NUR 590 Topic 6 Discussion Question
NUR 590 Topic 6 Discussion Question
When reviewing the literature for your evaluation plan and different types of evidence for your project, what gaps in the findings did you encounter? How could these gaps influence other researchers?
The purpose of an evaluation plan is to monitor and evaluate the proposed intervention. It is also intended to evaluate the results of the intervention for the purpose of making improvements where needed and determine the effectiveness of the intervention. One of the many first steps in the evaluation plan is clarify what is needs to be evaluated. When reviewing literature for the evaluation plan I was successful in finding enough articles to support my intervention plan. One of the gaps that I found in the research were the need for further studies as recommended by the researchers on the how nursing shortages impact patient care. The studies did however highlight the correlations but insisted that more studies need to be conducted. The nursing shortage has been growing worse now then ever before with the COVID-19 pandemic pushing more and more nurses to the breaking point. Hospitals are now experiencing record staffing shortages and a growing number or patients flooding the ICU and hospitals with COVID-19 (over 90% of them are unvaccinated). “The problem of implementing valid research results in nursing practice is well known; Despite an accumulating body of knowledge about the effectiveness of some nursing interventions, a gap often exists between what is known and what is practiced; Continuing professional education has been promoted as one way to bridge the gap between research and practice so that patients may benefit” (Thomson, n.d.). These gaps can possibly influence other researchers by challenging the argument that nursing shortages do not have a great deal of impact on nursing shortage but according to the new data being published it is creating a public health crisis.
Translational research appears to be a tool used to close the gap between evidence-base practice and the clinical delivery of direct nursing care. It is described as a way to improve population health and the delivery system. Translational science looks for ways to implement evidence based practice, so being something entirely different than EBP, it works hand in hand with EBP to improve patient outcomes. Translational research digs in to make a clear understanding of what implementation strategies work, the people they work for and answers the question of why. This body of knowledge, translation science, provides a base for guiding the selection of implementation strategies. (Titler, 2018) The are levels of translational research, T1 developing treatments and interventions, T2 testing the effectiveness of those treatments and interventions and T3 is dissemination and implementation for change. In addition another resource describes 5 phases beginning with T0 through T5. T0 starts with basic research, preclinical. T1 is testing on a small group of humans, T2 and T3 are more trials on an even larger group of humans. T4 is the outcome research / translation to practice and lastly T5 goes out to the population or translation to the community. This type of research seems more hands on and creates positive outcomes to the patients who are in need of direct and immediate care.
Thomson, M. (n.d.). Closing the gap between nursing research and practice. Retrieved from https://ebn.bmj.com/content/1/1/7
Evidence based practice research is not without it’s flaws. Although research questions are formulated to understanding the relation between two or more variables, the outcomes are not always desirable to the researchers. Research gaps occur with these outcomes or with the limitations that arise during the research process. In order to evaluate the effectiveness of the implementation process, identifying research gaps can help researchers strengthen evidence by identifying missing information or address topics that were not included but generally related to the main topic. Identifying and addressing these topics can increase the supporting information. Research gaps can be present in generalized research or more specific research questions in which topics are discussed in detail but do not include information on how to be applied to other related settings or too generalized that applying it would cause disparities in multiple populations (Shahriari & Rasuli, 2020). While I was reviewing the literature for my project, I noticed a research gap between types of weight loss interventions and the type of foods they eat. Most studies looked at nutrition of a single diet modification and its affect on health and wellness but rarely compared it to more than one other diet modification types to compare which would be the most effective (Suleiman, Mohamed & Baker, 2020). There is also very few systemic reviews of this topic that would support a single type greater than the other by having stronger evidence. This is why it is important to identify research gaps and limitations so that the research presented can also explore if it is lacking factors that would make it significantly stronger so that future studies can build strength from the last.
Parviz Shahriari, & Behrooz Rasuli. (2020). No study is Ever Perfectly Flawless: Exploring Research Limitations in Theses and Dissertations of Iranian Higher Education Institutes. Iranian Journal of Information Processing & Management, 36(1), 95–126.
Joseph Bagi Suleiman, Mahaneem Mohamed, & Ainul Bahiyah Abu Bakar. (2020). A systematic review on different models of inducing obesity in animals: Advantages and limitations. Journal of Advanced Veterinary and Animal Research, 7(1), 103–114. https://doi-org.lopes.idm.oclc.org/10.5455/javar.2020.g399
When there is a lack of information, it can either demoralize or energize a researcher. Research could be done on a different population or the population can have a slightly different intervention. Some research should be started with the goal in minds, see what others have done, and try to apply it to your facilities situation.
In the case of my project, educating informal caregivers in PPE usage, it was hard to find both the target population, intervention, and setting. The best articles I found was hand hygiene compliance or PPE compliance for family members/visitors in acute care For example, Biswal et al. (2020) studied the hand hygiene compliance of family caregivers in hospitals in India and Seibert et al. (2018) explored use of contact precautions among visitors at hospitals. Research on family members of a sick patient is limited and seems to show up more for pediatrics patient family, like in Biswal et al (2020). Or, if I look at the intervention of PPE training, most is about staff. Research is sparser in long term care settings.
Gaps in knowledge can cause demoralization due to lack of information. If I didn’t care about the suffering I saw, I may have rewritten my proposal. Recently, I picked up a new job on a telemetry floor, so its not as easy to see what is happening on a day-to-day basis at my long-term care facility anymore. I find I’m spending more time keeping up with the changes LTC is forced to make due to fears, regulations and legal implications. This gaps in knowledge make it harder to design a proposal and keep relevant.
Biswal, M., Angrup, A., Rajpoot, S., Kaur, R., Kaur, K., Kaur, H., Kaur, H., Dhaliwal, N., Arora, P., & Gupta, A. K. (2020). Hand hygiene compliance of patients’ family members in India: importance of educating the unofficial ‘fourth category’ of healthcare personnel. Journal of Hospital Infection, 104(4), 425–429. https://doi-org.lopes.idm.oclc.org/10.1016/j.jhin.2019.09.013
Seibert, G., Ewers, T., Barker, A. K., Slavick, A., Wright, M. O., Stevens, L., & Safdar, N. (2018). What do visitors know and how do they feel about contact precautions? American Journal of Infection. 46(1): 115–117.
Research showed gaps between hand-washing knowledge and practice when reviewing the literature towards the evaluation plan compared to different types of evidence found for the project. In initial, midpoint, and end-line data, a disparity between hygienic hand washing knowledge and self-reported behaviors was discovered. In many hospital settings, hand washing is regarded as one of the most effective hygiene promotion actions for public health (Kuehn, 2020). In hand washing, there is still a disconnect between knowledge and practice. People can be educated about the need for hand washing through long-term and broad campaigns. Tradition, customs, and obsolete information are frequently used in practice, and there is commonly a gap between theoretical aspects and its use in existence. To enhance hand washing practice with soap, there is a persistent gap between knowledge and practice, and long-term motivational activities are required (Rabbi & Dey, 2017). To effectively integrate new techniques, healthcare practitioners must believe that they are desirable and relevant to their work. Therefore, presenting a new notion known as the theory-practice-ethics gap. When looking at some of the persistently bad outcomes in healthcare, this theory-practice-ethics imbalance must be considered.
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Kuehn, B. M. (2020). Hand Hygiene Gaps Identified. JAMA, 324(20). https://doi.org/10.1001/jama.2020.22227
Rabbi, S. E., & Dey, N. C. (2017). Exploring the gap between hand washing knowledge and practices in Bangladesh: a cross-sectional comparative study. BMC Public Health, 13(1). https://doi.org/10.1186/1471-2458-13-89
Gaps in research
When doing the research to support my PICOT statement, there were not many studies to choose from, which has been my experience in the other PICOT questions I have formed, I have no idea if this is just because I choose hard subjects or if other students find this as well. After going through the laborious task of finding ten that work with your subject matter, usually there are a couple that might not perfectly fit but fit just enough to work. With my research an issue I have found, is that a lot of the research available regarding syphilis and its spread only focus on men who sleep with men and not a whole areas population. I understand why, MSM are more likely to get syphilis and are therefore focused upon, but it leaves a large population out of the study that could have been included. Another issue like in Romo et al., (2019) study is that there is a decline over time in adherence to the study parameters, which have sparked a lot of what I include into my study, as I would like to have a better percentage of adherence. Pascoal et al., (2017) study goes into the gaps I discussed earlier, about most studies focusing on MSM and a certain age demographic. They interviewed physicians regarding how often they discussed the sexual health of their elderly patients, and the answer was rarely without the patient bringing it up first (Pascoal et al., 2017). That is not how we should operate; I don’t know about any of you, but I used to work in an infectious disease office, and we treated many elderly patients that had STD’s including syphilis and HIV (Human Immunodeficiency Virus). We cannot judge a book by its cover in this day and age, and my PICOT and interventions hope to challenge that mind set.
Romo, D., Nagendra, G., Schechter, S., Pavlish, A., Cohall, A., & Neu, N. (2019). An educational intervention to improve provider screening for syphilis among men who have sex with men utilizing an urban urgent care center. Journal of Community Health: The Publication for Health Promotion and Disease Prevention, 44(4), 822–827. https://doi-org.lopes.idm.oclc.org/10.1007/s10900-019-00647-4
Pascoal, E. L., Slater, M., & Guiang, C. (2017). Discussing sexual health with aging patients in primary care: Exploratory findings at a Canadian urban academic hospital. Canadian Journal of Human Sexuality, 26(3), 226–237. https://doi-org.lopes.idm.oclc.org/10.3138/cjhs.2016-0011
Upon reviewing the literature for my evaluation plan and different types of evidence for my project, some gaps I discovered that other researchers have encountered include ensuring that the reported metrics cover all five areas of evidence-based practice, as recommended by Albarquoni et. al (2018). According to Albarquoni, inter-rater reliability, content validity, internal validity, responsive validity, discriminative validity and criterion validity all play an important part in ensuring the data collected, results obtained and discussion provided are valid (2018). Other challenges include unanticipated complexities in synthesizing and analyzing the data, creating a systematic framework in which evaluation is performed, multiple level resources, specialized databases and clarifying the specific needs of certain groups, to name a few (Wolf, 2000).
These gaps may influence other researchers in that it is valuable to review another’s previous challenges, gaps or opportunities to ensure that they are covered with one’s current research. Additionally, considering something such as systematic frameworks for reviewing and analyzing data may need to be further examined, and expertise drawn upon by outside individuals, in order to make it valuable, efficient and timely (Wolf, 2000). Wolf discusses that understanding the difference in primary and secondary databases and resources has significantly improved in recent years, but still must be considered when evaluating evidence (2000). Wolf also discusses that clinicians create great questions, but really struggle to validate their findings and present them in a way that further promotes up-to-date information and practices that can be put to use by the bedside clinician (2000). Ultimately, it is important for designers of an EBP project to understand that there are many limitations and challenges presented during the path to pursuing an answer to a PICOT. However, it is important to address these gaps as best we can, with help from one another, and relentlessly pursue the very best quality of care for our patients and communities.
Albarqouni, L., Hoffmann, T., & Glasziou, P. (2018). Evidence-based practice educational intervention studies: A systematic review of what is taught and how it is measured.
BMC Medical Education, 18(1), p 1-8. http://doi.org/10.1186/s12909-018-1284-1
Wolf, F.M. Lessons to be learned from evidence-based medicine: Practice and promise of evidence-based medicine and evidence-based education. Medical Teacher, 22(3), p 251-259. https://doi.org/10.1080/01421590050006214