NR 505 Week 3 Collaboration Cafe
Complete the Johns Hopkins Nursing Evidence Based Practice Appendix E Evidence Appraisal Tool Download Johns Hopkins Nursing Evidence Based Practice Appendix E Evidence Appraisal Tool. Once you’ve completed the tool, use your own words to summarize your appraisal of the article. Include the following:
- Description of the purpose
- Explanation of research design
- Discussion of sample
- Description of data collection methods
- Summary of findings
- Strengths of the study (minimum of 1)
- Limitations of the study (minimum of 1)
- Recommendations regarding potential application for future practice that are insightful and appropriate.
Attach the article to your post, in addition to including the full reference for the article in your post.
During the week, read a minimum of two articles posted by peers and add your thoughts about whether you feel their article would support an EBP change.
The John Hopkins tool does not need to be turned in, it is a worksheet for you to decide what type of article you have.
For full credit, submit your initial post by Wednesday at 11:59 PM MT. Complete your two responses to peers by Sunday at 11:59 PM MT.
Sample Post
Aim
The randomized control study performed by Houben et al., 2019 had a clear aims; to establish if advanced care planning (ACP) improves the quality of patient-provider communication on end-of-life (EOL) decisions as well as the process of death and dying without causing distress.
Design
This study consisted of a cluster-randomized control trial (CRCT), a type of randomized control trial which random assignment is given to groups as opposed to individuals. In this instance, the patients were the cluster group and their trial assignment was based on randomization of their pulmonologist.
Sampling
The study sample was quite complex being that it was a CRCT. A total of 165 patients took part in the study, and each were asked to identify 1-4 family members to include in the study. In total, 196 family members were also participants in the study. A total of 89 patients (109 family member) were assigned to the intervention group, 76 patients (87 family members) were assigned to the control. The patients were assigned to either the control or intervention based on what pulmonologist they saw. There were 29 physician participants who were randomly assigned to either the control group or intervention group, although there wes no numerical data provided as to how many pulmonologists were in each group. The patients were blinded in that they were unaware of weather they were receiving ACP intervention, and they all received standard COPD care.
Data collection methods
In order to test their theory, Houben et al., 2019 researchers provided a 2-day training to 8 respiratory nurses on ACP including communication skills. These nurse where to provide a 90-minute ACP discussion in the homes of the patients and their families within 4 weeks of discharge from the hospital for acute COPD exacerbation. While the article itself did not extensively describe the nurse-led ACP intervention, details were provided via supplemental material. Initially the nurse would take a baseline assessment, followed by a person-centered discussion of the patients’ values, goals and beliefs in order to encourage patient discussion with providers and families about their possible health outcomes (Houben et al., 2014). Although the sessions were considered structured, because the same topics were discussed, the sessions were also personalized to the patient/family cultural needs. At the end of the session the nurse would complete a physician feedback form which stated the patient’s wishes, and any additional questions they may have. In addition to a baseline assessment, patients and their loved ones were assessed at 6 month and again at 12 months. The follow-up assessments were based on several outcome measures such as the quality of care (QOC) EOL subscale questionnaire, hospital anxiety and depression scale (HADS) and quality of death and dying (QODD) questionnaire (Houben et al., 2014).
Summary of findings
Overall Houben et al (2019) found that a single educational session on advanced care planning significantly improved the patient and/or families perception on EOL care communication between the patient and their pulmonologist. Without causing distress, the ACP session and subsequent communication with the physician demonstrated a decrease in the level of anxiety experienced by family members at the 6 month follow up, when compared to those in the control group. Unfortunately, there was no statistical impact on the quality of death and dying.
Strength
Because many EOL decisions are made by patient’s family member, it was imperative that the study included them in their trial. By doing so, it also allowed for post mortem survey which would have otherwise not been available. Additionally the intervention was initiated following a health crisis, acute exacerbation of COPD. The study being a CRCT also leads to research strength with low risk of cross contamination.
Limitations
Houben et al., 2019 describes how the ceiling effected may have impacted the quality of death and dying by family members as both the control and intervention groups rated the quality of the patient EOL as high. This may be especially significant seeing as how the author notes that in general families perception of QOC during death and dying in the Netherlands is already considered favorable. Another limitation to the CRCT is the clustering of samples, and the intervention group having more family and patient participants then that of the control group.
Recommendations
This structured intervention has the potential for implementation in other practice areas and/or being delivered by other healthcare providers such as APRN’s. Additionally, the research finding may be implemented into my future practice setting though the utilization of a quality improvement initiative. It is also important to remember that while this study was based on a single nurse-led education session, ACP should remain a continuous process that actively engages patients and their families in future decision making.
Overall, this research provided consistent results, was well controlled and had decent sample sizes. Recommendations were concise and based on the evidenced gained. However, there were some flaws with the randomization of cluster groups. Additionally, data collection methods and instrument validity were only discussed in detail via supplemental material. For these reasons my overall rating for this study is good.
References
Houben, C., Spruit, M., Luyten, H., Pennings, H., Boofaart, V., Creemers, J., … Janssen, D. (2019) Cluster-randomised trial of a nurse-led advanced care planning session in patients with COPD and their loved ones. Thorax 74(4), 328-336. https://thorax.bmj.com/content/74/4/328
Houben, C., Spruit, M., Wouters, E., & Janssen, D. (2014). A randomised controlled trial on the efficacy of advanced care planning on the quality of end-of-life care and communication in patients with COPD: the research protocol. BMJ. 4, 1-6. https://bmjopen.bmj.com/content/bmjopen/4/1/e004465.full.pdf
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