Assessment of The Strength of Recommendation And Quality of Evidence Essay

Search Strategy

A comprehensive search strategy was carried out using PubMed, CINAHL, and Cochrane Library databases to identify scholarly studies on the topic of the use of pre-operative education interventions for surgical patients and their impact on postoperative outcomes. In the search process, the search terms that were combined included “pre-operative education,” “pre-operative teaching,” “pre-surgery education,” “pre-surgery teaching,” “surgical procedures,” “surgery,” “postoperative outcomes,” “postoperative anxiety,” “postoperative pain,” and “length of stay.” These keywords were combined using the Boolean Operators, including AND, OR, NOT, or AND NOT, which helped provide more focused and productive results. The inclusion criteria for the articles to be included in the literature included articles written in English, randomized controlled trials, meta-analyses, and systematic reviews that were published in the last five years. Assessment of The Strength of Recommendation And Quality of Evidence Essay

Presentation of Evidence to Answer the PICO Question

The search process yielded 147 articles. These sources were screened using the title and abstract provided as per the requirements of the inclusion/exclusion criteria. The studies that assessed various educational interventions used preoperatively and measured either postoperative anxiety, pain, and/or length of hospital stay. After the comprehensive screening process, 22 articles were retrieved for full-text review. Out of these,  15 studies were determined to meet the expected criteria in the evidence appraisal. Assessment of The Strength of Recommendation And Quality of Evidence Essay

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Critical Appraisal of Varying Evidence

The articles selected from the search strategy were predominantly randomized control trials (RCT) (9) and systematic reviews and meta-analyses of RCTs,  with a few studies being economic analyses. Randomized controlled trials are categorized as having the highest level of evidence, with systematic review and meta-analysis noted as having a higher evidence level than single RCTs. The RCTS were expected to be of higher quality since they were designed to be unbiased and have less risk of systematic errors. In their study, Zabor et al. (2020), randomized controlled trials (RCTs) have been considered the gold standard of clinical trial design, and at the top of the hierarchy of levels of evidence in a clinical study, with the process of randomization being capable of reducing the characteristics of groups that may influence the outcome. One issue affecting the quality of the RCT is its being single-site and having minimal sample sizes, which may limit the generalizability of the findings. Few studies performed economic analyses, though one found lower associated costs resulting from earlier discharges after pre-operative education. Assessment of The Strength of Recommendation And Quality of Evidence Essay

Quality of Evidence and Strength of Recommendations

Based on the overall GRADE framework, it was clear that the overall quality of evidence for the impact of pre-operative education on postoperative outcomes ranges from moderate to high. The GRADE framework is a tool for evidence quality assessment and strength-of-evidence recommendation that offers transparency and structuring evidence synthesis development process (Bezerra et al., 2022). The RCTs offer strong evidence supporting the use of pre-operative education to manage patient’s anxiety, which helps improve outcomes. It can, therefore, be noted that there is a strong recommendation is made to include pre-operative education in normal practice care to manage anxiety among surgical patients. The overall quality of evidence supports its integration into standard care practices. The Grade framework, therefore, helped in evaluating the quality and strength of evidence using a systematic manner. From the analysis of the evidence, it is clear that more research is needed to explore the long-term effects of pre-operative education and its cost-effectiveness in diverse patient populations. Assessment of The Strength of Recommendation And Quality of Evidence Essay

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Evidence-based practice involves a great deal more than simply reading nursing periodicals on a regular basis. Advanced Practice Nurses can take a more proactive approach to evidence-based practice by identifying authentic problems and concerns, and then using that to guide their inquiries into current research. In this way, APRNs can connect the results of relevant research studies to their nursing practice.

For the EBP Project, you identify and apply relevant research to a specific patient problem or topic. You begin by formulating an answerable question that is relevant to nursing and evidence-based practice. In later weeks of this course, you continue the Course Project by conducting a literature review and then determining how the evidence from the literature can be applied to nursing practice. Assessment of The Strength of Recommendation And Quality of Evidence Essay

Submit the following sections of your project:

Methods

1. Presentation of Search Strategy
2. Presentation of Evidence to Answer your PICO Question
1. Discuss Critical Appraisal of varying Evidence (RCTs, CDSS, Economic, Clinical Prediction)
2. Quality of Evidence and Strength of Recommendations

Literature reviews in published studies provide what is known, what is not known, and what the possible contribution is of a study. APRN’s review the literature to synthesize the available evidence to find a solution to a problem in practice or to remain current in their practice. During the interpretation of the findings, the researcher may review the literature again to determine if additional relevant studies have been published. Reviews of the literature in published studies can be critically appraised for current, quality sources; relevant content; and synthesis of relevant content. A checklist for reviewing the literature includes preparing, conducting the search, processing the information, and writing the review. A written review of literature should be grammatically correct with a logical flow and a reference list that is accurate and complete. Assessment of The Strength of Recommendation And Quality of Evidence Essay

References

Bezerra, C. T., Grande, A. J., Galvão, V. K., Santos, D. H. M. D., Atallah, Á. N., & Silva, V. (2022). Assessment of the strength of recommendation and quality of evidence: GRADE checklist. A descriptive study. Sao Paulo Medical Journal, 140, 829-836. https://doi.org/10.1590/1516-3180.2022.0043.R1.07042022

Zabor, E. C., Kaizer, A. M., & Hobbs, B. P. (2020). Randomized controlled trials. Chest, 158(1), S79-S87. https://doi.org/10.1016/j.chest.2020.03.013 Assessment of The Strength of Recommendation And Quality of Evidence Essay