Rsearch Methods for Nursing (NUR2300)
NUR2300 Research Methods for Nursing Assignment 2
FORMATTING:
- Typed responses
- Times New Roman, Size 12 Font
- Double line spacing
- No cover sheet required
- Header including your name and student number on each page of the assignment
- Type your responses directly into the Assignment 2 Marking Criteria and Template. No need for additional or different headings.
REFERENCING:
- APA (6th Edition)
- Use of in text referencing throughout your assignment
- Full list of references provided on a separate page at the end of your assignment
Identifying Recommendations for Practice
1. Refer back to the literature which you had located an analysed as part of Assignment 1 (your 15 sources of evidence). Reflect on the key findings from across the evidence, in relation to recommended areas of nursing practice that could be changed to improve patient care.
2. From this published research, your task is to identify and describe three (3) recommendations for nursing practice based on the research literature.
Your description should include:
- How the recommendation may lead to improvements in patient care
- How the recommendation may lead to a change in the way nurses provide care (e.g. assessment, communication)
- The significance or importance of the recommendation for nursing practice or patient care
- The strength of the evidence that supports the change (i.e. hierarchy of evidence)
- A description of the recommended practice change
- In text referencing (this should reflect the number of references that support each recommendation)
- Paragraph style (no dot points)
3. Each of the three recommendations for nursing practice should also have a rationale based upon the criteria for research utilisation outlined by Borbasi and Jackson (2012) in Chapter 8, from page 206.
Example of Suggested Structure for this Task:
Recommendation for Nursing Practice (1): (provide a short phrase or title to reflect the type of recommendation)
Description:
Evidence that supports the recommendation for practice:
Rationale for Practice:
Relevance
Rigour
Applicability
Implementation
Part 3: Strategies to Facilitate Research Utilisation
There are a number of frameworks that can be used to consider stages and steps involved in translating evidence into practice. For this task you are asked to:
Choose one (1) of the following research utilisation frameworks:
- ACE Star Model of Knowledge Transformation
- Iowa Model
- Stetler Model
- Promoting Action on Research Implementation Health Services Framework
1. You are asked to describe your chosen framework in terms of:
Key features or components of the research utilisation framework
How the model can be used to guide evidence-based practice nursing
How this framework has been used before (refer to a published study that has utilised this framework to guide practice change)
2. Based on your chosen research utilisation framework, discuss three (3) important strategies that could assist in facilitating the translation of your practice recommendations into practice.
For example, one framework may outline that clinicians readiness to change is a key factor prior to implementing change. If this is the case, that what could be a strategy to determine this amongst the staff that work in your area? You will need to base your strategies from literature about the framework, therefore you discussion will need to use in text referencing.
Part 4: Ethical Considerations and Evidence-Based Practice
It is suggested in the nursing literature, that there are both moral and ethical reasons as to why evidence-based practice is important for nursing. Discuss the four principles of healthcare ethics in relation to evidence-based practice:
- Beneficence (doing good)
- Non-maleficence (avoiding unnecessary harm)
- Autonomy (respecting freedom of action)
- Justice (fairness)
Part 5: Identifying and Evaluating Outcomes
1. This task links with Part 2 of this assignment. For each of the recommendations for practice that you identified, outline and describe (1) nursing practice or patient outcome which you might expect or anticipate in relation to implementing your recommendation into practice. Your suggested outcomes must be objective and measurable and based upon outcomes identified in the nursing literature (support your answer therefore with in text referencing). So for each recommendation for practice you will need one related nursing or patient outcome.Please write in paragraph style using the headings provided.
For each aspect, support your answer with relevant literature.
Example of Suggested Structure for this Task: (for each recommendation you can set out like this)
Recommendation for Practice 1 (provide a short phrase or title of your recommendation)
Anticipated outcome:
How the outcome could be measured:
How the overall implementation of the recommendation could be evaluated to determine its effectiveness:
Part 6: Disseminating Evidence-Based Practice Outcomes
1. Describe the concept of disseminating research findings (use references to support your answer)
2. Based on the evidence-based nursing literature, outline three (3) effective ways of disseminating the outcomes of implementation of evidence into practice. This could include both formal and informal approaches. (Support your answer with relevant literature).
Student Name: Student Number:
Part 2: Identifying Recommendations for Practice (25 marks)
Introduction:
Recommendation for Nursing Practice (1):
Description:
Evidence that supports the recommendation for practice:
Rationale for Practice:
Relevance
Rigour
Applicability
Implementation
Recommendation for Nursing Practice (2):
Description:
Evidence that supports the recommendation for practice:
Rationale for Practice:
Relevance
Rigour
Applicability
Implementation
Recommendation for Nursing Practice (3):
Description:
Evidence that supports the recommendation for practice:
Rationale for Practice:
Relevance
Rigour
Applicability
Implementation
Conclusion:
Part 3: Strategies to Facilitate Research Utilisation (25 marks)
Introduction
Heading: Research Utilisation Model / Framework
Key features or components of the research utilisation framework:
How the model can be used to guide evidence-based practice nursing:
How this framework has been used before
Heading: Strategies to facilitate translation of practice recommendations into practice
Conclusion
Part 4: Ethical Considerations and Evidence-Based Practice (15 marks)
Principles of healthcare ethics in relation to evidence-based practice
Part 5: Identifying and Evaluating Outcomes (15 marks)
Recommendation for Practice 1
Description of anticipated outcome:
How the outcome could be measured:
How the overall implementation of the recommendation could be evaluated to determine its effectiveness:
Recommendation for Practice 2
Description of anticipated outcome:
How the outcome could be measured:
How the overall implementation of the recommendation could be evaluated to determine its effectiveness:
Recommendation for Practice 3
Description of anticipated outcome:
How the outcome could be measured:
How the overall implementation of the recommendation could be evaluated to determine its effectiveness:
Part 6: Disseminating Evidence-Based Practice Outcomes (10 marks)
The concept of disseminating research findings
Effective ways of disseminating outcomes
Name:
Institution:
Date:
Identifying Recommendations in Measuring Blood Pressure (BP)
Introduction
Among the routine aspects of nursing practice is obtaining a patient’s blood pressure measurements that are accurate and reliable so as to guarantee optimal and appropriate care and avoid putting patients in unnecessary risk. Blood pressure has been traditionally measured with a manual sphygmomanometer, but today there are automated blood pressure machines, for example, Dinamap and Omron (Heinemann, Sellick, Rickard, Reynolds, & McGrail, 2011).
Identifying Recommendations for Practice
There is a general agreement that manual measurement BP recorded in routine clinical practice lacks the accuracy and reliability of the readings required in research (Myers, Godwin, Dawes, Kiss, Tobe, & Kaczorowski, 2011). Therefore, modern more accurate and non-invasive methods of measuring BP as those that will be recommended below should be employed to ensure effectiveness in BP measurement in all settings and promote accuracy and reliability in measurement.
Recommendation (1): The BpTRU
Among the modern automatic oscillometric devices introduced for measuring BP, is the BpTRU. This is a sphygmomanometer that is fully automated, and the oscillometric method does the BP recording. The design allows taking of an initial test reading to verify the proper positioning of the cuff to ensure that valid readings are obtained. The observer leaves the individual whose measurements are being taken alone, and the machine automatically takes five readings (Myers, Godwin, Dawes, Kiss, Tobe, & Kaczorowski, 2011).
In a CAMBO study conducted in Canada, the primary care practices in the eastern part of Canada were allocated through cluster randomization regarding the use of Automated Office Blood Pressure (AOBP) or to the Manual Office Blood Pressure (MOBP) in patients that had systolic hypertension. The primary outcome here was the mean difference between Awake Ambulatory Blood Pressure (AABP) and MOBP versus AOBP (Myers, Godwin, Dawes, Kiss, Tobe, & Kaczorowski, 2011). The results revealed that the average (95% Cl) decrease in the systolic BP before to after enrolment was greater (P < 0.001) at the first visit for AOBP patients (252) that is [-14.3 (-16.6, -12.0)]. This is in comparison to the MOBP patients (209) that is [-8.0 (-2.2, -5.8)] (Myers, Godwin, Dawes, Kiss, Tobe, & Kaczorowski, 2011). In year two, there was a reduction in AOBP by -16.3 (18.6, -14.1) this is in comparison to the reduced MOBP that is -12.4 (-14.7, -10.1) (P = 0.02). The average difference after enrolment office visit [- 7.3 (-9.7, -4.9)] was greater than (P < 0.001) compared to the difference for AOBP [- 1.8 (-4.0, 0.4)]. In the second year the differences were – 5.2 (-7.5, -3.0) for MOBP and for AOBP -2.8 (-4.9, -0.7) (P = 0.13) (Myers, Godwin, Dawes, Kiss, Tobe, & Kaczorowski, 2011).
Recommendation (2): Employ Dinamap PRO-100 in measuring BP at the wrist for older adults.
Dinamap PRO-100 is a monitor that provides a non-invasive approach towards the determination of systolic and diastolic BP, mean arterial pressure and the pulse rate. There has been much doubt regarding the accuracy in measurement of the oscillatory devices and heir acceptance in field research being unclear (Ni et al., 2006). BP readings obtained from Dinamap PRO-100 were compared with those obtained by a standard mercury sphygmomanometer. BP during the study was randomly measures thrice a day with each device (Ni et al., 2006).
Measurements by the Dinamap and mercury were correlated that is systolic BP r = 0.89 and diastolic BP r = 0.81. About a half of the participants were male, and 46.6% of them had hypertension. Dinamap was found to overestimate the systolic BP for those participants aged between 75 – 86 years old with a pulse rate of > or = 60 mmHg and hypertension that ranged from stages I to III (Ni et al., 2006). The discrepancies that existed vary with demographic characteristics. Due to its non-invasive nature it enhances improved treatment and patient outcomes (Ni et al., 2006).
Recommendation for Nursing Practice (3): Replace all mercury sphygmomanometers with aneroid manometers and Omron HEM – 197 an automated oscillometric device.
Aneroid manometers are instruments that measure the BP directly through a catheter placed inside the peripheral artery and the Omron HEM – 197 is an electronic device that monitors the BP of an individual. These may be alternatives to the potentially toxic mercury sphygmomanometer. In a study by Elliot et al. (2007), they compared the performance of the aneroid manometer and the Omron HEM – 197 in the measurement of BP and the standard here was the mercury sphygmomanometer (Elliott, Young, DeVivo, Feldstein, & Black, 2007). The difference (mean and sd) obtained when comparing the mercury column to the aneroid and automated Omron HEM – 197 were obtained in every period of measurement for both the systolic and diastolic pressure readings (Elliott, Young, DeVivo, Feldstein, & Black, 2007).
Each device met the standards and criteria set by the Association for the Advancement of Medical Instrumentation for sphygmomanometers. These are the average difference of <5 mmHg and the difference standard deviation of < 8 mmHg for all three readings. When they were compared to the mercury sphygmomanometer readings, no significant differences existed using the paired t-test with the aneroid manometer that is -0.83/0.73 mmHg and a p-value of P = 0.25/0.09 (Elliott, Young, DeVivo, Feldstein, & Black, 2007). However, with the Omron HEM – 197, the systolic BP was slightly overestimated by about 2.12 mmHg, P = 0.002 while the diastolic BP was also slightly underestimated by approximately 2.36 mmHg, P = 0.0002 (Elliott, Young, DeVivo, Feldstein, & Black, 2007).
Strategies to Facilitate Research Utilization
ACE Star Model of Knowledge Transformation
This is a model used to understand the characteristics, nature, and the cycle of knowledge used in aspects of practice that is based on evidence. The model organizes past and present concepts of healthcare improvement into a single form and provides a framework for organizing evidence-based practice processes and approaches (Stevens, 2004). This model is parsimonious and reveals the stages of transforming knowledge as new knowledge is used in into practice. The model contains the common practices and emphasizes the unique components of EBP. It includes the previous work in nursing in the context of EBP and is an organizer for the examination and application of EBP and mainstream nursing in a formal EBP network (Stevens, 2004). This model comprises of five stages that are research discovery, summary of evidence, translation to guidelines, integration into practice, and process outcome evaluation (Stevens, 2004).
The model makes depictions of the different types of knowledge in a sequential manner as evidence from research moves through several cycles and combined with other knowledge and integrated into nursing practice. This model hence provides a framework for putting the process of evidence-based practice into operation (Stevens, 2004).
In a study conducted by Donelly in 2010, she intended to determine the appropriate treatment of hypoparathyroidism (hyperphosphatemia treatment) the model was utilized as a guide in determining the knowledge on hyperphosphatemia treatments in hypoparathyroidism. The evidence that was collected in this study was selected and organized around the model of knowledge transformation. Each point was used as a guide for the determination and c...