Understanding Research Concepts in Evidence Based Nursing

This document provides an in-depth understanding of research concepts in evidence based nursing. It covers the role of evidence based practice in nursing, integration of EBP model in clinical judgment, barriers and strategies for implementing EBP, and a study on total knee replacement. The study examines the aim, independent and dependent variables, intention to treat analysis, risk of placebo effect, sample size, baseline characteristics, and effectiveness of knee replacement.

Running head: EVIDENCE OF NURSING
EVIDENCE FOR NURSING: Assessment Item 2: Understanding research concepts Weight: 35% of overall
mark
PART ONE: Contribution to Week 3, Week 4, and Week 5 in-class workshops (max 6 marks)
PART TWO: General Questions on Evidence based Practice (max 12 marks)
1. Referring to the Registered nurse standards for practice (2016), explain the role of evidence based practice
in nursing profession? (Max 100 words, 2 marks)
Evidence-based practice (EBP) is an approach centred for patient benefit originated on self-governing
scientific research, clinical proficiency and patient involvements. It is used by the nurses and healthcare
facilities in order to provide a better care and treatment to the patient. The evidence-based practice
underlines critical thinking assistances and inspire nurses to focus on the patient’s health condition,
religious, ethnic and socioeconomic experiences and also the recent scientific research information.
Evidence-based practice (EBP) incorporation in nursing education and practice, and clinical experiences
develops a better critical thinking ability and decision-making services. It enhances the ability of nurses to
adapt into any situation, exploit information and work with interdisciplinary groups.
2. How the Evidence Based Practice model can be integrated in to the tanner’s model of clinical judgment to
enhance nurses’ clinical decision makings? (Max 150 words, 2 marks)
The Tanner’s Model of Clinical judgement is the clarification and assumption regarding the problems or
requirements of the patients in order to bring up the best decision for the patient’s health. The clinical
judgement involves persistence, analytical reasoning skills sound judgement skills, inquisitiveness, and
patient and self- awareness application. The evidence-based practice includes various evidence and research
involving the patients and healthcare experience in order to provide ideal patient care. In the evidence-
based practice, the nurse proceeds with identifying the patient’s problem and then recognizes the core of
research in the nursing practice. The next step taken by the nurse is to identify the preferences of the
patient and the family members or values they possess and account to it. Both Evidence-based practice and
Tanner’s Model of Clinical judgement are co-related as there are factors which measure whether they are
effective or not for the well-being of the patient involved.
3. One of the components of Evidence Based Practice is consideration of the patient’s values and
preferences. What does this mean? Using an example, explain the importance of this component (max
100, 2 marks).
The consideration of the values and preferences of evidence based practice defines the need of the
knowledge regarding the choices and preferences of a patient in order to obtain a better decision making
and to deliver a better health care plan for the patient. A patient’s preferences might be religious or psychic
values, social and ethical values, different thoughts and preferences regarding their lives, individual
priorities, and choices regarding their health. It helps the patient to choose respective treatment process
regarding their health and comfort zone, which helps them to improve better in their health condition. It
also helps the nurse to design a better treatment plan focusing their needs and likings.

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4. What are some barriers to implementation of evidence based practice? (Max 3 barriers, 1.5 marks)
Evidence based practice is problem-solving approach in clinical practice which includes best evidence from
the primary or secondary studies in order to provide the best effective treatment to the patient to get cure.
There are certain hurdles or barriers which comes during the implementation of the evidence based
practice. These hurdles should be resolved in order to implement the evidence based practice in an
organization such as, evidence- based practice is considered as a low management priority, there are
difficulties in management of the innovation and there are difficulties in accessing the resource constraint
and the evidence.
5. What strategies can facilitate evidence based practice in the clinical settings? (Max 3 strategies, 1.5 marks)
The strategies that can be used to facilitate the evidence based practice in the health care setting is:
 With the help off evidence based practice in health care setting is that it allows the nurses to design the
complex clinical decision based on the findings from the high quality or rigorous research paper, patient
perspectives and the clinical expertise.
 To implement evidence based practice in the clinical setting, adequate access to the computers on the
healthcare organization.
 Communication and engagement with different heath care staff that help in implementing different
intervention in order to provide the effective treatment.
6. Why randomised controlled trails are considered as ‘higher level evidence’ compared with cohort studies?
(max 50 words, 2 marks)
Randomized control trial that the carefully scheduled experiments which introduce exposure to the study or
treatment on the real patients. This type of study are assessed and reviewed to find the effects and cause of
the disease, while in the cohort study, there are other variables that influences the outcomes.
7. What is the difference between primary and secondary studies? (1 marks)
Primary study is referred to as the result that are directly obtained thorough conducting an experiment or
study. Primary information is the most useful source when any specific information about any particular
disease is required. Secondary research is referred as an interpretation or analysis of the primary research.
Secondary research includes the summary, synthesis or collation of the existing research or primary
research. Hence primary research is more reliable if the current or specific information is needed. Other
difference between the primary and secondary research is that, in case of primary research generation of
data is involved whereas, secondary research uses primary research as the source.
Evidence for Nursing Assessment 2: Understanding research concepts 1

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PART THREEE: Research methodology and results (17 marks)
Read the article by Skou et al. (2015) titled ‘A Randomized, Controlled Trial of Total Knee Replacement’. A copy of
this article is in Assessment 2 folder.
8. What was the aim of this study (1 mark)?
The aim of the study has been assessment of the results of the knee replacement processes which has been
performed among patients who have been in need of the process. The whole experiment has been
conducted through randomised control trials. The number of adverse events has been seen and the control
for the study has been the patients not undergoing knee replacement. Thus, the total responses of the
patients both undergoing surgical as well as nonsurgical assessment regarding the surgical procedures of
knee replacement surgeries has been measured through this study.
9. What was the independent variable in this study (0.5 mark)?
The independent variable are the surgical procedures inclusive of the knee replacement procedures
including the surgical as well as non-surgical methods. Such procedures are considered as the independent
variable as they would be changed and varied through the results of the dependent variables which is the
outcome of the patients undergoing knee replacement through surgical as well as non-surgical procedures.
10. What were dependant variables (name three dependant variables) (1.5 marks)?
The dependant variable is inclusive of the outcome of the experiment which has been the measurement of
change in the baseline value in the mean score on the four Knee Injury and Osteoarthritis Outcome Score
subscales which would range from 0 to 100. The three variables would be the assessment of symptoms,
pain, as well as the various activities of the Daily living along with the quality of life. These have been
considered as the dependent variable as the values and results of the knee replacement processes would
vary according to the measures of the outcomes of both the surgical and non-surgical methods.
11. The study used an intention to treat analysis. What does this mean (1 marks)?
Two of the major problems during the process of randomised control trials are missing outcomes as well as
non-compliance. Thus to treat these discrepancies among the statistical methods of randomised control
trails the concept of intention to react is used which means that all the randomised patients in the groups
according to their orders of being randomly assigned would be regardless of their adherence with the
various entry criteria which would be not depending on the kind of treatment used. This concept would also
involve being regardless of the withdrawal from the treatment process or the deviation of the protocol.
12. How the risk of placebo effect can affect the results of this study? (2 marks)
One of the limitations of the study include the risk of the placebo effects associated with nonsurgical treatments.
The risks of the placebo effect are that it may lead to overestimation of the effects of the attributes to the surgery in
particular and the specific treatments especially. Moreover alternative designs of the study would lead to similar
results thus reducing the risk which is especially associated with the individuals during the trial of the placebo.
13. Who was blind to the group allocations in this study (0.5 mark)?
Regarding the group allocations in the study, the patients have been divided according to those who have undergone
surgical treatment and those who have not undergone surgical treatment. These groups have been blind to the
study as there has been no mention regarding the patients being well informed during the study.
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14. Did the study use an adequate sample size? (Justify your answer, 1.5 marks):
The studies have used proper and adequate sample size as total 100 patients has been used for the randomised
clinical trial assessment.
All the processes have been performed and positive outcomes have been received for the process including the
surgical assessments of the knee replacement procedure. Among 127 patients, exclusion criteria were have been
incorporated and then 100 patients have been selected. Among them 50 of them has undergone surgical treatment
and 50 has been undergone nonsurgical treatment.
15. In this study, the baseline characteristics were similar between intervention and control group
participants, why is this important? (1 mark):
The baseline characteristics have been found similar between the two groups and it is important because the
baseline characteristics are important for assessing the effectiveness of the knee replacement procedures
among the patients undergoing the treatment procedures. Baseline characterization is important and has a
greater influence on the outcome of the experiment. Imbalance between the various groups in the baseline
characteristics are pivotal to the biasness of the statistical test. Moreover, chance bias can be protected due
to the differences in the baseline variables. Thus similar characteristics in the baseline are indicative of
absence of biasness. Thus it can be understood that the results of the patients undergoing non-surgical
methods and the surgical methods are same.
16. The study reports that in the total-knee-replacement group, the increase in the KOOS score (Knee Injury
and Osteoarthritis Outcome Score) was 32.5 (95% CI, 26.6 to 38.3), see Table 2. How would you interpret
this result? (3 marks).
From the results of the KOOS score (Knee replacement and Osteoarthritis Outcome score) has been 32.5 % . It means
that there has been a greater change in the percentage of the patients who have chosen to undergo the procedures
involving total knee replacement. The percentage of people undergoing the non-surgical treatment is 6 which is less
than 50 % of the percentage of the patient undergoing surgical procedures. Thus this significance difference in the
surgical procedures claim that the patient has shown a greater difference in the baselines during the surgical
procedures. Thus the crude mean values hs been 16.5 at 95% confidence interval
17. Was the intervention (knee replacement plus 12 weeks non-surgical treatment) effective in improving
‘Time on the 20-m walk test’?, see Table 2. (Justify your answer, 3 marks)
From the results of the KOOS scores, it has been found that the values of the mean improvement of the people
undergoing total knee replacement has been reduced from - 1.2 to -24. Thus a greater decrease in the negative
value depicts that there has been total improvements in the scores. These score regarding all the five KOOS
subscales along with times including the timed up and go tests have shown improvements from the original values.
18. Would you recommend knee replacement to patients with moderate to server osteoarthritis? (Justify your
answer taking into consideration the benefits and harms or costs of the intervention) (2 marks)
The analysis of the people undergoing knee replacement process through surgical and non-surgical methods along
with the analysis of the per protocol methods have shown that there has been a significant improvement of the total
knee replacement group involving the index including the cases where the knee has been injured due to deep vein
thrombosis. Thus, I would recommend the process of knee replacement to the patients suffering from
osteoarthroitis and recommend them very the nonsurgical methods.
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