evidence-based intervention for the selected practice problem, including the level and quality of each source of research evi

 evidence-based intervention for the selected practice problem, including the level and quality of each source of research evidence. A synthesis involves combining two or more summaries. Synthesis writing is more difficult than it might first appear because this combining must be done in a meaningful way. Synthesis is all about collecting information from different sources and putting it together as one content.

Assignment: Evidence Synthesis and Tables

Purpose: The purpose of this assignment is to document sources of research evidence that support the evidence-based intervention for the selected practice problem, including the level and quality of each source of research evidence. A synthesis of the evidence is conducted to determine the overall strength and quality of the evidence. The development of an evidence table and synthesis are foundational to inform actions and decisions to improve healthcare outcomes. Construction of an evidence table and synthesis supports the professional formation of the DNP-prepared nurse.

Course Outcomes. This assignment enables the student to meet the following course outcome: CO 3: Develop strategies to lead project planning, implementation, management, and evaluation to promote high-value healthcare. (POs 3, 5, 7)

Instructions: Download the Johns Hopkins Research Evidence Appraisal Tool (Links to an external site.) and the Johns Hopkins Individual Evidence Summary Tool (Links to an external site.) located in the Student Resource Center under "Project & Practicum Resources."

As you incorporate published research study findings into your own writing, you aim for synthesis of the material. Before learning how to write a synthesis, it is important to define this term. At its most basic level, a synthesis involves combining two or more summaries. Synthesis writing is more difficult than it might first appear because this combining must be done in a meaningful way. A synthesis requires critical reading and thinking in order to compare different material, highlighting similarities, differences, and connections. When practicing scholar synthesizes successfully, they present new ideas based on interpretations of published research evidence. Conceptually, it can be helpful to think about synthesis existing at both the local (or paragraph) level and the global (or paper) level. Synthesis is all about collecting information from different sources and putting it together as one content.

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Follow these guidelines when completing each component of this assignment:

Title Page

Introduce the Practice Problem

Practice Problem Statement

Describe the Significance of the Practice Problem at the National Level (1 paragraph)

Synthesis of Evidence to Support the Evidence-Based Intervention for the Selected Practice Problem. Include 3 Current LEVEL I, II, or III Peer-Reviewed Primary Research Studies and/or Systematic Reviews.

Synthesis of the Literature (2 paragraphs).

Main Points/Salient Themes That Emerge from the Sources (Cited).

Compare and Contrast Main Points /Themes from All Sources (Cited).

Support for Evidence-Based Intervention (1 paragraph).

Objective Rationale for the Intervention Based on the Literature.

Summary Table of Evidence to Address the Evidence-Based Intervention for the Selected Practice Problem Using the Johns Hopkins Nursing Evidence-Based Practice Evidence Summary Tool. Include as an appendix.

Reference Page with Complete References for the 3 Sources of Research Evidence, Including the Permalink

APA Formatting/ References

APA Standards for Scholarly Papers

Level I Headings are included

All policies related to plagiarism must be observed.

Assignment Grading Rubric: Evidence Synthesis and Tables (140 pts).

Practice Problem Requirements: 1. State the Practice Problem. 2. Describe the significance of the practice problem at the national level. (Cite all sources).

Includes all data requirements and provides an in-depth discussion about the practice problem.

Evidence Synthesis to Support the Evidence-Based Intervention Requirements: 1. State the Main themes in the findings that emerge from the sources (Cited). 2. Contrast the main points from the sources (Cited). 3. Present an objective rationale for the intervention based on the literature.

Includes all requirements and provides an in-depth synthesis of research evidence supporting the evidence-based Intervention.

Johns Hopkins Individual Evidence Summary Table Requirements: 1. Enter the information for the Three Research Studies. 2. Complete all sections and identify the quality and the levels of evidence.

Includes all requirements of the Johns Hopkins Individual Evidence Summary Table and provides an in-depth evidence table presentation.

APA Style and Standards Requirements: 1. Uses appropriate Level I headers. 2. Reference Page with complete references including the 3 sources of research evidence including the Permalink. 3. Reference and citations are in current APA style

Includes all requirements of APA style and standards.

Clarity of Writing Requirements: 1. Uses standard English grammar and sentence structure.   2. No spelling or typographical errors.  3. Organized presentation of ideas.

Includes all requirements of clarity of writing.

,

Practice Question:

Date:

Article Number

Author and Date

Evidence Type

Sample, Sample Size, Setting

Findings That Help Answer the EBP Question

Observable Measures

Limitations

Evidence Level, Quality

· N/A

· N/A

· N/A

· N/A

· N/A

· N/A

· N/A

Attach a reference list with full citations of articles reviewed for this Practice question.

Johns Hopkins Nursing Evidence-Based Practice

Appendix G: Individual Evidence Summary Tool

The Johns Hopkins Hospital/ The Johns Hopkins University

1

Directions for Use of the Individual Evidence Summary Tool

Purpose

This form is used to document the results of evidence appraisal in preparation for evidence synthesis. The form provides the EBP team with documentation of the sources of evidence used, the year the evidence was published or otherwise communicated, the information gathered from each evidence source that helps the team answer the EBP question, and the level and quality of each source of evidence.

Article Number

Assign a number to each reviewed source of evidence. This organizes the individual evidence summary and provides an easy way to reference articles.

Author and Date

Indicate the last name of the first author or the evidence source and the publication/communication date. List both author/evidence source and date.

Evidence Type

Indicate the type of evidence reviewed (for example: RCT, meta-analysis, mixed methods, quaLitative, systematic review, case study, narrative literature review).

Sample, Sample Size, and Setting

Provide a quick view of the population, number of participants, and study location.

Findings That Help Answer the EBP Question

Although the reviewer may find many points of interest, list only findings that directly apply to the EBP question.

Observable Measures

QuaNtitative measures or variables are used to answer a research question, test a hypothesis, describe characteristics, or determine the effect, impact, or influence. QuaLitative evidence uses cases, context, opinions, experiences, and thoughts to represent the phenomenon of study.

Limitations

Include information that may or may not be within the text of the article regarding drawbacks of the piece of evidence. The evidence may list limitations, or it may be evident to you, as you review the evidence, that an important point is missed or the sample does not apply to the population of interest.

Evidence Level and Quality

Using information from the individual appraisal tools, transfer the evidence level and quality rating into this column.

,

Johns Hopkins Nursing Evidence-Based Practice

Appendix E

Research Evidence Appraisal Tool

Evidence level and quality rating:

Enter level and quality rating

Article title: Article Title

Number: Article Number

Author(s): Authors names

Publication date: Date

Journal: Journal

Setting: Setting

Sample: Sample composition/size

Does this evidence address my EBP question? ☐Yes

☐No-Do not proceed with appraisal of this evidence

Is this study:

☐QuaNtitative (collection, analysis, and reporting of numerical data) Measurable data (how many; how much; or how often) used to formulate facts, uncover patterns in research, and generalize results from a larger sample population; provides observed effects of a program, problem, or condition, measured precisely, rather than through researcher interpretation of data. Common methods are surveys, face-to-face structured interviews, observations, and reviews of records or documents. Statistical tests are used in data analysis.

Go to Section I: QuaNtitative

☐QuaLitative (collection, analysis, and reporting of narrative data) Rich narrative documents are used for uncovering themes; describes a problem or condition from the point of view of those experiencing it. Common methods are focus groups, individual interviews (unstructured or semi structured), and participation/observations. Sample sizes are small and are determined when data saturation is achieved. Data saturation is reached when the researcher identifies that no new themes emerge and redundancy is occurring. Synthesis is used in data analysis. Often a starting point for studies when little research exists; may use results to design empirical studies. The researcher describes, analyzes, and interprets reports, descriptions, and observations from participants.

Go to Section II: QuaLitative

☐Mixed methods (results reported both numerically and narratively) Both quaNtitative and quaLitative methods are used in the study design. Using both approaches, in combination, provides a better understanding of research problems than using either approach alone. Sample sizes vary based on methods used. Data collection involves collecting and analyzing both quaNtitative and quaLitative data in a single study or series of studies. Interpretation is continual and can influence stages in the research process. Go to Section III: Mixed Methods

Johns Hopkins Nursing Evidence-Based Practice

Appendix E

Research Evidence Appraisal Tool

Page 6 of 10

Johns Hopkins Nursing Evidence-Based Practice

Appendix E

Research Evidence Appraisal Tool

The Johns Hopkins Hospital/ The Johns Hopkins University

© 2017 The Johns Hopkins Hospital/ Johns Hopkins University School of Nursing 1

Section I: QuaNtitative

Level of Evidence (Study Design)

Is this a report of a single research study?

A

☐ Yes

☐ No Go to B

1. Was there manipulation of an independent variable?

☐ Yes

☐ No

2. Was there a control group?

☐ Yes

☐ No

3. Were study participants randomly assigned to the intervention and control groups?

☐ Yes

☐ No

If Yes to questions 1, 2, and 3, this is a randomized controlled trial (RCT) or experimental study.

LEVEL I

If Yes to questions 1 and 2 and No to question 3 or Yes to question 1 and No to questions 2 and 3, this is quasi-experimental. (Some degree of investigator control, some manipulation of an independent variable, lacks random assignment to groups, and may have a control group).

LEVEL II

If No to questions 1, 2, and 3, this is nonexperimental. (No manipulation of independent variable; can be descriptive, comparative, or correlational; often uses secondary data).

LEVEL III

Study Findings That Help Answer the EBP Question:

Enter Text Here

Skip to the Appraisal of QuaNtitative Research Studies section

Section I: QuaNtitative (continued)

Is this a summary of multiple sources of research evidence?

☐Yes Continue

☐No Use Appendix F

1. Does it employ a comprehensive search strategy and rigorous appraisal method?

If this study includes research, nonresearch, and experiential evidence, it is an integrative review (see Appendix F).

☐Yes Continue

☐No Use Appendix F

2. For systematic reviews and systematic reviews with meta-analysis (see descriptions below):

B

a. Are all studies included RCTs?

☐LEVEL I

b. Are the studies a combination of RCTs and quasi-experimental, or quasi-experimental only?

☐LEVEL II

c. Are the studies a combination of RCTs, quasi-experimental, and nonexperimental, or non- experimental only?

☐LEVEL III

A systematic review employs a search strategy and a rigorous appraisal method, but does not generate an effect size.

A meta-analysis , or systematic review with meta-analysis, combines and analyzes results from studies to generate a new statistic: the effect size.

Study Findings That Help Answer the EBP Question:

Enter Text Here

Skip to the Appraisal of Systematic Review (With or Without a Meta-Analysis) section

Appraisal of QuaNtitative Research Studies

Does the researcher identify what is known and not known about the problem and how the study will address any gaps in knowledge?

☐ Yes

☐ No

Was the purpose of the study clearly presented?

☐ Yes

☐ No

Was the literature review current (most sources within the past five years or a seminal study)?

☐ Yes

☐ No

Was sample size sufficient based on study design and rationale?

☐ Yes

☐ No

If there is a control group:

· Were the characteristics and/or demographics similar in both the control and intervention groups?

☐ Yes

☐ No

☐N/A

· If multiple settings were used, were the settings similar?

☐ Yes

☐ No

☐N/A

· Were all groups equally treated except for the intervention group(s)?

☐ Yes

☐ No

☐N/A

Are data collection methods described clearly?

☐ Yes

☐ No

Were the instruments reliable (Cronbach’s [alpha] > 0.70)?

☐ Yes

☐ No

☐N/A

Was instrument validity discussed?

☐ Yes

☐ No

☐N/A

If surveys or questionnaires were used, was the response rate > 25%?

☐ Yes

☐ No

☐N/A

Were the results presented clearly?

☐ Yes

☐ No

If tables were presented, was the narrative consistent with the table content?

☐ Yes

☐ No

☐N/A

Were study limitations identified and addressed?

☐ Yes

☐ No

Were conclusions based on results?

☐ Yes

☐ No

Complete the Quality Rating for QuaNtitative Studies section

Appraisal of Systematic Review (With or Without Meta-Analysis)

Were the variables of interest clearly identified?

☐ Yes

☐ No

Was the search comprehensive and reproducible?

· Key search terms stated

☐ Yes

☐ No

· Multiple databases searched and identified

☐ Yes

☐ No

· Inclusion and exclusion criteria stated

☐ Yes

☐ No

Was there a flow diagram that included the number of studies eliminated at each level of review?

☐ Yes

☐ No

Were details of included studies presented (design, sample, methods, results, outcomes, strengths, and limitations)?

☐ Yes

☐ No

Were methods for appraising the strength of evidence (level and quality) described?

☐ Yes

☐ No

Were conclusions based on results?

☐ Yes

☐ No

· Results were interpreted

☐ Yes

☐ No

· Conclusions flowed logically from the interpretation and systematic review question

☐ Yes

☐ No

Did the systematic review include a section addressing limitations and how they were addressed?

☐ Yes

☐ No

Complete the Quality Rating for QuaNtitative Studies section (below)

Quality Rating for QuaNtitative Studies

Circle the appropriate quality rating below:

A High quality: Consistent, generalizable results; sufficient sample size for the study design; adequate control; definitive conclusions; consistent recommendations based on comprehensive literature review that includes thorough reference to scientific evidence.

B Good quality: Reasonably consistent results; sufficient sample size for the study design; some control, and fairly definitive conclusions; reasonably consistent recommendations based on fairly comprehensive literature review that includes some reference to scientific evidence.

C Low quality or major flaws: Little evidence with inconsistent results; insufficient sample size for the study design; conclusions cannot be drawn.

Johns Hopkins Nursing Evidence-Based Practice

Appendix E

Research Evidence Appraisal Tool

Section II: QuaLitative

Level of Evidence (Study Design)

A

Is this a report of a single research study?

☐ Yes this is Level III

☐ No go to II B

Study Findings That Help Answer the EBP Question:

Enter Text Here

Complete the Appraisal of Single QuaLitative Research Study section (below)

Appraisal of a Single QuaLitative Research Study

Was there a clearly identifiable and articulated:

· Purpose?

☐ Yes

☐ No

· Research question?

☐ Yes

☐ No

· Justification for method(s) used?

☐ Yes

☐ No

· Phenomenon that is the focus of the research?

☐ Yes

☐ No

Were study sample participants representative?

☐ Yes

☐ No

Did they have knowledge of or experience with the research area?

☐ Yes

☐ No

Were participant characteristics described?

☐ Yes

☐ No

Was sampling adequate, as evidenced by achieving saturation of data?

☐ Yes

☐ No

Data analysis:

· Was a verification process used in every step by checking and confirming with participants the trustworthiness of analysis and interpretation?

☐ Yes

☐ No

· Was there a description of how data were analyzed (i.e., method), by computer or manually?

☐ Yes

☐ No

Do findings support the narrative data (quotes)?

☐ Yes

☐ No

Do findings flow from research question to data collected to analysis undertaken?

☐ Yes

☐ No

Are conclusions clearly explained?

☐ Yes

☐ No

Skip to the Quality Rating for QuaLitative Studies section

For summaries of multiple quaLitative research studies (meta-synthesis), was a comprehensive search strategy and rigorous appraisal method used?

B

☐ Yes Level III

☐ No go to Appendix F

Study Findings That Help Answer the EBP Question:

Enter Text Here

Complete the Appraisal of Meta-Synthesis Studies section (below)

Appraisal of Meta-Synthesis Studies

Were the search strategy and criteria for selecting primary studies clearly defined?

☐ Yes

☐ No

Were findings appropriate and convincing?

☐ Yes

☐ No

Was a description of methods used to:

· Compare findings from each study?

☐ Yes

☐ No

· Interpret data?

☐ Yes

☐ No

Did synthesis reflect:

☐ Yes

☐ No

· New insights?

☐ Yes

☐ No

· Discovery of essential features of phenomena?

☐ Yes

☐ No

· A fuller understanding of the phenomena?

☐ Yes

☐ No

Was sufficient data presented to support the interpretations?

☐ Yes

☐ No

Complete the Quality Rating for QuaLititative Studies section (below)

Quality Rating for QuaLitative Studies

Select the appropriate quality rating below:

No commonly agreed-on principles exist for judging the quality of quaLitative studies. It is a subjective process based on the extent to which study data contributes to synthesis and how much information is known about the researchers’ efforts to meet the appraisal criteria.

For meta-synthesis, there is preliminary agreement that quality assessments should be made before synthesis to screen out poor-quality studies1.

☐A/B High/Good quality is used for single studies and meta-syntheses2.

The report discusses efforts to enhance or evaluate the quality of the data and the overall inquiry in sufficient detail; and it describes the specific techniques used to enhance the quality of the inquiry.

Evidence of some or all of the following is found in the report:

· Transparency: Describes how information was documented to justify decisions, how data were reviewed by others, and how themes and categories were formulated.

· Diligence: Reads and rereads data to check interpretations; seeks opportunity to find multiple sources to corroborate evidence.

· Verification: The process of checking, confirming, and ensuring methodologic coherence.

· Self-reflection and self-scrutiny: Being continuously aware of how a researcher’s experiences, background, or prejudices might shape and bias analysis and interpretations.

· Participant-driven inquiry: Participants shape the scope and breadth of questions; analysis and interpretation give voice to those who participated.

· Insightful interpretation: Data and knowledge are linked in meaningful ways to relevant literature.

☐C Lower-quality studies contribute little to the overall review of findings and have few, if any, of the features listed for High/Good quality.

1 https://www.york.ac.uk/crd/SysRev/!SSL!/WebHelp/6_4_ASSESSMENT_OF_QUALIT A TIVE_RESEARCH.htm 2 Adapted from Polit & Beck (2017).

Section III: Mixed Methods

Level of Evidence (Study Design)

You will need to appraise both the quaNtitative and quaLitative parts of the study independently, before appraising the study in its entirety.

1. Evaluate the quaNitative part of the study using Section I.

Level

Quality

Insert here the level of evidence and overall quality for this part:

 Level Quality

2. Evaluate the quaLitative part of the study using Section II.

Level

Quality

Insert here the level of evidence and overall quality for this part:

 Level Quality

3. To determine the level of evidence, circle the appropriate study design:

· Explanatory sequential designs collect quaNtitative data first, followed by the quaLitative data; and their purpose is to explain quaNtitative results using qu

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