Evidence Based Nursing Research

This document is a submission template for Assessment 3 of the course 92318 Evidence for Nursing. It guides the student through the process of developing a focused question and acquiring relevant evidence using PICO categories. The document also includes a systematic search strategy worksheet, appraisal of a randomized controlled trial using the CASP tool, and a qualitative study relevant to the PICO question. The subject is nursing research and the document type is a submission template.

EVIDENCE BASED NURSING RESEARCH 1
EVIDENCE-BASED NURSING RESEARCH
Student Name
Institution Affiliation
Facilitator
Course
Date
92318 Evidence for Nursing Assessment 3 Submission Template 1

EVIDENCE BASED NURSING RESEARCH 2
ASSESSMENT Item Three: SUBMISSION TEMPLATE Weight: 50%
of the overall mark
Due date: 11: 59 pm, Sunday 27 January 2019, through Turnitin. No paper submission is required.
Please complete the following the activities by filling in the spaces below. This is a word document so
you can add space as needed.
This assessment builds on your assessment one. Read and follow the template carefully.
Part 2.1 of the Assessment 3 template is the work you undertook in Assessment 1 (with any
improvements suggested in the feedback you received).
PART 1: PARTICIPATES IN THE FIRST AND THE SECOND ONLINE DISCUSSION FORUMS (4
marks).
PART 2.1: DEVELOPING A FOCUSED QUESTION AND ACQUIRING RELEVANT EVIDENCE (3
marks).
1. Use the following categories to help define your problem and what you are looking at in simple terms
PICO: Patient/Problem, Intervention, Comparison, and Outcome.
(Remember to use your readings to help you if you are unsure)
Patient/Problem: heart failure patients
Intervention: remote telemonitoring technology
Comparison: frequent visits to the clinic
Outcome: unnecessary traveling
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EVIDENCE BASED NURSING RESEARCH 3
2. Now use these terms from the question above to create your PICO research question so that you have a
clear purpose for your search:
In (P) heart failure patients, does (I) remote telemonitoring technologies compared with (C) frequent visits to
the clinic improve/reduce (O) unnecessary traveling?
3. What type of clinical question do you think this PICO answers?
□ Therapeutic □ Aetiology □ Diagnostic √□ Prevention □ Prognosis □ Others
4. The table below will help you to think of the other terms that you might also like to look up when
searching for evidence to help you answer your question – this is part of basic planning for a research
search.
 We ask you to look up alternative terms because sometimes articles from different countries and
health systems call things different names – for example, in Australia we sometimes use the term
‘community nurses’, but in the UK they often talk about ‘district nurses’ – if you only searched
under ‘district nurse’ you’d miss all the articles which happened to a different term – you would be
missing some of the pictures!
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Population Intervention Comparison
(not commonly used in
actual database search
strategy)
Outcome
(not commonly used in
actual database search
strategy)
What is your population?
Heart Failure Patients:
What other terms might
have been used?
Chronic Heart Failure
patients, Heart attack
patients:
What is your
intervention?
Remote telemonitoring
technology:
What other terms might
have been used?
Remote telemonitoring
devices:
What is your
comparison? N/A:
What other terms might
have been used?
N/A:
What is your outcome?
N/A:
What other terms might
have been used?
N/A:
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5. Is there a particular group of people that you want to look at? List here any inclusion criteria you might
use to refine your search if you have too many papers:
Gender: N/A Age Range: N/A
Publication Dates: N/A Language: N/A
6. What kind of study do you think would best answer your question? Select here which type of article you
might want to access. You can also use these to refine your search if you have a lot of papers.
√□ Randomized Controlled Trial (RCT)
□ Cohort Study
□ Qualitative Study
□ Economic Evaluation
□ Case-control Study/Case Series
Systematic Search Strategy Worksheet
7. Now that you have decided on WHAT you will be searching, you need to put down a plan of HOW you
will search for your articles. This helps you and others to see how you got your evidence and how you made
sure you got the best evidence to help you decide on your clinical action.
 Using the PICO terms in your table, enter each term in a row (group them together under the PICO
categories).
 The next step is to combine similar terms using ‘OR’
 The final step is to use ‘AND’ to combine your searches for different PICO elements.
Key terms:
1 Heart Failure Patients
2 Chronic Heart Failure
3 Remote telemonitoring technology
4 Heart complications
5 Remote telemonitoring devices
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6 How remote telemonitoring technology works
7 Examples of remote telemonitoring devices
8 Heart failure OR Heart attack OR chronic heart failure OR chronic heart attack
9 Remote monitoring technology OR how remote monitoring works
1
0
Telemonitoring technology AND remote treatment
OR = combine alternate terms for the same topic – to get as many potential papers as possible!
AND = combine the groups of topics to get papers which cover ALL the terms!
PART 2.2: EVIDENCE OF APPLICATION OF SEARCH STRATEGY (PLAN) IN DATABASE
SEARCHES (3 marks)
Enter your planned search into two different databases of your choice (such as Medline and CINHAL) using
the skills you have learned in the library session, online library videos, and library workshops.
8. Place the screenshots/screengrabs/digital pictures of your two (2) database searchers here. Please
ensure your screenshots provide all steps of your search (see the example in Assessment one templet) and
are clear enough to be legible – these must be READABLE!!
Database search 1
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Database search 2
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9. Select a randomized controlled trial that can help you answer your PICO question and place the
abstract here. Please add this as a screenshot, do not retype this yourself. (The abstract must be readable)
10. Choose a qualitative study that is relevant to your PICO from the list of provided articles in
Assessment 3 folder and places the abstract here. It is ok if your qualitative study does not exactly match
your PICO, but it should be relevant. Please add this as a screenshot, do not retype this yourself. (The
abstracts must be readable).
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PART 3.1 APPRAISAL OF YOUR RANDOMISED CONTROLLED TRIAL (Please consider the word
limit for each question, 13 marks )
Assessing the quality of the available evidence has also been a key focus this semester. Use the CASP tool
for RCTs below to appraise the quality of your selected RCT.
Section A: Are the results of the trial valid?
Screening Questions
1. Did the trial address a clearly focused issue?
√Yes No Can‘t tell
Justify your answer: (Max 50 words)
The trial is clearly focused because of several reasons. First of all, in consideration to the population which
will take place in this trial (heart failure patients), it is a population which can be easily identified to help the
researcher carry on with the research. In consideration to the intervention which has been proposed (remote
92318 Evidence for Nursing Assessment 3 Submission Template 10
Randomised Controlled Trial
Appraisal Tool

EVIDENCE BASED NURSING RESEARCH 11
telemonitoring technology), this is a new technology and hence the researcher will easily access supportive
materials for the research (Kim et al, 2016, p.230). On the comparative factor, the proposed intervention has
a profound difference with the initial approach and hence the effectiveness of the proposed intervention can
be easily built from the weaknesses of the past approach. Finally, when the proposed intervention (remote
telemonitoring technology) is compared with the traditional method used (visits to the clinic physically), it’s
beyond any reasonable doubt that the intervention will directly change the process positively
2. Was the assignment of patients to treatments randomized? (Max 50 Words)
√Yes No  Can’t tell
Justify your answer:
To obtain the sample of the patients who would participate in the trial, no specific procedure was used to
gather them from the large population (heart attack patients). Instead, the sample size was picked just
randomly from the entire population. Also, there was no allocation sequence followed and that meant that
any patient stood an equal chance of being selected (Or et al, 2017, p.160).
3. Were all of the patients who entered the trial properly accounted for at its conclusion? (Max 50
words)
√Yes No Can’t tell
Justify your answer:
Generally, all the patients who entered the trial process were properly accounted for at its conclusion
because of two reasons. First, the trial was given enough time to ensure that the trial has been administered
to all the patients who took place in the trial in an equal measure. Secondly, all the patients were fully
analyzed within the scope of groups to which they had been randomized (Van Der et al, 2018, p.20).
4. Were patients, health workers, and study personnel ‘blind’ to treatment? (Max 50 words)
Yes √No Can’t tell
Justify your answer:
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The RCT proceeded in an open manner where most of the patients had a hint of the remote telemonitoring
technology as it can be observed from the initial patient who talks of friends living in regional NSW and
who uses the remote telemonitoring device to monitor their condition from their home (Vegesna et al, 2017,
p.10). In consideration to the health worker, although the case study has presented him as a little bit
unfamiliar with the technology, it does not completely present him as unfamiliar with the technology. That’s
an indication that the trial proceeded in an open manner because both parties had hint on the technology.
5. Were the groups similar at the start of the trial? (Max 50 words)
√Yes No Can’t tell
Justify your answer:
Before the random selection from the population, the patients were balanced in consideration to their age,
gender, and social class. Through this grouping, the random selection strictly saw the sample obtained
consist of patients of balanced age, gender, and social class. This played a major role in ensuring that the
results of this trial were free from any kind of bias (Ambrosino et al, 2016).
6. Aside from the experimental intervention were the groups treated equally? (Max 50 words)
√Yes No  Can’t tell
Justify your answer:
The resultant groups obtained after the randomization process, they were treated equally in all the preceding
aspects of the trial. For instance, the questions which were administered on the first group were repeated all
through the rest of the groups, the response duration allowed on the first group was allowed to all the other
groups and finally, any interpretation required was administered to all the groups equally to ensure that all
understood the questions (Innominato et al, 2018, p.10).
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Section B: What are the results?
7. How large was the treatment effect? (Max 150 words)
Justify your answer:
The treatment effect as a result of this intervention was considerably large because of several reasons. First,
most of chronic heart failure patients face severe difficulties which hinder them from accessing regular
check-ups and that has been a reason behind their health status deteriorating largely than expected. With
remote telemonitoring technology, however, most of them would be able to undertake regular check-ups
because that will no longer demand movement or traveling (Karhula et al, 2015, p.6).
8. How precise was the estimate of the treatment effect? (Max 100 words)
Justify your answer:
The treatment effect estimates were high because the usage of the remote telemonitoring devices was simple
and straightforward. In addition, considering the fact that check-ups would be facilitated without necessary
moving or visiting the clinics gave the patients confidence that the intervention would be effective.
However, low-class patients raised the issue of gadget affordability and which was responded by a
suggestion that clinic management would be giving out those gadgets in a rental basis (Rimpiläinen,
Morrison and Rooney, 2016, p.60).
Section C: Will the results help locally?
9. Can the results be applied in your context? (or to the local population?) (Max 100 words)
√Yes No Can’t tell
Justify your answer:
The results can be applied comfortably within my context because the patients used in the trial are just the
same as those to whom I will apply the intervention. The level of illiteracy needed in order to interact with
the device is not that high and patients will be able to learn and grasp easily just like it was the case in the
trial session.
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10. Were all clinically important outcomes considered? (Max 50 words)
√Yes No Can’t tell
Justify your answer:
Most of the clinically important outcomes were put into consideration. For instance, the affordability factor
across different class of patients was the main concern and which was countered by the proposal that
hospitals or clinics could be renting those devices to low-class patients. Also, the issue of usability of this
device was a major concern and which was countered by the proposal that the device usage was simple and
patients could be briefed before being given the device.
11. Are the benefits worth the harms and costs?
√Yes Can’t tell No (Max 100 words)
Justify your answer:
Without any reasonable doubt, the benefits of the proposed intervention are worth the expected costs and
harms. First of all, traveling or moving to clinics for regular check-ups costs the patients in terms of money
spent and risks their lives because of their critical conditions (Inglis et al, 2017, p.200). Secondly, heart
failure patients are prone to health emergencies which require fast respond and any delay may cost the life of
the patient. Putting these two factors into consideration and the fact that telemonitoring technology will
alleviate both, the cost of the device and its usage training is outdone.
PART 3.2 APPRAISAL OF YOUR QUALITATIVE ARTICLE (please consider the word limit for each
question, 10 marks )
Use the CASP Appraisal for Qualitative Research below to decide whether the information presented in
your paper is trustworthy and truly reflective of the participant’s voice.
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SCREENING QUESTIONS
1) Was there a clear statement of the aims? ☒Yes ☐ Can’t tell ☐ No
The aim of this study was clear; it aimed at seeking an alternative to clinical check-ups specifically for heart
failure patients. The study was important because it would help alleviate the suffering and risks taken by
chronic heart failure patients in their attempts to attend clinical check-ups.
2. Is a qualitative methodology appropriate? ☒Yes ☐ Can’t tell ☐ No
The qualitative methodology will be appropriate for this research because it will aid in uncovering the trends
in the opinions and thoughts of the sample population before the researcher can dive deeper into the research
question. This will help in determining the best approaches to come up with a desirable outcome.
3. Was the research design appropriate to address the aims of the research? ☒Yes ☐ Can’t tell ☐ No
This research adopted a descriptive design where it combined case studies with naturalistic observations and
surveys. The choice of this design was highly significant in realizing the results to address the aim of the
research. For instance, through the case study approach, the researcher was able to reveal the importance of
the intervention on the basis of the evidence from other patients (Pigini et al, 2017, p.285).
4. Was the recruitment strategy appropriate to the aims of the research? ☒Yes ☐ Can’t tell ☐ No
The recruitment strategy was in line with the aims of the research in various ways. First of all, the research
aim had not been aligned in favor of any gender, age group or social class and that’s was taken care of by
considering patients from the two genders, distributed age groups and also social classes. In regard to natural
observations, the researcher was able to identify the gap between the traditional approach and the new
technology. Lastly, through surveys, the research was able to extract customer reactions with regard to the
proposed intervention (Pigini et al, 2017, p.285)
5. Was the data collected in a way that addressed the research issue? ☒Yes ☐ Can’t tell ☐ No
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The data collected fully addressed the research issue. This is in consideration of the fact that the researcher
did not limit himself in a single data collection approach but used a combined approach in order to fully
exploit the participants and obtain adequate data. For instance, through the case study approach, the
researcher was able to reveal the importance of the intervention on the basis of the evidence from other
patients. In regard to natural observations, the researcher was able to identify the gap between the traditional
approach and the new technology (Albert et al, 2017, p.290).
6. Has the relationship between researcher and participants been adequately considered ☒Yes ☐
can’t tell ☐ No
From the presented evidence, a critical examination of the role of the researcher as well as his influence
during the question formulation of research questions has not been clearly presented. How the researcher
responded to different events during the course of the study has also not been revealed in a manner that they
can be judged.
7. Have ethical issues been taken into consideration? ☒Yes ☐ Can’t tell ☐ No
As a form of research which mainly proceeded in a manner that mainly involved interactions with patient’s
information, maintaining privacy and confidentiality of the patient information was highly emphasized as
the research progressed. Lastly, through surveys, the research was able to extract customer reactions with
regard to the proposed intervention (Desmaris et al, 2018, p.10).
8. Was the data analysis sufficiently rigorous? ☒Yes ☐ Can’t tell ☐ No
Data analysis in this research was done sufficiently rigorous; this is in consideration of several factors. First
of all, the researcher has described his analysis processes in an in-depth manner enabling the readers to draw
the relationship between various data collected in the course of the study. This also enabled the readers to
see the logic in the results realized. Data was also presented with all the supportive findings together and
that simplified the understanding of the end results (Sultan et al, 2018, p.14).
9. Is there a clear statement of findings? ☒Yes ☐ Can’t tell ☐ No
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The statement of findings as presented in the findings is very clear. It has presented all its findings attached
to their respective supportive data and all the arguments both against and in support with them. Evidence has
also been attached to all the findings made from the research. The findings have also been discussed in line
with the original research question.
10. How valuable is the research?
The research is highly valuable due to various reasons. Firstly, it has clearly addressed the contribution and
the impacts of telemonitoring technology in alleviating suffering and risks which have been rampant using
the traditional approach. This research has also explained how its findings will be transferred to other
populations and how it will be useful for its implementation (Van Doorn et al, 2018).
PART 4 OVERALL SUMMARY
PART 4.1 PROVIDE AN OVERALL SUMMARY OF WHAT THESE TWO PAPERS CONTRIBUTE
TO ANSWERING YOUR RESEARCH QUESTION (400 words, 10 marks).
My original clinical question was “how remote telemonitoring technology could be used to minimize
unnecessary traveling on heart failure patients”. The two papers have contributed to answering my research
question in different ways. The first article, for instance, has tackled all the aspects of remote telemonitoring
right from how it should be handled to how it works (Ware, Seto, and Ross, 2018, p.20). Considering the
fact that my research question has its basis on the implementation of remote telemonitoring technology to
replace the traditional way of facilitating check-ups, the knowledge gained from this study will contribute in
my research question through the provision of insights to be used in educating the participants on the usage
of these devices. It also helps in answering some of the questions which may arise from the patients. These
include but not limited to the privacy of this technology (Parati et al, 2018, p.1130). In addition to that, this
article has provided an evidence-based revelation on how effective this technology can be as far as the
health sector is concerned. Through these and other details which have been covered in this article, my
major concerns in explaining how the technology will be useful in facilitating clinical check-ups without
necessarily visiting the clinic have been fully addressed and support to my arguments obtained. Corrections
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EVIDENCE BASED NURSING RESEARCH 18
in some of the points which I had gotten wrong have also been criticized and hence prompting for re-
adjustments.
In the second article, and whose main concern was to clarify the effectiveness of remote telemonitoring
technology in the health sector (Greenhalgh et al, 2017, p.11). It emphasized on some of the concerns raised
under my research question. For instance, the article has addressed the emergency concern in relation to
remote telemonitoring technology. It has revealed how this technology would enable health practitioners to
get in touch with the patients under these conditions to provide advice on the necessary attention needed for
the victims to be assisted without necessarily having to be rushed to the hospital which may take some time
and lead to death of the patient (Omboni and Ferrari, 2015, p.21). When framed in the context of my
research question, this article has contributed to explaining the importance of this technology for heart
failure patients, a disease which is under the category of critical illness. In addition to that, this article has
expounded on the security concern of this technology. This has also added on my research which had briefly
touched on the ethical issues which were to be considered in the implementation of this technology.
PART 4.2 SYNTHESISING THE EVIDENCE (300 words, 7 marks).
Finally, you need to summarise the evidence that relates to your clinical questions in plain language as if
you were explaining the rationale for your clinical decision making to a patient within your care.
Heart failure complications can be classified under chronic illness and therefore requires quick responses
whenever they occur. Considering the fact that not all people can afford to have personal doctors, the lives
of many victims of this condition are highly under risk because the severity of the disease may not give a
room for traveling up to the clinic (Inglis et al, 2015, p.250). This has led to the loss of many lives in the
course of traveling up to the hospital. These deaths can, however, be minimized through the remote
telemonitoring technology which will allow health professionals interact with patients remotely.
Through this technology, doctors interact with chronic patients without necessarily visiting the
clinics physically and that will mitigate the risks associated with traveling under such conditions. In
consideration to emergency responses, this technology enables the doctors to advise the people in charge of
a chronic patient on how to administer first aid or any other attention which may help to curb the condition
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as he/she is rushed to the clinic or waiting for the doctor to arrive (Kolominsky-Rabas et al, 2016, p.780).
For that matter, this technology will evidently minimize the deaths which result from some of the chronic
infections like heart failure through availing the necessary attention to the victims which will sustain them
until the moment they get into the hands of the doctors for treatment. In addition to that, this article has
expounded on the security concern of this technology. This has also added on my research which had briefly
touched on the ethical issues which were to be considered in the implementation of this technology
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