NURS 5367 Critical Appraisal Assignment: Evidence Based Practice

This assignment comprises a critical appraisal of three nursing research studies, adhering to the provided appraisal guides (Appendices C, E, and F). The first study is a systematic review by Boyce et al. (2017) on the frequency of alcohol-based hand rub use by nurses. The second study, by Piras et al. (2017), is a qualitative study exploring critical care nurses' beliefs about hand hygiene. The third study, by Karaoglu & Akin (2018), is a quantitative study evaluating the effectiveness of hand washing training. Each study is evaluated based on the quality of its methodology, the credibility of its findings, its clinical significance, and its applicability to nursing practice. The assignment includes detailed responses to the questions in each appraisal guide, along with the necessary citations and comments. The student analyzed the studies according to the provided rubric, ensuring all questions were addressed and all criteria were met to demonstrate a complete understanding of the research and its implications for nursing care.

Running head: NURSING
CRITICAL APPRAISAL
Name of the Student
Name of the University
Author Note

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APPENDIX C
Appraisal Guide:
Conclusions of a Systematic Review with Narrative Synthesis
Citation:
Boyce, J. M., Polgreen, P. M., Monsalve, M., Macinga, D. R., & Arbogast, J. W. (2017).
Frequency of use of alcohol-based hand rubs by nurses: a systematic review. infection
control & hospital epidemiology, 38(2), 189-195.
Synopsis
What organization or persons produced the systematic review (SR)?
Answer: The organization responsible for the SR is Infect Control Hosp Epidemiol 2 done by
Boyce et al., (2017).
How many persons were involved in conducting the review?
Answer: Five persons were involved in the conduction of the review.
What topic or question did the SR address?
Answer: The topic selected for the study was the frequency of alcohol wash by nurses during
their handwashing process.
How were potential research reports identified?
Answer: PubMed was used as the primary database for the identification of research reports.
English language reports were collected from the database and systematic review was
conducted
What determined if a study was included in the analysis?
Answer: The results section showed that that study included an analysis of WHO hand
hygiene and electronic hand hygiene monitoring studies were performed in the research
study.
How many studies were included in the review?
Answer: 326 articles were finally reviewed after screening them from 3487 nonduplicate
articles.
What research designs were used in the studies?
Answer: Retrospective review of the literature was the study design used for the study.
What were the consistent and important across-studies conclusions?
Answer: The most important feature of the conclusion was that the nurses and other HCWs
focus on the use of alcohol wash for hand hygiene varying with levels of exposure.

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Credibility
Was the topic clearly defined? ✓Yes  No  Not clear
Was the search for studies and other
evidence comprehensive and unbiased? ✓ Yes  No  Not clear
Was the screening of citations for
inclusion based on explicit criteria? ✓ Yes  No  Not clear
*Were the included studies assessed
for quality? ✓ Yes  No  Not clear
Were the design characteristics and
findings of the included studies displayed
or discussed in sufficient detail?  Yes ✓ No  Not clear
*Was there a true integration (i.e., synthesis) of the findings—not
merely reporting of findings from
each study individually? ✓ Yes  No  Not clear
*Did the reviewers explore why differences
in findings might have occurred? ✓ Yes  No  Not clear
Did the reviewers distinguish between
conclusions based on consistent findings
from several good studies and those
based on inferior evidence (number or quality)?  Yes ✓ No  Not clear
Which conclusions were supported by
consistent findings from two or more
good or high-quality studies? List
Answer: The hand hygiene ECM system has been used to observe the varying frequency of
alcohol washing among the nurses. This process has been supported by various pieces of
literature (Labrague et al., 2018). Alcohol wash is frequent for various hospitals is also a
factor in the conclusion which has been supported by another existing literature (Kingston et
al., 2018).
ARE THE CONCLUSIONS
CREDIBLE? ✓ Yes All  Yes Some 
No
Clinical Significance
*Across studies, is the size of the
treatment or the strength of the
association found or the
meaningfulness of qualitative findings
strong enough to make a difference
in patient outcomes or experiences of care? ✓ Yes  No  Not clear
Are the conclusions relevant to the
care the nurse gives? ✓Yes  No  Not clear

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ARE THE CONCLUSIONS
CLINICALLY SIGNIFICANT? ✓Yes All  Yes Some 
No
Applicability
Does the SR address a problem,
situation, or decision we are addressing in our setting? ✓Yes  No  Not clear
Are the patients in the studies or a
subgroup of patients in the studies
similar to those we see? ✓Yes  No  Not clear
What changes, additions, training, or
purchases would be needed to implement
and sustain a clinical protocol based
on these conclusions? Specify and list
Answer: Many changes are not required for the addition, training and purchases for the
implementation of alcohol washing among the nurses. A guideline may be provided to the
nurses in order to make them wash hands with alcohol rub in order to prevent the patients
from communicable infections.
Is what we will have to do to implement
the new protocol realistically achievable
by us (resources, capability, commitment)? ✓ Yes  No  Not clear
How will we know if our patients are
benefiting from our new protocol? Specify
Answer: By assessing the conditions of the patients for the reduction in communicable
diseases.
ARE THESE CONCLUSIONS
APPLICABLE TO YOUR SETTING? ✓ Yes All  Yes Some 
No
SHOULD YOU PROCEED TO DESIGN
A PROTOCOL INCORPORATING
THESE CONCLUSIONS? ✓ Yes All  Yes Some 
No
* = Important criteria
Comments
The new protocol will be effective than normal soap and water washing among the nurses.

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APPENDIX E
Appraisal Guide:
Findings of a Qualitative Study
Citation:
Piras, S. E., Lauderdale, J., & Minnick, A. (2017). An elicitation study of critical care nurses’
salient hand hygiene beliefs. Intensive and Critical Care Nursing, 42, 10-16.
Synopsis
What experience, situation, or subculture does the researcher seek to understand?
Answer: The researcher aims to describe the role of hand hygiene in critical care nurses.
Does the researcher want to produce a description of an experience, a social process, or an
event, or is the goal to generate a theory?
Answer: The researcher uses a description of experiences in order to test the role of hand
hygiene among the nurses.
How was data collected?
Answer: Face to face recruitment procedures were used in order to collect data.
How did the researcher control his or her biases and preconceptions?
Answer: The researchers minimized by ensuring anonymity and confidentiality for each of
the selected participants.
Are specific pieces of data (e.g., direct quotes) and more generalized statements (themes,
theories) included in the report?
Answer: Yes, quotes and generalized statements were included in the study. Four major
themes were identified from the study.
What are the main findings of the study?
Answer: The main findings from the study include hand hygiene as the protective behavior,
hand hygiene is a protective response, hand hygiene norms have been looked between nurse
to nurse, hand hygiene causes time-related concerns and the convenience has been found to
be essential for hand hygiene performance.
Credibility
Is the study published in a source
that required peer review? ✓Yes  No  Not clear
Were the methods used appropriate
to the study purpose? ✓Yes  No  Not clear
Was the sampling of observations or
interviews appropriate and varied
enough to serve the purpose of the study? ✓Yes  No  Not clear

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*Were data collection methods
effective in obtaining in-depth data? ✓Yes  No  Not clear
Did the data collection methods
avoid the possibility of oversight,
underrepresentation, or
overrepresentation from certain
types of sources? ✓Yes  No  Not clear
Were data collection and analysis
intermingled in a dynamic way? ✓Yes  No  Not clear
*Is the data presented in ways that
provide a vivid portrayal of what was
experienced or happened and its
context? ✓Yes  No  Not clear
*Does the data provided justify
generalized statements, themes,
or theory? ✓Yes  No  Not clear
ARE THE FINDINGS CREDIBLE? ✓Yes All  Yes Some  No
Clinical Significance
*Are the findings rich and informative? ✓Yes  No  Not clear
*Is the perspective provided
potentially useful in providing
insight, support, or guidance
for assessing patient status
or progress? ✓Yes  Some  No  Not clear
ARE THE FINDINGS
CLINICALLY SIGNIFICANT? ✓Yes All  Yes Some  No
* = Important criteria
Comments
Hand hygiene is very much essential for proper care of patients by nurses.

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APPENDIX F
Appraisal Guide:
Findings of a Quantitative Study
Citation:
Karaoglu, M. K., & Akin, S. (2018). Effectiveness of Hygienic Hand Washing Training on
Hand Washing Practices and Knowledge: A Nonrandomized Quasi-Experimental
Design. The Journal of Continuing Education in Nursing, 49(8), 360-371.
Synopsis
What was the purpose of the study (research questions, purposes, and hypotheses)?
Answer: The purpose of the study was to understand the effectiveness of hand hygiene
among the nurse population based on the gathered knowledge.
How was the sample obtained?
Answer: The sample was obtained in the form of 88 nurses working in the hematology,
oncology, chemotherapy, surgical intensive care and transplant units.
What inclusion or exclusion criteria were used?
Answer: 63 of the 88 appointed nurses met the inclusion criteria. Nothing has been stated
bout the exclusion criteria.
Who from the sample actually participated or contributed data (demographic or clinical
profile and dropout rate)?
Answer: Sixty-three nurses have been found to participate and contribute data to the research
study.
What methods were used to collect data (e.g., sequence, timing, types of data, and measures)?
Answer: Data was collected by using data collection tools which includes questionnaires and
direct observation.
Was an intervention tested? ✓Yes  No
1. How was the sample size determined?
Answer: The sample size was determined by a power analysis with G*Power (v 3.17)
program.
2. Were patients randomly assigned to treatment groups?
Answer: Yes, patients were randomly assigned to the treatment groups.
What are the main findings?
Answer: The study has been found to reveal that hand hygiene training improves the attitudes
and knowledge of nurses associated with hand hygiene practice and hand washing
techniques.

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Credibility
Is the study published in a source
that required peer review? ✓Yes  No  Not clear
*Did the data obtained and the
analysis conducted answer the
research question? ✓Yes  No  Not clear
Were the measuring instruments
reliable and valid? ✓Yes  No  Not clear
*Were important extraneous
variables and bias controlled? ✓Yes  No  Not clear
*If an intervention was tested,
answer the following five questions: ✓Yes  No  Not clear
1. Were participants randomly
assigned to groups and were
the two groups similar at the
start (before the intervention)? ✓Yes  No  Not clear
2. Were the interventions well
defined and consistently
delivered? ✓Yes  No  Not clear
3. Were the groups treated
equally other than the
difference in interventions? ✓Yes  No  Not clear
4. If no difference was found, was
the sample size large enough
to detect a difference if one existed? ✓Yes  No  Not clear
5. If a difference was found, are
you confident it was due to the
intervention? ✓Yes  No  Not clear
Are the findings consistent with
findings from other studies? ✓Yes  Some  No  Not
clear
ARE THE FINDINGS CREDIBLE? ✓Yes All  Yes Some  No
Clinical Significance
Note any difference in means, r2s, or measures of clinical effects (ABI, NNT, RR, OR)
*Is the target population clearly
described? ✓Yes  No  Not clear
*Is the frequency, association, or

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treatment effect impressive enough
for you to be confident that the finding
would make a clinical difference if used
as the basis for care? ✓Yes  No  Not clear
ARE THE FINDINGS
CLINICALLY SIGNIFICANT? ✓Yes All  Yes Some  No
* = Important criteria
Comments
The study has been found to be significant for this study because the p value is less than
0.001 and 0.05.

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References
Boyce, J. M., Polgreen, P. M., Monsalve, M., Macinga, D. R., & Arbogast, J. W. (2017).
Frequency of use of alcohol-based hand rubs by nurses: a systematic review. infection
control & hospital epidemiology, 38(2), 189-195.
Karaoglu, M. K., & Akin, S. (2018). Effectiveness of Hygienic Hand Washing Training on
Hand Washing Practices and Knowledge: A Nonrandomized Quasi-Experimental
Design. The Journal of Continuing Education in Nursing, 49(8), 360-371.
Kingston, L. M., O’Connell, N. H., & Dunne, C. P. (2018). A comparative study of hand
hygiene and alcohol-based hand rub use among Irish nursing and medical
students. Nurse education today, 63, 112-118.
Labrague, L. J., McEnroe‐Petitte, D. M., Van de Mortel, T., & Nasirudeen, A. M. A. (2018).
A systematic review on hand hygiene knowledge and compliance in student
nurses. International nursing review, 65(3), 336-348.
Piras, S. E., Lauderdale, J., & Minnick, A. (2017). An elicitation study of critical care nurses’
salient hand hygiene beliefs. Intensive and Critical Care Nursing, 42, 10-16.