Assignment: Evidence-Based Project, Part 3: Critical Appraisal of Research NURS 6052

Walden University Assignment: Evidence-Based Project, Part 3: Critical Appraisal of Research NURS 6052– Step-By-Step Guide

This guide will demonstrate how to complete the Walden University Assignment: Evidence-Based Project, Part 3: Critical Appraisal of Research NURS 6052 assignment based on general principles of academic writing. Here, we will show you the A, B, Cs of completing an academic paper, irrespective of the instructions. After guiding you through what to do, the guide will leave one or two sample essays at the end to highlight the various sections discussed below.

How to Research and Prepare for Assignment: Evidence-Based Project, Part 3: Critical Appraisal of Research NURS 6052

Whether one passes or fails an academic assignment such as the Walden University Assignment: Evidence-Based Project, Part 3: Critical Appraisal of Research NURS 6052 depends on the preparation done beforehand. The first thing to do once you receive an assignment is to quickly skim through the requirements. Once that is done, start going through the instructions one by one to clearly understand what the instructor wants. The most important thing here is to understand the required format—whether it is APA, MLA, Chicago, etc.

After understanding the requirements of the paper, the next phase is to gather relevant materials. The first place to start the research process is the weekly resources. Go through the resources provided in the instructions to determine which ones fit the assignment. After reviewing the provided resources, use the university library to search for additional resources. After gathering sufficient and necessary resources, you are now ready to start drafting your paper.

How to Write the Introduction for Assignment: Evidence-Based Project, Part 3: Critical Appraisal of Research NURS 6052

The introduction for the Walden University Assignment: Evidence-Based Project, Part 3: Critical Appraisal of Research NURS 6052 is where you tell the instructor what your paper will encompass. In three to four statements, highlight the important points that will form the basis of your paper. Here, you can include statistics to show the importance of the topic you will be discussing. At the end of the introduction, write a clear purpose statement outlining what exactly will be contained in the paper. This statement will start with “The purpose of this paper…” and then proceed to outline the various sections of the instructions.

How to Write the Body for Assignment: Evidence-Based Project, Part 3: Critical Appraisal of Research NURS 6052

After the introduction, move into the main part of the Assignment: Evidence-Based Project, Part 3: Critical Appraisal of Research NURS 6052 assignment, which is the body. Given that the paper you will be writing is not experimental, the way you organize the headings and subheadings of your paper is critically important. In some cases, you might have to use more subheadings to properly organize the assignment. The organization will depend on the rubric provided. Carefully examine the rubric, as it will contain all the detailed requirements of the assignment. Sometimes, the rubric will have information that the normal instructions lack.

Another important factor to consider at this point is how to do citations. In-text citations are fundamental as they support the arguments and points you make in the paper. At this point, the resources gathered at the beginning will come in handy. Integrating the ideas of the authors with your own will ensure that you produce a comprehensive paper. Also, follow the given citation format. In most cases, APA 7 is the preferred format for nursing assignments.

How to Write the Conclusion for Assignment: Evidence-Based Project, Part 3: Critical Appraisal of Research NURS 6052

After completing the main sections, write the conclusion of your paper. The conclusion is a summary of the main points you made in your paper. However, you need to rewrite the points and not simply copy and paste them. By restating the points from each subheading, you will provide a nuanced overview of the assignment to the reader.

How to Format the References List for Assignment: Evidence-Based Project, Part 3: Critical Appraisal of Research NURS 6052

The very last part of your paper involves listing the sources used in your paper. These sources should be listed in alphabetical order and double-spaced. Additionally, use a hanging indent for each source that appears in this list. Lastly, only the sources cited within the body of the paper should appear here.

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Sample Answer for Assignment: Evidence-Based Project, Part 3: Critical Appraisal of Research NURS 6052

A critical appraisal assists in reducing the research burden by enabling a researcher to identify and focus more on relevant articles to their research question. The research can either provide support or disapprove the claims made by the researcher through the utilization of quality, and evidence-based practice interventions. The selected topic for the research study is use of resilience training to redice the problem of nurse burnout among nurses in different care settings. Nurse burnout remains a critical problem that impacts the quality of care and patient outcomes in different care setting. Resilience training allows nurses to develop and use evidence-based interventions to reduce burnout and enhance their overall performance and improve the quality of care.

There will always be barriers when implementing change. A study written by Mathieson, et al, in 2019 explored the barriers to implementing EBP in nursing. It was found that organizational changes – restructuring and the decentralization of services – had a negative impact upon implementation. I think the biggest barrier to change is timing. If the unit or hospital is not fully invested or there are other priorities then the EBP changes will suffer. The timing of implementation is crucial to the success of a project. For example, for my EBP proposal I think there will be obstacles because of our staffing issues. The lack of proper staff takes priority and it can be difficult to train and implement a new process when there is constant turnover of nurses. I am hopeful with a recent change in leadership, there will be better staffing models and my unit can return to focusing on improving nursing practice instead of staffing shortages.

Evidence-based practice (EBP) incorporates best practices from studies and patient care information with clinician experience and patient preferences leading to the delivery of highest quality of care, and improving patient outcomes. The use of EBP requires care providers to formulate a clinical question of interest. In this case, the PICOT question is: Among nurses with burnout (P), does resilience training (I) compared to no intervention (C) reduce burnout(O) in six months (T)? The purpose of this assignment is to appraises critically peer-reviewed article for evidence to support resilience training among nurses with burnout to reduce its prevalence.

The prevalence of CLABSI is high, compromising the quality of care provided to patients admitted to hospitals. As a result, there is a need to investigate evidence-based practices that can be used to reduce health issues, particularly in the ICU. The goal of this study is to evaluate the evidence on the various measures of responding to CLABSI in inpatient units.

Evaluation Table

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Full APA formatted citation of selected article.	Article #1	Article #2	Article #3	Article #4
Full APA formatted citation of selected article.	Afonso, E., Blot, K., & Blot, S. (2016). Prevention of hospital-acquired bloodstream infections through chlorhexidine gluconate-impregnated washcloth bathing in intensive care units: A systematic review and meta-analysis of randomised crossover trials. Eurosurveillance, 21(46). https://doi.org/10.2807/1560-7917.es.2016.21.46.30400	Scheier, T., Saleschus, D., Dunic, M., Fröhlich, M., Schüpbach, R., Falk, C., Sax, H., Kuster, S., & Schreiber, P. (2021). Implementation of daily chlorhexidine bathing in intensive care units for reduction of central line-associated bloodstream infections. Journal of Hospital Infection, 110, 26-32. https://doi.org/10.1016/j.jhin.2021.01.007	Reynolds, S. S., Woltz, P., Keating, E., Neff, J., Elliott, J., Hatch, D., Yang, Q., & Granger, B. B. (2021). Results of the chlorhexidine gluconate bathing implementation intervention to improve evidence-based nursing practices for prevention of central line associated bloodstream infections study (Changing baths): A stepped wedge cluster randomized trial. Implementation Science, 16(1). https://doi.org/10.1186/s13012-021-01112-4	Esposito, M. R., Guillari, A., & Angelillo, I. F. (2017). Knowledge, attitudes, and practice on the prevention of central line-associated bloodstream infections among nurses in oncological care: A cross-sectional study in an area of southern Italy. PLOS ONE, 12(6), e0180473. https://doi.org/10.1371/journal.pone.0180473
Evidence Level * (I, II, or III)	III	I	I	II
Conceptual Framework Describe the theoretical basis for the study (If there is not one mentioned in the article, say that here).**	The classic RCT methodology is best suited for medical interventions in which the therapy has a significant micro-effect. Moreover, treatment	No conceptual or theoretical framework indicated.	No theoretical framework defined	No theoretical framework defined.
Design/Method Describe the design and how the study was carried out (In detail, including inclusion/exclusion criteria).	The study involved a systematic review and meta-analysis conducted in conformity to the PRISMA and MOOSE guidelines. Sources from the various databases including MEDLINE, CINAHL, EMBASE, Scopus and Cochrane were involved. Only studies that involved randomized trials, and quasi experiment on the effect of CHG bathing versus non-CHG bathing in preventing CLABSI among the adult populations were included.	The study involved a non-randomized clinical trial. The study focused on the patients admitted in the ICU in the University Hospital Zurich.	The study involved a wedged cluster-randomized design conducted in four sequences.	The study involved cross-sectional survey.
Sample/Setting The number and characteristics of patients, attrition rate, etc.	Data were obtained from reputable journal sources and covered studies conducted in clinical setting.	The study was conducted in an ICU setting.	The study was conducted in the university hospital setting.	The study was conducted in healthcare setting
Major Variables Studied List and define dependent and independent variables	The dependent variable was CHG baths while the independent variable was the risk of CLABSI.	The predictor variable included the daily chlorhexidine bathing in ICU and while the outcome variable was risk of CLABSI.	The dependent variable was CHG bathing while the independent variable was CLABSI rates.	The dependent variable was knowledge, attitude and practice among nurses while the outcome variable was CLABSI rates.
Measurement Identify primary statistics used to answer clinical questions (You need to list the actual tests done).	The DerSimonian average intervention was used in estimating the average intervention effect. The logistic regression model was used in estimating the relationship between the dependent (predictor) and the outcome variable.	The statistics conducted included multivariable regression analysis, odd ratio, and descriptive statistics.	The primary statistics used included descriptive statistics and linear regression model.	Chis-square and t-test were used.
Data Analysis Statistical or Qualitative findings (You need to enter the actual numbers determined by the statistical tests or qualitative data).	The data analysis was quantitative based. The risk for CLABSI infections reduced the incidence of CLABSI by about 40%. The effect of the CHG bath was significant (0.67, 95% CI: 0.53–0.85).	The study was quantitative based. Multivariate analysis indicated that the intervention was significant (OR 0.47, 95% CI 0.26e0.84, P¼0.011).	The study findings indicated that the number of healthcare providers correctly identifying facts about CHG bathing increased, from 31.11 to 50.0% (χ2 = 9.32, p = .002).	Majority of nurses, with frequencies ranging from 70.7% to 90.1% were aware of the CLABSI prevention guidelines. Nursing workshops and courses (67.3%) was the main source of information CLABSIs prevention, followed by guidelines (42.7%), and internet (30.7%).
Findings and Recommendations General findings and recommendations of the research	CHG bathing can help in reducing the risks of CLABSI among the patients admitted in hospitals.	CHG bathing can help reduce the risk of CLABSI in the ICU unit.	Educating the healthcare providers on the CHG bathing improves its implementation and reduce the risk for CLABSI.	Improved knowledge on CLABSI prevention helps in enhancing adherence to infection prevention protocols.
*Appraisal and Study Quality* Describe the general worth of this research to practice. What are the strengths and limitations of study? What are the risks associated with implementation of the suggested practices or processes detailed in the research? What is the feasibility of use in your practice?	The study involved a large sample population and the data covered were appropriate. On the other hand, the main weakness is that the study was based on adult populations alone and so cannot be inferred to children. However, the findings from the study can be used in reducing CLABSI among the adults.	The study’s setting was appropriate and could provide reliable answers to the research question. On the other hand, the weakness of the study was monocentric and did not monitor the intervention and this could bias the findings. However, the results from the study are feasible.	The study recruited adequate sample population. On the other hand, the weakness was that the CHG bathing processes were not standardized and this could affect the outcome recorded. The findings from the study are feasible for clinical practice.	The study covered various aspects influencing CLABSI prevention measures. The statistical tests were appropriate. On the other hand, the main weakness was lack of standard method for measuring attitude and level of knowledge. The findings from the study are feasible and can be used for clinical practice.
Key findings	CHG bathing reduces the risk for CLABI.	CHG bathing reduces the CLABSI.	There is a need to educate ICU nursing on CHG bathing protocols.	There is need to increase education programs on reducing CLABSI.
Outcomes	Reduced CLABSI	Reduced cases of CLABSI among the ICU patients.	Increased awareness on CHG bathing	Increased knowledge on CLABSI prevention.
General Notes/Comments	Healthcare institution should implement the CHG baths among other interventions to reduce CLABSI.	The use of CHG bath can be used to reduce the risks for CLABSI among patients in ICU.	Healthcare institutions should have standard guidelines for CHG bathing.	Educating the nurses on CLABSI prevention measures allows them to implement to protocols accordingly.

Also Read:

NURS 6052 Discussion: Developing a Culture of Evidence-Based Practice

NURS 6052 EBP Part 4 Recommending An Evidence-Based Practice Change

Critical Appraisal of Research

The studies looked into the best practices for reducing CLABSI in ICU patients. Nosocomial infections are common in patients with catheters and central lines. Furthermore, studies show that the risk of CLABSI increases with the length of hospital stay (Afonso et al., 2016). Healthcare providers must make certain that appropriate interventions are used and that patients are only discharged when they are ready. As a result, it is necessary to monitor and ensure safe practices in order to reduce the risk of CLABSI in patients. Bathing in CHG has been shown to reduce the risk of CLABSI (Reynolds et al., 2021). Variations in CHG bathing protocols among healthcare institutions, on the other hand, continue to be a major source of concern. As a result, procedure standardization and increased awareness are required so that all nurses understand what they should do when interacting with patients.

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The study by Esposito et al. (2017) indicated a gap in the knowledge and practice of the CHG prevention measures by the nurses in the ICU units. Also, the study

Assignment Evidence-Based Project Part 3 Critical Appraisal of Research NURS 6052

indicates variations in the attitudes of the nurses towards the clinical practice and this affects the level of its implementation in the healthcare settings. Therefore, there is a need to create awareness and let the nurses understand the importance and the procedures involved in the CHG bathing as part of preventing the CLABSI. Besides, there should be guidelines published and that are readily available to ensure standardized safety protocols in the ICU units. The burden of CLABSI is high and this needs that adequate and prompt interventions must be developed to curb the health menace. The guidelines should be made available to all inpatient units. Thirdly, there is a need to conduct regular trainings on the CLABSI prevention measures to ensure that all the nurses have updated information on how to respond to the CLABSI.

Finally, there is enough evidence from the analysis that CHG bathing can reduce CLABSI. Though, future studies should be conducted to explore other alternative methods that can be used alongside the intervention especially among children. In addition, having a standard protocol for CHG bathing will means that all people will be aware of what they should do to prevent CLABSI.

References

Afonso, E., Blot, K., & Blot, S. (2016). Prevention of hospital-acquired bloodstream infections through chlorhexidine gluconate-impregnated washcloth bathing in intensive care units: A systematic review and meta-analysis of randomised crossover trials. Eurosurveillance, 21(46). https://doi.org/10.2807/1560-7917.es.2016.21.46.30400

Esposito, M. R., Guillari, A., & Angelillo, I. F. (2017). Knowledge, attitudes, and practice on the prevention of central line-associated bloodstream infections among nurses in oncological care: A cross-sectional study in an area of southern Italy. PLOS ONE, 12(6), e0180473. https://doi.org/10.1371/journal.pone.0180473

Reynolds, S. S., Woltz, P., Keating, E., Neff, J., Elliott, J., Hatch, D., Yang, Q., & Granger, B. B. (2021). Results of the chlorhexidine gluconate bathing implementation intervention to improve evidence-based nursing practices for prevention of central line associated bloodstream infections study (Changing baths): A stepped wedge cluster randomized trial. Implementation Science, 16(1). https://doi.org/10.1186/s13012-021-01112-4

Scheier, T., Saleschus, D., Dunic, M., Fröhlich, M., Schüpbach, R., Falk, C., Sax, H., Kuster, S., & Schreiber, P. (2021). Implementation of daily chlorhexidine bathing in intensive care units for reduction of central line-associated bloodstream infections. Journal of Hospital Infection, 110, 26-32. https://doi.org/10.1016/j.jhin.2021.01.007

Assignment: Evidence-Based Project, Part 3: Critical Appraisal of Research NURS 6052

Sample Answer 2 for Assignment: Evidence-Based Project, Part 3: Critical Appraisal of Research NURS 6052

The burden of CLABSI is high and this compromises the quality of care delivered to the patients admitted in the hospitals. Therefore, there is need to explore the evidence-based practices that can be used to reduce the health issue especially in the ICU. The purpose of this study is to appraise the evidences provided on the various measures of responding to the CLABSI in the inpatient units.

Also Read:

NURS 6052 Change is necessary in the healthcare systems

Evaluation Table

Full APA formatted citation of selected article.	Article #1	Article #2	Article #3	Article #4
Full APA formatted citation of selected article.	Afonso, E., Blot, K., & Blot, S. (2016). Prevention of hospital-acquired bloodstream infections through chlorhexidine gluconate-impregnated washcloth bathing in intensive care units: A systematic review and meta-analysis of randomised crossover trials. Eurosurveillance, 21(46). https://doi.org/10.2807/1560-7917.es.2016.21.46.30400	Scheier, T., Saleschus, D., Dunic, M., Fröhlich, M., Schüpbach, R., Falk, C., Sax, H., Kuster, S., & Schreiber, P. (2021). Implementation of daily chlorhexidine bathing in intensive care units for reduction of central line-associated bloodstream infections. Journal of Hospital Infection, 110, 26-32. https://doi.org/10.1016/j.jhin.2021.01.007	Reynolds, S. S., Woltz, P., Keating, E., Neff, J., Elliott, J., Hatch, D., Yang, Q., & Granger, B. B. (2021). Results of the chlorhexidine gluconate bathing implementation intervention to improve evidence-based nursing practices for prevention of central line associated bloodstream infections study (Changing baths): A stepped wedge cluster randomized trial. Implementation Science, 16(1). https://doi.org/10.1186/s13012-021-01112-4	Esposito, M. R., Guillari, A., & Angelillo, I. F. (2017). Knowledge, attitudes, and practice on the prevention of central line-associated bloodstream infections among nurses in oncological care: A cross-sectional study in an area of southern Italy. PLOS ONE, 12(6), e0180473. https://doi.org/10.1371/journal.pone.0180473
Evidence Level * (I, II, or III)	III	I	I	II
Conceptual Framework Describe the theoretical basis for the study (If there is not one mentioned in the article, say that here).**	The conceptual framework not indicated	No conceptual or theoretical framework indicated.	No theoretical framework defined	No theoretical framework defined.
Design/Method Describe the design and how the study was carried out (In detail, including inclusion/exclusion criteria).	The study involved a systematic review and meta-analysis conducted in conformity to the PRISMA and MOOSE guidelines. Sources from the various databases including MEDLINE, CINAHL, EMBASE, Scopus and Cochrane were involved. Only studies that involved randomized trials, and quasi experiment on the effect of CHG bathing versus non-CHG bathing in preventing CLABSI among the adult populations were included.	The study involved a non-randomized clinical trial. The study focused on the patients admitted in the ICU in the University Hospital Zurich with the cases of CLABSI analyzed after the implementation of CHG bathe.	The study involved a wedged cluster-randomized design conducted in four sequences. The indices of CLABSI among the patients undergoing the CHG bathing were analyzed before and after the implementation of bath protocol in the hospital.	The study involved cross-sectional survey where the target population were given questions to indicate their level of knowledge and awareness on CHG bathing.
Sample/Setting The number and characteristics of patients, attrition rate, etc.	Data were obtained from reputable journal sources and covered studies conducted in clinical setting. The sample population was 22,850 patients with 8% attrition rate.	The study was conducted in an ICU setting. The sample population was 5008 patients. All participants were included. The attrition rate was 0%.	The study was conducted in the university hospital setting. The total sample population was 1640. All the participants were included in the study. Attrition rate was 0%.	The study was conducted in healthcare setting. A total of 335 nurses were included in the study. The attrition rate was 0%.
Major Variables Studied List and define dependent and independent variables	The major variables were CHG bath and risk for CLABSI. The dependent variable was CHG baths while the independent variable was the risk of CLABSI.	The major variables were daily CHG bathe and CLABSI incidences. The predictor variable included the daily chlorhexidine bathing in ICU and while the outcome variable was risk of CLABSI.	The variables were CHG bath and CLABSI rates. The dependent variable was CHG bathing while the independent variable was CLABSI rates.	The variables were knowledge and attitude towards CHG bath and the CLABSI rates. The dependent variable was knowledge, attitude and practice among nurses while the outcome variable was CLABSI rates.
Measurement Identify primary statistics used to answer clinical questions (You need to list the actual tests done).	The DerSimonian average intervention was used in estimating the average intervention effect. The logistic regression model was used in estimating the relationship between the dependent (predictor) and the outcome variable.	The statistics conducted included multivariable regression analysis, odd ratio, and descriptive statistics.	The primary statistics used included descriptive statistics and linear regression model.	Chis-square and t-test were used.
Data Analysis Statistical or Qualitative findings (You need to enter the actual numbers determined by the statistical tests or qualitative data).	The data analysis was quantitative based. The risk for CLABSI infections reduced the incidence of CLABSI by about 40%. The effect of the CHG bath was significant (0.67, 95% CI: 0.53–0.85).	The study was quantitative based. Multivariate analysis indicated that the intervention was significant (OR 0.47, 95% CI 0.26e0.84, P¼0.011).	The study findings indicated that the number of healthcare providers correctly identifying facts about CHG bathing increased, from 31.11 to 50.0% (χ2 = 9.32, p = .002).	Majority of nurses, with frequencies ranging from 70.7% to 90.1% were aware of the CLABSI prevention guidelines. Nursing workshops and courses (67.3%) was the main source of information CLABSIs prevention, followed by guidelines (42.7%), and internet (30.7%).
Findings and Recommendations General findings and recommendations of the research	CHG bathing can help in reducing the risks of CLABSI among the patients admitted in hospitals. Therefore, healthcare institutions should adopt CHG bathing.	CHG bathing can help reduce the risk of CLABSI in the ICU unit. Therefore, healthcare institutions should adopt CHG bathing.	Educating the healthcare providers on the CHG bathing improves its implementation and reduce the risk for CLABSI. Therefore, healthcare institutions should adopt CHG bathing.	Improved knowledge on CLABSI prevention helps in enhancing adherence to infection prevention protocols. Therefore, healthcare institutions should adopt CHG bathing.
*Appraisal and Study Quality* Describe the general worth of this research to practice. What are the strengths and limitations of study? What are the risks associated with implementation of the suggested practices or processes detailed in the research? What is the feasibility of use in your practice?	The study involved a large sample population and the data covered were appropriate. On the other hand, the main weakness is that the study was based on adult populations alone and so cannot be inferred to children. However, the findings from the study can be used in reducing CLABSI among the adults.	The study’s setting was appropriate and could provide reliable answers to the research question. On the other hand, the weakness of the study was monocentric and did not monitor the intervention and this could bias the findings. However, the results from the study are feasible.	The study recruited adequate sample population. On the other hand, the weakness was that the CHG bathing processes were not standardized and this could affect the outcome recorded. The findings from the study are feasible for clinical practice.	The study covered various aspects influencing CLABSI prevention measures. The statistical tests were appropriate. On the other hand, the main weakness was lack of standard method for measuring attitude and level of knowledge. The findings from the study are feasible and can be used for clinical practice.
Key findings	CHG bathing reduces the risk for CLABI.	CHG bathing reduces the CLABSI.	There is a need to educate ICU nursing on CHG bathing protocols.	There is need to increase education programs on reducing CLABSI.
Outcomes	Reduced CLABSI	Reduced cases of CLABSI among the ICU patients.	Increased awareness on CHG bathing	Increased knowledge on CLABSI prevention.
General Notes/Comments	Healthcare institution should implement the CHG baths among other interventions to reduce CLABSI.	The use of CHG bath can be used to reduce the risks for CLABSI among patients in ICU.	Healthcare institutions should have standard guidelines for CHG bathing.	Educating the nurses on CLABSI prevention measures allows them to implement to protocols accordingly.

Critical Appraisal of Research

The studies reviewed explored the best practices that can be used to reduce the incidences of CLABSI among the patients in ICU. Nosocomial infections are common among the patients on catheters and those on central lines. Furthermore, the studies indicate that the risk of CLABSI increases with the prolonged hospital stay (Afonso et al., 2016). The healthcare providers have the responsibility to ensure that they engage the right interventions and only discharge the patients when they are ready. As a result, there is need to monitor and ensure safe practices and reduce the risk of the patients contracting CLABSI. The use of CHG bathing has been proven effective in reducing the risks for CLABSI (Reynolds et al., 2021). However, variations in the protocols for the CHG bathing procedure among the healthcare institutions remain a major concern. Therefore, there is need for standardizing the procedures and creating awareness so that all the nurses are aware of what they should do as they interact with the patients.

The study by Esposito et al. (2017) indicated a gap in the knowledge and practice of the CHG prevention measures by the nurses in the ICU units. Also, the study indicates variations in the attitudes of the nurses towards the clinical practice and this affects the level of its implementation in the healthcare settings. Therefore, there is a need to create awareness and let the nurses understand the importance and the procedures involved in the CHG bathing as part of preventing the CLABSI. Besides, there should be guidelines published and that are readily available to ensure standardized safety protocols in the ICU units. The burden of CLABSI is high and this needs that adequate and prompt interventions must be developed to curb the health menace. The guidelines should be made available to all inpatient units. Thirdly, there is a need to conduct regular trainings on the CLABSI prevention measures to ensure that all the nurses have updated information on how to respond to the CLABSI.

Assignment: Evidence-Based Project, Part 3: Critical Appraisal of Research NURS 6052

Research appraisal is not that different. The critical appraisal process utilizes formal appraisal tools to assess the results of research to determine value to the context at hand. Evidence-based practitioners often present these findings to make the case for specific courses of action.

Realtors rely on detailed property appraisals—conducted using appraisal tools—to assign market values to houses and other properties. These values are then presented to buyers and sellers to set prices and initiate offers.

In this Assignment, you will use an appraisal tool to conduct a critical appraisal of published research. You will then present the results of your efforts.

To Prepare:

Reflect on the four peer-reviewed articles you selected in Module 2 and the four systematic reviews (or other filtered high- level evidence) you selected in Module 3.
Reflect on the four peer-reviewed articles you selected in Module 2 and analyzed in Module 3.
Review and download the Critical Appraisal Tool Worksheet Template provided in the Resources.

The Assignment (Evidence-Based Project)

Part 3A: Critical Appraisal of Research

Conduct a critical appraisal of the four peer-reviewed articles you selected by completing the Evaluation Table within the Critical Appraisal Tool Worksheet Template. Choose a total of four peer- reviewed articles that you selected related to your clinical topic of interest in Module 2 and Module 3.

Note: You can choose any combination of articles from Modules 2 and 3 for your Critical Appraisal. For example, you may choose two unfiltered research articles from Module 2 and two filtered research articles (systematic reviews) from Module 3 or one article from Module 2 and three articles from Module 3. You can choose any combination of articles from the prior Module Assignments as long as both modules and types of studies are represented.

Part 3B: Critical Appraisal of Research

Based on your appraisal, in a 1-2-page critical appraisal, suggest a best practice that emerges from the research you reviewed. Briefly explain the best practice, justifying your proposal with APA citations of the research.

By Day 7 of Week 7

Submit Part 3A and 3B of your Evidence-Based Project.

Submission and Grading Information

To submit your completed Assignment for review and grading, do the following:

Please save your Assignment using the naming convention “WK7Assgn+last name+first initial.(extension)” as the name.
Click the Week 7 Assignment Rubric to review the Grading Criteria for the Assignment.
Click the Week 7 Assignment link. You will also be able to “View Rubric” for grading criteria from this area.
Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK7Assgn+last name+first initial.(extension)” and click Open.
If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
Click on the Submit button to complete your submission.

Grading Criteria

To access your rubric:

Week 7 Assignment Rubric

Check Your Assignment Draft for Authenticity

To check your Assignment Draft for Authenticity

Submit your Week 7 Assignment Draft and review the originality report

Submit Your Assignment by Day 7 of Week 7

To participate in this Assignment:

Week 7 Assignment

Next Module

To go to the next module:

Module 5

Module 4: Critical Appraisal, Evaluation/Summary, and Synthesis of Evidence (Weeks 6-7)

Laureate Education (Producer). (2018). Critical Appraisal [Video file]. Baltimore, MD: Author.

Due By	Assignment
Week 6, Days 1-4	Read the Learning Resources. Begin to compose Part A of your Assignment..
Week 6, Days 5-7	Continue to compose Part B of your Assignment. Begin to compose Part B of your Assignment.
Week 7, Days 1-6	Continue to compose Part A and B of your Assignment.
Week 7, Day 7	Deadline to submit Part A and B of your Assignment.

Learning Objectives

Students will:

Evaluate peer-reviewed articles using critical appraisal tools
Analyze best practices based on critical appraisal of evidence-based research

Learning Resources

Note: To access this module’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer.

Chapter 5, “Critically Appraising Quantitative Evidence for Clinical Decision Making” (pp. 124–188)
Chapter 6, “Critically Appraising Qualitative Evidence for Clinical Decision Making” (pp. 189–218)

Fineout-Overholt, E., Melnyk, B. M., Stillwell, S. B., & Williamson, K. M. (2010a). Evidence-based practice step by step: Critical appraisal of the evidence: Part I. American Journal of Nursing, 110(7), 47–52. doi:10.1097/01.NAJ.0000383935.22721.9c

Note: You will access this article from the Walden Library databases.

Fineout-Overholt, E., Melnyk, B. M., Stillwell, S. B., & Williamson, K. M. (2010b). Evidence-based practice, step by step: Critical appraisal of the evidence: Part II: Digging deeper—examining the “keeper” studies. American Journal of Nursing, 110(9), 41–48. doi:10.1097/01.NAJ.0000388264.49427.f9

Note: You will access this article from the Walden Library databases.

Fineout-Overholt, E., Melnyk, B. M., Stillwell, S. B., & Williamson, K. M. (2010c). Evidence-based practice, step by step: Critical appraisal of the evidence: Part III: The process of synthesis: Seeing similarities and differences across the body of evidence. American Journal of Nursing, 110(11), 43–51. doi: 10.1097/01.NAJ.0000390523.99066.b5

Note: You will access this article from the Walden Library databases.

Williamson, K. M. (2009). Evidence-based practice: Critical appraisal of qualitative evidence. Journal of the American Psychiatric Nurses Association, 15(3), 202–207. doi:10.1177/1078390309338733

Note: You will access this article from the Walden Library databases.

Document: Critical Appraisal Tool Worksheet Template (Word document)

Assignment: Evidence-Based Project, Part 3: Critical Appraisal of Research NURS 6052 Required Media

Laureate Education (Producer). (2018). Appraising the Research [Video file]. Baltimore, MD: Author.

Laureate Education (Producer). (2018). Interpreting Statistics [Video file]. Baltimore, MD: Author.

Laureate Education (Producer). (2018). Review of research: Hierarchy of evidence pyramid [Mutlimedia file]. Baltimore, MD: Author.

Schulich Library McGill. (2017, June 6). Types of reviews [Video file]. Retrieved from https://youtu.be/5Rv9z7Mp4kg

Name: NURS_6052_Module04_Week07_Assignment_Rubric

	Excellent	Good	Fair	Poor
Part 3A: Critical Appraisal of Research Conduct a critical appraisal of the four peer-reviewed articles you selected and analyzed by completing the Critical Appraisal Tool Worksheet Template. Be sure to include: · An Evaluation Table	Points Range: 45 (45%) – 50 (50%) The critical appraisal accurately and clearly provides a detailed evaluation table. The responses provide a detailed, specific, and accurate evaluation of each of the peer-reviewed articles selected.	Points Range: 40 (40%) – 44 (44%) The critical appraisal accurately provides an evaluation table. The responses provide an accurate evaluation of each of the peer-reviewed articles selected with some specificity.	Points Range: 35 (35%) – 39 (39%) The critical appraisal provides an evaluation table that is inaccurate or vague. The responses provide an inaccurate or vague evaluation of each of the peer-reviewed articles selected.	Points Range: 0 (0%) – 34 (34%) The critical appraisal provides an evaluation table that is inaccurate and vague or is missing.
Part 3B: Evidence-Based Best Practices Based on your appraisal, suggest a best practice that emerges from the research you reviewed. Briefly explain the best practice, justifying your proposal with APA citations of the research.	Points Range: 32 (32%) – 35 (35%) The responses accurately and clearly suggest a detailed best practice that is fully aligned to the research reviewed. The responses accurately and clearly explain in detail the best practice, with sufficient justification of why this represents a best practice in the field. The responses provide a complete, detailed, and specific synthesis of two outside resources reviewed on the best practice explained. The response fully integrates at least two outside resources and two or three course-specific resources that fully support the responses provided. Accurate, complete, and full APA citations are provided for the research reviewed.	Points Range: 28 (28%) – 31 (31%) The responses accurately suggest a best practice that is adequately aligned to the research reviewed. The responses accurately explain the best practice, with adequately justification of why this represents a best practice in the field. The responses provide an accurate synthesis of at least one outside resource reviewed on the best practice explained. The response integrates at least one outside resource and two or three course-specific resources that may support the responses provided. Accurate and complete APA citations are provided for the research reviewed.	Points Range: 25 (25%) – 27 (27%) The responses inaccurately or vaguely suggest a best practice that may be aligned to the research reviewed. The responses inaccurately or vaguely explain the best practice, with inaccurate or vague justification for why this represents a best practice in the field. The responses provide a vague or inaccurate synthesis of outside resources reviewed on the best practice explained. The response minimally integrates resources that may support the responses provided. Inaccurate and incomplete APA citations are provided for the research reviewed.	Points Range: 0 (0%) – 24 (24%) The responses inaccurately and vaguely suggest a best practice that may be aligned to the research reviewed or are missing. The responses inaccurately and vaguely explain the best practice, with inaccurate and vague justification for why this represents a best practice in the field, or are missing. A vague and inaccurate synthesis of no outside resources reviewed on the best practice explained is provided or is missing. The response fails to integrate any resources to support the responses provided. Inaccurate and incomplete APA citations are provided for the research reviewed or is missing.
Written Expression and Formatting—Paragraph Development and Organization: Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction is provided which delineates all required criteria.	Points Range: 5 (5%) – 5 (5%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity. A clear and comprehensive purpose statement, introduction, and conclusion is provided which delineates all required criteria.	Points Range: 4 (4%) – 4 (4%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time. Purpose, introduction, and conclusion of the assignment is stated yet is brief and not descriptive.	Points Range: 3.5 (3.5%) – 3.5 (3.5%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60–79% of the time. Purpose, introduction, and conclusion of the assignment is vague or off topic.	Points Range: 0 (0%) – 3 (3%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity less than 60% of the time. No purpose statement, introduction, or conclusion was provided.
Written Expression and Formatting—English Writing Standards: Correct grammar, mechanics, and proper punctuation.	Points Range: 5 (5%) – 5 (5%) Uses correct grammar, spelling, and punctuation with no errors.	Points Range: 4 (4%) – 4 (4%) Contains a few (one or two) grammar, spelling, and punctuation errors.	Points Range: 3.5 (3.5%) – 3.5 (3.5%) Contains several (three or four) grammar, spelling, and punctuation errors.	Points Range: 0 (0%) – 3 (3%) Contains many (five or more) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.
Written Expression and Formatting—The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running head, parenthetical/in-text citations, and reference list.	Points Range: 5 (5%) – 5 (5%) Uses correct APA format with no errors.	Points Range: 4 (4%) – 4 (4%) Contains a few (one or two) APA format errors.	Points Range: 3.5 (3.5%) – 3.5 (3.5%) Contains several (three or four) APA format errors.	Points Range: 0 (0%) – 3 (3%) Contains many (five or more) APA format errors.

Total Points: 100

Name: NURS_6052_Module04_Week07_Assignment_Rubric

Critical Appraisal Tool Worksheet Template

Evaluation Table

Use this document to complete the evaluation table requirement of the Module 4 Assessment,Evidence-Based Project, Part 4A: Critical Appraisal of Research

Full APA formatted citation of selected article.	Article #1	Article #2	Article #3	Article #4
Full APA formatted citation of selected article.	Bridges, J., Griffiths, P., Oliver, E., & Pickering, R. M. (2019). Hospital nurse staffing and staff–patient interactions: an observational study. BMJ quality & safety, 28(9), 706-713. https://qualitysafety.bmj.com/content/28/9/706	Nantsupawat, A., Kunaviktikul, W., Nantsupawat, R., Wichaikhum, O. A., Thienthong, H., & Poghosyan, L. (2017). Effects of nurse work environment on job dissatisfaction, burnout, intention to leave. International nursing review, 64(1), 91-98.doi: 10.1111/inr.12342	Perry, S. J., Richter, J. P., & Beauvais, B. (2018). The Effects of Nursing Satisfaction and Turnover Cognitions on Patient Attitudes and Outcomes: A Three-Level Multisource Study. Health services research, 53(6), 4943–4969. https://doi.org/10.1111/1475-6773.12997	Jarrar, M. T., Minai, M. S., Al‐Bsheish, M., Meri, A., & Jaber, M. (2019). Hospital nurse shift length, patient‐centered care, and the perceived quality and patient safety. The International journal of health planning and management, 34(1), e387-e396. https://doi.org/10.1002/hpm.2656
Evidence Level * (I, II, or III)	Level III because it was an observational study (non-experimental)	Level II	Level II	Level II
Conceptual Framework Describe the theoretical basis for the study (If there is not one mentioned in the article, say that here).**	Not stated	The Quality Health Outcomes Model (QHOM) guided the study. The model demonstrates the existence of a linear correlation between process, structure and outcomes. The nurse practice environment was considered the structural factor that influences nurse outcomes that included burnout, turnover and job dissatisfaction among nurses.	The turnover theory and Self-Determination Theory were used to guide this study. The turnover theory was used to conceptualize the dissatisfaction-motivated desired as well as the intention of the employees to leave their jobs. The Self-Determination Theory was used to provide underpinnings for the role of work environment on behaviors such as motivation and energizing employees to perform optimally.	The conceptual framework was note stated.
Design/Method Describe the design and how the study was carried out (In detail, including inclusion/exclusion criteria).	The study was secondary of observational data. The study was conducted in two NHS hospital Trusts in England. Six wards that provided care to paged aged above 65 years were selected. The wards had an average of 44-full-time registered nurses staffs and healthcare assistants. The relationship between length and quality of interaction was determined using Quality of Interaction Schedule. The observations were undertaken between 2015 and 2016. Index patients were chosen randomly to participate in the study. The exclusion criteria included patients who were not able to communicate their choices, those who did not wish to participate in the study, unconscious and critically ill or isolated due to being at a risk of infection.	The study utilized a cross-sectional study design. Questionnaires were used for data collection. Stratified sampling was used for random selection of hospitals to participate in the study. Work units in each hospital were selected using purposive sampling. Inclusion criteria included inpatient nurses with at least two years’ experience as bedside nurses. The exclusion criteria included nurse managers.	The study was a multisource study. Participants were provided with online surveys to provide information related to their experiences. The inclusion and exclusion criteria was not provided in the research.	The study design was a cross-sectional survey study. The study was conducted on nurses who were identified using stratified random sampling. All the nurses working in the medical, surgical and multidisciplinary wards that agreed to participate in the study were included. The exclusion criteria included nurses who decline to participate in the study.
Sample/Setting The number and characteristics of patients, attrition rate, etc.	The sample consisted of 270 elderly patients aged 65 years and above. The setting was two NHS hospital Trusts in England. The participants were obtained from six wards that included urology, orthopedics, and medicine wards for the older people.	The setting of the study was 43 inpatient units in five university hospitals in Thailand. The participants comprised of 1351 nurses who were working in the above setting.	The setting of the study was Army Military Treatment facilities in the United States. The participants included 2596 registered nurses that were working in 110 Army treatment hospitals and facilities across 35 healthcare systems in the US.	The setting of the study was 12 private hospitals in Malaysia. The participants included 1055 nurses working in the medical and surgical wards alongside multidisciplinary wards. Of this number, 652 nurses provided complete responses to the survey questionnaires.
Major Variables Studied List and define dependent and independent variables	The dependent outcomes included quality of staffing and staff-patient interactions. The independent variables included a reduction or increase in nurse staffing and skill mix, professional background of the healthcare staffs and duration of the staff-patient interaction.	The dependent or outcome variables in the study included burnout, job dissatisfaction and intention to leave among the participants. The independent variables included nature of work environment, resource adequacy, staffing level, nurse engagement in organizational affairs, management and leadership ability, and collegial nurse-physician relationships.	The dependent or outcome variables in the study included turnover cognitions and outcomes, nursing satisfaction and attitude. The independent variables included leadership style, nature of work environment and collegial relationships with other providers.	The dependent variables in the study included quality and safety of care as perceived by nurses. The independent variables included shift length and patient-centered care.
Measurement Identify primary statistics used to answer clinical questions (You need to list the actual tests done).	The statistics included three-level mixed logistic regression using command xtmelogit in Stata V.11.0, odds ratio for QuIS rating, Wald tests for post-estimation of interaction effect, negative binomial model for patient experiences with interaction and normal-based models for time that patient and staffs spent interacting.	Lake’s Practice Environment Scale of the Nursing Work Index was used to measure nurse work environment. The composite scores in the rating scale was tabulated by aggregating individual nurse-level responses with the responses of the unit followed by calculating the mean of the subscale means. The level of job satisfaction was measured by asking the current satisfaction of the nurses with their jobs. Intention to leave was measured by asking nurses to provide information on whether they intend to leave their current jobs in a year. The Emotional Exhaustion subscale of the Maslach Burnout Inventory was used to measure burnout.	Measurement and analysis were done at three different levels to test the hypotheses. Level 1 measurement and analysis was done on individual-level perception of nurses on outcomes and predictors. Level 2 measurement and analysis were done on six aggregated variables of patient satisfaction. Level 3 measurement and analysis were done using adverse event indicators and predictors of nurses’ responses. CFA was used to confirm the fit for Level-1 independent variables. Exploratory factor analysis using Promax rotation was used to analyze non-hypothesized factors. Variance inflation factor was used to test threat of common method variance. Multilevel modeling was performed at levels 1 and 2 to test all the hypotheses of the study. Multilevel mixed effects modelling was used to analyze level 1 data on dissatisfaction due to intention to quit and desire. Multilevel logistic regression and ordinary least squares regression were used for level 3 analyses.	The study used Hayes macro for regression analyzes to determine the mediation effect of patient-centeredness on the relationship between care quality, safety and shift length.
Data Analysis Statistical or Qualitative findings (You need to enter the actual numbers determined by the statistical tests or qualitative data).	The results of the study showed that 3076 interactions were observed. Of this number, 10% of them were rated negatively. The odd of a negative interaction rose significantly as more patients were added to each registered nurse (p=0.035, OR of 2.82 for > 8 patients/RN compared with >6 to<8 patients/RN). The results also showed a similar but insignificant pattern for healthcare assistance (p=0.056). The results also showed that odds of negative interaction increased with high level of healthcare assistants staffing and low registered nurse staffing.	The study results showed that 97% of the participants were females. The composite score of the mean of 5 PES-NWI was 2.91 with the highest mean being 3.23 and lowest being 2.56. Of the 43 units, the participants ranked 16 units as good and seven units being poor. The odd of nurses reporting to be dissatisfied with their jobs was (OR=0.67, 95% CI 0.57-0.77), intention to leave their current job (OR=0.75, 95% CI 0.54-0.99), and emotional exhaustion (OR=0.78, 95% CI 0.70-0.99) were significantly reduced in nurses working in better work environment when compared to those working in mixed environment. The rate of job dissatisfaction, emotional exhaustion and intention to leave in nurses with better work environment was at a 39 to 55% lower than those working in poor work environments.	The results showed that level 1 results were adequately supported. Staffing, teamwork, and reliance on nursing practices were negatively associated with intentions to leave. Self-reported level of nurse satisfaction was a significant predictor of patient willingness to recommend alongside see providers when needed. Self-reported satisfaction was found a significant predictor for medication errors and falls with injury. Dissatisfaction-based desire to leave a job was a significant predictor for patient falls and medication errors.	The majority of participants (99%) were of Malaysian origin. Regression analysis indicated insignificant impact of the length of shift on quality of service (F=1.27, P=0.28) and safety (F=1.81, P=0.13). Patient-centeredness has potential mediating effect in relation to shift length and service quality (F=42.90, P=0.000). Nurses working 12-hour shift (95% CI, -0.18 to -0.15) and 10 hour shift (95% CI, -0.17 to -0.03) indirectly affected the quality of care unlike those working for 7-hour shift. Patient-centeredness was also found to have a linking effect on patient safety and shift length (F=25.12, P=0.000). The results also showed that a significant mediation effect of patient-centered care exist between the effect of length of shift on perceived patient safety (F=25.12, P<0.001) and perceived quality (F=42.90, P<0.001).
Findings and Recommendations General findings and recommendations of the research	The general finding of this study was that the ratio of registered nurses to patients is a critical determinant of nature of nurse-patient interaction. A reduction in registered nurses staffing level causes a change in the quantity and quality of staff-patient interaction. The results also showed that staff-patient interactions does not improve in cases where registered nurses staffing is low with increased staffing of healthcare assistants. Therefore, adequate register nurse staffing ratio is important for quality staff-patient interaction.	The general results of the study were that nurse working in university hospitals that have better work environments have less intention to leave, burnout and job dissatisfaction. The researchers recommended that health organizations should strive to improve the work environment for the nurses. Improving the work environment will lower the levels of job dissatisfaction, burnout and intention to leave.	The general findings of this study were that predictors of nurse satisfaction as well as turnover cognitions included staffing levels, supportive leadership, nurse-physician teamwork, advancement opportunities and adoption of nursing care practice. The results also showed aggregated nurse satisfaction to be the most consistent predictor of adverse events and patient satisfaction. Therefore, the authors recommended the need for healthcare organizations, managers and leaders to adopt interventions that enhance job satisfaction and retention among nurses.	The general findings of this study is that there exist a significant mediation effect of patient-centered care between the effect of length of shift on the perceived quality of care and patient safety. The authors recommended that health policymakers should consider restructuring shift length for nurses and strengthening patient-centeredness in nursing care.
*Appraisal and Study Quality* Describe the general worth of this research to practice. What are the strengths and limitations of study? What are the risks associated with implementation of the suggested practices or processes detailed in the research? What is the feasibility of use in your practice?	The study informs the importance of adequate staffing ratios in nursing. The study shows that staffing ratio determines the quality of care that registered nurses give. The study is worthy for implementation in practice. The strengths of the study include the use of large sample size and randomizing patients to the intervention group. The study has weaknesses of not assigning participants to a control group. It also has the weakness of lacking inference of exposure versus effect relationship because it was an observational study. The risk of implementing the suggested practices in the research is therefore the lack of highly valid and reliable data on the effectiveness of the interventions in nursing. The intervention is however highly feasible for use in practice due to the replicable nature of the study methods.	The study is worthy and relevant to nursing practice. It informs the need for the adoption of interventions that aim at improving the environmental conditions for nurses. The study also shows the negative effects of unhealthy work environments. The strength of this study is the use of a large number of participants. The study is also a multicenter investigation. The study has the limitation of relying on self-reported findings from the nurses. The validation of self-reported experiences might be a challenge. The study is feasible for use in my practice. The feasibility is seen in the applicability of interventions to improve workplace conditions in nursing.	The study is important to nursing practice because it informs the need for the creation of enabling cultures for provider and organizational success. The study also informs the adoption of effective leadership styles that promote performance and excellence. The strength of this study is that it has high validity and reliability due to it being a multisource study. The study has the weaknesses of lack of generalizability of findings due to it being conducted in military setting. The risk of implementing this study in a general setting is that the workplace conditions in a military setting might be different from the general setting, hence, inapplicability of findings. The study is therefore less feasible in use in my practice.	The study is worthy for use in nursing because it informs the adoption of interventions that promote safety and quality in patient care. The study also advocates the adoption of organizational interventions that promote effective workplace culture. The strength of this study is the large sample size and being multi-center in nature. The weakness of this study was that it mainly used private hospitals, which might affect the generalizability of findings. The risk of implementing the interventions in this study is that they might not produce similar outcomes as those seen in the study. The contexts might differ because the current study was conducted in private hospitals. The study however has high feasibility as seen from the use of interventions that are applicable to any healthcare setting.
Key findings	Low levels of registered nurses staffing affects the quality and quantity of staff-patient interactions. A high level of staffing for healthcare assistants and low level of staffing for registered nurses does not improve the quality of staff-patient interactions. Sufficient registered nurses staffing levels is therefore critical determinant of the quality of staff-patient interactions.	The findings of this study showed that better work environments have less job dissatisfaction, intent to leave and burnout.	Nurse attitude have an effect on the actual and perceived performance across health care systems and facilities. Perceived nurse satisfaction is a critical predictor of adverse events and patient satisfaction.	Patient-centeredness in care mitigates the effects of shift length on outcomes of care that include safety and quality.
Outcomes	The outcomes included the quality and quantity of staff-patient interactions.	The outcomes of the study included burnout, job dissatisfaction and intervention to leave among nurses.	The outcomes in the study included patient and nurse satisfaction, patient outcomes and turnover cognitions among nurses.	The outcomes in this study included patient safety and quality of care as perceived by the nurses.
General Notes/Comments	The study has results that are generalizable.	The study findings are highly generalizable to practice due to the use of a high sample size.	The results have high validity and reliability. However, they are not generalizable because it was conducted in a military setting that might have different environmental characteristics from general settings.	The shift length should be restructured to underpin safety and quality in nursing care and practice.

Reflection

According to the evidence analyzed above, the best practice that can be implemented to promote safety and quality in nursing care is the transformation of work environmental conditions. According to the evidence, the nature of the work environment has a direct influence on the level of satisfaction, burnout, and intent to leave among nurses. Organizations with better working conditions or healthy work environments have lower rates of burnout, intention to leave, and job dissatisfaction among their nurses (Nantsupawat et al., 2017). The reduction or elimination of these issues promotes nursing care and practice safety and quality. The analysis also revealed that work environment transformation includes the adoption of effective leadership behaviors that increase job satisfaction and reduce nurses’ intent to leave. As a result, the evaluation revealed that supportive leadership, effective nurse-physician teamwork, and the provision of opportunities for professional and personal advancement increase provider satisfaction and reduce nurse burnout (Bridges et al., 2019). Environmental transformation also includes identifying work-related factors that contribute to burnout, job dissatisfaction, and high turnover rates among nurses. The evidence reviewed revealed that workplace factors such as staffing levels, nursing care practice adoption, and patient-centeredness play an important role in influencing the behaviors of nurses and other healthcare providers (Perry et al., 2018). Adequate registered nurse staffing levels reduce burnout and errors in practice, which improves safety and quality of care. The negative effects of length shift and perceived safety and quality of care are mitigated by patient-centeredness (Jarrar et al., 2019). As a result, nurse managers and leaders must be proactive in assessing the need for and implementing strategies to improve working conditions in their organizations. It will achieve care goals such as safety, quality, efficiency, and patient-centeredness.

References

Bridges, J., Griffiths, P., Oliver, E., & Pickering, R. M. (2019). Hospital nurse staffing and staff–patient interactions: An observational study. BMJ Quality & Safety, 28(9), 706–713. https://doi.org/10.1136/bmjqs-2018-008948

Jarrar, M., Minai, M. S., Al‐Bsheish, M., Meri, A., & Jaber, M. (2019). Hospital nurse shift length, patient-centered care, and the perceived quality and patient safety. The International Journal of Health Planning and Management, 34(1), e387–e396. https://doi.org/10.1002/hpm.2656

Nantsupawat, A., Kunaviktikul, W., Nantsupawat, R., Wichaikhum, O.-A., Thienthong, H., & Poghosyan, L. (2017). Effects of nurse work environment on job dissatisfaction, burnout, intention to leave. International Nursing Review, 64(1), 91–98. https://doi.org/10.1111/inr.12342

Perry, S. J., Richter, J. P., & Beauvais, B. (2018). The Effects of Nursing Satisfaction and Turnover Cognitions on Patient Attitudes and Outcomes: A Three-Level Multisource Study. Health Services Research, 53(6), 4943–4969. https://doi.org/10.1111/1475-6773.12997

Sample Answer 3 for Assignment: Evidence-Based Project, Part 3: Critical Appraisal of Research NURS 6052

Nursing practices influence the risks for CAUTIs among the patients in ICU. Therefore, there is need to develop evidence-based practices that will help reduce the burden of CAUTIs among the patients on catheters. The current study appraises the various sources providing recommendations on the best practices to reduce CAUTIs.

Evaluation Table

Full APA formatted citation of selected article.	Article #1	Article #2	Article #3	Article #4
Full APA formatted citation of selected article.	Parker, V., Giles, M., Graham, L., Suthers, B., Watts, W., O’Brien, T., & Searles, A. (2017). Avoiding inappropriate urinary catheter use and catheter-associated urinary tract infections: a pre-post control intervention study. BMC Health Services, 17(314). doi: 10.1186/s12913-017-2268-2.	Ferguson, A. (2018). Implementing a CAUTI Prevention Program in an Acute Care Hospital Setting. Urologic Nursing,38(6), 273–302. DOI: 10.7257/1053-816X.2018.38.6.273.	Scanlon, K. A. (2017). Saving Lives and Reducing Harm: A CAUTI Reductions Program. Nursing Economics, 35(3):134-141.	Menegueti, M. G., Ciol, M. A., Bellissimo-Rodrigues, F., Auxiliadora-Martins, M., Gaspar, G. G., Canini, S. R. M. da S., Bakir., M. (2019). Long-term prevention of catheter-associated urinary tract infections among critically ill patient through the implementation of an educational program and a daily checklist for maintenance of indwelling urinary catheter: A quasi-experimental study. Medicine. 98(8). DOI: 10.1097/MD.0000000000014417
Evidence Level * (I, II, or III)	II	II	I	I
Conceptual Framework Describe the theoretical basis for the study (If there is not one mentioned in the article, say that here).**	No theoretical framework mentioned in the text.	No theoretical or conceptual framework defined.	The study was based on the dry bag Concept”, innovative modifications and root cause analysis concept.	No theoretical framework indicated
Design/Method Describe the design and how the study was carried out (In detail, including inclusion/exclusion criteria).	The study used the multiple pre-post control intervention design based on the phased mixed method. The sample population included four acute care hospitals from the two Health Districts in NSW. The point data were collected from all the adult inpatient wards in the hospital.	The study involved the use of survey design to assess the effects of offering on-time educational program to enhance nurses’ knowledge about CAUTIs.	The study involved quantitative measures in determining the overall success of standardized infection ratio, rations and catheter days in intensive care unit and non-critical areas in the facility	The study involved a quasi-experimental study conducted in an intensive care unit of hospital for over 12 years.
Sample/Setting The number and characteristics of patients, attrition rate, etc.	The sample used in the study were obtained from the acute care hospital. A total of 500 patients per Health District were targeted.	The sample population included two units in a 393-bed acute care facility and a total of 59 nurses completed the education program in three months-term	The study was conducted in non-ICU setting.	The study was conducted in the intensive care unit setting. Sample size not defined
Major Variables Studied List and define dependent and independent variables	The dependent variable was the catheter-associated urinary tract infections (CAUTI) while the dependent variable was appropriate urinary catheter insertion practices.	The dependent variable was education on CUATIs prevention while the independent variable was CAUTIs risk.	The dependent variable was risk for CAUTIs while independent variables included the interventions developed such as standardized infection ratio, rations and catheter days in intensive care unit and non-critical areas in the facility	The independent variables included healthcare workers (HCWs) educational program and a daily checklist for indwelling urinary catheter indications. The dependent variable included CAUTIs.
Measurement Identify primary statistics used to answer clinical questions (You need to list the actual tests done).	Descriptive statistics were used to determine the trends in the CAUTIs.	Descriptive statistics were used to compare the outcomes before and after the intervention.	The study involved the use of descriptive statistics.	Descriptive statistics were used in the study.
Data Analysis Statistical or Qualitative findings (You need to enter the actual numbers determined by the statistical tests or qualitative data).	No actual data indicated.	The mean value for the knowledge on institutional policies before and after the interventions were 9.71 and 12.3 respectively. Mean for the method to prevent catheter-related infections were 4.59 and 5.24 respectively.	The CAUTIs reduced by h, 2015 reduced by 57% with a SIR of .67, following the intervention.	The study reports that the urinary catheter utilization decreased from phase I to phase IV (73.1%, 74.1%, 54.9%, and 45.6%, respectively). The rate of CAUTI decreased from phase I to phase IV (14.9, 7.3, 3.8, and 1.1 per 1000 catheter-days, respectively
Findings and Recommendations General findings and recommendations of the research	The study findings indicated that regular evaluation in the clinical practices can significantly help in reducing the burden on CAUTIs.	The study recommends the provision of education to the nurses on CAUTIs prevention.	Healthcare institution should consciously develop measures to minimize CAUTIs.	Providing education to healthcare workers on CAUTIs prevention can be implemented to address the high burden of infections among patients in ICU.
*Appraisal and Study Quality* Describe the general worth of this research to practice. What are the strengths and limitations of study? What are the risks associated with implementation of the suggested practices or processes detailed in the research? What is the feasibility of use in your practice?	The strength of the study is that it used a multifaceted approach where the intervention focused on mixed methods to provide the answer to the research question. On the other hand, the main weakness in the study is that it fails to provide statistical evidence to the effectiveness of the improvement protocols developed in the hospitals. The findings from the study be supplemented with the results from other study.	The study’s strength is that it includes a multifaceted nature, interactive program that is consistent with literature on evidence-based care practice. On the other hand, the weakness is that the sample population was not adequate to provide data to be inferred to the general population. The study findings are feasible and can be used to address CAUTIs issues in hospitals.	The main strength in the article is that it provides data to show the effectiveness of developing and transferring best practices in all areas of care in the facility, especially in critical. On the other hand, the main weakness is that the study does not define the sample population characteristics. Findings from the study are feasible and can be used in clinical practice.	The study has strengths as it was carried out for over ten years and so provides tested and verified results. On the other hand, the weakness is that the study does not provides the approaches used in monitoring the practices in the ICU unit. Findings from the study are reliable and feasible for clinical practice.
Key findings	The critical care nurses can reduce CAUTIs by understanding the effects of indwelling catheters and catheterization.	Education can help reduce the burden of CAUTIs in hospitals.	Continuous education on infection prevention reduces the risk for CAUTIs.	Healthcare workers (HCWs) educational program and a daily checklist for indwelling urinary catheter indications reduced the risk of CAUTIs.
Outcomes	Reduced CAUTIs	Improved level of knowledge on CAUTIs prevention	Risk for CAUTIs	Risk for CAUTIs
General Notes/Comments	Healthcare facilities should engage continuous quality improvement process.	Healthcare facilities should have standard measures to prevent CAUTIs.	The study indicates that generation of data is a critical aspect of improving overall patient delivery and safety, especially in infection control.	The study indicates that effective programs over a duration provides a comprehensive outlook of the benefits of safety interventions focused on improving quality of care delivered to patients.

Part 3

The burden presented by CAUTIs among the patients in the intensive care units cannot be underestimated. Therefore, healthcare institutions should be deliberate in providing quality improvement and safety protocols for the healthcare workers in the units. The review of literature indicates the need to provide continuous education to the healthcare providers and ensuring that they promote the safety of their patients and minimize the risks of CAUTIs transmission. The role of education in reducing the burden of CAUTIs among the patients in ICU was highly emphasized (Ferguson, 2018).

The education should be provided continuously to the healthcare provider to increase their level of consciousness in promoting safety during the catheter insertion. Besides, the regular insertions and prolonged stay of the catheters were also associated with increased risk for infection. The findings from the studies provide relevant guidelines that can be implemented to promote safe treatment environment for the patients in needs of catheter insertion and they are supported by Durant (2017). It is apparent that some of the healthcare providers are not aware of the safety measures needed for the ICU practice and so may predispose the patients to CAUTIs by failing to observe the aseptic measures.

Finally, the results from the analysis are essential and can be used to promote safety in the ICU departments. The risk for CAUTIs is high among the patients with prolonged catheterizations (Carr, 2017). Therefore, the nurses and healthcare providers must observe aseptic protocols. However, such can only be effective with standardized protocols and procedures for ICU nursing practice.

Conclusion

CAUTIs are significant factors in the delivery of healthcare. Several studies have analyzed the interventions that could help facilities to address them. There is a consensus amongst the studies that education of healthcare providers will play a fundamental role in reducing the incidences of CAUTIs in facilities.

References

Carr, A. N. (2017). CAUTI Prevention: Streaming Quality Care in a Progressive Care Unit. Medsurg Nursing, 26(5).

Durant, D. J. (2017). Nurse-driven protocols and the prevention of catheter-associated urinary tract infections: a systematic review. American journal of infection control, 45(12), 1331-1341. https://doi.org/10.1016/j.ajic.2017.07.020

Ferguson, A. (2018). Implementing a CAUTI Prevention Program in an Acute Care Hospital Setting. Urologic Nursing, 38(6). DOI: 10.7257/1053-816X.2018.38.6.273.

Menegueti, M. G., Ciol, M. A., Bellissimo-Rodrigues, F., Auxiliadora-Martins, M., Gaspar, G. G., Canini, S. R. M. da S., Bakir., M. (2019). Long-term prevention of catheter-associated urinary tract infections among critically ill patient through the implementation of an educational program and a daily checklist for maintenance of indwelling urinary catheter: A quasi-experimental study. Medicine. 98(8). DOI: 10.1097/MD.0000000000014417

Parker, V., Giles, M., Graham, L., Suthers, B., Watts, W., O’Brien, T., & Searles, A. (2017). Avoiding inappropriate urinary catheter use and catheter-associated urinary tract infections: a pre-post control intervention study. BMC Health Services, 17(314). doi: 10.1186/s12913-017-2268-2.

Scanlon, K. A. (2017). Saving Lives and Reducing Harm: A CAUTI Reductions Program. Nursing Economics, 35(3):134-141.