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NUR2300 Evidence-Based Practices in Nursing For Ulcer Prevention Assessment 1 Answer

    NUR2300: Written Assessment 1

    Task overview

    Assessment nameWritten Assessment 1
    Brief task descriptionYou are to respond to a clinical scenario by applying the key concepts of evidence-based nursing practice. 
    Rationale for assessment taskContemporary nursing practice requires the use of evidence to improve health outcomes for patients, families, and populations. It is important for nursing students to understand the relationship between the generation of evidence and the delivery of safe and effective nursing care.
    Length750 words +/-10% (Introduction & conclusion required. Word length includes in-text referencing and excludes your reference list and appendices) 
    Marks out of:
    Weighting:
    		Marks out of:    40
    Weighting:        40%
    Course Objectives measured
    1. Define evidence-based practice and identify key stages, principles, and processes of an evidence-based practice approach in nursing
    2. Define the research process and identify common research methods within qualitative and quantitative paradigms
    3. Describe the relationship between research and identify evidence-based nursing praxis
    4. Evaluate data and research findings
    5. Determine ways to improve nursing practice and patient outcomes by using an evidence-based practice approach to planning, implementing and evaluating nursing care
    6. Examine the issues and ethical considerations which impact on nursing and health care research
    ExemplarNo. Information of a general nature will be posted to Study Desk to facilitate an informed response.


    Task detailChoose ONE of the following TWO scenarios to inform your response to the task:
    Scenario 1
    • You attend clinical placement at an aged care home where the Nurse Unit Manager tells you they are wanting to find out best practice for preventing constipation in residents. The research question they want you to answer is: “In adults, what nurse-initiated interventions are effective for treating constipation?”                                                         Or
    Scenario 2
    • You attend clinical placement in a hospital where the Nurse Unit Manager tells you they are wanting to find out best practice for preventing pressure ulcers. The research question they want you to answer is: “In adults, what nurse-initiated interventions prevent the onset of pressure ulcers?”
    TASK
    Using the following A’s of Evidence Based Practice, you are to:
    • ACQUIRE the literature by using a structured search strategy adapted as appropriate for various research databases (e.g. Google Scholar, PubMed; CINAHL; PsycINFO) to identify evidence that will inform your response to the research question. You are to report and justify your search strategy. (~300 words)
    • APPRAISE the quality of studies by grouping according to their position on the NHMRC Level of Evidence and comment on implications of study quality. (~250 words)
    Writing StyleThis assessment piece will be written in the form of a structured response using the headings “ACQUIRE” and “APPRAISE” with an introduction and conclusion. Every statement of fact must be supported by a valid reference. 
    Referencing/ citations
    • For this assessment you will use APA 7th referencing style.
    • Sources: You are expected to justify every statement of fact with a valid/peer-reviewed reference.
    • In text citations: You must include in-text citations in the body of your work. Each new point or piece of evidence must be attributed (via in-text citation) to the source.
    Formatting StyleTimes New Roman, Size 12, 1.5 spaced. Headings are permitted. No graphics, coloured texts or title pages. 


    Answer

    Evidence-based practices 

    Introduction 

           Evidence-based practise (EBP) is the method by which study findings are gathered, analysed, and applied to enhance clinical practise the job responsibilities, or patient outcomes (Ellis, 2019). The use of the EBP strategy to clinical practice allows healthcare professionals to deliver the best possible efficiency and more cost-efficient clinical care (Skaggs et al., 2018). This assessment aims at highlighting the scenario 2 to find the evidence-based interventions and to address the research question “In adults, what nurse-initiated interventions prevent the onset of pressure ulcers?”. Also, it deals with the analysis of search strategy and levels of evidence as per NHMRC. 

    ACQUIRE 

          Nurses use various evidence-based strategies to formulate particular research questions that will be used to determine the methodological approaches which can provide patients with evidence-based treatment. Through a concept called PICO question, such questions are posed. A properly structured study question/topic requires extreme specificity and accuracy that by taking into account multiple variables and target audience, helps to implement the work. In this case, the research question is established is using the PICO model that is composed of three components, population, intervention, and context. Population refers to an interest group that poses a particular problem identified by the researcher. PICO makes it easy to describe the person or group, the intervention or issue, the consequences of the interventions and the time needed to address the questions (Eriksen & Frandsen, 2018).

    Question 

    In adults, what nurse-initiated interventions prevent the onset of pressure ulcers?

    Search strategy 

          The search strategy comprises of Boolean operators and use of keywords. The various keywords include pressure ulcers, nursing-based interventions, pressure ulcer interventions, nurse-initiated interventions and onset of pressure ulcer. The various Boolean operators used are Pressure ulcers OR pressure injury OR pressure sores, pressure ulcers AND nurse-initiated interventions, prevention OR intervention AND nurse-initiated interventions, pressure ulcer AND interventions, pressure ulcers AND nurse-led interventions. Systematic analysis is the method used to analyse the evidence. A systematic analysis is an important effort to promote evidence-based practice and healthcare-related initiatives (Cantor & Poh, 2018). It is a consistent and measurable methodology for drawing the inference from the different facts available. The identified databases include PubMed, Cinhal, Google Scholar, PsycINFO and Medline. These databases will be reviewed using valid keywords, evidence-based protocols, for pressure ulcer procedures. The papers that do not include these main terms will be exempted from the technique of search. The appropriate keywords for evaluating the repositories were used to document a total of five articles. The articles were selected since they had at least 2 different keywords used to search for the publications. Critical research was conducted for the compilation of these papers. To this end, the CASP tool was used. This approach is effective in selecting the best papers and seeks to produce the right results (Bramer et al., 2018).

    APPRAISE

         The first study by Gunningberg et al., (2017) is a randomised controlled trial and hence can be evaluated as the evidence level II as per NHMRC level. This is because the study includes a comparison with an adequate reference standard (NHMRC, 2009). This research failed to show the positive effect of a pressure mapping system on the frequency and occurrence of pressure ulcers. The research may, however, have improved staff understanding and emphasis on the prevention of pressure ulcers, thereby positively impacting the frequency and occurrence of pressure ulcers in all study populations. The second study by Sharp et al. (2019) is at level IV as per NHMRC as it is a cross-sectional analytical survey. The quality implications show that results might not be reliable and effective. 

          The third study by Avsar et al. (2020) is level I being a systematic review. The quality implications show that the findings of this systematic review demonstrate that pressure ulcer incidence is reduced by regular repositioning and the use of a rotating team. Considering the low surety of the evidence the results are inconsistent and should be interpreted with caution. Next study by Serraes et al. (2018) meets the criteria I of NHMRC being a systematic review. Quality implication includes reliable results and improved patient health outcomes. The fifth study is by Damanik et al. (2020) is a randomized control trial and meets the NHMRC at level II. The study is appropriate and reliable as it meets the high-quality levels and ensures the evidence-based practice (NHMRC, 2009). 

    Conclusion 

          From the above, it can be concluded that evidence-based practice is essential for appropriate and reliable approaches for pressure ulcer preventions. The major nurse-initiated interventions include appropriate nutrition, use of adequate mattress and repositioning as per the high-quality evidence rated according to NHMRC levels of evidence. 

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