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NURS 3150 – Foundations of Nursing Research

In this assignment I shall discuss the concepts of Evidence Based Practice (EBP), and briefly outline its importance to my professional practice. I shall select a relevant aspect of my practice in relation to my professional discipline. I will provide a rationale for selecting my aspect of professional discipline, which will be within the context of (EBP). I will discuss the extent to which my selected aspect of professional practice is informed by various types of evidence. In relation my chosen aspect of professional practice, I shall then identify factors that may facilitate and hinder the implementation of (EBP). NURS 3150 – Foundations of Nursing Research Paper

Q1

Evidence based practice (EBP) is to demonstrate the best practice, which has been supported, with a clear rationale to back it up. Whilst using (EBP), this also acknowledges the patient/clients best interest. (EBP) is ‘the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patient/clients’ (Sackett et al, 1996). NURS 3150 – Foundations of Nursing Research Paper

In this definition Sackett facilitates an understanding between (EBP) and decisions we make in everyday practice. This demonstrates the strong connection between both aspects. Here, Sackett emphasises the importance of decisions we make as healthcare professionals, and how clearly they should be stated. This shows that decisions are well thought-out, which demonstrates that the use of evidence is used sensibly and carefully, which means that any care or support we deliver must be evidence based. It shows that Sackett understands that if care or support we provide has a rationale, then this enables us to deliver it with a meaningful purpose. NURS 3150 – Foundations of Nursing Research Paper

According to the Nursing and Midwifery Council (NMC) we as healthcare professionals must deliver care on the best evidence or best practice (2008). The code of conduct clearly states that any advice we give must be evidence based. If we fail to adhere to the code, then this may result in disciplinary action by the (NMC) (2008).

As healthcare professionals I feel any care we deliver should have a rational to justify anything we carry out. I believe that as healthcare professionals we are expected to understand why we are caring for patient/clients, whereby a rationale is provided for the care that we provide. (EBP) helps us as healthcare professionals keep updated with policies and procedures (ref). It is fundamental that we keep our skills and knowledge current, which enables us to provide effective care. NURS 3150 – Foundations of Nursing Research Paper

(EBP) in its earlier days of evidence based medicine, which provides a suitable way in producing efficient clinical decisions, avoiding routinely work practice, which increases clinical performance (Evidence Based Medicine Working Group 1992, Davidoff et al ,1995). In the above statement it demonstrates that (EBP) contributes to significant clinical decisions, which may subsequently develop

It is important that we adhere to policies and procedures for the best practice available, which may prevent us from making any errors. As practitioners we are accountable for our actions. Justifying what we do is vital, which must have a rationale behind it. Failure to adhere to (NMC) may result in professional misconduct (2008). NURS 3150 – Foundations of Nursing Research Paper

Here I shall formulate the question according the (PICO) method, which is population, intervention, comparison intervention, and outcome. This was devised by Sackett et al, which is a useful method in order to make questions more purposeful (1997).

My selected aspect of professional practice is the Treatment of Depression and its Effectiveness in Adults with Cancer.

I personally feel there is a high prevalence of depression in cancer patients. In my experience, I have found that there are many cancer patients, which may be suffering from depression. According to Barraclough (1994) states that depression is the most common psychiatric illness in patients with terminal cancer. The high prevalence of depression in cancer patient has influenced me carry out my own research, which will effectively enhance my knowledge. Personally, I feel that by developing my knowledge on my chosen topic will help enable me to have a greater understanding, t in my future practice. NURS 3150 – Foundations of Nursing Research Paper

Hinton (1963) found that 24% of patients dying in an acute hospital were depressed. It has been found by Casey that patients suffering with depression may be assessed by asking them if they have symptoms such as ; loss of pleasure in activities, feelings of guilt and worthlessness, or thoughts of self harm, which may help in recognizing a diagnosis in depression (1994). NURS 3150 – Foundations of Nursing Research Paper

Q3

The objective of a qualitative research is to describe, explore, and give explanation to the phenomenon what is being studied (Marshall & Rossman, 2006. (Morse & Richards 2002) established that there many techniques used in the collection of data involved in the production of a qualitative study, but the commonly used are observing and interviewing partakers. A meta-analysis is within a qualitative study, whereby the findings of qualitative are carefully examined, the methods and theories from different studies, to form an overview or conclusive ways of thinking about phenomena Thorne et al (2004). NURS 3150 – Foundations of Nursing Research Paper

In my experience I have found that many patients whom have cancer have been low in mood, but often go left untreated. Maguire found that up to 80% of psychological and psychiatric morbidity, which develops in cancer patients often goes unrecognised and untreated (1985).

It speaks about how patients are non-compliant in discussing symptoms unreservedly with nursing and medical staff. It mentions that in the United Kingdom (U.K) clinical nurse specialists play an important role in assessing the symptoms and providing advice to cancer patient with highly developed and metastatic cancer (Gray et al,1999). NURS 3150 – Foundations of Nursing Research Paper

This qualitative study was purposely carried to deter how clinical nurse specialist manage, assess, and perceive depression in such patients, in both hospital and community settings. Atkin et al (1993) found that 43.4% of nurses reported that early recognition of, signs of anxiety and depression was part of their role. It shows the difficulty nurses are faced with in convincing medical staff to follow up assessment or prescribe antidepressant medication.

I shall now critique the study. Firstly, none of the nurses had any form of mental health training. Therefore, I feel their lack of knowledge may have falsified the findings of the study. Lastly, the demographic area may have been expanded further afield, which subsequently makes the findings minimalistic. NURS 3150 – Foundations of Nursing Research Paper

The view proposed by Long (1995, p94) that the most problematic characteristic of the hierarchy of evidence model, is that it completely lacks recognition of qualitative study methods. According to Sackett et al (1996) a qualitative is in the ranking of research evidence at the base. Here, it shows that a qualitative study has inadequate efficacy, whereby it lacks randomization, it also has scarce before and after studies.

However, it does give emphasis to the fact that open ended question were asked in a qualitative study, which demonstrates its feasibility. An open ended question can have many answers, whereby it can be answered in many ways than one. If in depth answers are obtained, then this may enable the researchers to capture a greater insight of the situation. NURS 3150 – Foundations of Nursing Research Paper

Nevertheless, it has been discovered that identifying the findings in a qualitative study can be complex, this may due the style of reports, or they may be perceived wrongly (Sandelowski & Barroso 2004).

Systematic reviews were first defined as ‘concise of the best available evidence that address sharply defined clinical questions’ (Murlow et al 1997). Here, it states that a systematic review involves gathering quality information, which is then analysed, whereby it is then summarised. A systematic review is a vital source of evidence-informed policy and practice movement, which connects research in decision-making (Chalmers, 2003).

Secondly, this systematic review provides us with evidence on cancer patients receiving interventions such as drug therapy, and their efficacy. In this systematic review it found that depression is the most common in cancer patients, which often goes undiscovered and untreated (Lloyd-Williams, (2000); Bailey et al,(2005). NURS 3150 – Foundations of Nursing Research Paper

It also shows that cancer patient’s survival rate may be decline if their immune response is impaired. (Andersen et al, 1998; Newport and Nemeroff, 1998; Reiche et al, 2004) and poorer survival (Buccheri, 1998; Faller et al, 1999; Watson et al, 1999; Faller and Bulzebruck 2002; Herjl et al, 2003; Goodwin et al, 2004). It is known that in previous systematic reviews and meta-analyses of the effectiveness of interventions for cancer patients whom are suffering from depression have been unsuccessful in differentiating between depression/depressive symptoms.

Dale and Williams (2005) refers to the findings from this review, which demonstrate that there little trial data on the effectiveness of antidepressants, which are prescribed to reduce major depression and depressive symptoms in those suffering with cancer. NURS 3150 – Foundations of Nursing Research Paper

Nevertheless, previous reviews which have failed to identify the dissimilarity between both depression and depressive symptoms. It shows little data from clinical trials, which demonstrate psychotherapeutic interventions, which may effective in reducing depression in cancer patients.

A number of small-scale trials showed that psychotherapeutic interventions, more so Cognitive Behavioural Therapy (CBT), which may be effective in treating cancer patient whom have depressive symptoms. NURS 3150 – Foundations of Nursing Research Paper

In conclusion, this review shows that there is a hard-pressed need for a more rigorous process in the examination of the effectiveness and consequences regarding approaches towards in managing depression in cancer patients, and providing them with appropriate healthcare services.

In respect to the hierarchy of evidence chart Sackett (1996) states that systematic reviews are at the peak of the chart, which demonstrates this, a strong piece of evidence. The results of a systematic reviews are produced in such a way, whereby a thorough examination of evidence is processed (Murlow,1987; Cook et al.,1998). Sackett and Straus (1998) found that systematic reviews of (RCTs) are ranked as the ”best” evidence in making clinical decisions in relation to a patients care. NURS 3150 – Foundations of Nursing Research Paper

Within this study a systematic review of randomised controlled trials (RCT) of pharmacological and psychotherapeutic implementation for cancer patients with depression/depressive symptoms. This study had a specific criterion for the selection of (RCTs) of the pharmacology and psychotherapeutic interventions. Partakers were either adult cancer patients with depression, or depressive symptoms receiving interventions such as pharmacology and psychotherapeutic. NURS 3150 – Foundations of Nursing Research Paper

This source of evidence fits into the hierarchy of evidence at the apex of the chart. It is known that a singular RCT or Several RCT’s are well thought-out as the uppermost level of evidence, and anything below this is classed as a lower level of evidence, which may be classed as an inadequate source of information (Ellis 2000, Lake 2006, Morse 2006b, Rolfe & Gardner 2006). Evidence shows that (RCTs) are considered highly effective sources of information (Muir Gray, 1997;Mulrow & Oxman, 1997; Sackett et al.,1997).

It would be highly unethical to use these findings as a prejudice against patients with cancer who wish receive treatment for depression and depressive symptoms, because of the limited data on effectiveness. NURS 3150 – Foundations of Nursing Research Paper

However, traditional or unsystematic reviews can be apparent and suitable to attain, which can also be deceptive at times, above all they are scientific Murlow(1987).

None of these studies make mention of persons centred planning (PCP), which is slightly concerning. Professionals may have four ways in which they can contribute towards (PCP): introducing, contributing, safeguarding, and implementing/integrating (PCP) (Kilbane and Sanderson ,2004).

Q4.

Although, there may be an accumulating body of knowledge about the efficacy of immeasurable nursing practises, which leaves gap between what is in fact known and what is actually practised (Grol and Grimshaw, 2003).

People whom have been in the profession for a long time may not approve or wish to adhere to the implementation of (EBP). This may be due to a number of reasons such as; culture, age, learning ability, or even attitudes towards changes within an organisation. NURS 3150 – Foundations of Nursing Research Paper

It is known that there may be barriers which may cause complications in applying (EBP) in nursing practise, this has been established in extensive literature reports (Estabrooks et al 2004). If a nurse’s workload is too big, then this may influence their ability to adapt to changes in practise.

A significant source of implementing (EBP) is; student nurses or newly qualified nurse. I have found that student nurses and newly qualified nurses are an important source in the utilisation of (EBP). If for example; they have carried out research at university for an assignment, then they may be able to apply and demonstrate this in practise, and also influence fellow colleagues. NURS 3150 – Foundations of Nursing Research Paper

Conclusion

In writing this assignment I have found depression in cancer patients is significantly high. I am now able to say that on the completion of this I am now able to acknowledge the complexities of depression in cancer patient. This will enhance my future practice as a nurse, which will enable me to apply the knowledge I have gained from this assignment into practise. I am now able understand the importance of (EBP), and its relation to my future practise. This has helped assist me in developing my academic skills. On the completion of this assignment I have developed my analysis skills immensely, which will help assist me in my future practise. NURS 3150 – Foundations of Nursing Research Paper

References

Atkin K., Lunt N., Parker G. & Hirst M. (1993) Nurses Count: A

National Census of Practice Nurses. Social Policy Research

Unit, University of York, York.

Barraclough J, (1994), Cancer and emotion. Chichester UK:Wiley

Casey P. Depression in the dying- disorder or distress. Progr Palliat Care 1994; 2: 1-3.

Davidoff F, Haynes B, Sackett D & Smith R, (1993) Evidence-based medicine: a new journal to help doctors identify the information they need. British Medical Journal 310, 1085-1085.

Ellis J (2000) Sharing the evidence: clinical practice benchmarking to improve continuously the quality of care. Journal of Advanced Nursing 32, 215-225. Preston, Lancashire

Estabrooks CA, Winther C, Derkson L. Mapping he feild: a bibliometric analysis of the research utilization literature in nursing. Nurs Res 2004; 53:293-303

EVANS D, Journal of Clinical Nursing 2003; 12: 77-84, Hierarchy of evidence: a framework for ranking evidence evaluating healthcare interventions

As a nurse educator, you may be expected to lead and participate in the development and revision of nursing programs. Therefore, it is essential that you have the competencies to analyze internal and external factors and trends that impact the design and delivery of nursing curricula. You must also be able to use a variety of learning theories to guide the development of nursing curriculum and integrate relevant educational philosophies, modalities, and assessments to achieve identified program outcomes. The clear articulation of the ethical standards and desired learner outcomes to stakeholders will be necessary for achieving the requirements of state and national regulatory and accrediting agencies. NURS 3150 – Foundations of Nursing Research Paper

Scenario:

At Hartford Community College, the executive team has decided to change the current two-year associate degree nursing program to a four-year bachelor of science in nursing (BSN) program. As the director of allied health programs, you have been asked to chair the nursing curriculum committee, which is charged with fully designing the new BSN program. Your position gives you access to societal, economic, and institutional trends that are current in the field of nursing education. Taking these items into consideration, your committee has been tasked with gathering information and presenting it for the new BSN program. You are to ensure the new BSN program is consistent with state and national professional standards and guidelines. You will be creating a report to take to the board of directors for approval. NURS 3150 – Foundations of Nursing Research Paper

Requirements:

A. Create a report that contains the following components:

• table of contents

• components identified in aspects B through K

B. Justify the change from an associate degree nursing program to a BSN program.

Note: Please include one or two sentences to serve as a brief introduction to the justification for the change from an associate degree nursing program to a BSN program. Details of the justification will be amplified in items B1 and B2.

1. Explain two factors (e.g., social, economic, political, institutional) that influence the need for a BSN program.

2. Explain how at least one of the following external forces has informed the decision for a BSN program:

• The Institute of Medicine (IOM)

• The Future of Nursing: Leading Change, Advancing Health

• Magnet hospital recognition

• Patricia Benner’s Educating Nurses: A Call for Radical Transformation

• Contemporary literature on patient outcomes related to academic preparation for nurses.  NURS 3150 – Foundations of Nursing Research Paper

C. Select a recommendation from one of the following organizations or institutions to guide the integration of quality and safety initiatives in the new BSN program:

• Quality and Safety Education for Nurses (QSEN)

• The Institute of Medicine (IOM)

• American Association of Colleges of Nursing (AACN)

• National League for Nursing (NLN)

• The Joint Commission

1. Provide a rationale for your selected recommendation.

2. Discuss one possible barrier (e.g., faculty shortage, financial incentives) you may encounter as you implement your selected recommendation.

D. Develop an argument for how a learning theory (e.g., constructivist, cognitivist, humanistic) would support the development of critical thinking skills in the new BSN program.

1. Critique the selected learning theory, including the following:

• two advantages of using the selected theory in the new BSN program

• two disadvantages of using the selected theory in the new BSN program

E. Describe the key components of one of the following educational philosophies or conceptual underpinnings that can inform the development of the new BSN curriculum: NURS 3150 – Foundations of Nursing Research Paper

• multiple intelligences

• adult education

• critical andragogy/pedagogy

• narrative andragogy/pedagogy

• authentic learning

1. Critique the selected philosophical approach, including the following:

• one advantage of using the selected philosophy in the new BSN program

• one disadvantage of using the selected philosophy in the new BSN program

F. Select two current modalities for the delivery of the new BSN program (e.g., traditional classroom, online education, live web streaming, telehealth, social networks, electronic health records, simulations/clinical education experiences, competency-based learning).

1. Provide a justification for each of the selected modalities.

2. Analyze whether potential barriers exist in implementing your selected modalities.

G. Describe why formative and summative assessments will be used in the new BSN program.

1. Discuss at least two benefits of using formative assessments in the new BSN program.

2. Discuss at least two benefits of using summative assessments in the new BSN program. NURS 3150 – Foundations of Nursing Research Paper

3. Discuss at least two limitations of using formative assessments in the new BSN program.

4. Discuss at least two limitations of using summative assessments in the new BSN program.

5. Analyze how one of the following assessment methods could increase student success in the new BSN program:

• paper and pencil exams

• high-stakes exams

• classroom assessment techniques (CAT)

• computer-based testing (CBT)

H. Explain how the ANA Code of Ethics will be incorporated and applied in the new BSN program.

1. Analyze how each of the following legal accountabilities in nursing education will be incorporated and applied in the new BSN program:

a. Family Educational Rights and Privacy Act (FERPA)

b. Americans with Disabilities Act (ADA)

c. Health Insurance Portability and Accountability Act (HIPAA)

d. copyright laws

I. Analyze how one of the following nursing accreditation methods would be incorporated and applied in the new BSN program:

• the Commission on Collegiate Nursing Education (CCNE)

• National League for Nursing (NLN)

• state boards of nursing

J. Create a conclusion that includes a summary of the final key recommendations essential for consideration in this new BSN program. NURS 3150 – Foundations of Nursing Research Paper

K. When you use sources,

This paper presents a critique of a qualitative research article titled: ‘Perceived support from healthcare practitioners among adults with type 2 diabetes’ (Oftedal et al, 2010) (appendix 1). To enable the critique of this article the Caldwell critiquing tool (2005) will be utilized. (Appendix 2)

Research critiquing is a valuable skill, to gain as it enables student nurses to develop and improve knowledge and skills and also adheres to the NMC code of conduct (NMC, 2008). Polit and Beck (2006) emphasis the ability to analyse research enables individuals to gain knowledge.NURS 3150 – Foundations of Nursing Research Paper

A great importance of research is that it introduces improvements and changes into practice based from evidence based practice (EBP). According to Pioneer David Sacklett (2000). EBP can be defined as “the integration of the best research evidence and clinical expertise, and patient values” (Sacklett,2000). This article was selected as diabetes is becoming an international epidemic affecting all healthcare professions (WHO,2012).

First point of interest to a reader is the title; giving clear indication of the subject (Polit and beck, 2012). It should grab the attention of a reader as discussed by Parahoo (2006). A good title should contemplate all aspects of the above, also considering Polit and Becks (2012) thoughts on the title being with a 15 word limit. This title is very clear to the reader, in relation to the subject under study being short, concise and use of good language.

Appropriate selection for a research paper relies highly on validity and reliability, which can be shown via credentials of authors. Working statues within health studies and behavioural research within university of Stavanger clearly quoted against each of the authors. This article has clearly labelled, educational status and working status of all authors.

Willis (2007) believes that an author’s academic background can give validity and credibility within the research itself. Education held by authors was ‘MSc, PhD, RNT’ being of an university level (Oftedal et al, 2010). NURS 3150 – Foundations of Nursing Research Paper

Further interest to a reader commences from the information shown within an abstract. This has to hold enough information for it to show a brief understanding of the study in place. Holloway and Wheeler (2010) recommend a clear, concise summary of the research and how it should be implemented. Burns and Grove (2007) mention good abstracts convey findings and capturing attention of a reader. A benefit to this article is that it is clear, readable and structured with subheadings providing a deeper structured understanding.

The introduction of this article evidently outlines the rationale for the study; with reference of findings from other relevant studies completed. Holloway and Wheeler (2010) declare authors have to provide awareness of their subject and reasons for their study. Suggestions made indicated that it is paramount for study for the improvements to be made, emphasising on the rise in statistics from the condition (Oftedal et al, 2010).

Within the article, there is no clear indication of a literature review. Although, through reading this it has become apparent that it has been included within the background section. Polit and Beck (2012) discuss a literature review being a summary of previous research. Explanations are given within reference to other studies such as Schilling et al (2002) which has shown to lack empirical evidence.

However, Thorne and Paterson (2001) look at aspects, but indicate more research can be done. The purpose of a literature review is essential as it gives more emphasis on why the study is important; for instance lack of previous research on the subject. Within this article has an disadvantage, because there is no clear stating of a literature review, which would in some circumstances confuse a reader. Research referenced within the article was between the years 1992-2008; mentioning the need for further research (Oftedal et al, 2010). NURS 3150 – Foundations of Nursing Research Paper

A purpose for an article is to generalise there aims, informing subject under study stating what is likely to be achievable from the study; Polit and beck (2012) emphasis this being an importance. The aim is clearly sub headed giving the reader clear positioning within the report, it is short and concise with relevant information; indicating the subject of study and what is desired. The aim being ‘perceived support from healthcare and different attributes, that influence people’s self-management of the disease’ (Oftedal et al, 2010).

The study is complete by using participants. Ethical issues have a vast importance relating to the validity and credibility of the research. Approval of ethical committee’s is exceptional, including reference. Legal rights and ethical aspects for all research methods have to be considered (Holloway and Wheeler, 2002; Moule 2011; Strubert, 2011). The study appears to have been approved by Norwegian regional committee for medical and health research ethics, social science data services all having reference provided.

Implications can be studied at length but four rights are paramount in research: the right not to be harmed, the right of full disclosure, the right to self-determination and the right to privacy, anonymity and confidentiality (ICN, 2012). It is apparent from the study that informed consent was gained from participants, as an invitation was sent, and approval from participants was gained. The right to withdraw was shown as two participants never contributed from initial approval. NURS 3150 – Foundations of Nursing Research Paper

Methodology is discussed by Parahoo (2007) simply as a plan that describes, how, when and where data is to be collected and analysed. This article does not visibly show methodology but it is an interchangeable term such as research design is present. An advantage from the article is that further reading and comprehension is not necessary as it obviously indicates this research as “interpretive and descriptive qualitative design” (Oftedal et al, 2010). Holloway and Wheeler (2002) state it gives an understanding of human experiences, giving an advantage to this research as it is what they wish to achieve.