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MSN5300 Rev. 1.2020

MSN5300: Advanced Nursing Inquiry, Research, and Evidence-Based Practice Section: 1 C Team:_ Group 5

Group #5 section 1-C:

Katia Lopez De Mendoza, Maricela Mayo San Luis, Marlenis Perez Camargo, Dunieski Pina Angulo,

Yadira Pulido Pena, Urbicio Reinoso Hernandez, Maribel Ruiz Sanchez, Kenia Sanchez, YAnetsys

Veliz Alfonso, Hazel Zaldivar Hernandez.

Prof. Idania Martin

Advanced Nursing Inquiry and Evidence Based Practice

C r i t i c a l A

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p p r a i s a l W o r k s h e e t f o r G r o u p P r o j e c

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t 2 , P a r t b

Elements of Ap- praisal

Discussion

Study Design

Was the study a qualitative or quantitative de- sign? Explain.

The study by Simpson, Goans, Loh, Ryall, Middleton, and Dalton (2021) was a

quantitative design study. This is because the study involved the collection of

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numerical data and statistical analysis to evaluate the performance of the Colum-

bia Suicide Severity Rating Scale Screener in identifying suicide risk among pa-

tients in the emergency department. The study also used a comparison group,

which is a hallmark of a quantitative design. The results of the study were re-

ported in terms of statistical measures, such as sensitivity and specificity, rather

than through

descriptive narratives or interpretations of personal experiences.

Practice Problem

State the practice problem/issue that is the fo- cus of the study.

How does this practice problem/issue affect your nursing practice?

The practice problem or issue that is the focus of the study is the sensitivity of

the Columbia Suicide Severity Rating Scale (CSSRS) in identifying suicide

risk among patients after emergency department discharge. This study aims to

examine the performance characteristics of the CSSRS in detecting suicidal

ideation and assessing suicide risk in patients after they are discharged from the

emergency department.

This practice problem affects nursing practice by highlighting the importance

of early suicide risk identification and the need for accurate and reliable assess-

ment tools to identify patients who are at risk of self-harm and suicide. In the

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medical-

surgical unit, nurses play a crucial role in identifying patients at risk of suicide and

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taking the necessary steps to reduce their risk of self-harm. The results of this

study can inform nursing practice by providing valuable information on the ef-

fectiveness of the CSSRS in detecting suicide risk and informing the develop-

ment of evidence- based nursing interventions to reduce self-harm habits.

Study Purpose

State the purpose of the study.

Discuss whether this study was feasible to con- duct in terms of money commitment; the re- searchers' expertise; availability of subjects, and ethical considerations.

The purpose of the study by Simpson et al. (2021) was to examine the perfor-

mance characteristics of the Columbia-Suicide Severity Rating Scale

(CSSRS) in identifying suicide risk among patients who had been discharged

from the emergency department. The study aimed to assess whether the

CSSRS effectively detect suicidal ideation in patients who had recently pre-

sented at the emergency department with a suicide-related concern and to

evaluate the feasibility of using the CSSRS to screen patients for suicide risk

in the medical-surgical unit.

The study has been adequately funded in terms of feasibility, as the authors do

not mention any financial constraints or limitations. The authors have relevant

expertise in emergency medicine and suicidology, which suggests they had

the

necessary skills and experience to conduct the study. The availability of subjects

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was not mentioned as a limitation. Still, the study was likely conducted in a

large hospital with a significant number of patients presenting with suicide-re-

lated concerns, providing sufficient subjects for the study. The study was con-

ducted in accordance with ethical standards, as the authors mention obtaining

informed consent from patients and maintaining confidentiality in their han-

dling of patient information.

Review of Literature

Was the literature review organized to show the progressive development of evidence from pre- vious research?

Was a clear, concise summary presented of the current empirical and theoretical knowl- edge in the area of the study?

Did the literature review summary identify what was known and not known about the research problem? Did it logically direct the research pur- pose?

The literature review in the study by Simpson et al. (2021) does not appear to

show the progressive development of evidence from previous research, as the fo-

cus of the study is specifically on the performance characteristics of the Colum-

bia Suicide Severity Rating Scale Screener.

A clear and concise summary of the current empirical and theoretical knowledge

in the area of the study is not presented in the article. The article focuses solely

on the results and discussion of the study and does not include a comprehensive

literature

review.

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The literature review summary in the article does not seem to identify what is

known and not known about the research problem, as it is not present in the

article. The purpose of the study is to evaluate the performance characteristics

of the Columbia Suicide Severity Rating Scale Screener, so it logically directs

the research purpose.

Theoretical Framework

Is a conceptual model or theoretical framework used? If so, is it presented with clarity? Does it adequately explain the phenomenon of concern?

Is the framework linked to the research pur- pose? If not, would another framework fit more logically with the study?

If a proposition or relationship from a theory is to be tested, is the proposition clearly identified and linked to the study hypothesis?

The study by Simpson et al. (2021) does not present a clear conceptual model

or theoretical framework. Instead, the study focuses on evaluating the perfor-

mance characteristics of the Columbia-Suicide Severity Rating Scale (C-

SSRS) screener for identifying suicide risk in patients who have been dis-

charged from the emergency department. The study does not link the frame-

work to the research purpose and it is not clear if another framework would fit

more logically with the study.

The study does not test a proposition or relationship from a theory, but rather

focuses on evaluating the effectiveness of the C-SSRS screener in identifying

suicide risk in patients. The study hypothesis is not clearly identified or linked

to a

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theoretical framework.

Research Question(s) and Hpothesis(es)

What is the research question? Is it clearly stated?

Does the research question match the purpose of the study?

What is the research hypothesis? Is it clearly stated?

Does the hypothesis match the purpose of the study?

Formulate a null hypothesis for this study.

Were the objectives, questions, or hypotheses logically linked to the concepts and relationships (propositions) in the framework? Explain.

The research question of the study is: Does the implementation of the Colum-

bia Suicide Severity Rating Scale (CSSRS) and the application of safety best

practices in emergency departments increase the early identification of suicide

risk and reduce self-harm habits in patients aged 18 years and above?

Yes, the research question is clearly stated.

The research question does match the purpose of the study, which is to evaluate

the performance characteristics of the CSSRS screener for identifying suicide

risk in emergency department patients.

The research hypothesis is not explicitly stated in the study.

Since the hypothesis is not stated, it is not possible to determine if it matches the

purpose of the study.

A possible null hypothesis for this study could be: The implementation of the

Columbia Suicide Severity Rating Scale (CSSRS) and the application of safety

best

practices in emergency departments does not increase the early identification of

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suicide risk and does not reduce self-harm habits in patients aged 18 years and

above.

The objectives, questions, and hypotheses are logically linked to the concepts

and relationships in the framework because the study is evaluating the perfor-

mance characteristics of the CSSRS screener, which is a tool for identifying

suicide risk in emergency department patients. The purpose of the study is to

determine the effectiveness of the CSSRS in identifying suicide risk and reduc-

ing self-harm habits, which is directly related to the concept of suicide risk as-

sessment and the relationships between risk factors and self-harm behaviors.

Variables

List all research variables with corresponding levels of measurement on the NOIR scale.

Do variables represent the concepts identified in the framework?

How is each study variable defined (both concep- tually and operationally)?

Are conceptual definitions of variables consistent with operational definitions?

The research variables in the study by Simpson et al. (2021) are as follows:

Suicide risk: The dependent variable, represented by the scores on the Co-

lumbia Suicide Severity Rating Scale (CSSRS). The level of measurement is

ordinal.

Age: A demographic variable, represented by the age of the patients. The level

of measurement is interval.

Emergency department (ED) discharge: A timing variable, representing the

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discharge status of patients from the ED. The level of measurement is nominal.

Suicidal ideation: An independent variable, represented by the presence or ab-

sence of suicidal thoughts. The level of measurement is nominal.

Early suicide risk identification: The outcome variable, represented by the abil-

ity to accurately identify patients with a high risk of suicide. The level of mea-

surement is ordinal.

The variables represent the concepts identified in the framework of the PICOT

question, as the study aimed to determine the impact of implementing the

CSSRS on early suicide risk identification in patients aged 18 years and above.

The conceptual definition of the variables are consistent with their operational

definitions. For example, the operational definition of suicide risk is repre-

sented by scores on the CSSRS, while the conceptual definition of suicide risk

refers to the likelihood of a patient attempting or completing suicide. The oper-

ational definition of early suicide risk identification refers to the accuracy of

identifying patients with a high risk of suicide, while the conceptual definition

refers to the process of

identifying patients who are at a higher risk of self-harm behaviors.

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Study Design

What was the design was used in the study? Was it the most appropriate design to answer the study question? Explain.

Was the design logically linked to the sampling method and statistical analyses?

Did the design provide a means to examine all objectives, questions, or hypotheses?

If there was an intervention (treatment) in the study:

– what was the intervention? was it clearly described?

– was the treatment appropriate for examining the study purpose and hypotheses?

– did the study framework explain the links between the treatment (indepen- dent variable) and the proposed out- comes (dependent variables)?

– were subjects randomly assigned to the treatment group, or were the treatment and comparison groups dependent?

– were the treatment and comparison group assignments appropriate for the purpose of

The design used in the study by Simpson et al. (2021) is a prospective cohort

study. The study was conducted in an emergency department setting and aimed

to assess the performance characteristics of the Columbia Suicide Severity Rat-

ing Scale (CSSRS) in identifying patients with suicidal ideation and suicide

risk.

In terms of the appropriateness of the design to answer the study question, a

prospective cohort study is a suitable design for evaluating the effectiveness of

an intervention, such as the implementation of the CSSRS and a bundle of

safety best practices. The study design allows for the examination of the out-

come of interest (early suicide risk identification and reducing self-harm

habits) over time, following the implementation of the intervention. However,

it may not have been the best design to examine the impact of implementing

the Columbia Suicide Severity Rating Scale and a bundle of safety best prac-

tices in reducing self-harm habits compared to no intervention. A randomized

controlled trial design would have been more suitable to examine the interven-

tion effect and answer this question.

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the study?

– was a protocol developed to pro- mote consistent implementation of the treatment to ensure interven- tion fidelity?

– did the researcher monitor imple- mentation of the treatment to en- sure consistency? How might this impact findings?

The design was logically linked to the sampling method and statistical analy-

ses. The participants were selected from emergency department patients who

had been discharged and had a screening score on the Columbia-Suicide

Severity Rating Scale. The statistical analyses used included sensitivity, speci-

ficity, positive predictive value, and negative predictive value of the screener

in detecting suicidal ideation.

The design provided a means to examine the performance characteristics of the

Columbia-Suicide Severity Rating Scale Screener in detecting suicidal

ideation, but did not provide a means to examine the impact of implementing a

bundle of safety best practices in reducing self-harm habits compared to no in-

tervention. To examine this aspect, a different study design would be required.

Yes, there was an intervention in the study. The intervention was the imple-

mentation of the Columbia Suicide Severity Rating Scale (CSSRS), which is

a tool used to assess the severity of suicide risk, and the application of a bun-

dle of safety best practices.

The intervention was clearly described in the study, and it was appropriate for

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examining the study purpose and hypotheses. The study framework explained the

links between the CSSRS (independent variable) and the proposed outcomes (de-

pendent variables) by evaluating the performance of the CSSRS in identifying

suicide risk after emergency department discharge.

The subjects were not randomly assigned to the treatment group, but the study

compared the performance of the CSSRS to the performance of a standard care

group. The treatment and comparison group assignments were appropriate for the

purpose of the study, as the study was evaluating the performance of the CSSRS.

It is unclear from the study whether a protocol was developed to promote consis-

tent implementation of the CSSRS to ensure intervention fidelity, and whether the

researchers monitored implementation of the CSSRS to ensure consistency.

However, these factors may have had an impact on the findings of the study if

they were not controlled for.

Study Sample

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Were any subjects excluded from the study be- cause of age, socioeconomic status, or ethnic- ity? If so, explain. Was sound rationale pro- vided?

Did the sample include an understudied or vul- nerable population, such as young, elderly, preg- nant, or minority subjects?

What sampling criteria (inclusion and exclusion) were used? Was sampling criteria appropriate for the type of study conducted? Explain.

Were the rights of human subjects protected? Explain.

Was the refusal rate for the study provided? If so:

– was it greater than 20%?

– how might this have affected the representativeness of the sample?

– did the researchers provide rationale for the refusals?

Was the attrition rate for the study provided? If so:

– what was it?

– did the researchers provide a rationale for the attrition of study participants?

According to the study by Simpson et al. (2021), the subjects included in the

study were adults aged 18 years and above who presented to the emergency

department with suicidal ideation or self-harm behaviors. No information was

provided regarding the exclusion of subjects based on age, socioeconomic sta-

tus, or ethnicity.

The study sample included only adults who presented to the emergency de-

partment, which may not be representative of the general population and may

exclude individuals who may be at risk for suicide but do not present to the

emergency department.

The rights of human subjects were protected in the study as the study was ap-

proved by the institutional review board and informed consent was obtained

from each participant.

The sample size in the study was 92,643 patients. The sample size was deter-

mined based on the number of patients who presented to the emergency de-

partment with suicidal ideation or behavior during the study period. The sam-

ple size was chosen to provide sufficient statistical power to detect meaning-

ful differences in the

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– how did attrition influence the final sample as well as study results and findings?

How large is the sample?

How was sample size determined?

performance of the Columbia-Suicide Severity Rating Scale Screener.

Research Instruments

Did the measurement methods selected for the study adequately measure the study variables?

What instruments or tools were used to collect data?

How did you determine if the instruments are valid? reliable?

Respond to the following questions that are relevant to the measurement approaches used in the study:

1. Scales and questionnaires (a) Were the instruments clearly described?

(b) Were techniques for completion and scor- ing of the instruments provided?

(c) Were validity and reliability of the instru- ments described?

(d) Did the researcher reexamine the validity and reliability of instruments for the present sample?

According to the study by Simpson et al. (2021), the Columbia Suicide Sever-

ity Rating Scale (CSSRS) was used as the primary instrument to measure the

outcome of early suicide risk identification. The CSSRS is a validated tool for

the assessment of suicide risk in medical-surgical patients.

(a) Yes, the instrument was clearly described in the study, including the con-

tent and structure of the scale.

(b) Yes, the techniques for completion and scoring of the CSSRS were pro-

vided, including the instructions for the interviewer and the scoring criteria

for each item on the scale.

(c) Yes, the validity and reliability of the CSSRS were described in the study.

The CSSRS has been previously validated and has demonstrated good reli-

ability and validity in a number of different populations.

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(e) If an instrument was developed for the study, was the instrument development process described?

2. Observation (a) Were phenomenon that were to be ob-

served clearly identified and defined?

(b) Was interrater reliability described?

(c) Were techniques for recording observa- tions described?

3. Interviews (a) Did interview questions address con-

cerns expressed in the research prob- lem?

(b) Were interview questions relevant for the research purpose and objectives, questions, or hypotheses? </