NMHS30970 EBP Workbook 2017-18

Evidence Based Practice for
Healthcare
SNMHS 30970
Student Workbook
2017-2018
BSc Nursing (General)

BSc Nursing (Children’s & General)
BSc Midwifery
BSc Psychiatric Nursing
Name: Alexandria Aquino

Student Number: 14459828
Programme: BA Gen. Nursing, stage four
Hospital: Mater Misericordiae Hospital
©SNMHS2016
Contents
Module Coordinator ............................................................................................................... 4
Clinical Placement Coordinator (s) ........................................................................................ 4
Clinical Allocations Officer ................................................................................................... 4
Course Lecturers .................................................................................................................... 4
Expectations ............................................................................................................................... 7
Module Assessment ................................................................................................................... 8
Week One Module Components: ............................................................................................. 12
EBP lecture ...................................................................................................................... 12
Week Two Teaching Components: .......................................................................................... 13
EBP Lecture ..................................................................................................................... 13
Week Three Teaching Components: ........................................................................................ 15
EBP Lecture ..................................................................................................................... 15
Week Four Teaching Components: ......................................................................................... 20
EBP Lecture ..................................................................................................................... 20
Week Five Teaching Components: .......................................................................................... 25
EBP Lecture ..................................................................................................................... 25
Week Six Teaching Components: ............................................................................................ 33
EBP Lecture ..................................................................................................................... 33
Week Seven Teaching Components: ....................................................................................... 39
EBP Lecture ..................................................................................................................... 39
Week Eight Teaching Components: ........................................................................................ 47
EBP Lecture ..................................................................................................................... 47
Week Nine Teaching Components: ......................................................................................... 48
EBP Lecture ..................................................................................................................... 48
Week Ten Teaching Components: ........................................................................................... 50
EBP Lecture ..................................................................................................................... 50
Week Eleven Teaching Components: ...................................... Error! Bookmark not defined.
EBP Lecture ..................................................................... Error! Bookmark not defined.
Week Twelve Teaching Components: ..................................... Error! Bookmark not defined.
EBP Lecture ..................................................................... Error! Bookmark not defined.
TUTORIAL CONTENT .......................................................... Error! Bookmark not defined.
Tutorial One ..................................................................... Error! Bookmark not defined.
Tutorial Two .................................................................... Error! Bookmark not defined.
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Tutorial Three .................................................................. Error! Bookmark not defined.
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Contact Details
Module Coordinator
Name: Dr Emma Nicholson
Email: emma.nicholson@ucd.ie
Office: B308
Clinical Placement Coordinator (s)

Name: ___________________
Email: ___________________
Office: ___________________
Name: ___________________
Email: ___________________
Office: ___________________
Clinical Allocations Officer

Name: Bernadette Maher
Email: mary.maher@ucd.ie
Office: B217
Course Lecturers
Name: Dr Hasheem Mannan
Email: hasheem.mannan@ucd.ie
Office: B223
Name: Dr Éidín NíShé

Email: eidin.nishe@ucd.ie
Office: C145
Name: Ms Marie Meskell

Email: marie.meskell@ucd.ie
Office: C127
4
Key Dates
Task Date
Lectures begin X 12 Friday the 15th of

September
Clinical learning days begin X 10 Wednesday the 20th

of September
Submission of assessment 3 (30%): The research matrix Friday the 17th of

November
Submission of assignment 4 (50%): The Evidence Review Monday the 19th of

February
Tutorials Date
Block One Tutorial One Friday the 29th of
September
Tutorial Two Friday the 20th October
Tutorial Three Friday the 10th of

November
Block Two Tutorial One Friday the 6th of
October
Tutorial Two Friday the 27th of
October
Tutorial Three Friday the 17th of
November
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Introduction
Evidence-Based Practice (EBP) has been defined as “the conscientious, explicit, and
judicious use of current best evidence in making decisions about the care of individual
patients” (Sackett, Rosenberg, Gray, Haynes, & Richardson, 1996). Providing evidence-
based care is widely recognised as a key skill for healthcare workers. However, despite
awareness of the importance of practicing by using best evidence, integration of evidence
into daily clinical practice across the multi-disciplinary healthcare environment remains
inconsistent (Caldwell, Coleman, Copp, Bell, & Ghazi, 2007; Makic, Martin, Burns,
Philbrick, & Rauen, 2013). Research has noted the increasing importance placed upon the
adoption of EBP principles in the current healthcare environment and in the training and on-
going development of healthcare professionals (Clark, 2013; French, 1998).
Nursing/midwifery students are best placed to influence the adoption of EBP within the
nursing/midwifery profession (Brown, Kim, Stichler, & Fields, 2010). This module therefore
aims to equip you with the appropriate language, knowledge and skills which would facilitate
your engagement with, and appraisal of, evidence to inform your developing practice.
Clinical Experience
Best Research
Evidence Evidence
based
practice
Patient Values and
Preferences
During the 4th year of your nursing or midwifery programme you will complete an Evidence
Based Practice module. The teaching component of this module will run for 12 weeks during
semester 1, commencing on Friday the 15th of September. As well as weekly lectures, you
must attend 10 clinical learning days (CLDs) in your allocated hospital(s) commencing in
week 2 (September 20th) and finishing in week 11 (November 22nd). In conjunction with the
lectures and the CLDs you must also attend 3 tutorials on campus. You have been allocated
to a tutorial group and this group will meet three times during semester 1.
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Expectations
At the end of semester 1, you will have achieved the following outcomes:
 Actively participated in the 10 clinical learning days and 3 tutorials enhancing your
understanding of nursing/midwifery research
 Completed the EBP workbook tasks every week including the development of a
matrix of research evidence to be submitted in Week 9
 Completed 5 bi-weekly short MCQ exams via blackboard
 Identified a systematic review of quantitative studies or a meta-synthesis of
qualitative studies which you will use to complete an EBP review of evidence
 Sourced a minimum of 5 of the original articles which are reviewed in the systematic
review or meta-synthesis which will be appraised in your EBP review of evidence
 Undertaken a preliminary analysis of the systematic review/meta-synthesis in which
you have identified the key appraisal features of this course
 Reflected on the role of evidence in your current clinical nursing/midwifery practice
 Identified the audit department in your clinical setting and become familiar with
audits recently undertaken in your setting which relate to nursing/midwifery practice
 Be familiar with your hospital’s clinical guidelines and policies which relate to
nursing/midwifery practice and aware of how to access these documents within your
hospital system
 Be clinically prepared to commence your stage 4 internship placements.
Please ensure that you are familiar with the hospital resources available to you and utilise
them in your learning for this module. These resources include the clinical nursing/midwifery
staff, the library, hospital guidelines and policies. Your clinical placement coordinator (CPC)
will assist you in linking with appropriate resources which will support and guide you
through your EBP review of evidence. It will be your responsibility to seek support for your
review. All learning time outside of structured classroom CLD sessions or allocated clinical
time must have prior approval of your CPC.
This workbook is structured according to the 12 week duration of the module in semester 1. It
provides learning material for each of the weekly sessions as well as a guide for tutorial
discussions which will complement the CLD learning. Please ensure that you bring this
workbook to each of your CLDs as well as the tutorials. You are expected to complete the
workbook tasks after every lecture. This workbook and learning log will be very beneficial to
you when carrying out your review of the evidence and will result in a portfolio of research
related to nursing/midwifery practice. This portfolio will serve as a resource for your
internship period which will encourage you to reflect upon the evidence which underpins
your developing practice. Please remember to maintain patient confidentiality at all times.
You are reminded to bring your laptops to your 10 CLDs and
your 3 tutorials.
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Module Assessment
This 10 credit module is facilitated over two semesters and comprises different
complimentary strands including taught lectures, tutorials and clinical learning days. As a
result the different components of the module are captured in four assessments which build
on one another to provide an overall module grade.
1. Attendance and participation at 10 clinical days (CLDs) and 3 tutorials 10%
2. Bi-weekly short MCQ quizzes based on lecture content 10%
3. Submission of a matrix of research evidence in week 9 (portfolio) 30%
4. Completion of an EBP review of evidence (Semester 2) 50%
The MCQ quizzes should be completed via Blackboard by the submission deadline. Once the
deadline has passed there will be no opportunity to resubmit the quiz. One typed copy of each
piece of coursework (matrix and review of evidence) must be submitted to the programme
office and one electronic copy via SafeAssign.
Submit to:
Nursing Programme Office for the Attention of
Dr Emma Nicholson
UCD School of Nursing, Midwifery and Health Systems
Health Sciences Building
Belfield
Dublin 4
Assessment 1: Attendance and participation at 10 clinical days (CLDs) and 3 tutorials

The first assessment contributes 10% of the overall grade. This involves attendance at 10
clinical days (CLDs) and 3 tutorials. The aim of the CLDs and the tutorials are to assist you
in consolidating the learning necessary for successful completion of this module. You will be
encouraged to reflect upon the role of evidence in your developing clinical practice.
Furthermore, you will be guided in the completion of the workbook tasks building towards
the development of a matrix of research evidence. The CLDs will also prepare you for your
stage 4 supernumerary placements and internship period.
Your attendance at the CLDs and the tutorials will contribute 10% to your overall grade for
this module. Participation will be assessed via your level of preparation for the tutorials and
your completion of the workbook tasks. Attendance and participation will be marked on
an ‘all or nothing’ basis. In other words any uncertified CLD or tutorial absence will incur a
loss of all 10% of the grades allocated for this component of the module. Similarly, if you
come to tutorials without your workbook or without having attempted to keep up-to-date with
the workbook tasks you will incur a loss of all 10% of the grades allocated for this
component of the module. Sick leave certifications for the CLDs must go to Bernadette
Maher in the UCD clinical allocations office. Sick leave certifications for the tutorials
must go to the module coordinator Dr Emma Nicholson. UCD and the module
coordinator will be informed of any absent time from the CLDs and registration will be taken
at each of the tutorials.
Assessment 2: Bi-weekly short MCQ quizzes

The second assessment is composed of 5 short MCQ quizzes in weeks 2, 4, 6, 8 and 10. This
assessment will contribute a total of 10% of your overall grade for this module. The MCQ
quizzes are based on the lecture content of the previous two weeks and are to be completed
via blackboard. The quiz will become available on blackboard at 11am on the Friday (after
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the EBP lecture) of the relevant week and will remain open for completion for 10 days; after
which it will no longer be available. If you have an uncertified non-completion of the MCQ
within that timeframe you will lose 2% of your grades allocated for each quiz. A certified
non-completion will be recognised only where you can provide a cert which covers you
for the entire 11 day period in which the quiz is open on Blackboard. There will be no
opportunity for a resubmit. The table below outlines the dates by which each quiz will be
opened and closed for completion:
Quiz Open for completion Closed for completion Marks allocated
1 Friday the 22nd Sept 11am Monday the 2nd of Oct 3pm 2%
2 Friday the 6th Oct 11am Monday the 16th of Oct 3pm 2%
3 Friday the 20th Oct 11am Monday the 30th of Oct 3pm 2%
4 Friday the 3rd of Nov 11am Monday the 13th of Nov 2%

3pm
5 Friday the 17th Nov 11am Monday the 27th of Nov 2%

3pm
Assessment 3: Submission of a matrix of research evidence (portfolio)

The third assessment component for this module is completed during the first 8 weeks of
semester 1 and makes up 30% of your overall final module grade. The submission due date
for this assessment is 3pm on Friday the 17th of November. You are asked to complete a
research matrix for 6 research articles relevant to nursing or midwifery practice. The research
designs discussed in the lectures will provide the basis for article selection. You are asked to
find 3 research articles describing qualitative studies representing the three qualitative
research designs featured in the course. You are furthermore, asked to identify 3 quantitative
research articles representing three of the six quantitative research designs featured in the
course. The guideline for the total word count for this assessment component is not more than
3,500 words. This matrix will provide a summary of the key features of the 6 research
articles including (but not limited to):
o Topic and problem
o Paradigm and approach
o PICO/PS question elements
o Question type
o Research design
o Evidence hierarchy position
o Key findings
o Implications for practice, policy and/or guideline
Assessment 5: Completion of the EBP review of evidence

The final assessment contributes 50% of your overall final grade. The submission due date
for this assessment is 3pm on Monday the 19th of February. The word limit for this
assessment piece is 4000 words. This assignment involves selecting and reviewing a
systematic review or meta-synthesis of nursing/midwifery research evidence and reporting on
the implications of this review for nursing/midwifery practice. You are required to find a
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systematic review of quantitative evidence or a meta-synthesis of qualitative evidence from a
search of the relevant nursing/midwifery literature databases. You will subsequently apply
the critical appraisal guidelines for a systematic review or meta-synthesis which you have
acquired in the lectures and reading for this module. Furthermore, you are required to source
a minimum of five of the individual research studies which are reported in the systematic
review/meta-synthesis and conduct a critical appraisal of these individual studies using the
appropriate critical appraisal guidelines relevant to the individual research design. In this
appraisal you will consider how these individual studies are represented in the systematic
review/meta-synthesis. Finally, you will write a conclusion in which you reflect upon the
findings of the studies you have reviewed as well as your critical appraisal and consider
whether and how these findings should be applied to nursing/midwifery practice in your
context.
Keep the following elements in mind when structuring your essay:
1. Introduction and background to the topic of the systematic review/ meta-synthesis. This
involves providing an outline of the topic area and the problem which provides the
background to the systematic review/ meta-synthesis. Why is this topic important? What
does the reader need to know about the context for this systematic review/ meta-synthesis?
This discussion will be informed by your own reading of supplementary background
material to the topic.
2. Identifying the PICOT/PECOT/PST question. You will need to clearly identify the
question which is at the centre of the systematic review/ meta-synthesis. You are required
to use the PICOT/PECOT/PST framework to structure the question and identify the
relevant question elements.
3. Documenting the search strategy of the systematic review/ meta-synthesis. How did
the systematic review/ meta-synthesis authors find the articles for their review? What
databases did they search and what key words did they use? What were their inclusion and
exclusion criteria? Did they select the best level of evidence available to address their
question? Comment on the comprehensiveness and the replicability of this strategy.
4. Critically appraise the systematic review/ meta-synthesis. Apply the critical appraisal
guidelines and your learning from the module to the systematic review/ meta-synthesis.
What were the key findings and what is your appraisal of the integrity of the research
design?
5. Identify individual articles for review. Select and source a minimum of 5 individual
articles reviewed in the systematic review/ meta-synthesis. Explain your rationale for
choosing these studies.
6. Identify the PICOT/PECOT/PST questions. Clearly identify the questions which
inform each of the individual studies selected for review. Use the PICOT/PECOT/PST
framework to structure the question and consider how this question relates to the
objectives of the systematic review/ meta-synthesis.
7. Critically appraise each of the individual articles. Select and apply the relevant critical
appraisal guideline as well as your module learning to appraise the integrity of the
individual research designs.
8. Conclude with a discussion of the implications for nursing/midwifery practice.
Having identified the key findings of your systematic review/ meta-synthesis and the
individual studies and having critically appraised the research designs what would you do?
How do these findings relate to nursing/midwifery practice? What actions would you take
in relation to this evidence?
The assignments must comply with the School of Nursing, Midwifery & Health Systems
Referencing Guidelines and Plagiarism Policy. The appropriate UCD assignment form
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and Plagiarism Declaration Form must accompany the matrix (assessment 3) and the
EBP review of evidence (assessment 5).
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Week One
Week One Module Components:

 EBP Lecture
EBP lecture
Date: Friday 15th of November
Room: B004 Health Sciences Building
Time: 9am-10.45am
Lecturer(s): Dr Emma Nicholson, Dr Hasheem Mannan, Ms Marie Meskell, Clinical
Placement Co-ordinators
Content: Introduction to the aims and content of the module and its assessment. The
importance of evidence-based professional nursing and midwifery practice.
On completing the reading, online material and attending the lecture for this
week you will be able to:
 Understand the aims and content of the module and its assessment
 Define the concept of EBP
 Connect evidence with nursing/midwifery practice
 Reflect on barriers to EBP in nursing/midwifery practice
Reading: Polit & Beck (2014) Chapters 1 & 2
Polit & Beck (2010) Chapters 1 & 2
Workbook Task: Following the lecture take the time to answer the following questions:
What area of nursing/midwifery practice interests you as a nursing/midwifery student?
Pressure Ulcers
Why are you interested in this topic?
It is something that should not be obtained from being admitted to the hospital yet there are
many cases of it happening in the clinical setting
Is there a particular nursing/midwifery intervention or practice that you are interested in
learning more about?
I would like to learn more about the older population i.e. 65+ year olds
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Week Two
Week Two Teaching Components:

 EBP Lecture
 Clinical Learning Day 1
EBP Lecture
Date: Friday September 22nd
Time: 9-10.45am
Lecturer: Dr Éidín NíShé
Content: Asking the research question
 Summarise research questions in PICOT/PECOT format
 Summarise research questions in PST format
 Develop an efficient search strategy using PICOT, PECOT and PST
Reading: Polit & Beck (2014) Chapter 6
Polit & Beck (2010) Chapter 6
Workbook Task: Following the lecture take the time to complete the following tasks:
The following journals are recommended as sources of evidence related to nursing/midwifery
practice:
 Evidence-Based Nursing
 Evidence-Based Child Health: A Cochrane Review Journal
 Evidence-Based Mental Health
These journals contain commentaries on original research articles which are reporting
primary data related to nursing/midwifery practice. Choose at least three commentaries from
these journals where the original research article is accessible to you through the UCD
library. Read both the commentaries and the original reference articles and complete the
tables below using information from the empirical research articles NOT the commentaries:
Research Article One
Title of paper Parental concerns, parental identity and functional status influence
medical treatment decisions of patients with advances cancer
Author Carmen Loiselle, Arlrie-Santure-Trieil
Year of publication 2017
Journal Evidence-based Nursing
Volume and issue 20(14)
Pages 114
Key Findings Psychological concerns are intensified among parents with poorer
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function status
Research Article Two
Title of paper Simulation training appears to improve nurse’s ability to recognise
and manage clinical deterioration
Author Wei Ling Chan
Pages 122-123
Key Findings (1) Length of session is more efficient that number of clinical
sessions
(2) Face-to-face sims increases knowledge than web-based
Research Article Three
Title of paper Greater nurse autonomy associated with lower mortality and failure to
rescue rates
Author Catharina Van Oostesen, Hester Vermewen
Pages 56
Key Findings Patients in hospitals that promote nurse autonomy decreased risk
death within 30 days e.g. in small (<100 beds) and non-teaching
hospitals
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Week Three
Week Three Teaching Components:

 EBP Lecture
 EBP Tutorial 1 (Tutorial Block One Only)
EBP Lecture
Date: Friday September 29th
Time: 9-10.45am
Content: Introduction to research paradigms and design
 Identify major characteristics of research theories and designs
 Link research paradigms and types of research questions
Reading: Polit & Beck (2014) Chapters 3, 6 & 8
Polit & Beck (2010) Chapters 3, 6 & 8
Workbook Task: Following the lecture return to the research articles you identified in
week two from the key evidence based nursing/midwifery journals. Note the following
content for each of the three articles:
Research Article One:
The research topic, problem
Parents with advanced cancer with dependent children are prone to higher distress than those
without. Few studies have focused in the realities of raising children while coping with
advanced cancer and its effect in the context of palliative and end-of-life care
The research paradigm and approach
Interpretivist paradigm and inductive approach
15
The research design
Qualitative design
The research method
Cross-sectional study
P - The population, patient group or situation of interest
42 patients with cancer diagnoses (many with women with breast cancer) who had dependent
children
I/E/S - The intervention or situation of interest (as relevant)
The impacts of dependent children might have on the parents who have cancer diagnoses
related to their decision-making with treatment
C - The comparison of interest (if relevant) ______________________________________

__________________________________________________________________________
__________________________________________________________________________
O - The outcome of interest (if relevant)
The psychological concerns are intensified with parents with poorer functional status
T – The timeframe (if relevant) ________________________________________________

__________________________________________________________________________
__________________________________________________________________________
The question type
Intervention
Using the PICOT/PECOT/PST elements above write out the clinical research question below:
How does having dependent children by patients with advanced cancer affect the medical
treatment decisions due to parents concerns, identity and functional status?
Note the best level of evidence to address this question (evidence hierarchy):
1. Level One: ___________________________________________________________

2. Level Two: Single qualitative studies
3. Level Three __________________________________________________________
4. Level Four ___________________________________________________________
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Research Article Two:
The effects of simulation training on a nurse’s ability to recognise and manage clinical
deterioration
Positivist paradigm and deductive approach
The research design
Quantitative design
The research method
Prospective Cohort Study
Nurses
Simulated-based learning to the nurses
C - The comparison of interest (if relevant)
Length of session vs increasing clinical scenarios vs face-to-face
Length of session was more efficient than increasing number of clinical sessions. Face-to-
face simulation was more effective than web-based

__________________________________________________________________________
__________________________________________________________________________
The question type
Intervention
In nurses, how does simulated-based learning compared to face-to-face learning affect their
ability to recognise and manage clinical deterioration
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1. Level One: ___________________________________________________________

2. Level Two: Case control studies
3. Level Three __________________________________________________________
4. Level Four ___________________________________________________________
Research Article Three:
The effects of nurse autonomy on patient mortality rate
The research design
Quantitative design
The research method
100,000 randomly sampled registered nurses from four states in USA
The outcome of nurse autonomy on patient mortality rate
Nurses employed in small (<100 beds) and non-teaching hospitals vs large, teaching hospitals
Patients receiving care within hospitals that promote nurse autonomy have lower risks for
death within 30 days and complications leading to death within 30 days
T – The timeframe (if relevant)
30 days
The question type
Etiology
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Are nurses who have greater autonomy in small, non-teaching hospitals compared to less
autonomy in large, teaching hospitals influence the patient mortality and rescue rates?
1. Level One: ___________________________________________________________

2. Level Two: Cross sectional studies
3. Level Three __________________________________________________________
4. Level Four ___________________________________________________________
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Week Four
Week Four Teaching Components:

 EBP Lecture
 EBP Tutorial 1 (Tutorial Block Two Only)
EBP Lecture
Date: Friday October 6th
Time: 9-10.45am
Content: Introduction to qualitative research designs
 Identify and describe different sampling approaches for qualitative
studies
 Identify the major steps of ethnographic, phenomenological and
grounded theory designs
Reading: Polit & Beck (2014) Chapter 14-17
Polit & Beck (2010) Chapter 10, 12, 13, 17 & 18
Following the lecture take the time to complete the following tasks:
practice:
primary data related to nursing/midwifery practice. Using these journals and/or the library
catalogues of peer-reviewed journals in UCD or your home institution, source 3 original
research articles which describe empirical research conducted using one of the qualitative
research designs described in this week’s EBP lecture. Please source one article per design
listed below:
1. Interpretive phenomenology
2. Grounded theory
3. Ethnography
Read each of the three articles and complete the following content:
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Bibliographic reference
Angel, S., Kirkevold, M. and Pedersen, B. (2011) ‘Rehabilitation after spinal cord injury and
the influence of the progessional’s support (or lack thereof)’, Journal of Clinical Nursing,
20(11), pp. 1713-1722.
The struggles of spinal cord injured patients with their rehabilitation and their feelings about
professionals influencing this process.
Interpretivist inductive approach
The research design
Qualitative design
The research method
Interpretive phenomenology
12 newly injured, adult Danish-speaking patients
S - The issue or situation of interest
The patient’s struggles with their rehabilitation and how professionals influence this process
Using the PS elements above write out the clinical research question below:
How do patients with spinal cord injuries perceive their struggles with their rehabilitation and
how professionals influence this process?
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The question type
Meaning
Note where this research article sits on the relevant evidence hierarchy for this question type:
1. Level One: ___________________________________________________________

3. Level Three __________________________________________________________
4. Level Four ___________________________________________________________
Key findings
The patients regained meaning and got on with life through resolute fighting for a meaningful
life. When the patient and professionals agreed on the way forward, the patient experienced
the professionals as supportive. However, if the patient’s goals were not consistent with the
professionals’ views, the patient felt that the professionals withdrew their support.
Sandren, A., Thulesius, H., Petersson, K. and Fridlund, B. (2010) ‘Living on Hold in
Palliative Cancer Care’, The Grounded Theory Review, 9(1), pp. 79-100.
The aim of this study was to develop a classic grounded theory of palliative cancer patients
and their relatives in the context of home care
Inductive, interpretivist grounded theory
The research design
Qualitative design
The research method
25 formal interviews and field notes/memos from informal interviews guided by theoretical
sampling, and participant observations at cancer care conferences
Patients with various cancer diagnoses at different stages and with different prognoses
How the palliative cancer patients and their relatives handle their situation in home care
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How do palliative cancer patients and their relatives perceive their situation in home care?
The question type
Meaning
1. Level One: ___________________________________________________________

3. Level Three __________________________________________________________
4. Level Four ___________________________________________________________
Key findings
The theory ‘Living on Hold’ explains how palliative cancer patients and their relatives handle
their lives being put on hold. This involves the behaviour modes Fighting, Adjusting and
Surrendering. Mode synchronicity can vary for patient and relatives, and this can cause
problems and conflicts within the family, or with health professionals.
Hyde, A., Nee, J., Howlett, E., Drenman, J. and Butler, M. (2010) ‘Menopause Narratives:
The Interplay of Women’s Embodied Experiences With Biomedical Discourses’, Qual
Health Res, 20(805), pp. 805-815.
The impact of biomedicine in shaping participants’ perceptions of their status as menopausal

Interpretivist paradigm and inductive approach
The research design
Qualitative design
The research method
Ethnographic method
39 menopausal women
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The impact of biomedicine in shaping participants’ perceptions of their status as menopausal
How do women with menopause perceive their status as menopausal?
The question type
Meaning
1. Level One: ___________________________________________________________

2. Level Two: Single qualitive studies
3. Level Three __________________________________________________________
4. Level Four ___________________________________________________________
Key findings
The cultural authority of biomedicine shaped participants’ experiences of the body and how
they constituted their health identity
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Week Five
Week Five Teaching Components:

 EBP Lecture
EBP Lecture
Time: 9-10.45am
Content: Critical appraisal of qualitative research designs
 Critically appraise qualitative evidence for clinical decision-making
using trustworthiness criteria
 Interpret the results of a qualitative study
Reading: Polit & Beck (2014) Chapter 14-17
Polit & Beck (2010) Chapter 10, 12, 13, 17 & 18
Following the lecture return to the three research articles you identified in week four from the
key evidence based nursing/midwifery journals. These three original research articles
describe empirical research conducted using one of the qualitative research designs described
in the lecture content for this module. Select one of these articles and using the CASP
appraisal tool for qualitative research complete the quality assessment form below:
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CASP: Quality Assessment Form
Study Author(s): Angel, S., Kirkevold, M. and Pedersen, B.
Year of Publication: 2011
Study Title: Rehabilitation after spinal cord injury and the influence of the professional’s support (or lack
thereof)
Journal (name, volume, issue, page numbers): Journal of Clinical Nursing, 20(11), pp. 1713-1722.
CASP ITEM ASSESSMENT SUPPORT FOR JUDGEMENT LOCATION IN TEXT OR

(include direct quotes where available SOURCE (pg., fig, table)
with explanatory comments
YES CAN’T TELL NO
Q.1: Was there a The authors clearly write their aims pp. 1714 under the
clear statement of ☒ ☐ ☐ and objectives at the beginning of the ‘Introduction’ section
aims? article and their reasons for examining
this area.
“[…] few studies have explored in-
depth the patients’ experiences of how
professionals’ care and support
influence this process with respect to
their fight to regain a meaningful life.
This is the focus of the present paper.”
Q.2 Is a qualitative Yes, as they sought to illuminate and pp. 1714 under the
methodology ☒ ☐ ☐ focus on the experiences of the ‘Theoretical framework’
appropriate? patients. section
“The patient’s narratives consisted of
[Type here]
story-fragments’ in the form of lived
stories, spontaneous narration of
concrete events, dreams and
conflicting episodes. From these, the
narrator drew elements to form a
meaning-giving narrative”
Q.3 Was the Yes, as the patient’s narratives pp. 1714 under the
research design ☒ ☐ ☐ consisted of story ‘fragments’ in the ‘Theoretical framework’
appropriate to form of lived stories thus the study section
address the aims of adopted a qualitative, narrative
the research? approach.
“The present study adopts a narrative
approach, because narratives provide
important insights into the individual’s
process of regaining meaning,
establishing coherence and
understanding life.”
Q.4 Was the Yes. 12 rehab patients (6 men and 6 pp. 1714 under the
recruitment strategy ☒ ☐ ☐ women) were sampled to obtain ‘Subjects’ section
appropriate to variation. The criteria was that the
address the aims of participants must have “had been
the research? living a ‘normal life’ at the time they
suffered an accident’.” Only one man
declined, expressing that he had
“nothing to tell and just wanted to
focus on getting up from his
wheelchair.” The participants were
followed for two years after their
traumatic spinal cord injury.
27
YES CAN’T TELL NO
Q.5 Was the data Yes. “The data was collected through pp. 1716 under the ‘Data
collected in a way ☒ ☐ ☐ field collection 7-11 times with each Collection’ section
that addressed the participant, focusing on the patient’s
research issue? daily life at the unit and at home […]
and were written down as soon as
possible.” The author’s reason for this
was that “the spinal cord injured
person usually [found themselves] in a
chaotic situation after the accident
[and thus] used observations to get a
broader picture than would be possible
by relying exclusively on the
participants’ narratives, to broaden
the researcher’s preunderstanding and
to strengthen [their] interpretation of
the data.”
Patients were interviewed six or seven
times during the first year. A final
interview was conducted after two
years to explore the patient’s status at
the time and to obtain a retrospective
perspective on the narratives for the
first year. The interviews were
recorded and transcribed.
28
Q.6 Has the While the researchers did not critically pp. 1714 and 1716 under the
relationship ☐ ☒ ☒ examine their own role, potential bias ‘Data Collection’ section
between the and influence during the formation of
researcher and the research questions and data
participants been collection, they analysed the interviews
adequately and field observations separately and
considered? as a whole, several times. Thus, their
guesses and interpretations were
continually “challenged and/or
substantiated”.
Q.7 Have ethical Yes, ethical issues had been taken into pp. 1716 under the ‘Ethical
issues been taken ☒ ☐ ☐ consideration. The patients were not Consideration’ section
into consideration? invited to participate in the study
unless the nurses judged that they had
the strength to manage participation.
Written, informed consent was
obtained after the patients were given
written and oral information and were
promised full confidentially and a
right to withdraw their consent at any
time. Thus, fictitious names and
restricted descriptions were used to
protect patient identity. Furthermore,
the Ethical Committee in the County
of Aarhus had no objections to the
study.
29
Q.8 Was the data Yes. The researcher read and pp. 1716 under the
analysis sufficiently ☒ ☐ ☐ interpreted the transcribed interviews ‘Analysis’ section
rigorous? and field observations both separately
and as a whole. Then, they examined
the narratives to clarify and explain
what it was discussing. At the end of
the analysis, their interpretations were
challenged and/or substantiated and
were continued to be under scrutiny
until the interpretations “seemed to be
the most significant among possible
interpretations”.
30
YES CAN’T TELL NO
Q.9 Is there a clear Yes. From their findings, the pp. 1716-1720 under the
statement of ☒ ☐ ☐ researchers concluded that the patients Results’ section
findings? regained meaning and got on with life
through “resolute fighting for a
meaningful life”, spurred by the size of
the challenge and threat of loss. They
identified three characteristics of
‘fight’ where either the patients would
fight with themselves, or against the
professionals, or would stop counting
on the professionals and fight for
themselves. The researchers explained
in detail each characteristic and
included direct quotes from patient
narratives to support their statements.
Q.10 How valuable The study gave substance to the pp. 1720 under the
is the research? ☐ ☒ ☐ abstract idea of supporting the ‘Discussion’ section
patient’s existential process of
regaining meaning. Knowing the
devastating consequences for the pp. 1721 under the
patient if such a situation is not ‘Conclusion’ section
established, everything must be
carried out to reach a common
understanding between the patient and pp. 1721 under the
the professionals. Situations where ‘Implications for Research’
31
patients turned away and distanced section
themselves from the professionals in
frustration may be difficult to detect
for professionals. This study
emphasised the importance of a close
and confident relationship.
However, as this was done in

Denmark, cultural differences must be
considered and begs the question
whether patients in Ireland would also
react in the way the Danish patients
responded to their condition. The
study also lacks more indicators of
different kinds of fight to further
appropriate professional interventions.
32
Week Six
Week Six Teaching Components:

 EBP Lecture
EBP Lecture
Time: 9-10.45am
Lecturer: Dr Emma Nicholson
Content: Introduction to quantitative research designs
 Understand how to distinguish between questions of effectiveness and
causation
 Learn the most common research designs to answer your questions
 Recognise which study designs are most appropriate for your questions
Reading: Polit & Beck (2014) Chapters 9 to 13
Polit & Beck (2010) Chapters 9, 12, 13, 14, 15 and 16
Workbook Task: Following the lecture take the time to complete the following tasks:
practice:
catalogues of peer-reviewed journals in UCD or your home institution, source 3 original
research articles which describe empirical research conducted using one of the quantitative
research designs described in this week’s EBP lecture. Please note that the three articles you
source for this task should be distinct from each other in that they each describe a different
research design as per the following list:
1. A randomised controlled trial
2. Cohort-analytic design
3. Single pre and post intervention design
4. Case-control study
5. Cohort (observational) design
6. Cross-sectional design
Read each of the three articles and complete the tables below:
Kypri, K., Hallett, J., Howatt, P., McManus, A., Maycock, B., Bowe, S. and Horton, N.
(2009) ‘Randomised Controlled Trial of Proactive Web-Based Alcohol Screening and Brief
Intervention for University Students’, Arch Intern Med, 169(16), pp. 1508-1514.
University students unaware of their risky and heavy drinking (as compared to nonstudent
peers) that were often exceeding normative levels.
Positivist deductive approach
The research design
Quantitative design
The research method
Randomised controlled trial
P - The population, patient group
7237 undergraduates at an Australian University in 2007
I/E- The intervention or issue of interest OR the exposure
University students drinking more heavily than their nonstudent peers and their lack of
awareness that their drinking exceed normative levels
Screening alone acted as the control
34
O - The outcome of interest
After 1 month, participants receiving intervention drank less often than the controls. At 6
months, intervention effects persisted for drinking frequency and overall volume but not for
other variables.
1 month
Using the PICOT/PECOT elements above write out the clinical research question below:
In university students, how does intervention for alcohol consumption compared with a lack
of intervention affect their intake during a 1-month intervention.
The question type:
Intervention
1. Level One:
3. Level Three __________________________________________________________
4. Level Four ___________________________________________________________
Key findings: After 1 month, participants receiving intervention drank less often than the
controls. At 6 months, intervention effects persisted for drinking frequency and overall
volume but not for other variables.
Vifladt, A., Simonsen, B. and Lydersen, S. (2016) ‘The association between patient safety
culture and burnout and sense of coherence: A cross-sectional study in restructured and not
restructured intensive care units’, Intensive & Critical Care Nursing, 36(1), pp. 26-34.
Compromise of patient safety due to staff burnout
The research design
Quantitative design
35
The research method
Registered nurses at seven ICUs in six hospitals at a Norwegian Hospital Trust
Safety culture, burnout and sense of coherence
Registered nurses not restructured care units is the comparison
How the issue influences the quality of patient safety and rate of burn out and sense of
coherence

__________________________________________________________________________
__________________________________________________________________________
How do registered nurses who have worked in restructured intensive care units compared to
not restructured care units influence the quality of patient safety and rate of burn out and
sense of coherence?
The question type:
Etiology
1. Level One:
3. Level Three __________________________________________________________
4. Level Four ___________________________________________________________
Key findings:
There was a high quality, positive safety culture present when the nurses were able to manage
stressful situations and where there was an absence of burnout. There was, however, a higher
fate for burnout amongst the nurses working in the restructured intensive care units. Good
teamwork and a strong sense of coherence were also associated with low reports of medical
mistakes.
36
Andersen, Z., Jorgensen, J., Gron, R., Brauner, E. and Lynge, E. (2017) ‘Active smoking and
risk of breast cancer in a Danish nurse cohort study’, BMC Cancer, 17(1), pp. 556-567.
The risk of breast cancer from active smoking
The research design
Quantitative design
The research method
Prospective Cohort Study
21,867 female nurses (age > 44 years)
Active smoking
Never smokers are the control
The results of active smoking in relation to breast cancer
15.7 years of follow-up
Are nurses over the age of 44 who have an active smoking lifestyle compared to those who
never smoke at risk of breast cancer in a 15.7 years of follow-up?
The question type:
Etiology
37
1. Level One: ___________________________________________________________

2. Level Two: Case control studies
3. Level Three __________________________________________________________
4. Level Four ___________________________________________________________
Key findings:
5.3% of the participants during the 15.7 years of follow-up who actively smoked developed
breast cancer. Compared to never smokers, there was a 18% risk (in past smokers) and 27%
risk (in current smokers). There was a trend that illustrated a link between high smoking
intensity and high breast cancer risk in women who smoke more than 15 grams per day.
38
Week Seven
Week Seven Teaching Components:

 EBP Lecture
EBP Lecture
Time: 9-10.45am
Lecturer: Dr Emma Nicholson
Content: Critical appraisal of quantitative designs
 Develop skills in applying criteria for critical appraisal of intervention
studies
 Evaluate trustworthiness of the study’s findings
Reading: Polit & Beck (2014) Chapters 9 to 13
Polit & Beck (2010) Chapters 9, 12, 13, 14, 15 and 16
Rempher, K.J. (2007) How to appraise quantitative research articles. American
Nurse Today pp.26-28
Following the lecture return to the three research articles you identified in week six from the
key evidence based nursing/midwifery journals. These three original research articles
describe empirical research conducted using one of the quantitative research designs
described in the lecture content for this module. Select one of these articles and using the
relevant CASP appraisal tool for quantitative research complete the quality assessment
form below:
39
CASP: Quality Assessment Form
Study Author(s): Kypri, K., Hallett, J., Howatt, P., McManus, A., Maycock, B., Bowe, S. and Horton, N.
Year of Publication: 2009
Study Title: Randomised Controlled Trial of Proactive Web-Based Alcohol Screening and Brief
Intervention for University Students
Journal (name, volume, issue, page numbers): Arch Intern Med, 169(16), pp. 1508-1514.

YES CAN’T TELL NO
Q.1: Did the trial The researchers acknowledged the pp. 1508-1509 under the
address a clearly ☒ ☐ ☐ potential reach of a proactive e-SBI ‘Introduction’ section
focused issue? (an web-based motivational
intervention) approach and thus
perceived that there was value in
contrasting this intervention with
screening alone and in assessing
outcomes beyond one month. By doing
this, they were able to address a clear
focus on the efficacy of a Web-based
motivational intervention delivered
after screening of a large population of
undergraduates.
Q.2 Was the In co-operation with the university pp. 1509-1510 under the
assignment of ☒ ☐ ☐ administration, the researchers drew a Randomization and
patients to random sample of 13,000 full-time Interventions’ section
[Type here]
treatments undergraduates ranging from 17-24
randomised? years old using survey recruitment
procedures. Afterwards, respondents
were given a hyperlink to a web
questionnaire. Students who scored 8
or more on the survey and exceeded
the Australian National Health and
Medical Research Council’s guideline
for acute risk of binge drinking were
randomly assigned by the software to
the control group (Screening only) or
to the intervention group, thus
maintaining randomisation.
According to the researchers,

participants were “blind to the nature
of the study”, which was presented as a
series of surveys. The researchers
themselves claimed to have been
“blind to participants’ group
allocation.
Q.3 Were all of the Yes, all of the students who entered the pp. 1509-1510 under the
patients who ☒ ☐ ☐ trial were properly accounted for at its ‘Randomization and
entered the trial conclusion. Students who scored 8 or Interventions’ section
properly accounted more on the audit and who exceeded
for at its the Australian National Health and
conclusion? Medical Research Council’s guideline
for acute risk of binge drinking were
randomly assigned by the software to
the control group (Screening only) or
41
to the intervention group.
Thus, participants were analysed in
the group to which they were
randomised (intention to treat), and all
participants were followed up
regardless of their compliance with the
intervention
Q.4 Were patients, Yes, the patients and study personnel pp. 1509-1510 under the
health workers and ☒ ☐ ☐ were ‘blinded’ to the treatment. The ‘Randomization and
study personnel participants of the survey were blind Interventions’ section
‘blind’ to to the true nature of the study, which
treatment? was presented as a series of surveys
and the researchers were blind to pp. 1510 under the
participants’ group allocation. ‘Outcomes and Follow-up’
section

YES CAN’T TELL NO
Q.5 Were the Yes, the groups were similar at the pp. 1509 under the
groups similar at ☒ ☐ ☐ start of the trial. In co-operation with ‘Recruitment’ section
the start of the trial? the university administration, the
researches drew a random sample of
13,000 full-time undergraduates aged
17 to 24
42
Q.6 Aside from the Yes, the groups were treated equally. pp. 1510 under the
experimental ☒ ☐ ☐ Bias was not possible as the students ‘Randomization and
intervention, were were blind to the true nature of the Interventions’ section
the groups treated study and were given the same initial
equally? surveys to fill out. Those who were
assigned to the intervention group all
received the same treatment, which
was an explanation of the associated
health risks and information about
how to reduce that risk.
Q.7 How large was Of the 13,000 undergraduates that pp. 1512-1513 under the
the treatment ☐ ☒ ☐ were sampled, 2,435 respondents were ‘Comment’ section
effect? randomised. Consequently, there were
1,021 participants in the control group
and 1,414 participants in the
intervention group. Results showed
that participants receiving
intervention drank less often and less
alcohol overall than the controls,
although the differences in alcohol-
related harms were non-significant.
Overall, the researchers claimed that
“the intervention was somewhat
smaller than those found using the
same screening criteria and a similar
intervention with university studies
presenting to a health service in New
Zealand”. They claimed the potency
was reduced due to the lack of face-to-
face interaction and the taking of the
43
intervention out of a health care
setting.
Q.8 How precise The treatment effect was estimated by pp. 1511-1512 under the
was the estimate of ☐ ☒ ☒ giving follow-up assessment surveys to ‘Results’ section
the treatment both the participants in the control
effect? and intervention groups after one
month and after 6 months. Accuracy is pp. 1512 under the
questionable as the study personnel ‘Comment’ section
relied completely on the authenticity of
the participants and researchers were
opted not to do face-to-face
interactions.
44
YES CAN’T TELL NO
Q.9 Can the results As this group primarily focused on pp. 1511-1512 under the
be applied in your ☐ ☐ ☒ full-time undergraduate university ‘Results’ section
contest (or to the students ranging from 17 to 21 years
local population)? old, the results would be applicable to
the patients whom I will apply this. pp. 1512-1512 under the
The population I focus on are ‘Comment’ section
primarily patients who are clinically
unwell ranging from late teens to the
older adult groups thus the results
would be greatly different compared to
this study’s findings.
Q.10 Were all Yes, all clinically important outcomes pp. 1511-1512 under the
clinically important ☒ ☐ ☐ were considered. There were no other ‘Results’ section
outcomes information I would like have seen as
considered? the study personnel included the
results from control and intervention
group, thus fulfilling their aim, which
was to determine the efficacy of the of
a Web-based motivational intervention
(e-SBI) delivered after screening of a
large population of undergraduates.
45
Q. 11 Are the Yes, although the researchers did not pp. 1510 under the
benefits worth the ☒ ☐ ☐ explicitly address this area, the ‘Randomization and
harms and costs? benefits were worth the harm and Interventions’ section
costs. As it did not cost a considerable
amount of time on the study
personnel’s side, the results it gave pp. 1511-1512 under the
them was worth the time. On the ‘Results’ section
participants side, the benefits
outweighed the harm and cost of time
involved in the two groups.
Q.12 N/A N/A N/A

☐ ☐ ☐
46
Week Eight
Week Eight Teaching Components:

 EBP Lecture
EBP Lecture
Date: Friday November 3rd
Time: 9-10.45am
Lecturer: Dr Suja Somanadhan, Clinical Audit & Nursing Research Facilitator, Temple St.
Children’s University Hospital
Content: Translating evidence into practice: Practical & Innovative Approach to Clinical
Audit & Nursing/midwifery Research
 Differentiate between Clinical Audit and Research
 Plan a Clinical Audit
Reading: A Practical Guide to Clinical Audit (2013)
http://www.hse.ie/eng/about/Who/qualityandpatientsafety/Clinical_Audit/clau
ditfilespdfs/practicalguideclaudit2013.pdf
Registered Nurses’ Association of Ontario. (2012). Toolkit: Implementation of best
practice guidelines (2nd Ed.). Toronto, ON: Registered Nurses’ Association of
Ontario. http://rnao.ca/bpg/resources/toolkit-implementation-best-practice-guidelines-
second-edition
[Type here]
Week Nine
Week Nine Teaching Components:

 EBP Lecture
EBP Lecture
Date: Friday November 10th
Time: 9-10.45am
Lecturer: Dr Hasheem Mannan
Content: Critical appraisal of intervention studies
 Identify the best level of evidence for evaluating interventions
 Appreciate the features of research design which attempt to reduce the
role of bias and increase the validity and reliability of research findings
 Be familiar with critical appraisal tools for different research designs
 Apply a relevant critical appraisal tool to evaluate the integrity of
intervention trial design
Reading: Twycross, A. (2004) Validity and reliability – What’s it all about? Part 1 Validity
in quantitative studies. Paediatric Nursing 16(9) p.28
Twycross, A. (2004) Validity and reliability – What’s it all about? Part 2 Validity
in quantitative studies. Paediatric Nursing 16(10) p. 36
Following the lecture take the time to complete the following tasks:
practice:
catalogues of peer-reviewed journals in UCD or your home institution, source one
systematic review OR one meta-synthesis of qualitative studies. The systematic review or
meta-synthesis must be related to nursing/midwifery practice but can be any topic area which
is of interest to you. Read the systematic review/meta-synthesis and complete the content
below:
48
Reddy, M., Gill, S. and Rochon, P. (2014) ‘Preventing Pressure Ulcers: A Systematic
Review’, JAMA, 296(8), pp. 974-984.
Interventions to prevent pressure ulcers
What is the PICOT/PECOT/PST question at the centre of the systematic review/meta-

synthesis?
In patients with impaired mobility and nutrition, how do interventions compared with no
interventions affect the risk rates of developing pressure ulcers?
Comment on the replicability of the search strategy (did the authors provide enough detail
about their search strategy to enable replication? Search terms, databases, inclusion criteria)
The authors provided enough detail about their search strategy to enable replication. They
searched MEDLINE, EMBASE, and CINAHL (from inception through June 2014) and
Cochrane databases (through issue 1, 2014) in order to identify controlled trials (RCTs).
UMIProquestDigital Dissertations, ISI Web of Science, and Cambridge Scientific Abstracts
were also searched. All searches used the terms pressure ulcer, pressure sore, decubitus,
bedsore, prevention, prophylactic, reduction, randomized, and clinical trials.
Criteria for selection of studies included RCTs that reported objective, clinically relevant
outcome measures (such as incidence of pressure ulcers). There were no restrictions on
language, publication date, or setting.
49
Week Ten
Week Ten Teaching Components:

 EBP Lecture
EBP Lecture
Date: Friday November 17th
Time: 9-10.45am
Lecturer: Dr Hasheem Mannan
Content: Interpreting systematic reviews and meta-analysis
 Discuss approaches to integrating research evidence and the advantages
of a systematic method of reviewing research
 Identify key steps of a metanalysis and a metasynthesis
 Synthesise evidence from a systematic review and identify the key
critical appraisal features
Reading: Polit & Beck (2014) Chapter 19
Polit & Beck (2010) Chapter 19
Following the lecture return to the systematic review/meta-synthesis you identified in

week nine. Think about critically appraising the review use the following prompts as a
starting point for this appraisal:
Did the review address a clearly focused question (note the PICOT/PECOT/PST elements as
well as the question type)?
Yes, the review addressed a clearly focused question. As this was an intervention question,
the author presented an overview of the results of the RCTs through the use of tables. It
illustrated the different approaches to impaired mobility using static or standard support
surfaces/repositioning/exercise/treatment of incontinence for reduction of pressure ulcer
incidence. In the same manner, the authors presented another table of the results of RCTs
addressing approaches to impaired nutrition.
Did the authors look for the right types of papers (refer to relevant evidence hierarchy?
The level of evidence was a level four, where the authors took evidence from well-designed
cohort studies. Specifically, fifty-nine RCTs were selected from reputable sources.
50
Do you think all the important, relevant studies were included (refer to the search strategy –
search terms, databases, inclusion and exclusion criteria)?
All important and relevant studies were included. The authors included their data sources and
study selection (MEDLINE, EMBASE, CINAHL, UMI Proquest Digital Dissertations, ISI
Web of Science, Cambridge Scientific Abstracts), as well as mentioned what terms they used
for her searches (pressure ulcer, pressure sore, decubitus, bedsore, prevention, prophylactic,
reduction, randomised, clinical trials).
They also pointed out their inclusion (RCTs that reports objective, clinically relevant
outcome measures such as incidence of pressure ulcers) and exclusion criteria (inadequate
information about outcome measured or used proxy outcome measures, no original data,
focused on treatment not prevention, outcomes other than pressure ulcers, interventions not
addressing risk factors for pressure ulcers, and did not use human participants) in relation to
the studies used.
Did the reviewers do enough to assess the quality of the studies included (note if they used a
quality appraisal tool)?
According to the authors, methodological quality for the RCTs was “variable and generally
suboptimal”. The authors determined the quality of the RCTs using six elements from the
CLEAR NPT: (1) adequate allocation sequence generation (i.e. use of an appropriate method
to generate the sequence of randomisation); (2) concealed treatment allocation; (3) adequate
participant blinding (where participant blinding was possible); (4) adequate outcome assessor
blinding; (5) consistent follow-up schedule; and (6) intent-to-treat analysis. Thus, they
examined the trials to ensure that similar follow-up schedules were present in each group,
unless a trial specifically set out to determine the frequency with which an intervention was
applied.
For a systematic review of quantitative studies:
What are the overall results of the review (ORs, SMDs, RRs etc.)?
According to the forest plot provided by the authors, the odd ratio was >1, suggesting that the
result was statistically significant. It also suggested that the outcome of interest occurred
more frequently in the intervention group than the control groupFurthermore, according to
the authors, the standard mean difference (SMD), which is the actual average effect size, was
-0.42. The SMD was presented in an interval scale data. This would suggest that the
interventions being tested in these studies had a small to medium effect size – in order words,
‘it worked’ and had a moderate effect.
How precise are the results (report confidence intervals and/or p-values and your
understanding of them)?
According to the forest plot, there were 95% confidence intervals, meaning that there was a
95% chance that the true effect in the population lied within the range. This is under the
assumption that there were no systematic errors that could bias the results. As well as this, the
51
forest plot included a very big sample and thus meant greater precision and a small
confidence interval. The p-value, which indicates the difference between the groups, was
0.04, thus signifying that there was no difference between the observed data and what was
expected.
52

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Evidence Based Practice for

BSc Nursing (General)

Name: Alexandria Aquino

Clinical Placement Coordinator (s)

Clinical Allocations Officer

Name: Dr Éidín NíShé

Name: Ms Marie Meskell

Lectures begin X 12 Friday the 15th of

Clinical learning days begin X 10 Wednesday the 20th

Submission of assessment 3 (30%): The research matrix Friday the 17th of

Submission of assignment 4 (50%): The Evidence Review Monday the 19th of

Tutorial Three Friday the 10th of

Assessment 1: Attendance and participation at 10 clinical days (CLDs) and 3 tutorials

Assessment 2: Bi-weekly short MCQ quizzes

Quiz Open for completion Closed for completion Marks allocated

4 Friday the 3rd of Nov 11am Monday the 13th of Nov 2%

5 Friday the 17th Nov 11am Monday the 27th of Nov 2%

Assessment 3: Submission of a matrix of research evidence (portfolio)

Assessment 5: Completion of the EBP review of evidence

Week One Module Components:

Week Two Teaching Components:

Week Three Teaching Components:

The research topic, problem

The research paradigm and approach

Interpretivist paradigm and inductive approach

The research method

P - The population, patient group or situation of interest

I/E/S - The intervention or situation of interest (as relevant)

C - The comparison of interest (if relevant) ______________________________________

O - The outcome of interest (if relevant)

T – The timeframe (if relevant) ________________________________________________

The question type

1. Level One: ___________________________________________________________

The research topic, problem

The research paradigm and approach

Positivist paradigm and deductive approach

The research design

The research method

Prospective Cohort Study

P - The population, patient group or situation of interest

I/E/S - The intervention or situation of interest (as relevant)

Simulated-based learning to the nurses

C - The comparison of interest (if relevant)

Length of session vs increasing clinical scenarios vs face-to-face

O - The outcome of interest (if relevant)

T – The timeframe (if relevant) ________________________________________________

The question type

1. Level One: ___________________________________________________________

Research Article Three:

The research topic, problem

The effects of nurse autonomy on patient mortality rate

The research paradigm and approach

Positivist paradigm and deductive approach

The research design

The research method

P - The population, patient group or situation of interest

100,000 randomly sampled registered nurses from four states in USA

I/E/S - The intervention or situation of interest (as relevant)

The outcome of nurse autonomy on patient mortality rate

C - The comparison of interest (if relevant)

O - The outcome of interest (if relevant)

T – The timeframe (if relevant)

The question type