Understanding Research Concepts: Evidence for Nursing Assessment 2

This document provides a detailed solution to a nursing assessment focused on understanding research concepts and evidence-based practice (EBP). The assessment covers the role of EBP in nursing, integrating EBP with Tanner's model of clinical judgment, and the importance of patient values. It al...Read More

EVIDENCE FOR NURSING: Assessment Item 2: Understanding research concepts Weight: 35% of the
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 the nursing profession? (Max 100 words, 2 marks)
According to NMBA (2016) nurses make judgments in order to offer and translate the best available care
through evidence which entails the most current, valid and available research findings into the practices.
Nurses in this sense play a critical role in providing quality care through comprehensive and systematic best
available evidence so as to achieve planned and agreed outcomes for the people. Hence the nurses have to
research with critical assessments and other available evidence in order to identify quality findings which are
applicable to the practice which increases the care quality in the nursing fields and offers patients quick
recovery and healing.
2. How the Evidence-Based Practice model can be integrated into to the tanner’s model of clinical judgment
to enhance nurses’ clinical decision makings? (Max 150 words, 2 marks)
Clinical judgment is viewed as a crucial and important skill which is essential for the health professional. It is
a problem-saving skill which entails various steps of clinical judgment, problem-solving, decision making and
critical thinking which are often used interchangeably.
Tanner Hill model assess and interprets clinical judgment as a process in which interpretation of patient
needs, occurrence, health issues decisions are used or modified to change standard approaches which are
deemed appropriate for the patient(Tanner, 2006,). The nurses have to use clinical judgment which entails
the use of evidence-based knowledge which allows for noticing, interpreting, responding and reflection of
nursing action undertaken by nurses.
The Tanner model allows for recognizing patterns and recognizing how these patterns enhance nursing care
action and the ability to utilize theoretical information in the nursing field. This aspect promotes clinical
judgment development and utilization of gathered evidence in making a critical nursing decision in health
care.
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).
- Nurses have a role of incorporating evidenced-based care with patient-centered care. This two seem to
be mutually inclusive with the inclusion of patients and family members. Patient values play a critical
role in the overall recovery process healing start with the patient acceptance and willingness to
cooperate in the process. The role of friends and family in the understanding of how the patients and
families consider each other. Nurses who engage in Evidence-based practices have observed that social
and cultural factors have a role in health care. Patients can prefer to be treated at home for faster
recovery. Respect o this decision promoted positive health outcomes (van der Weijden et al., 2010).
4. What are some barriers to implementation of evidence-based practice? (Max 3 barriers, 1.5 marks)
Nursing characteristics- nurses often lack the needed knowledge to interpret the statistical information
to provide in the research evidence while others feel overwhelmed with the information provides to
them.
Evidence for Nursing Assessment 2: Understanding research concepts 1

Organizational barriers- such as limited time, heavy patient workloads staffing and limited access to
resources hinders them in accessing full information.
Research information obtained- challenges related to this entailed the nature of the research which for
most nurses are complicated, scholarly have a high statistic and ambiguous to be interested in the
clinical practices.
5. What strategies can facilitate evidence-based practice in clinical settings? (Max 3 strategies, 1.5 marks)
- Strategies involve providing the nurses with an opportunity to work in online studies which engages
them in identifying nursing evidence which is vital for care and incorporation of EBP (Mashiach, 2011, p.
33)
- Provisioning of the support system in the health care which allows accessibility of these materials much
more easier (Eisenberg, Hunt & Speer, 2012).
- Establishment of leadership which allows for a coherent strategy for relationship change between care
providers and managers is essential for health care practices.
6. Why randomized controlled trials are considered as ‘higher level evidence’ compared with cohort studies?
(max 50 words, 2 marks)
Randomized are considered high-level evidence due to its nature of being carefully planned experiments
which have treatments and exposure to assess its effect on real patents. They incorporate measures to
reduce bias and allows for group comparisons on groups and control.
7. What is the difference between primary and secondary studies? (1 marks)
Primary studies entail the research being conducted by the researcher, the information is obtained from the
field, while secondary research entails studies done based on the analysis and interpretation if primary
research.
PART THREE: 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 the Assessment 2 folder.
8. What was the aim of this study (1 mark)?
- The study assessed the relationship of patients who are eligible to total knee replacement being offered
nonsurgical treatments in order to find out how it reliefs the pain and improves the function and quality
of life.
9. What was the independent variable in this study (0.5 marks)?
- Greater improvement of pain relief and improvement of function and quality of life of patients.
10. What were dependent variables (name three dependent variables) (1.5 marks)?
- Exercise
- Education
- Dietary advice
11. The study used an intention to treat analysis. What does this mean (1 marks)?
- Intention treat entails the inclusion of all subjects who were randomized and it ignores noncompliance
and withdrawals from protocols.
- The study offered to none surgical treatment management to two groups separately but identically at
the same study site in order to reduce crossovers and enhance proper standardization.
Evidence for Nursing Assessment 2: Understanding research concepts 2

12. How the risk of the placebo effect can affect the results of this study? (2 marks)
- At times in research, the effect does not cause symptoms but rather placebo indicates either positive or
negative results in the study.
- Placebo effect in this study could affect the overall results in that the patients who were subjected to
total knee surgeries could attribute improved treatment outcomes on the treatment offered as they
were the placebo group. Thus
13. Who was blind to the group allocations in this study (0.5 marks)?
- The orthopedic surgeons who identified the subjects
14. Did the study use an adequate sample size? (Justify your answer, 1.5 marks):
- The study utilized an adequate sample size for the groups as this could illustrate cause and effect on the
variables being assessed. The sample chosen in the study will have a good significant effect on the test
used as it will be significant in analyzing the results with no biases of analysis.
15. In this study, the baseline characteristics were similar between intervention and control group
participants, why is this important? (1 mark):
- In randomized controlled studies the intervention and control group must have an equal number so as
to ensure that any treatment effect occurring is not skewed but reflect possible causes and establishes
cause and effect. Further, it allows for balance results. An imbalance occurring at the groups at the
baseline can lead to significant statistical biases an occurrence by chance and not by the treatment
offered.
16. The study reports that in the total-knee-replacement group, the increase in the KOOS score (Knee Injury
and Osteoarthritis Outcome Score) were 32.5 (95% CI, 26.6 to 38.3), see Table 2. How would you interpret
this result? (3 marks).
- The results indicate that improvement of the knee injury and osteoarthritis outcome score patients had
32.5 more times likely to have better outcome score compared to the intervention group in the study.
- Or the intervention group were 77.5 times less likely to have a positive outcome on the KOOS score after
the treatment process.
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)
- The nonsurgical treatment group had greater and improved score compared to the intervention group.
There was a greater improvement on the KOOS score with a crude mean difference of 16.5 (95% 10.2-
22.7), with an adjusted mean difference of 15.8 (95% 10-21.5). There was an improvement in the total
knee treatment group as they are more likely to have better outcomes compared to non treatment
group in the study. The positive outcome was achieved with 32.5 more times being likely to have a
positive outcome at 95% (26.6-38.3).
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)
- NO. Knee replacement process for the patient was associated with serious adverse effects compared to
none surgical treatment group with p value=0.005 8 vs.1 involving the index knee and overall score of
p=0.005. The key adverse effects in the total knee injury were venous thrombosis and stiffness which
necessitated other treatments. Total knee replacement despite its costs is exposing patients to more
harm compared to none surgical treatment group. Generally, the two groups showed improved
outcomes in terms of outcome. There was observed clinical benefits and improvements however total
knee injury patients were having a higher chance of adverse events. Hence assessment on harm and
benefit analysis none surgical treatment process offers positive care of outcome for patients having
moderate to severe osteoarthritis.
Evidence for Nursing Assessment 2: Understanding research concepts 3

References
Eisenberg, D., Hunt, J., & Speer, N. (2012). Help seeking for mental health on college campuses: Review of evidence
and next steps for research and practice.
Harvard review of psychiatry,
20(4), 222-232.
Mashiach Eizenberg, M. (2011). Implementation of evidence‐based nursing practice: nurses’ personal and
professional factors?.
Journal of advanced nursing,
67(1), 33-42.
NMBA-Registered nurse standards for practice (2016). Accessed at
https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards/registered-
nurse-standards-for-practice.aspx. viewed on 14/04/2019.
Skou, S. T., Roos, E. M., Laursen, M. B., Rathleff, M. S., Arendt-Nielsen, L., Simonsen, O., & Rasmussen, S. (2015). A
randomized, controlled trial of total knee replacement.
New England Journal of Medicine,
373(17), 1597-1606.
Tanner C. A. (2006). Thinking like a nurse: A research-based model of clinical judgment in nursing.
Journal of Nursing
Education, 45(6), 204-211. http://www.healio.com/nursing/journals/jne
van der Weijden, T., Légaré, F., Boivin, A., Burgers, J. S., van Veenendaal, H., Stiggelbout, A. M., ... & Elwyn, G. (2010).
How to integrate individual patient values and preferences in clinical practice guidelines? A research protocol.Implementation Science,
5(1), 10.
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