Assignment: Appraisal of Evidence

Assignment: Appraisal of Evidence ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Assignment: Appraisal of Evidence Section C To begin, work through the reference list that was created in the “Section B: Problem Description” assignment in Topic 2. Appraise each resource using the “Rapid Critical Appraisal Checklists,” available in the textbook appendix. The specific checklist you use will be determined by the type of evidence within the resource. Assignment: Appraisal of Evidence Develop a research table to organize and summarize the research studies. Using a summary table allows you to be more concise in your narrative description. Only research studies used to support your intervention are summarized in this table. Refer to the “Evaluation Table Template,” available in the textbook appendix. Use the “Evaluation Table Template” as an adaptable template. Write a narrative of 750-1,000 words (not including the title page and references) that presents the research support for the projects problem and proposed solution. Make sure to do the following: Assignment: Appraisal of Evidence Include a description of the search method (e.g., databases, keywords, criteria for inclusion and exclusion, and number of studies that fit your criteria). Summarize all of the research studies used as evidence. The essential components of each study need to be described so that readers can evaluate its scientific merit, including study strengths and limitations. Incorporate a description of the validity of the internal and external research. It is essential to make sure that the research support for the proposed solution is sufficient, compelling, relevant, and from peer-reviewed professional journal articles. Although you will not be submitting the checklist information or the evaluation table you design in Topic 3 with the narrative, the checklist information and evaluation table should be placed in the appendices for the final paper. Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required. This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion. You are required to submit this assignment to Turnitin. Please refer to the directions in the Student Success Center. Upon receiving feedback from the instructor, refine “Section C: Literature Support” for your final submission. This will be a continuous process throughout the course for each section. ebp_section_b_julie_braylock.docx summary_of_reviewed_evidence.docx section_c_rubric.docx Running head: MOVING FOR HOME 1 Section B EBP Problem Statement: Moving For Home Julie Braylock Grand Canyon University: Nurs-699 February 4, 2018 Professor Cindy Boyer MOVING FOR HOME 2 According to (Truong et al, 2009) “In the Intensive Care Unit, critically ill mechanically ventilated patients have been considered too ill to move leaving them to traditional bed rest to which can lead to detrimental effects on the patients physical, emotional, and social health. ICU acquired weakness (ICU-AW) is an accumulative effect of prolonged bed rest, malnutrition, and systemic inflammation”. The author goes on to explain that “Once a patient has been compromised by ICU-AW, the patient may experience prolonged mechanical ventilation, prolonged hospitalization due to secondary diagnoses from hospital acquired injuries (HAIs), muscle wasting requiring ECF placement, and decreased quality of life due to prolonged effects of immobility” (Truong et al 2009). The general weakness of the muscles develops in patients admitted in the ICU due to acute illness or treatment of the disease. The loss of muscle mass and muscle strength in patients in the ICU was first recorded in the nineteenth century (Hermans & Berghe, 2015). The main complications related to ICU-AW are critical illness polyneuropathy and critical illness myopathy. The incidence rate of ICU-AW is reported to be 25% to 100% (Zororwitz, 2016). It is a frequent complication of a critical illness which is linked to high morbidity and mortality rates. Additionally, the condition has long-term consequences in patients who are discharged from the hospital for an instance post-intensive care syndrome which comprise of mental, physical and cognitive dysfunction. ICU-AW is associated with multiple dysfunctions of organs, and thus patients have activity limitations. These patients require physical assistance mostly from the nurses to perform even the most basic activities related to bed movement.Assignment: Appraisal of Evidence The purpose of this paper is to provide a proposed evidence-based project whose aim is to reduce the effects of ICU-AW and decrease hospitalization duration for patients with mechanical intubation in Spring Valley Hospital. MOVING FOR HOME 3 The proposed problem is an issue not only in the US but a globally. Patients in ICU are at a higher risk of losing muscle mass and mass strength due to reduced physical inactivity and increased metabolism. Additionally, decreased pathophysiological mechanisms which include metabolic, microvascular, electrical and bioenergetic adaptation give rise to muscle atrophy and reduced muscle mass and strength (Zhou et al, 2014). From the proposed problem, researching Spring Valley Hospital would be of great importance as there would be an evidence-based project that will be used in the field of nursing. Moreover, the hospital will receive a good reputation. Weaning off mechanical ventilation is related to problems of the diaphragm, intercostals muscles, phrenic nerves and other accessory respiratory muscles. In rare cases, facial muscles may be affected, and thus paralysis of the muscles surrounding the eye may occur. The research will benefit patients who are in the ICU all over the world as well as nurses. EBP in the hospital will only be possible if there is collaboration among hospital workers and support from peers and colleagues as well as managerial support. When conducting this research, it is essential to develop a PICOT statement to enable useful interview due to this epidemic. The question could be: In critically ill mechanically ventilated patients (P), does the implementation of early mobility to reduce the risk of ICU acquired weakness (ICU-AW) (I) compared to use of complete bed rest (C) decrease hospital stay (O) over time (T)? The purpose of conducting this research is to find out practical interventions that will facilitate reduction of the effects of ICU-AW and aid in the reduction of hospital stay for patients with mechanical intubation. This will, therefore, reduce morbidity and mortality rate in the US as well as reduce the long-term complications for patients who are discharged. The EBP is essential in the field of nursing as it provides practical care for patients with similar conditions with the intention of improving the outcome of the patients. MOVING FOR HOME 4 References Amidei, C. (2012). Assignment: Appraisal of Evidence Measurement of physiologic responses to mobilization in critically ill adults. Intensive and Critical Care Nursing, (28), 58-72. doi: 10.1016/j.iccn.2011.09.002 Amidei, C. (2012). Mobilization in critical care: A concept analysis. Intensive and Critical Care Nursing, (28), 73-81. doi: 10.1016/j.iccn.2011.12.006 Hermans, G., & Berghe, G. (2015, August 5). Clinical review: intensive care unit-acquired weakness. Retrieved January 31, 2018, from Pubmed: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4526175/ Leditschke, A., Green, M., Irvine, J. A., Bissett, B., & Mitchell, I. (2012). What are the barriers to mobilizing intensive care patients? Cardiopulmonary Physical Therapy Journal, 23(1), 26-29. Lipshutz, A., & Gropper, M. (2013). Acquired neuromuscular weakness and early mobilization in the intensive care unit. Anesthesiology, 118(1), 202-215. Mendez-Tellez, P., & Needham, D. (2012). Early physical rehabilitation in the icu and ventilator liberation. Respiratory Care, 57(10), 1663-1669. doi: 10.4187/respcare.01931 Perme, C., & Chandrashekar, R. K. (2008). Managing the patient on mechanical ventilation in icu: Early mobility and walking program. Acute Care Perspectives, (Spring), 10-15. Perme, C., & Chandrashekar, R. (2009). Early mobilization and walking program for patients in intensive care units: Creating a standard of care. American journal of Critical care: an MOVING FOR HOME 5 official publication, American Association of Critical Care Nurses, 18(3), 212-221. doi: 10.4037/ajcc200959 Schweickert, W., Pohlman, M., Pholman, A. J., Nigos, C., Pawlik, A., Esbrook, C., Spears, L., & Miller, M. (2009). Early physical and occupational therapy in mechanically ventilated, critically ill patients: A randomized controlled trial. Lancet, 373, 1874-1882. doi: 10.1016/50140-6736(09)60658-9 Stockley, R., Morrison, J., Rooney, J., & Hughes, J. (2012). Move it or lose it?: A survey of the aims of treatment when using passive movements in intensive care. Intensive and Critical Care Nursing, (28), 82-87. doi: 10.1016/j.iccn.2011.10.01 Truong, A., Fan, E., Brower, R., & Needham, D. (2009). Bench-to-bedside review: Mobilizing patients in the intensive care unit – from pathophysiology to clinical trials. Critical Care Alert, 13(4), doi: 10.1186/cc7885 Vollman, K. (2013). Understanding critically ill patients hemodynamic response to mobilization:Assignment: Appraisal of Evidence Using the evidence to make it safe and feasible. Critical Care Nursing Quarterly, 36(1), 17-27. doi: 10.1097/CNQ.0b013e3182750767 Winkelman, C., Johnson, K., Hejal, R., Gordon, N., Rowbottom, J., Daly, J., Peereboom, K., & Levine, A. (2012). Examining the positive effects of exercise in intubated adults in icu: A prospective repeated measures clinical study. Intensive and Critical Care Nursing, (28), 307-320. doi: 10.1016/j.iccn.2012.02.007 Zhou, C., Wu, L., Ni, F., Wu, J., Ji, W., & Zhang, H. (2014). Critical illness polyneuropathy and myopathy: a systematic review. Neural Regeneration Research, 9 (1). MOVING FOR HOME Zororwitz, R. (2016). ICU–Acquired Weakness: A Rehabilitation Perspective of Diagnosis, Treatment, and Functional Management. Chest, 150 (4). 6 MOVING FOR HOME Summary of Reviewed Evidence 10 Author(s)/ (Year) Sample/Setting/ Data Collection Design Tools Amidei, C. (2012). Sample: N= 567 Adults Measurement of physiologic > 239 patients responses to mechanically mobilisation in ventilated. critically ill adults. 5 out of 12 Intensive and studies RCT Critical Care setting: ICU Nursing, (28), setting, post ICU 58-72. setting and community setting Vital signs monitored pre, post, and during intervention include heart rate, blood pressure, Respiratory rate, Sa02, SV02, C02 Findings/Results Appraisal of Evidence: Worth to Practice include Strengths, Weaknesses and Conclusions Level of Evidence (LOE) All the studies included in the strengths: There was a mixture of LOE: I systemic review assessed physiologic studies presented and evaluated. Systematic responses to mobilization on identified cytokine as the only Review critically ill patients. The SR evaluation variable that is a safety explained in depth to what extend measure and a desired outcome. that all the noted evaluation tools may be performed and how the reliability of each evaluation tool Weaknesses: No evaluation for may be altered by medications, measurements was focused on production, IL-6 & techniques, performance by comfort or sleep related to IL-10 technicians, or the patients mobilization or length of understanding of the surveys. The hospitalization address in this inflammation SR also stressed on markers, Borg review. rating of the patient safety before evaluation Design/Method: of efficacy. Assignment: Appraisal of Evidence Despite each perceived Systematic Conclusion: The SR does not Review MOVING FOR HOME twelve articles were retrieved from electronic databases, from 1990-2011, exertion surveys, measurement tool having the ability answer the clinical question but it and muscle to be inaccurate to some extend, it is does give beneficial evaluation strength the collaboration of multiple tools and guidance to monitor for measurement tests, measurement tools to evaluate an safety and effects of mobility on (MMT) manual accurate assessment of mobility on a critically ill patients. muscle testing, critically ill patient. including CINAHL, (MRC) medical MEDLINE, research council muscle strength PubMED, and grading scale, and Cochrane PFT Database of Systematic for respiratory muscle strength. Reviews. 11 MOVING FOR HOME Bassett, R., Sample: N=130 Vollman, K., non specific ICU Brandwene, L., & patients 10 from Murray, T. (2012). each facility studied over a 30 Integrating a day period multidisciplinary mobility programme into setting: 8 intensive care hospitals, a practice (immptp): mixture of large A multicentre academic centers collaborative. to small rural Intensive and community Critical Care hospitals Nursing, (28), 13 ICU setting 88-97. doi: from trauma to 10.1016/j.iccn.20 CVICU, MICU, 11.12.001 12 Qualitative surveys The literature review suggest that Strengths: This study addresses LOE : IV from team early mobilization has been shown the critical illness of patients while Cohort study members on to decrease VAP, skin injuries, length giving an algorithm like protocol to culture of change of hospital stay, decreased delirium follow for severity of illness and Quantitative results and improve the amount of amount of PT the patient can from retrospective ventilator free days as well as follow. It addresses the culture to chart abstractions physical function after hospital which the ICU can present as a and concurrent discharge. In this qualitative and barrier to EPB and implemented direct observational quantitate study, the trend towards techniques to improve compliance data decreased length of ventilator days and promote exuberance of the decreased P=0.06 improved. treatment team. Monthly conference calls for However, no statically significant Weakness: The study was not Coaching (culture) were shown in the number of randomized, and the culture of the and Strategy ventilator free days P=1.1, ICU treatment settings were already (clinical content, mortality P=0.69, ICU length of stay use to implementing new changes date collection, and (LOS) P=0.6 and hospital LOS P=0.31. within the institution. sample data evaluation). Assignment: Appraisal of Evidence The qualitative study evaluated the was small, 10 participants per barriers to the change of culture and institution 13 over a 30 day Progressive safety of early mobilization. 57% of interval. mobility to SICU patients received PT consults on day continuum, Conclusion: This study does 1 of ICU stay. Patients who receive early PT assessment will usually answer the clinical question but Method: more importantly give an receive treatment on day 1.5 days Literature review, qualitative and quantitative MOVING FOR HOME 13 study design, no RASS or MASS compared to 7.4 from time of randomization intubation. The implementation of scales to monitor the (PMC) progressive mobility agitation and motor continuum reinforces the need for activity scales. PT to be a daily priority of care for algorithm like measure tool to be utilized for education for patients/family/and staff. It also addresses techniques that may be used to facilitate compliance ICU patients regardless of intubation when implementing the EBP or LOS. project. Leditschke, A., Green, M., Sample: N=106 ICU patients – a mixture of Irvine, J. A., Bissett, mechanically B., & Mitchell, I. intubate and (2012). What are spontaneously the barriers to breathing. mobilizing intensive care patients? Setting: Mixed Cardiopulmonary ICU setting Physical Therapy including trauma Journal, 23(1), and surgical patients 26-29. Demographics, APACHE II 54% of all patient days involved Strengths: This study examined LOE: VI mobility. The staff felt that this was a mechanically intubated patients Qualitative low number but when compared to along with other ICU patients. It scores, number of Study recent literature this amount of identified what the barriers to patients mobilized participation is well above the mobility were. It also identified a day, type of standards reported. The reasons for that despite low numbers of mobilization, inactive where accounted for mostly patients who participate in adverse events, and by avoidable measures such as IV mobilization, mobilization can be reasons for inability access (femoral lines), scheduling completed safely despite to mobilize. each conflict, agitation or over sedation, mechanical ventilation. patient was and lack of MD order. counted each day Weakness: Limited number of for a total of 327 studies identifying barriers to patients/days mobilization. audited. Conclusion: The study did not answer the clinical question but did give evidence to some barriers Design: 4 week that may need be prospective audit assessed before mobilization care commenced. 14 MOVING FOR HOME Lipshutz, A., & Sample: N=868 10 Demographics, This review outlines the Strength:Assignment: Appraisal of Evidence A wide array of research LOE: I Gropper, M. studies; 2 Vital Signs, APACHE physiological effects of prolonged studies, comprehensive Systematic (2013). Acquired prospective II bed rest, the pathophysiological presentation of pathophysiological Review neuromuscular cohort studies, 2 effects on the body, potential effects need of early mobility and score, Ventilator weakness and prospective of critical illness, the developments complete follow up on feasibility settings, types of early mobilization observational of ICU acquired weakness and and measurable outcomes mobility in the intensive studies, possible treatments for the treatments, Weakness: Further research is care unit. descriptive study neuromuscular weakness. The adverse effects, needed in the technological and of RCT, review also analysis the safety, Anesthesiology, GCS, Diagnosis, medicinal aspects of treatments feasibility, and potential case series, 2 RCT, BMI, medications 118(1), 202-215. for ICUAW. benefits of early mobility on and restrictive MOVING FOR HOME 15 prospective before/after study, and retrospective analysis. mobility orders. ICU critically ill patients versus Conclusion: I found this review LOS, LOS traditional bed rest. 50% of ICU very helpful. It directly answered patients with Sepsis, MOF and the clinical question and provides hospital, level of prolonged intubation will suffer the background information on active achieved, neuromuscular weakness, the ICU acquired weakness, the ventilator free days presents of SIRS increases to 100% potential complication that may when accompanied with the above arise from prolonged bed rest, diagnoses. diaphragmic weakness is potential interventions to prevent Setting: Academic seen 18 hours after intubation, 2 ICUAW, and research studies that health centers, days of ICU stay 25% of patients will provide the basis for feasibility, community present with some ICU-acquired and outcomes. hospitals and weakness (ICUAW). Studies rural hospitals reviewed show that mobilization can MICUs, RICUs, be directed to the “as tolerated” M/SICUs activity to promote safety and therapeutic effects, LOS does show a downward trend but the RCTs differ Design: in results of statistical significances. Systematic Number of Review days ventilator free has shown a significant decrease. MOVING FOR HOME Rukstele, C., & Sample: N/A None Gagnon, M. (2013). Making strides in preventing icuSetting: Large acquired Academic Hospital weakness: 20 bed SICU Involving family in early progressive mobility. Critical Design: Literature Care Nursing Review Quarterly, 36(1), 141-147. doi: 10.1097/CNQ.0b 013e31827539cc 16 This article addresses the presence of family as a motivational factor and benefit for early mobility. Engaging family and patient in the plan of care has always been a standard of care, but in an ICU setting families are traditionally not overtly welcomed. This article identifies the roles in which family may participate in to help both the patient and staff on the road to recovery. Assignment: Appraisal of Evidence The six roles of active presence, protector, facilitator, historian, coach and voluntary caregiver are spelled out and ways to invite, educate, and Strength: the use of the patient LOE: VII and family centered care model Expert (PFCC) is identified to increase Opinion compliance and decrease stressor for all parties involved, family, patient and healthcare professionals Weakness: This article is not a study and does provide rationale for steps taken but no sustainable evidence on how the families, patients, or staff valued the PFCC model approach. A qualitative study would be suggested. Worth: I find this article MOVING FOR HOME 17 support family care is encouraged. extremely useful in light of providing patient centered care. Not only are we in need to provide the best care evident but also provide that care around the patient continuum. Schweickert, W., Pohlman, M., Pholman, A. J., Sample: N=104 mechanically intubated MICU patients 49 in Nigos, C., Pawlik, intervention A., Esbrook, C., group and 55 in Spears, L., & Miller, control group M. (2009). Early physical and occupational Setting: 2 large therapy in Midwest mechanically Academic Health ventilated, Centers critically ill patients: A randomised Design: Random controlled trial. control trial Lancet, 373, 1874-1882. doi: 10.1016/50140- Demographics APACHE II Random control trial monitored 104 Strength: the random control trial LOE: II intubated critical care patients who was set with comparable Random had an independent active 2 weeks participants with similar APACHE II score, Barthel index Controlled prior to illness by history obtained & BI scores to diminish any bias. score pre and post Trial by family. separated into 2 groups, The study monitored physical interventions, control group intent to treat and strength at discharge and QOL Richmond Agitation intervention group with early Weakness: The study did not Sedation Scale mobility. All patients were started on address any evidence of adverse (RASS), enteral feeding and tight glycemic effects of ICU acquired immobility control was monitored. such as atelectasis, skin injuries or Confusion and increase in delirium. Assessment There was no statistical significance method for the ICU in days ventilator free, LOS – ICU or Conclusion: This study shows for delirium and LOS hospital between groups, a significant improvement in coma (CAM- ICU), statistical significance was noted in increasing muscle tone and Functional the BI, CAM-ICU, and return of subsequently decreasing ICU independence independe … Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10