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Advanced Practice Nurse Outcomes 1990-2008: A Systematic Review
Essentially, research must be reviewed for it to be considered accurate and reliable for implementation. Notably, a systematic research review is a study that considers various reports on a specific topic and then investigates them for accuracy and reliability. As such, a systematic review must identify all relevant published or unpublished evidence, select high quality reports or evidence for assessment, synthesize the information, and interpret the findings in unbiased method to form conclusions. Basicaly, this systematic review was carried out by Newhouse, R. et al, (2011) to find the efficiency and competence of Advanced Practice Nurses (APNs) in the USA.
Relevance of the Research
Importantly, this systemic review was done to evaluate whether patients who were attended by APNs had equal survival rates as compared to those attended by doctors or other physicians. Generally, there has been a steady increase in the access and cost of medication globally. Essentially, these issues are pressing due to the rising costs of treating diseases. Worse still, the US has not yet identified if APNs are effective, and whether they should continue been given the roles of treating patients especially in underserved areas. Specifically, the research aimed at identifying the best models of health care and how to integrate advanced practicing registered nurses (APRN). Moreover, the research also aimed at identifying the extent that APRNs can contribute to improvements in access to quality health care.
Notably, there had been several systematic reviews which formed various conclusions on the importance of APRNs. Noteworthy, among the researches were, assessment of patients’ satisfaction, patient health status, use of emergency departments, and midwifery. Although all reports indicated that APRNs were beneficial in facilitating efficiency in treatment, on the contrast, a review by Cochrane indicated that midwifery in the US had higher instances of child loss, use of regional analgesia, epistomies, and late initiation to breastfeeding. Consequently, although the past reviews provided information on the importance of APRNs, there was a need to come up with an updated and comprehensive scientific review of their importance.
Levels of Evidence for Study
Generally, evidence for the research was collected systematically from the database of PubMed, Cumulative Index to Nursing and Allied Health Literature (CINHAL), and Proquest. Importantly, for each APRN group, a wide array of search strategies was used to improve search sensitivity. Additionally, randomized control trials (RCT), or observational study of at least two groups were conducted. Further, the research materials were from 1990 to 2008.
In essence, this selection criterion was important and provided accurate information. Firstly, the exclusion of information published before 1990 ensured that the data used for the study was relevant. Evidently, data collected before 1990 is outdated. Additionally, currently there are newer treatment methods, facilities, and elimination of certain treatments that were present before 1990. Further still, the use of randomized controlled trials, and observation of at least two groups ensured consistency. Evidently, there is always a risk of bias, and misinterpretation of information. Consequently, the use of more than one source of information enabled the researchers to evaluate consistency of the research.
In brief, studies were excluded if they were not written in English, had no quantitative data, and contained outcomes that could not be affected by APRNs. Further sill, only US studies were included in the experiment. Notably, the exclusion of non-English data limited the scope of this review. Consequently, there was a likelihood of bias. Additionally, the use of US data limited the areas where the researchers could compare their results. In light of this, the researchers only compared the performance of the nurses based on patients’ feedback. As a result of only depending on patients’ feedback, and not comparing the nurses’ performance to others in developed countries, there was a limitation of scope.
Presentation of the Design
Importantly, the researchers evaluated the data in a professional manner so as to avoid bas or calculation errors. Notably, the researchers used two reviewers when conducting data abstractions. Moreover, there was quality assessment of individual data, which was done through a modified structure that was developed using the Jadad scale. Additionally, study quality was assessed by agreement of at least two team members. Further, data analysis and synthesis was conducted, by re-checking information extracted from the approved studies.
Notably, the researchers used a study quality assurance method referred to as Grade of Recommendations Assessment, Development and Evaluation (GRADE). Generally, this assessment was done on the overall evidence of the outcome to evaluate their accuracy. In brief, the evidence was categorized into four levels; high, moderate, low, or very low. Basically, a high baseline was issued if there were two or at least one recommendation and one high-quality observation. Similarly, a moderate baseline had one recommendation, one high quality research and one low-quality observation. Accordingly, a low baseline had fewer than three high-quality observations. In a similar vein, a very low baseline had fewer than three high quality observations, and no recommendation.
Additionally, the researchers used well-structured grading questions. Nonetheless, the researchers did not consider the size of the study. Instead, they used the significance level of the research as reported by the authors. Consequently, the lack of evaluating the size of the study may have weakened the overall quality of the research review. Nevertheless, the study design checked on quality, consistency, and accuracy of the results. In light of this, the researchers were accurate, objective, and precise in the design of the systemic research review.
Overall Findings
Generally, the research study showed that APRNs are important in promoting health access and treatment. In essence, this was in conformity to the expected trends that had indicated the importance of nurses in health care. Particularly, the outcomes showed that patient care provided by nursing practitioners (NPs), and certified nurse midwives (CNMs) in collaboration with physicians were similar or better than care provided by physicians alone. Additionally, the research review also showed that the use of nurses can reduce the length of stay for acute care patients.
In brief, the research indicated that nurses provide effective and high-quality health care, and had an important role in improving the overall health care of patients in the US. Notably, since the research results were in conformity to similar results and the outright importance of nurses, especially in underserved areas, the findings appear correct. Evidently, a nurse is important in improving the welfare of the sick as they advocate, and assist them during the treatment process. Consequently, the research review was able to form a realistic conclusion.
Conclusively, the researchers were able to review past researches and form an evidence based review of the importance of nursing. Nonetheless, this research review had various limitations. Consequently, this research model should act as a guide in the investigation of the importance of nurses in various populations, and in the achievement of health goals. Importantly, however, the research review was able to find the importance of APRNs in the US and to support its conclusion.
Newhouse, R., Stanik-Hutt, J., White, K., Johantgen, M., Bass, E., Zangaro, G., Wilson, R., Fountain, L., Steinwachs, D., Heindel, L., &, Weiner, J. (2011). Advanced Practice Nurse Outcomes 1990-2008: A systemic Review. Nursing Economics, 29.5, 1-22. Retrieved from<>
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