Critical Appraisal of Evidence

Critical Appraisal of Evidence Name: Institution  Critical Appraisal of Evidence The healthcare system is constantly changing as growing expectations of society among other factors continue to affect the modes of service delivery in the sector. These changes make the transition of undergraduate nurses into clinical practice a very stressful period, resulting in increased focus on strategies of improving the transition process. There exists extensive research and studies on transition strategies to determine whether they improve clinical competence and productivity of nurses. This paper contains a critical appraisal of a systematic review on the effectiveness of strategies applied in the transition from undergraduate nurse to clinical practice. Summary Existing literature such as ‘Bridging the theory practice gap: a review of Graduate Nurse Program (GNP) in Dubai, United Arab Emirates’ (2011), analyses the effect of the graduate Nurse Program in the United Arab Emirates. Strauss (2009) in ‘Easing the Transition: A successful New Graduate Program’ conducted a project on the effect of New Graduate Program at Winchester. They concluded that the program was effective in retaining graduate nurses in the profession. A study by Fielden, (2012) supports this conclusion by arguing that the use of graduate programs in Saudi Arabia improved on the number of nurses in the career. A study conducted by Duchscher, (2009) in ‘Transition shock: the initial stage of role adaptation for newly graduated Registered Nurses’ reveals that there is a need of using preparatory theory on the senior students who face the challenge of the changing environment between school and their new professions. Edwards et al. (2011) in ‘The effectiveness of strategies and interventions that aim to assist the transition from student to newly qualified nurse’ identifies as the highest source of evidence in the study review of transition programs. The review is made up of several existing evidence summarized into one comprehensive review showing the effectiveness of strategies used in the transition process. It also fully addresses the issue of quality, precision, and validity of the study results thus making it the best evidence for critical appraisal. Critical Appraisal The studies completed by Edwards et al. (2011) intended to establish whether support strategies during transition are effective and their impact on retention rates. The objective of the review is to answer this question by synthesizing available data from previous studies regarding the effectiveness of strategies and support offered during transition from undergraduate nurses in final school years to the clinical workplace. The clear review objective is to evaluate and update any progress on interventions since 2002 (Edwards et al., 2011). The review justifies appraisal findings using results from data synthesis and outcomes of thirty-three studies in the review. The rationale behind the studies is to identify all areas impacted by transition programs using various categories of study. The selection criteria for the studies were limited to quantitative studies including randomized control trials, non-randomized control trials, quasi-experimental studies, observational studies, surveys and descriptive studies (Edwards et al., 2011). This type of study was appropriate for intervention in identifying the best and most current evidence available. The participants in the inclusion criteria were newly qualified nurses in their first year of practice in the clinical area (Edwards et al., 2011). There was also exclusion of study results because the reports of newly qualified and registered nurses were combined. The types of intervention included any support strategies and interventions assisting newly qualified nurses in the transition from student to clinical practice (Edwards et al., 2011). This is besides the types of outcome measures for the employer and the newly qualified nurse, which are the inclusion criteria. The inclusion and exclusion criteria used were appropriate to the study question and they ensured that the studies achieved their purpose. The criteria of selecting newly qualified nurses as principal targets of the research enhanced the quality of the research outcome (Edwards et al., 2011). Data Extraction and Synthesis The review used a three-stage search strategy for data extraction from major databases using the preliminary keywords; transition, nurse, graduate, clinical support, internship, preceptorship, and program (Edwards et al., 2011). Inclusion criteria for data extraction included published and unpublished studies from 2000 to present date and only English papers (Edwards et al., 2011). The data extraction strategy and inclusion criteria used in the studies was effective in ensuring relevance, quality and wide range of data collected. Electronic searching for articles was based on abstract or title and a full report retrieved for studies that met full inclusion criteria (Edwards et al., 2011). This search method ensures no important and relevant content for the study is omitted. The reviewers used a narrative summary to synthesize extracted data because data could not statistically combine data due to lack of identifiable Randomized Controlled Trials (Edwards et al., 2011). Two independent reviewers independently assessed the data while a third reviewer resolved disagreements. This validates the integrity of the studies by ensuring methodological quality of the review. Results and implications Results of the study were from thirty-three studies consisting one random control trial, three quasi-experimental and twenty-nine observational/descriptive studies. These were group...