Clinical Guidelines and Strength of Recommendation
Clinical guidelines are systematic established statements that assist practitioners and patients in making proper decisions about better health care for specific clinical settings. Clinical recommendations that use an evidence-based framework now score each suggestion by categorizing the category of evidence and indicating the strength of the recommendation (Roddy et al., 2006). The strength of evidence-based healthcare guidelines is frequently ranked in relation to the level of the scientific evidence that supports it. The current methodology does not allow for the intensity of the suggestion for upgrading in cases when there are unethical or impracticable randomized controlled trials. The main aim of this research study was to develop a new system for determining the strength of recommendation through the integration of expert opinion and the research evidence.
The Use of Delphi Technique and ANOVA Analysis
There was the use of Delphi technique to generate ten recommendations chiefly for the role of the exercise therapy within the management of osteoarthritis of the knee or hip. The determination of the strength of recommendation involved the conventional technique that is closely associated with the classification of the research evidence within the systematic search of literature and on the visual analogue scale (Roddy et al., 2006). There was the grouping of the recommendations that consisted from A to D in accordance with the conventional strength of recommendations that was allocated and the mean visual analogue scale computed. The distinction across the categories was evaluated through the utilization of one-way ANOVA variance analysis.
New System for Grading Strength of Recommendation
The mean visual analogue scale for the conventional strength of recommendation categories from A to D and the suggestion that was not recommended displayed considerable linear association with the one-way ANOVA. Nevertheless, some recommendations wherein the pragmatic reasons would not be evaluated in the randomized controlled trials thus would not be recommended robustly through the conventional methodology were allocated a robust recommendation by the visual analogue scale. The new system for grading the strength of recommendation is less constrained as compared to the conventional methodology and provides the benefit of permitting the strength of recommendations for the procedures that may not be evaluated in the randomized controlled trials for the ethical or practical reasons for expert opinion upgrading (Roddy et al., 2006).
Research Questions and Design
Roddy Analysis Worksheet
What was the research question? In what way does the existing methodology within the clinical practice guidelines grade the strength of recommendations? What is the role of the clinical practice in reviewing and enhancement of the strength of recommendation wherein the randomized control trials are unethical or impractical?
What were the independent variables?
What was the dependent variable? The independent variable was the existing methodology in the guideline of clinical practice whereas the dependent variable was the evidence-based clinical practices.
What was the sample size and how was it chosen? The sample size was 150 nurses. There were randomly chosen utilizing simple random sampling.
What was the experimental design and use of control group? A Delphi technique was used in the survey to generate the strength of recommendation for the role played by the exercise therapy in osteoarthritis management of the knee. The conventional techniques were applied in the determination of the strength of recommendation, for instance, the visual analogue scale and the systematic literature search. One way ANOVA was utilized to analyze the results.
Were the instruments of measurement shown to be reliable and valid? The instruments of measurement were shown to be valid and reliable because there was linearity between the measurement of the mean visual analogue score for strength of recommendation categories and the one-way ANOVA analysis.
What data types were included? The kind of data used in the survey was quantitative data because it could be easily analyzed.
Describe the statistics used, what they were used for, and the results. A record of the data obtained from the nurses was made utilizing the visual analogue scale wherein for every recommendation there was the calculation of the mean visual analogue score and the standard deviation. The data was classified in accordance with the initial strength of recommendation and their related mean visual analogue score. Afterward, the researcher computed the confidence level at 95% for every category.
What were the researchers' conclusions? How did they answer the research question(s)? There were low levels of evidence-based practices, but there was a high priority given the oral care. There existed no significant association between the utilization of the demographic and professional characteristics. The nurses should be adequately trained on the evidence-based and oral care practices.
How was error controlled? The large sample size in the survey controlled the error by minimizing it.
Did you see any concerns with the research study? If so, what? The main concern with the research study is the need to offer adequate education for the nurses concerning the oral care and evidence-centered practices and also the answering of the questionnaires.
Oral Care Practices of ICU Nurses
Ganz Analysis
The study aimed to explore the oral care practices of the nurses of the ICU. It was intended to make a comparison of the practices with the present evidence-centered practice. Moreover, it aimed to determine whether the utilization of the evidence-centered practice was linked to the individual professional or demographic characteristics (Ganz et al., 2009).
The oral care practices of the ICU nurses' national survey were performed utilizing a sample of two hundred and eighteen between 2004 and 2005. The instrument of the survey comprised the questions concerning the professional and demographic characteristics of the oral care practices. Moreover, it included a checklist of the oral care practices. The nurses ranked their professed priority level regarding the oral care through the use of a scale that ranges from 0 to 100. There was the computation of the score that embodied a total of fourteen items that are related to assessments, solutions, equipment and the techniques that are linked to present the best evidence (Ganz et al., 2009). Afterward, the score was analyzed statistically utilizing one-way ANOVA for the determination of the distinctions of the evidence-based practices centered on the professional and demographic characteristics.
The findings revealed that the equipment that was commonly utilized was gauze, then the tongue depressors and lastly the toothbrushes. The most common solution that was utilized was Chlorhexidine. Few nurses reported to have been brushing the teeth of patients. Numerous nurses carried out an oral assessment prior to the start of the oral care. Nevertheless, they all failed in the description of the apparatus utilized. Nearly sixty percent of the nurses documented their oral care. The ratings of the oral care of the intubated patients ranged between 40 and 94 (Ganz et al., 2009). There was a broad difference between and in the units with regard to the utilization of the solutions and equipment. There was no significant association between the evidence-centered practice and the professional and demographic characteristics and also with the precedence that was offered to the oral care.
Numerous nurses failed to execute the most recent evidence into the present practice although the nurses rated oral care on a high priority. The research use level was not associated with the professional or individual characteristics. Thus, there is the need to make exertions to inspire the entire ICU nurses to initiate and utilize the oral care and evidence based practices. The ICU nurses that were practicing in the survey were frequently not conforming to the most recent evidence centered protocol; thus, they should be trained and given confidence to adhere to the evidence based practices to enhance the patient care (Ganz et al., 2009).
Ganz Analysis Worksheet
What was the research question? What are the oral care practices of the ICU nurses through evidence based comparison and are the evidence based practices related to the demographic and the professional characteristics?
What were the independent variables?
What was the dependent variable? The dependent variable was the oral care practices. The independent variable was the current best evidence.
What was the sample size and how was it chosen? The sample size was 218 nurses. This involved only the practicing nurses when the survey happened.
What was the experimental design and use of control group? Questions were utilized in the experiment with regard to the professional and demographic traits of the practicing nurses. A scale ranging between 0 and 100 was utilized to rate the nurses. The computation of the score involved the use of fourteen items.
Were the instruments of measurement shown to be reliable and valid? The instruments of measurement were shown to be valid and reliable because there was linearity between the measures of dispersion and the one-way ANOVA analysis
What data types were included? Quantitative data was utilized in the survey because it gives appropriate conclusions.
Describe the statistics used, what they were used for, and the results. Mean and the standard deviation was computed using the data obtained from the nurses. There was the computation of the score that represented a total of fourteen items that are connected to assessments, solutions, equipment and the techniques that are linked to present the best evidence. The score was analyzed statistically utilizing the one-way ANOVA.
What were the researchers' conclusions? How did they answer the research question(s)? There was no significant association amongst oral care practices of the nurses of the ICU and the current evidence based practice.
How was error controlled? The error was controlled through having a large sample size that reduces the error.
Did you see any concerns with the research study? If so, what? Proper and adequate training needs to be provided to the ICU nurses on the current evidence centered and oral care practices.
References
Ganz, F., Fink, N., Raanan, O., Asher, M., Bruttin, M., Nun, M., et al. (2009). ICU nurses' oral-care practices and the current best evidence. Journal of Nursing Scholarship, 41(2), 132-138. Retrieved from http://library.gcu.edu:2048/login?url=http://proquest.umi.com.library.gcu.edu:2048/pqdweb?did=1780947491&sid=1&Fmt=3&clientId=48377&RQT=309&VName=PQD
Roddy, E., Zhang, W., Doherty, M., Arden, N. K., Barlow, J., Birrell, F., et al. (2006). Evidence-based clinical guidelines: A new system to better determine true strength of recommendation. Journal of Evaluation in Clinical Practice, 12(3), 347-352. Retrieved from http://library.gcu.edu:2048/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=20870724&site=ehost-live&scope=site
