Evidence for Nursing: Research Concepts and Practice Assignment

This assignment comprehensively addresses evidence-based practice (EBP) in nursing, covering its role, integration with Tanner's model of clinical judgment, and the importance of patient values. It explores barriers and strategies for EBP implementation, the significance of randomized controlled trials, and the distinction between primary and secondary studies. The assignment also analyzes a research article by Skou et al. (2015) on total knee replacement, examining the study's aim, variables, methodology, and results interpretation, including the impact of placebo effects and the effectiveness of the intervention. Finally, it provides recommendations for knee replacement based on the study's findings, emphasizing the balance between benefits, harms, and costs.

EVIDENCE FOR NURSING Assessment Item 2: Understanding
research concepts
Due date: Sunday December 22, 2019 Weight: 35% of overall mark
PART ONE: Contribution to the second and the third online discussions (max 6 marks)
PART TWO: General Questions on Evidence based Practice (max 12 marks)
1. Refereeing to the Registered nurse standards for practice (2016), explain the role of evidence
based practice in nursing profession? (Max 100 words, 2 marks)- needs referencing
Evidence based practice is used in making sure that the nurse makes the right decisions and provides
safe, quality nursing practices in the line of person centered and evidence based frameworks,
(Registered nurse standards for practice 2016). This is done by accessing, analyzing and using all the
available research evidence, developing practice via knowledge, actions, feelings, beliefs and
experiences reflection in identifying how to carry out practice. Through evidence based practice, the
nurse is able to respect all cultures and experiences of clients presented to them and responds to
community and family roles. It is through evidence based practice that the registered nurse is able to
comply to the regulations, legislation, policies and guidelines that are of importance in their practice
when making decisions. 1
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)- needs
referencing
Tanner’s model of clinical judgement stressed the impact the background of a nurse, his/her situation how
the relationship between the nurse and the patient influences how the nurse notices, interprets data and
outcomes, how the nurse takes action and evaluates an experience reflectively, ("Tanner's Model of Clinical
Judgment Applied To: Journal for Nurses in Professional Development,"). Through evidence based practice,
the nurse can make sound clinical judgement through noticing, interpreting, responding and reflecting. in the
noticing phase, impressions are formed in the nurse’s mind about a situation in regard to the nurses’
knowledge, expectations, values, experiences and how he/she relates with the patient. The next phase
involves data interpretation where the nurse uses diverse reasoning types to respond by taking action or not.
The nurse uses a reflection on action to intervene and evaluate the effectiveness and the paths of change
needed. The reflection on action is evidence based through self-evaluation which the nurse can develop and
improve their clinical judgement from research based experience.2
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)- needs referencing
This means that the patient’s values and preferences and the freedom they need should be analysed when
making decisions in evidence based practice. Patients should be involved in the decision making process
1 "Registered Nurse Standards for Practice," Nursing and Midwifery Board of Australia - Home, accessed December 21, 2019,
https://www.nursingmidwiferyboard.gov.au/codes-guidelines-statements/professional-standards/registered-nurse-standards-
for-practice.aspx.
2 " Tanner's Model of Clinical Judgment Applied To...: Journal for Nurses in Professional Development," LWW,
accessed December 21, 2019,
https://journals.lww.com/jnsdonline/Citation/2013/09000/Tanner_s_Model_of_Clinical_Judgment_Applied_to.12.aspx
https://journals.lww.com/jnsdonline/Citation/2013/09000/Tanner_s_Model_of_Clinical_Judgment_Applied_to.12.aspx.
Evidence for Nursing Assessment 2: Understanding research concepts 1

thus shared decision making is used where the patient and the doctor work together in assessing the benefits
and the risks accompanied by all the treatment options available, ((Kunneman et al 2015). Patient’s values
and needs are carefully and systematically analysed in decision making to help deal with uncertainties in
medicine where the patient’s outcome desired through every treatment strategy is put into consideration. The
value a patient place in the expected outcomes is identified through various ways that helps identify the
probability of better health state in a patient that can make them indifferent with their current state of health
and gamble for a better state of health. 3
4. What are some barriers to implementation of evidence based practice? (Max 3 barriers, 1.5
marks)- needs referencing
The barriers towards implementation of evidence based practise include lack of time where the nurse
lacks sufficient time to follow the procedures of EBP due to at times work overload and patient
cases, (American Journal of Nursing 112, no. 12 2012) Another barrier is organizational culture that
does not support EBP such as getting past workplace resistance and constraining power of the
phrase. The other challenge is finding it hard to change behaviour due to earlier education offered to
nurses.4
5. What strategies can facilitate evidence based practice in the clinical settings? (Max 3 strategies,
1.5 marks)- needs referencing
One of the strategies to facilitate EBP is the use of enough mentors of EBP at the bedside who can
work hand in hand with the clinician on duty and help them learn the skills of EBP and consistently
implement them, ("AJN On the Web," 2019). Another strategy should address the organizational
culture where the current strategy should be analysed and instil the need of using EBP in an hospital
and show how it works through reminders and reinforcement. Another strategy is the making sure
that there are enough EBP resources, patients populations and a good setting for this practice.5
6. Why randomised controlled trails are considered as ‘higher level evidence’? (max 50 words, 2
marks)- needs referencing
They are considered higher level evidence because their design is unbiased and they have minimal
risk of systematic errors, (&NA 2013). An example includes when allocating subjects to two or
more groups for treatment, the two study types randomise the confounding factors which may lead to
biased results. An experts’ opinion is biased by the experience of the author and so confounding
factors are not controlled. 6
7. What is the difference between primary and secondary studies? (1 marks)- needs referencing
Primary studies in research are the first-hand accounts of the study that are written by the person who was
part of the study while secondary study in research is the interpretation and analysis of the primary research
3 "Kunneman, M., C. A. Marijnen, M. C. Baas-Thijssen, Y. M. Van der Linden, T. Rozema, K. Muller, A. H. Pieterse, et al.
"Considering patient values and treatment preferences enhances patient involvement in rectal cancer treatment decision
making." Radiotherapy and Oncology 117, no. 2 (2015), 338-342. doi:10.1016/j.radonc.2015.09.005.
4 Michael Fergenson, "AJN On the Cover," AJN, American Journal of Nursing 112, no. 12 (2012): xx,
doi:10.1097/01.naj.0000423495.77404.0b.
5 "EBP 2.0: From Strategy to Implementation: AJN The American Journal of Nursing," LWW, accessed December 21, 2019,
https://journals.lww.com/ajnonline/Fulltext/2019/04000/EBP_2_0__From_Strategy_to_Implementation.27.aspx.
6 "Cited by ..," National Center for Biotechnology Information, accessed December 21, 2019,
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3124652/citedby/.
Evidence for Nursing Assessment 2: Understanding research concepts 2

by the use of the articles of research used and their findings, ("Primary & Secondary Research: Definition,
Differences & Methods," ). 7
PART THREEE: Research methodology and results (17 marks)
No need for referencing your answers to the questions below.
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 marks)?
The aim of the study was to look for the evidence that supports the effectiveness of knee
replacements procedure as compared to non-surgical interventions in United States.
9. What was the independent variable in this study (0.5 mark)?
The independent variable in this study is the Evidence. Independent variables cannot be changed by the
scientist/researcher and can change only on its own, (Leatham 2012)
10. What were dependant variables (name three dependant variables) (1.5 marks)?
The dependent variables are the Effectiveness, Knee replacement procedure and the non – surgical
interventions. A dependent variable is what is being studied, (Profetto-McGrath, Polit, & Beck 2010).
11. The study used an intention to treat analysis. What does this mean (1 marks)?
This means that there was a specific aim to carry out the research as a result of a prior investigation
/observation.
12. How the risk of placebo effect can affect the results of this study? (2 marks)
Placebo effect can affect this study by making the patients believe that they received actual knee
replacement instead of non-surgical interventions and that why they recovered.
13. Who was blind to the group allocations in this study (0.5 mark)?
The participants were blind in the group allocations because they do not know the group they have been
assigned to.
14. Did the study use an adequate sample size? (Justify your answer, 1.5 marks):
Yes. The sample size was adequate because it involved a group of patient with confirmed knee osteoarthritis
condition to represent 670,000 number of knee replacement surgeries that had been done earlier in U.S per
year.it acted as the representative of the whole population with such cases.
15. In this study, the baseline characteristics were similar between intervention and control group
participants, why is this important? (1 mark):
This is important because precise knowledge for particular clinical characteristics is needed to
establish the disease’s long term effect and the patterns of the surgery in daily medical practice. The
research knowledge can allow the particular aspects of care that need t be improved and acted on.
7 "Primary & Secondary Research: Definition, Differences & Methods," Study.com, accessed December 21, 2019,
https://study.com/academy/lesson/primary-secondary-research-definition-differences-methods.html.
Evidence for Nursing Assessment 2: Understanding research concepts 3

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).
My interpretation could be that there is effectiveness in the total knee replacement surgery. This is
associated with greater reduction of the patient’s pain relief, improved functional ability than the non –
surgical treatment. 32.5 at one year has shown a 95%confidence interval as compared to 16.0 (10.1 to 21.9).
The 95% confidence interval is calculated by computing the standard and the mean error, where M=
(2+3+5+6+9)/5=5.z,95, which is 0.95 according to the normal distributing calculator, (Parker 2016).
Was the intervention (knew 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)
Yes. The intervention was effective because the patients were analysed before surgery and after the knee
replacement surgery to identify how effective the surgery was by assessing their behaviour before and after
the surgery.
17. Would you recommend knew 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)
Yes. I can recommend knew replacement to patients with moderate and server osteoarthritis because the
benefits of the surgery were high irrespective of how costly the surgery is. Well-being should be given
the first hand priority irrespective of the costs. The benefits of the surgery outweigh the harms thus I
completely support the surgery to patients.
Bibliography
Evidence for Nursing Assessment 2: Understanding research concepts 4

"Cited by ..." National Center for Biotechnology Information. Accessed December 21, 2019.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3124652/citedby/.
Kunneman, M., C. A. Marijnen, M. C. Baas-Thijssen, Y. M. Van der Linden, T. Rozema, K. Muller, A. H.
Pieterse, et al. "Considering patient values and treatment preferences enhances patient involvement in rectal
cancer treatment decision making." Radiotherapy and Oncology 117, no. 2 (2015), 338-342.
doi:10.1016/j.radonc.2015.09.005.
"EBP 2.0: From Strategy to Implementation : AJN The American Journal of Nursing." LWW. Accessed
December 21, 2019.
https://journals.lww.com/ajnonline/Fulltext/2019/04000/EBP_2_0__From_Strategy_to_Implementa
tion.27.aspx.
Fergenson, Michael. "AJN On the Cover." AJN, American Journal of Nursing 112, no. 12 (2012), 19.
doi:10.1097/01.naj.0000423495.77404.0b.
"Primary & Secondary Research: Definition, Differences & Methods." Study.com. Accessed
December 21, 2019. https://study.com/academy/lesson/primary-secondary-research-definition-
differences-methods.html.
"Registered Nurse Standards for Practice." Nursing and Midwifery Board of Australia - Home. Accessed
December 21, 2019. https://www.nursingmidwiferyboard.gov.au/codes-guidelines-statements/
professional-standards/registered-nurse-standards-for-practice.aspx.
"Tanner's Model of Clinical Judgment Applied To... : Journal for Nurses in Professional Development." LWW.
Accessed December 21, 2019.
https://journals.lww.com/jnsdonline/Citation/2013/09000/Tanner_s_Model_of_Clinical_Judgmen
Leatham, Keith R. "Problems Identifying Independent and Dependent Variables." School Science and
Mathematics 112, no. 6 (2012), 349-358. doi:10.1111/j.1949-8594.2012.00155.x.
Profetto-McGrath, Joanne, Denise F. Polit, and Cheryl T. Beck. Canadian Essentials of Nursing Research.
Philadelphia: Lippincott Williams & Wilkins, 2010.
Parker, David. Management of Knee Osteoarthritis in the Younger, Active Patient: An Evidence-Based Practical Guide
for Clinicians. Basingstoke: Springer, 2016
Evidence for Nursing Assessment 2: Understanding research concepts 5