evidence-based practice in the organization. The highest survey scores included those of the questions that focused on whether the mission reflects evidence-based practice, commitment of the nursing staff to evidence-based practice, and championing level of the healthcare providers. The survey questions with the lowest scores included those concerning the readiness of the physicians and availability of fiscal resources to support evidence-based practice. The overall survey result shows that evidence-based practice can be successfully introduced in the firm. The success can be seen in its current practices that align with the requirements of successful integration of evidence-based practice in an organization.
There exist possible barriers that might hinder the adoption of evidence-based practice in our organization. One of them is the low level of commitment from the physicians towards the adoption of evidence-based practice. Efforts need to be embraced to ensure that all the healthcare providers support to use of evidence-based practice in the provision of healthcare. The other potential barrier is the limited fiscal resources needed to support evidence-based practice in the organization. Healthcare organizations are supposed to support the adoption of evidence-based practice in their settings. The support could be in the form of providing learning materials and organizing training for the healthcare providers. This challenge can be addressed by raising the level of awareness of the management and leadership of the organization on the importance of evidence-based practice.
Section B: Proposal/Problem Statement and Literature Review
Background of the Topic
End stage renal disease is one of the health problems that affect a significant proportion of the world’s population. It is estimated that 750, 000 patients are diagnosed with end stage renal disease in the US on an annual basis. About 2 million people are also affected by the disease globally (University of California San Francisco, n.d.). The World Health Organization reports that about 1.2 million people lost their lives to end stage renal disease in 2015. The rate represented an increase by 32% when compared to the statistics of the year 2005. Globally, approximately 5-10 million people die annually due to chronic diseases of the kidney (Luyckx, Tonelli,&Stanifer, 2018). The prevalence of end-stage kidney disease is high in women than in men. There is disproportionate prevalence of the disease across races. For instance, it is more common in individuals with non-Hispanic blacks when compare to non-Hispanic white and non-Hispanic Asians (CDC, 2019).
End stage renal disease is characterized by the loss of kidney function and represents glomerular filtration rate below 13 ml/min (Bujanget al., 2017). The disease is associated with risk factors that include diabetes, infections such as HIV/AIDS, malaria, and hypertension (Luyckxet al., 2018). The management of end-stage renal disease relies mainly on the use of peritoneal dialysis and hemodialysis. These methods of management are effective in preventing mortalities caused by uremia. The selection of a method of treatment depends on a wide range of factors such as patient’s preferences, logistical considerations of the existing treatment facilities, comorbidities, and timing or acuity of uremia (Zhou et al., 2019).
The duration of survival and mortality rates among end-stage renal disease patients on hemodialysis and peritoneal dialysis has been an issue of concern to patients and healthcare providers. Controversy exists as to whether there is survival advantage between peritoneal dialysis and hemodialysis (Xueet al., 2019). The findings reported in observational studies on the survival rates between the two treatment approaches have been inconsistent. Some observational studies have shown that there is an initial survival advantage with the use of peritoneal dialysis within the first 2 years of diagnosis with end stage renal disease. The mortality risk increases significantly after this period. Other studies have shown the lack of clear mortality between the two treatments, thereby, attributing the mortalities to residual confounding factors (Zhou et al., 2019).
Studies conducted in the past can provide insights into the mortalities associated with hemodialysis and peritoneal dialysis in patients suffering from end-stage renal disease. A meta-analysis conducted by Xueet al. (2019) showed that there was no statistical difference in mortalities in end-stage kidney disease patients on hemodialysis and peritoneal dialysis. Instead, the analysis revealed that the benefits of these treatment methods outweigh their potential risks. The study by Yang et al. (2015) revealed that hemodialysis was associated with better survival results when compared to those started in hemodialysis. However, there was no significant difference in mortalities reported among young as well as healthier patients. The findings reported by these scholars cannot be relied upon wholly as the research was confounded by selection bias. A study by Wong et al., (2018) showed that there were no differences in mortalities among patients on hemodialysis and peritoneal dialysis. Rufinoet al. (2011) argue that while peritoneal dialysis might be associated with better survival outcomes, its beneficial effects are short-lived and cannot be the basis for its adoption over hemodialysis. Therefore, it makes it evident that further studies exploring the mortalities associated with these treatment modalities are conducted, hence, the need for this proposed research.
The PICOT question for this research is; In patients with chronic kidney disease, will the use of hemodialysis as compared to peritoneal dialysis reduce incidences of mortalities caused by end-stage renal diseases within a period of 9 months?
Purpose of the Project and Significance to Nursing
The purpose of this proposed project is to investigate whether the use of hemodialysis will result in incidence of mortalities caused by end stage renal disease within nine months when compared to the use of peritoneal dialysis. On the other hand, the use of evidence-based practice data has gained significant need in the modern practice of nursing. As a result, this project will act as a source of evidence-based data on the effectiveness of the two treatment approaches in end stage renal disease. The proposal will raise the level of knowledge among the nurses on the type of management that is appropriate to the patients with end stage renal disease they serve on a regular basis. The research will also inform policy changes in healthcare organizations. The results might shift the focus of management of end stage renal disease in the institution. Lastly, it can stimulate more researches into the topic among the nurses. The results of the study might act as a basis for future researches conducted by the nurses to explore the survival benefits between the two treatment methods of end stage renal disease.
Section C: Solution Description
The PICOT question for this research is; In patients with chronic kidney disease, will the use of hemodialysis as compared to peritoneal dialysis reduce incidences of mortalities cause by end stage renal disease within a period of 9 months? Therefore, the proposed intervention for this research would be a retrospective study that will be conducted in our unit. Patients suffering from end-stage renal failure will be assigned to either hemodialysis treatment or peritoneal dialysis treatment. The participants will then be followed for a period of nine months to determine the clinical outcomes. The outcome of focus would be the mortality rate reported in the two groups of patients.
The above-proposed solution aligns with previous studies conducted on the topic. Wang et al. (2018) conducted a study to compare the survival rate between patients with end-stage renal disease on hemodialysis and peritoneal dialysis in the era of icodextrin treatment. The outcomes showed that icodextrin has the ability of attenuating the survival advantage among patients on peritoneal dialysis unlike in hemodialysis. Another study by Zhou et al., (2019) compared early mortality rates among patients on hemodialysis and peritoneal dialysis who were transitioned with an optimal start at the outpatient clinic. The outcomes showed that there were no differences in early mortality rate among patients on hemodialysis and peritoneal dialysis.
Gonçalves et al. (2015) also conducted a study that aimed at comparing the quality of life of patients with chronic kidney disease on either peritoneal dialysis or hemodialysis. The results showed that peritoneal dialysis was associated with better quality of life when compared to hemodialysis. Therefore, these studies show that the proposed intervention in this research can provide a better understanding of the topic.
The intervention is realistic for our setting. It has a large number of patients seeking hemodialysis and peritoneal dialysis care. Therefore, it is expected that an adequate number of participants will be obtained for the research. The adequacy will also imply that the conclusions that will be reached will support evidence-based practice in the management of end-stage renal disease.
The proposed solution is consistent with the culture and resources of our organization. Vanderbloemen (2018) has defined culture as the manner in which organizational tasks and decisions are undertaken. Our organization recognizes the fact that evidence-based practice is an important aspect that enhances the quality of care. As a result, it has invested its resources in initiatives that will promote evidence-based practice. This includes supporting studies that explore the use of different treatment approaches to case management in our institution. The healthcare providers are also trained on evidence-based practice. They constantly appraise evidence on the use of various clinical interventions to improve the health outcomes of their patients. Therefore, it is believed that the supportive culture in the organization will enhance the adoption of the proposed intervention.
It is expected that this proposed intervention will provide insight into the effectiveness of hemodialysis and peritoneal dialysis in reducing the mortality rate among patients suffering from end-stage renal failure. The intervention will enable clinicians to determine the most effective treatment approach for these patients, with the aim of optimizing their health outcomes. Through this research, it is expected that the outcomes will agree or contradict with those reported in other studies. Therefore, it will inform the clinical practice in relation to the management of end-stage renal failure.
Method to Achieve the Outcomes
The participants in this study will be followed throughout the study period. Their response to the treatment will be examined using the symptoms and adverse reactions they report to the healthcare team. By the end of the study period, statistics on the survival rate among the patients on hemodialysis and peritoneal dialysis will be computed to provide insights into their efficacy and safety. Some of the barriers that might be experienced include low adherence to the prescribed treatment among the patients and their lack of willingness to utilize a treatment approach from the two methods. These barriers will be eliminated through active follow-up of the patients and informing them on the two treatment approaches for them to make informed decisions. One of the assumptions made in this intervention is that any mortality that will be reported during the study period will be due to complications of hemodialysis or peritoneal dialysis alone.
The results from this intervention will inform clinical practice. They will inform the decision on whether patients suffering from end-stage renal disease should be placed on hemodialysis or peritoneal dialysis. The results will also form a basis of other studies into the topic as clinicians try to examine additional ways of optimizing the care given to patients suffering from end-stage renal disease. The intervention will also promote the provision of safe and quality care to these patients since the most effective treatment approach will be utilized in managing their conditions.
Section D: Change Model
Selected Model and its Applicability to My Project
The selected model for my evidence-based proposal is Trans-theoretical Model of behavioral change. Prochaska and DiClemente developed it in the 1970s. The model provides information on the manner in which individuals make decisions to change their behaviors. It assumes that behavioral change does not occur in a faster rate but continuously through incremental improvement of behaviors (Glanz, Rimer & Viswanath, 2015). This model is relevant to my project because it recognizes the fact that change occurs in a sequential process and not a drastic event. The introduction of my project requires sequential interventions in the organization. The staffs have to be made aware about the need for the change, behaviors that they should adopt, and ways of sustaining the desired success. Therefore, the increased focus of the model of stimulating behavior change among the adopters make it an important framework for my project as it mainly relies on the change in behavior among nurses working in the renal unit.
Steps of Change in the Model
According to the theory, behavioral change occurs in a series of steps. They include precontemplation, contemplation, preparation, action, maintenance, and termination. Precontemplation is the first stage in the Trans-theoretical Model of behavioral change. In this stage, those to be affected by the change agent do not have any intentions to embrace actions in their near future. They do not perceive their behaviors as being problematic or having undesired consequences to them or others. Therefore, they underestimate any need for behavioral change in their organizations (Sharma, 2017). Contemplation is the second phase of the Trans-theoretical Model of behavioral change. The stage is characterized by people showing intentions to embrace healthy behaviors in their near future. They have recognized that their behaviors are problematic and have undesired outcomes to them and others (Glanz et al., 2015). Despite this awareness, they are still ambivalent on the need to change their behaviors.
Preparation is the third stage in the Trans-theoretical Model of behavioral change. The people are ready to embrace change within a period of one month in this stage. They begin exploring small incremental steps that will enable them to achieve their desired behavioral change. The main reason for embracing change interventions is that they perceive the change to have healthier outcomes in their lives. The fourth phase is action stage. This stage is characterized by people who have recently adopted change behaviors planning to sustain the behavior change. They modify their behaviors as a way of promoting continuous change and improvement in their healthy behaviors (Sharma, 2017). The fifth stage is maintenance stage. The adopters in this stage have sustained the desired behaviors for a period and are willing to continue with the behavioral change going further. They focus on adopting interventions that would prevent or reduce incidences of relapse of the earlier behaviors. The last stage in the model is termination. The people in this stage are characterized by lacking any desire to return to their previously held unhealthy behaviors. They strongly believe that they will not experience relapse of their unhealthy behaviors (Glanz et al., 2015). Therefore, these people are ready to explore other ways in which extra benefits of the behavioral change can be achieved.
Application of Each Stage on Project Implementation
Each of the above stages of the Trans-theoretical Model is applicable to my change project. In precontemplation stage, the nurses do not plan to take any action related to the evaluation of the survival rate between patients on hemodialysis and peritoneal dialysis. They do not understand that these treatment methods might have undesired effect on the survival rate of patients suffering from end-stage renal disease. The nurses in contemplation stage begin to understand the need for examining the survival rate among end-stage renal disease patients on peritoneal dialysis and hemodialysis. They see the need to engage in research on this area in their near future. However, they are still skeptical on embracing the change (Hayden, 2019). The nurses in the preparation stage are ready to engage in research exploring the above treatment methods. They start small actions such as critical appraisal of studies on the issue. They then move to the next step of the model, action stage where they intend to keep exploring the issue by undertaking research on the topic. The nurses in the maintenance stage are willing to focus on future clinical researches on the topic to increase its relevance in the clinical practice. They implement their research findings in the clinical practice and explore their efficacy on a regular basis. Termination is characterized by the nurses implementing the study findings in clinical practice and sustaining the culture of evidence-based practice in providing care to patients suffering from renal conditions.
Section E: Implementation Plan
Setting and Access to Potential Subjects
The PICOT question that will guide the intervention is;in patients with chronic kidney disease, will the use of hemodialysis as compared to peritoneal dialysis reduce incidences of mortalities cause by end stage renal disease within a period of 9 months? The proposed intervention will be undertaken in the renal unit in our hospital. The unit is the largest in the region and serves approximately 300 patients on a weekly basis. The potential subjects for this intervention will be patients with chronic kidney disease who are to be initiated on either hemodialysis or peritoneal dialysis. These patients are considered part of the vulnerable population due to their health status. Therefore, it would be important to implement the intervention with a consideration of the research ethics. One of the most critical ethics that would be considered is seeking informed consent from the study participants. Informed consent is important in any clinical research since it creates awareness among the research participants on the potential benefits as well as risks of the interventions (Blease, Kelley & Trachsel, 2018). The potential subjects will be informed that their participation in the study is voluntary and have the right to decline to take part in it.
Timeline for Project
The projected time for this intervention will be at least nine months. The patients will be initiated on either hemodialysis or peritoneal dialysis and followed up for nine months. The measures of the study will include survival rates, complications, and the general wellbeing of the patients on each of these treatments. The project is expected to commence on January 2020 up to September 2020. The analysis of data will begin in October, completion of report writing in November, and communication of the findings by December.
The implementation of the intervention will demand a wide range of resources. As shown bySargeant et al., (2015), the healthcare providers are the most critical resources in the implementation of evidence-based practice. They need to embrace the desired behaviors, knowledge, and skills for successful implementation of the change agent. The other resource is financial support from the hospital. Healthcare providers should be trained on the intervention for its successful implementation. The management should also support the implementation process. They should act as role models of the intervention. The intervention will result in the approach to providing care to patients with chronic kidney disease. A focus will be placed on active follow-up and selection of the patients to be initiated in each of the treatment. The healthcare providers will also champion for the provision of safe, effective and appropriate care to patients in each category since it will affect the outcomes of the research.
Methods and Instruments
Methods for research should be chosen carefully to obtain data that answers the research aims. The methods should cover a wide range of issues related to topic, as it is important in providing different perspectives of the issue under investigation (Drake, Rancilio & Stafford, 2017). The proposed intervention will employ the use of questionnaires to obtain the needed data. The questionnaires will have both open and closed ended questions. The use of the combined question formats will allow for the acquisition of a broader range of data, hence, better understanding of the topic.
Process of Delivering the Intervention
The study participants will be selected based on their assessment findings. They will be assigned to either hemodialysis or peritoneal dialysis. Baseline data will be obtained at the beginning of each session, stored, and compared throughout the period of data collection. The selection of the subjects will be done randomly. The random selection will ensure the generalizability of the findings. Training will be provided to the healthcare providers on the delivery of the interventions and acquisition of the relevant data.
Data Collection Plan
Data will be collected using structured questionnaires. The questionnaires will be administered to the patients during and after their dialysis sessions. The healthcare providers will collect baseline data at each encounter with the patients. Patients will also be visited once a month in their homes to assess their functional abilities, complications, and adaptation to the treatment. The collected data will be kept in a secured locker in the hospital. The cabinet will only be accessed by the researcher. Descriptive statistics will be used to analyze the demographic data of the subjects. The analysis of the data will also be done using SPSS version 20. The analyzed data will be presented using tables, charts, and graphs. The statistics will provide insights into the comparative response of the patients in the two groups to the treatment.
Strategies to Barriers, Facilitators and Challenges
One of the barriers that might be experienced is the unwillingness of the subjects to participate in the research. The issue will be addressed by providing adequate information to the subjects on the aims of the research (Harvey & Kitson, 2015). The other barrier is the resistance from the staffs. The challenge will be addressed through training them on the intervention and involving them in the activities of the research (Sargeant et al., 2015). An example of a facilitator is support from the organization. This could be through providing financial incentives and training to the staffs on the intervention. The other facilitator is the awareness of the staff on the benefits of the study (Brehaut et al., 2019). The staffs will be ready to embrace the intervention if they are aware of its intended benefit to the promotion of evidence-based practice.
Feasibility of the Implementation
Successful implementation of the intervention will require a wide range of resources. One of them is personnel training. The healthcare providers should be trained on the provision of the two treatment methods to the selected study subjects. There is also the need for additional finances for following up the patients when they are not on dialysis sessions. The other resource that is needed is five computers that would be used for capturing and storing the data from the selected patients. Data analysts will be outsourced. Therefore, there is a need to set aside the financial resources for them. The hospital should also add two more dialysis machines in the unit to balance the needs of those taking part in the research and those not part of the process. The last resource is printing materials. The research will also need much of paperwork, hence, a need to purchase adequate materials for this use.
Plans to Maintain, Extend, Revise, and Discontinue the Solution
The intervention will be extended beyond the proposed time if the research participants are inadequate or withdraw from the research. It will be revised if the estimate metrics are not met within the given time. It will be discontinued if it predisposes the participants to any adverse outcomes. It will also be discontinued if more than 50% of the participants withdraw from the research.
Section F: Evaluation of Process
Methods Used in Collecting the Outcome Data
Quantitative data will be collected in this proposed intervention. The data will be numerical and can be computed mathematically. Self-administered questionnaires will be used to obtain the quantitative data for this research. The questionnaires will contain questions as well as prompts that a related to the intervention. The selection of this method of obtaining outcome data is the most effective because diverse questions on the research question can be asked. Unlike methods such as interviews, the use of questionnaires is cheap and easy to conduct. The self-administered nature of the questionnaires will make it faster and easy to obtain the data for the research. The questionnaires also provide quantifiable data that can be analyzed easily by the researcher. Therefore, it makes them the best method in which the data for the outcome measure can be obtained in this intervention.
The outcome measures for the proposed intervention will be varied. They will include the improvement in the clinical condition or indication for the management, reduction in adverse reactions to the treatment, survival rate, and patient’s ability to undertake in the activities of the daily living, and their sense of wellbeing with the treatment modality. The patient’s wellbeing will be measured based on aspects such as pain, anxiety, depression, and functional impairment with the treatment (Surendra et al., 2019). The outcomes measures will aid in the determination of the extent to which the objectives of the interventions are being achieved. The overall outcome of the intervention will be the survival rate among patients with chronic kidney disease on either peritoneal dialysis or hemodialysis. Therefore, indicators such as improvement in the clinical state of the patient, reduction in adverse events with the treatment, enhanced patient’s ability to engage in the activities of the daily living, and patient’s sense of wellbeing will translate into the objectives of the intervention being achieved.
Measuring of Outcomes
The outcomes of the proposed intervention will be measured in various methods. The overall quality of life of patients on either peritoneal dialysis or hemodialysis will be determined using Persian correlation. This measuring will aid in the evaluation of the determinants of quality of life such as physical functioning, engagement in the activities of the daily living, and mental wellbeing (Atapour et al., 2016). Symptoms of the treatment will be measured with the use of POS-S renal scale while IIRS tool will be used to measure the impact of the treatment on the life of the patient. Anxiety and depression among the patients will be measured with the use of HADS tool (Iyasere et al., 2018). Lastly, Pearson correlation will be done to determine whether a relationship exists between the treatment and the experiences of the patients with chronic kidney disease. Validity of the intervention will be promoted using randomization in the selection of the participants and pre-testing the measurement techniques as a way of improving its accuracy. The reliability of the intervention will be promoted by ensuring that human raters are used, ensuring familiarity of the participants with the intervention, and exposing them to similar environments. Scientific methods of research that promote rigor will be used to enhance applicability of the evidence.
Strategies in case of Negative Results
The intervention outcomes will be reported irrespective of the results. Negative results will imply that the interventions do not promote the well-being of the patients using them. Therefore, it will increase the need for re-evaluation of the methods that were used and their accuracy. It will also increase the need for additional researches to be conducted elsewhere to determine whether there will be duplication of the findings. Consequently, negative outcomes will form the basis of future studies into the topic.
Implications to Practice and Future Research
The proposed intervention will have significant implications to practice as well as research. It will inform the utilization of either peritoneal dialysis or hemodialysis in treating chronic kidney disease. It will also act as a source of evidence-based practice on the efficacy of these interventions in patients with chronic kidney disease. The intervention will also raise the interest of the healthcare providers to explore additional aspects influencing the health of patients with kidney disease. The intervention will act as the basis for future research. It will pinpoint areas of research that should be explored for the provision of optimum care to patients with kidney disease.
Atapour, A., Nasr, S., Boroujeni, A. M., Taheri, D., & Dolatkhah, S. (2016). A comparison of the quality of life of the patients undergoing hemodialysis versus peritoneal dialysis and its correlation to the quality of dialysis. Saudi Journal of Kidney Diseases and Transplantation, 27(2), 270.
Blease, C., Kelley, J. M., & Trachsel, M. (2018). Informed consent in psychotherapy: Implications of evidence-based practice. Journal of Contemporary Psychotherapy, 48(2), 69-78.
Brehaut, J. C., Colquhoun, H. L., Eva, K. W., Carroll, K., Sales, A., Michie, S., … & Grimshaw, J. M. (2016). Practice feedback interventions: 15 suggestions for optimizing effectiveness. Annals of internal medicine, 164(6), 435-441.
Bujang, M. A., Adnan, T. H., Hashim, N. H., Mohan, K., Kim Liong, A., Ahmad, G., … &Haniff, J. (2017). Forecasting the incidence and prevalence of patients with end-stage renal disease in Malaysia up to the year 2040. International journal of nephrology, 2017.
CDC. (2019). Chronic Kidney Diseases in the United States, 2019. Retrieved on 24th Sept. 2019 from https://www.cdc.gov/kidneydisease/publications-resources/2019-national-facts.html
Drake, B. F., Rancilio, D. M., & Stafford, J. D. (2017). Research methods. In Public Health Research Methods for Partnerships and Practice (pp. 174-187). Routledge.
Glanz, K., Rimer, B. K., & Viswanath, K. (2015). Health behavior: Theory, research, and practice. San Francisco, CA : Jossey-Bass.
Gonçalves, F. A., Dalosso, I. F., Borba, J. M. C., Bucaneve, J., Valerio, N. M. P., Okamoto, C. T., & Bucharles, S. G. E. (2015). Quality of life in chronic renal patients on hemodialysis or peritoneal dialysis: A comparative study in a referral service of Curitiba-PR. Brazilian Journal of Nephrology, 37(4), 467-474.
Harvey, G., & Kitson, A. (2015). Implementing evidence-based practice in healthcare: a facilitation guide. Routledge.
Hayden, J. (2019). Introduction to health behavior theory. Burlington, MA: Jones & Bartlett Learning.
Iyasere, O., Brown, E. A., Johansson, L., Davenport, A., Farrington, K., Maxwell, A. P., … & Woodrow, G. (2018). Quality of life with conservative care compared with assisted peritoneal dialysis and haemodialysis. Clinical Kidney Journal, 12(2), 262-268.
Kueny, A., Shever, L. L., Mackin, M. L., & Titler, M. G. (2015). Facilitating the implementation of evidence-based practice through contextual support and nursing leadership. Journal of healthcare leadership, 7, 29.
Luyckx, V. A., Tonelli, M., &Stanifer, J. W. (2018). The global burden of kidney disease and the sustainable development goals. Bulletin of the World Health Organization, 96(6), 414.
Melnyk, B. M., &Fineout-Overholt, E. (2011). Evidence-based practice in nursing & healthcare: A guide to best practice. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins.
Rufino, J. M., Rufino, J. M., García, C., García, C., Vega, N., Vega, N., … & Rodríguez, A. (2011). Current peritoneal dialysis compared with haemodialysis: medium-term survival analysis of incident dialysis patients in the Canary Islands in recent years. Nefrología (English Edition), 31(2), 174-184.
Sargeant, J., Lockyer, J., Mann, K., Holmboe, E., Silver, I., Armson, H., … & Power, M. (2015). Facilitated reflective performance feedback: developing an evidence-and theory-based model that builds relationship, explores reactions and content, and coaches for performance change (R2C2). Academic Medicine, 90(12), 1698-1706.
Sharma, M. (2017). Theoretical foundations of health education and health promotion. Burlington, MA : Jones & Bartlett Learning.
Surendra, N. K., Manaf, M. R. A., Hooi, L. S., Bavanandan, S., Nor, F. S. M., Khan, S. S. F., … & Gafor, A. H. A. (2019). Health related quality of life of dialysis patients in Malaysia: Haemodialysis versus continuous ambulatory peritoneal dialysis. BMC nephrology, 20(1), 151.
University of California San Francisco. (n.d.). The Kidney Project. Retrieved on 24th Sept. 2019 from https://pharm.ucsf.edu/kidney/need/statistics
Vanderbloemen, W. (2018). Culture wins: The roadmap to an irresistible workplace. Los Gatos : Smashwords.
Wang, I. K., Lin, C. L., Yen, T. H., Lin, S. Y., & Sung, F. C. (2018). Comparison of survival between hemodialysis and peritoneal dialysis patients with end-stage renal disease in the era of icodextrin treatment. European journal of internal medicine, 50, 69-74.
Wong, B., Ravani, P., Oliver, M. J., Holroyd-Leduc, J., Venturato, L., Garg, A. X., & Quinn, R. R. (2018). Comparison of patient survival between hemodialysis and peritoneal dialysis among patients eligible for both modalities. American Journal of Kidney Diseases, 71(3), 344-351.
Xue, J., Li, H., Zhou, Q., Wen, S., Zhou, Q., & Chen, W. (2019). Comparison of peritoneal dialysis with hemodialysis on survival of diabetic patients with end-stage kidney disease: a meta-analysis of cohort studies. Renal Failure, 41(1), 521-531
Yang, F., Khin, L. W., Lau, T., Chua, H. R., Vathsala, A., Lee, E., & Luo, N. (2015). Hemodialysis versus peritoneal dialysis: a comparison of survival outcomes in South-East Asian patients with end-stage renal disease. PloS one, 10(10), e0140195.
Zhou, H., Sim, J. J., Bhandari, S. K., Shaw, S. F., Shi, J., Rasgon, S. A., … & Jacobsen, S. J. (2019). Early Mortality among Peritoneal Dialysis and Hemodialysis Patients Who Transitioned With an Optimal Outpatient Start. Kidney international reports, 4(2), 275-284.
Appendix A: Conceptual Model of the Project
Appendix B: Data Evaluation and Collection Tools
Please answer the questions to the best of your ability
- What is your gender?
- How old are you?
- Which type of dialysis treatment are you currently using?
- How many sessions of dialysis do you attend weekly?
- How long does each dialysis session end?
- Do you believe that the treatment has adversely affected your health? Tell us some of the ways
- What health problems have you experienced with the treatment?
Appendix C: Project Budget
|Two dialysis machines
Appendix D: Project Timeline
|Follow-up with data collection
|Completion of follow-up and data collection
|Completion of report writing
|Communication of findings
Appendix E (a): Approval Forms (Informed Consent)
Hello, my name is Y. I am conducting a research in collaboration with our hospital to investigate the survival outcomes of patients with chronic kidney disease on hemodialysis or peritoneal dialysis. The focus of the research is to determine the mortalities and complications associated with these treatment methods after a period of nine months. Your participation in the study is voluntary. You will be allocated randomly to any of the two treatment methods and followed up closely for nine months. Your participation is highly important since it will provide evidence on the effectiveness of these treatment methods. Be informed that your participation will not cause you any health harm. The data will be kept private and confidential. Your identity will be kept anonymous.
Appendix E (b): Participant Consent
I have read and understood that my participation in the research is voluntary. I have also understood that my participation in the study will not subject me to any health risk. Therefore, I consent to participate in the research.
Appendix F: List of Resources
- Atapour, A., Nasr, S., Boroujeni, A. M., Taheri, D., & Dolatkhah, S. (2016). A comparison of the quality of life of the patients undergoing hemodialysis versus peritoneal dialysis and its correlation to the quality of dialysis. Saudi Journal of Kidney Diseases and Transplantation, 27(2), 270.
- Blease, C., Kelley, J. M., & Trachsel, M. (2018). Informed consent in psychotherapy: Implications of evidence-based practice. Journal of Contemporary Psychotherapy, 48(2), 69-78.
- Brehaut, J. C., Colquhoun, H. L., Eva, K. W., Carroll, K., Sales, A., Michie, S., … & Grimshaw, J. M. (2016). Practice feedback interventions: 15 suggestions for optimizing effectiveness. Annals of internal medicine, 164(6), 435-441.
- Bujang, M. A., Adnan, T. H., Hashim, N. H., Mohan, K., Kim Liong, A., Ahmad, G., … &Haniff, J. (2017). Forecasting the incidence and prevalence of patients with end-stage renal disease in Malaysia up to the year 2040. International journal of nephrology, 2017.
- CDC. (2019). Chronic Kidney Diseases in the United States, 2019. Retrieved on 24th Sept. 2019 from https://www.cdc.gov/kidneydisease/publications-resources/2019-national-facts.html
- Drake, B. F., Rancilio, D. M., & Stafford, J. D. (2017). Research methods. In Public Health Research Methods for Partnerships and Practice (pp. 174-187). Routledge.
- Glanz, K., Rimer, B. K., & Viswanath, K. (2015). Health behavior: Theory, research, and practice. San Francisco, CA : Jossey-Bass.
- Gonçalves, F. A., Dalosso, I. F., Borba, J. M. C., Bucaneve, J., Valerio, N. M. P., Okamoto, C. T., & Bucharles, S. G. E. (2015). Quality of life in chronic renal patients on hemodialysis or peritoneal dialysis: A comparative study in a referral service of Curitiba-PR. Brazilian Journal of Nephrology, 37(4), 467-474.
- Harvey, G., & Kitson, A. (2015). Implementing evidence-based practice in healthcare: a facilitation guide. Routledge.
- Hayden, J. (2019). Introduction to health behavior theory. Burlington, MA: Jones & Bartlett Learning.
- Iyasere, O., Brown, E. A., Johansson, L., Davenport, A., Farrington, K., Maxwell, A. P., & Woodrow, G. (2018). Quality of life with conservative care compared with assisted peritoneal dialysis and haemodialysis. Clinical Kidney Journal, 12(2), 262-268.
- Kueny, A., Shever, L. L., Mackin, M. L., & Titler, M. G. (2015). Facilitating the implementation of evidence-based practice through contextual support and nursing leadership. Journal of healthcare leadership, 7, 29.
- Luyckx, V. A., Tonelli, M., &Stanifer, J. W. (2018). The global burden of kidney disease and the sustainable development goals. Bulletin of the World Health Organization, 96(6), 414.
- Melnyk, B. M., &Fineout-Overholt, E. (2011). Evidence-based practice in nursing & healthcare: A guide to best practice. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins.
- Rufino, J. M., Rufino, J. M., García, C., García, C., Vega, N., Vega, N., … & Rodríguez, A. (2011). Current peritoneal dialysis compared with haemodialysis: medium-term survival analysis of incident dialysis patients in the Canary Islands in recent years. Nefrología (English Edition), 31(2), 174-184.
- Sargeant, J., Lockyer, J., Mann, K., Holmboe, E., Silver, I., Armson, H., … & Power, M. (2015). Facilitated reflective performance feedback: developing an evidence-and theory-based model that builds relationship, explores reactions and content, and coaches for performance change (R2C2). Academic Medicine, 90(12), 1698-1706.
- Sharma, M. (2017). Theoretical foundations of health education and health promotion. Burlington, MA : Jones & Bartlett Learning.
- Surendra, N. K., Manaf, M. R. A., Hooi, L. S., Bavanandan, S., Nor, F. S. M., Khan, S. S. F., … & Gafor, A. H. A. (2019). Health related quality of life of dialysis patients in Malaysia: Haemodialysis versus continuous ambulatory peritoneal dialysis. BMC nephrology, 20(1), 151.
- University of California San Francisco. (n.d.). The Kidney Project. Retrieved on 24th Sept. 2019 from https://pharm.ucsf.edu/kidney/need/statistics
- Vanderbloemen, W. (2018). Culture wins: The roadmap to an irresistible workplace. Los Gatos : Smashwords.
- Wang, I. K., Lin, C. L., Yen, T. H., Lin, S. Y., & Sung, F. C. (2018). Comparison of survival between hemodialysis and peritoneal dialysis patients with end-stage renal disease in the era of icodextrin treatment. European journal of internal medicine, 50, 69-74.
- Wong, B., Ravani, P., Oliver, M. J., Holroyd-Leduc, J., Venturato, L., Garg, A. X., & Quinn, R. R. (2018). Comparison of patient survival between hemodialysis and peritoneal dialysis among patients eligible for both modalities. American Journal of Kidney Diseases, 71(3), 344-351.
- Xue, J., Li, H., Zhou, Q., Wen, S., Zhou, Q., & Chen, W. (2019). Comparison of peritoneal dialysis with hemodialysis on survival of diabetic patients with end-stage kidney disease: a meta-analysis of cohort studies. Renal Failure, 41(1), 521-531
- Yang, F., Khin, L. W., Lau, T., Chua, H. R., Vathsala, A., Lee, E., & Luo, N. (2015). Hemodialysis versus peritoneal dialysis: a comparison of survival outcomes in South-East Asian patients with end-stage renal disease. PloS one, 10(10), e0140195.
- Zhou, H., Sim, J. J., Bhandari, S. K., Shaw, S. F., Shi, J., Rasgon, S. A., … & Jacobsen, S. J. (2019). Early Mortality among Peritoneal Dialysis and Hemodialysis Patients Who Transitioned With an Optimal Outpatient Start. Kidney international reports, 4(2), 275-284.