ResearchEBP
Literature Review due February 26, 2022 by 2355
1. Select a minimum of 5 primary research studies from your literature search. Articles must justify the PICOT.
2. Critically appraise the selected articles.
3. Synthesize the findings of the articles to come up with a justified conclusion to your PICOT.
4. All references and in-text citations must follow APA guidelines.
See rubric in Syllabus Supplement for additional information and grading guidelines.
**No late submissions or resubmissions will be allowed. Do your best work the first time. I look forward to reading your papers.**
Literature Review
Virginia Nzolewane
Stratford University
NSG 410: Research and Evidence-Based Nursing Practice.
12/4/2021
Dr. Karen Benson
Introduction
Clinical research in nursing is conducted to investigate a specific issue. In any research, theoretical framework provides support and justification for the research problem. For this particular case, Dorothea Orem’s theory of self-care deficit serves as the theoretical framework upon which the literature review will be based. Self-care, theory of nursing systems, and the concept of self-care deficit were used to identify the need of the patients (Aga et al., 2019). In the theory of self-care, Dorothea Orem defines self-care as the daily living activities that can be done as an individual to maintain one’s well-being. In this stage the individual should be able to understand their level of functioning such as being able to be independent. This self-care is usually carried out to fulfill self-care requisites (such as universal, self-developmental and health) (Smith, 2019). A patient will be considered in self-care deficit if any of the aforementioned self-care requisites are lacking. The self-care deficit simply indicates that there is a need, and this need will necessitate the use of nursing systems to provide care. This care can either be carried out by a provider or care giver depending on the degree of the deficit the individual is presenting with. Nursing systems will also be used to evaluate care provided to measure if the goals were met.
The research question is; Does lifestyle modification improve clinical health outcomes in hypertension management?
The chosen population already has a deficit. This deficit is hypertension, and the plan is to educate the chosen population about the advantageous effects that lifestyle modifications has compared to pharmacological therapy in managing hypertension. Orem’s nursing process will be used to guide this research. Orem’s nursing process follows the following steps:
· Assessment – In this step, the provider will gather the patient’s history. Within the gathered history, lifestyle habits questions will also be gathered (e.g. medication regimen compliance, diet and exercise regimen).
· Diagnosis – The information compiled from the assessment above will help the provider arrive at a diagnosis.
· Plan – Here, the provider comes up with a plan of action which is also known as the care plan. This plan includes the procedural tactics to achieve the goals that will be set by the patient and the provider.
· Implementation – During this step, the plan mentioned above will be set into motion.
· Evaluation – Finally, the entire nursing practice is evaluated. This process is also done during the implementation phase to make changes.
In conducting this literature review, Google Scholar was used to search for articles related to this PICOT question. Specifically, this literature review aims to answer: does lifestyle modification improve clinical health outcomes in hypertension management?
Key words used: blood pressure, hypertension, dietary therapy, physical activity, pharmacotherapy, digital therapeutics, lifestyle modification, ambulatory blood pressure, home blood pressure.
Literature Review
Hypertension (also known as high blood pressure) is a condition in which the pressure of the blood in the vessels is higher than normal. High blood pressure is also known as the silent killer; high blood pressure is a prevalent and dangerous condition. This condition can be known as the silent killer because many individuals with hypertension are asymptomatic until the condition progresses to a stroke, kidney failure, or heart failure (Centers for Disease Control and Prevention [CDC], 2019). This can be prevented or well managed through diet, exercise and adherence to treatment regimen. Two of the top causes of mortality in the United States are heart disease and stroke, which can be caused by uncontrolled hypertension. One out of every three adults (about 75 million people in the United Sates) has been diagnosed with hypertension and only 50% of these individuals have controlled hypertension. In 2013 alone, approximately 360,000 deaths were reported from hypertension (CDC, 2019). Therefore, 29% of adults in the United States have hypertension; men (30.2%) have slightly higher hypertension prevalence than women (27.7%). Hypertension becomes more common with the aging population; 63.1% of individuals with hypertension are aged 60 years or older, while 33.2% of adults with hypertension are in the 40-59 age group. Adults between the ages of 18-39 have a prevalence of 7.5%. (CDC, 2019). Hypertension has become a public health issue due to the increment in incidence and prevalence; with this continuous increase, it has been estimated that in 2025 one out of three people will be diagnosed with this disease (Ashoorkhani et al., 2018).
A trial overview carried out by Ozemek et. al. (2020) sought to assess the value of exercise and diet in lowering blood pressure in patients with resistant hypertension. In this trial, a randomized sampling of one hundred forty patients with a mean age of 63 years diagnosed with resistant hypertension were separated into a group that delivered lifestyle intervention through a center-based cardiac rehabilitation facility (C-LIF) and another group that underwent standardized education and physician advice (SEPA). The DASH (Dietary Approaches to Stop Hypertension) diet was mentioned as one of the recommended food intake plans to help manage resistant hypertension. The investigation revealed that reduction in clinic systolic blood pressure was greater in patients under C-LIF compared to SEPA. 24-hours ambulatory systolic blood pressure was also reduced in C-LIF with no reported change in patients under the SEPA group. While hypertension is a condition that can vary among different people, it was shown in this study that a regulated program of diet and exercise can lower blood pressure in patients with resistant hypertension. This literature is vital in the improvement of discourse about patient education and hypertension management since it suggests ways of improving the care that the nursing service seeks to provide (Ozemek et. al., 2020).
A descriptive cross-sectional study done in Kenya by Kimani et. al. (2020) investigated the association of lifestyle modification and pharmacological adherence among patients with hypertension in a national referral hospital. 229 patients diagnosed with primary hypertension were chosen at random for this study. The study found that respondents on antihypertensive medication that also engaged in healthy lifestyle and had proper adherence to medication had lower mean blood pressure than those only on medication. The study also showed that ageing, being female, having fast food and animal fat intake were associated with missed blood pressure targets and hypertension-related complications. Pharmacological interventions for hypertension are used in healthcare, but there is great emphasis on non-pharmacological approaches such as lifestyle modifications. Lifestyle modifications (such as diet and exercise) can be implemented to prevent hypertension in pre hypertensive patients, and these lifestyle modifications can be implemented as an adjunct therapy or primary therapy in hypertensive patients prior to drug therapy initiation. This study was limited in its cross-sectional design and by the restriction of assessing lifestyle choices (e.g., smoking, alcohol consumption) to just one point in time might have contributed to gaps in the study about the association of lifestyle modifications and hypertension management (Kimani et. al., 2020).
Other risk factors related to hypertension were also studied in a quantitative, epidemiologic, and cross-sectional research design by Guptha. (2021). Specifically, the study examined the effect of National Institute of Health and Clinical Excellence and American Diabetes Association consensus adjusted BMI on the risk of T2DM in a representative sample of ~ 6,000 Asian Indians to narrow the knowledge gap and achieve population specificity. It was shown that both lifestyle changes and medical treatment were beneficial and had a significant effect on hypertension management. This study fills in the knowledge gaps about reducing systolic and diastolic BP and the decrease of cardiovascular risk by non-pharmacological (lifestyle measures) as well as pharmacological means. Like the previous cross-sectional study, this research was also limited to this design in which hidden biases might have emerged and confounded the variables and its results in the study. The study did not also include respondents from rural areas, which is where more than half of the people in India reside, possibly limiting the extrapolation of results to only urban regions of India and risking misrepresentation of the target population (Guptha., 2021).
To further expound the effect of nonpharmacologic treatment, a Bayesian network meta-analysis by Fu et. al. (2020) was reviewed and showed that nonpharmacologic interventions, including dietary approaches, are a cornerstone for the prevention and treatment of hypertension. A total of 60,166 articles were identified in the initial systematic search, and 888 potentially eligible articles were narrowed down and retrieved as full text. Overall, 120 articles (corresponding to 126 randomized controlled trials) with 14,923 participants met the inclusion criteria and were included in the network meta‐analysis. This study affirms that DASH is a potent effector in modulating dietary changes and decisions of patients with hypertension. However, the study reported only the effectiveness of nonpharmacologic interventions in lowering BP, lacking secondary end points such as rate of BP control, incidence of hypertension, and mortality due to complications of hypertension. In addition, upon further review of this meta-analysis, it was found that only 8 interventions were only directly compared with usual care. Smoking as a lifestyle risk factor was excluded from this study because existing randomized controlled trials on smoking cessation in patients with hypertension or prehypertension were not truly implemented. This network meta‐analysis showed that, among 22 nonpharmacologic interventions, DASH was the most effective intervention in lowering BP for adults with prehypertension to established hypertension. Aerobic exercise, isometric training, low‐sodium and high‐potassium salt, comprehensive lifestyle modification, breathing control, meditation, and low‐calorie diet also have obvious effects in lowering BP. Moreover, the findings suggest that salt restriction be used for lowering BP, especially in patients with hypertension (Fu et. al., 2020).
Rounding out this literature review is a randomized, open-label HERB-DH1 study by Kario et. al. (2021) which showed that the HERB-DH1 pivotal study showed the superiority of digital therapeutics compared with standard lifestyle modification alone to reduce 24-h ambulatory, home, and office BPs in the absence of antihypertensive medications. All 390 respondents were 20-64 years old (mean age range of 52-52.4)) and diagnosed with essential hypertension were randomly grouped into the digital therapeutics group and the control group. Digital therapeutics is a novel approach to managing non-pharmacological treatment of hypertension. The HERB system helps the user to make lifestyle modifications to reduce BP by the use of an interactive smartphone app. For the duration of the study, pharmacological interventions were prohibited and discouraged with physician monitoring so as to avoid confounding the results. Being a pilot study, the research was limited to the variables that could be studied and numerous knowledge gaps were identified. The time period of monitoring BP change through non-pharmacological methods was also inadequate (12 weeks) to properly determine whether the lifestyle modifications were able to provide significant change to the patient’s blood pressure (Kario et. al., 2021).
Conclusion
Conducting this literature review gave me the opportunity to peruse various sources for the evaluation of non-pharmaceutical methods in managing hypertension among patients 40-70 years of age. I realized that the worldwide disease burden of hypertension is too big to ignore and has become a significant public health issue over the decades. With more and more people becoming obese and acquiring hypertension and hypertension-related complications, it is imperative to study and research about the protocols that can be put in place to mitigate this condition. It must also be noted that medications alone will not have a significant effect. The patient must be able to make health decisions on their diet, exercise, and other lifestyle choices by being well-informed, and this patient education begins with the nurse at the helm of the care team as a patient advocate.
Better designed researches must also be conducted to fill in the gaps of knowledge established by prior researches. The studies reviewed here had similarities other than the inclusion criteria of having a respondent diagnosed with hypertension, the studies also were designed to study multiple therapeutic approaches to gain a better insight. Overall, the weaknesses of the studies, other than the ones detailed in the literature review above, was only prominent in descriptive and cross-sectional studies, as the variation in research variables can be significant enough to affect the results of the study. The level of scientific evidence must also be taken into account when designing a research study, wherein the most apt and highest yield study design must be chosen.
References
Ademe, S., Aga, F., & Gela, D. (2019). Hypertension self-care practice and associated factors among patients in public health facilities of Dessie town, Ethiopia. BMC health services research, 19(1), 1-9.
Fu, J., Liu, Y., Zhang, L., Zhou, L., Li, D., Quan, H., … & Zhao, Y. (2020). Nonpharmacologic interventions for reducing blood pressure in adults with prehypertension to established hypertension. Journal of the American Heart Association, 9(19), e016804.
Guptha, L. S. (2021). A Cross-Sectional Epidemiology Study of the Relationships between Body Mass Index and the Risk of Diabetes, and Diabetes and the QRISK2 10-Year Cardiovascular Risk Score Using India Heart Watch Data (Doctoral dissertation, Trident University International).
Hypertension. (2019). Retrieved from https://www.cdc.gov/bloodpressure/index.html
Kario, K., Nomura, A., Harada, N., Okura, A., Nakagawa, K., Tanigawa, T., & Hida, E. (2021). Efficacy of a digital therapeutics system in the management of essential hypertension: the HERB-DH1 pivotal trial. European heart journal, 42(40), 4111-4122.
Kimani S, Mirie W, Chege M, et al (2020) Association of lifestyle modification and pharmacological adherence on blood pressure control among patients with hypertension at Kenyatta National Hospital, Kenya: a cross-sectional study BMJ Open 2019;9:e023995. doi: 10.1136/bmjopen-2018-023995
Ozemek, C., Tiwari, S., Sabbahi, A., Carbone, S., & Lavie, C. J. (2020). Impact of therapeutic lifestyle changes in resistant hypertension. Progress in cardiovascular diseases, 63(1), 4-9.
Smith, M. C. (2019). Nursing theories and nursing practice. FA Davis.
Sheet1
for preventing acute
in children up to 12 years of age. Cochrane database of systematic reviews, (8).
Xylitol
, and the vast majority of those studies all came from the same study organization.
quality to minimize the occurrence of AOM.
therapy for masticatory myofascial and temporomandibular pain: a controlled
. Evidence-based complementary and alternative medicine, 2015
clinical trial
Ear acupuncture
in spontaneous healing of traumatic tympanic membrane perforation. Nepalese Journal of ENT Head and Neck Surgery, 5(1), 14-16
decongestants
good
meta-analysis
good
prospective studies
otitis media
moderate
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD007095.pub3/abstract?cookiesEnabled https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD007095.pub3/abstract?cookiesEnabled
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0150949
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0150949
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD007095.pub3/abstract?cookiesEnabled
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD007095.pub3/abstract?cookiesEnabled
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD007095.pub3/abstract?cookiesEnabled
https://www.hindawi.com/journals/ecam/2015/342507/
https://sci-hub.se/10.3126/njenthns.v5i1.16854
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4753897/
Sheet1
for preventing acute
in children up to 12 years of age. Cochrane database of systematic reviews, (8).
Xylitol
, and the vast majority of those studies all came from the same study organization.
quality to minimize the occurrence of AOM.
therapy for masticatory myofascial and temporomandibular pain: a controlled
. Evidence-based complementary and alternative medicine, 2015
s, children, or chewing gum
clinical trial
Ear acupuncture
in spontaneous healing of traumatic tympanic membrane perforation. Nepalese Journal of ENT Head and Neck Surgery, 5(1), 14-16
decongestants
good
meta-analysis
ear infection
good
otitis media
moderate
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD007095.pub3/abstract?cookiesEnabled https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD007095.pub3/abstract?cookiesEnabled
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0150949
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0150949
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD007095.pub3/abstract?cookiesEnabled
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD007095.pub3/abstract?cookiesEnabled
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD007095.pub3/abstract?cookiesEnabled
https://www.hindawi.com/journals/ecam/2015/342507/
https://sci-hub.se/10.3126/njenthns.v5i1.16854
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4753897/
<
p
>2
P
I
C
O
T Question:
A patient of age 40 years is diagnosed with some lung problems and admitted to hospital. How effective will be the strategy of
cessation of smoking
for the period of two months to overcome the lung problems as compared to
chemotherapy and inhalers
| p |
A 40year-old patient diagnosed with lung cancer The most common cancer-related cause of death in the United States is malignant lung tumors. As many as 83 percent of lung cancer patients continue to smoke after being diagnosed with the disease, according to a recent study. People with early-stage lung cancer who smoke have an almost twofold increased risk of dying from the condition if they continue to smoke. Cigarette smoking is responsible for as many as 90 percent of all lung cancer cases, according to current estimates. Lung cancer is diagnosed in 24–60% of patients, compared to 12–29% of the general population in the United States. Up to 83% of people with lung cancer who have been diagnosed with smoking after obtaining the diagnosis, continue to smoke. (Cataldo, et al, 2010) |
| I |
cessation of smoking
Preparation, intervention, and maintenance make up the three components of smoking cessation therapy (Stead, et al, 2013). In order to boost both a smoker’s desire to stop and his or her belief in one’s own ability to succeed in their efforts, it is important to take actions to prepare. Intervention can come in a variety of forms to help smokers kick the habit. Long-term sobriety involves the practice of maintenance, which may include encouragement, coping techniques, and the use of behavioral substitutions. Smokers who want to completely quit smoking typically follow the advice of a medical practitioner. Quitting smoking can be made easier with the help of public or private smoking cessation kits, books, recordings, and over-the-counter medications, as well as private smoking cessation packages. An example of how one group might benefit from the assistance of another is the Great American Smoke out and other mass media and community-based campaigns. Many choices are available, including free and commercial clinics, counseling, and more. For the vast majority of smokers, this is the most effective and cost-efficient method for quitting. Quitting smoking can be accomplished in a variety of ways, including on one’s own, with the help of a health professional, or with the aid of a quit-smoking guide. It is possible to effectively quit smoking, but sustaining that status requires assistance from others and additional measures like relapse prevention. |
| C |
chemotherapy and inhalers
(Etter, et al, 2002) explains that, Additional treatments to stop smoking, such as nicotine inhalers and chemotherapy, are also available. Smoking cessation is the most popular technique of stopping smoking, and it is also the most effective. The puffing motion of a nicotine inhaler might cause irritation of the tongue and throat. As well as causing stomach pain and headaches, it can induce coughing. In addition, the cost is considerably high. Cigarette smokers are more likely to experience side effects from chemotherapy and radiation such as infection, weariness, heart and lung difficulties, and weight loss than nonsmokers, according to the American Society for Clinical Oncology (ASCO). |
| O |
Outcome of cessation of smoke are immediate benefits such as improved oxygenation and lower blood pressure, improved senses of smell and taste, improved circulation and breathing, greater energy and an improved immune response after quitting smoking. Health advantages include; risk of developing multiple primary lung cancer tumors decreases. (Cataldo, et al, 2010) remaining life expectancy has been lengthened. Patients who quit smoking after being diagnosed with lung cancer have shown to have a considerable improvement in their quality of life. primary lung tumor increased the risk of death by around 20%, but adjusted estimates showed that continuing smoking increased that risk by more than twofold. There are fewer complications following surgery than there are before. Postoperative problems are more common in smokers, whereas nonsmokers are at a lower risk. NSCLC patients who had surgery for sleeve lobotomies were studied for surgical morbidity and mortality. Postoperative complications, including infection and bronchopleural fistula, as well as morbidity and death, were significantly influenced by current smoking in the research participants. |
citation
Research statement
Sample size and method
Results
limitation
Final summary
Cataldo, J. K., Dubey, S., & Prochaska, J. J. (2010). Smoking cessation: an integral part of lung cancer treatment. Oncology, 78(5-6), 289-301.
The paper reports on
the benefits of smoking cessation for lung cancer patients
Descriptive
Quantitative analysis
immediate benefits such as improved oxygenation and lower blood pressure, improved senses of smell and taste.
Patients have a considerable improvement in their quality of life
More study is required in order to design smoking cessation strategies that are successful and personalized.
lung cancer patients who smoke are extremely dependent on tobacco during a life-threatening situation; study is needed to provide effective and targeted smoking cessation therapies for these patients
Stead, L. F., Buitrago, D., Preciado, N., Sanchez, G., Hartmann‐Boyce, J., & Lancaster, T. (2013). Physician advice for smoking cessation. Cochrane database of systematic reviews, (5).
To assess the effectiveness of advice from physicians in promoting smoking cessation
analytical
Randomized trials
Although more intensive therapies have an advantage over very brief interventions, simple guidance has no influence on quitting rates.
The development of techniques to increase the frequency with which smokers are identified and offered guidance and help presents a significant challenge.
Etter, J. F., Laszlo, E., Zellweger, J. P., Perrot, C., & Perneger, T. V. (2002). Nicotine replacement to reduce cigarette consumption in smokers who are unwilling to quit: a randomized trial. Journal of clinical psychopharmacology, 22(5), 487-495.
To evaluate if nicotine replacement treatment, provided in a real-world setting, could reduce cigarette consumption among smokers who were unwilling to stop.
analytical
Randomized trials.
Sample-20 Cigarette smokers who had no intention of quitting in 6 months
Cigarette smokers will experience side effects from chemotherapy and radiation such as infection
A placebo effect was responsible for a large portion of this reduction. Treatment with nicotine to reduce smoking had no negative effects on quitting.
It is costly to conduct tests for specific markers like anabasine or any of the other non-specific indicators seen in the blood after exposure to smoke from a cigarette.
References
https://scholar.google.com/scholar?hl=en&as_sdt=0%2C5&q=Smoking+Cessation%3A+An+Integral+Part+of+Lung+Cancer+Treatment&btnG=
https://journals.lww.com/psychopharmacology/Abstract/2002/10000/Nicotine_Replacement_to_Reduce_Cigarette.8.aspx
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD000165.pub4/full
Literature Review Sample 1 x
2
11
Patient Violence Against Nursing Staff and De-Escalation Courses: Literature Review
Name
NSG 410 Research and Evidence- Based Nursing Practice
Dr. Coffin
Patient Violence Against Nursing Staff and De-Escalation Courses: Literature Review
Overview and Introduction
Patient violence against nursing staff is an ongoing, and rising, issue in the healthcare field not just in the U.S., but worldwide. According to The Joint Commission (2018), workplace violence (WPV) occurs four times more in nurses in hospital settings than any other worker in the private sector. Nurses working in emergency departments are at the greatest risk of verbal and/or physical assault than any other unit of nursing due in part to being the first point of contact with the patient from the outside (Wong et al., 2015). That being said, WPV still occurs in all nursing fields putting each nurse working bedside at risk. Using meticulous technique, a literature review was conducted using primary sources in the span of several weeks. Search terms such as “violence in nursing”, “workplace violence”, “occurrences”, and “de-escalation training” were combined and inputted into databases such as ProQuest, National Institutes of Health, and CINAHL with additional search terms applied when needed for clarification. The articles that will be discussed in this review were chosen because they are primary sources that moved the discussion forward on solutions to reduce patient violence against nurses. Knowles’ Adult Learning Theory was the theoretical framework used to guide this research with the understanding that adult learning is mainly self-directed and self- motivated, so in order to be able to implement successful education programs, such as that of this intervention, this understanding must be acknowledged (Casey, 2019). Comment by Rebecca Coffin: The problem is clearly presented and data is provided to show the magnitude of the problem Comment by Rebecca Coffin: Search terms are provided Comment by Rebecca Coffin: No need to use a theory to guide your paper, but you are welcome to do so if you wish Comment by Rebecca Coffin [2]: Great introduction!
Clinical Question
The clinical research question in focus for this literature review is as follows: Among nursing staff in acute hospital units, what is the effect of de-escalation training courses in reducing the number of violent events compared with learning de-escalation on the job, within 12 months of implementation. Comment by Rebecca Coffin [2]: PICOT
Appraisal of Articles
With Knowles’ Adult Learning Theory in mind, articles were chosen that exemplified the integration of adult learning into their interventions. In the article “Management of Aggressive Patients: Results of an Educational Program for Nurses in Non- Psychiatric Settings,” by Casey (2019), a non- experimental one-group, pre-post test design was used to evaluate the effectiveness of an education program that utilized multiple teaching strategies. The study recruited 36 registered nurses from a neurological unit in an adult hospital in southern United States. The program was delivered in a hybrid format over 6 weeks that utilized online presentations as well as in person classroom sessions. In line with the theoretical framework, the researchers utilized case studies to foster critical thinking, face to face role play was used demonstrate and build up de-escalation techniques, and group reflections were used to collectively bring together what was learned. Data was collected using self- reported Likert scale questionnaires that were validated by experts in emergency and psychiatric nursing. Analysis of the data concluded significant improvement in demonstration of preparedness and increased confidence in managing aggressive behaviors through the use of the designed educational program. Comment by Rebecca Coffin [2]: Don’t need to include the title of the article in APA style
The major limitation of the study was the small sample size not being significant enough to be generalizable. There was also time constraints limiting the amount of time for learning but was necessary in this study to feasibly allow maximum number of participants due to having to work around shift schedules. The researcher in this study recommends expanding similar interventions into other acute hospital units.
The article, “Reducing conflict and containment rates on acute psychiatric wards: The Safewards cluster randomized controlled trial” by Bowers et al. (2015) implemented 10 carefully selected interventions into a clustered randomized control trial to study its effects on rates of conflict and containment. The study came about from the understanding that there is a need for RCT’s in this topic. The study comprised of 15 psychiatric wards surrounding central London with inclusion criteria being acute psychiatric inpatient wards and were excluded if the wards had any major changes coming up in the course of the 18-month study, if they didn’t have a permanent nurse manager on post, and if the staff vacancy rate was greater than 30%. With these criteria put in place, nurses in the included wards chose to participate bringing the total number of participants to 564 (88% of the potential total). The confidence in this sample size was confirmed in each category with a power analysis. Baseline data was collected for 8 weeks, then participants had 8 weeks to implement the trained interventions, and 8 weeks additional were for observation of the implementation. This study was double blind in that both researchers and participants were unaware of which was the control and which was the intervention. Wards were visited 2-3 times a week by researchers who delivered and collected questionnaires and answered any questions about the interventions in order to ensure strong reliability. Results showed the interventions implemented in the Safewards interventions were significantly effective in reducing patient conflict and containment. Given that the primary source of data collection came from questionnaires, the main limitation of this study was missing data from unsubmitted questionnaires by charge nurses working the participating shifts. After accounting for these deficits however, they concluded that the missing data was not significant enough to shift the findings. The second limitation and recommendation for future research was that the study length was too short of a time period to really see significant change after implementation. Comment by Rebecca Coffin: Good critique! Look for whether a power analysis was performed in quantitative studies Comment by Rebecca Coffin [2]: What effect does this have on the study? Is this a good thing to do?
This study understood that there was a lack of quantitative research on violence against nurses in the form of randomized control trials, so the research design itself was created with the hopes of being the trailblazers for future research to continue RCT’s in the study of this concept. By explicitly highlighting each limitation set forth in their study, they were able to use their limitations to pave the path for future research.
In the study “Educational and Managerial Policy Making to Reduce Workplace Violence Against Nurses: An Action Research Study” Hemati- Esmaeili et al. (2018), look beyond education at the bedside nurse level to go a step up the ladder to include managerial interventions. This study took place in Iran but many issues presented in this study are parallel universally to many other hospital settings. With a sample size of 44 nurses confirmed by a p value test, a workplace violence prevention program was developed in conjunction with the development of a new nursing position called the violence prevention nurse, whose role was to screen patients and their families upon arrival to the hospital for potentially aggressive behaviors. Careful analysis using SPSS software analyzed the results of the self-report surveys and focus groups and concluded that the implementation of the program significantly reduced fear associated with these violent events because the nurses felt more prepared to handle them. This study went a step further than the previously discussed studies by including a managerial intervention where a protocol was put in place of how to take care of staff who had been attacked. Comment by Rebecca Coffin [2]: Good point to highlight!
This study did an excellent job of highlighting the need for interventions that are individualized to each unique unit. They explained that many aspects of the design, such as altering the questionnaire scales used to better suit Iranian culture, was a big step in improving fidelity in the study because the nurses could answer more accurately. Unique to this study and also not included in the previously mentioned studies, was a follow up survey four months after conclusion of the study. Researchers could still see strong evidence of the interventions being implemented. Follow up studies should be included in future research in this topic to measure long term effects. Comment by Rebecca Coffin [2]: That is a good thing to do to check how long the effect lasts
The study “Coordinating a Team Response to Behavioral Emergencies in the Emergency Department: A Simulation- Enhanced Interprofessional Curriculum further enhance the findings from all the previously mentioned studies by integrating teamwork into simulation scenarios using larger sample sizes. Wong et al. (2015) hoped that through implementation of an interprofessional curriculum into simulation enhanced education, teamwork and staff attitudes toward patient violence would improve. Ten 3-hour simulation sessions were conducted for this study. In the simulation, formal roles were predetermined, meaning each member of the healthcare team knew exactly what their roles were immediately once a violent event was occurring. The study recruited 162 ED staff members. Surveys used to collect data were published from a British nursing education group that showed reliability and internal validity. Data collected was reflective of participant’s changing attitudes through the duration of the course. Risk for bias in response was present though in that evaluators of the program were in leadership positions within the participating department, which may have confounded responses with staff members answering in responses favorable to the evaluators. As was the main theme with all the studies discussed thus far, the main limitation of the study was time constraints and lack of longitudinal data. Comment by Rebecca Coffin: Another great critique!
Given the emotional magnitude of this research topic, it was necessary to include a qualitative study into this review to increase the magnitude of its relevance to the nursing profession and place further emphasis that research in this field is what the people directly involved want. The qualitative phenomenological study “The Patient Care Paradox: An Interprofessional Qualitative Study of Agitated Patient Care in the Emergency Department” by Wong et al. (2016), took their research further from the previously discussed study to look at the experience of these healthcare workers to provide a broader perspective of ED patient violence. Convenience, but purposive, sampling was used to recruit participants. This study took careful measures to reduce bias in all aspects of the study. For example to balance out and decrease bias during data collection, the research team consisted of 2 board certified ED physicians, but also 2 nurses working outside of the ED (palliative and midwifery) so as to maintain an insider/ outsider approach and to bracket potential personal biases which could have skewed the data collection. In the research design, 1 member of the research team with no prior relationships to any of the participants was trained for qualitative data collection while another member assisted in equipment setup and took field notes. The interview process was standardized and data was cross-checked. Interview responses and focus group discussions were all recorded, transcribed, and later professionally transcribed by a third party. In this study, data saturation was reached at 31 participants. Comment by Rebecca Coffin: Spell out “two” Comment by Rebecca Coffin: Here also, “two” should be spelled out Comment by Rebecca Coffin [2]: Spell out numbers <10 per APA style Comment by Rebecca Coffin [2]: Good!
Three themes were discovered as a result of these interviews. The first is the patient care paradox: that in the process of providing high- quality care for these potentially aggressive patients, staff are putting themselves at greater risk of a violent incident, and finding a balance is not easy. Under this theme, direct quotes were included that talked about injuries many of the participants sustained as a result of trying to provide quality care. The second theme was that teamwork is key to resolution of a violent situation, however, pre-existing conflicts up the linear ladder of command make it hard to fluidly work as a team. In this particular hospital, quotes were included that talked about how techs can’t do anything to de-escalate a situation unless the nurse is involved, and the nurse can’t prophylactically prevent a violent incident unless he/she gets orders from a doctor, and it causes delay in action when not all members are on the same page. The third theme was environmental factors that further exacerbate aggressive behaviors such as lack of privacy, volume of people. The main limitation of this study is that while data saturation was reached, this data may not be generalizable to all ED’s because it was conducted in a heavy volume, urban ED in New York City. Researchers also stated that descriptions of patient population were reliant on descriptions from participants and not confirmed with demographic statistical data, thus increasing the likelihood of personal and recall bias. Comment by Rebecca Coffin [2]: Fantastic review of the articles! The articles were relevant to the PICOT and you captured all the highlights
Conclusion
A literature review was conducted using five primary sources to examine the effect of de-escalation courses and interventions on patient violence against nursing staff in acute hospital units. Across each article presented in this literature review was the same recurring theme: change needs to occur to decrease the rate of patient violence against nurses and healthcare staff. The articles in review were not limited to the United States to allow a comparison of occurrence of patient violence worldwide. The similarities in research topic of each of these articles is enough to attest to the ongoing need for a long-lasting intervention. Each article highlighted that this is a significant problem that is only getting worse with time. Each article was able to recognize that any intervention showed improvements than no intervention. Comment by Rebecca Coffin [2]: Was there one intervention that was better than others? Why or why not?
Limitations encountered in the search for literature included a saturation of studies conducted in emergency departments and psychiatric wards. The study by Casey (2019) was conducted in an adult neurological unit but even in their discussion they explained how they borrowed scales more suited for emergency departments. Another limitation noted in these studies was that no matter what statistical data is published on rates of workplace violence in nursing, the number is always higher because there is always the incidences that don’t get reported. One strength of these studies was their use of self-report data collection to foster an outlet for these nurses and healthcare workers to have their thoughts heard that they might otherwise have been too scared to report for fear of job security or backlash. The limitation of time led to many gaps and inconsistencies in the results of a number of these studies. For example, the articles by Wong(year) and Bowers (year)both explained how implementing a new protocol for an entire hospital unit is a very time- consuming task in and of itself. They both explained how by the time their interventions were taught at the level suitable to continue on with the study, weeks had already gone by. In both discussions, it was highlighted that longer time for data collection would have allowed more significant results. Research must continue on this topic for the improvement of the nursing field as a whole. Comment by Rebecca Coffin [2]: Not surprising, I’m sure! Comment by Rebecca Coffin [2]: Yes but what do we know about the limitations of self-report? Comment by Rebecca Coffin [2]: Nicely done! I think you could have had a more definitive conclusion, but you did a great job in comparing / contrasting the studies overall
References Comment by Rebecca Coffin: References are formatted per APA guidelines
Bowers, L., James, K., Quirk, A., Simpson, A., Stewart, D., & Hodsoll, J. (2015). Reducing conflict and containment rates on acute psychiatric wards: The Safewards cluster randomized controlled trial. International Journal of Nursing Studies, 52(9), 1412-1422.
Casey, C. (2019). Management of aggressive patients: Results of an educational program for nurses in non-psychiatric settings. MEDSURG Nursing, 28(1), 9-21.
Hemati-Esmaeili, M., Heshmati-Nabavi, F., Pouresmail, Z., Mazlom, S., & Reihani, H. (2018). Educational and managerial policy making to reduce workplace violence against nurses: An action research study. Iranian Journal of Nursing and Midwifery Research, 23(6), 478–485. https://doi.org/10.4103/ijnmr.IJNMR_77_17
The Joint Commission. (2018). Physical and verbal violence against health care workers. Sentinel Event Alert.
Wong, A. H., Wing, L., Weiss, B., & Gang, M. (2015). Coordinating a team response to behavioral emergencies in the emergency department: A simulation- enhanced interprofessional curriculum. The Western Journal of Emergency Medicine, 16(6), 859-865. https://doi.org/10.5811/westjem.2015.8.26220
Wong, A. H., Combellick, J., Wispelwey, B.A., Squires, A., & Gang, M. (2016). The patient care paradox: An interprofessional qualitative study of agitated patient care in the emergency department. Academic Emergency Medicine, 24(2), 226-235. https://doi.org/10.1111/acem.13117
Literature Review Sample 2 x
Running Head: LITERATURE REVIEW 1
LITERATURE REVIEW 6
Literature Review
Stratford University
Introduction Comment by Rebecca Coffin: Good introduction, used a statistic to support why hand-washing is important in school-age children. This could be more powerful in grabbing the reader’s attention with additional statistics and better describing the relationship between the variables.
Keeping the hands clean and proper handwashing, are some of the most important steps to take to avoid getting sick and spreading germs to others (CDC, 2017). Keeping that in mind, absenteeism is a growing problem among school-aged children, with approximately 75% of all school absences attributed to illness (Lau et al., 2013). Hand washing is of great importance in this matter, but the role of instruction is far less obvious. The purpose of this literature review, is to evaluate five research articles that focus on the importance of hand washing education, and its relation to illness-related absenteeism among school-age children. My article search was done by use of Medline/PubMed Resources and ProQuest, using keywords, hand hygiene, illness-related absenteeism, and childhood illness prevention. Comment by Rebecca Coffin: Good!
Clinical Question
In District of Columbia Public School students, grades K-4, what is the effect of a comprehensive handwashing program (handwashing education and use of hand sanitizer), compared with no comprehensive handwashing program, on the rate of illness-related absenteeism, within 3 months.
Appraisal of Articles
The first article, “Effectiveness of Hand Hygiene Intervention in Reducing Illness Absence Among Children in Educational Settings, by Wilmott et al., is a systematic review and meta-analysis study, done to establish the effectiveness of handwashing in reducing absence among school-aged children. Specifically, the study took an in depth look at the spread of respiratory tract and gastrointestinal infections, and their frequency among children and/or staff in the educational setting. Interventions in this study, consisted of education with a hand hygiene component, which involved eighteen cluster RCT’s of 13 school-based and 5 child day care facilities (Wilmott et al., 2015). Results of the teaching suggested that interventions may reduce children’s absences, although randomization was inadequate. The study was not well executed or reported, despite an updated existing systematic review, which found that identifying new studies relating evidence of the effect of hand hygiene interventions on absenteeism, would need to be more robust (Wilmott et al., 2015). Comment by Rebecca Coffin [2]: No systematic reviews allowed in this assignment Comment by Rebecca Coffin [2]: What does this mean?
The second article, “The Impact of Common Infections on School Absenteeism During an Academic Year,” by Azor-Martinez et al., is a randomized, controlled open study, which focused on the assessment of the impact of infections on school absenteeism, and their reduction with a handwashing program using hand sanitizer (Azor-Martinez, 2014). The study, which took place over an 8-month time frame, consisted of an experimental group of 4-12-year-olds, who washed hands with soap and water, complemented with hand sanitizer. There was also a control group that followed usual handwashing protocol. It was found that the percentage of missed days due to upper respiratory infections and GI infections, were significantly lower in the experimental group, during a flu period (Azor-Martinez, 2014). Researchers determined that this approach was effective, due to full participation of students and staff. Comment by Rebecca Coffin: Don’t need to refer to article by the title of the article. Just follow APA and cite the authors and date.
The third article, “Comparative efficacy of a simplified handwashing program for improvement in hand hygiene and reduction of school absenteeism among children with intellectual disability,” by Lee et al., is a quasi-experimental study, which purpose is to test the feasibility and sustainability of a simplified 5-step handwashing technique, to measure the hand hygiene outcome for students with mild intellectual disability. An intervention group of 20 students underwent pre and post testing using available social learning factors, a multimedia approach, and fluorescent stain rating tests to assess handwashing quality. Results from the intervention group, showed that there was significant increase in the rating of handwashing quality in both hands of each student (Lee et al., 2015). Students in this study showed better performance in simplified handwashing techniques, and experienced lower absenteeism than using usual practice (Lee et al., 2015). Comment by Rebecca Coffin: Where’s the date!?!? Comment by Rebecca Coffin [2]: What type of testing?
The fourth article, “Effect Evaluation of a Randomized Trial to Reduce Infectious Illness and Illness-related Absenteeism Among School children: The Hi Five Study,” by Denbaek et al., evaluates whether a school-based multicomponent intervention would improve handwashing among schoolchildren, and succeed in reducing infectious illness and illness-related absenteeism in schools (Denbaek et al., 2018). The multicomponent intervention used in this study, is called The Hi Five study, a three-armed cluster-randomized controlled trial. It involved 43 randomly selected schools in Denmark (half control, half intervention), in which parents were educated and surveyed via text message, regarding proper handwashing. A questionnaire was also administered to school children, regarding handwashing practices at home and school (Denbaek et al., 2018). Mandatory daily handwashing was also implemented before lunch. A follow-up showed that intervention schools did not differ from control schools, in number of illness days, and that the multicomponent intervention achieved no difference in the number of illness day, illness episodes, or illness-related absences among children (Denbaek et al., 2018). Comment by Rebecca Coffin [2]: What type of questionnaire? Did it demonstrate validity/reliability?
The fifth article is, “Hand hygiene instruction decreases illness-related absenteeism in elementary school: a prospective cohort study,” by Lau et al. The purpose of this study was to compare absenteeism rates among elementary students, who were given access to hand hygiene facilities versus being given both access and short repetitive instruction (Lau et al., 2013). During one academic year, students in an intervention group and control group, were systematically assigned. Intervention students were given short repetitive instruction in hand washing every 2 months, where the control was only given access to hand washing facilities (Lau et al., 2013). Percentage of absent days were calculated, and bivariate analyses were performed to compare percent absent days of students given access to hand hygiene facilities, versus those given instruction and access (Lau et al., 2013). Participants were fully compliant, and results showed that total absent day and illness-related absences were significantly lower in the group receiving short instruction and access (Lau et al., 2013). Comment by Rebecca Coffin [2]: These summaries are succinct, but there is not much analysis/critique going on here
Conclusion
Each of the articles that I have listed were similar, in that they are primary sources, had one common goal, to factor in the importance of proper handwashing, through education and active participation, to lower the rate of illness-related absenteeism among school-age children. All but one of the studies consisted of randomization sampling, which was “Comparative efficacy of a simplified handwashing program for improvement in hand hygiene and reduction of school absenteeism among children with intellectual disability.” The only inconsistencies present are with the study titled, “Effectiveness of hand hygiene interventions in reducing illness absence among children in educational settings.” This study was not generally well executed or reported, due to the young age of some of the participants, lack of cooperation, and quality issues including small numbers of clusters/participants, which resulted in inadequate randomization (Wilmott et al., 2015). Comment by Rebecca Coffin: Don’t use the title of the article when referring to it – that does not follow APA style. Use the author name and year. Comment by Rebecca Coffin: Where is the answer to the question? You should be attempting to answer the question in this section by analyzing and synthesizing the strengths and weakness of the articles that were previously described. This section is worth 25 points, so make sure the content reflects that.
References
Azor-Martinez, Gonzalez-Jimenez, Seijas-Vasquez, Carrascosa, & Santisteban-Martinez. (2014). The Impact of Common Infections on School Absenteeism During an Academic Year. American Journal of Infection Control, 632-637.
Centers for Disease Control and Prevention. (2017). Clean Hands Count for Safe Healthcare. Retrieved from Centers for Disease Control and Prevention: https://www.cdc.gov/features/handhygiene/index.html
Denbaek, Andersen, Bomnesen, Laursen, & Johansen. (2018). Effect Evaluaion of a Randomized Trial to Reduce Infectious Illness and Illness-related Absenteeism Among Schoolchildren: The Hi Five Study. Pediatric Infectious Disease Journal.
Lau, Springston, Sohn, Mason, Gadola, Damitz, & Gupta. (2013). Hand Hygiene Instruction Decreases illness-related Absenteeism in Elementary Schools: A Prospective Cohort Study. BMC Pediatrics.
Lee, Leung, Tong, Chen, & Lee, H. (2015). Comparative Efficacy of a Simplified Handwashing Program for Improvement in Hand Hygiene and Reduction of School Absenteeism among Children with Intellectual Disability. American Journal of Infection Control, 907-912.
Wilmott, Nicholson, Busse, MacArthur, Brooker, & Campbell. (2015). Effectiveness of Hand Hygiene Intervention in Reducing Illness Absence Among Children in Educational Settings. BMJ Journal: Archives of Disease in Childhood.
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