Critical Appraisal of Practice Guidelines
DNP 820 Week 3 Critical Appraisal of Practice Guidelines
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Details:
While there are several tools to critically appraise practice guidelines, the most comprehensively validated appraisal tool is the AGREE II Instrument. Critical Appraisal of Practice Guidelines. The AGREE II Instrument can be used by individual practitioners to critically appraise health guidelines and by decision makers to inform policy decisions. The purpose of the AGREE II Instrument is to provide a framework to:
- Assess the quality of guidelines.
- Provide a methodological strategy for the development of guidelines.
- Inform what information and how the information ought to be reported in guidelines.
Overall assessment includes rating the overall quality of the guideline and whether the guideline would be recommended for use in practice.
Items are rated on a 7-point scale from 1 (Strongly Disagree) to 7 (Strongly Agree). A score of 1 is given when there is no information on that item or if it is poorly reported. A score of 7 is given if the quality of reporting is excellent and when full criteria have been met (Score explanations found in the AGREE II-GRS Instrument).
A quality score is calculated for each of the six domains, which are independently scored. Domain scores are calculated by summing up all the scores of the items in the domain and by scaling the total as a percentage of the maximum possible score for that specific domain.
For this assignment, you will choose a guideline and assess the overall quality and whether the guideline would be recommended for use in practice.
General Requirements:
Use the following information to ensure successful completion of this assignment:
- Download the AGREE II instrument.
- Doctoral learners are required to use APA style for their writing assignments. The APA Style Guide is located in the Student Success Center. An abstract is not required.
- This assignment uses a rubric. Please Review the rubric prior to the beginning to become familiar with the expectations for successful completion.
- You are not required to submit this assignment to LopesWrite.
Directions:
Perform the following tasks to complete this assignment:
- Using the AGREE II instrument as your guide, create a table that discusses a practice guideline in which you might have questioned the recommendations. (Note: You may be able to copy and paste the instrument into a new Word document and complete the information.)
- Each domain must have its own cell (similar to the one shown in the manual) and add domain scores and an overall guideline assessment. Be sure to include comments and additional considerations that influenced your rating decision and cite any sources used.
Portfolio Practice Hours:
Practice immersion assignments are based on your current course objectives, and are intended to be application-based learning using your real-world practice setting. These assignments earn practice immersion hours, and are indicated in the assignment by a Portfolio Practice Hours statement which reminds you, the learner, to enter in a corresponding case log in Typhon. Actual clock hours are entered, but the average hours associated with each practice immersion assignment is 10.
You are required to complete your assignment using real-world application. Real-world application requires the use of evidence-based data, contemporary theories, and concepts presented in the course. The culmination of your assignment must present a viable application in a current practice setting. For more information on parameters for practice immersion hours, please refer to DNP resources in the DC Network.
To earn portfolio practice hours, enter the following after the references section of your paper:
Practice Hours Completion Statement DNP-820
I, (INSERT NAME), verify that I have completed (NUMBER OF) clock hours in association with the goals and objectives for this assignment. I have also tracked said practice hours in the Typhon Student Tracking System for verification purposes and will be sure that all approvals are in place from my faculty and practice mentor.
Critical Appraisal of Practice Guidelines
1
Unsatisfactory
0.00% 2
Less Than Satisfactory
74.00% 3
Satisfactory
79.00% 4
Good
87.00% 5
Excellent
100.00%
70.0 %Content
20.0 %Discuss a practice guideline in which you might have questioned the recommendations. Discussion of the practice is not presented. Discussion of the practice is presented but incomplete. Discussion of the practice is presented but at a cursory level. Critical Appraisal of Practice Guidelines Discussion of the practice is clearly presented and convincing. Sources cited are from current scholarly but some outdated sources. Discussion of the practice is clearly presented and perceptive. Sources cited are from current scholarly sources.
25.0 %Create a table for each domain (similar to the one shown in the manual) and add domain scores and an overall guideline assessment. A table with each domain is not presented. A table with each domain is presented but incomplete. A table with each domain is presented but at a cursory level. A table with each domain is clearly presented. Scores are present for each domain and justification is beyond surface understanding. A table with each domain is clearly presented. Scores are present for each domain and justification is insightful.
25.0 %Create a table for the overall guideline assessment. A table for the overall guideline assessment is not presented.Critical Appraisal of Practice Guidelines A table for the overall guideline assessment is presented but incomplete. A table for the overall guideline assessment is presented but at a cursory level. A table for the overall guideline assessment is clearly presented and convincing. A table for the overall guideline assessment is clearly presented and perceptive.
20.0 %Organization and Effectiveness
7.0 %Thesis Development and Purpose Paper lacks any discernible overall purpose or organizing claim. Thesis and/or main claim are insufficiently developed and/or vague; purpose is not clear. Thesis is apparent and appropriate to purpose.Critical Appraisal of Practice Guidelines Thesis is clear and forecasts the development of the paper. Thesis is descriptive and reflective of the arguments and appropriate to the purpose. Thesis is comprehensive and contains the essence of the paper. Thesis statement makes the purpose of the paper clear.
8.0 %Argument Logic and Construction Statement of purpose is not justified by the conclusion. The conclusion does not support the claim made. Argument is incoherent and uses noncredible sources.Critical Appraisal of Practice Guidelines Sufficient justification of claims is lacking. Argument lacks consistent unity. There are obvious flaws in the logic. Some sources have questionable credibility. Argument is orderly, but may have a few inconsistencies. The argument presents minimal justification of claims. Argument logically, but not thoroughly, supports the purpose. Sources used are credible. Introduction and conclusion bracket the thesis. Argument shows logical progressions. Techniques of argumentation are evident. There is a smooth progression of claims from introduction to conclusion. Most sources are authoritative. Clear and convincing argument that presents a persuasive claim in a distinctive and compelling manner is present. All sources are authoritative.
5.0 %Mechanics of Writing (includes spelling, punctuation, grammar, language use) Surface errors are pervasive enough that they impede communication of meaning. Inappropriate word choice and/or sentence construction are used. Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register), sentence structure, and/or word choice are present. Some mechanical errors or typos are present, but are not overly distracting to the reader. Correct sentence structure and audience-appropriate language are used. Prose is largely free of mechanical errors, although a few may be present. A variety of sentence structures and effective figures of speech are used. Writer is clearly in command of standard, written, academic English.Critical Appraisal of Practice Guidelines
10.0 %Format
5.0 %Paper Format (Use of appropriate style for the major and assignment) Template is not used appropriately or documentation format is rarely followed correctly. Appropriate template is used, but some elements are missing or mistaken. A lack of control with formatting is apparent. Appropriate template is used. Formatting is correct, although some minor errors may be present. Appropriate template is fully used. There are virtually no errors in formatting style. All format elements are correct.
5.0 %Documentation of Sources (citations, footnotes, references, bibliography, etc., as appropriate to assignment and style) Sources are not documented.Critical Appraisal of Practice Guidelines Documentation of sources is inconsistent or incorrect, as appropriate to assignment and style, with numerous formatting errors. Sources are documented, as appropriate to assignment and style, although some formatting errors may be present. Sources are documented, as appropriate to assignment and style, and format is mostly correct. Sources are completely and correctly documented, as appropriate to assignment and style, and format is free of error.
100 %Total Weightage
The Ten Strategic Points Sample Paper
| 10 Strategic Points | Comments/Feedback | |
| Broad Topic Area | Evaluation of benefits of transradial vs. transfemoral cardiac catheterization for adult patients in a Level I Trauma Center located in Alabama | |
| Literature Review | Background of the Study
Cardiac problems, especially the coronary artery diseases, are among the common ailments experienced in various healthcare institutions. Basing the issue on the sensitivity of the heart to cardiac problems, healthcare providers pride the various approaches used to combat diseases for that matter. The transfemoral approach takes place in light of femoral artery at the groin that serves as the main channel for catheterization to the chest (Sanidas, Buysschaert & van Langenhove, 2014) On the other hand, the transradial approach utilizes radial artery whereby the catheter is inserted with a balloon in it to facilitate opening of the blocked artery (Aamir, Mohammed, & Sudhir, 2016). That being said, it is not clear if transradial approach is better than the transfemoral approach hence giving the study a new starting point. Therefore, basing the research on level 1 trauma center in Alabama in relation to determining the benefits of both transradial and transfemoral approach is critical in the attempt to evaluating the best approach to adopt. Theoretical Foundations Organizational change theory The organizational change theory is one of the models that highlight more on organizational capabilities in making either transradial or transfemoral approach a success. The theory considers both approaches as a non-issue and lays blame on the involved healthcare providers bearing in mind that they need to be innovative enough to better the patient care outcomes (Basile et al., 2018). However, the organizational change theory also appreciates Lewin’s theory of change which elaborates that caregivers in the cardiac catheterization laboratory must incorporate and embrace new changes to facilitate the quality of the outcomes. In this case, embarking on transradial approach becomes the center of attention since the approach allows treatment modifications necessary to containing artery problems. Theory of diffusion Recent research conducted by Dibraa (2015) suggests that the theory of diffusion seeks to explain rates, means and reasons at which embracement of new ideas takes place. In a healthcare arena, the diffusion theory outlines that transradial approach is one of the new ideas that healthcare providers need to prioritize as it easily accomplishes treatment objectives. System theory System theory is a clinician-based model that steers caregivers to understanding the operation of a given system. One of the fascinating ideas regarding system theory is that it does not favor transradial catheterization approach more than the transfemoral approach (McEvoy et al., 2014). Instead, it encourages the caregiver to comprehend how each approach works particularly radial and femoral artery. In so doing, any of the two approaches can yield dependable results.
Review of Literature According to Seto et al. (2015), transfemoral and transradial cardiac catheterization work best to diagnose various heart conditions. However, the transfemoral approach does not hold insisting on its unwelcome outcomes ranging from prolonged hospital stays to nerve bleeding. On the same note, the transfemoral approach is known for causing bleeding at the puncture site. Major complications associated with femoral catheterization technique include death by major vascular bleeding (Piccolo et al., 2014). It is significant to note that femoral artery is wider than the radial artery, an aspect that subjects the patient to excessive bleeding after treatment. Basile et al. (2018) posit that Transradial approach is the best move toward containing cardiac artery diseases simply because the patients can walk right after treatment. As explained above, the radial artery is small enough to allow pressure pumping in a bid to contain bleeding after the procedure is complete. As such, Transradial approach has recently gained popularity in Asia and Europe due to its decreased impacts on bleeding complications. It is unfortunate that femoral artery does not hold when it comes to applying direct pressure to combat bleeding hence proving to be an ineffective method of treating cardiac problems. However, much transradial catheterization appears to be; it is only limited to patients with sufficient blood flow to their hands. The reason behind the good supply of blood is to assist in tackling issues of artery blockage (Jang et al., 2016). The transradial approach also leads to problems such as nerve damage, blood clot and damage to the blood vessel. Whichever the case, it is always necessary for healthcare providers to understand the required procedures in each case to minimize the risks involved. Summary: Femoral artery has a wider lumen than radial artery making it more accessible by practitioners (Qi et al., 2017). As such, the femoral approach is common than the transradial approach. The dangers of the femoral approach outweigh the benefits of the transradial approach. Transradial procedure minimizes vascular and nerve injuries as well as patient morbidity which have dangerous consequences.
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| Problem Statement | Heart conditions have been known to increase with age, and in some cases, they lead to the death of the individuals who have not taken a keen interest in checking their vulnerability. Interventions to the heart conditions early enough, therefore, can save the lives of the potentially vulnerable people. The purpose of cardiac catheterization, therefore, is to detect early heart conditions after which the right intervention methods can be applied for timely treatment (Feldkamp et al., 2018). The approaches used to diagnose possible heart conditions have nonetheless been marred with many risks which have often outweighed the approach’s many benefits. Even though the transfemoral interventions that have often been used have been associated with more health problems, it is not known if prioritization of transradial catheterization approach is reliable enough. | 1. |
| Clinical/PICO Questions | P – Adult patients aged 45 and above with heart diseases
I – Cardiac catheterization in both groups of patients. C – Transradial Vs. Femoral approaches. O – Reduced complications and problems during cardiac catheterization. T – The study was set to take place for three months during which the patients that have undergone the procedures would offer information regarding the procedure undertaken. |
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| Sample | A sample of 50 adult patients with heart diseases aged 45 years and above will be necessary for the study. It is quite important to highlight that the sample contains both the healthcare providers and the patients in that caregivers would give individual accounts of their knowledge on transradial and transfemoral approach while the patients’ responses to such approaches are recorded as well (Sahlström, 2016). The study will take place in the Level I Trauma Center located in Alabama.
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| Define Variables | Independent variable: Femoral and Transradial catherization procedures.
Dependent variables: The follow-up checks carried out by practitioners. That is, Follow up checks carried out by practitioners(Y) = Femoral(X) or Transradial (Z) catheterization procedures. It is also true to deduce that Reduction in bleeding complications, readmissions, infections, and improved patient comfort (Y) = Femoral(X) or Transradial (Z) catheterization procedures. That means, for patients to pride reduction in bleeding complication, improved patient comfort, and reduced infections and readmissions, it all depends on the choice of catheterization procedures (transradial or transfemoral). |
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| Methodology and Design | The project will use the qualitative methodology and quasi-experimental design. Qualitative methodology rightly fits in most of the studies citing its ability to capture expressive information (Thanh, 2015). Unlike quantitative methodology that relies on feelings, values, and beliefs, the quantitative method serves best to get to the bottom line of the whole issue concerning the suitability of both transfemoral and transradial approaches. It is not possible to leave cardiac ailments at the mercies of feelings and values since the study seeks to identify the best treatment approach by evaluating the data at hand. The quasi-experimental design serves best to facilitate the quality of the study because it combats disruption. One of the facts about quasi-experimental design is that it works on the basis of arbitrary selection of participants (Ceritoglu et al., 2017). It would, therefore, be important for the study to arbitrarily select the first 50 patients according to the order in which they appear in the healthcare register to avoid unnecessary commotion not forgetting research only seeks to highlight the variation in the recovery process to determine the right catheterization approach. | |
| Purpose Statement | The main purpose of this quantitative study is to explore and describe the benefits of using the transradial approach for cardiac catheterization over the classical transfemoral approach of cardiac catheterization in the adult patients in the Level I Trauma Center located in Alabama. This is measured by a reduction in bleeding complications, readmissions, infections, and improved patient comfort over a period of 4 weeks. It, therefore, helps the healthcare practitioners administering care in the facility to reflect under the project in the process of identifying the benefits and the negative impact of the approach outcomes through the nominal scale. |
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| Data Collection Approach | There would be the use of interviews and questionnaires to find out basic information regarding the femoral and transradial approaches from the sample population and the healthcare providers (Vaismoradi, Jordan & Kangasniemi, 2015). In particular, interviews will purposely serve the healthcare providers as it will allow them to express their knowledge of both femoral and transradial approaches. In such a case, the reliability and validity in terms of success rate about reduced bleeding, reduced hospital stays linked to catheterization approaches will be examined.
The open-ended questionnaire will rightly fit the sampled patients because it will take care of their privacy and ensure their relationships with the healthcare providers will not be undermined. Now that the study blends both the patients who underwent transfemoral approach of cardiac catheterization and those committed to transradial approach of cardiac catheterization, the open-ended questionnaire will be the best fit in examining patients’ encounters for that matter. For instance, the questionnaire would assess both cases by requiring the patients to record the extents of bleeding at the puncture site, comfort, and readmissions. It is from that point the study will gain momentum particularly in determining the right procedure to apply when treating cardiac ailments. For example, if the questionnaires indicate a high number of readmissions for patients that underwent transradial catheterization, it would mean transfemoral approach is more effective and vice versa. |
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| Data Analysis Approach | Here, the use of the independent T-tests will be critical in determining the best approach to treat the sample population. The t-test surpasses other data analysis approaches in that it enhances statistical significance (Kim, 2015). In other words, in the end, the researcher can fully understand the meaning of the results. One of the facts about t-test is that it gives accounts populations regarding their means while explaining why the means significantly differ. In the case of the research at hand, the participants constitute both transfemoral and transradial approaches. Considering such factors as a reduction in bleeding complications, readmissions, infections, and improved patient comfort it will be possible to achieve dependable outcomes regarding the t-test as it will expose mean differences of the sample population hence contributing the selection of the most appropriate approach to containing heart-related problems. The t-test will also justify the sample size thus yielding multiple benefits to the study. |
References
Aamir, S., Mohammed, S., & Sudhir, R. (2016). Transradial approach for coronary procedures in the elderly population. Journal of Geriatric Cardiology: JGC, 13(9), 798.
Basile, A., Rebonato, A., Failla, G., Caltabiano, G., Boncoraglio, A., Gozzo, C., … & Garcia-Medina, J. (2018). Early post-procedural patients compliance and VAS after UAE through transradial versus transfemoral approach: preliminary results. La Radiologia Medica, 1-5.Critical Appraisal of Practice Guidelines
Ceritoglu, E., Yunculer, H. B. G., Torun, H., & Tumen, S. (2017). The impact of Syrian refugees on natives’ labor market outcomes in Turkey: evidence from a quasi-experimental design. IZA Journal of Labor Policy, 6(1), 5.Critical Appraisal of Practice Guidelines
Dibraa, M. (2015). Rogers theory on diffusion of innovation-the most appropriate theoretical model in the study of factors influencing the integration of sustainability in tourism businesses. Procedia-Social and Behavioral Sciences, 195, 1453-1462.
Feldkamp, T., Luedemann, M., Spehlmann, M. E., Freitag-CreWolf, S., Gaensbacher, J., Schulte, K., … & Frey, N. (2018). Radial access protects from contrast media induced nephropathy after cardiac catheterization procedures. Clinical Research in Cardiology, 107(2), 148-157.Critical Appraisal of Practice Guidelines
Jang, H. J., Kim, J. Y., Han, J. D., Lee, H. J., Kim, J. S., Park, J. S., … & Kim, T. H. (2016). Numbness after transradial cardiac catheterization: the results from a nerve conduction study of the superficial radial nerve. Korean circulation journal, 46(2), 161-168.
Kim, T. K. (2015). T test as a parametric statistic. Korean Journal of Anesthesiology, 68(6), 540-546.
McEvoy, R., Ballini, L., Maltoni, S., O’Donnell, C. A., Mair, F. S., & MacFarlane, A. (2014). A qualitative systematic review of studies using the normalization process theory to research implementation processes. Implementation Science, 9(1), 2.
Piccolo, R., Galasso, G., Capuano, E., De Luca, S., Esposito, G., Trimarco, B., & Piscione, F. (2014). Transradial versus transfemoral approach in patients undergoing percutaneous coronary intervention for acute coronary syndrome. A meta-analysis and trial sequential analysis of randomized controlled trials. PLoS One, 9(5), e96127.Critical Appraisal of Practice Guidelines
Qi, G., Sun, Q., Xia, Y., & Wei, L. (2017). Emergency percutaneous coronary intervention through the left radial artery is associated with less vascular complications than emergency percutaneous coronary intervention through the femoral artery. Clinics, 72(1), 1-4.
Sahlström, M., Partanen, P., Rathert, C., & Turunen, H. (2016). Patient participation in patient safety still missing: Patient safety experts’ views. International Journal of Nursing Practice, 22, 5, 461-469
Sanidas, E. L. I. A. S., Buysschaert, I., & van Langenhove, G. (2014). Iatrogenic left main coronary artery dissection and intramural hematoma caused by diagnostic transradial cardiac catheterization. Hellenic J Cardiol, 55(1), 65-69.
Seto, A. H., Roberts, J. S., Abu-Fadel, M. S., Czak, S. J., Latif, F., Jain, S. P., … & Kern, M. J. (2015). Real-time ultrasound guidance facilitates transradial access: RAUST (Radial Artery access with Ultrasound Trial). JACC: Cardiovascular Interventions, 8(2), 283-291.
Thanh, N. C., & Thanh, T. T. (2015). The interconnection between interpretivist paradigm and qualitative methods in education. American Journal of Educational Science, 1(2), 24-27.
Vaismoradi, M., Jordan, S., & Kangasniemi, M. (2015). Patient participation in patient safety and nursing input – a systematic review. Journal of Clinical Nursing, 24(5/6), 627-639 Critical Appraisal of Practice Guidelines
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DNP 815 10 Strategic Points Table
(Use this table to complete the 10 Strategic Points document for your project.)
| 10 Strategic Points | Comments/Feedback | |
| Broad Topic Area | Benefits of transradial vs. femoral cardiac catheterization patient downtime. | |
| Literature Review | Background of the study and literature review:
Femoral approach is classical approach used to diagnose heart diseases. Transradial approach came up as solution to femoral procedures (Stefanescu Schmidt et al., 2017). The femoral approach can be performed to the same patient, especially those with pulses difficult to pulpate. The minor complications that may occur during transfemoral access include hematomas, fistulae and signs of pseudoaneurysm (Garbade et al., 2016). Major complications associated with femoral catheterization technique include death by major vascular bleeding. Transradial approach has recently gained popularity in Asia and Europe due to its decreased impacts on bleeding complications. It takes 10 to 15 minutes longer than the transfemoral approach (Squire et al., 2014). Bleeding at the radial artery can be controlled easily through compression, this may be difficult in the transfemoral approach Stefanescu Schmidt et al., 2017). The transradial approach offers easy access, fewer complications, timely ambulation, and less total costs of hospitalization when compared to the classical transfemoral access (Garbade et al., 2016). Summary: Femoral artery has a wider lumen than radial artery making it more accessible by practitioners. As such, femoral approach is common than transradial approach. The dangers of the femoral approach outweigh the benefits of transradial approach. Transradial procedure minimizes vascular and nerve injuries as well as patient morbidity which have dangerous consequences. |
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| Problem Statement | Heart conditions have been known to increase with age, and in some cases, they lead to the death of the individuals who have not taken a keen interest in checking their vulnerability. Interventions to the heart conditions early enough, therefore, can save the lives of the potentially vulnerable people. The purpose of cardiac catheterization, therefore, is to detect early heart conditions after which the right intervention methods can be applied for timely treatment. The approaches used to diagnose possible heart conditions have nonetheless been marred with many risks which have often outweighed the approach’s many benefits. Even though, the transfemoral interventions that have often been used have been associated with more health problems which raise interest in how the transradial approach may be relied on as a better approach. | |
| Clinical/PICO Questions | P – Adult patients aged 45 and above with heart diseases
I – Cardiac catheterization in both groups of patients. C – Transradial Vs. Femoral approaches. O – Reduced complications and problems during cardiac catheterization. T – The study was set to take place for three months during which the patients that have undergone the procedures would offer information regarding the procedure undertaken. |
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| Sample | Adults 45 years and above.
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