Assignment: Evidence-Based Project, Part 3: Critical Appraisal of Research NURS 6052

Walden University Assignment: Evidence-Based Project, Part 3: Critical Appraisal of Research NURS 6052-Step-By-Step Guide

This guide will demonstrate how to complete the Walden University Assignment: Evidence-Based Project, Part 3: Critical Appraisal of Research NURS 6052 assignment based on general principles of academic writing. Here, we will show you the A, B, Cs of completing an academic paper, irrespective of the instructions. After guiding you through what to do, the guide will leave one or two sample essays at the end to highlight the various sections discussed below.

How to Research and Prepare for Assignment: Evidence-Based Project, Part 3: Critical Appraisal of Research NURS 6052

Whether one passes or fails an academic assignment such as the Walden University Assignment: Evidence-Based Project, Part 3: Critical Appraisal of Research NURS 6052 depends on the preparation done beforehand. The first thing to do once you receive an assignment is to quickly skim through the requirements. Once that is done, start going through the instructions one by one to clearly understand what the instructor wants. The most important thing here is to understand the required format—whether it is APA, MLA, Chicago, etc.

After understanding the requirements of the paper, the next phase is to gather relevant materials. The first place to start the research process is the weekly resources. Go through the resources provided in the instructions to determine which ones fit the assignment. After reviewing the provided resources, use the university library to search for additional resources. After gathering sufficient and necessary resources, you are now ready to start drafting your paper.

How to Write the Introduction for Assignment: Evidence-Based Project, Part 3: Critical Appraisal of Research NURS 6052

The introduction for the Walden University Assignment: Evidence-Based Project, Part 3: Critical Appraisal of Research NURS 6052 is where you tell the instructor what your paper will encompass. In three to four statements, highlight the important points that will form the basis of your paper. Here, you can include statistics to show the importance of the topic you will be discussing. At the end of the introduction, write a clear purpose statement outlining what exactly will be contained in the paper. This statement will start with “The purpose of this paper…” and then proceed to outline the various sections of the instructions.

How to Write the Body for Assignment: Evidence-Based Project, Part 3: Critical Appraisal of Research NURS 6052

After the introduction, move into the main part of the Assignment: Evidence-Based Project, Part 3: Critical Appraisal of Research NURS 6052 assignment, which is the body. Given that the paper you will be writing is not experimental, the way you organize the headings and subheadings of your paper is critically important. In some cases, you might have to use more subheadings to properly organize the assignment. The organization will depend on the rubric provided. Carefully examine the rubric, as it will contain all the detailed requirements of the assignment. Sometimes, the rubric will have information that the normal instructions lack.

Another important factor to consider at this point is how to do citations. In-text citations are fundamental as they support the arguments and points you make in the paper. At this point, the resources gathered at the beginning will come in handy. Integrating the ideas of the authors with your own will ensure that you produce a comprehensive paper. Also, follow the given citation format. In most cases, APA 7 is the preferred format for nursing assignments.

How to Write the Conclusion for Assignment: Evidence-Based Project, Part 3: Critical Appraisal of Research NURS 6052

After completing the main sections, write the conclusion of your paper. The conclusion is a summary of the main points you made in your paper. However, you need to rewrite the points and not simply copy and paste them. By restating the points from each subheading, you will provide a nuanced overview of the assignment to the reader.

How to Format the References List for Assignment: Evidence-Based Project, Part 3: Critical Appraisal of Research NURS 6052

The very last part of your paper involves listing the sources used in your paper. These sources should be listed in alphabetical order and double-spaced. Additionally, use a hanging indent for each source that appears in this list. Lastly, only the sources cited within the body of the paper should appear here.

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A Sample Answer For the Assignment: Assignment: Evidence-Based Project, Part 3: Critical Appraisal of Research NURS 6052

Title: Assignment: Evidence-Based Project, Part 3: Critical Appraisal of Research NURS 6052

Assignment: Evidence-Based Project, Part 3: Critical Appraisal of Research NURS 6052

A critical appraisal assists in reducing the research burden by enabling a researcher to identify and focus more on relevant articles to their research question. The research can either provide support or disapprove the claims made by the researcher through the utilization of quality, and evidence-based practice interventions.

The selected topic for the research study is use of resilience training to redice the problem of nurse burnout among nurses in different care settings. Nurse burnout remains a critical problem that impacts the quality of care and patient outcomes in different care setting. Resilience training allows nurses to develop and use evidence-based interventions to reduce burnout and enhance their overall performance and improve the quality of care.

Evidence-based practice (EBP) incorporates best practices from studies and patient care information with clinician experience and patient preferences leading to the delivery of highest quality of care, and improving patient outcomes. The use of EBP requires care providers to formulate a clinical question of interest. In this case, the PICOT question is: Among nurses with burnout (P), does resilience training (I) compared to no intervention (C) reduce burnout(O) in six months (T)? The purpose of this assignment is to appraises critically peer-reviewed article for evidence to support resilience training among nurses with burnout to reduce its prevalence.

The prevalence of CLABSI is high, compromising the quality of care provided to patients admitted to hospitals. As a result, there is a need to investigate evidence-based practices that can be used to reduce health issues, particularly in the ICU. The goal of this study is to evaluate the evidence on the various measures of responding to CLABSI in inpatient units.

Evaluation Table

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Full APA formatted citation of selected article.	Article #1	Article #2	Article #3	Article #4
Full APA formatted citation of selected article.	Afonso, E., Blot, K., & Blot, S. (2016). Prevention of hospital-acquired bloodstream infections through chlorhexidine gluconate-impregnated washcloth bathing in intensive care units: A systematic review and meta-analysis of randomised crossover trials. Eurosurveillance, 21(46). https://doi.org/10.2807/1560-7917.es.2016.21.46.30400	Scheier, T., Saleschus, D., Dunic, M., Fröhlich, M., Schüpbach, R., Falk, C., Sax, H., Kuster, S., & Schreiber, P. (2021). Implementation of daily chlorhexidine bathing in intensive care units for reduction of central line-associated bloodstream infections. Journal of Hospital Infection, 110, 26-32. https://doi.org/10.1016/j.jhin.2021.01.007	Reynolds, S. S., Woltz, P., Keating, E., Neff, J., Elliott, J., Hatch, D., Yang, Q., & Granger, B. B. (2021). Results of the chlorhexidine gluconate bathing implementation intervention to improve evidence-based nursing practices for prevention of central line associated bloodstream infections study (Changing baths): A stepped wedge cluster randomized trial. Implementation Science, 16(1). https://doi.org/10.1186/s13012-021-01112-4	Esposito, M. R., Guillari, A., & Angelillo, I. F. (2017). Knowledge, attitudes, and practice on the prevention of central line-associated bloodstream infections among nurses in oncological care: A cross-sectional study in an area of southern Italy. PLOS ONE, 12(6), e0180473. https://doi.org/10.1371/journal.pone.0180473
Evidence Level * (I, II, or III)	III	I	I	II
Conceptual Framework Describe the theoretical basis for the study (If there is not one mentioned in the article, say that here).**	The classic RCT methodology is best suited for medical interventions in which the therapy has a significant micro-effect. Moreover, treatment	No conceptual or theoretical framework indicated.	No theoretical framework defined	No theoretical framework defined.
Design/Method Describe the design and how the study was carried out (In detail, including inclusion/exclusion criteria).	The study involved a systematic review and meta-analysis conducted in conformity to the PRISMA and MOOSE guidelines. Sources from the various databases including MEDLINE, CINAHL, EMBASE, Scopus and Cochrane were involved. Only studies that involved randomized trials, and quasi experiment on the effect of CHG bathing versus non-CHG bathing in preventing CLABSI among the adult populations were included.	The study involved a non-randomized clinical trial. The study focused on the patients admitted in the ICU in the University Hospital Zurich.	The study involved a wedged cluster-randomized design conducted in four sequences.	The study involved cross-sectional survey.
Sample/Setting The number and characteristics of patients, attrition rate, etc.	Data were obtained from reputable journal sources and covered studies conducted in clinical setting.	The study was conducted in an ICU setting.	The study was conducted in the university hospital setting.	The study was conducted in healthcare setting
Major Variables Studied List and define dependent and independent variables	The dependent variable was CHG baths while the independent variable was the risk of CLABSI.	The predictor variable included the daily chlorhexidine bathing in ICU and while the outcome variable was risk of CLABSI.	The dependent variable was CHG bathing while the independent variable was CLABSI rates.	The dependent variable was knowledge, attitude and practice among nurses while the outcome variable was CLABSI rates.
Measurement Identify primary statistics used to answer clinical questions (You need to list the actual tests done).	The DerSimonian average intervention was used in estimating the average intervention effect. The logistic regression model was used in estimating the relationship between the dependent (predictor) and the outcome variable.	The statistics conducted included multivariable regression analysis, odd ratio, and descriptive statistics.	The primary statistics used included descriptive statistics and linear regression model.	Chis-square and t-test were used.
Data Analysis Statistical or Qualitative findings (You need to enter the actual numbers determined by the statistical tests or qualitative data).	The data analysis was quantitative based. The risk for CLABSI infections reduced the incidence of CLABSI by about 40%. The effect of the CHG bath was significant (0.67, 95% CI: 0.53–0.85).	The study was quantitative based. Multivariate analysis indicated that the intervention was significant (OR 0.47, 95% CI 0.26e0.84, P¼0.011).	The study findings indicated that the number of healthcare providers correctly identifying facts about CHG bathing increased, from 31.11 to 50.0% (χ2 = 9.32, p = .002).	Majority of nurses, with frequencies ranging from 70.7% to 90.1% were aware of the CLABSI prevention guidelines. Nursing workshops and courses (67.3%) was the main source of information CLABSIs prevention, followed by guidelines (42.7%), and internet (30.7%).
Findings and Recommendations General findings and recommendations of the research	CHG bathing can help in reducing the risks of CLABSI among the patients admitted in hospitals.	CHG bathing can help reduce the risk of CLABSI in the ICU unit.	Educating the healthcare providers on the CHG bathing improves its implementation and reduce the risk for CLABSI.	Improved knowledge on CLABSI prevention helps in enhancing adherence to infection prevention protocols.
*Appraisal and Study Quality* Describe the general worth of this research to practice. What are the strengths and limitations of study? What are the risks associated with implementation of the suggested practices or processes detailed in the research? What is the feasibility of use in your practice?	The study involved a large sample population and the data covered were appropriate. On the other hand, the main weakness is that the study was based on adult populations alone and so cannot be inferred to children. However, the findings from the study can be used in reducing CLABSI among the adults.	The study’s setting was appropriate and could provide reliable answers to the research question. On the other hand, the weakness of the study was monocentric and did not monitor the intervention and this could bias the findings. However, the results from the study are feasible.	The study recruited adequate sample population. On the other hand, the weakness was that the CHG bathing processes were not standardized and this could affect the outcome recorded. The findings from the study are feasible for clinical practice.	The study covered various aspects influencing CLABSI prevention measures. The statistical tests were appropriate. On the other hand, the main weakness was lack of standard method for measuring attitude and level of knowledge. The findings from the study are feasible and can be used for clinical practice.
Key findings	CHG bathing reduces the risk for CLABI.	CHG bathing reduces the CLABSI.	There is a need to educate ICU nursing on CHG bathing protocols.	There is need to increase education programs on reducing CLABSI.
Outcomes	Reduced CLABSI	Reduced cases of CLABSI among the ICU patients.	Increased awareness on CHG bathing	Increased knowledge on CLABSI prevention.
General Notes/Comments	Healthcare institution should implement the CHG baths among other interventions to reduce CLABSI.	The use of CHG bath can be used to reduce the risks for CLABSI among patients in ICU.	Healthcare institutions should have standard guidelines for CHG bathing.	Educating the nurses on CLABSI prevention measures allows them to implement to protocols accordingly.

Critical Appraisal of Research

The studies looked into the best practices for reducing CLABSI in ICU patients. Nosocomial infections are common in patients with catheters and central lines. Furthermore, studies show that the risk of CLABSI increases with the length of hospital stay (Afonso et al., 2016). Healthcare providers must make certain that appropriate interventions are used and that patients are only discharged when they are ready.

As a result, it is necessary to monitor and ensure safe practices in order to reduce the risk of CLABSI in patients. Bathing in CHG has been shown to reduce the risk of CLABSI (Reynolds et al., 2021). Variations in CHG bathing protocols among healthcare institutions, on the other hand, continue to be a major source of concern. As a result, procedure standardization and increased awareness are required so that all nurses understand what they should do when interacting with patients.

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Besides, there should be guidelines published and that are readily available to ensure standardized safety protocols in the ICU units. The burden of CLABSI is high and this needs that adequate and prompt interventions must be developed to curb the health menace. The guidelines should be made available to all inpatient units. Thirdly, there is a need to conduct regular trainings on the CLABSI prevention measures to ensure that all the nurses have updated information on how to respond to the CLABSI.

Finally, there is enough evidence from the analysis that CHG bathing can reduce CLABSI. Though, future studies should be conducted to explore other alternative methods that can be used alongside the intervention especially among children. In addition, having a standard protocol for CHG bathing will means that all people will be aware of what they should do to prevent CLABSI.

References

Afonso, E., Blot, K., & Blot, S. (2016). Prevention of hospital-acquired bloodstream infections through chlorhexidine gluconate-impregnated washcloth bathing in intensive care units: A systematic review and meta-analysis of randomised crossover trials. Eurosurveillance, 21(46). https://doi.org/10.2807/1560-7917.es.2016.21.46.30400

Esposito, M. R., Guillari, A., & Angelillo, I. F. (2017). Knowledge, attitudes, and practice on the prevention of central line-associated bloodstream infections among nurses in oncological care: A cross-sectional study in an area of southern Italy. PLOS ONE, 12(6), e0180473. https://doi.org/10.1371/journal.pone.0180473

Reynolds, S. S., Woltz, P., Keating, E., Neff, J., Elliott, J., Hatch, D., Yang, Q., & Granger, B. B. (2021). Results of the chlorhexidine gluconate bathing implementation intervention to improve evidence-based nursing practices for prevention of central line associated bloodstream infections study (Changing baths): A stepped wedge cluster randomized trial. Implementation Science, 16(1). https://doi.org/10.1186/s13012-021-01112-4

Scheier, T., Saleschus, D., Dunic, M., Fröhlich, M., Schüpbach, R., Falk, C., Sax, H., Kuster, S., & Schreiber, P. (2021). Implementation of daily chlorhexidine bathing in intensive care units for reduction of central line-associated bloodstream infections. Journal of Hospital Infection, 110, 26-32. https://doi.org/10.1016/j.jhin.2021.01.007

Sample Answer for Assignment: Evidence-Based Project, Part 3: Critical Appraisal of Research NURS 6052 Included After Question

Assignment: Evidence-Based Project, Part 3: Critical Appraisal of Research

The burden of CLABSI is high and this compromises the quality of care delivered to the patients admitted in the hospitals. Therefore, there is need to explore the evidence-based practices that can be used to reduce the health issue especially in the ICU. The purpose of this study is to appraise the evidences provided on the various measures of responding to the CLABSI in the inpatient units.

Evaluation Table

Full APA formatted citation of selected article.	Article #1	Article #2	Article #3	Article #4
Full APA formatted citation of selected article.	Afonso, E., Blot, K., & Blot, S. (2016). Prevention of hospital-acquired bloodstream infections through chlorhexidine gluconate-impregnated washcloth bathing in intensive care units: A systematic review and meta-analysis of randomised crossover trials. Eurosurveillance, 21(46). https://doi.org/10.2807/1560-7917.es.2016.21.46.30400	Scheier, T., Saleschus, D., Dunic, M., Fröhlich, M., Schüpbach, R., Falk, C., Sax, H., Kuster, S., & Schreiber, P. (2021). Implementation of daily chlorhexidine bathing in intensive care units for reduction of central line-associated bloodstream infections. Journal of Hospital Infection, 110, 26-32. https://doi.org/10.1016/j.jhin.2021.01.007	Reynolds, S. S., Woltz, P., Keating, E., Neff, J., Elliott, J., Hatch, D., Yang, Q., & Granger, B. B. (2021). Results of the chlorhexidine gluconate bathing implementation intervention to improve evidence-based nursing practices for prevention of central line associated bloodstream infections study (Changing baths): A stepped wedge cluster randomized trial. Implementation Science, 16(1). https://doi.org/10.1186/s13012-021-01112-4	Esposito, M. R., Guillari, A., & Angelillo, I. F. (2017). Knowledge, attitudes, and practice on the prevention of central line-associated bloodstream infections among nurses in oncological care: A cross-sectional study in an area of southern Italy. PLOS ONE, 12(6), e0180473. https://doi.org/10.1371/journal.pone.0180473
Evidence Level * (I, II, or III)	III	I	I	II
Conceptual Framework Describe the theoretical basis for the study (If there is not one mentioned in the article, say that here).**	The conceptual framework not indicated	No conceptual or theoretical framework indicated.	No theoretical framework defined	No theoretical framework defined.
Design/Method Describe the design and how the study was carried out (In detail, including inclusion/exclusion criteria).	The study involved a systematic review and meta-analysis conducted in conformity to the PRISMA and MOOSE guidelines. Sources from the various databases including MEDLINE, CINAHL, EMBASE, Scopus and Cochrane were involved. Only studies that involved randomized trials, and quasi experiment on the effect of CHG bathing versus non-CHG bathing in preventing CLABSI among the adult populations were included.	The study involved a non-randomized clinical trial. The study focused on the patients admitted in the ICU in the University Hospital Zurich with the cases of CLABSI analyzed after the implementation of CHG bathe.	The study involved a wedged cluster-randomized design conducted in four sequences. The indices of CLABSI among the patients undergoing the CHG bathing were analyzed before and after the implementation of bath protocol in the hospital.	The study involved cross-sectional survey where the target population were given questions to indicate their level of knowledge and awareness on CHG bathing.
Sample/Setting The number and characteristics of patients, attrition rate, etc.	Data were obtained from reputable journal sources and covered studies conducted in clinical setting. The sample population was 22,850 patients with 8% attrition rate.	The study was conducted in an ICU setting. The sample population was 5008 patients. All participants were included. The attrition rate was 0%.	The study was conducted in the university hospital setting. The total sample population was 1640. All the participants were included in the study. Attrition rate was 0%.	The study was conducted in healthcare setting. A total of 335 nurses were included in the study. The attrition rate was 0%.
Major Variables Studied List and define dependent and independent variables	The major variables were CHG bath and risk for CLABSI. The dependent variable was CHG baths while the independent variable was the risk of CLABSI.	The major variables were daily CHG bathe and CLABSI incidences. The predictor variable included the daily chlorhexidine bathing in ICU and while the outcome variable was risk of CLABSI.	The variables were CHG bath and CLABSI rates. The dependent variable was CHG bathing while the independent variable was CLABSI rates.	The variables were knowledge and attitude towards CHG bath and the CLABSI rates. The dependent variable was knowledge, attitude and practice among nurses while the outcome variable was CLABSI rates.
Measurement Identify primary statistics used to answer clinical questions (You need to list the actual tests done).	The DerSimonian average intervention was used in estimating the average intervention effect. The logistic regression model was used in estimating the relationship between the dependent (predictor) and the outcome variable.	The statistics conducted included multivariable regression analysis, odd ratio, and descriptive statistics.	The primary statistics used included descriptive statistics and linear regression model.	Chis-square and t-test were used.
Data Analysis Statistical or Qualitative findings (You need to enter the actual numbers determined by the statistical tests or qualitative data).	The data analysis was quantitative based. The risk for CLABSI infections reduced the incidence of CLABSI by about 40%. The effect of the CHG bath was significant (0.67, 95% CI: 0.53–0.85).	The study was quantitative based. Multivariate analysis indicated that the intervention was significant (OR 0.47, 95% CI 0.26e0.84, P¼0.011).	The study findings indicated that the number of healthcare providers correctly identifying facts about CHG bathing increased, from 31.11 to 50.0% (χ2 = 9.32, p = .002).	Majority of nurses, with frequencies ranging from 70.7% to 90.1% were aware of the CLABSI prevention guidelines. Nursing workshops and courses (67.3%) was the main source of information CLABSIs prevention, followed by guidelines (42.7%), and internet (30.7%).
Findings and Recommendations General findings and recommendations of the research	CHG bathing can help in reducing the risks of CLABSI among the patients admitted in hospitals. Therefore, healthcare institutions should adopt CHG bathing.	CHG bathing can help reduce the risk of CLABSI in the ICU unit. Therefore, healthcare institutions should adopt CHG bathing.	Educating the healthcare providers on the CHG bathing improves its implementation and reduce the risk for CLABSI. Therefore, healthcare institutions should adopt CHG bathing.	Improved knowledge on CLABSI prevention helps in enhancing adherence to infection prevention protocols. Therefore, healthcare institutions should adopt CHG bathing.
*Appraisal and Study Quality* Describe the general worth of this research to practice. What are the strengths and limitations of study? What are the risks associated with implementation of the suggested practices or processes detailed in the research? What is the feasibility of use in your practice?	The study involved a large sample population and the data covered were appropriate. On the other hand, the main weakness is that the study was based on adult populations alone and so cannot be inferred to children. However, the findings from the study can be used in reducing CLABSI among the adults.	The study’s setting was appropriate and could provide reliable answers to the research question. On the other hand, the weakness of the study was monocentric and did not monitor the intervention and this could bias the findings. However, the results from the study are feasible.	The study recruited adequate sample population. On the other hand, the weakness was that the CHG bathing processes were not standardized and this could affect the outcome recorded. The findings from the study are feasible for clinical practice.	The study covered various aspects influencing CLABSI prevention measures. The statistical tests were appropriate. On the other hand, the main weakness was lack of standard method for measuring attitude and level of knowledge. The findings from the study are feasible and can be used for clinical practice.
Key findings	CHG bathing reduces the risk for CLABI.	CHG bathing reduces the CLABSI.	There is a need to educate ICU nursing on CHG bathing protocols.	There is need to increase education programs on reducing CLABSI.
Outcomes	Reduced CLABSI	Reduced cases of CLABSI among the ICU patients.	Increased awareness on CHG bathing	Increased knowledge on CLABSI prevention.
General Notes/Comments	Healthcare institution should implement the CHG baths among other interventions to reduce CLABSI.	The use of CHG bath can be used to reduce the risks for CLABSI among patients in ICU.	Healthcare institutions should have standard guidelines for CHG bathing.	Educating the nurses on CLABSI prevention measures allows them to implement to protocols accordingly.

Critical Appraisal of Research

The studies reviewed explored the best practices that can be used to reduce the incidences of CLABSI among the patients in ICU. Nosocomial infections are common among the patients on catheters and those on central lines. Furthermore, the studies indicate that the risk of CLABSI increases with the prolonged hospital stay (Afonso et al., 2016). The healthcare providers have the responsibility to ensure that they engage the right interventions and only discharge the patients when they are ready.

As a result, there is need to monitor and ensure safe practices and reduce the risk of the patients contracting CLABSI. The use of CHG bathing has been proven effective in reducing the risks for CLABSI (Reynolds et al., 2021). However, variations in the protocols for the CHG bathing procedure among the healthcare institutions remain a major concern. Therefore, there is need for standardizing the procedures and creating awareness so that all the nurses are aware of what they should do as they interact with the patients.

The study by Esposito et al. (2017) indicated a gap in the knowledge and practice of the CHG prevention measures by the nurses in the ICU units. Also, the study indicates variations in the attitudes of the nurses towards the clinical practice and this affects the level of its implementation in the healthcare settings. Therefore, there is a need to create awareness and let the nurses understand the importance and the procedures involved in the CHG bathing as part of preventing the CLABSI. Besides, there should be guidelines published and that are readily available to ensure standardized safety protocols in the ICU units. The burden of CLABSI is high and this needs that adequate and prompt interventions must be developed to curb the health menace. The guidelines should be made available to all inpatient units. Thirdly, there is a need to conduct regular trainings on the CLABSI prevention measures to ensure that all the nurses have updated information on how to respond to the CLABSI.

Mental health disorders have far-reaching consequences on patients, health care practitioners, and families. As a result, evidence-based care interventions that engage patients in care and promote self-management are recommended. Telehealth provides a tech-based platform for health care and health education (Zhao et al., 2021). If applied effectively and its risks controlled, telehealth can optimize care effectiveness and reduce mental health burdens in many populations. The purpose of this worksheet is to critically appraise research on the role and effectiveness of telehealth interventions in improving treatment outcomes among patients with depression.

Full APA formatted citation of selected article.	Article #1	Article #2	Article #3	Article #4
Full APA formatted citation of selected article.	Bellanti, D. M., Kelber, M. S., Workman, D. E., Beech, E. H., & Belsher, B. E. (2022). Rapid review on the effectiveness of telehealth interventions for the treatment of behavioral health disorders. Military Medicine, 187(5–6), e577–e588. https://doi.org/10.1093/milmed/usab318	Egede, L. E., Dismuke, C. E., Walker, R. J., Acierno, R., & Frueh, B. C. (2018). cost-effectiveness of behavioral activation for depression in older adult veterans: In-person care versus telehealth. The Journal of Clinical Psychiatry, 79(5), 3853. https://doi.org/10.4088/JCP.17m11888	Scott, A. M., Clark, J., Greenwood, H., Krzyzaniak, N., Cardona, M., Peiris, R., Sims, R., & Glasziou, P. (2022). Telehealth v. face-to-face provision of care to patients with depression: a systematic review and meta-analysis. Psychological Medicine, 52(14), 2852–2860. https://doi.org/10.1017/S0033291722002331	Zhao, L., Chen, J., Lan, L., Deng, N., Liao, Y., Yue, L., Chen, I., Wen, S. W., & Xie, R. (2021). Effectiveness of telehealth interventions for women with postpartum depression: Systematic review and meta-analysis. JMIR MHealth and UHealth, 9(10), e32544. https://doi.org/10.2196/32544
Evidence Level * (I, II, or III)	Level I (review of randomized controlled trials).	Level I (randomized, non-inferiority trial)	Level I (systematic review and meta-analysis of randomized controlled trials)	Level I (systematic review of RCTs and meta-analysis.
Conceptual Framework Describe the theoretical basis for the study (If there is not one mentioned in the article, say that here).**	No conceptual framework has been identified in the article.	None has been identified.	No framework has been identified in the article.	No framework has been identified in the article.
Design/Method Describe the design and how the study was carried out (In detail, including inclusion/exclusion criteria).	The study involved a systematic search of PubMed and hand-searching relevant systematic reviews. To enhance reliability and validity, the articles were also dual screened and single-person abstraction data were verified by a second person. The articles included were full-text, peer-reviewed randomized controlled trials published in English. Articles that were not randomized controlled trials or with a wrong population, intervention, or comparator were excluded.	The study was a randomized, non-inferiority trial for examining whether telehealth is more effective than in-person care in delivering behavioral activation for depression. Eligible participants were assigned to 1 of 2 arms of 8-week behavioral activation therapy. Veterans with depression were included, while those who did not exhibit measures of depression for DSM-IV were excluded.	The study was a systematic review and meta-analysis of RCTs that compared real-time telehealth to face-to-face therapy for depressed individuals. All randomized controlled trials of any design were included provided that participants received car for chronic and symptomatic depressive disorder regardless of their age. All other studies (not RCTs) were excluded.	The study was a systematic review of RCTs form PubMed, The Cochrane Library, CINAHL and other credible databases evaluating the effectiveness of telehealth interventions for women with postpartum depression (PPD). Included studies targeted adult women with PPD, using telehealth interventions, published in English or Chinese, and assessing the primary outcome of depression symptoms using the Edinburgh Postnatal Depression Scale (EPDS). RCTs protocol or duplicate and studies where women had severe illnesses or a history of mental illness were excluded.
Sample/Setting The number and characteristics of patients, attrition rate, etc.	Bellanti et al. (2022) analyzed twenty-two randomized controlled trials (RCTs) – eight were non-inferiority trials.	The study included 241 participants (veterans) with depression.	Researchers reviewed nine trials (28 references with 1268 patients) comparing telehealth to face-to-face care delivery to patients with a depressive disorder.	9 RCTs with a total of 1958 participants (women with PPD) were reviewed.
Major Variables Studied List and define dependent and independent variables	Dependent variable: the effectiveness of behavioral health treatments. These (treatments included psychotherapy and psychiatry). Independent variable: care delivered in person and telehealth (telephone or video conference).	Researchers studied whether delivering behavioral activation for depression (independent variable) through telehealth is cost-effective (dependent variable) compared to in-person care. Cost-effectiveness is the dependent variable since it varies with the treatment interventions.	Dependent variables include care outcomes, such as therapeutic alliance care satisfaction, and quality of life. Independent variables were the treatment/intervention methods (telehealth and face-to-face) care delivery for depression or depressive symptoms.	The dependent variable was depressive symptoms and anxiety while the independent variable was telehealth interventions.
Measurement Identify primary statistics used to answer clinical questions (You need to list the actual tests done).	After screening, a single reviewer extracted essential data characteristics that were further verified by a second reviewer. For each RCT, two reviewers completed the Cochrane Risk of Bias Assessment and discussed findings to resolve disagreements.	Researchers used the 36-Item Short Form Health Survey to evaluate health services utilization costs between 1 year pre-intervention and 1 year post-intervention.	Data were extracted by independent authors and discrepancies resolved via consensus. The risk of Bias Tool 1.0 was used to assess biases.	Two independent researchers extracted data and performed quality assessment using the Cochrane risk-of-bias tool. The meta-analyses was conducted using RevMan 5.4 software.
Data Analysis Statistical or Qualitative findings (You need to enter the actual numbers determined by the statistical tests or qualitative data).	Most RCTs and 7/8 of the non-inferiority trials found no difference between telehealth (TH) and in person (IP) treatment delivery. Two studies found patients with higher symptom severity in the telehealth group exhibited worse treatment-related outcomes than in person participants.	Post-intervention, veterans treated via telehealth had a mean of $870.91 higher costs relative to pre-invention while those treated in-person had a mean of $2,998 health care utilization costs.	Researchers found no significant differences between the treatment interventions for depression severity at post-treatment except at 9 months post-treatment. No major differences were found between telehealth and face-to-face care in treatment satisfaction while most studies, except one, showed the same for therapeutic alliance.	The primary statistical finding was a significantly lower EPDS (p<.001) and anxiety (p=.005) scores in the telehealth group compared to the control group.
Findings and Recommendations General findings and recommendations of the research	Based on the evidence from the RCTs, telehealth and in person treatment (face-to-face) modalities produces similar outcomes for psychotherapy and psychiatry services.	The study confirmed the practicality of telehealth in lowering health utilization costs for depression treatment among veterans. As a result, it should be utilized more in health care settings to improve outcomes for patients and care practitioners.	Evidence shows that telehealth and face-to-face care can be used interchangeably for depression treatment and deliver similar outcomes. However, additional trials with longer follow-up are necessary to ascertain the findings.	Telehealth effectively reduces depression and anxiety symptoms among women with PPD. However, large scale RCTs targeting specific therapies are crucial.
*Appraisal and Study Quality* Describe the general worth of this research to practice. What are the strengths and limitations of study? What are the risks associated with implementation of the suggested practices or processes detailed in the research? What is the feasibility of use in your practice?	The research is significant to mental health practice since it demonstrates the effectiveness of treatment modalities. The primary strength is that the article is high-level evidence. Reliability and validity are also high due to the involvement of a third/independent researcher. The most notable limitation is the lack of meta-analysis due to the heterogeneity of results. Rapid reviews also omit relevant research. Telehealth is associated with privacy and security issues. The article is feasible for use in mental health practice since it demonstrates the effectiveness of telehealth and face-to-face interventions for treating behavioral health disorders.	The research is significant to mental health practice since it explains the importance of telehealth in care delivery as a cost-effective method. The article’s main strengths include high-level evidence and a large sample size. The main limitation was utilizing one survey tool hence possible analysis bias. The main risks associated with implementing telehealth are privacy breaches, although they can be controlled through appropriate safeguards. The article is feasible for use in mental health practice since it explains the appropriateness of telehealth as a cost-effective intervention for delivering mental health care for people with depression.	The research demonstrates the effectiveness of telehealth in mental health care in the evolving practice. It highlights why telehealth should be integrated into care delivery and potential outcomes. Study strengths include comprehensive searches and rigorous methodologies. The findings also support previous research. Limitations include a sort trial follow-up in majority of the patients in most studies. All trials were conducted in the United States, which limits their generalizability. No major risks associated with telehealth implementation have been noted in the study. The article is feasible for use in mental health practice since it demonstrates the effectiveness of telehealth as a viable alternative for face-to-face care provision for depression.	The research is worth to practice since it explains the role of telehealth in treating depression and anxiety. The main strengths are high-level evidence and rigorous search. The study is also generalizable since it was conducted in both developed and developing countries. Limitations include possible bias and meta-analysis being limited by major heterogeneity. No risk regarding telehealth implementation has been detailed in the research. The research is feasible for use in mental health practice since it demonstrates the importance of telehealth in mental health support.
Key findings	Care delivered via telehealth is as effective as in person care. As a result, mental health practitioners can use videoconferencing, telephone, and other tech-based interventions to provide mental health support.	Care delivered via telehealth is more cost-effective compared to in-person care.	For patients with depression, telehealth is a viable alternative for care provision for in-person (face-to-face) care. This is because there were no significant differences in treatment outcomes, including satisfaction, between the two methods.	Telehealth is highly effective in treating depression and anxiety among women with PPD.
Outcomes	The primary outcome is effective behavioral health treatments. In this case, psychiatry and psychotherapy treatments can be offered effectively via telehealth.	The primary clinical outcome was measures of depression at 12 months while the economic differences included differences in health care utilization costs.	The study’s primary outcome was depression severity. Other (secondary) outcomes were the quality of life, client-care provider therapeutic alliance, and satisfaction with care.	Main outcomes are PPD measured by the EPDS.
General Notes/Comments	The article informs mental health practitioners on the suitability of telehealth in facilitating behavioral health interventions for patients with mental health problems.	The article informs mental health practitioners on the need for adopting telehealth for better clinical and economic outcomes in treatment for mental disorders such as depression. As used in treating and supporting veterans with depression, telehealth can be implemented to provide care to other individuals with mental disorders.	The study underlines the role and effectiveness of telehealth as an effective intervention for face-to-face care provision for patients with depression. It shows that telehealth has the potential to increase accessible, evidence-based interventions for patients with depression.	The study supports the application of telehealth in delivering care to women with PPD. As a result, it is a valuable article for mental health practitioners and other professionals interested in optimizing health outcomes via technology.

Conclusion

As reviewed in the above grid, telehealth interventions effectively improve outcomes in managing depression. The other major highlight is that telehealth complements face-to-face care, and the two interventions can be used interchangeably. Besides, telehealth has emerged as a more cost-effective intervention than face-to-face care. As a result, it should be explored more in mental health practice.

References

Bellanti, D. M., Kelber, M. S., Workman, D. E., Beech, E. H., & Belsher, B. E. (2022). Rapid review on the effectiveness of telehealth interventions for the treatment of behavioral health disorders. Military Medicine, 187(5–6), e577–e588. https://doi.org/10.1093/milmed/usab318

Egede, L. E., Dismuke, C. E., Walker, R. J., Acierno, R., & Frueh, B. C. (2018). Cost-effectiveness of behavioral activation for depression in older adult veterans: in-person care versus telehealth. The Journal of Clinical Psychiatry, 79(5), 3853. https://doi.org/10.4088/JCP.17m11888

Scott, A. M., Clark, J., Greenwood, H., Krzyzaniak, N., Cardona, M., Peiris, R., Sims, R., & Glasziou, P. (2022). Telehealth v. face-to-face provision of care to patients with depression: a systematic review and meta-analysis. Psychological Medicine, 52(14), 2852–2860. https://doi.org/10.1017/S0033291722002331

Zhao, L., Chen, J., Lan, L., Deng, N., Liao, Y., Yue, L., Chen, I., Wen, S. W., & Xie, R. (2021). Effectiveness of telehealth interventions for women with postpartum depression: Systematic review and meta-analysis. JMIR MHealth and UHealth, 9(10), e32544. https://doi.org/10.2196/32544

In healthcare today, there are new technologies released daily to improve patient care. Some of the latest trends utilized in healthcare are telehealth, and the PICOT question you have proposed is essential in identifying telehealth pros and cons. The question is relative to the online care many of us are currently receiving due to the Coronavirus epidemic. My gut instinct always told me that face-to-face care was the best option, but recently participating in a zoom medical appointment, this appointment was much more personal and thorough.

The benefit of online support groups for bereavement includes being part of an understanding community of persons who have experienced a similar loss, emotional support, sharing of information, remembrance, reconstruction of a sense of identity, and a realization of the changing nature of grief over time (Robinson & Pond, 2019). Accessibility of therapy is paramount, especially after the loss of a loved one, and attaining a face to face appointment could have a waiting list upwards of one month. Compared to face-to-face therapy, Internet-based interventions facilitate more flexibility and anonymity as well as faster attainability (Hoffmann et al., 2018). The PICOT question you have identified will yield a diverse amount of results, and I look forward to reading your research.

References

Hoffmann, R., Große, J., Nagl, M., Niederwieser, D., Mehnert, A., & Kersting, A. (2018). Internet-based grief therapy for bereaved individuals after loss due to haematological cancer: Study protocol of a randomized controlled trial. BMC Psychiatry, 18(1). Retrieved June 26, 2020, from https://doi.org/10.1186/s12888-018-1633-y

Robinson, C., & Pond, D. (2019). Do online support groups for grief benefit the bereaved? systematic review of the quantitative and qualitative literature. Computers in Human Behavior, 100, 48–59. Retrieved June 26, 2020, from https://doi.org/10.1016/j.chb.2019.06.011

Critical Appraisal Tool Worksheet Template

Evaluation Table

Use this document to complete the evaluation table requirement of the Module 4 Assessment, Evidence-Based Project, Part 4A: Critical Appraisal of Research

Full APA formatted citation of selected article.	Article #1	Article #2	Article #3	Article #4
Full APA formatted citation of selected article.	Bridges, J., Griffiths, P., Oliver, E., & Pickering, R. M. (2019). Hospital nurse staffing and staff–patient interactions: an observational study. BMJ quality & safety, 28(9), 706-713. https://qualitysafety.bmj.com/content/28/9/706	Nantsupawat, A., Kunaviktikul, W., Nantsupawat, R., Wichaikhum, O. A., Thienthong, H., & Poghosyan, L. (2017). Effects of nurse work environment on job dissatisfaction, burnout, intention to leave. International nursing review, 64(1), 91-98.doi: 10.1111/inr.12342	Perry, S. J., Richter, J. P., & Beauvais, B. (2018). The Effects of Nursing Satisfaction and Turnover Cognitions on Patient Attitudes and Outcomes: A Three-Level Multisource Study. Health services research, 53(6), 4943–4969. https://doi.org/10.1111/1475-6773.12997	Jarrar, M. T., Minai, M. S., Al‐Bsheish, M., Meri, A., & Jaber, M. (2019). Hospital nurse shift length, patient‐centered care, and the perceived quality and patient safety. The International journal of health planning and management, 34(1), e387-e396. https://doi.org/10.1002/hpm.2656
Evidence Level * (I, II, or III)	Level III because it was an observational study (non-experimental)	Level II	Level II	Level II
Conceptual Framework Describe the theoretical basis for the study (If there is not one mentioned in the article, say that here).**	Not stated	The Quality Health Outcomes Model (QHOM) guided the study. The model demonstrates the existence of a linear correlation between process, structure and outcomes. The nurse practice environment was considered the structural factor that influences nurse outcomes that included burnout, turnover and job dissatisfaction among nurses.	The turnover theory and Self-Determination Theory were used to guide this study. The turnover theory was used to conceptualize the dissatisfaction-motivated desired as well as the intention of the employees to leave their jobs. The Self-Determination Theory was used to provide underpinnings for the role of work environment on behaviors such as motivation and energizing employees to perform optimally.	The conceptual framework was note stated.
Design/Method Describe the design and how the study was carried out (In detail, including inclusion/exclusion criteria).	The study was secondary of observational data. The study was conducted in two NHS hospital Trusts in England. Six wards that provided care to paged aged above 65 years were selected. The wards had an average of 44-full-time registered nurses staffs and healthcare assistants. The relationship between length and quality of interaction was determined using Quality of Interaction Schedule. The observations were undertaken between 2015 and 2016. Index patients were chosen randomly to participate in the study. The exclusion criteria included patients who were not able to communicate their choices, those who did not wish to participate in the study, unconscious and critically ill or isolated due to being at a risk of infection.	The study utilized a cross-sectional study design. Questionnaires were used for data collection. Stratified sampling was used for random selection of hospitals to participate in the study. Work units in each hospital were selected using purposive sampling. Inclusion criteria included inpatient nurses with at least two years’ experience as bedside nurses. The exclusion criteria included nurse managers.	The study was a multisource study. Participants were provided with online surveys to provide information related to their experiences. The inclusion and exclusion criteria was not provided in the research.	The study design was a cross-sectional survey study. The study was conducted on nurses who were identified using stratified random sampling. All the nurses working in the medical, surgical and multidisciplinary wards that agreed to participate in the study were included. The exclusion criteria included nurses who decline to participate in the study.
Sample/Setting The number and characteristics of patients, attrition rate, etc.	The sample consisted of 270 elderly patients aged 65 years and above. The setting was two NHS hospital Trusts in England. The participants were obtained from six wards that included urology, orthopedics, and medicine wards for the older people.	The setting of the study was 43 inpatient units in five university hospitals in Thailand. The participants comprised of 1351 nurses who were working in the above setting.	The setting of the study was Army Military Treatment facilities in the United States. The participants included 2596 registered nurses that were working in 110 Army treatment hospitals and facilities across 35 healthcare systems in the US.	The setting of the study was 12 private hospitals in Malaysia. The participants included 1055 nurses working in the medical and surgical wards alongside multidisciplinary wards. Of this number, 652 nurses provided complete responses to the survey questionnaires.
Major Variables Studied List and define dependent and independent variables	The dependent outcomes included quality of staffing and staff-patient interactions. The independent variables included a reduction or increase in nurse staffing and skill mix, professional background of the healthcare staffs and duration of the staff-patient interaction.	The dependent or outcome variables in the study included burnout, job dissatisfaction and intention to leave among the participants. The independent variables included nature of work environment, resource adequacy, staffing level, nurse engagement in organizational affairs, management and leadership ability, and collegial nurse-physician relationships.	The dependent or outcome variables in the study included turnover cognitions and outcomes, nursing satisfaction and attitude. The independent variables included leadership style, nature of work environment and collegial relationships with other providers.	The dependent variables in the study included quality and safety of care as perceived by nurses. The independent variables included shift length and patient-centered care.
Measurement Identify primary statistics used to answer clinical questions (You need to list the actual tests done).	The statistics included three-level mixed logistic regression using command xtmelogit in Stata V.11.0, odds ratio for QuIS rating, Wald tests for post-estimation of interaction effect, negative binomial model for patient experiences with interaction and normal-based models for time that patient and staffs spent interacting.	Lake’s Practice Environment Scale of the Nursing Work Index was used to measure nurse work environment. The composite scores in the rating scale was tabulated by aggregating individual nurse-level responses with the responses of the unit followed by calculating the mean of the subscale means. The level of job satisfaction was measured by asking the current satisfaction of the nurses with their jobs. Intention to leave was measured by asking nurses to provide information on whether they intend to leave their current jobs in a year. The Emotional Exhaustion subscale of the Maslach Burnout Inventory was used to measure burnout.	Measurement and analysis were done at three different levels to test the hypotheses. Level 1 measurement and analysis was done on individual-level perception of nurses on outcomes and predictors. Level 2 measurement and analysis were done on six aggregated variables of patient satisfaction. Level 3 measurement and analysis were done using adverse event indicators and predictors of nurses’ responses. CFA was used to confirm the fit for Level-1 independent variables. Exploratory factor analysis using Promax rotation was used to analyze non-hypothesized factors. Variance inflation factor was used to test threat of common method variance. Multilevel modeling was performed at levels 1 and 2 to test all the hypotheses of the study. Multilevel mixed effects modelling was used to analyze level 1 data on dissatisfaction due to intention to quit and desire. Multilevel logistic regression and ordinary least squares regression were used for level 3 analyses.	The study used Hayes macro for regression analyzes to determine the mediation effect of patient-centeredness on the relationship between care quality, safety and shift length.
Data Analysis Statistical or Qualitative findings (You need to enter the actual numbers determined by the statistical tests or qualitative data).	The results of the study showed that 3076 interactions were observed. Of this number, 10% of them were rated negatively. The odd of a negative interaction rose significantly as more patients were added to each registered nurse (p=0.035, OR of 2.82 for > 8 patients/RN compared with >6 to<8 patients/RN). The results also showed a similar but insignificant pattern for healthcare assistance (p=0.056). The results also showed that odds of negative interaction increased with high level of healthcare assistants staffing and low registered nurse staffing.	The study results showed that 97% of the participants were females. The composite score of the mean of 5 PES-NWI was 2.91 with the highest mean being 3.23 and lowest being 2.56. Of the 43 units, the participants ranked 16 units as good and seven units being poor. The odd of nurses reporting to be dissatisfied with their jobs was (OR=0.67, 95% CI 0.57-0.77), intention to leave their current job (OR=0.75, 95% CI 0.54-0.99), and emotional exhaustion (OR=0.78, 95% CI 0.70-0.99) were significantly reduced in nurses working in better work environment when compared to those working in mixed environment. The rate of job dissatisfaction, emotional exhaustion and intention to leave in nurses with better work environment was at a 39 to 55% lower than those working in poor work environments.	The results showed that level 1 results were adequately supported. Staffing, teamwork, and reliance on nursing practices were negatively associated with intentions to leave. Self-reported level of nurse satisfaction was a significant predictor of patient willingness to recommend alongside see providers when needed. Self-reported satisfaction was found a significant predictor for medication errors and falls with injury. Dissatisfaction-based desire to leave a job was a significant predictor for patient falls and medication errors.	The majority of participants (99%) were of Malaysian origin. Regression analysis indicated insignificant impact of the length of shift on quality of service (F=1.27, P=0.28) and safety (F=1.81, P=0.13). Patient-centeredness has potential mediating effect in relation to shift length and service quality (F=42.90, P=0.000). Nurses working 12-hour shift (95% CI, -0.18 to -0.15) and 10 hour shift (95% CI, -0.17 to -0.03) indirectly affected the quality of care unlike those working for 7-hour shift. Patient-centeredness was also found to have a linking effect on patient safety and shift length (F=25.12, P=0.000). The results also showed that a significant mediation effect of patient-centered care exist between the effect of length of shift on perceived patient safety (F=25.12, P<0.001) and perceived quality (F=42.90, P<0.001).
Findings and Recommendations General findings and recommendations of the research	The general finding of this study was that the ratio of registered nurses to patients is a critical determinant of nature of nurse-patient interaction. A reduction in registered nurses staffing level causes a change in the quantity and quality of staff-patient interaction. The results also showed that staff-patient interactions does not improve in cases where registered nurses staffing is low with increased staffing of healthcare assistants. Therefore, adequate register nurse staffing ratio is important for quality staff-patient interaction.	The general results of the study were that nurse working in university hospitals that have better work environments have less intention to leave, burnout and job dissatisfaction. The researchers recommended that health organizations should strive to improve the work environment for the nurses. Improving the work environment will lower the levels of job dissatisfaction, burnout and intention to leave.	The general findings of this study were that predictors of nurse satisfaction as well as turnover cognitions included staffing levels, supportive leadership, nurse-physician teamwork, advancement opportunities and adoption of nursing care practice. The results also showed aggregated nurse satisfaction to be the most consistent predictor of adverse events and patient satisfaction. Therefore, the authors recommended the need for healthcare organizations, managers and leaders to adopt interventions that enhance job satisfaction and retention among nurses.	The general findings of this study is that there exist a significant mediation effect of patient-centered care between the effect of length of shift on the perceived quality of care and patient safety. The authors recommended that health policymakers should consider restructuring shift length for nurses and strengthening patient-centeredness in nursing care.
*Appraisal and Study Quality* Describe the general worth of this research to practice. What are the strengths and limitations of study? What are the risks associated with implementation of the suggested practices or processes detailed in the research? What is the feasibility of use in your practice?	The study informs the importance of adequate staffing ratios in nursing. The study shows that staffing ratio determines the quality of care that registered nurses give. The study is worthy for implementation in practice. The strengths of the study include the use of large sample size and randomizing patients to the intervention group. The study has weaknesses of not assigning participants to a control group. It also has the weakness of lacking inference of exposure versus effect relationship because it was an observational study. The risk of implementing the suggested practices in the research is therefore the lack of highly valid and reliable data on the effectiveness of the interventions in nursing. The intervention is however highly feasible for use in practice due to the replicable nature of the study methods.	The study is worthy and relevant to nursing practice. It informs the need for the adoption of interventions that aim at improving the environmental conditions for nurses. The study also shows the negative effects of unhealthy work environments. The strength of this study is the use of a large number of participants. The study is also a multicenter investigation. The study has the limitation of relying on self-reported findings from the nurses. The validation of self-reported experiences might be a challenge. The study is feasible for use in my practice. The feasibility is seen in the applicability of interventions to improve workplace conditions in nursing.	The study is important to nursing practice because it informs the need for the creation of enabling cultures for provider and organizational success. The study also informs the adoption of effective leadership styles that promote performance and excellence. The strength of this study is that it has high validity and reliability due to it being a multisource study. The study has the weaknesses of lack of generalizability of findings due to it being conducted in military setting. The risk of implementing this study in a general setting is that the workplace conditions in a military setting might be different from the general setting, hence, inapplicability of findings. The study is therefore less feasible in use in my practice.	The study is worthy for use in nursing because it informs the adoption of interventions that promote safety and quality in patient care. The study also advocates the adoption of organizational interventions that promote effective workplace culture. The strength of this study is the large sample size and being multi-center in nature. The weakness of this study was that it mainly used private hospitals, which might affect the generalizability of findings. The risk of implementing the interventions in this study is that they might not produce similar outcomes as those seen in the study. The contexts might differ because the current study was conducted in private hospitals. The study however has high feasibility as seen from the use of interventions that are applicable to any healthcare setting.
Key findings	Low levels of registered nurses staffing affects the quality and quantity of staff-patient interactions. A high level of staffing for healthcare assistants and low level of staffing for registered nurses does not improve the quality of staff-patient interactions. Sufficient registered nurses staffing levels is therefore critical determinant of the quality of staff-patient interactions.	The findings of this study showed that better work environments have less job dissatisfaction, intent to leave and burnout.	Nurse attitude have an effect on the actual and perceived performance across health care systems and facilities. Perceived nurse satisfaction is a critical predictor of adverse events and patient satisfaction.	Patient-centeredness in care mitigates the effects of shift length on outcomes of care that include safety and quality.
Outcomes	The outcomes included the quality and quantity of staff-patient interactions.	The outcomes of the study included burnout, job dissatisfaction and intervention to leave among nurses.	The outcomes in the study included patient and nurse satisfaction, patient outcomes and turnover cognitions among nurses.	The outcomes in this study included patient safety and quality of care as perceived by the nurses.
General Notes/Comments	The study has results that are generalizable.	The study findings are highly generalizable to practice due to the use of a high sample size.	The results have high validity and reliability. However, they are not generalizable because it was conducted in a military setting that might have different environmental characteristics from general settings.	The shift length should be restructured to underpin safety and quality in nursing care and practice.

Reflection

According to the evidence analyzed above, the best practice that can be implemented to promote safety and quality in nursing care is the transformation of work environmental conditions. According to the evidence, the nature of the work environment has a direct influence on the level of satisfaction, burnout, and intent to leave among nurses. Organizations with better working conditions or healthy work environments have lower rates of burnout, intention to leave, and job dissatisfaction among their nurses (Nantsupawat et al., 2017). The reduction or elimination of these issues promotes nursing care and practice safety and quality.

The analysis also revealed that work environment transformation includes the adoption of effective leadership behaviors that increase job satisfaction and reduce nurses’ intent to leave. As a result, the evaluation revealed that supportive leadership, effective nurse-physician teamwork, and the provision of opportunities for professional and personal advancement increase provider satisfaction and reduce nurse burnout (Bridges et al., 2019). Environmental transformation also includes identifying work-related factors that contribute to burnout, job dissatisfaction, and high turnover rates among nurses.

The evidence reviewed revealed that workplace factors such as staffing levels, nursing care practice adoption, and patient-centeredness play an important role in influencing the behaviors of nurses and other healthcare providers (Perry et al., 2018). Adequate registered nurse staffing levels reduce burnout and errors in practice, which improves safety and quality of care. The negative effects of length shift and perceived safety and quality of care are mitigated by patient-centeredness (Jarrar et al., 2019). As a result, nurse managers and leaders must be proactive in assessing the need for and implementing strategies to improve working conditions in their organizations. It will achieve care goals such as safety, quality, efficiency, and patient-centeredness.

References

Bridges, J., Griffiths, P., Oliver, E., & Pickering, R. M. (2019). Hospital nurse staffing and staff–patient interactions: An observational study. BMJ Quality & Safety, 28(9), 706–713. https://doi.org/10.1136/bmjqs-2018-008948

Jarrar, M., Minai, M. S., Al‐Bsheish, M., Meri, A., & Jaber, M. (2019). Hospital nurse shift length, patient-centered care, and the perceived quality and patient safety. The International Journal of Health Planning and Management, 34(1), e387–e396. https://doi.org/10.1002/hpm.2656

Nantsupawat, A., Kunaviktikul, W., Nantsupawat, R., Wichaikhum, O.-A., Thienthong, H., & Poghosyan, L. (2017). Effects of nurse work environment on job dissatisfaction, burnout, intention to leave. International Nursing Review, 64(1), 91–98. https://doi.org/10.1111/inr.12342

Perry, S. J., Richter, J. P., & Beauvais, B. (2018). The Effects of Nursing Satisfaction and Turnover Cognitions on Patient Attitudes and Outcomes: A Three-Level Multisource Study. Health Services Research, 53(6), 4943–4969. https://doi.org/10.1111/1475-6773.12997

In health practice, clinical problems vary, prompting health care providers to adopt different interventions depending on the nature of a problem. Practice change based on current, relevant, and scientific research evidence is among the widespread interventions. However, not all research evidence is relevant in practice, necessitating research appraisal. According to Melnyk and Fineout-Overholt (2018), research appraisal involves systematically evaluating research evidence to determine its relevance and value. The primary aim is to assess the reliability and validity of the research. This paper appraises research on workplace incivility and analyzes the best practice that emerges from the reviewed research.

Part 1: Evaluation Table

Full APA formatted citation of selected article.	Article #1	Article #2	Article #3	Article #4
Full APA formatted citation of selected article.	Shi, Y., Guo, H., Zhang, S., Xie, F., Wang, J., Sun, Z., … & Fan, L. (2018). Impact of workplace incivility against new nurses on job burn-out: A cross-sectional study in China. BMJ Open, 8(4), e020461. doi:10.1136/ bmjopen-2017-020461	Armstrong, N. (2018). Management of nursing workplace incivility in the health care settings: A systematic review. Workplace Health & Safety, 66(8), 403-410. https://doi.org/10.1177%2F2165079918771106	Abdollahzadeh, F., Asghari, E., Ebrahimi, H., Rahmani, A., & Vahidi, M. (2017). How to prevent workplace incivility?: Nurses’ perspective. Iranian Journal of Nursing and Midwifery Research, 22(2), 157-163. https://doi.org/10.4103/1735-9066.205966	Kile, D., Eaton, M., deValpine, M., & Gilbert, R. (2019). The effectiveness of education and cognitive rehearsal in managing nurse‐to‐nurse incivility: A pilot study. Journal of Nursing Management, 27(3), 543-552. https://doi.org/10.1111/jonm.12709
Evidence Level * (I, II, or III)	III	I	III	II
Conceptual Framework Describe the theoretical basis for the study (If there is not one mentioned in the article, say that here).**	The study is based on the premise that anxiety predicts workplace incivility, which generates job burnout among nurses. Resilience moderates the incivility-burnout connection.	No exact framework has been mentioned.	No theory has been mentioned.	Bandura’s social learning theory was used as the underpinning for introducing educational interventions and cognitive rehearsal techniques.
Design/Method Describe the design and how the study was carried out (In detail, including inclusion/exclusion criteria).	The study was a cross-sectional survey through anonymous questionnaires. Participants included nurses with a maximum of three years in service. Irregular nurses, those who had served for more than three years, and unwilling participants were excluded.	Armstrong (2018) critiqued and summarized relevant evidence on workplace incivility and management. Only English articles were reviewed. Articles published before 2010 were excluded.	The descriptive study design was used to describe nurses’ perspective on workplace incivility. Nurses selected had at least one year practice experience and a bachelor’s degree in nursing.	The study was a mixed method, pilot study design. It involved conducting educational programs about incivility in practice and cognitive rehearsal techniques. All registered nurses in the PACU participated in the study. Ancillary personnel and those unable to read and write in English were excluded.
Sample/Setting The number and characteristics of patients, attrition rate, etc.	696 nurses completed the questionnaire. The study took place in a hospital in China.	The final sample had 10 articles for systematic review and analysis.	Sampling was continuous as the analysis of interviews continued. The pilot study was conducted at educational hospitals of Tabriz University of Medical Sciences.	The study used a convenient sample of registered nurses. It was conducted in a community hospital (post-anesthesia care unit) in Virginia.
Major Variables Studied List and define dependent and independent variables	The dependent variable was workplace incivility. Independent variables included anxiety, burnout, and resilience.	The dependent variable was workplace incivility whose levels can be reduced through education training, awareness training, and active learning behaviors (independent variables).	The structured interviews concentrated on nurses’ views on workplace incivility prevention.	The study variables included education on incivility and cognitive rehearsal techniques (independent variables) on workplace incivility (dependent variable).
Measurement Identify primary statistics used to answer clinical questions (You need to list the actual tests done).	Shi et al. (2018) explored the relationship between variables using descriptive statistical analysis. In particular, Pearson’s correlation coefficient and multiple linear regression analysis were used.	Intervention research about managing workplace incivility was the primary focus. Evidence strength was scored to determine information inclusion.	The MAXQDA software version 10 was used to analyze data on 36 interviews and 8 field notes.	Quantitative data for the Nursing Incivility Survey (NIS) was rated using 5-point Likert scale. Sources of incivility were divided into subscale. Data was analyzed using IBM SPSS website.
Data Analysis Statistical or Qualitative findings (You need to enter the actual numbers determined by the statistical tests or qualitative data).	Workplace incivility was found to be positively correlated with anxiety and job burnout. Anxiety (r=0.371, p<0.01) Burnout ((r=0.238, p<0.01) Resilience moderated (β=−0.564, p<0.01) the workplace incivility-job burnout connection.	Education programs were ranked the highest followed by effective communication and active learning programs in workplace incivility prevention.	3 subthemes and 1 core theme emerged from the analysis. Subthemes- nurse, organization, and public. Core theme- a need for comprehensive attempt.	Items under nurse incivility subscale included hostile climate, gossip and rumors, and free-riding. Displaced frustration p=0.042 was found to be the most statistically significant factor.
Findings and Recommendations General findings and recommendations of the research	Due to the prevalence nature of workplace incivility in nursing, administrators should consider resilience training to reduce incivility, particularly among new nurses.	Workplace incivility can be prevented by combining educational, awareness, and training programs. The emphasis should be civil behaviors.	Workplace incivility in nursing is complex and requires nurses, health care organizations, and the general public’s commitment to address effectively. It is an issue requiring concerted effort to minimize.	Nursing incivility can be effectively addressed by recognition and ability to confront it.
*Appraisal and Study Quality* Describe the general worth of this research to practice. What are the strengths and limitations of study? What are the risks associated with implementation of the suggested practices or processes detailed in the research? What is the feasibility of use in your practice?	The study is a useful and detailed resource for understanding workplace incivility from a cause-and-prevention viewpoint. The main strength includes the study innovatively examining the relationship between incivility and burnout and the moderating role of resilience. However, self-reports from participants were potential source of response bias. On risks associated with resilience training, it can lead to physical and mental exhaustion of some nurses. The approach can also lead to the normalization of workplace incivility. Overall, it is feasible for use in practice since it addresses a major problem in the current practice and practical solutions.	The study expands literature on workplace incivility by illustrating how it can be prevented in nursing practice. Majority of the studies used in the systematic review used psychometrically tested instruments. However, which was a main limitation, low research quality characterized majority of the studies. No major risk is associated with implementing the suggested practices. They would be fairly convenient to reproduce without any risks to participants. It is crucial to address workplace incivility by improving communication and nurses’ self-efficacy regarding the same. Thus, the study is feasible for use in practice.	The study illustrates the need for concerted effort in workplace incivility management, which health care organizations should emulate. The study showed how workplace incivility can be prevented from a broadened perspective. Randomization of participants’ selection could have led to selection bias. No significant risk is associated with implementing the proposed intervention programs. The study explains the diverse nature of workplace incivility prevention strategies; thus, feasible in practice.	The study illustrates how job satisfaction can be improved by recognizing incivility and how to confront it. Regarding strengths, it is a mixed method study highly detailed on workplace incivility. However, the pilot study had a small initial sample size (limitation). No risks are associated with implementing the suggested practices in practice since the study proposes behavioral approaches. Its usefulness and convenience in applying the proposed strategies confirm its feasibility.
Key findings	Workplace incivility is prevalent among new nurses. Anxiety is a reliable predictor, leading to workplace burnout. The adverse outcomes of incivility can be moderated through resilience-based interventions, such as resilience training.	Education training on workplace incivility is among the most effective strategies in combating the prevalent nursing problem. However, it should be supplemented with other strategies to enhance outcomes.	Nursing administrators and nursing staff cannot succeed while working alone to address workplace incivility. A broadened focus is vital to address the problem successfully.	Enhanced awareness is vital in enabling nurses cope with workplace incivility. Cognitive rehearsal techniques can help nurses to confront workplace incivility.
Outcomes	Highly resilient nurses could buffer the negative influence of workplace incivility regardless of their experience. Therefore, resilience should be adopted in health care settings as a coping style.	Improving nurses’ ability to recognize and manage workplace incivility should be the guiding principle in education programs on workplace incivility.	Workplace incivility is preventable through a comprehensive and systematic attempt. Nurses should improve their skills as the health care managers work on other strategies such as improving the image of the profession and position of nurses in organizations.	Highly aware and prepared nurses are excellently positioned to deal with workplace incivility. Awareness programs should be intensified in health care settings as buffers.
General Notes/Comments	The study is highly informative on workplace incivility, predictors, outcomes, and feasible solutions. It will be pivotal in developing the PICOT by illustrating the importance of resilient training as part of awareness programs for reducing workplace incivility.	The article is a useful resource to expand literature on workplace incivility management.	The study is highly informative on the need for a more comprehensive and systematic approach in workplace incivility management.	The study expands literature on workplace incivility recognition and prevention.

Part B: Best Practice

Research on workplace incivility is expansive and explores many strategies that can be used to prevent or buffer the prevalent nursing problem. Among the many practices suggested in the studies, enabling nurses to recognize and confront the problem through cognitive rehearsal is a highly effective strategy in incivility management. From a practice viewpoint, cognitive rehearsal involves imagining a situation that produces self-defeating behavior and applying the necessary coping mechanism (Clark, 2019). It is a strategy that admits a problem and its adverse impacts and prepares the affected group to adopt appropriate behavior when they face the same problem.

In nursing, cognitive rehearsal can help nurses cope with workplace incivility to a considerable extent. According to Clark and Gorton (2019), cognitive rehearsal involves equipping nurses with the relevant skills to respond to situations that can be emotionally and mentally harming such as workplace incivility. It is a practical intervention in preventing workplace problems since it prepares nurses mentally to face everyday issues dominating the nursing practice. To justify its relevance in practice, cognitive rehearsal enables nurses to protect themselves and the patients. However, nurses need to implement cognitive rehearsal with other strategies to enhance outcomes.

Generally, workplace incivility is prevalent among nurses and cannot be overlooked. New nurses are more vulnerable to the devastating effects of workplace incivility since they are not used to the problem, and their resilience is low (Mohamed & MahdyAttia, 2020; Muliira et al., 2017). To avoid frustration and possible turnover, nurses should be helped to recognize incivility and respond to it effectively. Awareness and educational programs are highly effective. Training nurses through cognitive rehearsal programs is also an effective intervention to prepare them to cope with the prevalent nursing problem mentally.

Conclusion

Workplace incivility has devastating effects on nurses’ well-being and ability to provide optimal care. In response, it is crucial to apply evidence-based interventions from current and relevant research. The above research appraisal evaluates the appropriateness of various research articles as evidence sources for addressing workplace incivility. The proposed interventions such as cognitive rehearsal have been proven effective in addressing workplace incivility and can be used across settings.

References

Abdollahzadeh, F., Asghari, E., Ebrahimi, H., Rahmani, A., & Vahidi, M. (2017). How to prevent workplace incivility?: Nurses’ perspective. Iranian Journal of Nursing and Midwifery Research, 22(2), 157-163. https://doi.org/10.4103/1735-9066.205966

Armstrong, N. (2018). Management of nursing workplace incivility in the health care settings: A systematic review. Workplace Health & Safety, 66(8), 403-410. https://doi.org/10.1177%2F2165079918771106

Clark, C. M. (2019). Combining cognitive rehearsal, simulation, and evidence-based scripting to address incivility. Nurse Educator, 44(2), 64-68. doi: 10.1097/NNE.0000000000000563

Clark, C. M., & Gorton, K. L. (2019). Cognitive rehearsal, HeartMath, and simulation: An intervention to build resilience and address incivility. Journal of Nursing Education, 58(12), 690-697. https://doi.org/10.3928/01484834-20191120-03

Kile, D., Eaton, M., deValpine, M., & Gilbert, R. (2019). The effectiveness of education and cognitive rehearsal in managing nurse‐to‐nurse incivility: A pilot study. Journal of Nursing Management, 27(3), 543-552. https://doi.org/10.1111/jonm.12709

Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Wolters Kluwer.

Mohamed, A., & MahdyAttia, N. (2020). Factors associated with incivility behaviors, coping strategies and level of engagement among post graduate nursing students. IOSR Journal of Nursing and Health Science (IOSR-JNHS), 9(01), 2020. doi: 10.9790/1959-0901141727

Muliira, J. K., Natarajan, J., & Van Der Colff, J. (2017). Nursing faculty academic incivility: perceptions of nursing students and faculty. BMC Medical Education, 17(1), 1-10. doi: 10.1186/s12909-017-1096-8

Shi, Y., Guo, H., Zhang, S., Xie, F., Wang, J., Sun, Z., … & Fan, L. (2018). Impact of workplace incivility against new nurses on job burn-out: A cross-sectional study in China. BMJ Open, 8(4), e020461. doi:10.1136/ bmjopen-2017-020461

he study showed that in persons with mild to moderate AD, a defined cognitive training was associated with improved or stabilized initiative and episodic memory compared to non-cognitive therapies such as AMT and NE.

· The study recommends the use of cognitive training and non-cognitive treatments to improve mood in AD patients.

2 Appraisal and Study Quality

Describe the general worth of this research to practice.

What are the strengths and limitations of study?

What are the risks associated with implementation of the suggested practices or processes detailed in the research?

What is the feasibility of use in your practice?

· The research is of minimal worth since it does not offer sufficient evidence on whether cognitive training decreases the risk for future MCI or dementia.

· It does not provide enough evidence for health care providers to support or encourage any particular cognitive training to lower the risk for cognitive decline or onset of dementia.

· Strengths: The researchers only analyzed studies with low or medium risk of bias which reduces the potential for publication bias.

· Limitations: Outcomes mostly evaluated test performance instead of global function or dementia diagnosis.

· The risk of implementing cognitive training on patients with MCI is that it may have no impact in reducing the risk for cognitive decline or reducing the risk of developing dementia.

· Feasibility: Cognitive training can easily be implemented in my practice since we provide care to older adults who need cognitive training to improve performance in the aspect of training.

· CCT can be applied in clinical practice on patients with MCI to improve their cognition, memory, working memory, and attention. It can also be used to enhance psychosocial functioning and depressive symptoms in dementia patients.

· Strengths: The study compared effect size estimates and precision in active- and passive-controlled trials.

· Limitations: Functional outcomes were measured primarily using proxy measures that are prone to multiple-source bias.

· Risks: Implementing CCC can be associated with lack of improved cognition or function in dementia patients.

· Feasibility: CCT is feasible for use in my practice since we have embraced the use of technology among the staff and our patients. Patients with MCI can thus be provided with CCT interventions to enhance cognition.

· The research is useful to clinical practice as it shows that cognitive training can be used in patients with MCI to improve cognitive function, working memory and daily life ability of daily living.

· Strengths: The study employed a randomized control study, which helped to compare the impact of two treatment modalities (Cognitive training and mental leisure activities).

· Limitations: The study used a small sample size and most of the subjects were female, which limits generalizability.

· Risks: Implementing cognitive training can have a transfer effect on execution function.

· Feasibility: The cognitive training programs can easily be implemented in our practice on AD patients.

· The research is useful to clinical practice as it proves that combining cognitive training and non-cognitive therapies may have useful clinical implications.

· Strengths: The study employed a randomized control study, which helped to compare the impact of two treatment modalities (Cognitive training vs. AMT and NE).

· Limitations: There was a failure to control for multiple comparisons comparatively to the sample size.

· Risks: Implementing cognitive training can have a transfer effect on execution function.

· Feasibility: The cognitive training programs can easily be implemented in our practice on older adults with MCI.

Key findings

· In older adults with supposed normal cognition, cognitive training seemed to provide some degree of protection against reducing performance in the domain of training but no broader cognitive or functional benefit.

· Cognitive training enhances cognitive test performance in otherwise healthy older adults, for the domain trained.

· Small- moderate effects were exhibited for global cognition, working memory, attention, learning, and memory, except nonverbal memory.

· There was an impact in psychosocial functioning, including depressive symptoms.

· In dementia, significant effects were seen in overall cognition and visuospatial skills, · The study revealed that the impact of cognitive training on overall cognitive function, working memory and daily life ability of daily living of MCI can be maintained for at least 3 months.

· Complete mediating effects of cognitive training were found in executive function through working memory and working memory in ability of daily living though executive function.

· At the end of the cognitive training, initiative significantly improved, while, at the end of active music therapy (AMT) and neuro-education (NE), it was unchanged. Episodic memory had no changes at the end of cognitive training or AMT and worsened after NE.

Outcomes

· Inadequate evidence on whether cognitive training decreases the risk for future

MCI or dementia.

15 · Subjects in the CCT groups improved significantly over the intervention period, while those in the control group did not exhibit any cognitive change.

· Cognition training had a high level of acceptance in the in-home MCI older adults in urban communities.

· The compliance in the cognitive training process was satisfactory.

· Mood and social relationships improved in the three groups, with greater changes after active music therapy (AMT) or neuro-education (NE).

General Notes/Comments · Cognitive training can be incorporated as part of health promotion interventions in healthy older adults to improve their cognitive test performance.

10 · CCT is a practical intervention for improving cognition in individuals with mild cognitive impairment.

· Cognitive training can effectively improve working memory in older adults with MCI.

· In patients with mild to moderate AD, cognitive training can enhance patients’ initiative and stabilize memory, while the non-cognitive measures can improve the psychosocial aspects.

1 Evidence-Based Project Part 3 B: 2 Critical Appraisal of Research

The critical appraisal of research has revealed that cognitive training effectively improves cognitive function in persons having mild cognitive impairment (MCI) and dementia. Cognitive training can also improve cognitive performance in older patients since they have a high risk of cognitive decline. MCI often precedes dementia. It is characterized by mainly normal functions in spite of objective evidence of cognitive decline. MCI is a major risk factor for dementia, falls, and high healthcare costs.

The risk increases relatively with impaired cognitive domains and severity of symptoms. Cognitive training is the best practice that emerges from the research analysis. 5 Butler et al. (2018) revealed that cognitive training improved cognitive performance in healthy elderly persons. Therefore, it the training be incorporated in the preventative care of older adults to lower the risk of declined cognitive function, which is common in advanced age.

Cognitive training can be implemented using technology computerized cognitive training (CCT). 10 Hill et al. (2017) demonstrated CCT as an effective and safe approach for promoting cognitive function in the elderly. Besides, CCT value has been established in improving cognition and psychosocial functioning, including alleviating depression and neuropsychiatric symptoms and improving the quality of life of individuals MCI. Furthermore, Weng et al.’s (2019) study shows that cognitive training significantly impacts the domains of executive function, memory, and performance of ADLs.

The impact on these domains can be sustained for at least three months. It can convey to other untrained areas, including executive function. Executive function also enhances the ability to carry out ADLs. The study justifies cognitive training as a practical approach to enhance working memory in elderly persons having MCI. 4 Giovagnoli et al. (2017) further show that cognitive training is useful in increasing initiative and stabilizing memory in persons with mild-moderate AD.

Conclusion

The above peer-reviewed articles include two systematic reviews of randomized controlled trials and Randomized control trials. 4 The studies sought to evaluate the impact of cognitive training in improving cognitive function in AD patients. They support my PICOT by establishing that indeed cognitive training is a feasible intervention that can improve cognitive function in AD patients. Therefore, the interventions can be incorporated in patients’’ treatment plans.

References

5 Butler, M., McCreedy, E., Nelson, V. A., Desai, P., Ratner, E., Fink, H. A.,. & Kane, R. L. (2018). 8 Does cognitive training prevent cognitive decline? 9 A systematic review. 5 Annals of internal medicine, 168(1), 63-68. https://doi.org/10.7326/M17-1531

Giovagnoli, A. 4 R., Manfredi, V., Parente, A., Schifano, L., Oliveri, S., & Avanzini, G. (2017). 4 Cognitive training in Alzheimer’s disease: 11 a controlled randomized study. 4 Neurological Sciences, 38(8), 1485-1493. https://doi.org/10.1007/s10072-017-3003-9

Hill, N. 5 T., Mowszowski, L., Naismith, S. L., Chadwick, V. L., Valenzuela, M., & Lampit, A. (2017). 10 Computerized cognitive training in older adults with mild cognitive impairment or dementia: a systematic review and meta-analysis. 5 American Journal of Psychiatry, 174(4), 329-340. https://doi.org/10.1176/appi.ajp.2016.16030360

4 Weng, W., Liang, J., Xue, J., Zhu, T., Jiang, Y., Wang, J., & Chen, S. (2019). 4 The transfer effects of cognitive training on working memory among Chinese older adults with mild cognitive impairment: 9 a randomized controlled trial. 4 Frontiers in aging neuroscience, 11, 212. https://doi.org/10.3389/fnagi.2019.00212

Module 3: Discussion Response Two

I hope you’re having a great week so far, Timothy. I really enjoyed reading your discussion post for this week! This was very intriguing and interesting. I feel as if end-of-life can be very taboo and hard to talk about, so I’m glad you’re shedding light and opening the ground for conversation to this clinical area of interest. I love how you mentioned that your focus is on relieving existential distress at the end of life, as I feel that everyone deserves to pass away in a peaceful and dignified manner. I feel as if the evidence you locate could bring up a lot of different arguments. The first one that popped into my head is if, “what if this individual has a bad trip/experience”. Personally, I have never tried a psychedelic, but I have heard many stories from patients that I have cared for, as I work in a methadone clinic. Many have spoken about taking a psychedelic and having a “bad trip” because they were not in a good headspace. Some signs of a “bad trip” include rage, paranoia, frightening hallucination and delusions, anxiety, mood swings, nausea and vomiting, dizziness, and headache (Hartney, 2022). I feel that many people in hospice or seeking end-of-life care may not mentally be in the best spot mentally, and there may be a good chance that taking a psychedelic could enhance those feelings of fear and distress.

On the other hand, it’s amazing how psychedelics can change one’s life for the better. The specific one I’m thinking of is ketamine, and how it can be used for treatment-resistant depression. When I worked at a mental health clinic, there were many patients who had tried so many antidepressants to no avail… As a last resort, they were referred to a ketamine clinic, which ended up helping tremendously with their depression. Who would have thought that a horse tranquilizer and a drug commonly used at parties and raves would provide relief for depression, in a healthcare setting, to so many?! Ketamine can be administered intravenously (which is often not covered by insurance), or there is a new Ketamine nasal spray called Esketamine/Spravato, which is more accessible as it’s easier to get covered by insurance. Both the infusions and nasal spray are administered in a healthcare setting, and one would be monitored by a healthcare provider during and after therapy due to the dissociative state Ketamine can cause (Janssen Neuroscience, 2023).

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Assignment: Evidence-Based Project, Part 3: Critical Appraisal of Research

Evaluation Table

Critical Appraisal of Research

Conclusion

References

References

Evaluation Table

Reflection

References

Part 1: Evaluation Table

Part B: Best Practice

Conclusion

References

Key findings

Outcomes

MCI or dementia.

1 Evidence-Based Project Part 3 B: 2 Critical Appraisal of Research

Conclusion

References

Module 3: Discussion Response Two

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