Week 5 Overview
Over the past two weeks, you collected evidence to answer the PICOT question you wrote to guide the search of the literature. You then appraised that evidence using the rapid critical appraisal tools and created an Evaluation Table for your “keeper” studies. This week, you will synthesize the evidence in the Evaluation Table to determine best evidence as a basis for your project. Synthesis table templates to assist you can be found in Appendix E in your text (Melnyk & Fineout-Overholt, 2011). The Word document template versions are also available in Week 3 Overview.
Synthesizing the evidence involves determining the levels of evidence, the variables of interest, and the impact of the interventions across the studies, which should now be referred to as the “body of evidence,” a term used to refer to the results from the Evaluation Table. Creating several Synthesis Tables may be required in order for you to fully understand the best evidence for your quality improvement project proposal. This synthesis will determine what intervention you will use to facilitate change and improve outcomes.
Patient preferences and clinical expertise are important to consider. As you synthesize the body of evidence, viewing it from an experts perspective is crucial. Benner and Leonard (in Melnyk & Fineout-Overholt, 2011) provide practical suggestions for assessing bias in research. That approach along with solid clinical judgment is essential to making decisions regarding your body of evidence. Remember when your math teacher encouraged you to look at your work from a practical perspective, asking yourself, “does it make sense?” It is important that you look at the body of evidence from that perspective at this juncture.
• Demonstrate synthesis of the knowledge and skills acquired in preceding graduate nursing core and specialty curriculum content.
• Integrate this synthesis in the creation of a scholarly project of either an evidenced-based practice proposal or a research proposal that generates new nursing knowledge.
• Incorporate evidence-based research methods, scientific writing, and critical thinking demonstrative of graduate level professional nursing practice.
Benner, P. E., & Leonard, V. W. (2011). Patient concerns, choices, and clinical judgment in evidence-based practice. In B. M. Melynk, & E. Fineout-Overholt (Eds.), Evidence-based practice in nursing & healthcare (2nd ed.). Philadelphia: Lippincott Williams & Wilkins.
This week, you focused on development of the Synthesis Table(s) and described the studies of interest in narrative terms for Part 3 of your project proposal. Next week you will reassess your clinical question to begin the study phase of your evidence-based practice project proposal. In addition, you will determine the appropriate theoretical framework(s) to guide your study.
Assignment 1: Discussion
As you work on your capstone project proposal, you may want to share your progress with your peers and instructor and seek or provide guidance or share insights. By Tuesday, January 5, 2016, go to the Discussion Area and post responses to the discussion question. All responses should be posted to the appropriate topic in this Discussion Area. It is important to support what you say with relevant citations in the APA format from both the course materials and outside resources. Include the South University online library in your research activities utilizing not only the nursing resource database, but also those pertaining to education, business, and human resources.
Assignment 1: Discussion
This week the discussion focuses on creating a Synthesis Table(s) as a means to summarize and organize the body of evidence from the Evaluation Table. The Synthesis tables will be included in your formal proposal in the Appendix. In the body of the paper, you will describe the “keeper” studies in narrative format.
For this discussion, include the following:
• Share your approach to synthesizing the evidence. What were the variables of interest you identified?
• Learning to write in a scholarly fashion requires that you are able to succinctly summarize an article in a sentence or two and cite it appropriately using APA format. In this discussion, practice summarizing 2 articles you have identified from the Synthesis Table as pertinent to your proposal. Include the level of evidence, study design, and evidence of rigor. Use appropriate APA citation in text and references. Incorporate feedback from peers and faculty in your Dropbox assignment for this week.
• In addition to research studies, patient preference and clinical expertise should also be considered. Discuss how you will incorporate these important perspectives into your project proposal.
Synthesizing evidence for this project has been like piecing a puzzle. Breaking it down into each section is surely making it a bit easier. Although, the evidence table was very time consuming, it has made synthesizing the evidence much easier to create summaries, as the ones that follow. According to Melynk and Fineout-Overholt (2011) synthesizing the evidence is not to produce new knowledge as much as the goal, it is to synthesize what is already known.
Buthorne (2013) implemented a review of literature that addressed end of life (EOL) decisions and discussions, comparing satisfaction and quality of EOL experience. They discovered that families that had the conversation and made decisions known had greater satisfaction of loved ones death. They concluded that more education is needed on both the healthcare and patient sides of conversation, regarding choices and communication skills. The level of evidence is IV and there is evidence of rigor.
The second article by Fabro, Schaffer and Scharton (2014) is a qualitative and quantitative study stressing the importance of implementing class sessions for nursing students on palliative or end-of-life care. The level of evidence is a IV whereas a Nursing Education Simulation Framework, which was developed for designing, implementing, and evaluating simulations for nurses and EOL was used (Fabro, Schaffer & Scharton, 2014); the framework consisted of five major components that served as a guide for planning, implementing, and evaluating the EOL simulation scenario. For instance, two scenarios about an EOL hospital experience were developed for an elective EOL course in a baccalaureate nursing program, replacing a four-hour EOL observation experience that was part of the course in previous years. The authors concluded that students evaluation from elective course/scenario from nursing school compared to new graduate nurses from just four-hour experience, indicated that they were more satisfied with their learning experiences and they reported an increased level of confidence in their ability to care for dying patients. Thus, Fabro and his colleagues (2014) added that end-of life nursing courses should be inculcated in nursing institutions; it can effectively prepare nurses to provide safe, effective palliative care by exposing them to a variety of clinical scenarios in a supportive learning environment.
These articles that I found pertinent to include have been supportive of my proposed EOL guide to nursing education. Implementation would enhance EOL comfort and quality of experience for patient, family and healthcare provider.