92440 Evidence For Nursing


Part 1: Contents General

Answer to Question: 92440 Evidence For Nursing

Part 1: Questions About General Content

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One of the main concepts in this subject was to communicate broad clinical scenarios to searchable questions. Then, using refined search words to extract data, it was possible to do so.

1.Short searches find relevant information, because databases can be indexed.

Databases will not search for all words in long sentences. This results in unexpected results.

2.Specific search phrases only literature that matches the search term.

Broad search terms may return many results, even the ones that aren’t as relevant.

3.Tanner’s Model of Clinical Judgement summarises a method for managing health situations.

This model describes how health concerns, patients’ problems and care approaches should be handled.

Simulation can help improve clinical judgment and abilities.

It emphasizes that clinical judgments need critical thinking creativity as well as decision making.

This research-based model emphasizes the components of observation, interpretation, response, reflection, and decision making.

Evidence-Based Practice (EBP), a clinical approach that takes current nest evidence into consideration and uses it conscientiously, explicitly, and judiciously to form clinical decisions.

It is the integration and use of external evidence to support clinical knowledge.

EBP incorporates the clinical expertise, the consumer’s values, as well as reliable research evidence, in order to make decisions.

Clinicians bring their experience, education, and then incorporate it with the experiences and beliefs of consumers.

4. A systematic review focuses on one particular clinical topic with the goal of providing a specific answer.

The authors conduct extensive research to identify relevant studies. After reviewing and assessing their quality, they summarize the findings in a predetermined fashion according to the question.

Randomized control trial are experiments that involve the use of real patients for their outcome.

Part 2 – Research Methodology and Results

Byrne, et al. (2017).

Assessment 2 folder has a copy.

5. Randomization was used in this study to eliminate bias.

The performance bias was reduced by the blinding of data collection.

The concealment of allocations minimized biases that could have caused performance bias or assessment bias.

Prospective design was able to reduce recall errors as well as bias in the selection.

Randomization made it possible to eliminate potential confounding variables that could have been caused due to an uneven distribution of predictive factor. It also made comparisons more straightforward.

6. The first outcome was the discharge period. This was not significant, with or without any adjustment to the surgery.

The scores of the two groups were (5.8 and 6.1 days respectively) for the chewing and the non-chewing.

Another outcome was the first flatus.

The score difference between the two groups was not significant (P = 0.076): 42.0 (8.2) for chewing, and 58.0 (8.2) for non-chewing.

After adjustment of the surgery type, the score remained insignificant.

The last primary outcome was first stool motion (TBM).

The TBM in the chewing and non-chewing groups was 50.0 hours (2.4), and 80.0 (6.5), which was significantly less.

TBM decreased also after surgery.

Secondary outcomes included pain, complication rates and total morphine equal (TMEq), medication for 7 days after the procedure.

Complication rates were another secondary outcome.

Intraoperative complications were reported by the CG at 79% and the NCG at 79%, respectively.

36 (44%) was the rate for CG and 42(55%) were recorded for NCG.

There were 13 patients at NCG (17%) who had recurrent ileus, compared to the eight (10%) at CG.

Three patients required reoperation for NCG were (4%) and (0) respectively.

The medication was also a success. There was no variance in the total morphine equal for 24 hours.

However, CG showed a significant reduction in morphine equivalents during the first 7 days.

Pain scores were also higher for patients who had not experienced a bowel event in NCG compared to CG.

7.Pain was first noted using a paper-based CRF (Case Report Form).

Patients were only allowed to report their pain scores after the patient’s TBM.

Patients were asked to rate their pain using a scale between 0 and 10, with 0 representing no pain and 10 representing extreme pain.

8. The sample size was adequate.

Prospective design allows researchers to monitor patient recovery and the outcomes.

This design allowed researchers to consider other factors.

They were able select, allocate, administer and monitor the development of chewing gums in the treatment group.

The blinding succeeded, and the results were consistent.

9. The significant difference between the baseline and the randomization was what could have affected this study.

The CG group had 43% patients who had ileostomy closes and the NCG had 25%.

An ileostomy is a minor surgical procedure that closes the ileostomy temporarily.

This resection is much less painful than other types of colectomy, and it requires less analgesia.

The pain and recovery assessment could have been affected by the variation in these procedures.

Blinding is used to reduce or eliminate performance ascertainment after randomization.

A failure to blind patients can have huge effects on the trial, as they will be aware of the different group assignments.

Patient’s reactions and behavior can affect subjective outcomes.

A patient might decide to reject the trial if they know that they are not receiving treatment that could have improved their conditions.

The patient may also try to find alternate treatment outside of the protocol.

The patient may also be allowed to leave the study. However, her/his data will not be stored.

11.Yes. However, there was no signifi cant efficacy.

The difference between these two groups was LOS, which was 0.9.

The LOS of the chewing group was 5.8 Days, while that for the non-chewing group is 6.1 Days.

This was a difference in only 0.9 day.

Even after adjusting the type and extent of the surgery, there was still very little merging.

12.Median is a number that represents the middle value after placing all the numbers in a sequential order.

Accordingly, the median is somewhere in between the lower and upper halves.

The authors indicate that the median TBM time was 50 hours in CG. This is because they had arranged the TBM of the 82 patients in CG. They then took the TBMs from the 42 and 41 patients.

They found the 50-hour mean of their TBM.

So, if the median was fifty hours, then more that half of the patients had TBMs less than or equal to 50.

13.The median in CG 95% 95.2-54.8 was 50 hours.

This estimate cannot be used to provide relevant information as it does not assume that all patients who chewed gum would have taken 50 hours of TBM.

If all patients were surveyed, there is no way to know how much the mean would have varied.

For example, the authors were unable to prove that all patients had a median TBM within the range of 5 hours to 50 hours.

With a confidence interval between 95% CI 45.2-24.8, more information is available.

The median time to chew gum for patients would be 45.22 hours. However, 95% of the calculated CI would show a 50 hour TBM.

If the authors took repeated samples and calculated a 95% confidence range on each one, 95% of the intervals that contained the medians would be found. However, 5% of all intervals would not contain population medians.

14. This is the null hypothesis. We assume that chewing the gum has no effect on the morphine requirements for morphine substitutes.

The null point is 1, which indicates that there have been no effects.

The higher the level of validity of null hypothesis, the closer the value of morphine equivalents to 1 is.

24 hours later the P was 0.589. This was closer to 1 which indicates that chewing tobacco did not work.

Day 2 saw a P of 0.019. This is far below 1. This indicates that chewing gum actually works

Day 3’s P was 0.002, which is far from 1. This means that chewing Gum worked and was improved upon day 2.

Day 4, P was 0.025. That’s far from 1. This indicates that chewing gum did work but there was a dip from the prior trend.

Day 5, the P was 0.33. It was not far from 1. This means the chewing gel worked, but for some reason, it was moving towards one.

Day 6, the value of the P was 0.013, which was quite far from 1. This means the chewing candy returned to its working trend.

Day 7, P = 0.002, not 1. It was far lower than 1, but the chewing gum did work. The trend continued back to day two, which indicates that the external variable that caused the variation could be controlled.

A low P-value is generally an indicator that the sample was sufficient to reject the null hypothesis, and accept that the chewing tobacco was effective for all patients.

15.Yes. Because of Byrne, et al.

There are many benefits to chewing gum, according to other studies.

Byrne, et al. (2017) showed that chewing gum can shorten the stay and reduce the time to get the first bowel movement.

Study results also showed that sugar-free gum could speed up recovery time and improve bowel function.

Chewing gum can also reduce the need of analgesics.

It is worth chewing gum if it proves to be safe for the patient.

Part 3: Implementation EBP

These questions can help you think more broadly about your engagement with evidence in clinical practice.

16.There are many hurdles that can prevent research findings from being implemented in clinical practice.

These barriers can be classified into three categories: those that are caused by patients, health professionals, or government.

These barriers are often more personal.

Because each patient is different, there are many factors that can influence the implementation of the finding.

Given that patients should participate in a decision-making process together, it is possible for some patients to disagree with healthcare professionals.

As such, healthcare officials need to respect patients’ decisions.

Patients are expected to adopt a particular lifestyle and purchase certain products. Lack of funds could hinder their ability to implement the findings.

Patient education is another key factor. Patients may not understand the purpose of a new approach and will be less likely to accept it.

Implementing clinical finding can also be hindered by the presence of health care professionals.

These obstacles are caused by information constraints. This is when there is not enough information to make the approach work.

Other obstacles for clinicians are lack of support tools, limited guidance, provider altitude, or lack thereof.

Organizational obstacles include poor implementation policies and lack of financial support.

17.This subject has enhanced my skills in evidence-based practices.

I have gained more knowledge about making clinical decisions that can aid patients in recovery.

Nursing is a profession that requires the ability to interpret clinical findings.

In addition to understanding the results, I learned how to conduct my own research.

This subject taught me how to develop a search strategy in databases.

Given that research is an important area for nurses to gather evidence, I will have an easier time with my research if I use short terms to find specific results.

I can also evaluate different studies done by other researchers to help me identify what is relevant to my clinical question.