Posted: August 27th, 2015

OCCUPATIONAL CONTACT DERMATITIS

Evidence Review (this is based on previous and current work already done)
Using your PICOT question as a guide and your starting point for this next project, you will conduct an efficient, thorough search for evidence to address the clinical question. The study types you seek will depend on the clinical question being asked. The best evidence to answer a question might be found in systematic reviews, randomized controlled trials, nonrandomized experimental studies, qualitative or descriptive studies, evidence-based practice guidelines, or expert opinion. Information should be searched for in all relevant sources, and the highest level of evidence should always be sought.

For this assignment, write an 8–10 page paper in which you describe search for evidence and evaluation using one of the rapid critical appraisal checklists in Appendix B of Evidence-Based Practice in Nursing and Health Care (keep this checklist in your portfolio for later use).

In this paper:

Conduct a search for evidence that justifies the extent of the problem using:
Scientific literature and practice guidelines (if applicable).
Consensus documents (if applicable).
Quality improvement data (if available and applicable).
Expert opinion.
List your search terms, databases used, and process by which you narrowed your search to find the best evidence.
Use the rating of evidence to rank the strength of selected articles.
Construct an evidence table summarizing at least five studies. Use the table in Appendix B of Evidence-Based Practice in Nursing and Health Care as a template.
TEMPLATE:appendix B: Template for Asking PICOT Questions

An electronic copy of the question templates appears on the CD-ROM that accompanies the text.

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Intervention

In__________________(P), how does__________________(I) compared to_________________(C) affect______________(O) within______________(T)?

Etiology

Are_________________(P), who have_________________(I) compared with those without_________________(C) at_________________risk for/of_________________(O) over_________________(T)?

Diagnosis or Diagnostic Test

In_________________(P) are/is_________________(I) compared with_________________(C) more accurate in diagnosing_________________(O)?

Prognosis/Prediction

In_________________(P), how does_________________(I) compared to_________________ (C) influence_________________(O) over_________________(T)?

Meaning

How do_________________(P) with_________________(I) perceive_________________(O) during_________________(T)?

Short Definitions of Different Types of Questions

Intervention: Questions addressing how a clinical issue, illness, or disability is treated.

Etiology: Questions that address the causes or origin of disease, the factors which produce or predispose toward a certain disease or disorder.

Diagnosis: Questions addressing the act or process of identifying or determining the nature and cause of a disease or injury through evaluation.

Prognosis/Prediction: Questions addressing the prediction of the course of a disease.

Meaning: Questions addressing how one experiences a phenomenon—or why we need to approach practice differently.

Sample Questions

Intervention: In African American female adolescents with hepatitis B (P), how does acetaminophen (I) compared to ibuprofen (C) affect liver function (O)?

Etiology: Are 30- to 50-year-old women (P) who have high blood pressure (I) compared with those without high blood pressure (C) at increased risk for an acute myocardial infarction (O) during the first year after hysterectomy (T)?

Diagnosis: In middle-aged males with suspected myocardial infarction (P), are serial 12-lead ECGs (I) compared to one initial 12-lead ECG (C) more accurate in diagnosing an acute myocardial infarction (O)?

Prognosis/Prediction: (1) For patients 65 years and older (P), how does the use of an influenza vaccine (I) compared to not receiving the vaccine (C) influence the risk of developing pneumonia (O) during flu season (T)?

(2) In patients who have experienced an acute myocardial infarction (P), how does being a smoker (I) compared to being a nonsmoker (C) influence death and infarction rates (O) during the first 5 years after the myocardial infarction (T)?

HERE IS A COPY OF MY CLINICAL PROBLEM STATEMENT:
Background:
Occupational contact dermatitis in healthcare is a common disease that is consuming workers across the globe. Critics indicate that the problem attracts the turnout of approximately 30% of workers from their occupations to escape the health hazard. It is a perception where the disease attacks people as they work due to the exposure to different substances. The disease takes two dimensions in its affection to people (Pittet, Allegranzi & Boyce, 2009). Firstly, the allergic contact dermatitis that is caused by exposure to allergens inclusively the nickel sulphate and rubber chemicals among others (Shaffer & Belsito, 2000). Secondly, the workers are prone to the irritant contact dermatitis that is associated with the exposure to a wide range of irritants in the work place. The respective irritants entail the soup, solvents, cleansers and gloves. The truth of the matter is that the workers’ exposition to the irritants and allergens is difficult because they operate their tasks through the aid of products enriched which such infectors (Suneja & Belsito, 2008). Therefore, the concept derives a healthcare problem where when the people strife to work, they endure the occupational dermatitis caused by such substances.

PICOT APPROACH:

P: The patient problem entails occupational contact dermatitis

C: Comparatively, it would be necessary to provide antibodies which will absorb the negative implication of the allergic reactions caused by the allergens or irritants

I: The intervention involves assessment of the symptoms to determine the type of dermatitis experienced and entails recommendations for the patient

O: The outcome for the intervention is for a full recovery of the skin since the irritants and the allergen will be avoided

T: Time of outcome to be achieved is within one-six months

Among the employees who work in companies in the United States 30 % of them are

affected by the allergic contact dermatitis. It is a perception where the patients suffer from flaky skin, pruritus, blisters and pain due to the unhealthy occupational conditions (Kampf & Loeffler, 2007). The viable intervention entails the identification and removal of the causing agent to the dermatitis. Comparatively, the patient can use lukewarm water, nonsoap cleansers and mild soap when bathing. Additionally, the physician can advise the patients to dry the skin after bathing and avoid rubbing (Nettie, Colanardi, Soccio, Ferrannini & Tursi, 2002). Such approaches will provide a ground for recovery in comparison to the removal of the causal agent. Critically, the removal of the causal agent provides an adequate conviction that the patients will realize complete recovery of the skin condition since the allergens will be absorbed. Such outcomes will be realized after a period of one to six months in medication.

References
appendix C: Walking the Walk and Talking the Talk: An Appraisal Guide for Qualitative Evidence
Next Page
appendix C: Walking the Walk and Talking the Talk: An Appraisal Guide for Qualitative Evidence

Qualitative Description

#1 Sword, W., Busser, D., Ganann, R., McMillan, T., & Swinton, M. (2008). Women’s care-seeking experiences after referral for postpartum depression. Qualitative Health Research, 18, 1161–1173.
Question: What were women’s experiences of seeking care after referral from public health nurse for probable postpartum depression, including responses to being referred, specific factors that hindered or facilitated care seeking, experiences seeking care, and responses to interventions offered?

Design: Qualitative description…“the method of choice when straight descriptions of phenomena are desired… The description in qualitative descriptive studies entails the presentation of the facts of the case in everyday language… [It] is less interpretive than phenomenological, theoretical, ethnographic, or narrative descriptions…[but] more interpretive than quantitative description, which typically entails surveys or other prestructured means to obtain a common dataset on preselected variables…” (Sandelowski, 2000, pp. 336, 339).

Sample: New mothers (N = 18) recruited from an early prevention and intervention initiative (Healthy Babies, Healthy Children) who accepted, as part of the program, the offer of a home visit by a public health nurse

Procedures: In-depth, semistructured telephone interviews conducted approximately 4 weeks after screening for postpartum depression were thought to be less burdensome on new mothers than asking for face-to-face interviews in their homes or another location. Two trained research assistants used an interview guide containing broad, open-ended questions about women’s feelings about being referred for probable postpartum depression and their subsequent care-seeking experiences. The conversational interview style included probes and reflective statements to obtain clarification and to encourage more detailed description. The interviews, averaging 40–50 minutes in length, were audiotaped and transcribed verbatim. In addition, participants’ demographic data were obtained from the women’s completion of a structured questionnaire.

Data entry and management in NVivo qualitative data software supported conventional content analysis as described by Hsieh and Shannon (2005). Preliminary codes were assigned to meaningful units of data (sentences or phrases). Further data reduction occurred over the course
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of the analysis, as related codes were subsumed under broader emergent categories. Focusing on the research questions led to development of a rich description of women’s care seeking after referral for postpartum depression.

appendix D: Rapid Critical Appraisal Checklists

Electronic copies of rapid critical appraisal (RCA) checklists can be found on the accompanying CD-ROM.

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Rapid Critical Appraisal Checklist for Case–Control Studies

1. Are the Results of the Study Valid?

a. How were the cases obtained?

Yes

No

Unknown

b. Were appropriate controls selected?

Yes

No

Unknown

c. Were data collection methods the same for the cases and controls?

Yes

No

Unknown

2. What Are the Results?

a. Is an estimate of effect given (do the numbers add up)?

Yes

No

Unknown

b. Are there multiple comparisons of data?

Yes

No

Unknown

d. Is there any possibility of bias or confounding?

Yes

No

Unknown
appendix E: Templates for Evaluation and Synthesis Tables for Conducting an Evidence Review

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Evaluation Table Template

Caveats

(1) The only studies you should put in these tables are the ones that you know answer your question after you have done rapid critical appraisal.
(2) This evaluation is for the purpose of synthesis.
(3) Simplicity is key to a successful evaluation table.
Citation

Conceptual Framework

Design/Method

Sample/Setting

Major Variables Studied and Their Definitions

Measurement

Data Analysis

Findings

Appraisal: Worth to Practice
The topics below are prompts for each column. Please do not repeat the topics, just provide the appropriate data extracted from the studies.

Author, Year, Title

Theoretical basis for study

Indicate design & briefly describe what was done in the study

Number, Characteristics, Attrition rate & why?

Independent variables (e.g., IV1 = IV2 =)

Dependent variables (e.g., DV =)

What scales were used to measure the outcome variables (e.g., name of scale, author, reliability info [e.g., Cronbach alphas])

What stats were used to answer the clinical question (i.e., all stats do not need to be put into the table)

Statistical findings or qualitative findings (i.e., for every statistical test you have in the data analysis column, you should have a finding)

• strengths and limitations of the study
• Risk or harm if study intervention or findings implemented
• Feasibility of use in your practice
• Remember: level of evidence + quality of evidence = strength of evidence & confidence to act
© Fineout-Overholt, 2007. This form may be used for educational and research purposes without permission.
Melnyk and Fineout-Overholt text, Evidence-Based Practice in Nursing and Health Care: A Guide to Best Practice:
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Synthesize the findings.
Adhere to APA style and formatting throughout your paper and when citing your sources.
It is important to note that this will not be considered an exhaustive search for evidence. However, moving forward in the program and toward your final DNP project you will have to demonstrate that there is little to no doubt that you attempted to find everything possible.

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