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Critical Appraisal of Research

Critical Appraisal of Research

Part 3A

Evaluation Table

Full APA formatted citation of selected article. Article #1 Article #2 Article #3 Article #4
de Rooij, D., Belfroid, E., Eilers, R., Roßkamp, D., Swaan, C., & Timen, A. (2020). Qualitative Research: Institutional Preparedness During Threats of Infectious Disease Outbreaks. BioMed Research International, 2020, 5861894.


McTavish, J. R., Sverdlichenko, I., MacMillan, H. L., & Wekerle, C. (2019). Child sexual abuse, disclosure and PTSD: A systematic and critical review. Child Abuse & Neglect, 92, 196–208. Fruh, S. M., Golden, A., Graves, R. J., Hall, H. R., Minchew, L. A., & Williams, S. (2019). Advanced Practice Nursing student knowledge in obesity management: A mixed methods research study. Nurse Education Today, 77, 59–64. Jordan, G., Malla, A., & Iyer, S. N. (2016). Posttraumatic growth following a first episode of psychosis: a mixed methods research protocol using a convergent design. BMC Psychiatry, 16, 262.
Evidence Level *

(I, II, or III)

Level IV Level II Level I Level I
Conceptual Framework


Describe the theoretical basis for the study (If there is not one mentioned in the article, say that here).**

None Child sexual abuse (CSA) can potentially result in posttraumatic stress disorder (PTSD) and its symptomatology. The authors point out that counseling confidence is a factor in the ability of providers to guide patients in overweight and obesity management. One way to increase competent providers in obesity management is by preparing the next generation by enhancing the advanced practice programs’ curriculum. Positive changes (such as becoming more mature, learning how to better handle stress, or developing stronger connections with others) can occur following or alongside trauma or illness, and this is referred to Post Traumatic Growth.


Describe the design and how the study was carried out (In detail, including inclusion/exclusion criteria).

Purposeful sampling was used.

The authors conducted a three-step study with experts in preventing and controlling infectious diseases. The interviews were conducted to identify the trigger factors of preparedness in the event of a threat unfolding. The second step was designing a phased system of preparedness based on the triggering factors and which focus group discussion tested. The preparedness activities were identified by phase and by the institution. The last section was to complete and verify the preparedness system in individual interviews.

Inclusion: Professionals from academic hospitals: infectious disease specialists and microbiologists; infection preventionists from peripheral hospitals; national and regional managers in the ambulance services; representatives of the Dutch College of General Practitioners (NHG) and National Association for General Practitioners (LHV) general practitioners; and regional consultants and specialists in  communicable disease control and infectious disease control in the municipal health services

The authors conducted a systematic and critical review of the studies. Inclusion criteria involved articles that explored adults’ or children’s experiences of disclosure of child sexual abuse; quantitative design; explored disclosure patterns and their relationship to PTSD symptoms or diagnosis; and in English-language, published before October 17, 2017.

Exclusion criteria involved articles that reported sexual victimization outside of childhood abuse, focused on disclosure writing, or children’s involvement in pornography, using a qualitative design; that failed to include how disclosure mediates or moderates PTSD or PTSD as an outcome of CSA; non-English and unpublished works.

A modified convergent mixed-methods design was used. The participants were from a university in the Deep South, were currently doing an MSc in Nursing or a Doctorate in NP specializing in family health, and had a high BMI as overweight or obese. The researchers conducted a mixed-methods study. The study sought to answer: 1) How people experience posttraumatic growth after experiencing a first episode of psychosis and 2) The predictors or facilitators of posttraumatic growth after the first episode of psychosis.

Inclusion criteria involved: service-users being offered treatment for an FEP and their case managers all sourced from the Prevention and Early Intervention Program for Psychoses (PEPP) at the Douglas Mental Health University Institute and at the McGill University Health Centre; between the ages of 18 and 35; participants must be clinically stable; and received treatment for a minimum of six months and a maximum of five years. Any participants that did not fit these descriptions were excluded.



The number and characteristics of

patients, attrition rate, etc.

The authors aimed in steps 1 and 3 for one participant for every healthcare institution and for step 2, 1–3 participants per healthcare institution.

The authors used a fictitious scenario to collect data, which experts from the National Institute for Public Health and the Environment developed.

22 articles were included in this review, of which Eighteen studies were cross-sectional, one was a cohort study, and one was a randomized controlled trial. Three studies used representative community samples; 11 studies included children only, while nine studies included adults only 99 participants filled out the survey with a mean BMI of 27.81. Participants who have experienced some degree of growth following their FEP using a purposive sampling technique. The authors estimated 10-15 participants would take part in the study.
Major Variables Studied


List and define dependent and independent variables

In the first step, the participant was asked if and why preparedness activities in the healthcare institution were necessary. In the second step, 1–3 representatives per type of healthcare institution validated the concept preparedness system. The third step was individual, in-depth, semi-structured interviews. Comparisons were also made between healthcare institutions to determine if their expectations matched. The authors looked into different variables in the selected articles, and these were: Measures of disclosure and PTSD; Characterization of disclosure processes and reactions to disclosure in relation to PTSD; Disclosure vs. no disclosure; Disclosure timing; Persons that participants disclosed their CSA experiences to at the time of exposure or following; and Reactions to disclosure.

The authors studied comfort level with aspects of obesity management; the current level of knowledge regarding national guidelines for anti-obesity medication management; an evaluation of preparation regarding obesity management during graduate nursing education; and the relationship of provider BMI to comfort level with obesity management.



Identify primary statistics used to answer clinical questions (You need to list the actual tests done).

All interviews and focus group sessions were coded using content analysis using ATLAS.ti. QUIPS tool domains showed that most of the studies received a moderate or high risk of measurement bias with strategies to assess this factor as inadequately valid or reliable (n=19). Evidence was assessed using GRADE with the randomized controlled trial, the cohort study starting off at low certainty, and the remaining cross-sectional studies starting at low certainty. The APN students’ comfort with managing a patient with obesity was assessed with nine questions using a Likert-type scale; Cronbach’s alpha for this assessment tool was .871. The three final open-ended qualitative questions gathered information on successful strategies and challenges related to obesity management as well as  ways of improving obesity management by the students as healthcare providers. The Subjective Experiences of Psychosis Scale would be used to measure the impact of psychosis; the Brief COPE scale for measuring coping; the Multidimensional Scale of Perceived Social Support for social support measuring; the Recovery Assessment Scale for measuring recovery; and the Child and Youth Resilience Measure, as well as the adult version, will be used for the different appropriate age groups, to measure resilience.
Data Analysis Statistical or

Qualitative findings


(You need to enter the actual numbers determined by the statistical tests or qualitative data).

The triggers discussed were: trigger one is if the likelihood of admitting a VHF patient increases, the second trigger is unrest among the general population and staff, and the third was several (potential) patients hospitalized in the country, which could lead to different referral pathways between healthcare institutions.

Four phases based on the three triggers formed the final preparedness system and were color-coded as follows: Yellow phase for the disease occurrence somewhere in the world but lacking triggers one and two. An orange phase is when trigger one or two applies. The red phase is where number three applies. The green phase is where there is no outbreak.

Ten studies discussed characteristics of reactions to disclosure in reference to PTSD symptoms, while some of these did not report on correlations between these variables; six offered descriptions about who participants disclosed CSA experiences; four studies discussed the relationship between PTSD diagnosis or symptoms to disclosure timing; Six studies reported on the relationship between disclosure versus no disclosure and PTSD diagnosis or symptoms; four studies provided estimates for PTSD symptom clusters; nine studies identified a theoretical framework for basing the relationship between disclosure and PTSD. The participants’ BMI was: 43.9% in the normal weight category, 20.4% and 35.7% in the overweight and obese 1, obese 2, and obese 3 categories, respectively. The majority of APN students in this study reported feeling some degree of comfort with all identified aspects of obesity management except prescribing anti-obesity medications and having knowledge of billing for obesity management. Most of the participants in this study did not know that The Endocrine Society recommends starting anti-obesity medications when an individual has a BMI ≥ 27 with one or more comorbidities or ≥ 30 without comorbidities. Participants in this study who were overweight or obese included statements about their weight causing them to hesitate before discussing the issue of weight management with patients. Only a third of the APN students believed that their graduate nursing program prepared them well to address obesity. A deductive approach would be used in interview results coding. Multiple stepwise regression will be conducted to determine predictors of PTG.
Findings and Recommendations


General findings and recommendations of the research

Academic hospitals commence all activities of preparedness from phase yellow. Peripheral hospitals inform professionals and staff at the triage gate during the yellow phase. Ambulance services commence their preparedness activities start in the orange phase, while general practitioners perceive the orange phase as the most important. Training and diagnostics at MHS commence from the yellow phase and depend on the pathogen type. The researchers concluded that it is unclear if, when

and how disclosure of CSA results in a reduction in  PTSD. The authors recommend that more attention be given to theories that attend to the trauma responses’ multi-faceted nature, such as the social-ecological theory, and the differences between the experiences of children from those of adults;  what are the essential moderators and mediators to CSA disclosure processes analysis as well as the associated trauma responses, which goes beyond focusing on

poly-victimization, CSA and ACE chronicity; and how specific symptom clusters of PTSD theoretically relate to disclosure processes of CSA.

 More than half of the sample (52%) reported being extremely comfortable conversing about weight with their healthcare provider, and 52% said they would not be offended if the provider diagnosed them as overweight or obese. Student participants expressed insecurity about prescribing anti-obesity medications. There is a need to enhance education regarding obesity management in the investigated APN programs to increase knowledge and confidence. The research proposal does not indicate this section.
Appraisal and Study Quality



Describe the general worth of this research to practice.


What are the strengths and limitations of study?


What are the risks associated with implementation of the suggested practices or processes detailed in the research?


What is the feasibility of use in your practice?

The research is replicable; though done in the Netherlands, it can be replicated in other countries, including the U.S. The main strength of the research is that the authors engaged professionals in their respective fields, making the information they gave robust. The main limitations were a high attrition rate between the focus group and the last interview round, leading to a lack of representation of academic hospitals and ambulance services. The second was that data collection was only through interviewing, yet direct observation of preparedness activities may have yielded additional findings.


The research is feasible though it would take a sufficient amount of resources both for the researcher and the professionals who would need to find time to simultaneously participate in the interviews and discussion groups.

The research is very useful in informing future researchers on what to focus on and how to ensure that the studies are unbiased. The study can be used in my practice as a guide to training staff in not only identifying PTSD related to CSA but also in encouraging victims to report abuse as soon as possible.

The strength of this review is the use of systematic review procedures to find and evaluate studies, as well as critical review methodology to consider methodological and theoretical limitations of included studies. The limitation of this study is in its explicit focus on PTSD, as compared to a broader understanding of mental health symptoms or distress associated with disclosures of CSA.

The results of the research are useful and reproducible as they inform nursing education institutions on the need to adequately prepare students on how to care for obese and overweight patients. Participants’ self-report of quantitative data can be identified as a limitation of this study. The qualitative portion was based on the personal experiences of APN students in various levels of training.

The results of the study are feasible in my area of work because the organization can organize for staff in-house training on caring for obese patients when the physician is himself obese or overweight.

The research proposal does not indicate this section.


Key findings




Although specific preparedness activities differ among the healthcare institutions and in the threat phases, the study developed a uniform enhanced preparedness system. The researchers also noted that the absence of uniform terminology impeded public and curative healthcare communication, which could be devastating in the event of threats or outbreaks. As CSA exposure may result in ongoing health concerns that, depending on responses of the system, may need re-disclosure of CSA at the meso-exosystem levels and gaining an understanding of the impact that the disclosure processes and reactions have over and above the microsystem responses is an important future research area. There is a need to enhance education regarding obesity management; students expressed insecurity regarding prescribing anti-obesity medications. Students indicated that they want both general education on obesity management and use specific case studies. The research proposal does not indicate this section.






The system developed by the authors contains clear definitions of phases, thus offering this uniformity within and among institutions. The system can be used to arrange effective communication about the required specific enhanced preparedness. Most studies did not indicate the child’s safety and that it is possible that children experiencing multiple forms of maltreatment may be less likely to disclose CSA. Additionally, the authors point out that negative reactions to disclosure may not impact participants with high PTSD levels, while those with moderate PTSD  levels may be significantly impacted by negative

reactions to disclosure

Providing effective strategies and confidence builders is crucial when training APNs to care for patients who struggle with weight issues. There should be the inclusion of  “hands-on” practice and comprehensive obesity management information in APN graduate education improvement as evidenced by participants’ 1) lack of confidence in obesity management, 2) identification of concepts they desired to have included in obesity management training, and 3) inability to identify anti-obesity medications. The research proposal does not indicate this section.
General Notes/Comments  


This study explored preparedness during threats of infectious diseases requiring centralized care. The U.S. would have benefited from proper preparation for COVID-19 if it had taken major lessons and made robust adjustments after the Ebola outbreak a few years back.

The study exposed major gaps in linking CSA exposure and disclosure to PTSD. With the epidemic rates of overweight and obesity, nursing is well-positioned to take on the challenge of providing evidence-based care and promoting health.

Nurse practitioners throughout the years have taken the lead in implementing high-quality health promotion and disease prevention and can thus take the lead in providing high-quality obesity management.

This study is one of few that would investigate posttraumatic

growth following a first episode of psychosis, and will be the first to do so with a mixed-methods approach.

Part 3B

Based on the articles appraised, it is evident that the mixed method is preferable for research to be more comprehensive. When conducting mixed-method research, the researchers need to have well-structured interviews that cover all research areas and eliminate any form of bias. The study by McTavish et al. (2019) could yield very important results; however, the researchers noted that the studies they analyzed failed in one area; bias in measurement. This fact puts the studies in question on their validity. The results from the studies analyzed, according to Travis et al., should be used with much precaution. Bias results in incorrect conclusions and also can be potentially misleading. Therefore, it is both unethical and immoral to conduct biased research. Every researcher should be aware of all the potential bias sources and then take the possible actions to minimize or reduce deviation from what is true. Researchers can avoid bias by reviewing the findings with peers as the latter can help identify gaps in the arguments presented in research or affirm that the conclusions are reasonable and sound. Additionally, a researcher can take other measures to eliminate bias, such as checking for alternative explanations for the results and conclusions reached; when the researcher can rule out or account for other interpretations, it makes the results more valid. More data sources should also be used when the results of the study are questionable, a process known as triangulation. Triangulation involves other data sources that can support the interpretations of the study at hand. Lastly, a researcher should have multiple people who will code the data because if there is some consistency in the interpretation that the researcher makes with that of others, then there is a likelihood that the interpretations are in agreement, and thus the conclusions are true.


McTavish, J. R., Sverdlichenko, I., MacMillan, H. L., & Wekerle, C. (2019). Child sexual abuse, disclosure and PTSD: A systematic and critical review. Child Abuse & Neglect, 92, 196–208.


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Critical Appraisal of Research

In this Assignment, you will use an appraisal tool to conduct a critical appraisal of published research. You will then present the results of your efforts.

To Prepare:

  • Reflect on the four peer-reviewed articles you selected in Module 2 and the four systematic reviews (or other filtered high- level evidence) you selected in Module 3.
  • Reflect on the four peer-reviewed articles you selected in Module 2 and analyzed in Module 3.
  • Review and download the Critical Appraisal Tool Worksheet Template provided in the Resources.

    Critical Appraisal of Research

    Critical Appraisal of Research

The Assignment (Evidence-Based Project)

Part 3A: Critical Appraisal of Research
Conduct a critical appraisal of the four peer-reviewed articles you selected by completing the Evaluation Table within the Critical Appraisal Tool Worksheet Template. Choose a total of four peer- reviewed articles that you selected related to your clinical topic of interest in Module 2 and Module 3.

Note: You can choose any combination of articles from Modules 2 and 3 for your Critical Appraisal. For example, you may choose two unfiltered research articles from Module 2 and two filtered research articles (systematic reviews) from Module 3 or one article from Module 2 and three articles from Module 3. You can choose any combination of articles from the prior Module Assignments as long as both modules and types of studies are represented.

Part 3B: Critical Appraisal of Research
Based on your appraisal, in a 1-2-page critical appraisal, suggest a best practice that emerges from the research you reviewed. Briefly explain the best practice, justifying your proposal with APA citations of the research.

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