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 Article #1 Article #2 Article #3 Article #4 Full APA formatted citation of selected article. Evidence Level * (I, II, or III) Conceptual Framework Describe the theoretical basis for the study (If there is not one mentioned in the article, say that here).** Design/Method Describe the design and how the © 2018 Laureate Education Inc. 1 study was carried out (In detail, including inclusion/exclusion criteria). Sample/Setting The number and characteristics of patients, attrition rate, etc. Major Variables Studied List and define dependent and independent variables Measurement Identify primary statistics used to answer clinical questions (You need to list the actual tests done). Data Analysis Statistical or Qualitative findings (You need to enter the actual numbers determined by the statistical tests or qualitative data). Findings and Recommendations General findings and recommendations of the research Appraisal and Study Quality © 2018 Laureate Education Inc. 2 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? Key findings Outcomes General Notes/Comments © 2018 Laureate Education Inc. 3 *These levels are from the Johns Hopkins Nursing Evidence-Based Practice: Evidence Level and Quality Guide • Level I Experimental, randomized controlled trial (RCT), systematic review RTCs with or without meta-analysis • Level II Quasi-experimental studies, systematic review of a combination of RCTs and quasi-experimental studies, or quasi-experimental studies only, with or without metaanalysis • Level III Nonexperimental, systematic review of RCTs, quasi-experimental with/without meta-analysis, qualitative, qualitative systematic review with/without meta-synthesis • Level IV Respected authorities’ opinions, nationally recognized expert committee/consensus panel reports based on scientific evidence • Level V Literature reviews, quality improvement, program evaluation, financial evaluation, case reports, nationally recognized expert(s) opinion based on experiential evidence **Note on Conceptual Framework • The following information is from Walden academic guides which helps explain conceptual frameworks and the reasons they are used in research. Here is the link https://academicguides.waldenu.edu/library/conceptualframework • Researchers create theoretical and conceptual frameworks that include a philosophical and methodological model to help design their work. A formal theory provides context for the outcome of the events conducted in the research. The data collection and analysis are also based on the theoretical and conceptual framework. • As stated by Grant and Osanloo (2014), “Without a theoretical framework, the structure and vision for a study is unclear, much like a house that cannot be constructed without a blueprint. By contrast, a research plan that contains a theoretical framework allows the dissertation study to be strong and structured with an organized flow from one chapter to the next.” • Theoretical and conceptual frameworks provide evidence of academic standards and procedure. They also offer an explanation of why the study is pertinent and how the researcher expects to fill the gap in the literature. • Literature does not always clearly delineate between a theoretical or conceptual framework. With that being said, there are slight differences between the two. © 2018 Laureate Education Inc. 4 References The Johns Hopkins Hospital/Johns Hopkins University (n.d.). Johns Hopkins nursing dvidence-based practice: appendix C: evidence level and quality guide. Retrieved October 23, 2019 from https://www.hopkinsmedicine.org/evidence-basedpractice/_docs/appendix_c_evidence_level_quality_guide.pdf Grant, C., & Osanloo, A. (2014). Understanding, Selecting, and Integrating a Theoretical Framework in Dissertation Research: Creating the Blueprint for Your" House". Administrative Issues Journal: Education, Practice, and Research, 4(2), 12-26. Walden University Academic Guides (n.d.). Conceptual & theoretical frameworks overview. Retrieved October 23, 2019 from https://academicguides.waldenu.edu/library/conceptualframework © 2018 Laureate Education Inc. 5 Clinical, Cosmetic and Investigational Dermatology Dovepress open access to scientific and medical research Original Research Clinical, Cosmetic and Investigational Dermatology downloaded from https://www.dovepress.com/ by 23.161.128.2 on 15-Jul-2020 For personal use only. Open Access Full Text Article Nurses’ knowledge on pressure injury prevention: a systematic review and meta-analysis based on the Pressure Ulcer Knowledge Assessment Tool This article was published in the following Dove Press journal: Clinical, Cosmetic and Investigational Dermatology Sahar Dalvand 1 Abbas Ebadi 2 Reza Ghanei Gheshlagh 3,4 1 Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran; 2Behavioral Sciences Research Center, Life Style Institute, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran; 3Department of Nursing, School of Nursing and Midwifery, Kurdistan University of Medical Sciences, Sanandaj, Iran; 4Clinical Care Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran Introduction Correspondence: Reza Ghanei Gheshlagh Department of Nursing, School of Nursing and Midwifery, Kurdistan University of Medical Sciences, Pasdaran Street, 66177–13446 Sanandaj, Kurdistan, Iran Email rezaghanei30@yahoo.com Pressure injury (PI) is a painful, costly, but potentially preventable problem that is common in older people and patients with limited mobility.1 The cost of the treatment of PI is 2.5 times than its prevention.2 PI increases the length of stay in the hospital from 4 to 30 days, decreases quality of life, and increases pain, morbidity, and mortality.3–5 Limited use of knowledge is a common problem in clinical practice. Nurses are not completely aware of up-to-date care protocols and may not have enough knowledge on the current evidence-based practices. Sometimes, nurses’ activities are not based on knowledge, but rather on intuition, experience, or habit.6 Control and prevention of PI requires interdisciplinary collaboration. In order to keep the integrity of patients’ skin and prevent the complications of PI, nurses need to receive support and advice from other health professionals.7 Different prevalence rates have been reported for PI in different hospital wards. Patients with spinal cord injury, older adults, and especially patients in intensive care units (ICUs) are at a higher risk of developing PI.8 613 submit your manuscript | www.dovepress.com Clinical, Cosmetic and Investigational Dermatology 2018:11 613–620 Dovepress © 2018 Dalvand et al. This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms. php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php). http://dx.doi.org/10.2147/CCID.S186381 Powered by TCPDF (www.tcpdf.org) Introduction: Inadequate knowledge on pressure injury (PI) can have a detrimental effect on preventive care strategies. The aim of this study was to assess the overall knowledge of nurses on PI prevention based on their scores on the Pressure Ulcer Knowledge Assessment Tool (PUKAT) and its subscales in different settings. Methods: In this systematic review and meta-analysis, databases including Web of Science, Science Direct, Google Scholar, PubMed, and Scopus were searched, using the following keywords: Pressure Ulcer, Pressure injury, Bedsore, Pressure Sore, Decubitus Ulcer, knowledge, and their possible combinations. Based on heterogeneity between the studies, the data were analyzed using a random effects model. All of the analyses were performed using STATA v.12 software. Results: In all three groups (nurses, assistant nurses, and nursing students), the lowest knowledge scores were for prevention measures to reduce the amount of pressure/shear. Nurses’ knowledge (55.4%, 95% CI: 42.4–68.4) was higher than that of nursing students (52.7%, 95% CI: 3–49.56) and assistant nurses (42.2%, 95% CI: 16.4–68). Conclusion: The overall knowledge of nurses on PI prevention was lower than the recommended level (60%). Regular training courses and review of PI prevention guidelines can be useful in updating the knowledge of nurses, especially assistant nurses and nursing students on PI prevention. Keywords: pressure injury, knowledge on pressure injury prevention, nurse Dovepress Clinical, Cosmetic and Investigational Dermatology downloaded from https://www.dovepress.com/ by 23.161.128.2 on 15-Jul-2020 For personal use only. Dalvand et al In the Vanderwee et al’s study, only 10% of the patients at risk of developing PI received adequate preventive care.9 Prevention of PI begins by identifying high-risk individuals, systematical examination of skin, using bed and chair support surfaces, changing posture, mobility, and nutritional support.10 Low knowledge on PI prevention negatively affects preventive care strategies.11 The review of literature suggests that nurses’ knowledge on PI prevention is limited and that this lack of knowledge can negatively influence their performance.12 There are various tools for evaluating nurses’ knowledge on PI prevention that often lack adequate validation, so their results cannot be generalized.13–16 The Pressure Ulcer Knowledge Assessment Tool (PUKAT) is a 26-item questionnaire, designed by Beeckman et al to assess nurses’ knowledge on pressure injury in six areas of etiology and development (six items), classification and observation (five items), risk assessment (two items), nutrition (one item), reduction in the amount of pressure/shear (seven items), and reduction in the duration of pressure/shear (five items). A score of 16 and higher (out of 26) indicates acceptable level of knowledge and proficiency on PI (60% of the total score).17 The PUKAT has been used in different countries, including Australia, Mexico, China, Italy, Sweden, Ireland, and Belgium, to assess nurses’ knowledge on PI prevention.11,18–24 PI is an index of nursing care quality, and management of PI is one of the main nursing tasks, which is influenced by nurses’ knowledge on this issue. Different studies have reported different results about nurses’ knowledge on PI prevention. The results indicated that nurses’ level of knowledge on PI prevention ranged from 28% to 74%. Considering the importance of improving nurses’ knowledge on PI prevention, we should first have an insight on their current level of knowledge; this systematic review and meta-analysis was conducted with the aim of evaluating nurses’ overall knowledge on PI prevention. Methods Search strategy Nurses’ knowledge on PI prevention was evaluated based on their scores on the PUKAT, reported in articles conducted from 2010 to March 2018.17 The year 2010 was selected because the PUKAT was published in that year, and ever since it has been cited in various research studies. In terms of language, the articles published in English and Spanish were included in the analysis. The search was conducted in Web of Science, Science Direct, Google Scholar, PubMed, and Scopus using the following keywords: Pressure Injury, Pressure Ulcer, Bedsore, Pressure Sore, Decubitus Ulcer, 614 Powered by TCPDF (www.tcpdf.org) submit your manuscript | www.dovepress.com Dovepress and Knowledge, and their possible combinations. The reference lists of the articles were also reviewed to improve the coverage. Selection of studies and data extraction First, all the articles that had used the keywords in their titles were selected based on inclusion and exclusion criteria. The inclusion criteria were the use of the PUKAT for measuring nurses’ knowledge on PI prevention and reporting the required data. Lack of access to the article’s full text and use of other tools to gather data were the exclusion criteria. Using the abovementioned criteria, the titles and abstracts of the articles were independently reviewed by two researchers, and the related materials were extracted. In the next step, the full texts of the articles providing useful information were analyzed. The methodological quality of the articles was analyzed using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE). This checklist contains 22 items assessing six different sections of research articles, including title and abstract, introduction, method, results, discussion, and sponsorship.25 Disagreements between the two researchers were resolved by the correspondent author who was experienced in meta-analysis. The data from the selected articles were recorded in an Excel chart, including the name of the first author, year of publication, country of study, total sample size, target group (nurses, assistant nurses, and nursing students), total scores on the PUKAT, and scores on the six dimensions of the instrument. Statistical analysis Because in the selected studies, total scores on the PUKAT and scores on its six dimensions were provided as percentages, the scores were estimated using the binomial distribution. The variance of each study was calculated using the binomial distribution formula. A weighted mean was used to combine the percentages of the scores in each study, so that each study was weighted in proportion to its variance. Because of the percentage difference in total PI prevention knowledge scores and dimension scores between different studies, and due to the significance of heterogeneity indices, the random effects model was used to combine the studies and estimate the percentage of total and dimension scores. The I2 index and Cochran’s Q test were used to examine the heterogeneity between the studies (I2 statistics below 25% indicated low heterogeneity, between 25% and 50% moderate heterogeneity, and over 75% high heterogeneity). For the Cochran’s Q test, the P-value was set at
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