Critical Appraisal of Research
Realtors rely on detailed property appraisals—conducted using appraisal tools—to assign market values to houses and other properties. These values are then presented to buyers and sellers to set prices and initiate offers.
Research appraisal is not that different. The critical appraisal process utilizes formal appraisal tools to assess the results of research to determine value to the context at hand. Evidence-based practitioners often present these findings to make the case for specific courses of action.
In this Assignment, you will use an appraisal tool to conduct a critical appraisal of published research. You will then present the results of your efforts.
To Prepare:
- Review the Resources and consider the importance of critically appraising research evidence.
- Reflect on the four peer-reviewed articles you selected in Module 2 and analyzed in Module 3.
- Review and download the Critical Appraisal Tool Worksheet Template provided in the Resources.
The Assignment (Evidence-Based Project)
Part 4A: Critical Appraisal of Research
Conduct a critical appraisal of the four peer-reviewed articles you selected and analyzed by completing the Evaluation Table within the Critical Appraisal Tool Worksheet Template.
Part 4B: Critical Appraisal of Research
Based on your appraisal, in a 1-2-page critical appraisal, suggest a best practice that emerges from the research you reviewed. Briefly explain the best practice, justifying your proposal with APA citations of the research.
Evaluation Table
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Full |
Article #1 |
Article #2 |
Article #3 |
Article #4 |
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Mckelvey, L. M., Edge, N. A., Fitzgerald, S., Kraleti, S., & Whiteside-Mansell, L. (2017). Adverse childhood experiences: Screening and health in children from birth to age 5. Families, Systems, & Health, 35(4), 420-429. doi:10.1037/fsh0000301 |
Melville, A. (2017). Adverse Childhood Experiences from Ages 0–2 and Young Adult Health: Implications for Preventive Screening and Early Intervention. Journal of Child & Adolescent Trauma, 10(3), 207-215. doi:10.1007/s40653-017-0161-0 |
Schofield, T. J., Donnellan, M. B., Merrick, M. T., Ports, K. A., Klevens, J., & Leeb, R. (2018). Intergenerational Continuity in Adverse Childhood Experiences and Rural Community Environments. American Journal of Public Health, 108(9), 1148-1152. doi:10.2105/ajph.2018.304598 |
Zare, M., Narayan, M., Lasway, A., Kitsantas, P., Wojtusiak, J., & Oetjen, C.A. (2018). Influence of adverse childhood experiences on anxiety and depression in children aged 6 to 11 years. Pediatric Nursing, 44(6), 267-274, 287. |
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Conceptual Framework Describe the theoretical basis for the study |
Childhood toxic stress, precipitated by ACEs, is associated with biological changes in the developing brain and body that affect concurrent and long-term health and behavior. |
Exposure to adversity, such as trauma, neglect, and abuse, in childhood has been identified as a major global public health issue. I chose this article because it focused on the assessment of ACEs that occurred in the early development of children. It explored the short and long-term impacts of childhood adversity during specific developmental periods, such as infancy and toddlerhood. |
ACEs show intergenerational continuity and their impact on health and well-being can be repeated across generations. I chose this research article because it focused on reducing or preventing ACEs and its potential to produce long-lasting benefits in both the physical/mental health and quality of life across generations. How effective is breaking the chain in a long history of trauma and other childhood adversities? |
I chose this last research article because it examined the association of adverse childhood experiences with depression and anxiety in children aged 6 to 11 years old. The article explains that when children experience prolonged stressors such as ACEs, both a chemical and physical change can occur which can alter the neural pathways and the metabolic processes. This can lead to lifelong issues both with mental health and chronic illnesses. |
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Design/Method and how the study was carried out |
The survey asked all respondents the same questions in the same order to allow for statistical analysis. The survey gathered a narrow amount of information, 10 yes or no questions, from a large number of respondents. All of the questions were closed questions for quantification in order to be coded and processed quickly. This study used data collected for the evaluation of voluntary home visiting services funded through the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program in the state of Arkansas. |
This study examined whether there is evidence to support a screening approach that assesses children’s current exposures to risks that act as precursors for ACEs, measured in a way that falls below a threshold of explicit abuse, neglect, or illegal behavior. |
Mixed-methods research- The study examined the relationship between ACEs measured from age 0–2 and adult health outcomes using data from the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN) dataset which pull data from five national data collection sites. The data included past ACE scores as well as CPS reports and self-proclaimed adverse childhood experiences. |
Quantitative research – During each assessment period, professional interviewers made home visits to each family for approximately 2 hours on 2 occasions. At each visit, father, mother, and adolescent independently completed a set of questionnaires in separate rooms covering an array of topics related to work, finances, school, family life, mental and physical health status, and social relationships. |
Quantitative research – This article used data already collected by the National Survey of Children’s Health (NSCH). The NSCH collected interviews randomly all over the US of 95,677 children. This article took those surveys that applied to children aged 6-7 which included 31,060 children. The article focused further on only depression and anxiety relevant answers. Coding the answer as no or yes. Then that data was correlated with ACEs scores received from the same survey. |
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Sample/Setting The number and characteristics of patients , attrition rate, etc. |
2,004 participants Families were eligible for services if they reported at least one of the following risks: low income (250% of federal poverty), homelessness, single and/or teen (aged 19 or younger) parent(s), parent mental illness, substance abuse, incarceration, military deployment, disability, suspected child maltreatment (based on referrals from child-protective services), child developmental delay, preterm/low-birth weight, or chronic illness. |
139 participants Child Maltreatment Physical Abuse 17.4% (24), Emotional Abuse 8% (11), Physical Neglect 8.7% (12), Household Dysfunction Caregiver mental illness 35.5% (49), Substance use 34.8% (48), Caregiver treated violently 40.3% (60), Criminal household member 3.6% (5), Caregiver separation/divorce 11.6% (16). |
451 two-parent families via telephone through the cohort of all seventh-grade students (aged 12–13 years) in 8 counties in north central Iowa who were enrolled in public or private schools during winter and spring of 1989. An additional criterion for inclusion in the study was the presence of a sibling within 4 years of age of the focal seventh grader. Seventy-seven percent of the eligible families agreed to participate in the study. We first conducted interviews in 1989 with adolescents (G2) and their parents (G1) when they were in seventh grade. |
The NSCH was conducted using telephone numbers that were dialed at random to identify households with children under 18 years old. In total, interviewers contacted 847,881 households, of which 87,422 households had age-eligible children, and interviews were completed on 95,677 children. The sample for the analysis included only children between the ages of 6 and 11 years. This subsample included 31,060 children. |
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Major Variables Studied List and define dependent and independent variables |
Demographic controls and family resources scale scores. Below poverty line. Primary caregivers were 28 years of age (range = 13–74), White (60%), and had a high school education or less (61%). Children were 32 months of age (range = 13–76 months) and approximately half (51%) were male. |
ACEs Measured early childhood ACE categories of child maltreatment were physical abuse, emotional abuse, and physical neglect. Household dysfunction was measured by caregiver mental illness, caregiver treated violently, incarceration, substance abuse, and parental separation or divorce. Traditional ACE categories of sexual abuse and emotional neglect were not measured due to limited variance of available data |
ACEs items included indicators of abuse (physical, sexual, emotional), emotional neglect, and other household challenges (parent treated violently by spouse, household substance abuse, household mental illness, and parental separation or divorce). Community characteristics (block group level) Low socioeconomic status 6.42 (3.07), Population density (people per mi2) 227.93 (493.49), Perceived lack of community services (scale 1–4) 3.09 (0.29), Perceived community social cohesion (scale 1–4) 3.00 (0.27), Alcohol vendor density (vendors per km2) 4.13 (7.76) |
outcome variable, namely depression and/or anxiety. Sociodemographic variables included race/ethnicity (Hispanic, White non-Hispanic, Black non-Hispanic, and Other; “Other” includes Asian, Ameri can Indian, Native Alaskan, Native Hawaiian, Other Pacific Islander and multi-racial children), family structure (two biological parents, parent and step-parent, single mother-no father, other family type), sex (male, female), and poverty level (0% to 99% Federal Poverty Level (FPL), 100% to 199% FPL, 200% to 399% FPL, 400% FPL or greater). The variable poverty level was constructed based on household income reported in the NSCH. |
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Measurement Identify primary statistics used to answer clinical questions |
Using logistic regressions to examine the association between FMI-ACE groups (i.e., children in families with scores of 0, 1, 2, 3, and 4 or more FMI-ACEs) and health outcomes. Odds ratios reported in previous ACE work were used to inform power estimates for logistic regression. |
Logistic regression was used to explore whether overall ACE score at age two as well as individual ACE categories predicted health worry and overall health. Both models utilized control variables of child race/ethnicity, gender, and income. Almost half of the sample in this study experienced two or more ACEs between the ages of 0 and 2. The central finding of this study was that early childhood ACEs, experienced from age 0–2, predicted health worries in adulthood. |
During each assessment period, professional interviewers made home visits to each family for approximately 2 hours on 2 occasions. At each visit, father, mother, and adolescent independently completed a set of questionnaires in separate rooms covering an array of topics related to work, finances, school, family life, mental and physical health status, and social relationships. Assessments occurred when the adolescent was in 7th, 8th, 9th, 10th, and 12th grade, as well as a year later, when the adolescents averaged 18 years of age. |
The nine adverse childhood experiences included: •How often has it been hard to get by on your family’s income, such as having enough money for basics like food or housing? •Did [child’s name] ever live with a parent or guardian who got divorced or separated after [he/she] was born? •Did [child’s name] ever live with a parent or guardian who died? •Did [child’s name] ever live with a parent or guardian who served time in jail or prison after [child’s name] was born? •Did [child’s name] ever see or hear any parents, guardians, or any other adults in [his/her] home slap, hit, kick, punch, or beat each other up? •Was [child’s name] ever the victim of violence or witnessed any violence in [his/her] neighborhood? •Did [child’s name] ever live with anyone who was mentally ill or suicidal, or severely depressed for more than a couple of weeks? •Did [child’s name] ever live with anyone who had a problem with alcohol or drugs? •Was [child’s name] ever treated or judged unfairly because of [his/her] race or ethnic group? |
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Data Analysis Statistical or qualitative findings |
Results demonstrated significant associations between FMI-ACE scores and the environmental safety of the children, namely the home- and car-safety index and secondhand smoke exposure in the home. The odds of scoring at risk in home and car safety were nearly five times higher for children in families with the highest FMI-ACEs than for those with a score of 0. Further, the odds of secondhand smoke exposure for children with the highest FMIACE scores of 4 or more were four times higher than children with an FMI-ACE score of 0. Children in families with FMI-ACE scores of 2, 3, and 4 or more had twice the odds of having inadequate preventive care than children with FMI-ACE scores of 0. Children with FMI-ACE scores of 2, 3, and 4 or more had significantly higher odds of having emergency or urgent medical care than those with FMI-ACE scores of 0. |
Forty-four percent of children in the study had experienced two or more ACEs by age two. Seventeen percent of children in the study had experienced no ACEs, and 39% of the children had experienced one ACE by age two. When exploring prevalence rates for types of early childhood ACEs in this sample, house hold dysfunction rates were more prevalent than child maltreatment adversities, with exposure to domestic violence (44.2%), caregiver mental illness (36.2%), and substance abuse (24.6%) being the most common types of household dysfunction measured. Physical abuse was the most commonly measured type of child maltreatment ACE category (16.7%). |
analyses on the basis of restricted maximum-likelihood estimation, with sandwich estimation of SEs to account for some families sharing the same block group. 19 Residents select into particular neighborhoods by preexisting traits, 20 including personality. 21 As a robustness check, we included parent neuroticism and alcohol problems as covariates because they show spatial autocorrelation, 20, 21 have been linked with ACEs in previous studies, 22 and were significantly related to G2 ACEs in this sample. |
Descriptive and bivariate analyses were conducted to examine the distribution of adverse childhood experiences and sociodemographic variables, as well as depression and/or anxiety, across the independent variables. Logistic regression analysis was performed to assess the magnitude and direction of adverse childhood experiences on depression and/or anxiety. Collinearity diagnostics were performed to ensure the adverse childhood experience variables in particular were not associated among themselves and other sociodemographic variables. |
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Findings and Recommendations General findings and recommendations of the research |
The findings suggest a need for home health and safety interventions for families who have reported even one ACE. Screening more widely for ACEs in these contexts would permit targeting of intervention to those families with greater need. The article also found that receiving inadequate preventive health care and receiving urgent medical treatment were more likely for children with two or more ACEs. Also found that being less healthy (i.e., having a chronic condition or screening at risk for developmental delay) was more likely for young children in families with the highest levels of ACEs. |
Findings from this study highlight the potential use for the ACE survey as a frame for prevention of risk in early childhood. Traditionally, ACE scores of 4 or more have been associated with increased risk factors in adulthood, however this study highlights early childhood ACE scores of 2 or more as critical within the early childhood frame. It is important for professionals across disciplines who interact with infants and toddlers to be aware of the short and long-term risks that exposure to childhood adversities cause. The ACE survey is a short, easy to administer questionnaire that is able to be incorporated into interdisciplinary settings that encounter infants, toddlers, and their families, thus results from this study are easy to translate into screening recommendations. Short screenings using the ACE survey can easily be incorporated into pediatric visits and other early childhood settings, and ACE scores of 2 or more may prompt a referral to an early intervention program. These findings also emphasize the importance of exploring the role of early intervention programs in helping to mitigate the impacts of adversities and reduce further adversity exposure through family-based services |
Exposure to early adversity is associated with a host of health problems, interferes with successful relationship formation, and reduces productivity and success in the workplace. Exposure to these risk factors (collectively called ACEs) shows continuity across generations among families in this rural sample. However, that cycle may be disrupted in White, rural, lower SES communities when adolescents are living in a community with low alcohol vendor density or in a community that their parents characterize as high in social cohesion. If replicated, these findings suggest that efforts to foster social cohesion and limit the density of alcohol vendors may help families break the cycle of exposure to adverse experiences during childhood and adolescence. |
Analysis of adverse childhood experience factors indicated that children whose families “very often” and “sometimes” had difficulty affording basics, such as food or housing, were 3.25 (2.26 to 4.68) and 1.79 (1.32 to 2.43) times more likely, respectively, to have depression and/or anxiety compared to children whose families “never” had difficulties affording basic necessities. Children who had lived with a parent or guardian who died were at higher risk (OR = 1.75, 95% CI = 1.13 to 2.70) for depression and/or anxiety compared to children who never lived with a parent or guardian who died. The likelihood of depression and/or anxiety was also higher among children who experienced or witnessed any violence in their neighborhoods (OR = 2.33, 95% CI = 1.63 to 3.04) or were ever treated or judged unfairly because of race or ethnicity (OR = 1.80, 95% CI = 1.17 to 2.78). Further, children who had lived with anyone with mental illness for more than a couple of weeks were almost 3.0 (2.05 to 3.94) times more likely to have depression and/or anxiety compared to children who never lived in a similar situation. |
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Appraisal Describe the general worth of this research to practice. What are the strengths and limitations of study? What are the risks associated with implementation of the suggested practices or processes detailed in the research? What is the feasibility of use in your practice? |
This study expanded the readers understanding of approaches to ACE screening. The FMI-ACE screening showed validity in that the measure makes it possible to detect adverse experiences, allowing time for healthcare providers and services to intercede on the child’s behalf to reduce risk of further negative impacts and outcomes. I believe the methodology used was reliable and the results could be used to further research in this filed. |
Although this article points to a correlation between early childhood adversity and negative adult outcomes, the data is limited due to the age of the individual and the reluctance for caregivers to report at that age. Thus, may lack in some validity. The study group was small but it raises questions about the link between these early developmental stages and what is impacted by adversity. Specifically, cortisol levels and inflammation in the body with regards to fighting infections that can lead to chronic illness. Its conclusions are consistent and reliable but more research is needed. |
This methodology used showed validity due to the fact that it used similar rural areas with a population of similar backgrounds and had a large study group that was assessed over a long period of time. I believe this study also showed reliability due to its consistent results over multiple community groups. |
I found this article very reliable as the assessment tools used produced stable and consistent results. I also found that it had validity as the surveys conducted measured ACEs, depression, and anxiety effectively and proved useful when conducting the proposed aim. This study has several limitations. Because it is a cross-sectional survey, it is not possible to longitudinally examine the effects adverse childhood experiences have on depression and/or anxiety, or to infer causal relationships between adverse childhood experiences or mental health outcomes. Longitudinal data could enable examination of how one set of adverse childhood experiences may influence other adverse childhood experiences (e.g., divorce earlier in childhood may influence economic hardship) based on their onset and frequency in children’s lives. |
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General Notes/Comments |
This study addressed gaps in the literature by documenting the associations between ACE screening scores, less optimal health environments, health-care use, and developmental outcomes for infants, toddlers, and preschoolers. Findings suggest that our approach to ACE screening can identify children whose health is at risk very early in development. Expanding screening for ACEs into pediatric settings could support direct intervention by linking families to assistance, such as home-visiting services, that can support the development of the child. |
Pediatric nurses can provide anticipatory guidance to parents and other caregivers about how to prevent adverse childhood experience exposure by seeking safe physical and emotional environments for their children or by seeking counseling for themselves if they are suffering from mental health or substance abuse problems |
Levels of Evidence Table
Use this document to complete the
levels of evidence table
requirement of the Module 4 Assessment,
Evidence-Based Project, Part 4A: Critical Appraisal of Research
|
Author |
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| Mckelvey, L. M., Edge, N. A., Fitzgerald, S., Kraleti, S., & Whiteside-Mansell, L. (2017). | Melville, A. (2017). | Schofield, T. J., Donnellan, M. B., Merrick, M. T., Ports, K. A., Klevens, J., & Leeb, R. (2018). | Zare, M., Narayan, M., Lasway, A., Kitsantas, P., Wojtusiak, J., & Oetjen, C.A. (2018). | ||||
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Study Design Theoretical basis for the study |
This research article examines the association of adverse childhood experiences with depression and anxiety in children aged 6 to 11 years old. The article explains that when children experience prolonged stressors such as ACEs, both a chemical and physical change can occur which can alter the neural pathways and the metabolic processes. This can lead to lifelong issues both with mental health and chronic illnesses. |
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Sample/Setting The number and |
2,004 patients Low-income (100% of federal poverty or less) 84.4%, Homeless 5.3%, Single parent 52.4%, Teen parent 11.0%, Suspected abuse/neglect 1.1%, Parent mental illness 3.9%, Substance abuse 3.5%, Incarcerated parent 1.8%, Parent disability/chronic illness 3.1%, Child developmental delay 7.6%, Child low birth weight 8.5%, Child chronic illness 4.8% |
139 participants Child Maltreatment Physical Abuse 17.4% (24), Emotional Abuse 8% (11), Physical Neglect 8.7% (12), Household Dysfunction Caregiver mental illness 35.5% (49), Substance use 34.8% (48), Caregiver treated violently 40.3% (60), Criminal household member 3.6% (5), Caregiver separation/divorce 11.6% (16). |
451 two-parent families via telephone through the cohort of all seventh-grade students (aged 12–13 years) in 8 counties in north central Iowa who were enrolled in public or private schools during winter and spring of 1989. An additional criterion for inclusion in the study was the presence of a sibling within 4 years of age of the focal seventh grader. Seventy-seven percent of the eligible families agreed to participate in the study. We first conducted interviews in 1989 with adolescents (G2) and their parents (G1) when they were in seventh grade. | ||||
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Evidence Level * (I, II, or III) |
Level 2 Quasi-experimental studies / cohort study |
Level 1 Randomized control trial RCT |
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Outcomes |
Children were exposed at rates of 27%, 17%, 11%, and 11% to 1, 2, 3, and 4 or more FMI-ACEs, respectively. Logistic regressions revealed significant associations between FMI-ACE scores and health environments and outcomes for children, including health risks in the home (e.g., safety and secondhand smoke exposure), underuse of preventive health care, and overuse of emergency medical treatment. In terms of development, having four or more FMI-ACEs was associated with the child having a chronic health condition and screening at risk for delay in at least one area of development. |
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* Evidence Levels:
· Level I
Experimental, randomized controlled trial (RCT), systematic review RTCs with or without meta-analysis
· Level II
Quasi-experimental studies, systematic review of a combination of RCTs and quasi-experimental studies, or quasi-experimental studies only, with or without meta-analysis
· Level III
Nonexperimental, systematic review of RCTs, quasi-experimental with/without meta-analysis, qualitative, qualitative systematic review with/without meta-synthesis
· Level IV
Respected authorities’ opinions, nationally recognized expert committee/consensus panel reports based on scientific evidence
· Level V
Literature reviews, quality improvement, program evaluation, financial evaluation, case reports, nationally recognized expert(s) opinion based on experiential evidence
Outcomes Synthesis Table
Use this document to complete the
outcomes synthesis table
requirement of the Module 4 Assessment,
Evidence-Based Project, Part 4A: Critical Appraisal of Research
|
2,004 patients Low-income (100% of federal poverty or less) 84.4%, Homeless 5.3%, Single parent 52.4%, Teen parent 11.0%, Suspected abuse/neglect 1.1%, Parent mental illness 3.9%, Substance abuse 3.5%, Incarcerated parent 1.8%, Parent disability/chronic illness 3.1%, Child developmental delay 7.6%, Child low birth weight 8.5%, Child chronic illness 4.8% |
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Outcomes |
Forty-four percent of children in the study had experienced two or more ACEs by age two. Seventeen percent of children in the study had experienced no ACEs, and 39% of the children had experienced one ACE by age two. When exploring prevalence rates for types of early childhood ACEs in this sample, household dysfunction rates were more prevalent than child maltreatment adversities, with exposure to domestic violence (44.2%), caregiver mental illness (36.2%), and substance abuse (24.6%) being the most common types of household dysfunction measured. Physical abuse was the most commonly measured type of child maltreatment ACE category (16.7%). |
During each assessment period, professional interviewers made home visits to each family for approximately 2 hours on 2 occasions. At each visit, father, mother, and adolescent independently completed a set of questionnaires in separate rooms covering an array of topics related to work, finances, school, family life, mental and physical health status, and social relationships. In these White, rural, lower SES communities, high perceived community social cohesion was associated with a reduction in ACEs across generations. This is consistent with cross-sectional work showing a negative correlation between collective efficacy and child maltreatment and points to the importance of social cohesion for health and well-being among rural populations. In addition, the moderation effect shows that social cohesion reduces intergenerational continuity in ACEs. |
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Key Findings |
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Appraisal and Study Quality |
I found this article very reliable as the assessment tools used produced stable and consistent results. I also found that it had validity as the surveys conducted measured ACEs, depression, and anxiety effectively and proved useful when conducting the proposed aim. |
© 2018 Laureate Education Inc.
2
The Assignment (Evidence-Based Project)
Part 4A: Critical Appraisal of Research
Conduct a critical appraisal of the four peer-reviewed articles you selected and analyzed by completing the Critical Appraisal Tools document. Be sure to include:
· An evaluation table
· A levels of
evidence
table
· An outcomes synthesis table
Part 4B: Critical Appraisal of Research
Based on your appraisal, in a 1-2-page critical appraisal, suggest a best practice that emerges from the research you reviewed. Briefly explain the best practice, justifying your proposal with APA citations of the research.
By Day 7 of Week 7
Submit Part 4A and 4B of your Evidence-Based Project.
Name
Fall 2018
Evidence-Based Project, Part 4: Critical Appraisal of Research
Dr. Instructor
Walden University
1. Evaluation table
2. Level of Evidence Table
3. Outcome Synthesis Table
Author (Year)
Conceptual framework
Design/
Method
Sample/
Setting
Major Variables
Measurement
Data
analysis
Findings
Appraisal
Schultz et al, (2018)
BMJ open, 8(1), e019789
None
Randomized
Controlled
Trial (RCT)
Purpose: effectiveness of Normal Saline instillation (NSI) to determine its feasibility for full efficacy trial.
Searched 4 databases from 2014-2019.
Focussed only on
studies
with a control group.
Excluded those without controlled trials
N- 825 studies
Setting-
respiratory
care hospital
Age-(0-16 years) intubated
IV- NSI, Lung Recruitment
DV 1- Oxygen concentration
DV2- Secretion Efficieny
NSI –
0.1 ml/kg of NaCl with ETS event/
Lung Recruitment-increasing PEEP by a factor of two
Oxygen
Concentration
Feasibility for full efficacy.
Feasibility of the entire study through examination of recruitment,
Eligibility,
Protocol,
adherence and missing data
Normal Saline has no potential benefit to tracheostomy process
Weaknesses-
·
Does not
Contain full
Body of research
Potential missed
Evidence with
Restriction to
Only controlled
Trials.
Strengths
A large sample
Of study hence
Reliable
Identified the
Exact impact of
NS
during
Suctioning of
Respiratory
Patients
Conclusion
Use of NS in tracheostomy is
Feasible with no
Supported
Benefit in
Suctioning.
Feasibility
Benefits
Outweigh
Potential risks
Eliminating NSI
Is cost effective
And EBP
Friendly
Wang et al.,( 2017 )Australian Critical Care, 30(5), 260-265
NSI has
Adverse
Effects on
Respiratory
Patients such
As increased
Hear rate, dyspenia and reduced oxygen
SR-systematic
Review
Purpose:
To evaluate the necessity of NSI to ICU
patients
.
Data sources.
Cochrane,
Embase and scienceDirect.
Focussed only on studies with a control group
Limited search
To RCT
N-337
Study setting- ICU in respiratory care.
Intubated patients.
IV-NSI
DV-oxygen saturation
DV2-Heart rate
Was a similar amount of NSI involved?
Heart rate- pulses
Blood pressure-
examination
Oxygen saturation-pool mean difference using the random
effect model.
NS
instillation reduces oxygen concentration but has little effect on heart rate and blood pressure
The pooled mean difference between w
as -1.14
%
Weakness
Low
methodology
quality
Missing data
Strengths
Large body
of sources
identified the
pooled mean
difference in
the saturation
of oxygen
as -1.14
conclusion
NSI is harmful
To the health,
By reducing
Oxygen
saturation
Leddy &
Wilkinson
(2015) RCTR, 51(3), 60
Current Evidence does not support the routine NS instilatilation for ETS
Survey, Expert opinion.
Purpose: to determine the practises of
therapists
and registered nurses in six Hospitals in Ontario
Survey admission to 180 participants
Setting six hospitals in Ontario
IV-NSI
DV-oxygen saturation
DV2-Heart rate
DV3-expert application opinion
Survey administration and response analysis using descriptive statistical analysis, comparative statistics on RN and RRT opinions
Report, statistical analysis using
SPSS software and
Pearson rule
38.6 % of RN’s frequently used NS
42% Rarely used NS for Suctioning.
51.4 % observed patient adverse effects of NS
NS reduces oxygen saturation
NS increases
Patient
agitation
Weakness
Does not
contain full
body of
evidence
Full of bias
because it
mainly
consists of
opinions.
Strengths
Compares,
opinions from
different
professionals
Analyses
literature on
subject
Caparros & Forbes (2014) 33(4), 246-253
None
SR
Qualitative
Review of literature.
Purpose: -to ascertain if the routine method is harmful or beneficial and provide
evidence based
advice
Searched 3 databases from 2014-2019.
Focussed only on studies without any exclusions
NS instillation in patients and Harmful effects
N/A
Qualitative analysis
of relevant journal sources from relevant databases
Compared literature
From scholarly sources
NS is not beneficial to the human secretion suctioning hence should
Stopped
Strengths
Large body
of sources
identified the
pooled mean
difference in
the saturation
of oxygen
as -1.14
conclusion
NSI is harmful
To the health
References
Caparros, A. C. S., & Forbes, A. (2014). Mechanical ventilation and the role of saline instillation in suctioning adult intensive care unit patients: An evidence-based practice review.
Dimensions of Critical Care Nursing, 33(4), 246-253.
Leddy, R., & Wilkinson, J. M. (2015). Endotracheal suctioning practices of nurses and respiratory therapists: how well do they align with clinical practice guidelines? Canadian journal of respiratory therapy: CJRT= Revue canadienne de la therapie respiratoire: RCTR, 51(3), 60.
Schults, J. A., Cooke, M., Long, D. A., Schibler, A., Ware, R. S., & Mitchell, M. L. (2018). Normal saline instillation versus no normal saline instillation and lung Recruitment versus no lung recruitment with paediatric Endotracheal Suction: the NARES trial. A study protocol for a pilot, factorial randomized controlled trial. BMJ open, 8(1), e019789.
https://
bmjopen.bmj.com/content/8/1/e019789.abstract
Wang, C. H., Tsai, J. C., Chen, S. F., Su, C. L., Chen, L., Lin, C. C., & Tam, K. W. (2017). Normal saline instillation before suctioning: A meta-analysis of randomized controlled
trials.
Australian Critical Care, 30(5), 260-265. https://
www.sciencedirect.com/science/article/pii/S1036731416301369
|
Peer Reviewed Article |
Level |
|
|
Wang et al., (2017) Normal saline instillation before suctioning |
Level I |
Provides a meta-analysis from randomized controlled trials involving normal saline use |
|
Schultz et al., (2018) Normal saline instillation versus no normal saline instillation and lung Recruitment versus no lung recruitment with paediatric Endotracheal Suction |
Level II |
It entails a randomized experiment in which all the members of group are subjected to a particular treatment with normal saline. All the members of the particular group had results recorded then evaluated |
| Caparros, A. C. S., & Forbes, A. (2014). Mechanical ventilation and the role of saline instillation in suctioning adult intensive care unit patients: An evidence-based practice review. |
Level V |
A critical analysis of the qualitative studies surrounding the use of Normal saline in suctioning |
|
Leddy, R., & Wilkinson, J. M. (2015). Endotracheal suctioning practices of nurses and respiratory therapists: how well do they align with clinical practice guidelines?. |
Level VII |
Involves a thorough analysis of the opinions of RN’s and respiratory theorists on the overall use of NS and observed effects |
Levels of evidence in the Peer Reviewed Articles
|
Author Year |
Sample/setting |
Key Findings |
Appraisal and study Quality |
General Comments |
|
N- 825 patients studies Age-(0-16 years) intubated patients |
Feasibility of the entire study through examination of recruitment, Eligibility, Protocol, adherence and missing data Normal Saline has no potential benefit to tracheostomy process |
Weaknesses- Does not contain full body of research Potential missed evidence with restriction to only controlled trials. A large sample of study hence reliable Identified the exact impact of NS during Suctioning of respiratory patients feasible with no supported benefit in suctioning. Feasibility Benefits outweigh potential risks Eliminating NSI is cost effective and EBP friendly |
Very relevant to the study with a large sample setting. The results effectively answer the clinical question of inquiry. Provides level one evidence which offers best outcomes for professional practise amendments |
|
|
Survey admission to 180 participants
Setting six hospitals in Ontario. Private, public and institutional hospitals Registered nurses and respiratory |
Weakness
Does not contain full body of evidence Full of bias because it mainly consists of opinions. Strengths Compares, opinions from different professionals Analyses literature on Subject Conclusion- moderately reliable since it is level VII but accurate resource on NS application |
Provides expert opinion on the application of NS. Relevant for analysing impact of NS from nursing professionals. However, being in the levels VII of evidence, must be supported by other stronger sources. It also comprehensively reviews literature thus efficient in boosting the knowledge of clinical experts on about the clinical issue. Generally ineffective unless supported by other sources |
||
|
Review of quantitative and qualitative literature. NS instillation in patients and Harmful effects |
Strengths
Large body of sources Different EBP scholarly sources. Weaknesses Does not provide full body evidence since little or efficacy trial employed conclusion NSI is harmful to the health Feasibility Moderately applicable |
Comprehensively reviews literature thus efficient in boosting the knowledge of clinical experts on about the clinical issue. Generally ineffective unless supported by other sources |
||
|
N-337 patients Study setting- ICU in respiratory care. 18 -30years |
NS instillation reduces oxygen concentration but has little effect on heart rate and blood pressure The pooled mean difference between was oxygen concentration was -1.14% NSI is a common practise in ICU Respiratory care |
Weakness
Low methodology quality Missing data Large body of sources identified the pooled mean difference in the saturation of oxygen as -1.14 NSI is harmful to the health, by reducing Oxygen Saturation in tracheostomy patients. Feasibility. Benefits of the entire study outweigh the potential risks. Research results are reliable and pooled from large resources. |
This is one of the most relevant sources to this study with a large population and sample setting. Being a level two evidence with favourable outcomes, it helps to solve the clinical question and provides a comprehensive answer to the study question |
Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer.
· Chapter 5, “Critically Appraising Quantitative Evidence for Clinical Decision Making” (pp. 124–188)
· Chapter 6, “Critically Appraising Qualitative Evidence for Clinical Decision Making” (pp. 189–218)
Fineout-Overholt, E., Melnyk, B. M., Stillwell, S. B., & Williamson, K. M. (2010a). Evidence-based practice step by step: Critical appraisal of the evidence: Part I. American Journal of Nursing, 110(7), 47–52. doi:10.1097/01.NAJ.0000383935.22721.9c. Retrieved from
https://journals.lww.com/ajnonline/Fulltext/2010/07000/Evidence_Based_Practice_Step_by_Step__Critical.26.asp
Fineout-Overholt, E., Melnyk, B. M., Stillwell, S. B., & Williamson, K. M. (2010b). Evidence-based practice, step by step: Critical appraisal of the evidence: Part II: Digging deeper—examining the “keeper” studies. American Journal of Nursing, 110(9), 41–48. doi:10.1097/01.NAJ.0000388264.49427.f9. Retrieved from https://www.nursingcenter.com/nursingcenter_redesign/media/EBP/AJNseries/Critical2
Fineout-Overholt, E., Melnyk, B. M., Stillwell, S. B., & Williamson, K. M. (2010c). Evidence-based practice, step by step: Critical appraisal of the evidence: Part III: The process of synthesis: Seeing similarities and differences across the body of evidence. American Journal of Nursing, 110(11), 43–51. doi: 10.1097/01.NAJ.0000390523.99066.b5. Retrieved from https://www.nursingcenter.com/nursingcenter_redesign/media/EBP/AJNseries/Critical3
Williamson, K. M. (2009). Evidence-based practice: Critical appraisal of qualitative evidence. Journal of the American Psychiatric Nurses Association, 15(3), 202–207. doi:10.1177/1078390309338733. Retrieved from http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.1022.62&rep=rep1&type=pdf
Evaluation Table
Use this document to complete the
evaluation table
requirement of the Module 4 Assessment,
Evidence-Based Project, Part 4A: Critical Appraisal of Research
Full APA formatted citation of selected article.
Article #1
Article #2
Article #3
Article #4
Evidence Level *
(I, II, or III)
Conceptual Framework
Describe the theoretical basis for the study (If there is not one mentioned in the article, say that here).**
Design/Method
Describe the design and how the study was carried out (In detail, including inclusion/exclusion criteria).
Sample/Setting
The number and characteristics of
patients, attrition rate, etc.
Major Variables Studied
List and define dependent and independent variables
Measurement
Identify primary statistics used to answer clinical questions (You need to list the actual tests done).
Data Analysis Statistical or
Qualitative findings
(You need to enter the actual numbers determined by the statistical tests or qualitative data).
Findings and Recommendations
General findings and recommendations of the research
Appraisal and Study Quality
Describe the general worth of this research to practice.
What are the strengths and limitations of study?
What are the risks associated with implementation of the suggested practices or processes detailed in the research?
What is the feasibility of use in your practice?
Key findings
Outcomes
General Notes/Comments
*These levels are from the Johns Hopkins Nursing Evidence-Based Practice: Evidence Level and Quality Guide
· Level I
Experimental, randomized controlled trial (RCT), systematic review RTCs with or without meta-analysis
· Level II
Quasi-experimental studies, systematic review of a combination of RCTs and quasi-experimental studies, or quasi-experimental studies only, with or without meta-analysis
· Level III
Nonexperimental, systematic review of RCTs, quasi-experimental with/without meta-analysis, qualitative, qualitative systematic review with/without meta-synthesis
· Level IV
Respected authorities’ opinions, nationally recognized expert committee/consensus panel reports based on scientific evidence
References
The Johns Hopkins Hospital/Johns Hopkins University (n.d.). Johns Hopkins nursing dvidence-based practice: appendix C: evidence level and quality guide. Retrieved October 23, 2019 from https://www.hopkinsmedicine.org/evidence-based-practice/_docs/appendix_c_evidence_level_quality_guide
Grant, C., & Osanloo, A. (2014). Understanding, Selecting, and Integrating a Theoretical Framework in Dissertation Research: Creating the Blueprint for Your” House”. Administrative Issues Journal: Education, Practice, and Research, 4(2), 12-26.
Walden University Academic Guides (n.d.). Conceptual & theoretical frameworks overview. Retrieved October 23, 2019 from https://academicguides.waldenu.edu/library/conceptualframework
Critical Appraisal Tool Worksheet Template
© 2018 Laureate Education Inc.
2
Matrix Worksheet Template
Use this document to complete Part 2 of the Module 2 Assessment,
Evidence-Based Project, Part 1: An Introduction to Clinical Inquiry and Part 2: Research Methodologies
Full
citation
of selected article
Article #1
Article #2
Article #3
Article #4
Braun, K., Utech, A., Velez, M. E., & Walker, R. (2018). Parenteral nutrition electrolyte abnormalities and associated factors before and after nutrition support team initiation. Journal of Parenteral and Enteral Nutrition, 42(2), 387-392.
Fivez, T., Kerklaan, D., Mesotten, D., Verbruggen, S., Wouters, P. J., Vanhorebeek, I., … & Garcia Guerra, G. (2016). Early versus late parenteral nutrition in critically ill children. New England Journal of Medicine, 374(12), 1111-1122.
Thomson, F. C., Naysmith, M., & Lindsay, A. (2019). Managing drug therapy in patients receiving enteral and parenteral nutrition. Hospital Pharmacist2002, 7(6).
Worthington, P., Balint, J., Bechtold, M., Bingham, A., Chan, L. N., Durfee, S., … & Holcombe, B. (2017). When is parenteral nutrition appropriate?. Journal of Parenteral and Enteral Nutrition, 41(3), 324-377.
Why
you chose this article and/or
how it relates
to the clinical issue of interest (include a brief
explanation of the ethics
of research related to your clinical issue of interest)
The reason why chose this peer-reviewed article is that it sheds more light more about parenteral nutrition. The article was published taking into consideration the clinical guidelines, statements and standards governing how the clinical issue of parenteral nutrition is practiced. The article is directly related to my clinical issue of interest because it shows the value of the nutrition support team by measuring differences in parenteral nutrition variables. Some of the ethical considerations of research related to my clinical issue of interest include the privacy and confidentiality of the information obtained. It is always for a researcher to keep the information private and confidential to protect research participants from harm that include psychological harm and social harm.
The reason why I chose this peer-reviewed article is that it highlights more about parenteral nutrition. The article was published taking into consideration the clinical guidelines, statements and standards governing how the clinical issue of parenteral nutrition is practiced. The article is directly related to my clinical issue of interest because it investigates whether withholding parenteral nutrition for 1 week (i.e., providing late parenteral nutrition) in the pediatric intensive care unit (ICU) is clinically superior to providing early parenteral nutrition. Some of the ethical considerations of research related to my clinical issue of interest include the privacy and confidentiality of the information obtained. It is always for a researcher to keep the information private and confidential to protect research participants from harm that include psychological harm and social harm.
The reason why I chose this peer-reviewed article is that it outlines more about parenteral nutrition. The article was published taking into consideration the clinical guidelines, statements and standards governing how the clinical issue of parenteral nutrition is practiced. The article is directly related to my clinical issue of interest because it finds out inappropriate administration techniques and frequent problems that are related to drug interactions or incompatibilities with parenteral nutrition. Some of the ethical considerations of research related to my clinical issue of interest include the privacy and confidentiality of the information obtained. It is always for a researcher to keep the information private and confidential to protect research participants from harm that include psychological harm and social harm.
The reason why I chose this peer-reviewed article is that it highlights more about parenteral nutrition. The articles were published taking into consideration the clinical guidelines, statements and standards governing how the clinical issue of parenteral nutrition is practiced. The article is directly related to my clinical issue of interest because it outlines when it is appropriate to administer parenteral nutrition to patients. Some of the ethical considerations of research related to my clinical issue of interest include the privacy and confidentiality of the information obtained. It is always for a researcher to keep the information private and confidential to protect research participants from harm that include psychological harm and social harm.
Brief
description of the aims
of the research of each peer-reviewed article
The research conducted by (Braun et al., 2018) aimed at showing the value of the nutrition support team by measuring differences in parenteral nutrition variables, especially electrolyte abnormalities before and after nutrition support team initiation at a large medical center. The research also aimed at identifying factors associated with electrolyte abnormalities among adult subjects receiving parenteral nutrition.
The aim of the randomized, multicenter, controlled trial conducted by (Fivez et al., 2016) was to investigate whether withholding parenteral nutrition for 1 week (i.e., providing late parenteral nutrition) in the pediatric intensive care unit (ICU) is clinically superior to providing early parenteral nutrition. 1,440 critically ill children were involved in the research (Fivez et al., 2016).
(Thomson, Naysmith & Lindsay, 2019) conducted a study that aimed at finding out inappropriate administration techniques and frequent problems that are related to drug interactions or incompatibilities with parenteral nutrition.
The aim of the research study carried out by (Worthington et al., 2017) was to delineate appropriate parenteral nutrition use and promote clinical benefits and minimize the risks associated with the therapy.
Brief description of the
research methodology
used Be sure to identify if the methodology used was
qualitative
,
quantitative
, or a
mixed-methods
approach. Be specific.
This particular article used a quantitative approach. The quantitative research approach involves the use of statistical, computational, and mathematical tools to obtain the results. The nature of the study prompted the researchers to use the quantitative research approach. Another reason why most of these studies took a quantitative approach is that they were composed of variables that were supposed to be measured by using numbers and analyzed using various statistical techniques.
The article used a quantitative approach. The quantitative research approach involves the use of statistical, computational, and mathematical tools to obtain the results. The nature of the study prompted the researchers to use the quantitative research approach. Another reason why most of these studies took a quantitative approach is that they were composed of variables that were supposed to be measured by using numbers and analyzed using various statistical techniques.
This article employed a quantitative approach. The quantitative research approach involves the use of statistical, computational, and mathematical tools to obtain the results. The nature of the study prompted the researchers to use the quantitative research approach. Another reason why most of these studies took a quantitative approach is that they were composed of variables that were supposed to be measured by using numbers and analyzed using various statistical techniques.
This particular article used a quantitative approach. The quantitative research approach involves the use of statistical, computational, and mathematical tools to obtain the results. The nature of the study prompted the researchers to use the quantitative research approach. Another reason why most of these studies took a quantitative approach is that they were composed of variables that were supposed to be measured by using numbers and analyzed using various statistical techniques.
A brief description of the
strengths
of each of the research methodologies used, including
reliability
and
validity
of how the methodology was applied in each of the peer-reviewed articles you selected.
The research methodologies used were reliable and valid. The article employed research methodologies that were multicenter, randomized and controlled in nature. The data collection instruments used by the researchers to gather the data were valid. This is because the instruments were able to measure what it was intended to measure. The findings of the research studies was accurate hence reliable for making suggestions and recommendations. The results obtained were consistent after repeated trials.
The research methodologies used were reliable and valid. The article used methodologies that were multicenter, randomized and controlled in nature. The data collection instruments used by the researchers to gather the data were valid. This is because the instruments were able to measure what it was intended to measure. The outcome of all the research studies was accurate hence reliable for making suggestions and recommendations. The results obtained were consistent after repeated trials.
The research methodologies used were reliable and valid. Most of the reviewed studies used the research methodologies that were multicenter, randomized and controlled in nature. The data collection instruments used by the researchers to gather the data were valid. This is because the instruments were able to measure what it was intended to measure. The results were accurate hence reliable for making suggestions and recommendations. The results obtained were consistent after repeated trials.
The research methodologies used were reliable and valid. Most of the reviewed studies used the research methodologies that were multicenter, randomized and controlled in nature. The data collection instruments used by the researchers to gather the data were valid. This is because the instruments were able to measure what it was intended to measure. The results was accurate hence reliable for making suggestions and recommendations. The results obtained were consistent after repeated trials.
General Notes/Comments
Matrix Worksheet Template
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