Nursing

92318 EVIDENCE FOR NURSING Assessment Item 3: Using evidence to inform clinical decision making Weight: 50% of overall mark Submission: Midnight, Sunday 23rd October 2016, through Turnitin submission portal in UTS Online. No paper submission is required. Task: Using your scenario and search strategy developed in Assessment 1, you will need to systematically extract evidence from the UTS Library databases, appraise the quality of the evidence using validated tools and summarise the evidence in a way that could be communicated to a patient in your care. Instructions This assignment will build on your ability to find and appraise information that could be used in clinical decision making. A large component of our role as a nurse is in education, this assignment will also ask you to summarise the evidence you find in a way that would be understandable for a patient in your care. This assignment is in four (4) parts: PART 1: DEVELOPMENT OF PICO AND SEARCH STRATEGY (PLAN) 1. Take the opportunity now to review and refine your PICO and search strategy in response to the feedback from your first assignment. PART 2: EVIDENCE OF APPLICATION OF SEARCH STRATEGY (PLAN) IN DATABASE SEARCHES Enter your search into two different databases of your choice (such as Medline and CINHAL) using the your Systematic Search Plan and the skills you have learnt in the online UTSLibrary search guide in Week 2. 2. Take a screenshot/screengrab/digital picture of your completed searches and paste these into the submission template. These must be READABLE!! 3. From the search results, select two published articles on your topic - one randomised control trial and one qualitative study that provide you with information on your clinical question. 4. Take a screenshot/screengrab/digital picture of the abstract of the two chosen articles and paste these into the submission template. PART 3: APPRAISAL OF YOUR TWO ARTICLES 5. Use the quality appraisal tools, that we have used in class, assess the quality of the evidence in your randomised controlled trial and qualitative study. PART 4: SYNTHESISING THE EVIDENCE 6. Write a 400 word summary of the evidence that the two articles provide (approximately 200 words each). You need to summarise the important information that relates to your clinical question, and also write this in simple language (300 words) as if you were explaining the rationale for your clinical decision making to a patient within your care. Assessment Criteria (50 marks of overall subject) Your assignment will be marked in Turnitin in relation to the following criteria: Marking Criteria Develops PICO and search terms (3 marks as revision of Assessment 1) • Determines elements of PICO relevant to the chosen scenario • Converts the question into a succinct and searchable PICO format relevant to the given scenario • Identifies appropriate main and alternative search terms • Identifies appropriate limits for the search, if appropriate (gender, age range, publication dates, and/ or language) • Transfers PICO terms into the systematic search plan with terms grouped in a logical order • Appropriately combines the search using ‘OR’ and ‘AND’ Boolean operators Applies systematic search plan to extract relevant evidence (8 marks as revision of Assessment 1) • Accurately transfers search into two databases database according the planned search strategy • Provides a legible screenshots/screengrabs as evidence of the search • Identifies an appropriate Randomised Control Trial that addresses the specified PICO question • Identifies an appropriate qualitative study that addresses the specified PICO question • Provides an abstract for both the Randomised Controlled Trial and qualitative study as screenshots Appraising the evidence (23 marks) • Analyses the quality of the randomised control trial using the CASP Randomised Controlled Trial Appraisal Tool • Analyses the quality of the qualitative study using the CASP Appraisal Tool for qualitative studies. Synthesising the evidence (16 marks) • Accurately summarises the information provided in the Randomised Controlled Trial that is relevant to the PICO question (3 marks). • Accurately summarises the information provided in the qualitative study that is relevant to the PICO question (3 marks). • Draws overall conclusions and critically appraises the evidence in relation to the PICO question (3 marks). • Presents the summary in simple language as if you were explaining the rationale for your clinical decision making to a patient within your care (5 marks). • Provides reference to their selected articles (1 mark). Databases you may consider using: • Either Medline (Ovid), CINAHL, ProQuest Health & Medicine or Academic Search Complete (EBSCO) to search for a RCT and a qualitative study. • Access the databases via the UTS library. ***PLEASE FILL IN THE TEMPLATE PROVIDED IN UTS ONLINE TO COMPLETE YOUR ASSIGNMENT*** Assessment Task 2: Evidence appraisal MARKING MATRIX (50 marks of overall grade) PICO question (3 marks as revision of previous) Unsatisfactory Pass Credit Distinction High Distinction • Determines elements of PICO relevant to the chosen scenario • Converts the question into a succinct and searchable PICO format relevant to the given scenario • Identifies appropriate main and alternative search terms • Identifies appropriate limits for the search, if appropriate (gender, age range, publication dates, and/ or language) • Transfers PICO terms into the systematic search plan with terms grouped in a logical order • Appropriately combines the search using ‘OR’ and ‘AND’ Boolean operators Superficial and insufficient completion of the PICO elements and research question and application in systematic search plan. Basic application of PICO elements with some elements incorrect or not present. Limited understanding of development and application of systematic search plan process. Clear application of PICO elements showing satisfactory understanding of development and application of systematic search plan process. Clear and appropriate application of PICO elements demonstrating more than satisfactory understanding of development and application of systematic search plan process. Clear and appropriate application of PICO elements to a superior level, demonstrating superior understanding of development and application of systematic search plan process. Literature search (8 marks as revision of previous) Unsatisfactory Pass Credit Distinction High Distinction • Accurately transfers search into two databases according the planned search strategy • Provides a legible screenshots/screengrabs as evidence of the search • Identifies an appropriate Randomised Control Trial that addresses the specified PICO question • Identifies an appropriate qualitative study that addresses the specified PICO question • Provides an abstract for both the Randomised Controlled Trial and qualitative study as screenshots Search plan inaccurate and screenshot not present. Chosen evidence inappropriate or not present. Basic application of search plan. Demonstrates limited understanding of search strategy process. Screen shot present. Clear application of search plan demonstrating satisfactory understanding of process. Screen shot present. Clear and appropriate application of search plan demonstrating more than satisfactory understanding of search strategy process. Screen shot present. Clear and appropriate of search application of search plan to a superior level, demonstrating superior understanding of search strategy process. Screenshot present. Appraising the evidence (23 marks) Unsatisfactory Pass Credit Distinction High Distinction • Analyses the quality of the randomised control trial using the CASP Randomised Controlled Trial Appraisal Tool • Analyses the quality of the qualitative study using the CASP Qualitative Study Appraisal Tool Superficial and insufficient analysis of elements of the CASP appraisal tools. Basic response to CASP appraisal elements and some elements incorrect or not present. Demonstrates limited understanding of appraisal process. Clear response to the CASP appraisal elements demonstrating satisfactory understanding of appraisal process. Clear and detailed response to the CASP appraisal elements demonstrating more than satisfactory understanding of appraisal process. Clear and detailed response to CASP appraisal elements to a superior level, demonstrating superior understanding of appraisal process. Synthesising the evidence (16 marks) Unsatisfactory Pass Credit Distinction High Distinction • Accurately summarises the evidence provided in the RCT that is relevant to the PICO question • Accurately summarises the evidence provided in the qualitative study that is relevant to the PICO question • Draws overall conclusions and critically appraises the evidence in relation to the PICO question (2.5 marks max) • Presents the summary in simple language as if you were explaining the rationale for your clinical decision making to a patient within your care Superficial and insufficient summary of evidence and relation to PICO question. Does not provide information in easily understood language. Basic summary of evidence in both RCT and SR in relation to PICO question, with some elements incorrect or not present. Summary of information in easily understood language limited. Clear summary and appraisal of evidence in both RCT and SR and overall conclusions in relation to PICO question. Summary of information in easily understood language to a satisfactory level. Clear and appropriate summary and critical appraisal of evidence in both RCT and SR and overall conclusions in relation to PICO question. Summary of information in easily understood language to a more than satisfactory level. Clear and detailed summary and critical appraisal of evidence in both RCT and SR and overall conclusions in relation to PICO question to a superior level. Summary of information in easily understood language to a superior level. Overall Grade Unsatisfactory Pass Credit Distinction High Distinction Work showing an unsatisfactory achievement on the overall objectives of the assessment criteria 0-24.5 (0-50% ) Work showing a satisfactory achievement on the overall objectives of the subject assessment criteria 25-32 (50-64%) Work of good quality on the overall objectives of the assessment criteria 26-32.5-37 (65-74%) Work of superior quality on the overall objectives of the assessment criteria 37.5-42 (75-84%) Work of outstanding quality on all objectives of the assessment criteria. 42.5 (85-100%) ASSESSMENT Item Three: SUBMISSION TEMPLATE Weight: 50% of overall mark Submission: Midnight Sunday 23 October 2016, through Turnitin. No paper submission is required. Please complete the following the activities by filling in the spaces below. This is a word document so you can add space as needed. Scenario 1: Depression You are a community mental health nurse in Sydney. In a recent review of referrals to your service it was noted that there has been a large number of clients referred for treatment of depression. The treatment provided by your service for these clients is antidepressant medication. Some of your patients, however, are not keen to take antidepressant medications for different reasons. You are aware that in other mental health services psychological interventions such as cognitive behavioural therapy (CBT) are offered as an alternative or adjunct to medication. Your team is open to change and it is decided to search for evidence of the most optimal care for these clients. PART 1: DEVELOPING A FOCUSED QUESTION AND ACQUIRING RELEVANT EVIDENCE 1. Use the following categories to help define your problem and what you are looking at in simple terms PICO: Patient/Problem, Intervention, Comparison, and Outcome. (Remember to use your readings to help you if you are unsure) Patient/Problem: _________Depression_________________________________ Intervention: _____________Cognitive Behavioural Therapy__________________ Comparison: _____________Antidepressant Medications _______________ Outcome: ____________________________________________________________________ 2. Now use these terms from the question above to create your PICO research question so that you have a clear purpose for your search: In (P)_______ Depression __________________ does (I) ____ Cognitive Behavioural Therapy ________________ compared with (C)_____ Antidepressant Medications ________________ improve/reduce (O) _________________? 3. What type of clinical question do you think this PICO answers? □ Therapeutic □ Aetiology □ Diagnostic □ Prevention □ Prognosis □ Others 4. The table below will help you to think of the other terms that you might also like to look up when searching for evidence to help you answer your question – this is part of basic planning for a research search. • We ask you to look up alternative terms because sometimes articles from different countries and health systems call things different names – for example, in Australia we sometimes us the term ‘community nurses’, but in the UK they often talk about ‘district nurses’ – if you only searched under ‘district nurse’ you’d miss all the articles which happened to a different term – you would be missing some of the picture! Population Intervention Comparison (not commonly used in actual database search strategy) Outcome (not commonly used in actual database search strategy) What is your population? Main search term: Depression What other terms might have been used? Alternative search terms: What is your intervention? Main search term: Cognitive Behavioural Therapy What other terms might have been used? Alternative search terms: What is your comparison? Main search term: Antidepressant Medications What other terms might have been used? Alternative search terms: What is your outcome? Main search term: What other terms might have been used? Alternative search terms: 5. Is there a particular group of people that you want to look at? List here any inclusion criteria you might use to refine your search if you have too many papers: Gender: ______________________________ Age Range: ___________________________ Publication Dates: ______________________ Language: ____________________________ 6. What kind of study do you think would best answer your question? Select here which type of article you might want to access. You can also use these to refine your search if you have a lot of papers. □ Systematic Review of Controlled Trials □ Randomized Controlled Trial (RCT) □ Cohort Study □ Qualitative Study □ Economic Evaluation □ Case-control Study/Case Series Systematic Search Strategy Worksheet 7. Now that you have decided on WHAT you will be searching, you need to put down a plan of HOW you will search for your articles. This helps you and others to see how you got your evidence and how you made sure you got the best evidence to help you decide on your clinical action. • Using the PICO terms in your table, enter each term in a row (group them together under the PICO categories). • The next step is to combine similar terms using ‘OR’ so that you have all the papers on the same topic together • The final step is to find papers which only talk about both the population AND the intervention. To do this you use ‘AND’ in the database. Key terms: 1 2 3 4 5 6 7 8 9 10 11 12 __ OR___OR___OR___ (combine alternate terms for same topic) 13 __ OR___OR___OR___ (combine alternate terms for same topic) 14 ____AND____ OR = combine alternate terms for the same topic – to get as many potential papers as possible! AND = combine the groups of topics to get papers which cover ALL the terms! PART 2: EVIDENCE OF APPLICATION OF SEARCH STRATEGY (PLAN) IN DATABASE SEARCHES Enter your search into two different databases of your choice (such as Medline and CINHAL) using the your Systematic Search Plan and the skills you have learnt in the online UTSLibrary search guide in Week 2. 8. Place the screenshots/screengrabs/digital pictures of your two (2) databases here. Please ensure your screenshots provide all steps of your search and are clear enough to be legible – these must be READABLE!! Database search 1 Add space as needed Database search 2 Add space as needed 9. Place the abstract of your selected randomised controlled trial here. Please add this as a screenshot, do not retype this yourself. (The abstract must be readable) Add space as needed 10. Place the abstract of your selected qualitative study here. Please add this as a screenshot, do not retype this yourself. (The abstracts must be readable). Add space as needed PART 3.1 APPRAISAL OF YOUR RANDOMISED CONTROLLED TRIAL (Please consider the word limit for each question, 13 marks ) Assessing the quality of the available evidence has also been a key focus this semester. Use the CASP tool for RCTs below to appraise the quality of your selected RCT. Section A: Are the results of the trial valid? Screening Questions 1. Did the trial address a clearly focused issue? Yes No Can’t tell Justify your answer: (Max 50 words) HINT: An issue can be ‘focused’ In terms of • The population studied • The intervention given • The comparator given • The outcomes considered 2. Was the assignment of patients to treatments randomised? (Max 100 Words) Yes No Can’t tell Justify your answer: HINT: Consider • How was this carried out? • Was the allocation sequence concealed from 3. Were all of the patients who entered the trial properly accounted for at its conclusion? (Max 100 words) Yes No Can’t tell Justify your answer: HINT: Consider • Was the trial stopped early? • Were patients analysed in the groups to which they were randomised? Detailed questions 4. Were patients, health workers and study personnel ‘blind’ to treatment? (Max 100 words) Yes No Can’t tell Justify your answer: HINT: Think about • Patients? • Health workers? • Study personnel? 5. Were the groups similar at the start of the trial? (Max 100 words) Yes No Can’t tell Justify your answer: HINT: Look at • Other factors that might affect the outcome such as age, • sex, social class • researchers and patients? 6. Aside from the experimental intervention were the groups treated equally? (Max 100 words) Yes No Can’t tell Justify your answer: Section B: What are the results? 7. How large was the treatment effect? (Max 150 words) Justify your answer: HINT: Consider • What outcomes were measured? • Is the primary outcome clearly specified? • What results were found for each outcome? 8. How precise was the estimate of the treatment effect? (Max 100 words) Justify your answer: HINT: Consider • What are the confidence limits? Section C: Will the results help locally? 9. Can the results be applied in your context? (or to the local population?) (Max 100 words) Yes No Can’t tell Justify your answer: HINT: Consider whether • Do you think that the patients covered by the trial • are similar enough to the patients to whom you will • apply this?, if not how to they differ? 10. Were all clinically important outcomes considered? (Max 50 words) Yes No Can’t tell Justify your answer: HINT: Consider • Is there other information you would like to have seen? • If not, does this affect the decision? 11. Are the benefits worth the harms and costs? Yes Can’t tell No (Max 100 words) Justify your answer: HINT: Consider: Even if this is not addressed by the review, what do you think? PART 3.2 APPRAISAL OF YOUR QUALITATIVE ARTICLE (please consider the word limit for each question, 11marks ) Use the CASP Appraisal for Qualitative Research below to decide whether the information presented in your paper is trustworthy and truly reflective of the participant’s voice. SCREENING QUESTIONS 1. Was there a clear statement of the aims? ☐Yes ☐ Can’t tell ☐ No HINT: Consider • What was the goal of the research? • Why it was thought important? • Its relevance Your comment: (max 100 words) 2. Is a qualitative methodology appropriate? ☐Yes ☐ Can’t tell ☐ No HINT: Consider • If the research seeks to interpret or illuminate the actions and/or subjective experiences of research participants • Is qualitative research the right methodology for addressing the research goal? Your comment: (max 50 words) DETAILED QUESTIONS 3. Was the research design appropriate to address the aims of the research? ☐Yes ☐ Can’t tell ☐ No HINT: Consider • If the researcher has justified the research design (e.g. have they discussed how they decided which method to use)? Your comment: (max 50 words) 4. Was the recruitment strategy appropriate to the aims of the research? ☐Yes ☐ Can’t tell ☐ No HINT: Consider • If the researcher has explained how the participants were selected • If they explained why the participants they selected were the most appropriate to provide access to the type of knowledge sought by the study • If there are any discussions around recruitment (e.g. why some people chose not to take part) Your comment: (max 100 words) 5. Was the data collected in a way that addressed the research issue? ☐Yes ☐ Can’t tell ☐ No HINT: Consider • If the setting for data collection was justified • If it is clear how data were collected (e.g. focus group, semi-structured interview etc.) • If the researcher has justified the methods chosen • If the researcher has made the methods explicit (e.g. for interview method, is there an indication of how interviews were conducted, or did they use a topic guide)? • If methods were modified during the study. If so, has the researcher explained how and why? • If the form of data is clear (e.g. tape recordings, video material, notes etc) • If the researcher has discussed saturation of data Your comment: (Max 150 words) 6. Has the relationship between researcher and participants been adequately considered ☐Yes ☐ Can’t tell ☐ No HINT: Consider • If the researcher critically examined their own role, potential bias and influence during a) Formulation of the research questions b) Data collection, including sample recruitment and choice of location • How the researcher responded to events during the study and whether they considered the implications of any changes in the research design Your comment: (max 50 words) 7. Have ethical issues been taken into consideration? ☐Yes ☐ Can’t tell ☐ No HINT: Consider • If there are sufficient details of how the research was explained to participants for the reader to assess whether ethical standards were maintained • If the researcher has discussed issues raised by the study (e.g. issues around informed consent or confidentiality or how they have handled the effects of the study on the participants during and after the study) • If approval has been sought from the ethics committee Your comment: (Max 50 words) 8. Was the data analysis sufficiently rigorous? ☐Yes ☐ Can’t tell ☐ No HINT: Consider • If there is an in-depth description of the analysis process • If thematic analysis is used. If so, is it clear how the categories/themes were derived from the data? • Whether the researcher explains how the data presented were selected from the original sample to demonstrate the analysis process • If sufficient data are presented to support the findings • To what extent contradictory data are taken into account • Whether the researcher critically examined their own role, potential bias and influence during analysis and selection of data for presentation Your comment: (max 100 words) 9. Is there a clear statement of findings? ☐Yes ☐ Can’t tell ☐ No HINT: Consider whether • If the findings are explicit • If there is adequate discussion of the evidence both for and against the researchers arguments • If the researcher has discussed the credibility of their findings (e.g. triangulation, respondent validation, more than one analyst) • If the findings are discussed in relation to the original research question Your comment: (max 100 words) 10. How valuable is the research? (max 100 words) HINT: Consider • If the researcher discusses the contribution the study makes to existing knowledge or understanding e.g. do they consider the findings in relation to current practice or policy?, or relevant research-based literature? • If they identify new areas where research is necessary • If the researchers have discussed whether or how the findings can be transferred to other populations or considered other ways the research may be used Your comment: PART 4.1 OVERALL SUMMARY (400 words, 11 marks ) 11. Provide an overall summary of what these two papers contribute to answering your research question HINT: Consider • What was your original clinical question? • What information do you think is useful from these two articles? • Do you think the information in the articles is unbiased? • If the information from the articles helpful in answering your overall question? PART 4.2 SYNTHESISING THE EVIDENCE (300 words, 5 marks ) Finally, you need to summarise the evidence that relates to your clinical questions in simple language as if you were explaining the rationale for your clinical decision making to a patient within your care.