Theoretical and Scientific Foundations of Nursing
SEARCH-BASED QUESTIONS
3 years ago 20
discusion.wk.8.SEARCH.docx
AddressingHighRelapseRatesinBipolarPatientsasaQualityImprovementInitiative.edited.docx
PracticeProblemAsaCriticalQuestionwithMeasurableOutcomes.edited1.docx
EvidenceSynthesisandRecommendationForm2.pdf
discusion.wk.8.SEARCH.docx
SEARCH-BASED QUESTIONS
This is a graded discussion: 100 points possible
The Discussion this week invites you to check in with colleagues and your Instructor on your experience as you begin your Module 4 Assignment to conduct a literature search in the Walden Library. This Discussion is a particularly good example of how colleagues can support one another in tandem as common work gets underway.
Note what you are discovering about search strategies that could be of benefit to colleagues, and prepare to consider their recommendations as well. Be sure that you search scholarly literature.
TO PREPARE:
· Review the Week 8 Learning Resources, with particular attention to the Walden Library resources to support your literature search.
· Evaluate your process as you access the resource materials and your literature search gets underway. Keep in mind the importance of selecting current literature, i.e., published in the previous 5 years. Consider what is working for you in identifying search topics related to your critical question and in finding relevant current articles, and what questions you have for colleagues and your Instructor.
· Also draw on your Week 7 Discussion experience in identifying scholarly articles related to your critical question (MENTAL HEALTH/BIPOLAR DISORDER) and comments from colleagues to act on as you begin your literature search. Be proactive in stating your questions and needs and clarifying your search process, to maximize the value of this Discussion and your Assignment in this module..
With these thoughts in mind …
Post a summary of your experience in beginning your literature search and assess your initial progress. Explain what is working for you in terms of a plan or search strategy for finding relevant, current literature, including Walden Library support resources you would recommend. Explain issues of concern and specific questions regarding the search process.
AddressingHighRelapseRatesinBipolarPatientsasaQualityImprovementInitiative.edited.docx
4
Addressing High Relapse Rates in Bipolar Patients as a Quality Improvement Initiative
Synthesis of Articles Selected
Good day, Dr. Barrett. Although effective drugs for the condition are available, bipolar disorder remains one of the significant causes of disability, mortality, and functional decline, significantly reducing patients' quality of life. Rantala et al. (2021) highlight Cognitive-Behavioral Therapy (CBT) as an effective evidence-based strategy for reducing relapse rates in bipolar patients. CBT can help patients recognize and manage symptoms and triggers, enhancing coping skills and reducing the risk of relapse. If individuals with bipolar disorder are not given proper treatment and follow-up, the disorder usually relapses during their lives (McIntyre et al., 2020). For individuals with bipolar disorder, discontinuing medication against the recommendations of mental health specialists may cause a recurrence of mood episodes, delayed remission, and residual symptoms (O'Donovan & Alda, 2020). These outcomes commonly result in hospitalization, heightened risk of suicide, and hindered psychosocial recovery (Rantala et al., 2021). On the other hand, adhering to recommended treatment plans reduces patients' chances of recurrence by spacing out episodes and giving them more time in the euthymic, stable state (O'Donovan & Alda, 2020). Relapse worsens the symptoms of bipolar disorder. Manic and depressive episodes affect patients significantly, disrupting their daily lives. These patients often struggle to function effectively in various life aspects, including work and relationships. Integrated care can ensure comprehensive disorder management (Davarinejad et al., 2021).
Language to Use With Stakeholders
When addressing stakeholders of bipolar disorder EBP QI, including patients, their families, health care professionals, hospital administration, and the broader community, it is essential to communicate in a respectful and empathetic language. An empathetic and supportive tone shows that one understands the problem, acknowledges the challenges individuals and families face, and is determined to bring practical solutions to the problem. Using a language that educates stakeholders about the condition is also essential. Furthermore, it is important to use clear and simple language so that patients unfamiliar with complex medical terms can understand the intended message.
References
Davarinejad, O., Majd, T. M., Golmohammadi, F., Mohamadi, P., Radmehr, F., Nazari, S., & Moradinazar, M. (2021). Factors Influencing the Number of Relapse in Patients with Bipolar I Disorder. Shiraz E-Medical Journal, 22(8).
McIntyre, R. S., Berk, M., Brietzke, E., Goldstein, B. I., López-Jaramillo, C., Kessing, L. V., ... & Mansur, R. B. (2020). Bipolar disorders. The Lancet, 396(10265), 1841-1856.
O'Donovan, C., & Alda, M. (2020). Depression preceding diagnosis of bipolar disorder. Frontiers in psychiatry, 11, 500.
Rantala, M. J., Luoto, S., Borráz-León, J. I., & Krams, I. (2021). Bipolar disorder: An evolutionary psychoneuroimmunological approach. Neuroscience & Biobehavioral Reviews, 122, 28-37.
PracticeProblemAsaCriticalQuestionwithMeasurableOutcomes.edited1.docx
2
Practice Problem as a Critical Question With Measurable Outcome
Student’s Name
Institution
Course number and name
Assignment due date
Practice Problem as a Critical Question With Measurable Outcome
Critical Question
Evidence-based practice quality improvement (EBP QI) is essential in nursing since it helps nurses identify and implement best practices that have been proven to improve patient outcomes. Integrating evidence-based interventions into practice reduces complications, enhances recovery times, and improves overall patient well-being. My practice issue is bipolar disorder. A critical question about bipolar disorder that calls for EBP QI is how nurses can reduce relapse rates in individuals with bipolar disorder.
Bipolar disorder is a mood disorder and a terminal, severe, and recurrent mental issue. People with the disorder experience serious changes in their mood. Although effective drugs for the condition are available, bipolar remains one of the significant causes of disability, mortality, and functional decline, significantly reducing patients' quality of life (Rantala et al., 2021). If bipolar patients are not given proper treatment and follow-up, the disorder usually relapses during their lives. Relapse is a significant therapeutic challenge for individuals with mental illnesses, particularly those with bipolar disorder. It imposes significant economic and societal costs. Relapse is a term used frequently in the mental health delivery system to describe the deterioration of psychiatric patients' conditions and the return of illness following an apparent period of recovery. Bipolar patients who choose to discontinue their medication against the recommendations of mental health specialists may have a recurrence of mood episodes, delayed remission, and residual symptoms. These outcomes commonly result in hospitalization, heightened risk of suicide, and hindered psychosocial recovery (Rantala et al., 2021).
The Value of Addressing High Relapse Rates in Bipolar Patients as a Quality Improvement Initiative.
Focusing on the reduction or relapse rates should be a focus of a quality improvement initiative since relapse undermines outcomes for patients with bipolar disorder. According to research, over 90% of patients with the condition experience relapse during their lifetime, usually within the first two years of an initial episode (Davarinejad et al., 2021). Relapses in bipolar disorder are reasonably common. Numerous studies have been conducted to determine the precise relapse rate but have shown varying results. In summary, the longer one has bipolar disorder, the greater the likelihood of relapse (Davarinejad et al., 2021). On the other hand, sticking to medicine and treatment plans reduces patients' chances of recurrence by spacing out episodes and giving them more time in the euthymic, stable state. One of the significant goals of an evidence-based treatment plan is to keep bipolar disorder from relapsing.
The specific subtype of bipolar disorder influences the frequency of relapse that an individual has. Individuals diagnosed with bipolar II disorder experience a higher frequency of depressive episodes and a comparatively reduced length of euthymic periods in comparison to individuals diagnosed with bipolar I disorder (McIntyre et al., 2020). While Bipolar I and II may appear to be similar, there is a key difference between the two subtypes of the disorder. Individuals with bipolar I experience at least one manic episode in their lifetime. However, those with bipolar II also experience at least one manic episode but the mania is less severe hypomania. When experiencing manic episodes, patients with bipolar I typically experience more severe symptoms that interfere with their daily lives (McIntyre et al., 2020).
The length of an episode subsequent to relapse in individuals with bipolar disorder shows significant variability. The duration of symptoms associated with mania or depression can range from a period of one to two weeks to an extended duration of many months. Several variables influence the duration of symptom manifestation, including the specific subtype of bipolar disorder that an individual has and whether they are undergoing treatment.
Patients with bipolar I disorder who are not undergoing any treatment can have manic episodes lasting for a week to many months in some cases. These patients experience depressive episodes with irregular attacks of hypomania (O'Donovan & Alda, 2020). Hypomania is a less severe type of mania. Episodes of hypomania last at least four days, but depressive episodes typically last longer than that.
The impacts of relapse are significant for bipolar patients. Relapse worsens the symptoms of bipolar. Manic and depressive episodes affect patients significantly, disrupting their daily lives. These patients often struggle to function effectively in various life aspects, including work and relationships (Davarinejad et al., 2021). Individuals with bipolar disorder may also turn to substance abuse as a way of coping with severe mood swings and distress brought on by relapse. Substance abuse significantly affects patient outcomes. It is also important to note that after relapse, some patients may become less compliant with treatment plans, worsening their condition (Davarinejad et al., 2021). Given the adverse effects of bipolar disorder relapse, there is a need for EBP QI aiming to reduce relapse rates.
References
Davarinejad, O., Majd, T. M., Golmohammadi, F., Mohamadi, P., Radmehr, F., Nazari, S., & Moradinazar, M. (2021). Factors Influencing the Number of Relapse in Patients with Bipolar I Disorder. Shiraz E-Medical Journal, 22(8).
McIntyre, R. S., Berk, M., Brietzke, E., Goldstein, B. I., López-Jaramillo, C., Kessing, L. V., ... & Mansur, R. B. (2020). Bipolar disorders. The Lancet, 396(10265), 1841-1856.
O'Donovan, C., & Alda, M. (2020). Depression preceding diagnosis of bipolar disorder. Frontiers in psychiatry, 11, 500.
Rantala, M. J., Luoto, S., Borráz-León, J. I., & Krams, I. (2021). Bipolar disorder: An evolutionary psychoneuroimmunological approach. Neuroscience & Biobehavioral Reviews, 122, 28-37.
EvidenceSynthesisandRecommendationForm2.pdf
© 2017 The Johns Hopkins Hospital/ Johns Hopkins University School of Nursing
Synthesis Process and Recommendations Tool
Key Points:
• Evidence synthesis is best done through group discussion. All team members share
their perspectives, and the team uses critical thinking to arrive at a judgment based
on consensus during the synthesis process. The synthesis process involves both
subjective and objective reasoning by the full EBP team. Through reasoning, the
team:
▪ Reviews the quality appraisal of the individual pieces of evidence
▪ Assesses and assimilates consistencies in findings
▪ Evaluates the meaning and relevance of the findings
▪ Merges findings that may either enhance the team’s knowledge or
generate new insights, perspectives, and understandings
▪ Highlights inconsistencies in findings
▪ Makes recommendations based on the synthesis process
• When evidence includes multiple studies of Level I and Level II evidence, there is
a similar population or setting of interest, and there is consistency across findings,
EBP teams can have greater confidence in recommending a practice change.
However, with a majority of Level II and Level III evidence, the team should
proceed cautiously in making practice changes. In this instance,
recommendation(s) typically include completing a pilot before deciding to
implement a full-scale change.
• Generally, practice changes are not made on Level IV or Level V evidence alone.
Nonetheless, teams have a variety of options for actions that include, but are not
limited to: creating awareness campaigns, conducting informational and educational
updates, monitoring evidence sources for new information, and designing research
studies.
© 2017 The Johns Hopkins Hospital/ Johns Hopkins University School of Nursing
• The quality rating (see Appendix D) is used to appraise both individual quality of
evidence and overall quality of evidence.
© 2017 The Johns Hopkins Hospital/ Johns Hopkins University School of Nursing
Date:
EBP Question:
Article
Number
Author and Date
Evidence Type
Sample, Sample
Size, Setting
Findings That
Help Answer the EBP Question
Observable Measures
Limitations
Evidence Level,
Quality
Johns Hopkins Nursing Evidence-Based Practice
Appendix H Synthesis Process and Recommendations Tool
© 2017 The Johns Hopkins Hospital/ Johns Hopkins University School of Nursing
EBP Question:
Category (Level Type) Total Number of Sources/Level
Overall Quality Rating
Synthesis of Findings Evidence That Answers the EBP Question
Level I
▪ Experimental study ▪ Randomized controlled trial (RCT)
▪ Systematic review of RCTs with or without meta-analysis
▪ Explanatory mixed method design that includes only a Level I quaNtitative study
Level II
▪ Quasi-experimental studies
▪ Systematic review of a combination of RCTs and quasi-experimental studies, or quasi- experimental studies only, with or without meta-analysis
▪ Explanatory mixed method design that includes only a Level II quaNtitative study
Level III
▪ Nonexperimental study ▪ Systematic review of a combination of RCTs,
quasi-experimental and nonexperimental studies, or nonexperimental studies only, with or without meta- analysis
▪ QuaLitative study or meta- synthesis
▪ Exploratory, convergent, or multiphasic mixed-methods studies
▪ Explanatory mixed method design that includes only a level III QuaNtitative study
Johns Hopkins Nursing Evidence-Based Practice
Appendix H Synthesis Process and Recommendations Tool
© 2017 The Johns Hopkins Hospital/ Johns Hopkins University School of Nursing
Category (Level Type) Total Number of Sources/Level
Overall Quality Rating
Synthesis of Findings
Evidence That Answers the EBP Question
Level IV
▪ Opinions of respected authorities and/or reports of nationally recognized expert committees or consensus panels based on scientific evidence
Level V
▪ Evidence obtained from literature or integrative reviews, quality improvement, program evaluation, financial evaluation, or case reports
▪ Opinion of nationally recognized expert(s) based on experiential evidence
Johns Hopkins Nursing Evidence-Based Practice
Appendix H Synthesis Process and Recommendations Tool
© 2017 The Johns Hopkins Hospital/ Johns Hopkins University School of Nursing
Based on your synthesis, which of the following four pathways to translation represents the overall strength of the evidence?
❑Strong, compelling evidence, consistent results: Solid indication for a practice change is indicated.
❑Good and consistent evidence: Consider pilot of change or further investigation.
❑Good but conflicting evidence: No indication for practice change; consider further investigation for new evidence or develop a research study.
❑Little or no evidence: No indication for practice change; consider further investigation for new evidence, develop a research study, or discontinue project.
If you selected either the first option or the second option, continue. If not, STOP , translation is not indicated.
Recommendations based on evidence synthesis and selected translation pathway
Consider the following as you examine fit:
Are the recommendations:
▪ Compatible with the unit/departmental/organizational cultural values or norms?
▪ Consistent with unit/departmental/organizational assumptions, structures, attitudes, beliefs, and/or
practices?
▪ Consistent with the unit/departmental/organizational priorities?
Consider the following as you examine feasibility:
▪ Can we do what they did in our work environment?
▪ Are the following supports available?
• Resources
• Funding
• Approval from administration and clinical leaders
• Stakeholder support
• Is it likely that the recommendations can be implemented within the unit/department/organization?
Johns Hopkins Nursing Evidence-Based Practice
Appendix H Synthesis Process and Recommendations Tool
© 2017 The Johns Hopkins Hospital/ Johns Hopkins University School of Nursing
Directions for Use of This Form
Purpose of form
Use this form to compile the results of the individual evidence appraisal to answer the EBP question. The
pertinent findings for each level of evidence are synthesized, and a quality rating is assigned to each level.
Total number of sources per level
Record the number of sources of evidence for each level.
Overall quality rating
Summarize the overall quality of evidence for each level. Use Appendix D to rate the quality of evidence.
Synthesis of findings: evidence that answers the EBP question
• Include only findings from evidence of A or B quality.
• Include only statements that directly answer the EBP question.
• Summarize findings within each level of evidence.
• Record article number(s) from individual evidence summary in parentheses next to each statement
so that the source of the finding is easy to identify.
Develop recommendations based on evidence synthesis and the selected translation pathway
Review the synthesis of findings and determine which of the following four pathways to translation
represents the overall strength of the evidence:
• Strong, compelling evidence, consistent results: Solid indication for a practice change.
• Good and consistent evidence: Consider pilot of change or further investigation.
• Good but conflicting evidence: No indication for practice change; consider further investigation for
new evidence or develop a research study.
• Little or no evidence: No indication for practice change; consider further investigation for new
evidence, develop a research study, or discontinue the project.
Fit and feasibility
Even when evidence is strong and of high quality, it may not be appropriate to implement a change in
practice. It is crucial to examine feasibility that considers the resources available, the readiness for
change, and the balance between risk and benefit. Fit refers to the compatibility of the proposed change
with the organization’s mission, goals, objectives, and priorities. A change that does not fit within the
organizational priorities will be less likely to receive leadership and financial support, making success
difficult. Implementing processes with a low likelihood of success wastes valuable time and resources on
efforts that produce negligible benefits.
Johns Hopkins Nursing Evidence-Based Practice
Appendix H Synthesis Process and Recommendations Tool
© 2017 The Johns Hopkins Hospital/ Johns Hopkins University School of Nursing
References
discusion.wk.8.SEARCH.docx
SEARCH-BASED QUESTIONS
This is a graded discussion: 100 points possible
The Discussion this week invites you to check in with colleagues and your Instructor on your experience as you begin your Module 4 Assignment to conduct a literature search in the Walden Library. This Discussion is a particularly good example of how colleagues can support one another in tandem as common work gets underway.
Note what you are discovering about search strategies that could be of benefit to colleagues, and prepare to consider their recommendations as well. Be sure that you search scholarly literature.
TO PREPARE:
· Review the Week 8 Learning Resources, with particular attention to the Walden Library resources to support your literature search.
· Evaluate your process as you access the resource materials and your literature search gets underway. Keep in mind the importance of selecting current literature, i.e., published in the previous 5 years. Consider what is working for you in identifying search topics related to your critical question and in finding relevant current articles, and what questions you have for colleagues and your Instructor.
· Also draw on your Week 7 Discussion experience in identifying scholarly articles related to your critical question (MENTAL HEALTH/BIPOLAR DISORDER) and comments from colleagues to act on as you begin your literature search. Be proactive in stating your questions and needs and clarifying your search process, to maximize the value of this Discussion and your Assignment in this module..
With these thoughts in mind …
Post a summary of your experience in beginning your literature search and assess your initial progress. Explain what is working for you in terms of a plan or search strategy for finding relevant, current literature, including Walden Library support resources you would recommend. Explain issues of concern and specific questions regarding the search process.
AddressingHighRelapseRatesinBipolarPatientsasaQualityImprovementInitiative.edited.docx
4
Addressing High Relapse Rates in Bipolar Patients as a Quality Improvement Initiative
Synthesis of Articles Selected
Good day, Dr. Barrett. Although effective drugs for the condition are available, bipolar disorder remains one of the significant causes of disability, mortality, and functional decline, significantly reducing patients' quality of life. Rantala et al. (2021) highlight Cognitive-Behavioral Therapy (CBT) as an effective evidence-based strategy for reducing relapse rates in bipolar patients. CBT can help patients recognize and manage symptoms and triggers, enhancing coping skills and reducing the risk of relapse. If individuals with bipolar disorder are not given proper treatment and follow-up, the disorder usually relapses during their lives (McIntyre et al., 2020). For individuals with bipolar disorder, discontinuing medication against the recommendations of mental health specialists may cause a recurrence of mood episodes, delayed remission, and residual symptoms (O'Donovan & Alda, 2020). These outcomes commonly result in hospitalization, heightened risk of suicide, and hindered psychosocial recovery (Rantala et al., 2021). On the other hand, adhering to recommended treatment plans reduces patients' chances of recurrence by spacing out episodes and giving them more time in the euthymic, stable state (O'Donovan & Alda, 2020). Relapse worsens the symptoms of bipolar disorder. Manic and depressive episodes affect patients significantly, disrupting their daily lives. These patients often struggle to function effectively in various life aspects, including work and relationships. Integrated care can ensure comprehensive disorder management (Davarinejad et al., 2021).
Language to Use With Stakeholders
When addressing stakeholders of bipolar disorder EBP QI, including patients, their families, health care professionals, hospital administration, and the broader community, it is essential to communicate in a respectful and empathetic language. An empathetic and supportive tone shows that one understands the problem, acknowledges the challenges individuals and families face, and is determined to bring practical solutions to the problem. Using a language that educates stakeholders about the condition is also essential. Furthermore, it is important to use clear and simple language so that patients unfamiliar with complex medical terms can understand the intended message.
References
Davarinejad, O., Majd, T. M., Golmohammadi, F., Mohamadi, P., Radmehr, F., Nazari, S., & Moradinazar, M. (2021). Factors Influencing the Number of Relapse in Patients with Bipolar I Disorder. Shiraz E-Medical Journal, 22(8).
McIntyre, R. S., Berk, M., Brietzke, E., Goldstein, B. I., López-Jaramillo, C., Kessing, L. V., ... & Mansur, R. B. (2020). Bipolar disorders. The Lancet, 396(10265), 1841-1856.
O'Donovan, C., & Alda, M. (2020). Depression preceding diagnosis of bipolar disorder. Frontiers in psychiatry, 11, 500.
Rantala, M. J., Luoto, S., Borráz-León, J. I., & Krams, I. (2021). Bipolar disorder: An evolutionary psychoneuroimmunological approach. Neuroscience & Biobehavioral Reviews, 122, 28-37.
PracticeProblemAsaCriticalQuestionwithMeasurableOutcomes.edited1.docx
2
Practice Problem as a Critical Question With Measurable Outcome
Student’s Name
Institution
Course number and name
Assignment due date
Practice Problem as a Critical Question With Measurable Outcome
Critical Question
Evidence-based practice quality improvement (EBP QI) is essential in nursing since it helps nurses identify and implement best practices that have been proven to improve patient outcomes. Integrating evidence-based interventions into practice reduces complications, enhances recovery times, and improves overall patient well-being. My practice issue is bipolar disorder. A critical question about bipolar disorder that calls for EBP QI is how nurses can reduce relapse rates in individuals with bipolar disorder.
Bipolar disorder is a mood disorder and a terminal, severe, and recurrent mental issue. People with the disorder experience serious changes in their mood. Although effective drugs for the condition are available, bipolar remains one of the significant causes of disability, mortality, and functional decline, significantly reducing patients' quality of life (Rantala et al., 2021). If bipolar patients are not given proper treatment and follow-up, the disorder usually relapses during their lives. Relapse is a significant therapeutic challenge for individuals with mental illnesses, particularly those with bipolar disorder. It imposes significant economic and societal costs. Relapse is a term used frequently in the mental health delivery system to describe the deterioration of psychiatric patients' conditions and the return of illness following an apparent period of recovery. Bipolar patients who choose to discontinue their medication against the recommendations of mental health specialists may have a recurrence of mood episodes, delayed remission, and residual symptoms. These outcomes commonly result in hospitalization, heightened risk of suicide, and hindered psychosocial recovery (Rantala et al., 2021).
The Value of Addressing High Relapse Rates in Bipolar Patients as a Quality Improvement Initiative.
Focusing on the reduction or relapse rates should be a focus of a quality improvement initiative since relapse undermines outcomes for patients with bipolar disorder. According to research, over 90% of patients with the condition experience relapse during their lifetime, usually within the first two years of an initial episode (Davarinejad et al., 2021). Relapses in bipolar disorder are reasonably common. Numerous studies have been conducted to determine the precise relapse rate but have shown varying results. In summary, the longer one has bipolar disorder, the greater the likelihood of relapse (Davarinejad et al., 2021). On the other hand, sticking to medicine and treatment plans reduces patients' chances of recurrence by spacing out episodes and giving them more time in the euthymic, stable state. One of the significant goals of an evidence-based treatment plan is to keep bipolar disorder from relapsing.
The specific subtype of bipolar disorder influences the frequency of relapse that an individual has. Individuals diagnosed with bipolar II disorder experience a higher frequency of depressive episodes and a comparatively reduced length of euthymic periods in comparison to individuals diagnosed with bipolar I disorder (McIntyre et al., 2020). While Bipolar I and II may appear to be similar, there is a key difference between the two subtypes of the disorder. Individuals with bipolar I experience at least one manic episode in their lifetime. However, those with bipolar II also experience at least one manic episode but the mania is less severe hypomania. When experiencing manic episodes, patients with bipolar I typically experience more severe symptoms that interfere with their daily lives (McIntyre et al., 2020).
The length of an episode subsequent to relapse in individuals with bipolar disorder shows significant variability. The duration of symptoms associated with mania or depression can range from a period of one to two weeks to an extended duration of many months. Several variables influence the duration of symptom manifestation, including the specific subtype of bipolar disorder that an individual has and whether they are undergoing treatment.
Patients with bipolar I disorder who are not undergoing any treatment can have manic episodes lasting for a week to many months in some cases. These patients experience depressive episodes with irregular attacks of hypomania (O'Donovan & Alda, 2020). Hypomania is a less severe type of mania. Episodes of hypomania last at least four days, but depressive episodes typically last longer than that.
The impacts of relapse are significant for bipolar patients. Relapse worsens the symptoms of bipolar. Manic and depressive episodes affect patients significantly, disrupting their daily lives. These patients often struggle to function effectively in various life aspects, including work and relationships (Davarinejad et al., 2021). Individuals with bipolar disorder may also turn to substance abuse as a way of coping with severe mood swings and distress brought on by relapse. Substance abuse significantly affects patient outcomes. It is also important to note that after relapse, some patients may become less compliant with treatment plans, worsening their condition (Davarinejad et al., 2021). Given the adverse effects of bipolar disorder relapse, there is a need for EBP QI aiming to reduce relapse rates.
References
Davarinejad, O., Majd, T. M., Golmohammadi, F., Mohamadi, P., Radmehr, F., Nazari, S., & Moradinazar, M. (2021). Factors Influencing the Number of Relapse in Patients with Bipolar I Disorder. Shiraz E-Medical Journal, 22(8).
McIntyre, R. S., Berk, M., Brietzke, E., Goldstein, B. I., López-Jaramillo, C., Kessing, L. V., ... & Mansur, R. B. (2020). Bipolar disorders. The Lancet, 396(10265), 1841-1856.
O'Donovan, C., & Alda, M. (2020). Depression preceding diagnosis of bipolar disorder. Frontiers in psychiatry, 11, 500.
Rantala, M. J., Luoto, S., Borráz-León, J. I., & Krams, I. (2021). Bipolar disorder: An evolutionary psychoneuroimmunological approach. Neuroscience & Biobehavioral Reviews, 122, 28-37.
EvidenceSynthesisandRecommendationForm2.pdf
© 2017 The Johns Hopkins Hospital/ Johns Hopkins University School of Nursing
Synthesis Process and Recommendations Tool
Key Points:
• Evidence synthesis is best done through group discussion. All team members share
their perspectives, and the team uses critical thinking to arrive at a judgment based
on consensus during the synthesis process. The synthesis process involves both
subjective and objective reasoning by the full EBP team. Through reasoning, the
team:
▪ Reviews the quality appraisal of the individual pieces of evidence
▪ Assesses and assimilates consistencies in findings
▪ Evaluates the meaning and relevance of the findings
▪ Merges findings that may either enhance the team’s knowledge or
generate new insights, perspectives, and understandings
▪ Highlights inconsistencies in findings
▪ Makes recommendations based on the synthesis process
• When evidence includes multiple studies of Level I and Level II evidence, there is
a similar population or setting of interest, and there is consistency across findings,
EBP teams can have greater confidence in recommending a practice change.
However, with a majority of Level II and Level III evidence, the team should
proceed cautiously in making practice changes. In this instance,
recommendation(s) typically include completing a pilot before deciding to
implement a full-scale change.
• Generally, practice changes are not made on Level IV or Level V evidence alone.
Nonetheless, teams have a variety of options for actions that include, but are not
limited to: creating awareness campaigns, conducting informational and educational
updates, monitoring evidence sources for new information, and designing research
studies.
© 2017 The Johns Hopkins Hospital/ Johns Hopkins University School of Nursing
• The quality rating (see Appendix D) is used to appraise both individual quality of
evidence and overall quality of evidence.
© 2017 The Johns Hopkins Hospital/ Johns Hopkins University School of Nursing
Date:
EBP Question:
Article
Number
Author and Date
Evidence Type
Sample, Sample
Size, Setting
Findings That
Help Answer the EBP Question
Observable Measures
Limitations
Evidence Level,
Quality
Johns Hopkins Nursing Evidence-Based Practice
Appendix H Synthesis Process and Recommendations Tool
© 2017 The Johns Hopkins Hospital/ Johns Hopkins University School of Nursing
EBP Question:
Category (Level Type) Total Number of Sources/Level
Overall Quality Rating
Synthesis of Findings Evidence That Answers the EBP Question
Level I
▪ Experimental study ▪ Randomized controlled trial (RCT)
▪ Systematic review of RCTs with or without meta-analysis
▪ Explanatory mixed method design that includes only a Level I quaNtitative study
Level II
▪ Quasi-experimental studies
▪ Systematic review of a combination of RCTs and quasi-experimental studies, or quasi- experimental studies only, with or without meta-analysis
▪ Explanatory mixed method design that includes only a Level II quaNtitative study
Level III
▪ Nonexperimental study ▪ Systematic review of a combination of RCTs,
quasi-experimental and nonexperimental studies, or nonexperimental studies only, with or without meta- analysis
▪ QuaLitative study or meta- synthesis
▪ Exploratory, convergent, or multiphasic mixed-methods studies
▪ Explanatory mixed method design that includes only a level III QuaNtitative study
Johns Hopkins Nursing Evidence-Based Practice
Appendix H Synthesis Process and Recommendations Tool
© 2017 The Johns Hopkins Hospital/ Johns Hopkins University School of Nursing
Category (Level Type) Total Number of Sources/Level
Overall Quality Rating
Synthesis of Findings
Evidence That Answers the EBP Question
Level IV
▪ Opinions of respected authorities and/or reports of nationally recognized expert committees or consensus panels based on scientific evidence
Level V
▪ Evidence obtained from literature or integrative reviews, quality improvement, program evaluation, financial evaluation, or case reports
▪ Opinion of nationally recognized expert(s) based on experiential evidence
Johns Hopkins Nursing Evidence-Based Practice
Appendix H Synthesis Process and Recommendations Tool
© 2017 The Johns Hopkins Hospital/ Johns Hopkins University School of Nursing
Based on your synthesis, which of the following four pathways to translation represents the overall strength of the evidence?
❑Strong, compelling evidence, consistent results: Solid indication for a practice change is indicated.
❑Good and consistent evidence: Consider pilot of change or further investigation.
❑Good but conflicting evidence: No indication for practice change; consider further investigation for new evidence or develop a research study.
❑Little or no evidence: No indication for practice change; consider further investigation for new evidence, develop a research study, or discontinue project.
If you selected either the first option or the second option, continue. If not, STOP , translation is not indicated.
Recommendations based on evidence synthesis and selected translation pathway
Consider the following as you examine fit:
Are the recommendations:
▪ Compatible with the unit/departmental/organizational cultural values or norms?
▪ Consistent with unit/departmental/organizational assumptions, structures, attitudes, beliefs, and/or
practices?
▪ Consistent with the unit/departmental/organizational priorities?
Consider the following as you examine feasibility:
▪ Can we do what they did in our work environment?
▪ Are the following supports available?
• Resources
• Funding
• Approval from administration and clinical leaders
• Stakeholder support
• Is it likely that the recommendations can be implemented within the unit/department/organization?
Johns Hopkins Nursing Evidence-Based Practice
Appendix H Synthesis Process and Recommendations Tool
© 2017 The Johns Hopkins Hospital/ Johns Hopkins University School of Nursing
Directions for Use of This Form
Purpose of form
Use this form to compile the results of the individual evidence appraisal to answer the EBP question. The
pertinent findings for each level of evidence are synthesized, and a quality rating is assigned to each level.
Total number of sources per level
Record the number of sources of evidence for each level.
Overall quality rating
Summarize the overall quality of evidence for each level. Use Appendix D to rate the quality of evidence.
Synthesis of findings: evidence that answers the EBP question
• Include only findings from evidence of A or B quality.
• Include only statements that directly answer the EBP question.
• Summarize findings within each level of evidence.
• Record article number(s) from individual evidence summary in parentheses next to each statement
so that the source of the finding is easy to identify.
Develop recommendations based on evidence synthesis and the selected translation pathway
Review the synthesis of findings and determine which of the following four pathways to translation
represents the overall strength of the evidence:
• Strong, compelling evidence, consistent results: Solid indication for a practice change.
• Good and consistent evidence: Consider pilot of change or further investigation.
• Good but conflicting evidence: No indication for practice change; consider further investigation for
new evidence or develop a research study.
• Little or no evidence: No indication for practice change; consider further investigation for new
evidence, develop a research study, or discontinue the project.
Fit and feasibility
Even when evidence is strong and of high quality, it may not be appropriate to implement a change in
practice. It is crucial to examine feasibility that considers the resources available, the readiness for
change, and the balance between risk and benefit. Fit refers to the compatibility of the proposed change
with the organization’s mission, goals, objectives, and priorities. A change that does not fit within the
organizational priorities will be less likely to receive leadership and financial support, making success
difficult. Implementing processes with a low likelihood of success wastes valuable time and resources on
efforts that produce negligible benefits.
Johns Hopkins Nursing Evidence-Based Practice
Appendix H Synthesis Process and Recommendations Tool
© 2017 The Johns Hopkins Hospital/ Johns Hopkins University School of Nursing
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