State your clinical/practice question and explore the literature pertaining to your clinical/practice problem as you described in your Module 3 Discussion Board.
CThe purpose of this assignment is to state your clinical/practice question and explore the literature pertaining to your clinical/practice problem as you described in your Module 3 Discussion Board. According to Moran et al. (2020) when conducting a literature review, the goal is to obtain a representative sample of the literature which describes the concepts related to the phenomenon of interest and the research results applicable to the clinical/practice question and identify what gaps need to be further researched. Your work for this paper may be used to build upon your scholarly project and publishable manuscript—thus it is important that you align your literature review with the topic you have selected (or are considering) for your PICOT question and DNP project.
Instructions:
Your work for this paper may be used to build upon your scholarly project and publishable manuscript—thus it is important that you align your literature review with the topic you have selected (or are considering) for your PICOT question and DNP project.
Paper length is no more than 8 pages excluding references and title page.
DNP 800 ROL Exemplar 2019-.pdfonstruction of Clinical/Practice Question and Literature Review.
Requirements: 6-8 pages
Running head: LITERATURE REVIEW 1 Construction of Practice Question and Literature Review Student Name Northern Kentucky University
LITERATURE REVIEW 2 Construction of Practice Question and Literature Review This paper is the first step of the author’s scholarly project for the Doctor of Nursing degree. The paper will state the practice question for scholarly project to be developed. This paper will present a literature review of the available evidence within the last four years that addresses the practice problem. Appraisal of some of the evidence will be presented. Exploration of needed further research on the topic will also be discussed. Introduction & Practice Question The author’s scholarly project will be focused on the new graduated nurses and confidence to advocate patient changes to the interprofessional team. All new graduates who take the Registered Nurse National Council Licensure Examination are exposed to information about patient advocacy and collaboration with the interdisciplinary team (NCSBN, 2016). Learning about these concepts in a classroom is much different than application in a clinical setting. New graduates must have confidence and be assertive when communicating a change in patient’s condition to a health care provider. The author’s wants to implement a project that will assist new nursing graduates to feel confident speaking up for patents. The practice question asks, (P) In nurses working in an acute care setting and who have graduated within the past 6 months (I) what is the effect of interprofessional patient simulation (C) compared with no simulation on (O) increased confidence in communicating with health care team members about patient changes (T) within the time frame of end of orientation, 6 months, and one year? The author searched for the knowledge regarding new graduate nurses’ confidence in the ability to communicate with physicians. Literature was searched using Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, and Google Scholar. Databases were
LITERATURE REVIEW 3 searched with using the terms new graduate nurses, patient simulation, physicians, confidence, and also included several synonyms of the terms. These terms were searched using “AND” and resulted in an initial finding of one article. A broad criteria was then adopted using terms in any order or combinations to find articles that discussed new nurses and confidence with a focus on situations with a physicians. Inclusion criteria was restricted to peer-reviewed, related to experiences in nursing practice or transition to practice, and English language research between 2014 and 2018. Excluded any research that was focused on strategies only implemented in nursing programs with students. A total of 25 abstracts were reviewed for relevance, 20 articles were read for consideration and 7 was the total number of articles used in the literature review. Review of Literature New nurses reported that they lacked professional confidence at the beginning of their career (Ortiz, 2016). New graduate nurses expressed the learning to challenge, speak up, is a complex process that is dependent on experiences. When new graduate nurses did raise concerns about a potential patient safety issues, there was a lack of responsiveness from other nurses and superiors (Yee-Shuri Law, & Chan, 2015). The historical role of nurses being subservient to physicians could lead to a lack of assertive communication (Foronda, MacWilliams, & McAuthur, 2016). New nurses reported low confidence about communicating with physicians. Berman et al., used a modified Casey-Fink Graduate Nurse Experience Survey and found that the average score for confidence about communicating with physicians as 2.73, with highest rating possible for an item as a 4 (2014). Little to no interaction with physicians occurs as nursing students and can cause fear of working with physicians. Difficult experiences were reported when communicating with members of the interdisciplinary team with physicians who were not receptive to patient
LITERATURE REVIEW 4 advocacy (Ortiz, 2016). Fear can be increased with the witnessed abusive behavior of some physicians toward other experienced nurses (Shatto & Lutz, 2017). Simulation can be a highly successful method in building interprofessional communication skills (Foronda, MacWilliams, & McAuthur, 2016; Salam, Saylor, & Cowperthwait, 2014). Nurses and physicians reported strong positive attitudes supportive for education to improve collaboration before interprofessional simulation with 26.3 % agreed and 73.7% strongly agreed; after the simulation experience, there was a statically significant shift p=0.078 with 16.1% agreed and 83.9% strongly agreed (Salam, Saylor, & Cowperthwait, 2014). New graduate nurses with simulation experiences during orientation reported an increase in confidence that continued through 12 months post experience (Rhodes et al., 2016). According to Rhodes et al., (2016), statistically significant increase in confidence scores occurred after a simulation experience. Simulation is a tool that can be used for difficult situations that may occur as a new nurse, especially a situation that requires working as a team and having crucial conversations (Ortiz, 2016). Appraisal and Synthesis Appraisal This author divided the evidence into subcategories by type in order to complete the appraisal of the research. The evidence hierarchy from Polit & Beck (2017) was used for the appraisal. The Critical Appraisal Skills Programme (CASP) checklist were used to appraise the cohort study (2018). Guidelines from Polit & Beck (2017) were used to critique literature reviews. Appraisal of surveys was completed with tool from Center for Evidence-Based Management (2018). The qualitative studies were not appraised related to the page count restriction for this assignment.
LITERATURE REVIEW 5 Cohort Study Rhodes et al. (2016) is level 4 (Polit & Beck, 2017) prospective cohort study. The study had a clear focus. A power analysis of n=72 was determined as an appropriate sample size. All newly licensed registered nurses at the institution in the residency were required to participate in the simulations, an initial and multidisciplinary. 93 new nurses participated in the residency at the time of study. All of new nurses participated in the simulations and some were asked to complete surveys prior to the simulation at baseline, post simulation, and six, twelve, eighteen months post simulation. Completion of the surveys was considered consent. Content validity of the measurement tools was completed. Possible confounding factors are not discussed in the research or does this author believe it occurred. Highest response rates were from baseline and 6 months and decreased at 18 months. This author is not clear with the actual completion rate, but from the result one can infer that the response rate may have dropped to 81%. The follow-up to 18 months does appear to be sufficient to measure the study outcome. Increases in knowledge were modest from mean scores, was not statistically significant and this was confirmed with Friedman test. Steady increase in mean scores for confidence measurements, and Friedman test indicate statistically significant increases after initial simulation to 18 months. Multidisciplinary training did not result in statistically significant confidence level changes. Wilcoxan signed rank tests indicate statistically significant changes in satisfaction after simulations with the multidisciplinary being highest. Confidence intervals are not present. Type II error is likely related to decreased response rates and some with the data being underpowered. Results are believable, but hard to clearly discern what the actual completion rates were for each survey period. This results can be applied to other nurse residency programs with simulation components. This author cannot comment if the results fit with other available evidence, since
LITERATURE REVIEW 6 other cohort studies were not found for this literature review. Results were used to modify the institution’s nurse residency program, other practice implications were not discussed. Surveys Salam, Saylor, & Cowperthwait (2014) is a level 6 (Polit & Beck, 2017) cross-sectional survey. The study is clearer focused on the issue and the study design is appropriate for the pilot program. The participants came from three institutions to collaborate on this study. Selection bias may be present, there is no discussion of randomization in the study. Participants are representative of the population being studied. Participants include medical and nursing students, residents, nurse interns, and faculty. Sample size was made up of 68 participants. The study does not mention statistical power for appropriate sample size. A 96% survey completion rate was achieved. The survey used a 4-point Likert scale to rate confidence of rating pain and also part of the Jefferson Scale of Attitudes Toward Physician-Nurse Collaboration, these tools are likely to be valid and reliable. Statistical significance was assessed and met with confidence after simulation and in attitudes toward interprofessional collaboration. Confidence intervals are not present. Person confounding is possible since students, residents, and nurse interns are all included in the same sample. The results are applicable to practice when planning interprofessional simulations. Berman et al., (2014) is a level 6 (Polit & Beck, 2017) cross-sectional survey. The study is focused on the competence gaps among new registered nurse graduates and research method is appropriate. The process of selection of subjects is clearly described. Participants were total of 345 new graduates, from 23 different schools of nursing, enrolled in the program where the surveys were administered. Selection bias is possible with a limited number of program spots and there were at least three qualified applicants for every program spot. Participants are
LITERATURE REVIEW 7 representative of the population being studied with all being currently unemployed new registered nurse graduates. The study does not mention statistical power for appropriate sample size. Completion rate of the survey is not mentioned in the study. Modified Casey-Fink Graduate Nurse Experience Survey was administered and likely a valid and reliable tool. Statistical significance was not measured and confidence intervals are not present. Person confounding is possible since students from 23 different schools of nursing and various degree programs, including associate, baccalaureate, and direct entry master degrees, are all included in the same sample. The results are applicable to practice and can be used to consider confidence and competence gaps of new graduate nurses. Qualitative Studies Yee-Shuri Law, & Chan (2015) is a level 7 (Polit & Beck, 2017) narrative inquiry study based on three new graduate nurses in Hong Kong. The findings cannot be transferable to all new graduate nurses, but meant to help others to understand the process of learning to speak up for one’s self. Ortiz (2016) is a level 7 (Polit & Beck, 2017) descriptive qualitative study with a convenience sample of 12 new graduate nurses. Data was collected with the use of interviews. Results are not transferable to all new graduate nurses related to the small purposive sample of participants from two hospitals in the New York area. The results from the study give insight about the process of developing professional confidence. Literature Reviews Shatto & Lutz (2017) is a level 8 (Polit & Beck, 2017) literature review that included evidence from 12 primary source articles about transition to practice of new nurses from 2003-2017. All of the research is focused on the nursing profession. The articles used are from
LITERATURE REVIEW 8 academic journals, but do not specifically state as peer-reviewed. Shatto & Lutz review is summary of the existing work and does not identify gaps in literature or critically appraise the articles. The review is organized, objective, and tentative in language with the use of paraphrasing when discussing findings. The literature review does not make education or practice implications. The review is not part of a research report and there is no clear support for new research studies. Foronda, MacWilliams, & McAuthur, 2016 is a level 8 (Polit & Beck, 2017) literature review that included primary source evidence from 18 research studies, six papers, three literature reviews, and one theoretical framework paper from 2005 until 2014. The literature review includes research from various disciplines which is appropriate since focusing on interprofessional communication. The literature review does not include peer-reviewed as an inclusion criteria. The research is well-organized, appraised and compared within the literature review. The review does have many quotes embedded from the original evidence, but does examine the limitations. The review discusses recommendations for both education and practice. Areas for further exploration is discussed. Synthesis Based on the evidence for this literature review, three synthesis statements can be made. First, new graduate nurses have a lack of confidence (Ortiz, 2016); (Yee-Shuri Law, & Chan, 2015); (Berman et al., 2014). Second, new graduate nurses have a difficult time speaking to physicians (Berman et al., 2014); (Shatto & Lutz, 2017); (Foronda, MacWilliams, & McAuthur, 2016); (Ortiz, 2016); (Yee-Shuri Law, & Chan, 2015). Third, simulation experiences have a positive influence on confidence of new graduate nurses (Foronda, MacWilliams, & McAuthur, 2016); (Salam, Saylor, & Cowperthwait, 2014); (Rhodes et al., 2016).
LITERATURE REVIEW 9 Conclusion There is a lack of evidence about the author’s PICOT question. The article by Salam, Saylor, & Cowperthwait (2014) was the closet fit to the PICOT question, but does not discuss confidence of new graduate nurses. Confidence of new graduate nurses about raising concerns about patient changes to physicians needs to be studied. The nurse-physician relationship is vital for safe patient outcomes and should be research in order to find ways to improve the transition from education to practice for nurses. Simulation is a useful teaching method in education and practice. Evidence searches reveal less available research about the use of simulation in practice. More research about the use of simulation in practice is needed. Focus on these simulations effect on working with the interprofessional team and effect on confidence of new nurses should be explored. This paper explored the relevant literature about new nurse confidence levels communicating with physicians. Creative searching was needed to expand the topic to find research to review. The lack of evidence was not anticipated by the author of the paper. The analysis of literature found limited strength of evidence. Generalizability and transference from the research to a greater audience is limited. There is an obvious gap in the research for the author’s PICOT question. More research needs to be done to explore ways to increase confidence of new graduate nurses discussing patient concerns to physicians. This topic is important to explore and an appropriate focus for a Doctor of Nursing scholarly project.
LITERATURE REVIEW 10 References Berman, A., Beazley, B., Karshmer, J., Prion, S., Van, P., Wallance, J., & West, N. (2014). Competence gaps among unemployed new nursing graduates entering a community-based transition-to-practice program. Nurse Educator, 39(2), 56-61. doi: 10.1097/NNE.0000000000000018. Center for Evidence-Based Management (2018). Critical Appraisal of a Cross-Sectional Study (Survey). [online]. Retrieved from https://www.cebma.org/wp-content/uploads/Critical-Appraisal-Questions-for-a-Cross-Sectional-Study-july-2014.pdf. Critical Appraisal Skills Programme (2018). CASP Cohort Study Checklist. [online]. Retrieved from https://casp-uk.net/wp-content/uploads/2018/01/CASP-Cohort-Study-Checklist.pdf. Foronda, C., MacWilliams, B., & McArthur, E. (2016). Interprofessional communication in healthcare: An integrative review. Nurse Education in Practice, 1936-40. doi: 10.1016/j.nepr.2016.04.005 Law, B.Y., & Chan, E.A. (2015). The experiences of learning to speak up: a narrative inquiry on newly graduated registered nurses. Journal of Clinical Nursing, 24(13/14), 1837-1848. doi: 10.1111/jocn.12805 National Council of State Boards of Nursing (NCSBN) (2016). 2016 NCLEX-RN Test Plan. Retrieved from https://www.ncsbn.org/RN_Test_Plan_2016_Final.pdf Ortiz, J. (2015). New graduate nurses’ experiences about lack of professional confidence. Journal of Continuing Education in Nursing, 46(1), 34-40. doi:10.3928/00220124-20141122-01. Polit, D. & Beck, C. (2017). Nursing Research Generating and Assessing Evidence for Nursing Practice. (10th ed.). Philadelphia: Wolters Kluwer.
LITERATURE REVIEW 11 Rhodes, C.A., Grimm, D., Kerber, K., Bradas, C., Halliday, B., McClendon, S., & Medes, J., Noeller, T.P., & McNett, M. (2016). Evaluation of nurse-specific and multidisciplinary simulation for nurse residency programs. Clinical Simulation in Nursing, 12(7), 243-250. doi:10.1016/j.ecns.2016.02.010 Salam, T., Saylor, J.L., & Cowperthwait, A.L. (2015). Attitudes of nurses and physicians trainees toward an interprofessional simulated education experience on pain assessment and management. Journal of Interprofessional Care, 29(3), 276-278. doi: 10.3109/13561820.2014.950726 Shatto, B., & Lutz, L.M. (2017). Transition from education to practice for new nursing graduates: A literature review. Creative Nursing, 23(4), 248-254. doi: 10.1891/1078-4535.23.4.248.
Collepals.com Plagiarism Free Papers
Are you looking for custom essay writing service or even dissertation writing services? Just request for our write my paper service, and we'll match you with the best essay writer in your subject! With an exceptional team of professional academic experts in a wide range of subjects, we can guarantee you an unrivaled quality of custom-written papers.
Get ZERO PLAGIARISM, HUMAN WRITTEN ESSAYS
Why Hire Collepals.com writers to do your paper?
Quality- We are experienced and have access to ample research materials.
We write plagiarism Free Content
Confidential- We never share or sell your personal information to third parties.
Support-Chat with us today! We are always waiting to answer all your questions.
