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DATE STAMP | A S S I G N M E N T C O V E R S H E E TPlease complete all fields below. | PART A – to be completed by Student (please print clearly) | PART B – For Lecturer use | Surname: Thamilselvan | Date received | Date returned to PVC Office | First Name: Gayatri Pravina | | | Student I D:15481483 | | Unit Name: Evidence Informed Clinical Practice | Unit Number:5005 | Assignment Number:1 | Assignment Title: Evidence | Due Date: 08 April 2016 | | | Lecturer’s Name: Professor
Gavin Leslie | Tutorial Group No (Please circle one of tutorials): T1 T2 T3 T4 T5 T6 | | | Class Day and Time: nil | Student comments tolecturer (if any) | | Please read the following and sign where indicatedDECLARATION: I declare the attached assignment is my own work and has not previously been submitted for assessment. This work complies with Curtin University of Technology rules concerning plagiarism and copyright. [Refer to www.policies.curtin.edu.au/documents/unit_outlines_plagiarism_state.doc for plagiarism and copyright information.] I have retained a copy of this assignment for my own records. Signed: Date: | PART C – to be completed by Lecturer: Comments to Student | | | | | | | | | | | | Recorded Mark: | | Lecturer: | | Date: |

Content Page

﷒1) Introduction

﷒2) Objective

﷒3) Information Source

﷒4) Key search terms and Boolean Operators

﷒5) Critical Appraisal Checklist

﷒6) Conclusion

﷒7) References

Introduction
Nurses are the front liners in many diverse ways of healthcare. Many a time, nurses stand as the primary contact person of witnessing a patient who collapse and reach a state of cardiac arrest (Heng, Seow & Tham, 2011). Therefore, the nurses’ response following that is crucial, showing how essential it is for a nurse to be well-educated with resuscitation skills to not only provide quality care but also to enhance survival rate of patients. The Advance Cardiac Life Support course is an important module to for medical staff undergoing training in advanced resuscitation practices. In Singapore, to enhance high performance in emergency response and to increase the knowledge during resuscitation they have originated the Life Support Course for Nurses (LSCN) in Singapore (Heng, Seow & Tham, 2011).

Objective

Life support course for nurses (LSCN), equip candidates to use critical thinking and to link theory knowledge into practice in caring for collapsed-patients, especially cardiac-arrested patients, in hospitals and clinics (SGH, 2013). Moreover, the course teaches useful skills pertaining to cardiopulmonary resuscitation and also helps you to analyse cardiac arrhythmias with the acquired knowledge.

According to Heng, Seow and Tham (2011), they mentioned that one of the factors preventing a nurse to participate during resuscitation could be the lack of confidence and also the anxiety of harming the patient due to lack of exposure to resuscitation. Thus, LSCN is a structured course which moulds a nurse to become more confident participating during resuscitation with the acquired skills and knowledge ( Heng, Seow & Tham , 2011). Charles, Lateef, & Anantharaman, (2002), stated that stimulation training is one of the essential way to boost a person’s self confidence. In the course of LSCN, one of the stages of training and assessment would be a simulation practice whereby nurses experience how a resuscitation would be like. The engagement during the simulation helps nurses to be familiarise with the resuscitation and allows them to put their knowledge to practice. There are abundant research studies done on simulation training to facilitate the increase in nurses’ confidence-level. However, currently no research has been done to prove that LSCN boosts the confidence in nurses.
PICO Question The PICO format was used suitably to create a clinical research question . PICO is described as the patient or problem, intervention, comparison and outcome (Wilczynski & McKibon, 2013).

The study is to determine whether there would be a significant increase in confidence level during resuscitation by LSCN-trained Registered Nurses (RN).

PICO Question Population | Registered Nurses | Intervention | LSCN (Life Support Course for Nurses) | Comparison | Nil | Outcome | To increase confidence level during resuscitation |

Information sources
With the use of electronic databases such as PubMed, The Cochrane Library, ScienceDirect , Cinahl (EBSCO) and MedLine , a well regulated search was rendered . Additional hand searches were performed to find journal of simulation based resuscitation, self efficacy in emergency response . The reference list of selected journals were filtered with the use of hand search within the time frame between 2000 to 2016. Singhealth Alice Lee Institute of Advance Nursing website was searched for the current guidelines and competencies for the LSCN course.

There were significant key terms used to aid the search engine . The key terms were categorized into primary and secondary searches. Primary search key terms were simulation based learning, advanced cardiac , life support, adult resuscitation and registered nurses . The secondary search key terms were performance measurement , confidence level, competencies and self-efficacy. There were no limitations of years restricted using the database searches in order to collate all applicable references. However the only limitation in all the searches were , English Language journals and articles.

Key search terms and Boolean Operators
Selected key terms such as resuscitation and registered nurses were put together to enhance and to broaden a widespread of references. Many references were found using the key search terms .However ,only the relevant references pertaining to the research question were considered as useful literature review while they rest were carefully filtered out.

The common two examples of Boolean commands are ‘AND’ , the other command would be ‘OR’ are commonly used to join key terms which enhances the search engine to provide a wide range of informative references (Wilczynski & McKibon, 2013). Nesting is a form of search in Boolean operators which groups several keyword searches into a summarized search (Wilczynski & McKibon, 2013). With the use of nesting , key terms such as confidence , resuscitation and emergency response were searched.Cinahl (EBSCO) database search (see table 1) was used to merge the primary and secondary key search terms such as ‘registered nurses’ was joined with ‘AND resuscitation’ resulted in filtering out the other possible significant references. Some of the references found were eliminated as they did not meet the inclusion and exclusion criteria based on this review. Inclusion criteria references were based on resuscitation and emergency response.

However, some of the articles did not focus on registered nurses and they had a comparison between medical students and allied health .Hence, these articles fell into the exclusion criteria reference list. Inclusion criteria references were full text articles and journals which were published in English. Most importantly the selected reference list researches had been carried out in those reviews with a methodology and guidelines.
Search Results
Detailed searches were performed using various databases and the results were compared against the different databases to eliminate the unnecessary information which did not fit into the criteria based on the review. Key words were used within the databases to enhance a thorough search . Out of the 340 retrieved references , there were 34 significant references were appropriate to be further critiqued after excluding the database identicals. Some of the references were not eligible after reading the abstracts as they were including student nurses and doctors which did not fit into the PICO question. Thus, these results in 9 suitable full- text articles . Three additional references were found with the use of hand search which were included in the reference line up. The summary of the selected articles were outlined in a PRSIMA FLOW diagram (figure 1). The summary of all the references were listed (table 2).
Critical Appraisal Checklist
The appraisal tool used to critique the research were based on the level of evidence and the study design of the research. Critical Appraisal System Programme (CASP) website was accessed to critique the literature reviews and the quantitative researches (CASP, 2016). Joanna Briggs Institute Level of Evidence tools were used to grade the quality of the research articles ( The Joanna Briggs Institute, 2014). The three papers that were chosen for Assessment 2 are listed below.
Arnold, J. J., Johnson, L. M., Tucker, S. J., Chesak, S. S., & Dierkhising, R. A. (2013). Comparison of Three Simulation-Based Teaching Methodologies for Emergency Response. Clinical Simulation in Nursing, 9(3), e85-e93. doi:10.1016/j.ecns.2011.09.004

Hamilton, R. (2004). Nurses’ knowledge and skill retention following cardiopulmonary resuscitation training: a review of the literature. Journal of Advanced Nursing 51(3), 288–297.

Makinen, M., Niemi-Murola, L., Kaila, M., & Castren, M. (2009). Nurses' attitudes towards resuscitation and national resuscitation guidelines--nurses hesitate to start CPR-D. Resuscitation, 80(12), 1399-1404. doi:10.1016/j.resuscitation.2009.08.025

These three papers were based on different levels of evidences; a randomized controlled trial study (Arnold, Johnson, Tucker, Chesak, & Dierkhising, 2013),a systemic literature review (Hamilton, 2004) and a cross sectional quantiative study (Makinen, Niemi-Murola, Kaila, & Castren, 2009).

CASP has an appropriate checklist tool to review randomised controlled trials, hence it was used to appraise (Arnold et al., 2013)while Makinen et al., 2009 were appraised using Reading Research Worksheets by Davis and Logan (CASP, 2013;Davis & Logan, 2008). In overall these three papers were the best amongst the eight articles that were listed out in the references. All three chosen articles had a strong foundation and realistic framework. Moreover, they had an idealistic structures and solid grounds which are favourable to lead the PICO question for the next paper.
Conclusion
Many studies done have identified the constant barriers that prevent nurses from performing optimally to their ability-best during resuscitation. This includes a decreased confidence level, a perception that they might cause harm to the patient or themselves in view of a lack of understanding and interpreting electrocardiogram (ECG) rhythm and also a lack of exposure to resuscitative situation. Thus, whether being certified with LSCN would help in effective resuscitation would be appraised in detail with evidence in comparison to the three chosen research articles to facilitate the PICO question on the next paper for this module.

Search Number | Key Word Search Broadened By Boolean Operators ___________________________ Search TotalCombination Results | Key Word Search Results Narrowed By Boolean Operators___________________________ Search TotalCombination Results | S1S2S3S4S5S6 | Resuscitat*ion AND registerednursesconfidence AND knowledgeemergency ORefficacyperform*anceORsimulationcritical careANDResus*cardiac arrestORlife support | N=1230N=630N=434N=1294N=343N=211 | S1 AND S5 60S2 AND S4 36S4 AND S5 64S5 AND S3 23S4 AND S6 14S1 AND S2 39S1 AND S4 53S4 AND S3 10S5 AND S2 14S3 AND S6 2 |
TABLE 1
Cinahl (EBSCO) Database Search Strategy
Note. Boolean Operators – Resuscitat*ion = resuscitate, resuscitating, ; perform*ance = perform ,performing, performed ; AND = combines search ; OR = either search term, widens search (Aveyard, 2014) .
Identification
Identification
Additional records identified through other sources (n =3)

Additional records identified through other sources (n =3)

Records identified through database searching
(n = 160)

Records identified through database searching
(n = 160)

PRISMA Flow Diagram (Figure 1)

Records after duplicates (100) removed (n = 63)

( (n =2) (n =2)

Records after duplicates (100) removed (n = 63)

( (n =2) (n =2)

Screening
Screening

Records screened
(n = 63)
Records screened
(n = 63) Records excluded (n = 30)

\
(n= 30)

Records excluded (n = 30)

\
(n= 30)

Included
Included
Eligibility
Eligibility

El
El

Full-Text articles assessed for eligibility
N

(n=

Full-Text articles assessed for eligibility
N

(n=

Full-Text articles excluded with reasons
(n = 20)

(n = 20)

Full-Text articles excluded with reasons
(n = 20)

(n = 20)

Studied included in qualitative synthesis

(n =
Studied included in qualitative synthesis

(n =

Studied included in quantitative synthesis (n =
Studied included in quantitative synthesis (n =

(Moher, Liberati, Tetzlaff, & Altman, 2009)

Author (Date) | Aim of study/paper | Type of study/information | Level of Evidencea | Samplesize | Main findings/conclusions | Strengths/Limitations | | | | | | | |

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