DNP 816 Matrix and
Summary
Rubric
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Element |
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7.5 points |
5 points |
3.5 points |
2 points |
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Source information and quality (7.5 points) |
All key elements are present: Author credentials listed, article is less than 5 years old, and publication is peer reviewed/ scholarly, article is based on research and relates to the chosen topic of concern; is a primary source |
Two key elements are present: Author credentials listed, article is less than 5 years old, ad publication is peer reviewed/ scholarly, article is based on research and relates to the chosen topic of concern but is a secondary source |
One key element is listed: Author credentials listed, article is less than 5 years old, ad publication is peer reviewed/ scholarly, the articles only partially relate to the chosen topic of concern or is a secondary source |
Missing key elements: Author credentials listed, article is more than 5 years old, and publication is peer reviewed/ scholarly, the article has little or nothing to do with the topic of concern and is a secondary source. The article is not research. |
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Research Design and interventions described (.7.5 points) See Polit/Beck pp. 18, 210), (pp. 17, 201 in 11th ed.) |
All key elements are present: appropriate research design identified, thorough description of intervention, justification for not using a different research design, longitudinal or prospective, or causal intent. Identifies IV and DV if appropriate |
Elements are covered but not in enough depth: appropriate research design identified, thorough description of intervention, justification for not using a different research design, longitudinal or prospective, or causal intent. Identifies IV and DV |
Missing elements in this category- research design or intervention: appropriate research design identified, thorough description of intervention, justification for not using a different research design, longitudinal or prospective, or causal intent. Identifies IV and DV |
Missing key elements: does not identify the correct research design, no description of the intervention (if present), does not identify IV or DV (if appropriate) |
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Level of Evidence and model used to grade evidence and Evaluation tool used (CASP or others) (7.5 points) See Polit/Beck p. 35 (p. 36-37 in 11th ed) |
Key elements addressed: What was the strength of the evidence in support of your research topic- what model was used to grade the evidence? What evaluation tool was used to assess the evidence? |
Key elements are not well described but are present: Strength of evidence, model used to grade the evidence and evaluation tool used. |
Missing elements in this category: Includes some information but it missing content related to grading the evidence, model use or evaluation tool. |
Does not include the level of evidence and model used to grade it. Does not use an evaluation tool to assess design |
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Sample/# of participants, how recruited, power analysis? Data Collection procedure (7.5 points) See p. 263 in Polit /Beck (p. 274 in 11th Ed) |
Key elements addressed: was population identified, were sample procedures described? What type sampling plan as used? How were people recruited? Was there a power analysis? Was sample size large enough? All elements thoroughly addressed. |
Key elements are not well described but are present: was population identified, were sample procedures described? What type sampling plan as used? How were people recruited? Was there a power analysis? Was sample size large enough? |
Missing or superficial information: was population identified, were sample procedures described? What type sampling plan as used? How were people recruited? Was there a power analysis? Was sample size large enough? |
Does not include a discussion of the participants, how they were recruited, power analysis information, sample size adequacy. Limited information included. |
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Instruments and Reliability/validity of instruments (7.5 points) See p. 325 in Polit/Beck (p. 336 in 11th Ed). |
Key Elements addressed: includes a complete and thorough discussion of the instruments used, types of questions, reliability- (Cronbach alpha) and validity, LOM |
Key elements are not well described but are present: includes some discussion of the instruments used, types of questions, reliability- (Cronbach alpha) and validity, LOM |
Key elements are missing or are very superficial: includes a complete discussion of the instruments used, types of questions, reliability (Cronbach alpha) and validity, LOM |
Does not include information concerning reliability or validity of instruments. |
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Data Analysis- identify statistics, LOM, findings, Results (7.5 points) See pp. 371, 399 in Polit /Beck (pp. 381, 408 in 11th Ed) |
Key elements addressed thoroughly: Was level of measurement identified? Were inferential stats used? Were tests parametric or nonparametric- why used? Were there significant results? Was there an appropriate amount of statistics info reported? Were all important results discussed? |
Key elements are not well described but are present: Was level of measurement identified? Were inferential stats used? Were tests parametric or nonparametric- why used? Were there significant results? Was there an appropriate amount of statistics info reported? Were all important results discussed? |
Key elements are missing or very superficial discussion: Was level of measurement identified? Were inferential stats used? Were tests parametric or nonparametric- why used? Were there significant results? Was there an appropriate amount of statistics info reported? Were all important results discussed? |
Missing information from discussion of data analysis: does not identify statistics used, no LOM, findings or results |
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Discussion/ Significance of findings, Reliability and Validity of study, limitations (7.5 points) See p. 457 in Polit/Beck (p. 465 in 11th ed) |
Key elements addressed thoroughly: Was interpretation appropriate? Were limitations identified? Addressed study implications for clinical practice, did they make specific recommendations or miss important implications? Did research address clinical significance? Did they address generalizability? |
Key elements are not well described but are present: interpretation, limitations, implications for clinical practice, clinical significance, generalizability |
Key elements superficial : interpretation, limitations, implications for clinical practice, clinical significance, generalizability |
Missing information regarding: interpretation, limitations, implications for clinical practice, clinical significance, generalizability |
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Analysis, Helpful/Reliable Compared to other articles (7.5 points) |
Key elements answered thoughtfully: is the information biased or objective, useful and reliable or not? How does the source compare with other reviewed articles? How is this information similar or different from other articles you have read? Was the information helpful? How? |
Key elements are not well described but are present: is the information biased or objective, useful and reliable or not? How does the source compare with other reviewed articles? How is this information similar or different from other articles you have read? Was the information helpful? How? |
Key elements are present but superficial: is the information biased or objective, useful and reliable or not? How does the source compare with other reviewed articles? How is this information similar or different from other articles you have read? Was the information helpful? How? |
Missing key elements: is the information biased or objective, useful and reliable or not? How does the source compare with other reviewed articles? How is this information similar or different from other articles you have read? Was the information helpful? How? |
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Summary (20 points) |
20 points |
14 points |
0 points |
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Summary
Overall Synthesis of all 5 research articles Use Polit Box20.1, p. 457 as guide , (11th ed Box 21.1, p. 465) (20 points) |
Key Elements: Thorough and complete discussion about the quality of the articles (level of evidence), overall findings, what research still needs to be done on your topic, identifies gaps in care, addresses health promotion pertinent for area, analyzes interventions for populations. Did the article change your thinking about your research topic? |
Discusses each article individually, with some evaluation of quality and needed research. Did the article change your thinking about your research topic? Addresses a gap in care of population, few health promotion or prevention issues, few interventions for population |
Includes most of the articles, spotty evaluation of the articles, no research identified, limited discussion if view changed on the topic. Limited analysis/summary with focus on gaps identified, health prevention/promotion or interventions |
Does not include the summary of all 5 articles, no evaluation of quality of the articles, no needed research identified, limited discussion addressing gaps in care, health promotion/prevention or interventions. Did not address if view on topic has changed |
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SCHOLARLY WRITING (20 points) |
10 points (each category below is worth 10) |
7.5 points (each below are worth 7.5 pts in this category) |
5 points (each below are worth 5 pts in this category) |
0 points (each below are worth 0 pts in this category) |
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Writing quality (10 points) |
No grammatical, spelling or punctuation errors. Succinct |
Almost no grammatical, spelling or punctuation errors. Nearly succinct |
A few grammatical spelling or punctuation errors. |
Many grammatical, spelling or punctuation errors. Too brief or not succinct |
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APA Format (10 points) |
Source is consistently documented in APA format |
Source is accurately documented but a few minor errors noted |
Multiple errors in accuracy and APA format. |
Sources are neither accurately documented nor in APA Format |
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TOTAL Points= 100 |
10.2020
DNP 618 Article Matrix and Analysis
Student Name __________________________________
PICO Question ___________________________________________________________________
Search process :
Search terms:
Data bases:
Total number of articles obtained from search results: N=
Number of articles initially excluded based on abstract reading: N=
Number of articles reviewed: N=
Number of articles excluded based on criteria: N=
Inclusion Criteria:
Exclusion Criteria:
Number of systematic reviews or meta analyses used in Matrix- N =
Repeat this table – one for each article you are review. DO NOT double space in the table
The matrix and analysis assignment to submit consists of : 1). introduction describing the search process for this topic, 2). the review table (1 for each article = 5), 3). summary analysis, 4). reference page and 5). PDF copies of the articles – list by 1st author name as attachments
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Author, year; Credentials Article #1 |
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If credentials not identified- just state here, or identify place of employment |
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Article Focus/Title |
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Research Design/Intervention (describe intervention) |
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Level of Evidence and model used to grade evidence |
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Evaluation Tool (CASP or others- identify tool used) |
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Sample/# of subjects, how recruited, power analysis? |
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Data Collection procedure |
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Instruments and Reliability/validity of instruments |
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Data Analysis- id statistics, LOM, findings |
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Results |
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Discussion/ Significance of findings |
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Reliability and Validity of study, limitations |
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Helpful/Reliable Compared to other articles |
Author, year; Credentials Article #1
If credentials not identified- just state here, or identify place of employment
Article Focus/Title
Research Design/Intervention (describe intervention)
Level of Evidence and model used to grade evidence
Evaluation Tool (CASP or others- identify tool used)
Sample/# of subjects, how recruited, power analysis?
Data Collection procedure
Instruments and
Reliability/validity
of instruments
Data Analysis- id statistics, LOM, findings
Results
Discussion/
Significance of findings
Reliability and Validity of study, limitations
Helpful/Reliable
Compared to other articles
| Author, year; Credentials Article #1 |
Author, year; Credentials Article #1
If credentials not identified- just state here, or identify place of employment
Article Focus/Title
Research Design/Intervention (describe intervention)
Level of Evidence and model used to grade evidence
Evaluation Tool (CASP or others- identify tool used)
Sample/# of subjects, how recruited, power analysis?
Data Collection procedure
Instruments and
Reliability/validity
of instruments
Data Analysis- id statistics, LOM, findings
Results
Discussion/
Significance of findings
Reliability and Validity of study, limitations
Helpful/Reliable
Compared to other articles
Author, year; Credentials Article #1
If credentials not identified- just state here, or identify place of employment
Article Focus/Title
Research Design/Intervention (describe intervention)
Level of Evidence and model used to grade evidence
Evaluation Tool (CASP or others- identify tool used)
Sample/# of subjects, how recruited, power analysis?
Data Collection procedure
Instruments and
Reliability/validity
of instruments
Data Analysis- id statistics, LOM, findings
Results
Discussion/
Significance of findings
Reliability and Validity of study, limitations
Helpful/Reliable
Compared to other articles
Summary section:
Summary and synthesis of all 5 research articles; include level of evidence of all 5 articles, summary and comparison of outcomes of articles, include statements about the quality of the articles, instruments, what research still needs to be done on your topic, identifies gaps in care, addresses health promotion pertinent for area, analyzes interventions for populations. Did the article change your thinking about your research topic?
Reference Page – List articles used in the matrix as well as any other references you might have used in the summary.
Start this on a new page.
Fall 10.2020
DNP 816 Matrix and
Summary
Rubric
|
Element |
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7.5 points |
5 points |
3.5 points |
2 points |
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Source information and quality (7.5 points) |
All key elements are present: Author credentials listed, article is less than 5 years old, and publication is peer reviewed/ scholarly, article is based on research and relates to the chosen topic of concern; is a primary source |
Two key elements are present: Author credentials listed, article is less than 5 years old, ad publication is peer reviewed/ scholarly, article is based on research and relates to the chosen topic of concern but is a secondary source |
One key element is listed: Author credentials listed, article is less than 5 years old, ad publication is peer reviewed/ scholarly, the articles only partially relate to the chosen topic of concern or is a secondary source |
Missing key elements: Author credentials listed, article is more than 5 years old, and publication is peer reviewed/ scholarly, the article has little or nothing to do with the topic of concern and is a secondary source. The article is not research. |
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Research Design and interventions described (.7.5 points) See Polit/Beck pp. 18, 210), (pp. 17, 201 in 11th ed.) |
All key elements are present: appropriate research design identified, thorough description of intervention, justification for not using a different research design, longitudinal or prospective, or causal intent. Identifies IV and DV if appropriate |
Elements are covered but not in enough depth: appropriate research design identified, thorough description of intervention, justification for not using a different research design, longitudinal or prospective, or causal intent. Identifies IV and DV |
Missing elements in this category- research design or intervention: appropriate research design identified, thorough description of intervention, justification for not using a different research design, longitudinal or prospective, or causal intent. Identifies IV and DV |
Missing key elements: does not identify the correct research design, no description of the intervention (if present), does not identify IV or DV (if appropriate) |
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Level of Evidence and model used to grade evidence and Evaluation tool used (CASP or others) (7.5 points) See Polit/Beck p. 35 (p. 36-37 in 11th ed) |
Key elements addressed: What was the strength of the evidence in support of your research topic- what model was used to grade the evidence? What evaluation tool was used to assess the evidence? |
Key elements are not well described but are present: Strength of evidence, model used to grade the evidence and evaluation tool used. |
Missing elements in this category: Includes some information but it missing content related to grading the evidence, model use or evaluation tool. |
Does not include the level of evidence and model used to grade it. Does not use an evaluation tool to assess design |
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Sample/# of participants, how recruited, power analysis? Data Collection procedure (7.5 points) See p. 263 in Polit /Beck (p. 274 in 11th Ed) |
Key elements addressed: was population identified, were sample procedures described? What type sampling plan as used? How were people recruited? Was there a power analysis? Was sample size large enough? All elements thoroughly addressed. |
Key elements are not well described but are present: was population identified, were sample procedures described? What type sampling plan as used? How were people recruited? Was there a power analysis? Was sample size large enough? |
Missing or superficial information: was population identified, were sample procedures described? What type sampling plan as used? How were people recruited? Was there a power analysis? Was sample size large enough? |
Does not include a discussion of the participants, how they were recruited, power analysis information, sample size adequacy. Limited information included. |
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Instruments and Reliability/validity of instruments (7.5 points) See p. 325 in Polit/Beck (p. 336 in 11th Ed). |
Key Elements addressed: includes a complete and thorough discussion of the instruments used, types of questions, reliability- (Cronbach alpha) and validity, LOM |
Key elements are not well described but are present: includes some discussion of the instruments used, types of questions, reliability- (Cronbach alpha) and validity, LOM |
Key elements are missing or are very superficial: includes a complete discussion of the instruments used, types of questions, reliability (Cronbach alpha) and validity, LOM |
Does not include information concerning reliability or validity of instruments. |
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Data Analysis- identify statistics, LOM, findings, Results (7.5 points) See pp. 371, 399 in Polit /Beck (pp. 381, 408 in 11th Ed) |
Key elements addressed thoroughly: Was level of measurement identified? Were inferential stats used? Were tests parametric or nonparametric- why used? Were there significant results? Was there an appropriate amount of statistics info reported? Were all important results discussed? |
Key elements are not well described but are present: Was level of measurement identified? Were inferential stats used? Were tests parametric or nonparametric- why used? Were there significant results? Was there an appropriate amount of statistics info reported? Were all important results discussed? |
Key elements are missing or very superficial discussion: Was level of measurement identified? Were inferential stats used? Were tests parametric or nonparametric- why used? Were there significant results? Was there an appropriate amount of statistics info reported? Were all important results discussed? |
Missing information from discussion of data analysis: does not identify statistics used, no LOM, findings or results |
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Discussion/ Significance of findings, Reliability and Validity of study, limitations (7.5 points) See p. 457 in Polit/Beck (p. 465 in 11th ed) |
Key elements addressed thoroughly: Was interpretation appropriate? Were limitations identified? Addressed study implications for clinical practice, did they make specific recommendations or miss important implications? Did research address clinical significance? Did they address generalizability? |
Key elements are not well described but are present: interpretation, limitations, implications for clinical practice, clinical significance, generalizability |
Key elements superficial : interpretation, limitations, implications for clinical practice, clinical significance, generalizability |
Missing information regarding: interpretation, limitations, implications for clinical practice, clinical significance, generalizability |
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Analysis, Helpful/Reliable Compared to other articles (7.5 points) |
Key elements answered thoughtfully: is the information biased or objective, useful and reliable or not? How does the source compare with other reviewed articles? How is this information similar or different from other articles you have read? Was the information helpful? How? |
Key elements are not well described but are present: is the information biased or objective, useful and reliable or not? How does the source compare with other reviewed articles? How is this information similar or different from other articles you have read? Was the information helpful? How? |
Key elements are present but superficial: is the information biased or objective, useful and reliable or not? How does the source compare with other reviewed articles? How is this information similar or different from other articles you have read? Was the information helpful? How? |
Missing key elements: is the information biased or objective, useful and reliable or not? How does the source compare with other reviewed articles? How is this information similar or different from other articles you have read? Was the information helpful? How? |
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Summary (20 points) |
20 points |
14 points |
0 points |
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Summary
Overall Synthesis of all 5 research articles Use Polit Box20.1, p. 457 as guide , (11th ed Box 21.1, p. 465) (20 points) |
Key Elements: Thorough and complete discussion about the quality of the articles (level of evidence), overall findings, what research still needs to be done on your topic, identifies gaps in care, addresses health promotion pertinent for area, analyzes interventions for populations. Did the article change your thinking about your research topic? |
Discusses each article individually, with some evaluation of quality and needed research. Did the article change your thinking about your research topic? Addresses a gap in care of population, few health promotion or prevention issues, few interventions for population |
Includes most of the articles, spotty evaluation of the articles, no research identified, limited discussion if view changed on the topic. Limited analysis/summary with focus on gaps identified, health prevention/promotion or interventions |
Does not include the summary of all 5 articles, no evaluation of quality of the articles, no needed research identified, limited discussion addressing gaps in care, health promotion/prevention or interventions. Did not address if view on topic has changed |
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SCHOLARLY WRITING (20 points) |
10 points (each category below is worth 10) |
7.5 points (each below are worth 7.5 pts in this category) |
5 points (each below are worth 5 pts in this category) |
0 points (each below are worth 0 pts in this category) |
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Writing quality (10 points) |
No grammatical, spelling or punctuation errors. Succinct |
Almost no grammatical, spelling or punctuation errors. Nearly succinct |
A few grammatical spelling or punctuation errors. |
Many grammatical, spelling or punctuation errors. Too brief or not succinct |
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APA Format (10 points) |
Source is consistently documented in APA format |
Source is accurately documented but a few minor errors noted |
Multiple errors in accuracy and APA format. |
Sources are neither accurately documented nor in APA Format |
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TOTAL Points= 100 |
10.2020
2
Article Matrix and Analysis
Student Name: Used with Permission
College of Health and Human Services-School of Nursing, Northern Kentucky University
DNP 816: Analysis & Application of Health Data for ANP
Dr. Faculty Name
September 20, 2020
Article Matrix and Analysis
Student Name: XXXXX
PICO Question: In adult patients with diabetes (P), how does strict glucose monitoring and treatment regimens (I), when compared to decreased compliance to home treatment i.e. routine glucose monitoring, medication adherence and nutritional changes (C), affect and influence patient quality of life through improvement in treatment education and expectations (O) over one year (T)?
Search process: I utilized the NKU online library to search for articles. The data bases included CINHAL and MEDLINE PLUS. These are peer-reviewed, current and reputable search engines that provided the most accurate and reliable articles for the assignment.
Search terms: Patients with diabetes AND adherence OR compliance to treatment OR management; noncompliance OR nonadherence in diabetic treatment AND effects on quality of life; compliance to diabetic treatment AND management AND importance OR significance
Data bases: CINHAL COMPLETE and MEDLINE
Total number of articles obtained from search results: N=11,568
Number of articles initially excluded based on abstract reading: N=37 (out of first 100 relevant)
Number of articles reviewed: N=9
Number of articles excluded based on criteria: N=7,868
Inclusion Criteria: Must be in English, full text only, research or review article, published in 2013 or later, peer-reviewed articles, include adults as the subject, be discovered in a reputable database
Exclusion Criteria: Article published prior to 2013, language other than English, no full text link, obtained from a non-reputable source
Number of systematic review or meta-analysis used in Matrix: N =0
Repeat this table – one for each article you are reviewing.
The matrix and analysis assignment to submit consists of : 1). introduction describing the search process for this topic, 2). the review table (1 for each article = 5), 3). summary analysis, 4). reference page and 5). 5 PDF copies of the articles
Author, year; Credentials Article #1
Mirahmadizadeh, A. Delam, H. Seif, M. et al. (2019). All authors had a doctorate degree with one holding a masters. Published in the International Journal of Molecular Sciences.
Article Focus/Title
Factors Affecting Insulin Compliance in Patients with Type 2 Diabetes in South Iran, 2017: We Are Faced with Insulin Phobia
Research Design/Intervention
Cross-sectional study : No intervention
Level of Evidence
and model used to grade evidence
Level IV
:Johns Hopkins
Sample/# of subjects
, how recruited
Adults aged 30 years or greater who attended one of twelve diabetic clinics in Shiraz, Iran were evaluated once written consent was obtained. Sample N= 457 patients among 8376 diabetic patients in total. The sample was obtained via convenience sampling. There was 95% confidence interval, error of 0.05 and design effect of 1.7.
Evaluation Tool (CASP or others- identify tool used)
JBI Critical Appraisal Checklist for Analytical Cross-Sectional Studies, Score 8/8
Data Collection procedure
Collected via a questionnaire that was administered by a trained nurse who completed face-to-face interviews, obtained the responses from the participants, and then completed a verify and read-back with the patients to confirm accuracy of responses.
Type of Instrument, reliability and validity of instrument
Questionnaire broken into two parts. Part one encompassed demographic information. Part two included 28 questions that assessed the patients’ reasons for noncompliance to treatment. This second component held two dimensions that focused on noncompliance related to use of insulin as well as noncompliance related to socioeconomic factors.
Reliability and Validity of study, limitations
Validity determined through a review of diabetic experts, epidemiologists, and five professors at multiple stages throughout the collection process. All experts approved the questionnaire. Reliability and internal consistency of the questionnaire was evaluated through test-retest as well as Chronbach’s alpha. The reliability was determined to be 0.91 and the Chronbach alpha was calculated to be 0.92. Study approval from the Ethics Committee of Shiraz. Written informed consent obtained. Statistical data listed in percentages and standard deviations. Appropriate statistical and standardized methods.
Data Analysis – identify LOM, Statistics, findings
T-test was implemented to analyze data. A logistic regression model was utilized to evaluate the relationship between the demographic variables and the clinical variables. Analysis of this model was completed through the Wald method. In addition, the statistical software used to analyze the data was the SPSS version 19. Statistical significance level was 0.05.
Results
N+308 (67.4% of participants) were women. Mean age= 55.16 +/- 5.79 years mean A1C level was 8.92%. 60.2% of participants were noncompliant with insulin administration. Factors such as age, gender, marital status, educational level, residence, insurance, diet, and physical activity were all variables associated with noncompliance as evidenced by statistical significance P<0.001. The duration that the participants had with diabetes was also associated with compliance with a P value of 0.025.
Discussion/
Significance/
Limitations
Findings demonstrate multiple variables and the association with decreased compliance to diabetic treatment. Additionally, the findings support the need for increased educational and financial support for diabetic patients.
Limitations: data was only obtained from public diabetic centers. There was no inclusion of private practices. Convenience sampling implemented. Limits generalizability. The cross-sectional design of the study as limits causation of results.
Helpful/Reliable/Compared to other art
Helpful. Statistically significant results. Appropriate analysis and interpretation of results. Clear findings. Addressed limitations and gaps in research for future studies. This study was Other literature makes note of noncompliance to diabetic treatment. In this present study, <40% of the participants were willing to complete insulin therapy. A study in existing literature was mentioned to state that 48% of the population was willing to start insulin therapy. Discrepancies in result could be in relation to sociocultural and financial differences among the different nations. Other studies reported determine compliances to insulin treatment and other modalities comes from experience. These findings were also similar in the present study. Fear, concerns, and adverse effects were lessened in participants who had initiated and implemented insulin therapy in the past.
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Author, year; Credentials, Article #2 |
Sahin, G. Rizalar, S. (2018). Both authors held a doctorate level degree. Published in International Journal of Caring Sciences. |
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Relationship between Nutritional Status, Treatment and Care Attitude in Diabetic Individuals |
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Descriptive and cross-sectional study- no intervention used |
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Level IV:Johns Hopkins |
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| Sample/# of subjects |
Volunteer individuals with type 2 diabetes N=100 who applied to the Samsun Education Research Hospital. Participants must have had diabetes for at least one year. |
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JBI Critical Appraisal Checklist for Analytical Cross-Sectional Studies, Score 6/8 |
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Questionnaire prepared by researcher and Diabetes Attitude Scale developed by National Diabetes Commission. No other information included regarding collection process. |
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Type of Instrument reliability and validity of instruments |
Questionnaire survey and Diabetes Attitude Scale. 33 questions identifying the sociodemographic characteristics, nutritional status and diabetes characteristics of participants were collected via a survey form. A Diabetes Attitude Scale was also included. This Likert-type scoring system ranged from 1-5 with a score >3 equivalent to a positive attitude and a score of <3 equivalent to a negative attitude. |
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Validity and reliability were performed by Ozcan. Obtained ethics committee approval. Consent obtained from volunteer individuals. All results listed as percentages or standard deviations. Information and statistical methods appropriate. |
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Data Analysis: id statistics, LOM, findings |
Analysis completed in SPSS. Descriptive statistics were shown as mean +/- standard deviation for variables that demonstrated normal distribution. One -way ANOVA for distribution of normal groups. P value results < 0.05 were deemed statistically significant. |
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Mean age of participants was 59.54 +/- 12.04 years. Participants deemed “slightly obese” was 21% and those considered “obese” was 64%. Participants who follow the prescribed dietary lifestyle was 9% and 49% demonstrated partial adherence. The Diabetic Attitude Scale (DAS) score was not significantly affected by the demographic variables of gender, marital status, BMI, education, occupation, and diet compliance. Statistical significance (P=0.000) was reported between compliance and income levels of the participants. Statitical significance was also noted between the attitude scale and physical exercise with a P value of 0.032. |
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Many socioeconomic factors, except for income, were significant to the DAS Score. Physical exercise and DAS score showed statistical significance. No significant difference was discovered between duration of the disease, fasting glucose level, A1C, and the type of treatment implemented. Diet compliance is low, and education is inadequate regarding treatment. Limitations: small sample size, no mention of sampling technique, poor description of data collection process and analyzation. |
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Helpful but cautions warranted. Sampling method, effect size and power analysis are not mentioned. Small sample size. However, statistically significant results, appropriate use of tables and interpretation of results. Clear findings provided. Other literature shows similar results that concluded that education and income levels regarding diabetes, treatment, and importance of compliance are generally low. |
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Author, year; Credentials, Article #3 |
Furthauer, J. Flamm, M. and Sonnichsen, A. (2013). All authors have some relation to an Institute of General Practice. Published through Biomed Central. |
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Patient and Physician Related Factors of Adherence to Evidence Based Guidelines in Diabetes Mellitus Type 2, Cardiovascular Disease and Prevention: A Cross- Sectional Study |
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Research Design/Intervention- describe intervention |
Cross-sectional study no intervention done |
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| Level of Evidence | Level IV | |
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Sample/# of subjects, how recruited. |
N=58 general practitioners (GP) were included in the study. Initially 124 were randomly selected, but only 58 responded. They were under the agreement to work 58 straight consecutive days from January to April 2011. All consecutive patients were included from that day as long as the inclusion criteria were met. N=501 patients were included in the study. 526 patients were eligible to participate but only 95.3% gave consent to be included. The patient sample represents a random consecutive selection. |
|
|
Evaluation Tool (CASP or other tool used) |
JBI Critical Appraisal Checklist for Analytical Cross-Sectional Studies, Score 7.5/8 |
|
|
A structured case report form (CRF) was completed on each patient to collect demographic data regarding chronic diseases, medication and past medical history. Nine quality indicators were implemented after the CRF to determine the guideline-adherence of treatment for the chronic target diseases. Interviews of the patients and GPs occurred independently of one another, again using the structured CRF. |
||
|
Type of Instrument, reliability and validity of instruments used |
Interview, quality (QI) and structured case report form (CRF) |
|
|
Informed consent was obtained from both participant party members. The study was compliant with the Declaration of Helsinki and with the Austrian data protection legislation. Ethics approval was obtained from the ethics committee and federal state of Salzburg. Randomization utilized in sampling. Appropriate statistical methods implemented. |
||
|
Data Analysis – identify statistics, LOM, findings |
All data obtained from the CRFs was recorded and transferred to IBM SPSS Statistics v. 19.0 for analysis. Response rate documented in percentages. |
|
|
46.8% of GP responded to participate in the study. In these 58 GP surgeries, 95.3% of patients gave consent to be included corresponding to a mean of 8.6+/-5.3 standard deviation patients per surgery. 1224 total QIs were analyzed, 174 of which had type II diabetes. The remaining included other chronic disease evaluated in the study. 64.4% of patients are unsure why they are taking a particular drug as treatment for their chronic conditions, 20.0% state they do not need treatment, 3.4% state they do not want treatment, 5.4% report an adverse drug event to the treatment, and 6.8% falsely report discontinuation of treatment. From the GP perspective, nonadherence is related to contraindications, falsely discontinued, noncompliance, adverse drug even, avoidance of polypharmacy and falsely not indicated. 72.2% of all nonadherence to chronic treatment is as a result of the GPs not initiating/thoroughly explaining the therapy. A large knowledge gap between physicians and patients regarding treatment regimens and expectations was determined. |
||
|
Discussion/Significance/ Limitations |
More than half of participants are unaware why they are prescribed particular drugs making physicians responsible for nonadherence to treatment for diabetes and other chronic conditions alike. It was noted that physicians ignore guideline recommendations for treatment most frequent because they falsely assumed a particular prescription or treatment was not necessary or indicated. Education plays an essential role to treatment compliance. Lack of knowledge, communication and, awareness about proper treatment guidelines and expectations of the patient were noted in this study and indicative for implementation of better health education practices. Limitations: reported small sample size, 50% response rate of GPs, single visitation day for each GP and only interviewing patients on that particular day. Possible biases to result from this. Narrow set of only nine quality indicators implemented in the study to judge adherence to treatments. |
|
|
Helpful. Randomization in sample selection, valid and reliable. Results were clear and interpreted appropriated. Proper use of tables throughout the study. Rigorous analysis of data. Adds to evidence base and provided enhancement on need for further education. When compared to other literature, findings are consistent and enhances the evidence. |
|
Author, year; Credentials, Article #4 |
Andradre-Dias, J. Rodriguez, R. Sales, Z. et al. (2016). All authors are nurses, many of which have obtained a PhD or are a PhD student. |
|
|
Diabetes Mellitus Clients’ Conceptions About the Treatment |
||
|
Research Design/Intervention (describe intervention) |
Descriptive and exploratory study with a qualitative approach – no intervention |
|
|
Level IV Johns Hopkins |
||
|
Sample/# of subjects. How recruited? |
Registered users in diabetes service, N=11. Obtained through convenience sampling of a project presentation held in a basic health unit. |
|
|
Evaluation Tool (CASP or other tools used) |
CASP Qualitative checklist, Score 7/10 |
|
|
Information was obtained through a semi-structured interview and voice recorder. No mention of who collected the data or how despite brief information of tool used. |
||
|
Semi-structured interview. Voice recorder also utilized. |
||
|
Reliability and Validity of study, limitations |
Research approved by Research Ethics Committee, participants informed and aware of these, objectives, rationale, risks and benefits. All participants signed consent form. Standard and synonymous method of data collection. Appropriate literature review provided. |
|
|
Data Analysis – identify statistics, LOM, findings |
Data was obtained from the eleven interviews with a deeper reading occurring later. This information was coded and grouped semantically after collection from the interviews. This allowed for the identification of five categories: correct use of hypoglycemic drugs, adoption of proper diet, physical activities, use of phytotherapy and adoption of preventative attitude. |
|
|
Participants are aware of DM treatment, but lack substantiative knowledge and lack applicable treatment to their daily routines often leading to nonadherence. It was determined that there is a greater need for health education on the subject in order to overcome knowledge deficiencies related to proper DM treatment. Five categorical themes derived. |
||
|
Discussion/Significance/ Limitations |
Lack of essential knowledge needed for patients to be compliant. Limitations: difficult to generalize as sample is small, no mention of effect size. Poor mention of data collection process and analyzation of results. |
|
|
Helpful, but cautious. This study was a small sample size. Missing information regarding thorough data collection and analysis process of said data. However, thorough and clear representation of discussion section and five categorical themes identified. Interpretation of these results are appropriate. Sahin, G and Rizalar, S. (2018) support the notion that compliance to the five categorical themes are essential to diabetic management and improved quality of life. |
|
Author, year; Credentials, Article #5 |
Gimenes Faria, H. T., Luchetti Rodrigues, F. F., Zanetti, M. L., et al. (2013). All authors are associated with two different universities in Brazil. It is unknown of further credentialing or roles at said universities. |
|
Factors Associated with Adherence to Treatment of Patients with Diabetes Mellitus |
|
|
Cross-sectional Study |
|
|
Level of Evidence and model used to grade evidence |
|
|
Sample/# of subjects, how recruited |
N=357 out of a population of 1,406 individuals with type 2 diabetes mellitus from 17 primary care institutions in brazil. All participants were greater than 18 years of age, used oral antidiabetic therapies, had cognitive and hearing capacities and were a patient in the institution of study. |
|
Evaluation Tool (CASP or others -identify tool used) |
|
|
Data was collected between February and December 2010 by trained researchers. Data collection was broken into several stages. Structured interviews were obtained in the participant homes and then a second stage was completed within the 17 health institutions. |
|
| Type of Instrument, reliability and validity of instruments |
Four questionnaires. The first questionnaire evaluated demographic/clinical/and metabolic variables. The second was titled Measurements of Treatment Adherence (MTA) which assessed patient behaviors related to treatment drug use. A food consumption frequency questionnaire and an international physical activity questionnaire. |
|
Study was compliant with national and international standards of ethics. Consent and inclusion criteria were implemented prior to data collection. Standard data collection used as well as appropriate statistical methods. |
|
|
Descriptive statistics were used to analyze data. This form of analysis assisted in the determination of the prevalence of adherence to treatment and the characterization of the first questionnaire implemented. The MTA was analyzed on a 6-point ordinal scale. Scores greater than or equal to 5 were indicative of adherent patients and scores less than 5 resembled nonadherent patients. Patients who were adherent based off of the food consumption questionnaire attended 3/6 nutritional recommendations. To analyze the final questionnaire regarding physical activity, those considered adherent were participants who were classified as moderately to very active. Nonadherent patients were classified as sedentary and inactive. Fisher’s exact test was implemented to analyze adherence with the demographic variables. Crude Odd’s ratio was calculated with a confidence interval of 95%. Statistical analysis was performed with SAS 9.0 statistical software. Values of P <0.05 are considered statistically significant. |
|
|
Mean age was 62.4 years +/- 11.8; 66.7% of the sample were female. 84.4% of the sample showed adherence to medication therapy, 58.6% to physical exercise and 3.1% to diet. Only 6 patients showed adherence to all three components. No association noted between adherence to treatment and gender, age, education, family income or time since diagnosis. A1C and physical exercise were statistically significant and showed association with adherence as evidenced by a p value of 0.036 and p=0.006 respectively. |
|
|
Findings showed no association between demographic variable and adherence to treatment. Exercise and A1C show showed statistically significant results in association with aadherence. Support groups and knowledge are important to achieving adherence to diabetic treatment. Limitations: cross-sectional design which prevents cause/effect relationships. |
|
|
Helpful. Appropriate data analysis with statistically significant results. Clear representation of findings. Rigor and validity established. Findings are consistent with other literature results which indicates that demographics are weak predictors of treatment adherence. |
Summary of Article Matrix
It has been stated that by the year 2030, diabetes mellitus is estimated to be the seventh leading cause of death in the world (Mirahmadizadeh, A., Delam, H., Seif, M., 2019). This condition, for the most part, is highly manageable and in some cases preventable. For those who do have it, it is essential that patients are compliant and adhere to the prescribed treatment regimens to have the best quality of life. This was noted in all of the studies. The literature reviews from the studies were a mix of the different treatment modalities for diabetes mellitus and the evaluation of compliance to said treatments.
The articles used in this matrix assignment included five level IV articles, four of which were cross-sectional studies and one being a qualitative exploratory design. All articles utilized showed importance to the topic discussed. Several themes were noted either in the literature or in the gaps of literature. It was stated numerous times throughout the various studies the significance that proper patient and physician education has on treatment compliance, yet many of the studies mention the lack of education, knowledge and awareness that patients often have regarding their own treatment. The studies also supported the notion that lack of proper education was a major reason behind a patient’s noncompliance.
While research is quick to state the best treatment options to manage the disease, the studies had many gaps in their reviews that need to be further evaluated to determine the potential effect they may have. These gaps, apart from the lack of education, include limited information on social support and a patient’s mental frame of mind when it comes to treatment of their condition. Attitudes affect behavior (Sahin, G., and Rizalar, S. (2018). These two criteria may provide essential information when it comes to why a person is noncompliant. Further research should be completed evaluating these components.
It was difficult to find literature exemplifying exactly what I was searching for in relation to my PICO. I do think it would be in my best interest to change up my initial PICO question. I found it interesting that education, social support and mentality were not primary components when it came to compliance. I would like to adjust my PICO to reflect these areas. I am changing my PICO to: In patients with diabetes mellitus, how does a patient’s support system and attitude toward treatment compared to lack of support and poor mentality affect compliance and quality of life over one year? I feel that this change addresses the why factor when it comes to the compliance issue that floods our healthcare establishments and can provide the best insight into this prevalent frame of mind.
References
Andrade-Dias, J. A., Alves Rodrigues, R., Nogueira Sales, Z., Meira Oliveira, Z., & Gonçalves Nery, P. I. (2016). Diabetes mellitus clients’ conceptions about the treatment. Journal of Nursing UFPE / Journal of Nursing UFPE, 10(7), 2470–2479. https://doi.org/10.5205/reuol.9106-80230-1-SM1007201622
CASP checklist for qualitative research. (2020). CASP – Critical Appraisal Skills Programme. https://casp-uk.net/wp- content/uploads/2018/01/CASP-Qualitative-Checklist-2018
Checklist for analytical cross-sectional studies. (2020). Joanna Briggs Institute. https://joannabriggs.org/sites/default/files/2020- 08/Checklist_for_Analytical_Cross_Sectional_Studies
Fürthauer, J., Flamm, M., & Sönnichsen, A. (2013). Patient and physician related factors of adherence to evidence-based guidelines in diabetes mellitus type 2, cardiovascular disease and prevention: a cross sectional study. BMC Family Practice, 14, 47.
https://doi-
org.northernkentuckyuniversity.idm.oclc.org/10.1186/1471-2296-14-47
Gimenes Faria, H. T., Luchetti Rodrigues, F. F., Zanetti, M. L., de Araújo, M. F. M., & Coelho Damasceno, M. M. (2013). Factors associated with adherence to treatment of patients with diabetes mellitus. Acta Paulista de Enfermagem, 26(3), 231–237.
JBI levels of evidence. (2013). Joanna Briggs Institute.
https://joannabriggs.org/sites/default/files/2019-05/JBI-Levels-of- evidence_2014_0
Mirahmadizadeh, A., Delam, H., Seif, M., Banihashemi, S. A., & Tabatabaee, H. (2019). Factors Affecting Insulin Compliance in Patients with Type 2 Diabetes in South Iran, 2017: We Are Faced with Insulin Phobia. Iranian Journal of Medical Sciences, 44(3), 204–213.
Sahin, G., & Rizalar, S. (2018). Relationship between nutritional status, treatment and care attitude in diabetic individuals. International Journal of Caring Sciences, 11(3), 1557–1565.
Summer 2019
Module 5: Overview Prediction,
Systematic Reviews, Interpretation of
Results
This module will address biostatistics content as well as multiple linear regression a
nd
modeling.
Additionally I have included information about the process of data analysis.
Module Overview
Module on regression,
systematic reviews and
significance/interpretation of
results
Denise Robinson
Module Objectives
At the end of this module students will be able to:
1. Explain the concepts of simple and multiple linear regression. (CO 1)
2. Choose the right regression analysis for a given research problem/question. (CO 1).
3. Distinguish one-way Analysis of Variance (ANOVA) from more advanced ANOVA designs, such
as factorial ANOVA, repeated measure ANOVA, ANCOVA, multivariate analysis of variance
(MANOVA), and multivariate analysis of covariance (MANCOVA)
4. Discuss the importance of systematic reviews for evidence based practice. (CO 1, 2, 3, 4)
5. Categorize the differences between meta-analysis, metasynthesis and mixed studies reviews.
(CO 1)
6. Evaluate the application of reviews to practice. (CO 1, 2, 3, 4)
Module Activities
Below is an outline of the items for which you will be responsible throughout the module.
1. Polit, D. & Beck, C. (2022). Nursing research: Generating and assessing evidence for nursing
practice. (11 Ed). Walters Kluwer: Chapters 19, 21, pp. 655-675
2. Kim, M., Mallory, C. & Valerio, T (2022). Statistics for evidence based practice in nursing. (3
Ed). : Jones & Bartlett: Chapter 10.
3. Review the module lecture materials. (https://nku.instructure.com/courses/53642/pages/module-
5-lecture-materials)
4. Submit Assignment — Matrix Table and Summary
(https://nku.instructure.com/courses/53642/assignments/894162)
5. Article to discuss in Zoom meeting this week: 2021.Clari et al. barriers to and facilitators of
bedside nursing handover. SR and metasynthesis.
(https://nku.instructure.com/courses/53642/files/7170208?wrap=1)
th
nd
https://nku.instructure.com/courses/53642/pages/module-5-lecture-materials
https://nku.instructure.com/courses/53642/assignments/894162
https://nku.instructure.com/courses/53642/files/7170208?wrap=1
Module 5: Lecture Materials
Online Lecture
Select the video below to watch the online lecture.
Narrated PPT: Multivariate Statistics 8:59 min (https://nku.tegrity.com/#/recording/6fb9a8dd-
0a78-4ca0-a20e-775817ae310e?playbackToken=3429RIMVDZAOG)
0:00 / 8:58
Narrated PPT: Regression 17:39 min (https://nku.tegrity.com/#/recording/93f49b57-2a45-4b2c-
9b59-fd4357e452a3?playbackToken=12PJKUR6Y1ZXC)
https://nku.tegrity.com/#/recording/6fb9a8dd-0a78-4ca0-a20e-775817ae310e?playbackToken=3429RIMVDZAOG
https://nku.tegrity.com/#/recording/93f49b57-2a45-4b2c-9b59-fd4357e452a3?playbackToken=12PJKUR6Y1ZXC
0:00 / 17:39
Systematic Reviews states it is week 7 but it has been moved to week 5 so that we can talk about it
before your Matrix assignment is due. Narrated Systematic Reviews PPT 4:44 min
Non-narrated PPT slides:
0:00 / 4:44
multivariate stats manova (https://nku.instructure.com/courses/53642/files/7148522/download?
wrap=1)
printing PPT file: multivariate stats manova-1.pptx
(https://nku.instructure.com/courses/53642/files/7148505/download?wrap=1)
Regression (https://nku.instructure.com/courses/53642/files/7148523/download?wrap=1)
printing PPT: file: Regression -1.pptx
(https://nku.instructure.com/courses/53642/files/7148506/download?wrap=1)
Additional Materials
https://nku.instructure.com/courses/53642/files/7148522/download?wrap=1
https://nku.instructure.com/courses/53642/files/7148505/download?wrap=1
https://nku.instructure.com/courses/53642/files/7148523/download?wrap=1
https://nku.instructure.com/courses/53642/files/7148506/download?wrap=1
Videos:
Regression youtube: 14:00min
The Easiest Introduction to Regression Analysis! – Statistics HelpThe Easiest Introduction to Regression Analysis! – Statistics Help
You tube videos describing what systematic reviews are; they provide a different view/examples of
the topics:
(https://www.youtube.com/watch?v=NSUk5FLbJoY)
(https://www.youtube.com/watch?v=NSUk5FLbJoY)
How to Critically Appraise a Systematic Revi
ew: Part 1 (https://www.youtube.com/watch?v=NSUk5FLbJoY)
(https://www.youtube.com/watch?v=NSUk5FLbJoY)
7.42 min
(https://www.youtube.com/watch?v=Ly__U-n4fiQ)
(https://www.youtube.com/watch?v=Ly__U-n4fiQ)
How to Critically Appraise a Systematic Review: Part 2 (https://www.youtube.com/watch?
v=Ly__U-n4fiQ&t=6s) 4.57 min
(https://www.youtube.com/watch?v=egJlW4vkb1Y)
(https://www.youtube.com/watch?v=egJlW4vkb1Y)
What are systematic Reviews? (https://www.youtube.com/watch?v=egJlW4vkb1Y&t=10s)
youtube video 3.23 min
What are systematic reviews and literature reviews: (https://www.youtube.com/watch?
v=vVG9jlE-o2g) 4.03 min
Resources for Module 5:
Guidelines for Critiquing systematic Reviews: Guidelines for Critiquing Systematic Reviews
(1) x (https://nku.instructure.com/courses/53642/files/7148548/download?wrap=1)
Useful Website for Resources for systematic reviews: Useful Websites for Resources for
Systematic Reviews (1) x (https://nku.instructure.com/courses/53642/files/7148549/download?
wrap=1)
Selected formulas for calculating effect size: Selected Formulas for Calculating (1) x
(https://nku.instructure.com/courses/53642/files/7148456/download?wrap=1)
2009 Prisma statement article: 2009 prisma statement article-1
(https://nku.instructure.com/courses/53642/files/7148457/download?wrap=1)
Prisma 2009 Checklist and flow diagram: PRISMA 2009 flow diagram (2)
(https://nku.instructure.com/courses/53642/files/7148460/download?wrap=1) , PRISMA 2009 checklist
(2) (https://nku.instructure.com/courses/53642/files/7148458/download?wrap=1)
Example of data extraction form for a meta analysis: Example of a Data Extraction Form for a
Meta Analysis-2 x (https://nku.instructure.com/courses/53642/files/7148459/download?wrap=1)
Samples of systematic review articles:
Metanalysis chocolate consumption CV disease
(https://nku.instructure.com/courses/53642/files/7148551/download?wrap=1)
https://nku.instructure.com/courses/53642/files/7148548/download?wrap=1
https://nku.instructure.com/courses/53642/files/7148549/download?wrap=1
https://nku.instructure.com/courses/53642/files/7148456/download?wrap=1
https://nku.instructure.com/courses/53642/files/7148457/download?wrap=1
https://nku.instructure.com/courses/53642/files/7148460/download?wrap=1
https://nku.instructure.com/courses/53642/files/7148458/download?wrap=1
https://nku.instructure.com/courses/53642/files/7148459/download?wrap=1
https://nku.instructure.com/courses/53642/files/7148551/download?wrap=1
Metasynthesis family experiences vent dependent child
(https://nku.instructure.com/courses/53642/files/7148552/download?wrap=1)
Integrative review and HESI testing
(https://nku.instructure.com/courses/53642/files/7148472/download?wrap=1)
https://nku.instructure.com/courses/53642/files/7148552/download?wrap=1
https://nku.instructure.com/courses/53642/files/7148472/download?wrap=1
1
Article Matrix and Analysis
Used with Permission
College of Health and Human Services-School of Nursing, Northern Kentucky University
DNP 816: Analysis and Application of Health Data for APRN Practice
September 20, 2020
Article Matrix and Analysis
Student Name: XXXXXX
PICO Question: In patients with hypertension (P), what is the effect of education about hypertension and medications (I) in comparison to no education (C), on compliance with following medication regimens (O) within three months of the first prescription (T).
Search process: Data base search was done using Northern Kentucky University library. Boolean phrases were used. Articles were assessed based on abstract and criteria listed below until five articles were left.
Search terms: hypertension OR high blood pressure AND education OR educational (must be in title) AND medication adherence OR medication compliance
Data bases: CINAHL Complete, Gale Academic OneFile
Total number of articles obtained from search results: N=29/ N=18 N= 33
Number of articles initially excluded based on abstract reading: N=1/N=4
Number of articles reviewed: N= 3/N=6
Number of articles excluded based on criteria: N=20/N=8 N=20
Inclusion Criteria: Full text only, English, Article within the past five years, Peer reviewed
Exclusion Criteria: Article published before 2015, No full text link, Language other than English, Not peer reviewed, Duplicate article, Non-research article
Studies included in systematic review or meta-analysis- N = 0
|
Author, year; Credentials Article #1 |
Aghakhani, N. (PhD), Parizad, N. (PhD), Soltani, B. (MSN), Khademvatan, K. (MD), & Rahimi, Z. (MSN) (2019) |
|||||||
|
Article Focus/Title |
The effect of the blended education program on treatment concordance of patients with hypertension: A single-blinded randomized, control trial |
|||||||
|
Research Design/Intervention |
Randomized control trial, single-blind. The intervention was education that was blended in style between face-to-face education and online education. |
|||||||
|
Level of Evidence |
Level I (Dearholt et al., 2012) |
|||||||
|
Sample/# of subjects |
Patients age 20-65, hypertension diagnosis, blood pressure greater than 140/90 but less than 180/110, agree to participate in the study, able to read and write, able to receive emails and texts, no severe underlying disease (ex. Kidney disease or heart problems) that could impact the study. Total number of participants – 60 |
|||||||
|
Evaluation Tool |
CASP for randomized control trial Score 11/11 |
|||||||
|
Data Collection procedure |
Questionnaires/tests were administered and scored; control and intervention group received respective education; two weeks after education programs were finished, the same questionnaire/test was administered and scored |
|||||||
|
Type of Instrument |
Questionnaire/test that included demographic information and questions addressing treatment in three dimensions; dietary adherence, compliance to medication regimen, and physical activity plan, the questionnaire had thirty four, twelve, and fourteen items per category respectively. |
|||||||
|
Reliability and Validity |
The questionnaires were used in another study that confirmed validity and reliability. The face and content validity was inspected and in this other study Cronbach’s alpha was used along with intraclass correlation coefficient to confirm reliability. Standard data collection was performed. Approved by IRB and informed consent was obtained prior to the beginning of the study. Adequate statistical data is presented and appropriate statistical methods were used. |
|||||||
|
Data Analysis |
Data was analyzed by a researcher who was blind to the data. Descriptive statistics including mean and standard deviation were utilized and inferential statistics including |
|||||||
|
Results/Themes |
There was a statistical difference in the results of the post-test between the control and the intervention groups for dietary adherence ( Themes: blended educational program; improving medication adherence |
|||||||
|
Discussion/ Significance/ Limitations |
Is an additional study that strengthens the evidence on the use of blended education programs. The use of blended education programs could promote better treatment/recommendation adherence in patients by increasing the effectiveness and desirability of the educational experience. Limitations: The sample was a convenience sample from one geographical area. The intervention period was relatively short. |
|||||||
|
Helpful/Reliable/Compared to other art |
Helpful, reliable, results were statistically significant. Clear statement of findings. Compared to other articles: |
|
Author, year; Credentials, Article #2 |
Delavar, F., Pashaeypoor, S., & Negarandeh, R. (2020). Published in the Journal of Patient Education and Counseling. All authors were associated with Tehran University of Medical Sciences. |
|
|
The effects of self-management education tailored to health literacy on medication adherence and blood pressure control among elderly people with primary hypertension: A randomized controlled trial |
||
|
Randomized control trial. The intervention was education based on the participants health literacy for two weeks in the form of two, thirty to forty-five minute face-to-face sessions. After the two weeks of face-to-face education, there were two weeks of fifteen minute educational sessions held via telephone call, two each week. Educational topics included hypertension, risk factors, complications, medications, side effects, management of side effects, importance of medication adherence, and doctors appointments. |
||
|
Elderly patients who had uncontrolled hypertension and inadequate health literacy who had been referred to the cardiovascular clinic at Fayyazbakhsh hospital in Iran. Inclusion criteria: over the age of sixty, diagnosed uncontrolled hypertension (BP over 140/90 or more), prescription for antihypertensives, can speak Persian, does not have cognitive or psychiatric disorders, not addicted to drugs, and inadequate health literacy defined by the Health Literacy for Iranian Adults (HELIA) scale (score of less than sixty six percent). Exclusion criteria: unwilling to stay in the study, development of serious health conditions that led to hospitalization or death, failure to attend one of the face to face sessions of the intervention, or failure to answer two or more of the telephone calls. Intervention group n=54, control group n=58, total sample size N=112 |
||
|
CASP for randomized control trial Score 10/11 |
||
|
Data was collected/measured by demographic questionnaire, eight-item Morisky Medication Adherence Scale (MMAS), and blood pressure measurement at the beginning of the study; the control and intervention groups received their respective education; then the same tools were used to collect/measure data six weeks after the intervention was completed. |
||
|
Questionnaire: ten questions related to the demographic information of the participants Eight-item MMAS: has seven yes/no style questions and one Likert scale question that is scored the same as a yes/no question. The scores can vary between zero and eight (eight indicating good medication adherence) Blood pressure measurements: instrument used was a mercury sphygmomanometer |
||
|
The eight-item MMAS was translated to Persian and was reported to be validated by two other studies. The reliability of the eight-item MMAS was shown by an intraclass correlation coefficient (ICC) of 0.71. The blood pressures were collected using standardized procedures. The measurement device’s validity was confirmed based on measurement precision and authenticity of manufacturer. Reliability was confirmed through repeated measurements on twenty patients, the ICC of the systolic and diastolic blood pressures were 0.81 and 0.60 respectively. Standardized data collection procedures were used. Ethical considerations were made. Approved by the Ethics Committee of Tehran University of Medical Sciences. Written, informed consent was obtained from participants. |
||
|
SPSS was used to analyze data. Fischer’s exact tests and Chi-squared tests were used to assess between group comparisons for categorical variable. Independent |
||
|
The systolic and diastolic blood pressures of the intervention group were significantly lower in the post-test ( Themes: Patient education based on health literacy; improving medication adherence; uncontrolled hypertension; elderly population |
||
|
Shows improvement in medication adherence after an educational program about hypertension/medications compared to basic education given when prescription is given. Identifies the benefit of using education tailored to the health literacy level of the patient. Limitations: Limited validity because author credentials are not expressed in the article, only the Universities they are affiliated with. Risk of type II error because fifty nine participants were needed per group and that was not achieved. Researchers discuss limitations related to short intervention time and possibility of unrealistic responses from participants about adherence. |
||
|
Helpful but cautious, small sample size and no credentials of the authors contributes to lack of validity, clear statement of findings. Compared to other articles: Consistent with Aghakhani et al. (2019); both establish that education beyond what is traditionally provided with the start of a prescription improved medication adherence. |
|
Author, year; Credentials, Article #3 |
Farazian, F. (MSN), Moghadam, Z. E. (Assistant Professor), Nabavi, F. H. (Assoictate Professor), & Vashani, H. B. (Instructor) (2019). Published in the Journal of Evidence-Based Care. All are faculty at Mashhad University of Medical Sciences |
|
Effect of self-care education designed based on bandura’s self-efficacy model on patients with hypertension: A randomized clinical trial. |
|
|
Randomized control trial. The intervention was one forty-five minute educational session each week for four weeks. The sessions were designed based on Bandura’s social learning theory and the content was based on Bandura’s self-efficacy theory |
|
|
Sample was collected using a two-stage random sampling technique. Population was the residents of Mashhad, Iran who had hypertension. Inclusion criteria: age of 40-70, living with family, resident of Mashhad, had been diagnosed with hypertension for more than one year, diagnosis confirmed by a cardiologist, active medical file at the health center, no cognitive impairment, no participation in self-care programs within the last six months. Exclusion criteria: participation in another educational program, missing more than one session, failure to participate in the post-test. Sample size n=60. |
|
|
All participants completed the demographic form and the questionnaire before the intervention started. Then the intervention group received their education and the control group received routine education. The questionnaire was administered again immediately after the intervention was complete and then again one month later. |
|
|
Questionnaire with twenty nine questions addressing self-care for patients with high blood pressure. Topics that were a part of the questionnaire include; medication adherence, adherence to a low-salt diet, physical activity, smoking, alcohol and weight management. |
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|
Research approved by the research ethics committee at the Mashhad University of Medical Sciences, Consent obtained, Standard data collection methods. Potential bias is evident – the researcher was the educator and also exchanged phone numbers with participants to provide additional encouragement or counseling if needed. Validity was tested by assessment of the questionnaire by ten experts according to word choice, grammar, and readability, potential for bias because all ten experts were also faculty of the same University that the researchers were affiliated with. Reliability was confirmed by measuring internal consistency, the Cronbach’s alpha was measured ( |
|
|
Data was analyzed using SSPS (version 16). CI of 95%, significance level was less than 0.05. A repeated measures ANOVA was used to test the hypotheses, Kolmogorov-Smirnov test was used to confirm the normal distribution of the quantitative data, and Shapiro-Wilk test was used to confirm the normal distribution of the qualitative data. |
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|
Significant positive effect overall on self-care and self-management of hypertension. Statistically significant results in categories for medication adherence, physical activity, and weight management. Statistically non-significant results in categories for low salt diet and non-smoking. Repeated measures ANOVA was used and in regard to medication adherence showed that the effect of the group ( Themes: self-care in patients with hypertension, educational interventions |
|
|
Highlighted the use of an educational program to improve self-care in patients with hypertension. Shows that educational programs are superior to routine education that is provided at practices. Shows medication adherence and some of the other aspects of self-care are still improved one month after the intervention is finished. Limitations: Lack of knowledge about patient’s baseline knowledge about hypertension management and the degree to which they could be influenced by other sources of information. Short time frame for follow up. Potential for bias is evident in the intervention itself and in the assessment of the validity of the questionnaire. |
|
|
Helpful but cautious, the potential bias negatively impacts the validity and the reliability of the study. Clear statement of findings. Importance of the topic was established. Rigorous data analysis. Compared to other articles: Consistent findings in regard to education programs and increased medication adherence. |
|
Author, year; Credentials, Article #4 |
Ozoemena, E. L., Iweama, C. N., Agbaje, O. S., Umoke, P. C. I., Ene, O. C., Ofili, P. C., Agu, B. N., Orisa, C. U., Agu, M., & Anthony, E. (2019), Published in the Archives of Public Health All authors are associated with the Department of Human Kinetics and Health Education and are faculty at the University of Nigeria except B. Agu and C. Orisa. Agu is associated with the Department of Public Health and is faculty in health sciences at Madonna University Elele. Orisa is associated with the Department of Human Kinetics, Health, and Safety Education and Ignatius Ajuru University of Education. |
|
Effects of a health education intervention on hypertension-related knowledge, prevention and self-care practices in Nigerian retirees: A quasi-experimental study. |
|
|
Quasi-experimental study. Intervention was a twelve-week health education course about hypertension and was based on the information-motivation-behavioral skills model. There were twelve sessions each one lasting around sixty minutes. |
|
|
Level II (Dearholt et al., 2012) |
|
|
Two-stage sampling procedure. Purposeful selection of three specific zones to enhance representativeness, then convenience sampling to acquire the 400 participants. Participants were randomly assigned to the control or intervention groups. Inclusion criteria: over or equal to the age of sixty, classified as a retiree, gave informed consent, located in the geographical zone selected. Exclusion criteria: those who were ill prior to the study, those who declined participation. Total participants = 400, each group containing 200 participants. |
|
|
JBI checklist for quasi-experimental studies score 8/9 |
|
|
Pre-test post-test was used. Demographic information was collected at baseline as well. The intervention lasted twelve weeks and there was a post-test at the sixteen week mark and a follow-up one month after that. The tests were administered/facilitated by health education experts and nurses but were supervised by the principal researchers. Height and weight were taken to calculate BMI and blood pressure was taken from each participant. It is not stated exactly when these measures were taken, |
|
|
Questionnaire. Included questions about demographics, hypertension knowledge, practices on prevention and self-care related to hypertension, physical activity (IPAQ-SF), the quality and pattern of sleep (PSQI), substance (smoking and alcohol) use, maintaining a healthy diet, medication adherence (MMAS-4), and home blood pressure monitoring. Face validity, content validity, and construct validity were all confirmed. Kuder-Richardson-20 coefficient was used to confirm reliability (0.72). |
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|
Written script was used to ensure standardization of material provided to participants. Standardized data collection procedures were used. No apparent bias. Approved by the Ethical Committee on Research Projects at Enugu State Ministry of Health. Informed consent obtained. Repeated measures were performed. Appropriate statistical methods were used. |
|
|
Data analysis was done using SPSS (version 20). Demographic data was analyzed using independent sample |
|
|
All participants showed improved hypertension knowledge from the pre-test to post-test. The intervention group had significant ( Themes: Education program to improve hypertension knowledge, Self-care, Follow-up testing, Educating older adults |
|
|
Highlighted that adequate knowledge about hypertension can help improve medication adherence and lifestyle changes. Provides an example of an effective education program that utilizes educational booklets, videos, charts, and discussion. Limitations: Credentials of authors are not stated, only their associations/Universities. There was baseline differences in the gender and BMI categories that were statistically significant. Self-report measures were used with participants which introduce risk for bias. Potential for poor generalizability because the population was only retirees from Enugu state. |
|
|
Helpful, reliable, valid. Clear statement of findings. Importance to topic established in thorough literature review. Compared to other articles: Consistent findings in regard to education programs and increased medication adherence. |
|
Author, year; Credentials, Article #5 |
Yazdanpanah, Y. (MSC of Geriatric Nursing), Saleh Moghadam, A. R.(Assistant Professor), Mazlom, S. R. (Instructor), Ali Beigloo, R. H.( MSC of Medical Surgical Nursing), & Mohajer, S. (PhD) (2019), Published in Journal of Evidence-Based Care |
|
Effect of an educational program based on health belief model on medication adherence in elderly patients with hypertension. |
|
|
Randomized control trial. The intervention was eight educational sessions about hypertension based on the Health Belief Model (HBM). Sessions were held twice a week for four weeks and lasted about an hour in length. |
|
|
Population was elderly patients with hypertension at health centers in the western region of Mashhad, Iran. Inclusion criteria: aged sixty years or older, able to read and write, history of office visit in the past six months, history of hypertension (self-report and health record), history of use of hypertension medication daily for at least six months, and no psychological or cognitive disorders. Exclusion criteria: declined participation, failure to attend in two or more sessions, and suffering from acute illness or hospitalization. It is not stated what method is used for collecting the sample. The separating into intervention and control groups was randomized but it is not clear as to if there was any blinding involved. Total number of participants was sixty, with thirty in each group (intervention and control). |
|
|
Pre-test post-test method was used. The pre-test was administered prior to the intervention, then the intervention group received their education sessions on hypertension and the control group received sessions typical to the centers the sessions were provided at. The post-test was administered after the last session. |
|
|
Questionnaire including demographic information and the MMAS-8. Content validity was confirmed. Reliability was confirmed with internal consistency using Cronbach’s coefficient alpha (0.69). Reliability was also confirmed by test-retest method. The Pearson correlation coefficient was r=0.86. |
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|
Sessions were administered by one of the researchers while the rest of the researchers supervised. Data collection was standardized. Approved by the Ethics Committee of Mashhad University of Medical Sciences. Informed consent was obtained. Ethical considerations were assessed, and the control group was provided with all of the information the intervention group received after the study was complete. |
|
|
Data was analyzed using SPSS (version 20). Mann-Whitney U test was used to check for significant difference between the control and intervention group ( |
|
|
Overall, the education program is associated with improved the medication adherence of the intervention group. The results of the independent Themes: Education program for elderly patients with hypertension, improving medication adherence, Health-belief model |
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|
It was estimated that implementing this educational program could increase medication adherence by about fifty nine percent. This research provides additional strength to the evidence that education designed based on the HBM can help improve medication adherence. Limitation: The method of sample collection is not clear and blinding about group assignment is not expressed. Self-report method can present the possibility for bias from participants. The sample was elderly so mental or psychological conditions that older adults experience may have had an effect on their answers. |
|
|
Helpful but cautious, the Cronbach’s coefficient alpha is 0.69 which is moderately low this indicates a lower reliability of the questionnaire and the ANOVA did not have a post hoc analysis. There was a clear statement of findings. The importance of the topic was established by a thorough literature review. Compared to other articles: Consistent findings in regard to education programs and increased medication adherence. Similar to Farazian et al. in the way the education program is created based on a model (Bandura’s self-efficacy model and the HBM) (2019). |
Summary and Analysis of Article Matrix
This review of literature provided evidence for the benefit of utilizing educational programs for patients with hypertension to improve medication adherence. Failure to adhere to a medication regimen in a patient with hypertension can increase the risk for serious health problems. Baseline (traditional) education about hypertension, medications, prevention, and self-care can be very minimal, leaving patients with a knowledge deficit that can impact their quality of life in a dramatic way such as a stroke or a heart attack.
Feedback from the studies done on using education to increase medication adherence in people with hypertensive has been helpful but there were flaws in some of the studies that could impact the results. The articles reviewed in this matrix include four level I evidence articles, and one level II evidence article. The four randomized control trials were valid according to the CASP checklist for randomized control trials and the quasi-experimental study was valid according to the JBI checklist for quasi-experimental studies. All of the studies provided a review that established importance for this topic. Three of the studies had aspects that may hurt the reliability and/or validity of the study, but their results were still consistent with other research. The studies all presented data collection that was standard, and the findings seemed to be interpreted appropriately.
The studies all are consistent in their statement that after an educational program for patients with hypertension the rate of medication adherence increases. There still needs to be more research done on the long term effects of these educational programs. Three of studies included no follow-up after the post-test. Ozoemena et al. and Farazian et al. both completed a follow-up one month after the intervention was complete (2019;2019). This was still considered a short time frame and was considered a limitation of the research (Farazian et al., 2019). Knowing the long term effects would add additional strength to the evidence that is established on the benefit of educational programs. The variety in the focus of the educational programs shows that whether the educational program is focused on a model such as the HBM in the article by Yazdanpanah et al. or if it focuses on the way education is presented, such as in the article by Aghakhani et al. who uses blended education, the results still show an improvement in medication adherence (2019; 2019). The studies reviewed utilized pre-test/post-test methods to assess medication adherence. There is a gap in care related to this topic because more emphasis is not being placed on education to improve medication adherence. These are only a few of the many articles that present evidence supporting additional education to hypertension patients. Physicians and their extenders may be prescribing the medications and they should provide education. However, this topic identifies an opportunity for the utilization of nurses for education (Aghakhani et al., 2019; Delavar et al., 2020). An educational program is associated with health promotion in the aspects of prevention and to guide people into taking charge of their own health. While all of these studies were done with small to moderate sample sizes, the same programs can be applied to larger populations. This indicates the need to research what the most beneficial class size would be, but since most of the research has been focused on group classes and not individual meetings, it provides an easier transition from sample sized interventions to entire populations.
In summary, all articles reviewed came to the same conclusion; that an educational program that focuses on hypertension and medications increases medication adherence in the participants. The long term effects need additional research, but overall the studies reviewed in the matrix addressed the original PICOT question. No changes to the PICOT question are indicated at this time.
References
Aghakhani, N., Parizad, N., Soltani, B., Khademvatan, K., & Rahimi, Z. (2019). The effect of the blended education program on treatment concordance of patients with hypertension: A single-blind randomized, controlled trial.
Journal of Vascular Nursing, 37(4), 250–256. https://doi.org/10.1016/j.jvn.2019.08.001
Dearholt, S., Dang, D., & Sigma Theta Tau International. (2012).
Johns hopkins nursing evidence-based practice: Models and guidelines. https://libguides.ohsu.edu/ld.php?content_id=16277844
Delavar, F., Pashaeypoor, S., & Negarandeh, R. (2020). The effects of self-management education tailored to health literacy on medication adherence and blood pressure control among elderly people with primary hypertension: A randomized controlled trial.
Patient Education and Counseling, 103(2), 336–342. https://doi.org/10.1016/j.pec.2019.08.028
Farazian, F., Moghadam, Z. E., Nabavi, F. H., & Vashani, H. B. (2019). Effect of self-care education designed based on bandura’s self-efficacy model on patients with hypertension: A randomized clinical trial.
Journal of Evidence-Based Care, 9(2), 43–52. doi: 10.22038/ebcj.2019.36466.1944
Ozoemena, E. L., Iweama, C. N., Agbaje, O. S., Umoke, P. C. I., Ene, O. C., Ofili, P. C., Agu, B. N., Orisa, C. U., Agu, M., & Anthony, E. (2019). Effects of a health education intervention on hypertension-related knowledge, prevention and self-care practices in Nigerian retirees: A quasi-experimental study.
Archives of Public Health, 77(1), N.PAG. https://doi.org/10.1186/s13690-019-0349-x
Yazdanpanah, Y., Saleh Moghadam, A. R., Mazlom, S. R., Ali Beigloo, R. H., & Mohajer, S. (2019). Effect of an educational program based on health belief model on medication adherence in elderly patients with hypertension.
Journal of Evidence-Based Care, 9(1), 52–62. https://doi.org/10.22038/ebcj.2019.35215.1895
Barriers to and Facilitators of Bedside
Nursing Handover
A Systematic Review and Meta-synthesis
Marco Clari, PhD, RN; Alessio Conti, PhD, RN; Daniela Chiarini, RN; Barbara Martin, MSc;
Valerio Dimonte, MSc, RN; Sara Campagna, PhD, RN
ABSTRACT
Background: Bedside nursing handover (BNH) has been recognized as a contributor to patient-centered
care. However, concerns about its effectiveness suggest that contextual factors should be considered before
and after BNH implementation.
Purpose: This review aimed to identify, evaluate, and synthetize the qualitative literature on the barriers to
and facilitators of BNH as experienced by nurses and patients.
Methods: The Joanna Briggs Institute meta-aggregation method was applied. A systematic search was per-
formed to identify qualitative studies published from inception to June 30, 2020. Two independent researchers
assessed methodological quality and extracted data.
Results: Twenty-four articles were included, comprising 161 findings, and 5 synthesized findings emerged
with a moderate level of confidence.
Conclusions: BNH ensures patient safety and increases satisfaction and recognition among patients and
nurses. This evidence on the barriers to and facilitators of BNH could help health care providers who have
implemented or plan to implement this practice.
Keywords: implementation science, meta-aggregation method, patient handoff, quality of health care,
systematic review
The term “handover” refers to a routine
nursing activity during which information,
professional responsibility, and accountability
for the care of patients are transferred due to a
transition in care.1 Handovers can be performed
in different ways2 and occur up to 3 times per
day across different settings when patients are
admitted, transferred, or discharged from or
within health care providers. This process is
complex and has been widely recognized as a
time-consuming, potentially risk-laden activity,
representing a challenge in clinical practice
Author Affiliations: Department of Public Health and Pediatrics,
University of Torino, Torino, Italy (Drs Clari, Conti, and Campagna
and Ms Martin and Mr Dimonte); and Department of Surgery,
Città della Salute e della Scienza University Hospital, Torino, Italy
(Ms Chiarini).
The authors declare no conflicts of interest.
Supplemental digital content is available for this article. Direct URL
citations appear in the printed text and are provided in the HTML
and PDF versions of this article on the journal’s Web site
(www.jncqjournal.com).
Correspondence: Alessio Conti, PhD, RN, Department of Public
Health and Pediatrics, University of Torino Via Santena 5 bis,
10126 Torino, Italy (alessio.conti@unito.it).
Accepted for publication: February 15, 2021
Published ahead of print: April 12, 2021
DOI: 10.1097/NCQ.0000000000000564
and management.3,4 Because handovers are
recurrent and potentially lead to patient harm,4
ensuring safety and quality in this process has
recently become a health care priority.5 Conse-
quently, greater focus has been placed on the
handover process, specifically on the promising
characteristics of bedside nursing handover
(BNH).
The value of moving handovers to patients’
bedsides through BNH has gradually gained
recognition in acute care hospitals,6-8 because it
allows patients to interact; thus, it maximizes
the proficiency of care delivery while minimizing
communication problems.9 Unlike nonbedside
handover processes, nurses are not taken away
from patients’ beds during BNH, which can
result in a more efficient use of their time.1,2
Although previous studies have presented BNH
as a necessary practice that contributes to
patient-centered care,10 conflicting evidence
exists on the long-term effectiveness of BNH.11
This suggests that contextual factors (eg, social
processes, resources, and organization policies)
should be considered before and after BNH is
implemented.
Although BNH has been promoted emphat-
ically to improve patient safety, many existing
Copyright © 2021 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
J Nurs Care Qual • Vol. 36, No. 4, pp. E51–E58 • Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved. www.jncqjournal.com E51
E52 Barriers to and Facilitators of BNH Journal of Nursing Care Quality
reviews that described this process were not sys-
tematic; instead they used narrative approaches.
These reviews focused on the impact of BNH
on patients and providers,12,13 the issues related
to implementation, the tools needed to assess
BNH in practice,14 the content of the information
shared,15 and patient participation during the
process.10 Two systematic reviews summarized
the qualitative literature on patients’, families’,
and nurses’ experiences of BNH.16,17 Despite the
need for evidence on the contextual factors rel-
evant to BNH, no review has focused on which
of these factors should be considered before and
after the implementation of BNH to ensure opti-
mal results. Indeed, implementing nontraditional
handover processes in real-life settings may rep-
resent a challenge for health care providers.18
Therefore, it seems necessary to identify el-
ements that support or hinder BNH from an
end user perspective. Qualitative research can
improve our understanding of which elements
patients and nurses consider relevant in applying
BNH, and the synthesis of these elements might
represent useful evidence that can be applied in
the clinical context. Thus, this systematic review
aimed to identify, evaluate, and synthetize the
qualitative literature on the barriers to and fa-
cilitators of BNH as experienced by nurses and
patients.
METHODS
This systematic review and meta-synthesis was
conducted following the Joanna Briggs Institute
(JBI) method of meta-aggregation,19 and pre-
sented following the enhancing transparency in
reporting the synthesis of qualitative research
(ENTREQ) guidelines.20 Meta-aggregation is a
well-consolidated, rigorous method for produc-
ing evidence to inform clinical decision-making.
It retains the conventions and requirements of
qualitative approaches by implementing a quan-
titative review process that conforms to the
meta-analytic process.19 Two researchers, 1 with
clinical experience and 1 with methodological
experience, completed the process independently.
Search strategy
The literature search strategy combined elec-
tronic and manual searches,19 involving an
expert librarian. A preliminary search was per-
formed to strengthen the search sensitivity and to
identify additional suitable keywords and index
terms referring to the review question. A system-
atic search was then performed in the PubMed,
Cumulative Index to Nursing and Allied Health
Literature (CINAHL), PsycINFO, Scopus, Em-
base, and Web of Science databases, applying a
combination of thesaurus terms and free key-
words with Boolean operators, consistent with
the Participants, phenomenon of Interest, and
Context (PICo) model.19 A manual search of the
reference lists of all included articles was also
performed to identify any additional articles.
Duplicates were identified through a citation
manager software and removed. The complete
search strategy is reported in Supplemental Dig-
ital Content Table 1 (available at: http://links.
lww.com/JNCQ/A852). The inclusion and ex-
clusion criteria are presented in Supplemental
Digital Content Figure 1 (available at: http://
links.lww.com/JNCQ/A853).
Assessment of methodological quality
The methodological quality of eligible articles
was appraised with the 10-item JBI Qualita-
tive Assessment and Review Instrument (QARI)
critical appraisal tool.19 Each item was scored
as “yes” (fulfilled), “no” (not fulfilled), or “un-
clear.” The researchers agreed to include only
eligible articles that attained a score of at least
60% (see Supplemental Digital Content Table 2,
available at: http://links.lww.com/JNCQ/A854).
Data extraction
The following data were extracted from each
included article: study methodology, data collec-
tion method, phenomenon of interest, geograph-
ical/cultural setting, participants, data analysis,
and conclusions. Findings were independently
extracted as reported in the original articles.19
The JBI-QARI software was used to analyze and
classify findings as unequivocal (ie, supported by
data beyond any doubt) or credible (ie, plausible
considering the data and the theoretical frame-
work). Findings for which no connection was
identified between the data and the findings were
classified as unsupported and excluded.19
Data synthesis
Unequivocal and credible findings were aggre-
gated and synthesized into categories based on
homogeneity in meaning.19 Consistent with the
JBI approach, a minimum of 2 findings were re-
quired to create a category. All researchers inde-
pendently appraised the categories created, and
disagreements were solved through discussion.
Copyright © 2021 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
October–December 2021 • Volume 36 • Number 4 www.jncqjournal.com E53
The final set of synthesized findings was created
by aggregating all obtained categories.19
Assessment of level of confidence
The ConQual approach was applied to assess the
level of confidence of each synthesized finding.
Developed to assist clinical decision-making, this
assessment method ranks the level of confidence
of qualitative evidence as high, moderate, low,
and very low. The type of study, as well as its
dependability and credibility, can contribute to a
reduction in the level of confidence.21
RESULTS
A description of the search outcome is presented
in Supplemental Digital Content Figure 1 (avail-
able at: http://links.lww.com/JNCQ/A853). A
total of 24 articles, published between January
1, 1998, and June 30, 2020, were included in
the review.22-45 The details of the included stud-
ies are reported in Supplemental Digital Content
Table 3 (available at: http://links.lww.com/
JNCQ/A855).
A total of 161 findings were extracted from
the included articles; no findings were excluded
due to a lack of quality. Findings were aggregated
into 5 synthesized findings, composed of 23 cat-
egories depicting barriers to and facilitators of
BNH. They are reported in Supplemental Digital
Content Table 4 (available at: http://links.lww.
com/JNCQ/A856), with some illustrative quotes.
Humanize care and ensure safety, but may
cause stress and feelings of inadequacy
BNH enhanced patients’ awareness of and their
connection with nurses, and allowed them to
participate in their own care.22,24,31 Patient in-
volvement during BNH provided an opportunity
for them to spend more time with nurses, thereby
promoting dialogue.22,27,30,32,43 Furthermore, pa-
tients described that the personalized approach
of BNH ensured tailored care delivery,24,36 in
which the person came first.24,37,43 The rela-
tionship between nurses and patients became a
partnership during BNH. Patients and nurses
could acquire further clarifications and provide
additional information, which helped to ensure
quality of care.39,40,42,43
During BNH, patients observed and listened
to the information transmitted, which increased
their confidence in the care.32,40,43 This interac-
tive partnership ensured the right of negotiation
between patients and nurses, and decreased
anxiety and perceived isolation, thus preserv-
ing their physical and emotional security.33,34,40
Active participation during BNH involved pa-
tients directly in their care process, keeping
them informed of their progress and ensuring
that the clinical information they received was
personalized.23,26,28,33,37,43 BNH also allowed pa-
tients to complain about inadequate care,25
and allowed nurses to verify the complete-
ness of the information collected during BNH
so that prompt adjustments could be made
if needed.23,28,29,32,35,39,41-44 Nurses also reported
having to improve the quality of written records
to avoid embarrassing situations in front of
patients.33
Patients often reported refusing to dialogue
with nurses during BNH, as they felt they could
not contribute meaningfully because they lacked
the appropriate knowledge.23 The more complex
the clinical decisions became, the less patients
wanted participate in BNH, preferring instead
to take on a passive role.23,40,42 Indeed, patients
with complex health problems described BNH as
an activity that was performed by professionals
and did not require their presence.44 Nurses had
conflicting opinions about the importance of pa-
tient involvement during BNH.45 Their rationale
for excluding patients from this process was re-
lated to patients’ lack of expertise and the fatigue
nurses experienced when they failed to succeed
in the time-consuming task of understanding pa-
tients’ needs.34 Such failures led nurses to be
superficial and shorten BNH,23,34,43 resulting in
patients feeling excluded and in negative patient
perceptions of the process.37
Optimize organization of care but may lead
to overtime and transmission of redundant
information
Through BNH, nurses could perform compre-
hensive clinical assessments of patients rapidly
and prioritize care activities.22,24,27,29,35,39 The
continuous flow of information ensured a con-
stant control of care,24,26,27 while the use of
technological supports facilitated the transmis-
sion and regular updating of data.28 The head
nurse was a fundamental reference point, ensur-
ing that the data were processed and forwarded
by all staff members.38 Through BNH, patients
reported that they became aware of the organiza-
tional patterns in the hospital.25,27,35 They would
call nurses less because they were more aware of
the nurses’ schedules and did not want to risk
Copyright © 2021 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
E54 Barriers to and Facilitators of BNH Journal of Nursing Care Quality
interrupting them.35,43 Patients were also able to
evaluate available staff resources, and wondered
whether BNH needed to be repeated daily, but
expressed their willingness to remain involved.23
Nurses who had to work overtime often
felt the need to rush to complete all their
tasks, including BNH.27,35,44 Moreover, tech-
nological supports were sometimes seen as
time-consuming tools.28 Some nurses even ac-
knowledged stopping BNH with patients who
had more complex issues.35 Patients whose BNH
was performed with nurses who were working
overtime were sometimes frustrated, because
these nurses were perceived to be absent, hasty,
superficial, and not engaged in the therapeutic
relationship.34 Nurses claimed that distrac-
tions, noises, and interruptions were inevitable
during BNH, and that these could lead to
omissions.28,31,41,45 In their opinion, the old han-
dover methods, for which nurses sat around a
table, entailed less risk of losing
information.28,31,44 If nurses expressed their
dissatisfaction with discontinuity of care during
BNH, patients sometimes felt less considered
in the organization of care.26,42 The need to
repeat the same information at every shift could
overwhelm both nurses and patients. Both par-
ties failed to recognize the need to perform
BNH regularly, and in some cases considered
it a waste of time.30,31 Nurses considered that
repeating information could lead to the poten-
tially dangerous loss or omission of necessary
clinical details, especially if there were frequent
overlapping shifts or interruptions.39
Can lead to lack of confidentiality but
shared decision-making may reduce these
concerns in patients
Privacy violations were always considered prob-
lematic during BNH.26 Patients described a
paradox of confidentiality37; they considered re-
spect for privacy to be fundamental, but they
were not concerned about it during BNH.36,37
Simple strategies were used to maintain confi-
dentiality during BNH, such as asking patients
if they wanted to have caregivers present.28,31
Maintaining a private setting provided further
confidentiality during BNH,31,34 as did agree-
ments between nurses and patients concerning
what information could be communicated in
front of others.32,42,44
Nurses described the management of confi-
dential information as an additional complexity
of BNH.28,33,35 They were particularly concerned
about the privacy violations that could oc-
cur due to the presence of other patients or
caregivers.27,28,31,35,38,44 The greatest challenge
was to pass relevant information to incoming
colleagues while maintaining confidentiality.41,45
Patients perceived their medical data as sensi-
tive and considered information about sexually
transmitted diseases or addiction problems to
be discriminatory. They thought that such issues
should be treated with great care and should
not be discussed during BNH.32,36,42-44 As pa-
tients also often confused BNH and medical
examinations,36 they renounced BNH when they
believed it was affecting their privacy.42
Promote clear, interactive communication
but may lead to uncertainty and discomfort
The mutual exchange of information between
patients and nurses made for interactive com-
munication during BNH.30,40 Dialogues between
staff and patients were described as friendly and
included humor and gratitude.25 It was empha-
sized that, to ensure a reasonable exchange of
information, communication should take place
in a cordial and friendly context and leave the
appropriate space for emotions.23,24 BNH of-
fered nurses and patients the opportunity to
ask questions and receive answers.25,35,42 Be-
cause of BNH, nurses were obligated to translate
clinical information into more comprehensible
language, so that patients could understand
changes in their health status.25,30,42 This was
valuable in ensuring patient safety and ensuring
their right to receive transparent information.42
Nurses described that BNH facilitated commu-
nication between professionals because it is a
structured method.31,38 BNH promoted the use
of specialized language, which in turn reassured
patients of nurses’ competence.28,29 The structure
of BNH also facilitated its execution and pro-
vided a guide for less experienced colleagues and
students.28,39
Although BNH is a structured method, nurses
expressed a sense of uncertainty as to the level
of detail they should use during this process.24
In particular, they felt that they could not
answer patients’ questions during BNH and
complained about the confusion this might
create.35 Such concerns about communication
were particularly prevalent among less expe-
rienced nurses.28 The scientific language that
BNH requires left some patients feeling excluded
Copyright © 2021 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
October–December 2021 • Volume 36 • Number 4 www.jncqjournal.com E55
from the process.36 They perceived BNH as an
excuse for the staff to exercise control and as-
sert their authority over them.23,36,37 In addition,
language barriers sometimes limited nurses’ un-
derstanding of specific information, which in
some cases led patients to exhibit discriminatory
behaviours.31
Promote professionalism and emotional
exchanges among nurses but may
contribute to decreased sense of
collegiality and security
Nurses described BNH as a means to provide
insight into the nursing profession in front of
patients.22,24 Nurses claimed that BNH encour-
aged them to give further explanations of clinical
information and use appropriate language con-
fidently, which patients and nursing students
perceived as nurses’ professionalism.23,37 Com-
pared to traditional methods, BNH gave nurses a
greater sense of responsibility and constituted a
valuable tool for students to understand the im-
portance of patients having an active role during
nursing practice.23 Nurses reported that observ-
ing colleagues during BNH offered them both
the opportunity to learn from and teach each
other, reinforcing the relationships among staff
involved in planning and care.28,35 In addition
to its professional influence, BNH offered nurses
the time to deal with and calm their anxiety, and
lighten their emotional burden.23 These benefi-
cial effects were also evident to patients, who rec-
ognized BNH as a tool for professional and emo-
tional debriefing among health care providers.23
BNH was not always warmly accepted by
all nursing staff; some described that the re-
placement of nonbedside handover methods
substantially limited collegiality.38 They referred
explicitly to the free expression that nonbedside
handover methods afforded them, methods that
were devoted to sharing concerns and reducing
frustrations among colleagues.38,45 When BNH
was applied in contexts where nurses were less
skilled and cared for a small number of patients,
BNH especially provoked calls for a return to
previous handover methods.27,31,38 BNH some-
times led to feelings of uncertainty in nurses,
especially if they felt judged by patients or expe-
rienced colleagues during the process.23,35 Nurses
described interacting with and being questioned
in front of the patient without having enough
information as an anxiety-generating barrier
that contributed to embarrassing situations.35,44
Sometimes nurses reported that practicing an
intellectual task like BNH, which included no
technical element, caused them embarrassment,
because patients did not consider BNH a neces-
sary process, but as a chat between the staff that
was inconsistent with care.44
The 5 synthesized findings had a moderate ev-
idence quality score due to the downgrading of
1 level in a credibility criterion (see Supplemen-
tal Digital Content Table 5, available at: http://
links.lww.com/JNCQ/A857).
DISCUSSION
This systematic review provided qualitative evi-
dence of the experiences of patients and nurses
regarding barriers to and facilitators of BNH.
These findings could deepen our knowledge
about the barriers and facilitators that are rec-
ognized by nurses and patients. Moreover, the
moderate level of confidence of the synthesized
findings suggests that they are suitable for incor-
poration into clinical practice.
The active role of patients in BNH distin-
guishes this method from conventional medical
models; it recognizes that nurses have different
identities, and patients considered BNH as an
opportunity to spend time with nurses.7 The in-
volvement of patients and families is promoted in
BNH,16 and when patients and families were in-
volved in BNH, they reported feeling recognized
as care partners. They also said they under-
stood the medical condition better, and became
more aware of both the care provided and future
treatment plans.16 This involvement helped pa-
tients develop closer relationships with staff and
contributed to the humanization of care. BNH
has been recommended as a method that main-
tains relational continuity, individualizes care,
and provides a patient-centered approach that
allows patients to be part of their care process,
thus ensuring safety.1,12 Indeed, patient involve-
ment has gained increasing relevance in clinical
settings, and is now recognized as essential to the
provision of safe care.46 However, some patients
and nurses had negative reflections on BNH. The
use of medical jargon and talking over patients
have already been described as things to avoid
to keep patients from feeling excluded and to
promote their involvement in BNH.10 Although
some patients described this behavior as reassur-
ing, as it signals a high level of competence, it
might amplify the vulnerability of patients, espe-
cially those without linguistic proficiency.47
Copyright © 2021 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
E56 Barriers to and Facilitators of BNH Journal of Nursing Care Quality
BNH enables early patient assessment and has
been found to promote the prioritization of care
rather than the performance of routine activities
or preestablished tasks.10,15 In this regard, evi-
dence has shown that starting nursing shifts with
rounds before performing handovers increased
the amount of time spent directly with patients,
ensured that their needs were addressed, and al-
lowed them to participate meaningfully in the
handover without requiring additional care.8 Al-
though nurses in the included studies expressed
concerns about having to work overtime, BNH
has actually been found to decrease the time
spent on handovers,13,14 leading to reduced over-
time costs and discharge times, and generating
cost savings for the organization.48 Findings
from the included articles highlighted that BNH
requires considerable effort from nurses, but in
contrast to traditional approaches, it does not
move them away from the patient’s bed and can
result in a more efficient use of their time. This
results in a continuity of care that depends on
the accuracy and completeness of the informa-
tion conveyed.1
BNH seemed to improve staff satisfaction and
enhance the working environment, playing a
fundamental role in the improvement of team
collaboration.48 In particular, the findings of
the present review supported emerging evidence
that BNH can improve communication between
colleagues and patients and provide an opportu-
nity to further strengthen their relationships.10,12
Moreover, BNH can enable a mutual exchange
of information and emotions, creating a cli-
mate that supports the emotional well-being
of staff and improves quality of care and
safety.49
Addressing confidentiality concerns is essen-
tial in the implementation of BNH, as such con-
cerns can generate anxiety in nurses and become
an obstacle to effective communication.12,14
Some strategies that could be employed by nurses
to address privacy concerns have been identified
in this review. They include approaches that have
already been outlined, such as moving close to
patients and other nurses, speaking quietly at the
bedside, discussing sensitive information in a pri-
vate area, pointing at written information, and
pulling curtains closed in patients’ rooms.50 In
these ways, behaviors that do not promote ef-
fective communication, such as those connected
to a lack of confidence, fear of being judged
by colleagues and patients, a negative opinion
about the relevance of information supplied by
patients, and the time required to communicate,
should be limited.12,13
The findings of this review acknowledged the
impact BNH can have on professionalism. Dur-
ing BNH, nurses are close to patients for a con-
siderable amount of time, which leads patients
to have an increased knowledge of and trust in
staff members.51 Nurses experienced increased
professional satisfaction with BNH, and BNH
has already been shown to enhance the quality
of the nursing process and nurses’ accountabil-
ity, teamwork, and prioritization abilities.7 This
systematic review has implications for nursing
practice and for research on contextual factors
that should be considered when implementing
the BNH, as shown in Supplemental Digital Con-
tent Table 6 (available at: http://links.lww.com/
JNCQ/A858).
Our meta-synthesis has some limitations. The
review of 6 literature databases and the re-
striction to studies published in English and
Italian could have excluded relevant articles that
offer further results or examined different con-
texts and cultural perspectives. The majority of
our findings came from studies performed in
high-income countries with different health care
systems and different social considerations when
it comes to nurses, which may limit the general-
izability of our findings. Furthermore, we cannot
exclude the possibility that bias has occurred in
the research and selection of studies, which was
carried out by 2 independent researchers. Despite
the aforementioned limitations, this review was
conducted following the JBI meta-aggregative
approach,24 which ensures the highest rigor, and
it is the first meta-synthesis to describe the barri-
ers to and facilitators of BNH.
CONCLUSIONS
This meta-synthesis provided qualitative evi-
dence on the barriers to and facilitators of BNH.
The identified findings, derived from the expe-
riences of patients and nurses, encompass areas
related to the humanization of care, patient
safety, health care management, and profession-
alism. Health care providers should consider
these barriers and facilitators before implement-
ing BNH and when adapting BNH in their
facility after implementation, in order to design
processes that will offer safer care for patients
and their families, and ensure increased satisfac-
tion and social recognition.
Copyright © 2021 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
October–December 2021 • Volume 36 • Number 4 www.jncqjournal.com E57
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Copyright © 2021 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
Article Matrix and Analysis
Student Name __________________________________
PICO Question ___________________________________________________________________
Search process :
Search terms:
Data bases:
Total number of articles obtained from search results: N=
Number of articles initially excluded based on abstract reading: N=
Number of articles reviewed: N=
Number of articles excluded based on criteria: N=
Inclusion Criteria:
Exclusion Criteria:
Number of systematic reviews or meta analyses used in Matrix- N =
Repeat this table – one for each article you are review. DO NOT double space in the table
The matrix and analysis assignment to submit consists of : 1). introduction describing the search process for this topic, 2). the review table (1 for each article = 5), 3). summary analysis, 4). reference page and 5). PDF copies of the articles – list by 1st author name as attachments
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Author, year; Credentials Article #1 |
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If credentials not identified- just state here, or identify place of employment |
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Article Focus/Title |
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Research Design/Intervention (describe intervention) |
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Level of Evidence and model used to grade evidence |
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Evaluation Tool (CASP or others- identify tool used) |
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Sample/# of subjects, how recruited, power analysis? |
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Data Collection procedure |
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Instruments and Reliability/validity of instruments |
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Data Analysis- id statistics, LOM, findings |
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Results |
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Discussion/ Significance of findings |
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Reliability and Validity of study, limitations |
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Helpful/Reliable Compared to other articles |
Author, year; Credentials Article #1
If credentials not identified- just state here, or identify place of employment
Article Focus/Title
Research Design/Intervention (describe intervention)
Level of Evidence and model used to grade evidence
Evaluation Tool (CASP or others- identify tool used)
Sample/# of subjects, how recruited, power analysis?
Data Collection procedure
Instruments and
Reliability/validity
of instruments
Data Analysis- id statistics, LOM, findings
Results
Discussion/
Significance of findings
Reliability and Validity of study, limitations
Helpful/Reliable
Compared to other articles
| Author, year; Credentials Article #1 |
Author, year; Credentials Article #1
If credentials not identified- just state here, or identify place of employment
Article Focus/Title
Research Design/Intervention (describe intervention)
Level of Evidence and model used to grade evidence
Evaluation Tool (CASP or others- identify tool used)
Sample/# of subjects, how recruited, power analysis?
Data Collection procedure
Instruments and
Reliability/validity
of instruments
Data Analysis- id statistics, LOM, findings
Results
Discussion/
Significance of findings
Reliability and Validity of study, limitations
Helpful/Reliable
Compared to other articles
Author, year; Credentials Article #1
If credentials not identified- just state here, or identify place of employment
Article Focus/Title
Research Design/Intervention (describe intervention)
Level of Evidence and model used to grade evidence
Evaluation Tool (CASP or others- identify tool used)
Sample/# of subjects, how recruited, power analysis?
Data Collection procedure
Instruments and
Reliability/validity
of instruments
Data Analysis- id statistics, LOM, findings
Results
Discussion/
Significance of findings
Reliability and Validity of study, limitations
Helpful/Reliable
Compared to other articles
Summary section:
Summary and synthesis of all 5 research articles; include level of evidence of all 5 articles, summary and comparison of outcomes of articles, include statements about the quality of the articles, instruments, what research still needs to be done on your topic, identifies gaps in care, addresses health promotion pertinent for area, analyzes interventions for populations. Did the article change your thinking about your research topic?
Reference Page – List articles used in the matrix as well as any other references you might have used in the summary.
Start this on a new page.
Fall 10.2020
·
Due Sep 20 by 10:59pm CST
·
Points 100
Overview VT of Matrix Assignment:
This assignment will require you to take the PICO,
5 research articles and place them in a table for analysis. You will critique each article and identify the most important parts of the research, analysis, and findings.
Then you will summarize the articles by grading the research and identifying gaps in the literature as well as possible interventions (see grading rubric and examples).
This will serve as the foundation for the work you will do in the Project/Practicum courses. As you work with your preceptor and finalize your capstone project, you will continue to build on this material. This assignment will be graded within 3-4 days of due date, with feedback provided once all grading has been completed.
This assignment enables the learners to meet Course SLO #1, 2, 3, 4
Instructions:
1. Identify your PICO or research question of interest
2. Gather 5
research articles on your topic:
be sure to save them and submit them along with the matrix; please make sure they are PDF documents.
3.
Do not use clinical guidelines or Cochran Reviews, abstracts, or poster presentations. You can search for research only by indicating “research” when you do an advanced search. If you can’t answer a lot of the questions, it is probably not a research article.
4.
We do not recommend that you use more than one systematic review or meta analysis. These are harder to evaluate because they have so much more information in them. Remember it is not individuals in these studies- it is there articles. Use the articles to find individual studies that may be easier to understand and use.
5. Review sample matrices and summaries
6. Use matrix table- one for each article and critique the parts of the article using the rubric
7. Be sure to identify the evaluation tool used to grade the evidence such as (See below for grading the evidence tools)
8. Identify where there are issues with the articles and what gaps were not addressed with the research; be prepared this may change the way you look at your topic or may result in a slightly different direction for your area of interest. This is ok- that is what you want to accomplish with this assignment. It will really assist you as you move forward with your project.
9. For this assignment you will turn in the matrix tables, summary, references and pdf copies of your 5 articles.
10.
Key definitions:
1.
Level of evidence: the process used to evaluate the level of evidence of your articles- such as Jones Hopkins, Cincinnati Children’s evaluation etc,
2.
Evaluation tool: use the method and describe how you arrived at the scoring or knowing that the article included all content it needed to- such as CASP;
3.
Instrument: What type of instrument or tool was used in the article? This could be a depression screening tool, Nurse satisfaction tool etc. Describe the instrument- how many questions, reliability- consistency with test-retest, Cronbach Alpha, inter-rater reliablity; validity with content validity, face validity
Files:
Use this form for your assignment:
Article Matrix and Analysis Revised 10.2020-1 x
Rubric:
DNP 816 Rubric for Matrix and Summary 10.2020 Final v2 x
Sample 1 Matrix_dnp816. Fall 2020 with permission x
Sample 2 DNP 816 Matrix Fall 2020 with permission x
Links to critical appraisal tools to evaluate research quality:
Joanna Briggs Institute (joannabriggs.org)
Joanna Briggs Institute (Links to an external site.)
(Links to an external site.)
CASP checklists (Links to an external site.)
Mixed Method appraisal checklist McGill: (Links to an external site.)
Cincinnati Children’s Hospital Medical Center Legend tools- very helpful (Links to an external site.)
Johns Hopkins EBP Models and Tools (Links to an external site.)
This assignment will require you to take the PICO, 5 research articles and place them in a table for
analysis. You will critique each article and identify the most important parts of the research, analysis,
and findings.
Then you will summarize the articles by grading the research, and identifying gaps in the literature as
well as possible interventions (see grading rubric and examples).
This will serve as the foundation for the work you will do in the Project/Practicum courses. As you
work with your preceptor and finalize your capstone project, you will continue to build on this
material. This assignment will be graded within 3-4 days of due date, with feedback provided once all
grading has been completed.
This assignment enables the learners to meet Course SLO #1, 2, 3, 4
Instructions:
1. Identify your PICO or research question of interest
2. Gather 5 research articles on your topic: be sure to save them and submit them along with the
matrix; please make sure they are PDF documents.
3. Do not use clinical guidelines or Cochran Reviews, abstracts, or poster presentations. You
can search for research only by indicating “research” when you do an advanced search. If
you can’t answer a lot of the questions, it is probably not a research article.
4. We do not recommend that you use more than one systematic review or meta analysis. These
are harder to evaluate because they have so much more information in them. Remember it is not
individuals in these studies- it is there articles. Use the articles to find individual studies that may
be easier to understand and use.
5. Review sample matrices and summaries
6. Use matrix table- one for each article and critique the parts of the article using the rubric
7. Be sure to identify the evaluation tool used to grade the evidence such as (See below for grading
the evidence tools)
8. Identify where there are issues with the articles and what gaps were not addressed with the
research; be prepared this may change the way you look at your topic or may result in a slightly
different direction for your area of interest. This is ok- that is what you want to accomplish with this
assignment. It will really assist you as you move forward with your project.
9. For this assignment you will turn in the matrix tables, summary, references and pdf copies of your
5 articles.
10. Key definitions:
1. Level of evidence: the process used to evaluate the level of evidence of your articles- such
as Jones Hopkins, Cincinnati Children’s evaluation etc,
2. Evaluation tool: use the method and describe how you arrived at the scoring or knowing that
the article included all content it needed to- such as CASP;
3. Instrument: What type of instrument or tool was used in the article? This could be a
depression screening tool, Nurse satisfaction tool etc. Describe the instrument- how many
questions, reliability- consistency with test-retest, Cronbach Alpha, inter-rater reliablity; validity
with content validity, face validity
Files:
Use this form for your assignment: Article Matrix and Analysis Revised 10.2020-1 x
Rubric: DNP 816 Rubric for Matrix and Summary 10.2020 Final v2 x
Sample 1 Matrix_dnp816. Fall 2020 with permission x
Sample 2 DNP 816 Matrix Fall 2020 with permission x
Links to critical appraisal tools to evaluate research quality:
https://nku.instructure.com/courses/53642/files/7148558/download?wrap=1
https://nku.instructure.com/courses/53642/files/7148559/download?wrap=1
https://nku.instructure.com/courses/53642/files/7148560/download?wrap=1
https://nku.instructure.com/courses/53642/files/7148561/download?wrap=1
DNP 816 Matrix Rubric 10.2020
Joanna Briggs Institute (joannabriggs.org) Joanna Briggs Institute
CASP checklists
Mixed Method appraisal checklist McGill:
Cincinnati Children’s Hospital Medical Center Legend tools- very helpful
Johns Hopkins EBP Models and Tools
https://jbi.global/critical-appraisal-tools
https://casp-uk.net/casp-tools-checklists/
https://casp-uk.net/casp-tools-checklists/
http://mixedmethodsappraisaltoolpublic.pbworks.com/w/page/24607821/FrontPage
https://www.cincinnatichildrens.org/research/divisions/j/anderson-center/evidence-based-care/legend
https://www.hopkinsmedicine.org/evidence-based-practice/ijhn_2017_ebp.html
FAQ about Matrix
Here are some answers to questions that students have asked about the Matrix assignment:
1. You will essentially be doing a critique of each of the 5 quantitative research articles, using
the table provided (1 table per article = 5), analyzing your articles. So you will have the introduction
describing your search, 5 tables, and 1 summary + references.
2. Choose one of the evaluation tools to assist you in evaluating the articles- choose a specific tool
based on the type of research that was used- match the evaluation tool to the article. You only need to
use one tool. These are ones such as Johns Hopkins, Cincinnati Children’s Medical Center. JBI, etc.
They are identified on the instructions with links.
3. The initial questions on the matrix- key words, inclusion/exclusion information etc only
needs to be completed one time- as it was this search that enabled you to find the articles.
4. This is a BIG assignment so make sure you get started now. Use single space in the table-
otherwise it will take up too much space. The information does not need to be complete sentences in
the tables. The summary needs to follow APA and use complete sentences.
5. Based on this review, you may need to change or reframe your PICO/T question. That
frequently is the outcome of doing an in-depth analysis such as this. Changing your PICO/T is not
something you need to do for this assignment. You may do it and get feedback from your faculty, but it
is not required. You should discuss in the summary that based on your review and the findings, the
PICOT will need to be changed.
6. As long as you identify the authors of the articles used in the critique and include the citation in the
reference list you will be fine for the matrix. Just be sure to paraphrase information you put into the
table- do not cut/paste into the table. You may have some tables that are longer so the tables may
run into the next page at times depending on how much you write.
7. For the evaluation tool portion of the Matrix I have chosen to use the Joanna Briggs Institute
Appraisal tool for the majority of my articles. With this tool are the results simply Include or Exclude in
contrast to the CASP Checklist where a score is given? Answer: You could just identify the number
of questions that were addressed- so 9/11 or 5/10 or whatever you found.
8. There is not a mixed methods appraisal for CASP or the Joanna Briggs organizations. Here is a
link to a mixed method checklist. See if that works for you. If this doesn’t work, then choose the
predominant method- generally the 1st one they use- and use that checklist.
Mixed Methods Appraisal Tool
9. For the first column in the table, the authors/credentials/year, if there are a large number of
authors, can we use et. al. after listing the first 6 as in APA format, or do you prefer all authors listed
because you want to know their credentials? I ask because I have a few articles with 10-15 authors
listed. Answer: You don’t need to write all authors in the table- follow APA rules for that- remember
with 7th edition you only need to include 3 in the citation with et al. Here is a link to Purdue Owl with
current APA information
10. The example matrix table uses ONE table with multiple rows for each article being reviewed. Is
this the format you want, or would you prefer each article to have its own table (with the headings of
each column above)? Answer: I find having the tables all together is time saving to grade, but each
article should have its ‘ own ‘ table/page but they are all combined into one document. However, if
there are issues with the table they can be separated but need to be submitted as one document. It
becomes very cumbersome with separate files for each.
http://mixedmethodsappraisaltoolpublic.pbworks.com/w/page/24607821/FrontPage
https://owl.purdue.edu/owl/research_and_citation/apa_style/apa_formatting_and_style_guide/general_format.html
11. For the matrix assignment, how should we report the results from the evaluation tool if it
specifically states it is not intended to be scored as a number? The MMAT states “it is discouraged to
calculate an overall score from the ratings of each criterion”. Additionally, the JBI tool only has options
of yes/no/unclear/not applicable. I saw that another student asked about this and was told to score
based on how many criterion were met, but how would we score items which were unclear? Answer:
Identify what you can and then report it as 3/9 ? on 4 or something that indicates that you are unsure.
You can identify your concerns under reliability of the research. It just may give you an indication of
what is and what is not present. It is not really presenting a score. Again, this matrix is for you to
include information that is helpful to you so that you don’t have to keep searching in the article.
12.Other questions about the matrix:
13. Could someone clarify what the introduction portion means with regards to: “Studies
included in systematic review or meta analysis- N =”. Are we supposed to include a systematic review
as one of our articles or are we referring to out of the thousands of articles searched, X are systematic
reviews? Answer: If you use a systematic review or meta-analysis- just identify out of the five how
many are SR or MA. See the matrix + annotation with this written in green. If you have included
systematic reviews in your 5 articles (you do not have to), you will identify the specifics of the articles
within the table.
14. Typically we are supposed to avoid first person when writing. The example is written in first
person. Is there a right or wrong way for this project? Also, are we supposed to stay around 300 words
total for our summary? Answer: 1st person is fine for this summary as the sample demonstrates as it
is really your findings from doing the analysis. I would say your summary should be able to
accomplished on 1 page.
15. Follow APA 7th Edition for a Professional Paper as to running head, page numbers, title page.
16. I am having a hard time finding a critical appraisal tool for a descriptive survey study. Do you
have any suggestions on a tool to use for this? Answer: Try the JBI- prevalence scale. If that doesn’t
work you can use the polit/beck list – Box 16-1, p 371.
17. Can I use a national guideline for one of my articles? If so, is there an evaluation tool that best
fits this type of article? I used CASP tool for all of my other articles; however, I do not see one for a
guideline. Answer: The only way I think a national guideline works is if it is evidence based and that
is shown in the guideline. And if you have the references, why not go to the primary source? That is
always the best way to go.
18. I am struggling with the data analysis section of a systematic review. Can you help with some
suggestions about how to address the information? Answer: The article title is Using teach-back
method to prevent 30-day readmissions in patients with heart failure: A systematic review by
Almkuist. Answer: It sounds like it is an intervention study. Describe the criteria the reviewers used to
review the studies- and how the articles fared. Generally they identify an effect size in systematic
reviews- that may be a good choice to look for. Or you could summarize. The readmission rate is
Result/ “theme” section. This refers to the outcomes of the research you have reviewed. If it is
quantitative, then you would include the results (t = 5.7, p = 0.03) with group one significantly different
from group 2 on blood sugars (making this up). For a qualitative article if you have that, then you
would include the themes of the research that were identified
Some articles do not list the credentials of the all the authors, is it ok to say “unknown” for that?
Yes
Would you like a title page for this Assignment? Yes- include a title page
Yes, you can use narrow margins for the table- that is best as you want to include all the information.
Check with your faculty to see acceptable font. 10-12 would probably be best.
generally nominal- either they returned or they didn’t in 30 days. I would probably lean toward
grouping the studies together- 5 did this and had this result, while 6 did this and had this result.
19. Answer: If possible, you should choose quantitative articles within 5 years of publishing. This
includes systematic reviews or meta analysis. For some topics there may be limited research
published and you may have more difficulty in finding articles so then you will have to expand the type
and year it is published. The topic you are interested in should drive your choice of articles. You need
to evaluate each article for its strengths and weaknesses according to the areas identified on the
columns.
20. For our cover page, can the title just be Summary and analysis of Article Matrix? or do we need to
have personalized titles? Answer: Yes, you can use that as the title, but you may want to go ahead
and give it a more specific title as you will need a title for the presentation.
21. Where do I find the learning tools you mention in the following
announcement? Answer: Information has been posted under Learning Tools (module 0) related to
your MSN NP and NEL capstone projects. This will help you identify articles that you may choose to
use for the matrix assignment.
22. Information about the preliminary section: the number of studies reviewed: N = refers to how
many articles did you review out of the ones found during the search? Answer: If you are reviewing
the topic of rapid response teams, and your key words are NP lead RRT, or RN lead RRT or
physician let RRT, or hospitalist led RRT and you find 100 articles, but you eliminate 45 because they
are not research articles, and only 5 discuss a NP led team for the rapid response, that is what you
would indicate as the number of articles reviewed. You will indicate the number of studies included in
a meta analysis or systematic review, but that would go into the table, not in the preliminary section.
23. Please note: As long as you identify the authors of the articles used in the critique and include the
citation in the reference list you will be fine for the matrix. Just be sure to paraphrase information
you put into the table- do not cut/paste into the table. You may have some tables that are longer
so the tables may run into the next page at times depending on how much you write.
24. My matrix is not in English!
FAQ about Matrix
Here are some answers to questions that students have asked about the Matrix assignment:
1. You will essentially be doing a critique of each of the 5 quantitative research articles, using
the table provided (1 table per article = 5), analyzing your articles. So you will have the introduction
describing your search, 5 tables, and 1 summary + references.
2. Choose one of the evaluation tools to assist you in evaluating the articles- choose a specific tool
based on the type of research that was used- match the evaluation tool to the article. You only need to
use one tool. These are ones such as Johns Hopkins, Cincinnati Children’s Medical Center. JBI, etc.
They are identified on the instructions with links.
3. The initial questions on the matrix- key words, inclusion/exclusion information etc only
needs to be completed one time- as it was this search that enabled you to find the articles.
4. This is a BIG assignment so make sure you get started now. Use single space in the table-
otherwise it will take up too much space. The information does not need to be complete sentences in
the tables. The summary needs to follow APA and use complete sentences.
5. Based on this review, you may need to change or reframe your PICO/T question. That
frequently is the outcome of doing an in-depth analysis such as this. Changing your PICO/T is not
something you need to do for this assignment. You may do it and get feedback from your faculty, but it
is not required. You should discuss in the summary that based on your review and the findings, the
PICOT will need to be changed.
6. As long as you identify the authors of the articles used in the critique and include the citation in the
reference list you will be fine for the matrix. Just be sure to paraphrase information you put into the
table- do not cut/paste into the table. You may have some tables that are longer so the tables may
run into the next page at times depending on how much you write.
7. For the evaluation tool portion of the Matrix I have chosen to use the Joanna Briggs Institute
Appraisal tool for the majority of my articles. With this tool are the results simply Include or Exclude in
contrast to the CASP Checklist where a score is given? Answer: You could just identify the number
of questions that were addressed- so 9/11 or 5/10 or whatever you found.
8. There is not a mixed methods appraisal for CASP or the Joanna Briggs organizations. Here is a
link to a mixed method checklist. See if that works for you. If this doesn’t work, then choose the
predominant method- generally the 1st one they use- and use that checklist.
Mixed Methods Appraisal Tool
9. For the first column in the table, the authors/credentials/year, if there are a large number of
authors, can we use et. al. after listing the first 6 as in APA format, or do you prefer all authors listed
because you want to know their credentials? I ask because I have a few articles with 10-15 authors
listed. Answer: You don’t need to write all authors in the table- follow APA rules for that- remember
with 7th edition you only need to include 3 in the citation with et al. Here is a link to Purdue Owl with
current APA information
10. The example matrix table uses ONE table with multiple rows for each article being reviewed. Is
this the format you want, or would you prefer each article to have its own table (with the headings of
each column above)? Answer: I find having the tables all together is time saving to grade, but each
article should have its ‘ own ‘ table/page but they are all combined into one document. However, if
there are issues with the table they can be separated but need to be submitted as one document. It
becomes very cumbersome with separate files for each.
http://mixedmethodsappraisaltoolpublic.pbworks.com/w/page/24607821/FrontPage
https://owl.purdue.edu/owl/research_and_citation/apa_style/apa_formatting_and_style_guide/general_format.html
11. For the matrix assignment, how should we report the results from the evaluation tool if it
specifically states it is not intended to be scored as a number? The MMAT states “it is discouraged to
calculate an overall score from the ratings of each criterion”. Additionally, the JBI tool only has options
of yes/no/unclear/not applicable. I saw that another student asked about this and was told to score
based on how many criterion were met, but how would we score items which were unclear? Answer:
Identify what you can and then report it as 3/9 ? on 4 or something that indicates that you are unsure.
You can identify your concerns under reliability of the research. It just may give you an indication of
what is and what is not present. It is not really presenting a score. Again, this matrix is for you to
include information that is helpful to you so that you don’t have to keep searching in the article.
12.Other questions about the matrix:
13. Could someone clarify what the introduction portion means with regards to: “Studies
included in systematic review or meta analysis- N =”. Are we supposed to include a systematic review
as one of our articles or are we referring to out of the thousands of articles searched, X are systematic
reviews? Answer: If you use a systematic review or meta-analysis- just identify out of the five how
many are SR or MA. See the matrix + annotation with this written in green. If you have included
systematic reviews in your 5 articles (you do not have to), you will identify the specifics of the articles
within the table.
14. Typically we are supposed to avoid first person when writing. The example is written in first
person. Is there a right or wrong way for this project? Also, are we supposed to stay around 300 words
total for our summary? Answer: 1st person is fine for this summary as the sample demonstrates as it
is really your findings from doing the analysis. I would say your summary should be able to
accomplished on 1 page.
15. Follow APA 7th Edition for a Professional Paper as to running head, page numbers, title page.
16. I am having a hard time finding a critical appraisal tool for a descriptive survey study. Do you
have any suggestions on a tool to use for this? Answer: Try the JBI- prevalence scale. If that doesn’t
work you can use the polit/beck list – Box 16-1, p 371.
17. Can I use a national guideline for one of my articles? If so, is there an evaluation tool that best
fits this type of article? I used CASP tool for all of my other articles; however, I do not see one for a
guideline. Answer: The only way I think a national guideline works is if it is evidence based and that
is shown in the guideline. And if you have the references, why not go to the primary source? That is
always the best way to go.
18. I am struggling with the data analysis section of a systematic review. Can you help with some
suggestions about how to address the information? Answer: The article title is Using teach-back
method to prevent 30-day readmissions in patients with heart failure: A systematic review by
Almkuist. Answer: It sounds like it is an intervention study. Describe the criteria the reviewers used to
review the studies- and how the articles fared. Generally they identify an effect size in systematic
reviews- that may be a good choice to look for. Or you could summarize. The readmission rate is
Result/ “theme” section. This refers to the outcomes of the research you have reviewed. If it is
quantitative, then you would include the results (t = 5.7, p = 0.03) with group one significantly different
from group 2 on blood sugars (making this up). For a qualitative article if you have that, then you
would include the themes of the research that were identified
Some articles do not list the credentials of the all the authors, is it ok to say “unknown” for that?
Yes
Would you like a title page for this Assignment? Yes- include a title page
Yes, you can use narrow margins for the table- that is best as you want to include all the information.
Check with your faculty to see acceptable font. 10-12 would probably be best.
generally nominal- either they returned or they didn’t in 30 days. I would probably lean toward
grouping the studies together- 5 did this and had this result, while 6 did this and had this result.
19. Answer: If possible, you should choose quantitative articles within 5 years of publishing. This
includes systematic reviews or meta analysis. For some topics there may be limited research
published and you may have more difficulty in finding articles so then you will have to expand the type
and year it is published. The topic you are interested in should drive your choice of articles. You need
to evaluate each article for its strengths and weaknesses according to the areas identified on the
columns.
20. For our cover page, can the title just be Summary and analysis of Article Matrix? or do we need to
have personalized titles? Answer: Yes, you can use that as the title, but you may want to go ahead
and give it a more specific title as you will need a title for the presentation.
21. Where do I find the learning tools you mention in the following
announcement? Answer: Information has been posted under Learning Tools (module 0) related to
your MSN NP and NEL capstone projects. This will help you identify articles that you may choose to
use for the matrix assignment.
22. Information about the preliminary section: the number of studies reviewed: N = refers to how
many articles did you review out of the ones found during the search? Answer: If you are reviewing
the topic of rapid response teams, and your key words are NP lead RRT, or RN lead RRT or
physician let RRT, or hospitalist led RRT and you find 100 articles, but you eliminate 45 because they
are not research articles, and only 5 discuss a NP led team for the rapid response, that is what you
would indicate as the number of articles reviewed. You will indicate the number of studies included in
a meta analysis or systematic review, but that would go into the table, not in the preliminary section.
23. Please note: As long as you identify the authors of the articles used in the critique and include the
citation in the reference list you will be fine for the matrix. Just be sure to paraphrase information
you put into the table- do not cut/paste into the table. You may have some tables that are longer
so the tables may run into the next page at times depending on how much you write.
DNP 816: PICOT QUESTION
PICOT Format
• P = Patients with Anxiety Disorder.
• I = video conference call offering coping support.
• C = as opposed to no phone call.
• O = Increased the patient’s confidence in managing anxiety disorder
• T = six months
PICOT QUESTION
In patients with anxiety disorder (P), would a follow-up video conference call offering coping support (I), as opposed to no phone call (C), increase the patient’s confidence in managing anxiety disorder (O) over the span of six months (T)?
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