Nurs 5052-3 Essentials of Evidence Based Practice

This is a continuation of the Course Project presented in Week 2. Before you begin, review the Course Project Overview document located in the Week 2 Resources area.
The literature review is a critical piece in the research process because it helps a researcher determine what is currently known about a topic and identify gaps or further questions. Conducting a thorough literature review can be a time-consuming process, but the effort helps establish the foundation for everything that will follow. For this part of your Course Project, you will conduct a brief literature review to find information on the question you developed in Week 2. This will provide you with experience in searching databases and identifying applicable resources.
To prepare:
Review the information in Chapter 5 of the course text, focusing on the steps for conducting a literature review and for compiling your findings.
Using the question you selected in your Week 2 Project (Part 1 of the Course Project), locate 5 or more full-text research articles that are relevant to your PICOT question. Include at least 1 systematic review and 1 integrative review if possible. Use the search tools and techniques mentioned in your readings this week to enhance the comprehensiveness and objectivity of your review. You may gather these articles from any appropriate source, but make sure at least 3 of these articles are available as full-text versions through Walden Library's databases.
Read through the articles carefully. Eliminate studies that are not appropriate and add others to your list as needed. Although you may include more, you are expected to include a minimum of five articles. Complete a literature review summary table using the Literature Review Summary Table Template located in this week's Learning Resources.
Prepare to summarize and synthesize the literature using the information on writing a literature review found in Chapter 5 of the course text.
To complete:
Write a 3- to 4-page literature review that includes the following:
A synthesis of what the studies reveal about the current state of knowledge on the question that you developed
Point out inconsistencies and contradictions in the literature and offer possible explanations for inconsistencies.
Preliminary conclusions on whether the evidence provides strong support for a change in practice or whether further research is needed to adequately address your inquiry
Your literature review summary table with all references formatted in correct APA style
Note: Certain aspects of conducting a standard review of literature have not yet been covered in this course. Therefore, while you are invited to critically examine any aspect of the studies (e.g., a study's design, appropriateness of the theoretic framework, data sampling methods), your conclusion should be considered preliminary. Bear in mind that five studies are typically not enough to reflect the full range of knowledge on a particular question and you are not expected to be familiar enough with research methodology to conduct a comprehensive evaluation of all aspects of the studies.
By Day 7 of Week 5
This part of the Course Project is due. It will also be a component in your Portfolio Assignment in this course, which is due by Day 7 of Week 10.
Sample Part 1
Posted by Donna Hathorn at Wednesday, March 8, 2017 2:14:20 PM
Use this sample paper as a guide. Please do not plagiarize this sample. I used an "A" paper form a former student and changed it a bit to conform to the standards I prefer. Use the assignment guidelines or criteria to create the purpose statement, this is a criteria in the grading rubric. Follow the guidelines for paper length, this will challenge some of you to be succinct in your writing. Please remember to NOT write in first or second person. This is a violation of APA writing style. I hope this sample paper will help in writing part 1 of the course project.
Literature Review: Sepsis and fluid resusication
Student Name
Walden University

Literature Review: Sepsis and fluid resusication
The purpose of this paper is to describe and synthesize evidence from five of the highest level studies that anawers the evidenced baased practice research question. The PICOT question developed is: In patients with septic shock is normal saline compared to other fluids such as plasmalyte, lactated ringer's and albumin more effective in decreasing the mortality rate in patients in the intensive care unit? Disucss the process of the literature review from the text (Polit & Beck, 2017). Describe the hierarchy of evidence from Walden sources.
Article # 1
The first study by Owyand & Shah (2015) is a systematic review of randomized control trial studies involving critically ill adults with either severe sepsis or septic shock who required resuscitation. Fluids were classified as crystalloids (balanced and unbalance) and colloids. The outcome measured for this study was 90 day mortality and if unavailable then a 30 day ICU hospital mortality was used, whichever was longer (Owyand & Shah, 2015). This study found 14 randomized trials that were available for analysis. This study explais that normal saline solution, albumin, lactated ringer's, hydroxyethyl starch and Plasmalyte have been found to numerous effects as resuscitation fluids in the setting of sepsis (Owyand & Shah, 2015). This study concludes that balanced crystalloids in sepsis have been linked indirectly with lower mortality and should be considered as and alternative to unbalanced crystalloids as the initial resuscitation fluid (Owyand & Shah, 2015). Even though there was lack of definitive evidence for a mortality benefit with balanced crystalloids, the results of this analysis with the current understanding of saline solution's physiologic effects should cause consideration for expanding the use of balanced crystalloids in sepsis resuscitation (Owyand & Shah, 2015). This study would be considered a Level I on the hierarchy of evidence level because it is a systematic review of randomized trials.
Article #2
The second study is a systematic review and network meta-analysis by Rochwerg et al. (2014). This study also focuses on randomized control trials, and the purpose was to examine the effect of different resuscitative fluids on mortality in patients with sepsis. Since this article is a systematic review the hierarchy of evidence level is a level I. This study included fourteen studies, 18,916 patients with 15 direct comparisons. The study explains the difference between balanced crystalloids (lactated ringer's,) and unbalanced crystalloids (normal saline). The article also discusses how the presence of buffering substances and chloride content is often overlooked when resuscitative fluids are being chosen in the clinical setting and is not really reported in clinical trials, and that this needs to change. The study concluded that among patients with sepsis, resuscitation with balanced crystalloids or albumin compared with other fluids seems to be associated with reduced mortality (Rochwerg et al., 2014). The study selected parallel group RCT, including factorial designs but excluded quasirandomized and crossover trials (Rochwerg et al., 2014).
Article # 3
The third study is a systematic review of randomized control trials is a level 1 study by Zong et al (2013). The objective of this study was to assess the effects on mortality and safety of using different colloid solutions in patients with sepsis who require volume replacement by direct comparisons of colloid solutions. This study reviewed seventeen randomized clinical trials with a total of 1281 participants that met their inclusion criteria, the rate of mortality was obtained from all trials. The colloids considered for this study were dextran, HES, modified gelatins, and albumin (Zhong et al., 2013). The study concluded that there is no evidence that one colloid solution is more effective and safer than another for fluid resuscitation in sepsis (Zhong et al., 2013). The hierarchy evidence level for this study is a level I, because it s a systematic review.
Article # 4
The third article is quantitative cohort study by Guirgis, 2015). The information obtained was through retrospective chart review. The objective of this study was to evaluate the relationship of intravenous fluid chloride content to kidney function in patients with severe sepsis or septic shock. A retrospective chart review was performed to determine quantity and type of bolus intravenous fluids, serum creatinine, at presentation and upon discharge, and the need for emergent hemodialysis or renal replacement therapy (Guirgis et al., 2015). This study concluded that chloride administered in the first 24 hours did not influence kidney function with severe sepsis or septic shock (Guirgis et al, 2015). The hierarchy evidence level for this study is level IV, because it is a cohort study.
Article # 5
The fifth article is a pilot randomized controlled trial by Mcintyre (2012). The purpose of this study was to describe the fluid resuscitation with 5% albumin versus normal saline in early septic shock (PRECISE) pilot trial study design and report feasibility of patient recruitment This study conduced a concealed, double blind, randomized, controlled trial in six academic emergency departments and intensive care units across Canada. A total of 51 eligible patients were recruited with staggered start dates. The information found in this study may also help researchers in the design and implementation of future clinical trials. This study concluded that the PRECISE pilot trial demonstrates that clinicians can identify patients with early septic shock and recruit them into a trial in a timely manner. A large trial comparing albumin to normal saline for the early resuscitation of patients with septic shock with a sample size adequate to assess the effect of treatment on 90 day mortality is being planned (Mcintyre et al, 2012).
Consistencies Inconsistiences and Contradictions

The first three articles discussed all provide strong evidence for their findings. These first three studies are all systematic reviews and are randomized control trials. In an experimental or randomized control trial, researchers are active agents not passive observers. Controlled experiments are considered the gold standard for yielding reliable evidence about causes and effects (Polit & Beck, 2017). In the first three studies, there were no inconsistencies or contraindications found. Each of those three studies had a little bit of a different focus but the information discussed was the same. The fourth article was a cohort study that was a retrospective chart review. Studies with a retrospective design are ones in which a phenomenon existing in the present is linked to phenomena that occurred in the past (Polit & Beck, 2017). This study focused on the effects of chloride content to kidney function in septic patients. The information revealed in this study correlated with the information and knowledge discussed in the previous studies. The problem with retrospective studies is that recollection is usually less accurate than simultaneous measurement (Polit & Beck, 2017). The last article discussed was a randomized control pilot trial. A pilot study is a trial run of a study done in preparation for a major study; it is designed to assess the feasibility of, and to support the improvement of the protocols, methods, and procedures to be used in a clinical trial (Pilot & Beck, 2017). This study's focus was different but the knowledge discussed was consistent with the other articles discussed.
Summary
In performing a literature review and searching for articles on the topic of sepsis and fluid resuscitation much of the knowledge on this topic was the same and it correlated. It is important to narrow down one's search and know how to eliminate irrelevant articles. Performing this literature review allowed for further exploration of the PICOT question developed. It also demonstrated the importance of developing a well-structured research question. Performing the research allowed for an increase in knowledge on this subject and to explore the most current evidence based practice. State how the evidence answered the PICOT question.
References
Guirgis, F. W., Williams, D. J., Hale, M., Bajwa, A. A., Shujaat, A., Patel, N., & ... Dodani, S. (2015). The relationship of intravenous fluid chloride content to kidney function in patients with severe sepsis or septic shock. American Journal Of Emergency Medicine, 33(3), 439-443 5p. doi:10.1016/j.ajem.2014.12.013
McIntyre, L. A., Fergusson, D. A., Cook, D. J., Rowe, B. H., Bagshaw, S. M., Easton, D., & ... Zarychanski, R. (2012). Fluid resuscitation with 5% albumin versus normal saline in early septic shock: A pilot randomized, controlled trial.Journal Of Critical Care, 27(3), 317.e1-6 1p. doi:10.1016/j.jcrc.2011.10.007
Owyang, C. G., & Shah, K. H. (2015). Are balanced crystalloids the preferred resuscitation fluid for severe sepsis and septic shock?. Annals Of Emergency Medicine, 66(5), 523-525 3p. doi:10.1016/j.annemergmed.2015.02.022
Polit, D. F., & Beck, C. T. (2017). Nursing research: Generating and assessing evidence for nursing practice (10th ed.). Philadelphia, PA: Wolters Kluwer.
Rochwerg, B., Alhazzani, W., Sindi, A., Heels-Ansdell, D., Thabane, L., Fox-Robichaud, A., & ... Annane, D. (2014). Fluid resuscitation in sepsis: a systematic review and network meta-analysis. Annals Of Internal Medicine, 161(5), 347-355 9p. doi:10.7326/M14-0178
Zhong, J., Wei, D., Pan, H., Chen, Y., Liang, X., Yang, Z., & Tang, H. (2013). Colloid solutions for fluid resuscitation in patients with sepsis: systematic review of randomized controlled trials. Journal Of Emergency Medicine (0736-4679),45(4), 485-495 11p. doi:10.1016/j.jemermed.2013.05.018
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