Evidence Based Research related to the Operating Room

This task really centers on B1 and B5, the problem and the recommendation. You are going to choose a nursing topic that you recognize as a problem in healthcare (one that nurses can improve). Then you will search for ten research articles, less than 10 years old (a body of evidence all telling us what nursing action will fix or reduce the problem). In the B5 section you will recommend a nursing strategy or action that will reduce or eliminate the problem. The whole paper revolves around those two sections. All of your articles will be on that topic and support your nursing strategy. The nursing strategy may be bundled or comprehensive, encompassing more than one evidence based recommendation.
Here are common questions related to task one:

1. What should I use for a topic?
You may want to choose a topic that you are passionate about, or you may want to choose a topic that can be researched quickly. Sometimes we find that our topics do not have a great deal of recent research available and we have to choose again. Try taking two topics to the library for a federated database search and see what brings you the most results. We have additional assistance in the Study Guide for choosing a topic. Whatever you pick, remember that your solution must be nurse-sensitive. DO NOT choose a topic you need a physician’s order to change. This is about nursing practice. Please note that you may want to consider using the same topic for task one and task two. This is certainly possible, though there are differences between the two tasks. Review the Help Document for task two before deciding.

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2. I have a topic but I can’t find any evidence in the library.
Searching is a learned art. It takes a little practice, and you want to know how to use the tools at your disposal. Remember the federated databases are the place to go. There are library tutorials available on the home page, and we have assistance in the Study Guide. The federated databases use the Ebscohost search engine to search the healthcare databases. You can help your search along by limiting your search to peer reviewed articles and full text articles. This task requires that your articles are peer reviewed, and you will not be able to learn enough from your articles without having the full text. Please check out our library video for great helpful hints like emailing the articles to yourself and sending the APA formatted reference with it to yourself. Do not forget that you also have the chat with the librarian function and the request an article function.

3. How long is this paper going to be?
This paper may be 25 or even 35 pages. There is no limit, nor will points be deducted for having a short paper. The goal is to adequately cover the material. Please use the general rule of thumb of providing no less than a full 5-7 sentence paragraph for each section that you are answering in written format in the body of your paper. The matrix will lengthen your paper and can be quite large. The matrix will generally be 4 pages or more. Please request a blank matrix word document from your assigned course mentor. You are also going to need a full reference page in your paper. Your entire paper will be checked for originality. You can and should view your originality score before proceeding with your submission. Remember that your references and citations will not count against you in originality.

4. What has to be APA formatted in this paper and how many pieces can I turn in?
You should turn in two pieces of work. The matrix may be submitted as a separate attachment, but all other sections of the task should be formatted into one document. Use the rubric prompts to create APA formatted subheadings throughout the paper. In this paper you will complete a visual representation section, or graphic, in the A section. The graphic does not need to be double spaced. You will also complete a matrix in the B section. The matrix does not need to be double spaced. The annotated bibliography section does have to be in APA format, and entries should be alphabetical. Please use a cover page, running head, and page numbers.
What follows are the directions from taskstream (typed in black) and the clarifying guidance (typed in blue) from your course mentors. Although we follow the order of the task directions in this help document, this is not the order in which you should approach the task. Here is how we suggest accomplishing task 1:
1. After you choose the topic, find your 10 research articles, less than 10 years old. Do not write a word of the task until you are certain that you have 10 research articles.
2. Complete the matrix and the annotated bibliographies first.
3. It may be better if you continue by completing section B next. In sections B3b through B5, you will be synthesizing the evidence from all ten of the articles.
4. Finally, choose the article you feel most comfortable describing and critiquing. Go back to the beginning of the task directions and complete section A.

1. Select a piece of primary research (original research reports) from a research journal that has nursing implications and critique the article (suggested length of 2–3 pages) by doing the following:

What does primary research mean? You must have a good understanding before you search or you will be frustrated. Consider reading your course textbook chapters that focus on types of research. Our course text by Brown has great examples of research articles and how to determine if you are looking at research. Houser talks in depth about the types of research and the parts of a research article. Gerard, chapter two, clearly explains how to differentiate primary and secondary research. Our Task one workshop will assist you in this topic. Also, the librarians have a great webpage about distinguishing primary for secondary research in the healthcare professions section of the Guides tab. Remember, you are looking for primary research where the authors themselves gather the data and do the research. Filling in the matrix will help you determine if you have chosen well. While you are not confined to nursing journals, your researchers must speak to what nurses do as the strategy. Generally, nurse researchers speak to nursing strategy.

Important: Please note that you must collect 10 research reports, less than 10 years old, first and then select one of those to complete aspect A of this task. We fully recommend that you complete all of section B before returning to finish section A of the task.
You are looking for a body of evidence that supports your nursing strategy in section B5. All ten research articles will go into your matrix (further below in the B section) and the annotated bibliographies. One of the ten articles will also be used for the A section of your paper. This article will be viewed over and over by the graders and will be a major portion of your paper. You are critiquing the article. Choose the article based on how well you understand the type of research and be very sure that it is primary research.

1. Identify the article you have chosen in an APA-formatted citation.

You are only demonstrating your competency on formatting a full APA reference here. You can place this citation in the graphic below where it states ‘full APA citation’ or just start section A with a full APA reference so the grader clearly knows what piece of evidence you are using for section A. The words citation and reference are used interchangeably. You want a full APA reference here in hanging indent format.

2. Design a visual representation (e.g., graph or chart) to show how the researcher addressed the five areas of a research report (background information or introduction, review of the literature, discussion of methodology, specific data analysis, and conclusion).

Note: You may use the following table, or you can ask your course mentor to send you a template for the table.
Please do use the example below or in the instructions posted in taskstream. We can send you a template for the table. You will need the same areas of the research report that are listed in the left column. If you use this chart, please read the directions and then remove the directions written in blue as you prepare your copy for submission. Your goal here is to critique how well the authors in your chosen research article have written each of these five areas. The only way you can critique them is if you know what information is supposed to be in each section. While some examples are listed for you, you will need to go into our class textbook written by Houser and read each of these sections. Once you have done that, you will read your chosen article and critique how well the author has written that section using examples from the work. You do not need to provide citations as you already have a full reference listed.


Article Place full APA citation here to document your competency to format a full APA citation. Make this a full reference in “hanging indent” style.
Background Information Houser Chapter 3 and Brown Chapter 3. What is the author’s purpose statement? Does it make sense to you? Did they situate/describe their problem enough for you to understand? Did they have an abstract? Was it structured or unstructured? Did it tell you enough information about the topic to make you care about it? Was there an introduction? These topics and more are what you should cover in your paragraph critiquing this section of the research paper. Remember, this is not a question and answer format. You want to develop a paragraph that answers all of these questions in the body of the paragraph. Feel free to use some examples along with your critique. You do not need to cite as you have provided a full reference above for this article.
Review of Literature Houser Chapter 5– How up to date, thorough, explanatory was this author’s own review of literature presented after the introduction and before the methodology? Typically the authors present what they reviewed in past literature within groups of topics. If the authors do not include a section subtitled Review of Literature, say so. Tell how and where they present their evidence from other authors. List what topics they presented, how many articles they cited, and based on all this ‘review of literature’– did they give you enough knowledge about their topic? Note: THIS IS NOT A REVIEW OF THE WHOLE ARTICLE- just a description of what the authors cited as evidence of the problem. Create a paragraph in this section that answers the questions above in the body of the paragraph and give examples from the article that you have chosen. This critique is about the specific section of the chosen paper called “Literature Review”.
Methodology What did they state was their methodology for their study? Remember methodology corresponds to the section of your matrix that says “research type.” You will want to talk about the major type of research (qualitative or quantitative) and the subtype (such as descriptive).
Remember the webinars and the workshops. We have several chapters in both class texts that address the research/methodology types and subtypes. Chapters 2, 4 & 5 in Houser, Chapters 2 and 4 in Brown and more.
Quantitative—and they have subtypes that are most commonly mentioned such as cohort studies, descriptive, experimental, quasi-experimental.
Qualitative- and also subtypes- maybe grounded theory, phenomenology, and also descriptive.
Use the text to help you understand different methodologies researchers use. The researchers should tell you the methods they used to research their questions. Identifying research types and subtypes is a big concept. In this section you are going to identify the type and subtype of research methodology in your chosen article and tell the reader why it is that type and subtype. Usually, that means you are going to bring in parts of the definitions for those types and use them to help explain why you have chosen it as the type of subtype.
Data Analysis Throughout Houser and covered in Chapters 3, 4 and 5 depending upon the research methods used. Chapter 3 in Brown. How did the researchers’ analyze the data? Did they explain it enough for you to evaluate for external or internal validity? Give examples from your article. What statistical testing was used? What analysis was discussed?
Conclusion What are the conclusions of the researchers? Do they make sense to you as a clinician? Chapter 3 in Brown will help you here. Use examples here, giving some of the conclusions. Remember each section in this graphic is not you telling us what the authors said, but you telling us how well the author said it. Write in third person and give examples.

A 3. Based on your analysis of the five areas, assess whether the evidence presented in the research report supports the author’s stated conclusions.

Can these researchers support the conclusions that they made? Would anything else explain their results?
Are there any other plausible explanations for their conclusions? Chapter 3 in Brown is a good resource here. Remember you will want to justify your answer. Give a full paragraph on why or why not the evidence in the five areas of the research paper supported the conclusion.

A 4. Discuss ethical issues that may have arisen for the researcher while conducting the research for the article.

Did you note any ethical issues? How did they protect the rights of the study participants? Did they mention IRB or informed consent? Read Houser chapters on legal and ethical issues in research. Depending on your edition of Houser this is likely Chapter 3. Remember that even if there are no ethical issues in the article, you are demonstrating your understanding of the ethical issues in healthcare (human subjects) research. Give a full paragraph on this topic in your paper. There are many great sources on ethical issues in healthcare research. Do not hesitate to go to your textbook and beyond to the great world of google or the federated databases!

A 5. Discuss the type of research used for the study.

Discuss the type/subtype and methods of the research study that you listed in the graphic above in the methodology section. Define it and describe it as a method. Houser will help you. Use the search bar in the text to find references to the type that your authors listed in their methods section. If the authors do not describe the type of research and the subtype, then you will need to determine it for yourself. Use what you have learned from the chapters in the text. Remember that you are showing the reader that you understand the type of research and subtype that you have chosen, so pull in some of the definitions and tie in what you have read in your article to why they fall into the category you have chosen.

A5a. Explain whether or not other types of research would have been appropriate in the same situation.

If your article was quantitative, explain why a qualitative study would not have worked better. If you article was qualitative, explain why a quantitative study would not have worked better. If the opposite research type would have worked better, then explain why it would have worked better. Would there be another way to examine the research question (such doing a qualitative study versus quantitative or vice versa?) Could you suggest another way they could have studied the same research question that would be more efficient? less cost?, less burdensome on the subjects/participants? Since you are collecting 9 more pieces of evidence for the matrix and the annotations… you can look at how others examined similar research questions– there may be examples of other types of research that you can offer here. In this section you are showing the reader that you understand the other major type of research category and another subtype. For example if your answer was quantitative cohort study above, then you will be talking about qualitative studies and any other subtype here.

B. Conduct a literature search to evaluate nursing care or management implications of a nursing intervention by doing the following:

B 1. Discuss evidence for a nursing care or management problem.

Develop your own problem statement that is driving your review of research. Use evidence, meaning in-text citations, to demonstrate the importance of your problem. Note how the authors in your articles write their problem statements. Remember that this whole paper is based around B1 and B5. In this section you are telling the reader the topic of the whole paper. All ten of your articles are about this problem. Remember also that we are not asking for a research question or a PICO formulated problem. Simply state the problem you are addressing and fill in the rest of the paragraph with evidence (using in-text citations) that there is a documented problem. Please avoid problem statements that are outside of the nursing area of practice for all Registered Nurses. Advanced Nurse Practice topics or physician driven topics will not be accepted.

B 2. Complete the attached matrix to list 10 research sources, in APA format, from scholarly journal sources you locate in major medical databases (e.g., CINAHL, PubMed, MedLine, Google Scholar or a hard copy journal).

The article you review in Section A must be primary research. The remaining nine articles may be research. Please note that all 10 articles must be listed in the matrix and all 10 articles must have an annotated bibliography.

Note: If you locate your articles in the WGU library, you may indicate this in place of the database.

Note: In aspect B you should gather 9 more pieces of similar research on the same topic as in aspect A so you have a total of 10 pieces of research to make a practice implication (a minimum of 8 authors should be used).

Note: You have access to major medical databases within the WGU Library.

Note: You may submit your completed matrix as a separate attachment to the task or you may include the matrix within your paper.

The matrix & and annotated bibs are of the major tools that researchers use for gathering and collecting evidence. No one can remember all the nuances of 10 pieces of evidence. So a matrix/table helps us briefly envision the evidence- just as a chart of vital signs help us. Not all the patient information is within a vital sign chart, but there is enough to help us see the overall structure. Do not use full sentences, but brief phrases telling us the sample size or the major outcomes measured. You do not want to include information in full sentences as that information will count against you in the authenticity evaluation. Your matrix will not need to be double spaced.
If your matrix is getting too long, consider that the information you are putting there is more appropriate for the annotations than the matrix. Do not use full sentences in your matrix. Phrases only. Use the matrix below by copying and pasting it into a word document. It will grow as you type into it. Remove the directions prior to submission.

Before you collect your evidence, make sure you have a firm understanding of what primary research is and how to determine what is peer reviewed. Scholarly databases are almost exclusively peer-reviewed and you can note that in the articles full detail section under journal.) By viewing the recordings on how to search for research in the library (linked in the Study Guide) you can determine how to narrow your search to only peer reviewed articles. Note that there is also a version of this matrix in taskstream that you can download. That copy does not have the blue directions. If you have difficulty, we can send you a blank matrix word document.

On the next page is an example matrix table with instructions on what to place under each heading and an example entry for each type of research: qualitative, quantitative, and mixed methods.
Evidence-Based Practice Matrix of Ten Pieces of Primary Research on One Topic Related to Nursing
Authors Resource &
Database Year of Publication
(must be less than 10 years old) Research Type Population/
Sample Size Outcome Variables Measured Pertinent Data from Results Author’s Suggested Conclusions Comments
In this section type the authors last names separated by commas as if you were writing a citation without the year.

Journal and database where the article came from ie CINAHL or PubMed
or if you locate your articles in the WGU library, you may indicate this in place of the database
Year the article was published. Use Houser to identify the research type. Also, the author’s should indicate type of research in their methodology section. In this section you want the major type of research for each article How many participants? Where was the study conducted? Geographic region as well as sample setting (hospital, clinic, community?). If you cannot find a sample size- you likely do not have a primary research article What were the major outcome variables they measured?
Both of our texts have good info on this. Just the name of the thing being measured here. Not the results. What did the authors identify as their key findings? Remember these should tell you about the results of the thing being measured from the last column. The author’s conclusions. Short phrases only here. You want to include information about your strategy here that applies Make notes here as to why this piece of research/evidence is important to you, why you chose to make this part of your 10 article review. Do not omit this column
B3a: Do results match type of research (quantitative is numeric and qualitative is words/themes)?
B3b: Do results match author’s recommendations?
B3c: Tool used to measure outcome

B3d: How does tool bias/affect results
Merlo, A. a., Goodman, A., Mcclenaghan, B. A., & Fritz, S. L Physical Therapy

WGU library 2013 Qualitative

8 stroke patients and their families Impressions of a therapy intervention Themes: fatigue, intensity of physical requirement, truncated duration, enjoyment, soreness
Participants derived great physical and emotional benefits from the physical therapy
Tool: Interview/focus group for subjective feelings regarding therapy
Qualitative study findings are not generalizable to others…etc
DiFrisco, E.,

Goodman, K.E.,

W. C.,

Lilienthal, M. W., Kleinma

n, A., &

B. Journal Of Perinatal

WGU library
2011 Quantitative

113 mothers
gave birth in
the last 2-4
weeks Breast
87.5% of
mothers still
breastfeeding Breastfeeding within 1 hour of birth lead to higher breastfeeding rates at 2 to 4 weeks Tool: Survey
Bias: Self-reported,
subjective, from
mothers who
breastfeed within
one hour after giving
F. Worldviews On

WGU library
2009 Mixed
24 charge
nurses from
11 hospitals
In Izmir, Turkey Current
practices Interview; There is a lack of adherence to the best practice
Survey; measured % that reported adherence to best practice Increased compliance to guidelines will
expedite best
practices Qualitative tool; interview

Quantitative tool; survey
B 3. Conduct a review of the 10 peer-reviewed research articles (Use the same articles used in the matrix above) in which you:
a. Annotated Bibliography:
First list the APA formatted citation. Then write the summary using the example from taskstream to see the format. The six areas of the summary include the content (one paragraph), and a second paragraph on the following: usefulness (1 sentence), limitations (1 sentence), audience(1 sentence), conclusions (1 sentence), and your reactions (1 sentence). The TaskStream instructions state that the recommended length is 2 -3 pages overall. This is completely inaccurate. If you can fit two entries on a page, it will take 5 pages for all 10 annotated bibliographies. Plan on at least 5 pages, and do not be surprised if it is longer.
Note: An annotated bibliography includes a brief summary of content for each article reviewed and other comments of importance to you as well as information that you believe can be of help for your future study. Relevance may also be addressed.
Annotated bibs are the place where you can express in full sentences what is most important about an article. Think of what you would tell your peers quickly about an article, why you care about it, and why you want them to care about it. There will be one section in your paper subtitled Annotated Bibliography. It should include a separate entry for each of your ten primary research articles. The entries must be alphabetized by the lead author’s last name.

The remaining sections of B3 are NOT part of the annotated bibliographies. Each prompt from B3b through B3d is a separate subsection of the paper and should be labeled with an APA-formatted subtitle.

B3b. Discuss whether the researchers’ evidence collected is adequate to make a recommendation for a practice change.

You must provide in text citations from at least 7 sources in your matrix to support your statements in this section. Consider here what evidence the researchers presented that convinces you of the need to change practice. Remember you are looking at all ten of your articles and talking about the evidence they provide that supports the need for change, the benefit of change. What did they show as evidence in the research? Will hospitals stay be decreased? What hard data did they show you that you can use as evidence here? Give examples and citations of several of your articles.

B3c. Identify the tools used to measure the outcome in the ten studies and whether the researchers chose tools that were similar or different.

List the tools used in the ten studies. No in text citations. Tools in Houser (chapters 10, 11 and throughout) are called instruments. Put Instruments in the search bar of the text and you will see discussions on tools/instruments. What were the tools used to measure the outcome variables? Were they similar in all the studies or were they different? Discuss how the researchers measured the variables. Did they measure the same variable with different tools? Using the example variable of obesity: Did some measure self-reported ht and wt and convert to BMI versus some that measured body fat with doubly-labeled water or MRI? Remember, your tools measure the data in your outcome variable column of the matrix. Some example quantitative tools include observation, use of instruments or lab tests, and closed ended questions on a questionnaire (also called scales or surveys) Some example qualitative tools include interviews, focus groups, and open ended questions on a questionnaire. You can summarize the ten studies based on the type of tool they used to measure the outcome and give some examples of how it was done.

B3d. Discuss whether you believe the tools the researchers chose could have affected their results.

After you know what tools/instruments the researchers used to measure their variables… could some of the researchers have used less accurate tools of measurement than others? Could that have affected results? The tools we have all come with drawbacks and benefits. Describe how those drawbacks or benefits could bias the results.

B4. Develop an evidence summary of the articles, identifying what key criteria were used to develop it (suggested length of 1/2–1 page).

You must provide in text citations from all ten 10 sources in your matrix to support your statements in this section. In this section you are going to show the reader that you can talk about the group of articles as you synthesize your evidence and summarize key points. Begin this section with a sentence stating the two key criteria. Talk about at least two key criteria, which are themes you find that link all 10 pieces of research. Use in-text citations from all 10 articles as you discuss what is similar and what is different about the evidence in all 10 articles. Imagine that as you went into the federated database to search thru the articles, you started looking from article to article to see which ones you would keep—what did you look for? What things were you looking for that you wanted to compare?

B5. Recommend a specific nursing strategy based on the researcher’s recommendations and evidence you found in your review.

You must provide at least 5 in text citations from the ten sources in your matrix to support your statements in this section. This is what your whole paper has been about. You were out to find something to implement that would improve the problem that you addressed in B1. In this section you are telling the reader what nursing strategy you have found that is supported by your 10 primary research articles. This is a nursing action you can implement or recommend that will reduce or eliminate the problem. You will need to use evidence in the form of in-text citations for a number of your articles. (Your matrix should provide further evidence that the strategy you write about is supported by your research articles. What you say here should reflect the Outcome Measures, Pertinent Data, and Suggested Conclusions columns in the matrix.)

B6. Explain why you believe it is important to use a theoretical model for nursing research (suggested length of 1/2–1 page).
Use the Houser text to see how theory influences or constructs research (Chapter 7). It used to be a convention that nurse researchers devoted a section of their publications to describing their theoretical model. Most researchers do not mention their theoretical framework/model nowadays. In this task you can talk in general about how theoretical framework influences research. Investigate the question of why theoretical framework is important in research. Use your book, the internet, and your articles as sources to investigate.

C. Include all in-text citations and References in APA format.
This paper is a mix of tables and narrative discussions. Focus on using in-text citations and provide a reference list. Even though you may have placed references in the annotations, you will always have a reference list at the end of a paper. APA has title pages, pagination (page numbers on each page), running head and margin. All of this is outlined in the Owl Purdue site for you or the APA text. Tables in APA do NOT have to be double spaced. Please consider using the outstanding resource of the Center for Writing Excellence for your APA questions: writing

The submission MUST include APA formatted in-text citations with a corresponding reference list for any direct quotes or paraphrasing. It is not necessary to list sources that were consulted if they have not been quoted or paraphrased in the text of the paper or project.
Note: No more than a combined total of 30% of a submission can be directly quoted or closely paraphrased from sources, even if cited correctly. For tips on using APA style, please refer to the APA Handout web link included in the General Instructions section.

Do not forget to review the rubric criteria. Email your course mentor early and often if you have questions.

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