Description of Purpose Practice Team Compositions & Care Practices Discussion With new information continually emerging, professional nurses must be equipp

Description of Purpose Practice Team Compositions & Care Practices Discussion With new information continually emerging, professional nurses must be equipped to critique scholarly literature and discern its value for practice.

Select one current, qualitative or mixed methods scholarly nursing article related to your PICOT question and determine its strengths, limitations, and potential application.

My PICOT below , you did these assignments for me , all the information is below , APA , no plagiarism , sources peer reviw within 5 years

In community-dwelling adults (Population) what is the effect of NP intervention(Intervention) in comparison to standard care (Comparison) on a decrease in hospital admissions (Outcome) to be completed over 3 years (Time)?question

Identify and describe one practice-related issue or concern. Explain why the issue/concern is important to nurse practitioner practice and its impact on health outcomes.

The issue to be discussed is the primary care gap. The landscape of primary care practice is declining. Hospitals have started to buy up primary care practices. People who finish their education on primary care are opting to join bigger organizations (Enochs, 2019). The United States has a serious geographical maldistribution in giving out primary care services and is in a state of primary care employee shortages. This issue is not only a United States issue but a worldwide concern. With a decline in premature mortality, a rise in longevity, as well as an increase in a healthy lifestyle, the fitness-for-purpose of present health systems can be examined. This makes it a significant issue for nurse practitioners (Penm, et al, 2017).

P-Population and problem

These are Grown-up, Primary care patients, who have been receiving treatment on chronic diseases. The second population is children with special health care needs.

I- intervention

The primary care gap strategy is aimed at improving chronic diseases care of giving out the provision in preventive services. The intervention of the primary care gap is a combination of these components; Team base care, coordinated care, enhanced access to care, comprehensiveness, reorganizing care delivery, and a sustainable partnership.

C-comparison

Usual care and programs that are aimed at improving primary care quality.

O – Outcome

The outcomes include the Process of care, experiences by the staffs, which include retention rates, and job satisfaction. Also, patients experience and assessed validated measure is also an outcome.

T- Time frame

The time will depend on the quality of care given and the seriousness of the disease. The minimum time is 1 year.

PICOT question

Are ­­­­­­­­­­­________ (P) who have____________ (I) at________ (increased/decrease) risk of _______ (O) in comparison with _______ (P) with __________(C) over _________ (T)

Are the hospitalized patient’s populations at the age of between 25 to 80 years, (P) suffering from brittle diabetes (I) compared with those with normal diabetes (C) at increased risk of all having brittle diabetes (O) during the first year of admission (T)?

References

Enochs, S. (2019). Bridging the Gap between Emotional Trauma Practice Guidelines and Care Delivery in the Primary Care Setting (Doctoral dissertation, Brandman University).

Penm, J., MacKinnon, N. J., Strakowski, S. M., Ying, J., & Doty, M. M. (2017). Minding the gap: factors associated with primary care coordination of adults in 11 countries. The Annals of Family Medicine, 15(2), 113-119.

Complete the Johns Hopkins Nursing Evidence Based Practice Appendix E Evidence Appraisal Tool. Once you’ve completed the tool, use your own words to summarize your appraisal of the article. Include the following:

Description of the purpose
Explanation of research design
Discussion of sample
Description of data collection methods
Summary of findings
Strengths of the study (minimum of 1)
Limitations of the study (minimum of 1)
Recommendations regarding potential application for future practice that are insightful and appropriate.

Attach the article to your post, in addition to including the full reference for the article in your post.

During the week, read a minimum of two articles posted by peers and add your thoughts about whether you feel their article would support an EBP change. Johns Hopkins Nursing Evidence-Based Practice
Appendix E
Research Evidence Appraisal Tool
Evidence level and quality rating:
Article title:
Number:
Author(s):
Publication date:
Journal:
Setting:
Sample (composition and size):
Does this evidence address my EBP question?
Yes
No-Do not proceed with appraisal of this evidence
Is this study:
QuaNtitative (collection, analysis, and reporting of numerical data)
Measurable data (how many; how much; or how often) used to formulate facts, uncover patterns in
research, and generalize results from a larger sample population; provides observed effects of a
program, problem, or condition, measured precisely, rather than through researcher interpretation of
data. Common methods are surveys, face-to-face structured interviews, observations, and reviews of
records or documents. Statistical tests are used in data analysis.
Go to Section I: QuaNtitative
QuaLitative (collection, analysis, and reporting of narrative data)
Rich narrative documents are used for uncovering themes; describes a problem or condition from the
point of view of those experiencing it. Common methods are focus groups, individual interviews
(unstructured or semi structured), and participation/observations. Sample sizes are small and are
determined when data saturation is achieved. Data saturation is reached when the researcher identifies
that no new themes emerge and redundancy is occurring. Synthesis is used in data analysis. Often a
starting point for studies when little research exists; may use results to design empirical studies. The
researcher describes, analyzes, and interprets reports, descriptions, and observations from participants.
Go to Section II: QuaLitative
Mixed methods (results reported both numerically and narratively)
Both quaNtitative and quaLitative methods are used in the study design. Using both approaches, in
combination, provides a better understanding of research problems than using either approach alone.
Sample sizes vary based on methods used. Data collection involves collecting and analyzing both
quaNtitative and quaLitative data in a single study or series of studies. Interpretation is continual and
can influence stages in the research process.
Go to Section III: Mixed Methods
1
Johns Hopkins Nursing Evidence-Based Practice
Appendix E
Research Evidence Appraisal Tool
Section I: QuaNtitative
Level of Evidence (Study Design)
A
Is this a report of a single research study?

Yes
Go to B
1. Was there manipulation of an independent variable?

Yes

No
2. Was there a control group?

Yes

No
3. Were study participants randomly assigned to the intervention
and control groups?

Yes

No
If Yes to questions 1, 2, and 3, this is a randomized controlled trial (RCT) or
experimental study.
If Yes to questions 1 and 2 and No to question 3 or Yes to question 1 and
No to questions 2 and 3, this is quasi-experimental.
(Some degree of investigator control, some manipulation of an independent variable,
lacks random assignment to groups, and may have a control group).
If No to questions 1, 2, and 3, this is nonexperimental.
(No manipulation of independent variable; can be descriptive, comparative, or
correlational; often uses secondary data).
Study Findings That Help Answer the EBP Question
Skip to the Appraisal of QuaNtitative Research Studies section
2
 No
LEVEL I
LEVEL II
LEVEL III
Johns Hopkins Nursing Evidence-Based Practice
Appendix E
Research Evidence Appraisal Tool
Section I: QuaNtitative (continued)
B
Is this a summary of multiple sources of research
evidence?
1. Does it employ a comprehensive search strategy and rigorous
appraisal method?
If this study includes research, nonresearch, and experiential
evidence, it is an integrative review (see Appendix F).

Yes
Continue

Yes
Continue
 No
Use Appendix F
 No
Use Appendix F
2. For systematic reviews and systematic reviews with meta-analysis
(see descriptions below):
a. Are all studies included RCTs?
LEVEL I
b. Are the studies a combination of RCTs and quasi-experimental,
or quasi-experimental only?
LEVEL II
c. Are the studies a combination of RCTs, quasi-experimental, and
nonexperimental, or non- experimental only?
LEVEL III
A systematic review employs a search strategy and a rigorous appraisal method, but does not
generate an effect size.
A meta-analysis, or systematic review with meta-analysis, combines and analyzes results from
studies to generate a new statistic: the effect size.
Study Findings That Help Answer the EBP Question
Skip to the Appraisal of Systematic Review (With or Without a Meta-Analysis) section
3
Johns Hopkins Nursing Evidence-Based Practice
Appendix E
Research Evidence Appraisal Tool
Appraisal of QuaNtitative Research Studies
Does the researcher identify what is known and not known
about the problem and how the study will address any gaps in
knowledge?

Yes

No
Was the purpose of the study clearly presented?

Yes

No
Was the literature review current (most sources within the past
five years or a seminal study)?

Yes

No
Was sample size sufficient based on study design and rationale?

Yes

No
If there is a control group:
• Were the characteristics and/or demographics similar in
both the control and intervention groups?

Yes

No
N/A
• If multiple settings were used, were the settings
similar?

Yes

No
N/A
• Were all groups equally treated except for the
intervention group(s)?

Yes

No
N/A
Are data collection methods described clearly?

Yes

No
Were the instruments reliable (Cronbach’s [alpha] > 0.70)?

Yes

No
N/A
Was instrument validity discussed?

Yes

No
N/A
If surveys or questionnaires were used, was the response
rate > 25%?

Yes

No
N/A
Were the results presented clearly?

Yes

No
If tables were presented, was the narrative consistent with the
table content?

Yes

No
Were study limitations identified and addressed?

Yes

No
Were conclusions based on results?

Yes

No
Complete the Quality Rating for QuaNtitative Studies section
4
N/A
Johns Hopkins Nursing Evidence-Based Practice
Appendix E
Research Evidence Appraisal Tool
Appraisal of Systematic Review (With or Without Meta-Analysis)
Were the variables of interest clearly identified?

Yes

No
Was the search comprehensive and reproducible?
• Key search terms stated

Yes

No
• Multiple databases searched and identified

Yes

No
• Inclusion and exclusion criteria stated

Yes

No
Was there a flow diagram that included the number of studies eliminated
at each level of review?

Yes

No
Were details of included studies presented (design, sample, methods,
results, outcomes, strengths, and limitations)?

Yes

No
Were methods for appraising the strength of evidence (level and quality)
described?

Yes

No
Were conclusions based on results?

Yes

No
• Results were interpreted

Yes

No
• Conclusions flowed logically from the interpretation and systematic
review question

Yes

No

Yes

No
Did the systematic review include a section addressing limitations and
how they were addressed?
Complete the Quality Rating for QuaNtitative Studies section (below)
Quality Rating for QuaNtitative Studies
Circle the appropriate quality rating below:
A High quality: Consistent, generalizable results; sufficient sample size for the study design; adequate
control; definitive conclusions; consistent recommendations based on comprehensive literature review
that includes thorough reference to scientific evidence.
B Good quality: Reasonably consistent results; sufficient sample size for the study design; some control,
and fairly definitive conclusions; reasonably consistent recommendations based on fairly comprehensive
literature review that includes some reference to scientific evidence.
C Low quality or major flaws: Little evidence with inconsistent results; insufficient sample size for the
study design; conclusions cannot be drawn.
5
Johns Hopkins Nursing Evidence-Based Practice
Appendix E
Research Evidence Appraisal Tool
Section II: QuaLitative
Level of Evidence (Study Design)
A
Is this a report of a single research study?
 Yes
this is
Level III
 No
go to II B
Study Findings That Help Answer the EBP Question
Complete the Appraisal of Single QuaLitative Research Study section (below)
Appraisal of a Single QuaLitative Research Study
Was there a clearly identifiable and articulated:
• Purpose?
❑
Yes
❑ No
•
Research question?
❑
Yes
❑ No
•
Justification for method(s) used?
❑
Yes
❑ No
•
Phenomenon that is the focus of the research?
❑
Yes
❑ No
Were study sample participants representative?
❑
Yes
❑ No
Did they have knowledge of or experience with the research area?
❑
Yes
❑ No
Were participant characteristics described?
❑
Yes
❑ No
Was sampling adequate, as evidenced by achieving saturation of data?
❑
Yes
❑ No
Data analysis:
• Was a verification process used in every step by checking and confirming ❑ Yes
with participants the trustworthiness of analysis and interpretation?
❑
Yes
❑ No
Do findings support the narrative data (quotes)?
❑
Yes
❑ No
Do findings flow from research question to data collected to analysis undertaken?
❑
Yes
❑ No
Are conclusions clearly explained?
❑
Yes
❑ No
•
Was there a description of how data were analyzed (i.e., method), by
computer or manually?
Skip to the Quality Rating for QuaLitative Studies section
1
❑ No
Johns Hopkins Nursing Evidence-Based Practice
Appendix E
Research Evidence Appraisal Tool
B
For summaries of multiple quaLitative research studies
(meta-synthesis), was a comprehensive search strategy and
rigorous appraisal method used?
 Yes
Level III
 No
go to Appendix F
Study Findings That Help Answer the EBP Question
Complete the Appraisal of Meta-Synthesis Studies section (below)
Appraisal of Meta-Synthesis Studies
Were the search strategy and criteria for selecting primary studies clearly defined?
❑
Yes
❑ No
Were findings appropriate and convincing?
❑
Yes
❑ No
Was a description of methods used to:
• Compare findings from each study?
❑
Yes
❑ No
❑
Yes
❑ No
Did synthesis reflect:
❑
Yes
❑ No
•
New insights?
❑
Yes
❑ No
•
Discovery of essential features of phenomena?
❑
Yes
❑ No
•
A fuller understanding of the phenomena?
❑
Yes
❑ No
❑
Yes
❑ No
•
Interpret data?
Was sufficient data presented to support the interpretations?
Complete the Quality Rating for QuaLititative Studies section (below)
2
Johns Hopkins Nursing Evidence-Based Practice
Appendix E
Research Evidence Appraisal Tool
Quality Rating for QuaLitative Studies
Circle the appropriate quality rating below:
No commonly agreed-on principles exist for judging the quality of quaLitative studies. It is a subjective
process based on the extent to which study data contributes to synthesis and how much information is
known about the researchers’ efforts to meet the appraisal criteria.
For meta-synthesis, there is preliminary agreement that quality assessments should be made before
synthesis to screen out poor-quality studies1.
A/B High/Good quality is used for single studies and meta-syntheses2.
The report discusses efforts to enhance or evaluate the quality of the data and the overall inquiry in
sufficient detail; and it describes the specific techniques used to enhance the quality of the inquiry.
Evidence of some or all of the following is found in the report:
• Transparency: Describes how information was documented to justify decisions, how data were
reviewed by others, and how themes and categories were formulated.
• Diligence: Reads and rereads data to check interpretations; seeks opportunity to find multiple
sources to corroborate evidence.
• Verification: The process of checking, confirming, and ensuring methodologic coherence.
• Self-reflection and self-scrutiny: Being continuously aware of how a researcher’s experiences,
background, or prejudices might shape and bias analysis and interpretations.
• Participant-driven inquiry: Participants shape the scope and breadth of questions; analysis and
interpretation give voice to those who participated.
• Insightful interpretation: Data and knowledge are linked in meaningful ways to relevant literature.
C Lower-quality studies contribute little to the overall review of findings and have few, if any, of the
features listed for High/Good quality.
1 https://www.york.ac.uk/crd/SysRev/!SSL!/WebHelp/6_4_ASSESSMENT_OF_QUALITATIVE_RESEARCH.htm
2 Adapted from Polit & Beck (2017).
3
Johns Hopkins Nursing Evidence-Based Practice
Appendix E
Research Evidence Appraisal Tool
Section III: Mixed Methods
Level of Evidence (Study Design)
You will need to appraise both the quaNtitative and quaLitative parts of the study independently, before
appraising the study in its entirety.
1. Evaluate the quaNitative part of the study using Section I.
Level
Quality
Level
Quality
Insert here the level of evidence and overall quality for this part:
2. Evaluate the quaLitative part of the study using Section II.
Insert here the level of evidence and overall quality for this part:
3. To determine the level of evidence, circle the appropriate study design:
• Explanatory sequential designs collect quaNtitative data first, followed by the quaLitative data; and their
purpose is to explain quaNtitative results using quaLitative findings. The level is determined based on the
level of the quaNtitative part.
• Exploratory sequential designs collect quaLitative data first, followed by the quaNtitative data; and their
purpose is to explain quaLitative findings using the quaNtitative results. The level is determined based on
the level of the quaLitative part, and it is always Level III.
• Convergent parallel designs collect the quaLitative and quaNtitative data concurrently for the purpose of
providing a more complete understanding of a phenomenon by merging both datasets. These designs are
Level III.
• Multiphasic designs collect quaLitative and quaNtitative data over more than one phase, with each
phase informing the next phase. These designs are Level III.
Study Findings That Help Answer the EBP Question
Complete the Appraisal of Mixed Methods Studies section (below)
4
Johns Hopkins Nursing Evidence-Based Practice
Appendix E
Research Evidence Appraisal Tool
Appraisal of Mixed Methods Studies 3
Was the mixed-methods research design relevant to address the quaNtitative
and quaLitative research questions (or objectives)?
❑
Yes
❑ No
❑
N/A
Was the research design relevant to address the quaNtitative and quaLitative
aspects of the mixed-methods question (or objective)?
❑
Yes
❑ No
❑
N/A
For convergent parallel designs, was the integration of quaNtitative and
quaLitative data (or results) relevant to address the research question or
objective?
❑
Yes
❑ No
❑
N/A
For convergent parallel designs, were the limitations associated with the
integration (for example, the divergence of quaLitative and quaNtitative data or
results) sufficiently addressed?
❑
Yes
❑ No
❑
N/A
Complete the Quality Rating for Mixed-Method Studies section (below)
3 National Collaborating Centre for Methods and Tools. (2015). Appraising Qualitative, Quantitative, and Mixed Methods Studie s included in Mixed Studies Reviews: The MMAT.
Hamilton, ON: McMaster University. (Updated 20 July, 2015) Retrieved from http://www.nccmt.ca/ resources/search/232
Quality Rating for Mixed-Methods Studies
Circle the appropriate quality rating below
A High quality: Contains high-quality quaNtitative and quaLitative study components; highly relevant
study design; relevant integration of data or results; and careful consideration of the limitations of the
chosen approach.
B Good quality: Contains good-quality quaNtitative and quaLitative study components; relevant study
design; moderately relevant integration of data or results; and some discussion of limitations of
integration.
C Low quality or major flaws: Contains low quality quaNtitative and quaLitative study components;
study design not relevant to research questions or objectives; poorly integrated data or results; and no
consideration of limits of integration.
5

Purchase answer to see full
attachment