Evidence-Based Project, Part 3: Critical Appraisal of Research Paper

Critical Appraisal Tool Worksheet Template

Heart failure (HF), especially among the elderly patients who are 65 years and above, is a complex chronic condition that contributes to increasing cost of healthcare. Patients with the condition have a high incidence of hospital readmission within 30 days after discharge than any other condition. The disease is a leading cause of hospital admissions among the elderly patients (Al-Tamimi et al., 2018). The purpose of this critical appraisal paper is to identify best practices that emerges from the researched and reviewed literature comprising of four articles on the kind of interventions that nurses can have to reduce the prevalence of readmissions of patients with heart failure within 30 days after discharge.

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Part 3A: Critical Appraisal of Research: Evaluation Table

Full APA formatted citation of selected article.	Article #1	Article #2	Article #3	Article #4
Full APA formatted citation of selected article.	Awoke, M., Baptiste, D., Davidson, P., Roberts, A., & Dennison-Himmelfarb, C. (2019). A quasi-experimental study examining a nurse-led education program to improve knowledge, self-care, and reduce readmission for individuals with heart failure. Contemporary Nurse, 55(1), 15–26. DOI: 10.1080/10376178.2019.1568198	Breathitt, K., Maffett, S., Foraker, R. E., Sturdivant, R., Moon, K., Hasan, A., Abraham, T. W. (2018). Pilot randomized controlled trial to reduce readmission for heart Struggling to meet your deadline ? Get assistance on Evidence-Based Project, Part 3: Critical Appraisal of Research Paper done on time by medical experts. Don’t wait – ORDER NOW! Meet My Deadline failure using novel tablet and nurse practitioner education. The American Journal of Medicine, 131(8) 8, 974–978.https://doi.org/10.1016/j.amjmed.2018.02.017	Clarkson, J. N., Schaffer, S., & Clarkson, J. J. (2017). The effect of an inter-professional heart failure education program on hospital readmissions. Journal for Healthcare Quality, 39(2), 78–84. DOI: 10.1097/JHQ.0000000000000027	Rice, H., Say, R., & Betihavas, V. (2018). The effect of nurse-led education on hospitalization, readmission, quality of life and cost in adults with heart failure: A systematic review. Patient Education and Counseling, 101(3), 363–374. DOI: 10.1016/j.pec.2017.10.002.
Evidence Level * (I, II, or III)	Level II is a quasi-experimental study.	Level I since it is a randomized control trial.	Level IV since the study constitutes evidence from well-designed case control trials	Level I-systematic review to show the effects of nurse education to reduce hospitalizations and readmissions rate for individuals with heart failure.
Conceptual Framework Describe the theoretical basis for the study (If there is not one mentioned in the article, say that here).**	The study’s conceptual framework is that nurse-led heart failure hospital education enhances knowledge, self-care behaviors and reduce 30-day readmissions.	The article asserts that no standardized heart failure education programs exist. Therefore, the study’s framework is to show if using a novel tablet application to nurse practitioner education is better than NP education alone.	The conceptual model is that an education-based strategy decreases hospital readmissions for heart failure patients within 30 days of discharge.	The conceptual model is that having nurse led patient education sessions can improve quality of life, reduce readmission rates and healthcare costs among adults with heart failure living independently in community setting.
Design/Method Describe the design and how the study was carried out (In detail, including inclusion/exclusion criteria).	The study uses a quasi-experimental design with pre and post-tests on a convenient samples at two cardiac units in a large urban facility in the United States	The study used randomized control trial where patients were grouped in treatment using nurse education and tablet application and the second group was control comprising of NP education only.	The authors conduct a retrospective case-control to compare the readmission rates of heart failure patients attending heart failure university (HFU) and those getting standard education	A systematic review of randomized control trials. The authors use search terms as inclusion criteria that include nurse education, heart failure, hospitalization and readmissions and economic burden and quality of life. The criteria also entails using databases like PubMed, CINAHL and Google Scholar based on the terms.
Sample/Setting The number and characteristics of patients, attrition rate, etc.	The sample comprised of 29 persons diagnosed with heart failure in the two cardiac units in a large urban setting.	The sample consisted of two groups: where the treatment group had 60 patients. The control group had 66 patients.	The study had a sample of 106 participants as receiving the intervention while 104 did not receive the education (HFU). The setting was a large private hospital in Florida.	The authors conducted a systematic review using different databases and terms in different patient settings, especially community setting.
Major Variables Studied List and define dependent and independent variables	The major variables in the study included knowledge among patients, self-care maintenance practices and self-care management with seven days and 30 days. The dependent variables include the rate of readmissions, number of patients, and duration. The independent variables include the variations in self-care management and self-care maintenance.	The main variable studied included trends and rates of readmissions within a 30-day period. The dependent variable includes treatment interventions while the independent variable was rates of readmissions. They researchers also focused on levels of satisfaction among patients; both control and treatment group.	The variables in the study include effects of HFU on patients who received the intervention and functional disability for those who did not get the education. The independent variable was the 30-day readmission rate.	No major variables are included in the systematic review. However, one-on-one patient education session was the main variable and its effects on quality of life, rates of readmissions and healthcare costs among adults with heart failure in community settings.
Measurement Identify primary statistics used to answer clinical questions (You need to list the actual tests done).	The authors in the study used pre-tests and post-tests to measure different outcomes of the study. The authors measured level of self-care confidence at 30 days as a post test to determine the effects of nurse-led educational intervention. Post-discharge follow-up was measured after 90 days.	The primary statistics used in answering clinical questions included the rate of treatment and control group’s readmissions, and level of satisfaction after 30 days.	The main statistics applied to answer clinical questions included readmission rates, a reduction in costs and enhancing the quality of care for HF patients.	The study does not use tests since it is a systematic review of existing research studies on the topic.
Data Analysis Statistical or Qualitative findings (You need to enter the actual numbers determined by the statistical tests or qualitative data).	Qualitative findings show a statistic significant improvement in 30-day readmissions of (P ≥ .05).	Qualitative findings show that the readmission rates trended lower but were not statistically significant at 13.2% and 26.7% respectively. These representing (p=0.08).	The qualitative results showed a positive interaction between patients who received HFU and reduced readmission rates. (χ [1, N = 106] = 5.68, p = .02).	Data analysis from the selected articles shows qualitatively that nurse-led patient education can help better the quality of life among HF patients, reduces the cost of healthcare and lower incidences of readmissions among heart failure patients.
Findings and Recommendations General findings and recommendations of the research	The findings show the significance of creating patient education programs that focus on enhancing knowledge and self-care behaviors for heart failure patients. The study recommends the unique role that nurses play in implementation of such programs to enhance health outcome. The authors recommend the integration of these interventions in all care settings.	The findings show that not significant reduction is associated with NP education plus using tablet in reducing the 30-day readmission rates compared to NP education alone. However, there was a positive trend. The authors assert that patient satisfaction levels increased with heart failure explanations improving by using the intervention. There is need for a larger research to determine the effect of the intervention.	The findings show the significance of inter-professional educational-based disease management approaches targeted at the HF patients. The study recommends increased role play among nurses to enhance adherence to treatment protocols to lower rates of readmissions.	The general findings from the systematic review show that nurse-led patient education for individuals with HF enhances quality of life and lowers hospital admissions and readmissions.
*Appraisal and Study Quality* Describe the general worth of this research to practice. What are the strengths and limitations of study? What are the risks associated with implementation of the suggested practices or processes detailed in the research? What is the feasibility of use in your practice?	The research is worth since it demonstrates the unique role that nurses can play to enhance interventions in addressing heart failure problems among the population. The strengths of this study include its use of pre and post-test aspects, study settings which are cardiac units and effective follow-up of up to 90 days after discharge. A key limitation is the use of a small sample size of 29 patients only. The implementation of the suggested practice in the study faces risks like effective inter-professional collaboration and acceptance among providers. The feasibility of using the recommendations is high due to the benefits they will offer in reducing readmissions.	The research is worth to practice as it shows that nurses can enhance patient education on heart failure using tablet alongside nurse education. The study can enhance provision of patient education by nurses in practice. Key strengths of the study include its inclusion criteria and recommendations based on the findings. However, a core limitation is the study sample and setting. The risks linked to the implementation of the recommendations include potential violation of patient privacy, and need for training. It could also increase nurses’ workload. The feasibility is low because of the uncertain findings as the authors say that no significant association exists between the intervention and a reduction in heart failure patients’ readmissions.	The study is worth for nurses to integrate education to reduce readmissions among HF patients. The strengths of the study include its focus on HF population in a large facility, use of sufficient sample to show the effects of education, and increased need for providers to focus on inter-professional collaborations. However, the limitation is its sample size that may not replicate different patient situations. No risks are associated with implementing the suggested interventions since inter-professional approaches are essential in care provision. The feasibility of implementing these suggestions in my practice is high because of the benefits it provides to mitigate readmissions among HF patients within 30 days.	The study is worth for nurse practice since it shows that interventions can lower susceptibility to HF and improve the quality of life. Systematic reviews offer best evidence as they obtain findings from different studies. The only limitation of this study is its effective application in clinical setting since it integrates different outcomes from various researches. No risks exist in implementing the interventions since they are based on evidence. The feasibility of using the interventions is high due to their ease of implementation in different settings.
Key findings	The key findings from the study include incorporation of nurses in patient education, implementation of education programs to reduce heart failure readmissions, and importance of self-care management and education.	The study’s key findings show that including certain interventions can enhance patient satisfaction with physician’s explanations about heart failure. The study also shows the need to investigate the effects of using tablets alongside nurse education to improve adherence to treatment protocols and reduce readmissions for heart failure.	Key finding from the study is that nurse-led inter-professional approaches are essential in enhancing patient education to prevent readmissions among heart failure patients.	Key findings show that nurse-led education can happen using diverse approaches and influence the rate of readmissions and hospitalization.
Outcomes	The outcomes from the study shows that nurses have a unique position to enhance self-care and nurse-led interventions are essential to reduce readmission rates among heart failure patients.	The study outcomes are categorical that nurse-led interventions help reduce rates of readmissions for heart failure patients within 30 days after discharge.	The outcomes from this article show that nurses should create effective interventions that help enhance care provision and ensure that patients with heart failure receive the best care.	The outcomes from the study illustrate the critical role that research interventions play in enhancing patient care and quality of life.
General Notes/Comments	The article provides sufficient evidence based on the level for effective interventions among nurses and other providers in different settings.	The study offers effective evidence to demonstrate that not all nurse-led interventions lead to reduce readmissions of heart failure patients in different care settings.	The article implores providers to focus on educational-based disease management approaches to help enhance the quality of life for heart failure patients.	The study encourages nurses to create interventions to educate HF patients on self-care management and maintenance to reduce the rate of readmissions upon discharge.

Part 3B: Critical Appraisal of Research

The reviewed literature comprises of four articles on the selected topic of heart failure among patients aged 65 years and above and the use of nurse-led educational interventions to reduce the surging prevalence. Studies consistently show that the main cause of these readmissions within 30 days after discharge is non-compliance to treatment protocols and self-management care. The provision of nurse-led multidisciplinary education can help reduce the prevalence and this emerges as the best practice based on the reviewed four articles. The first article by Awoke et al. (2019) is a quasi-experimental study that evaluates the impact of nurse-led education program to improve knowledge, and self-care management with the aim of reducing the rate of readmissions for individuals with heart failure.

The second article by Breathitt et al. (2018) is a randomized controlled trial that leverages use of tablets and nurse practitioner education to reduce the rate of readmission for patients with heart failure condition. These two articles provide level one and two evidence, implying that the best practice they recommend works in different settings and has proof of efficacy. The two articles are categorical that using nurse-led interventions alongside others can help patients with heart failure improve their self-care and compliance to treatment interventions, especially at home once discharged from hospitals.

Nurses play a critical role in management of diseases and patient care. These providers are tasked with the responsibility of ensuring that patients are free from the risk of getting readmissions upon discharge through effective compliance with treatment interventions (Melnyk & Fineout-Overholt, 2018). Nurse-led self-care management education and practices enhance information distribution to patients and their families, ensuring that patients follow the suggested or recommended treatment interventions.

The article by Clarkson et al. (2017) focuses on the impact of an inter-professional heart failure education program to mitigate heart failure readmissions. This article supports the need for a nurse-led education program through the inter-professional team to enhance adherence to treatment protocols and self-care management. The implication is that effective self-care management happens when nurses are involved since they are patient advocates, interact more with the patients than any other health professional, and are based placed to understand their needs.

The study by Rice et al. (2018) also emphasizes the role of nurse-led education to reduce hospital readmission and quality of life and lower the cost among adults with heart failure. The systematic review presents the best evidence to demonstrate the significant role that nurses play in mitigating readmissions and enhancing the quality of life for patients with heart failure condition. These articles identify a hands-on nurse-led education program through increased interactions with patients and provision of materials that allow patients to adhere to the treatment protocols and recommendations as offered by their providers.

Conclusion

Conclusively, better nurse-led interventions are a core aspect of managing heart failure and reducing readmissions. The reviewed articles show that nurse have a critical role to enhance patient education and better outcomes in heart failure condition. Their efforts improve self-care and reduce susceptibility to readmissions thus lowering the overall cost of care burden on patients, their families and the healthcare system.

References

Al-Tamimi, M. A. A., Gillani, S. W., Abd Alhakam, M. E., & Sam, K. G. (2021). Factors

Associated With Hospital Readmission of Heart Failure Patients. Frontiers in pharmacology, 2726. https://doi.org/10.3389/fphar.2021.732760

Awoke, M., Baptiste, D., Davidson, P., Roberts, A., & Dennison-Himmelfarb, C. (2019). A

quasi-experimental study examining a nurse-led education program to improve knowledge, self-care, and reduce readmission for individuals with heart failure. Contemporary Nurse, 55(1), 15–26. doi: 10.1080/10376178.2019.1568198

Breathitt, K., Maffett, S., Foraker, R. E., Sturdivant, R., Moon, K., Hasan, A., Abraham,

W. (2018). Pilot randomized controlled trial to reduce readmission for heart failure using novel tablet and nurse practitioner education. The American Journal of Medicine, 131(8) 8, 974–978.https://doi.org/10.1016/j.amjmed.2018.02.017

Clarkson, J. N., Schaffer, S., & Clarkson, J. J. (2017). The effect of an inter-professional heart

failure education program on hospital readmissions. Journal for Healthcare Quality, 39(2), 78–84. DOI: 10.1097/JHQ.0000000000000027

Melnyk, B. M. & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare:

A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer.

Rice, H., Say, R., & Betihavas, V. (2018). The effect of nurse-led education on hospitalization,

readmission, quality of life and cost in adults with heart failure: A systematic review. Patient Education and Counseling, 101(3), 363–374. doi: 10.1016/j.pec.2017.10.002.

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Realtors rely on detailed property appraisalsâ€”conducted using appraisal toolsâ€”to assign market values to houses and other properties. These values are then presented to buyers and sellers to set prices and initiate offers.
Research appraisal is not that different. The critical appraisal process utilizes formal appraisal tools to assess the results of research to determine value to the context at hand. Evidence-based practitioners often present these findings to make the case for specific courses of action.
In this Assignment, you will use an appraisal tool to conduct a critical appraisal of published research. You will then present the results of your efforts.
To Prepare:
â€¢ Reflect on the four peer-reviewed articles you selected in Module 2 and the four systematic reviews (or other filtered high- level evidence) you selected in Module 3.
â€¢ Reflect on the four peer-reviewed articles you selected in Module 2 and analyzed in Module 3.
â€¢ Review and download the Critical Appraisal Tool Worksheet Template provided in the Resources.
The Assignment (Evidence-Based Project)
Part 3A: Critical Appraisal of Research
Conduct a critical appraisal of the four peer-reviewed articles you selected by completing the Evaluation Table within the Critical Appraisal Tool Worksheet Template. Choose a total of four peer- reviewed articles that you selected related to your clinical topic of interest in Module 2 and Module 3.
Note: You can choose any combination of articles from Modules 2 and 3 for your Critical Appraisal. For example, you may choose two unfiltered research articles from Module 2 and two filtered research articles (systematic reviews) from Module 3 or one article from Module 2 and three articles from Module 3. You can choose any combination of articles from the prior Module Assignments as long as both modules and types of studies are represented.
Part 3B: Critical Appraisal of Research
Based on your appraisal, in a 1-2-page critical appraisal, suggest a best practice that emerges from the research you reviewed. Briefly explain the best practice, justifying your proposal with APA citations of the research.

FYI: It is a continuity of the assignment. Please refers to previous assignment to complete this one. Thanks

Evidence-Based Project, Part 3: Critical Appraisal of Research Paper