University Nursing Assignment: Evidence-Based Practice and Research

This nursing assignment addresses key concepts in evidence-based practice (EBP) as outlined in the Registered Nurses Standards for Practice. It covers the EBP model, its integration with Tanner's clinical judgment model, and the importance of patient values and preferences. The assignment also identifies barriers to EBP implementation at organizational, individual, and patient levels, alongside strategies to facilitate EBP in clinical settings. It explores randomized controlled trials (RCTs) as higher-level evidence and differentiates between primary and secondary research. Furthermore, the assignment analyzes a study comparing total knee replacement with non-surgical interventions for osteoarthritis, discussing variables, intention-to-treat analysis, placebo effects, bias reduction, sample size, and the study's findings on patient outcomes, including the recommendation for treatment. The assignment emphasizes the benefits of the combined intervention, including pain relief, improved quality of life, and enhanced functional activities, with no significant side effects.

Running head: NURSING
Nursing
Name of the Student
Name of the University
Author Note

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Part 2
Answer 1
According to Standard 6 of Registered Nurses Standards For Practice by Nursing and
Midwifery Board of Australia (2016), it is the duty of the nursing professional to provide
safe, responsive and quality care to the patients. Evidence-based practice (EBP) in nursing is
conscientious yet problem solving approach under the clinical practice that helps to
incorporate the best evidences from the well-designed studies, the values of the patients and
clinicians expertise in order to design therapy plan. Proper designing of the therapy planning
based on the patient preferences and clinical guidelines help to design care patient-centred
care plan and thereby helping to improve the overall quality of care (LoBiondo-Wood and
Haber 2017).
Answer 2
The five steps of the evidence-based practice model include ask, acquire, appraise,
apply and assess the information associated with the prevailing patient scenario and
prevailing guidelines. The four phases of the Tanner’s 2006 Clinical judgment include
noticing, interpreting, responding and reflecting of the current scenario. Noticing is the
process of perceiving salient or important aspects of the situation and this can be linked to the
observation of the patient situation and current trends in practice of EBP guidelines.
Interpreting signifies making sense o what is being noticed and this can be linked with the
analysis of the information from the scholarly articles of EBP guidelines. Responding
include acting based don situation alternatively it can be said that linking the therapy or
intervention planning with the patients’ clinical priority. Reflecting signifies professional
development that is also a part of EBP (Hines and Wood 2016).

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Figure: Relationship between the Tanner’s 2006 Clinical judgment and evidence-based
practice
(Source: Tanner 2006)
Answer 3
Consideration of the patient’s values and preferences signifies cultural, spiritual and
ethnic values of the patient. For example, the indigenous populations residing in Australia are
inclined towards their family members. The connection to the family and community is
reported as an important aspect of the indigenous culture. The family members play a
significant role in the promotion of healthy lifestyle habits among the indigenous people.
Such that during the promotion of the physical activity among indigenous obese and Type 2
Diabetes patients must be family centered in order to increase the level of adherence
(Dahlberg et al. 2018).

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Answer 4
Barriers at the organizational level towards the implementation of the EBP include
back of trained human resources, lack of proper access to internet connection (mainly in the
rural areas) and heavy workload creating problem for successful critical thinking approach.
Barriers at the individual level include lack of adequate time and unwillingness to go through
the systematic review of literatures, lack of proper skills to navigate through the computer
and lack of standard proficiency in English (Khammarnia et al. 2015). The barriers at the
patient level towards the implementation of the EBP include lack of familiarity of the patient
population with EBP guidelines and inability of the patient and their family members of
about the outcome of the EBP therapy towards improving the level of patients’ outcome
(Khammarnia et al. 2015).
Answer 5
The strategies that can facilitate the implementation of the evidence-based practice
under the clinical settings include: (i) Promotion of leadership quality among the nurse
managers for promoting EBP under clinical units within the hospital settings. Facilitating
proper leadership quality among the nurse managers helps to improve the workplace culture,
structure and function of human resources and thus helping to increase the provision for EBP
(Kueny et al. 2015). (ii) Improving perception of the nursing professionals about EBP and its
importance in promoting quality care to the patient will help to motivate the nurse to
implement EBP more frequently into practice (Weng et al. 2013).
Answer 6
Randomized control trials (RCT) are considered higher level evidence because they
are considered to be unbiased and are associated with less systematic errors. Random
allocation of subjects in experimental and placebo groups help in the reduction on the

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allocation bias and thereby helping to improve the reliability and validity of the study
(Schmidt and Brown 2017).
Answer 7
Primary research is conducted by the authors themselves and thus helping to report
first hand information. In secondary research, the authors of the article have not conducted
any wet lab research and dry lab research on their own. Instead they use duty to collect and
summaries the data numerous articles published online over a single topic. Giving summative
overview of the articles helps to generate authentic information and can be used for the
generation of EBP (Brennan and Bakken 2015).

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Part 3
Answer 8
The aim of the study is to compare the effectiveness of the total knee replacement
(surgical procedure) with non-surgical interventions (Skou et al. 2015).
Answer 9
The independent variables are surgical intervention for end-stage knee osteoarthritis
that is total knee replacement, pharmacological treatments and non-pharmacological
interventions like exercise, dietary education (Skou et al. 2015)..
Answer 10
Dependent variable is being tested in the scientific experiment. The first dependent
variable is change in the mean score of knee injury, reduction in the level of pain,
improvement in the activities of daily living, improvement in the quality of life and reduction
in the osteoarthritis outcome score subscales (Skou et al. 2015).
Answer 11
Intention to treatment (ITT) analysis is a technique that is used in the randomized
control trial where the patients are compared in the domain of final results within the groups
to which they were randomized initially and is independent of the receiving allocated
treatment or having dropped out of the study or having violated the overall protocol of the
study. In order words, ITT for this study helped to analyze the results (primary and secondary
outcome) of the patients before initial process of randomization and not on the basis of the
actual treatment that has been received. This helped to analyze the overall outcome of the
both surgical and non-surgical interventions in improving the quality outcome for patients
with osteoarthritis (Sedgwick 2015).

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Answer 12
Placebo-effects are psychobiological phenomenon that is attributable to the overall
therapeutic context. Evidence suggests that placebo effects can exist within the clinical
practice even when there is no placebo present. The placebo effect can effect the result of the
study because the association of placebo effects with the RCT might lead to confusion due to
the response present in the placebo arm. The response in the placebo arm is not a genuine
psychosocial response to the simulation of the overall treatment (Kaptchuk and Miller 2015).
The observed response to placebo in this study (implementation of 12 months of non-surgical
interventions) might reflect the natural course of the disease (osteoarthritis), change in
symptoms (pain), regression to the mean and response to the level of bias in comparison to
the overall patients’ reporting of the overall subjective symptoms (poor quality of life) and
other concurrent treatments.
Answer 13
In order to reduce overall risk of bias, during the process of interpretation, the authors
who were analyzing the results were blinded about the process of group allocation. However,
the study failed to mention whether the process of blinding was done during the time of
allocation. Certo et al. (2016) stated that blinding during the time of allocation helps to
reduce the chances of selection bias.
Answer 14
Total of 100 patients with moderate-to-severe osteoarthritis who were considered to
be eligible for the unilateral total knee replacement were included in the trial. These 100
patients were randomly assigned in 1:1 ratio to the experimental and placebo group. At the
end, total of 95 patients completed the follow-up assessment. According to () and (),
minimum sample size to gain a meaningful yet significant statistical analysis is 100.

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However, the sample size of this study was reduced during the follow-up session. Thus, it can
be stated that the sample size of the study is not adequate (Certo et al. 2016).
Answer 15
The baseline characteristics were similar between the intervention and the control
group. All the patients included in the study had knee osteoarthritis that is radiological
confirmed and were eligible for the knee replacement. Patients who had previous knee
replacement on the same knee, suffering from knee pain or at a risk for getting bilateral total
knee replacement were excluded from the study. The characteristics of the patients influence
the outcome of the results. Thus, imbalance between the baseline data of the control and
experimental groups might influence the outcome leading to biased statistical tests and
increasing the vulnerability of chance bias. Similar characteristics of the control and
experimental group help to promote generalization of results (Kaptchuk, 2001).
Answer 16
The result signifies that the total-knee replacement group had higher improvement in
the KOOS4 score in comparison to the nonsurgical treatment group. The crude mean
difference is 16.5 with an adjusted difference of 15.8. Among the non-surgical treatment
group, the increase in the KOOS4 from the baseline to 12th month was 16.0 and in case of
total knee replacement group, the increase in the baseline data was 32.5. KOOS ranges from
0 (worst) to 100 (best) In other words it can be stated that total knee replacement followed by
nonsurgical treatment helps to enjoy better pain relief and improvement in functional
activities after 12 months of follow-up in comparison to nonsurgical treatment alone (Skou et
al. 2015).

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Answer 17
Time on the 20-m walk tests (sec) for Total Knee Replacement Group is 163 seconds
and for Nonsurgical Treatment Group is 185 seconds. Thus indicating the time taken to walk
20 meter is less among the Total Knee Replacement Group in comparison to Nonsurgical
Treatment Group. Alternatively it can be said that the efficacy of Total Knee Replacement
followed by non-surgical interventions is higher for improving the physical activity of
patients suffering from osteoarthritis (Skou et al. 2015).
Answer 18
Yes, I would recommend patients with moderate to server osteoarthritis requirement
for who to go for unilateral total knee replacement followed by non-surgical interventions for
12 months. The main benefits of this combined intervention include reduction in the level of
pain, reduction in the debilitating symptoms associated with osteoarthritis, improvement in
the overall quality of life. Combinational intervention discussed in the study of Skou et al.
(2015) helped to improve the tenacity to accomplish the activities of daily living. There are
no significant side effects of the combinational intervention discussed by Skou et al. 2015
unlike non-surgical intervention alone. Thus, the benefits are higher than the cost and harm.

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References
Brennan, P.F. and Bakken, S., 2015. Nursing needs big data and big data needs
nursing. Journal of Nursing Scholarship, 47(5), pp.477-484.
Certo, S.T., Busenbark, J.R., Woo, H.S. and Semadeni, M., 2016. Sample selection bias and
Heckman models in strategic management research. Strategic Management Journal, 37(13),
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Dahlberg, E.E., Hamilton, S.J., Hamid, F. and Thompson, S.C., 2018. Indigenous Australians
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