Evidence for Nursing: Research Concepts, Methodology & EBP

This assignment focuses on understanding research concepts in nursing, encompassing key areas such as effective search term usage, the relationship between Tanner’s Model of Clinical Judgement and Evidence-Based Practice, and the purpose of systematic reviews versus randomized controlled trials. Through a case study analysis of an article by Byrne et al. (2017), the assignment delves into the benefits of randomized controlled trial designs, identifies primary and secondary outcomes, assesses pain measurement methods, and evaluates sample size adequacy. It also addresses potential biases, the effectiveness of interventions like chewing gum post-bowel surgery, and the interpretation of statistical data, including confidence intervals and p-values. Furthermore, the assignment explores barriers to implementing new research findings in clinical practice and reflects on how the subject prepares junior clinicians for evidence-based decision-making and patient care. The student uses provided research to justify the use of chewing gum post bowel surgery considering statistics, clinical significance, and cost.

92440 EVIDENCE FOR NURSING
Assessment Item 2: Understanding research concepts Weight: 35% of overall mark
PART ONE: Contribution to Week 5 and Week 6 Discussion Forums
PART TWO: General content questions (7 marks)
One of the underlying concepts explored through this subject was conveying broad clinical scenarios and questions
to searchable questions and using refined search terms to extract data.
1. Why is it important to use short search terms in database search instead of long descriptive sentences? (Max
30 words, 1 mark)
It is important to use short search terms which are also known as key terms while conducting a search on the
popular databases because the key words connect with the basic concept of the research idea and are useful in
retrieving relevant results (Greenhalgh 2014).
2. Why is it important to use specific search terms in database search instead of broad search terms (Max 30
words 1 mark).
It should be noted that databases do not identify long phrases and hence the use of short adjacent phrases in
combination with Boolean operators helps in retrieving relevant results within a stipulated time frame.
3. Describe the relationship between the two frameworks that underpin this subject: Tanner’s Model of Clinical
Judgement and Evidence Based Practice? (Max 150 words, 3 marks)
Tanner’s model of clinical judgement critically investigates and analyses the health concerns of a patient and
undertakes an appropriate clinical decision for adapting a particular intervention strategy. Clinical judgement
requires curiosity, analytical reasoning skills, decision making ability and patience. On the other hand, the evidence
based practice makes use of the best clinical evidence and integrates it to the practice in order to yield positive
patient outcomes (De Nisco and Barker 2013). The evidence based practice involves identifying the patient problem
and conducting making use of research to address the problem in context of the nursing field. The care providers
must also identify the values of the patient and their family members so as to deliver effective care. Tanner’s model
of clinical judgement as well as the evidence based nursing practice are thus related to one another so as to yield
effective patient care delivery.
It should be said that Tanner’s model of clinical judgement is used to evaluate the effectiveness of the evidence
based practice used to impart care.
4. Describe the purpose of a systematic review compared to a single randomised controlled trial? (Max 50 words,
2 marks)
Systematic review is a research approach that is used to address a clinical question. This research method makes use
of the available studies and reviews the literary evidence so as to summarize important results. On the other hand,
randomized controlled trials are experiments that study the impact or exposure to a particular treatment in a
targeted population base. While systematic review largely forms a secondary research type, randomized control
trials are categorized as primary research type.
PART THREEE: Research methodology and results (17 marks)
CASE STUDY 1: Read the article carried out by Byrne et al. (2017). A copy of this article is in Assessment 2 folder.
5. What is the benefit of using randomised control trail study design in this study? (1 mark)
The benefit of using randomized control trial in this study can be explained as the direct comparison of the
treatment methods in order to determine the effectiveness. Also, the study design helps in bringing out empirical
evidence to determine the efficacy of the treatment.
92440 Evidence for Nursing Assessment 2: Understanding research concepts 1

6. What are the study’s primary and secondary outcomes? (2 marks)
The primary research outcomes included time to discharge, time to first flatus and time to first bowel motion within
the participants. Whereas, the secondary outcomes included, complication rates, pain and consideration of total
morphine equivalent, seven days post operation.
7. How did the researchers assess pain? (1 mark)
The researchers assessed pain with the help of pain score which was continuously recorded till the time, the patient
had their first bowel motion post-surgery.
8. Has the study used an adequate sample size? (Justify your answer, 1.5 marks)
Yes, the study has used an appropriate sample size. As has been mentioned, between the time frame of 2010-2013,
the researchers had considered a sample size of 162 patients under 22 randomized control trials. A sample size
above 150 participants can be considered appropriate as it would help in the collection of diverse patient data.
9. What important baseline differences between intervention and control group participants exist that may affect
the study results? (2 mark)
The important baseline differences between the intervention and the control group participants included the
consumption of chewing gum so as to critically compare and contrast between the effectiveness of chewing gum in
normalizing the bowel function.
10: how is the patients’ lack of blindness to their group allocation likely to affect the study results (1.5 marks)?
Patient’s lack of blindness leads to biasness within the research study. It is therefore recommended to blind the
patients while allocating to different groups in order to avoid biasness and type 2 errors and generate effective
estimates which can be generalized to yield relevant results and findings.
11. Was chewing gum effective in reducing length of hospital stay in this study? (Justify your answer, 1.5 marks)
No, chewing gum was not effective in decreasing the over-all length of stay of the patients considered for the
research study. The effect of chewing gum could only be seen to return normal bowel functioning and reduced
analgesic requirements.
12. Authors report that the median time to first bowel motion (TBM) was 50 hours in the chewing gum group?
What does this mean to you? (1 mark)
The chewing gum used by the researcher comprised of 50% sorbitol and mannitol both of which are effective
laxatives and the median time recorded for the first bowel movement which is 50 hours indicates that after the
intake of the laxative sugars through mastication, within 50 hours the first normal bowel functioning could be
observed (Bryne et al. 2018).
13. Authors found that the median time to first bowel motion (TBM) was 50 hours in the chewing gum group with
95% CI 45.2-54.8. What does this confidence interval tell to you? (See figure 4, justify your answer, mark 2)
It can be said with 95% confidence that the true mean time for the first bowel movement in the chewing gum group
lies in between 45.2 hours to 54.8 hours (Bryne et al. 2018).
14. Looking at Table 3, did chewing gum reduce the need for morphine equivalents for the total 7 days post-
surgery in the intervention group? (Hint: compare the mean required morphine for the chewing gum group with
the mean required morphine for the non-chewing gum group, see the reported p value). (Justify your answer,
mark 1.5)
The p value between the chewing gum and the non-chewing consuming groups has been reported to be 0.009 which
implies that the difference in the mean time of the two groups is significant. The mean value for the chewing group
has been recorded to be 41.7 and that of the non-chewing gum group is 61.3. This states that the in the chewing
gum group the dependence for morphine equivalent is less within 7 days post-surgery (Bryne et al. 2018).
92440 Evidence for Nursing Assessment 2: Understanding research concepts 2

15. Would you consider using chewing gum for your patients post bowel surgery? (Justify your answer taking into
consideration the results of statistics, clinical significance, and cost) (2 marks)
Yes, it would be feasible to use chewing gum for the patients post bowel surgery in order to return normal bowel
functioning within 50 hours. Also, chewing gums are cost effective, readily available and at the same time have not
been linked with any significant side effects (Bryne et al. 2018).
PART THREE: Implementation of EBP (5 marks)
Thinking broadly about the way you engage with evidence in your clinical practice, please answer the following
questions:
16. What are some of the barriers to implementing new research findings into clinical practice? (2 marks for 4
identified barriers)
Evidence based practice makes use of the available evidence from the literatures in order to imply the findings to
address a clinical problem. Studies show that the application of evidence based practices successfully yield positive
patient outcome, however the barriers encountered in the implementation process include, poor organizational
cultures, resistance from nursing leaders and management authorities and restricted time frame (Polit and Beck
2013).
17. Reflecting on your learning experience in this subject, how the subject help prepare you for your role as a
junior clinician? (Max 150 words, 3 marks).
This subject would be of utmost importance to me as it would train me in being able to conduct a research
effectively. As a junior clinician, I would be responsible for handling a wide range of patient problems that would
require me to ideally identify the patient problems and make use of the available evidence based studies to
strategically plan a nursing intervention. I would be required to undertake critical clinical decision so as to promote
positive patient outcomes, hence, this subject would ideally prepare me to address the patient needs in an efficient
manner. On successfully acquiring the learning goals of the subject, I would be able to ideally consider the patient
needs and address the same in relation to the associated patient and family values. Therefore, this subject would
ideally prepare me as an effective junior clinician to render effective patient care.
References:
Byrne, C.M., Zahid, A., Young, J.M., Solomon, M.J. and Young, C.J., 2018. Gum chewing aids bowel function return
and analgesic requirements after bowel surgery: a randomized controlled trial. Colorectal Disease, 20(5), pp.438-448.
DeNisco, S.M. and Barker, A.M., 2013. Advanced practice nursing: Evolving roles for the transformation of the
profession.
Greenhalgh, T., 2014. How to read a paper: The basics of evidence-based medicine. John Wiley & Sons.
Polit, D.F. and Beck, C.T., 2013. Study guide for essentials of nursing research: appraising evidence for nursing
practice. Lippincott Williams & Wilkins.
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