NURS 8114 WEEK 10 ASSIGNMENT: INVESTIGATING A CRITICAL PRACTICE QUESTION THROUGH A LITERATURE REVIEW

 NURS 8114 WEEK 10 ASSIGNMENT: INVESTIGATING A CRITICAL PRACTICE QUESTION THROUGH A LITERATURE REVIEW

NURS 8114 WEEK 10 ASSIGNMENT: INVESTIGATING A CRITICAL PRACTICE QUESTION THROUGH A LITERATURE REVIEW

This a quick tip as you work on the module 4 assignment.

Remember that your question you have developed is used as the guide for your literature search. You need to include at least 10 articles in the matrix/evidence table. You want to start with retrieving all of the evidence so that you can then synthesize it together.

INVESTIGATING A CRITICAL PRACTICE QUESTION THROUGH A LITERATURE REVIEW

Complete Parts 1 and 2 of your Assignment:

• Part 1: Literature Review: Be sure you have completed all required sections of the template (PDF) document.
• Part 2: Critical Assessment paper: Reflect on comments from colleagues in response to your Week 10 Discussion post. Apply feedback of value to you in completing your synthesis of evidence to inform a practice change initiative focusing on quality improvement.
  

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Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center provides an example of those required elements (available at https://academicguides.waldenu.edu/writingcenter/templates/general#s-lg-box-20293632Links to an external site.). All papers submitted must use this formatting.

RESOURCES

Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.

WEEKLY RESOURCES

BY DAY 7 OF WEEK 10

Submit Parts 1 and 2 of your Assignment.

INVESTIGATING A CRITICAL PRACTICE QUESTION THROUGH A LITERATURE REVIEW

This week you will begin your Module 4 Assignment, which is intended to inform and support your planning for your DNP Project in your program of study. This Assignment has two parts: a literature review in the Walden Library of research to address the critical practice question that you framed in Week 7, and a critical assessment of your search outcomes in which you synthesize the evidence. Both Parts 1 and 2 will be due by Day 7 of Week 10. Plan your time accordingly.

RESOURCES

Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.

WEEKLY RESOURCES

To prepare:

• Analyze your critical practice question from the Week 7 Discussion. Based on feedback from colleagues and your Instructor, revise your question, as necessary, to ensure a clear and relevant focus for your literature search.
• Review the Learning Resources to support your search.
• Access the Individual Evidence Summary and Synthesis Tool document from the Learning Resources. This is a word document that you will complete with at least 10 scholarly articles relevant to your critical practice question. Scan the template to ensure you understand how to enter information for each article you identify.
• Use the Week 8 Discussion to guide and clarify your search process and to pose any questions related to the template categories, search terms, or others.

The Assignment

Part 1: Literature Review (10+ scholarly articles)

Using the Walden Library as your source, search to select at least 10 scholarly articles that represent current literature (i.e., published within the previous 5 years) with evidence that addresses your critical question and could inform a practice change initiative for quality improvement. Using the Individual Evidence Summary Tool/Evidence Synthesis Tool template document, complete all sections for each article.

Part 2: Critical Assessment (7+ pages)

In a paper of at least 7 pages, plus cover page and references page, include the following:

• Write a critical assessment of your search outcomes that synthesizes the evidence from your literature review.
• Demonstrate clear connections between the practice problem that informs your critical question, your appraisal of evidence that addresses the critical question, and resulting clarification on the need for a practice change initiative focusing on quality improvement. Be specific and provide examples.

Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center provides an example of those required elements (available at https://academicguides.waldenu.edu/writingcenter/templates/general#s-lg-box-20293632Links to an external site.). All papers submitted must use this formatting.

There is no submission due this week.

Complete Parts 1 and 2 of your Assignment by Day 7 of Week 10.

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Synthesis Process and Recommendations Tool

KeyPoints:

• Allteammembersshare theirperspectives,andtheteamusescriticalthinkingtoarriveatajudgmentbased on consensus during the synthesis process. The synthesis process involves both subjective and objective reasoning by the full EBP team.Through reasoning, the team:
  • Reviewsthequalityappraisaloftheindividualpiecesofevidence
  • Assessesandassimilatesconsistenciesinfindings
  • Evaluatesthemeaningandrelevanceofthefindings
  • Mergesfindingsthatmayeitherenhancetheteam’sknowledgeor

generatenewinsights,perspectives,andunderstandings

• Highlightsinconsistenciesinfindings
• Makesrecommendationsbasedonthesynthesisprocess
• When evidence includes multiple studies of Level I and Level II evidence, there is asimilarpopulationorsettingofinterest,andthereisconsistencyacrossfindings, EBP teams can have greater confidence in recommending a practice change. However, with a majority of Level II and Level III evidence, the team should proceed cautiously in making practice changes. In this instance, recommendation(s) typically include completing a pilot before deciding to implement a full-scale change.
• Generally, practice changes are not made on Level IV or Level V evidence alone. Nonetheless, teams have a variety of options for actions that include, but are not limitedto:creatingawarenesscampaigns,conductinginformationalandeducational updates, monitoring evidence sources for new information, and designing research
• Thequalityrating(seeAppendixD)isusedtoappraisebothindividualqualityof evidence and overallquality of evidence.

Date:		EBP Question:
Article Number	Author and Date	Evidence Type	Sample, Sample Size, Setting	Findings That Help Answer the EBP Question	Observable Measures	Limitations	Evidence Level, Quality
1	Siddique et al. 2022	Cross-sectional study	2036 university students in Bangladesh	·         Good mental health was significantly positively associated with high awareness of mental health problems. ·         More than half of the participants believed that environmental and social factors were the main causes of psychological problems. ·         Despite having awareness of mental health issues, the participants had poor mental health knowledge. Their low level of knowledge of mental illness prevented them from properly recognizing these problems and offering support.	Qualitative measures	·         There was no comparison between the questionnaire used and other multidimensional scales developed to evaluate knowledge and awareness of mental health problems. ·         This was a cross-sectional study design, which prevented examination of the chronological sequence of mental health knowledge and awareness, and causal associations cannot be identified.	III
2	Mann et al. 2021	Systematic review	97 RCTs with suicidal behavior or ideation as primary outcomes, and epidemiological studies	·         Educating the youth about depression and suicidal behavior, and active outreach of psychiatric patients following discharge or a suicidal crisis, prevents suicidal behavior. ·         Educating other gatekeepers about the signs of suicide risk and need to refer for help raises questions on the individuals to focus on for the best results.	Quantitative	·         The reviews had uneven quality and quantity of data for different suicide prevention strategies. ·         Small sample sizes, very few studies, and lack of replication studies prevented firm conclusions about various measures.	I
3	O’Connell et al. 2021	Randomized Controlled Trial	203 frontline staff across different professions from a tertiary pediatric hospital.	·         Face-to-face and digital training can be employed to increase mental health knowledge, confidence in identifying mental health problems, and understanding what to do when having mental health issues.	Quantitative	·         The study used stratification variables like clinical vs. non-clinical professions, number of patients interacted with, and duration of time working in the hospital, that may have reduced the variance observed in the depression vignette baseline data.	I
4	Waqas et al. 2020	Systematic Review	44      RCTs	·         Education interventions through lectures and case scenarios, contact-based interventions, and role-plays helped to address stigma towards mental illnesses. ·         The interventions led to a marked improvement for stigma, attitude, helping-seeking, and knowledge of mental health including recognition of depression. ·         Anti-stigma measures were successful in improving mental health literacy, attitude, and beliefs towards mental health conditions.	Quantitative	·         Because of heterogeneity, varying intervention design, and different outcome measures, meta-analysis could not be performed. ·          There was a high risk of bias in the selected studies while interpreting the results of the studies.	I
5	Lien et al. 2021	Network meta-analysis.	18 studies (22 randomized and non-randomized controlled trials) from 9 countries	·         Education that combines social contact was found to be the most effective anti-stigma intervention, which can be employed in clinical practices to lower stigma towards mental health and improve healthcare services for patients with mental conditions.	Quantitative	The analysis only included peer-reviewed papers and excluded grey literature, online research reports, and doctoral theses. The study only approximates the short-term effect of anti-stigma interventions for mental illness among HCPs	II
6	Tsai et al. 2021	Quasi-experimental single group study design	39 young adults with at-risk mental state.	·         The participants  who completed the online health-promotion program for physical and mental health demonstrated significant improvements in: i.            Mental risk ii.            Anxiety iii.            Physical activity ·         An online health-promotion program increases the physical and mental health of young individuals with at-risk mental state and increases the accessibility by using an online platform during certain barriers like the COVID-19 pandemic.	Quantitative	The study did not recruit a control group.  The study used a small sample size, which limits generalizability.	III
7	Tóth et al. 2023	Systematic review	22 intervention studies: 3 with high quality, 13 with moderate quality 6 with weak quality.	·         Online antistigma interventions were found to be just as effective as face-to-face interventions in on reducing stigmatizing attitudes and discrimination of persons with mental conditions. ·         The interventions were found to increase: i.            Health literacy ii.            Intention to seek help. iii.            Resilience iv.            Help-seeking behavior	Quantitative	Only studies with quantitative measurement were included in the review. All the included studies were conducted in either European countries, North-America, Australia or Japan. Thus, the do not represent experiences from other parts of the world, with larger parts of the populations with lower economic status.	II
8	Lam et al. 2022	Cluster randomized controlled trial.	456 employees in specific industries with high levels of work-related stress,	·         The psychoeducation mental health intervention program examined in the study led to: ·         Increased recognition of mental problems among participants. ·         Increased help-seeking behavior. ·         Reduced stigmatization of mental illnesses.	Quantitative	The study is a wait-listed cluster RCT, which may not be as strong as a parallel-arm RCT. There were missing values in some of the demographic variables.	I
9	Heim et al. 2020	Systematic review	Nine studies from six countries- Brazil, China, Malaysia, Nigeria, Somaliland and Turkey.	·         All the studies reported significant positive results in at least one of their outcome measures. ·         The studies show that in general, negative attitudes towards persons with mental illnesses can be improved with specific interventions among medical and nursing students.	Quantitative	The systematic review relied on previous reviews before 2013. The included studies were published in English, and only articles with an English abstract were included.	II
10	Tsai et al. 2021	Pre- and post-test randomized trial	92 young adults with at-risk mental state	·         A health-awareness-strengthening lifestyle (HASL) program, led to significant improvements in the experimental group like: i.            Anxiety level ii.            Health promotion lifestyles iii.            Quality of life one week after participating in the program. ·         Individuals in the experimental group Also demonstrated additional long-term positive effect on mental risk, physical exercises, and physical health after the follow-ups. ·         The health awareness program led to more positive health effects on young adults with at-risk mental state.	Quantitative	The control group was not included in the long-term follow-up because of ethical considerations. The study had a small sample size.	I

 

EBPQuestion:
Category(LevelType)	TotalNumberof Sources/Level	OverallQuality Rating	SynthesisofFindings EvidenceThatAnswerstheEBPQuestion
LevelI § Experimentalstudy § Randomizedcontrolledtrial(RCT) § SystematicreviewofRCTswithorwithout meta-analysis § Explanatorymixedmethoddesignthat includesonlyaLevelIquaNtitativestudy	5	Strong	Mental health awareness programs are an effective way on increasing mental health awareness, reducing stigma related to mental illnesses, and increasing individuals’  help-seeking behavior.
LevelII § Quasi-experimentalstudies § SystematicreviewofacombinationofRCTs and quasi-experimental studies, or quasi- experimental studies only, with or without meta-analysis § Explanatory mixed method design that includesonlyaLevelIIquaNtitativestudy	3	Strong	Mental health awareness improves mental health outcomes by reducing related stigma. This encourages more individuals to recognize mental health symptoms and seek help from healthcare professionals resulting in early treatment and reduced mental health risks like suicide.
LevelIII § Nonexperimentalstudy § SystematicreviewofacombinationofRCTs, quasi-experimental and nonexperimental studies, or nonexperimental studies only, with or without meta- analysis § QuaLitativestudyormeta-synthesis § Exploratory,convergent,ormultiphasic mixed-methods studies § Explanatory mixed method design that includesonlyalevelIIIQuaNtitativestudy	2	Good	Mental health awareness increases individuals’ knowledge on mental illnesses and helps the recognize symptoms. Mental health promotion programs improve mental risk, mental health symptoms ,and physical activity.

 

 

Category(LevelType)	TotalNumberof Sources/Level	OverallQuality Rating	SynthesisofFindings EvidenceThatAnswerstheEBPQuestion
LevelIV § Opinionsofrespectedauthoritiesand/or reportsofnationallyrecognizedexpert committeesorconsensuspanelsbasedon scientific evidence	0
LevelV § Evidence obtained from literature or integrative reviews, quality improvement, programevaluation,financialevaluation,or casereports § Opinionofnationallyrecognizedexpert(s) based on experiential evidence	0

 

Basedonyoursynthesis,whichofthefollowingfourpathwaystotranslationrepresentsthe overall strength of the evidence?

X Strong,compellingevidence,consistentresults:Solidindicationforapracticechangeisindicated. ❑ Goodandconsistentevidence:Considerpilotofchangeorfurtherinvestigation. ❑ Goodbutconflictingevidence:Noindicationforpracticechange;considerfurtherinvestigationfornew evidenceordeveloparesearchstudy. ❑ Littleornoevidence:Noindicationforpracticechange;considerfurtherinvestigationfornewevidence, developaresearchstudy,ordiscontinueproject.

Ifyouselectedeitherthefirstoptionorthesecondoption,continue.Ifnot,STOP,translationisnotindicated.

Recommendationsbasedonevidencesynthesisandselectedtranslationpathway

Based on the evidence synthesis, I would recommend implementing mental health promotion programs in schools and communities to increases individuals’ awareness of mental illnesses. I would recommend anti-stigma measures to lower stigma associated with mental illnesses and encourage help-seeking behavior. This will promote better mental health outcomes and lower the cases of mental risks like suicide.

Considerthefollowingasyouexaminefit:

Aretherecommendations: § Compatiblewiththeunit/departmental/organizationalculturalvaluesornorms? § Consistentwithunit/departmental/organizationalassumptions,structures,attitudes,beliefs,and/or practices? § Consistentwiththeunit/departmental/organizationalpriorities?

Considerthefollowingasyouexaminefeasibility:

§  Canwedowhattheydidinourwork environment? §  Arethefollowingsupportsavailable? ·      Resources ·      Funding ·      Approvalfromadministrationandclinicalleaders ·      Stakeholdersupport ·      Isitlikelythattherecommendationscanbeimplementedwithintheunit/department/organization?

 

DirectionsforUseofThisForm

Purposeofform

UsethisformtocompiletheresultsoftheindividualevidenceappraisaltoanswertheEBPquestion.The pertinentfindingsforeachlevelofevidenceare synthesized,andaqualityratingisassignedtoeachlevel.

Totalnumberofsourcesperlevel

Recordthenumberofsourcesofevidenceforeachlevel.

Overallqualityrating

Summarizetheoverallqualityofevidenceforeachlevel.UseAppendixDtoratethequalityofevidence.

Synthesisoffindings:evidencethatanswerstheEBPquestion

• IncludeonlyfindingsfromevidenceofAorB
• IncludeonlystatementsthatdirectlyanswertheEBP
• Summarizefindingswithineachlevelof
• Recordarticlenumber(s)fromindividualevidencesummaryinparenthesesnexttoeachstatement so that the source of the finding is easy to identify.

Developrecommendationsbasedonevidencesynthesisandtheselectedtranslation pathway

Reviewthesynthesisoffindingsanddeterminewhichofthefollowingfourpathwaystotranslation represents the overall strength of the evidence:

• Strong,compellingevidence,consistentresults:Solidindicationforapractice
• Goodandconsistentevidence:Considerpilotofchangeorfurther
• Goodbutconflictingevidence:Noindicationforpracticechange;considerfurtherinvestigationfor new evidence or develop a research study.
• Littleornoevidence:Noindicationforpracticechange;considerfurtherinvestigationfornew evidence, develop a research study, or discontinue the project.

Fitandfeasibility

Even when evidence is strong and of high quality, it may not be appropriate to implement a change in practice. It is crucial to examine feasibility that considers the resources available, the readiness for change,andthebalancebetweenriskandbenefit.Fitreferstothecompatibilityoftheproposedchange with the organization’s mission, goals, objectives, and priorities. A change that does not fit within the organizational priorities will be less likely to receive leadership and financial support, making success difficult.Implementingprocesseswithalowlikelihoodofsuccesswastesvaluabletimeandresourceson efforts that produce negligible benefits.

References

Heim, E., Henderson, C., Kohrt, B. A., Koschorke, M., Milenova, M., & Thornicroft, G. (2020). Reducing mental health-related stigma among medical and nursing students in low-and middle-income countries: a systematic review. Epidemiology and psychiatric sciences, 29, e28. https://doi.org/10.1017/S2045796019000167

Lam, L. T., Lam, M. K., Reddy, P., & Wong, P. (2022). Efficacy of a Workplace Intervention Program With Web-Based Online and Offline Modalities for Improving Workers’ Mental Health. Frontiers in psychiatry, 13, 888157. https://doi.org/10.3389/fpsyt.2022.888157

Lien, Y. Y., Lin, H. S., Lien, Y. J., Tsai, C. H., Wu, T. T., Li, H., & Tu, Y. K. (2021). Challenging mental illness stigma in healthcare professionals and students: a systematic review and network meta-analysis. Psychology & Health, 36(6), 669-684. https://doi.org/10.1080/08870446.2020.1828413

Mann, J. J., Michel, C. A., & Auerbach, R. P. (2021). Improving Suicide Prevention Through Evidence-Based Strategies: A Systematic Review. The American journal of psychiatry, 178(7), 611–624. https://doi.org/10.1176/appi.ajp.2020.20060864

O’Connell, J., Shafran, R., & Pote, H. (2021). A Randomized Controlled Trial Evaluating the Effectiveness of Face-to-Face and Digital Training in Improving Child Mental Health Literacy Rates in Frontline Pediatric Hospital Staff. Frontiers in psychiatry, 11, 570125. https://doi.org/10.3389/fpsyt.2020.570125

Siddique, M. A. B., Ovi, M. R., Ahammed, T., Chowdhury, M. A. B., & Uddin, M. J. (2022). Mental health knowledge and awareness among university students in Bangladesh. Heliyon, 8(10), e11084. https://doi.org/10.1016/j.heliyon.2022.e11084

Tóth, M. D., Ihionvien, S., Leduc, C., Aust, B., Amann, B. L., Cresswell-Smith, J., … & Purebl, G. (2023). Evidence for the effectiveness of interventions to reduce mental health related stigma in the workplace: a systematic review. BMJ open, 13(2), e067126. doi: 10.1136/bmjopen-2022-067126

Tsai, C. L., Lin, Y. W., Hsu, H. C., Lou, M. L., Lane, H. Y., Tu, C. H., & Ma, W. F. (2021). Effects of the Health-Awareness-Strengthening Lifestyle Program in a Randomized Trial of Young Adults with an At-Risk Mental State. International journal of environmental research and public health, 18(4), 1959. https://doi.org/10.3390/ijerph18041959

Tsai, C. L., Tu, C. H., Chen, J. C., Lane, H. Y., & Ma, W. F. (2021). Efficiency of an Online Health-Promotion Program in Individuals with At-Risk Mental State during the COVID-19 Pandemic. International journal of environmental research and public health, 18(22), 11875. https://doi.org/10.3390/ijerph182211875

Waqas, A., Malik, S., Fida, A., Abbas, N., Mian, N., Miryala, S., Amray, A. N., Shah, Z., & Naveed, S. (2020). Interventions to Reduce Stigma Related to Mental Illnesses in Educational Institutes: a Systematic Review. The Psychiatric quarterly, 91(3), 887–903. https://doi.org/10.1007/s11126-020-09751-4